>> coming up this morning the obama administration starts the k think press conference on climate emissions. announcement set for 10:30 a.m. eastern this morning. we will have it live on c-span. we invite you to share your thoughts on our facebook and winter pages. -- twitter pages. president obama is preparing to leave for four days over to europe. he will mark the 70th anniversary of the d-day invasion. russian president vladimir putin is also set to attend that, but no bilateral meeting is set by the white house. at 2:00 p.m. we will return to the heritage foundation for a live discussion of the supreme nt decision. and tonight, a look at baseball in american life. i think it is a very good idea. -- chiefhy birds justice roberts said that we were like umpires on the field. we know that we get something wrong sometime so we have to have an appeal to the umpires in new york who review the replay. the only thing that is wrong with the system is that it has two levels. [laughter] >> you can watch the entire as they talk baseball and its place in american culture tonight at 8:00 p.m. eastern on c-span. coming up in just under 30 minutes we will hear from gina mccarthy where she will announce the agencies plan to cut carbon emissions by 30% by 2030. until then, a discussion about the aging infrastructure and its impact on jobs. host: we are back with ray lahood. he is the cochair of building america's future. a recent headline, quoting you, saying america is one big pothole. why did you say that? guest: we had one of the most brutal winters anyone has experienced just about anyone in america. just about anyone in america. local governments do not have the money to fix the hundreds of potholes that exist all over america and the federal government is doing absolutely nothing for its part to help cities and states fix the roads and bridges. we have crumbling roads and ,ridges that are not safe although people are still traveling on them. we have the worst infrastructure anybody can remember. we built the interstate system. our interstate system is falling apart. local roads are one big pothole. bridges are falling down. this is not the america that helped build the economy that we have had in the past. foxx said, earlier in may, he was talking about this. [video clip] >> i would like to be here celebrating the work that is happening around our country and reinvigorate our nation's networks. unfortunately, this may be the the americanoment transportation system has faced in decades. the highwayugust, trust fund, the account that pays for repairing and building our roads will stop -- checks. roadwork, bridge building, transit maintenance, all of these types of projects may be delayed or shut down completely. freight will not move, trade will slow, businesses will not hire. your morning commute will be longer because the roads you are driving on will crumble and no one will show up to fix them. happens if this deadline is not met? guest: i think it will be met. i served in congress for 14 years. we passed transportation bills. congress only passed a two-year bill. happened during the time i was secretary of transportation and the money began to run out, congress will take money from the general fund. they will extend it through the election and come back here in november and december and try and figure out what to do. a lame way of running a transportation system. this is a very serious problem. to do ourthe way transportation program in america. host: why not? what is bad about taking it from the general fund? we could fill all of these potholes, but we could give money to the government to the states to work on projects that need to be worked on, whether it is extending a road or fixing a bridge. approach patchwork that will not continue to keep america number one in its provide the infrastructure to provide economic opportunity. every other country in the world is doing better. china is building multiple airports all over the country. high-speed rail all over the country. america, theyh are building rail and roads. you go anyplace else in the dubai -- what in is going on there is roads, -- connecting their countries, the way we used to do in america. host: when did the decline begin? guest: after president eisenhower signed the interstate bill. what is vision. between president reagan's first and second term, after he was reelected in 1984, a democratic congress with a conservative republican president passed a six-year transportation bill and increased the gas tax. the last time the gas tax was increased was 1993. that was during a time when president clinton worked with a democratic congress to figure out a compromise to increase the gas tax. we have not raised the gas tax since then. -- in someates, states, 95% of the referendums passed. people are ready to fix up roads and bridges. they are tired of potholes. they are tired of flat tires and having to take their cars into to get fixed because they hit a pothole. host: what about the political -- you do not want the campaign had to say you raise taxes. guest: they should take a page out of what is going on in the country, where they have referendums where 95% of the referendums to raise the gas tax or sales tax to pay for infrastructure, 95% have passed. politicians should not be afraid to raise tax. if they do, people in their districts will know that money will go to the kind of infrastructure repair that is needed. host: how much do you increase the gas tax by? galloni say $.10 a and index it. if it were done the last time, we would not have this debate. it would be adjusted for the inflation, or, or however you want to say. that would be a good way to do it. upget a good start on fixing america's infrastructure, probably $.10 a gallon. host: is that what you advocate it? guest: i was part of president obama's team. they advocated using part of the funds that were not being used for the war in iraq and afghanistan. ae idea that we did not have proposal is not accurate. we did. the idea was to take the money from the surplus does not being used for the two wars. host: is raising the gas tax a long-term solution? people say the highway trust fund, the way it works right now, it is not sustainable when you have people driving less and you have people have fuel efficiency standards and do not consume as much gas. aest: it has to be part of program. the pot of money that built america the pot of money that taxpayers see being used to help roads or bridges has always been the highway trust fund. replenished. be that is what built america. that is the pot of money people have been accustomed to paying into, where they can see results. you can do tolling. some states have done that. vatecan do public-pri partnerships. there are loan programs and other opportunities. you have to have a significant resource. that has been the highway trust fund. we should not let that go away. we should not. with ae are talking former transportation secretary. we want to get your questions and comments to him. buffalo, new york, you're up first. caller: thank you for taking my call. first of all, i think you are a patriot. you put your country before your party. that is not the easiest thing to do right now. i have a quick question. where do corporations tie into this, the ones who have to ship between states? it seems they have been silent for the longest time and they use our roads and bridges the most. corporations pay a lot of taxes. thank you for your comment. i enjoyed my 35 years of public service. the best job i ever had was secretary of transportation for four and a half years. corporations pay a lot of corporate tax and they pay a lot of taxes and part of those go the coffers in d.c. transportation system here in america, we need traditional, but also use an innovative approaches. that has held us in good step for a long time. about a user fee? guest: certainly trucking companies. --ge trunking companies large trucking companies pay a lot of tax. it goes into the highway trust fund. there are many that contribute to this fund. we need to replenish it to give people the idea that we have a vision. and not paying attention to our crumbling infrastructure. at one time, america was number one. now, we are way down the list, particularly compared to other countries. when you do not have good infrastructure, you cannot attract business, and become the kind of economic business community and states want to be. >> where is the evidence? where were you briefed about concrete evidence that this is a competitive issue for the united states? time we served here and served on the transportation committee as a member of congress, we passed two strong bills that helped contractors all across america. arel businesses of america the contractors. the people that hire people to build roads and bridges, many have gone out of business because there aren't resources in states to fund the projects. this is not only bad for communities and infrastructure, it is bad for small business, bad for the opportunities for contractors and those who build roads and bridges to have the opportunity to work. we also invested a lot of our into transit and light rail and streetcars and high-speed rail. the nextese things are generation of transportation for america. for the factacking there is not the funding there to continue to do what we have been able to do. >> on twitter, increasing fuel increases the cost of everything transported to market. >> most people, now, have become accustomed to the fluctuation in gasoline prices. said is if you increase the gas tax, most people will not notice the difference. particularly as we come into the summertime, we know there are environmental rules and regulations that will increase across part of america. we do not think it will impinge on the budgets of common ordinary citizens, particularly if they know that money is going to create jobs for friends and neighbors who will build infrastructure, roads, and for the bridges. is part of putting america back to work. this is part of friends and neighbors who know how to build roads. the businesses, small businesses that can really be affected. >> does more infrastructure lead to more consumption, greenhouse gas emission, and more severe climate change? >> no administration has taken initiative on climate change than this administration then president obama. -- telling the epa to come up with higher standards, the gasoline standard for all trucks would be 54.5 miles per gallon. the epa will announce another very strong proposal to deal with climate change. of raising the gas tax, people will drive more, is not quite accurate. a lot of people are using transit, light rail, streetcars, and we see it all over america. >> is that separate money than what we are talking about? preprocessed by the president includes those -- caller,io, republican you're on the air. i believe ray lahood has something wrong there. take familynot even gastions because of high prices. you do not understand america. he just proved himself yesterday he is destroying our country. what a mess we have. >> i agree potholess a mess with and bridges falling down and infrastructure crumbling. some of us will continue to speak out to make sure we have resources so you can take that vacation. >> what has been happening in recent years with these transportation bills? in the past, how long have they passed? >> the last one was only two years. they run at the end of the fiscal year. that is a terrible dilemma and a terrible mess for america. in the years i've served in billsss, we passed two and they were funded robustly and helped rebuild america. 23 last bill passed with extensions was a two-year bill. to contractors, no opportunity for people to plan long-term for big projects. it is a stopgap measure. they have passed a six-year committee -- in their committee a six-year bill. getting it back is critical for certainty, the vision, planning, long-term credibility for america. >> from twitter -- >> is a good question. a lot of bureaucracy was short allow for projects to be completed on time. there were good for visions in the last bill that allowed for big benchmarks. not as much bureaucracy involved. we will go to write next, independent color. caller: i would like to make a comment about taxes. everybody who goes on the road knows in the last 15 years, probably the traffic has doubled. gas used has probably doubled. for failing wages, everything has to be a union job. when a book of pennsylvania turnpike, it took them three years to put in a northeast extension. today, that would be a 20 year project. it would be delayed. new jersey a few years ago theed to sell bonds to fix roads. every cent of the gas tax was squandered in the administration. clean out all these highways and get them back on the roads. to getto be a union their contributions back to the politicians. >> all right. class the federal gas tax is $.18 per gallon. now, states have imposed their own gas taxes. perhaps in pennsylvania, it might amount to $.50 a gallon. i do not know precisely. the federal gas tax, which has not been raised since 1993 is $.18 per gallon. we haved, short-circuited a number of the bureaucratic stumbling blocks that cause projects to take forever to complete. those are good provisions, but we need a long-range view on this. host: a tweet -- guest: the people that build the bridges are people who are well-trained and well prepared to build this kind of infrastructure. some folks do belong to unions. another tweet -- nin been raiseds not since 1993. states impose their own tax. the price of gas has gone up. the federal government does not raise gasoline prices. that is done by old companies. host: token caller. alaska. good morning to you. caller: why don't we make the contractors that do the highways guarantee their work for a hot -- a number of years. we have been doing the work over and over again. thank you. that is my comments. >> there are provisions in some of these contracts that there andto be a quality of work a time when the contractors responsible. it is not for the life of the project or the life of the roadway. host: we are talking with ray congress ford seven years, republican from illinois. in anderved in 1994 begin the 16th secretary of transportation back in 2009 and just left office in july of 2013. what is building america's future? an organization that promotes infrastructure and construction and the idea that, if we're going to have a strong economy and put people to work, if we're going to have the kind of infrastructure america has been known for, we have to make invested -- investments. cochaired by the former mayor of new york and a former governor of pennsylvania and mayor of -- and myself. it continues our opportunities to use a loud bullhorn to promote infrastructure and what is good for america and promote jobs in -- andber development economic development. that is my goal, putting people to work and making america a place where people want to live and travel to. we have to have the infrastructure to do it. class who are the names of the companies behind it? is funded primarily by mayor bloomberg's foundation. that is where the lions share of the money comes from eric >> two e-mails in. how do we know money from will not begas tax put in general fund and spent on something else? thet: will all requires money be spent for infrastructure. someess will have to take money from the general fund, but spelledry specifically out in the authorization how the money will be spent and where and how it will be distributed to each state. democratic caller. caller: i would like to hear your opinion on why you think chris christie knocks down the tunnel in new jersey. another thing i want to say to the woman who called and and did not like the five to one deal for the prisoner. i wonder how she would feel if it was her fun being released -- sun being released. -- her son being released. office,hen we came into we were confronted with the election of a new governor in new jersey, chris christie. there was a project that had been worked on for a number of years and another of transportation professionals .rea -- professionals. it is very congested. right now, they're using infrastructure that is very old and needs to continually be prepared and fixed up. couple of new tunnels that would have allowed for a lot more capacity for people to get into new york was very appealing. governor christie fel ginaive now to remarks from mccarthy was expected to announce the new administration initiative to reduce greenhouse emissions by 30% by the year 2030. [applause] >> thank you. do to happy here, thank you. -- glad to have you here, thank you. it is great to be here. thank you for accompanying me and and for all of the leadership you bring to this agency. i want to tell you a little bit of a story. about a month ago i took a trip to the cleveland clinic. i met a lot of really great people, but one person stood out. even if he needed to have to stand on a chair to make himself seen while talking. he was 10 years old, and he struggled with severe asthma his entire life. his mom said that despite his challenges, he is a tough, active kid in a really good hockey player. sometimes the air is too dangerous for him to play outside. in the united states of america, no parent should ever have to have that worry. thank you. that is why epa exists, that is our job. laws, andected by our reaffirmed by the courts, that we are here to protect public health and the environment. that about climate change is fueled by carbon pollution is supercharging risks, not just to our health but to our communities, our economy, and our way of life. that is why epa is delivering on a vital piece of president obama's climate action plan. to thank our acting assistant administrator at the office of air and radiation. and all of the entire team and teams across epa who work so hard to deliver this proposal. they should be incredibly proud of their hard work. i know that i am incredibly proud. [applause] but today, epa is proposing a clean carbon plan that will cut carbon from our power sector by using clean energy sources and cutting energy waste. although we limit pollutants like mercury, arsenic muscle for, currently there are no limits on carbon pollution from power plants, our nations largest sources. for the sake of our family's future,and for our kids we have a moral obligation to act on climate. when we do, we will turn risks of climate into business opportunity. andill spur innovation investment, and we will build -leading clean energy economy. cost keep piling up. rising temperatures bring more smog, or as the imam or allergy seasons -- more asthma, and longer allergy seasons. if your kid does not use an inhaler, you should consider your self lucky because one in 10 kids offers from asthma. carbon pollution from power plants comes packaged with dangerous pollution like nitrogen oxide and sulfur dioxide, and they put our atldren and/or our families even more risk. climate in action is costing us more money in more places more often. was the second most expensive year in u.s. history for natural disasters. even the largest sect yours of ectors of our- scto economy buckle under the pressures of a changing climate, and when they give way, so do the local economies that depend on them. as our seas rise, so do insurance premiums, property tax is, and food prices. if we do not think, in our grand lifetime, temperatures could rise 10 degrees and seas could rise by four feet. the s&p recently said that climate change will continue to affect credit risk worldwide. this is not just about disappearing polar bears and melting ice caps, although i like polar bears, and i know about melting ice caps. this is about protecting our health, and it is about protecting our homes. this is about protecting local economies, and it is about protecting jobs. the time to act is now, that is why president obama laid out a climate action plan to cut carbon pollution, to build a more resilient nation, and to leave the world in the global fight against climate. proposed climate clean power plant is a -- plan is a major step forward. advise built on your from states, cities, businesses, utilities, and geos, and thousands of people who provided us with comments. i want to thank you for that comment, you will see that they made a difference. today is about kicking off what we see as a second phase of critical engagement. shaped by public input, by present trends, by preventing elegies, as well as a healthy dose of common sense, our plan aims to cut energy waste and leverage leader energy sources died doing two things. first, by setting achievable, and forcible state goals to cut carbon pollution four megawatts hours of electricity generation. laying out a national framework that gives states the flexibility to chart their own customized path on how they need -- meet their goals. all told, in 2030 when they meet those goals, our proposal will result in 30% less carbon pollution from the power or across the united states in comparison to 2005 levels. thanks -- [applause] -- you. just to print that in perspective, that is if we the carbont pollution from two thirds of the cars and trucks in america. this is the preferred path forward. before 2030 even comes, it is more than double the carbon pollution from every power plant in america in 2012. it is double what every power plant generated in terms of pollution in 2012, and as a bonus, and 2013 we will -- in cut smog and pollution by 25% or more if we do not have this rule in place. that is a great added bonus. [applause] now all of that means it is going to result in lower medical thes, fewer trips to emergency rooms, especially for those most alterable. kids, especially those kids who have asthma, our elderly, and our infirm. lower income families and families of color are the hardest hit. let me get into the details of the proposal. it is all about flexibility. that is what makes it ambitious, but also achievable. that is how we keep our energy affordable, and all reliable. the glue that holds this plan together and the key to making it work is that each state's goal is tailored to its own havemstances, and states the flexibility to reach their goals in whatever way works best for them. two graphs state goals we looked at where states are today, and we followed and looked at where they are heading. each state is different, so each hole and each path can be different. the goals come from smart and sensible opportunities that states and businesses are taking advantage of right now, from the plant to the plug. let me tell you about the kind of opportunities that i am talking about. we know that coal and natural gas play a significant role today in a diverse energy mix . this plan does not change that. it recognizes that there are opportunities to about a nice aging plants, to increase efficiency, and to lower pollution. that is hard of and all of the above strategy that paves the way forward. have the opportunity to shift their alliance to more efficient and last alluding plans. pollutingooting plants. 2009, wind energy in america has tripled. solar energy has grown tenfold. our nuclear fleet continues to supply zero carbon base load power. isegrown clean energy posting record revenues and creating jobs that cannot be shipped overseas. those are all opportunities at lance about but what about the plug? existing technologies can squeeze the most out of every uset drawn, helping us electricity more efficiently and our homes and businesses. more efficiency means that we need less electricity to will our refrigerators or to charge our phones. for the fuel we burn, let's get the biggest bang for our buck. all of these options are not new ideas. are based on the technologies, proven approaches, storyey are part of the of the energy progress in the united states of america. pre-scribed, we compel already to joine technology progress underway. there is no one-size-fits-all solution, states can pick from a portfolio of options. it is up to states to mix and match to get their goals. if states do not want to go wit hangoan, they can out with other states, we can do multistate market programs. we are doing them today. [applause] or, they can be creative and make new ones. more players mean more flexibility, and when you look at this proposal you will see that more flexibility means lower cost. justs have flexibility not in the means and the methods, but in the timeline as well. under our proposal, states have to design plans now, and they have to start reducing so they on ae on a uri -- trajectory to meet their final goals in 2030. that means a smooth transition to a cleaner power that does not leave any investment opportunities behind. our cleanility of power plan affords the choices that lead them to a healthier future. choices that level the playing field, and keep options on the them offes not take the table, choices that reflect where we are today, and that sees the opportunities that are here for us tomorrow. onices that are focused building up, not on shutting down. commonan raise the denominator for a cleaner, low carbon economy that will fuel growth for decades to come. what is special about the flexibility of our plan? it does not just give states the more options, it gives entrepreneurs and investors options to play as well. [applause] it will deliver the certainty that private investment is looking for that will unleash market forces, that will drive even deeper into innovation and investment. it will spur cleaner technologies and power of all sorts. we can bring new, low carbon technologies to the table here . pull private investment off the shelves and revolutionean energy and in all directions, not just the one or two that we know today. opportunities are endless. thegood news is that states, cities, and businesses have already blazed the trail. we are not doing cutting-edge work here. we are just opening up the door for cutting edge to happen. energy revolution has been unfolding on front of us -- in front of us. i went to salt lake city where the mayor and the utilities are teaming up on building yo efficiency. i went to st. paul where there is a science center that is cycling energy waste, and is actually teaching kids what we adults are just beginning to learn. i have seen fortune 500 companies revamp strategies to lower business risk by meeting the demands of a carbon constrained future. i want to give a shout out to all of the local officials, all of the rural co-ops, and all of the power operators and utilities that have been leading the charge on climate change. you know who you are. thank you. it is clear you act not just as because it is reasonable, but because it is right. a partisan not as obstacle, but as a powerful opportunity. we know that excess breeds success. breeds success. that is how everybody ends up winning. has had a long-standing partnership with states to protect public health. we set goals, and states are always in the drivers seat to meet them. plansing the clean power shifts much of the conversation to the states. if you're a teacher, a scientist, a mechanic, a business person, or just someone who has a good idea, share your thoughts with your state leaders. help them see that they can build a plan that will better all of our futures. are wondering, can we cut pollution while keeping our energy affordable and reliable? sure we can. we can, and we will. critics claim that your energy bills will skyrocket, but they are wrong. shall i say that again? they are wrong. [applause] any small short-term change in electricity prices would be within normal fluctuations the ealtr or has already dele with four years. this is about the price of a gallon of milk a month. the hugeset by benefits. this is investment in better health and in a better future for our kids. just like these kids right here. are they girl scouts? just hanging out? [laughter] in 2030 the clean power plan will deliver health benefits of up to 90 billion dollars. for slit and smog reductions alone, for every dollar we invest in this plan, families will see seven dollars in direct health benefits. if states are smart about taking advantage of opportunities, when the effects of this plan are in place in 2030, average electricity bills will be eight percent cheaper. that is how you write a rule. [applause] this plan is a down payment, we will know it to be a more efficient when he first century power system. proven path, and a lot of states have been doing it for years. think about it like this. is stored you'll efficiency and earns that doubled the distance our cars will go on a gallon of gas. were engaged with that rulemaking. that means you fill up less often, and you save more money. that is what efficiency does for you in the audio industry, that is what it will do for you in the power sector as well. given the astronomical price climate in for action, the most costly thing of all we can do is nothing. the most costly thing that we can do is to do nothing. the critics are wrong about reliability. plants have power met pollution limits without reliability. what threatens reliability and causes blackouts is the devastating extreme weather that we are going to see that is fueled by climate change. tired of people pointing to the polar vortex as a reason not to act on climate. it is exactly the opposite. it is a wake-up call. riskte change heightens from extreme cold that freezes our power grid, superstorm that brown our power plants, and heat waves that stress our power supply. it turns out that efficiency upgrades that slow condiments help -- climate change cities insulate themselves against blackouts. that is how it works. we know it, they know which. ofs i it -- despite all that, we are going to see special interest skeptics who will cry that the sky is falling, who will deliberately ignore the risks, who will deliberately overestimate the cost, and will deliberately undervalued the benefits. the facts are very clear. for over four decades, epa has cut their pollution by the 70% percent, and the economy has tripled. all the while putting the power we need to keep america strong. [applause] climate action does not actually dole american -- dull american competitive edge, it sharpens it, it spurs innovation and investment. %n 2011 we waited almost 33 more than 2009. a clear sign of a competitive industry. our fuel efficiency standards help to make that happen. buy ares like best investing in low carbon operations. bank of america actually pays its employees to cut carbon pollution because investors see climate risk as business opportunities. a raceget any hand that has been ordered for these people, but this is good news. tell you thatill eliminating waste means more money for other things, like hiring employees, corporate climate action is not bells and whistles, it is an all hands on deck call. standards,t national the energy sector seems the handwriting on the wall. billions ofting dollars in clean energy, and climates are weaving considerations into their business plans. all of this means more jobs, not less. we will need thousands of inerican workers construction, transmission, and more to make cleaner power a reality. [applause] you have heard me say this before, but it is worth reiterating again. the bottom line is, we have never, nor will we ever have a have to choose between a healthy economy and a healthy environment. [applause] there is a reason why empty allegations from critics sound a little bit like a broken record. it is because it is the same tired play from the same national interest playbook that they have been using for decades. 1960's, when smog choked our cities, critics call ed wolf and said that epa action would put the brakes on auto production. our air got cleaner, our kid got healthier, we sold more cars. thank you for the folks that epa. cried wolf's critics and said that fighting acid industryd make our die a quiet death. they were wrong again. industry is alive and well, our lights are still on and we have dramatically reduced acid rain. time after time, when science pointed to health risk, special interest cried wolf to protect their own agenda, not the agenda of the american people. followed theme, we science, we protected the american people, and the doomsday predictions never came true. now climate change is calling our number. right on cue, the same critics will once again talk me acts, standing in the way to meet our moral obligation as stewards of our natural resources. that scienceim will harm us, will fly in the face of history, and show a decided lack of faith in american ingenuity and entrepreneurship. i do not accept that premise, the president of the united states does not accept that, we should not. fight, we canis innovate our way to a better future. that is what america does best. [applause] yes, our climate crisis is a global problem, and it demands a global solution, and there is no hail mary play we can call on to reverse it expects -- its effects. but we can act today to limit the dangers of punting this problem to our children. it is no accident that our iece ofl is a key pe president obama action plan. there is still much work to be done before we get carbon pollution down to be safe levels we need, but i am hopeful. i am hopeful when i see the progress made, i am hopeful when i see the pattern of perseverance that defines america. from the light bulb to the local locomotive, america has always turned small steps into giant leaps. diseases, we have explored the stars, we have connected corners of the globe with the quick of a mouse. -- click of a mouse. when critics say it cannot be done, we say what just. that is what america is made up, we do not settle, we lead. that is how we will confront this climate crisis. when it comes to our plan, we may not agree on the details of how we do it, but i sure hope we agree on why we do it. us if we did asked everything we could to leave safer, cleaner world, we all want to say yes we did. when we think of our children, arc we think of kids like are from ohio, it is easy to see why we have to be compelled to act. as governors, mayors, ceo's, school teachers, nurses, factory workers, and most of all as , in particular the moms who are here, we have a moral thegation to ensure that world we leave behind is safe, healthy, and vibrant, just like the one we inherited. our clean power plan is a huge step to delivering on that promise. thank you very much. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2014] >> i have some signing to do. this is the opening of the second round of engagement. i am looking forward to it. thank you very much. thank you, everybody. [applause] >> the administrator announcing a new initiative to reduce greenhouse gas emissions by 30% by the year 2030. we invite you to share your thoughts on the facebook age. here is some of what you are saying. this from leading carbon reduction omissions is a good thing but america should be focused on the basics. we only have one planet. i see a lot of jobs coming. dan posted anything needs to be cut in the country, it is the epa budget. and we need to remove the regulatory power from the agency. this reaction from house leaders -- nancy pelosi has this to say -- for over 35 years c-span brings public affairs events from washington directly to you, putting you in the room at congressional hearings, white house events, briefings and conferences and offering complete gavel-to-gavel coverage of the u.s. house all as a theant -- service of private industry. c-span created by their 35 industry 35 years ago. like us on hd, facebook and follow us on twitter. >> speaking today at the heritage foundation and washington. andussing russian politics russian relationships. we will have that live at noon eastern. at 2:00 back to heritage for a live discussion on the supreme court recent decision striking down individual campaign contribution limits and how that impacts free speech. tonight, a look at baseball with lifelong baseball fan, samuel alito. is a very good idea. chief justice roberts famously said a few years ago that judges are like umpires. i think that is true. the umpires on the field are like the trial judges. we know we get things wrong sometimes a you have to have an appeal to the umpires in new york who review the replay. the only thing wrong with the system is it only has two levels. [laughter] you can watch the entire discussion along with david brooks and george will and espn analyst as they talk baseball and its place in american culture at 8:00 eastern here on c-span. the chair of the energy and oversight subcommittee held a briefing last week to discuss a recent report investigating federal programs that address severe mental illness. tim murphy was joined by a forensic psychiatrist and the father whose son suffers from schizophrenia. this is about an hour. good afternoon, everybody. others will be joining us shortly. last weekend there was another awful episode of mass violence. before there was elliott rogers, there was adam lanza, jared lautner in tucson, james holmes in overall, colorado. there were many victims. man and aalso a young mental-health crisis but was denied extended inpatient care before he killed himself and stabbed his father am a virginia state senator. all had untreated or undertreated serious mental illness. all spiraled out of control within a system that lacks a six mechanisms to help. many had parents who were pleading for more help. persons with mental illness is extraordinarily rare and far more likely to be self-directed. there were 40,000 suicides in this country last year, almost one million attempts. the mentally ill are more likely to be the victims of violence. the mentally ill are 10 times more likely to be in jail than in the hospital. that is because of seriously mentally ill law enforcement after they refuse medical care. what makes the painful episodes so confounding is the reality that so many tragedies involving a person with mental illness are entirely preventable. for example, in 34 states elliott rogers family would have been able to ask the court to order an emergency psychiatric evaluation. in california the law says they cannot. the families know when a loved one is in a mental health crisis and when it is deteriorating. >> families are shut out for being part of the care delivery team. as i wrote in the gazette just two weeks after the shooting in newtown, the lesson for americans from the poor firing tragedy the is we better take off loud -- binders and deal with such illnesses or we are sure to face the same problems again. not only what is in a person's hands and makes the act violence but what is in his minds. -- what is in his mind. how many must die before we deal with a broken mental health system? in the nearly year than -- year and a half since i have been investigating on oversight and investigations, even with my 30 year background in clinical psychology i have been shocked to learn how much our country has failed those with persistent mental illness. the current mental system does not respond until after crisis has already occurred because we do not empower parents patients, clinicians, law-enforcement and others to stop this from happening. even in the face of these tragedies, we have been too uncomfortable to knowledge this sobering fact, because the last bastion of stigma in mental health concerns those with serious mental illness. between january, 2013 in march this year, an investigation held a dozen public forums, and expended considerable hours determining how mental illness is being prioritized. the committee focused on three areas of critical public policy interest rate one, the scope of society's problem that is unseeded mental illness. two, mental health situations third three, how federal resources are being spent. we have heard from the director of the national institute for mental health, experts on hipaa privacy rules, the roots of the failures of the current mental health system and begin to identify legislative path to reinvigorate and rebuilt the system. reef we come here are our main findings. first, families have been shut out from the treatment team. the inability of an individual experiencing a serious mental illness to recognize that they have an illness, a neurological condition, elevates importance that the individual family helps that patient get the treatment. persons with serious mental illness like schizophrenia or bipolar disorder. health care providers often misinterpret the information, portability and accountability act, or the hipaa privacy rule. in some cases heard by the committees, the lack of understanding of the privacy rule was so persuasive, the film is rector told they could not even give information to the doctor. three, there is a critical shortage of psychiatric beds, shortage of providers and shortage of out nation treatment options for patients dealing with a psychiatric crisis. we cannot and will not go back to the 19th century. for those who need acute, intensive therapy, there are not enough places, none of doctors and not enough community to help them. a person with mental illness must be homicide death must be homicidal or suicidal before we can give them treatment. it is like denying a patient care until after they have a heart attack. number five, federal resources are not targeted toward serious mental illness like schizophrenia, bipolar disorder and major clinical depression. they're often at the end of the line when it comes to receiving effective help across a spectrum of services. number six, anti-psychiatrist activists have used federal resources to block care for the hardest to reach patients. number seven, we know that proper intervention can be very effective in providing health to those with serious mental illness to get in back towards being independent, holding jobs and recovering. our report provides a legislative to rebuilding our mental health system and finally taking it out of the shadows and into right hope and recovery. where there is no help there is no. towards that end, -- this afternoon we're joined by federal experts who should be familiar to those who attended or follow this committee's work on serious mental illness over the past year. he is an advocate for mental health reform. his everest to maintain the best possible treatment was repeatedly stymied in no small part to misinterpretations of hipaa. mr. jaffe is a founder and director of the policy organization. his wife became the first sister-in-law who had schizophrenia. he's a clinical and forensic psychiatrist whom courts have invited to examine many of the most complex cases and notorious killers in america. dr. welner has been a leading edge of limiting mass killings for the last decade. i thank all of them for being with us today. i would like to welcome a couple of my colleagues. a doctor from the city of georgia, i welcome you, and a dash and an attorney from the state of virginia. some people want to grab a seat, they're welcome here. i want to leave a couple of center seats for members of congress. those standing in the back can,. we're going to ask person and maybe talk for five minutes. just make sure your button is on. >> we will ask each person to talk for four or five minutes. just make >> thank you, sure your button is on. >> thank you, congressman. a few housekeeping items. my name is ed kelly and i am the parent of three children, one of which is paranoid schizophrenia. we have been going through virtual madness for 15 years. importantly, this is different than in the past. there are more cameras. on the off chance my son sees this, i want to tell him i love him and i am doing this for him. that is a risk we take when we do this. our resume as a family covers 15 years of dealing with our son descending into a madness that is impossible to describe. those 15 years include over 30 hospitalizations and seven different hospitals in four counties in the city. 15 years of the revolving door, trouble with the law, dealing with the courts, dealing with the state's attorneys, dealing with hospitals and social workers and everybody here a gatekeeper somehow the mental system -- mental health care system, years of judges ridiculing us and saying we are not going to warehouse your child to make your life easier, your zip or services, good people who want to provide great services to our son. their sand because what they're educated and trained and committed to do you not allowed to. i say that we are committed to this battle, we are committed to this battle. i'm about to tell you about an army that is committed with us. more importantly, our son refuses our help. his illness refuses our help. as a result, we have watched for 15 years, we have watched the laws support his delusions instead of our needs. my wife teaches family support groups. i will tell you, and all due respect to mental health america, the reason she went there is because she was shocked and angered by how she was -- how she would refuse to believe that not everyone will volunteer. it is an impairment of the brain that causes you to refuse treatment. you're willing to do about anything. i've seen him think he was cia, a u.s. marshall, veteran of both gulf wars, did not believe we were his parents for three years. he has lived under bridges, boarded up our wouldn't -- our windows from inside and done things i can't even tell you. he is been beaten, robbed, abused him up in shelters at his own intentions. if you think that is someone, after 15 years, that is voluntarily looking for treatment, i ask you how many years is enough. i have spoken in front of federal and state hearings. last year had the pleasure and privilege of being part of the state of maryland's department of mental health hygiene's continuity of care program, which is a five month exercise. i want to ask for forgiveness for what i'm about to say. five months we focused on one topic, how do we deal with the most years the mentally ill are 18 and older? after these hearings and after that continuity of care, there is one painful fact that has emerged that i must share. that is that the opposition groups do not care but my family, they do not care what my son -- care about my son. only care about their own needs. don't treat the seriously mentally ill who don't believe their ill in a manner that you think they will seek treatment, because they will not. you're putting at risk, you're putting my wife it risk, you're putting my neighbors at risk. i have reached out to the opposition groups in no small measure these past five months of 2013 and asked them from one carve out aort to different set of roles for the seriously mentally ill who do not believe they are ill. not only is there a movement to make something happen together, i have been ridiculed, told my testimony is pretty much saying i am lying, and that is changing. something happening and no small part because of congressman murphy's efforts. this bill is doing something different this time. when i first started testifying families did not want to do what i was doing. to --e pouring your how your heart and soul out to complete strangers. we are letting you into our lives. i have seen people crumple and fall to their knees and cry trying to get out their story. that is why you did not have people doing this. there are 7 million families who share our plight. if you don't think that is a large number, we did around mass. 19 immediate family members. 30 close friends. it is about easily 50 people time 7 million people. then you take the people who are handcuffed and cannot provide treatment. it is unimaginable. times are changing. i want to tell you the pain of standing here and talking to each of you is far less than accepting the pain that it will never change. hipaa needs to change. our family has not known where our son was. hipaa cannot tell us he has been released. imagine you cannot tell us -- find out whether your son has been released. he has no transition of medical records. every time he goes to a hospital, he is a guinea pig. sometimes the only force the doctors listen to is psychosis and delusions. when he gets released, we are not involved with that. if you don't make aot an alternative, the only choice is in hospitals. we prayed and waited for the laws to except that we were right. every time we do that, we are a risk. if he does not get into the hospital and he does not have aot, i want to tell you what happened. the signs of serious mental illness when you are in the downward slide of very subtle at first. the families see it first. but we are not listened to. the poor family that heard on the radio about the shooting. i cannot imagine. we're are the first ones to know. we can tell when the delusions and voices are taking over. we can see his personal hygiene declining. the next thing you know, he disappears. no baths, no showers, no shaving, no haircut, tattered clothes. in about two months, he is this person. dirty, can't imagine what he smells like, hair down to hear, beard down to here. he looks like he is lost about 40 pounds, sleeping under bridges. at his own choice. then he walks through our neighborhoods and shopping centers and talks to himself and scares the hell out of people. you want to talk stigma? that is were stigma comes from. that is what hollywood portrays. that is what happens to someone who is not treated. then what happens? the support network starts to pull back. usually it is too painful to watch. that person becomes isolated. they become frustrated and angry. then you have psychosis, loneliness, isolation, anger, and then they self medicate. and you wonder why things in california happen? beckett acknowledged in a hundred 20 page document how i still waited and frustrated he was -- isolated and frustrated he was. you sit those parents down here and they could have predicted this long ago. our system refuses to accept that families can play a major gatekeeping role in safeguarding role for all of you out there. when lawmakers are making decisions, they need to make incisions without fearing the wrong things. don't fear the threats of unconstitutionality. don't fear the threats of lawsuits. those groups don't care. you need to care. this could happen to your child, or your child's child. try that one. someone is try to help their child help their child. i want to make it publicly to senator mikulski. get the appropriation money in place for this part of the bill to pass. it has been made law, it just needs to be funded for an aot grant program. you did it for alzheimer's. you can deal -- do it for the rest of the mentally ill population. for the lawmakers, when you put your hat on the pillow tonight, ask yourself how important this law would be to you if one of the members of your family had this going on or your next-door neighbor. you could be the next family. it is growing like crazy. i don't have an explanation for it. i am asking you to care. you are asking too much of the families. if the families ever give up, you are in deep trouble. thank you. >> we appreciate that. >> wow. to ed's point, both gerald lochner and james holmes were identified by the mental health system is needing treatment. hipaa kept their parents in the dark before the tragedy. what he is talking about israel. -- is real. i want to think the congressman and mr. murphy, congressman murphy. what you are seeing is something different going on. we have had tons of mental health bills. this is the first one that focuses on the elephant in the room, which is how do we get people known to have serious mental illness and particular adults -- adults known to have serious mental illness to go untreated? this is the first bill that does that. we agree with the majority report. we are not advocates for mental health. we are not advocates for improving the mental health of all americans. we are advocates for the most seriously mentally ill. not all mental illness is serious. 100% of adults can have their mental health improved. 20% of adults have a diagnosable mental illness. that is people in this room and your coworkers on prozac or zoloft to were doing quite well. woman 4% -- only 4% have severe mental illness. we have to stop ignoring the most seriously ill. we cannot go on pretending that they do not exist. until the 1960's, virtually all mental health expenditures were spent on the most seriously ill because the expenditures went to state psychiatric hospitals. after that, at the request of the mental health industry, the funds are now spent on all others. as a result of this shift from focusing on the seriously mentally ill to try to improve the mental health of all others, 164,000 are homeless and 300,000 incarcerated. a disproportionate number of them are people of color who cannot get treatment. i get calls from people all the time. they beg and plead for treatment for their adult children known to have serious mental illness and the mental health system turns them away. they fund everything else. we do know how to treat the most seriously mentally ill to see that the gain, to see that they get treatment. we have to prioritize spending. this is one of those issues where it may not be that we are not spending enough. we spent $130 billion. what we have to do is start sending the seriously ill to the head of the line. we have to replace mission creep with mission control. if we do that, we can start to address the problems we see. ed has talked about hipaa. there are some seriously mentally ill people who need to be in hospitals. we do not have enough hospitals for them. we need more hospital beds. this bill does not ignore that. it recognizes it and starts to fix it. if we can only do one thing, i want to cut spending. stop samsa from funding anti-treatment advocacy and stop empowering that. you can see a lot of information on our website how they do that. samsa is the biggest problem we have. we have to recognize that some people are so sick they do not know they are sick. when you see somebody going down the street screaming and voices only they can hear, yelling that they are the messiah, it is not because they think they are the messiah. they know they are the messiah. the illness tells them they are the messiah. as the messiah, they are never going to volunteer for treatment. we have to recognize this reality. most importantly, we have to expand the use of assisted outpatient treatment for a very small group of people -- the most seriously ill. earlier, i talked about 4% or 5% being mentally ill. there is a small subset of that group who do not recognize their ability to get their need for treatment, who already have multiple arrests, multiple incarcerations, multiple instances of homelessness all associated with going off all and terry treatment -- voluntary treatment that was made available to them. what aot does, after folder process, for this tiny group of people, and including a lawyer, it allows judges to order them into six months of mandated and monitored treatment in the community. in the community. it has been proven to reduce violence 66%. reduce homelessness, arrest, hospitalization, incarceration 74% each. peer support and trauma informed care do not do that. consistent with the spirit, aot prevents us from needing expensive, inhumane inpatient commitment, incarceration, or hospitalization. it allows people to live in the community. it is the most humane thing we can do. it is an off ramp before jail. it is like putting a fence at the edge of the cliff, rather than an ambulance at the bottom. the committee heard from police chiefs, sheriffs, judges, homeless advocates, parents, and children of the seriously mentally ill in support of aot. the only opposition comes from the samsa funded mental health industry. that is the only opposition. they are basing their opposition based on stuff that is not fact. it does not force -- it does not drive people from care. 80% said it helped them get well and stay well. one police chief said it best when he told the committee we have two mental health systems today serving two mutually exclusive populations. community programs serve those who voluntarily accept and seek treatment. those who refuse or are too sick to seek treatment following terribly become law enforcement responsibility. mental health officials, especially samhsa, semen responsible to take responsibility for the second group. this puts the public at risk. i think representative mercy -- murphy, i think the congressman who support it, and i support my fellow democrats. i am about as liberal as you can get. for too long, we democrats have failed to ignite unpleasant truths, like not everyone recovers. sometimes hospitals are needed. left untreated, there is a small group of the seriously mentally ill who do become violent. what i say is we have to pass hr 3717. we have to move from a system that requires tragedy to one that prevents it. on our website, i have attached my statement and you can find more information. in >> dr. wilner. >> thank you. we really appreciate hearing from you, learning from you, and we want to thank the members for coming. certainly those of you who are here today, we appreciate you taking the time, taking it seriously. there comes a time when denial is no longer possible. we have reached that time. many of us and perhaps most of us are here now because of that denial. thick about it. -- think about it. because we have denied that serious mental illness unmanaged can go away just because you will it to, what do you think happens to serious mental illness? what is the difference between serious mental illness and just mental illness? well it is serious enough to warrant treatment and it does not just go away because we deny it exists and we avert our gaze. we are here because we are in denial that serious mental illness does not just go away because hospitals close, so the people in the hospitals get discharged. where do they go? we are in denial because the biggest institutions of the world in america are now prisons. congratulations. you have the right to remain silent. feel better now? you are not in an institution which could benefit from modern medicine. forget the sanitariums. there is more than just a reason of regulation and accountability that congressman murphy speaks to for why we are not going to go but -- back to the psychiatry of old. this is why psychiatry does not step up to the plate. this is not a form of psychiatry. we have better treatments and more accurate treatments and more precise treatments, more humane treatments, more researched treatments, we spend a bazillion dollars on the decade of the brain and we have something to show for it. when you contrast that with the money we spend on wars. we have a windfall from the decade of the brain which could be treating people who need serious treatment for their serious mental illness. it is there. it is humane. it is digestible. it is palatable. it is not savagery. in "one flew over the cuckoo's nest" is about as outdated as shirley temple. it is time to get past that thinking. it is quite antiquated. we are in denial. not just about serious mental illness, but about crisis mental health. which is what brings us here today. we have heard about schizophrenia and bipolar illness. i am here to tell you, as a frantic psychiatrist, and i have interviewed mass killers who have spoken to length and i have talked to people who have carried out crimes that we think are unthinkable and sometimes they are psychotic and sometimes they are not, as much as we hate to admit it. one thing they all have in tom and is that they are in crisis. we are here because we are in denial. but if someone gets discharge from an emergency room or hospital, the crisis goes away. magically. we are here because we are in denial that if someone decides if someone is not dangerous enough to be hospitalized, well, that means the crisis will go away. we are here because we deny -- forget that you -- how many of you in this room know someone who has committed suicide? who has made that choice? who has made that choice thinking about? not delusional. people make permanent choices because they want things to be dramatically different and they may be in crisis and the world may be black and that is a blackness that they cannot endure. you know and i know, as people who are still here and grieving them, that if they just got the right care and the right intervention at the right time from the right people they would be here with us today. do we feel so much better that they have the rights six feet under at room temperature? does that make us feel better? does that make us a better society? i will let you answer it. i will at the members answer it. this is a crisis mental health bill. it does not direct itself that every single person who has ever had a diagnosis. it does not direct itself in an intrusive way. it directs itself to the individual who was in a place at a moment in time who lacks the insight to recognize that they are in a place where they are about to make a catastrophic choice. you cannot let the crisis run the situation. this is why one has leadership. members of the house of representatives are leaders chosen by the people to lead, not to placate. doctors are chosen, doctors are trained to make choices that may be difficult, and sometimes, and i can tell you this as a clinician who started my career treating the violent -- imagine if you will, close your eyes and imagine this scenario of someone i knew to be violent as an on armed person not owning a gun. let's put the gun thing aside for a moment. this person was on the cusp of being violent. should i commit him or should i not? the repercussions might be that he would be so angry and feel so betrayed that his next violence victim would be me. no decision that a clinician makes to commit someone forcibly is made without great ambivalence because we are on the frontlines. i live in new york city, were any of you who follow the news know about a psychologist who was knifed by a patient. we have our own safety issues. we don't see patients behind bars. we see them in private rooms. you are exposed. i have had patients in my office get violent. i had one guy beat the hell out of his father. i had to drag them both down to the street because i did not want them to mess the office up anymore. i had to hold one down while i call the ambulance to come. when you have those kinds of experiences, he recognized that you are. but that you also have to preserve and protect the alliance with the patient. of course we try to negotiate a voluntary resolution. sometimes it is not possible. especially with a person in crisis, who denies that there is something wrong. then you reach a point where denial is no longer possible. isn't that why we are all here? with this isla vista thing? what it has blown the doors off of is the denial that when someone carries out a mass killing ill or not, that they snap. i think you made it quite clear that he was contemplating and at least before he bought his first gun, way back in 2012. can we now dispel the idea that all we have to do is get these people help? let's just get him help and this will never happen. he was in help, he was getting therapy. he was getting therapy from before woody allen was getting therapy and he was still in therapy. and guess what happened? the mass killer is so invested in the life choice -- we may think it is irrational -- but that is our world -- a person who makes an unacceptable choice to him and his world, he is so invested in it, that he will pull it together in such a way that police, who may be very trained, and can count and sit down and say, nice boy, have a good day, you take care. the parents know. right? the families know. sometimes the relationship is afraid. -- frayed. as a doctor, you draw history from those folks. as a physician with a person who is in crisis and i feel that i can help the person in my office, but the crisis is not resolved -- what happens when the person goes out the door and the family can be an auxiliary safety net? hipaa says i cannot talk to the family because the patient is not imminently dangerous. the family has no idea what is happening. it is a betrayal. this is a law that is a betrayal of a sacred relationship of intimacy of a family that would do anything for loved one, more than a doctor would. it is not fair. it is not right. i am plenty confident in my ability to assess a person in an emergency room about whether they are a danger to themselves or others. but i could see you and you know you do not want to come in the hospital. you do not want treatment. you are looking at the world the way you want to look at the world and we are going to agree to disagree and you know that you have to tell me, no, doctor, no, we just had a misunderstanding. i just had a little bit too much to drink, but i am ok now. i was just crashing from the cocaine, but i feel better now. i will get into detox. and you give me the card for a referral? but the family that i'm not allowed to talk to can say, she is going down the drain. somebody do something. this country is full of people who have thought in their head, somebody do something please. somebody do something place. before the suicide. before the self injury. before the homelessness. before the child under the bridge. before the loved one gets the tar beat out of them. before the next beating from the abusive husband. before the next father who was abusive within the home because his seven-year-old is to a mature to articulate. somebody do something. hipaa is a law that stands in the way of crisis situations. i want to underline this just to dispense with the political distortion. we are talking about crisis situations, where the doctor can make a collective decision. this person is going to walk out of my office. i am not going to commit them. this is a precarious situation. i need help. hipaa will not let me help my patients. i have better care that i want to combine with a better love. in a humanistic profession. that law will not allow me as a psychiatrist to be human. i don't know any psychiatrist who does not go through that experience and who would not feel that they trust themselves with the latitude to make a decision when something is a crisis. if you don't have that confidence in your doctor, go pick another doctor. it is a free country. you know? but if you trust your doctor, you trust them to make that appraisal. if we come to appreciate it of denial brought us to this situation. all of these police officers who went to check out this one individual who did a disgusting thing in california, let's call it for what it is -- that is a familiar pattern. family expresses concerns, family smells it, authority looks into it, person in a mental health crisis does not want help, or lacks the insight or is invested in a bad outcome -- let's stop for a minute here. people who carry out mass killings, these are long, premeditated crimes, they are invested in making it happen. they will pull it together and they will do everything they can to protect their agenda. you have someone who cannot hold down a job, who cannot keep himself in school, who could not be unselfish enough to maintain a personal relationship, but what he could do is write and rewrite and stage manage a production for youtube. you think he really looked like that? that was a best possible camera angle that he could ever summon from the director's son. that is not saying anything flippant about the family. it is the same thing as the silly gunplay over to abc. you think you look so tough in real life? that is how we get there in the first place. he is invested in becoming a different person. because of that, because of that we have to appreciate that if somebody smells trouble and the danger is so catastrophic, we have to trust families. we have to trust families to know there is trouble ahead. we are not giving families the wherewithal to be involved. i respect psychiatry's capabilities. i believe that families need to be directly involved. we have court systems. we have the ability for judges to sorted out. we also have a revolving door of commitment here the people are familiar with. how does that go when somebody is actually able to get care? and the family input is not disregarded? well, the person goes into the hospital, where they are greeted with a strong incentive to discharge them as quickly as possible because there are not enough beds. as congressman murphy has so properly and courageously pointed out. the person in crisis wants out also. they know exactly what to say. if they do not know what to say, they asked the other patients. just say this, just say this, and then you will get discharged. they get discharged. to go right back to the family with no owners manual. what happens to the family? the family loses confidence in psychiatry. it happens enough times, the family is going to say, what's the point? the family loses confidence and mental health, the person in serious crisis is lost to treatment and then there is a bad outcome. i want to give everybody opportunity for asking questions. i'm going to make a couple of very quick points and then open the floor and allow everybody to get involved. there is a certain amount of talk about stigma. let's take to hypothetical people that are walking down the street. let's take a bully who looks for the week person to prey upon. those folks are identical twins. they both have a serious mental illness. one takes his medicine and one does not. the person who was taking his antipsychotics is not experiencing side effects because these medicines are easy to take. the person not taking his medicines is experiencing florid symptoms. which one do you think is going to get stigmatized? let's put both of those folks as job applicants. which one do you think is going to get hired? which one do you think is going to build to pass a class or be thought of as more intellectually capable and to have more ability? it is the denial of illness that is responsible for stigma. it is the denial of treatment that is responsible for stigma. it is a disrespect for psychiatry and what it has accomplished that enables stigma. no medical specialty has to encounter the adversity that psychiatry has. you have pediatricians who promote vaccination and they are never stigmatized for causing a public health problem. you have psychiatrists who treat with medications and have to contend with a budget, a budget that is controlled by folks who are anti-psychiatry. i respect holistic medicine is much as the next person. you should see the diet my wife has me on. be that as it may, we would not have holistic medicine control the budget of medicine in surgery. they are competing perspectives. nothing against the organizations involved. with that said, i realize the members have a difficult choice. i also realize we have a full room. we have the nation watching. for that reason, i want to underscore -- you think you are tired of it? you think you are tired of the adam lanza's? you think you're tired of this clown in california looking for his 15 minutes of everybody's going to see him at different way? so are we. people are doing something about this. if it matters to you, we have an election coming up in november. ask yourself. you are going to go into the ballot box, you're going to make a choice. would you vote for somebody who ran on a record that said that he would not change commitment laws to make sure that adam lanza's mother could get him treatment in a community? would you vote for a person like that? would you want him to run on a record saying that you support laws that keep the parents from knowing they were going down the drain of virginia tech? is that the person you want to be representing her interest in the community? would you vote for somebody who would run on a record saying that your lawn or -- jerod launer on personal? if we are in denial, we can always say the illness happens to somebody else in someone else's family, but when you have a mass shooting. i don't think abby giffords anticipated that she would be shot. i don't think anybody anticipated that it would happen to them in california. i don't think anybody forgets that russell west tried to get into the capital and got into tom delay's office shooting before he was subdued. let me tell you, i did not forget. it was a physician that saved his life who was in the u.s. senate. doctors are trying to solve this problem. we are blessed that a psychologist has devoted his energies the way congressman murphy has to this. i would encourage you to have a dialogue with your congressman and to tell them that you feel it is important, imperative for us to change commitment laws to enable people who need help, who are in crisis, to get help, before they are dangerous. so that families can be involved in a way. families know and families love and families can keep us safe. thank you for coming. >> thank you, dr.. i want to recognize marsha blackburn of tennessee, bill johnson of ohio. we have a few minutes. i want to see if any of my colleagues want to make any comments or questions regarding anything that has come up. anything anybody wants to say? >> i appreciate what you are doing, tim. we need to move forward on this legislation. this is very important. thank you to the panel. this is such an important issue. it is timely. we have to prevent these things from happening. the only thing that we are able to do is help empower families and patients in mental health. >> thank you. >> i want to make one question of the panel. one thing that comes up is the question of denial. there is an urological basis for denial. some people call it a non-consensus reality. is there such a thing as a neurological basis for denial? >> we are still learning a lot about it. the physiological appreciation is that when a person suffers a stroke on the right side of the brain, the neglect an entire side of their body. one learns from that that from one single event, that one can actually be of the belief that partisan does not even exist. there is a physiological basis for denial of illness. that is where it originates. there is a lot of thinking within psychiatry that for those who are irrational to the degree that they are psychotic, that there is something going on with them physiologically that resembles this. everybody in this room has denial of something. the question is, at what point are we talking about the physiology of a psychological complex as opposed to an actual physiology of illness? it may be specific to the diagnosis. some folks who have chronic mental illness who are young men deny illnesses such as schizophrenia because they have been exposed to too much stigma, saying they have no hope. we can promote public health that encourages people that if you get treatment early and will appropriate, that you have avenues of accomplishment open new to you and that will have an impact on denial. the answer is both. >> thank you. i am going to see if other -- if members staff who have questions. clarifying questions on the hearing or anything like that. i know some of us have to run to the floor. if the press has questions you want to ask of the panel, you can stick around, if that is ok. >> i'm from laszlo congressional bureau. >> i want to have staff first. >> ok. sounds good. >> i want to make sure we are going to run and make our votes on the floor. no other questions from members? this is a briefing on our findings. this panel has been involved and has participated in the hearings. please feel free to ask clarifying questions. if one of my staff could moderate. dr., did you have any questions? you are ok? thanks. dr. burgess is the vice chair of the health committee. the welcome member of the committee. you can continue here if you would. >> thank you very much. so, part of this bill that representative murphy has put forward six to immigrate behavioral health in primary and care -- seeks to integrate behavioral health and primary care. you have said that you would not have much trouble in er settings telling if someone had trouble and warning signs? mr. rogers manifesto seems to suggest a than an aggressive and violent incident that he admitted he instigated brought him to the er and that was the final straw for him. there is the suggestion of telemedicine as a way of keeping mental health professionals in the loop with er care. however, there is a competing bill or maybe another bill that representative barbers put forward strengthening mental health in our communities act. it has 40 cosponsors. it seeks hhs awards for co-locating behavioral health services in primary care settings. i was wondering how you think that plays with telemedicine. is it better? can telemedicine work as well? i appreciate your input. >> i think both bills have telemedicine in them. somebody who thinks their messiah is not going to go to their messiah is not any more likely to go to a psychiatrist. if you attached my testimony -- there is a comparison of the and him bill barber proposed with the bill that is being proposed by 86 cosponsors, including democrats and republicans. i think those supporting the barber bill have been misled by the mental health industry. again, i am a uber liberal democrat. but when nancy pelosi told roll call that she wants a bill that was supported by the mental health industry, the barber bill got it. it gives the mental health industry more money without requiring them to serve the seriously mentally ill. we cannot pretend they do not exist. telemedicine is related more to getting primary care takers in rural areas access to psychiatrists who do not live in those areas for consultation. >> i want to take -- i want to add to the response. i have mixed feelings about telemedicine. i think what congressman murphy has been attempting to underscore that has not come across more clearly -- i want to underline it. there is a serious shortage of mental health per for -- professionals. above all, a serious shortage of needed specialist. what do you do? you want to make an immediate fix to people who have mental health needs in non-served areas, let alone underserved areas. you can use technology to ramp up a solution. i view telemedicine as a bridge. i don't view it as a long-term solution. but we have a problem that needs immediate resolution. i think the solution is on a national level we have got to turn the behavioral sciences into a growth industry. if we could spend a bazillion dollars getting people to like obamacare -- and i am not telling you my position about it -- but considering the amount of money that went into promoting obamacare so that people would experience it as warm and fuzzy, forget your feelings about it. i'm just talking about the promotional level. if we spent a fraction of that budget on promoting the behavioral sciences for how wonderful it is, i could tell you this as a psychiatrist. it would give someone their life back, their outlook that, their hope back, to restore their soul, to give them some sense of future. what an amazing gift. i went to medical school. i picked psychiatry. i made that call. the reason others do not make that call is because psychiatry and discussion at this point for live coverage of the u.s. house. members meeting in a brief pro forma session. -- a live life conference. the speaker pro tempore: the house will be in order. the chair lays before the house a communication from the speaker. the clerk: the speaker's rooms, washington, d.c. june 2, 2014. i hereby appoint the honorable

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