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tv   Washington This Week  CSPAN  October 20, 2013 1:00pm-3:01pm EDT

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those who have taken the option. the next slide shows the non- magi population. aged, blind, disabled, medically needy. and then we have something very unique. unique. again, to the right side of the chart and i think we may be unique in the country -- there may be counties in california that may do this. we cover people who are not eligible for medicaid. children and adults up to 200% of the federal poverty limit and that is solely with local dollars. i don't believe there is another program in the country. it is a medicaid-like benefit. it doesn't have quite all the coverage levels, but it is darn near close. so our early efforts to cover childless adults started way before healthcare reform.
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we started with a waiver to cover individuals who are h.i.v. positive with incomes below the federal poverty limit. this coverage was extended to individuals who are h.i.v. positive with incomes 100% below the federal poverty limit. the key to maintaining control of the costs there was cost neutrality. the other piece of -- let me go back. how do i go back? oh. we then also took the early option to cover childless adults up to 133%. i mentioned that. effective july, 2010. we also then received another 1115 waiver which is funded through an allocation to cover adults up to 200% of the federal poverty limit. we have received another 1115
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waiver which is funded through a dish allocation to cover adults up to 200% of the federal poverty limit. we have expanded, unlike most state who is have opted for the medicaid expansion, who are expecting to see a large influx of people into their medicaid program, we do expect to see more people enrolled because we're doing a lot of outreach, but the large influx authority happens. we have some experience with this expansion in population. it is about 44,000-45,000 adults to the medicaid roles. it is adults to the medicaid roles. actually when we counted up to 200%, it is over 50,000 individuals. so one of the things that we can tell you, because we have experience, and again, this may be a little unique because the district of columbia is a very urban area. we're not like many states. we are an urban center. so what we found particularly with this expansion population is fairly high rates of h.i.v. infection, hep c and other disease states that are quite expensive. what we found when we were expanded, the delivery system is through our managed care plans.
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through capitation. these folks were a little more expensive than we anticipated. you can see in the slide when you look at our legacy population, within that legacy population, this was f.y. 2011 data, there were 664 individuals with h.i.v. but when you looked at that adult group, up to 133, that new adult group, the numbers jump up to 968 or 3.1% compared to 1.8%. that additional population, that 133% to 200%, it was 5.8% of the population. the numbers in red just show the prevalence rates for the males only because they are again the disparity when you look at the legacy population, which is primarily your women, children, the people normally covered in the medicaid program, 1.1% of males in the legacy population, but that new group, particularly
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that 133% to 200%, the prevalence rate of h.i.v. was 8.9%. that is pretty significant. that drove pharmacy costs off the charts. again, you can see that the legacy m.c.o. rate for pharmacy was about $24 per person. the 774 and 775, those are our program codes for the expansion group, but you can see those costs really significantly jumped. $78 per member, per month. so i have another -- so how did we deal with that? one of the things we did is carved healthy h.i.v. drugs from the m.c.o. rate so that we could take advantage -- we have a department of health pharmaceutical warehouse and pharmacy that uses d.o.d. pricing and we were able to do that and got waiver to do that. we also created a new rate cell
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for that expensive population so our rates could remain sound. we're looking at some payment reforms and health delivery reforms such as care coordination models. that is very important as we go forward. so when we look at the district and i think this may be -- did i yeah. ok. so i don't know if you can see this. you probably can't read the numbers. the blue area represents -- this is again a comparison between d.c. at the top, maryland in the middle, and virginia at the bottom. this is just a snapshot of states with kind of different approaches to the medicaid expansion and what happens with healthcare reform? the blue represents medicaid coverage levels. you can see the district because we're way out there, up to 200% of the federal poverty limit. we're going to be covering a lot
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of folks, and then where we end, the subsidies and the exchange continue on. that's the purple area. it is not really important to know about the numbers, but if you jump down to the bottom where you see those red bars, what happens in a state like virginia, that is not expanding, you end up with an enormous coverage gap. i can't read those numbers. i'm too far away. as we noted in the earlier slide, virginia's coverage for parents and caretakers is fairly low. that doesn't change. the subsidies pick up at 138% of poverty, and then that red in the middle represents the people who don't get anything. so you have a significant population of people who are significantly, probably vulnerable. low income. who are not going to have access to healthcare coverage. again, the district has closed that gap. maryland has closed that gap. that is what the medicaid
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expansion helps you to do. so we're very glad that we were able to do that. as we move forward, one of the things i should say is that because of the federal money that is available for the expansion population, beginning in january, if all goes right, we get our spas in and they are approved, that the districts -- district's expenses for that adult population, those newly eligible individuals will be 100% reimbursed under the federal government. this for us was a no-brainer. get everybody covered and the federal government will pay for it. at least for a while. so as we move forward, we are very much at the forefront of implementing healthcare reform. we have taken advantage of every
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opportunity to pull down federal dollars to help us basically retire a 25-year-old eligibility legacy eligibility system that has caused no end in headaches and problems and lawsuits and everything else. we have gotten a waiver from the federal government to implement magi determinations early. so we have permission to start that october 1 when we launched healthcare reform so that we could align it in the exchange beginning on day one. we have waiver to defer renewals during that safe harbor period between january and march 31. so we will not have to do any renewals for those three months and we can begin doing passive renewals april 1. we have secured a tremendous amount of federal funding through our eligibility funding
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through establishment grants and the planning document. what is interesting about what d.c. is doing is there is a lot of mechanics involved in coordination between medicaid and the exchange eligibility. we have had our share of challenges. i'm not going to sugarcoat it, but the law requires that if you apply -- an application for medicaid is an application for exchange subsidies. if you apply and are found ineligible for medicaid, then you have to transfer that case over to the exchange so they can complete the exchange eligibility. we have eliminated that step. what we have done is used the money that we have gotten from the feds to replace our aging legacy eligibility system with a single system with a shared platform. instead of medicaid owning it or the exchange owning it, it is actually owned by the district and we are all customers of that system. we will not have to do any case transferring. you apply. it is a single door entry.
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it is stream lined. you'll get your eligibility determination, and through all of our interagency agreements, we are coordinating the work that has to flow around that, but the case itself doesn't have to transfer. we have been working with c.m.s. to develop an fmap methodology so we can claim that 100% for newly eligibles. i know that has been a struggle for states. we have been able to work something out with c.m.s. that we think is going to minimize the burden in terms of how we go about doing that. and we did launch d.c. health link, which is the name of our exchange. our eligibility portal. on 10/1/2013. one of the most wonderful things about this new system is all the data that we can pull out of it and how quickly we can get it, which is not something we can do with our legacy system. i get a report every evening
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about the activity on the d.c. health link. i can tell you since day one, we have had nearly 12,000 people who have gone into the system. we're talking about 6% uninsured. there is not a lot of people. maybe under 50,000 people in district that we have to reach. already we have just under 12,000 people who have created accounts. we have employers who have signed up. we have had employees sign up. we have over 1,500 applications in the queue. we have gotten people through the system that have shopped for plans and chosen plans and they have paid their premiums. we had a meeting the other day to sort of regroup and we said it hasn't always been pretty and it hasn't always been easy, but we have struggled through it and we feel really, really proud of what we have been able to accomplish, and more to come because we're now going to integrate all the non-magi groups into our system.
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plus all of our human services programs. we're going to have a single port of entry, not only for magi medicaid and the exchange and non-magi and tanf, food stamps and every other benefit program the district offers its residents. with that, i will sit down and will be happy to answer any questions. >> well, good morning. i want to thank, first of all, liz, for the very kind introduction and ahip for inviting me to speak and share the iowa story. i would also like to thank matt and claudia for being on the panel. looking at the speakers and the panel that i was going to be with on stage, i felt pretty overwhelmed from a healthcare perspective. because, as liz mentioned, i come from a little bit of a different background. i was trained as an accountant and trained as lawyer and now
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i'm in politics. to my father, in iowa, that just means i'm licensed to lie, cheat and steal. to the governor, that means i look at problems in a really annoying way. what we looked at, i sat down with the governor when he took office in 2011. i said governor, what do you think about healthcare reform? where are you at? politics aside, he said michael, what i think is missing, what the discussion hasn't been about is about getting people healthier. really focusing on the metrics. what is the goal of medicaid in iowa, our state-based medicaid, what is the goal of what we're trying to accomplish when folks get on health insurance? is it just provide access so they can go to a doctor? in iowa, we've had over 90% coverage in that sphere. no, that is not it. at least it shouldn't be. our duty is it should be about getting people healthier.
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about taking those steps to pick low income iowans up and getting them back on their feet in a health manner so they can go forward. that means for me, this focus couldn't just be on the system and the focus couldn't just be the population, but the focus had to be on the system and the population. let me tell you a story about a gentleman in iowa named bob fagan. about 30 years ago he buried his father. his dad has type 2 diabetes and then he lost his eye sight. then he lost his legs, and then he lost his life. bob fagan is a city manager in state of iowa. he is somebody ho has had health insurance for many years but his health coverage has treated him in a way where it was just
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paying for reimbursement. not looking at the whole person, doctor by doctor, problem by problem. bob fagan went to his doctor to get a health risk assessment. the city he was working for in northwest iowa was requiring it as part of their premium package. he goes and he has a test done and his doc says your blood level is a little off. so we're going to do some more tests. well, his kidneys were functioning at 1/3 of their capacity. he is on medication for type 2 diabetes. he is on medication for heart problems. he is on medication for cholesterol. his kidneys, what killed his father, were functioning at 1/3 of their capacity. the very next day, he went home and he started walking. around the same time, we were instituting a project in the state of iowa called the healthiest state initiative. we were -- we started looking at the problem, well, how do we make iowa healthier? we said you know what? government is not the answer. i worked for the governor, terry branstad. a long serving governor who never ever is going to go for a ban on big gulps. not happening.
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iowa is the purplest of states but that is not going to happen. how do we engage iowans in their communities, neighborhoods, businesses? we worked with our largest health insurer, our largest grocer, our public universities and associations, and we started saying what are ways that we can approach the health of our populations? we did it through two ways. one would be blue zones and the other would be the healthiest state initiative and healthy state walks. let me tell you why that is important, though. iowa, when we came in. like i said, i look at problems in an annoying way. we knew healthcare reform was on the horizon. governor branstad, what we had to do is kind of like bob fagan, get an idea for what we faced as
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a state. so we said ok. we need to look at the people. people are taxpayers. taxpayers fund everything we do. so first, where are we going as a state? well, we're one of eight states in the nation who have failed to grow by 100% of our 1900 census. eight. we're the only state in the nation who has failed to grow by even 50% of our 1900 census. the only one in the nation. 36.5% since 1,900. we have grown consistently except for two parts of our history. world war ii and the farm crisis of the 1980's. however, we're looking at how we grow also. by 2040, right now in iowa, there is one county, one, that has more people over 65 than under 18. one. let's magnify that by the fact that 57% of our 5 and under population live in just 13 of our 99 counties. now i can tell you later about why a state the size of iowa has 99 counties, but there is not really a good reason. [laughter] the next fact is we have to say
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governor, how are we spending our money? right? so in iowa, we have a legislative session every year. starts in january and ends right around planting season. believe it or not. hopefully and what we did is we said ok. where are we spending our general fund? 96% of our general fund in the state of iowa is spent on three areas. three areas, all entitlements by one definition or another. state salaries and benefits. education and funding and medicaid. 96%. i kind of again looking at the world in an odd way said we spend six months a year arguing about 4% of our budget? there has got to be more productive ways to do what we do. in the past decade we have expanded medicaid in iowa by 65% as a population. however, our costs have gone up 129%. chronic disease has increased by
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66%. every single health metric, whether it was depression and treatment or infections has gone the wrong way during that same medicaid expansion period. we have over 90% coverage, but in iowa, anecdotally, or as they found in the "new england journal of medicine" in oregon, pure access was not the answer. i had a governor who was convinced of the fact that we needed to attack the system and the population. we started on the population immediately with the healthiest state initiative going from 19th to 9th. we hope now the hard part is going from 9th to first. we want to do it by 2016. we're doing it by engaging communities, engaging businesses, instituting- evidence-based practices. letting communities take the lead, not the state. the other side of that is we do need to make sure our healthcare system is working in a way that is effective towards the goals and results and performance that we all desire as taxpayers, let alone as people who are
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administrators of this plan entrusted to lead the state. when it came time to have this debate about medicaid or medicaid expansion or healthcare reform in iowa, we wanted to do it our own way. so i call that a common sense approach. what we did is that is kind of how we looked at health care reform. we have a partnership exchange in iowa. not totally federal. not totally state. if you have ever been to a website in iowa, you know we shouldn't be building them. what we did is we said federal government, apparently, you're better than us at that, which results might say otherwise. that being said, we would have failed also. we focused on regulating our plans, informing our consumers and maintaining control over our
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eligibility of the medicaid population. you also need to understand that since 2005, iowa has had a very base level of coverage for our citizens. it is called iowa care. it was an 1115 waiver, which is medicaid talk for not traditional medicaid. it was a plan that covered adults from 0% to 200% of the poverty level at kind of a basic level of coverage. if you had more detailed or more problematic conditions, you had to go to one of two hospitals in the state. so a very narrow network. it worked to provide healthcare coverage. healthcare coverage has been in iowa. this idea and the question really in iowa was starting january 1 of 2014, were we going to take away coverage at least on some basic level from adults in iowa from 0% to 200% of the poverty level. i think that is a key point for debate, in iowa at least. we came up with originally the healthy iowa plan. it became the iowa health and wellness plan. there were five core principles that drove the development of that plan. the first was a pretty simple principle that we see in private
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sector plans everywhere. that is investment. what we had seen is that co-pays were not effective. they were not equitable. they were not predictable and frankly they were not working. we said why don't we look at a premium contribution from iowans above 50% of the poverty level that lets them know there is value for the services they are getting. there is an investment in their healthcare. the next goes hand in hand with that. that is a personal responsibility principle. you have to pay for a portion. a modest amount, no more than $10 at 50% of the poverty level per month. if you do the right thing, not only will we waive your premium, we'll give you a bonus. it is not a new idea. it is not a new concept. private health insurance plans have been taking people and
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their problem in private health insurance is trying to get people who are on heart meds to getting off heart meds. my problem is running this, isn't to getting people off heart meds, it is getting them to get on heart meds instead of having heart attacks. we want to get our population in to see their doctor. get a physical. get a risk assessment. if you do that, it is worth the investment to have that premium contribution the first year. it is called the healthy behaviors program. next was quality. and it goes hand in hand with the fourth principle, access. governor branstad refused to expand access. wouldn't work. we were calling for the population to have more personal responsibility in investment. but we also need to look at providers. access would be quality access. starting in the first year, we were going to pay providers. having worked with our number one insurer, we didn't want to reinvent the wheel. the state is not good at defining that. you know who is good at it? private health insurance plans. they already have agreements
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with the systems. they know what that field looks like. why do i need to relitigate it with our major hospital systems? when i can just say you guys agreed to it once -- we're going to measure quality. and have this whole population be at risk within five years. finally, the governor and the legislature wanted increased private insurance. so our plan, as most people know is bifurcated to a 0 to 200 population, iowans who have served not on a medicaid health plan, but on the plan that i get, the governor gets, but with a little bit of mental health added to that. the other side of that is from 101 to 138, the iowans get to choose on the exchange the private health care they want.
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it not only increases folks on private health insurance, but also makes policy sense. iowa has seen the second greatest rise in incomes of any state in the nation. we're only second to north dakota. we have agriculture money. north dakota has agricultural money and oil money. oil money trumps. so what we have done is said ok. we have incomes rising in our state. what we want people to do is as those incomes go up, i want continuity of care for them and their families. to me, that just makes good sense. it is fair to the iowa families. and less people on state programs is good for the taxpayers because then we can be better stewards for the folks who are served by it. we're better with the state funds that are entrusted to pay for it. rooted in all of these ideas, that core concept that i touched on at the very beginning, which was governor branstad wanted to focus on healthcare reform. focused on making people healthier. that is engaging iowans to invest in their own healthcare. that is also rooted in the same concept that as we have seen healthcare costs rise, it reminds me of the economic principle if something cannot go on forever, it won't.
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healthcare costs have grown at a rate that very simply cannot continue. what i kind of look at and as we see this steep curve of healthcare costs increasing and obesity on the rise and all of these contributing factors, i realized this is not a curve that can continue forever. it is a problem that be states, whether private sector or public sector, are really starting to tackle. this is something that to me as i look through history, these are problems that we have tackled over the last century. i'm not a huge fan of quoting people but there is that margaret mead quote, "never doubt what a group of people can do to change the world." something along those lines. over the past century, what we have seen is the average life spans of humans increase by two. the average per capita income
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increase three-fold. child mortality drop 10-fold. the cost of transportation, 100 times less expensive than it was a century ago. communications, for everyone on their phones, 1,000 times less expensive than they were a century ago. never doubt what a group of thoughtful committed citizens can do coming together. we can change the world because we have tackled the big problems and i'm here to tell you in iowa, we're up to the challenge. maybe that is just midwestern optimism, but it is something that we're working on. i would like to again thank ahip for inviting me here and i really look forward to your questions. [applause] >> speaking on behalf of the audience, what a great series of three presentation. thank you so much. i'm going to ask a question and i hope that you all will participate and ask questions on your own. matt, on october 8, you and your group offered a series of
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recommendations to congress with respect to changes to the behavioral health system as it affects medicaid and i was hoping that you might give us a snapshot of what those recommendations are. >> behavioral health. this really kind of got its start, obviously it is an issue that has been important to medicaid for a very long time. we actually looked at the numbers. about 30% of medicaid spending is mental health related. that is kind of staggering when you think about it. but the motivation for us sort of coming together, we have put out basically a pretty extensive list of recommendations. it kind of all comes out of the congressional conversations, quite frankly on gun control after sandy hook. when it became clear that
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congress wasn't going to be able to come together on gun control, they started to look to mental health. they felt the need to do something. and unfortunately, what they kind of seem to be coalescing towards is the sense of well, mental health is a really challenging issue. we don't really understand it very well. let's just make medicaid do more of something, because that tends to be an easy answer. and the idea that was getting some traction is let's create a new entitlement within medicaid. let's create a new provider group that has never existed before. mandate its creation. mandate it as an entitled service. something they were calling federal -- federally qualified
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community or behavioral health centers. something along those lines. not only sort of saying medicaid must create and pay for these, but to dictate in federal statute what that payment would be using the basis of what exists now, federally qualified health centers, which are essentially the only entity in the medicaid program that has the reimbursement rates dictated by federal statute. we just sort of said wait, wait, wait. this is the completely wrong way to go about this problem. first of all, medicaid does more in mental health than anybody else. second of all, this, what you're trying to fix, is not the problem. and what you're doing is actually going to make things worse if you actually move forward with this. so that kind of got us thinking, ok, but we need to be able to say not just no, no, no, but no, but here is something else you could do. so we spent a lot of time with our members thinking through what are the problems? what do we need? and we ended up with a pretty lengthy list that kind of boils
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down to the fact that -- an i'll draw a parallel to long-term care in general in that the issues around behavioral he will, mental health in this country, are very, very deeply rooted, are very, very complex and very, very expensive and people don't want to talk about them like adults. people, policy makers are afraid to have real conversations about how we pay for these things. and so we just kind of do it piecemeal and medicaid ends up picking up the slack for all of it. and that has got to stop. there has got to be a more cohesive federal, national, doesn't necessarily need to be federally funded, but a national conversation around what with are we about mental health. not just sweep it under the rug
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of medicaid. how are the exchange plans going to deal with this? how are we dealing with it elsewhere. at the same time, there is an enormous amount of exciting activity going on at the state level which has made it difficult by confusing contradictory federal policies. we need to find ways to break down some of those barriers and enable some of those promises state practices to really take hold. iowa has really been at the forefront of a lot of behavioral health and acute care integration and a number of other states are seeing this as well. it has got to be a complex, you know, solution that involves housing. this is not just a healthcare issue. the irony is one of the things we have struggled for so long is that there is a pretty clear,
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clear problem with medicaid in that medicaid can't pay for what we call i.n.d.'s. institutes for mental disease. medicaid won't pay for them. that forces states to pay for them with 100% state dollars. that doesn't really -- that was done 40 years ago and maybe it made sense then. it doesn't make sense anymore. and that if you really want to get at concrete ways that you can improve what medicaid does do, let's take a look at some of those things. it is up on our website. it is like 20-something pages of recommendations. so, you know, be careful with it. we think -- we think it is the first step in a broader conversation that i think quite frankly, a lot of people, if not everyone in this room, can have a lot to benefit from and to share in terms of support. so we would like to figure out how are there ways that we can talk about this together to try to figure out what the solutions are.
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>> claudia and michael, do you want to speak to this issue on mental health? and the affordable care act? >> sure. well to, matt's point, in the state of iowa, we spend on average $225,000 per person per year to institutionalize. i was talking with liz before the session and as an accountant looking at our state, what i saw was it costs us $85 per person per year the medicate. $33,000 per year to incarcerate. $225,000 per year to institutionalize.
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it creates some pretty funky incentives for where you want folks reside who might have mental illness. what we have done is the fact of the matter is medicaid exists in the political realm. and so i have politics means that is going to be tough to close down an institution, let's say in toledo, iowa, that employs 114 iowans in a town that frankly isn't that big. what we have instead done is look to managed care. we don't have a lot of managed care in our traditional medicaid population. we have one tanf plan. that is it. but we do have magellan managed care in our i.d. population and they can present creative solutions that don't take us having to work with the legislature and what i like to call when i'm talking to business folks, i have a board of directors of 150, 100 representatives and 50 senators elected from across the state. half of them hate us and every
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one of them think they have a better idea than us. so you have to approach problems creatively and what we found is that magellan that is freedom and flexibility do that and they are very good at incorporating that care and helping provide solutions for the state. that is what matt was referring to. it is something that has been long standing. we have been able to get it right. that is how we approached it. >> so in the district, we no longer have large, long-term psychiatric hospitals. st. elizabeth's hospital was downsized. i was the monitor for the district's mental health system for a period of time so i was very much involved with the downsizing and ultimate closure of the long-term hospital for people with psychiatric illness.
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and the district has over several decades developed a fairly robust system of community-based mental health services. that said, we still have significant problems. when we look at our medicaid population in particular, they are the drivers of a lot of our costs. part of my job is to oversee the business. oversee the data unit, our research team, and we have looked at this from numerous ways. we have found things from our hospital payments. it is always mental health and substance abuse that seem to be the highest cost items. we have looked at this carefully. we have found our frequent fliers. we have identified them. we know who they are. these are people who have serious mental illness and/or
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substance abuse issues. now we no longer have a long- term psychiatric hospital. they are using our hospitals pretty much for housing. anecdotally, we can confirm this. a lot of people are being admitted to psych beds that medicaid pays for, not because they have acute mental illness. there is no or else to -- a lot of people are being admitted to psych beds that have acute mental illness. there is no where else to put them. housing prices are so high. i cannot really address the parity issue in the exchange. i am going to be interested in how new folks coming into private insurance, particularly in the 200% to 400% fpl level and how average insurance is able to help.
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what we have seen in our nco plans and the legacy group is that behavioral health is a significant issue. we have not done a great job in addressing it. there are a number of reforms underway. we are one of the sites for the american psychiatric illustration, and that is allowing us to pay medicaid and that has allowed for better care coordination. we are hoping to see better outcomes from that. we have a health homes planning grant and are moving forward to implement that program. it will be focused on individuals with serious chronic mental illness and substance abuse. we see this population, even with a fairly good care that is out there in the community, these are people who require high touch. they require a higher level of service and a higher level of care coordination that we have been able to ovide at this point.
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we have also recently -- it happened october 1 -- we have integrated our behavioral health and substance abuse operation and they will be working as one. we will see what happens. >> one of the questions most people want to know, some of the exceptions you are asking for. you might want to speak to what those exceptions are. >> they are back to work. we were talking with secretary kathleen sibelius. our plan is different. it is not only having and a ploy an employee benefit plan instead of medicaid. it is bifurcating the population and limiting wraparound because of the plan chosen. it is rethinking how we are
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going to pay providers. we want to pay providers based on quality of outcomes and something called the value index score. that has to start right away. within five years, we will go at risk for the entire population. looking at the fqhc's and how they will be part of the solution and the changing landscape in iowa. what has gotten the most rest and insight from -- most press would be premium contributions for iowans below the poverty level. that has not been instituted in states before. i think i said in my remarks, the premium for folks below the poverty level, we saw them as more predictable and more equitable and something that was even more affordable.
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it was a simple demonstration case of one dollar and two dollar premiums it can easily show you that $10 per month premiums that you know you have to pay -- there can be incentives that you don't have to pay it. it is paid to the state and you don't have to go to a doctor. you can say, i do not have that three dollars. will that doctor turn iowans away? a working iowan may not have the feasibility of making that payment. it is hard to forget how many.
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i am close to see the trees and not the forest anymore we have already enrolled hundreds of iowans. we are going to roll over thousands into our plan. we have our own eligibility site like the district. we have had hundreds of iowans set up. our plan passed with broad bipartisan support. it was specific in some areas. let us try it our way what the governor -- he harkens back to the 1990s during welfare reform. they met with the health and human services secretary it turns out they worked.
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they were adopted on a wider basis states have -- on a wider basis. states have figure out how they fit each state. we are very optimistic. >> i am being told our time is up. i apologize for those of you have questions. i am going to ask each of you to vacate the room so we can set up for lunch. we appreciate your time and your attention. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2013]
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>> that was part of the today conference posted by the group representing health insurance of a secured we will have more tomorrow morning on washington journal. gold on joined by jenny health insurance exchanges. mcmahonalso have steve and brian walsh on political strategies for both parties after the government shutdown. will also hear from devlin
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barrett about how the fbi will deal with the sequestration cuts. senator teding, by cruz and former florida governor jeb bush. defended his actions on abc's "this week." he said he will do anything he can to prevent obamacare. and jeb bush criticized senator the thing there was some ground lost from a political point of view. he thinks these health care law will fail on its own. you can listen to agree -- a rebroadcast of abc's "this week ." that will air again after midnight tonight on c-span radio. if you listen to c-span radio on xm satellite, i want to let you know we have a new channel, xm channel 120. you can also use your computer to listen to c-span radio, streaming live online, and just go to to do
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that. student cam video competition asks -- what is the most important issue congress should consider in toy 14? -- in 2014? allcompetition is open to middle and high school students. the grand prize is $5,000. this time, we have doubled the number of winners in total prizes. entries are due by january 20, 2014. for more information, visit >> now, a look at some of the withs on the un's agenda secretary general jan eliasson. this is a little more than an hour.
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>> good afternoon, everyone. i am the acting vice president director of the foreign-policy program here at brookings. thank you for coming. we have a very privileged discussion this afternoon. what we call the states and form. i can think of no other better title for our guest today, the current deputy secretary-general of the united nations, jan eliasson. on behalf of our president and all of us at brookings, i want to give a big welcome to the deputy secretary-general and also to ambassador tom pickering , a distinguished fellow here at the brookings institution and well-known to many of you. ambassador secretary-general
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eliasson took up this post on the appointment of secretary general moon in july of 2012 . he has a long and established career in diplomacy around the and the u.n. system and for sweden. he served as the ambassador to sweden for the united states and spent time as sweden's word minister. in the early 1990's, he was the first u.n. under-secretary general for humanitarian affairs and was the special envoy of the u.n. secretary-general in darfur. the list goes on and on. many years of experience in africa, sudan, mozambique, the balkans. he is particularly well-known for his work and you monetary affairs,anitarian including prevention of landmines, prevention of
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conflicts, getting people most in need on human rights and increasingly speaking quite a bit about water quality and how important that is to the future of health care around the world. we will take some time to hear from the deputy secretary- general and i will turn to ambassador pickering who served in his last post as the under secretary of state for political affairs at the state department. he is a career ambassador, which is the highest-ranking the foreign service and has served as ambassador on every continent in the world. russia, india, el salvador, just to name a few. he also served as the u.s. representative to the united nations in new york during a particularly critical time during the first gulf war. he has held a number of other positions and we are honored to have him here and he will be able to stay for part of the time and provide some comments
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on the deputy secretary- general's remarks and we will be remarks and we will be a will to have some conversation and open it up for questions and answers. so, with no further ado, the deputy secretary-general. [applause] >> thank you very much. it's great to be here. when i was ambassador in washington in 2002 and 2005 come to be close to the ink tank circuit here was quite a consolation and inspiration and i congratulate you who live in washington that you have this environment in which you can discuss and debate what is sometimes called the washington consensus. it is interesting to be here at this dramatic time for the united states. i hope it turns out ok and i can return to new york.
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i want to tell you i'm extremely honored to have one of my best friends at the podium, tom pickering. i think it is more fitting to be at the statesman forum than for me. you certainly are a legendary figure in american and international diplomacy. i'm very glad you could come. i will start with a story. it takes a precious few minutes away from my remarks and then i will be available for informal discussion. i was noting i had no title. there is no title given for my speech except giving a few ideas about what i would cover. this reminds me of the time i was an exchange student in america a long time ago. i will not say how long ago in front of the ladies. i gave the standard speech there. the swedish student coming to
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the united states, you could come to me at 2:00 in the morning and i would make that speech. i gave 44 speeches in the state of indiana. then i was faced with a completely new situation where i had no inkling what is going to speak about because the following thing happened. i was invited by a wife to a rotary president to a presbyterian women's yearly convention on indianapolis. 400 ladies, white hair, blue hair, shiny, glasses, enormous expectations. khaki pants, sports shirt, 18 years old, prepared with his speech. then the lady who introduced me with a big smile and great expectations as of now, let's
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welcome our swedish exchange student. he will speak to us about the following subject. remember, this is a presbyterian church. how well have we shared our christian joys? [laughter] but i delivered the same speech. a long story about you not having a title. thank you very much. i have some prepared remarks. i want to be a bit precise. i have been in washington two days now to speak about syria and afghanistan. a number of crisis situations in the world. iran is a diplomatic challenge of course. also the post 2015 development agenda. i think i want to cover these
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subjects by this introduction, and then i'm ready to speak about these subjects or any other subjects you want to raise. i would take as a starting point this year's session of the general assembly, which was unusually productive, with implications not only on specific issues, but more broadly on the state of the u.n. in his main speech to the member states, secretary ban ki moon appealed to our leaders to embrace what he called the global logic of our time. another way of framing this that i sometimes used to say is the challenges today in today's globalized world, the task of the united nations is to show good international solutions are in the national interest of the member states. take an issue like migration or climate, and the solution is
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basically a national interest. if we can come to that conclusion, we are home. then we take away the distinction. we may live in an age of what some call a la carte. think g 20, regional arrangements, but this year's u.n. general debate was another reminder of the strength of universality and the strength of global norms. let me go into a bit of detail. i need not explain to this audience the significance of the security council's breakthrough resolution on chemical weapons in syria. this was the first sign of unity after a painful time of division that has prolonged the conflict
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and led to syria's criticism of the u.n. and the security council. we all welcome this step and recognize the difficult task that is now before the u.n., the prohibition of chemical weapons and the international community to safeguard and destroy syria's arsenal of chemical weapons by the middle of next year. quite a mission, but doable. people tend to think of the u.n. sometimes as bureacratic, and i don't completely deny that, but the joint operation had the ground within four days of the council's decision and i'm happy to note it was such a fast and effective work. the chemical weapons teams have also been brave. the mission confirmed that the use of chemical weapons moved through battlefield conditions through their job and at one point was targeted by shots from
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a sniper. they went back to their base and went back again. fortunately, they didn't ask for permission to go. they went back and picked up a new car and did their job. of course, they richly deserve the nobel peace prize that was just announced. not only for its work in syria, but for more than a decade of determined efforts to rid the world of these horrible weapons. i've seen the effect of them during the iran-iraq war. it's one of the worst anxiety experienced to see soldiers come back from the field where iraqis had used these horrible chemical weapons. and you all know about the use of saddam hussein and chemical weapons. it was unthinkable.
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at the same time, action on chemical weapons is just one step on the road to peace in syria. after the killing -- after all of the killing with conventional weapons goes on. we continue to place the appalling figures before the member states. the death toll of more than 100 the refugees of 200 million, out of which will one million are children. one million syrian children are refugees. there are 4.5 million people displaced in syria and we have seriously underfunded the humanitarian aid. about 45% of what we need in terms of disbursement money. and as you know, the entire region is being destabilized. we have great fears for the neighboring countries.
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we need to use the diplomatic momentum now created by the world's response to the use of chemical weapons to push for a diplomatic solution. we also need to work on the humanitarian access. fortunately, the security council agreed on a presidential statement. fortunately, the secy council agreed on a presidential statement. that has to be translated to concrete action on the field. the situation is horrible. there are cities that are completely isolated, where conditions are absolutely horrifying. now with the winter approaching one more time, we have further challenges on the humanitarian front and -- the road ahead will be difficult. there are still those who believe vaguely and military solutions. there are two ways of ending this war. either by negotiating transition as negotiated by kofi annan to create a governing body with
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full executive powers and to transition the agenda items. or there is a belief in possible military solutions. but i would say the so-called military solutions could lead to situations that are worse than the present stage with a wave of revenge against one sectarian group or the other. we hope now very much that the secretary-general and all of us involved can now focus completely with the help of member states on convening the geneva to conference in november. syria was the top concern during the opening session two weeks ago, but there were other important steps on peace and security challenges. i will give you some examples.
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they reported to resume negotiations between israelis and palestinians who were there with chief negotiators. in lebanon, we launched a group to deal with the syrian crisis not only on the refugee needs but the pressures on schools and infrastructure. absolutely important now to have a relationship between the humanitarian and development site. thirdly, transitions in the arab world, arab states came together to support the national biological in yemen and continued toward libya and egypt. miramar, the focus on interfaith dialogue. during the assembly session, we stood back from specific crises and took strength on mediation. many tend to focus on chapter
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seven of the u.n. charter which opens up for the use of horse and is a crucial charter because it provides the muscular capacity sometimes needed. i am convinced there is a highly underutilized position in chapter six of the disputes. i have it here and my favorite article is pacific -- article 33 is christmas eve for a diplomat and a lawyer, i hope. what the party should do before a conflict. they should first of all seek a solution. negotiation, inquiry,
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arbitration, resort to regional arrangements or other peaceful means. this is what diplomacy is all about. we also saw last week, two weeks ago, the great value of the u.n. as a meeting place and bilateral contacts that take place in the margins of the assembly sessions. this year, iran used the u.n. platform ford diplomatic openings to the world, including on the nuclear issue. tom pickering is a specialist in this and we have talked about many years and only just 15 minutes ago. i know there are several interpretations of this effort. i would hope only that the opening is testing seriously. tests and verify. trust and verify.
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trust, test and verify. reducing tensions around miranda is of great little significance. this reminds me of a quote by john f. kennedy -- almost exactly 50 years ago he said it is never too early to try and it is never too late to talk area beyond the political crisis of the moment, the assembly. highlighted some of the x essential challenges we face. several streams work to converge and 2015. remarkable progress has made. global poverty has been cut in half during these past 13 years great two years are remaining.
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aflac is writing a new -- more girls are learning to read and write than ever before. great progress in education generally, at the same time progress is uneven and we need to accelerate efforts where development is lagging. there are more people -- more poor people living in middle income countries -- that says a lot about inequality. but the also need progress into areas -- maternal health, it's a shame so many women are dying in childbirth. we need midwives all over africa. i saw that in darfur and we need to make progress in sanitation. sanitation is behind and water is still, a glass of tap water
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is a luxury for 768 million people in the world. 2.5 billion people die. to .5 billion people do not have sanitation. that's a euphemism for toilets. more than 2000 children die every day out of have diarrhea, dysentery and cholera. we have to do something about it. we have the ongoing goals we have to work with. 2015 is the year which we plan to adopt a plan development agenda. our goal is a set of goals that will mobilize the world. we believe we can eradicate extreme poverty by 2013. 2030 should be our goal. we want to see sustainability
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take hold. you are the first generation that has to think about the existence and health of this planet. you may have planned be in your life that you are no planet b. sustainability has to be combined with public education. then we want to add a stronger focus on institutions, power, the rule of rights and human law. such an agenda would be daunting but inspiring. i hope the members will move this direction in next two years and present this set of new goals and targets. it's also the year in which member states pledged to reach
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agreements on climate change. the secretary -- the secretary general will convene a climate summit. the centrality of the u.n. today is encouraging, but the secretary and iran recognize the responsibility this confers upon us. we have to learn from our failing and shortcomings and we have them. syria represents a collective failure to stop the destruction. we expect to see -- noted a systemic failure on the different parts of the u.n.. member states did not meet the tasks they himself had set and we did not adapt properly. a broader u.n. practice had been focused on development. we work hard to draw the right lessons from this experience that we are focusing not only on sri lanka but beyond. internally, one main lesson is to ensure the main system has
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human rights resources in place whenever they are needed. this is important, i say to those people who want to work with them, prevention. if you look back at crises, that the first vibrations, that the beginning. maybe even ethnic lensing and genocide. a third aspect as we must have the courage to act and speak out about what we see. i continue to lead this process on behalf of the secretary-general. we will be reaching out to members soon because this is a collective responsibility and there is an important task for us all to do. in conclusion, it is not a
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banality i hope to say that we are at a crucial juncture, at a crossroads. we see big trends with eight implications, migration, urbanization, population growth, the emergence of the global south. we are making headway against poverty even as inequality grows. the 21st-century progress to finally be the century of women's empowerment despite the of remaining cultural gap, we see the world growing more collect his, but there is strong inward looking tendencies. technology is making tremendous advances against hunger, disease and the wasteful use of energy and it empowers organized crime and it raises the specter are of cyber attacks.
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there is an upside and downside to everything trade people in the world are looking to the u.n. for big decisions and big changes, expectations and hopes are high. the united nations provides immense lu, paris -- feeding 90 million people, assisting dozens of countries for years with electoins and keeping peace with these keepers. the services we provide, standard telecommunication provides art of the backbone of the global economy and global corporations. i hope the american people and taxpayers should feel proud of their contributions to this work, not their shared values, but our shared work every day and again come to the conclusion that international cooperation is basically a national interest. our fates are more connected than ever. our future must be one of ever greater cooperation. we need to determine who can continue to work together.
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look at the united nations not just in terms of where we hope to be but in terms of national interest. engagement at the u.n. is not something you do for someone out there, but rather for yourselves and your children. a friend of mine, rich gardner am paradoxically, i love my country, that's why i am an internationalist. the secretary and i are determined to make the most of the current moment. from the very beginning of the arab awakening, he spoke out and called the leaders of the old order to listen to those, not just the young seeking change, realizing this is a long and arduous journey. as a child, he experienced the devastation of war in korea. i know these values guide his work and -- in this time of global turmoil. in closing, the secretary- general succeeded in luring me back to the organization and his side after time away on the
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organization. like my wife and others know, i'm in the did to the united nations. it is a drug in my veins and i and q for your attention and i look forward to the more informal part starting now. [applause] >> thank you, my old friend. you reminded me today that we probably have known each other for a longer time than most of you have lived who are present here in this room. it is a special pleasure and honor to be asked to say a few words about this speech. how well you have shared with us your internationalist joys today.
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i share them with you because each of us having served together at the united nations at a particularly interesting time have come to understand the capabilities, strengths, and some of the foibles and problems of the only organization we have to bring 193 countries together around the world, to pursue peace and security. thank you for your remarks, particularly for three point -- i would like to begin with one that may not be at the top of everyone's agenda, but in my view ought to be. diplomacy counts, diplomacy is important, and diplomacy can make a difference. i grew up in cold war days, when we were deeply concerned about a catastrophic nuclear conflict and diplomacy was our main weapon to deal with the consequences of inadvertent miscalculation, accidents and
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cussedness in terms of a potential for a nuclear conflict. it was successful. i remain somewhat distraught as someone whose career has been heavily in diplomacy that for the last 10 years, in two major areas, we have attempted to find a way to short-circuit the poet see with rapid military solutions and indeed have found disastrous answers. it is time to come back to diplomacy, but i was also chagrined by the notion that when a year ago i began to speak of the necessity for a political answer in syria, everyone thought i was certifiably local. the fact we have created among ourselves with this reoccupation with military solutions a distrust and disparagement of diplomacy as an effect it means of maintaining international security is a serious one and
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hang you for bringing us back to that reality which i think is important. we now see in a serious way that reality being used to address two very difficult problem's, which again you have recalled for us in a very important way. one is syria. the breakthrough in syria opens the door, and i say only opens the door to us abilities because we must be realistic about the difficulties of what must be achieved. but the fact that within hours, a seemingly throwaway proposal by the american secretary of state was accepted by the russians, who, incidentally, had on hand in moscow the foreign minister of syria, who immediately marched at the drum of future diplomacy rather than the war drum is an interesting indication that this is
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something people have been thinking about for some time, even if they didn't reveal it at the time or subsequently. it also brought oceans of skepticism about whether this is working or would work and this has been pointed out by the weights you have made by which the degree to which in fact the inspectors arrived on the scene and the process has begun and an almost impossible deadline seems less impossible now than it did ring weeks ago, and that is important. it also opens the door to other things. it opens the door to the possibility that the u.s. and russia can cooperate not only in destroying chemical weapons in syria, but in moving back to
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geneva, to the kofi annan principles and to a process that can undertake what is clearly in my view impossible on the field of battle. there is no military victory around the corner or with in the years ahead. those who two years ago thought it would be three months have been proven wrong and my sense is the destruction of 100,000 people should he enough on itself to take us to the conference table, whether we in fact believe that can't happen or not. my own sense is it's extremely important that preconditions to negotiations should no longer vex the problem. it is in my view very important that the parties should agree that nothing is agreed until everything is agreed, a perfectly fine diplomatic principle, but one that works against progress in this case should be dropped. but i also think it is imperative we move as i think the deputy secretary-general has suggested toward a cease-fire.
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all of the things necessary to protect the syrian population against what are clearly the arbitrary vicissitudes of a civil war. beyond that, the challenge will be a new government for syria. the parties all agree that will have to happen one time or another. my sense is the diplomatic challenge of negotiating a new challenge for syria is a necessary and tough one and will be made easier if a cease-fire can be achieved. there, i see a huge role for the united nations, not just in monitoring a cease-fire, but hopefully finding a way for pre--- for peacekeepers to protect the minorities, a la lights, druze, christians, kurds, who will be under
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pressure as a result of the conflict which will not go away even if a cease-fire can be achieved. that is a huge and very difficult challenge, but in my view, closer today than it was a month ago and we have to find a way to move from that. the second thing you mentioned was iran. a meeting took lace yesterday. it was not a millennial come to solution meeting, but it was certainly a meeting that in my view has moved things beyond where they had been stuck for many decades. my hope is it will be the beginning of change. iran will be challenged to be specific about what it is putting on the table with respect to the limitations which is willing to expect and the inspections and allow the kind of transparency that can assure those who have been skeptical about around's nuclear program,
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that it is not leading to weapons but is devoted to peaceful purposes. we will be challenged on our side not only to accept the notion that as they make serious moves ahead, and i believe they have started, we will have to undertake serious moves on sanctions to create a sense of mutual confidence and restore the trust that has been lacking for 33 years to move that assess ahead. it won't be solved easily, it won't be solved in a summer, it won't be solved before the endgame is reached in whatever form that will take, but i think it is clear that iran will have to have a peaceful program, well monitored, and sanctions will have to go away as this particular process proceeds. we will be challenged to deal with what has been the remnant
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of past negotiations, whether in fact there has to be a time of zero enrichment in iran for a full agreement. i believe we are well past that date, but many people are still mesmerized by it. that challenge will continue to come. in the center of all of this will be the united nations. almost everything you touched on involves the most serious problem's before today's world. the challenges of 2015 and indeed all of the issues out there that will once again require us to come together with 193 other countries to deal with them wherever that might be. so thank you for coming down either by lane or train, thank you for being with us, and thank you even more for your words and inspiration or it i know firsthand by working with you over the years, for your
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dedication and refusal to quit in times of adversity, many of which you have had to face. [applause] >> let me thank tom again for joining us in making those comments. i think he hit on so many of the keep points in bringing it back to the u.n. role in some of the most important crises and challenges facing us right now. i appreciate his comments and i want to be a little provocative and come back to some of the points you made before we open it up to you all. one thing you touched on which was very important, but since we are in washington, we are compelled to ask you about the role of the united states in the world right now. there is an increasing debate about where we are headed in terms of the way the world is
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changing and the leadership we can offer to the rest of the world. traditionally and for many of us during the cold war and after, it was assumed the u.s. would be up on a pedestal in some ways and sometimes we put ourselves up on that pedestal in some helpful and unhelpful ways area i'm thinking about what's happening in washington and the crisis we are facing in our own governance. president obama has played a mixed role in how he is asserting u.s. leadership great we talk about the importance of diplomacy, but the way it played out in syria, there is an element of coercive diplomacy and i would like to comment about the use of force in getting states to act and did that make a difference in moving the parties along on the syrian
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front? more generally, i would like to say more about what you're reading is of the u.s. role. we have rising powers that are wanting a bigger voice. you did not touch about the question for the member states, but i would like you to talk about the shifting tempest in the world and the role of the united states. >> thank you. a president of the u.n. foundation -- i hope i am not premature in saying that the latest polls there is growing support of the united nations as an organization. it is possible the syria development have played a role in this regard.
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of course, i wanted to say i spent -- i was not only an exchange student to this nation. i was an ambassador to this nation for five years. i have been working to the united states for so long. the commitment of the united states to the united nations is absolutely crucial for the health of our organization. therefore, i made the point strongly -- maybe i overdid it i claim the work we do is in the national interest of every country, also the larger countries. the larger countries do not have to worry so much because they have enough power to create their own solutions, political and economic and in other areas. but i would say that also the larger countries should, by the logic of the goal of these global corporations, realize it is in the national interest.
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some of it is impossible to think of, like climate and migration. i would hope this will bemore and more the realized. the united states, like the other members of the security council, realize what a tremendous responsibility, and the gift they have been given by the world by having the veto power in the security council. i hope that that veto power would be used at a minimum, and that in fact, the security council more and more will become a body where you negotiate, where it is a duty to come up with a solution. i would hope the security council would take the work more in the direction of prevention. the security council needs to act on threats for international peace and security. what is a threat? it is before anything has
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happened. usually we are like a fireman who gets in there when the house is on fire, not when the smoke develops. it should be accountable prevention that could clearly revitalize the security council. it is an unsolved issue. and i was president of the general assembly, it was the most difficult reform item to get, and the determination to say this is a reflection on the work of 1945, particularly some of the major emerging powers playing an enormous import role. the use of force -- i am a great friend of [indiscernible] i showed you the charter. i'm saying [indiscernible] the best way of using force is the credible threat use of force. the best case is when that comes from a united security council. it is more problematic if it comes only from one or two in
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the security council, but then you would have an action not of the security council. i would certainly say to show the security council can be unified on the show of force that would have a positive effect on the willingness of the parties to agree to solutions according to the charter. >> building on the same thing, and we covered a lot of ground on syria, and i'm glad we did because it is such a pressing concern, but there is a concept wrapped up in what we are seeing in syria that has been a very important sign of progress. as you talked about the marriage of national and international interests, the responsibility to protect, adopted by all member states -- in 2005, used for the intervention in libya, that has been very controversial and it is for her to say the syrian
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people are the victim of that circumstance -- is the r2p doctrine. how do you see a role in that playing forward, and it looks like some government is not protecting its own people, and the international community is called on to intervene? >> i am very proud to have been president of the general assembly when that formula was gaveled on the 16th of september 2005. it is a great to forward. in a wider context, i would put it in the context of the preeminent part of that declaration, where it says -- i paraphrase -- there is no peace without development. there is no development without peace. there's no lasting peace or sustainable development without respect to human rights and the rule of law.
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in other words, for an international assistance to work and even a nation to work, you have to have least developed with respect to human rights and the law. if you have serious violations of human rights, you have by definition instability and lack of prosperity. so that is a basis. here is a tension in this urbanization. we had a principle of sovereignty, but we have in everything the principle of solidarity with people in need. the paradox is sometimes international law puts us in a position where solidarity has to stop at the border and not as human beings in need. when intervention came up as a concept in the early 1990's, people said no, intervention means infringement of sovereignty, you're interfering in our affairs, as will be a political trojan horse by the western powers.
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when we say to the few -- we have to -- [indiscernible] >> here comes a stroke of genius. someone said if sovereignty is so important, wouldn't that imply you have an obligation to make sure your own population is not subject to ethnic cleansing and genocide and mass killing? the answer is yes, of course, sovereignty is that important. if you accept that then you have to answer the second question -- what happens if you as a state fails and do not guarantee your population that security? that it is found in this document that the international community is responsible. it is difficult to follow the sequence of the second paragraph. on a collective basis, and in the end it is the security
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council decision. it comes back to the security council. we have established a principle that states are responsible for the safety of the population. syria him a constant reminder that we should have applied it better, and in two years i came to the conclusion that the concept is -- [indiscernible] there were only one or two nations of skeptical in talking about it. we have to place an emphasis on prevention, the rational elements, and of course read the words among members states that they have the primary responsibility to prevent atrocities. >> can i come back to the reform of the security council? do you have any thoughts on that issue? >> you're really making this difficult. [laughter]
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the veto right is written into the charter. abolishing the veto -- i've come to the conclusion that is probably an unrealistic opposition. the other road is to reduce the use of the veto. and i would say that there have been several proposals, some nations, small nations, the s5, came up with a proposal that every time the veto is cast it should be reported what the reasons are given to the general assembly as a sign of the very exclusive situation where a veto is cast. as a negotiator, i am more using the council as a negotiating body where they have this privilege of having the veto as a last resort.
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they should initiate. i jokingly said when i was president of the general assembly to the p5, it should work like the catholic church when they select popes. you know, the white smoke comes up of from the sistine chapel? then there is a resolution, and the papa is elected. we had unfortunately for too long cold war impulses that the vetoes were automatic. they cannot be changed. now i think we have a situation where it is growing between the united states and russia that there is more comfort in finding a negotiating solution. >> if you step back and look at how money is being spent in the u.n. system -- it is one of the three main pillars at the u.n., but it only gets about 3% of the u.n.'s budget. i am wondering -- we have had some dramatic reform in getting to the human rights council.
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the council has proven to be more active than the commission. a number of independent experts who are deployed on the ground, exactly as you said, in the earning warning facilities -- should we have any hope that the member states should put more money behind the human rights color of the united nations? >> i was mentioning the work from the sri lanka tragedy in 2009, and i think there are three conclusions. we will have to improve and strengthen the human rights pillar of the united nations. we need also to be that are at protecting civilians once we fail to listen to the early warning signatures on human rights. then we have human rights violations during a time when
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the syrians are severely affect. then we need to work more speedily. in sri lanka, we needed to have more of a development team, and we did not have the flexibility to change our presence. i think we are moving in that direction, and i hope we will see human rights as a universal obligation. the whole declaration of december 1948 is the universal declaration of human rights, and we have to be very, very careful to make sure that the human rights complex is universally excepted. we have to accept more than we do, particularly in western countries, that the economic and social rights are also part of the human rights body. it is important to create that
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universality around the culture. r2p, i'm so glad we have so many countries that are behind this in latin america to make sure that human rights become universal. the most interesting new factor that i would like to mention is there is a concept that is revitalized which is the rule of law. the rule of law is post-conflict institutions. it is anti-corruption for development. it is women's, children's rights, human rights, and that rule of law is a door that can open up to human rights. when i talked about the post -- 2015 agenda -- institution building. the reason why people -- countries fail all is there are no institutions. look at afghanistan, somalia, and now some signs in libya, with the same characters. no institutions are holding up. institutions play an enormously
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important role. i can talk about my own country. sweden was one of europe's poorest countries years ago. we build up a strong infrastructure, a strong education system, and strong institutions. these were the three factors that built our country -- institution building, rule of law, and by that, a rights perspective is so important, and that qualitative development is very crucial. >> why don't we open the floor five or so minutes, take a couple questions. then we will come back to the city secretary general. gentleman in the middle by the aisle? >> thank you. university of wisconsin. i wonder if the mission statements we have seen in kenya about a possible withdrawal from
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the icc might signal perhaps an unraveling of some global organizations, or do you think that is just a political statement? >> of the front row here? >> thanks very much. garrett mitchell, and i want to ask the deputy secretary-general a question that comes from one of your opening remarks about the global logic of our time. and expand a bit on a question that ted asked you about the security council itself, wondering if we could broaden that out and try this --
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in 1945 the global logic of our time led us to create three institutions that have played an important role in global relations. now there is a new global logic of our time, as you are you and ban ki-moon described it. can you give us a sense of specificity about what the elements of the global logic of our time are. given that it has already led the imf to make some institutional changes and that dr. kim is afoot at the world bank to do the same, i wonder if it calls on the u.n. to do something along those lines? >> thanks, and i saw one hand in the back. >> thank you very much. migration policy institute, and i was pleased to hear you mention migration because almost no one else does.
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i wonder if you could share with us what you think the u.n. in particular has to offer on that subject? in the last two weeks we have seen people die, but is the u.n. an institution that can help with us? >> thank you very much. please. >> well, there is a situation now which is causing concern for the s.c. and myself, and that is several african nations are reacting to the fact that africa and african leaders are the objects of the icc. what we should remember is that four of the eight cases where africans are involved are
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brought to the icc by african states themselves and two of them by the security council. but the matter has become more dramatic after the fact that the two people who were going to -- became president and vice president of kenya. there has been many discussions about whether we could find pragmatic takeaways of hearing them in their own countries or in the neighboring countries. these formulas did not work out, and there was a reaction from the side of kenya, but from other members in africa, that sitting heads of state should not be prosecuted or should -- there should be deferral as long as they were sitting heads of state. this was problematic, because 27
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of those do not make that decision. there was a solution adopted last week along these lines. we have suggested to our african friends to bring up this issue with the assembly of parties meeting in november to go through whether there could be changes made to their own statute, and be brought through in a more regular way. i do not note what extent that we done. it is not a mass walkout, but we are chiefly concerned that this discussion takes place because fighting impunity or accountability for the kind of crimes that this court has to
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work with has to be accepted by all member states. it is now a challenge for all of us. they have put up a lot of time and effort on all of us. [indiscernible] i think we have reached a stage now where we have never had closer cooperation between the united nations and the world bank, particularly. san francisco and bretton woods are coming together in a great way, and the model, no peace without a moment, no moment without peace, is translated into an ambitious agenda, and the new president of the world bank is working hand in hand with us, and we with them, on a number of issues. kim visited the great lakes region in africa recently. they are on their way to sahel. we're working on issues like rule of law and in a new way which has given us, from the humanitarian side, a link to the
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development side. there has to be connection between the humanitarian relief and development. you see that in the neighboring countries and syria. you have to help them with crowded schools, crowded health facilities, job fairs, and we work now along these lines in a completely new way. my view is that the global logic of our time -- i could spend an hour on this -- got to do this together, that when you look at the enormity of the task, you realize the united nations cannot do it alone, the world bank cannot do it alone, you need to put the problem at the center, of migration? this is today's global problem.
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it turns out you need to have not only peace and security, development of human rights and human law, you need to reach out, and maybe sometimes the expectations are too high on the u.n. to solve problems. the u.n. is the lead on a number of issue, but the u.n. is in some cases could be a catalyst or even be a part of doing the job, because we will not be able to fight -- reached the goal of eradicating poverty if we do not have the help not only at bretton woods, not only ever regional relations at the european union, the private sector, with training and innovation. we need a civil society, men of youth and a background, and they
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play an enormously important role on actors of the world scene, and the scientific community. scientific research in general, and each and every one of you. i have a line that i use that i believe in very strong, nobody can do everything, everybody can do something. we have to realize that because i sense that in several parts of the world a hopelessness that's a situation is so difficult, the enormity of tasks is so high that you turn off the television and say i want to stop the world and get off. you have to define the problems she departs. you have to -- that is my take on the global logic of our time. >> on migration and then -- >> there are a couple of issues that i have been asking for a long time we should be doing
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more. migration has been one. it is a huge issue. the remittances from migrants is bigger than the whole official system in the world. migrants, human rights, huge issue. the political explosive nature of that issue in many countries, where you divide humanity and people between us and them is set at this.
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the tragedy of the situation of the huge inequalities is demonstrated by those as absolutely horrible, people drowning a mile off the shore. we went down to the general assembly and i suggested a moment of silence, at the least we can do, but there has to be action taken. if we do not take in the migration to mention in the post-2015 development, we do a major mistake. i hope that member states will note in that issue because we cannot disconnect from that from the 2015 work. same thing goes for other issues that are growing. we need to focus on the more, like the urbanization, which is the potential and a promise. sanitation is mostly now in the big cities. 60% of humanity live in big
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cities. that is where you have problems of sanitation, no infrastructure, poor people will begin to poor countries' big cities. we had a cholera outbreak in sierra leone. one issue which i think is completely disregarded is the role of organized crime, related to drugs, illicit arms transfer, prostitution, trafficking -- and a horrible and growing problem, added to the security openings for organized crime. >> funny you mention it. yesterday on this platform we have a forum on organized crime and political finance. we just published a new book on the subject as it relates to this issue and its impact on democracy in latin america. i cannot agree more. one of the comments was this his new research that needs to be done and we would like to do here. i want to come up from the bottom of my heart, thank you for your comments because i found them to be not only thoughtful, but also inspiring. when we talk about the global logic of our time, i think we have to think about in terms of leadership am and what we heard
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today was a global leader for our time. please join me in thanking jan. [applause] >> thank you very much. i was inspired by tom piccone when he said i had proved that diplomacy counts, and i was visiting a professor before i was drafted into this job, and i was challenged by my professor, my colleague, who is known to this institution, as a great researcher. he said, can you list the reasons you fail or succeed in negotiation or mediation or diplomacy? we need to be more systematic about how we succeed. he forced me to think over the whole weekend about my failures and my successes.
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[laughter] i have negotiated in six different crises, lots of humanitarian situations that required negotiation. i came to four conclusions why you fail or succeed. the first one is how you use your language, the word. if you look at your own life, your most important tool is your word, your spoken word or your written word. it is your most important tool that you have, and how much do we take care of that tool, how much do we work with the nuances, how much do we find synonyms, how much can we turn around sentences so you can make it meet the problem better? a journalist's life, a lawyer's life. the love of words and the care for words. very strong statement, and one of his markings where he says that to misuse a word is
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poisoning the wells. the second reason to fail or succeed is a simple thing, but extremely important in negotiation and mediation, and that is timing. i have been so in situations where you have done things too early. you need to think carefully about timing. the geniuses are children when it comes to timing. have you ever had a child ask for raise or an allowance on monday morning on your way to work? friday night with a glass of wine? [laughter] third reason to fail or succeed is cultural sensitivity.
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the importance of respecting culture, history, tradition is absolutely crucial to create the right atmosphere. i am not speaking in a manipulative way, but through curiousity, an interest and openness in recognizing the quality of people. and the last recent and the most important i would say after a long life is personal relations. your own personality. the most important word in diplomacy and negotiation and mediation is trust. be absolutely exact in your recording, to create a personal relationship is absolutely crucial. classou meet a university and create networks, remember that those you relate -- that -- wehose relationships
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have been in contact from all different parts of the world and have always tried to find each other and find our colleagues. we were bad -- we were ambassadors at the end of the cold war. we are still a group of friends and have our addresses in the inside pockets. >> thank you, brilliant. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2013] in related news, it was reported at the head of the arab league is saying there will be a geneva conference aimed at ending syria's civil war. that will occur on november 23,
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and 24th. later today, at 6 p.m. eastern, you can watch chris van hollen on newsmakers. she is the top democrat on the budget committee and one of the conferees assigned to working on a budget proposal now that the government shutdown has ended. here is a brief look at the interview. hope that within the scope of these conversations we are able to move the ball forward. the negotiators will have to decide what the scope is, how much do we want to try to bite off and chew as part of this negotiation? that will probably be one of the early decisions we try to reach. hope thatews is we our republican colleagues have learned the right lesson from the debacle we just went through, unnecessary pain imposed on the country for 16 days. it did not have to be that way.
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we are hoping that our colleagues will have to put down the clubs and recognize that these negotiations should be between the two budgets and no one should try to gain advantage again by threatening to shut down the government or defaulting on our debt. if we can put down those clubs and have a serious conversation, maybe we can advance the ball a little bit. >> patty murray, democrat, said yesterday that you're going to look for common ground. >> common ground is different than a compromise. one of the areas where there might be some common ground is to try to get rid of some of -- some or all of these across-the- board cuts that are hitting the pentagon and every domestic agency. at is probably what we are looking at, and if so what are democrats willing to look -- willing to give up? >> any part of any conversation would be to replace what is called sequester.
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there are these deep and immediate across-the-board cuts and important investments, like transportation, education and science and research. and the congressional budget office recently said, if you keep those lower, depending levels in place by this time next year, you will have 800,000 fewer jobs in the united states of america. so that is a self-inflicted wound that we don't think the country can afford and so we want to replace those sequester cuts with an equal cut -- with an equal amount of deficit recession -- deficit reduction. >> again, that interview with commerce mendenhall and 6 p.m. eastern on c-span's newsmakers. mccrory signed new voter id laws.


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