Transcripts For CSPAN2 Key Capitol Hill Hearings 20141010

The cdc is doing its traditional tracking and working with Health Departments across the country to understand when there are cases and make sure the appropriate whether it is that virus or not. We are doing the tracking in terms of the numbers and the numbers by state and locality so we have an understanding of that. The other thing the cdc is doing is communicating clearly about the things we believe are most important and i would encourage everyone in this room to step up your handwashing and if you have children to make sure you are encouraging that kind of handwashing. Thats one of the basic things and something that before meals and before everything making sure we are doing that. The last point gets to the core of your question is cdc is working with individual Health Departments to do the investigatory work to understand in these cases whether its a question of paralysis or a question of visit directly related to the virus. We are part of that investigative process to determine this things the cdc is doing its traditional work we do with Public Health. As you are appropriately reflecting this much focus on the ebola issue. Our teams are deeply engaged in this issue. Thats a question i would refer to dr. Fallacy. I am married with Kaiser Health news. Just a couple of questions about healthcare. Gov. You talk about how consumers public response to deadlines. What are you doing with the site to make sure we wont have problems when we have a lot of demand particularly at the beginning of enrollment and at the end of enrollment and could you talk a little bit about building up the backend . With regard to the question of load that something that was spoken to a little bit yesterday which is we are doing a lot of different kinds of testin testih is something i think most people, thats what most people focus on. One of the types of testing we are doing is loads testing and thats trying to test the system with different amounts of volume to try and address the issue that you are raising it to make sure we are properly prepared for surges that would occur. With regard to the issue of there were a number of things, parts of the backend that were happening last year and that there are other parts that i think you are referring to may be payment issues or those kinds of things. We are continuing to work on some of the backend issues or the irs issues that we are doing and continuing to make progress on each of those issues. As i mentioned in the beginning we are prioritizing as we go through and continue to make progress on the backend functions and whether the database learning what some folks have asked questions about before we continue to work in the case of insurers and their own systems on this. If i could followup for the next question. Can you give us an update on the people who still need to get in documentation and how many people have been cut off and how many people have had their subsidies change . Two different categories. One is the category of immigration documentation and documentation related to that and we are continuing to process that information. You can imagine more paper has come in. The same thing with the income. When you send out the letters that say things will change that so may start to get the documents. Where in the middle of processing those who may want to get all of that process as much as possible before we get to the final enrollment. Good numbers continue to go down from the numbers made public in what we are trying to do and this is to the transparency point earlier split up the numbers. 15,000 letters were sent and that number will come down. Similarly the number at the starting point was 1. 2 million households that had income issues. We send out letters to that block. Have you actually cut anybody off or change the subsidies . With regard to the subsea change of a cut in terms of how that will be implemented is him over a month to month. Of linear cycle so that had to do with insurers. Hi, ricardo with ap and the focus is on people signing up for the first time next year. Theres a lot of focus on that but i want to ask you what are your goals for retention for the people who are already in the system . What are your goals for a satisfying Consumer Experience for those people can particularly since for many of them it may not be a good option since the cost of a planned in premium and subsidy could change. Can you lay out for us your objectives both on the Consumer Experience and the kind of percentage share for attention you want to see . Enrollment is important to raise race with us as we think of the system and going through the process i think its not year to because the point you just race. This is the first year we will have free enrollment and aromas such as averse to do this cycle and to be honest its the first year there will reconciliation cycle. I think the focus on rare moment is something we are equally focused on. As i said earlier in terms of analytic buildup when i think about whatever number we think is the right number we have to derive this number to macs are right now we are working with the insured and their analytics and are on analytics terms of what percentage retention will be there. Continuing to work through to try to get to the right place in the right places based on this is a new product and this is the product that has not been used in trying to get to that right number. With regard to the deep focus on making sure to things happen that the people want to do auto enrollment are able to do that in the easiest way possible and we want to encourage those that thats part of what the marketplace is. Our communications are targeted for exactly what you just suggest a which is make an sure people know the importance of going in and shopping. I think it was outlined yesterday and i think we are going to spend time and come back and i think andy and i will both be talking further about the specifics of the rand roma process but let me say a few general things. Encouraging people to come and because we believe it is best to shop. Thats an idea of the marketplace to make sure you get the best deal. Kevin mentioned yesterday we want to make this a as simple as possible and doing simplified instructions that are easy, usable and very simple arent important part of the process. The other thing thats an important part of what we are going to do to make sure that the consumer has an experience and make it easier for them with the question of free enrollment is making sure they have alternatives. Different people will want to do this different ways. Some people will want to put in their plan and go shop. Some people want to auto enrollment on plan. Some people want to use help and guidance so making sure we have different avenues. One of the things i think is true and gets reflected as we get into the questions about how people should go and in different people have different needs than what we are trying to do is meet as many as we can. Are you going to tell people who are being read in bold that their costs might change the mite change and they might get a better deal if they shop . Yes, that will be part of the communication. Communication will start with marketplace communication and ensure communication as open enrollment starts. Then we will go through that period in terms of making sure that people know and understand that in people who are auto enrolled velocity communication so they know they still have an ability to go in and change while we are still in the open enrollment. I wanted to know what you are doing, and sorry diane weber Kaiser Health news. We saw a big difference in states that had an insurer who sort of actively did a marketing plan like in florida through the healthcare. Gov active in sure on the ground versus states like iowa or south dakota were the biggest insurers got out of year one. What do you know about insurers marketing plan and have customers, what can you tell us about that . Are they stepping up and planning to put the information out there . With regard to insurers i think it is the reflection that for those insurers that aggressively pursued market share solving impacting results of what they did and i think that is something that is at least understanding from our conversation that they are thinking about in different insurers are thinking about different ways to go about that for both in terms of the issue that was mentioned in terms of preenrollment as well as the issue of additional and roman. I think as they would would do if they each have their own marketing plan in terms of how they will go about doing that as it is about competition. It is our sense in conversations with the insurers that this is something they are each individually thinking about. [inaudible] we are encouraging whether its our stakeholder partners or insurer partners to partner with us as we going to open enrollment. That has to be with free enrollment in how we communicate what we are trying to do as much as possible to communicate with the insurers. Our communication in terms of what they will contain so they know what we are doing in the same thing with the stakeholders making sure people know what we are doing so their efforts can be complementary in terms of getting people good information about reenrollment which is a challenging thing for many people who have never experienced it in the insured population as well as people in the marketplace. The thing that we we are trying to do is make sure we are clear. Joyce frieden, one of the things that is, but that plans on health care. Gov is the issue of narrow networks. Some plans offering only one hospital in very limited choice of doctors. I know some states are developing for the niac is developing a model standard for what constitutes a network but i wondered if hhs was thinking about putting in any more standards for that . As you appropriately reflected the role of the state insurance commissioner and the regulating of the networks is the place where there is the core of the plan. We want to listen and understand how the marketplace is working. A 25 increase in the number plans that are coming and we are hopeful that thats going to increase more competition in the types of plans it will be in place. Its the kind of things who want to listen and understand in terms of how people are bathing in the marketplace as well as we continue to let what people are doing in the park it private marketplace so we understand how consumers are bathing and we are continuing to do that but also providing any support recanted efforts of state commissioners if they have questions or need help if theyre working through this issue. Dan with the cbc. Im im curious where do things stand in terms of web brokers like the Health Insurance being able to enroll qualified individuals directly without having to go through healthcare. Com interface . That was supposed to happen last year. There were problems and was going to happen as far as i know its not happening on an equal scale. In terms of the specifics of where they go through thats a question im going to defer to andy to make sure exactly what they are able to do in terms of the click through and whether or not they can do it individually themselves. I want to make sure we get that right but with regard to the welcoming of the issue of brokers and intermediaries as a part of that this is part of the system and we think its an important part of the system. I think kevin mentioned yesterday that we think its something that we welcome. I think with regard to our ability to make progress in terms of integrating from a systemic theres a balance on consumer friendliness and making sure the functionality is there with regard to making sure we have the space. Have we have made as we have made decisions as the balance of those two things. Hi, tomer the washington times. I just wanted out you could give us a status update on the states further on exchanges. It was a shaky time in the first round as first transitioning to the federal platform and states have their own technology. Where do you see things and are they going to stabilize and then this next goround . There are a number of different statuses in terms of what the data is doing is different from what maryland is doing and massachusetts. Each of the states on a statebystate basis. This is another one that is retail because of a different city to the states. We are continuing to work on a statebystate basis and whether thats making sure the folks in nevada have an opportunity and how they are going to reenroll as we work with them or in the state of massachusetts and maryland and making sure there states are ready. We are working on statebystate basis and the support is different in each of the states. What we do as we continue to track it and work with each of them directly. Again the issue of communication and clarity is one that i think is a tool that we are trying to use from a management perspective in terms of being clear about what our expectations are and making sure we are communicating with them about what their expectations are of us and what you are reflecting is the point where we have crossover with the states that have had challenges. [inaudible] we are doing everything we can to ensure. We work with them on it day by day basis in terms of progress for different states. There were different issues and we continue to work with them on a statebystate basis. Arthur alex from politico and i want to ask a slightly more obscure area of policy but on health i. T. There has been a lot of dissatisfaction by some provider groups about the meaningful use of and also on the other side theres a lot of sword of the Health Systems and computers and hospitals arent talking to each other as well as we would like yet and im just wondering whether things have reached a point where you consider talks with the lnc your cms changing the focus or altering the Incentive Program at all . It is the providers what we do is link to that. That is how we get that information to get access to that information. Continue to work with the insurers on transparency not just a market issue with employer based in terms of the entire market. Transparency of the entire health care state because the marketplace had so many questions but the issue you are racing this is raising is a lack of transparency. Issue way across the board reached try to encourage the hope that would encourage the providers to provide the information what they need for decision making. Doctors and hospitals with the increase of high deductible plans with later stage cancer is the middleclass worse off or better off with their plans and what about the Nations Health . That is something we want to see if there is evidence of what you described but with regard to the important part of with the Affordable Care act is in terms of prevention and screening and the the thing sadder very important because of the Affordable Care act people can have access to any number of cases without a co pay or to understand how to use health care. Route those that were space entered into the marketplace. The most educated group if i ask everyone to write down the top six things that you could get to do because of the change of the Affordable Care act is three do need to know that theyre not taking advantage of that with their own health care but the issues of plans to charge more for women is no longer there that is the important issue you chose to make good decision to change your employer right now if there is anyone in your family with a condition you can now do that without fear you will not be covered. And with regards to the middleclass. And the employer base system but what it is are the benefits. I am with the huffington opposed. A little over a year ago. Down the line to talk about the experience would be and it was not the case so what can you do to assure the public that how though website is better . That the experience would be better and we know there are issues raised as to go through the process. With the application up and running since last july that reduces the number of screens from 76 down at 16 in terms of the application that everyone can use that b. C. We have that in place and second with the experience one is the functionality they were reflecting the problem as well as the Consumer Experience with a the functionality outlined in detail with regard to the testing we are doing of the functionality has that capability with the functional testing and all the testing. Those are the pieces of evidence that we reflect. What we want to work is not talking about expectations that is what were focused on. As secretary you feel you have a firm grasp where you stand what is working and not working because it seemed the people at the top of the change did not know that the web site would not work. What i said it will continue is every day we work through the debt by two the deadline to have a good Consumer Experience and each day we did that we look of the technological side and also the Consumer Experience. If consumers do the homework to track down which providers are in which plans providers can drop out during the plan year. Other than requiring the dance notice as well as medicare a vintage other than requiring an advanced warning what can we do to address this problem . With very limited problems we may not have a lot of options. It is an issue for the entire marketplace. That is a decision that a providers make so our ability to control the provider what we want to do is create a marketplace that the competition would make those decisions. Web rissole last year to see it in the private employer place they do make that decision based on price so as we continue to move forward we will learn what the consumers are making choices on. But this is the marketplace and that is a part of the system that we have and support. Hhs regulates the plan so if your doctor leaves should you be able to leave . U. S. Skiing the question should you have a special Enrollment Period if your plan changes with you . I have had that before with that specific issue. As we work through this to understand what the consumer wants that is what we will incorporate into our thinking. Thank you very much. Thanks for having me. Thank you for coming to the press conference. With the world bank and imf an annual meeting. Dr jim will give the Opening Statement that we will take questions. Thank you. Good morning will come to the 2014 world bank and imf an annual meeting. I have three topic somewhat like to talk about denial take your questions. I just came from a meeting focused on the ebola epidemic and we had an extremely productive discussion. We had the president from new guinea with us in president on Video Conference they not only addressed us but made extremely specific request. Based on what they need now in the country to focus their response. The crisis that we now could have the enormous impact yesterday we had a better understanding of the economic damage from the help break. Releasing a new Economic Impact assessment is not contained and spreads to neighboring countries the to your impact could reach 3. 6 billion by the end of 2015. That would be catastrophic for west africa. One of the things of the secretary of state that the United Kingdom points out every day that we dont put money into stopping the crisis is many, many more dollars and pounds we have to use later it is an extremely good investment right now to prevent this kind of loss to put all the money on the table right now to get the response going. Said in a ratio estimated liberia alone needs 364 medical staff today to treat those infected. One of the speaking points giving staff into these countries is a lack of medical evacuation. We heard this morning from the European Commission and the United States that both of those groups have now committed to medically evacuating Health Workers and others. This is a major roadblock were now on a better path to be able to have a faster response. And lp happy to talk about the other outcomes. Today i will launch a new Partnership Initiative to help tackle the massive and infrastructure deficit now facing developing countries. They need 1 trillion per year of extra investment through 2020. The extra facility has a unique collaboration between the Public Sector especially Institutional Investors and donations for billions of dollars for Infrastructure Projects in virginia economy it is significant with the worlds leading Institutional Investors to sign up as partners with the gif having 82 in assets was 1 of Infrastructure Projects have been hearing a loud and clear the money is out there it is not a matter of money but bankable projects. Commercially viable the new concept that doesnt require tens of billions of new resources or more potentially sitting on the sidelines waiting for investments we can bring that online by addressing issues like risk. To date of rogue bank replacing 50 million to help pay for access to all haitians preventing Waterborne Diseases later i will be chairing a meeting with the objective to raise even more donor funds. Now i will take your questions. Please identify yourself and your organization. Is there a microphone . Dr. Kim i have a question about the investment bank. What is your comment compared to the world bank . Day think it can cooperate . But also avoid . Minor understanding the Business Model is still being discussed. Ive made it very clear from the very beginning with the discussions we think we can be a strong partner. For example, we have 70 Years Experience with project proper rate preparation and also the safeguard that we bring to the table would be helpful to reduce risk for investors this is the major concern not one to suffer the reputation no damage with those social safeguards. We are already in close discussions with this new Development Bank and our intention and expectation is looking very closely but just as i said there is said lead for more investment and infrastructure than any organization focused on infrastructure to fight poverty is our friend. With the emerging markets the world bank has progressively with drawn from infrastructure and coming from engineering and finance but it will stop up again . We actually do have a large portfolio of Infrastructure Projects it is relatively smaller of the overall portfolio day and decades ago. On the other hand, we did over 60 billion in business last year. A and as rescale out global practices groups on particular areas, if we need to bring in more experts we will do so but were already doing quite a bit of infrastructure. But the platform is very important in a new sense that as we start to put projects together will be people from the world bank to have expertise. With the multilateral Development Banks and also from the private sector. This is the platform to bring together the expertise what we know of spain will projects without the preparation that makes it clear there bankable projects were looking to draw on expertise from all over the world. Your projection, i am from nigeria. But to go 5 to for the country like nigeria. But we dont know to the extent the growth rate is arent the action policy. Thankyou. I am not sure that question in. I am sorry. What i am saying is given the growth rates in africa to what extent . Is the question to what extent is the growth rate in africa impacting . To make this is an important question. In 1990 the number of People Living in extreme poverty in east asia and africa was about the same. 55 . And less than 10 but africans remained at 46 . One of the things that is a bit of a disappointment poverty rates have remained high despite its proposal very specifically in africa we work with countries to insure the high growth rates are translated into lowering levels of extreme poverty. Many african countries have new discoveries of oil and what we know it in so many cases do not lead to direct benefits. This is one of the most important priorities to ensure rework with african countries to take these new wonderful important discoveries of mineral and oil wealth to translate into the deepest levels of poverty. All of the ministers of finance that i speak with there very committed to reduce extreme poverty to reassure the prosperity is baird. With the solutions from around the world. I and jennifer with hongkong tv. In your remarks you mention to but could you elaborate more on that and were doozy there could be the spill over effect . One of the things we did as economist we look what are the impacts economically . And what weve learned is the impact of sars only with 800 deaths but 46 billion. The impact it is not from the virus itself but from the aversion to lessen the Economic Impact to have systems in place so responses are quaking in defective. One of the things we talked about this morning we know exactly what it will take not only to stop the virus but the aversion behavior that leads to the huge Economic Impact. That is good news that doing the right thing thatll identify cases to provide treatment for those who are ill all things are the right thing to do do to prevent the spread from the Public Health perspective and also to adopt the year that causes the enormous Economic Impact so everyone redoubled their commitment for the adequate treatment prevention Identification System in place are there other spillover you fax . Effects the to workers that died in spain had have been they already see the Economic Impact. And are from bloomberg news. Dr. Kim can you clarify that the 32. 6 billion geography come in as i cover western job western africa . Is western africa and the surrounding countries. I can give you a list of the countries. Its looking at what will happen if the cases began to spread and the point that we were making is that right now as long as its not under control, let me put it this way, right now because we dont have adequate Treatment Services and you know if you think about it from the perspective of a person from kenya sierra leone or liberia the Public Health, the Public Health imperative is to stop the spread that the human imperative, the individual human imperatives to get treatment so the incentive right now is to go wherever you need to go to get treatment so you can live. Right now we dont have the services in place so that the first thought of the people from those three countries is i need to go to my local clinic because i know they will take care of me effectively so thats what we need to do. The presumption of the 32. 6 billion as things get delayed and delayed and delayed and the people inside the country to the rest of things for themselves and try to find care elsewhere and that is where the impact is going to happen. We see this impact already with two or maybe four cases in spain we know that historically the aversion behavior does fear factor can spread very quickly. With two clarified you have a global figure at this point . Not yet. We have time for two more questions in the back there. Michael with dr. Kim on tuesday you held an improvised town hall meeting to hear concerns and questions from staff about the ongoing reforms at the world bank group. What was your biggest take away from that meeting and do you expect it will lead to any concrete changes in either the implementation or communication of your reform and then sorry just a quick second question. You are undergoing a strategic staffing exercise to the global practices. How do you know where expertise will be required before you have seen demand for your services under the new organizational structure . Thank you. Thanks michael. First of all we are undergoing the most thorough, the most ambitious free urbanization in 20 years so its not a surprise to me that there is anxiety and that there is concern. More than anything what this staff were saying was that they wanted to talk to me directly. They wanted to tell me what the problems are that they were seeing. I was aware of some of them. There were some that were new to me but we had an extremely good discussion. My take away frum, the most important thing was the thing that kept coming up is that they wanted to talk to me more. We will have another town hall next week and we will do as many as we need to until people feel that they are being heard. This is what happens when you try to reorganize a multilateral institution. Ive done reorganizations before but the complexity of this institution is enormous. We work in many different languages and work in so many different countries. On the one hand im not surprised but i would also point out look at all the things we have already gotten done. For example we have been able to double lending to middle income families. We have a record last year. Already the global practice are providing information and support for example to Prime Minister modi of india that caused him to tweak out immediately after my meeting that they dont need our money but we will be their Information Bank and the reason is because what will be able to provide such interesting insight as to how we can Bring Solutions to the problems. There are a lot of good things are ready but anytime you undertake something is enormous you will have these kinds of problems. In terms of strategic staffing we know it a lot from what we have been doing so we have some ideas about the kinds of staff we will and wont need. What i would like to stress is that the expenditures and the strategic staffing and all the stuff you have to do as an organization of matter what, we havent been doing it for quite a few years. So when you start the process of asking questions from what are we spending on Different Things . Are we spending the same amount in their redo the same thing here is over there and when youre asking the questions for the first time its really tough to go through but its just something that everyone should go through. Every organization should ask itself do we have the right step in our we fit for purpose for what we are trying do . Im glad that we have done it and we will continue in the good news is we are almost done. Im looking for some gender balance please. Thank you so much. On the chinese economic slowdown its been a year since the Chinese Government has carried out measures to make the economy more stable so what is your view on their farms have been carried out the form and how would you integrate the slowdown . Do you take them as cyclical changes or his changes brought out by those reforms . Thank you. China is trying to go undergo a massive change in the growth model and this is something that my predecessor bob zoellick i think worked truly brilliantly with the Chinese Government over several years to put together a plan called china 2030. If your intention, china going from some of the highest investment rates that we have ever seen, 46 of gdp and then to try to focus much more in consumption and services to move up the value chain if you will in terms of economic productivity this is a very difficult thing to do. We have been watching very carefully and there has been a slowdown from traditional rates so high rates of 10 . And i think the important thing as we watch is that china continues to be committed to that reform process. We believe that reform process and moving toward a different growth model is what china needs to do. So its a very delicate balance. They have two on one hand be ready to move to another growth model but on the other hand you need the growth for the job entrance on the market. We have faith in chinese leadership. We think that they very clearly understand these tradeoffs and we will continue to work very closely with them. For example one of the things that after the china 2030 report the Chinese Government has continued to ask us to help them solve their most difficult problems. Last year we launched a report on urbanization and as an example of what a global practices now able to do our many different global practices got together in support of the best models in the world and in china for how china can handle the next 300 Million People coming into the citys . China will be the first country in the world that has 1 billion urban dwellers so we looked at everything from how to reform the system to provide health and clean energy, how to increase the density of cities so that we lowered the Carbon Footprint and china is already undertaking the recommendations that we came together jointly to provide. Right now we are working on an assessment and a plan for the health care system. China spends 5 of gdp which is a huge amount but are not happy with the amount of Health Improvement that they are getting from these expenditures. This is so healthy for a country to be able to say we want to do better in a particular area and we think if we can help them to make the most of their current expenditures and make those expenditures as efficient as possible so we have healthier people that this will be a way to spur economic growth. Its difficult for many people to watch china has lower growth rates but we feel doing in a way thats very much with a tremendous awareness what they are trying to accomplish. Thank you very much and we will be putting out a transcript later today. Thank you. [inaudible conversations] her remarks focused on the imf reform package awaiting action in congress. This is 45 minutes. Good morning everyone and thank you for coming today. And welcome to our 2014 annual meeting. We look forward to your questions this morning. I would ask you to be brief and we can try to do as many as possible. Let me introduce to you this morning are managing director madam Christine Lagarde and we have with us our first deputy managing director david lipton. Without further ado let me turn to the managing director for some opening remarks and then we will come to your questions in the room. Please identify yourself before asking the question. Good morning to all of you. I hope you all are well and i would like to welcome you but include you in wishing this institution a happy birthday. Its seven years old and have brandnew relevant energized machine i can assure you. I will say a few words about the current Economic Outlook as we see it for those of you who have not followed Previous Press conferences by our Terrific Team and i would like to say a few words about the institution first. As i said it is 70 years old, founded in 1944 and i believe that it is not only relevant but in a position to respond to the challenges that the world is facing. As a sign of that i would like to mention a couple of examples. I said this morning in the presence of a lot of the members of the Community Working in trying to help the three west african countries that are plagued by a boa i said its absolutely fine if those countries increase their fiscal deficit. David was a bit concerned actually and im sure that we have some colleagues that would be a bit concerned but its just an indication that we are capable of mobilizing resources. They are not grown and others will have to put in significant numbers. There are also capable of revisiting traditional standards. We have done the same this year concerning some of that restructuring. As you know this is a model we have studied where we have come up with proposals, revisions of certain sovereign bond issues and we will continue to work on those issues. In the same vein we are also helping the fsb following up monitoring and helping with profound changes and regulations applicable to the financial sector. There are areas where we were not expected and at the age of 70 its not bad to actually look at the fiscal side of Climate Change and what can be done about it and we have made proposals concerning removing subsidies in a socially responsible way. We have made proposals concerning pricesetting and including externalities in the price of fossil energies. Also responsible in my view to assess the sustainability of growth in light of strongly increasing inequalities becoming excessive and therefore likely to have growth and it is not irrelevant either for the imf to look into growth and jobs and the inclusion of women in the job market. Now those are areas that some might argue are not absolutely core business and yet we pretend that it is part of partial of the imf to look at issues that are macrocritical but touch on topics that we are facing that in many ways can be more acute. In addition to that we do all the normal things that we have to do. So sir vance, the intersection of the two, of course lending, of course and we have done more lending then maybe might have been considered. We extended a significant to ukraine earlier this year. We are negotiating with a couple of african countries that are looking at support. The arab countries in transition are also major client of the funds. And the third areas where business is expanding if i may say as Technical Assistance, Capacity Building and training. We have opened our fifth Training Center this year and Technical Assistance is an area where there is massive massive demand from all corners of the membership. So its with that background that i wanted to wish us a happy 70th anniversary. Now moving to the more traditional comments that you might have expected from me. For those of you who have seen the world Economic Outlook or watch the press conference as you well know we have trim their forecasts for 2014 and 20153. 3 in 2014, 3. 8 in 2015 and what we have noted clearly is more and more countries specificity in the cup knowledge that we work. Its not emerging market economies where recovery would be lagging behind. Within each group, some countries are ahead and others are lagging behind. The advanced economy clearly the recovery strip him by the United States in the United Kingdom where japan is lighting behind an emerging economies you have reasonably strong although Slower Growth out of china, better than what we had out of india and clearly a major slowdown in countries like brazil and russia. So very country specific and by the same token the low Income Countries are thriving. On a much smaller base granted that their growth rates are very impressive which is what makes the current epidemic ebola even more threatening because it might certainly jeopardize economic recovery was underway and entail a decline of those economies. That would be wasting the gains that they have earned as a result of their effort. So in the face of what we have called the risk of a new mediocre where growth is low and uneven, we certainly believe that there has to be a new momentum and that is what well be discussing with the membership in the final days. I believe that you have received the Global Policy agenda a copy of which i have here somewhere. You have perceived that, right . So this is the document that encapsulates for the membership the Strategic Direction of the work that we will be discharging over the next 12 months. This is the document on which we seek their approval and their support. Now this new momentum with hopefully more growth, more jobs, better growth and better jobs is what we would certainly call upon the membership to produce. What does it mean in practice and i will very quickly touch on the three key topics. The first one is Monetary Policy where we will be seeing movements probably but we believe particular in the eurozone and japan more of that Monetary Policy is needed Going Forward in order to support the economy. While at the same time the fed is probably going to normalize its Monetary Policy and where we are going to continue to caution a lot of the emerging Market Countries and lowincome families in developing countries to prepare themselves for a bit more volatility than we have observed over the last human spirit in on the fiscal front we believe that more growth friendly physical policies can be put in place and those of you who have followed the press conference of the new head of the Fiscal Affairs department and you will understand what they mean by pointing to the potential labor reforms and fiscal policies adjusted to support job market reforms which we believe could make a lot of sense we also think that the financial policies must continue to aim at producing excesses, make the Financial System sounder and strengthen its ability to help the recovery. Now there is a third package that we have been referring to regularly which is the Structural Reforms and we dont believe that the structural reform is the third chapter. By the way we believe its very important that it has to be country specific. At the juncture of demand and supplydriven measures, we have strongly held the views that infrastructure and Investment Infrastructure can be a good way to support growth in the short term by putting it to work by launching Major Construction efforts or maintenance jobs but can also impact on the supplyside in the medium term by facilitating and accelerating the creation of value down the road. So this is in a nutshell what we are focusing, what we hope to discuss the next few days. I would be very happy to take questions together with david on any topic that you would like to ask questions about. Thank you. Thank you madam lagarde. Lets begin right here with this lady. You had your hand up. I was wondering in your Global Policy agenda you said your analysis of the world looks uneasily familiar and a lot of your advice has been you have been seeing it for the past three years or more since the crisis countries need to do the Structural Reforms and it looks like fiscal and Monetary Policy has reached some of their limit and that is why we are turning to restructure spending. Would you agree with that analysis india think countries need to step up their game . Thank you. We strongly agree and we hope to convince those countries to satisfy the various conditions. Its not investment in infrastructure at any rate under any circumstances. Its clearly beneficial and we believe that it can be not only growth friendly but he then got if its done under the right conditions so that it picks up from there with financing situation that continues to be very accommodative and very low cost and we clearly have a need for infrastructure. On that basis we believe that it is helpful and as i said it addresses both the demand in the short term and the supplyside of the economy. Structural reforms, yes we have said that and in a way its the common factor to many of the countries in the various regio regions. Though what we are seeing is that they have to be country specific. They have to be welladjusted to the political of the accessibility, the multiplying effect that it can produce on those economies but its a question of doing it. Not just talking about it. We can talk and we can publish reports and we will continue to do so and we will be as as we can although its not necessarily our domain of confidence. Other institutions can do that better but we can certainly incorporate with them and number two continue to bring forward the question. The question of getting on with the job and doing it. Yes sir right in the front row. Hello. Im with ap and according to the data released this week by the imf china will overtake the u. S. In terms of gdp. How challenging it is it for the imf and do you think the legitimacy is at risk and the imf would have to go beyond the 2010 reforms that is currently in tax . Thank you very much. The reform is an absolute must. It has to be implemented and Everybody Knows that it is currently stuck before the u. S. Congress. We very much hope that the different branches of the u. S. Authorities and members of the legislative members themselves will understand the relevance of having an i that is representative of the Global Economy and includes the people that should sit at the table. Now, this has not happened. It was during 2012. Its overdue in 2014 and i strongly hope that under president obamas leadership and with the right understanding of the parties the role of the eye at math words that. Who was first on the job concerning ukraine . The i. Who managed to disperse very quickly and put cash in the banks of guinea, sierra leone and liberia . Not to say that others are not doing the job but we are capable of dealing with crazy situation of that nature like no institution. Now, im not finished. [laughter] i also want to say that notwithstanding that the reform has not been ratified we as management include a representative china. One of the deputy managing directors plays a full part of the management and we are delighted that he is sitting at the table with us. Within the teams we have a lot of the underrepresented Staff Members and heads of departments. The head of the i is a chinese national. You were talking about china in particular but i would like to enlarge the topic to say that those underrepresented in the quota are not underrepresented necessarily in the management circle and at the highest level and we certainly pay as much attention as we should to all and not just to the big players. Im going to stay down here. The lady in the front row. We have seen a lot of countries speaking with the imf african countries and specific even working with the imf with regards to Technical Assistance. Some have issued bonds tapping into International Bond markets. To what extent do you think african countries are capable of pumping that into the right Infrastructure Projects are not making the same mistakes of the past given the history of the conflicts . You are right in that quite a few african countries have lately issued sovereign bonds and have been very successful which is fine that there is progress, there is more stability, they are more reliable borrowers probably is seen by the financial markets. I think it should be done with measure like everything. No excess, no abuse and i would like to point out to you that we are currently working within the Fiscal Affairs department on specific Research Work to actually focus on how Public Finance, how Civil Service in each country can actually well served the discharge of major Infrastructure Projects and we will make that expertise available to the australian presidency of bayji 20 and to all our members of course to make sure that they appreciate how Good Management of Public Finance for Good Governance of Public Finance and how focused project management can be in order to serve the efficiency of infrastructure. This is what we have advocated. It will work if its efficient. It will be efficient if it is well handled by those in charge and theres a way to do that. Yes, with the glasses, yes. Good morning. My question is about greece madam lagarde. The feeling in our countries that after four and a half years of the program there are at least enough austerity in enough pain. But we also believe Going Forward in order to deliver the contiguous satisfactory outcome said to be in a better position such talking about the evolution with the belief it to be extremely helpful for the country to move on to believe that it could be affected. Good morning. And with the imf board stands than the undertaking and with the geopolitical list. In and the solicitor considered the driver in the economic region . Were very engaged in general using the out the art world in general. Because with that transition were struggling for the moment with this significant military problems to be displaced about 11 million and trying to help the arab countries. The latest program in place that was approved a lot has it been achieved lets face it. So to use Public Finance with the safety before the pour. But still needs to be done. And for what they have done so they have to do continue. And there is a strong delegation coming from egypt. And i very much hope we could do article for with the egyptian friends. And we continue to be engaged across the world with the support and the Financial Support as well. The key issue teeeighteen and happy anniversary to the imf. And the fact that you mention that in your mind is connected. But where the options . So with the ukraine with that sanctions with a geopolitical risks that we identify as up cloud on the horizon of the Global Economy. So the modest growth of that area but own a part of the attributable that we see in that part of the world. So i would hope i see a result of the investments the goes hand in hand with giveandtake with better growth in that part of the world. I am with hong kong phoenix tv. With the Federal Reserve Monetary Policy as it has indicated relying on the economys that we also see the Federal Reserve had global growth. For the interestrate. Thank you. I cannot predict what the fed will do i also believe that chairman yellen is given very clear and understandable explanation about the Monetary Policy of the fed. So we could all be the same thing and what it is meant by what she says. And aunt we have also seen delivery of what she message to. From six months ago. But the other question dealt with others. In the areas to do christ a lot of work the outcome of what we call of remember back in may and june 2013 . Changing the Monetary Policy of the fed with the outflow of capital with the currency and Exchange Rate of the emerging world. And also the response by those countries to make sure that they will be exposed to build a sense to respond to volatility. But with large emerging market economies are in difficulty will still work with the originating country. And including in the communication to find out she was paying attention to both. I with a guardian. Talk about the it does the year ozone, we have been here before so how close is that to becoming the new japan . It has been commented upon about what yearago noticed of low inflation which is one of the attributes of what you describe of near japan. So low inflation was the risk and we identified that with the ec to reverse the risk. And more we hope will be done. And we have also alerted through the risk of recession and that is identified as a probability it a rare between 35 and 40 . But there is a serious risk if nothing is done. But we say also if both do what they have to do. Thank you. A question to think we should with that the data it is way behind the United States to what extent could it reflect the economy . Ppg and the measurements from for five years ago. Is one indicator. But they had gdp per capita. But you have to take all the factors into account. That why that particular criteria . China is growing. Last question. Speaking speaking a language speaking speaking foreign. Speenineteen and i would like to say that in particular with the negative impact on the economy. So what are the a their sources approach that they turn to so what they could tap into because they continue to grow. And those measures could address the partner countries. Thank you. If you did not get the translation, did you get it . It was the very comprehensive question from the peruvian colleague that peru will be hosting the next meeting next october for the imf and world bank. Then he asked question about the current Economic Situation of peru that is the economy clearly marked by a industries and that exports which profit from their recent decline. And on behalf of our tradition and Major Construction and to be together under one roof. In the we are of looking forward to it. I can assure you. With the peruvian economy and over the last decade to take the hits in the early months of 2014 with the combination with the great exporter and sec didnt and in the countrys. It does not necessarily follow as it should have. And seriously in the first few months compared with what it has produced in the last decade. With those policy measures that have been decided from the monetary standpoint to restore the situation. It is not easy from a political point of view. It will be focused