rare, but it doesn't have to be. when you are connected, you are not alone. cox supports c-span as a public service, along with these other television providers. giving you a front row seat to democracy. >> coming up on washington journal, your calls and comments live. a look at the u.s. suicide rate reaching its highest level in more than 80 years. we speak with the codirector of john hopkins university's -- group, polly wilcox and dr. paul adragna. dan wiseman discusses the cost of health care and related news of the day. "washington journal" starts now. ♪ host: good morning. it is saturday, december 9. earlier this week, three university presidents testified

on combating anti-semitism on college campuses. committee members questioned the panel over allowed and dashed speech. this morning, we are asking for your reaction to campus protests. free speech at colleges and the cost and value of college degrees. on our lines split by region this morning, eastern or central time zones, (202) 748-8000. mountain or pacific, (202) 748-8001. we have a special line set aside for college students or faculty. that number is (202) 748-8002. you can text us at (202) 748-8003. include your first name and city, state. we are on social media, facebook.com/c-span and x @cspanwj. "washington journal" welcome to today's"washington journal."

we are going to start with a portion of that hearing from tuesday. this is representatives to phonic questioning the three college presidents if calling the genocide of jews is harassment and bullying. >> does calling for the genocide of jews violate mips code of conduct or bullying or harassment? yes or no? >> it is not making public statements. >> yes or no? >> calling for the genocide of jews constitute of bullying or harassment? >> i have not called for -- >> -- >> i have heard chance which could be anti-semitic depending on context when calling for the elimination of the jewish people. >> those were not be according to the m.i.t.'s code of conduct or rules? >> that would be investigated as harassment, pervasive and severe. >> ms. mcgill, at penn, does

calling for the genocide of the jews violate pins rules or code of conduct? yes or no? >> if the speech turns into conduct, it could be harassment, yeah. >> i am asking, specifically calling for the genocide of jews, does that constitute bullying or harassment? >> if it is directed and severe or pervasive, it is harassment. >> so, the answer is yes. >> it is a context dependent decision. >> that is your testimony today? calling for the genocide of jews is depending upon the context? that is not bullying or harassment? this is the easiest question to answer yes, ms. mcgill. your testimony you would not answer, yes. yes or no? >> if the speech becomes conduct, it can be harassment, yes. >> conduct meaning committing

the act of genocide? because speech is not a resident? this is an acceptable. i'm going to give you one more opportunity for the world to see your answer. does calling for the genocide of jews violate penn's code of conduct when it comes to bullying and harassment? yes or no? >> it can be harassment. >> the answer is yes. dr. gay, at harvard, does calling for the genocide of jews violate harvard's rules of bullying and harassment, yes or no? >> it can be, depending on the context. >> what is the context? >> targeted at individual. >> it is targeted at jewish students, jewish individuals. do you understand your testimony is dehumanizing them? do you understand that dehumanization is part of antisemitism? i will ask you one more time. does calling for the genocide of

jews violate harvard's rules of bullying and harassment, yes or no? >> anti-semitic rhetoric -- >> antisemitic rhetoric -- >> antisemitic rhetoric when it crosses into conduct that amounts to bullying, harassment, intimidation, that is actionable conduct and we do take action. >> so, the answer is yes, that calling for the genocide of jews violates harvard code of conduct, correct. >> again, it depends on the context -- >> it does not depend on the context. the answer is yes, and this is why you should resign. these are acceptable answers across the board -- these are unacceptable answers across the board. host: we are getting your responses this morning to that, as well as in general, your assessment, your view of higher education in the united states. here is the new york times about that, it says college presidents under fire after dodging

questions about antisemitism. the leaders of harvard, m.i.t. and penn appeared to evade questions about whether students should be disciplined if they call for genocide of the jews. it is the support of presidents of his universities seem to evade quickly after they seemed to evade what seemed like a simple question during a congressional hearing. would they discipline students calling for the discipline -- or the genocide of the jews? here is what andrew bates -- this is unbelievable this needs to be said, calls for genocide are monsters, everything we represent as a country and josh shapiro, the democratic governor of pennsylvania said he found the responses by penn's president on acceptable. there were apologies. first, here is the university of his vain assident, liz mcgill, who said this. hat moment, i was focused on our country's polici aligned

with the u.s. constitution which say that speech alone not punishable. i would not -s not focused on but shove been -- on the irrefutable fact that a call for genocide of jewish people is a call for some of the most terrible violence human beings can perpetrate. it is evil, plain and simple. there is also a response from the president of harvard, published in the harvard crimson. it says, this harvard president apologized for her remarks at the end of her congressional testimony, which sparked criticism and led to leadership to say they do not trust her to protect jewish students at the university. "i am sorry, words matter." she said when words amplify stress and pain, i do not know how you could feel anything but regret.

it says the full hearing lasted for nearly six hours but it was a tense 92nd exchange with representative's to phonic at the end of gays testament drawing -- elise stefanik is a graduate of harvard university. we will start taking your calls. chris is in auburn, maine. what do you think? caller: good morning, i will have a controversial view. this whole thing appalls me, it disgusts me, it feels like, have you ever been a communist? they were asking a question with an answer these people could not po give that would be satisfactory. universities have policies about bullying and harassment, which is about if person a does things to person b, personally, they go on facebook, attack them, they tell them to kill themselves,

that is bullying or harassment under the schools policies. it might have violated a different section of the policy, but not the one on bullying or harassment. this is interesting, they are weaponizing this idea that somehow, there is piles of people out there who think that killing jews is totally cool. like this whole thing about, you are not talking enough about how -- women, are you kidding me? yes, we condemned it, but on a sunday news show to say, why are you guys silent on the rape of women by hamas? we are not silent on it, we condemned it completely, we condemned everything hamas did. we are focused on the fact that 18,000 people have been killed in gaza, among them about 10,000 children and women. one in every 200 children in gaza will be killed. you can criticize both things at the same time, but this dr. garbage against these professors whose careers are now going to

be ruined by this stupid political stunt incenses me. it is the right -- it is the way the right wing works and the democrats say, we can't say anything because they will attack us. host: was there anything you found objectionable in how the university presidents responded? did you like their response? caller: no, i mean i think they were tone deaf. they should have realized they were being put in a corner and forced to say something they did not want to say and should have come out with -- it is like wearing the interview on sunday, why are you guys silent about the rape of women by hamas? he should have immediately said, i am insulted by that question. we say it is horrible. that is what the presidents should have done. it violates our policy, they focused -- they are eggheads, the legal definition of harassment under our code is this. you know what? you are talking to humans. it is like bill clinton saying i did not have sex with that woman. host: people were saying that on

their campuses. caller: well, there are some kids who are saying incredibly stupid things and should not be saying them. if you come out there and call for the death of jews or muslims or anybody else on a campus, you should say, you are out. goodbye. host: got it. the honolulu -- honolulu, hawaii, good morning. caller: these people are very smart and educated people. i do not like what the gentleman was just saying. i do not understand why they just did not come out and say, yeah, it is wrong, it should not be done. what were they afraid of? i am really confused about it. i do not understand. host: all right. bill is in massachusetts. good morning, bill. caller: hi, how are you doing? host: good. caller: i have got a few comments.

the first comment is, why is it that we can yell death to jews and death to donald trump, but that is ok? what if somebody said death to joe biden and they had a head, remember -- i forgot that after who had a so-called severed head of donald trump, that was ok. this is what happens after 50 years of democrat infiltration of college campuses. this is what happens. so, number one, i think all jews now after they seen what has happened around the country, you have got to vote for donald trump. that is number one. number two, it is like, anybody who says that democrats are for the children and we are for helping illegal immigrants and we are the loving, caring party, we now see that they are for

abortion. host: bill, bill, going back to higher education in the united states. caller: higher education, that lady needs to be fired at harvard. let's go, donald trump, let's have this civil war once and for all. host: mitchell in north dakota, good morning. caller: good morning. host: what do you think about higher education in the u.s.? caller: it is a deplorable state. i have young children that will eventually be going to college and they seemed nervous and concerned for their future, for these administrators to take a position as they have and state these comments and not be more sensitive to anti-semitism and what has happened over in israel is insane. i hope that for the future of our country that higher

education will get the message through what is happening today and take it to a new level. host: what makes you worried? you said you are worried about your kids going to college. what is making you worried specifically? caller: because this thing you see is an original, and it appears if it continues on, it has been sizzling for a long time and has come to the surface now. host: all right. richard in louisville, kentucky. good morning. caller: so, when does the first amendment get thrown out the window? these college campuses all across this country, we are probably talking about 10,000, 20,000 people. glenn greenwald, a very respected, liberal reporter, just said yesterday that he called around the country to see how many people were actually calling for the death of jews. there is not that many.

he said he could not find it except for a few college campuses. i am saying that this is a bunch of phooey. is it ok to say kill whitey? is it ok to say kill a cop, wrap him in bacon? nothing has been done about that. host: we are talking about higher education, richard. you say, it is not that many. is in a ok? -- is any ok? caller: that is what our colleges and high school's are teaching. they are teaching that you will listen to our first amendment and the way we want it done, or you will not be part of this country. it is a bunch of who we -- hooey . let these people protest. the big-money people at these colleges, they are saying they do not like the way things are going, we are pulling our money back. let's see how long it takes them to straighten up. host: speaking of pulling money

back, this is axios with this headline, penn loses 100 million donation over anti-semitism hearing. it says the university of pennsylvania donors withdrawing a gift around $100 million to protest the school's response to anti-semitism on campus. the final straw for ross stevens, founder and ceo of stte down rich -- stoneridge management. let's take a look at another piece of that hearing. this is representative donald norcross, he asked the president about a controversial event that was posted last september. [video clip] >> so, given what happened in october, you could not see ahead that was going to happen. but, the idea that groups coming on that are clearly identified

as antisemitic would be a concern. >> i was concerned about the anti-semitism of some of the speakers at that conference, and also the timing of that conference was particularly painful because it occurred during the holiest time of the jewish year. that is why in advance of the conference, while saying we are committed to free expression, i specifically condemned the anti-semitism of some of the speakers. >> condemning, but you would have the power to stop it if, in your opinion, there was a security issue? >> well, congressman, whether there is a security issue is something that i leave to our public safety individuals and i defer to their judgments on those matters. >> did you ask them? >> we discussed the security and safety of every large conference that happens on our conference -- on our campus. yes, we talked about this one.

>> today, along with you, decide there were no security issues? >> we did not believe -- we believed we were ready for any security concerns that might arise. yes, it went ahead. >> in hindsight, do you think that was the proper decision? >> i think canceling that conference would have been very inconsistent with academic freedom and free expression, despite the fact the views of some of the people that came to that conference, i find very, very objectionable because of anti-semitism. >> would you permit your academic department to sponsor a conference of 25 speakers that the ncaap would identify as racist? >> congressman, we follow our policies, always. and our policies are guided by the united states constitution

and the commitment to academic read him and freedom of expression. >> is that a yes or no answer? >> the answer is that we follow our policies. host: that was you pins president, liz mcgill, from a hearing on tuesday. we are asking you about your opinion about u.s. higher education and we are taking your calls this morning by region. we have a line set aside for students, college students and college faculty. this is the article about what they were just talking about from fox news. this is from september with this headline, ivy league school under fire or hosting antisemitic writers festival, critics says event fueled hatred and perpetrates despicable antisemitic -- from pennsylvania, good morning. caller: i do not think there is any doubt this movement, this pro-palestinian, anti-jewish

movement, is coming from the left. it is a part of the left meeting itself. the woman from penn should happen fired the moment that she allowed a male swimmer to swim for the female team. a lot of jewish people are leftists, are liberals. they did not speak up against this male swimming on the female team. now, it is coming back -- there is an anti-jewish sentiment at penn. there is no question. it is disgraceful and to be expected from these leaders. they should get back to teaching science and math and making our youth better, instead of teaching diversity, equity and inclusion. if we teach math and science

properly, people of different diversities and ethnicities will thrive in this world, instead of teaching us hatred and that white people did this 200 years ago and -- it is just, there needs to be change in education to make it better, educated in the modern world. host: did you go to a university? caller: i did not. i lived in the penn area, i have been a fan of their best ball team as a child. i think it is a disgraceful. i think it is disgraceful. this woman at penn, all three of them should be fired. i think these universities need to expound on their science, math and education. host: got it. susan is a college student, rockville, connecticut.

what university do you go to? caller: trinity college in hartford. i would like to say when i was -- i am in my 60's, but my college was interrupted when i was normal age because my sister died in a fire and i was not able to complete. i am one of the lucky people to go back to college at an age where i feel it is a luxury to study. i would say on campus where i know that i was part of a group of students for justice for palestine before any of this happened. the younger kids, because i do not have to worry about a career or being blacklisted or whatever you want to call it, going to law school and getting kicked out -- the traditional age students are afraid to join that group because as soon as you join that group, you are called antisemitic. i do not think being for somebody, you know -- i like to

think if i was around when they were massacring the indians are putting them in special schools, i would say stop. that is basically what they are doing to the palestinians, which we have to separate from hamas. i would like to invite anybody interested, there is a museum in connecticut called palestine these em u.s. -- palestine museum u.s. they are going to show a film at 12:00 eastern time, the 100 year war on palestine tomorrow, they are going to have jewish voices or peace, a nice woman called esther farmer. if you can't go to both days, i would say go to the open house one. it is on zoom. google palestine museum u.s., listen to the woman for jewish voices for peace because it is hard to educate yourself on this issue in our country. please, do it. you can yell at the screen if you want to. host: all right, susan mentioned

students for justice in palestine, that is a college organization. it is online at national sj p.org if you want more information about that. nelson is in san diego, good morning. caller: good morning. there is a lot political football going on with anti-semitism. i do agree that the college presidents should resign. that was ridiculous, absolutely ridiculous. having said that, elise stefanik , she has promoted the qanon stuff, democrats are pedophiles, she has promoted that the great replacement conspiracy theory, adam kissinger called her out on that. they have no trouble, the republicans have no trouble with people going from the cpac in

orlando to the white supremacist conference with nick flint has and a lot of -- nick fuentes, and trump having the angst giving lunch last year with nick fuentes. another point, i am in la jolla right now, and for years, even now, they have this group called the -- group on campus where they say anti-black things all of the time. i think 2019, they put an alt right banner up. to say these things are not happening to other groups is not to on campus. -- is not true on campus. these say a lot of anti-blac

k stuff. host: where's the line between free speech and what should be prohibited on college campus? caller: well, when you call for the genocide of people, that should have been so obvious. when you are doing basic hate speech, when you are doing hate speech, i think it is obvious what hate speech is. to criticize it is not hate speech, but when you are saying -- i do not know what some of these terms are, like from the river to the sea. what is that word? i look at it on wikipedia, but it refers to different things at different times. maybe it is now just to jews,

the holocaust is talking about the jewish holocaust, not the armenian holocaust. host: all right, nelson. david is a faculty member in detroit, michigan. caller: good morning. listen, let me cut to the chase. i am completely outraged that we can be calling for the -- [indiscernible] presidents at university of penn , harvard and m.i.t., take a stand on something that is sensitive. let me just say this. it was in august of 2017. [indiscernible] host: can you try to call us back on a better line, because you are cutting in and out.

i want to hear what you want to say. carolyn in detroit, michigan, good morning. caller: good morning, i am a first time caller. thank you for taking my call. host: welcome to "washington journal." caller: hi. i really think if we keep the same energy across the board at these universities, whether it be black, white, asian, whatever it is, when it comes down to antisemitic or you are scaring someone, or you are scaring someone, then we need to bring them in. we need to go across the board at all universities. these are our children and we love them. any time you get to the point where you are starting to scare them to death, we need to reign

it in. i think we got this response because we are not doing it across the board. thank you so much for taking my call. this is my first call. i will call back in 30 days. thank you so much. have a wonderful -- host: we will talk to you in 30 days. george is in pennsylvania. caller: good morning, thank you so much for c-span. i love all of the "washington journal" and all of the programs. i am biased, you have people discussing issues and i appreciate that. we have got a son at that school. we see what happens when academia lifts up certain groups. they attempt to rake people into groups. these are the lgbtq, black lives, these are the whatever. it separates students.

when he first started there, they had mixers that were only specific or certain types of folks -- for certain types of folks. it was sad, if we were going to say we are an academic institution and say we support academic freedom, then you got to do that. as far as ms. mcgill, i was disappointed with her comments but it shows me i do not think she was that prepared. you know what kind of questions you are going to get asked. to sit there and say, you pretty much know what is going to happen and what they are going to try to make you look like. i think sometimes, some of this is overblown because there is four people. that being said, the goldie goldie thing, as far as that is concerned, that sounds like nazi germany in 1970. host: george, do you think that president mcgill should step

down? caller: you know, i do not think so. i think somebody -- she has to understand that she did not do well, for whatever reason. she did not look too good, ok? that being said, i am sure she is an intelligent person and there is some reason she got that position and i am sure it was based on her academic credentials, which are probably substantial. a lot of these institutions are -- i know that school is a fine, educational place. i think universities have got to get out of these politics thing and get into teaching young people the things they need to do and less diversity training and this other stuff we somehow think this is going to be the answer to everything. i hear this a lot. i'm glad to see people that look like me. what does that mean? i am sick of hearing that. host: we have to move on to

darrell who is in georgia, student. what college do you go to? caller: i am a graduate now, but i went to troy state in troy, alabama. what i want to say is that, i am an african-american. this type of stuff been going on with african-americans forever. we go to school and we get called all kinds of things. they want us to be ran off campus, murdered, killed, with everyone to call it. forever, it has been ok. soon as stuff like this come along, everybody want to make a big deal about it now. it is just all one-sided. host: darrell, did you face any of that when you were in college? caller: i have been thrown some ugly things before. i don't care to talk about it

now, but i have. it is hurtful. you come back home and you talk to your parents about it. what do you do? do you just leave school, or whatever? that is why you have so many, in my race, a lot of kids going to hbcus, historically black colleges, because they do not want to deal with that. we should be able to go to whatever school we want to go to. we put up with all of that stuff and had to deal with it. all of this stuff going on now with israel and all that, everybody making a big deal. what is going on with the people in palestine, is that ok for palestinians to be killed like that? it is not ok. but, we wonder to support israel? israel, you do whatever you want to do, kill hamas, kill palestinians at the same time?

it does not matter, but we are still going to support israel. israel is just as wrong as hamas, in my opinion. even though hamas started, does not mean israel has the right to do what they did. it is just bad. host: got it, darrell. this ia post on x from truth sayer, i am not aware of the comments made. burning the flag, protesters showing up at militarfurals are examples i do not agree with but arfr speech. speech and action are two separate issues. naomi in baltimore, maryland, good morning. caller: hi, good morning, good morning c-span c-span and c-span audience. my view is that we are all one. we are all humans. and, born in the image of god, every single one of us.

regardless of our color, our beliefs, or whatever, lgbtq, black, white, green, purple, it does not matter. we are all humans. a call to kill any particular group because of their beliefs, the color of their skin, whatever it is, their sexual orientation, ought to be absolutely condemned. there is just no reason that this should be allowed. there is no reason. host: naomi, beyond condemning it, should those students be punished in any way? what do you think? caller: yes, it is a call to action. host: what should that be? caller: calling for a genocide is calling for the deaths of a

particular group of people, because of some descriptor. host: what should the punishment be, in your opinion? caller: expulsion. and, i believe that these spokespeople or presidents at these universities need to step down if they cannot just simply say, yes, a call for genocide breaks our rules. they either need to change their rules, or they need to leave. no one should be calling for the death of anyone. period. host: got that point, naomi. mike in akron, ohio, faculty member. good morning. caller: thank you. i believe each of those presidents at different colleges should apologize, plain and simple.

they asked permission to make a comment. the comment would be this, if somebody publicly states that pows cannot be heroes because they were captured, you should not put that person in prison. that is a right of free speech. keep that person from being out of the oval office. i think we can agree on that. see if stefano would have apologized for trying to put from act in the white house, because she did say pows could not be heroes because they were captured. you should -- keep them out of the oval office. host: mike, are you still there? caller: yes, i am still here. host: i wanted to ask you about what is happening on your campus, you are a faculty member. caller: well, basically, i told

your call screener that i am a retired schoolteacher. i did go to ken state university -- host: the line is for college students and faculty. we have got to follow those rules. deborah in marietta, georgia, good morning. caller: hello? host: you are on the air. caller: yes, yes, i was calling about -- first of all, i am from louisiana and i went to dilip university. i am 63 years old. back then, we had a lot of problems. racism, anything like that. african-americans, this not nothing that we had to tolerate. we had no one to speak up for us. the guy that just got off the phone, he took the words out of my mouth. we have leaders here in the united states, in our government.

the reason things are going how it is going now is because of our leaders. we have the most highly disrespectful leaders, republicans and some democrats. republicans is more outspoken. i can't hear how you won't get rid of somebody because you -- in the background, that young lady trying to make them go against how they feel about the situation, will get in the background and they probably feel the same way. you can't make nobody change they mind. that is ludicrous. she going to make them say what they want them to say, that is ludicrous. host: previous caller had said universities need to be getting

back to teaching math and science. here is another portion from tuesday's hearing, where an exchange between representative haley stevens of michigan and the m.i.t. president about the importance of students learning humanities. [video clip] >> we need to have the proper place to exchange ideas and have the space to ask tough questions. what happens when we remove humanities? what happens when we allow for government to dictate what is being taught on our college campuses, similar to what we are seeing in florida and in west virginia? what risk does that pose, particularly when we talk about the proper teaching of history? >> may i take that? it is interesting, coming from a majority stem institution, i can't think of a place where it is more important that our students also learn humanities, have a humanistic perspective.

we all have to live and work together as people. in order for us to be successful when i think about the technologies that are coming down the road, we want our students to understand the moral implications -- >> we need to do both and we will continue to call out antisemitism as members of congress and push on this topic. five minutes is not enough. i call on our committee chair. let's have a hearing about affirmative action and what the supreme court ruling has done to minority students and minorities being able to join institutions of higher education. let's have a hearing about islamophobia and let's talk about anti-lgbtq practices affecting the mental health of students on college campuses. host: we are talking -- taking your calls about what you think about higher education in the u.s. here is a gallup poll taken in

july about the confidence in higher education, it says it is down sharply and the highlights are this. 36% have a lot of in higher education. confidence is down from 40% -- all major subgroups are less confident with republicans dropping the most. you can see this here visually. this is 2015. here is 2023. there is quite a lot, some and very little. you can see the drop there. broken down by party, you can see here the biggest drop is among republicans and also among those who have no college degree. richmond, virginia. caller: good morning, hi.

i wanted to talk about my graduate school and black and palestinian solidarity. when i went to george mason university, i was a history major. i took a class where i was the only black student in the classroom, other than a half black classmate. at that time, my professor started calling us african-americans and slowly black people and started calling us blacks. he would stumble over the word and everybody would look at me. it wasn't comfortable. for the caller who said, why do they want somebody to look like me? we did not call ourselves blacks or savages. we did not come up with those names. at tcu, very limited perspective of black people, of color,

lgbtq, our curriculum was white focused and they did their best to show diversity in all of that. moving on to -- i am sorry, i wanted to talk about the marches going on. no one has been calling for the death of israelis, of jewish people. if you pull up the israeli march of solidarity, you will hear them call for no cease fire. at that time, there were not 18,000 plus palestinians dead. also black and palestinian solidarity, there has been solidarity since the 1960's and 1970's. it is not antisemitism, y'all are not educated and y'all refuse to be. y'all are afraid and that is y'all's problem. have a good day. host: joyce is in canton -- sorry, birmingham, alabama. good morning. caller: probably do not meet the

criteria for the call. i just do not understand why the lady from penn state has been given such heck for trying to maintain some kind of equilibrium. i just did not get it. i hate this war that is going on. i think netanyahu needs to go. they are kind of the same sides of the coin and they are not doing anything to further humanity. host: joyce, did you attend college? caller: i did not finish, but i did attend. host: what were your thoughts back then on college, and what are your thoughts now on higher education? caller: i think higher education

is well worth it. my husband has a doctorate in education. he taught school for about 24 years. he is retired now, as am i. i think it is well worth everybody, anybody, to further their education. yes, it is well worth doing. host: all right. sorry, i thought you were done. marlene in canton, massachusetts, good morning. caller: good morning to you and everyone on c-span this morning. wow, there is really a lot to say but so little time. what do i think about higher education in the united states? i think that it can be very beneficial to people, particularly if you want to enter a profession like law or medicine. but, if i could just comment on some of the vibes i am picking

up from previous callers calling in stating that, you know, the focus of higher education should be stem focused and that a lot of the dei initiatives should be -- i think the point of a college education is not a glorified, vocational program. it is really about the expansion of knowledge and the pursuit of seeking the truth. so, i think that with respect to what has been going on currently on college campuses, with respect to the war in israel right now, i think that obviously, antisemitism is simply unacceptable and i do not think that students regardless of their race, ethnicity or

religion should be made to feel unsafe to the point they are unable to attend classes and participate in the campus community. so, let me just state that. but, also, i think with respect to speech, given that college is really about exposure to the free flow of ideas, i think that it should be allowed but it should be clear parameters drawn around that. i think if it crosses the line into which students are being bullied, harassed, intimidated or threatened, then i think that is on acceptable. host: marlene, i guess the big question, where is that line? i think the university presidents were trying to say, well, it is not acceptable if it is directed against an individual as opposed to a group.

what are your thoughts on that? caller: what are my thoughts on that? well, obviously, some of what has been going on is personally troubling to me, particularly as someone who has both an undergraduate and a graduate degree, and also someone who as a black woman has, for much of her educational career, attended predominantly white institutions. i can understand how some students, particularly those who may be feeling some of the protests against israel occurring on college campuses, i can definitely see where because of generational trauma that a lot of what is going on can be very triggering for them. but, i think that it is a fine line and i do not think that

there is really an easy answer. but, i think that we make the mistake by focusing on creating safe spaces for students to treat students as flowers. the truth of the fact is that antisemitism, racism, sexism, ageism all of the other isms, at some point we are going to encounter in our day to day, whether the workplace -- host: got it, marlene. let's go to david who is a faculty member in michigan. caller: i called in earlier and you said to call back. host: much better. caller: i was basically sharing that this conversation to conflate the issues of what is happening over in palestine and

jerusalem and to talk about the backdrop to conflate that with education and higher ed, let me just start from this point. that any college professor, faculty, adamant, we are guided by what is called the jane cleary at. -- act. it is a barrier, a reporting mechanism that it becomes public knowledge when you have these incidents on any college campus, and particularly if those colleges and universities except title ix money, it has to be reported. they are held by that. if my memory serves me right, to all of those that have called in on your forum today, jade only reminds me of what -- it only minds me of what took place in august of 2017 on the university

of virginia campus in charlottesville where you had a group of white men chanting jews will not replace us with tiki torches. it became combustible. as a consequence, someone lost their life. let's contrast that with the three presidents of these elite universities. they were trying to take the middle road and that is their fault for trying to take the center, ok? there was a guy by the name of president donald trump, who, and i quote, there are good people on both sides. how can there be -- there are good people on both sides. that is not taking incentive, that is not taking a stand. that is basically saying, i can go along with that. if anybody going to be outraged

and have a point to say that someone -- i think it starts with him. he was the leader of the free world. even though it was his interpretation there were good people on both sides, it was still not definitive. host: yeah, i understand that point. that took place five years ago. i have got to move on to scott in connecticut, retired faculty member. good morning. caller: good morning, thank you for including me in the discussion today. i would just like to say that, you talk about the need to focus on math and science. i assure you, having taught in college and i am sure this is still the case, math and science is still being taught and the important thing is to teach, one, what are documented facts and not exclude history, even

though it sometimes exposes some of the blemishes in america. and also to have students think radically. i have three degrees in the biological sciences, from bachelors to masters and phd. i taught biological sciences and environmental science as an adjunct professor part-time. when i turned 62 because in the state of connecticut, you can attend community college free, tuition free once you are a senior, prior to the pandemic i was taking two courses per semester just to take courses that i had not taken as a young man. i encourage people who have not gone to college who are speaking out of ignorance about what is and what is not being taught in college and have this concept that crt is being taught in biology courses and environmental science courses

and astronomy courses to sit in, just audit some of these courses, so that they have an idea of what college is about. and also, i am tired of hearing people talk about freedom of speech and trying to suppress freedom of speech for young people on college campuses. i aspire to the oliver wendell holmes concept of not shouting fire in a theater, maybe that is where freedom of speech should stop. those same people will defend donald trump, who's quotes plagiarize hitler and talks of dictatorship if elected to president. his supporters who waive the trump blue flag as the 21st century of the confederate

flag and defend that freedom of speech, while simultaneously opposing the freedom of speech of students who, however misguided, express it on college campuses. now, we have to understand that education is more important in this country than ever before. only about 30% of people in the country have a college degree, or even attend college. that is very low, with respect to other industrialized nations. our populace is easily uninformed and misinformed and guided by conspiracy theories and a lot of nonsense, which is divisive. as a result, we can even acknowledge the crises such as global warming and climate

change and nuclear weapon proliferation and pandemics and everything else, and whether we mask or do not mask and get vaccinations or do not get vaccinations. we can't even acknowledge reality and facts as a common ground, so how are we going to avoid these crises and solve these problems? host: got it. frank in cincinnati, ohio, good morning. caller: thanks for taking my call. if we use the highest possible recent critical thinking in the age of reason, the best ideas are out and that is what college is for. when you hold a sign until the jews and you are identified as a student at that university, you should be expelled. attacks on people because of characteristics, not ideas, should get you expelled. these college presidents did not do that, did not suspend them.

so, their jobs are forfeit. now, the question for me -- two things, one, the thing for me is, why are they so inactive? i believe it is because oil money pours into those universities to sway their opinion, a more positive way towards their world. host: when you say oil money, you're talking about from the middle east, from arab states? caller: arab states, their political action committees, yes. i follow the money. there has to be a reason why that is true. the other thing is, your callers, they do not think incomplete thoughts. the gaza strip elected hamas knowing their political opinions. adolf hitler was elected to germany.

both cultures are reaping a whirlwind of making bad choices for their political leadership. it is a mess over there, for sure. but, the people need to keep in mind that hamas started it. the suffering of the people in gaza in part is because of their own doing. host: all right, frank. new berlin, wisconsin, good morning. caller: good morning. first of all, let's start with gaza and this whole war. palestine has never been a country or a state called palestine. they are arabs, just like everybody else over there. that was a made up name. all of this stuff about -- host: what is the made up name? caller: palestine. after the ottoman empire, when that was broken up, they had this belfour and started to

divide up all these countries. number two, even if they wanted to states, they have been offered a two state solution over and over again and they have not accepted it. host: getting back to the question about your opinion about higher education in the u.s. caller: ok, i can give a example here in wisconsin. our colleges are closing because we do not have enough students here. not enough liberals here want to use the tax money. 21 more de i educators in their. people are not going to college, especially young men, because they say they see their friends going and can't get a job. basically, our legislature said, no, we are not going to give you money for that. we will give you money to give a much-needed engineering school and build that.

all of this social justice, all of this women's studies, and all of this useless crap should go, and teach the kids who want certain jobs like doctors and scientists and all of this stuff. you can go to community college and get just as good a job if not better. there is apprenticeships programs. we need apprenticeships instead of all of these people who get a college education. host: we got that point. we want to try and fit one more in. good morning. caller: yes, i'm calling in regard to another epidemic that has been going on in our colleges, and i don't think that general public is aware of what is going on. there has been spying going on and facilitated by china and others to get their students into our engineering schools and gate graduate programs funded by us. and they are taking our technology back to their own countries. i saw this with myself in the

1970's, and just before 9/11, number one, i picked up the phone and called the fbi and warned them about it. but the colleges are not going to stop it because they are getting so much money from these foreign countries through taking their students in here. but they are doing is taking our technology and taking it back to their own countries. this has been going on since we helped japan with its rebirth and our country needs to wake up to it. it is a serious epidemic of spying. i will he be with that. host: all right, ben. that is the last call there from new jersey. thanks, everybody they called in. next up, holly wilcox and dr. paul nestadt, codirectors of the suicide prevention working group at johns hopkins joius to discuss u.s. suicide rate reaching the highest point in more than 80 years. and later dan weissmann, the podcast peter and host of "an

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get the opinion that matters most, your own. this is what democracy looks like. c-span. powered by cable. >> "washington journal" continues. host: welcome back to "washington journal." we are joined by two members -- two codirectors of the suicide prevention working group at the johns hopkins suicide prevention school of health, holly wilcox and paul nestadt. dr. wilcox is a researcher and dr. nestadt is a suicide -- sorry, a psychiatry professor. welcome to both of you. guest: thank you for having us. host: dr. wilcox, if you can talk about the working group, what are its missions and goals? guest: sure, so we have a multidisciplinary suicide working group that has been getting together in the school of public health at johns

hopkins now for a while, and we focus on creating, developing, and implementing community-based, as well as hospital suicide prevention efforts. we work to influence local and national policy as well. host: can you tell us about your background and research focus? guest: sure. i am a public health professional, and i have spent the last 30 years focusing on implementing evidence-based programs in the community. i work in schools. i'm doing some work with social media. and also working in our hospital and other hospitals. i serve as the director of the center, but i serve in various other roles. i am on the school board in maryland and i am the acting director of the suicide commission in the state of maryland as well. host: dr. nestadt, a little bit

about your background and what you focus on? guest: sure. i a psychiatrist. but my research is in suicide, and specifically the epidemiology of suicide, the access to lethal means and how that plays a role. also the role of opioids. i am the codirector of the anxiety and clinical treatment and depression -- treatment of depression. i have been looking at suicide for quite some time now and i have been noticing some of these disturbing trends. host: let's talk about those trends, dr. nestadt, because according to the cdc there has been a record number of people in the u.s. who have died of suicide last year. the country's suicide rate has reached the highest level it has ever been in 80 years. what is the reason behind that, or what are the reasons? guest: it is first worth noting

this is not a new trend. suicide rates have been climbing relatively steadily throughout the 21st century. they have gone up about 35% since 2001. this most recent year was the single highest jump we have seen in one year since that time. yes, they are now higher rates since we have seen since world war ii. suicide is multifactorial. i think it is worth noting that the pandemic left a lot of people with mental health issues a little bit more vulnerable, and created stresses for people who had not previously experienced mental health issues. it is worth noting that psychiatric illness is one of the most important risk factors for suicide. it is also worth noting that during the pandemic there was a dramatic increase in firearm purchases. firearms are the number one method used in suicide in the united states. in firearm access has been clearly tied to suicide risk. more firearm buys then we have

ever seen. it is not surprising to see an increase in suicide, especially by firearms. host: i will invite our callers to call in and join the conversation. we are dividing those lines up by region this time. if you are in the easterners central time zones you can call (202) 748-8000. if you are in mountain or pacific, (202) 748-8001. we also have a line set aside for those who have experienced suicide or been impacted by it in any way. you can call (202) 748-8002. of course, you can also text and post on social media. dr. wilcox, let's talk a little bit about -- on a more granular level about those trends and the numbers. i have a chart here from axios, working down the change in the suicide rate by age.

it shows that all of the numbers went down over the course of last year for all of those that were, essentially under 35 years old. so, up to age 34, but they increased for all of those over age 35. what can you tell us about that? guest: i think we can't pay too much attention to the yearly. what we really look at our trends in the data. the suicide mortality rates change, fluctuate not majorly, but minorly, year by year. what we look for our trends in different groups that may be becoming at higher risk. for adults, they are typically harder to reach. young people we can reach in schools or other programming they are involved in. older adults can be seen by primary care doctors more frequently, but for a long time

we have had difficulty reaching adults. no, kind of middle-aged adults the bulk of suicides occur in italy aged adults. and so, efforts to reach people at work, where they work, and through community-based efforts, i think, the way we should be going with trying to reach adults. host: dr. nestadt, you did mention that the highest-risk community, are those with psychiatric illness. could you tell us more about risk factors and if those communities are getting the help they need? guest: that is a good question. there are several risk factors important to think about with suicide. i mentioned psychiatric illness. about 90% of people who do die by suicide had a psychiatric illness as a precipitating factor. other risk factors include substance use, things like alcohol or opioids.

there are demographic populations higher at risk. suicide tends to be more common in men. although women do attempt suicide much more frequently than men. men die by suicide very often. racially there is a higher suicide rate in white americans, as well as indigenous people. although it should be pointed out that the suicide rate in black americans has been climbing faster than in other populations, especially since around 2017. other risk factors include having access to a we lethal -- a lethal weapon. also divorce, chronic pain, terminal illness. there are many risk factors. because of that it can be hard to predict suicide in an individual. of these risk factors add up. there are none that are standouts, except perhaps a history of a suicide attempt or suicide attempt in the family. host: dr. wilcox, on the policy

side the biden administration has said that they want to impose new requirements on insurers. that would reduce out-of-pocket costs for mental health care, also substance abuse care. but the insurance industry is saying that is going to drive up costs for everybody. what do you think of that? guest: i think anything we can do to try to get people ready access to mental health care is ideal. we have to work to fight stigma, but we also have to increase access and availability of services. and services that are engaging to people, that they will want to dissipate in, and also evidence-based mental health care. we know what works to prevent suicide. part of the problem has been that many of these evidence-based practices never reach somebody at risk or thinking about suicide. and so as a field we have to be

a bit more proactive and try to get more upstream. any effort we can do to try to get ahead of somebody ideating and making an attempt our efforts we are thinking about in the public health field. rather than being reactive and waiting for somebody to make an attempt and then engaging them, we want to get upstream, we want to get more to prevention rather than treatment. and so that has been the mission of our center and group, and i think nationally we have to get to that point where we are going to have more of an integrated public health approach, like paul was saying. to a site is a complicated issue. it is multi-determined, so we have to treat it like that. have to have a multi-determined, multifaceted approach that is integrated. and we have not been able to build an infrastructure to make such a national impact like we need to make. so that is the situation,

unfortunately, we are in. we have to do a better job of focusing more on prevention and fighting stigma, and some of these other factors that can be barriers to people seeking the help they need. guest: we talk about the economic costs of providing mental health care it is worth noting that suicide, because they will strike people in the younger years sometimes, the economic costs to the u.s., losing those people in their working years is tremendous. the estimates have been from economic organizations that each suicide can cost the u.s. millions of dollars. not just in the cost of taking care of brief meant for those left behind, in years of working life lost. every dollar we invest in providing better mental health care for the people of the united states not only benefits those people and a leaves suffering, it improves our economic outlook as well because

of how common suicide is. suicide is thought of as a rare event, but it is worth noting as we talk about these numbers that suicide is the second or third-leading cause of death each year among americans. it has always been one of the top 10 causes of death in the u.s. this is a tremendous public health crisis that allowed -- that demands we take it seriously. host: even if there was lower cost accessing care, are there enough mental health practitioners available to help all of the people that are in need or crisis? guest: that is a really good point. there are several barriers to accessing care aside from money. stigma prevents people from accessing care sometimes. folks are worried about identifying themselves as having a problem. in some ways the pandemic help that. during the pandemic people started to recognize that it was ok to admit they were not doing ok. there was a focus on mental

health wellness. there is a shortage of mental health providers. there is a shortage of psychiatrists. it is my hope that that will improve. i think we are seeing in medical schools a shift to more people going into psychiatry then we have seen before. psychiatry is becoming competitive as a specialty. at the end of the day this country has not reimbursed for psychiatric care at the levels they do for things like surgery or internal medicine. so, there are these disincentives to becoming a psychiatrist. hopefully that will change. host: want to redo this, dr. nestadt, and have you comment on it. psychological association, who did a survey. not only did more thf of psychologists say they were seeingcrease in severity of symptoms among their patients, but said they were seeing an increase in the number of sessions spent treating each

patient, which may reduce the capacity to accept new patients. the miller lite, or than said they had no openings for ne patients, and more than two thirds of psychologists who maintained a waitlist said the average wait time is up to three months for a first appointment, while 31% said average wait times were longer than three months. you can't take somebody having a mental health crisis or that is contemplating harming themselves and say, my next available appointment is in three months. guest: you are absolutely right. i have seen those numbers. they are not surprising numbers. it is hard to get an appointment. we find ourselves relying more on more on crisis services, when people are in a very serious crisis, going to the emergency room, calling 988 is always a good option. there is a shortage to those waitlist. we in psychiatry work on triage as best we can. there is different levels of

psychiatric stress. when someone is acutely suicidal, that is an emergency, and they are usually able to get care right away in an emergency room setting, although it is not the most comfortable setting. the bottom line is, yes, there is a shortage of providers. thankfully people are seeking help, but when they do sometimes there is a wait. it is best not to wait too long. when you are starting to become worried about your mental health, not waiting until it becomes a crisis, but working to find help. it might be that getting things early prevents you from having extensive care later on that can be hard to attain. host: let's talk to college. carrie is up first in milwaukee, wisconsin. good morning. caller: good morning. i may need a full minute. i have a very different viewpoint and i would love if both of the doctors would like to comment on it. i am 63 years old. i have suffered from severe depression and anxiety since i was 30. so, for half of my life.

i am actually on disability for my severe mental illness. i have a suicidal fantasy that i have promised family members i will never carry out. but my point is, there are severely mentally ill people out there that have treatment-resistant depression, like myself, who feel that we treat some animals in this country better than we do people , with illnesses like mine. and bringing up the fact that in parts of canada now i no longer would have to go overseas to get physician-assisted suicide or even euthanasia for a severe mental illness, for someone like myself who very often does not want to be here. it is almost torturous. the government and all of you folks who pay taxes -- and i did

for most of my life -- you are supporting me, but i don't want to be here. so, just a viewpoint. i know what you are doing is very noble, but i doubt that most of the folks who work for suicide prevention have ever really wanted to not be alive and can understand that viewpoint. i think canada has it right. if you have someone who truly is so ill -- and it may not be physically terminally ill, but someone who has difficulty living and being alive, there is something to be said about showing compassion for folks. again, we show more mercy to animals in this country as far as euthanasia. host: i'm sorry you are struggling. it's get a response. dr. wilcox, do you want to go first? guest: think you so much for calling. thank you so much for sharing your viewpoint.

paul, do you? guest: i can address this as a clinician. first of all, i'm very sorry you are suffering. as you know, you are not alone. many people suffer from treatment-resistant depression. i mentioned earlier the specific focus of our clinic is treatment-resistant depression. most of the time depression does respond to the first treatment use. however, for many people that is not the case. many treatments can be tried and not found to be effective. we have found is that it is very, very rare that no treatment works. and we tried different combination of things in the rum of cognitive behavioral therapy, also meditation. use a relatively new drug which is given specifically for people who have not responded to multiple other treatments, including electroconvulsive therapy. it can be demoralizing to go through those treatments and not see a result. i encourage you to keep trying,

because we almost always do find a treatment that works for each individual. when you are depressed one of the symptoms of depression is feeling that hopelessness. that is something the illness does. it makes it seems like nothing is going to work. that is not the case. decades of psychiatric research have shown that we can find treatments in most cases. and it is distressing when somebody is feeling depressed and feeling like nothing has worked, because that is what the illness makes you feel like. i encourage you to continue working with doctors, pursuing new treatments. generally we will find something that works. it is heartbreaking sometimes to hear about some of the cases in canada where euthanasia has been performed for someone suffering from mental illness, because those of us in the field that treat the severely ill have found great improvements in people that for years have said there is no hope for me.

to hear about people who have died before they have a chance to get back to their lives, back to their families, is heartbreaking for me. i really hope you are able to find something that works for you. there are many treatments. i'm sure you have tried many of them. sometimes we wait too long to try some of our most effective treatments because of stigma, something like electroconvulsive therapy, things like ketamine and other sorts of treatments, combining psychotherapies can be very effective. but there are many things to do before taking about dying. and what we do know about suicide is that it is often people who have had suicidal thoughts for some time, the actual action can come on very suddenly. it can be very impulsive in some cases. that ambivalence resolving and then seeking death. people who have made a serious suicide attempt and do not die almost universally report tremendous regret that it was attempted. interestingly, only about 6% of

people that survive a suicide attempt ever go on to die by suicide later. it is generally the case that once one makes a serious attempt they regret that immediately as long as they do not die. which is why the method used is it so important. if the method used is something that is not likely to be fatal, the chance to survive is high. i wonder if a firearm, with a fatality rate around 90%, they never get a chance to get help. i'm sorry you are suffering. there are many things to be done and i hope the best for you. host: dorothy is calling from opal, virginia. good morning. caller: good morning. i am calling because i have sort of a different viewpoint on suicide and how to prevent it. i had heard earlier talking about the stigma.

in 2023i don't think it is the stigma of getting help that is preventing somebody people from receiving any treatment. i think it is more about the lack of a bit -- the lack of availability of any treatment. i personally have been suffering from anxiety and situational depression. since a move i made back in 2022. since then i have been trying to get help. i have become more depressed and more anxious over the actual trying to get help. it makes it worse, because i keep trying and there is never any appointment available. i have transportation issues, so i would need to do it online,

and online appointments. and i have seriously become more depressed and more anxious because i have not been able to receive the help. i have insurance that will pay for the help. i call, they tell you, yes, you go online to try to get the help, and they say, no appointments available. so, in my opinion, it is not stigma that is causing it. what is causing the actual suicides is because people, when they know they need help, they cannot receive it. host: all right, dorothy. that goes back to our point about there is not enough practitioners. guest: absolutely. as mentioned before, it is 2023, and during the pandemic they did to see -- they did seem to be a

decrease in stigma, but there remains accessibility problems. one thing i encourage people to do is call 988. aside from helping people in the moment, talking them down, the real strength of 988 is to help people find care. you will be put in touch with a center near you geographically. they use your cell phone number to find out where you are, and they use that to see who might be available to help you in your area. if you are calling from virginia what i recommend people do when they're in a state that has a strong state hospital -- sorry, university system -- is to call the local academic center, because they will often take just about every insurance, including public insurance. and often are equipped to do things like zoom appointments. it can be difficult to find help if you are in a more rural area. places like montana, wyoming

which are very sparsely populated. unsurprisingly they have some of the highest suicide rates in the country. what ends up being the most effective is continuing to call, friends and loved ones, to find out who can get that appointment soon as. and if it is an emergency going to the emergency room. often practitioners take referrals from the emergency room. guest: we need to be thinking about ways to incentivize people going into the mental health profession. whether that be scholarships, fellowships, or outreach and engagement of people to build the pipeline of mental health professionals do it but, you are right. i had a meeting not too long ago with some members of congress, and this was a big issue for them, and trying to think of ways to expand and build the mental health workforce. and we definitely need to do that. host: and mentioning 988, i have

that website. it is simply 988 on a cell phone. i understand that is not just phone, that is also text? host: yes. that has been very important, especially for reaching younger populations. you can text, you can call, online chat. 988 is a very good first step. host:his is a post we got from ajika, who says, is there a higher suicide rate among people in chronic pain? has there been any change since pain medication has become harder to get? guest: there is chronic pain a major risk factor for suicide. chnic pain is in some ways an epidemic of its own. it is a little bit complicated in terms of the medication

treatments, because opioids, which as you know have been part of a public health crisis, have become harder to get as we have recognized how dangerous they can be and how addicting they can be. opioid use has been a risk factor for suicide for quite some time. opioid use tends to increase rates of depression. it is a depressant, so that is a double-edged sword. it can treat pain, but create more depression. also because opioids are such an -- such a dangerous thing to overdose on, it can increase the risk of suicide directly. we need to shift to things that are not opioids. but also cognitive behavioral therapy focused on pain, mindfulness-oriented therapy that can be very helpful for chronic pain without the risks that opioids pose. we continue to seek chronic pain as a major life stressor that does contribute to suicide risk. ultimately dean with that pain

can be difficult, but something that can be accomplished. host: weava text from bric in texas who says, do you feel as though opioids are utilized as vehicles for suicide in any significant way? accidental overdoses seem mu more likely. another question. doouelieve people have the "right" to commit suicide? guest: just to address the first question, yes, opioids are used as a vehicle or method for suicide. especially as opioids became much more prevalent in the united states. the vast majority of suicide attempts are undergone with overdose of some sort. most suicide attempts. fortunately, it tends overdose are only fatal 2% of the time. 98% survive. the exception being when the overdose method is opioids.

it is also difficult to tell when somebody dies of an opioid overdose whether it was intentional. if someone leaves a note that it was a suicide, that makes it easy to tell, but that is the minority of people that leave notes. tickle examiners across the country are left trying to figure that out. in maryland of all of the opioid deaths in maryland -- and we have many -- maryland as many as 75% of those deaths are left as undetermined manner, or we are not sure if it was an accident. those deaths do not even count in our suicide statistics. actually, that is where a lot of my research is in. i interview families who have lost folks to overdose deaths to get a sense if there was any level of intention to it. i believe the second question was about whether anybody has the right to die by suicide, which is a very good question. it relates to the first question

we had on the show from wisconsin. it is a complicated ethical question. it is not my area of expertise. it worries me when people die by suicide when they are suffering from depression, because the actual condition of depression is that hopelessness. is that they're or the illness? if we can treat the illness, with the desire to be dead go away? generally, yes. when someone dies before depression has been treated it is heartbreaking. i think a lot about ernest hemingway, who suffered from depression. it was fairly severe depression, throughout most of his adult life. near the end of his life he finally decided to undergo electroconvulsive therapy, but no one had explained to him that it does take eight to 12 sessions. you should do it about three times a week for several weeks. after the first two sessions he just assumed it would not be effective and that hopelessness came forward, and he did die by firearm suicide.

it is those kind of images i have in my head when i think about someone seeking suicide, not knowing that the likelihood of getting better is there. i think it is a complicated ethical question, the right to die. as a psychologist i think about how depression plays a role in that. host: al is in annapolis, maryland. good morning. are you there? caller: yes, can you hear me? host: yes, go right ahead. caller: thank you for taking my call this morning. i probably want to take issue with a couple of your comments. that is, number one, is, shall we say, not being able to determine the cause of suicide, or suicide attempts. but let me start with the first premises you have, and that is you are trying to treat the patient, and i would have to say

through a silo perspective. when a patient meets with a therapist, a doctor, a hospital, they are all connected with pain medication. now, my wife, she was diagnosed bipolar two. she also had pain medication, so she was on morphine, gabapentin, and i could go on and on. hydrocodone. she attempted suicide twice. the last attempt was on hydrocodone acetaminophen, which you have to have about 7000 milligrams to overdose. her daily prescription was 1300. so she is fully aware that she was wolfing down additional pills to meet that threshold.

i grievance is i'm in a house with a wife and daughter that were both suicidal and attempting suicide and cutting, but i was never informed. i was totally left out because the doctors and therapists and hospitals protect the patient from communicating even to the husband. so, my final point is, when a therapist has a patient, at least the people that live in the same house with that patient should be part of the intervention and communication. you could probably appreciate my conundrum when i have a daughter . host: let's go ahead and get a response for you. caller: yeah. but i had no knowledge of. guest: so, patient privacy is important for a couple of reasons, but the most important one is that those patients feel

comfortable sharing their struggles with their therapist. they know there is a chance what they reveal to the therapist will be conveyed to their spouse or father, they might be much less willing to discuss those things. however, one of the first things any good therapist or mental health worker does when meeting with the new patient is work on figuring out who is going to be the network of support that they are in touch with to get to lateral information to be their eyes and ears inside the home, so to speak. to get early warnings when things are going bad. at johns hopkins we train our psychology residents to get in touch with family if they are allowed to. if the patient says, no, there is very little we can do unless it is life-threatening. or if there is child abuse involved. because of that it is come to get it. one of the more heartbreaking examples of where that comes into play is when someone ends up in a psychiatric union and

their family doesn't know where they are. they call police stations and hospitals. if they call the unit that person is in, we cannot even confirm that they are there because of patient privacy issues. there are subtleties where we can get things that are not in the best interests of the patient. it is legislated that we are not allowed to reveal things, even to close family members, if the patient will not permit it. now, if there is a situation where someone is likely to attempt suicide, there are ways we can sort of go around those confidentiality agreements, and we always explain that to the patient early on in the sessions. but it can be very frustrating for family members. and of the best things family members can do, even with those restrictions, is provide information to therapists and psychiatrists, even if it is a

one-directional you can always say, i don't know if you have my son there in the hospital, but let me tell you what i have seen. because we are always allowed to accept information. and be very helpful in treating them. your wife or your daughter, in any situation where you are at home with someone who is suffering and think their mental health worker might not know the extent, let them know. they are always allowed to listen. it is different than giving out information. i always encourage that. people often don't realize that. it generally is very helpful. guest: and there have been major efforts to think about ways to better integrate the family. often times with the child it is the parents taking care of that child, and subduing some level of education, giving them information about psychiatric conditions and disorders, and providing support to them to support their own child. so, there have been multiple efforts we are trying to work on that are in that front of

engaging the family to the extent we can and getting them were activated in the care of their family members that are struggling. host: dr. wilcox, you work with children and in schools. i wonder what the trends you have been seen, as far as the mental health of children? has there been a rebound after the dip of the pandemic? guest: yeah, in talking with principals and others working in schools, what they are seeing recently after the pandemic -- and this phase of the pandemic is kids being a little more reactive than they had been in the past. and, you know, increases in depression and anxiety. but also, you know, being quicker from thought to action, in fighting and saying mean things to other students. that is something they are grappling with, figuring out how

best to support students and how best to support families in general, and how to do it on their terms. and so, yes, it has been a big challenge. and even in schools where there are mental health professionals and lots of programs, they are always sort of struggling to figure out the best ways to support young people in schools. so, yeah, it is a constant challenge, but it is something i feel like we can really make impact on. host: lonnie is calling from sturgis, south dakota. good morning. caller: good morning. i sure appreciate your efforts. i am a disabled veteran. i was in vietnam when i was 19. and i got severe ptsd. and i have been in mental institutions. i have been in v.a. hospitals.

you got to dig down deep, you know? i just lost my wife about a year go to cancer. and i'm really depressed, myself, but a lot of these veterans here in sturgis, we have for me to hear, they are afraid to call out there because they send the police over. and then it makes you feel like you are doing something wrong, you know? and then they take you out to the v.a., and then they lock you up in the side room or whatever. i have been to that too -- through that too, so i kind of just give it to god, you know? that's about all i can do. it is really depressing a lot of times, but i go out and try to

help other people and try to do the best i can. but i have been on the streets too, and i have been on drugs. i tried to self-medicaid. i have been to different programs, and back in the 1990's there was a program that was christian-based that was a seminar concept, where it was like attack therapy. and that was about the best program i have ever been to, you know? they see you on a bench and everybody gives you feedback. i think we need more groups. even a chatline would be good, you know? anyway. host: i'm sorry to hear that you are struggling. go ahead, doctor. guest: what you're going through, again, when i listed suicide risk factors i had not mentioned all of them, but being a veteran is a risk factor for suicide we take seriously. as well as losing a loved one.

and chronic disability. these things are all risk factors. for ptsd, i agree with you. i think there is a role for medication. the most effective treatments are psychotherapeutic. cbt that is oriented toward your trauma is generally very effective. we are treating ptsd. and what you mentioned about going to groups, has been life-changing for many people. you also mentioned that you focused on helping other people. and sometimes we forget that that is one of the most effective treatments we have some of these struggles. it is turning to helping other people. it is a very adaptive coping mechanism that makes the sufferer feel good as well. turning to something that helps others can be uplifting to give yourself something to be doing that you feel like it is making a difference and is making a difference. that can be hard, especially for people on disability. that tends to be not as many options to fill your life if you

are not working. volunteering to help others is tremendously effective. it is also worth noting that bereavement, grief is a risk factor that is just addressed in my opinion through group work. so, finding those groups to organizations like nami. in your area there is often good support. but, yes, pursuing group, pursuing psychotherapy is effective. host: johnny in granite falls, washington. good morning. caller: yes, hello. i had a specific question about antidepressants, but i did want to make a comment after listening to the callers. i had not planned to share this, but in 1988i did make a suicide attempt. and i had an excellent therapist at the time. and i have since found another excellent therapist. both of them have helped me work through the issues i had.

and i regret so much, you know, that i made the attempt, because i had so many good things happen since then that i guess i just kind of encourage the people feeling so down right now to hang in there if you can. i know how difficult it is and how sometimes you just give up. but there is hope out there, and i just wanted to say that. i do have a specific question about antidepressants, and i'm wondering if there has been any correlation between suicide and the prevalence of antidepressants? guest: it is a great question. i'm so glad you are doing much better. it is more common that people get better than that they don't. i keep a drawer in my office with letters from patients. sometimes they will write years later, saying, doing so about, here is a picture of my grandkids. i always think of that drawer

when i hear about people struggling. about antidepressants. strongest correlation with antidepressants is a reduction in suicide rates. there are great studies that looked at as there was increasing prescription of antidepressants in individual zip codes suicide rates would go down. however, there were reports around the turn-of-the-century of people having increased suicidal thoughts when put on antidepressants. particularly young people. that led to their being a black box warning on antidepressants for young people put on those medicines. i will say that when we treat depression we tend to see people get better first in terms of their energy before even their mood gets better. so, depression can be characterized as people feeling very tired sometimes. everyone is different, but generally people will have low energy, they do not enjoy anything, there is what

churchill called the black dog of depression. and they start to get better first the energy comes back before even the mood comes back. so, people look better before they feel better. the problem with that is, then all of a sudden they have the energy they didn't have before two maybe act on the suicidal thoughts they frankly could not handle before. so, those suicidal thoughts are reported more readily, because they are talking more. the things inside their head are coming out more often. then also sometimes that energy can lead people to have the ability to act on it. however, ssri's and antidepressants are very effective for treating depression, which is a major driver of suicide. so, excepting your doctor's advice and taking these medications when you are suffering from clinical depression is much more likely to prevent suicide than to increase suicide. these are very effective treatments. host: just a reminder for

everybody, the number of 988 is the suicide and crisis lifeline. that number can be called or texted. holly wilcox, paul nestadt, codirectors of the suicide prevention working group at johns hopkins bloomberg school of public health. thanks to both of you for being on the program. guest: thanks for having me. guest: thank you. host: that is it for this segment. later this morning on "washington journal," dan weissmann, creator and host of the "an arm and leg" podcast discusses health care. but first, we will hear from more of you during open form. you can start calling in now. the numbers are on your screen. we will be right back. ♪

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c-span. your unfiltered view of government. >> next week on the c-span networks, congress returns. chambers will work on defense programs and policy legislation, which includes extending pfizer surveillance authority. the house also will vote to formally authorize a -- an impeachment inquiry into president bynum. the homeland security subcommittee holds a hearing on coast guard reform following a report that the academy is plagued by a toxic environment and sexual harassment dating back to the 1960's. on wednesday federal reserve chair jerome powell holds his quarterly news conference following the december open market committee meeting. watch next week live on the c-span networks or on c-span now, our free mobile video app. also, head over to c-span.org for scheduling information or to stream video anytime.

c-span. your unfiltered view of government. >> a healthy democracy does not just look like this. it looks like this. where americans can see democracy at work. and citizens are truly informed. our republic thrives. get informed, straight from the source on c-span. unfiltered, unbiased, word for word, from the nation's capital to wherever you are. the opinion that matters the most is your own. this is what democracy looks like. c-span. powered by cable. >> "washington journal" continues. host: welcome back to open for him. we are taking -- open forum. we are taking your calls on anything on your mind, anything you heard on the program earlier, or anything else politics-wise. the numbers are, republicans,

(202) 748-8001. democrats, (202) 748-8000. and independents, (202) 748-8002 . we will start with sydney in florida, a democrat. good morning. caller: good morning. i want to say that last segment was beautiful. i thought your guests were excellent. the thing is, i worked before as a therapist, a clinical therapist, for over 30 years. in illinois. i am retired now, but at the time i started i believe it was the late rosalynn carter had come up with what i consider the quintessential peak on mental health. she had nine volumes of information where she was the first person, i believe, that did the inclusion and diversity when he came to dealing with mental health.

her thing was to have clinicians trained that were from the various cultures and communities that are all around united states. and it was well-invested in the beginning, because we had all of the programs and things at our disposal, and there was a learning process that was going on at the time. i believe it was ronald reagan who actually snatched the carpet, took all of the funding out of her initiative that had already started where a lot of the community mental health centers, and actually began, as well as the case management programs. they even had home sites, and were able to go into the rural communities, utilizing clinicians that were from those various areas, and it was a very intentional program.

they had everybody, from the indigenous people of the united states who worked in the various areas, reservations or wherever. it was an all-inclusive program that i think needs to be drummed up again. but one of the key things she mentioned toward the end of the volumes of all of her initiatives, she said that in the beginning you are going to serve the people. and just like your guest, you could hear in their voice, the intention of wanting to help individuals. that clinicians will start that way, but because of the nature of our community, our country, when you talk about insurance and the various cutls, and trying to be more efficient, they took the grants out, made it more punitive for those who

were serving, it just became so rigorous. the reality at the end of it, she said, you were going to end up serving people, and that is going to be a beautiful thing. she said, toward the end you are going to serve people and it's going to be serving people to put them into the program so that people can get paid for serving the population, not that the end result was going to be important. that is how she ended it, and i thought it was a very few -- a very beautiful program. host: let's talk to darnell in philadelphia, pennsylvania. good morning. caller: good morning. my son committed suicide on june 26 at 10:00 a.m. i know, because c-span was just going off when i heard the banging on my door.

that was the police, because my son had committed suicide on facetime. one of the people watching managed to call and get the police to my house. i want to address the points of the toxic masculinity of this. i recently read -- because, you know, now after my son committed suicide when i see a news article i gravitate to it. one of the things i recently read is that men have such higher rate of suicide than women, and i was fortunate that i got access to my son's cell phone and i could see, like, one of the last texts he had, the statement was made to my son that, oh, we know he's not the man he should be, you know? that was one of the last texts he got within the 24 hours previous. and, hm, hm, hm, the toxic

masculinity, i would have loved to address that to your previous guest. i think that is very much a factor. the statement was made to my son -- there were three parties, my son and two women. my son committed suicide for love but one of the woman addressed him, oh, we know he is not the man he should be. host: it is so painful and i am so sorry for your loss. i appreciate you calling in and sharing that with us. dennis in rancho cordova, california, republican. caller: good morning. no wonder the suicide rate is on the rise. we have a fascist moron

running for president named donald trump. he is a dictator, a fascist, and no wonder people -- host: are you a republican? caller: why am i not republican? host: you are on the republican line. caller: of course. host: you are republican. caller: of course. host: who are you supporting? caller: this is why we normalize a fascist. you cannot believe that a republican would call out a fascist like donald trump. host: i can believe it, i was just making sure. caller: why would you question it? host: who are you supporting for president? caller: joe biden. host: did you vote for biden

last time? caller: of course, because why would we want a fascist in the office? host: are there any other republicans, since you are still republican, that you would support? caller: no, they are all backing -- well, yeah, liz cheney. adam kissinger. they were brave enough to call out a fascist but they were kicked out of the party. host: eileen in st. petersburg, florida, democrat. caller: good morning. this is open forum, correct? host: yes, it is. caller: excellent. i watched stefanik badger and grill the university president and everybody knows she is a huge maga supporter. she supports every comment trump

has ever made, whether it is calling black athletes sob's for annealing. i wonder how she would handle it if it was a democrat interrogating an nra president, trying to control gun laws? that would be infringement on the second amendment but they do not mind infringing on the first amendment. i think if this whole thing was reversed, look at how they would react. that is my comment. you do not want to infringe on the second amendment, well, let's not infringe on the first amendment. host: let's go to virginia, independent, bonnie. caller: thank you for taking my call. i am calling about the segment on depression. i would like to share i was severely depressed in my early

20's and i was suicidal for three and a half years. i barricaded myself in the room when they called two different psychologists to talk with me because i knew they would take me to saint elizabeth because i could not handle anything. but what really got me out of depression was taking yoga. the young man around the corner taught yoga and week by week i got better and better. there is something about, you know, you have to lift your legs up, energy going, blood circulating, nerves connecting, and the spiritual aspects. the meditation and all of that really helped.

i would really like to share with anybody who is possibly thinking of committing suicide or really down because of something that happened in your life to try taking a yoga class. there is different kinds of yoga. you will be led to the one that is right for you, and if not, try another type of yoga. host: i am so glad that worked out for you. janice in florida, republican. caller: good morning. i have quite a few things i would like to go over. i have been listening for a long time but the first one i want to start with is the hypocrisy from the democrats that i continue to keep hearing as they bash donald trump. it is their favorite pastime. they eat, sleep, dream trump.

it is astounding how it does not matter what the topic is somebody finds a way to bring up trump. i do not care what it is. it is absolutely sickening. i think the two women the other day that were going on and on -- she actually called trump supporters satan and how evil we almost be. it is absolutely insane the name-calling and the messages that come from them nonstop. i also wanted to speak about israel. i do not understand how any african-american cannot stand by the jewish people. we have so much in common. they are screaming now for jews to go back to israel. i remember when the democrat

party was saying the same thing to african-americans back in the day. it is disgraceful what democrats, especially democrat christians, stand for. but they want to kick us off the planet because we want to vote for trump. yet they call themselves christian and vote for everything that is anti-god, anti-american, anti-human, and no anti-semitic. i do not understand how they cannot see the difference. my last comment i want to go with is joe biden. anybody that can sit up there and talk about what a good job joe biden is doing, what planet are you living on? the twilight zone? he is the biggest joke and he is a senile buffoon. whatever you have to say about

trump all of his faculties are there. i sure enough enjoyed four years of trump as president. host: all right. anthony in maryland, democrat. caller: hi. how are you today? host: i am good. go right ahead. caller: i am on? host: you are. caller: i want to talk about the suicide. we need to have a serious conversation about suicide. host: anthony, you got to mute your tv. you are getting confused. caller: i thought i was talking to you. host: talk right into your phone. caller: ok.

host: anthony? caller: i hear me on the radio but what i want to say is when i listened to the conversation on the suicide i did not hear anything about race, depression, or isolation. host: ok. we did talk about race and isolation. dennis in amityville, new york, independent. caller: thank you for taking my call. you are a bright light on these conflicts, so, thank you.

i often find myself in a quandary where i see where we hold abortion as the most sacred thing and everyone should have an abortion. yet when someone commits suicide they mourn the life. what is the difference between a boarding a baby and somebody -- aborting a baby and 70 committing suicide -- somebody committing suicide? it seems like the culture of death is taking over this country. i will hang up and listen. host: james is in florida, republican. caller: thank you for taking my call. i would like to make a comment -- the previous caller on your segment about education and what

have you earlier made a statement that donald trump said there is good people on both sides. i keep hearing people echoing this comment and the fact is it is being edited by the mainstream media. they kind of cherry pick what they want to put on the network and what have you. there are so many people who keep believing everything that hear on television. host: do you believe that trump's response that there are good people on both sides was taken out of context in some way? can you explain what you think he meant? caller: actually, what they air on television is just that portion of what he said.

in actuality, because i saw the actual clip on another network where he said, you know, the white nationalists and company should be condemned. he said that they should be condemned. he went on to assume there are also good people on both sides. but the mainstream media jumped on the comment or cherry picked what he said and people just keep perpetuating this narrative over and over and over again to vilify the man. host: you don't think he meant there were good people on the side of the white nationalists? caller: no, no, no, that is not what he meant. he meant that also in the crowd there are other people besides white nationalists that are

decent people. host: but he did say on both sides, which would indicate he meant on the white nationalist side. caller: no. host: what are both sides then? caller: ok, all right, i guess i am confusing what you are asking me. he probably did mean that but not that they condoned -- host: what they were marching for. caller: what happened -- what they were saying. now they are: in an saying donald trump is going to be a dictator -- now they are calling in and saying donald trump is going to be a dictator. he says i am going to be a dictator for the first day. i am going to close the border and drill, drill, drill.

but now people are calling in saying trump is going to be a dictator. host: we did play that whole clip on "washington journal" yesterday actually. caller: did you? host: i did. i played the whole clip. let's talk to laura in massachusetts, democrat. caller: good morning. i just wanted to say i have been watching all the protests about the war and what is going on in gaza and i personally think, first of all, if you are real christian, you are anti-war. period. killing people is not what jesus would have wanted people to do. for that lady to talk about everybody is so bad because they like trump or this, you know, what is going on in gaza is horrific. what hamas did was horrific. you do not have to be

anti-semitic or pro-hamas to be anti-war. this is becoming convoluted through the media and the constant word of anti-somatic is being used against people for having a view of antiwar. stop the killing of people that are dying. taking babies out of incubators. and the united states is no more being the world leader in trying to stop these wars. i am on the democratic line. i will not vote democratic. i will not vote republican. i think both parties have failed

miserably. i would like to see kennedy get in. i do not think you will win but he is anti-war and this is where we need to go. host: jeffrey in northampton, pennsylvania, republican. jeffrey, are you there? caller: yes, i am here. host: go ahead. caller: i would like to comment on the previous caller -- the guy from california who claimed he was republican but cannot think of one republican candidate he would vote for besides liz cheney, who might as well be a democrat. it does not make sense to me. trump tells the truth. you get the real deal. he wants to solve the problems. he wants to make america great again. the democrats call him a dictator and a fascist. host: i want to ask you about liz cheney.

you said she might as well be a democrat. however, she is pretty conservative in her policy views. what do you think about that? caller: well, she is off the rails. she does not align herself with the correct votes in congress. host: she does not align with trump, correct, but her policy views are conservative. caller: yeah, but she never sides on the side of the united states and was in the best interest of the united states. host: that will be the last call for open forum. thank you to everybody who joined us. later this morning on -- coming up on "washington journal", dan weissmann, creator and host of "an arm and a leg" will discuss the cost of health care and other related news.

stay with us. ♪ announcer: next week on the c-span networks, congress returns. both chambers will work on defense programs and policy legislation which includes extending surveillance authority, which is set to expire at the end of the year. the house will also vote to formally authorize an impingement in -- impeachment inquiry into president biden. a subcommittee will hold a hearing on coast guard reform following report the academy plagued by a toxic workplace environment and sexual harassment dating back to the 196's. on wednesday federal reserve chair jerome powell holds his quarterly news conference following the december federal open market committee meeting. watch next week live on the c-span networks or on c-span now, our free mobileideo app. head over to c-span.org for scheduling information or to stream video live or on-demand anytime. c-span, your unfiltered view of

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continues. host: welcome back to "washington journal". it is our spotlight on podcasts segment. i am joined by dan weissmann, host of the podcast "an arm and a leg". before we talk about that tell us about the podcast itself. why did you start it, when, and your mission? guest: yes. i don't do this by myself. it is about why health care costs have increased and what we can do about it. i am a reporter and i like the challenge. we take one of the most enraging, terrifying, depressing parts of american life and create some thing entertaining and empowering and useful. otherwise, who would ever come back for a second episode? who would listen voluntarily to this terrifying and depressing topic? we all went to everybody -- owe

it to everybody to make it worth your while. host: besides depressing your audience what you want them to take away from it? [laughter] guest: i started this thinking -- how did i start this? this is a topic that is under witnessed in american life. i have been a reporter a long time. i would encounter the stories and i would encounter this phenomenon in my own life and be like, we should talk more about this. i started it as exploration. there is a lot of weird stuff i do not understand. how do we figure it out? over time, i think over the first year, when i came to figure out is that's good. there is a lot to figure out. but this is kind of urgent. we need to figure out strategies for self-defense.

the cavalry is not coming. you are in d.c. i am safe in chicago, but i don't see our government sweeping in to rescue us anytime soon. this was very much an in the meantime exercise. we should understand what we are up against and we should understand as much as we can about what we can do. there are things we can do for ourselves. we are not going to win them all, but we do not have to lose them all either. individually. host: speaking individually, i want to show you this from the centers for medicare and medicaid services. u.s. health care spending grew 2.7% in 2021 reaching, $4.3 trillion, which comes out to $12,914 per person. what is causing that rise and

where is all that money going? guest: yeah, super good question. i think what is causing that rise, i would say, there is money in it for people. everybody with power sees an opportunity to make a little more money. and, to be absolutely fair, one thing that has become clear is this is a game of shark versus shark. looking at the cost of medicine, . for instance there are the pharmaceutical companies looking to make as much money as they can. there is a group of players called pharmacy benefit managers that are also in this game looking to make a dollar and they are fighting each other. they are fighting each other over money that comes from us. whether it is paid by medicare, the government, our insurance companies which get their money from us, or charging us directly. all that money comes from us. that is $12,000 and some per american.

we are each of us contributing whatever it is toward that, whether it is in the form of taxes, insurance premiums. even if we get our insurance from work, the average family coverage from employers passed $20,000 a few years ago. that is awesome. my employer is paying $20,000. that is money your boss to be paying you. it is part of the line item for your position. it is coming out of our pockets and it is happening because all the players are taking it. [laughs] i don't know what else to say. people go into health care in whatever role for whatever reasons. we all need to earn a living. but things have gotten a little out of whack. that is probably not the most

sophisticated policy you have ever heard but those are the broad strokes. host: if you would like to join the conversation, you can do so on our lines by region. if you are in the eastern or central time zones, it is (202)-748-8000. if you are in mountain or pacific, it is (202)-748-8001. you can also text us at (202)-748-8003 and post our social media accounts, facebook.com/c-span or x @cspanwj. your latest episode was about when hospitals sue patients. what is that about? guest: it is one of the more shameful phenomena i have come across. people have been doing these stories for a long time and when i started doing the show in 2018, by 2019 there were amazing reports coming out documenting

hospitals that sued thousands of patients every year. garnished wages, take out liens on their homes, and frequently -- they were not like, i am going to sit on my yacht and ignore my bills. i am totally strapped. i don't have it. a question that comes up -- it is an outrage and often when hospitals get called out one of the things that stands out is how little money there is in it for the hospitals. the reporting on virginia commonwealth university looked at their house system and looked at the amount they were seeking combined and compared it to their annual surplus, because they are a nonprofit. it was tiny. the amounts they were seeking compared to the actual profits were minuscule.

a big report out of maryland tracking 145,000 lawsuits from hospitals across the state over 10 years compared the amount they are seeking to the amount they were paying and compensation to the executives there earned more than $1 million a year. the amounts were tiny. why do they do this? how does this happen? it is really worth noting this is not all hospitals. a study out of north carolina showed 95% of the lawsuits that hospitals have filed against patients were a small number of hospitals. this is not something most hospitals do. a study from new york showed -- because they were just a few hospitals responsible for the lawsuits -- but it was not like the most hospitals will do anything for cash. some of the biggest, richest hospitals were engaging in this behavior. and some of the poorest hospitals were not.

that is what is behind our inquiry. why did this happen? what is going on? in some ways, we still do not entirely know. [laughs] which is embarrassing to say because i have been going pretty hard at this with terrific partners from the baltimore banner for a year. there are questions we still did not know the answers to. we learned some interesting things along the way. host: you mentioned this earlier, the pharmacy benefit managers. explain exactly what that is and why have there been so many ads about it recently? guest: [laughs] yeah. pharmacy benefit managers are essentially middleman companies. you can think of them, and most encounter them, as proxies for our insurance.

your insurance company negotiates with hospitals and doctors and physical therapists and anyone else who might send you a bill for medical services. they will contract with or they may own a pharmacy benefit manager from express scripts or prime therapeutics. that entity is doing all that business with medicines, except it is really complicated. the basic idea is that they are saying to pharmaceutical companies, hey, give us your best price and we will decide which drugs we cover and put them on our formulary. us as people who have insurance will be subjected to a list of drugs. you want a statin? take this one. you need adhd meds?

we cover these. others you are on your own to pay for. oh, my god, i am getting lost already because this is so complicated. they are negotiating with the pharma companies and saying, give us your best price on your whole line of drugs and we will decide which ones we will cover. and you are going to give us a discount but rather than getting a discount they are getting a cash rebate. that is one big thing. when they pass -- you show up to the pharmacy counter and are told, you are going to pay $10, or $50, or $75. that is through all the negotiation with the pharma company, your insurance, walgreens, and cvs, or whoever the pharmacy is. they are getting a little cut from everybody. one thing that is controversial about this is when they have an

incentive to push for higher list prices for drugs, because if i am charging you $20 for this -- that is the price of my drug -- great. i want a discount. i want a rebate. i can only give you $19 before i am selling it to you for nothing. if my price is $100, i can sell it to you -- all i need is a dollar to make a profit. i can give you a $99 rebate if i priced $100. that is weird. sometimes when i show up to the pharmacy counter if i have a big deductible for my drugs, i might be charged that $100. that is not good. why are there so many ads? those ads are being taken out by the pharma companies who also make giant profits from

everything. they have been under tremendous pressure from congress, from the media, to charge less money. they are looking for some of the finger at and the pharmacy benefit managers are not just convenient targets but legitimate targets. that is why we are seeing ads. they are being taken up by the pharma industry. you are watching katie porter and her whiteboard have a lot to answer for themselves. i hope i did not completely lose you and everybody else in talking about what pharmacy benefit managers do. host: we are going to go to the phones. just a reminder of the phone lines. they are regional. eastern and central is (202)-748-8000 and mountain and pacific is (202)-748-8001. our social media feeds are open as well. let's start with timothy in vermont. good morning. caller: good morning, mimi. this is a real simple question

and i will summarize it in two words. medicare disadvantage. i will take my answer off air. host: dan? not sure where he is going with that. [laughter] guest: i think i know where you are going with this. this is such an enormous field, the cost of health care. there is elements that i have not given my full attention to yet, but medicare advantage is a sizable chunk of medicare. traditional medicare is the government runs it and pays the bills directly. medicare advantage is essentially the government asks insurance companies, would you like to do this for commission? we are going to give you a certain amount of money and you are going to provide insurance

under certain terms. insurance companies who do this act like insurance companies. they have on the one hand enticements. traditional medicare does not cover certain things. they will say, we will cover that. you can have more benefits. maybe we will say you pay less as your share of things. the downside is they make the rules about what doctors you can see and what is required in order for you to get remit. no, no, you can only see these doctors and they may say we need preauthorization. you need our say-so to get this treatment or that test. and we may say no. they often say no and you do not have a whole lot of recourse. that is the disadvantage of medicare advantage and there has

been a lot of reporting recently about the kind of profits insurance companies are realizing when they offer these medicare advantage programs. that is my decently well-informed take but there is a lot i am missing. host: california, colette, good morning. caller: why are members or people of the public -- they should start demanding a cap on insurance premiums like car payments based on the area where you live. like my zip code. host: what do you think, dan? guest: can the government stepped in and regulate what we pay for insurance? i mean, it is really tough. insurance comes from all different directions. maybe you get it from your job.

maybe you buy it on your own which is probably through healthcare.gov. maybe you are on medicare or medicaid. what i have learned is different laws and different levels of government regulate those things. if you are buying your own insurance that is regulated by your state as well as some laws -- like the affordable care act -- medicaid is administered by the states. medicare is regulated by the federal government. if you get your insurance by work, state insurance regulations do not cover it. that is governed by a federal law. it is part of the labor law. it is governed by the department of labor who are busy doing other things. it is a mishmash. part of what the affordable care

act does is regulate what insurance costs and says the government will subsidize your purchase of insurance on this exchange depend on your income. one small degree in the world of insurance that happens but we would need a very different system that is less fractured for there to be effective adjustment of what each of us pays. host: there is also the no surprises act. can you remind us when that took effect and what it does? guest: you are quizzing me. when did it take effect? it was passed by congress at the end of 2020. i think it took effect the beginning of 2022. what it does is more important. when i started making the show and started hearing about -- we have all heard about surprise bills -- i was going to be reporting on this forever.

it turned out something really changed with the no surprises act. the no surprises act has not eliminated unpleasant surprises in medical bills, but it has outlawed certain kinds of surprise bills which is to say if i go someplace, like a hospital, that my insurance says they cover, i expect my bills to reflect my insurance is going to step in and i am going to pay what my insurance says i am supposed to pay. except that many of the people i might see at that hospital don't work for the hospital, especially doctors. an emergency room doctor, a surgeon, radiologist, they're going to send me their own bills. they may or may not participate in my insurance network. before the no spry's is act they were free -- before the no surprises act they were free to

send me their bill and i would be on it for whatever. if my insurance company does not cover out-of-network bills, is the whole thing. is my insurance company says they will pay hundreds but it is for thousands, i am on it for the whole thing. the no surprises act says no. if you have gone to a place that is covered by insurance, everybody that you see you are going to pay whatever your insurance -- whatever you would pay for seeing someone in network. if they happen to be out of network and not covered by insurance that is not your problem,. you are going to pay whatever your co-pay is or whatever your share of the in network would be in that provider has to work it out with your insurance what they are going to get paid. if they cannot agree, there is government arbitration that will take place. but it is no longer your problem. this is surprisingly working to

the extent that more than a million bills were essentially made not our problem in the first year of implementation because of this law. good deal. [less] aughs] host: george is next in florida. caller: i have a chemical engineering degree and i also studied pharmacy. i wanted to work here in the united states and about the time i finished a lot of the pharmaceutical work went overseas. i had gotten sick with a lot of unusual stuff and i found someone who put me onto an electronic system which runs on a laptop computer that tests 12 different kinds of things.

it has thousands of items in it. i have my own plan. i bought one and what happened is i said, i am going to forget these people feeding at the trough. i will go all the way -- the money is going into all kinds of people's hands. i test myself and then i go to the doctor with whatever the system says. i get the prescription if i need or i go to the health food store and get some herbs. whitedoveglobal.com sells them. it has cut my health costs 95%

and everybody still employed except the people in the middle. host: following onto that there was a kaiser family foundation poll about the cost of health care. it said 40% of adults are either delaying care or forgoing care altogether just because of the cost. guest: yep. host: does it have an impact? guest: i don't know what to add to that except it is in raging and terrifying and depressing -- enraging and terrifying and depressing. there are things we can do to

mitigate some of the things we come across. some things we can find our way around. host: and that does not include the people who are in debt right now because of medical care that they did undergo. guest: although i will say one thing that has been the brightest spot is the discovery thanks to jared walker of how important charity care is. this is a requirement for non-profit hospitals, which is most hospitals in the united states. they are legally obligated to have a charity care policy. this is part of the affordable care act. it means they have to have a policy that says if you make under a certain amount of money, we will forgive your bill up to a larger amount of money. we often forgive a large chunk of your bill. it is not unusual for charity care policies to say if you make up to four times the federal

poverty level, we will forgive 75% of your bill and that is like $100,000 for a family of four. about 58% of american households earn less than four times the federal poverty level. most people will qualify for charity care from a hospital and hospital bills are one of the places where people go into unbelievable debt because that is when you get hit with everything. if you are going to a hospital, it is the norm for you to have the deductible on your insurance policy in the thousands out of your pocket. and then there is what is called one of my favorite terms co-insurance. this is the percentage of your bill that they are like, look at me, i am co-ensuring myself. you could be on the hook for 20% or 30%.

that is where people get into enormous amounts of debt and most of us are just not aware that we might qualify to have our bill forgiven or large chunks of it forgiven. hospitals do not always do the best job of making sure we are aware they offer charity care. even for profit hospitals have charity care. studies have shown they are often more generous than those that not profit hospitals. dollarfor.com. even if they are already billing, even if you are in collections, it may not get be too late to get access to charity care. press the button and it will say we think you qualify for

financial assistance at this hospital. we will help you apply. it is enormous. we were talking before about hospitals that sue people over medical debt. many people who have been sued over medical debt qualify for financial assistance. that is one of the biggest outrages. we talk about what can we do to protect ourselves and each other? spreading awareness of hospital charity care policies which non-profit hospitals are legally required to have. dollarfor.org. i want to spread that gospel, especially having spent the last year looking at hospitals suing people over debts. that is the thing we can do for ourselves and we can pass along to each other. host: karen in alabaster, alabama. caller: good morning.

i want to say thank you for having this guest on. he is refreshingly honest. i will definitely start listening to your podcast. this is why americans want to take the government back and put it in the hands of the people. there is corporations and the government that do not have our best interest at heart. this is not the only industry this is going on in. you kind of answered my two original questions. my question for you now is, is there any way -- instead of going to a pharmacy to get medication -- do something like essential oils? guest: thank you so much for the kind words about what you are seeing here. i am not a doctor. i don't know. [laughs] do not come to me for medical advice. i wish i could give it. unfortunately, that is my answer. host: sally in edwardsville,

illinois. caller: i remember i followed the passage of the affordable care act and there was a proposal to put a public option into it. i think if people had an option, you could pick private insurance, your employer could pick private insurance, but you can also sign on to say medicare if you want. i think it would be much cheaper because i read a few years ago some of the ceo's and private insurance companies make tens of millions of dollars every year and nobody in government makes that much. i think it would be much cheaper. the premiums from employers would be cheaper and we already have a system set up to administer it. i just want your opinion about all that. thank you. guest: thank you so much.

i steer away -- this is funny to say on c-span -- but i steer away from those top-level, what would be a more sensible system? partly because it is so polarizing in our country. you start talking about what you think we should do and suddenly, a large number of people are like, i am never listening to you about anything again. that is one reason i refrain. people really earn phd's to be able to make good arguments for these things. i officially do not have an opinion about these sorts of things. but other countries managed to do this without the kinds of costs we have and it is worth looking at how they do it. some of them do it with the government paying for everything. some of them do it with heavily regulated insurance.

worth looking at. host: kathy in washington, good morning. caller: our government knows medicare advantage is a scam. when are they going to step in and do something? host: i think you addressed that unless there's some thing else you want to say. guest: i will only say i am dimly aware there have been moves to more heavily regulate medicare advantage and that they have -- there was a plan put forward the last year that was not exactly rolled back but it was agreed insurance companies would administer medicare advantage. no, no, no, that would be terrible, so the government is waiting another year. host: atlantic beach, north carolina, rick.

caller: good morning. i am enjoying the broadcast this morning. a couple thoughts and follow-up to the issues of price transparency and clarity. that truly needs to be done. hospitals can do a better job. there are not a predominant majority that do a good job. i think the notion that mr. weissmann made about all the other positions, surgeons and emergency medicine physicians, that can cause surprise. the one area i want to take exception to is on the notion of co-pays and deductibles. that is a big dollar amount but it is key, in my judgment, to

remember that hospitals can get in trouble for waiving those. they have to have a different approach to this because then they can be accused of inducing or enticing patients to receive care. the last thing i want to get in is while there is bad apples anyplace i do think there is regulations on hospitals to prevent them. they have to voluntarily disclose cases of fraud abuse and neglect and that is appropriate. i just hope the government does the same thing when they do that when they are on capitol hill. guest: i am not sure i understand what your question is.

frankly, you may be getting into an area i have not studied. host: mike is in colorado. mike, are you there? caller: right here. sorry about that. dan? guest: yes, sir? caller: i am on medicare and turned 67 and had the advantage before we knew how crooked it was. i am now on a supplement and the medicare doctors i have seen are all hacks. they have no representation for the patients. they are representing their medical groups, medicare and the insurance companies. they do nothing for the patient. this is not just me. i have good friends who are all educated, experienced, and retired who are falling down from strokes. i am one of those.

they discontinued my painkillers. i have not slept for two years. i am not talking about two or three hours. i am talking about 10 minutes every other night. every doctor you go to see on medicare looks at your records, they will not give them to you, and i was listening to the other guy filibuster. i am not sure if he was an insurance paid regulator or what he was doing, but anybody who is on medicare, if you have been to the emergency room's -- which i have been to half a dozen the last year -- get you in, get you out, keep the groups set aside. it is not to treat the patients anymore. you are just talking and nobody is getting treated.

host: mike, sorry you are having a hard time. dan, any comments? guest: i would prefer for my job to be unnecessary. [laughs] i would be delighted to not do what i do. the other thing i will note is i hear you and ims are you are having that hard time. one thing i will note is i hear from listeners all the time and doctors saying, yes, we are frustrated. i came into the store for patients, to help people, and i find what i am doing is essentially an assembly line. i don't have the opportunity to serve people the way i want to, the way i trained to, the way i believe people deserve to be treated. some doctors have been doing interesting things.

there has been an increasing movement to unionize. other doctors -- and there is an association of emergency room physicians that have filed a lawsuit to prevent a lot of emergency rooms owned by private equity. demands that they operate like an assembly line and these doctors have filed a lawsuit in california to say, no, private he equity cannot run the doctors here because the state of california has a long against the corporate practice of medicine. that lawsuit is continuing. i hear you and that experience of what it is like to be treated by a doctor who is working for the insurance company is frustrating.

some doctors are doing what they can to take medicine back a little bit. host: we have got a question from james on x asking you to compare our medical system with the one in canada. guest: i am not qualified to do that. [laughter] i want to be clear. there is so much to know about our medical system and the canadian health care system. but i will note that i hear from people in canada saying -- and lots of other countries saying -- i cannot believe you people put up with that. [laughs] that is the only comment i will make. i hear from folks in canada and other countries saying, i am listening to your show, it is horrifying, i am grateful i live where i live.

host: vitas is in washington, d.c. can you mute your tv and talk into the phone? caller: yes. why is it that the people who come out of prison get medicare and a person who worked all their life and get insurance are limited to $4000 a year in medical prescriptions and stuff? but the person that was in jail and never paid taxes get unlimited care, pays a dollar for their prescriptions, and the other people pay more? why did the government put agueg the wrong guy here. this is not an area that i have looked at. host: ed in jackson, tennessee. good morning. caller: i was going to comment on why are we the only country

in the world that has single-payer health care. you covered that. number two, why are we talking about -- why aren't we talking about how $.33 of every dollar is wasted? guest: thank you. that's a really good question. to be really clear, when i first started doing this show, one of the questions i had was where do the dollars go and how much of that is wasted? there are reports i could not get through in a lifetime. but, from what i was able to glean, there are different measurements of waste. $.33 on the dollar could be realistic and could be based on a careful study. i think there is a good question , one question was like how much

of all of those millions and trillions of dollars is profit? and what are the profit margins? i have not been able to get my arms around it. i think the honest answer to that is there is so much money in it. and, people chase it. there is a reason private equity companies have been buying up practices. there is a reason they own a lot of those. they run a lot of emergency room physicians groups. and meteorology groups. there is money in this. and we are all, one way or another, in either a money or life situation. host: ernest is next. good morning. caller: good morning. thank you for taking my call. i've been working in health care for over 40 years. both as a social worker and an administrator. the biggest drain on our system

is the hmos. the medicare hmos. they talked about the overhead for medicare. it is 10-12%. and you compare that to the hmos who are extracting 30% overhead. the fact that the united health care ceo could make over $400 million a year, that is coming out of the health care system. that is where the waste is. and how is it being promulgated? in lobbies. the insurance industry owns congress. i will give you another question. why do we need insurance companies? we do not need insurance companies. all insurance companies, medicare uses insurance companies to pay claims. that's it. insurance companies have built out this monolith -- up this monolith of supposedly quality programs and utilization review that is meant to keep the patient away from the doctor. and from health care, because that's how they make their

money, by keeping people away. i don't understand why we don't go with a single-payer system with medicare. the other thing is if we encourage medicare for people below 65, and we can start with age 50, do you know how much money this will save? so we can put a little tax on those employers who are playing -- paying. but basically, we are going back to putting these people in medicare, which is a more economical system. the last thing i want to make about the health care system is primary care. why don't we have enough primary care doctors? we have so many specialists. when we talk about medicare cuts, people talk about medicare cuts in terms of cutting to the consumer. let's cut the rates to the specialists. let's even the playing field. let's lower the rates to the specialists so that more people will go into primary care. host: let's get a response to report do you think, dan?

guest: i have nothing to add. you are in the field, you are seeing this up close and studying this. yeah. thank you so much for your help. host: steve posts on next and he wants to know which private hospitals are the worst offenders in terms of overcharging patients and insurance companies. guest: that is such a good question, we should do an episode about it. host: speaking of episodes, what will your next episode be about? yes: -- guest: it is about why hospitals -- patients. it's coming out in a couple of weeks. i don't feel like we can talk more about it. it is a big investor issue. i don't want to say anything out of line. host: oh my goodness, ok. the podcast is called "an arm and a leg or co-their website --