Skip to main content

tv   U.S. House of Representatives Legislative Business  CSPAN  January 27, 2016 12:30pm-2:31pm EST

12:30 pm
the next panel and final panel. chief nick willard is chief of police, manchester, new hampshire. the largest city in that state. he's made attacking the opioid epidemic a hallmark of his tenure as chief. prior to being named chief last year, he served in various capacities in that department since 1992. prior to that, chief willard served in the u.s. air force as a security policeman. he has a degree in criminal justice from the new hampshire technical institute and is also a graduate of the f.b.i. national academy. the second witness we've heard senator portman speak of two or three times, tonda dare. after losing her daughter, holly, to a heroin overdose in 2014, she founded holly's song of hope, a nonprofit group
12:31 pm
dedicated to providing community support and education for those struggling with addiction. since that time, she has also been an outspoken community leader seeking solutions to this epidemic. ms. dare has traveled here today from her hometown, carrollton, ohio. our final witness, linda hurley, ms. hurley is chief operating officer and director of clinical services at codac, a nonprofit behavioral health and addiction treatment provider. she's been working in substance abuse, treatment and behavioral health care for more than 20 years and has been at codac since 1993. she received her b.a. from newman college and a masters degree in human development from salja regina university.
12:32 pm
in the case of ms. hurley, we heard ack i will mations from senator -- acclamations from senator whitehouse. i'll start with chief willard. chief willard: thank you, senator grassley. and members -- distinguished members of the panel. before i begin my remarks today, i just -- because i'm going to be talking about something that's really kind of consuming the state of new hampshire and with the eyes of the first primary upon us, i think it's important for me to note the city of manchester is a vibrant, exciting city with engaged, compassionate citizenry. they have an incredible strength and a connectivity that i'm proud to serve in that community. moreover, i think it's also important for the messaging to me the state of new hampshire is still an incredible, beautiful state with mountains, rivers, lakes, the ocean.
12:33 pm
so i don't want to give the impression that the state of new hampshire is, you know, falling into the abyss. yes, we are dealing with the throes of human tragedies every day but it's still a wonderful state and, please, come by and spend your dollars and tourism is still alive and well. but thank you for the invitation, senator, to appear before the committee today. it is an honor to be able to share with you what my officers are dealing with on a daily basis. with the prescription and opioid, heroin issues. in addition to the ever-increasing role of fentanyl in the fatal overdoses has been alarming. i want to also thank senators whitehouse, portman, ayotte, klobuchar for their leadership on the comprehensive addiction and recovery act. i fully support it. what law enforcement is -- what law enforcement needs is a comprehensive and sustained approach to help prevention efforts. improve treatment, support the individuals in recovery and
12:34 pm
adequate resources for state and local law enforcement who are on the front lines of this public safety crisis every day. the bill represents a huge step in the right direction and i hope the committee will pass this legislation. it's very much akin to some of the work we've done locally with the continuum of care in the city of manchester when i partnered with the fire chief and the health director and we worked on a lot of the same initiatives that i see in that bill. so i would encourage that you pass it. i think it's exceptional legislation. in 2013, the city of manchester had -- i don't want to get to fentanyl but that's what killing our citizens. in 2013, the city of manchester had 14 overdoses. 30% of those overdoses were heroin. 7% of those overdoses were heroin mixed with fentanyl. in 2014, we specioused 19 fatal overdoses -- we experienced 19 fatal overdoses, 22 were heroin -- 22 mixed with heroin
12:35 pm
fentanyl and then fentanyl alone. then we go into 2015 where we see an exceptional uptick in fentanyl overdoses. in 2015 we suffered in the city of manchester 69 fatal overdoses with a staggering 33% being straight fentanyl. 26% being fentanyl mixed with cocaine and another 9% being fentanyl mixed with heroin. so in 2013, heroin was what was killing our citizens. in 2015, it's fentanyl. our citizens are dying because of the synthetic fentanyl labs that are being produced in mexico. the poison the cartel is putting on the streets is an affront to our way of life. not only is it taking lives, it's deteriorating communities, leaving children without parents. we have case after case where toddlers, 10-year-olds are finding their parents dead from
12:36 pm
a drug overdose. and i have to say to have an american actor go and celebrate and romanticize with the very drug cartel kingpin that's poisoning our citizens and killing them is disturbing. senator ayotte noted in her stop the stop trafficking in fentanyl act which would bring parody to trafficking heroin and much more deadly fentanyl. i encourage the committee to pass that bill which would enhance law enforcement officers and prosecute those who are trafficking in it. recently, we just passed a bill to strengthen sentences for drug dealers who manufacture and dispense fentanyl on the streets of new hampshire. when i took over as chief, i expressed that i had two priorities -- to deal with the heroin and now fentanyl issue and support and boost the morale among the rank of officers within the manchester police department, given how tacked they are with the calls
12:37 pm
day in and day out and the negativity i'm seeing in the media about law enforcement. well, those two priorities are effectively irrelated at this point. officers are going out there every day trying to save lives and trying to make this community safe in spite of the national discord. today, far too often fentanyl and heroin are at the direct or indirect cause of any one public safety health issue in the city of manchester. when you look at the numbers of how taxed our officers have been, in 2013 officers responded to 166 overdose calls to service. in 2014, they went to 406 overdose calls. in 2015, manchester police officers responded to 616 overdose calls in the city of manchester. 69 fatalities. countless, hundreds have been saved through the administration of narcan. each one of these numbers, folks, represents a person, a human being, and from that person that it represents, you
12:38 pm
have the peripheral victims -- the families, the loved ones, the co-workers, the people that are even being victimized by the people that love them most. i don't need to tell everybody this. we heard what you and senator leahy, your opening statements told me and filled me with a sense of pride that you understand it. i didn't believe anybody did, to be frank with you, but to hear the opening statement by you and senator leahy, i was encouraged that we are on the right track, to hear the q&a from each one of you senators tell me we are on the right trang trakh. i'm going to leave her -- on the right track. i am going to leave here embolden. when i have two senators from the state of new hampshire, like ayotte and shaheen, how passionate they are to protect the lives in the state of new hampshire, i live in the best state in the union. sorry. i have a tendency to go off the rails, by the way. i will stick with my statement.
12:39 pm
the assistant chief wanted to make sure i stayed good. after testifying, what we did in manchester is partnered with the federal government and local law enforcement and we created a strike force that's going to go after the cartels that are american actors want to romanticize but we want to go after the head of the snake through the task force and that's partnering with local and federal agencies, working collaboratively with a prosecutor to go after them. but additionally, and i know some questions were asked, we're going to go after the dirty doctors because the doctors are playing in a role. it's unfortunate that senator sessions is not here because i'd love to answer his question about the new england journal of medicine. i'd answer it directly. i think it's nonsense. i don't know what their methodology was but i think it's absolute nonsense. when the new hampshire, maine and vermont are the top three states in prescription of the top five pain medications, and those same -- per capita and those same three states are in
12:40 pm
the top five of heroin abuse, i don't know what methodology they used but it's certainly not common sense. so after previously testifying, we did that. i've also locally i've invited vermont and the state police to work collaboratively to have a force multiplier to go after the quality of life drug dealers. in all your communities, the person that's inside the third floor apartment pumping heroin out of their apartment, they're bringing in undesirables, they're bringing in prostitution. they're people that are breaking into your cars en route to the drug house. i want to shut them down. at this point we take d.e.a., state police and manchester police department to make a buy. we arrest a person. we get a warrant. we go in the house. what we don't do is do these elongated investigations in which we don't -- we allow them to continue to work in the neighborhood. so we've done six of these operations. we arrested 62 drug dealers.
12:41 pm
we seized 604 grams of heroin and a large quantity of other drugs. just recently, our drug unit seized over 500 grams of pure fentanyl. now, every one of those grams, every gram of that fentanyl is a potential overdose is a potential fatality. before that from just one investigation, working in collaboration with d.e.a. and our local partners, in one investigation we seized over 27,000 grams of heroin and fentanyl. 15 kilos of that was pure fentanyl. that was in 2015. ll -- in all of 2013, the most manchester police department found in all was 1,300 grams. i mean, that is a stock increase -- stark increase. so the pool needs to shrink because we need to lessen the demand. it is with greater interdiction efforts. i say our border is a sive.
12:42 pm
drugs are coming across that border in droves. yes, the d.e.a. is doing a phenomenal job. like you said, senator, they've taken twice the amount of drugs off the streets since 2010 but there is more out there. if we can take 27 grams of heroin off the street and the next night we go out and we buy another 33 fingers, which is 10 grams per finger of heroin, that tells me we're not even putting a finger on a dike. so we must do more and we must do it now. at the same time we must recognize this problem for what it is -- a public safety issue. it certainly has been said before, we can't arrest our way out of crime. treatment and support for recovery are critical to our work in law enforcement. last summer, the city of manchester, through the leadership of the mayor, launched a comprehensive plan to confront this epidemic. it's very much like cara. one part of the plan was to develop a continuum of care by
12:43 pm
mapping all community assets devoted to drug addiction, allowing someone struggling with addiction to enter the system at any point during the continuum. we are also making great strides, and i'm almost done -- we are also making great care in our 24-hour our continuum facility. i think eventually this will be the manchester model and what this is, it's the great folks, the hope for new hampshire. it's going for a 24-hour facility that's going to house medical, counseling, recovery coaches. it's going to have beds for transitional families. it's going to be in one location. and what is that going to allow me to do? it's going to allow me to my department to have a more compassionate alternative to an arrest. so i can actually bring some of these folks directly to the facility. they will actually drive out to the location of a police officer and give them a ride to the facility in lieu of an arrest. so i think that is going to be the model. you don't need to come to the
12:44 pm
manchester police department to give us your drugs and get treatment. we're going to have a car come out and get you and bring you directly to a facility and you bypass law enforcement altogether. and finally, i will continue to be aggressive to fight and rid the city of manchester of drugs while supporting the recovery and treatment community with everything that i have. this is not just a law enforcement issue. it's a community issue. and as a community, we will prevail through tireless action. thank you, sir. senator grassley: your commercial for new hampshire, first in the nation primary, i heard all those nice adjectives. they all apply to iowa. [laughter] chief willard: indeed they do, sir. senator grassley: ms. dare. ms. dare: i just want to say thank you so very much for giving me -- senator grassley: is your microphone on? ms. dare: yes.
12:45 pm
thank you for giving me the opportunity to share my story here today. am not certified, educated diplomas and everything else. i know a lot of stats like everybody else does. and i'm not going to go off of my statement. [laughter] but i will keep this short. i want to fill in a few blanks from what i heard today. there's been some great information put out here. every day i speak with and deal active ple who are in addiction, people in recovery and families of those in recovery. and a few different things that i've seen that maybe didn't get covered here that i feel is
12:46 pm
mportant to keep in mind are the cost -- it's been said many times that heroin is cheap. but believe it or not, i believe a lot of especially parents don't understand how cheap. and i think that's very important for them to know. parents don't realize that when you give your kids $20 to go to the movies on a friday night you could have easily bought heroin for them with that $20. and i think that's really important to get out there. another thing that i know because i live in a very small community. my county is under 30,000. carol county, ohio. i live in carrollton.
12:47 pm
we have a small town. we don't even have a wal-mart, no hospital. a lot of our law enforcement went to school with my girls. my oldest, miranda, is 26, has already done four years in the vy and now has her bachelors in business. and one of the things that i see happening in our little , you hat frustrates me is were saying disconnect. our officers have worked so diligently to arrest people that they know are bringing this in, just have them go in front of our judges and our judges just slap these people on the wrist and send them right back out the door. and i can't tell you how often i get these boys that i
12:48 pm
consider sons because i've watched them grow up. people say, oh, they're terrible. they're not doing anything at all, and give them such a bad rap and that frustrates me because i watch them. they're busting their butts, but what do you expect them to do when they keep arresting the same people and sending them in front of these judges for the judges to turn around and put them right back on the street? the boys that sold my daughter the heroin that killed her just recently went back in front of a judge for his fourth offense for trafficking heroin. fourth time he's been arrested for this. and he was given five months. how's that possible? that's so frustrating. it frustrates me, of course, but i can't even imagine what
12:49 pm
our law enforcement deals with in that situation. you know, these are things that have to be dealt with. and then lastly, what do i now? know that when you find your 1-year-old on the floor blue with bruises already on her forehead and her nose from slamming into the sink because she'd died so fast, that that sticks with you for the rest of your life. that when you do c.p.r., praying for someone to show up and your ur child
12:50 pm
arms are burning because you've done it for so long waiting on help and you want to quit but you can't quit. it's your child. that's your baby. you can't stop. the sound of my air going into her lungs, that crackling and popping that i still hear in my ghtmares, we have to put a face to this. we have to help these kids. when they say i want to quit, i need help, we can't say to them, i'm sorry. give us two, three weeks and get back to us. this legislation, cara, gives . a little hope
12:51 pm
please, please do something to help our children. thank you. senator grassley: thank you, ms. dare. thank you very much. thank you. s. hurley. -- thank much of you so much. much of what i have included in the testimony -- senator grassley: could you pull the microphone in front of you? ms. hurley: is that better? senator grassley: yes. ms. hurry: i have been in the treatment field for over 26 years, and my -- i was asked to participate today to provide the perspective of kind of like what it's like when the rubber hits the road. what do the problems look like, what do the challenges look like. so i'm going to quickly skim
12:52 pm
through the statistics that everyone has heard over and over, astounding as they are, and get to the complexity of the disease and what is needed. completely to the system tm you have. it has resulted in 125 people in this country. in 2004. it continues to grow. since 2002, rates of heroin addiction have doubled and heroin related deaths have nearly quadrupled in the united states. the rate of opioid main medication prescription has increased dramatically. new vulnerable populations are emerging. parts of our country are faced with limited or no resources to assist those needing care. midwest states, our northeast. infectious disease such as hiv-aids is begin on the rise and hep c numbers have increased an alarming rate.
12:53 pm
this chronic relaptsing diseases the brain, is costing taxpayer dollars, costing lives and causing society to lose the creativity the individual contributions that each lost life represents. it's replacing those contributions with fear and grief. the pain, stress are the result of lost lives have permeated our communities and become a part of the problem. my understanding and daily 26-year experience in the treatment of this disease and its related tragedies is the reason i am honored to have been invited to participate in the conversation today. from the treatment perspective, i've been asked to speak on the issues of the prevalence that supports the need for prevention and treatment, what populations are being most affected by this disease, what are the treatment needs of those individuals and families and what challenges do we face in meeting those needs, in five minutes. the growing number of those with opioid use disorder,
12:54 pm
called dependence or addiction, reflect new trends on those becoming addicted to opioids. it's critical when we are trying to assist the people who are coming to us for care. the traditional bell curve of an opioid dependent individual coming to treatment has historically reflected an age of 39 to 42. 30% female, 70% male. much more urban than rural. lower education and health care support. there has been a conspicuous shift in these demographics between 2004 and 2014. i believe senator durbin referenced the c.d.c. mortality rates for white middle-aged population. there is also mortality rates that are changing in the mortality rates for young white adults. these numbers correspond to increases in emergency room visits, recorded treatment, episodes and police data all reflective of opioid use. what we're seeing is an increase in opioid dependence in younger and white populations, rural populations and female populations. emerging or growing vulnerable
12:55 pm
populations are -- women, young adults, adolescence, middle-aged adults, returning vets, those receiving multiple co-prescriptions, people receiving care for chronic pain, including the elderly, and those in the criminal justice system. i don't believe it leaves a lot of us out there that aren't impacted by this. the disease no longer follows gender, race, age or socioeconomic boundaries. the challenge of treating multiple populations is in providing care that is individualized, effective and evidence-based for each of the populations. cognitive and emotional development, stage of reproductive life, multiple forms of trauma, the individual's readiness for change, the strengths, resiliencies and the recovery support is some of the clinical variables that need to be addressed in providing successful treatment. over 50% of those who come to treatment come with at least one other mental health or psychiatric condition as well as multiple physical
12:56 pm
conditions. most commonly forms of depression, anxiety and other manifestations of trauma. this is a highly complex biological, psychological, social and spiritual disease. to be prepared to address the complexity with confidence, treatment providers, physicians licensed independent prackstigsers need knowledge of treatment options, compassionate and understanding of the addiction. opioid dependence has been the most effective research and evidence-based treatment for this disease. the farm could helogical practice of using methadone has helped people from regang their lives over opioid depend ens for over 50 years. it works by replacing the -- excuse me -- the heroin or prescribed opioids on the receptor sites on the areas of the brain affected by those
12:57 pm
opioids. science has shown us over and over again that replacement therapy works with behavioral health counseling. the current dosage of medication -- the correct dosage of medication allows an individual to not feel extreme pain of withdrawal but also does not provide the euphoria or highs associated with misuse and dependence. this in turn provides the individual the opportunity to heal physically, emotionally and spiritually. i'll jump ahead here. medication assisted therapy can preserve life and allow an individual to work on their recovery. sustain long-term recovery ideally includes health, home, community and a purpose. medication addresses none of these but allows an individual to work on all of these. a partial replacement therapy developed to address opioid dependence. effectivesly, particularly in populations naive. those that haven't used as long or much where the brain change has not been as severe or as
12:58 pm
permanent. the assessment process to determine which medication is indicated requires a deep understanding of the disease. research and now evidence-based, it is not heavily regulated and it is attainable like any other medication through a primary care physician's office. this can dramatically increase accessibility. however, at the same time these less stringent regulations do not require the same level of expertise. physicians are only required an eight-hour training to prescribe this. this speaks to the need, that you've spoken to, some attention to this in the medical schools and nursing areas. it is another challenge to confront this epidemic arises, clearly we need more accessible, effective treatment but there's no magic wand to providing only medication will not be successful for the majority of patients receiving m.a.t. we need more prescribing physicians and practitioners
12:59 pm
knowledgeable in this addiction. another medication that's been deponaltrax is overbings and it blocks the drug's euphoric effects. that medication works really well in populations that show a high amount of motivation because you have to be motivated to take it, to not have the euphoria. therefore, if you're experiencing cravings, it doesn't work for you. complicating matters, there continues to be a social vail of moral judgment stigmatizing this disease. those who come for care and even those who provide care. the stigma can be seen in the regulation of methadone treatment and those environments in which it's provided. the regulation appears to reflect the stigma attached to the population for whom it was created. the harsh laws incarcerating individuals for symptoms of the disease versus assisting them in rehabilitation and recovery still are -- in prisons and destroy lives. i'll just jump ahead here as
1:00 pm
well. this practice, which resulted the u.s. of having the highest incarceration rate in the world, is ineffective of reducing relapse and reincarceration. this is a so reflected in critical issue when we are talking about someone coming to the door saying i need care. often unattainable or difficulty obtaining authorization creates a significant barrier for treatment and these are for folks who have the benefit of affordable care act and insurance. families and individuals do not have the resources to advocate for themselves and loved ones. treatment providers do not have the staff hours and low reimbursement rates paralyze the provider and the complexity of
1:01 pm
the benefit utilization paralyzes the consumer. in addition, i will skip -- in addition to this challenge of stigma, we see challengeses to meeting the needs of the growing population. inadequate treatment capacity and inadequate provider competency. really can't say that enough. we are not developing our work force quickly enough and we are not paying them enough to stay. if we can hold our systems accountable to the best practice standards, reimburse at a realistic rate, we can reverse the societal crisis. i was asked to speak to prevention which i will will speak briefly here because much of what is here is what was stated in terms of physician education and the surge of prescriptions. one piece that hasn't been stated and is deadly is that
1:02 pm
concurrently with the surge in opioid prescription mid casion, there has been sedatives. in 2014 and 2015 in rhode receiving open oid prescriptions were also prescribed another medication which is a deadly combination. this statistics show nationally. we need to look at the co-prescription of ben zodiazopine. family education is needed, continuesed public health.
1:03 pm
treatment within a recovery-oriented system of care individualized for the patient that is easily accessible can prevent the progression of disease and overdose. and i'm quoting here from the rhode island governor's prevention and intervention task force. this is an epidemic exposing the the need for public health and safety. reaching into the medical, pharmacy and recovery communities and in partnership with civil society. this for me is one of the most exciting parts of the bill itself is that there is a piece there that mandates interagency collaboration and i believe the interagency collaboration is going to be able to start to
1:04 pm
remove some of the silos created by funding streams. huge reason that we have the silos that we do and that's going to create the foundation for the answer to this. and i know i represent a task force and those of us in rhode island providing treatment support. senator grassley: three questions one for each of you. dareoing to start with ms. and thanks for sharing your tragedy with us and i know it isn't easy and i thought we ought to give you an opportunity to talk about holly's song of hope and how the community provides support with those struggling with did he dick shon.
1:05 pm
and get oof the couch in the morning and not lay there and cry all day. i realized that what was lacking when i was going through everything after losing holly as family support. there's tons and tons of programs out there for those who are caught in the depths of this disease and fighting it, but the family support is greatly lacking. and the little bit that i did find that i was going to get charged for and i thought that as ridiculous.
1:06 pm
we started holly song of hope on facebook for friends and family to have memories -- to post memories about holly and maybe what things were going on with this heroin epidemic and things like that. mehow under a year's time, i nded up with 1,000 members and very active members. is realize, yeah, this something that we need. members from australia and
1:07 pm
scottland and ireland as well as across the united states. we started posting questions every couple of days that have to deal with addiction and in some form or another so people are constantly learning as well as getting support. and i had so many people saying you really need to take this outside of facebook. so i started talking to members and they started sending me, i want, i want, i want and currently working with just under 50 different facilitateors in states all across the united states looking to start their own chapters. i started actual meetings in carroll county. they run every other week at this point.
1:08 pm
e cover co-dependency or enabling. those two go hand in hand. i cover a street drug of some sort, make sure that people who come to the meetings see what it really looks like and what signs they need to pay attention to and how much it costs, so on and so forth. i firmly believe education is what's going to change every single piece of this puzzle. we educate the doctors, we need to educate the families, stigma. education is the only thing that is going to change that stigma. i can't tell you how often every single day -- i'm sure there is going to be a story on this and if you look in the comments you are going to see people say to
1:09 pm
me if you had done your job as a rent and your child wouldn't be dead. in the fifth grade, my daughter was going to a sleepover one weekend and came to me and said, mom, one of the girls got a joint for that sleepover and i'm scared to death. i don't want to blame anybody else -- absolutely, don't worry, you're not going. and i will give you a good excuse, something came up, that we didn't expect. i would have never went to my mother and said something like that. i don't know how many people in here would have went to their mother and openly said something like that. we talked our girls all the
1:10 pm
time. there was no taboo issues. we discussed very honestly and open with them. i thought i had done good and you know all those parent markers that you were a good parent, got them both through school, no trouble with the law, no pregnancies, no drugs. they both graduated. they were very popular in school for different reasons, but loved by all of their classmates. my oldest went into the navy and now a veteran. and boom, i have a child lying dead on the floor. senator grassley: thank you for that. .enator franken senator: thank you for sharing your experience and your
1:11 pm
for what nd your hope you're doing. ms. hurley on the treatment side . you talked about a number of things, work force, need to train providers. my understanding is that -- 21% of the people who need treatment get it. -- senator durbin domenici act he which is mental health parity and addiction act. you talked about having problems with parity and reimbursement
1:12 pm
of -- low reimbursement rate insurance companies on this. an you talk about this area, about what we need to do to meet the needs that we have of people o need treatment and what we should be doing and where we're not -- what barriers there are to meeting this need. ms. hurley: i think everyone has spoken on what's needed of the medical community i think at this point and that's the training and to increase capacity and one of the methods by which to increase capacity is for someone please hear that the
1:13 pm
independently licensed practitioners be allowed to prescribe medication for opioid dependence. increased capacity with training which would correlate to competency. because i can't say it often enough how complex this disease. t's not just biology biological, psychological. i can use the operational side. reimbursement rates have historically been lower than other mental health rates for substance abuse. and that continues. you can look at any of formulation of reimbursement rates for either commegs or medicaid. medicare is an area in which we desperately need. senator: how is it determined.
1:14 pm
how are the reimbursement rates determined? if someone goes into the hospital for cancer treatment, ey get reimbursed and no one is saying it's their fault they have cancer. what seems to be going on? is the he -- what justification and as the c.o.o., what's going on on the other side in the insurance industry and in terms of the federal government and state governments on this reimbursement? ms. hurley: we can start with medicaid and each state is different. and i believe the medicaid rates have been historically lower than other commercial insurance provider rates.
1:15 pm
and what ends up happening particularly in the behavioral health side is we very often have a very high percentage of those who are medicaid eligible. therefore a treatment facility is going to have anyone from 60% to 90% of the folks who are coming to us for care reimbursed at a medicaid rate. the medicaid rates are not negotiable but shoed by health and human services in each state. we choose to do the best with those and stay committed to our commission. on the commercial side there are negotiations that go on over and over. we don't have a lot in those negotiations. i have been part of this for 20 some years. we don't. that's the real issue and the results -- senator: i know i'm running out of time --
1:16 pm
ms. hurley: i'm sorry i missed your question. senator: you are speaking to the question. medicaid reimburses lower than some private and other areas, too. but is there a particular disparity between the actual costs and the reimbursement in ecovery, in the rehab? ms. hurley: yes. senator: that's what i wanted to know. i think that's interesting and -- ms. hurley: thank you. senator grassley: chief. senator: like senator grassley, a lot of the adjectives you used use hampshire i would
1:17 pm
about north carolina. and you pointed out it is a thriving state and community that is not unique to new hampshire. senator tillis: one question i have for you as a chief, what sorts of obstacles are either the federal government in this case -- i won't speak to state issues, what things have you seen as a matter of policy that taking this u or fight to law enforcement. chief: the relationships we have are robust. recent rned about the decision in forfeiture. and i read some articles about some law enforcement agencies that have maybe abused the practice of it. but there should be oversight as
1:18 pm
opposed to shutting it down and having this conversation that it's not being used properly. what does drug forfeiture look like for the forfeiture mean. . use the money to fund i pay a building and monthly leases, all the equipment that they use, surveillance equipment, cameras, any of the specialized they need, cowvert mics, all that stuff costs money and i take it out of the drug forfeiture money. i'm using his money to do drug investigations. there is a push in the state of new hampshire to take that money and put it into the general fund. t is unfathomable.
1:19 pm
this is a pandemic. what would it look like if d.o.j. doesn't open this money. i hope the splate stays the same. and if the state of new hampshire does the same thing. manchester police department has can do sions, i have to so much or i can go to the city of government and they are extremely cooperative and supportive of the manchester police department and then say i need these line items that you are now going to have to pass onto the taxpayer. instead of using the drug dealer's ill-gotten gains, it will shift to the consumer. t is bad policy. senator tillis: it's a matter of
1:20 pm
balance but i think there is a clear nexus between the source of that money. and preventing the kinds of cases that ms. dare continues to deal with. ms. hurley i had a question. you mentioned variations among states and with colleagues and any professional affiliations that you may be a part of, are there any states that seem to be a best practice and going about providing care back in their communities? ms. hurley: i'm most familiar with the new england area. i think that each state has a strength. vermont, what they refer to as the hub and spoke model to
1:21 pm
access rural areas and part of the new england school of addiction studies and i have worked with some of those physicians and in rhode island, the governor's task force on opioid overdose prevention has ought together -- it is an interagency, department of health, behavioral health, hospitals, a.g.'s office. 17 people are on the committee and they have had done strategies looking at dollars communely. that may be a very, very model. and we have been looking at every single thing that has been noted here today. senator tillis: i want to thank all the witnesses and thank senator ayotte for demonstrating her interest in this important
1:22 pm
matter. this will conclude the meeting. the record will remain open for one week to provide additional information potentially and respond to any questions to members who were not here. thank you all very much. god bless you. [captions copyright national cable satellite corp. 2016] [captioning performed by national captioning institute]
1:23 pm
1:24 pm
1:25 pm
>> democrat presidential candidate bernie sanders met
1:26 pm
rivately with president obama. colyeen nelson tweeted out saying he and obama discussed issues and occasionally a little bit of politics. and emerging from the white house said he has had productive and constructive meetings with president obama. brief news conference after that meeting. senator sanders: good morning. the president and i had what i thought was a very productive and constructive meeting talking about a number of issues. before i get into anything else, let me remind the american people something that unfortunately republican presidential candidates forget is that seven years ago when president bush left office, this country was hemorrhaging 800,000 jobs a month. we were running a $1.4 trillion
1:27 pm
deficit, large efforts in our country's history and by the way sometimes we forget the world's financial system was on the verge of collapse. so it is absolutely sad to say and i say it every day we have to do a lot better to protect the middle class and working families and also important to remember how far we have come in the last seven years under the leadership of president obama and vice president biden. the president and i discussed this morning a number of issues, foreign policy issues, domestic issues, occasionally, a little bit of politics. but i enjoyed the meeting and i thought it was positive and constructive meeting. we are right now as everybody knows in a very tough campaign in iowa and then we're going to
1:28 pm
new hampshire. i think what the iowa campaign ends up being about is one word and that is turnout. we are feeling really good about where we are and if there is a large voter turnout -- i'm not saying we could do what barack obama did in 2008, i wish we could. but if there is a large turnout, great. then we go to new hampshire and fight as hard as we can for a week in new hampshire and thinking we have a pretty good chance there and then going to nevada and south carolina. by the way, i think we will do a lot, lot better in those states than people think we are and then we head off to super tuesday. we were just in minnesota yesterday and phenomenal turnout in st. paul, 15,000 people. 6,000 people in duluth and
1:29 pm
feeling pretty good. the american people are working people, young people, want to see real movement in this country and we are tapping into that energy and i think we stand a very good chance to do well in iowa and forward. >> did you ask for the president's endorsement? senator sanders: of course not. what vice president has tried to do is to be as evenhanded as they can be. and there was some discussion the other day that he was tipping the scales, i don't believe that at all. i believe he and the vice president have tried to be fair and even handed in the process and i expect him to continue to be that way. [indiscernible] senator sanders: look i think everybody knows that for the before en years, well
1:30 pm
that, barack obama when he was united states senator was kind enough to come to vermont and campaign for me and i have never forgotten that. in 2008, i did my best to see that he would be elected president and campaigned hard for him as i did in 2012. there is no secret as is the case of a democratic society, we have differences of opinion. i was on the floor of the senate in 8 1/2 hours and disagreed over taxes and t.p.p. by and large, i have stood by his side where he has taken on unprecedented republican obstructionism, and has tried to do the right thing. >> your campaign going to go negative against hillary clinton?
1:31 pm
senator sanders: it was just a discussion to just get myself updated on some of the current issues facing this country, how we most effectively deal with isis, his assessment about iran and how we work with iran and our relationship with iran. that's what it was about. >> anybody else in the meeting? senator sanders: no. do you think hillary clinton has overplayed her presence in the white house? p sand -- senator sanders: the american people will make that decision. we did talk about this, as you all know, i voted against the war in iraq and that's a major point of distance between secretary clinton and myself. we both received the same information and came to a
1:32 pm
different conclusion. and as i mentioned to the president, i in my small state of vermont went to too many funerals of wonderful young people and in the last few years i have not gone to funerals of young men or women. what the president is trying to do is the right thing and what he is trying to do is keep our young men and women in the military out of a perpetual war in the quagmire of the middle east. what i will try to do is put together a coalition of the major powers with the muslim people on the ground, the muslim nations, muslim nations. if king abdullah recently reminded us, this is a war for the soul of islam against people -- and their senator barrasso:ity and has
1:33 pm
hijacked their and it must be the muslim people to destroy isis with the support of the major powers in the country and that's what the president is trying to do. e have to get going. [captions copyright national cable satellite corp. 2016] [captioning performed by national captioning institute] >> and more live road to the white house coverage now. this is jeff's pizza shop in ames, iowa where former governor mike huckabee. many of the candidates are meeting with voters ahead of monday's caucuses. we understand that mr. huckabee is running a little bit late. we will have live coverage here on c-span.
1:34 pm
a couple of other programming elements to pass on to you. texas senator ted cruz will be in des moines, iowa with governor perry. and that will be live right here beginning at 7:00 p.m. eastern and vermont senator sanders will be in mason city for a town hall meeting. you can see that campaign event live at 8:00 p.m. eastern. carly feern will be talking to voters. half an hour west of des moines.
1:35 pm
>> hello everybody i'm a friend of mike huckabee. this is an exciting time. first off, i had some folks being asked to view god not dead in a private showing on thursday. -- sunday evening. .com/u go to mikehuckabee god not dead. join myself and other folks to
1:36 pm
watch it on sunday night. >> where? >> jordan creek parkway. take a little road trip and see a free movie. i have learned if there weren't problems there wouldn't be great opportunities for great men to shine. i met mike huckabee when i was lieutenant governor and i went out visited his state, a dynamic individual and saw what they had done for a blue state, a guy who never worked across party lines when i got elected in the legislature. i got to see what it was like in the majority and in the senate, i saw what it was like in the minority. and i respected to find common ground. people who run for office say they are going to be hard nosed. they won't be an effective leader or person to make things happen.
1:37 pm
and mike huckabee is what i think shows great leadership. he was able to pass things and get things done. and what i have seen in the last few years in washington is not what i want to see the future of our country go. there are many, many opportunities to do better. and i want to feed on what is going on lately. they want to see positive things not only in this country, but the way we project ourselves around the world and see no opportunities. we have young people that are missing school right now because they wanted to come and hear the governor speak. they have priorities and want to know where the country is going. this is an opportunity and able to show the rest of the opportunity. i hope you'll join me in
1:38 pm
supporting mike huckabee and look deeply at his candidacy and what he has done in the past. promises are easy. track record is something you have to live with. and he has a fabulous track record. as we move forward, i ask you to not only going out monday night and caucusing you have the opportunity to affect so many others. there will be able that will never meet mike huckabee. if you tell them about your experience based on your judgment and personal relationships with them, they will vote for that person. so there are thousands upon thousands of votes sitting in this room right now if you utilize that friendship, relationship, relative, family member, co-worker, all of those can make a huge difference. i hope you get engaged in the process and this is the opportunity to change where our country goes.
1:39 pm
a man walks into a doctor's office and he was bitten by a dog. doctor runs a few tests and he has rabies and he makes out a list and the doctor sees him making his list out and the doctor says sir, you realize with modern medicine you are not going to die from rabies and said you do not have to make out a will. he said i'm making a list of the people i plan on biting. you can choose to make a difference. mike huckabee -- number one news show on the weebds in new york, great money, great lifestyle. i was a guest one time on his show. he chose to griff that up to try to make america better. i appreciate the fact that you would engage in the process. it's exciting for me.
1:40 pm
i took off nine days from work and i said use me. i thought i would be putting up signs or licking envelopes or mailing stuff, instead they put me in front of a crowd. i tell people i got out of politics for health reasons, the voters got sick of me. i appreciate the fact. young people you coming out. i got invited as a small child and my parents would take me around and said we want you to formulate your own opinions but expose you to the different candidates and different policy and visions. never did i think in my wildest deems i would meet a president or candidate for president or a governor. and so as citizens of iowa, you have the unique opportunity much like we do in south carolina. you get to see all of them. it's really unique experience
1:41 pm
for small rural states that both of us share. i don't know how far out the governor is. hey told me he is coming in. oh, is he? i heard one of the folks from the news media saying most of the time politicians will only answer expected questions. throw governor huckabee a curable. he's not scared of them. i have been with him on the stump. and i have seen him answer any question. throw out the toughest question. see where he stands. his answers have not changed since 2008 or every different part of the state we have been to. and we have been all over the state. you get to see the depth of an individual when you can throw
1:42 pm
him something different. i have a great relationship with win rockefeller and governor huckabee and see how effective someone can be. when you look at the legislature and it was about 85% democrat majority in arkansas, to get things done in those conditions is extremely difficult and so it speaks volumes for the fact -- there were over 100 tax cuts, they improved roads, education, quality of life and improved the actual annual income over those years. look who is here. [applause] looks like everybody is done about eating. everybody wants to eat off of clean plates but not a whole lot
1:43 pm
of people want to do the dishes. dishes require work. that is a man who is willing to work for the people. i'm excited about his candidacy. i hope you will be, too. [applause] >> my friend and people of iowa's friend, governor mike huckabee. mr. huckabee: thank you, and ray. this is packed in and i don't know if you can see but we had a big surprise as i walked in, i found out my three-year-old granddaughter is here. scarlet, can you wave at everybody. there you go. you are all dismissed. i'm going to go play with my granddaughter. we were told she was going to get to come and my daughter said no. she has not had a fever. she's fine. she just did that to disappoint
1:44 pm
us and then today bless us tremendously by having her show up. my day just got a lot better. are you going to eat that? i'm kidding. i promise i'm kidding. if it stays there the rest of the time, it's going to be gone, i'm telling you now. it looks really good. i keep looking around on everybody's plate and when we finish here, i'll dismiss all of you. let me say thanks for crowding into jeff's pizza place in ames. we are a few days away from the caucuses. i'm grateful to have friends from around the country who have come to show their support. the former lieutenant governor of south carolina. a great friend and public servant and spent his career as lieutenant governor primarily working on policies for seniors and he was very committed and dedicated to the task.
1:45 pm
a true public servant. later, you will meet the secretary of state from alabama who has also come. we have brought all these southern boys up here and introduced them to what what snow really looks like. we have been living with it in january and december and i don't know how you get used to it. when i would hear on television, people in the north would say some person had a heart attack shoveling snow. and i thought really, shoveling snow. why would you shovel snow? and i always thought those crazy yankees are shoveling snow. don't they know it will melt tomorrow. in the south we never got it and then it would melt. people out there shoveling snow, why would they do that. up here, it doesn't go away.
1:46 pm
>> just like your deficit. mr. huckabee: it never goes away and keeps piling and higher and at the end of the obama term it will be $20 trillion. just a few days away from the iowa caucuses, i want to encourage you. if you are going to caucus for me and if you do, i hope you will fill out this form and say i commit to caucus with mike. and if you are going to do that, take a friend or relative, someone from work, a neighbor and make sure they go with you to caucus for me. don't let anything keep you away. i don't care how bad the weather is, if it is snow or colder, whatever it is, go and caucus for me. if, however, you are thinking about caucusing for one of those
1:47 pm
other 320 people running on the republican ticket, i would encourage you to stay home that night, because it's cold out there and the snow is going to be falling and could be dangerous and treacherous. watch it on television, do not risk getting out in that terrible weather. we are doing 150 events in january here in iowa. we are doing that because i don't believe there is a shortcut to winning the iowa caucus. if there is, it will change forever the future of the caucus, but it's not iowa that loses if that happens. america loses. and here's why. i think the worst thing that has happened in the process of of tics is that a handful billionaires now control virtually every campaign and ultimately control the agenda of congress in washington. and three magic words that i can tell you that will help you get
1:48 pm
through the complexities of politics. i urge you to member rise these three words, follow the money. follow the money. if you wonder why things don't change many. why republicans and democrats are in power. things roll all along the same. borrowing money, taking care of the special interests, having no clue whatsoever that people in the heartland in america are experiencing. i met a man last week came to my event. he and his wife make $59 a year. guess what -- $59,000. guess what their health insurance is going to cost them in 2016? how much? >> $20,000. >> $15,000.
1:49 pm
>> $30,000. mr. huckabee: sounds like an auction. $28,000. you split the difference here. there is no prize. you get to pay that guy's insurance. $59,000 a year. he is spending half of his income. no children at home. no special pre-existing conditions or diseases. how can he afford that? this is what our country is coming to. i meet people every day in iowa who used to have a good job at maytag and newton and those jobs got shipped to mexico and never found a replacement job. we lost too many manufacturing jobs. 60,000 plants like the maytag plant have closed. i'm telling you now when people
1:50 pm
are fully financed by the folks on wall street and the billionaires and the goldman sachs. i don't care what they make. no matter what they say in their speeches, i guarantee you when they get to office, they will carry out the same policies that have cost a lot of americans their jobs, fortunes and retirements and those of you on social security, we may have to cut your benefits and raise the age you have to work without even understanding they don't understand what social security is. it is not an entitlement, it is not welfare, but an earned benefit that you paid for when you worked. and every time you got a paycheck, somebody took something out of your paycheck. you are nodding your heads.
1:51 pm
and i can remember some of my paychecks. i would have enjoyed keeping it, but they took it away. they said don't worry, we are taking this money from your paycheck so you can put it aside so when you retire, you can have your social security. it's not the government's money, it's yours. and when people are oblivious to that and say maybe people should work until their 72, that's great for a person who has sat at a desk for his or her career. i know a lot of people who have stood on concrete floors their entire working floors and you ask them to stand another six or seven years on those concrete floors you have given them a death sentence or pretty much put them in a wheelchair. and people making these kind of comments have no idea what people are having to do to make
1:52 pm
ends meet in america. i'm convinced of one thing, the people of iowa will make up their own minds as to who is going to win next monday night. every day i have to listen to the talking heads, the people on the east coast sitting in well-lit studios and they know who is going to be first, second, third. they have it all figured it out. and one thing they have forgotten, nobody in iowa has even voted yet. not one person. you will go and vote next week. and you will decide and every four years and every four years there's a big surprise in the iowa caucus. i'm trusting you to help provide a big surprise next monday night when you go to caucus for me. caucus for n't go
1:53 pm
me. where will you be? >> at home. mr. huckabee: we are making great progress. this is already a very productive day. i also -- i want to tell you about this little sticker for your car. take one of these and put it on your car. it will let your friends know how smart you are. but the second reason is we are getting reports when people put these stickers on their car, hey are getting gas mileage. i cannot guarantee you will get those results but try it for a week and see whether or not that works. i'm going to take some questions from you in a moment. i want a friend of mine to comment and just visit with you. i have folks from alabama and south carolina and arizona. friends from arkansas, dave and
1:54 pm
debbie. david was a legislator when i was governor. he was one of 15 republicans in a house of 100 people. he understands what it was like for me to govern in a state that democrat point 90% and he knows what i did to fight the clinton political machine and to do it repeatedly to keep winning and witness to the fact that not only did i challenge the political machine of the clintons, but i'm standing here as living proof that i live to tell about it. and that may be very significant of all. so if you want someone who can challenge hillary clinton in the election, i hear some of the republicans say, i can't wait to take on hillary. that's because you have never done it. but i have one other special friend i want to introduce to you.
1:55 pm
you have seen him on the television show "home improvement" and "santa clause" and he is a great friend, you'll get the accent that he probably from new york. maybe that will come through loud and clear. some of his friends as he will tell you. but i'm so delighted. great friend and traveling here in iowa going around with us and campaigning with us and i wanted him to come because sometimes in campaigns we take things so eriously, we forget to laugh a little bit and we need laughter in our lives. i said i'm mike huckabee running for president. and they said, yeah, we were just laughing about that a moment ago. to give you some real good fun and i'll take some of your
1:56 pm
questions and talk about the sues of iowa, jim, would you come up here. [applause] mr. huckabee: and be nice to these people. >> this is italian. this smells good. i'm italian. no offense, i have been sitting here for five minutes because italian people if we don't eat 11 minutes, it's all over. can i have a bite? thank you very much. what? you don't take a lunch break. that's good. i thought that was mine. can somebody order me a diet
1:57 pm
coke? any "home improvement" fans? i'm tim allen. i put on a few pounds. i'm on a new diet. this is where you hide people like me in the witness protection program. how do you hire a guy like me on the farm? yeah, what do i do? i'm a farmer. i bury things. thank you, sir. can you around. i come from one of those new york city that we had a lot of crime but no one heard or saw anything. and no matter how you got killed, it was an always heart attack.
1:58 pm
what is going on here. the guy grabbed his chest and fell on it 17 times. i'm up here and you're writing. geez, don't stare at my pizza. this is good. do you work for the f.b.i. you know what f.b.i. stands for? forever bothering italians. thank you, sweetheart. can you sit with this guy. no matter where we're fun. we all have something in common. you know what that is? stupidity. we all do the same stupid things. why is it when you are driving your car and looking for an address, you have to turn the
1:59 pm
radio down? does it make you see better. honey, we are lost, turn the radio down. there it is. you ever drive in your car and the needle is on e. you get real quiet. don't look at the gauge. and turn the radio down, i don't want to get lost. this smells bad. aste this. what the hell are you writing? you could have wrote the independence. look at the small writing. anybody read chinese? you are a good sport. give me a diet coke. before i leave folks. i have to tell you this is jeff's pizza -- what are you frayed of jeff -- afraid of
2:00 pm
jeff? what happened to the chef here last week. he is in the back with the other chef. i'm kind of getting nervous. i'm here because i was on his show three years ago and in 2008, i didn't know who he was and even me and my wife. and getting to know the governor the last few years what i know about him. i'm honored to be here because this guy, the other people, what you get what you see is maybe not what you are going to get.
2:01 pm
and one of those guys is from my neighborhood because i could have mel whacked. what you see is what you get. he is real and believes in his faith. he is a christian. hard to believe, right? jesus said let's count those votes again. . i'm honored to be here. this man is the real deal. this is the real america. everybody thinks it's new york and l.a., no, this is where it's at right here. this is the hope we've got.
2:02 pm
i say this sincerely from my heart, from god, to me, to you guys, my personal belief,s the reagan of our era right here. this is the reagan we need right now. please, just support him, i'm honored to be your friend, i love him he, brought me a turkey roaster, i'm going to do the fivers, you put the turkey in the grease, watch cnn i'm probably going to be blowing up. make sure you vote for him, i'm going to follow each and every one of you to the polls. we don't want any heart attacks. god bless you guys, god bless our next president, mike huckkey. [applause] -- mike huckabee. [applause] mike: jim will buy you an entire pizza to replace the slice the just devour. i'm so grateful to have friends
2:03 pm
with traveled at their own expense to be here. talk to your friends, explain how important it is that iowa makes a decision not based on the money but on the message and the future of our country. but i've got to ask, why am i running? i did walk away from what was a pretty decent life after, gee, almost 20-something plus years of hardball, tough politics in a state where republicans never got elect and i was on the -- only the fourth one to be elected in 150 years and the first in 25 year the only one at the capital -- capitol, the one who when -- who when he got to his office, had it nailed shut for 59 days before i could get in had to deal with the most lopsided legislature in all the country, more than massachusetts, or maine or vermont or new jersey. then after the 2008 election, ended up doing a television show, getting back to my first job, which was in radio, doing a
2:04 pm
radio commentary. why would i do this? quite frankly, you saw 20% of the reason just a moment ago when you saw my little granddaughter. because i have five grandkids. she's one of the five. and i'm doing it because i worry about the country we're about to hand to them. you see, i was so blessed to live in this nation but even more blessed to have parents and grandparents who made incredible sacrifices so that the country they gave to me was better than the one they grew up in. my parents group in the depression. i feel like sometimes i did because they told me so much about it, i honestly thought i'd lived through it as well. some of you know that feeling from having parents who told you about it. but i want you to understand, i did not grow up wealthy. i did not grow up well-connect mismed mother grew up, oldest of seven children in a house that didn't have a floor, just dirt. no electricity, no running water. my father never graduated high school. his father didn't and his father
2:05 pm
before him didn't. no male upstream from me had ever graduated from high school. i'm the first male in my lineage to do it. much less go to college. when i was a kid my dad used to say, son, don't look very far up the family tree. there's some stuff up there you don't need to see. of course i had to welcome and found out the old man was right, there was some stuff up there i didn't need to see. but my parents and grandparents gai me a much better america and a much better opportunity in life than they had had. but what we're about to turn over to the people of my children and more importantly my grarne's era, is -- is a country so deep into debt that most of their pablings will go to pay interest on the debt. a country that if they can afford to go to college, they'll have to take out huge loans and they never be able to pay them back. a country that's ship sod many jobs to mexico, to china, to indonesia and elsewhere. that they may never enjoy the
2:06 pm
level of opportunity and an optimistic view of having employment options that many of us have had. and i'm going to tell you something, i feel like i owe something to my parents and grandparents for the sacrifices they made. and i feel like i owe something to my grandchildren. and i don't want to sacrifice their future for my own comfort. this selection about getting america back on track, monetarily so we can grow the economy again and make it where americans who work get something for that. it's about getting this country back on track, militarily. so that we rebuild a very decimated military that now has half the number of ships that my grandfather knew in world war i when he served on a u.s. navy
2:07 pm
destroyer. half the -- the smallest number of troops that we've had since before pearl harbor. and in our air force, we have people flying b-52's right now that are older than i am. in fact, there's an air force pilot flying a b-52 that his father flew in the 1980's and his grandfather flew the same airplane in the 1950's. and we need to have the kind of mill tear force that's the strongest we've ever had in the history of the country was that's the way we make it so our sons and daughters have don't have to go to war. have a military nobody wants to fight. but in addition to getting thingings back in step, monetarily and militarily, let me unapl poll -- unapologetically say we have to get this country back morally. we can't be a great country if we're not a good country. we can't be a good country if we don't understand that what made us a great country, was that we
2:08 pm
were a god and generous people and up until the last several generations and certainly decades, we were a people that didn't need a big government because we had big hearts and we took care of our families and our friends and our neighbors. we railinced that while against big government and talk about how they take 50 cents of every dollar we earn, which is indeed tragic if those of us who call ourselves followers of christ, if we would just give a dime out of a dollar that we earn in what ought to be our bare minimum obligation as believers, and if we took care of the neerk widow the orphan, through our churches and through our generosity, we would do more with a dime out of each dollar from our tithes than the government would do with 50 crepts out of each dollar we earn and that's how you get government smaller, you make our
2:09 pm
hearts and our charity bigger. and we would solve a whole lot more of the issues of poverty than we ever will with government programs that entrap people in poverty and never let them out. let me take some of your questions, and i'll do my best to answer them or make you think i am. we'll see which way it goes. yes, sir. >> my name is robert, i'm a student at the university across the street. i'm also a believer. i want to bring up the issue of the younger generation because i have seen not only in the secular world, in the university, but also at my own church and in various other churches, there seems to be a disillusionment or ignorance or hostility toward conservative beliefs. on the christian side i think a lot of it is -- a lot of issues you brought up.
2:10 pm
we talk about, like, moral values, particularly the sanctity of marriage, but we're totally silent when no fault divorce was made legal, there was no movement to save marriage from divorce. how do we, particularly with our evangelical younger people, how do we get them back and admit, yeah we kind of, on the marriage we missed it. mike: that's a great question, how do we get young people interested, not just politically, but morally, getting our country back. robert says he's an evangelical and wans to make sure young people growing up in the church have a sense of perspective, that they're involved he mentions the difference between how many people rail against same-sex marriage but said
2:11 pm
nothing about the growing divorce rate among traditional married couples in the church. i think robert is right. quite frankly, one of the reasons that the couldn't vi in is because those of us who are professing believers, we've not been the salt and the light that wie called to be. there's a difference between being a thermometer and a thermostat. a thermometer reads the temperature of whatever the room is and reflects the temperature. most of the time, culture is a reflection. it doesn't change people, people change the culture. when we live as thermometers and when we elect people in political offices who are thermometer, they'll take a poll, find out what people think and believe and reflect what people think and believe. what we really need in america, we need thermostats. the purpose of a thermostat is, it can read the temperature but
2:12 pm
its purpose is to adjust the temperature. as a musician i understand that if i'm going to tune my fwi tar, i don't tune the tuning fork to the guitar, i tune the fwi tar to the tuning fork. you have a standard and you adjust your instrument to the standard. you don't adjust the standard to the instrument. what happens is, when we try to change the truth, the eternal truth of what's right and what's wrong, this is why i say there's a moral issue here, when we try to move the moral standards to meet culture, it's as ridiculous as trying to tune the tuning fork to the instrument rather than tuning the instrument to the tuning fork. i'm an evangelical, but one of my greatest heroes in the world was pope john paul ii. he was being interviewed and someone asked, can you ex-plin how the church can be more relevant, how it can change its
2:13 pm
views and positions because it's so south of step with culture? don't you think the church should modernize and be more progressive? and the pope said to the reporter who was interviewing him, when the question was raised don't you think the church should change its standards, the pope's response was, he said, my son, the church is the standard. i thought, what a brilliant answer, i wish i'd said it. but since i did, i'll attribute the quote. >> what about the pow over money in the political system. one thing in the country, people feel powerless, disillusioned buzz of the incredible concentration of wealth which has accelerated dramatically in the last decades. what's your tax policy?
2:14 pm
what are your ideas about tax reforms? mike: the question is, how can we do a real different tax policy, tax reform that would empower people at the bottom? and the reason i'm a passionate advocate for the fair tax is because that's exactly what it would do. the fair tax would transform the tax from punishing our productivity by taxing everything we do that's product i, whether it's our work or investment or save, even inheritance we wish to pass along in the form of a farm or business and tax that at point of consumption. people say that would be a regressive tax. it would be except a provision in the tax that untaxes people for their necessities. with the fair tax, the people in the bottom third of the economy, benefit the most by 14% or 15% over where they are today. the people in the middle of the economy benefit 7% or 8% and the people at the top are still
2:15 pm
better off but only by 4% or 5%. instead of being a regressive tax, it's not. here's what happens. today our tax system punishes the guy who wans to work harder and get ahead. give you an example, i met a guy in a machine shop in new hampshire. he's an eight-hour day guy, works on his feet, in ha machine shop, doing it since he got out of high school. his daughter is in grad school. he said, i didn't want her to go into a big student debt soy started working a double-shift, 16 hours a day. he wanted to get the second shift totally to his daughter. ok, i'm working 16 her, i'm working a double-shift, i'll get a double paycheck. guess what, when he got his first paycheck from the double-shift he, didn't get a double amount of pay because working double meant he got bumped into a new tax bracket and the government got as much of his second shift as he did system of rather than him
2:16 pm
benefiting double for double work, the government benefited from his double work he, didn't. folks, fundamentally wrong. so when we're talking about a tax policy, we ought to make it so that that tax policy helps the people at the bottom, not just the people at the top. the people at the top pay a lower rate of tax than the people who are working for a wage. people working for a wage will pay the highest tax rate. theoretically. people who are hiing off passive income and the greatest wealth in the country is concentrated on those getting their money off passive income, investments, rather than a wage, and the result is that tax rate is effectively higher and more stiff far guy working on the factory floor than it is for the big global investors who can move their country -- their money all over the world to protect it from the tax code. many of them don't pay any tax because they've been able to use good accountants and good
2:17 pm
lawyers to get out of of it. guess what? who's paying their share? you are. everybody pays tack when you buy something at the retail level. it's very transparent but transformative to the economy. that's what i would do let me tell you something else it does. you want to deal with the illegal immigration issue, have you ever wondered why republicans nor democrats ever deal wit and fix it? i can tell you why. goes back to my three magic words of politics, what were think they? follow the money. here's how. there's an economic advantage in hiring an illegal. robert if i hire you and you're an american and i pay you $12 an more i'm sure you're worth than that, but we'll take things out of your paycheck for income tax, payroll tax, social security, medicare, so on. if i hire you and you're an illegal immigrant, i don't think you are, but i do need to see your green card just to make
2:18 pm
sure but if i hire you and you're an illegal immigrant and i pay you $, i'm exploiting your hour by $4 an hour, underpaying what i would have to pay him. you're not going to tell anybody because you'd get in trouble. so you're going to keep your mouth shut. there's another reason you're not going to tell. at $ an hour you keep more money in your pocket than he made at $12 because nothing is coming out of your paycheck. as the employer, not only have i cheated you by $4 an hour, cost you your job, i'm pocketting the 7.5% employer portion of the payroll tax which means 15% of what you would have been paid and what i was paying in doesn't fund your social security or your medicare and if you wonder why we keep underfunding it, it's because we have so many people cheating and we have fewer people paying iand it's part of the shortfall. so if you want to fix illegal immigration, change the rules so that we don't make it
2:19 pm
economically advantageous to hire an illegal. that's part of what needs to happen. i saw another hand. yes, sir. did you get your pizza back? >> yes, i did. thank you very much. medical care is a complicated issue but i want to ask one question about it. i've read that pharmaceuticals from -- that one can guy in other couldn't res such as canada and europe are cheaper than they are here but most of the research and many of the medications are made here.
2:20 pm
why is it cheaper there? mike: there are a few reasons. one is the money has to be recovered before the drug can become je for the ex. second, the pharmaceutical manufacturer in the u.s. has to set aside billions because if somebody has an issue with a drug, it could be 1 years later, but if they have an issue with the drug, the liability from lawsuits is such that they have to protect themselves. now i'm not trying to let big pharma off the hook here. boy, did they make a nice keel with obama on obamacare. padded them nicely. but the importation of canadian drugs would be a great benefit to a lot of american consumers. but let's try to make it more permanent by having a situation where we limit and put a cap on punitive damage, not actual
2:21 pm
damages because i think if a person is truly injured by medical malpractice that's one thing but punitive damages can drive the cost disproportionately. also make it so that there is a reasonable way in which somebody who does spend a lot of money developing a dwrug will be a el to recover those costs so they have insent toiv go back and develop more. and if it's a drug that really does benefit the country, maybe the government should just buy it out a one-time, $100 billion, we buy the drug, it's now hour, we'll it to you at $1 a pill. as president i would declare war on the four big cost driving diseases in this country. i often get asked what would you do different any -- differently in obama care. there's a lot of things i'd do differently but from a big picture perspective, most of our cost in the health care system are because we're paying for the cost of chronic disease. in fact it's 5%, 85% of the
2:22 pm
over $2 trillion in the health care system is chronic los angeles. -- chronic disease. i'd say within a decade we're going to find cures to cancer, heart disease, diabetes and alzheimer's rm these four diseases. now i know there are a lot of other diseases but these four drive the biggest bulk of the health care $s in america. and we would approach it with the same intensity that we did the moon landing in the 1980's, and we would try to see the same results as we saw when polio was eradicated in my childhood. folks, i remember standing at the courthouse lawn in hope, arkansas, as a little kid, three sunday afternoons in a row, getting my polio vaccine so i wouldn't have to wear leg braces like older kids in town or have to go to the iron lung. do you know how much we spent on polio in america last year? nothing. because we eradicated it, cured it. we saved hundreds of billions of
2:23 pm
dollars because we don't have to treat polio. thank god for that imagine with me what it would be if we found event -- would either prevent or cure heart disease, alzheimer's dirke bee tees, cancer. it would transform not only the health care system but the economy of america. great ag urrounded by land, crop raise, i'd like to hear how you came about being so pro-ethanol. mike: question about ethanol. let me begin by saying it's really, really rare when the government comes up with an idea that works. agreed? usually the government comes up with something that fails. this time they came up with an idea, to create ethanol standards so we would move to greener and cleaner fuels, that we would use something sustainable and that was renewable, and that would be
2:24 pm
able to help reduce our dependence upon foreign oil which we were depending a lot on, particularly middle eastern oil which by the way when we bought it, it funded the very people who teach the terrorists how to hate and kill us. so it looked like a reasonable idea system of the government put a renewable fuel standard which meant that over the course of the next several years, we have to going blend into our fuel renewable fuels. so because the government created that mandate, billions of dollars were spent building the infrastructure to refine the ethanol that came from plants like you've got a lot of corn up here, i don't know if you've noticed that or not but thriving through in the summertime, let me assure you, you've got a lot of corn up here. there are times i've driven three hours in iowa and all i've seen is cornfields the entire time. here's the thing about ethanol.
2:25 pm
it used to be when the corn was harvested, the kernels were used for either the production of oil or feed, but the husk and the stalks all thrown away. it was just waste. those husks and stalks are now turned into ethanol. by being turned into ethanol, it becomes a renewable fuel, something to wasted, stabilizes the crop for the farmer, gives him a substantially better marketplace for his fuels, the people who go to work in the industry of refining, 75,000 jobs all told in iowa that are somehow related to ethanol. but here's the best thing. this is a government mandate that worked. it's cleaner. it's greener. the ock feign in ethanol is higher than tra degreesal fuel. i'll give you an example. how many of you knew that every nascar vehicle runs exclusively on ethanol? who knew that? couple of us. do you think nascar is putting it in their vehicles because it
2:26 pm
helps make their cars slow ore less efficient? of course not. now there are some candidates who don't support the renewable fuel stan tards. they want your vote for president. and polls show that some of them are leading and doing well here. help me understand why would iowa vote for someone who doesn't understand, appreciate, and will not support a program that helps iowa farmers make sure they have a good market for their crops that reduces dependence on foreign oil that helps reward the people who invested billions into the infrastructure of ethanol, why would anybody vote for someone who will help potentially cost iowa 75,000 jobs and make your neighbors feint upon you to make up for their lost jobs? folk that would be like coming to my state of arkansas and suggest that can people quit shopping at wal-mart and that nobody ought to ever eat rice or chicken again. you'll be wearing chicken feathers on top of the tar that will be poured all over you if
2:27 pm
you were to come to arkansas and sulling jest that because you would be in essence insulting a large portion of the population of my state and the economy of it. so i would ask people of iowa, think very carefully, now if you think i'm pandering about ethanol, it's what i've consistently said. it's also because i come from an agricultural state where over 75% of our entire state's economy is agriculture. i understand that the tai we don't have a strong agricultural foundation in our country is the day we quit being free. a country that doesn't feed itself, doesn't po deuce its own food and fiber, will be hostage to whoever is putting the food on its table. and we have the best, most efficient, safest food supply in the entire world and by golly, we need to keep it that way for the long-term benefit of anymy granddaughter and everybody else like her. ok, somebody else? yes, sir.
2:28 pm
>> i'd like to move our conversation back to health are. is ink the ageneral da is ruining our health care. we go become to the 1960's, we know what woodstock. is now they're running our health care system. it's destroying america. of the most one fundamental things america needs do is stop pharmaceutical advertisement. you see a pharmaceutical advertisement, run to a doctor to give wru that drug, it's drug dealing. mike: you make a good point. when you first used the word woodstock, i'm think, that takes me back to the 1960's. i wasn't at woodstock, i want to
2:29 pm
make that very clear for all the people who are here. but i know about it. new york i remember when it happened, for sure. the sound track was great, i will say that. but there's an important point here. the relationship of pharmaceuticals and the costs and how that figures into the health care system. somebody once observed that it's going to be very hard for us to ever balance the budget when 10,000 aging hippies retire a day and find out they can get free drugs on medicare part d. it's really a good kind of point to make. but what you point out, if you advertise drugs, and you tell people all the symptoms they might have and they self-diagnose and go to their doctor, they don't say, i've got a pain in my shoulder, they say, doctor, i think i need, and they name the drug. and the doctor is say, did you go to medical school in no, but i saw the ad, i'm pretty sure i know what i've got and what will
2:30 pm
fix it. and the balance between free marketplace, free speech and responsible health care is a tough one. bottom line in health care, if you don't have any interest in controlling the costs, we'll never control the costs. three things need to happen to replace obamacare resm place it sw something personal, portable and preventable and here's what i mean by that it's personal to you. your employer doesn't own your health insurance, you do. if you move, your health insurance moves with us. -- with you. it's portable. it mooves, you move. you own it. your employer doesn't own your car insurance, or your homeowners insurance, why should he own your health insurance? and the third thing is focused on prevention. you actually get rewarded for preventing or dealing with cures as opposed to just dealing with treatment. if your doctor takes seven visits before he correctly diagnoses your disease he, gets paid seven times. if he does it right the first time he only gets paid once.


info Stream Only

Uploaded by TV Archive on