ovechkin going the other way. right to deslauriers. we check the time remaining, 3:50 in the third. backstrom, settles. ovechkin, fires, deslauriers fire together post. on top for sloan. he lets it go. they score! backstrom with the insurance! >> craig: it's been all capitals. i don't think the edmonton oilers know and knew what hit them. the team in white has put together one heck of a road period here. pat quinn along with the fans are as surprised as his team is. again, gets his own rebound. back of defense, and another sharp angle shot, deslauriers would have stopped in the first. he doesn't stop two of these in the third period. that backstop one, identical to the ovechkin second goal. just not playing as sharp as he was in the first. two sharp angle shots, and all

of a sudden, looking like the caps will come out of here with points. >> joe: locker, i can't help but go back to a comment pat quinn made earlier in the day about ovechkin, calling him a gift to the game and that his leadership permeates the whole team like gretzky in the days gone by where almost by osmosis the team would elevate the play level, and ovechkin did it. he was quiet, but then in the first eight minutes of the third, he said boys follow me. >> craig: you always want to end the road on the last game in strong style. this is a game they can carryover into their next home game. if you can put together 20 minutes and still win, you know you're a heck of a hockey team. >> joe: steckel gets it out. quintin laing, more than content to make edmonton work

the full length of the ring. back come the oilers. full glass it's sneed. to penner. gagner tangling up. green also bumping his teammate there. quintin laing lobbed away. >> craig: that's all they have to continue to do, and this team is done. >> joe: four-goal explosion in the third period for the guys in the white sweaters. angling for win number 22 on the campaign. should this hold, the fastest 15 ever recorded in recorded recorded in -- recorded in capitals' franchise history. jurcina as it goes through him. brule shoved down by laich. penner on the perimeter. wrister on the way, knocked down in front of neuvirth. we will keep our eyes on

deslauriers. he will lift him for the extra skater, can't do it now. deslauriers recovers. >> craig: he was coming at full speed and said uh-oh. now he's out cleanly because the oilers have the puck. >> joe: semin and ovechkin going the other way. looking for the hat trick, back hands it wide. alex ovechkin trying to reel in the nhl's goal scoring leader with his two tallies in the third. 9-4 in the third. bumped to poti. just over a minute in regulation. nilsson did not keep it away. back pedaling away from alex semin. rexall place a much quieter place in the third. take nothing chances, sealing it to the ice. our capitals player the game compliments of the palm

restaurant, $100 gift certificate to the great 8. >> craig: two goals and assists in the third period alone. they wanted to leave the west in style, picking up some wins, and they fought hard to come back from the 2-0 deficit. well done performance here in the 3rd period by alex, and the rest of his teammates. >> joe: 48.3 seconds away from the finish line. with washington on top by 2, and the oilers diagramming some strategy, morgan franklin pivotal play. >> craig: just on the wrap around, again two shots on it. keeping the goal tender along the ice. poor defense in front of the net. you can always give the guy the original shot but giving ovechkin and super players in the nfl second and third whacks at it, you're looking for trouble. alex found his way around the net, and he's been the total difference.

>> joe: alex ovechkin was 10 years old the last time the capitals won in this building. that should change in 48 seconds. dustin penner would like to turn the table. the scores chancing dominated by dc. edmonton with the 2-0 lead after the two-goal second, but here in the third, ovechkin, fleischmann and jammed away. gilbert, that missile went wide. six attackers on for edmonton. pumped to the third of the goal. midpoint for gilbert. 28 seconds left. nilsson turns it, penner operates. for gagner. through the seem, horcoff. twister, looking for the deflection. jammed away by backstrom. on the outlet. he will send it wide. getting in the grill.

six seconds. now five. a spirited comeback is complete in the third. washington comes home from the great white north. a 4-2 winner. >> craig: one of the best games of the season as far as comebacks are concerned, joe. i mean just the way they rallied. they looked down and out after 40 minutes. i thought the team could be done, but the way they came out, their star player was the star, and that's the difference maker tonight. been brought to you by geico. 15 minutes could save you 15% or more on car insurance. 1-800-947-auto. by morgan franklin, your partners were long lasting business and technology solutions, and by land-rover. the luxury that's more than a luxury. to learn more about the 2010

land-rover vehicles, visitland- rover usa today. the capital's first visit to edmonton in more than three years. back in october of '06 they were blanked by the oilers 4-0. the guy in the white get 4 in the third to win it by the final of 4-2. for craig laughlin and all the men and women in our crew, joe beninati thanking you for your time. the caps will be back home and meet up with the buffalo sabers at 7:00 p.m. eastern time. up next on csn, net impact and then stay tuned for sportsnite at 1:00 a.m. eastern. a great night for the great eight. washington looking bleak after two. but the rally in the third, all started by ov.

ja brawl. >> this month a net impact, the best of 2009. tough man on the ice. alex the great ovenchin. and why fame and fortune has not changed him. and paying tribute to a man that taught everybody about the game. >> and then a dream comes true for one high school baseball player, a story that will warm

your heart holiday season. >> hello and welcome to this special edition of net impact. i'm art fa nel. this is the best of 2009 report where we look back at some of the stories that touched most and kept us talking. like the first report that we called a father's tribute when we went under the lights on the biggest stage in major league baseball where yankee catcher jose molina could not help but reflect on the death of his father. this year was particularly emotional for all of the brothers. we begin the coverage of a truly remarkable story. >> they are the quintessential

baseball family, the molinas, ben gypping, jose and yadar, a rare feat three brothers playing ints. the backbone is gone. ben molina santana passed away at at the age of 58. >> it is like somebody take your heart and threw it in the trash. >> his passing was stunning between games of a youth double-header. games played on the feel where he built them from scratch. >> he had high blood pressure and he wasn't taking his pills and he was going to the fields andmaing it. all of it got his blood pressure off and that's when he had the heart attack. >> the funeral within the

community where he lived. >> it was a major thing seeing 3 or 4000 people in two or three days showing respect, the most respect that they have for my dad. you have to be there to know how the kids were crying. i'm talking about nine, ten years old. >> my dad was a great man. he tried to help the little kids and got a bunch of teams. >> he died doing what he loved. he built that field literally. to die there was a special moment for him. >> a special moment as a special place, the ball feel which is such a community landmark and it's street builds the architect's name, it was on that field that a father taught his three kids had to play the game and how to live life through the game. >> he teach us about be a good player every day and try to be better every day we became a man

through baseball. he wasn't only baseball, he was the others things first like during the school, doing your homework and don't do drugs and don't do this. and then you play baseball. that's the way he taught us. >> among the invaluable life lessons, the importance of sacrifice. little known fact, ben molina had the chance to personally blaze his son's trail to the big leagues about the time benji was born the hitter in the amateur league was offered to try out with the briars and his decision to raise his family at home might be the reasons his sons make their living behind home. >> he is a very strong guy. he had a lot of respect. he worked from five a.m. to 3:30 every single day for that m years. to tell you the truth, i never heard him complain once.

i never heard that man complain one time of taking us to the field. >> he always had a smile and he was always there for you and his heart just -- the way my dad was, the tissue, everything, gave you everything he had for his family. >> now, as we approach the one year anniversary of his passing, the mo lipa brothers celebrate his father. they look at the letter he put in his casket. >> it will be a tough time without him and that i love him very much. >> benji channels his father's spirit by putting pens of words in a poem. >> thank you for loving me more now than ever, you are who i am today, you make me in soul, now it is my turn to love you, rest

in piece. i love you. >> of course the season had a bitter sweet ending for jose, the yanks would go on to win the world series and with that win jose picked up his second world series ring, he received the first one along with his brother ben gypping with the and gers, his brother yad dar won a ring with the cardinals in 2006. of course the entire baseball community in the city of brotherly love was saddened this year with the passing of one of the game's great announcer, hall of famer harry callus. he was one of those class acts that for so many of us made the moments on the field magical. derrick gunn reports on the voice we lost. >> this afternoon at a little past 1:00 p.m., harry callus

passed away at the age of 73, a day that will live in imfa knee in philadelphia. >> this ball is out of here!. the philadelphia phillies are 2008 world champions of baseball! >> a voice so distinct and recognizable emma knitting from a man that ca necked with fans throughout his career that took him from hawaii to houston to philadelphia. >> harry always had time to sign an you to graph, he always had time to take a picture with a fan. fans could would come up and hand him his cell phone and ask if he would record his outgoing message. >> you have reached kathy and kevin and they are not in writing now. >> it is out of here! >> it is a voice that provided the sound track for nfl films

for 34 years. >> whatever we asked for harry delivered and he did it on the spot, he would would hand him the script and we expected perfection and got it. >> we got the ball back in 57 seconds, a chance for both teams. >> upon the news of his passing, fans in philadelphia create add make-shift memorial outside of citizen's park with candles pile out. the phillies flag flew at half-staff. >> i literally grew up only listening and knowing the voice of harry callus for the phillies. >> the thing about it is that he probably passed up in the booth the way -- being in the place that he would have loved. >> thankfully we have his voice to throw back in the vcr and listen to, he will be missed. he was a great person. >> less than a week later

thousands took part in a public meme for harry inside of citizens' bank park family and friends came out to pay their final respect to the philadelphia icon. for all of us i believe i can look up and say harry, thank you for entering all of our lives and making them better and our prayers are that god's love and grace will you with you and your family forever. [applause] >> sanedoff so grand it had only been done on the baseball diamond two other times. for babe ruth and for legendarychart broadcaster jack carr. >> i'm a phillies fan that is feeling a tremendous loss today. i got to know harry when he first started broadcasting phillies game in 1971 and i was a 9-year-old fan tuning in. that is when i met the voice.

>> the phillies organization is honoring his memory with patches on the uniforms over their hearts. a broadcast booth is now named in callus' honor ant 7th season stretch featuring a song that allows harry's voice and personality to take over. >> when you are done, look around. he had high hopes. >> so while the city of philadelphia and its baseball team and football fans across america may have lost the voice, they will never forget it and as the tribute continues on, the impact of harry callus, the broadcaster and the person will never subside. >> in a world away, two nfl players on a humanitarian mission literally save a little

girl's life. >> i couldn't believe what was happening. happening. >> you will hear the inspiring

happening. >> you will hear the inspiring in 1977, in johannesburg, south africa, an 8-year-old boy picked up the game of golf from his father. by the age of 9, he was already outplaying him. the odds of this gentle lad winning the junior world golf championships at the age of 14? 1 in 16 million. the odds of that same boy then making it to the u.s. and european pro-golf tours? 1 in 7 million. the odds of the "big easy" winning the open championship once and the u.s. open championship twice? 1 in 780 million. the odds of this professional golfer having a child diagnosed with autism?

1 in 150. ernie els encourages you to learn the signs of autism at autismspeaks.org. early diagnosis can make a lifetime of difference. >> and still to come on this year's best of net impact are you ready for some racing? >> all right. here we go. more laps. my man dillon berger, we will go behind the wheel to show racing fans what it is like to go 120 miles per hour. stay right this because net impact is coming right back. >> welcome back to the best of net impact 2009. >> you may remember our report on washington capital's alex

ovenchin a player loaded with family and forks he has major endorsements and commercials and his own clothing line and that's just for starters. earlier we asked the hockey superstar if he is overwhelmed by all of his success. >> in washington it is a pretty cool thing. you go in a shop or you buy some stuff and shopping and people just say hey alex, good game last night, critical game. it is very fun. >> one more interesting thing, this tough guy on the ice actually admit that had he cries at movies. well, actually, so do i. go figure. finally, let's have some fun, some fast fun, some of the best work happened this year when our reporters got right in the middle of the action in this case, speeding through the turn at 120 miles per hour at the famous dover international speedway for chris miller it was time to start your engine to see if he could survive the notorious monster mile. >> chris miller and don knee knew birring here's dover international stairway, year two of the monster mile experience, got the fan experience and i'm going behind the wheel, time to go drive.

ten laps of fun, let's get it done. >> it's official, here is my pit pass and my name on it. if anything happens, put it in my meme mores. >> are now a semiprofessional race car driver. and maybe by the end of the day it will make you professional. >> it's that time. got to go put on my uniform and when i come back i will be a full fledged driver, i hope.

>> hey, buddy. thank you very much. >> make no mistake, if anything happens to me, you have to explain it to my wife. >> me and your wife have it worked out. >> is that why the insurance papers are out this morning? >> i'm moving right in. >> all right. here we go. more laps. my man don new berger. >> that was a tip, for us doing 120 miles per hour going into that first turn, you feel it. you feel it. and that was fun. that was fun. >> i can't wait to do it myself just to see what it will feel like being on the left side of it and being on the right side of it, that was a rush. that was a rush, man.

that was a rush. wow! >> all right, man. let's do this. >> it will be all right. it will be all right. >> we are ready. i am ready. all of the teachings that don gave me for the past year-and-a-half i get to a my it and go around the monster mile, they don't call it that for a

reason. that's it. let's go race. [ revving ] >> donnie, how did i do? >> what do you think hot rod. >> that was awesome. >> you look good. >> turns all right. >> not bad, for a rookie you did a great job. >> the hat man, call the hat man. >> all right. >> this is one of the toughest tracks, called the monster mile for a reason and it is a track you have to drive, you did all right for your first time out. >> we appreciate it. >> i don't know if you are my >> i don't know if you are my backup yet but

>> i don't know if you are my backup yet but in 1977, in johannesburg, south africa, an 8-year-old boy picked up the game of golf from his father. by the age of 9, he was already outplaying him. the odds of this gentle lad winning the junior world golf championships at the age of 14? 1 in 16 million. the odds of that same boy then making it to the u.s. and european pro-golf tours? 1 in 7 million. the odds of the "big easy" winning the open championship once and the u.s. open championship twice? 1 in 780 million. the odds of this professional golfer having a child diagnosed with autism? 1 in 150. ernie els encourages you to learn the signs of autism

at autismspeaks.org. early diagnosis can make a lifetime of difference.

hutu 'tis if you look at where most of the health care dollars though it goes into the pockets of people who are providing health care and that is really the question because until that is stripped out of the system how you really-- and can it be done? >> do you want to go for that? >> i was going to talk about mandates that come and go ahead. >> it seems that it has been said that the most expensive piece of equipment is the pen and the doctor's hand and i think that is completely right. not long ago one of my patients, i was out of town and one of my patients developed chest pain. a completely healthy young woman

develops chest pain. she is an unusual patient. she has real insurance and she still comes to see me. so she goes to the hospital and she goes and sees one of my colleagues to appropriately center to the emergency room to make sure she is not having a heart attack, as unlikely as that is then expecting she would just get a blood test and then ekg to let them know what was going on. she did not give a blood test and in ekg. she was rushed to the cardiac cath lab because she has solid gold insurance. it is a perverse incentive. no one is going to criticize a cardiologists for being concerned that this young woman could be having a heart attack. to be fair, she did have an ekg change but it was probably not significant. i knew it wasn't significant and i was 3,000 miles away. so, these are the decisions that are made and you can't really fault the doctor. it would be better if he weren't

making money off of the decisions that he made that we can't fault him because we have a system that says more care is better. let me just say this woman could not walk for several weeks because of where they put the catheter to go up to earnhardt's of these are very serious procedures. people die from them. she didn't come up for julie. she was just crippled for a couple of weeks but these are the kinds of decisions that add up. is there is the whole layer for administration but they are also ugly incentives that drive the way health care as provided. >> let me make a follow-up point on this which is that one of the real big problems facing politically is that the insurers are not the problem. they are just the only fillon we can attack. did you ever see a kid get angry at something he could not solve so he kicks the dog? they are the most malign actors and the system by far, and more

to the point everybody can imagine, people like doctors, who is very like a ballistic intel, hospitals they don't want to bleed on the floor. drugs you may not like the guys to make and let me need drugs. insurance, we don't need insurers but by the same token there not that important. the profit margin is three to 5%. you could strip the out of that system and we would be right back where we were in cost within one year was 7% rose. they just don't do that much and we are going right is not in going after them is fine and i think we should do it but it ain't going to get you where you need to be on cost control because fundamentally the people making the money are not in church. it is drug companies, doctors hospitals and we want the doctors to make money. we like it when they treat us and that is when they make their money. >> but why should we kick the dog then? >> insurers to a lot of bad things. it happens to be a secondary

problem. and to finish-- >> we will have time for questions. >> it is not that we shouldn't go after insurers. it is our inability to go after providers means we simply have not been able to get the big drivers of cost. we have just been able to give up the secondary one. >> sir, you can ask your questions when it is time to west questions from the ad is. >> at want to add a point because this has been one of the myths of this whole debate. it has been very easy to demonize insurance companies, and because insurance companies deny care, we know that sometimes-- we know that sometimes-- sorry. >> just take it from the top. >> i agree with ezra. what does happen in this debate is we have tended to demonize insurance companies because after all insurance companies to

deny claims but i think it's fair to point out they often do that because the employer policies that govern what you get, they may not necessarily require them to cover certain kinds of procedures so it is really the employers here, not the insurance companies. but i want to pass along something i learned very early on and i've spent a good part of my career covering in the 90's when managed care was supposed to be the cost saver of the u.s. sells system and i interviewed an hmo executive in california and he said to me you have to remember one thing, in america the medicine man sits at the right hand of the gotten may believe doctors of the medicine men. there has been an unwillingness i think in this debate to sort of look at what really are the cost drivers in the system and those are providers of care and the technology. it is not necessarily insurance companies.

>> you know what it is going to be, so do we need to ration care shannon-- >> are we all going to say the exact same thing? >> of course we are. >> there are different pieces to the answer. >> so, care is already ration. it is rationed every day. it is ration stupidly and badly and in effectively but it is rationed but based on money. >> based on who has insurance. the other piece of it is that if rationing is taking away something that would benefit you, it would make you live longer, it would make d.b. pain free etc we are $800 billion away from needing to ration care because that is how much there is in the system of unnecessary care. we have so much money in our

health care system, there is plenty of money to cover everybody and give everybody care that they really need that would really help them, but what we need to do is what trudi calls rationalizing care. there is an enormous amount of stock that is just given that isn't helping patients like the catheterization for young woman who was almost certainly not having a heart attack. so i think we are a long ways away from even needing to talk about rationing. >> it is more demonizing the way that reimbursement rates are set and if you look at how hospitals make their money, certain procedures get a lot more money then certain other non-procedures and so it is not so much effective in looking at insurance companies profits i don't think is the right thing to let get. i think you have to look at where does the money go throughout the entire system because certain procedures are

rewarded much more than non-procedures. i think this pandemic. >> but that is very political, so one of the things that gets reimbursed well is doing a pet scan to see if a person has alzheimer's and the way that he got paid for is that the people who have a financial interest in pet scans, in the machines and the agents that you have to give to patients when they have a pet scan lobby congress and got congress to push medicare to pay for pet scans for people who might have alzheimer's. the thing is this that there is a perfectly good way to do this which is a neurological tests, a paper and pencil test. in fact the pet scan is hugely expensive. it has a 25%, one in four people be told they have alzheimer's when they don't, which would kind of be a bummer, so it is very political and then what

happens is once medicare pays for something the private insurers do it so once again the providers, the manufacturers, the providers lobby congress and we have this sort of squirly way of reimbursing for things. >> there is not even a treatment for alzheimer's. >> that is right, so who cares? >> a couple of pills. >> to add insult to injury we are probably spending twice as much for the same machine that other countries are. the most cost-conscious purchasers in hospitals and america are paying much more than anybody would pay for the same machine. >> to just make a synthesist point here, if the panel is trying to sell you something it is the even the things you think are wrong with the american health care system are also wrong with the american health care system. >> the other way to put it is the things that most americans are afraid are going to happen

to them are already happening. >> honestly, you could not do it by design. you are not that smart to make it by design. you would not have the talent, he would not have the foresight, you would not have the vision. it is an absolute monster and the fact that we are so afraid it's changing status quo, honestly it is a behavior by as. does nothing to do to the relative merits of the status quo. it is an absolutely insane situation. and we have not gotten into cost effectiveness. this will mammogram thing that came out had nothing to do with cost incidently. we got into the question of all the things we could be spending our money on that are tessa believe in beyond where things are actually actively hurting us making trade-offs and everybody is terrified to talk about that.

>> synthesis point. is massachusetts the answer? massachusetts health care reform, which i have heard some people say is probably going to be the shape of the current bill when it passes. maybe you can tell as or if it is true, the kind of bill that will end up looking like massachusetts. >> there is a layer that people know about pretty much which is a basic tranche-- concerns change and then there's the delivery system side arguably which is more important. mass is a basic shape of what we are doing on coverage. massachusetts itself would tell you we are not the answer and the reason is this. you often get them in the conversation and people say whether caused her still going up. that is a bit like yelling at the fireman because he is not very good at making breakfast. they did not try to do cost-control mass. they tried to do coverage and the one really good thing and the interesting lesson is when you do coverage the political

incentive to do cost. massachusetts right now because that they don't do cost will have to essentially dismantle the system there protivin covers everybody in the state. they are going after cost in the way they have a bit four actually targeting what shannon would want you to target which is fee-for-service medicine but without the political incentive to do so without having something the government actually has to make a decision a there we are going to tell people were throwing them off of insurance wartell bravadas we are changing the way they get paid. nobody makes that decision. ride bone ashley we have the pies because the don't have to do anything to let 2 million people become uninsured. congress has not signed the act into law but for her providers they descended into lauper could you change the system such that they have to make the decision between it and it will often said but people but first you have to make it so they have to choose a site. >> we have been covering the massachusetts health plan on cj are dog barked for most of this year so we know quite a lot

about how the laws really working there, and i think our conclusion is that massachusetts may be a model but it is also the canary in the coal mine. there are a lot of things that are going on up there that are not really well-known because the media has chosen not to talk about them and of course politicians who are using massachusetts as the moral without the public plan i should add, it don't really want to talk about it in the press tends to follow wit, the politicians and advocacy groups. so what we have been there, and this is something i think people ought to know about, is affordability is becoming a real issue in massachusetts. yes people are covered. it is about 95% of the population now. the numbers dropping a bit we know from the latest census numbers but what is happening is that people are mandated to buy insurance as they will be under whatever comes out of congress, and some of them, many of them are choosing to take the penalty

which is still fairly low, instead of buying expensive insurance. massachusetts has the most expensive health care in the country and it doesn't seem to be getting any cheaper and there's still no agreement about these bundled payments and other things that they are thinking about doing up there. so, what i found my reporting is that people are just simply not able to find policies even to this great big exchange called the connector, the shopping service at the well, and older people are particularly in trouble. that is because in massachusetts, insurance companies have to take everybody even if they are on death's door but they can charge older people twice as much as they charge the younger person so that means a 55-year-old this going to pay two times more than the 35-year-old. so what we are starting to see up there is that price differential can be several hundred dollars for the same policy in the same location, and

i think that we could see exactly the same thing happening nationally were right now insurers will be able to charge an older person three times more than a younger person. >> so, before we take questions, which we will have lots of, one more quick run to the panel. what are you most hopeful love in the bill and its current form? >> that it passes. >> that it passes, that something passes because i agree with ezra that, when we have coverage, webelo then start i hope to have the political will to do something about the delivery system side. it is really important to understand what is being debated right now. we are not talking about health care reform. health care reform is out care is delivered and that is the

part-- i mean believe it or not after all the debt panels, people bringing guns to the community forums and all of the arguing that has been going on, they are really hard part is ahead and that is changing the way that car is-- care is being delivered. getting care to be rationalized, have evidence behind it. to have it be the right care for the right patient at the right time as some people like to say, that is going to be the hard part so i just want this part to get done so we can get to the stuff that is going to be really, really important. >> really what we have now is a system that is in big city hospitals. eight is maxed out so now you are going to bring in a whole new crew of people into the system. that was one of the things they saw in massachusetts ride out the that, nobody could get a doctor's appointment so i think that is right, there's going to be some kind of markup force

that will actually work for good because the overcrowding is going to be who genned rationing is going to be happening because he cannot get an appointment to see a doctor. >> i am a little worried about getting this bill to the senate but i am tremendously excited by the prospect that we are closer than we have ever been to giving americans what citizens of every other developed country take for granted and that is access to medical care, so i think we are on the cusp of something truly historic. i just hope we have the political will to push it through the senate. >> i agree. i think that we need, i am back where i started. something is better than nothing. right now we have the were system in the world. how could we possibly make it worse by just covering more people? yes it is going to be harder to get doctors and you know that is not going to get better anytime soon because somebody told me or

said ten years ago that the way primary care is going only fools and saints will become primary care providers, so once you have insurance you will still have nothing but fools and saints like me. i don't know which one i am. it depends on the day of the week. to take care of you because it wants to go into primary care? you are only paid to do things, not to think of that is the problem i think we all look forward to having is, having so many people ensure that but don't have enough doctors to provide the care. >> work. it is a young people's turn-- term. >> what is the word? >> work. >> as in the word? >> okay. i think that there will be some improvements with this bill. certainly with the expansion of medicative will bring more

people into the safety net. certainly some people will be able to go to what doctors do exist and will treat them until we can solve this primary care problem and that is a positive thing. but i think until we really come to grips with the cost issue and how we pay for medical care and all this stuff we are talking about, the insurance that we are going to provide to people could be in jeopardy down the road. >> argue ready for questions from the audience? i'm going to ask you to please ask a question. short into the point. >> i would like to note also that if you would wait until i give you the mic and ask your question into the microphone. >> for prosperity. yes? >> i think my question is for shannon, yes. you said that there is $800 billion of unnecessary care in the system.

how is that number calculative? >> it is calculated in a number of ways and the number of groups that come up with essentially the same number but one of the primary ways is that you look at how similar patients are cared for around the country and we see enormous variation so for example if you have a heart attack in say boston, you would cost medicare $30,000 over the course of a year. that same heart attack in portland oregon would cost medicare about $23,000 a year and the difference, that's 7,000-dollar difference is lots more stuff happening to you in boston. but no better outcomes and in fact there is evidence to suggest that you have worked out comes in places where you get more care so that is one of the primary cares that-- aways that those numbers are calculated. if you just go talk to docks and not all hospital administrators but some, they will tell you

there's a tremendous amount of waste in the system and they are all sorts of reasons for it and everyone has their own reason for why it happens, but the waste is there and it endangers patients. >> the questions are all on this side. yes. >> why is our capital society got into so much worse than the european cabalistic societies? is there any way we can trace it back? i know about other types in our system but i can understand this, how bad it has gotten. >> the answer is the united states senate and in particular the filibuster. it is pretty simple. the other systems, if you like me to do this i'm going to do this thing and in their system that is how that works. the parliament comes in with them, their bill gets passed then everyone has a socialized health care system. in our system we say, they get

elected in filibusters and people say were you doing anything and then they move on. it is almost literally as simple as that. you can find a lot of reasons but a great paper deacons surgeon bender these terms on google called it is institutions do. people like to say america is a conservative society but we like our medicare, we like our social security. we don't appear to have differences of opinions toward social programs what they are enacted. what we have is a very conservative status quo political system where we can enact anything and people generally have a status quo bias. >> yeah, the systems in other countries, there is a big cultural difference between the u.s. and european countries and canada and that is called the principle of solidarity. in the other countries in this principle grows out of their history as opposed to what we have in this country which is quite a different history, and

that means that everybody in society shares together and they really do this in terms of their health care system. there is a cross subsidization that flows in the german system, the francis demand japanese system and so on and that is the young subsidize the old. the rich subsidize the poor and the rich subsidize the poor-- what was the other one? they will subsidize the sick. so these cross-subsidies are flowing in this principle of solidarity is so ingrained in those countries and they will tell you-- i had a-- had the head of a pharmaceutical group in germany tell me once nothing comes in our principal solidarity. i said not even the profits of the drug companies? he said not even the profits of the drug company. in this company-- country we don't have the principle of health care. we do sort of the medicare and sort of an social security. but when it comes health care it

is a very different dynamic, so what we are creating here if the bill passes is a system of more people getting private insurance in these very insurance companies a lot of people of spent most of the year demonizing, it is not a national health-insurance program but these cross-subsidies and the principle of solidarity. >> the lady in the blues' garv. >> hi, i have heard about, i have been reading about it a little bit and it seems like the obama administration and also the finance committee and the senate have made a number of deals with pharmaceutical companies, hospital lobby groups and whatever deal, they have even backtracked on those, and with a mandate, profits are only going to increase by hospitals and drug companies. how is there going to be-- you

will see positive that its some point we are going to address cost but even now when they have less power and less money, they are not doing their part. they are not actually willing, even though they are getting a lot in return with this bill. >> the question is how can we be sure of the bill passes that drug companies will then turn around and try to control costs? >> i have heard about taxes. idoni vinn remember the details now. exactly, all of those different things and basically they have been rolling them back with each version that has gone through, and all of these groups are basically-- any way-- >> the first outcome for this country is an incredibly intense fiscal crisis triggered by an impending bankruptcy which causes the interest rates to skyrocket indeed their government to collapse or

alternative health care system. the second order most likely outcome is we actually to cost control and a couple of years. the reason i slightly disagreed with trudi earlier, but there are four things you could seriously argue are the beginnings of brokaw's control. the thing about them is that they are all backward-- backloaded. the excise tax is the insurance plans particularly high crop insurance plan so if you get a plan that is $23,000 or more for your family every dollar over $23,000 gets a 40% tax on it in what you are basically doing is taxing the growth of health care insurance in order to force people to choose cheaper plans. economists very generally believe that it will work. the thing about it right now it only affects plans that are pretty far out of reach. i would gather to say a few people in this room have plant the cost as much money but it doesn't grow that quickly, that number. ten years from now a lot of us will the plans that are bumping

up against that and it's going to push us into what essentially are managed care. that is one way you actually control costs. there's this big medpac commission that is a continual reform of medicare attached to a very, to spending targets for kobett is another thing you have there but what you are saying is right. what we have followed here is the strategy of interest group neutralization. none of them are attacking this. they may not love it, they may not hated but they are not attacking it. their quiet and that is because we bought them off. revengefully they will have to figure out how to do something that will make it-- make tempore for reason insurance companies useless because maybe they can do the popularly but as they said the first most likely scenario, the fiscal crisis 10 or 15 years from now. >> i think there are a couple of other things in the bill that are sort of stealth cost control methods and the aller done through medicare because medicare is the elephant on the

block. even though every hospital complains that they don't make enough money off what medicare pays and the and they get most of their money from medicare, so if medicare changes the way it pays, hospital set up and listen and hospitals are where the money is. so medicare i think has an opportunity to really change the way it is paying if we have a brave secretary of health and human services, we have a brave director of medicare and medicaid and they just start pushing this stuff through. but that has been kind of under the radar. it hasn't really been talked about a lot because it is the other side of health care reform. we have been talking about the covered side. >> also i think a certain amount of this reform has already been going on in places all over on the country. i don't know if any of you were talking earlier about the article in "the new york times" last week about the doctor in utah. just systematizing procedures

saying we are not going to do something to in different ways. there's one way to do it that within the medical profession there is a way of just systematizing-- i don't know if that is the word but making more systematic procedures and that ultimately lower cost because to get better outcomes, you get more patience of the system because they have gotten through faster and the secret thing that is going on not in congress but in hospitals and doctors' offices around the country and even in the hospital i was looking at from floor to floor you could see a well managed for four things were happening and i think the real change is ultimately going to come from the ground up, not from washington but from the top down and i think that is where it is imperative on all of us to start becoming educated about things and start making demands and start actually being better patients. i don't mean being somebody saying i saw this drug advertise on tv and i want it but actually taking care of ourselves and

having real conversations with their doctors and talking to them and they think that these changes can't happen-- can happen but it is going to happen from both up and down and i think we are focusing only on up. it is going to happen in the dot of different ways. >> one quick point on the article she mentioned. they talk about intermountain healthcare's new topic of a had a great point in there. they did this thing and i can remember the exact procedure but say it was the cats can. they found a new protocol anthon that we should do 30% fewer cat scans. they found a way to do this, great. what happens next is into matt utah this fewer cat scans and loses $400,000. it is like trying to get best buy to decide themselves to stop selling new so many expensive televisions. i mean those are there incentives and that is a big part of this.

>> this duty is a gentleman in the front row. is this a related question? >> it is. my comment is on this idea that i think you just touched on witches wouldn't it be logically that we would ask professional committees of doctors in all of the different fields to say give us the best results with 25% less cost over the next 20 years and they would then reorients the guidelines and we would achieve those results and they would be the best decision-makers but that is not really part of any of the options i hear. are there any comments on that kind of an idea? [inaudible] >> it wouldn't even have to be legislation because we have medical guidelines for how to get care but that they were given the suggestion that we need to spend 25% less and still get better results those guidelines could be drawn up by experts. >> just this week we had the

science come out and demonstrate that mammography for women between 40 and 50 may cause more harm than good. and there's this tremendous backlash from patients and from doctors who are just accustomed to doing this. this has been the standard practice patterns. they believe it is helping their patients eatonville the signs is not there. it is just one of many examples of how difficult it is going to be to change the practice patterns of providers to conform to what is medically proven to be beneficial and there are others here, especially our expert here trudy can talk more articulate glee about this point. >> i have a question for the audience. how many people think that most of what their physicians prescribe, suggests that they do, recommended to is backed up by a really good science?

i know it is a trick question. how many people think it is close to 75%? how many think it is close to 50%? so there is a real mix in the hands. about 50% of what positions do has really good evidence to back it up and the rest of it is tradition, sometimes it is marketing from drug companies, from device makers. there are any number of reasons that things are done but they are not always backed up by a really good science and part of the reason is that we have been leaving the job of paying for that kind of research to the drug industry. they pay for 80% of clinical trials which is a really critical trial to find out what works and what doesn't work. so one of the things that we have to do is to start actually paying for the signs that needs to be done so that we know, and so that doctors have the information they need to help

their patients make good decisions. i am not criticizing doctors at all. >> i think the doctors do they best they can, but nobody has today, one of our residents want to prescribe nexium, a very nice drug but extremely expensive and there are other generic forms that are cheaper. i have asked, why did you picked-- choose salamon? i don't know, i always use it. there's no evidence to show that one is better than another or worse than another. i assume that they'll work the same but we don't even know that because nobody pays for that kind of research because that means if you said that that head to head steady and you lose, then you know, if you were people will buy your drug so why pay for that? there is a lot of data that we wish we had.

>> i am actually in the administration in the area, and so a lot of these things, i see it from the inside, so my question is, why do you think that health care is so resistant to change? everything from electronic medical records, i mean things like bark coating that we have been grocery stores the but we don't have in hospitals that cause so much damage and just so much suffering. why are we so resistant to change? how much of it is political? how much of it is individual behavioral, physicians, changing

patterns in what you feel we can do about it? i feel there are some ideas, things like quality metrics, you know, performance improvement, performance, paper performance type of things and things, ideas on the table, but why are we so resistant then why can't we raise these things? >> one thing, if you are a big hospital system, and we talk about health care again as this uniform body but within any hospital they are so many different constituencies one of which doesn't talk to the other, so everybody has got a different agenda and a different need. usaid the electronic medical record and we are talking about hospital profits but a lot of big city hospitals, and we are not talking about public hospitals, the voluntary hospitals the money doesn't necessarily going to things like

electronic medical records. those things would not be reimbursed so again we go back to the whole system paying for certain things and not paying for others and the other thing is it is chaos. you walk into any hospital and even something as simple as following the patient through the system, you look at the average pace in charge after they been in the hospital for a week, it is like moby dick. not the edited. and you'll have everybody on different schedules. the residents are owned one schedule and the nurses are three days a week. physicians come and go. sometimes usoa haass bill's. what you have is there is no unified body to put these things into place which is exactly what you need when you would really need in any hospital system would be people going through, ergonomics that the experts going through mansingh this is what we need to happen because everybody is on a treadmill.

nobody is and they are just pulling money. even the very wealthy doctors making millions dollars and a year working very hard but there's nobody stepping back in making these kinds of changes that need to be made. and there's nobody paying for them and that is why they are not being-- >> weep pay for more care, not better care. >> what would we need for the health care reform as opposed to health insurance reform at the political level? yes. it is my lack of epithet, avoiding creative powers. >> i asked the number of my doctor friends about this whole issue about payment reform and reading the studies about all the waste in the system and as someone who has been a consumer, it does not surprise me at all,

but, and i've read the story about intermountain in the times last week in and i read about isen berry and the hospital in rochester, minnesota. they all have a stack of salary doctors. they are all integrated systems. most of health care in america is not like that. you are talking about small groups of doctors having affiliations with a couple of hospitals in the region. it is all very kind of freeform. how do you transform the concept of paying for value? i understand how you actually get there. given that the system is not like intermountain or eisin barry. >> geisinger being a system a little bit like mayo clinic. these are called integrative group practices, organized group

practice, salary group practice, the idea of being a group of physicians were under one financial umbrella and they are salaried. every state in the country has at least one. states that have more of them have lower health care costs. they are clearly superior systems in many, many ways. they may not be the only way to do things that they are better systems and right now we don't pay them any better than we pay chaotic care at some hospitals where it is crazy and if anybody has spent any time in a hospital, as julie has, as lisa has and as i have and as any of us to report on health care, it is chaos out there. so these organized systems, i'd like to say do it better for less so we need to start rewarding those systems little bit more. maybe they can expand in the need to find ways to pay other systems to try to get them to emulate those systems. one of the things that is

happening right now politically is that some of the very big academic medical centers, you have all read their names in u.s. news report and are supposedly america's best hospitals, don't like this idea because they know they are going to get less money unless they change the way they practice. they don't like the prospect of having to get less money, so this is one of the sort of fights that is going to go on, that these chaotic and less efficient, less effective places are going to have to change and one of the ways to get them to change is to start paying them-- >> i want to point out, and i agree with that but i want to point out the systems we are holding up as paragons of virtue also played the same game that regular systems with fee-for-service doctors to end that is the marketing costs. the money that is expended by the systems, working with the

media, using the media to try to get patients in because they have financial imperatives. they have high paying patients, that is patients with insurance of their playing the same kind of games. i think we are really talking about something that has to be a total fundamental change in this system because you just can't say we are going to make everybody look like geisinger. that is not going to happen. >> where you would normally say in the market where something is working much better than other things, some things are working will come to dominate the market and that will happen through pricing. they will suddenly go to guys in there and nobody will go to whatever. the questioning of to ask is why the profit signals not working because profit often works at one consumer electronics store as terrible prices and never has what you want and yet there does, then the other loses out.

the fundamental fact here is health care is entirely screwed up in the way we pay for it. it is a giant shell game in the trick is on you so most of it is paid for through your employer. your employer does not pay for it that we talk about it like they do. there is arguably newmyer prada-- problematic for than calling health care benefits a bet that. it is it which detection and it doesn't come out of current wages. every year your health care costs go up in every year that raise does not. in the 90's were health care costs were restrained, medium wages went up 11%. they fill in when health care costs went back up again they fell again. but you don't know that. think about it, if you fell 27% of the heat when he touched they still view would not be as careful when you touch is still one that is fundamentally what is going on. there is the one with a good incentive to control costs. you think you are getting a good deal in the hospitals are making

money so the steps in the errants as we have to make some hard decisions? >> who wants to answer about who take steps to make our decisions? >> it is not his job. >> there are lots of questions. >> it sounds like the conclusion that we want to take to another level of destruction is that the panel is coming to or that is leading me to i guess i should say is that it doesn't sound like health care is delivered not optimally through a market-based system. there are problems with the incentives for at all levels, and it sort of creates a situation where no one is accountable at the end of the day to try and, to try and reform the system so my question is, is meaningful reform

possible? i mean everybody started out with an optimistic view but as we have gone a long i am getting extremely pessimistic about the possibilities of reform and keeping in mind that it is a long-term game in something that might and far, far in the future but is meaningful reform possible in the way be are going about it or is this fundamental reform of the entire system that we are pointing to, is that in the cards in the future? >> i may miss "this but i think it was mark twain his said america will always eventually do the right thing but only after exhausting all the alternatives. [laughter] i think that is what we have got here but i do think, we are sort of doomed to have this incremental approach to health care reform. we are not single-payer or some of the more sweeping reforms.

they just haven't been on the table and won't be in the foreseeable future but i do think that this public option, which is in both the house and senate version, can grow and we can eventually get to a place where a public medicare like plan begins to dominate the health care system. we are a long way from that but i do think that is a possibility in the future, to rationalize the system. >> other people want to add to that? >> yeah i just want to add one thing about the public plan because it is not well understand it may very well growth if it gets a foothold this time. right now the public plan is rather limited in who can use it and the cbo said that the house bill would only have about 6 million people in it and i guess the senate bill was three

to 4 million people, so not a lot of people are going to be able to use it and there is a lot of feeling that people can use it the prices of the choice premiums are going to be pretty high because it is likely to attract a lot of sick people and we are going to have a deteriorating risk pool right off the bat. so i think that if it does succeed it is going to take a long time before it gets as to the medicare for all approach that a lot of people would like to see. >> i think we are going to pause slightly before we go on to say goodnight to c-span, and american from new york, so maybe a brief round of applause for the panelist before we continue our questions. [applause] >> mcnally jackson books in new york city hosted this event go for more information visit

mcnally jackson.com. >> pollitz surprise winner neil sheehan author of the book a bright shining line has a new book out, "a fiery peace in a cold war." bernard schriever and the ultimate weapon. what is an icbm? >> and icbm as a rocket that with the hydrogen bomb in its warhead that is fired into space and travels through space at 16,000 miles an hour for 67,000 miles an hour and then it would come down. there's no way to stop it. >> they have never been used. the whole point, you and i would probably be not having this conversation if it wasn't for these people. they built this weapon not to have war with but this bernard schriever and the ultimate weapon would say this the first weapon humankind which is to deter war. >> i want to start with what and icbm was because i think it

tells the story of bernard schieber in the scientist who helped create for goody wanted tell me a little bit about bernard schriever? >> he was six years old money came to germany when his mother brought him here. to months before we declared war in germany. he got into the army air corps and was a protege of hap arnold who was the founder of the u.s. air force in world war ii. then with the scientific, bringing science into the air force, he who lies that an saab that this weaponed would guarantee peace because if we had it, we could deter the russians from doing anything that would trigger a nuclear war and then we ended up, he ended up creating a nuclear still might-- stalemate, mutual assured destruction. in other words neither side could get a surprise attack on the other because they would

destroy themselves in the same process. >> in the book you talk about the resistance that mr. shreve mer and his team had putting this together. can you talk a little bit about that resistance? >> sure, this is a book not about hardware but about people. there was tremendous resistance from curtis lemay who was the head of the strategic air command, the great bomber leader from world war ii who became, when over the edge in his later years and became the model for the general in kubrick's dr. strangelove, and jack the ripper was the general's name, so schriever in the people who worked with him were under tremendous resistance from the bomber people and they had to overcome it and they did. they got to eisenhower and eisenhower understood what they tried to do. jit be signed off on september 13th and had his heart

attack ten days later. >> how long have you been researching this book? >> i worked on the book for 14 years altogether but ten in ten said years. i did 52 interviews with schriever and another 120 people. everybody was alive who worked with him, chasing the grim reaper because these were old men and i had to catch them before the grim reaper did. they all cooperated with me. he gave me all of his papers, which, in his diary, all of which were terribly valuable but this is not come in this book is written not as an academic history. it is written as a fast-paced narrative and novelistic form because i believe in recreating history for the reader, bringing the reader into history and that is what i do here. >> 15 years of research is a long time. did your views on the cold war change any point during that

time? >> yes, because we all think of the cold war is one long icesave jenai discovered through writing this book that it was not. in the beginning it was a period that was overlooked which was one of the reasons i wanted to write this book. in the beginning of the cold war it was the very warm confrontation between the soviet union and the united states with both sides jockeying for power. if either side with made a misstep on that side do with it had nuclear war. these weapons don't just destroy cities. they create ecological effects. they blocked out the sun, you get nuclear winter. it would destroy the whole northern hemisphere in a war between the two sides and schriever and company prevented that from happening. >> are there bernard schriever's in the military right now. >> i would hope so. i don't know who they are but i would hope so.

this man is within the air force and he became the father of the modern height technological lehr force. the book is not about technology. it is about people. when he died, there are ten four-star generals in the u.s. air force, nine of them marched behind his coffin. the chief of staff of the times said we are not going to bury him as a four-star general, we are going to bury him as chief of staff. it was quite a moving occasion. >> the author is neil sheehan. the book is "a fiery peace in a cold war". thank you. >> thank you.

michael gordin, history and science professor princeton university recounts the soviet union's first atomic test bomb, first lightning that that needed on august 29, 1949. everett books imprints in new jersey hoes the hour-long event. [applause] >> thank you angela, thank you all for coming out this afternoon to hear about "red cloud at dawn" truman, stalin, and the end of the atomic monopoly.

red cloud at dawn is in international history of the nuclear intelligence during the atomic monopoly in the want to start by breaking down what that means part of the atomic and monopolies the pig from august 1945 to august 1949 when only the united states had atomic bombs and the power to deliver them upon their enemies. it was the period bounded by explosions. the first explosion that released urge the monopoly is on august 6, 1945 with the destruction of the city of hiroshima. the second explosion takes place in kazakhstan barcode is the first soviet nuclear test in the ninth nuclear explosion on the earth's surface, the only one that happened outside of the american auspices. this book is not just a book about atomic bombs. the american desire to hold on to the monopoly of those weapons are the soviet desire to break the monopoly. is fundamentally a book about intelligence. what do i mean by that? intelligence is the dedicated

gathering of the information about an interpretation of information about international matters. this is a tricky business. since every time you are trying to find out something about some foreign power in order to make concrete decisions about policy you can be reasonably sure that that is trying to deny you the information you want so every time a party say the americans wants to reveal something about the atomic bomb to the soviet union at the same time that triggers automatically by the nature of international relations a set of questions and the soviet mines. the first is, is disinformation reliable? this that it would be is it complete? maybe this reliable but it is powerful. the third is why specifically this piece of information and not another one? the fourth one is why tell us thou? each of those questions starts a whole box of problems. the story here is also fundamental international. the soviet quest for a neutral--

only the united states had these weapons and it bears pointing out had them, had used them twice, and as a result every decision the soviets make about nuclear weapons is fundamentally couch chabron the fact that the americans have this monopoly and what they think the americans are going to do with it. at the same time during the monopoly in for a long time after almost every decision the americans made about atomic weapons or atomic power is by the fact that the soviets are trying to break that monopoly, so the story can only be told by putting them both side-by-side. given the fact that in the monopoly on the americans have these weapons. most of the policies and certainly most of the documents are americans of the book is roughly three-quarters american, one quarter soviet but it is not just a story of the americans and the soviets. it is about the interaction of both sides and help people perceive what people perceive ou