Learn English with President Obama and Mark Zuckerberg at Facebook Town Hall English Subtitles
[Music]
there’s so much Facebook for hosting
this first of all my name is Barack
Obama and I’m the guy who got mark to
wear a jacket and time thank you I’m
very proud of that second time I know
III will say and I hate to tell stories
on mark but the first time we had dinner
together he and he wore this jacket and
tie
I’d say halfway through dinner you know
he’s starting to sweat a little bit it’s
really uncomfortable for him so I helped
him out of his jacket and in fact if
you’d like mark we can take our jackets
off
whoo that’s better isn’t yeah but you’re
a lot better at this stuff than me so
first of all I just want to say thank
you to all of you for taking the time
not only people who are here in the
audience but also folks all over the
country and some around the world who
are watching this townhall the main
reason we want to do this is first of
all because more and more people
especially young people are getting
their information through different
media and obviously what all of you have
built together
is helping to revolutionize how people
get information how they process
information how they’re connecting with
each other and you know historically
part of what makes for a healthy
democracy what is is a good politics is
when you’ve got citizens who are
informed who are engaged and what
Facebook allows us to do is make sure
this isn’t just a one-way conversation
make sure that not only am i speaking to
you but you’re also speaking back and
we’re in a conversation we’re in a
dialogue so I love doing town hall
meetings this format and this company I
think is an ideal means for us to be
able to carry on this conversation and
as Mark mentioned I’ll you know
obviously we’re having a very serious
debate right now about the future
direction of our country we are living
through as tumultuous a time as
certainly I’ve seen in my lifetime
admittedly my lifetimes a lot longer
than most of yours so far this is a
pretty young crowd but we’re seeing
domestically a whole series of
challenges starting with the worst
recession we’ve had since the Great
Depression we’re just now coming out of
it
we’ve got all sorts of disruptions
technological disruptions that are
taking place most of which hold the
promise of making our lives a lot better
but also mean that there are a lot of
adjustments that people are having to
make throughout the economy we still
have a very high unemployment rate that
is starting to come down but there are
awful lot of people who are being
challenged out there day in day out
worrying about whether they can pay the
bills whether they can keep their home
internationally we’re seeing the sorts
of changes that we haven’t seen in a
generation we’ve got certain challenges
like energy and climate change that no
one nation can solve but we’re going to
have to solve together and we don’t yet
have all the institutions that are in
place in order to do that but what makes
me incredibly optimistic and that’s why
being here at Facebook is so exciting
for me is that at every juncture in our
history whenever we’ve faced challenges
like this whether it’s been the shift
from a agricultural age to an industrial
age or whether it was facing the
challenges of the Cold War or trying to
figure out how we make this country more
fair and more inclusive at every
juncture we’ve always been able to adapt
we’ve been able to change and we’ve been
able to get ahead of the curve
and that’s true today as well and you
guys are at the cutting edge of what’s
happening and so I’m gonna be interested
in talking to all of you about why this
debate that we’re having around debt and
our deficits is so important because
it’s going to help determine whether we
can invest in our future and basic
research and innovation and
infrastructure that allow us to compete
in the 21st century and still preserve a
safety net for the most vulnerable among
us but I’m also going to want to share
ideas with you about how we can make our
democracy work better and our polit
sex work better because I don’t think
there’s a problem out there that we
can’t solve if we decide that we’re
gonna solve it together and for that I’m
grateful for the opportunity to speak to
you and instead of just giving a lot of
long speeches I want to make sure that
we’ve got time for as many questions as
possible so Marquette I understand
you’ve got the first one yes let’s start
off so let’s start off with the
conversation about the dead right so I
understand that yesterday morning you
had a town Town Hall in Virginia where
you talked about your framework not only
for resolving the short term budget
issues but the longer term debt and you
spent some time talking about tax reform
and some cost-cutting but you also spent
a lot of time talking about things that
you didn’t think that we could cut in
education infrastructure and clean
energy so my question to kind of start
off is what specifically do you think we
should do and what specifically do you
think we can cut in order to make this
all at a good well let me first of all
mark share with you sort of the nature
of the problem because I think a lot of
folks understand that it’s a problem but
but aren’t sure how it came about in in
2000 at the end of the Clinton
administration we not only had a
balanced budget but we actually had a
surplus and that was in part because of
some tough decisions that had made had
been made by President Clinton
Republican Congress Democratic Congress
and President George HW Bush and what
they had said was let’s make sure that
we’re spending wisely on the things that
matter let’s spend less on things that
don’t matter and let’s make sure that
we’re living within our means that we’re
taking in enough revenue to pay for some
of these basic obligations what happened
then was we went through 10 years where
we forgot what had created the surplus
in the first place so we had a massive
tax cut that wasn’t offset by cuts in
spending we had two wars that weren’t
paid for and this was the first time in
history where we had gone to war and not
asked for additional sacrifice from
American citizens
we had a huge prescription drug plan
that wasn’t paid for and so by the time
I started office we already had about a
trillion dollar annual deficit and we
had massive accumulated debt with
interest payments to boot then you have
this huge recession and so what happens
is less revenues coming in because
company sales are lower individuals are
making less money at the same time and
there’s more need out there so we’re
having to help states and we’re having
to help local governments and that a lot
of what the recovery was about was us
making sure that the economy didn’t tilt
over into a depression by making sure
that teachers weren’t laid off and
firefighters weren’t laid off and there
was still construction for roads and so
forth all of which was expensive I mean
that added about another trillion
dollars worth of debt so now what we’ve
got is a situation not only do we have
this accumulated debt but the baby
boomers are just now starting to retire
and what’s scary is not only that the
baby boomers are retiring at a greater
rate which means they’re making greater
demands on Social Security but primarily
Medicare and Medicaid but health care
costs go up a lot faster than inflation
and older populations use more health
care costs you put that all together and
we have an unsustainable situation so
right now we face a critical time where
we’re gonna have to make some decisions
how do we bring down the debt in the
short term and how do we bring down the
debt over the long term in the short
term Democrats and Republicans now agree
we’ve got to reduce the debt by about
four trillion dollars over the next 10
years and I know that sounds like a lot
of money it is but it’s doable if we do
it in a balanced way what I proposed was
that about two trillion dollars over 10
10 to 12 years is reduction in spending
you know government wastes just like
every other major institution does
and so there are things that we do that
we can afford not to do now there’s some
things that I’d like to do are fun to do
but we just can’t afford them right now
so we’ve made cuts in every area a good
example is Pentagon spending where
Congress oftentimes stuffs weapons
systems in the Pentagon budget that the
Pentagon itself says we don’t need but
special interests and constituencies
help to bloat the Pentagon budget so
we’ve already reduced the Pentagon
budget by about 400 billion dollars we
think we can do about another 400
billion dollars so we’ve got to look at
spending both on non-security issues as
well as defense spending and then what
we’ve said is let’s take another
trillion of that that we raise through a
reforms in the tax system that allows
people like me and frankly you mark for
paying a little more in tax I know
you’re okay with that
[Music]
keep in mind what we’re talking about is
going back to the rates that existed
when Bill Clinton was president now a
lot of you were I’m trying to say this
delicately still in diapers at that time
but but for those of you who were a call
the economy was booming and wealthy
people were getting wealthier there
wasn’t a problem at that time if we go
back to those rates alone that by itself
would do a lot in terms of us reducing
our overall spending and if we can get a
trillion dollars on the revenue side two
trillion and cutting spending we can
still make investments in basic research
we can still invest in something we call
arpa-e which is like DARPA except just
focused on energy so that we can figure
out what are the next breakthrough
technologies that can help us
reduce our reliance on fossil fuels we
can still make investments in education
so we’ve already expanded the Pell Grant
program so that more young people can go
to college we’re investing more in STEM
education of math and science and and
and technology education we can still
make those investments we can still
rebuild our roads and our bridges and
invest in high-speed rail and invest in
in the next generation of broadband and
and wireless and and make sure everybody
has access to the Internet we can do all
those things while still bringing down
the deficit medium term now there’s one
last component of this and I know this
is a long answer but I want to make sure
everybody had had the basic foundations
for it even if we get this four trillion
dollars we do still have a long term
problem with Medicare and Medicaid
because health care costs the inflation
goes up so much faster than wages and
salaries and this is where there’s
another big philosophical debate with
the Republicans because what I’ve said
is the best way for us to change it is
to build on the health reform that we
had last year and start getting a better
bang for our healthcare dollar we waste
so much on health care we spend about
20% more than any other country on earth
and we have worse outcomes because we
end up having multiple tests when we
could just do one test and have it
shared among physicians on Facebook for
example we could focus on the
chronically ill 20% of the patients
account for 80% of the costs so doing
something simple like reimbursing
hospitals and doctors for reducing their
readmissions rate and managing somebody
with a chronic illness like diabetes so
that they’re taking their meds on a
regular basis so that they don’t come to
the emergency room
that saves huge amounts of money so
that’s what health care reform was about
last year or a year and a half ago and
what we
do is build on that and continue to
improve the system what the Republicans
right now are saying is number one they
can’t agree to any increases in taxes
which means we’d have to cut out of that
four trillion all of it would come from
education transportation areas that I
think are critical for our long-term
future so for example they proposed
seventy percent cuts in clean energy
well III don’t know how we free
ourselves in dependence on foreign oil
and anybody who’s paying gas prices
knows that there’s an economic component
to this as well as an environmental
component to it if we’re not investing
in the basic research and technology
that allows solar wind and others to
thrive and develop at the same time what
they’ve said is let’s make Medicare into
a voucher program so that retirees
instead of knowing that they’re always
going to have health care they’re gonna
get a voucher that covers part of the
cost and whatever health care inflation
comes up is all going to be on them and
if the health insurance companies don’t
sell you a policy that covers your
illnesses you’re out of luck I think it
is very important for us to have a basic
social safety net for families with kids
with disabilities for seniors for folks
who are in nursing homes and I think
it’s important for us to invest in our
basic research we can do all those
things but we’re only going to be able
to do it by taking a balanced approach
and that’s what this big debate is about
all all about right now all right all
right so sorry don’t mean to cut off the
applause no no no no no no the very
thorough answer no they were they were
stunned by the length of that answer but
yeah that’s a complicated stuff so the
next question is from someone watching
Facebook live jf teen from Williamsburg
Virginia
writes in and asks the housing crisis
will not go away the mortgage financing
for new homebuyers with low to moderate
income is becoming very difficult
as president what can you do to relax
the policies that are disqualifying
qualified homebuyers from owning their
first home how can you assure the low to
moderate homebuyers that they will have
the opportunity to own their first home
well it’s a good question and I’ll be
honest with you this is probably the
biggest drag on the economy right now
that we have along with I know the
frustrations people have about gas
prices what we’ve really seen is the
housing market which was a bubble had
greatly over inflated in all regions of
the country and I know I probably don’t
get a lot of sympathy about that here
because I can only imagine what rents
and mortgages you guys are paying it is
a real drag
in all sorts of ways people first of all
they feel poor even if they still have a
home where they’ve already purchased a
home because for a lot of folks their
mortgages now what’s called underwater
the mortgage is more than the home is
worth and so if you feel like your most
important asset is now worth less than
your debt that’s going to constrain how
you spend people who want to move have a
great deal of trouble selling and people
who want to buy as you pointed out are
seeing terms a lot more restrictive so
we’ve put in place a bunch of programs
to try to see if we can speed along the
process of reaching a new equilibrium
for example what we did was we went to
the mortgage lender and said why don’t
you renegotiate with your mortgage with
the person with the mortgage renegotiate
the terms of their mortgage so that
their principal is a little bit lower
they can afford the payments and that
way homes don’t get foreclosed on there
are fewer homes on the on the market and
that will raise prices and they’ll be
good for everybody and we’ve seen some
significant progress on that front the
challenge we still have as your
questioner properly points out is the
a lot of people who bought a first home
when credit was easy now we’re finding
the credit is tough and we’ve got to
strike a balance frankly there’s some
folks who are probably better off
renting and what we don’t want to do is
return to a situation where people are
putting no money down and they’ve got
very easy payment terms at the front end
and then it turns out five years from
now because they’ve got adjustable rate
mortgage that they couldn’t afford it
and they lose their home I think the
regulator’s are trying to get that
balance right
there are certain communities with high
foreclosure rates where what we’re
trying to do is see if can we help state
and local governments take over some of
these homes and convert them and provide
favorable terms to first-time home
buyers but frankly I think we’ve got to
understand that the days where it was
really easy to buy a house without any
money down is probably over and what we
what I’m really concerned about is
making sure that the housing market
overall recovers enough that it’s not
such a huge drag on the economy because
if it isn’t then people will have more
confidence they’ll spend more more
people will get hired and overall the
economy will improve but I recognize for
a lot of folks who want to be first-time
homebuyers it’s still tough out there
it’s getting better in certain areas but
in some places particularly where there
was a big housing bubble it’s not so I
think the next question is from Facebook
employee in the in the room today
so Lauren Hale has a question Lauren
where are you from hey Lauren I thank
you so much for joining us today I am
originally from Detroit Michigan and now
I’m out here working at Facebook so my
question for you kind of builds on some
of the things you were just talking
about at the beginning of your term you
spend a lot of time talking about job
creation and the road to economic
recovery and one of the ways to do that
would be substantially increasing
federal investments in various areas as
a way to fill the void left from
consumer spending
since then we’ve seen the conversation
shift from that of job creation and
economic recovery to that of spending
cuts and the deficit so would love to
know your thoughts on how you’re going
to balance these two going forward or
even potentially shift the conversation
back well you’re exactly right that when
I first came into office that our number
one job was preventing us from getting
into a another Great Depression and that
was what the Recovery Act was all about
so we helped States make sure that they
could minimize some of the layoffs and
some of the difficult budget choices
that that they faced we made sure that
we had infrastructure spending all
around the country and in fact we made
the biggest investment in infrastructure
since Dwight Eisenhower built the
interstate highway system we made the
largest investment in history and clean
energy research and it’s really paying
off for example when I came into office
we had about 2% of the advanced battery
manufacturing here in America and as
everybody here knows what’s really
holding us back from that my goal of a
million electric vehicles on the road is
that battery technology is still tough
it’s clunky it’s heavy it’s expensive
and if we can make significant
improvements in battery technology then
you know I think the opportunities for
electric vehicles alternative vehicles
that are much cheaper you know the our
opportunities are limitless
so so those were all investments that we
made in the first two years now the
economy is now growing it’s not growing
quite as fast as we would like because
after a financial crisis typically
there’s a bigger drag on the economy for
a longer period of time but it is
growing and over the last year and a
half we’ve seen almost two million jobs
created in the private sector because
this recession came at a time when we
were already
people in debt and that made the debt
worse if we don’t have a serious plan to
tackle the debt and the deficit that
could actually end up being a bigger
drag on the economy than anything else
if the markets start feeling that we’re
not serious about the problem and if you
start seeing investors feel uncertain
about the future then they could pull
back right at the time when the economy
is taking off so you’re right that it’s
tricky any but you know folks around
here are used to the hills in San
Francisco and if you’ve driven I don’t
know if they still have clutch cars
around here anybody ever driven a clutch
car you know I mean you got a sort of
tap and well that’s sort of what we’ve
faced in terms of the economy right
we’ve got to hit the accelerator but you
know we’ve got to also make sure that we
don’t gun it we can’t let the car slip
backwards and so what we’re trying to do
then is put together a debt and deficit
plan that doesn’t slash spending so
drastically that we can’t still make
investments in education that we can’t
still make investments in infrastructure
all of which would help the economy grow
in December we passed a targeted tax cut
for business investment as well as the
payroll tax that has a stimulus effect
that helps to grow the economy we can do
those things and still grow the economy
while having a plan in place to reduce
the deficit first by 2015 and then over
the long term so I think we can do both
but it does require the balanced
approach that I was talking about if all
we’re doing is spending cuts and we’re
not discriminating about it if we’re
using a machete instead of a scalpel and
we’re cutting out things that create
jobs then the deficit could actually get
worse because we could slip back into
another recession and obviously for
folks in Detroit where you’re from they
know that our investments can make a
difference because we essentially saved
the
US auto industry we’ve now have three
auto companies here in America that are
all turning a profit GM just announced
that it’s hiring back all of the workers
that it was planning to layoff and we
did so by the way at the same time as we
were able to increase fuel efficiency
standards on cars for the first time in
thirty years so it can be done but it
takes a balanced approach all right so
we have a question from the University
of Florida where in in February we
launched this initiative at
whitehouse.gov/youngamericans with this
goal to have a hundred youth roundtables
across the country and a bunch of them
are taking place right now watching this
Facebook live so Cesare Fernandez and
ELISA retinas are participating in one
of those roundtables and they want to
ask you this mr. president in your
deficit-reduction speech last week you
spoke of the need to not only reduce
government spending but to also increase
federal revenue in light of our nation’s
budget challenges will your
administration consider a visiting
policies such as the DREAM Act which the
Congressional Budget Office estimates
will reduce the deficit by 1.4 billion
and increase the government revenue by
2.3 billion over the next 10 years let
me let me talk about not only the DREAM
Act but about immigration policy
generally and I want to thank Sheryl
Sandberg actually participated in
discussion that we had yesterday
bringing together business leaders and
government officials and faith leaders a
broad cross-section of Americans
together to talk about how do we finally
fix an immigration system that’s
fundamentally broken for those of you
who aren’t familiar the DREAM Act is it
deals with a particular portion of the
population kids who were brought here
when they were young by their parents
their parents might have come here
illegally the kids didn’t do anything
they were just doing what kids do which
is follow the
parents they’ve grown up as Americans
they went to school with us or with our
kids they think of themselves as
Americans but many of them still don’t
have a legal status and so what we’ve
said is for especially for these young
people who are our neighbors our friends
our children’s friends you know if they
are of good character and going to
school or joining our military they want
to be part of the American family why
wouldn’t we want to embrace them why
would why would why wouldn’t we want to
make sure that why wouldn’t we want to
make sure that they’re contributing to
our future so that’s the DREAM Act but
that’s just a small part of a broader
challenge that we have immigration in
this country has always been complicated
you know the truth of the matter is that
we are both a nation of immigrants and a
nation of laws sometimes the laws
haven’t been fair sometimes the laws
have been restricted to certain ethnic
groups there have been quotas sometimes
our immigration policies have been
arbitrary and have been determined by
whether industry at a particular time
was willing to bring in workers on the
cheek but what’s undeniable is America
is a nation of immigrants that’s our
history and that’s what makes us
stronger because we’ve got ambitious
people from all around the world who
come here because they’ve got a new idea
and and and they want to create the next
big thing or they just want a better
future for their kids and their family
and that dynamism is part of what’s
propelled our progress and kept us young
now I think most Americans understand
that and most Americans agree with that
at the same time I think most Americans
feel there should be an orderly process
to do it
people shouldn’t just be coming here and
cutting in front of the line essentially
and staying without having gone through
the proper channels so what we’ve said
is let’s fix the whole system first of
all let’s make the legal immigration
system more fair than it is and more
efficient than it is and that includes
by the way something I know that is of
great concern here in Silicon Valley if
we’ve got smart people who want to come
here and start businesses and our PhDs
and math and science and computer
science and why don’t we want them to
stay I mean why would we want to send
them someplace else so
well those are potential job creators
those are job generators you know I
think about somebody like an Andy Grove
of Intel I you know we want more Andy
groves here in the United States we
don’t want them starting companies we
don’t want them starting Intel in China
or starting it in France we want them
starting it here so there’s a lot that
we can do for making sure that
high-skilled immigrants who come here
study we’ve paid for their college
degrees we’ve given them scholarships
we’ve given them this training let’s
make sure that if they want to reinvest
and make their future here in America
that they can so that’s point number one
but point number two is you also have a
lot of unskilled workers who are now
here who are living in the shadows
they’re contributing to our economy in
all sorts of ways they’re working in the
agricultural sector they are in
restaurants and they’re you know in
communities all across the country
looking after children and and helping
to build America but they’re they’re
scared and they feel as if they’re
locked out of their surroundings
and what I’ve said is they did break the
law they came here they have to take
responsibility for that they should pay
a fine they should learn English they
should go to the back of the line so
that they don’t automatically get
citizenship but there should be a
pathway for them to get legalized in our
society so they don’t fear for
themselves or their families so that
families aren’t separated at the same
time let’s make sure we’ve got a secure
border so that folks aren’t wandering
through the desert to get here let’s
make the legal immigration system more
efficient and more effective so there
aren’t huge backlogs this is all part of
what we call comprehensive immigration
reform
and there’s no reason why we shouldn’t
be able to achieve a that is fair is
equitable is an economic engine for
America that helps the people who are
already here get acculturated and make
sure that our laws aren’t being broken
but we’re still true to our traditions
but as I mentioned to Cheryl yesterday I
can’t solve this problem by myself Nancy
Pelosi is a big champion of this the
Democratic caucus in the house I think
is prepared for a majority of them are
prepared to advance comprehensive
immigration reform but we’re gonna have
to have bipartisan support in order to
make it happen and all of you have to
make sure your voices are heard saying
this is a priority this is something
important because if if politicians
don’t hear from you then then it
probably won’t happen I can’t do it by
myself we’re gonna have to change laws
in Congress but I’m confident we can
make it happen
[Applause]
[Music]
all right so the next one is from a
facebook employee Lee or Abraham Leo
where are you from hey leo hey hey I’m
from San originally from San Jose
California my question is the 2012
budget plan proposed by Paul Ryan has
been praised by many in the media as
bold or brave do you see this as a time
that calls for boldness and do you think
that you’re the plan you outlined last
week demonstrates sufficient boldness or
is this just a media creation you know
it’s a great question look here’s what
I’d say the the the Republican budget
that was put forward I would say is
fairly radical I wouldn’t call it
particularly courageous I do think mr.
Ryan is sincere I think he’s a patriot I
think he wants to solve a real problem
which is our long-term deficit but I
think that what he and the other
Republicans in the House of
Representatives also want to do is
change our social compact in a pretty
fundamental way their basic view is that
no matter how successful I am no matter
how much I’ve taken from this country
you know I wasn’t born wealthy you know
I was raised by a single mom and my
grandparents I went to college on
scholarships there was a time when my
mom was trying to get her PhD where for
a short time she had to take food stamps
my grandparents relied on Medicare and
Social Security to help supplement their
income when they got old so their notion
is despite the fact that I’ve benefited
from all these investments my
grandfather benefited from the GI Bill
after he fought in World War two
that somehow I now have no obligation
to people who are less fortunate than me
and I have no real obligation to future
generations to make investments so that
they have a better future
so what his budget proposal does is not
only hold income tax flat he actually
wants to further reduce taxes for the
wealthy further reduced taxes for
corporations not pay for those and in
order to make his numbers work cut 70%
out of our clean energy budget cut 25%
out of our education budget cut
transportation budgets by 1/3 I guess
you could call that bold I would call it
short-sighted on
and then as I said there’s a fundamental
difference between how the Republicans
and and and I think about Medicare and
Medicaid in our health care system their
basic theory is that if we just turn
Medicare into a voucher program and turn
Medicaid into Block Grant programs then
now you a Medicare recipient will go out
and you’ll shop for the best insurance
that you’ve got that you can find and
that you’re going to control costs
because you’re gonna say the insurance
company this is all I can afford that
will control costs except if you get
sick and the policy that you bought
doesn’t cover what you’ve got then
either you’re gonna mortgage your house
or you’re gonna go to the emergency room
in which case I who do have insurance
you’re gonna have to pay for it
indirectly because the hospital’s going
to have uncompensated care so they don’t
really want to make the health care
system more efficient and cheaper what
they want to do is to push the costs of
health care inflation on to you and then
you’ll be on your own trying to figure
out in the marketplace how to make
health care cheaper the problem is
you’re just one person now you work at
Facebook it’s a big enough company
Facebook can probably negotiate with
insurance companies and providers to get
you a pretty good deal but if you’re a
startup company if you’re an
entrepreneur out there in the back of
your garage good luck trying to get
insurance on your own you can’t do it if
you’re somebody who’s older and has a
pre-existing condition insurance
companies won’t take you so what we’ve
said is let’s make sure instead of just
pushing the costs off on the people who
individually are not gonna have any
negotiating power ability to change how
providers operate or how hospitals or
doctors operate how insurance companies
operate
let’s make sure that we have a system
both for Medicare but also for people
who currently don’t have health
insurance where they can be part of a
big pool they can negotiate for changes
in how the healthcare system works so
that it’s more efficient so it’s more
effective so that you get better care so
that we have fewer infection rates for
example in hospitals so there are fewer
readmission rates so that we’re caring
for the chronically ill more effectively
so that there are fewer unnecessary
tests that’s how you save money the
government will save money but you’ll
also save money so we think that’s a
better way of doing it now what they’ll
say is well you know what that’ll never
work because it’s government imposed and
it’s bureaucracy and it’s a government
takeover and they’re death panels and I
you know I still don’t entirely
understand the whole death panel concept
but I guess what they’re saying is
somehow some remote bureaucrat will be
deciding your healthcare for you all
we’re saying is if we’ve got health care
experts doctors and nurses and consumers
who are helping to design how Medicare
works more intelligently then we don’t
have to radically change Medicare so yes
I think it’s fair to say that their
vision is radical no I don’t think it’s
particularly courageous because the last
point I’ll make is this nothing is
easier than solving a problem on the
backs of people who are poor or people
who are powerless or don’t have
lobbyists or don’t have clout
I don’t think that’s particular
courageous
all right the next one’s from the web
we’ve got a question from Kwame Simmons
from Orlando Florida and he asks I
strongly believe that education is the
greatest equalizer with so many problems
plaguing our current system is it
possible to examine a complete overhaul
of the systems that addresses the needs
and modern students and before you jump
in I just want to say if someone who’s
spent a bunch of time researching
education who cares about this I think
that their race to the top stuff that
you guys have done is one of most
underappreciated and most important
things that your administration has done
I appreciate that the this is an area
where actually I think you’ve seen the
parties actually come together and
there’s some good bipartisan work being
done it used to be that the argument
around education always revolved around
the Left saying we just need more money
and the right saying we should just blow
up the system because public schools
aren’t doing a good job and what you’re
now saying is people under recognizing
we need both money and reform it’s not
an either/or proposition it’s a both/and
proposition so what Mark just mentioned
something called race to the top pretty
simple concept most federal dollars are
allocated through a formula you know if
you’ve got a certain number of poor kids
or you’ve got certain number of disabled
kids in your school district there’s a
formula and you get a certain amount of
money in every state and every school
district gets that money according to
the formula what we did was we took
about one percent of the total spending
on education and we said to get this one
percent show us that you’re reforming
the system it’s almost it’s like a
competition model and so every state
every school district could apply and
you had to show us that you had a good
plan to retrain teachers
recruit and and do good professional
development so we got the best teachers
possible you had to have accountability
you had to show us that you were
actually making progress in the schools
and that you were measuring through data
the improvements that were being made
that you were reaching into the schools
that were hardest to reach because there
are about 2,000 schools around the
country that account for the majority of
dropouts in our country there like
dropout factories so show us a plan to
go into those schools and really make a
big difference
and what’s happened is that over 40
states in the process of competing for
this extra money ended up initiating
probably the most meaningful reforms
that we’ve seen in a generation and so
it’s made a huge difference even those
states that didn’t end up actually
winning the competition still made
changes that are improving the potential
for good outcomes in the schools so
that’s the kind of creative approach
that you’ve seen some Democrats and some
Republicans embrace and our hope is we
can build on that a couple of things
that we know work the most important
thing to a good education is making sure
we’ve got a good teacher in front of
that classroom and so providing more
support for teachers recruiting the best
and brightest into teaching making sure
that they’re compensated but also making
sure that they’re performing that’s
hugely important the other thing is good
data so that there’s a constant feedback
not just a bunch of standardized tests
that go into a drawer or the people may
gaym in order not to get penalized
that’s what happened under No Child Left
Behind but instead real good data that
you can present to the teacher while
they’re still teaching that child and
say you know what this child is falling
behind in math here’s some ways to do it
to improve their performance so we’re
starting to see real progress on the
ground and I’m optimistic that we can
actually before the 2012 election
potentially have a federal education law
that will
embody some of the best information that
we have about how to initiate good
school reform now last point I’ll make
on this government alone can’t do it one
of the things every time I come to
Silicon Valley that I’m inspired by but
I’m also frustrated by is how many smart
people are here but also frustrated that
I always hear stories about how we can’t
find enough engineers we can’t find
enough computer programmers you know
what that means our education systems
not working the way it should and that’s
got to start early and that’s why we’re
emphasizing math and science that’s why
we’re emphasizing teaching girls math
and science that’s why we’re emphasizing
making sure that black and Hispanic kids
are getting math and science you know
we’ve got we’ve got to do such a better
job when it comes to STEM education and
that that’s one of the reasons by the
way that we had our first science fair
at the White House in a very long time
just because we want to start making
science cool I I want I want everybody
to feel the same way that they did I
want people to feel the same way about
you know the next big energy
breakthrough or the Beck the next big
Internet breakthrough I want people to
feel the same way they felt about the
moon launch then that that’s how we’re
going to stay competitive for the future
and that’s why these investments in
education are so important but as I said
we’re government alone can’t do it
there’s got to be a shift in American
culture where once again we buckle down
and we say this stuff’s important and
it’s that’s why I mark the work you’re
doing a new work for example the the
work that folks like you know the Gates
Foundation are doing in philanthropic
investments in best practices in
education especially around math and
science training that are going to be so
important we’ve got to lift we’ve got a
pit
lift our game up when it comes to
technology in math and science that’s
hopefully one of the most important
legacies that I can have as president
the United States
all right so the next one is from
another Facebook employee here so
they’re James Mitchell
so James Mitchell where are you from
well here’s James Becker hi mr.
president
hey James Mitchell born in Chicago and
raised out here in Cupertino California
I have yet another question for you
about the debt and healthcare go ahead
so the biggest threat we have fiscal is
that is the rise in health care costs
unfortunately a lot of the solutions we
here to Medicare and Medicaid
don’t involve actually slowing down the
rise in health care costs instead they
involve shifting costs to beneficiaries
and States so my question is can you
talk a bit more about what provisions in
the Affordable Health Care Act are
designed to slow down the rise of health
care costs and what policies you’d like
to see enacted in the future to continue
to slow down the rise of health care
costs let me give you a couple of
examples because you’re exactly right in
how you described it I don’t want to
just shift the health care costs onto
the American people I want to actually
reduce health care costs let’s take the
example of health IT now we’re in
Silicon Valley so we can talk about IT
stuff now I’ll try to sound like I know
what I’m talking about the health care
system is one of the few aspects of our
society where a lot of stuff is still
done on paper right well if last time
you guys went to a doctor’s office or
maybe to your dentist’s office how many
people still had like fill out a form on
a clipboard right and the reason for
that is because a large chunk of our
provider system is is not automated so
what ends up happening is you may go to
your primary care physician he worked he
does some basic tests he sees something
of concern he refers you to a specialist
you go to the specialist he’ll do
another test
you’re getting charged or your insurance
company is getting charged for both
those tests as opposed to the test that
was taken by your primary care physician
being emailed to the specialist or
better yet if it turns out that there
may be three or four specialists
involved because it’s a difficult
diagnosis this is all hypothetical you
look very healthy but let’s say there
are a bunch of specialists what would be
ideal would be if you get all the
specialists together with the primary
care physician the first time you’re
seen so that you’re not paying for
multiple visits as well as multiple
tests that’s not how it works right now
now part of it is technology so what we
did in the Affordable Care Act building
on what we did to the Recovery Act is
try to provide incentives to providers
to start getting integrated automated
systems and it’s tough because the
individual doctor may say to them him or
herself I don’t want to put the initial
capital outlay that’s expensive even
though it may make my system more
efficient later on so providing some
incentives some help for the front-end
investments for a community hospital or
for individual providers so that we can
slowly get this system more effective
that’s priority number one we know it
can be done by the way surprisingly
enough the healthcare system that is
does the best job on this of anybody is
actually the Veterans Administration the
VA healthcare system because it’s a
fully integrated system
you know everybody is working for the VA
all the doctors all the hospitals all
the providers so they’ve been able to
achieve huge cost savings just because
everybody’s on a single system it’s also
though how we reimburse doctors and how
we reimburse hospitals so right now what
happens is when you’ve taken those two
tests if you’re
old enough to qualify for Medicare well
each doctor sends their bill to Medicare
and Medicare pays both bills and let’s
say that you end up getting an operation
they’ll send the bill for that and so
Medicare pays that let’s say they didn’t
do a very good job or you got sick in
the hospital and you are readmitted and
you have to be treated again and they
have to do the operation all over again
Medicare then gets billed for the second
operation I mean imagine if that’s how
it worked at when you bought a car so
you go you buy your car a week later the
car doesn’t work you go back to the
dealer and they charged you to fix the
bad job that they did in the first place
well that’s what Medicare does all the
time so we don’t provide incentives for
performance we just provide we just pay
for the number of qualified items that
that were you know procedures that were
performed or tests that were performed
by the provider so what we want to do is
to start changing how folks are
reimbursed let’s take a hospital we want
to give this sort of like race to the
top what Mark was talking about in
education we want to be able to say to a
hospital if you do a really good job
reducing infection rates in hospital
which kill tens of thousands of people
across America every year and are a huge
cause for readmission rates and we know
that hospitals can drastically reduce
those reinfection rates just by simple
protocols of you know how employees are
washing their hands and how they’re
moving from room to room and so forth
there are hospitals who have done it if
we can say to a hospital you’ll get a
bonus for that Medicare will reimburse
you for instituting these simple
procedures that saves the whole system
money and that’s what we’ve tried to do
in the Affordable Care Act is to start
institutionalizing
these new systems but it takes time
because we’ve you know we’ve got a
private sector system it’s not like the
VA it’s a bunch of individual doctors
individual hospitals you know spread out
all across the country with private
insurers so it’s not something that we
can do overnight our hope is is that
over the next five years we’re able to
see significant savings through these
mechanisms and that will save everybody
not just people who are Medicare and
Medicaid it’ll save everybody money
including folks here at Facebook because
you know I’m sure that you guys provide
health insurance and I suspect if if you
look at your health insurance bills they
don’t make you happy
okay so we have time for only one more
question time it’s a question from from
Terry Atwater from Houston Texas if you
had to do anything differently during
your your first four years what would it
be well it’s only been two and a half so
I’m sure I’ll make more mistakes in the
next year and a half the jury will still
be out the you know there are all sorts
of day-to-day issues where I say to
myself
oh you know I didn’t say that right or I
didn’t explain this clearly enough or
maybe if I had sequenced you know this
plan first as opposed to that one maybe
it would have gotten done quicker health
care obviously was a huge battle and if
it hadn’t been for Nancy Pelosi and her
leadership in the House and and the
great work that
you know and a su and my Conda and
others that we wouldn’t have gotten it
done if it hadn’t been for great work in
Congress but but I I do think that it
was it was so complicated that at a
certain point people just started saying
uh this is typical Washington bickering
and you know I’ve I’ve asked myself
sometimes is there a way that we could
have gotten it done more quickly and in
a way that the American people wouldn’t
have been so frustrated by I’m not sure
I could have because there’s a reason
why it hadn’t gotten done in a hundred
years it is a it’s it’s hard to fix a
system as big as as health care and as
complicated as our health care system I
can tell you that I think the best way
to answer the question is what do I feel
I still have to get done where I still
feel a huge sense of urgency I’ve talked
about a couple of things getting our
deficits and debt under control in a
balanced way I feel needs to happen
while I’m president I don’t want to
leave it to the next president
immigration something I mentioned we
have not gotten done it’s something I
care deeply about it’s the right thing
for the country I want to get that done
while I’m president energy you know we
haven’t talked a lot about energy today
but you know first of all $4 a gallon
gas really hurts a lot of people around
this country it’s not because they’re
wasteful but if you’re driving 50 miles
to work and that’s the only job you can
find and you can’t afford some hybrid so
you’re stuck with the old beater that
you’re driving around to get gets eight
miles a gallon these gas prices are
killing you
right now and so this is the reason why
I’ve said that it is so important for us
to invest in new approaches to energy
we’ve got to have a long term plan it
means investing in things like solar and
wind investing in biofuels investing in
clean car technology it means converting
the federal fleet a hundred percent to
fuel-efficient vehicles because we’re a
huge market maker obviously you know it
turns out that I’ve got a lot of cars as
president and you know if we’re out
there purchasing electric cars and
hybrids and you know that can help boost
demand and drive down prices continuing
to increase fuel efficiency standards on
cars increasing oil production but in an
intelligent way I mean those are all
hugely important and by the way we can
pay for it let me let me say this we
lose the Treasury loses 4 billion
dollars a year on subsidies to oil
companies now think about this the top
five oil companies have made somewhere
between 75 billion and 125 billion every
year for the last five years nobody’s
doing better than Exxon nobody’s doing
better than Shell or these other
companies they are doing great they are
making money hand over fist
well maybe Facebook’s doing a little
better but but you get the idea they’re
doing really well
they don’t need special tax breaks that
cost us four billion dollars and so what
we’ve said is why can’t we eliminate the
tax breaks for the oil companies who are
doing great and invest that in new
energy sources that can help us save the
planet
so so when it comes to energy when it
comes to immigration when it comes to
getting our deficit under control in a
balanced and smart way when it comes to
improving our math and science education
when it comes to reinvesting in our
infrastructure we’ve just got a lot more
work to do and I guess my closing
comment mark would just be I hope that
everybody here that you don’t get
frustrated and cynical about our
democracy I mean it is frustrating lord
knows it’s frustrating I and I know that
some of you who might have been involved
in the campaign or been energized back
in 2008 you know you’re frustrated that
Kasia didn’t get done fast enough and it
seems like everybody’s bickering all the
time just remember that we’ve been
through tougher times before we’ve
always come out ascendant we’ve always
come out on top
because we’ve still got the best
universities in the world we’ve still
got the most productive workers in the
world this is still the most dynamic
entrepreneurial culture in the world if
we come together we can solve all these
problems but I I can’t do it by myself
the only way it happens is if all of you
still get involved still get engaged it
hasn’t been that long since Election Day
and we’ve gone through some very very
tough times and we’ve still gotten a lot
done we’ve still been able to get this
economy recovering we’ve still been able
to get health care passed we’ve still
been able to invest in clean energy
we’ve still been able to make sure that
we overturn Don’t Ask Don’t Tell we
still made sure that we got to women on
the Supreme Court
we’ve made progress so so rather than be
discouraged I hope everybody is willing
to double down and work even harder
regardless of your political affiliation
you’ve got to be involved especially the
young people here your generation if you
don’t give us a shove if you don’t give
the system a push it’s just not going to
change and you’re going to be the ones
who end up suffering the consequences
but if you are behind it if you put the
same energy and and imagination that you
put into Facebook into the political
process I guarantee you there’s nothing
we can’t solve all right thank you Mark
[Applause]
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