Transcripts For CSPAN National Security Agency And Internet Security 20140713

Your entertainment last night. I want to call to order the meeting of the health and Human Services committee. By saying we have a few administrative items to take care of. The governors should have received briefing books in advance including the agenda and nga updates. Sitting next to me is melinda becker, legislative director for health and Human Services for nga, and she will be available after the services if anyone needs further details about what we are talking about. A reminder that the proceedings for this committee are open to the press, and all meeting attendees, i would ask you to silence your cell phones and electronic devices. The discussion will focus on two issues every governor spent a lot of time picking about and working on, first given the democratic demographic changes, rising cost of health care, and other factors, how can we expect the u. S. Health system to evolve over the next decade . For all of us, im willing to make the save that that Health Care Costs save that that Health Care Costs are a major part of our jobs. Secondly, how can governors harness these two improve health care in their state these to improve health care in our states. Whatever changes might be on the horizon, we can be certain governors will be dealing with them because a lot of what we do has to do with dealing with health care. In tennessee we launched a statewide initiative to better reward patientcentered, highvalue care. Over the next five years, tennessee Healthcare Initiative will shift healthcare spending, public and private, away for from fee for service to three outcome based strategy. The first is an episodebased strategy for discrete events such as a joint replacement or pregnancy. The second strategy focuses on identikit transformations that encourages prevention, coordination of care across providers. The third incorporates other value based payment services. With these efforts, it is our hope that tennessee will be at the forefront of a National Trend that is expected to Gain Momentum in the coming years. Many governors are implementing or considering similar statewide multiplayer initiatives multipayer initiatives to assist in their rewards for value over volume. The federal government is supporting many of these efforts to the state innovative models of initiative. Tennessee received a model design award in the first round and in the second round will compete for a second award. Despite these efforts to support statewide information, transformation will statewide innovation, transformation will require a new level of cooperation between state and federal partners. It is a key for states to continue moving the needle toward more efficient care and Better Health status. To this end, at the last nga meeting in february, the voters approved a series of recommendations developed by the task force. We had the privilege of leading the task force is working with the administration of the number of issues including streamlining the federal process for reviewing state innovation proposals, creating a path to permit c4 sustained successful state programs and allowing states to share in savings resulting from their efforts. Achieving these goals will give states the flexibility and the resources they need to transform the Health Care Systems in response to the future challenges and opportunities we will be discussing today. I would like to turn now to the vice chair of our committee, governor peter shumlin, for any remarks he may have. Thank you. I look forward to hearing from the panelists. I do not want to get myself in trouble, but i have to say this has been the most fun, successful summer nga meeting that i have been to, and i that theother governors bet other governors, and last Night Entertainment show was just another example of how youre getting this right. Thank you, Governor Haslam. [applause] it is going to make it tough for any of us to host future summit meetings. Maybe we will just summer meetings. Maybe we wouldve shut them down going forward. We will just shut them down going forward. [laughter] this is an area where we all agree that we have to get costs under control. Todays discussion is critically important to the work governors are doing. Around this table, around the country, leading in our state what it comes to health care, we all working to stop skyrocketing costs that are hammering businesses, hammering job creation, hammering the class, working families, and threatening our ability to invest in other priorities such as education, roads and bridges, public safety, job creation. I know in vermont, as an example, and this is probably no different in other states today come in vermont, we spent . 20 of every dollar we make on health care on average. If we were to see Health Care Costs rise, just for the next 10 years, at the same rate that they did for the last 10 years, that number would double. What i often say is raise your hand if you think that is a prescription for job growth, for economic prosperity, for a great future for all of us. So, healthcare costs is where it is at that containing cost at. Attaining cost there is alignment among stakeholders that outlines base payments moving from quantity to quality is the wave of the future. We governors are prepared for potential challenges that lay ahead, from a rapid, aging population, to increased consolidation of the Health Care Industries we are seeing in all of our states. That are many other trends have implications for Health Care Transformation in our states. In vermont, we are focused on containing costs by covering Health Care Providers and payers with funding from the state innovation models grant, which has been a huge help to us. So, just for a second, imagine the Health Care System where Healthcare Providers, everyone in the system, our doctors, nurses, hospitals, all the other ancillary services, are totally driven to keep you as healthy as they possibly can as a team, and do not have to use as many Expensive Health Care Services to achieve those goals. Second, imagine a system where providers have the healthcare records at their fingerprints fingertips, and an i. T. System that cannot be beat through american innovation, and they are there when they need them. Providers workre with people outside of the Healthcare System to make sure you have the support you need to stay healthy once you move back into your communities and homes such as good housing, good nutrition, active, Preventative Care i often say eating good, vermontgrown food, all of those things, getting off the smokes, exercising, all the things we should be doing. Does maple syrup help you that much . [laughter] maple syrup is that only the suite that you want to use and it has to be vermont syrup. [laughter] changing provider payment so that we pay for outcomes of care, not volume of care that will me a major transformation in our system. And, where we were providers and patients for achieving that where we reward providers and patients for achieving that. Second, Building Systems that link providers together, and third, designing a statewide system for how we target and coordinate services to keep folks getting better. What have we achieved so far in vermont in our innovation projects . We have created shared savings programs for providers. The obvious question is how do you achieve this model, how the move from the model of payment that we have to the new one that goes forward . Shared savings programs are the first step toward valued valuebased payments. We have launched one program for medicaid and one for private insurers. Vermont is the first day to launch that kind of program on a statewide, all payer basis, so that everyone is in Healthcare Providers, hospital executives, everyone around the table trying to figure out how to get this right. We have also invested grant funds in health care technology, as i mentioned, continued buildout of the base between Health Care Providers and the Exchange System is critically important. That includes establishing connections between hundreds of health care sites across the state. We all face the challenge of governors. Finally, building an electronic gateway that will route Health Care Data for quality reporting, care management, and improvements to patient care. Payers all of our major and providers of the state talking collaborative way collaboratively about improvements. Everyone knows it will not be affected unless suite focus completely on keeping vermont healthy. For all governors, the First Priority is quality of care, keeping people healthy. Second, everyone is taking their own approach to health care improvements. That is what we need. , coordinatedl out effort across the state, and, finally, this is what we are building in vermont. So, i look forward to the presentations we will here, the comments of the other governors. I really do believe that the governors working together in a bipartisan spirit with the states as the models for innovation and change in health care is where the rubber is going to hit the road and bringing about affordable, Quality Health care that allows us to spend more money growing jobs and investing in infrastructure. Thank you so much Governor Haslam, and im delighted to turn it back over to you. Thank you, governor peter shumlin. We have a distinct panel. If you could hold questions at the end of presentations. We will set aside a good chunk of time for questions and answers at the end. Let me begin by introducing tom lack of it tom, a director of mckinsey and company who has spent 13 years working to improve the performance of the Healthcare System. He leads the payment sector and the state and local government practice. He also found that health care analytics, a special department within mckinsey. Welcome. Dreyfus, us is andrew chief executive officer for blue cross, blue shield of massachusetts. Prior to becoming ceo, he spearheaded the alternative quality contract, one of the largest commercial payment reforms in the country. He also recently led the Massachusetts Foundation and massachusetts hospital foundation. He led numerous positions in massachusetts state government. Also, found out his son is an aspiring singer songwriter, so youre in the right place. Finally, bill rutherford of the Hospital Corporation of america, one of tennessees in the nations leading provider of health Care Services. They are based here in nashville. Servedhis tenure, he has to hisriety of roles current role as chief Financial Officer and executive vice president. In 2005 he took a brief hiatus to start his own training and education company, and then served as chief executive officer of the Behavioral Service provider psychiatric solutions. , mr. Tom latkovic, i would ask you to leadoff. Thank you. Im with mckinsey and company, a Consulting Firm better known for our work in the private sector, but we also do quite a bit of work with governors and states across education, economic development, technology, etc. , and we are working with a number of states on health care, payment innovation, performance improvement, technology, etc. Today, perspectives will be from our research is a firm in my personal experience working in the public and private sector. I should also clarify where not a political organization. , and weretty much nerds come at things from an operational, technical standpoint, but not from a political one, so none of my comments will reference any policies or pieces of legislation, including the Affordable Care act. I would like to take a step back and make a case for the kind of initiatives going on in tennessee and vermont. Dark water things i want to share with you. One, i think we have a unique time and opportunity to fundamentally change the trajectory of the Healthcare System in this country, and that is exciting. Years of the critical but the change will be difficult. Second other states may not. Third, i would argue that governors action and inaction would be consequential in the private sector and the public sector. There is a huge opportunity for what states do and governors do to encourage, enable, and innovation and to be they willcess path, need to be shifted agenda, capability, and governance. So, to start with, and i am a consultant, so i came with two charts, although two is pretty good. I will not belabor the point, strengths, its many there is an enormous and welldocumented opportunity to improve our Health Care System. There are a number of studies, including some done by mckinsey, that would suggest that hundreds of billions of dollars we spent hundreds of billions of dollars when we need to for the outcomes that we get. Medicaid,ue across and across the public sector. Documentinga paper how intelligent changes in our Payment System could literally lead to saving 1 trillion over the next decade. In the face of that opportunity, which there is strong consensus for, we are experiencing a number of real discontinuities or massive forces affecting the system some of them were mentioned. Increasing prevalence of current disease, it proliferation of technology and data, growing provider specialization, increasing role for consumers, and across all this, inaffordability crisis with an across all this, affordability crisis. Effectively, i believe these forces present a huge opportunity to capture the opportunity in front of us, however if ignored or addressed and effectively, it could make things worse. So, the challenge is harnessing these forces is quite difficult. There are a great deal of stakeholders in the Health Care System. It is externally fragmented. That brings me to my second perspective, which is we anticipate greater separation between states with highperforming Health Systems and those with less performing of their systems. Innovation that is needed will ultimately play out at a local level. It will depend on the actions and behaviors of literally thousands of physicians, hospitals, Mental Health professionals, managedcare company, employers, consumers, etc. Some will make changes more effectively than others. Allow me to be more specific. I will highlight a few areas where i think there is a lot of consensus, not exactly on how to do this, what the elements of success include. One of those factors on a success that is that there is nothing Competition Among sticklebacks there is productive there is a doubt the competition there is part of the competition. Productivee cap, competition is limited because few purchasers understand performance in ways that matter. On a success path, Healthcare Providers will be rewarded for delivering Better Outcomes at lower cost. A failure path will largely continue to pay providers for activity. The last example, on a success path, most consumers would have adequate insurance and savings, agnostic of the approach that we used to get there. The good news is that the state were communities that did on and aay on this success path had real opportunity to experience moderate health cost increases, more in line with inflation, luding Medicare Program or program. In other words, being on the success path has a really long return on investment both for states directly in terms of their budget and medicaid, and in a broader, societal sent. Sense. Much of the change will occur in the private sector, so why will government and state actions be consequential . The Largest Party state influence regulation and infrastructure, which has a profound effect on how the private sector operates, but safety is not just a referee in health care. It is an actor. There is a kiloway linkage between the actions of state takes twoway linkage between the actions a state takes three Medicaid Expansion is in large part a function of the performance of the entire Delivery System in a state. It is difficult for a medicaid system to improve from a cost standpoint without the Delivery System in that state fundamentally improving its performance. That includes physicians, nursing homes, Mental Health professionals, etc. It is incredibly difficult, if not impossible for those providers to change and improve the performance only for medicaid enrollees, thus medicaid enrollees and private sector enrollees are inextricably linked together from a performance standpoint. In that way, the two interact. Lets assume you want to be on the success path. That sounds a lot better. Lets assume you buy the argument that states could make a positive difference in private sector programs and in accelerating private Sector Innovation. What can you do . A few suggestions here at a high , i wouldthe first is argue to start to measure success on what you influence as governors and state, not what you directly control, and from the perspective of citizens and employers. For example, the employer premiums go up or down, did people get healthier or not, how many bankruptcies were there in your state . Onond, shift focus a bit enabling private Sector Innovation where most agree what is required but need help getting over the hump, especially given how fragmented the system is. One of those areas is performance transparency, which is fundamental for productive competition. Another is changing fee for service to outcomesbased payment and that includes episodebased payment and a number of different models. Most Health Care Stakeholders agree that is the right direction to travel, but it is really difficult to get done without a Critical Mass of both payers and providers agreeing on a way to do it, which is why the efforts in tennessee and vermont are so terrific. Another area of consensus, both Human Capital and technology. Lastly, there is an opportunity efficiency at optimal levels of insurance and savings. The other thing to consider in the way of doing that is to consider the influence of the state on health care beyond regulations specifically, both as a convener of the private sector and other stakeholders, as well as a purchaser and medicaid. The question there is both in medicaid and in providing benefits for employers in the state, are the programs designed in managing a way to put you on the success path, a way that is neutral to it, or in a way that actually causes it to be more difficult . The last thing i would say is along with shifting focus and the way you influence things, affecting this change will require identifying your governance model with more integration across various agencies that affect health care and its programs. Another way to say that is who is accountable within each state, in your states, for Overall Health care inflation . Not the medicare budget, but Overall Health care inflation is there such a person . Partneryou will need to to get stronger capabilities from a private sector standpoint, it is all of people that understand the models, healthcare technology, and largescale change, which i think is a different skill set than running administrative programs. The last thing i will say in a few seconds here is a couple of practical things who is on point, name somebody. Invest a little bit of time learning what is going on here at there is going on. There has been more inactivity in a long time then there has been a long time. Use that to build a action plan. Last thing, a number of states are innovating dissipating in the innovation model, it participating in the innovation model, and a number are not. I believe that could be a strong catalyst. Thank you. Thank you. Very helpful. Mr. Andrew dreyfus, we will let you bat second. Thank you very much. The most important point that i want to make to you was actually made by Governor Haslam and governor shulman when they spoke because you have governors from different that are geographically, ideologically, and in terms of their Health Care Markets. They both focus on the same solution, to change the fee for Service System to an outcomebased, valuebased system as central to the solution for both improving care and promoting affordability, and i will tell you a very short story about how massachusetts over the past five years has done just that, and what some of the results have been. Before i do so, you might step back and say is the experience in massachusetts really relevant to our state . After all, are you a deep blue rule, oneparty progressive use of social and other issues, and the Health Care Market centered on large, Academic Medical Centers . What i will tell you is we are much more diverse ideologically, politically, and in terms of markets than you might think, so there are some surprises in our story. From the diverse views within our state, we actually have forged the kind of consensus that the governors spoke about, and in doing so we have tackled some of the thorniest problems in health care, and we have done it right balance in these issues that we just heard about the role of government versus the role of the market how do you balance those two, constantly recalibrate those two forces, and how do we make sure the market and continue to innovate . So, let me tell you about what we have done in that respect. I think you probably mostly know the story of the progress we made on health care coverage. We passed our version of the aca , signed by governor romney, back in 2006, implemented in 2007, so what the nation is expanding in 2014 we experienced dramaticand you see a reduction in the number of uninsured in the state. There are no uninsured children in massachusetts today, in a very small number of uninsured adults, but we had a second problem, it cost problem. Some people say on the coverage issue you started from a stronger point. We started from a weaker point because we are the locus of the most Expensive Health care, not just in the country, but perhaps the world, so we had a lot of work to do on cost. Our plan, Blue Cross Blue Shield of massachusetts, we step back back in 2007 and said how do we tackle the cost problem, and the answer come as the governor said, was to fundamentally change the way we pay physicians, hospitals, and Health Care Givers that moves us away from the volumebased, activitybased system towards one that rewards polity and outcomes. We did it. We designed our own system. It is not the solution. It is a solution, but it has proved to be surprisingly popular and surprisingly productive. So, we started with what you might think of as a pilot or demonstration project in 2009. We had about 1500 physicians covering about 300,000 of our members in massachusetts who agree to accept, rather than fee for service payment, global payment for each of the blue cross members that each of those combineds cared for with very significant quality incentives, not just a point or two of a four performance, but up to 10 on top of what we paid them they could earn if they performed well on a set of agreed on quality incentives. No blackbox. These are transparent incentives that are nationally recognized. These are voluntary contracts, but we rapidly were successful. Very quickly, almost 90 of the physicians in massachusetts, now accept this form of payment. It covers about 700,000 of our members, making it the largest, or one of the largest payment reforms initiatives in the country. At one point, our own government, governor patrick asked me, andrew, how can we move this faster, and i said to him with all due respect, it will not the elected officials or Health Plan Executives who are going to persuade physicians to change something they have been doing for 75 years. It will be other physicians who say i can take better care of my patients under the system, and that is what they started saying. This is not only the largest, but the most carefully evaluated payment Reform Initiative in the country. From day one, a team of independent researchers, health economists, and physicians at Harvard Medical School were hired to evaluate it, and they published in the new england and other medicine, Academic Publications the results that showed us approaching what we all think of as the holy grail of American Health care better care at lower costs. We have the first two years of years threers 2 and four should be published this fall. I will not be able to talk about them because they are not published, but i will just tell you that i am happy about them. What else did we do not only did we ask physicians and hospitals to change what they did, but we had to change. Governor schaumann talked about how part of the solution is having data at the fingertips of the practices, so we put that data at their fingertips. I do not expect you to look at this. Usage of samples of the dashboards we get to physicians these are just samples of the dashboards we get to positions some was as a blessing did you know your patient was admitted to the emergency room last night . Many did not know unless they are on a system. A lot of it was did you know how your diabetic patients are faring relative to other diabetic patients in similar practices across the state here are ideas on how you can get at her. What happened when the physician started looking at this is they started changing the way they provide care to the patients. One of the leaders has talked to me about getting liberated from the tyranny of the office visit. We have constructed our Office System for 100 years around the office visit, and obviously, many times it is very important, but most healthcare takes place between visit. So, what are we doing between visits . The practices started hiring social workers, it embedding them in the practice inventing them in the practice. Embedding them into practice. They have pharmacist looking in medicus medicine cabinets. They start communicating with patients online through telemedicine and a variety of different efforts. They like practicing better. As a consequence, we now have close to half of the physicians in massachusetts except in this form of haman, not just from us, but you need all payer solution not just from us this form of payment, not just from us, but you need all payer solutions. This works in urban practices, practices that serve low income patients, practices in the suburbs, practices affiliate with large, Academic Medical Centers. But, i said is not just the private sector. It is also government. In 2006 we passed our Health Care Reform while, but every year, every two years after that, we passed and our governor signed a costcontainment law. Each law started to ratchet up the pressure until 2012 will we passed a law governor patrick sign that actually says state Health Spending in massachusetts shall not grow any faster than the overall state economy, and you probably know we have been growing at a bill that rate. It is not government that will enforce that law. It is the private sector. That is the balance between innovation and government involvement. Finally, repeating some of what you heard what can states do much mike i79 university of virginias millet i served on the university of Virginia Miller centers panel that looked at these issues and i encourage you to look at those results, to meaning a broadbased conversation within your state on cost, quality and value. Promoting experimentation we are hearing about in tennessee and vermont. Investing in wellness. I know Governor Haslam you have a Wellness Institute you establish and have worked hard on. Obviously, governor shumlin has done so much on the chronic care issue. We know 5 of our patients are driving half of our spending, almost all people with chronic illness. Then, Understanding Technology and the key role he could play. Again, from what appears to be a single, deep blue state, we have had an adverse a diverse experience of market innovation dallas with government involvement balanced with government involvement resulting in a dramatic drop in Health Care Expenses and supported by the physician and Health Care Leaders in massachusetts. Thank you very much. Thank you. Bill. To i. I am bill rutherford thank you. I am bill rutherford, chief Financial Officer of hca and it is my pleasure to be here this morning. I will a tasty i would like to take a few minutes with you. Is theht know hca largest nongovernMental Health care provider in the United States. Over 35,000twork of nonaffiliated efficient, and we operate in 42 markets across 20 states. System, across the hca we will see 7 million emergency room visits, have 1. 7 million inpatient admissions. 80 of our hospitals have been recognized as top performers, and historically, about 8 to 10 of the patients we care for have had no health insurance. We think that gives us a fairly unique perspective on the healthcare landscape. We see more health care than just about anyone across a range of diverse marketplaces. I wanted to share with you some observations. Clearly, what is dominating the discussion in our industry is health reform, efforts to help people gain access to care, and Delivery System reform improvements that we have earned about this morning. Those efforts are clearly continuing to unfold, but we are encouraged with early signs that we are seeing with the impact of that across many of our markets. When we reviewed our First Quarter results, we have about five states across the hca footprint that elected to expand medicaid, and in those states we saw a 30 in uninsured activity as those individuals gained access to 30 decline in uninsured activity as those in the visuals gained access. About onethird of the patients are newly insured. Momentum is clearly gaining on those efforts to help people gain access to care, and we think those are positive developments. I would like to share with you three key observations based on our experience across the marketplace. The first i will share is hca, and provide the systems that we see are investing heavily to create what i will refer to antivalue, innovative delivery highvalue, innovative and they areem, important prerequisites for preparing for changes in the evolution of care and reimbursement methodologies. Obviously, continuing to advance key quality it and a focus on innovation in what is historically a fragmented delivery place between hospitals, physicians, and ambulatory settings. We are investing heavily in technology. Electronic Health Records and other integrated that forms that will allow data to transition to the continuum is one easily. Cost ofd focus on the health care either through consolidating of administrative services, reducing variation, sharing best practices, and a host of other efforts, and most poorly continuing to focus on improving the Patient Experience and most importantly, continuing to focus on improving the Patient Experience. All of these are in an effort to bring together a hospital effort, a physician network, and ambulatory network tied together with technology in an effort to improve health value, outcomes over cost while improving the Patient Experience. I believe these are three key ingredients for success in prerequisites as changes in the Health Care System occur. The second observation i would like to share with you is the payment reform and valuebased purchasing is garnering, probably, a lot of attention. We see the models and limited to the slowly across many of our markets and in various forms. There are clearly models being introduced by governmental entities and commercial entities. We have new payforperformance entities in many payer relationships that largely theide incentives for achievement of certain quality or otherobjective objective measures that we heard about in massachusetts. We think it is really a prerequisite necessary for providers to continue to strengthen their Delivery System capability through integrating, technology, focusing on cost, and improving the Patient Experience. They are all important success factors that will survive and be important under an array of different payment mechanisms that might be in the marketplace. Lastly, the third observation i will share with you, as you may know, there are still many regulatory hurdles that likely will slow the pace of the evolution integration in the marketplace. We know there are many regulations that govern the relationships between hospitals and affiliated physicians. As we search for ways to provide incentives and the line key objectives, often times and the line key objectives, often times you have to set of administrative and public structures that require time in order for evolution to see in the marketplace. We also know there is a lot of administrative costs in Health Care System. Is ourantage of hca scale, that we are able to leverage our scale, if you need to work on reducing those costs and many of those are redundant between pairs of providers continuing to search out how to payers and providers. Continuing to search out how to reduce cost we believe is an important component. It is an exciting time health reform, efforts to help people gain access to care will be Important Development to no marketplace, and we are encouraged with early signs we development to our marketplace, and we are concerned encouraged with early signs. Bringing hospitals and physicians together to invest heavily in technology to be able to transport data and information that will help reduce the cost structure. Payment reform is occurring, unfolding at a moderate pace across the country. We think that will continue to accelerate and it will be an important component for Delivery System reform improvement. There are still initiative and revelatory activities that are real and operational that we have to deal with as we think about evolving the marketplace that will facilitate our move to the next generation of health care. So, it is my pleasure to be with you this morning i look for to questions or the discussion points. Thank you, governor. Thank you, bill, tom, and andrew. I will open it up for questions, but let me ask the first one. I think we all see the reality of Health Care Costs are driven by folks dealing with chronic disease or endoflife, and as we talked about patent reform and moving away from fee for service, how does the fact that, you know, the cost somebody here might know what is the cost of those two . Members is chronic, and they account for health half of the spending. So, if you have chronic illness and endoflife, youre talking about a big chunk of what health care is costing us. Given that, as we talk about payment reform and fee for service, given those realities, how does fee for Service Impact the world . Let me start on the chronic illness side. Almost the first thing that Physician Practices do when their given a different set of incentives if they focus on the patients with chronic illness because those are the patients that they see the most, are hospitalized most regularly, and most of the time those hospitalizations could be prevented if the patient chronic conditions could be managed more effectively. I sat with a practice in california that has eliminated and missions for patients with congestive Heart Failure because they are monitoring the patients in the home with electronic scales tied to the physicians offices, making sure the medication interactions are working appropriately, having a lot more homebased care. This is common to endoflife care and chronic illness trying to move the care out of the hospital and with all due reverence to the hospital were presented on the panel, i am sure he would agree that we only want the patients in the hospital who must be there. Most patients with chronic illness, they can avoid hospitalization, and if they are hospitalized, to prevent them from being readmitted to the hospital. So, there is a huge opportunity there. Many patients with chronic illness also have a psychiatric or Mental Health diagnosis, and managing those much better, we know patients with chronic illness will consume more services. So, getting the Clinical Team focused, and i say Clinical Team because health care is moving from an individual sport to a team sport, and as a team sport, nurse practitioners, pharmacists, social workers, care managers are making a difference. Variety ofad a chronic illnesses and she would often call her physician up and she just had a question about a symptom and he would take him to the office, i will take a look. She did not need to be seen. Mrs. Dreyfuss, lets change of medication, and that would have helped a lot. It wouldve saved a lot of money. It is a great opportunity and a great question. Epic is a great question from my view, dealing i think it is a great question from my view. I think there are some prerequisites. You have to bring the system of care together because as you mentioned, it requires a lot of different settings your primary care physicians, outpatient settings, specialists, postacute, and a lot of other activities. So, the first effort is to be able to collaborate what in many communities today is still a fragmented Delivery System. So, investments in technology to be able to transport data across those different continuums and provider settings is a very important prerequisite to occur. Creating structures that allow flow of information and other information to flow so that we can better manage those patients for the right condition. Other questions from the governor . I could keep going. My question is for mr. Tom latkovic. You mention in your presentation you call one of the essential first steps toward moving toward quality of care payment based on outcomes versus Services Performed was a transparent, factbased measure. Could you give some examples of some factbased data systems that the public could see . Sure. Sure. It is a great question, and i think there are two things i mentioned. One is simply there are some Overall Health care statistics in a state like premiums or Health Status, things like that, that are useful to track, but in terms of what will help actual providers make better decisions were compete on value, or help consumers trying to make a decision about which health care to, the trick is most of the data provided is selected the way the system is structured. As ill described, in any episode as bill described, lets say in an episode where you have to get your hip replaced, there could be a dozen providers you interact with over that episode of care, and today, the data released, it if it does exist, you might get a glimpse of those 10 providers. What you do not get a glimpse of is any sense of physically the surgeon doing the surgery or the hospital how does the performance look in terms of the entire episode of care . That would be a slightly different way to show transparency. Another example would be, as andrew described in their model, if you have a primary care physician or primary care team that is that historically were just see you in terms of office visits, as a consumer you almost have no way to know which of those teams or individual clinicians would do a better job in helping you manage your chronic conditions or a worse job. At asked, you might get a little bit of information as them on ms providers. The real trick with performance is not just the data, but framing it in a way that is actually usable for consumers, employers, etc. That, andfollow up on pick up on what andrew said, is moving from an individual sport to a team sport, so youre moving from playing a small what you are up that that, with the ball is he to you, where you are playing soccer or basketball, we record meeting with the team how ready is our entire Provider Community to play what looks like a fairly different game . Are different states of evolution. In some cases there is a generational divide, and some older physicians that are used to practicing the way they practice, and maybe one decade or less to retirement say i want to keep practicing that way. Younger physicians and older physicians that have come to see it better. Ike they see they can spend more. The chronic patients you cannot have a 10minute visit with a patient that is on eight to nine the medications and has multiple conditions cancer and depression, serious arthritis and asthma you cannot manage those patients in 10 minutes. Once they see they can be limited liberated from the 10minute office visit, they like it better. They see the value of the practitioners. This has been going on in edx for 20h in pediatrics years that needs to happen more often in adult medicine. Governor shumlin talked about having the data at fingertips. Some practices are wired. Some are not. It is important that we have some world practices that are not rural practices that are not yet wired that are performing previously in our new payment model fabulously in our new payment model. My observation, i agree with andrew i think it is very different in very in different communities across the country. There are certain places that are both culturally, from infrastructure standpoint, and from, you know, a formal sense, the way providers aggregate to each other or relate to each other is very Different Community by committee, and that is part of the reason why we all agree there is no single solution that will work everywhere. It will require differences in local markets. Ahead. Rnor herbert, go well, thank you. I appreciate that the watercooler topic of the day in most states is of care, and bill, you said it is an exciting time in health care. I guess that is the understatement of the day, because i think it has become and has been very divisive. It is a complex issue, and we appreciate the fact that you are coming here to shed some light on the issue for all of us. Utah thatm a state in is generally considered a healthy state, one of the healthiest in america. Been rated as the lowest cost for health care in america with about the fifth rated asked quality the quality. So, we are doing very well. We are below the National Average and those that do not have average access to health those couldlf of have helped her, but chose not to, for whatever reason. Care, but chose not to, for whatever reason. Mandate,we have this the concern is will go from a good system to the average. Cost and lower quality will say this is good, we are moving to the average. In massachusetts, you are grateful you are slowing the rate of growth in the highest Cost Health Care in america, or the world, and we do not want to be that high. So, my question for all of you is a simple, basic philosophy. One, i think we all share the same goals, although i did we do not define the goals very well. Is the goal for Health Care Reform in the future to be dues the cost of health care . To reduce the cost of health care . Is it to improve the access of health care . Is it to have better quality of health care . Maybe it is all of the above, or additional things. Where we disagree and the divisiveness is how do we get there what is the effect of process to get there . As we look at the history of america and our tradition of the free market system, free market competition, individual choice in making those decisions coupled with individual , some arelity concerned that we are moving away from that. Yeah. So, why, if we think historically that free market competition, individual choice and opportunity has given us the best products, the best service, for the most people at the lowest cost, why do we seem to be moving away from that that is a philosophical question and im anxious to hear you. Governor, it is a question of the nation right now. Couple of thoughts. First, you are right about all the comparative information. Is so the reasons utah successful is because they have systems such as the intermountain system, which was one of the early adopters of these practices we are talking about, and one of the first exchanges in the nation that was a private market oriented exchange. When the aca was passed, it anticipated a uniform national set of standards and activities that the nation would adopt. As a result of the Supreme Court decision and actions by individual governors, we are going to end up with five or six flavors or variations of how the aca is going to play out in various states. That may be a really positive thing. It allows for different models for different states that have different markets, different sense of what that balance is between five innovation and government involvement, different political cultures, and different Delivery Systems. Think that state experimentation variety will take us very far and governors can take the lead in that. That is why i said initially the statements that our cochair said comic from two very different states but showing extraordinary leadership in their states coming from two very different states but showing extraordinary leadership in their states. The best care at the lowest possible cost. We want an efficient system. Our system has a long way to go to promote the kind of efficiency you have established. Know that people who have coverage get that her health. It is not just that they have a card. The card is just a start. Betteretting them to health and respecting individual choices that people want to make. Let the state experimentation flower. Governor sandoval . A lot of the focus has been on changing a providers system, moving from a feeforservice to Outcome Based Services that rewards quality in outcomes. We have set a goal in iowa of becoming the Healthiest State in the country, which from where we began i guess 19th, and we are tense today. 10th today. The only way it works is to get take ownership of their own health, instead of looking to their Health Care Provider to have all the answers , to get people to make healthy choices, whether it is not using tobacco products, exercising regularly, making good choices in terms of nutrition and all of that, and then trying to align the provider reimbursement so that it also rewards and supports that. I guess i would like your reaction to that. I dont think all of these efforts work unless you get a buyin from the patient. There are too many people historically who i just look to my doctor for answers, as opposed to taking ownership of my own health. We are trying to lead by example and do a lot of things and get communities involved. We have these blue zone communities, and we are setting all this focus on that. Reaction fromhe the panel to that strategy that we are in the process of implementing. Fromiveyear goal is to go 19th to first. We are in the beginning of the third year of this. I am familiar with the strategies, and my colleague john forsyte speaks highly of the commitment you have made. Blue cross blue shield likes the idea of blue zones. You are right. You may have heard this before, the most expensive piece of medical technology is not a positron emission scanner, but a physicians pen because they are ordering the tests that cost so much. Piece of expensive medical technology is strapped to my belt, a pedometer. We need to engage patients at multiple levels, first in their , setting Ambitious Goals and getting people to participate. Both cochairs talked about tobacco, diet, nutrition, exercise. The second piece is, how do we products thatce place some responsibility on the patients to think about their own care, and how do we couple that with transparent public data that allows them to make steer orand how do we encourage patients to choose highvalue types of care . That is the advantage of consumer driven products in which patients have some skin in the game, some financial responsibility. We know from the early results that when that happens, they make different choices. Ask about Health Risk Assessments. We are trying to incentivize people to do Health Risk Assessments so they know their own risk factors and can work on those. That is a big role for employers, especially large employers are embracing that. Wellness at the worksite is an important setting. You have to understand your own health before you can know what actions to take, in collaboration with your physician or another caregiver. We have one program where we are paying the patient, the doctor, and giving incentives to Small Business owners together to promote the health not big, thousand Person Companies we find it is that circle, if you get all three focused and aligned around health and wellness, you will start to see actions. To build on that with some respects, in many Consumer Incentives are ahead of incentives of the delivery the issue in most parts of the country is the incentives are at odds with the consumer incentive. At minimum, i would say it is an incentive for the provider, the it up position or hospital. Specific examples, if someone at a hospital is being discharged, the hospital in most parts of , but they are it not really compensated to spend time understanding the medications. In many respects, what we need to do is catch up with the consumer and make things her things are aligned. Thank you governor. Listening to garys comments about your talk, that is very impressive. We made the decision to opt in with respect to the Affordable Care act. We were 49th in the country. Addinggoing to be 300,000 in short lives within a year. An immense amount of people coming into the Health Care System, many of whom have chronic diseases. I feel like we can bend the curve with respect to utilization and healthy living. The place where there is going to be a challenge is with regard to Health Care Costs. I would like to hear your thoughts and observations with regards to those costs. 80 of these lies will be in managed care. In nevada, we are trying to do everything we can, implement sose wellness programs, people are living healthier. As i look at what we are facing in terms of costs for that. , i dont know what to do. I would like to hear your thoughts. That is an easy question. I will take it. [laughter] that is incredibly different. That is the challenge of the western world. The truth of the matter is no one understands. A couple of the ingredients, there is reasonable consensus on, and it can be a helpful start. Activities that andrew bill described, was most people believe that there is an opportunity reduce inefficiencies in the Current System. Most people also believe that to change the actual rate of growth, it will require permanent changes, especially in the payment incentive system. There are some things you can do in the near term. That can reduce cost in the nearterm. Cross changing over time, you have to see how consumers behave. You have to think about the health of the population overall. You have to build longterm incentives for Health Care Providers to be inventing new ways. That is a longerterm challenge. Changes inermanent how you pay for and reward health care. If i can add a couple of thoughts there. We are trying to make advances in vermont. In planing last, when you look at big picture what is happening across all of our states to varying degrees, we are spending more than anyone on health care for less good outcomes. Long than countries that spend a lot less. We have higher infant mortality. We continue to have Health Care Costs that are higher than our income. Since i believe that money drives america that is what we do best, we are the best and trivial place in the world. You have to bring your providers around to the thought that they with abetter financially different Payment System. I believe that is true. When they actually sit down and work it through, they realize it is true. Maybe it is different and urban states. But in my rural state, most of my Hospital Administrators and providers believe that the Current System is not sustainable. That is a big one. We are not talking about the Corner Grocery store going out of business. We are talking about our Healthcare System. I had an experience a few months ago where i go down to the southwest part of my state. My Hospital Administrator is flipping out. The nearest hospital next to him , after 160 years of business, went out of business. First it was governor patricks problem. Attacks, having heart strokes, babies, getting cancer, and they did not know where to go except my hospital. What we have done is put together and this is really important we literally were given this technology to providers. When they are getting on one uniform system where they can actually measure a out. Theyey do that, they see can get Better Outcomes for less money. We sometimes forget that is what Health Care Providers want to do. Doctors, nurses, and the team arent trained to make it will navigate a to complex Payment System we currently have. I think the way you get the telln is governors cant their providers that we are going to do this together and you will love it. What we can do is have a very deliberate and carefully that allowstnership us to facilitate providers figuring out that they can do with a love to do, which is make people healthy, and a Payment System where they get rewarded and betterntity quality, and measure those outcomes so that those who are doing the chronic care dont end up getting punished for a system pays for less quantity and more quality. It is doable, but you have to have those three pieces, the ig, the buyin from the providers, and very measurable, agreedupon outcomes. This is so you are improving quality. I have a question for mr. Dreyfuss. , 85 of the Health Insurer Insurance Coverage is provided by north blue cross and blue shield. Why can i not tell blue cross that i can offer the alternative quality Care Contract and save myself years of groundwork trying to develop something . Youre going to get me in a lot trouble from my colleagues. Dont get any ideas governor. They care a lot about. Theyre texting north dakota blues right now. [laughter] becauset that far off the entire blue system is working on a model. The reality is the model i describe works great for people who live and work in massachusetts, but we ensure a lot of companies who have people that work across the country, in north dakota, in vermont, and. We have to be able to link our thats to payment models other states have. We are working on a National System that wont be identical. O this having said that, you have this idea as a governor setting a yourtion and pushing largest payer to accelerate their work around payment and delivery form is in a book is anole appropriate role. You dont have to write a lot of the regulations. You dont have to create a lot of organizations. I got some calls from a governor like that. I did not like in the first time. I want to make the point to preach a little patience. Thousands ofof americans who turned 65 every week and into the medicare system. There is one thing that does not get written about enough. Some of them have insurance, they work for companies, and some come in uninsurance. Uninsured. The was a come in uninsured are more expensive for the first two years. They have these chronic conditions. After a few years, they even out. The 300,000 newly covered people you have in nevada, some of them are ugly have not had insurance for years. For the first year or two they will be a little bit more expensive. We learned that in massachusetts. Dont assume that they will be more expensive forever. If we get the right systems in place, we can get the Health Care Inflation down. There is going to be a lot of attention to premium increases ,n the fall in different states and why is that, and we will have a lot of debate. If we push these kind of payment delivery reforms, focus on chronic illness and prevention, you will get the results you want. Your Health Status will improve. Your costs should not skyrocket. We need to move. I know youre going to close this off. I would like to make an observation. I think everybody here recognizes, and andrew, youre right, you learn from massachusetts. We put an exchange in place, which is a little bit different than yours. And thats more of our culture and desire to get Better Health care in utah. We learned from massachusetts. I hear some great things coming from a run vermont. I am concerned about the approach of onesizefitsall. As a committee, one of the things we ought to be pushing is to give states the opportunity to find their own way with their own unique demographics. They have their own unique challenges. They are all different. Nevada, they are similar in some ways, different in other ways. Our needs are different. Our challenges are different. Our solutions will be different. Lets make sure we give states the opportunity, these laboratories of democracy, where we can learn from each other, and probably grab a toy gravitate to my summer area. We will learn from our successes and failures. We will actually find that , andal place as a country get to the place where we want to be for healthcare reform. Thank you. You, mr. Chairman thank you for your work. I want to thank our panelists. Summarywe got the best we can get. We are at a time when not much is happening in washington dc. You have to make decisions and get things done. We will Work Together in a bipartisan spirit to do. I want to thank the nga staff for putting this panel together. As gary johnson, we are going to be the laboratories for change in health care to improve quality, reduce cost, and get Better Outcomes. If we can use this form, and the conversation we just had here as the feel for that transformation, we will all win. We can get this right. It boils down to governors having the courage to Work Together with our partners to push her we need to him of will where we need to, and share common discoveries where we need to. Is critical to job creation. It is critical to the quality of life. We have got to find ways to reduce the cost. Were trying to achieve prosperity. Thank you, mr. Chairman. Thank you am a panelist. Thank you, governors. This is the area where the nga can make a difference helping to be the tools laboratories for change. I think what you just heard from governor herbert is why we have nga. States. Different two different jealous ideologies. You will hear more agreement than disagreement as to the key issues. I really appreciate that. I do want to thank our panelists are you guys are terrific, very practical, very specific. Thank you very much. [applause] before we break, we will have a one and a half minute update on the center for best practices. Thank you very much. Thank you very much. I am Division Director at the nga. This conversation was a perfect segue. We want to announce that after ,he hard work of this committee one of the request that came out is if there is a way for the center to work to give individual states the ability to move forward with the federal government and negotiate individual authorities under medicaid around say transformation . We have been working these last few months. I want to thank the Robert Johnson foundation. We will be announcing in the next week or so on opportunity to Work Together to negotiate with the federal government new, broad authorities. These are individual authorities for each state. Not a onesizefitsall approach. To funding will allow us hire some leading National Consultants to assist the states. We will have an expert panel that will be working with the states in the federal government. We have received confirmation from leadership that they will ateam to bear on this so we can have constructive conversations. It would take about six weeks to respond. The lunch will be in october. We work over the next year with the individual states and with our experts to try to reach , broad say what authorities a medicaid. After it is over, we will be working very hard to build a template for other states and justin and receiving these kinds of authorities. We want to accelerate and move past the barriers that we often see in these discussions. Is there the ability to let states tilde had little bit and the discussions . If they use these templates. If youre interested, reach out to us. Highstakes. High rewards. Are we good . I want to thank everyone who attended. This is a great session. Thank you to nga for making it happen. Good job. [applause] coverage of the National Governors Association Annual summer meeting in nashville continues tomorrow. The closing session of the nga summer meeting will record that included marks remarks. Life coverage begins at noon eastern on cspan. Next, a congressional Gold Medal Ceremony honoring Raoul Wallenberg. Definition the legal in the u. S. Then a discussion on health care. Baseball the strike me i dont want to get metaphysical on this. Its a good sport and the National Pastime of a democratic nation, because democracy is settling, youse, dont get everything you want. Baseball is like that. Every team that goes to spring training knows it will loose and when. They have a whole season to sort out everything else. Youre mediocre if you win 10 to 20 games. Games, you have a good chance in october. George will on his latest book on baseball and Wrigley Field and the recent controversy surrounding one of his columns. On the night at 8 00 p. M. Eastern and pacific. On wednesday, a ceremony was rl Raoul Wallenbergwallenberg helda gold medal to Raoul Wallenberg. Speakers included Senate Majority leader harry reid and mitch mcconnell. House Speaker John Boehner as well. This is about one hour. Ladies and gentlemen, welcome our honored guests, members of the United States of the house of representatives, the house and senate, and the speaker. [applause] ladies and gentlemen, the speaker of the United States house of representatives, the honorable john boehner. [applause] ladies and gentlemen, good afternoon and welcome to the United States capitol. We are honored to be joined today by members of the diplomatic corps, former ambassadors, representatives of the state department and u. S. Mint. And leaders of the u. S. Jewish community throughout the country. , intly before christmas 1944, Raoul Wallenberg did something that many of us had to do. He told his mother he would not be home for christmas. I must send you my best wishes for christmas, he wrote. I hope the peace so long for is not far away. Addedttom of the note, he , lots of kisses to nina and her little girl. Sister. Brought will she is with this along with several members of the family. Thank you for being here. [applause] by the time he sent that letter, Raoul Wallenberg had saved more lives and we can count. He had done much of the work on his own. Dumbfounding, that the 90s and their guns above his head. Called the churchill most horrible crime ever committed in the whole of history. Cowered. Man, they like ald say he was comet across the dark sky seen once in a lifetime. He burns on, which is why we are all here today. In american history, only seven individuals were made honorary citizens. The first was winston churchill. Honor, we added the congressional gold medal, a tradition that began with George Washington himself. This metal is a tribute to a citizen of the world, but it is more than that. Honor hismmitment to family and his memory. Nd to tell the story it is the least we can do. His deeds may be beyond our capacity to limit his lessons are not. Is always to fear courage. Not one,ods children, is alone. Of course, honoring your mother. I hope you all enjoy todays program. [applause] ladies and gentlemen, police stand for the presentation of the colors by the United States armed forces color guard, the singing of the national anthem, and the return of the colors. [indiscernible] ladies and gentlemen, remain standing at the chaplain of the United States senate, barry black, give the invocation. Let us pray. Lord god almighty. Judge of all the earth. You are the sovereign lord of history. As we meet today, to honor with a congressional gold medal and in comparable humanitarian, Raoul Wallenberg. We praise you, o god. For you see him as an instrument of your mercy. We are grateful that you equipped him with the requisite skills and talents to become the right person in the right place at the right time. Thank you. For using him to organize and negotiate in order to save 100,000 jews from extermination. Today, as we celebrate the contributions of a man who captive so that people fit toive free, make us be, a Liberating Force in your world. From the slavery of negativity and from the bondage of selfishness. Purify our hearts and guide our purpose that your will may become our will. We pray in your sovereign name. Men. Gentlemen, United States representative from the Fifth District of new york, the honorable gregory meeks. Mr. Speaker, distinguished members, colleagues, all distinguished guests, i am delighted to join with all of you this afternoon for the congressional Gold Medal Ceremony honoring the life of Raoul Wallenberg. It is my distinct honor to have played a role of one of historys most unheralded heroes. Gratitude toepest the international Raoul Wallenberg foundation as well as ,y Congressional Colleagues especially the cosponsor of this bill. Learn of the remarkable asked of Raoul Wallenberg in my Elementary School or middle school or high school or college or even law school, for that matter. It was through entities like the international Raoul Wallenberg foundation, and other institutions and individuals that i became aware of the sterling deeds of this great man. The more i learned about Raoul Wallenberg, the more i was convinced that Congress Needed to acknowledge his legacy. That we could inspire future generations of americans by what Raoul Wallenberg accomplish. Overwhelming bipartisan passage of legislation reflects the undeniable interest to keep his legacy alive. I have had many moments of quiet reflection on the Raoul Wallenberg story. As we look to tackle the violent conflicts and unthinkable oppression around the world today, i am reminded that even in the midst of the most grotesque acts of inhumanity, one person can make a difference. That is regardless of any differences that distinguish us from each other. The moral courage of one person is sometimes enough to make all the difference for all of humankind. S boy, Raoul Wallenberg still echoes across the generations, his actions reverberate in time, summoning us at with the brokerage to do in our time when he did in his time. S legacyllenberg challenges us to coming together , to collaborate, to cooperate for humanitys sake and against the threats to human dignity, human rights, human life. I am honored to be one of the greatrs to honor this human being. Thank you. God bless you. [applause] ladies and gentlemen, United States senator from new york, the honorable Kirsten Gillibrand. [applause] today we are proud to honor Raoul Wallenberg with the ,ations highest civilian award the congressional gold medal of honor. During world war ii, Raoul Wallenberg chose to leave his life of ease in sweden for a diplomatic assignment in hungry, which was an allied not see germany. His assignment was a result of a save thent of oss to remaining hungarian jews from the holocaust. Effort, mr. Raoul wallenberg exceeded beyond all reasonable expectations. He provided swedish passports to thousands of jews. It literally made the difference between life and death. Raise thewallenberg and protected by diplomatic immunity. Within these buildings, he housed, protective, and say almost 10,000 precious lives. Gs braveryallenberg; and will to act as an example to all of us. Raoul wallenberg once climbed onto the roof of a train with jews departing for auschwitz, handing protective passports through the doors admit you from guards. Got dozens of those is a in a diplomatic convoy. Adolf eichmann moved to kill all the remaining jews in budapest, Raoul Wallenberg had a threaten hungarian leaders to prosecute him for war crimes. Was takenenberg prisoner when the soviet army liberated budapest. Hero inlook up the word the dictionary. , it tells is a person who is ,ired for great acts of bravery a legendary figure and down with great state frank, one who shows records. The word hero is sometimes used gratuitously. Raoul wallenberg truly personifies it. He was willing to raise his own lies for the others. He shouldnt dedication to humanity and a responsibility for all of us to seek out against atrocities. His enduring legacy lives on in the countless descendents of those he saved. I want to close reflecting on dr. Barry blacks rare to open the ceremony. Raoul wallenberg was placed there for a time such as this. All of us are placed where we are in our lives for a time such as this. We should never forget. [applause] ladies and gentlemen, mr. Olander. In the midst of the black storms. Ame a breeze of cleanest air and nobody could call behind words like trapped in ensnared. Us. Solitary man amongst glory to his name. Hope in agleam of world. He stirred farm to his ways. Or from true go far away. No shields upon his arms. No sword. And with cunning tricks, he snatched the victim. Us. Solitary man amongst now with glory to his name. Hope in agleam of world of guilt and shame. Like something in churning he stood firm to lead the denyo that no one could from true then far astray. And the light poured in freedom they could name my twin headed dragon he was stolen without shame. [applause] gentlemen, the democratic whip of the United States house of representatives,. He honorable steny hoyer [applause] as you have noticed, i am not nancy pelosi. She is outofstate. She wanted me to give you her very best and great respect. Leader harry reid, leader mitch mcconnell, eric ,antor, Kirsten Gillibrand gregory meeks, who sponsored the legislation. Raoul wallenberg foundation. I am pleased to be here. Unfortunate, nancy pelosi could not be with us, that she asked me to convey her greetings to all of you and express her familyde to the entire along with her congratulations on the presentation of this gold medal. Whoever destroys a single soul, it is considered as if he destroyed an entire world. Life, it iss a considered as if he saved an entire world. Raoul wallenberg saved 100,000 worlds. Whosescendents of those lives were spared, because of his courage and conviction, number like the stars. Ceremony as medal not only a moment to reflect on his heroism and his role as one of the most consequential , itteous among the nations is also an opportunity for all of us here to remember the lesson he taught us all through his example. It is a lesson as applicable today as it was amid the horrors of the Second World War and the holocaust. Never toon is for us be indifferent. Never to be a bystander in the face of injustice. Never to say, someone else will do the right thing. So i dont have to. Like his countrymen in sweden and those adventure begin in israel, in hungry, around the world, americans honor Raoul Wallenberg. We see in the man and his incredible act of resistance a reminder of the same values that led our nation to fight for the liberation of europe during the Second World War and to support movements for human rights, selfdetermination, and democracy ever since. Himress under him by making an honorary citizen in 1981, as the speaker pointed out. Likeness a bust of his that stands in emancipation hall. Today, we continue to work to celebrate his life and his heroism for which millions continue to give thanks. On a personal level, i am , raoull to your brother , for making possible the years of close friendship i was so very fortunate to share with the very extraneous american, next ready hungarian. All americans are indebted to him for the Irreplaceable Service to this country. As a member of this congress and a moral voice for human rights around the world. As a result of the many survivors, who have work to combat the forces of bloodshed and intolerance that marred the early years, Raoul Wallenberg works of saving lives continues to this day. Will pray that continues for generations the calm. The veneer ofat civilization is paperthin. We are the guardians. Rest. Never we must never rest. We must never forget. We must never forget the tragedy to tell the victims, the determination of the survivors, and, as we do today, the unbelievable courage who resisted and risked their lives to save others. ,oday, we present a goldmedal a goldmedal in remembrance of someone who was the gold proposition the that we are our brothers keepers. [applause] ladies and gentlemen, the majority leader of the United States house of representatives, the honorable eric cantor. [applause] fieger, leader harry reid, to my colleagues, and other members of the Raoul Wallenberg family. You todayonor to join to recognize one of historys man,e heroes, a remarkable Raoul Wallenberg. History has taught us that war and an overzealous close for our can bring out the worst of mankind. Throughout world war ii, we saw the advancement of tyranny and terror, along with the destruction of cities across the globe. We also witnessed the greatest tragedy of modern times, the holocaust. Like so many of you, i have visited and walked among the ruins and ashes of the death camps of auschwitz. Dumbfounded i was by how evil can overtake human kind. Undeniable, war was which is why history demands that we are here and proclaim, never again. Us same history has taught that through suffering and sorrow we can find the best of mankind. The one man that we honor here today, Raoul Wallenberg, provided strength and showed fearlessness while saving the lives of thousands of innocent people. He would eventually give his life to prevent men, women, and children from entering the death camps. Those he saved were people he had met and people he never knew. In the jewish faith, we believe that god works through messengers. I truly believe that Raoul Wallenberg was one of historys greatest messengers for freedom and peace. , ithe spirit of redemption is written in isaiah, the people that walked in darkness have seen a great light. To those were rescued by raoul lightberg, he was there that shines in their darkness. , and for to mankind these of the world, will continue to be immeasurable. The United States of america will remain forever grateful. Thank you. [applause] ladies and gentlemen, the republican leader of the United States senate, the honorable mitch mcconnell. [applause] as a young architecture , raoul in michigan wallenberg once wrote the following to his grandfather back in sweden. In my littlehome ann arbor that im beginning to have a hard time imagining my leaving it. Just over a decade later, Raoul Wallenberg would vanish, never to be heard from again. Between,short years in he found a different calling far from ann arbor. For as long as the story of world war ii is told, people will marvel at the good this man did. Between Raoul Wallenbergs youthful dreams of a pleasant and his eventual disappearance, he would fully and completely embrace the role that fate had handed him. There are countless acts of courage and daring he would not only earn a place in our hearts, he would earn a permanent waste in the pantheon of historys great men. He would become a hero for our times. And for all times. The context of Raoul Wallenberg s actions is wellknown. 1944, troops and hungry began to accelerate their wicked plan to eradicate hungrys jewish population. President roosevelt became aware of the situation and was determined to act. Representative a of the american war refugee board to neutral sweden to find someone who could lead a rescue mission for hungrys remaining jews. It was one of the great headhunting successes in history. Raoul wallenberg was clearly the man for the job. Few. Ools were with little more than a swedish diplomatic passport, american support, and an unswerving believe in his mission, and immense, immense personal courage, this remarkable man men, go on to save 100,000 women, and children. In 16month. , it is said they worked around the clock, at times without. Ating or sleeping one fellow member of the swedish litigation explain his success as a diplomat for a neutral country. As is the way he put it. He began his mission with only one source of power, an unfaltering faith in himself buttressed by the justice of his cause. With no army behind him, his passion and his cunning would have to suffice. Staff latern his recalled an incident where 800 and. Jews were being deported on foot to a concentration camp in austria. Raoul wallenberg caught up with him at the frontier. And on the basis of no earthly authority whatsoever, he issued a stern demand, who of you has the swedish, protective passport . Raise your hands. Between the columns and told people to raise their hands, whether they had a passport or not. As he remembered it, Raoul Wallenberg took command of all who had raised their hands with such confidence that none of the guards opposed him. Given the virtual impossibility of his task, we remain amazed today at Raoul Wallenbergs achievements. Inn he arrived in hungry early july of 1944, and he had few contacts of any influence. His knowledge of the language was limited. He had no official experience as a diplomat. He had a fire that burned within him. He found a way. When there was the creation of thousands of special swedish or the housing of tens of thousands of hungarian jews in the dozens of buildings he bought, he found a way. When the russians finally sees wereest, so many houses flying the familiar blue and , someoneag of sweden remarked that he must be in a swedish city instead of a hungarian one. One man, one man, did all of this. We honor him for his courage, his heroism, and his extraordinary example. May the memory of Raoul Wallenberg always inspire us to be our best selves or others. [applause] majorgeneral, the majority leader of the United States sentiment senate, the honorable harry reid. [applause] olander, i am familiar with your musical instrument. That was made popular in america. Instrument, instrument music, and wonderful voice was a perfect setting for this wonderful event. Thank you very much. [applause] as we look around this wonderful gathered in the hall of heroes. Rounders,g us, all our statues and busts of great men and women whose courage we praise. Rtwork adorns these walls they all remind us of their contributions. Even in the company of such iconic figures, the heroism of a young, swedish diplomat, Raoul Wallenberg, is remarkable. E of those resigned hisrined in the rotunda, heroism was not facilitated with physical power. Raoul wallenbergs was born of his audacity and his courage, not his physical courage, but his moral courage. Machine, Raoul Wallenberg fought for thousands upon thousands of hungry jews. He refused to accept their fate. Courage, the, his swedish protective passport, Raoul Wallenberg dispersed to do throughout budapest. Raoul wallenberg had the audacity and courage to purchase safe houses for jewish refugees. He labeled the buildings have swedish territory. Had thellenberg to bety and the courage in german uniforms, stationing them outside protective shelters, marking those houses off limits to the germans and their sympathizers. Raoul wallenberg was so audacious, so courageous, he even confronted a dog i commend. There are many stories about this. Courage resort lives. Some of those who all their lives to this diplomat are with us today. One. L make mention of a survivor who is no longer with us. I can see in my minds eye is posture, white hair, and that great speaking voice in a hungarian accent. I was fortunate to travel to budapest. Friend for aed our twohour tour of the city. As we walked some of the streets , he relayed his vivid experiences. These were personal experiences. His experiences were as living in a young, jewish boy and occupied budapest. Twice. Arrested twice. Ged to escape but he was determined not to be caught a third time. Tom had to tell the story het his lifes companion, and a Network Little kids together, and he saved both of live ad allowed them to happy life, having 17 grandchildren. For the rest of the war, tom lantos lived with his aunt in a safe house established by rob whalenberg. Ral he soon fall the footsteps of his young, swedish diplomat. Tom lantos with his blond hair and blue eyes, navigated his way delivering critical information to budapest jews. Saved byung man was wallenbergs audacity. Toms daughter is here today. Thehas called Wallenberg Moses of the jews. May we never forget his courage, his audacity to do good. As we have heard, one man and courage can make a difference. He made a difference. [applause] ladies and gentlemen, the speaker of the United States house of representatives, the honorable john boehner. [applause] thank my Congressional Colleagues for their testimonials. In a few moments we will have the presentation of the gold medal. We are honored to have a great friend with us, please join me in welcoming the rabbi. [applause] mr. Speaker, leaders, members. Let me offer the following