 My name is John Hamry. I'm the president of CSIS. And I want to say thank you to all of you for coming. All of us have had in our lives some remarkable educational moment. Let me share one with you that I had. This was back when I was the deputy secretary of defense. And I went to Bosnia. We still had all our troops in Bosnia. And I was talking with our commander there. And I said, well, what is it that you most need? What can I help you with? And he said, well, what I really need is I need about $10 million that I could use when I go around to have my soldiers go to a village. He said, if I go into a village and we come rolling in with tanks and everybody's got their guns out and you try to talk with a mayor, it's just nothing but suspicion. It's a very difficult meeting. He said, but if I can go in and say, look, mayor, I've got about $100,000 that I've got to spend, others, I've got to give it back, is there something you and I can work on together? Can we build a school or do something we can do? He said, it completely changes the landscape. And that was the first time I came to realize that well-designed economic assistance is one of the most powerful military tools we have. Now, we don't understand that in Washington. I learned that the hard way by talking to a guy that was working with it full-time. That's what led us to try to do the, well, it was a project four years ago we called Smart Power. And we asked Colleen Gale, and I asked another one of my military friends, Bill Fallon, who had been a four-star commander in this whole region if they would be willing to head up this commission, to say, how do we recover all of these tools that really, in some sense, are far more powerful than a gun? It led us to this commission. One of the recommendations in that commission was that one of the most powerful tools is health, global health. I remember seeing our popularity. And after 9-11, as a nation, we responded with a lot of anger and a lot of fear. And that led to military responses that, frankly, turned off a lot of people in the world. I'm not going to argue whether that was the right thing or not. What I'm going to say is that I saw what happened when that terrible earthquake hit Ache. And where our popularity was in the low teens, after we went in with military supporting health delivery, it went up into the high 70s and low 80s. And it just shows what the perception. So I come to this issue. I have many of you here come to it from an honest, genuine humanitarian impulse. And I honor that. I come to it from a national security impulse. This is good for our nation. It's good for us to have these tools in our arsenal so that we can do something about it. And when I see that we're going to spend $10 billion a year, I compare that to we're spending roughly $10 billion a month in Afghanistan, this is an investment we need to make. But that's a debate we're going to have in this country. And that's part of the reason that we launched what we call this Global Commission on Smart Health Policy. And one of the great figures of that, and we were so anxious to have her lead, it was Helene Gale. So can I introduce to you Helene Gale, who is now the head of care, one of my bosses at CSIS and the head of our commission. Helene, please come. Thanks, John, for that very warm introduction. And welcome to everybody. This is really fabulous to look out and to see this crowd here gathered and really very, very much looking forward to the discussion today. We're very pleased to have a distinguished panel, Congressman Keith Ellison, former Congressman Mark Green, Lois Kwam, the new Global Health GHI Executive Director. Congratulations. We'll see you six months from now if you still are smiling and happy about it. Tachi Yamada from the Gates Foundation, who has been a friend and a real role model for me for many years. Three of our commissioners from the Smart Global Health Policy, Karen Remly, Rajiv Venkaya, and Mike Merson, and colleagues from the Global Health Initiative. So we're really looking forward to the panel and the discussion that will come. We're here because, as John said, this is an issue that is critical. It's critical if you come from a sense of what's right and good to do or whether you believe that it is the way that we're going to have the greatest impact on peace, stability, and security around the world. But we come knowing that the US has been a real leader in global health for many, many, many years. And part of why we felt it was so important to have this discussion now is that we really are at a very critical juncture. As Steve said in the video and as we all know, these are really hard times. We have some really tough choices to make as a nation as we think about what does it take to balance the budget? What does it take to get us economically back on track? But at the same time, I think we recognize that this is not the area where we can choose to play it cheap, that we have made significant progress, whether it's looking at the 99% decline in polio that has come from the investments that the US has made, or whether it's the major declines in under five mortality, 35% declines in maternal mortality that we have finally started to see an impact over the years on one of the things that was the toughest. And I think some of the things we saw here in the film show that we really are starting to make real progress and see gains in even areas like emergency obstetrical care and things that for so long have been a challenge. So I think we're all here in this room because we believe that this truly is a good investment. Investment in human life, investment in our image around the world, investment in peace, stability, and security. And we want to really look and challenge ourselves to make sure that we are continuing to play the leadership role that the United States has played in the area of global health. I won't, there's lots more to be said, but I think at this point we want to get on with the panel and have a discussion with our group of experts that we've pulled together. Hope that you as an audience, we will also have opportunity for you as an audience to participate. And all of us leave here not only with our continued commitment to this as an area, but also thinking about how we continue to maintain the progress that we have made with these important global health advancements. So without further ado, I think I'm supposed to call John back to the floor and the panelists. Congressman, why don't we put you here? Put Mark, put you right in between. Folks, I'm not going to burn up valuable time reading resumes. That's up to you. You take care of that. So we want to get into this session. We're fortunate to have both Congressman Ellison, former Congressman Green, now Ambassador Green with us. And obviously what we want to explore in this session is the kind of climate that we're in in America right now. Let me start not with the Washington climate, but more broadly, Congressman, you used to have to go back home to Appleton and Green Bay to talk to your constituents. Congressman, you go back to Minneapolis. Everybody's afraid of their future. When you're afraid of your future, you start thinking about me. It's kind of a me time. And yet we're really going to have a conversation here about what do we do about people that are far away we don't even know. How do you motivate that kind of a sentiment? But before we do each, you probably have some things that you want to shape. And why don't you start, and then we'll come back to this question. Thank you, John. And Ambassador Green, it's an honor to be sharing the stage with you. And let me say thank you to everyone, including Steve Morrison, Helene Gale, and all others. My very good friend of many, many years, now helping to lead our effort in global health from the State Department, Lois Kwam. Give her a hand, please. Well, I think that it is certainly a time where there is a degree of uncertainty. There are no shortage of firm ideas as to what we should do. But it is a time when Americans of various backgrounds are thinking about what shall we do and which way shall we go. But there are a few things that I think are prevalent. One of those is that there is a certain amount of anxiety, John, about what is America's future? I mean, we are a mature democracy. We have the oldest constitution in the world. As much as we think of our country as young, we've been around for a long time. And there is a certain sense that perhaps we don't know if our place in the world is ascending, stagnant, or declining. And people have spilled ink on this topic. But one of the ways that we can project ourselves in the world as a nation that is still on the ascent is by continuing to play an important role in the health, security, safety development of the people of the world, particularly when Americans know that this is about 1% of our budget and if they are confident that the dollars spent for the things that we say we're going to spend it on actually go to the intended beneficiary. I'm lucky enough to have a father who is pretty dedicated Republican. And I'm proud, bleeding heart liberal. And we talk about these issues a lot. And I think the thing that both sides want to know is the dollars spent well. And so I think it's time for that conversation to take place. Nobody should be afraid of scrutiny. And everyone ought to be able to prove value associated with the American tax dollar. But I would submit to you that programs like PEPFAR, MCC, and a whole myriad of other ones that help deliver stability and good health to societies around the world are things that Americans will support if we take the time to actually explain it to people who are in a position to make a decision. And I'll say that the danger is the broad brush. We're just going to cut across the board. I think all of us have to resist this temptation to do this across the board thing. It doesn't make any sense that it's not fair. Some programs are more effective, more efficient than others. But I punish the good with the bad. It doesn't create the proper incentives to strive well. And so just as a preliminary comment, I just want to say I think the challenge before us is making the argument that we have to go through the budget as we are embarking on this budgetary process, not to mention the debt-sealing debate we're about to have and the CR debate we just had and will seem like we'll continue to have, at least for the foreseeable of the short-term future. I think the important challenge is to encourage people to look programmed by program for savings, for value, and for real impact. Please. Thank you. Well, Congressman, it's good to be with you. And John, thanks for the honor of being here. And this is an interesting day, an interesting topic, because if it's a topic that a proud Republican father and a bleeding heart liberal son can talk about, what's even more amazing is that a Viking fan and a Packer fan can actually share the stage and be civil to each other. If there is one thing that I can leave you with, one belief that I have as we talk about the challenges that we're facing, it's that this isn't a one election problem. I hear a lot of discussion about the partisan challenges, and they're certainly there on Capitol Hill. But I actually don't think that partisan challenges are leading to our current challenges. I think it's something more profound than that. I think these recent elections didn't lead to the challenges. Perhaps they exposed some of the challenges. I think the challenges that we really face as we look to build toward the future, John, as you're pointing to, is that we have to understand how much time has passed and how many elections have passed since the marvelous tools of PEPFAR and PMI, the foundation upon which GHI is built, since they were launched. And that to me is something that's important. I think what's happened is that in many ways we were spoiled by momentum and good fortune, if you will. We had a growing economy with revenues coming in. We had a grand, I won't even say bipartisan, nonpartisan alliance behind these programs that led to the ramping up of resources and the strong support behind these programs. But what happened was, with each election, quite frankly, we lost some of the institutional memory and some of the institutional leadership that crafted these programs in the first place. When you think back, PEPFAR was created, what, not even 10 years ago, and since then of the 100 US senators who actually voted on PEPFAR and had passed with, on a voice vote, as I recall, only 52 are in office right now. Of the 435 members of the House, only 225 are in. When you think about the leadership that we've lost, Dashel, Hastard, PEPFAR was reauthorized by Tom Lantos and Henry Hyde, God rest their souls. They've left the stage. When you look at the committees themselves, which were really crucial in crafting these bills, of the 19 members of the Senate Foreign Relations Committee who were on the committee helping to craft this, three serve today. And so what's really happened is, I think with these elections, we've turned around and suddenly seen the giants, if you will, the legislative giants of global health have left the stage. And so I think really what we have to do is go back to basics. I think what's happened to a lot of us is, we've assumed as we go to Capitol Hill, and there are some exceptions like Congressman Ellison, but we go to Capitol Hill assuming that there's a basic shared understanding of the value of these programs, of the benefits of these programs, when we engage in the discussion about the levels of resources that are necessary to make them strong and vital going into the future. And I think that's a mistake. I think instead we really do have to go back to basics. And we have to talk about why it is that we're engaged in the world. Why it is that we're involved in global health. Why this is not only the right thing to do, and I think we all believe that it is, but also as both of these gentlemen have talked about, why it's the smart thing to do. I would argue that the importance of these programs is not merely as important as it is. What we do for those in need around the world, we get an awful lot ourselves for it. When I had the honor of serving as ambassador, we used to talk all the time about diplomacy by deeds. And something that I believed in very strongly and continue to, you can talk all you want to, you can do all those op-eds and all those policy statements, and that's what ambassadors do. But none of that really matters, or none of that is comparable to the simple concrete fact of a PEPFAR funded clinic, or those bed nets that are getting distributed. As we look at GHI and the integration that is being proposed I think is so very important, the building of the lab facilities and the investment in that health infrastructure. To me that speaks more strongly, more loudly, more clearly about our values and does more to advance our image and advance our security interests than anything else that can be done, whether it be on Capitol Hill or at Foggy Bottom or wherever. And so I think what we really have to do is talk about back-to-basics, why we do this. And this video that we've seen in the trip that you put together is so very important because fewer and fewer policy makers, sadly, are getting the chance to see these things and there seems to be political toxin that goes along with traveling overseas and it's so unfortunate because there is nothing like seeing this up close and seeing it directly. And that's something that I think we really need to get back to and again, get back to basics and talk about why we do this. But you've opened up this question, Mark, as well as Keith, about a debate we're gonna have. We're gonna have whether it's gonna be on the debt ceiling extension, whether it's gonna be on supplemental, whether it's gonna be, but we're caught in this vortex of budget politics here. How does this issue stand apart and above from that as opposed to getting swept up as just part of the sound bites that sides use against each other, positive or negatively? I mean, we're gonna start with you and then we'll go to Keith. Well, first off, again, I think we need to go back to the basics as we take a look at the makeup of this Congress. We have an extraordinarily large freshman class and all the polling tells us that none of these elections were about foreign policy or foreign assistance. So in fact, I think you have a large number of members and not just the freshmen, but again, I think this is a multi-election challenge who I think are a good audience. I think they're ready to hear the message and I couldn't agree more with Congressman Ellison. These are programs that are working. And so if what drives you is effectiveness and efficiency of programs, I can take you to the islands of Zanzibar in Tanzania where we've seen child mortality and we've seen malaria infection rates plummet to the point where we're literally talking about crossing the threshold into something quite extraordinary that many of us thought wasn't even possible. So I think what we have to do is go member by member and talk about the value in terms of effectiveness and efficiency. Again, what we get for it and I don't think we should give into this notion that it's either hopeless or somehow overwhelming because of partisan challenges. I'm convinced that there are too many good arguments in favor of these programs, but that we have to make them. We really do have to go member by member and don't get caught in partisanship. That's too easy. I think it's much more open than that and much more promising. I agree. I think most people run for Congress with the best of intentions without regard to what their political orientation is. They go there to do good or to help the country. But I think we're in a time now where people want to see value. What is this doing for us? And those questions will certainly be asked and are being asked. And will continue to be asked all throughout 112 Congress. And that is good. Let us increase our gain and show how you can have a village in rural Kenya where years ago AIDS and HIV was a death sentence and now it is a manageable chronic illness. And these folks are feeling good about the United States. They can raise their own kids and supposed to see in an early gray. They can add to the economy. They can take care of their own needs. They can help solve their own problems whether they be water or malaria or whatever. And I think this makes a lot of sense. We do have to have be in a constant state of advocacy and justification. And at the bottom, there's nothing wrong. I think the real enemy is not any particular person or party. I think the real problem is, one, are we willing to make the case? And two, do we have a good case to be made? I think anybody who has not been using the public dollar well should be nervous. But I think those of us who are trying to say, look, the United States is the world's remaining superpower. We have the world's largest, not only military but economy. No matter what, all the talk about China, the United States still has an economy three times bigger than China does. And we have a certain responsibility in the world that has to be shared by the international community, but that we can't abandon. And I think if we show that this is a good value program that brings real value, I think we can succeed. And so you gotta put on your salesman hat and be able to make a good argument. I think we'll be successful. Washington's a town where 90% of the discussion's about inputs, very little about outcomes. We put in dollars, we don't know how to measure that output very well, and we kind of left the next year dollar input be a substitute for it. But I think that's changing, as both of you have said. So how do we get a stronger focus on outcomes? And how do we get out of this? I mean, we all use anecdotes, but anecdotes can be used to pull you down as well. So how do we do this? Congressman, you're in the middle of this. We absolutely have to build in metrics and outcomes as we set forth the program. As we conceive of the program, metrics and measurement must be built in from the very beginning. Because isn't it always like the last thing that we think about? We wanna go there and there and solve the problem. And of course, we're pretty sure our efforts will be effective except for when they're not. And so the point is that we need to be more sophisticated about measuring outcome and be more deliberate in the very beginning. That means data collection as we go. There are ways to improve the efficiency of measurement too. And I'm pretty certain that one of the elements is being deliberate in the very beginning. I'm mindful that the principles that were articulated in the video metrics were part of the presentation. That's smart. And we gotta make arguments to policymakers, people on Capitol Hill, everywhere, that look, we need to put into the budget because you can't just wish for good metrics. You have to pay for them. That has to be budget, that has to be accounted for in the budget from the very beginning. I am very optimistic when it comes to global health. I look at this as an area in which our policy is constantly evolving, constantly progressing and constantly building upon the good work of those who were in office before. I'm very proud of the tools that were crafted under the Bush administration, again with overwhelming nonpartisan support. And I think every administration and every Congress adds something to that. I think that the Obama administration, one of the elements that we're seeing that I think is a very useful contribution is an increased focus on monitoring and evaluation. And we're starting to see USAID building that in their programs. I think Dr. Shaw is on the right track and is making a great contribution here. And on top of that, we're also at a point in the history of these programs where we have results coming in. This is no longer speculative. We know that it works. And so now with these results, coupled with the increased monitoring and evaluation, I think this is precisely the time to take a look, a close look as the congressman says, and I absolutely agree with him. And we need to force every program to re-justify itself. That's the nature of the time that we're in. But I think when you look at most of these programs in the area of global health, I think there's a lot to see, a lot of good results and a great opportunity to fine tune them, to increase the integration, to build on it going forward. To me, that's a very exciting opportunity. I think every conversation I'm in these days in Washington, at some point, the word public-private partnership comes up. And half of the time, it's just a way to get a new buzzword to try to get your budget through. And the government isn't historically very good on public-private. We're good at regulating. We're not particularly good in encouraging and shaping. But I think this is one area there's been some exception. And you guys really are in the middle of that. I mean, how does, and of course, we've had the pioneering work of the Gates Foundation that's really kind of transformed this standing of global health in Washington. Where do you see this public-private dimension that's helping us with the budget battles we're looking at here? Is this a plus, and how do we make the most out of it? Keith, let's start with you. Well, I'll certainly say, the public-private partnership has been a tremendous plus. And I think we need to refine our use of these practices and get better at it. I do have a certain number. I'm worried sometimes, because I don't want government to ever say, well, this is public health and global health and public diplomacy and foreign aid are not the proper role of government. We'll just let the private sector do it. I think that is an inherent danger. But I also think that we're in these, we've worked well together and had good outcomes. I think we need to really put that on display. I mean, quite frankly, the public sector, whether it's the nonprofit or foundation sector or even the for-profit sector, because they're not encumbered by democratic processes, which I believe are necessary and important, they sometimes can be a little bit more nimble and quick. And yet at the same time, the public sector is critical because the public sector is, after all, the full weight and measure of the United States people, and has considerable resources as well. So we work well together, and I think we need to continue to study how we do better, and of course, we have some data to rely on, but we gotta keep the balance in the right order. Otherwise, I think things could go awry. I think one of the contributions of PEPFAR and PMI, and again, going forward, being built upon with GHI, is keeping it outcome-oriented. The basic idea that those that we seek to partner with and to help in the communities we seek to help lift in the lives that we seek to help lift, they deserve to get those services in the most effective, most efficient way that is possible. And on top of that, of course, the American taxpayers deserve to have their dollars spent in the most effective, most efficient way possible. And so I think with these programs, we've seen a partnering with the nonprofit sector and the for-profit sector, and the idea, again, is real simple. We wanna do this the best way we can. In many cases with programs, we're partnering with the faith-based sector. Why? Because oftentimes faith-based organizations can reach into parts of a country immediately, most directly, and so we don't have to rebuild or reinvent. And so I think this emphasis on effectiveness of how we deliver services is a very important contribution. I believe it'll go even higher with GHI. I'm going to say something here, because I don't want you to get blamed for this comment, but I also think we're in a period of time where the government's a little confused about whether they can work with a private sector because they're not sure ethically they're allowed to help the private sector. I mean, we've got to get out of that mindset that it's not a bad thing for the government to help, especially when it's a public good. And so Lois, this is good, but the hardest thing you're gonna work with all those ethics lawyers. You call me, I'll be the bad guy. Can I make one quick comment in that connection? You know, a lot of times we write ethical rules based on an instance of questionable ethical conduct. And I think we need to step back and review our ethics rules to make sure that they're up to date, they're clear, they're few in number, and that they're more pointed toward what people should do than what's gonna happen to you if somebody decides you didn't do it right. And so I'm talking about more like best practices, but I can tell you that if you look at most ethical systems, you know, that we have to deal with whether it's in Congress or anywhere, they're a hodgepodge because they're written for the occasion. And I think that we need to, this is a good time. I mean, that's part of what I meant when I said we need to refine our ability to work together. Part of that is what you said about ethics rules because quite frankly, ethical rules should be simple. We all should sort of have a sense of what they are, but you don't know what somebody did to really take advantage of a situation, you know, five years ago and before you were in Congress. And so you may not know that this sort of counterintuitive thing is something you can't do. And so this is part, if we're gonna work on building our public-private partnership, let's put review of our ethical rules on the list. Good call. We're running short of time and I just would like to end on a note. You, both of you interact, have your previous job and your current job, but both of you as elected officials interacted with people. And of course they come to you with selfish motives, but you also find a remarkable selflessness in Americans. You find, you know, I think the, as if you rank the benevolence of people, Americans are six times more benevolent than the next country. There's a genuine, strong impulse of humanity in this country. How do we bring that into this debate at a time when it's just such raw, you know, personal benefit that seems to be dominating our politics? How do we bring the nobility that as Abraham Lincoln said, the better angels of our nature to the front on this debate? Mark with you and then we'll end up with Keith. Well, you know, I, as ambassador, one of the great privileges I had was hosting a presidential visit. And I hosted President Bush in Tanzania and was able to take him around to places in Dar es Salaam, to AIDS clinics. And to let him see firsthand the actual results of these investments that he had helped to make. And it was interesting to watch his reaction. And you could see that in some ways, it rattled him a little bit. And I mean that in the most positive way possible. It is not possible to embrace that mother living with HIV. And to have someone whisper in your ear, Mr. President, she is not alive, but for you, but for PEPFAR. And not come away from that. Again, rattled in the most positive sense of the term. I think what we need to do is tell the story often. But with respect to our policy makers, encourage them to go and see it. We can do all the papers, we can do all the memos, we can do all the briefings. And you know, I love the video. It is no replacement, of course, for getting that congressman to Kakomega district in western Kenya, or the highlands of Tanzania, wherever it might be. Because if people get the chance to see just what good is being done, a lot of these debates, I think, would get settled rather quickly. Everything Ambassador Green said is absolutely right. Let me endorse that idea. Sometimes, you know, you've been on the radio program and somebody says, well, congressman, it's real nice, you're running all over the globe. What are you doing about unemployment right here and feeling the blank? That's always a tough question. But we do need really people like you to help make the case that travel is important. It is a part of the job, and it's all of our responsibility. So let me just say that I think you're absolutely right. Let me also say this. It is important to make the security argument. It is important to make the trade argument. It is important to make the economic argument. All those arguments. But let us never fail to make the argument that it's just the right thing to do. Let's not fail to make that argument because you know what, people believe it. You know, I can tell you that sometimes people think that within our political party-based arguments that one side has a monopoly on compassion or whatever, the reality is that that is not true at all. My experience tells me that people who are of a conservative background are as compassionate of not more so than people who are on the other side of the fence. It's just that they're not sure that government's always the right way to express that. On the other side, you know, so we've got to have some sense that everybody is capable and wants to do the right thing. We just have to find the way that they can get it in the most effective way. And then let me finally say, you know, in terms of corporate America. Look, a corporation that is only out there to make money is like a human being that is only trying to survive. The best corporations are animated by high ideals, right? I mean, seriously, the best ones want to, I mean, Southwest Airlines, they want to give us freedom to fly, right? They, I mean, so my point is, let's set up the ethical rules in a way that allow everyone to do what they do best and give them the incentives to do that, making sure that certain things don't happen, you know, that this is not just a marketing thing, that there is some sincere and genuine interest in making sure that this country can develop its dairy industry so that people can have milk, you know, things like that. There are rules we can set in place to guard against the ethical abuses, but we shouldn't walk in assuming that they're gonna be that way and we should set the rules up in a way that basically put the incentives in so that the real benefit is accruing to the people. Just a few scattered ideas, but I've been thinking about this idea importantly because there's no doubt about it. In the world we live in, you know, the role of the corporate community is just too all-encompassing to simply say, you know, they're out to make a buck so they can't be a part of this, right? So we've got to find a way so that they contribute in the most effective way that actually meets our aims to deliver greater development and things like that. Actually, I think if you could argue that if you could create the conditions where doing well and doing good are combined, then all the incentives are properly aligned. It's the best of all worlds. Folks, don't you wish we had 535 members of Congress like this? Let's thank them with our applause.