also, gavin newsom, the lieutenant governor talks about improving this relationship between citizens and government. ..

died from an infection that occurred in a hospital due to medical mistreatment. up next mr. goldhill, who is president and ceo of the game show network contends that his father's death was avoidable and questions how the health care system of wells over 200,000 similar deaths due to error. this is just over an hour will. >> hello, everybody. we are going to get started if you don't mind. thanks to all of you for coming

here today. i'm a senior fellow from the manhattan institute center for mathematical progress. and we are delighted to have david goldhill join us this afternoon to talk about his new book catastrophic care how american healthcare killed my father and how to fix it. what i think of to challenges of blind spots that conservatives have had on health care the first is that it tends to be liberals who criticize and critique our health care system largely because of the large on injured population and the reflexive intuitive response of conservatives have been to say the health care system is just fine. it's the best health care system in the world would. don't mess with it, don't change it. the second blind spot in general and in health care is that we tend to talk about policy, public policy philosophically or

with the charts and data and charts and the data are important. but a lot of times with the way the liberals have one argument is by talking about the single mother in oregon who doesn't have health insurance and what we need to do to help her or the child that is born with cystic fibrosis and how the child can't get health insurance. these are real challenges in the system and there are other challenges of people that are injured that have coverage set up in the way that we all think they should be who struggle with convoluted this and the expense and the mistakes that a rise in the health care system. with a reflection of those two things, the reflection of those two things is not surprising that it took a lifelong democrat, david goldhill, to write a cover story in the romantic about how the health care killed his father. health care didn't kill his father because david's father

was uninjured. david's father had insurance. he was on medicare. but because of the of responsiveness in the system that lead the american health care system to not be concerned about the patient first and foremost, david's father tragically died and i sure he will talk more about that in the remarks. what is in the kids bookies' he not only talks about the real people in our system who are affected, not just of the uninsured but every american in the health care system and how he sees it in a way that makes us understand how much better our system could be. but he critiques it from a free market point of view and appreciates there are so many things about the health care system that could be better precisely because it isn't in the market principles. one of the great cliches in the policy debate is that health care is different. health care is somehow immune

until wall of economics that affects every other aspect of how we live, and what david has done in his book is a great service in that regard in explaining why fact health care is much like other sectors of the economy. david grew up in new york outside of new york city in the nassau county is father was a psychiatrist. he went to harvard college and then got a master's at in my youth and became an investment banker doing mortgage finance at morgan stanley lehman brothers where he had a front-row seat which is something we might hear more of in the q&a. then he got involved in television and he is the ceo of the game show network who came in very late in life because of the strategy and the cover story in the land to magazine called health care killed his father and that turned into a book. it's an incredibly compelling book that i encourage all of you to buy and there are copies

outside. i'm also instructed to say the next season of american bible challenge in the game show network highest rated show is coming on in a few weeks we're giving them a plug to so please join me in welcoming david goldhill. [applause] >> thank you. i am sure that everyone here reads your blog. thank you for that and for the introduction today and everybody for coming. i am here because of what happened to my father. it's what got me interested in health care. some of you may know the story. my dad died of an infection that

he acquired at the hospital. it was a very painful. as you can imagine in a very difficult experience to go through. even worse for my sister who is an emergency room physician and watched helplessly about hospital acquired infections which i knew nothing about and i read about a statistic that many of you are familiar with that somewhere around 100,000 americans die every year of hospital infections somewhere around 100,000 people die of hospital in quite a defections and most of them are fairly easy preventable, not most of them that the doctors that design prada calls to prevent them have failed to convince hospitals to adopt them even though they were relatively low cost. i used to run a movie theater

chain among many of the jobs i felt incredibly short periods of time. when someone spells a soda on the floor we have a rule how quickly you have to mop it up. we didn't read about an industry where 100,000 people died and it wouldn't cost much, but they don't. and i think the combination of the grief i felt for losing my father and the sort of business man's curiosity however businessmen's are run made me wonder why do we give this industry a pass about so much. all of you in this room and it's one of the great things talking about health care have been patient or loved ones who are patients or there's roughly 310 million people in this country that have a story about health care that we should say or why don't we give the industry of pass? we would never accept this and a lot of us say well its health care.

fundamentally different. and what i want to talk about today is two things. one is what is fundamentally different the way that we've come to think of it is coming and i think it is blinding to the change in health care that has occurred since the first assumption that about our system and many other systems became conventional wisdom. unfortunately i think it's what we can do about it to begin to fix these problems. to me the answer to the question of why health care in the country is so expensive and so wasteful at the same time often unavailable to people who need it, so unsafe and deliver such a bad customer service that we don't even think of it as customer service is the punch line to a number i will tell but the punch line is because they can. to me it is the most fundamental

and important thing to understand about health care that nobody else trying to get your business can get away with it. they can't. they will take your business from them. that is not the case in health care to get in health care we felt the system has the most perverse incentives national more care over good care, more expensive care over less expensive care and less investment in the kind of things that tell your patient customers that you care about them which is ct and service and handling information and all of the other things we see. it's great in politics for the evil drug companies and insurers and the unions, but the problem is if you spend the time and health care what you find are people who are often so motivated they are almost saints. there are people who are devoting their whole lives to the care of others even evil

institutions you'll find lots of people that got into it and are still in it because they think they are helping others so you have a mix of systems i regard as catastrophic and people who seem to be motivated for great reasons by being there and to meet the bridge between understanding those is just the incentives in the system. the economic incentives for bad outcomes are so powerful that it over roms the efforts of the good intentioned people and not exactly a very catchy phrase, right? down with the incentives isn't going to get anyone elected to power, but i think it is the key to understanding how the system works. in health care we have decided we don't want to be a customer we want to have sarah gets be a customers of the private insurers in medicare, medicaid for cms they are the customer. and interestingly if you step back from the intricate debate about health care and ask

yourself how well the profit incentive works in health care it works perfectly. the health care providers perfectly meet the demand of the service gets that are different from ours and i want to talk about health. the biggest is reflected in the language. nobody or almost nobody, for deutsch become almost nobody talks about the health care prices. we talk of the cost. it's interesting in the political debate you always hear the word cost as if there is some independent thing going on or independent kryptonite that provides the health care and we only have so much of it that it is priced on unemployment. every cost as we all know is somebody's capital in yet in health care and think it is incredibly the binding. there is a cost-effective and if we can discover and pay as

little or close to, we have done well and a lot of health care policy is about discovering the cost as you can. in the book i joke about the cost of tom cruise. the cost of tom cruise is $20 million. he has just about as many molecules as any of us do. he actually has pretty much as much training as an actor as any of us do. but none of us have any problem if you are making a movie paying the cost of tom cruise because we sell far more than $20 million but that is his cost. tom cruise goes to work as a janitor. he doesn't get to say my cost is $20 million because his value isn't cut his price isn't, and in health care if you listen to how we try to regulate health care it is about discovering the cost as it is independent in the supply and demand, technology and all of the factors that set tom cruise's cost to $20 million

there's a lot of illusions on health care and probably the most important in health care is the tale of two went in. elizabeth warren are geared in some ways corruptly that a lot of people applied for loans, subprimal loans without understanding what cost them with the disclosure and that this is one of the things congress could correct and did try to correct. let me talk about a second woman her name is becky and she's a 23-year-old who started work for the company.

she expects to be really successful and she probably will be. she's an extraordinarily capable sales assistant promoted to seals woman. she's going to get to the top 1% of the income. she also thinks that she can never afford health care of her own. the system is such that even in the top 1% who is paying for the other 99 were but that's what she believes. of the cost increases by zero from now until she dies, becky will put $1.2 million in health care system. of the cost of health care increases at the rate at the affordable care act for the next ten years in other words it is successful she will put it at 1.9 million. if she has a spot working but

she provides insurance another half a million dollars. the two of them will put $2.5 million in health care system. they assume two separate things. she never gets rich that is entering the what is going to happen it would go the rest of her life or career and she never gets sick. the key element of the health care system is the showdown. becky things like paying for her insurance. i'm not. she is. if becky walked through tomorrow and said it years your health insurance back, give me my money that wouldn't happen to have the time it comes out of what we want to compensate and i know that is true for my company and i think most people now know it is true. you'd rather have them pay than to not pay that over time is coming out of what they were

willing to pay you. that is a big part of it punitive we all know about the medicare tax it's gone up significantly, right now 20 going up to 20% and 30% of the tax burden goes into subsidizing health care. 10% going to 15% of the tax burden was to finance medicaid. the point is when you add all of this out it is a flood of money. why does it matter? the reason that it matters as our health care system is so inefficient that the average person not only could afford their health care but would save an enormous amount of money if we transferred this back to them. we are not going to do it, but it enormously changes your perspective on what is happening. now a lot of you may be thinking what about those who can't afford it and don't have a job? somewhere around $850 million on subsidizing medicare and

medicaid. that's what we spent last year. you could give 100 million americans $8,500 a year with that money to feed a family of four, you give it to them every year of their life. so with that you could take the current system, the current spending, including everybody and have a complete direct system. we aren't going to do it but we could. that's how much money we spent. you have a problem with health care it is totally different than everything else. the consumer doesn't know anything. the doctors know everything and they can push the goods on them. it's the argument for having medicare or medicaid work on our behalf the problem is that article was written in 1963 before the trip adviser.

a lot of the asymmetry of information that was written about is no longer the case. in fact it is beyond the fact that we can exchange information on the internet. health care itself has become far more individual and far more about probably the and a lot less about being an auto mechanic and if you fix it you are done. very little full of health care is like that. you have these three or for treatment alternatives, and in fact every patient is encouraged to do this research that there is a bigger conceptual problem with what he wrote and it is the problem you know the joke about the guy is chased by a bear in the forest. one stops to take off his shoes and slid into slippers and his friend says you can't outrun of their bear in sneakers. he said i don't need to outrun the bear. i need to outrun you. the implication to which the argument has been is that because we are such terrible

customers of health care, insurers will be better have they been as effective as us? one of the perceptions about health care is it depends on consumers. but it doesn't. they said we demand lower prices. what's happened is someone woke up one day and said i know how i am going to make my billions. but no one does that in health care because we are not the consumer. they misunderstand saying we want consumer driven health care. we want consumer driven health care because consumers are idiots. we don't know anything about anything by the way. it's how irrational and how emotional just like he said was the case it doesn't matter. it was a group having people

chase us to buy their product, not that we are clever. the truth is the worst customers of health care that's what we think that we should have put this argument is discussed over and over again. the other assumption is that there are some object of amounts of health care needs and if you look at medicare and medicaid one of the ways they are unusual, anything that you need we will pay for. now, i am in favor of a similar policy and cable television. because here is what would happen. if the congress said we will pay for all of the television that you need we would convince you all need to watch 25 hours a day. what happened and we see it particularly in medicare utah

the industry we will pay for all of your customer needs the expand the definition of need and the interesting thing going back is when the customer has absolutely no scandal began at the moment of purchase, is more likely to say yes, not less likely. the concern is we as consumers are week if the doctor tells us to do something we will do it this system makes us more likely. the reason that medicare and medicaid has grown so much is that. it's entitlement cannot to the beneficiaries. that is what people think of it but the entitlement to providers to figured out ways. my mother is an extremely healthy woman who, in 52 so she is 52 plus, that's all i know, she's on medicare and she's healthy and works. she sees 12 or 13 doctors a year and they leave her depressed. my mother is a breast cancer

survivor, she got through it. when you look at the medical senior citizenship that medicare has caused, one could make the argument. i don't know how many of you are aware but there's a study last year had surgery in the year of their death it is completely shocking because surgery for an older person has far more health care costs, forget about my cost to anyone else there is greater risk. 1f3, one lf 590-year-old and everyone in health care knew how to read this. this is a system gone amok. 40% of people 75 and older are taking five or more prescription drugs. some of this may do good. i am not here to argue whether it does good or bad. that is and what i'm talking about. what i am talking about is as long as the system says whenever you need, we will pay for the

definition that we will expand, and unfortunately will expand without reference to the whole customer, the whole patient that expands more in reference to the industry and if you look at how we've gotten to 50% of the country it's best understood as the industrial policy. if you want everybody to nod in agreement at a conference of health care experts you will mention another piece of conventional wisdom that on its face we should have realized was observed and that is 70% of the health care in any given year are spent by the 10% of the population. everyone knows what that means. that is unusually intensive for just 10% of the people.

what about the other industries? if you look at health care as an expensive goods and service, that 70% is probably the least intensive use under 10% of us by 100 percent in any given year. under 10% have a wedding in any given year, under 10% of us are attending college in any given year. under 10% would apply refrigerator. i could go on forever. in fact may be to kill the rest of my time i should do that. but there's something very important about what i call the island thinking much as far as i know i started talking about health care no one has ever said wait a minute what makes health care unusual is in any given year 30% of the money or for those of us that like to think in dollars in year $800 billion.

i will take it even further. the key phrase is in any given year. when we started funding health care through insurance it was like a fire your house burns down and that is a financially tragic event. but in health care all of our houses are going to burn down. that is true. i hope i am not the one bringing this to people's attention, but a very large percentage of us in this room are going to be in that 10% for a few years of our lives. what makes health care different is that some small percentage of the population is in that 10% for much of their lives. but that is an argument for insuring that fact your house burns down is not an argument for insuring your furniture wearing out and the problem in health care is that everything we talk about is as if there is

just one way. there should be one way of paying for health care is we take the most extreme examples that will affect very few of us and we use it to cover the bulk of the economy as if we reduce the did restaurants according to the needs of those that are starving. one can argue we need to help those in the 10% for the many years in their lives, but that is different from saying that system should fund the $800 billion by the 30% or the other 90% every single year. and the assumptions that are fundamentally unquestionable. my dad's bill for the hospital killing him was $636,687, and my mother's share was $990, which she didn't pay. if you are in business you know it's an important we of communicating with your customer. this bill communicates you are lucky to be on medicare because none of the prices in the bill

bares resemblance to anything the was paid. it makes no sense whatsoever. to do so i said what they moved out of the hospital. what hospital equipment i know people there will let me do that got physicians to spend two hours a day with them, roughly one hour and 50 minutes more than the rest of the hospital in the dever around the clock nursing? reservists to top it off? said that would be priced assuming i didn't make a deal with the hotel at $150,000. to take them out of the hospital to recreate the experience that leaves $500,000 less. i'm not complaining that we only

had to pay $990. and i am pointing out that if you ever receive a health care bill or from your inter or medicare it's all fiction. fiction is great. i love fiction that the problem is people will say things like i had a friend that had an appendectomy and they charged him $10,000 which is in same if you have never actually had one but that is what the bill says. how could i have never afforded this without insurance? this is the we've i got to in the house and dollars lobbying around. this company paid $18,000 a year for his entrance, so if the had given that money to him his family would have run out of appendices well before they had run out of money. it affects the way we think about this. my aunt got a bill for something

like $400,000 the share was $100. that sounds pretty good except there is no for hundred thousand dollars and it is completely fiction it affects the way they think about the distance. it affects the we've resources are allocated. the medical examiner determined we cannot approve the hospital stay for the acute appendicitis with rapture. we don't have enough facts to show that it was medically necessary. this is the cost of insurance in the consumer driven system you don't do any work. they chase you. and then on consumer driven you are insane to get your money back and that is part of how it

works. it is a part of turning over being the customer to an intermediary. one of the answer is the political system has for dealing with this is let's reform the payment, let's get rid of the fee-for-service or change the rate that we pay people. it's always great in part because of the we the congressional budget office scoring works, and the interesting thing about the reforming payment is like so much and health care. it's the discussion now for the medicare problem. so much of health care is based on this enormous fallacy that the industry won't respond to be that everything will stay the same. the ronald reagan administration implemented the most important payment reform in the history of american health care which was to bundle payments for almost any inpatient hospital beds under what is called the prospective payment system so you have a diagnosis of they would pay per diagnosis and at

the time which is 1983, the bulk of the revenue in the health care system can from two things, physician services to pay for the doctors and the days spent in a hospital. let me tell you how successful this was, it's extraordinary. the number of days in the hospital per beneficiary has declined by 63%. the days spent in hospital total our medicare patient so even the population has almost doubled since then declined by 50%. the days per procedure in a hospital has declined by 50%. so whenever politicians talk about the payment reform to drive the change, could you imagine a greater change and basically cutting the core practice of the health care industry at that time and the patient services and have? succumb as we know the cost of health care declined by 50%.

i'm sorry. [laughter] i'm sorry. i get excited about the successful reform and i missed a couple of lines. [laughter] so if you cut the demand for some of product per day by 50%, per total, you must crush the prices. here's what actually happened. the average amount medicare reimburses per day in the hospital has grown by five times since 1983. a 60% decline in the number of patients, increase in the price. we should all be so lucky. i want to be in that business. now there's another statistic which is entirely sort of irrelevant, but fascinating. hospitals tell medicare with their costs are so that medicare can compare the price they pay for the hospital's cost. so in those 30 years that

medicare increased by five times, hospitals reported the costs had increased eight times. so the interesting thing is our demand collapsed in any industry that would have been devastating, right? medicare paid five times as more, but the hospitals say they are not only getting reimbursed 40% of their cost, down from 70%, and one of my most fun -- you have to stand outside to see this is that medicare incests the hospitals perform the medicare services at a loss and it has been growing you can see the number they show their gross margin number that loss has been growing over the last decade. since the medicare patient for the bulk of the hospital patients, nobody has ever ever asked why people were still building hospitals. because you would think if you lose money on every patient he would want to reduce the volume. there is a lot of that in health care.

right? there's a lot of things that say we've emineth, i get off the island and think in terms of the real world, you know, if the prices declined in half i probably wouldn't be increasing were being built in the factories. i want to spend one more moment on the prices because they are the circular system of the real economy and one of the things most misunderstood and it's but they drive the way the human beings receive service. one of the things that we assume is that we pay for health care. the question is how we pay for health care and one of the arguments i am making is how we pay drives the type of care that we are getting. at the centerpiece of the policy on health care is that medicare pays less for the service and medicare pays less of cost savings. it's almost impossible to compare these seven data i have actually 7-years-old on the

single service its for michigan at the time in michigan and the private insurance was just under $800 for an appendectomy to the surgery. medicare is bidding $676. medicaid is paying $335. sounds like a great deal. now to many of you have been in the cheeseburger markets. you can buy a cheeseburger at mcdonald's for 99 cents and go to the cheesecake factory, sit down and have a leisurely meal and by a cheeseburger for $11.95. you can go to the neighbor at the bistro and buy a burger for $32. if if you are in health care what you would say is there is cost shifting between mcdonald's and the bistro. here is my feeling we are seeing three different health care

systems perlo. the reason that medicare providers can sell their services at a loss is because they do make it, the package. it's one of the reasons they are getting more care as they are healthier and healthier as you drive the prices down you in sent the industry to find ways to sell more to the customer and if you look at medicare carefully what is being sold to patients it is hard to believe they are not more in the mcdonald's business. mcdonald's makes more money than the bistro. worcester medicaid i'm afraid something else is happening. if you look at medicaid it is really interesting the rate of growth in medicaid services has gone up rapidly but not all of them. the things that you can do high-volume, testing, certain types of procedures have gone through the roof. what we think of as more care takes a lot of time and

expertise and i think what you see in medicaid is an industry response of the reimbursement if i have a business model that lets me do volume of and if i don't i won't. again this sounds a very wonky but think of what it means for the patient if we think of health care as the single good can we get your health care? the affordable health care act has put more people into medicaid. if in fact what we are doing is driving the different types of surface then we have an issue. we were talking about our future intelligence were left so medicare will cost $600 billion this year. seniors are the best customer for the health care system. i think this probably 5,000 in the country. how is this possible? it is possible because the way that you reimburse says you can get this type of care but not this type of care and when we talk about health care we talk about health care to read we don't say there's too many

spinal fusion, hip replacements, too many people one pills, there's too many the cat scans. we talk about health care as if it is one thing as if it is a cheeseburger. but even cheeseburgers are very different and my fear is what we are missing in the system is this, we are driving the care decisions on these and it's not as simple as isn't this great we are making private insurers more cost to the company. i want to spend one more second on the consumer service. 50 years ago were, there were 20,010,000 before that there were tendered 50. probably a thousand people that knew how to use them. computers were extraordinarily complex. today almost half of us are carrying at least one, several

have to, three, four, five. all of us everywhere on earth. what happened as we all know is everybody became smart about computer science. we all required it, we have ph.d. is so the products that 50 years ago only 100,000 people on earth can use are used by 7 billion of us. of course that is not true. when you hear that healthcare is impossibly complex for the consumers will one of the things to remember is that nobody in health care can make money by making it easier, nobody. think about the computer. i don't understand anything and not tell any of my computer's work. i have three fonts', laptops, tablets, a lot of us do. it's not because i know what works and it's also not just because there is one that is a superior computer that we all

must have. it's a fact because of the opposite, this complex thing on earth, it's the dawn of medicare used only by nasa anthon irs and ibm. it was used by all of us because nobody said it's too complicated for consumers. somebody said i don't know how to make a living. we reached a study this month that said the $81 billion in savings we were going to make on the investment produced no savings. it too bad because the government puts up $25 billion on authority billion dollar investment. why? why did authority billion dollar investment get everybody box and software to not produce any savings? if you've been to the hospital or the doctor you can see in front of you i mentioned i took my son from an appendectomy next

month. we walked in to see a surgeon and he had a ruptured appendix. i filled out the forum for him. i don't know what he would have done if he were an adult. the surgeon said a rupture appendix let's get s. ghanem to confirm that. we went to the same hospital and filled a seven page form. we made the obvious point that we felt the same form 15 minutes before but i know you've all been through it. we then had to go to the emergency room where just for fun while they were waiting for the room i said if i want to pay for this out of cash what would happen? and it really was the equivalent of saying i have a bomb strapped to my chest and leg going to blow up this hospital unless you perform this appendectomy for

free. [laughter] the panic, but this belief of what is cash? [laughter] and then of course because he was in pain and i thought -- the surgery was delayed because they had no way of tracking. they have someone work back and forth. he was in a lot of pain and so they gave him morphine or they tried to. the pharmacy was firewood guess 20 yards away from here where he was having the operation and it took an hour and a half to fill it out. i imagine many of the people in this room a variety the use gun-control but trust me if my wife had been armed this story would have had a very ugly ending. you see that and what that is is

what i like to call the little picture. forget about the big picture of health care, this probably doesn't exist but let's not argue with your its solvent. but this is all of us, every single one of less going into the system that we need constantly that's been fully integrated into our lives to manage what used to be lifestyle issues and in extreme cases they saved our lives and are being treated as if we shouldn't be there, we are lucky to be there and mistakes ranging from the iowa rolling having your test results lost and one physician talk to another, the hospital staff change over faster than you can learn their names.

when the inspector general looked at how good of a job they were doing at reducing vote rate of accidents and hospitals, they discovered one out of for medicare commissions leads to a problem created in the hospital so one out of four compares to nothing. it doesn't exist anywhere else in the world. it's nonexistent. you can't get that bruseghin combat. this is so unusual and we give it a pass and one of the reasons is that because we let it live, we don't ask of the money that we've put in and the money that we take out, how we are treated and how we see it performed and how it compares to the dry cleaning. we don't do that. we need to take the i went back and put it under the microscope of everything else in life. we need to recognize health care in the future will be part of our lives regularly.

i will take some questions. [applause] as someone that has read the book is an interesting book and i say this not to be polite to the guest, it is one of the best health care policy books i've ever read and i would encourage you to buy one outside. with that, let's ask some questions from the audience there was a physician in the room. do you know the average survival was about 50 years ago? >> at the turn-of-the-century it was in the high 50s.

>> even lower. >> that's because of the health care that we have. let's give them a little credit. you know, it is a blanket taxed but let me take the computerization to get there was an article that a study done was done that said computers would solve all our problems and a decrease and if you asked anyone in medicine that would tell you this would increase and do it at a higher level of care we all knew that they forgot to tell us if the study was funded by huji ebe and that wasn't known so they sold all the computers. the hospital bought $140 million to implanted them and even my

technical friends because we have to set up the computer. the other point i bring to make that has nothing to do with hospitals or doctors and i am an oncologist. they should have gone to jail for the way they were pushing the product coming in with inducements to make more money, changing, putting more medicine so people could make more money and some of the doctors should of gone to jail. right after this they let them use the drug again. so we talked about sanitizers -- i'm sorry. so just address that. >> there's a couple points 1i agree with and 1i don't to read

the first would show the 80 billion worth and that should have been of the u.s.. that is a return. i don't know what anyone on the room is getting their money. there are some money managers believe getting less than 200% and i want a piece of that. what he didn't ask is why the industry hadn't made the investment itself, why with the industry that could achieve $80 billion in savings not make authority billion dollar investment in our lifetime and not asking that question they missed what was going to happen. what was going to happen is in health care, and i'm talking about industrial structure, not about people, nobody can monetize $80 billion in savings. when you're dry cleaner invested in i.t. it isn't because dry cleaning is more technologically advanced and it isn't because the people are better trained it is because it costs money.

that's it. that's why all of us do to 80 billion which translates into no increased profits. the technologically advanced hospital is regarded as intermountain that says our technology investments of cost between 25 to $50 million a year because you can't get paid. in the rest of the economy when i.t. helps you save money you can pass on to the consumer and make a fortune. wal-mart is a technology company about inventory management, but i think the study was right or wrong to me was irrelevant as it is obvious on its face it isn't going to work because and 80 billion-dollar return on $80 billion doesn't need to become a government intervention to happen. let's talk about the broad point because i think it's important. you are right lifespans have

gone up and are continuing to go up but as most people in the audience know while some amount is attributable to the personal health care a much greater amount is contributed to the public health and a far greater amount to the lifestyle. what is interesting about the last 50 years is the area we can definitively argeo is cardiac care. the bulk of the improvement almost every single study has shown has been about people drinking less, people having jobs that create fewer disabilities and to some extent some argue that it cuts both ways. there is no question if you do the comparative national work, look at the different country lifespans, the difference in health care in fact personal health care is almost never measured in the numbers. what we measure there's a study

in the u.s. this is the number one predictor on your life span is your education. what's interesting about what we have done in health care with 18% of the gdp we have nothing left or any other social priority of which are likely to drive greater improvement on health. i am appreciative of the health care that i get about systemically this is bankrupting us and exposing us to a variety of problems that are extreme. >> as a reminder we are on c-span's if you can give your name and affiliation to get to as many questions as possible. >> in my simplistic way what is your solution in your wonderful speech sounds like an argument for more consumer driven health

care but i hear you are a single-payer guy. >> any combination of extreme left and right. i like extremes. i think we need national health insurance but it has to be defined as catastrophic, and i think interestingly what has to happen over time we need to make it narrow rather than broad to expand the mandate. we can't switch to that system today i don't believe without giving everybody the security that their house is burning down would actually be covered. at the same time, we need to drive as much of the 2.7 that we are spending now back at people and whether that is getting the insurance premiums down to the type of catastrophic level we are talking to some people can save more going into the insurance system or whether that means turning subsidies away from the health care with all the terrible incentives created

which is different. but life proposed working towards in the system where all of us are in a single pull catastrophic plan that is narrow and has been over a 20 to 40 year period with the bulk of the health care running through our health savings accounts so most of the customers from the point of view of the industry is us so that what happened to my father and son is less likely to because you are less likely to use the customer and that is what i'm trying to get to. it resembles what they've done in singapore than any other single-payer state. winstrol sinnott catastrophic and the intent is taking the most complex and most administrative flee difficult form of the finance and applying it to things it didn't intend for which is non-catastrophe.

>> um fortunately we don't have any more time. >> thanks all of you for coming.

when her husband became president, but she never stepped foot in washington. her husband benjamin harrison died one month after his inauguration meet the other women that served as first lady over 44 administration and c-span's original series if first lady's influence and image their public and private lives of interest and influence on the president produced with the white house historical association, sees and one begins president's day february 18th at

9 p.m. eastern and pacific on c-span, c-span radio and c-span.org.

..