Now that is 10 trillion. So there are not many places you can say i can take 10 trillion out of the spending stream to keep you healthier. Let me follow up on this now speaker gingrich. You are a conservative and as a result may have credibility than i do in some circumstances on the question on the role of government here. Why isnt it enough to count on private industry to do this . Why do we have to have a substantial investment from the federal government . Its a question about American History. [ inaudible ] and i are developing a project on why George Washington matters. And people dont often notice that the Founding Fathers wrote into the constitute a Patent Office because they so deeply believed in the future. They made investments. The First Federal highway was built during washingtons lifetime. They believed in improving things. They talked about them as improvements. Jefferson launched an expedition to the west and there was a Childrens Book on this called from sea to shining sea it was supposed to cost 2,800 and it cost 38,000. And there are patterns that dont ever change. But the idea of jeffersons era of taking people and senting them to the pacific is comparable of going to mars today but jefferson understood we needed the knowledge and most of is stored up in the academy of Natural Sciences in philadelphia. So we have had a long history of investment. Congress passed the money to enable the first telegraph to be built between the capitol and baltimore. That was a congressional investment. Now i think that we have to recognize lincoln, he was the only president to hold a patent and lincoln was totally fascinated with technology and brought a lot of it into the civil war to the benefit of the union. So i think there is a long history of america being a company of Technology Advance and willing to invest in a Better Future and recognizing the government had a significant role to play in that. And let me ask that with a little bit more shortness to the point right now on health care in particular. Given that the taxpayers are on the hook for medicare, for the veterans administration, for other health care costs, if we fail to make the investments in nih and discover the cures that we need, who is ultimately going to pay for this . Well, let me try to paint a picture for a second because it is worse than your question. Anybody that goes out and talks to cuttingedge scientists know we are right at the edge of break throughs that are so extraordinary. Im at the age where i have several friends who have unique difficult problems and when i can help them find the best two or three people in the country their lives are suddenly transformed because the best two or three people in the country are 20 years ahead and are doing things in laboratories and doing things in hospitals that are like magic. And were having breakthroughs at every single level of health. To know that exists and this close in Regenerative Medicine and within a generation we could help you regrow your own liver rather than have a transplant. To help you re grow your kidney so you dont have to have insulin injected for the rest of your life, to help you re grow if you are in a car wreck, to re grow your nervous system that we have experiments with and we see things in the lab and look at a Wounded Warrior because the science we are applying is 20 years behind the science that is in the laboratory and then you look at the failure to fund this and frankly it is probably the thing which comes closest to driving me nuts because and i say this all to my fiscal conservative friends you have trillions of dollars of guaranteed expense sitting on the table and youll never get away from it and never have enough to my liberal friends youll never have nur bureaucracy to rationally spend this money because in the end you have to cut off services. That is what happens. So if you dont want to cut off services to people with long problems to people like alzheimers or autism, if you want the break thinks you have to solve this. And being creative and honest about it i can get us to a federal budget almost in perpetuity and there is no other strategy with the baby boomers aging that gets you to a sustainable balanced budget. And one and by the way which you hinted at us and by the way, while were saving trillions of dollars well create hundreds of thousands of high paying american jobs and strengthen our balance of payments. So if congress boosted nih funding again and if we could come together and get an agreement to do that, how would you recommend we structure this funding . Well, first of all, without putting him absurdly on the spot, i would try to get Francis Collins to really reflect on the lessons from the human genome project. Im not a big fan of the peer review small grant model. I think it leads to incrementalism and extraordinary caution and not made progress on the scale and i think this is one of the challenges we have in selling nih to people. When you double it you want to see so what is the rhythm and the excitement. It is a similar particular that nasa has. I mean boredom is not a good device for getting people to be involved. The human genome project was stunningly exciting and done outside of the traditional patterns so i would look at three key areas. One is to what degree can we design much larger grant projects that are driven toward goals, the way the human genome project was. The second is to what degree can a modest amount of money be put into prizes of a variety of forms and if you look at the history of aviation it is amazing how much activity was stimulated by modest prizes. Lindbergh flu the atlantic for 25,000. And a lot of people were trying simultaneously. And third, i would say, we need to find a way to guarantee that a significant part of that money goes to younger researchers so that they have a chance to become principal researchers not just surfs working for seniors. And also and i hesitate to do this because you represent the state most effected but i would love to have someone to question the scale of money we give to the universities for administering these stuff. If you look at the money of harvard or Johns Hopkins both of you in one look, just to look at that and say come on cant more of that go into research. And let me ask you on the funding part of this, should we be doing, should we be doing Capital Budgeting as a way to increase the funding substantially for nih . In order to fund nih, do we have to cut shortterm spending in other areas . We dont have to cut shortterm spending in other areas. I would take it off budget an issue of alzheimers bonds because i think the longterm title tidal wave it coming that the most fiscally prudent thing you could do is cut that wave through research. And im happy to cut that notion in terms of talking to conservatives because there is no other alternative that works. Second if you look at how the navy builds aircraft carriers they cant put the money in because of the nature of the federal appropriations process so they cant buy the whole carrier but they can sign a contract making it prohibitive of buying the carrier. It is slight prohibitive. I think we can Fund Projects over a four or five or six year period and i understand again im a constitutional conservative. I think congress should have control over things but i think there are practicalities. The transcontinental could not have been built on an annual budget so they had to design an innentive plan over a multiyear period. And i challenge this and this puts some of my Close Friends in a bind because they have to get this through omb and the white house and i would challenge nih to come back and say give us some project so large and so exciting that it justifies a Capital Budget and lets go fight for the Capital Budget. Sir thank you very much. Mr. Speaker, i feel like im standing or pitching low and slow over the plate. But i am very pleased to hear your answers. We have a gaping hole in the nih budget. Right now it is 12. 5 billion. We need a serious plan to fix it. And if we really want to dream big about what we can create then we need to get out here and fight for more funding for nih. I proposed a bill called the medical innovation act which would increase nih funding by 20 without raising taxes, without cutting critical programs and it doesnt have to go off budget. If there are other ideas folks should put them on the table but it is time to get this done. I think that it goes without saying that you and i have fundamental disagreements in some areas but it is clear that one thing we agree on is what Congress Must do and i hope that well be able to follow your example, double the funding for nih as you did in the 1990s and bring home some of the promises of medical research in this country right now. Thank you. You had another comment. Just one comment. Speaker gingrich i want to again thank you and going back to some comments we were making before we started today. Im hoping that youll use your influence to help us achieve the things that we have to achieve. As i was listening to you i dont want something to go unnoticed. You talked about key people who play significant roles in making sure that we had appropriate funding for research and particularly medical research. And i often say that out of our pain comes our passion to do our purpose. And you know i think that the people that you talked about obviously had pain that they had experienced in their families and they were able to take it to the halls of congress and make a difference not only perhaps for their families, but also for many others all around the world. An then i thought about what you said about how important senator warren said about how important this research is. I have a family member, ten years ago they said well they thought she had a terminal type cancer but because of work at nih it is now chronic. And so those are the things that we dont necessarily talk about when people when we are looking at dollars and cents but those things mean so much to so many people. And so i want to thank you again for being with us and im hoping that you will join us on our crusade to lift up all americans so they can live the very best lives they can. Thank you. Let me just thank you both for your leadership in doing this. These are the kind of conversations that ultimately in a fro society allow it to talk to it selfand find dramatically higher Value Solution and you two are doing is very important and you have my commitment that anything you need to help in this project, anything i can do you can call me. Thank you. Let this be the start of a new alliance. Thank you, speaker gingrich. I would like to ask our folks to set up for the second panel and we invite the members of the second panel to take their places. Our first panelist is dr. Carol espy wilson. Professor of electrical and Computer Engineering at the university of marylands a. James clark school of engineering. Dr. Espy wilson received her ph. D from the Massachusetts Institute of technology. An expert in speech communication, the doctor is a member of the National Advisory board of medical rehabilitation at the National Institute of health. She is already the founder of the omni speech, a company that is commercializing for youths in cell phones a Software Technology to separate speech from background noise that was created through dr. Epsy wilsons research. Welcome. And im very proud to have a chance to introduce our witness from massachusetts, dr. Aaron kesselheim is an associate professor of medicine at harvard and a faculty member in the division of i do this, pharm aco epidemiology at the bringham Womens Hospital where he brings regulation on therapeutics and law and he earned his bachelors from harvard and his medical and law degrees from the university of pennsylvania and he also earned his masters in Public Health from the Harvard School of Public Health. He is certified in internal medicine and he serves as a primary care physician at the phil is gen center at bringham Womens Hospital. Welcome, doctor kesselheim we are pleased to have you today and thank you for linding your lending your expertise to this panel. And im honored to welcome dr. Mariana mazzucato from the chair of the economics of innovation at the Science Policy Research unit of the university of sussex. The doctor completed her ph. D in economies at the new school for Search Research in new york. She is the author of the entrepreneurial state debunking public versus private sector myths which was included in the 2013 book of the year list issued by the financial times. So thank each of you for being here. And if you could each just provide some opening remarks and well get started with questions. Dr. Espy wilson. Good afternoon. Thank you for the opportunity. Sorry. Good afternoon. Thank you for the opportunity to be with you today to share my experience with federal investment and research in innovation. Ive been a professor now for almost 25 years and ive been able to sustain a Research Program with the support from the National Science foundation and the National Institute of health and im in the process of commercializing technology that originated from this Research Program and that effort too has been funded through Small BusinessInnovative Research grants from the National Science foundation and a Small BusinessTechnology TransferResearch Grant from the National Institutes of health. I think it would be informative for this hearing to start by describing typically that the academic career track will start for some as a post doc and then on to an assistant professor and then five or six years and then to an associate professor with ten year and then another five years one may become a full professor. Now if you are at a Major Research university, a significant part of your time as a professor is spent conducting research which includes the training of graduate students at independent researchers, possibly some training of undergraduates and this is becoming more and more important as we want to build the pipeline of graduate students ready for graduate school in the stem fields and collaborations with colleagues inside and outside of your university to address problems that may expand several disciplines. Even the combination of research in teaching is important because professors can share their research in the classroom to help students understand how the subject matter they are learning can be applied to do analysis or solve useful problems and to motivate them to seek a research career. As many have said here today, conducting basic Research Helps us to build a understanding of all sorts of matters, helps us to solve significant problems, develop useful technology that can be transformative and all the while training the next generation of scientists and engineers. The funding of research should be of highest priority, basic research that provides the advances that will benefit our children and grandchildren and it is supported almost exclusively by the federal government. Both basic and applied research are vauluable but there are alternative sources of support for applied research. Without basic research there is no applied research and innovation. And federal cutbacks in this funding has been huge. Excellent Innovative Research is not being funded. Nor example at the nih and we have talked about them today the funding percentile is as low as 9 in some schools whereas in 2001 it was as high as 29 . And this reduction in the number of proposals that are funded has had a significant negative impact on the morale of investigators, not just the one applying for the grants but the peers who are seeing the proposals not being funded. It also of course has a significant negative impact on the training of students and the degree to which fundamental Research Gets done. Young scientists and engineers are making other choices. Career choices. And these are the very people we should encourage the most to do research because they are the next generation of drivers of innovation. For some particularly like computer scientists and engineers, they can find interesting jobs Even Research jobs in industry however many of our young scientists are headed into underemployment. Also Program Offices are cutting budgets significantly because they are trying to spread the wealth but that causes considerable disruption in the research and the training of students and in particular one of the first things you cut is your travel budget but that doesnt allow you to send students to conference to develop the job prospects they need. Cutting back in funding also is having a negative impact of making agencies more conservative in the research they support as a result there are no incentives and encouragement and Financial Support of faculty and students toward out of the box and creative ways of thinks. In real terms, while Government Support