Skip to main content

tv   Public Affairs  CSPAN  July 2, 2013 10:00am-1:01pm EDT

10:00 am
east africans city, where resident bush happens to be as president obama wrapped up a weeklong tour of the continent. their wives engaged in a chatty public appearance. president obama also adjust the ongoing political conference. conflict in egypt today. responding to concerns being voiced by throngs of protesters seeking mohamed morsi's removal from office. president obama called him yesterday, as the egyptian military said mr. morsi must the main -- meet the demands of protesters who had taken to the street. president obama told mr. morsi the united states is committed to the democratic rosses and does not support any single party or group. also pointing out that the current crisis can only be resolved through a political the first family will be back tomorrow scheduled to take part
10:01 am
in a fourth of july celebration at the white house. here's what's coming up today on c-span. we'll bring you mental health care coverage. at lie yans for health reform is co-hosting this event. live coverage starting at 12:15 eastern. at 2:00 p.m., religious leaders will discuss the contraception rule. we'll be live at 2:00 p.m. eastern. over the past few months, we've featured a number of c.e.o.'s on c-span as they've spoken at public affairs events. tonight we'll show you some of their remarks. you'll hear from leaders from american express, apple, is ity group and microsoft, among others. a quick preview. >> microsoft and across the technology sector, we are
10:02 am
increasingly grappling with a significant economic challenge. we are not able to fill all the jobs that we are creating. the numbers help tell the story. at a time when unemployment nationally hovers just below 8%, the unemployment rate in the computer and mathematical occupation has fallen to 3.2%, and in many states and in many subcategories, it has fallen below 2%. unfortunately, the situation is likely to get worse rather than better. the bureau of labor statistics has estimated that this year the economy is going to create over 120,000 jobs, new jobs, that will require a bachelor's degree in computer science. and yet we estimate that all of the colleges and universities in the country put together will produce this year only 51,474 of these degrees. that is why high-skilled
10:03 am
immigration and this legislation is of such great importance. the bill you're considering does three very important things. first, it addresses the green card shortage. it eliminates or goes very far to reduce the backlog. it eliminates the per-country cap. and it creates a new green card category for advanced degrees, all things that are needed. second, in the h-1-b area, the bill quite rightly, i believe, has improvements in the number of h-1-b's that are available, but accompanies this with changes to ensure that american workers are protected. it raises the wage floor for h-1-b employees. it improves portability so h-1-b employees can switch employers. it addresses a number of other issues, and even though we have some lingering questions about
10:04 am
potential language and potential unintended consequences, we recognize that compromise is needed all around, and we hope to be able to work with this committee and its staff as you go through the details. there's a third thing this bill does. it is of -- of extraordinary importance. and that's this, it creates a national stem education fund. the reason we have such a shortage of high-skilled labor is because we've systematically underinvested as a country in the education of our own children. consider this, there are over 42,000 high schools in america. but this year, the numbers certified to teach the advanced placement course in computer science is only 2,250. senator, we're very grateful for the work that you and others have led to really
10:05 am
create the i-squared proposal, the i-squared act. it creates the model for a national stem education fund. and this bill follows much of that model. but i hope you might improve it even further. raise the fees on visas. raise the fees on some green cards and invest that money in the american people. so we can provide our own children with the educational opportunities they'll need to develop the skills to compete in an increasingly competitive world. as a company, microsoft spends more on research and development than any other company in the world. $9.8 billion this year. nd yet, we spend 85% of that money in one country, this country, the united states. our industry has come to washington because we want to keep jobs in america.we want to
10:06 am
america, and we want to help create more jobs in america. we know that in the short run we'll need to bring more people from other countries to america. and we hope that in the long run, some of them will follow in the footsteps of the alexander graham bells and albert einsteins, great technologists and scientists and entrepreneurs. but we want to do more than that. we think the country should seize the moment to invest in our own children as well. and if we're going to do all of that, if we're going to do any of that, we need your help. thank you. >> that discussion coming up tonight. we want to hear from you about your experiences working for a company or, if you run your own business, what is your message to corporate america? we'll take your calls and we'll hear from you on facebook and twitter. that's all tonight starting at 8:00 eastern. coming up next, remarks from
10:07 am
the special inspector general for iraq reconstruction. he spoke yesterday on u.s. stabilization efforts in iraq. mr. bowen has held his position since 2004, has made 34 trips to iraq. he's produced 390 audits and inspections. this event is just over an hour. >> so that the broadcast continues at pace. we're keen to welcome streaming live this morning and watching in followup sessions, so please also join us at understandingwar.org to learn more about i.s.w. but now for stuart bowen. stuart has served for nine really iraq, which gives him a lengthy perspective on u.s. and multinational engagement in iraq over such a
10:08 am
varied period of history. from early days, surge days, to drawdown days, to the current environment where we are actually watching from the completion of projects that were begun long ago, but also watching the strategic effects of u.s. engagement and disengagement. a very special position to be able to look at these things because the watchdog that ensures that u.s. tax dollars that are spent inside iraq are spent well and wisely. but it's also a wonderful position for evaluating our changing mission and changing program in iraq precisely because as a public watchdog, as someone who looks at
10:09 am
military projects from a civilian perspective, we -- he has the opportunity to talk different many problems, challenges and lessons learned that he's been able to work on over the past nine years. along so the author, with his team of learning from iraq, a book that i commend to you for reading, and for learning. and so with that introduction, please help me welcome stuart bowen. [applause] >> thank you. thank you, kim. thanks to the institute and to all of you for being here this morning. it's a privilege to be part of the institute -- an institute event because of the great work ou continue to do.
10:10 am
but particularly in iraq. i find your reporting on iraq to be the most comprehensive, the most effective, and so i urge all of you all to consult the i.s.w. website if you want to know what's going on day by day in iraq. that's something i've been focused on for 9 1/2 years, what's going on day by day in iraq. we produced 35 quarterly reports, 290 awed its and inspections. learning from iraq is the last report. but also hard lessons. our previous book which came out in 2009, all accessible at r website, www point sigir.mil. we're almost done with our aid on, both in iraq as an and assistance program but also as an overnight mission.
10:11 am
sigir will close its doors on september 30 this year, but not before we obtain about 20 more convictions. we hope to get another 100 million for the taxpayers because, as kim pointed out, we're the taxpayers' watchdog. we're not quite finished with ensuring that the taxpayers' dollars have been properly accounted for. but this morning i want to talk about the lessons from iraq, because as kim underscored, there is a lot to learn from our 10-year experience, our 10-year rebuilding program. applicable to how the united ates structures itself for stabilization and reconstruction operations. and so let me start with this challenging point. and that is, the united states s not significantly better off structurally with regard to planning for, executing or overseeing stabilization and
10:12 am
reconstruction operations than it was 10 years ago. what that should tell you is that we've got a lot to learn, a lot to apply systemically, structurally, that the legislature, that the executive branch should learn from these lessons, and we spelled them out reducing them to seven in learning from iraq, and they're really drawn from chapter two of learning from iraq, which encapsulates 44 interviews that what cted about happened, really, i asked two questions of the leadership in iraq, the former prime minister, the leadership across the board, also u.s. leadership, general petraeus, general austin, ambassador crocker, ambassador hill, deputy secretary burns, secretary panetta. and on the hill, senator mccain, and a number of house members as well.
10:13 am
two questions. how do you think that the iraq money was spent, the rebuilding money? and second, what lessons do you draw from that? and from their answers, we get these seven lessons. first, just what i said. foremost, that the united states must reform, restructure, improve its approach to planning and executing stabilization and reconstruction operations. chapter six proposes a solution for that. create the u.s. office for continuing operations and i'm happy to report this past riday, stockman welch bill hr-2606 was introduced to do exactly that. so there is an opportunity for change, an opportunity to apply a lesson learned from iraq. i'm -- i'm known for saying that a lesson learned that's not a lesson applied is a lesson lost. this will avert that loss if it
10:14 am
comes into being. more about that in a minute. second lesson, don't conduct significant rebuilding operations when the security situation is severe. and that was the case too often in iraq. it seems self-evident, however, for example, in fallujah, we proceeded with a very substantial waste water treatment plant that, because of the security situation, wasn't completed until two years ago. it took eight years to finish. it cost three times as much, is serving a third of the number of people targeted initially. why? because it was pursued in a very insecure environment. three, consult. this was what the iraqis said to me over and over again that he united states did not do. the prime minister said 52 billion should have brought us
10:15 am
more, if you had consulted with us about what we really needed at the outset, then we would have benefited from your -- from your investment, your substantial investment. consultation also was an issue that the u.s. interviewies raised. bill burns, secretary of state, said we tried to do it all and tried to do it our own way. and in recognition that from c.p.a., e that the the coalition provisional authority, the u.s.-led governance of iraq for the first 14 months, did not engage sufficiently with the iraqis about what they really needed. fourth, uniformity. there was a lack of uniform systems in iraq. agencies operated in their stovepipes, carrying out their missions, using their own contracting approaches, using their own oversight methods, using their own i.t. systems.
10:16 am
and as a result, you had stovepiped data. and when you have stovepipe data, you have inconsistencies. and that produces from our audits, we learned from our audits, the fact that about 30% of the projects completed in iraq were not properly accounted for, not properly recorded in any data base. and, therefore, we couldn't really analyze the details of them without trying to find the paperwork, wherever it may be hidden at particular agencies. that's something that -- that the reform of our approach to stabilization and reconstruction operations must address, and it similarly must address the need for uniformity in contracting and the stockman-welch bill proposes exactly that kind of reform. the core of engineers
10:17 am
commanders consistently have told me that they support that. the first commander of the gulf region in iraq, great guy, very sharp, succeeded early on, is succeeding now leading the core, is a strong proponent of this particular kind of contracting reform. fifth, oversight. i think the story says that oversight works when it's on the ground, it's forward-leaning, and it seeks to do more than just manage a list of findings or police blotter, so to speak, but takes what you're learning, turns it around quickly so that operators can use it to improve the mission. that was missing in the first year. too much waste occurred as a result. too much waste occurred throughout the program because of all of these issues, upwards of $8 billion wasted of our tax dollars. good oversight, good planning would certainly reduce that
10:18 am
number in future operations. six, preserve what worked. learning from iraq identifies a number of success stories. in iraq. it's not just bad news. you know, our reporting is focused on the challenges because that's our mission. audits, use of money, finding the crooks who have violated their trust. but we also included a number reports and a number of anecdotes in learning from iraq about what worked. two i want to highlight are the commander's response program, when properly managed, made a difference for the good in iraq. was a tool in the commander's arsenal. and when it was -- when they were executed as planned, that projects, targeted usually under $100,000, they made a difference. when they exceeded $1 million 10 million or even $20
10:19 am
million in a few audits we identified, then they lost focus, they lost control, and they lost money. properly managed can be useful in reconstruction operations. the reconstruction team program similarly when well led made an enormous difference in iraq. it embodies integration. but it was an ad hoc entity created that these are demands put upon us in these settings. but i hope we learned from the p.r.t. experience that the only way they can work is to plan in advance, to do some training in advance, to fund them in advance, and that's what they would do, among many things. finally, plan. it's, obviously, a very generic and basic term, but i heard too often, especially from the civilian side with regard to what was going on in iraq, the hrase, we don't like the plan.
10:20 am
that in a stabilization reconstruction operation setting is a nonsecretary witnesser. planning is the prewelcome ris it to success. in these operations. and it means planning before the operation begins. churchill said, those who plan do better than those who don't, though they really stick with that plan. his point being that planning is the key to opening the door to success. in challenging operations, like we faced in iraq. we can have a plan at the outset. hard lessons gets into this in detail, and the plan was liberate and leave. but as i was told in one interview, had you a plan a, but you didn't have a plan b. when we switched to plan b, which was occupy and rebuild, we didn't have a system in
10:21 am
place sufficient to sustain the expenditure of what became $60 billion. the first plan was $2 billion and be gone by september. by 10 years ago right now in iraq, we were up to $20 billion. so 10 times the amount in the blink of an eye, it shouldn't be any surprise that too much waste occurred. it is what it is, but it ought not to stand simply as a point of history. it needs to stand as a pointed lesson from which we should draw and from which i'm pleased to note that the hill has begun which in hr-2606, would establish the u.s. office for contingency operations, should it pass. and it would provide the kinds of solutions, the kind of solutions that i've suggested here that are key to ensure success in future stabilization
10:22 am
and reconstruction operations, planning, uniformity, drawing together the significant body of personnel that are out there, that could be focused in future operations. and we will have more stabilization reconstruction operations. seems to be sitting on our doorstep strategically with regard to this matter, and indeed its spillover effects are bringing to crisis conditions in iraq at this moment. as kim pointed out last week an article, that you know, iraq is effectively still at war. the war in iraq is not really over in the sense that the shia militia that caused so much carnage in 2005, 2006, 2007, and the sunni a.q.i. and islamic state of iraq, these various elements, these radical shia militia are stirring back up and causing, you know,
10:23 am
murder and mayhem across the country as we speak. 761 killed in iraq in june, following upon the two bloodiest months in five years. this last quarter has been the bloodiest quarter since the middle of 2008. and why? partly because of the failure to recognize on the part of the leadership in iraq the reconciliation is the essential piece to moving forward. and second, because of what's going on in sira. -- syria. the spillover effects are substantial. the reason why i lay that out is that while boots on the ground is something that no one wants, it may be that we have to have a capacity on the ground in syria post assad, should that come about. how that's going to be organized is an open question. a bill out of the senate recently approved $250 million for rebuilding in syria, but we
10:24 am
don't know who would spend it. and that's just an indicator of the need for the kind of reform that we can learn from iraq. that we propose in learning from iraq, and that thankfully is recognized in this most recent piece of legislation. so that's -- that's what we've learned at sigir for 9 1/2 years. and i'm honored again to be here with you, kim, and with the institute, and thanks to all of you for coming and happy to entertain any questions you might have. thank you. >> we have some wonderful -- wonderful people here with a great deal of expertise in a variety of areas, and i really look forward to having them ask eir questions, introducing themselves and the organization that they're with. i'd like to start with taking my moderator's prerogative. what -- what are the
10:25 am
impacts that these kinds of mistakes and errors have on in ving the mission whatever country we're operating in, in this case iraq? >> well, first and foremost, not having a coherent structure, a well-planned system, effective oversight and a capacity to execute means your stabilization and reconstruction operation can last 10 years. that's what happened in iraq. it's what's happened in afghanistan. and as i've described it, rather than a 10-year rebuilding program, it >> ben 10 one-year rebuilding programs n. both countries, i think. and the question that -- the rhetorical question that that process evokes is who's in charge here? and the answer is a question mark.
10:26 am
indeed, the commission on war time contracting asked that question of state defense at a hearing and they couldn't answer it. and the same issue has arisen in afghanistan, as i've heard from the special inspector general for afghan reconstruction. that the consequences though, to your question, kim, we identified in part in a report we issued last summer on the uman toll from reconstruction. concretely we could identify at while -- lives lost while conducting rebuilding activities. and so the cost in waste i've identified at least $8 billion. the cost in blood, 719 at least. it's too high. but most importantly, staying 10 years in carrying out a contingency operation. at some point it stops being a
10:27 am
contingency. proper planning, effective capacity to execute, good oversight will reduce that time. >> wonderful. if you could please introduce yourself to our c-span audience and your organization or affiliation. red, the first question. >> it's remarkable to have an uditor, someone whose job it is to study how funds have been misspent and prosecute people who have deliberately misspent them talk as passionately as do you about accomplishing the mission. and that's always been one of the things that was a hallmark of the war event that i think has not been necessarily replicated in other similar efforts, and i think as we learn lessons from iraq, that should be one of them. that the role of the auditor is
10:28 am
more than that of auditor. that we understand that this is a part of trying to accomplish our objectives, and the person who's accounting for the funds should be thinking about how to account for them in a way that supports the mission. and you've done that, which is remarkable. but i'd like to pose to you, i think, what for many is going to be a very fundamental question, which is why do we need to do this when we're never going to do this again? and isn't liberate and leave the maximum that we can ever expect to undertake since the model for the perfect intervention now is libya? and so wouldn't we say that if it became necessary to do anything in syria, which we're clearly desperate to avoid, that at most, it would be liberate and leave? so in that circumstance, aren't you preparing for something that policy has already decided we'll never do? >> from the ether, the policy
10:29 am
ether currently, yes. and let me -- let me offer a rejoinder to your underlying point, and that is if we don't reform our approach, then yes. we shouldn't engage in these kind of operations because i don't think we can afford with a $17 trillion debt to stay anywhere for an extended period to carry out these kinds of operations. from the blood cost, the cost in lives, also the same point. it's our responsibility as a country to take on the lessons of iraq, apply them to our system and improve a structure so that we don't occupy, rebuild year after year after year. that's the unacceptable outcome in iraq that i think there's 100% agreement about in the united states. but the point of it is not to decide what the decision would be, it's to provide the president with options, with choice. we don't have an army, we don't create a powerful military
10:30 am
because we want to go to war. we create it because there are national security interests that we must be prepared to protect under the president's leadership. and by training and equiping a substantial force, the president has those options, a wide variety. do we have them on the front? no, we don't. part of the challenge in syria is what choices are at hand for him to make if you don't have a capacity, other than bad ones? and that's why i agree, i'm all for no more iraqs and afghanistans, but that's not a policy, that's a hope. let's create policy choys by reforming our oversight of stabilization and reconstruction operations so that we're not limited to one hoice. yes? nice to see you. >> good to see you. good to see you again. thank you for your service and for a job very, very well done. >> thank you for your service.
10:31 am
>> thank you. probably this one's a little bit of a tough question. who do you think who did better with their projects as far as spending, executing, transparency and oversight, the military or the civilian side? >> well, there's enough fault to go around. so let me start with that. and second, let me say there are a number of important facts that we were able to derive in learning from iraq that we hadn't really underscored earlier, and that is over 80% of the contracts were military contracts. which is part of the problem. the policy, according to nspr-36, was given to the state department. but 80% of the contracts -- you have a dichotomy that's unworkable. and i saw it, you know, the various acronyms struggling across the departmental lines in iraq over eight years led to inefficiencies.
10:32 am
chief says we'd like to you do, this the head of the project and contracting office says we're doing y. that's a bad moment. and that kind of bad moment occurred much too often because of the lack of sin cronis at this among the departments in carrying out the mission. to your question, as we also point out in learning from iraq, about $25 billion of the $60 billion, was spent in building iraq's security forces. an army of 300,000, police force of 700,000. a million men in uniform. they are today better equipped, better trained than iraq has ever had. a security force that's better equipped, better trained than iraq has ever had. and so while there was certainly waste and challenges throughout, you know, the period called rebluing, back, you remember that, in 2006, 2007, where essentially had to clean out the ministry of the interior buse of the shia militia infilltration.
10:33 am
the end, it's a pretty -- a mixed blessing. the iraq special operations forces may be the best in the middle east and also their prime r in chief's the minister. that's a command and control line that's not the best for iraq at this juncture and is -- is presenting some challenging circumstances today. >> on that last, i actually want to take a moment to plug the report done by maurice sullivan. it talks about that chain of command, and some of the alternative chains of command that have developed within the iraqi security forces. because they present a political problem right now to the iraqi people as well as a
10:34 am
security problem. so thanks for bringing that up. >> exactly right. >> please. >> my question would be from the private sector perspective. when you talk to them, obviously, it's a very frustrating mission, but when you talked to them, what were the two or three things that they complained about that might be easiest to fix? >> not knowing who's in charge. that -- that's the -- that's the most salient weakness. and as a result, a constantly moving target with regard to the reconstruction program. having nine one-year reconstruction programs meant at you had to be prepared to completely reorient annually. and having, as was the case, 15 to 20 contracting officers over the life of a project, meant
10:35 am
you had to try and figure out what was going on continuously. and -- and having to deal with a security situation where it wasn't clear where the burden of providing security lay. private security contractors or the government, obviously a mix of both. it was developed on the fly in iraq, in a way unprecedenteded in our history. in 2008, there were 171,000 troops on the ground and 172,000 contractors. and a substantial percentage of those were security contractors. and we learned, you know, what happens if you don't plan well these ce for how systems should be integrated. iraq was about coordination. and coordination worked when personalities synchronized well. and, for example, general
10:36 am
petraeus and ambassador ryan crocker synchronized well at a critical moment with excellent outside advice on the strategy, and we survived. that synchronization though, that approach, that strategy is a hope, not a system. not a structure. >> thank you very much. you brought this up a little bit earlier when you mentioned instead of having one 10-year reconstruction, we had 10 one-year reconstructions. i've spoke tone a number of my friends who worked with development contractors and a thing that they consistently brought up was the fact that due to high turnover among contractors, you'd have people going in for one year, generating institutional knowledge, and then moving on to a new project. that's one of the advantages probably for you having been
10:37 am
there over the longer term of the -- of the conflict. but i'm wondering if there's ything in your -- that you learned that deals with preserving institutional knowledge generated during the course of an operation to prevent this sort of 10 one-year reconstruction problem. >> that's what what would be done. the department of defense has a significant lesson learned capacity at fort leavenworth, there's an entire school devoted to it. pksoi in carlisle similarly engages in such. but it's stovepiped. it's within one agency. these are unique. and they've been going on pretty steadily since 1980. somalia. haiti. panama. the balkans. iraq. afghanistan. they are the venue in which our
10:38 am
national security interests will be protected in the future, in this century. and if you do accept that -- some don't, by the way, and do accept that they will happen again and you do accept that they didn't go so well in iraq and afghanistan, then i hope you accept that we ought to learn our lessons and improve our structure. that's the only way to preserve hem. these are useful tones on what happened. but they're just that. they don't change our approach. >> on that, i'd actually like to ask a followup question, has is obviously, there to be some give and take between having a flexible strategy and having a long-term strategy. for stabilization and reconstruction. so how would you recommend creating some flexibility and
10:39 am
resiliency in how we approach stability and reconstruction without getting to that 10 one-year plan situation? >> great question, kim. and i think we are stuck in a place of significant lack of resilience right now. it's what fred was saying about the choices we have in front of us with regard to our current structure and the choices are very limited. and the only -- and resilience means options, right? and resilience means ca past to respond as -- as churchill said, to do your planning and then to be able to respond to what comes next. because your first plan a will be the first victim. and that's understandable in the operation. but we need to be able to do plan b, what we switch to. that can only happen if there's a structure in place that's prepared to execute b, c, d, e, whatever that plan might evolve into.
10:40 am
and that requires a uniform contracting, personnel procedures, funding, oversight, training. and that all occurs before the operation begins. if you try to do all that after the operation begins, then you're the provisional authority. they wrote their own personnel regs and they didn't succeed as much as we would all have liked because of the improvisational nature of it. improvisation in the area of national security is -- is a bad planning system. it is hard to resolve. >> from watching iraq so closely -- >> 34 trips. >> how do you view the future of iraq?
10:41 am
how do you see it going? >> well, my metaphor is a financial one. i'm short iraq in the short-term but long iraq in the long-term. and the reason being is unlike afghanistan, their bank's in the ground. they have the resources to succeed. if someone -- shows up with a vision, a recognition of the need for reconciliation, that it's an essential element for democracy to receive and in the male strum of ethnic and sectarian mixes that govern the country right now, that there's a way out and that path is iraqi nationalism. then -- then iraq should be the leading country in the middle east. and i'm hopeful that that person will arrive on the scene sometime in the next 10 years expect he does, then i
10:42 am
that long bet to pay off. >> as a followup, do you have any idea -- [question inaudible] >> as i said, it's a hope. and so we'll have to wait, as you have to with hope. >> so, in fact, actually, i want to take a moment to recognize steven for his most recent report, iraq cities in crisis. he is also the author, or one of the authors of our iraq weekly update which can be found on our website. so, thank you, for asking -- >> outstanding work. >> some hopeful questions. i actually -- i'm sorry. fred, go ahead. >> i'm guessing from your
10:43 am
answer that maliki is not -- [question inaudible] i'll throw one out there that you can duck and i'll throw one out there that i'd actually like you to answer. would we be in a better position if we had managed somehow to maintain u.s. forces in iraq and been able to continue to oversee these efforts? but the one that i expect you to answer is we talk about contractors a lot, and, of course, u.s. aid went long ago to a model of relying almost entirely on contractors for executing thing and the downsizing of our uniformed military has driven the military of relying on contractors for a variety of things. so what extent do you think the contractorization of our foreign security possible si is a problem or is that something that can be managed with adequate oversight as you're recommending? >> great questions. i'll answer the first one by
10:44 am
quoting my interview with secretary panetta in learning from iraq. according to the secretary, the inability to negotiate a basis for continuing u.s. military presence in the post 2011 strategic framework agreement left the united states without important leverage in iraq. this weakened american capacity to push for greater change within the government of iraq. on the outsourcing issue, that's a huge question. t started in 1989. it was the watershed, frankly, for outsourcing, moving fuel, food to the private sector. and under k.b.r. and three different contractors hold it. over $30 billion, $30 billion to $40 billion spent on it in iraq. but i think the challenge that was new and that's not resolved is a security issue.
10:45 am
how do you outsource aspects of the security management in a stabilization reconstruction operation? when historically that's always been a government's duty? and the commission on war time contracting tried to get into this and identified it as a problem but was unable to articulate a concrete solution for it. the congress is addressing it as well. but less and less so since these operations are winding down and going away. the problem hasn't gone away. to be a nk there needs center of gravity for grappling with it when it's not in your face. and that's what it would do, begin to plan with the department and work with the hill about structuring a solution to what is now a contractor-government operation.
10:46 am
given iraq and afghanistan. and -- but to a system that doesn't have concrete lines, and those lines need to be defined. >> if i can follow up on that question of security contracting, have you in your auditing and calculations actually been able to establish the cost of security contracting, outsourcing security in iraq, like the cost of maintaining u.s. forces to conduct that security or similar security operations in iraq? >> a comparative study was really beyond our reach, but we did identify that security costs averaged about 25% per project. so substantial amount of overhead for executing projects in iraq went to paying for
10:47 am
security. and that's, of course, private contractor security. it's impossible, i think, to -- to discreetly develop the data, develop the discreet data on the government side, on the military side, because it's sort of baked into the overall cost. but it's huge, for sure. >> valerie? >> i'm with i.s.w. but until very recently was with a contractor that worked in all f these areas. and so i know i was wondering if there was anything we haven't yet talked about if you could expand about a little further. >> great question. and yes, there is.
10:48 am
and the fact that you worked at i.t.o. broaches it. the office of transition initiatives formed about 20 years ago by rick barton who's now leading the bureau for conflict and stabilization operations at the state department. a great guy, exactly the right person to lead that, and both c.s.o. and o.t.i. accomplished good things. but through contractor significantly, and also fairly discreet modestly-sized programs like fighting gang violence in belize or elections in kenya or judicial security in honduras. but as bill burns in his interview with me recognized that it's not the solution to this kind of mission. and that's two of the pieces, of the stovepipe pieces within our government that ostensibly are assigned to planning for this kind of operation. misleadingly so, i think. also you have at the department
10:49 am
of defense the civilian expeditionary work force, an outgrowth of d.o.d. directive 3000.05 which was a revolutionary development at the pentagon in 2005 that says the army now has stabilization operatenesses its mission. how is that being realized? not very effectively. at treasury, you have the office of technical assistance, also created within the last 25 years. did a good job in iraq, but it was in a stovepipe. not integrated at all in any sort of planning for future stabilization and reconstruction operations. and then you have at the justice department, in charge of providing assistance to prosecutors, to judges, to the rule of law system in stabilization settings, also established in the last 25 years. what i'm identifying is that this is all -- this is pretty much a new structure across the board, within our department, in response to stabilization
10:50 am
challenges over the last 30 years. been a -- it's piecemeal development without any integration. and now i would say it's time to take account of that history, to recognize that it's had some successes but mostly it's not meeting the mission. it doesn't have the capacity to meet the mission now because of the lack of integration and it needs a center of gravity. and that center of gravity could be the u.s. office for contingency operations. >> a followup? >> sure. >> i couldn't agree with you more. >> thank you. >> but do you see that happening in reality, considering o.t.i. already has operations? >> yeah. >> do you see the integration that needs to happen and cooperation? actually the next big challenge here. >> not without reform. and i guess that's the operational answer. the structurele question will this become law?
10:51 am
i don't know. lift, as ep heavy they say on the hill, but you know, i think it's -- as you identify, a good idea and good ideas, you know, can develop their own inertia, their own momentum and time will tell. >> jessica? >> good morning. 'm with i.s.w. >> thanks for your service. >> thank you. you as well. my question is related, are there information gaps that you observed that consistently resulted in waste and is there a best practice for intelligence support reconstruction among your observations? >> yes and yes. and let me expound. on the first point, the government has the responsibility with regard to project management to implement
10:52 am
a quality assurance program, which is effectively ensuring that a contractor has a quality control program. and that requires personnel that go out and investigate that issue. and if you don't have the training, you don't have the personnel, you don't have the capacity to do that, then projects don't get visited. and then you don't have quality assurance. then you don't have quality control. and then you have waste. that's an information gap. and it happened all the time in iraq. i mean, there were too many situations when my in thors were get out to -- my inspectors would get out to visit the iraqi contractor and they were the first american they'd seen. that was -- that's a weakness, a gap. that allowed too much waste to occur. intelligence, i would love to resolve the e to wall, i guess, at some point and be able to have some access to data that would have
10:53 am
indicated or provided me information that would have allowed me to pursue. i understand it was there. i just was never able to fully connect those dots. we got -- we have 86 convictions to date. we'll have 105. but i believe there are substantially more. >> if i could follow up on that, from the perspective of afghanistan in particular, where i had the pleasure of serving with jessica, in afghanistan, of course, there is a special inspector general for afghan reconstruction. but one of the things that we saw over the course of 2010 and 2011 and 2012 inside of afghanistan was the need to create additional oversight thro such as
10:54 am
task force 2010, which went into investigate certain aspects of contracting. so from your vantage as an outside observer, why -- why is why is it or yeah, that subject lemental organizations were needed, particularly in afghanistan, to do some of this oversight when we didn't really have that same problem inside of iraq? >> i think task force 2010 was an attempt to apply lessons from iraq to afghanistan. you know, in iraq, the supplemental organization that was created was the contracting command. and i think it was partly audit of by our early the contracting problems. i remember our first contracting audit of c.p.a., we
10:55 am
asked for 41 contracts and they ouldn't find 33. and they had three people working. so it was this massive disconnect at the front that from which we were playing catchup. so jcci was part of the catchup. task force 2010 was part of the catchup in the afghan theater. but ultimately it circles back to my key point, who is in charge? who's doing the planning? who's -- who's responsibility for oversight? who has the capacity to execute? and it's, right now, nobody. and that's -- that weakness can only be resolved through reform. you know, from the decade of war study, that commissioned by general dempsey, the chief, one of the 11 findings was that
10:56 am
there must be a reform for the agency with regard to civ-mil operations and these s.r.o.'s. but that's a diagnosis. this is -- this is a cure. >> please. i did spend a couple months in iraq with the o.g.a. but it seems like over time there is a problem of getting government staffers into country to work on these projects and all this. do you s wondering, how -- you have to put a gun to the head of some foreign service officers to go to iraq. how do you -- how do you
10:57 am
propose to -- i mean, it's bad enough you do, instead of 10 years, you do one year 10 times, echoes of vietnam. but how do you propose to get the government staffers to do their job? >> well, that's one of the things that it would address. it would require those that sign up to recognize that they're deployable. not at their discretion, personal discretion. and you're right, there were a number of personnel pickups early on and one of them was sort of the self-veto, i'm not going. it happened too often. the other is that, is the penalty, to take it from their perspective. some didn't want to go because they felt they would, from a career perspective be penalized. and so this systemic reform would solve both of those issues. the reality is that today, our
10:58 am
personnel system is not really significantly improved from what it was 10 years ago. other than we have thousands of people with experience. nd but that -- that's a useful act but it needs organization. >> i want to get back to a point, the importance of complications. can i expand a little bit about what factors accounted for successful consultation within the u.s. but then also from the iraqi side from your observations there. and then relate to that what were the challenges to the consultation that you saw and what can we do better to improve? >> i think general petraeus'
10:59 am
interview here addressed that. the consultation issue, and a number of others. but he says that before you begin a stabilization reconstruction operation, you need to be sure that those engaging in it, that those planning for it are properly versed in the history, politics, the economy, social structure, infrastructure of the country before showing up. whether it's by historical professional background or consistent training. and with that capacity in hand, then you can engage in better consultation. because you have a context. just coming in and saying as was said so often in 2003 and 2004, we want to provide you the best. the best of breed was the phrase. while well intentioned, may not be a good fit. because of capacity issues. and that certainly was the case
11:00 am
, for example, with the water treatment system, the single most expensive project we did in iraq. and it's not operating at anywhere near full capacity ecause of the lack of fit. what was said to me was that the united states pursued its own -- the united states pursued its own agenda. the cpa would say we did talk to the united states and have the engagement is important and start a slow, start modestly and grudges -- gradually moved up. small successes into medium once and then larger ones. >> can i ask a follow-up question? recommend to you
11:01 am
the various efforts to rebuild and stabilize that do not improperly empower maligned actors or political factions during that, or as a result of that confrontation process? >> that requires heavy engagement, so that you have as many sources and in goods in the process, and proper preparation in advance to ensure that you have a sense of the political .andscape before you show up continuousontext and and talking to as many groups as you can will produce the best results. it will not always be perfect,
11:02 am
but it will be better than others. >> soon after we got in there -- i was there from the beginning, and we went in there as liberators and were officially recognized as occupiers. we became the first police. being in charge of the money and how did we do? >> we have had 29 audits on that subject. >> the development -- the development fund on that audit showed that controls were weak and accountability was poor with regard to $11.7 billion of the
11:03 am
$24 billion we had. there were specific examples of fraud that we uncovered. scheme thata fraud resulted in the conviction of eight people and the staff does tens of millions. but the big ones, the big crimes were on the iraqi side. corruption has been a cancer. i call it the second insurgency in iraq. it still burdens the country today. you remember the minister of 2004, his 2003 and
11:04 am
deputies told $1.2 billion. >> how about the samurai? zomorodi -- e is here. and he will goa to jail. why? he is at an american citizen. case,annot talk about the but as you said, you just said it, they are after him. >> any other questions? last question.
11:05 am
>> the details of this are not incredibly important, but the topic itself is very important. if we decide we do not want to go to war again as a nation, then what options we have in the international kareena -- arena? other than giving speeches, this is one of them. what we're talking about is building a solid foundation. but we're also talking about something that would coordinate the activities of the state department organization and the defense department organization and the department of defense. and you give a shout out to the activities program, which i'm happy to hear. in our experience, it has been very important and valuable. we found that the program has been at odds with the international agencies focus and
11:06 am
priorities. there seemed to be such a fundamental theoretical/between traditional modes of international development and that circledhing back to follow. even if we brought these groups together with a philosophy underlying some of these programs, it negates some of that. >> culture clash is exactly the phrase that ambassador hill used when i interviewed him. apropos of your comment and apropos of the need for reform. the reality is if we do not do anything, then yes, the problem will occur. there is very little receptivity across departmental
11:07 am
lines within the existing system. this is what would be resolved. have a discussion. can mean interagency groups. as the bill points out, take policy guidance from the international security adviser to the president, whose job is to mediate the differences any way in all spheres. and power the director with the reporting chain. the sopko director also reports and secdef. with the systems and challenges that are unique in the history of our security strategy. unless there are open discussions about how to
11:08 am
began. see aucrat culture clash -- again. >> george, can i ask you whether you have closing comments or recommendations from this discussion? >> first, thank you. it is a pleasure to be with you. the great questions, replete delving into the -- really delving into the mission. it has been an honor to serve and it has allowed me to contribute to the mission. my dad was a fighter pilot and flew 100 missions over the north. serving in iraq for me was a privilege. and to contribute to the improvement of the program was an honor. and to with you today, similarly is an honor.
11:09 am
thank you. >> thank you very much for your presence here today, for your long service throughout your career, but particularly over the past nine and a half years. are few who have had the same tenure of service , and few who iraq the the same insights into intory of our engagement our important operations that have consumed so much of our time, our energy, our efforts, our funding, and many, many lives. i have really gained insight today into some of the ongoing problems with stability and reconstruction operations,
11:10 am
because certainly, i think that whenever policy dictates now -- whatever policy dictates now, with them in the history of the war and conflict in foreign policy suggest that we ought to have the capacity to engage in stabilization operations, whether we believe that we will have large interventions with again or not. i will point out this past week we have heard about u.s. forces and funds going to jordan to help with the spillover of the crisis from syria. and that actually raises a red flag on this particular subject, because it means that even if we have a desire not to engage in conflict, we really must
11:11 am
engage in stabilization, stability, and it provision of --urity and revealing rebuilding in some areas of society's in areas of the world that are prone to conflict. i thank you for the insight you have given us. for our c-span.org audience, please do again check out "learning from iraq." and i invite you to visit the war./org nderstanding to understand the ongoing conflict in syria and our ongoing operations in afghanistan. thank you. [applause]
11:12 am
[captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2013]
11:13 am
>> and a quick reminder that if you missed any of this discussion, it is available to view any time on line at c- span.org. the u.s. capitol is a little bit quieter today as congress is not in session for the fourth of july holiday recess. members will be back next week. the associated press is reporting that u.s. congressman william gates -- william gray died yesterday. he was 71. he was in london attending a tennis championship with his son. a democrat to as congress in 1978 and served as chairman of the budget committee. he became the first african- american in the 20th-century become majority within the u.s. house. during his time, the u.s. implemented economic sanctions against south africa. in 1991, he resigned his colleagues by resigning to --coy resigning to run the united negro college fund.
11:14 am
at the age of 71. coming up at 12:15 p.m. eastern about an hour from now, we will bring you the impact of the health care reform law on mental health care. the allies for health reform and foundationjohnson are coasting. will be live with the southern baptist convention and the u.s. conference of catholic bishops at 2:00 p.m. the national cable and telecommunications association held its meeting in washington called the cable show. they got together to discuss the current state of and future of cable media. we will show you some discussions from the event. one each evening starting at 6:30 p.m. eastern right here on
11:15 am
c-span. tonight, will bring you have panel called interruption of destruction. -- the disruption. coming up at 6:30 p.m. eastern here on c-span. next, the opening plenary session from the meeting, focusing on digital media. this is about an hour. >> we are here. i cannot think of a better introduction. m.c. hammer and that dynasty on the same date -- same stage. myind of which i would have hunting cap. >> eirich like the dach guys. we are really excited to meet
11:16 am
another cable milestone this year. we hope we have brought some real fun to d.c. >> that is our overall goal. we want to bring more fun and more cost to the nation's capital. and we want to show off everything that cable has to offer. on behalf of myself and gabbe, as well as our stellar convention committee and a great staff here, we would like to welcome you to the cable show 2013. [applause] >> you may have seen some of the industry's ads saying cable is how we connect. i think we all planned to do a lot of connecting over the next three days. connecting with our amazing technology, with a stunning array of content, with many of the great talent that appear on our screens, with key government officials and opinion leaders and most importantly,
11:17 am
connecting with each other. >> i plan on doing some of my own connecting. i plan to immerse myself in the observatory to get a birds eye view of our industry's contribution. i want to do take in some of the discussions among the 40 sessions. i am going to look at a little bit of the future i cable net. i hope to connect with some of the nearly 300 companies who are displaying on the floor. bea&e networks is proud to exhibiting on the floor with so many of our programming and technology colleagues, it is a great few days. i'm especially looking forward to wednesday, when you will be receiving your vanguard award for leadership. let's give pat around of
11:18 am
applause. it is a great honor and well- deserved. [applause] i know we will be in great company along with my dear friend and colleague nancy and several other outstanding vanguard winners. >> thank you, that was kind. it has been a pleasure working with you and the vision you have brought to this year's cable show. it has been a fun experience. >> it has been really fun, never expected to be installing cable in monroe, louisiana. will not be doing that again. our objective has been to find ways of featuring all of the things that people love about cable. incredible entertainment and information, the power of broadband, and the role our industry plays in contributing to the american economy and enhancing the lives of all americans. show, the theme of the cable really is worlds ahead of
11:19 am
our competitors and those trying to emulate the success we have had. we are hoping by the time your visit at the show is over, you will be able to see why. >> we're lucky to be kicking off the show this morning with some remarks from an industry leader. with two impressive sediments, featuring global media leaders, one panel will examine the opportunities created by our platform and the other will take a closer look at our incredible robust content. >> we better get off the stage and let this morning's program get underway. thank you for coming to the
11:20 am
cable show. connect with your colleagues, soak in all of the information you can, and have a wonderful time. it is our pleasure to welcome to the stage the president and ceo michael powell. [applause] >> good morning. welcome to the cable show. good be with you. television, it opens the window on her world. storytelling is the most ancient of human endeavors and lets us learn our history, share a laugh, feel a thrill, celebrate. the very best stories live on cable. a medium of exceptional value and unparalleled quality. americans spend a lot of time with our product and they get a lot for their money. cable is on an innovation tear,
11:21 am
expanding the video experience to any screen you want, or any time you want, anywhere you want. cable is more than just great tv. it is a conduit of our future. cable is a significant innovation in its own right. important an contributor to another innovation on this list. the internet. the internet is heralded as the greatest invention of our time and it is. it empowers every one of us to learn, create, and publish. it has transformed industries, bolstered economies, and overthrowing governments. the power of the people has never been greater thanks to this amazing interconnection of networks that cable probably delivers to millions. not very long ago, getting
11:22 am
online required zen-like patience. it used to sound like this. it used to look like this. everyone, everyone wanted something better. we wanted something more powerful, something more useful, some even wanted to use the internet to practice magic. and faster and we wanted it always on. what we wanted was broadband. cable industry heard the cry and answered the call. we invented the cable modem. from this box, the world's information flows. painful dial up has been put to rest. we are on an endless journey to
11:23 am
deliver exceptional experience for american consumers and businesses. moving forward is always good, but it takes energy and effort and money -- lots of money. ofle had to dig up a lot streets and string a lot of wires across lot of poles. cable had to invest, and we have, to the tune of $200 billion as the mid-1990s. it was risky. truthfully, not everyone was a believer. there is much to believe in now. cable serves over 50 million broadband customers. we have worked hard to reach nearly everyone, offering
11:24 am
service to 93% of american homes. i mentioned that does not have a horsepower is not worth the effort. that is why we have increased broadband speeds over 1500% in a decade. today, cable networks available to 85% of all households. this is an achievement envied around the world. while speeds have skyrocketed, the price for consumers have not. all of this has been accomplished in private investment and the government's light touch. america is an innovation powerhouse largely because of the internet we help to build nearly everyone. thanks to this infrastructure,
11:25 am
america is home to the world's very best internet companies. despite our success, many people like to denigrate u.s. broadband by painting false comparisons to other countries. her are some nations doing very well. there are some nations doing well. it is foolish to compare countries like france and latvia to the united states of america. millionome to 316 people. and the land mass of the united states is 3.6 million square miles. our challenges are different, but our results are nonetheless impressive. if you can pare u.s. states to hundreds of foreign countries, 10 of the top fastest regions in the world are here in america. we are flying up the internet speed chart. in 2009, the u.s. ranked 22nd in the world. today, we ranked eighth.
11:26 am
average peak connection speeds have tripled over the past five years. like everyone, we want to deliver more. we want every american to have access to broadband number rich, poor, urban, and rural. we do not cherry pick the most lucrative customers. we serve everyone. ofstill have one quarter americans who have access to broadband but have not yet gotten online. we want to fix that. cable has launched adoption programs throughout the country offering low-priced broadband to low income american families. programs like connect to compete and internet essentials are helping get all of america
11:27 am
online. one great example is the boys and girls club of central oregon, partnering with a local cable operator to close the digital divide. there is no way for a child to succeed anymore without the internet. broadband is enabling more job opportunities, more power to more people. to help our children and citizens succeed, we will continue to empower our customers to go where they want and do what they want using the broadband connection. the cable industry has always believed in an open internet. we will continue to embrace it. it is our job to manage our network to keep their internet
11:28 am
humming as the world's greatest engine of innovation. we will continue to meet the explosive demand for internet capacity, investing, innovating, competing aggressively, but always fairly. this is the american way. we want america to soar in the information age. cable is the platform that makes our digital dreams come true. you will see it, you will feel it, you will touch it, and experience it this week as cable puts on a show for you. you will discover a world you thought you knew and find there is much more to know. you will leave more excited about the future yet to come. thank you so much and enjoy the show. [applause]
11:29 am
â♪ â♪ â♪ â♪
11:30 am
♪ >> ladies and gentlemen, please welcome the moderator for today's broadband innovation panel, jake tapper. [applause] ♪ thank you for being here. -- >> hello, everyone. thank you for being here. if you would wait and hold your applause to the very end. the founder and ceo of jawbone, the chief operating officer of twitter, gm of content and
11:31 am
services for roku. ♪ [applause] â♪ have a seat, everyone. before i begin and we start talking to this interesting panel, i would be remiss if i did not take the opportunity to asked our friend from twitter about a story that is in the news. there has been a report in the washington post and the about a program called prism in which, and there are the nsa is able to access files of participating
11:32 am
companies. twitter, according to public statements, is not a participant. what can you tell us about twitter refusing to participate? and what is your understanding of what chrism exactly is? >> first of all, it is nice to be here. [laughter] very nice to be here at meet the press. the truth of the matter is i cannot comment on details of the matter. we are very interested to see how this story plays out. i will say, one of the core values we have at the company is to defend and respect the user's voice and we believe that tweets belong to the users that create them and we have always try to find the right balance
11:33 am
between abiding by the law in any jurisdiction and doing what is right why our users. -- by our users. we will continue to do that. as far as specifics of prism or the issues of the nsa, i cannot really comment. >> thank you very much. i want to get to the real subtext of this panel. are you guys friend or foe to these guys? i would like to very briefly explain what your company does. >> i am with vox media, it is a company built entirely on broadband. in technology and culture and in gaming. each one of these is built on a technology platform that enables us to grow and scale quickly.
11:34 am
our business was enabled by broadband, so we see ourselves as a friend of the industry. we have partnerships with many companies in the room. particularly television programmers. we would not exist without broadband. for the new wave of talent that has emerged. i look forward to talking about that. >> explain to the people in the audience, what exactly is jawbone? >> we are leading the way around smart connected devices, around this whole notion of the internet of things. you can revolutionize what you are able to do. in the context of the cable industry, we think of it as very complementary.
11:35 am
it allows you to extend experiences in totally new ways. we created a whole new category of the speaker business will be connected smart devices to go along with your phone and ipad. those are the leading devices in the market. that whole part of the segment is growing fast. it is leading to new consumption models. we want to deliver these experiences that will make it richer. that is anywhere from things around you two things that are on you. to things that are i knew. >> most people in this room knows what twitter is, but how does twitter view its mission? >> we are lumped into the social media category, the what is distinctive about twitter is that we are public and not private.
11:36 am
our network and communication is in real time, partly because of the short format. ands conversational distributed. that makes twitter an amazing compliment to television. 35lions of our users -- million users last year -- tweeted about television programs while the programs were happening. our user base has exhibited a pattern using our service and connection to watching live television. we are really invested in building complementary experiences between what you guys do and the audience on twitter. our mission is to bring people closer to the things ty care
11:37 am
about and allow them to participate in the dialogue about those things. a lot of what people care about is what is on television. >> tom, charter communications. television cable company. we are a two-way interactive high-capacity digital platform and we still television, cable television, and packages. we have a high-capacity broadband network that is physically out on the streets and highways. hundreds of thousands of miles of physical infrastructure. we are a telephone company and we are a communications company. are we friends or enemies? we create the platform that allows these businesses to operate.
11:38 am
we want our platform used, so to the extent that people are using the broadband services, it helps our business grow. it is in our interest. there are times when we bump into each other. essentially, we have created an ecosystem that create a lot of value for our company and all of>> steve, roku. hockey looks like a puck, it is a streaming player to connect to your tv. to access nearly 1000 channels. we stream everything from the likes of netflix. we announced a deal recently with time warner cable. channels like hbo go, the
11:39 am
lunchbox, all the way down to local churches and all kinds of special interest content. >> let's cut to the quick. where do you think you and your companies find yourselves at odds the most with the people in this room? thosean be done to make challenges smoothed over or perhaps they are insurmountable? >> the punching bag, sure. a vast majority of our users are cable subscribers. is big initiative -- it roughly 70% are cable subscribers.
11:40 am
we are putting a lot of focus into tv everywhere right now. it is a phenomenal opportunity for us. it has been shown to drive affinity for the cable package. services like hbo go, a wonderful way to get hbo. alline multiplying across of the programmer networks, imagine what espn can do, what nickelodeon can do when these programmers can deliver software along with their video in the form of apps. all of that type of software oriented activity is opportunity for programmers and operators to bring new value as part of their overall pay-tv subscription and it is really working. about three fourths of our users are discovering new value to
11:41 am
their paid tv package. it has been a huge hit for us and it is helpful to the entire ecosystem. isthe biggest issue we have that the business we are in, the television business, is the television business. it is not the internet, not cable tv. you create audiences and the issues are around business model questions. how do you go and acquire customers if you have a video product? how do make those customers see your product? whether that is in a package or a bundle, those are the kinds of issues that are being challenged as the technology has brought all of the services together into a single wire, single devices, and you can access voice, data, video on the same device.
11:42 am
what is the service? the service is the content. we get into conflicts all the time about, it is the internet, it is cable tv. the reality is, it is content and it is sold a certain way thepeople are confused by notion of the internet and cable. it creates regulatory issues, business model issues, but it is all television. >> to be honest, i cannot really think of any ways in which our business is at odds with the cable and tv business. a truly see ourselves as compliment to the television business, to the cable business. in three or four respects, one of them is in terms of driving discovery to tv behavior. nielsen came out with a study
11:43 am
that indicated a very strong correlation between activity on twitter. in terms of creating a complementary content experience around programming that brings more value that from more value back to real-time viewing. in the area of measurement, for programmers measuring social engagement. in the area of complementary advertising and revenue models. companiestechnology of our ilk, you will not find a bigger fan and a bigger supporter of the tv business than twitter. >> for jawbone, it is the same. i have not seen any conflicts or issues. the thing that has been interesting, we are used to a
11:44 am
different pace of innovation, how fast we want to bring products and services to the market. i think it is aligning companies on being able to do that. comcast has been great and they are moving quickly. as an industry as a whole, it is something that is new for us, the pace of innovation. it is different from what we are used to in silicon valley. >> comcast is a major investor in our company. we are able to create great new journalistic and entertainment services. perhaps we might compete with some of the cable networks, but it is a very different type of business. this week, we will be covering the apple developer conference as well as e3.
11:45 am
we like to apply the level of coverage for fans of technology in the same way that cnn would cover a major news event. do it in a way that is not built for television, but built thethe internet and all of creative aspects of our medium. we think we are building value for broadband users and we appreciate the value they bring to us. >> what cable provider do you have at home? >> i am a loyal comcast guide. experiment with a few of them. we have files downtown and we have comcast as well.
11:46 am
wondering. >> time warner cable. >> i have files. but i have probably had every one of them at one point or another. let's pretend in and of these people are here. it is just as. what could they be doing better? >> this is applying to everyone who is not listening to rise, but some could be listening a lot faster. are aat applies if you technology company or a specially media company. >> we use technology printable specifically in technology, there's a method of agile. which means you're always releasing things. disruptt be afraid to
11:47 am
anyone especially yourselves. you have to listen users create a feedback cycle of data coming in based on what you put out and listen and act on that data. that applies on the technology side and even on the media side when you're putting out new programming for a consumer how quickly are you moving. get out of the cycle waiting for the fall release schedule >> i agree. in a world where there's new technologies and experiences being able to constantly, there's opportunities to try things and try them and fail quickly and see what sticks. that goes in hand with the pace of innovation and also with the pace of modernize experience. as long as people are using them there's opportunities.
11:48 am
it is moving quickly. >> the willing to fail not just a joke. >> i remember when twitter didn't exist. now i can't live without it. you see how fast behavior is changing. we got this device where people are tracking activity and we will announce interesting things thinking of that of a view and how that show up on screen. that's something people didn't do years ago and now they're addicted to it. behavior changes is happening fast. if you embrace it quickly and test it and try new ways to sort of exploit that utilization, it will happen. ofi largely agree with all that. the way i would say it, this is probably a statement that would have been more appropriate five years ago than today. my statement would be to view
11:49 am
technology as a friend as an enabler of new experiences for your experiences as opposed to a foe. that's not just the hardware that a company like jawbone is building. to think that twitter is going around realtime communication. generally having an orientation of technology being an enabler and extender of your business. >> as a cable industry, we're spending billions of dollars a year every year on technology development and infrastructure deployment. the technology in infrastructure that we're spending that money on. i like to go faster. i like to see us go faster. even though we're going very fast and the capacity networks are coming up, it's amazing how quickly the network capacity gets filled by applications that you build it.
11:50 am
i think we can keep going and keep building and create demand. on the programming side of the business, anything that you put anywhere is going to end up on every screen. you can't control it. if you think you can control the space where you distributed a piece of programming, some of the device and bring it back together and put it on the tv or put it on the distributed wifi network and the house or wherever. there's no way to control where your content goes. if you think you can segregate where it goes by calling that the internet and this cable tv, somebody will build a machine to abuse you of your notion. >> thank you for the infrastructure. i will be more specific. tv everywhere initiative is really a moment for the industry. we can move faster. we can make some vast
11:51 am
improvements in the way that works. it boils down to embracing the internet distribution of the content and most specifically, for mobile, we like to make it for tv's as well. that is still the primary place people want to watch all of this content. inple used dent have to log to watch tv. now we got that going, you have to log in to watch tv. these kind of problems are really ripe for solving in the industry as well as general embracing of the tv everywhere initiative and getting our content out there. >> that's all the time we have. i want to thank our panel. if you can give them a round of applause. thank you so much, appreciate your time. [applause]
11:52 am
>> now ladies and gentlemen, please welcome the moderator for our content creation panel, the editor in chief for television at variety cynthia littleton. now the rest of the family, the chairman and ceo of showtime networks incorporated, matt blank. the president and ceo of amc networks incorporated, josh. and the co-chair of media networks and anne sweeney.
11:53 am
>> thank you all for coming out. i really appreciate it. we were all talking backstage and listening to everybody that was speaking before us, it is a -- a of new ways to watch dizzying a ray of new ways to watch programming, new ways for viewers to engage in programming and literally, i realized it boils down to those two things. new ways to watch programming and new ways for viewers to engage in programming. as programming how has this explosion of platforms and opportunities, how has that changed your job? how has it change the name of what -- nature of what you do? >> we all realized that the
11:54 am
consumer has taken control and they're not giving it back. every new technology that comes forward is something that we have to integrate into the way we're thinking about distributing our content and also what happens to our content when it appears on a device. it appears on a new platform. we have an astounding relationship with twitter and pretty little liars from abc family. that show just never goes off the air. it never goes out of consciousness because the twitter verse and our viewers are one of the same. >> josh you've had an incredible run this year with the walking dead on amc, nice thing to have as the company is now newly solo to have the not only one show on cable but in all of the television universe. can you talk about how you harness all of these new opportunities to -- platform
11:55 am
that show? >> it's been a good run. asdo look at every platform an opportunity to do different things, second screen, viewing that are incremental to the show. show after the show, in which people get to talk about what they just saw. perhaps most interestingly and importantly, what occurs between seasons. in a certain sense, we look at the off season as not the off season but a full year of people who are very interested and try and provide them with the opportunity to stay on as a and in fact to invite new fans in. we all have seen that.
11:56 am
mostone of the interesting, i think, things occurring in tv is what happens between seasons. we've all seen shows, homeland and others, build in between seasons. that is a rich opportunity to expand fan base into a expanded audience. it's every piece of technology is a big opportunity and think the calendar is not quite the calendar anymore. >> do you actually program to that off season time? do you come up with original content. do you try to feed the audience to come back to our platform or is it about driving people to the awareness that you can catch up with catch one? >> it's both. depending upon the platform. on internet delivered and cable on demand, where it's in the sense same content windowed and delayed. which has been successful
11:57 am
bringing in lots of new people to subsequent seasons. it's incremental for the people who seen it. perhaps the most interesting thing of it, it seems to me, consequence, perhaps, i think showtime has done it so well and pretty little liars, is it creates a particular invitation for stories to go on. because people really like their favorites and they don't want to give them up. they can plan viewing them with their friends or families. i think the technology gives particular rise and influences the nature of content. i think happily its made it better and richer and the craft is better. so we do it all and it does it to us too, by the way.
11:58 am
it's doing it to us. the technology is basically informing a little bit what's happening on the creative side of the world. i think mostly for the better. >> it wepts from -- it benefits from all of these technologies. >> give them the opportunity to where you just got to watch one more episode. >> speculate. aboutt can you talk showtime any time and how that, the role out that service, how that differs from the traditional programming of especially cable shows, you give your viewers shortage of opportunities to catch up during the week. >> i wanted to start off by apologizing and admitting that we have participated in a government's prism program providing everyone watched homeland.
11:59 am
we view the showtime any time, this is another attribute. being premium, we have to be there first, someone is paying for a our service. as a technology it allows us to do different things. we were very early in high definition, premium category really invented the spod world. seenof these times, we've dramatic impact on how people use our service. showtime any time is another way of putting on demand platform out there. we're very different, unlike the josh and anne's network. we're not terribly focused on how many people watch the premier of one of our episodes. if we do well we'll see it in the press and if we don't, we don't talk about it.
12:00 pm
the reality of our network is 80% of the people who watch what did after the premiere sunday night, anher on demand or dvr or other place. people who watch "dexter" do not watch it the night of the premier. demandto take the on platform, which has been terrific for the premium business, and provide different access and different ways of accessing it, we think helps the service. i remember when we brought launching it, there were people that thought it would be totally virtual and no time. like to watch it vertically to a great extent.
12:01 pm
certainly the case ever premium network. you met -- mention the pay cable. there is a lot of chatter about the growth of the businesses that are outside of the traditional cable universe. and for the major media conglomerate, it has been a double-edge sword because of content creation of a lot of licensing money coming in. i am guessing the deal to bring back the killing, that probably would not have happened. i guess it is a question, are they friend or foe or someone at and between in terms of traditional cable businesses versus the world we're talking about? >> my sense is that they can
12:02 pm
peacefully coexist. it is all about identifying first window, second window. there are different places for content producers to put their shows. the other than we should pay close attention to its advertisers supported video on demand. when fast forward is a very positive bang for the economic flows of television and the economics of television production. i think this has been largely friend. friendshe specter of turning to fos either unwillingly or growing up and becoming goes. -- foes. we've been quite careful in the manner in which we license and windows the report extended amount of time between what goes on to cable tv and what goes on here.
12:03 pm
pretty happy world today. i think some of the tricks the including algorithms' make the internet delivered services particularly appealing today. do a lotwill start to of that. that is a happy thing to look forward to. we're on our way to a much
12:04 pm
improved cable service in terms of bells and whistles. is that something that you talk about, the need to improve theauthentication platform, need to steal this is all frofrm netflix. >> absolutely. they are aware of what is going on and how people are consuming and they are deployment plans. we do not have to ignite it. we're pleased about it. >> same question. >> we look at the business a number of ways. a revenue source to us. this p says of more programming, control more
12:05 pm
programming. in terms of competition, premium services were in business when there was no amc, ifc, no dis yet, we'vec family, never had better performance than in this highly-competitive environment. us it end of the day for is about making great content, controlling as much of the content as possible. things are easy to do. we're pretty good track record of doing it right now. that is the primary focus. whatever additional competition, different ways of can't reach it this division, and to the marked -- marketplace, showtime will be a highly-demand a brand.
12:06 pm
we do not want to slide back into a world where we're worried about every time someone turns on the tv, do they have to go to show time? always asking me when are you going to retire? the day that we become the least object will desire? . i want to be the most desired when someone turned on the television or smart -- buyers of the smart phone. again, it is content. you have all been in the cable business a long time. you have been the destructors. you have been the people charging in.
12:07 pm
>> we're still the destructors. we look at a news show or see a new show and say this will blow people's minds, maybe we're right or wrong, but we're still trying to be destructors. the thing that drives me crazy right now, you read in the media every day, the business news channels love to talk about it, you love to talk about it. arek the bigger companies the companies with no revenues and earnings. jobs and are running companies that keep growing subscribers revenues growing huge laugh -- free cash flow, and we're like how you feel about being disruptive? to wake up every morning like that. let me tell you.
12:08 pm
also disrupted, but responsive. when you talk about countries -- companies that are destructive, the best are those that are responsive to the consumers. we know it we want to hold them in their hands. we're making sure they can do that. the watched is the portfolio and most recently, that isd watch abc, being disruptive. also, disruptive in a way that is part of the great ecosystem
12:09 pm
because it is done in concert. earlier this that they are in the business of providing it all. i am not so sure the notion of destruction, which would normally put one on their heels is -- i am not sure i see it that way at all. conversationrlier all. i'm not so sure the notion of disruption which puts one on their heels. i'm not sure i see it that way at all. there are certain new technologies that provide different experiences. if you're in the content business, each one is just this rich fun opportunity because twitter is a big part now of what we do and second screen viewing is institutionalized. it's fun and we do webisodes on the show. that stuff is all addive. if you're a fan of walking dead or breaking bad, you're finding
12:10 pm
ways to get deeper and richer experience and much more connected social experiences particularly by using all of that s that's not a bad thing. that is a good thing. we sort of welcome it. if you actually look at ratings of good tv shows, we spoke about this briefly. we saw -- this is the metric if you want to get the tv metric. what's the rating in season three, four five and six. we've seen these escalations on ground swell of people talking so that this guy who does the walking dead robert kirkman said it's an internal zombie move that never ends. during the years the audience
12:11 pm
getting better aunt appetite increasing. i will look at that stuff as cool and not worrisome. >> that's the lightning in a bottle who would have thought. >> it's not just walking dead. we had probably 70% of our scripted shows saw increases in seasons where tv historically has gotten little longer. >> can you corollate? people watch 10 episodes. people caught up with the prevention seasons on -- previous seasons? >> let me give you one. last fall in the second season homeland, tremendous on demand viewing of the first season of homeland. there's a lot of ways that this viewing relates to linear
12:12 pm
viewing. we have four seasons. what we see almost universally is higher ratings for the final episode of a show than the first episode. we see for 12 weeks, the beauty of these 12 weeks -- you got people sucked in for 12 weeks and you move on, those shows will be in the top 10 of trender. we're not creating a viewing experience, we're creating an experience for all of this chatter, all of this talk around the shows. in a prescription business is very important. if you're in the eyeball business, makes those shows more important and more interesting and brings more people under if that tent has to change,
12:13 pm
we're still going to grow the size of that tent. >> unfortunately, i feel like we just got started. we have to wrap it up. i really appreciate your time and your thoughts and i wish we had more time. thank you so much. [applause]. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2012] >> we will have more from the national cable and television association meeting tonight. congress is on break this week. we are bringing your discussions from the conference. tonight a panel called disruption of irruption.
12:14 pm
commissioner, brian roberts and the discovery ceo tonight. for the past few months we have featured a number of ceos and other corporate leaders as they testified at a congressional hearing and spoke of other public affairs events. tonight we will show you were marks on topics like the economy, regulation and employment. you will hear from leaders of american express, apple, as a group and microsoft. here is a preview. >> what is a -- what i would say is a few key things. number one, i think the consumer has really demonstrated incredible resilience in a very challenging economic environment. the question is, how long will that last? the consumer has held up relatively well. i think you see that in the spending and credit performance,
12:15 pm
which the right off rates have substantially come down, and for the industry overall, very close to historical lows. >> as i look at it in the broad scale, it bill -- it will be relatively slow. i do not have a great deal of confidence there will be any turnaround in the near term. i think what we have to hope for is it will stay stable. >> that discussion coming up tonight. we want to hear from you working for a company or if you run your own business. we will take your calls and hear
12:16 pm
from you on facebook and twitter tonight at 8:00 eastern. capitol hill for a discussion of the health-care law. the alliance for health reform and the robert wood johnson co- hosting this event just getting under way. >> this program will play some small part in advancing the dialogue. what me make just a few quick points before we turn to the people appear to really understand the nuances of this complicated topic. first, there are millions and millions of americans who experience some mental-health issue each year. second, in both categories, both ordinary and more serious problems, a huge proportion it no services whatsoever. with the caserast
12:17 pm
of physical health services, government at several levels funds most mental -- mental health services in this country. fourth, the affordable care act will have a major effect on how mental health services are delivered and paid for, beginning in earnest next january. you will hear much more detail on that later. today we're not focusing on the relationship of the mental illness in connection with the shooting tragedies in connecticut and colorado. we are pleased to have our sponsor, the robert wood johnson foundation, which has been helping americans enjoy healthier lives and get the care they need for over 40 years now. we expect to have with us in just a few minutes and the high heiman who directs
12:18 pm
the coverage for the team and came from the national association of state and mental health program directors. he knows a bit about this topic, and we're looking forward to hearing from him when he gets here. a few logistical items before we get to the program. in your packets there's a lot of background information on this topic, including the power point presentation of our speakers today. biographical information about them that you should read, because it will not get the introductions they deserve from the moderator. watching on c-span or the web cast on our website, and you have access to a computer as well, you can find the power point, you can find other background material on our health.org, along
12:19 pm
with other digital materials that did not make it into the printed packet. in a few days if you will be able to view a transcript of today's discussion on the alliance website. at the appropriate time you -- theope you will feill out green question cards and try to stump the panel or go to the microphones and ask your question orally. blue evaluation packet that you can fill up before you leave so we can tailor these programs more to your needs and desires. can,ld like to turn if i at the moment, to the robert wood johnson's coverage team leader and mental health expert, andy hyman.
12:20 pm
>> let me begin by thanking ed as jack thompson for pulling this together and the panel for sharing their expertise in helping us to gain the perspective on this really important issue and the challenges facing the mental health field. around the room and it is really gratifying to see so many people that are responsible for the remarkable progress we have made in advancing policies aimed at helping those with mental illness and their families. less than a month ago president obama hosted a white house conference on mental-health. in his remarks he asserted we need to bring mental illness out of the shadows. true. know that this is
12:21 pm
that is, the need to bring mental health out of the shadows, but it is kind of a paradox. user all, virtually all of know what someone who has been suffering through mental illness or caring for such a person, but if this is the case, how can it be that so many of our friends, neighbors, and loved ones live in so many die in the shadows? it is actually an important thing for us to ponder. not too long ago i worked in the mental health field. it seems so much of the time was focused on promoting the great promise of recovery for people with mental illness and articulating a vision for hope for families struggling in navigating the mental health system. even after the triumph of president bush's new freedom commission on mental health, which was released -- the
12:22 pm
recommendations were released tens of -- 10 years ago this month, it somehow seemed we were still lost in the wilderness, but today we see steady progress on a number of levels due to innovation spearheaded by advocates, researchers, providers, policy makers -- people that would otherwise be homeless and language in institutions, jails, prisons, or if -- are indeed writing and living in communities receiving and demonstrating the true meaning of recovery. i am glad i can point to my colleagues who have sold -- who have helped to support some of this great work. permanentto develop support of housing. the models. financing thousands of housing units. developedues have project ago, an innovative model being tested to integrate mental
12:23 pm
health and primary care in patients with chronic conditions. recently my colleagues release of finding regarding a program that shows we can identify individuals at risk of mental illness very early and refer them to appropriate services when they experience -- before they experienced the most debilitating symptoms. alongside these and countless other breakthroughs there have been remarkable advances and policies that many of you in this room and many of the panel members have helped to achieve. laws will help to expand access and reduced financial barriers that stand in the way of millions of people getting services they desperately need. these are extraordinarily development, we know the barriers still remain.
12:24 pm
how far is part of what we want to explore today. with that, i would like to thank you for joining this discussion and turn it over to ted. >> thank you. good afternoon. it is wonderful to be here today as part of this terrific panel to talk about our nation's health-care system, the provision of services and supports for persons with mental illness. i have been asked to start the panel but briefly presenting information about mental-health and who did serve and who does not, trends in the finance and servicing system. since i work with state and mental health system, i will have overall mental health information but will focus on the safety net system run by mental health authorities. first of all, we know mental- health services to work.
12:25 pm
persons with mental illness can and do recover in the concept of person-centered treatment is a basic tenet of the mental health system. unfortunately we also know too few people get the services they need and often person -- persons go years before they get the help they need. mental illness affects virtually every family in america. one out of five persons has a mental illness, but only one out of three received a serious -- a service during the course of the year. 11.5 million adults, or 5% of the population has a serious mental illness, schizophrenia, bipolar, a major depressive disorders. we're doing a better job are reaching them. 60 percent of people with serious mental illness receive services. that still means 40% received no
12:26 pm
services each year. the cost of the mental illness to america are quite high. a recent study estimated the total directory and expenditures for mental health or $147 billion in 2009. an additional $24 billion per substance abuse treatment. collectively spending represented 7.4% of overall u.s. health spending. the state mental health system, which i will talk about more in detail, spends 37 billion providing services to persons with persistent mental illness and tree -- in children with mental this is. that system is largely funded by state general revenue funds and medicaid. in addition to the direct treatment cost, there are major treatment costs.
12:27 pm
mental illness across the u.s. estimated 193. billion dollars in lost earnings because often people with serious mental illness are unable to work. over 38 million suicides per year -- 38,000 suicides per year, more than twice as many homicides. 750,000 suicide attempts each year. every suicide in suicide attempts leaves a lasting impact on the family and friends of those who attend it. theddition, people in mental health system die prematurely. the study we conducted analyzed death rates among consumers and the public and the whole system. we found consumers in the state mental health system experience up to 25 years of premature life lost, usually due to physical health concerns. that leads to the next point.
12:28 pm
people with mental illness have high levels of physical health ailments. diabetes, heart disease, obesity, smoking -- a whole slew of physical health issues that are often not well addressed. the use emergency rooms of very high rates. overall health care costs are very high. my fellow panelists has a traffic center funded directly by the health services research administration that is working to address the integration and coordination of physical health with mental health and state and local activities around integrating will be discussed by fellow panelists. in addition, we know the person's and mental health system have high levels of unemployment. only 18 percent are competitively employed. as a result, we know that generally means they do not have private insurance that comes from working. we do know services like
12:29 pm
supported employment can help those it and maintain employment andemployment underemployment is a very serious issue. problems with homelessness, although one area we are successful at is when people get into the system, we are very good about getting them house of the street. jails in criminal justice system and stress to families. one question that comes up, why don't people get services? the survey asked why don't you get served? the number-one reason, 51 percent of respondents said they could not afford care or it costs too much. the insurance would not cover all the care they needed or insurance would not cover it at all. those are issues we think will be greatly benefit by the mental health parity act and the affordable care at that may bring coverage to many people and help them afford care. the state mental health agency
12:30 pm
exists in every state. states have been having the responsibility to provide in- patient treatment. every state operates psychiatric inpatient beds, but most of the services are now in the community, and are responsible for planning and implementing comprehensive systems, monitoring quality and outcomes, but state and mental health authorities have a primary public safety role with the provide services to people the courts deem as dangerous to themselves or others do to the mental illness. i will skip over a few of these slides in order to get through. this will be in your packet. one of the questions we get is why our state so fundamentally involved? why is this a government responsibility? >> states have had a primary responsibility dating back to before there was the united states government.
12:31 pm
since we are celebrating the fourth of july this week, i thought it was interesting the colony of virginia established the first get a mental health facility in williamsburg and several signers of the declaration of independence were on the board of the eastern state hospital. by the 1950's every state not only had a hospital, about 550,000 people and state hospital every day. today down to fewer than 40,000 people in state hospital and 96% of a 7 million consumers are served in the community. people.d, 7 million 2.2% of the population are served by state systems. 96% in the community. state hospitals serve between 2- 3%. the people served by state systems, 62 percent are white. minorities are served at higher
12:32 pm
rates. african-americans, multi-race. also, teenagers are served at a much higher utilization rate. as i said before, largely adults are not employed. that means medicaid is very important in providing coverage. 63 percent of medicaid paying for some or all of the care. this leads to the question, with the affordable care act, how will that help? >> our colleagues have done some really helpful work in analyzing the data and making estimates at the state and national level about how many people will gain the benefits? medicaid provides an extended benefit for people up to 133 percent of poverty. they estimate almost 1 million adults will be eligible for
12:33 pm
expanded medicaid coverage and almost 4 million adults with any mental illness. for a subsidized insurance, almost another 900,000 people eligible for insurance through the exchanges, people with serious mental illness. over 4 million adults will be eligible for coverage through an exchange. coveragereat potential for people who could not get coverage because it could not afford it. states spend 37 billion per year. if we control for inflation and population growth, we are right where we were 30 years ago. the recent budget cuts the states had to make lead to significant cuts in mental health system, about 1 billion per year. the closing of state hospital beds. it really has led to a big shift in the system. 30 years ago, two-thirds of the money was going to state hospitals.
12:34 pm
today 73 percent of the money goes to community services. spendings we're still $10 billion on state hospitals. an expensive treatment that people need. moree in hospitals are forensic and sex offenders. i will skip over that as well. the state organizes and funds the services primarily through community programs. 15,500 different community providers. many of them members of the national council. states increased and we find this through a combination of fee-for-service in managed care using various medicaid options in waivers. medicaid has become the important funding source for the system. states received $18 billion for the state mental health system. 58 percent of funds are for the
12:35 pm
community. state hospitals do not get much medicaid. we often hear from advocates, that means states are pulling out general revenue funds. this shows states are really not. general revenue has gone up to almost $15 billion. medicaid has grown so much faster. that is why it has become a larger share of the funding. what will be the impact of the affordable care act on mental health systems? we're hearing it will depend on what the governor and legislature is doing. this shows a couple of weeks ago 26 state-supported medicaid expansion but not all states even where the governor is supporting its.
12:36 pm
we will work with the exchange on what are the central health benefits, training consumers to help pick and select among insurance plans. working with providers to build up the new funding sources. looking at what services medicaid will not cover. and we have a number of states, and dr. wilson will talk about misery's by -- first your evidence about how effective they are.
12:37 pm
also, states that are not expanding medicaid. idaho, missouri, are doing health forums to coordinate and getting exciting results. similarly, and the medicaid friend, accountable care organizations are another area mental health is working with. finally, cms has other demonstration programs. these are for people that have mental health and medicare. states are looking at using to bridge the gap in mental health services. >> for those of you that do not know john, he is a state policy adviser at the centers for
12:38 pm
medicare and medicaid services. he has a great background in providing expertise to state and local human services and disease and medicaid programs and mental health programs and a senior leadership. he is even a director -- directed several robert wood johnson programs. very well qualified to be part of the panel. looking forward to hearing from him. >> thank you. good afternoon. thank you for inviting us here today. we would like to tell a little bit of a story about what we're doing, as relates to mental- health and substance-abuse programs, but also as that interfaces with the affordable care act. , let's talk a little bit about medicaid and behavioral health. pay year forrgest
12:39 pm
mental health services. report that i saw had the commercial plans coming in the healthy second, but we still continue to be the first. obviously with some of what what will occur beginning january 1, of mental health services that medicaid will underwrite will increase. a couple of things worth noting on this, and that is that we buy a fair amount of mental health services and substance-abuse services that exist in a variety of our authorities. i will not go through the whole laundry list, but there are a number of flexibility is. there are a fair amount that states have when they think about the substance abuse services and then 2014, the state's choosing to expand, as
12:40 pm
well as those states that are developing market places will have even more flexibility is a round coverage of use. thatlly want to stress while we're here to talk primarily about mental health services, that you cannot really talk about mental health services without talking about substance abuse services. 2014,begin to go past there will be a significant number of individuals, mostly single adults in states that were not covered by medicaid that will have coverage and will have to pay particular attention to what services we create for those populations. when we talk a little bit about the affordable care act, a lot of the focus has been around eligibility. we treat it like a three-legged stool. the important parts are employer
12:41 pm
coverage. last but not least, the marketplace. in less than 90 days, october 1, when i remember october 1, 2013 seems so long ago. it is here. we would like to fight another year, but we cannot. the fact remains that eligibility provisions and the ability for people to enroll, in the marketplaces and the places that will offer the of medicaid expansion will begin on october 1. we're certainly looking forward
12:42 pm
to that. we believe states have spent a lot of time and energy getting the system is ready. working hard with states to make sure they have the tools they need to get people enrolled, and we know that our friends are also doing the same as it relates to the marketplace. this graphic gives you a sense of what coverage will look like for a significant amount of americans. side youults site -- have places that are 133% to 400% of the adult poverty level. you have states that will expand. 133% and below. , we of thedren side ability to include them as part of the marketplace, and a regular medicaid program and
12:43 pm
children's health insurance program that are covering those children. aregood news is we reporting $32 million in grants for enrollment purposes for the children's health insurance program. we are obviously in the process of working with and awarding entities that will be getting navigator programs. we're working really closely with federal partners. the administration on community living, and the provider partners to be able to get the word out a round in romans, because we feel like the more people know about enrollment and enrollment options, i think the better it those individuals that will be in the expansion population and marketplace will know what options are. little bitntioned a
12:44 pm
about mental health parity. six months ago we put out a state health officials letter that outlines what the interface was between the mental health parity act and the various authorities within medicaid. suffice it to say, it is complicated. i think people welcomed the informational bulletin, but still had questions. it does apply to the children's health insurance program. it applies to medicaid managed care associations and also section 1937, which we effectively called the benefit plan. they have been under -- enhanced under the affordable care act. to go medicaid does not apply to
12:45 pm
state planned services. try as we might, no way to reach those planned services. it would be helpful to that have the goals been identified we have been doing a lot of work but felt like it was time to be probably organized andore focused on a number of these goals and they are pretty simple goals. very similar to some of the partners goals. the first one is making sure we identify mental health and substance abuse conditions early so that we can intervene earlier, and we have spent at least the last two years, especially the children side working with a small workgroup of federal partners and private citizens along boat early
12:46 pm
periodic screening and diagnoses and treatment program looking at behavioral health screens for children and adolescents and about three months ago we released an informational bulletin that identified not asy what we had recommended screens for those conditions but tool kits that if they could use to refer people once they actually identified. closely with the american academy of pediatrics, as well as the american academy of practitioners to be able to develop that. i will hold off on that.
12:47 pm
the affordable care act gave us additional tools or enhanced the tools that we had to be able to think about services, especially services for mental health and substance abuse services. that included the help home provisions as well as this program change. we are trying again through it good information out about what could coverage is. two months ago we began the coverage around mental-health focused focusing on children was significant mental health conditions. thehighlighted our program
12:48 pm
program had funded through as wetration, as well plan to roll out these programs. some of which are touching on what ted covered earlier of around these conditions. the third goal is a lofty goal. that is improving outcomes. we know people with mental health conditions do not have good outcomes and we would like to have them have the same we know that is a stretch, but that is our goal. last but not least, to goals are
12:49 pm
better availability of practices to enhance recovery and resiliency, and to reduce barriers of social inclusion, and we have been working very closely with state partners in terms of how they would like to be able to cover evidence-based practices, answering questions about what the evidence-based practices are, and other ways to be able to message what we hear, what we're told is the practice. last but not least, we have the really trying to test new ideas, new practices before they get to widespread dissemination. we do that through the 1115 program. we also do it through the innovation and cms. happy to say that innovation grants have a pretty significant
12:50 pm
focus on mental health and substance abuse and have a pretty significant focus on medicaid. that is what we are open to. -- we are up to. past beginning to get january 1, 2014. >> thank you. and good luck. of the is the ceo national council for behavioral rosenberg.da more than 30 years of service and mental health policy and services. the national council under her leadership has grown membership to over 2000 organizations. all of them committed to integration of health care in behavioral health care. pleased to have her with us.
12:51 pm
be here.elighted to and he began by talking about having mental health come out of the shadows. john went on to include addictions. i think it is events like this that have it happen. i want to thank them for the opportunity. it is great to see so many of my colleagues an audience to of worked so hard over the years to make some of these very wonderful policy changes have been. it is also a terrific to see lots of young people who are the next generation and will bring it to the next level and really be out of the shadows. i will take you back to 1963 when john f. kennedy signed the last piece of legislation. 50 years ago this coming
12:52 pm
october. i mention it because it really goes along with some of the data that presented, which is the transition from state hospital, which is supposed to solve the you can see some of those services listed on my slide. parts of the new frontier, again, bringing mental illness and developmental disabilities at the time out of the shadows. it was an end to the warehousing and often remote areas in the state with people with mental illnesses. these warehouses were really at best neglectful and at worst, abuse it. i began my career in the 1970's in a state hospital in can tell you the conditions were even at that time quite appalling.
12:53 pm
of energy and certainly the federal government began creating the community based mental health centers. the state added general fund money. someone on this panel was better than me. a lot of the services that had been funded directly with federal and state dollars were now funded by medicaid. that was a big change. the services that developed in our member organizations have an area of specialty that they have developed over these 50 years. really working with people who intersect social and clinical vulnerability. those are skills that are very much in demand now. the success we have had and what this shows you is the success of
12:54 pm
treatment for mental illnesses, specifically as it compares to treatment for other chronic illnesses. thoseten we are willing, of us who work in the mental- health field to somehow be defensive about not achieving outcomes. well, all comes are mixed for most illnesses. they are particularly difficult for chronic disorders. what i think this slide points out is we have had a tremendous degree of success and have developed skills in terms of care and coordination for complex populations. tedink the other thing, and mentioned things -- this in his data is the services, whether it is housing, vocational support or educational support for medication or any kind of treatment really are cost effective.
12:55 pm
is a very nice book called better but not well that talks about when you adjust for inflation, spending on mental health services, people with serious mental health services remain flat and has not escalated the way it was for the rest of health care. profits thatpoor deliver services have been good stewards. we are really next and a reiteration. no longer the building of a site load community service system for people with serious mental illness. now it is about how do we bring those services, those people who have those needs into the general health care field? we have a lot of hurdles that we need to work on. one of them is that americans really do not know about mental
12:56 pm
illness. when i was a little girl many years ago cancer was whispered about. we have made tremendous strides around that. we're just beginning, i think, the journey of around mental illness and addiction. the other thing is all the services we have developed for people once they are chronically ill and designated as seriously mentally ill and there are the pathways in every state to reject state to achieve the designation. you get medicaid and get the services available to you. for most people, but not all, they work, but you are already then facing a life of disability. what we have not been able to do, and what i think we will be working on the veryy is something that andy
12:57 pm
mentioned a round first episode psychosis. intervening at that point to prevent lifelong disability, to keep people at school and that work. the other thing is substance abuse must be put on the table. when you compare the 600,000 people have died of aids since 1980, but 3.3 million have died of addiction, i think we're facing a public health crisis. those who need treatment of addiction only 10 percent get it. when you look at where most people who have not been designated serious mentally ill get the health services, it is in primary care, and what the research shows it is usually medication not manage very well, and with very little attention to support or continuity. so we have these opportunities. we have the insurance reform people being covered to the age
12:58 pm
of 26. insurance companies to have to deliver mental health and addiction services just as they do all other services, and we have these really reforms of the delivery system and the payment structures. the is all about inverting trying goal, getting people out of institutions, coordinating chronic conditions, and taking health care dollars under new population base and integrated budget arrangements. that is what households are. that is with accountable care organizations are. putting together services for people under one roof. most importantly, our members are now picture that comes can also be available for people with serious mental illnesses and addictions and as you have heard from others, died prematurely. i think this is a map of states
12:59 pm
that have moved towards this. paul will talk about the first year experience that misery has had with the have been able to save money and improve care. has had andsouri have been able to save and improve care. this has to do with willingness for experimentation. i think some of these models we're all thinking will be very successful are really in some ways experiments and we will have to watch for unintended consequences and be ready to make other refinements. the other thing >> wal-mart controls 57% of all groceries. areof doctors today employees. that is a radical change. thank about wal-mart, think about home depot, then think about health care and think about ac
1:00 pm
telephones and the new structures that meet -- are needed to do what needs to be done. that will affect how we deliver services and local communities and the other thing is the liberation of information. there's a great piece in this great"new york magazine" by frank rich talking about how people believe are not very excited about this breach of their private information or about government listening in to their phone calls. they think about privacy very differently than we do. i think we have to think about that as we plan services and talk about the future. for specialty mental health that delivers services now for people with serious mental illnesses, there are some real issues and barriers. one is that small businesses with small margins lack human capital.

51 Views

info Stream Only

Uploaded by TV Archive on