corruptad should avoid the riches and serve the pork. so instead of those arguments the church needs to do lead to cause a transformation from that to how to deal with differences about homosexuality. i think john cardinal o'connor he had a brain tumor and died at night he would take all of the bishops best to go in as father john and dave aids victims because they wanted to hit them to see the love of christ before they died. this is the church wants you to see in this is what has to happen if you leave with real charity than there will be a transformation. if you are just one more person then so is everyone

else why do we have to become a church for that? is that we will die for or be martyred for that? it is to recover christianity first they expect the state to do what we are supposed to do. >> host: in what role specifically for the church and christians in the political state? >> the notion the state can be isolated for what it can't booker once you have of moral doctrine supply you will deal with legal issues. in the state is doing something different about marriage you have to defend yourself. no mutual territory. the same thing with abortion. the church will have to do things in a public square. is best if it is by charity

and of persuasion rather than get the state to do things. city will have the conflicts do involve legal battles. it will be spread all over the map and no way to avoid it, such church says we will sing the catacombs again. >> host: where would you like the conversation to go? the next that's? >> i want people to read my book but talk about the complexities. for example, to talk about jefferson to get more complexity in simply by yelling things headed is what i want to see. talk to these things deeply

to get a public conversation going. said from fat every where we can but this is a very different message. but then you cannot engage that way. i hope this will contribute to that. people will read this to say if you don't agree at least you'll know why. and we'll have a deeper understanding of why you don't and what is at stake. and i hope to control people to the deeper conversation. >> host: date you for sharing your book with us. >> guest: thank you for being so kind.

>> medicare and where we're headed and what it means for you and your patience. today in washington d.c. administration is preparing to release the budget proposal will have changes for the medicare program. you may think i am not over 65. what does medicare have to do with me? it has a role in the lives of all of us. the president's proposal is another ongoing salvo to the debate of the future of medicare. democrats and republicans have proposed raising the eligibility age from 65 up at 67. others propose coverage

today. this hospital in every hospital depends on medicare for substantial portions of its revenue. for those of you residents in training you may not know medicare pays the faculty salaries, and makes residency training possible. all of us pay for medicare and we will all be covered by is a we all have it in common in the united states. here is a graph from the cbo 2007 the projected using historical trends where are

we headed? in 1986 to point* 5% of gdp was just on medicare and if they continue by 2082 we will spend 25 percent of the gdp just on medicare. from that same congressional budget office report, these graphs were tucked away with the appendix on the last page to not see alighted david is important to know that for a total health care spending if asked -- historical trends continue we will be spending 99% of gdp on health care. of that is why there is urgency around medicare and health care to find some mechanism to limit how much we spend. that is the purpose of the book "medicare meltdown" to focus on the business aspect of medicare because the only is it the entitlement for

seniors but also big business for the kind of care patients received. and in that respect it shines lights of aspect we do not read much about. more of the news that i read no is on bloomberg to find out what is happening in health care. to find out where the money comes from who is getting it what they are doing with it. they have the right for this information because we pay for it with our paychecks and once again we look at the hillside influence of the health care industry it is the entitlement and also the federal entitlement base in the industry in the united states. to talk about the size of medicare, if it were a country it would be the

20th largest economy in the world. it is the enormous. medicare spends $560 billion in 2011 over 50 million people. this dollar amount is more than the size of sweden's economy and double the size of ireland's economy. just medicare as one portion of health care. so no matter whether democrats or republicans prevail to shape the future turns out medicare will be crowded by 23. and every day boomers' sign up for medicare. this number is equivalent to adding the current combined population to the medicare program. hospital's doctors and nursers -- nurses will be under increasing pressure to take care of everyone.

are we ready for it? >> medicare pays for residency training, almost all of it and the cost of the second, a teaching position salaries and other expenses. and with pressure on the federal that under the budget microscope the training is funded by nine point* $5 million funding for medicare, a five point* 8 million for medicaid as a combination of state and federal money and is being closely scrutinized. i would like to do three things this morning identify where the money goes and how would is being used in to discuss the impact and would a means for patients in to make the case for limits on medicare spending to sustain for current and future generations. for those of you your young

people count on medicare to ensure that it is therefore you. where does medicare's money come from and how was it being used? in 1965 it paid the establishment for the growth of the health care industry and we have seen an explosion of dramatic innovation of surgical procedure and tremendous success in the management of diseases once fatal. medicare has also changed the u.s. economy in unprecedented ways. here are two graphs on international spending 80 -- 1980 through 2007 total health expenditures as a percentage of gdp for developed countries sandy will see the united states, the black line is way ahead of the other countries. with this has enabled

innovation with the application of health care services to millions of americans who have benefited. who pays for medicare? it turns out we all do. from the 2.9% payroll tax deducted from the payroll check. if you look at the stuff you'll see this deducted every paycheck you also pay for medicare from your federal income tax and seniors over 65 pay a premium and co-payments. this is in response to a column from paul krugman in my opinion federal programs supported by participants insurance premiums and not a tax revenue should not be a political football. while they need to be reviewed they have not contributed to the federal debt. it is a myth.

here's the trick is 44% is paid for by federal income tax revenue. it does contribute to the federal debt because it does not collect sufficient money to pay all medicare bills and passed to borrow money to pay interest so yes does add to the federal debt. so when the bills sent to medicare the government does that have the money to pay all of them and borrows money from china. the u.s. federal debt exceeds $16 trillion. that is an enormous sum of money and growing. most people think of medicare as the entitlement for seniors. it is. that medicare is also big business. health care is the facilities to rely on medicare $560 million of a new revenue the amount that medicare spends in one year. in 1965 there were no health

care companies listed on the fortune 100 list today there are 15 on the last dependant on medicare and other sources of funding for their revenue and they have a powerful influence over the future of medicare. >> there is a debate whether medicare should be privatized to private health insurance plans and already it is partially privatized. most people don't know that and most blind to a private health insurance plan. and "medicare meltdown" i predict this will continue and health insurance companies want as many customers as they can and the 33 million new baby boomers and rolling between now and 23. -- 2030. best -- last semester less

september saying that medicare is lost to ways. it could be medicare cost of billing, it is an enormous sum of money. unnecessary treatment. fraud and abuse. this amount of medicare waste $170 billion is the size of the entire economy of new zealand. and all of us are paying for it from our paychecks, premiums. here is a narrative from a conscientious doctor who cut waste in his hospital and very dedicated zero surgeon and i am confident with my work and he heard us talk compositions should be good stewards of health care resources. he took it seriously ill and back to his hospital and asked the cfo to bring someone in to tell him how

much all the supplies in the operating room cost because he never knew. so they sent over a financial person and they went through inventory in the operating room for they found $700,000 worth of supplies. 10 percent had expired and had to be thrown away. $70,000 to run away. he said i needed $285,000 of that $700,000 that were needed. he was astonished. he had no clear. the sutures they were buying i could buy them $35,000 less said he encouraged the hospital to buy the less costly product. he was eager to tell the ceo that he thought he had discovered a gold mine that this is the way the hospital could save lots of money and keeps the money for patient care.

he set up a meeting with the ceo and did the back of the envelope calculation that the millions of dollars if they could purchase supplies more cheaply. it turns out he hit the bricks ceiling non-competitive, non transparent'' market for hospital supplies and equipment. at $200 billion market accounting for 8% of total health care spending and in the 1980's this receive the anti-kickback exemption from congress and what started off a model where people could buy volume and products in the services us expensive it is most expensive way possible to purchase anything on the planet. recently asked him how things are going and he said i went to me it by a piece of the ultrasound equipment and founded on line for a certain price and i realize the hospital had to purchase it through its own channels

and paid 100 times more than what he could find on the internet. i would like to discuss the impact of the financial incentives of the medicare program and with a means for patients and their physicians. we are as you see here around the country with the age of "productivity, and surveying more than 7,000 doctors and 46% had at least one symptom of burnout. demands for more productivity, quotas, are effecter. he may have seen the 60 minute segment the emergency room physicians employees of a hospital based in arkansas as a for zero profit institution at expressing deep concern about the quotas they had to limitations from the e r

into the hospital to keep the revenue growing. 60 minutes reported on the system that allegedly pressured the hour doctors to submit more patients regardless of medical need in order to increase revenue. the director reportedly told the doctors i have been told to replace you if you don't meet the numbers. for example, when physicians thought inappropriate to send a patient home the hospital computer system would send a message questioning the decision. decisions were concerned whether not favor for the er. here is a document over on the right are the goals they are expected to meet. one of the goals the hospital set is the percentage of patients over 65 who could be ignited was

over 50 percent. half of all medicare patients showed up in the er expected to be admitted to hospital. also testing guidelines. every patient admitted to the hospital there was the onset of testing guidelines it had to build up and on the right-hand side they were be rated for their compliance with fair measures for this is what happens to american medicine. probably not the one the doctor would have wanted to see. what about the patient? what about the person who shows up in the emergency room? fed expects they're getting good care? they may think they're well taken care of that the intention is very different. quotas and productivity are becoming more pervasive

around the country. patients may think they are getting good care. in fact, they don't know their place to of fresco of from complications without any benefit. and also they bear a financial burden in this band is $1 copays every day and their address can also paying for it. this is the new medicare. the hospital estimates that 10 percent is lost to fraud, roughly $60 million and meanwhile the talks to raise the eligibility age is so extraordinary in light of all of this. by the way this amount of

alleged fraud quoted by the fbi is the equivalent of a lifetime contribution to medicare from 1 million middle-income seniors every single year. this is part of the waste of medicare. says the business of medicare grosso does dual loyalty. facilities that have questionable health care that could finance patients create challenges for the ethical position and for profitability have a primary legal duty to shut -- shareholders get a physician who practices in an organization like that he or she recognizes their life requires that they have the primary duty and there is the inherent conflict. here's an example of overuse. from health sciences university has done extraordinary research about

back surgery. he publishes a steady in the "journal" of american medical association of the overuse of complex back surgery's of people on medicare. he looked at medicare billing data 2000 through 2007 for various forms of surgery and there is a link if you would like to take a look at it. while the overall rate did not increase, the percentage of cases which complex procedures were used climbed to nearly 20% and the use of the more complex and expensive approaches were correlated with a higher rate of complication, a greater risk of death and more than three times greater hospital charges. this is a booker be discussed. with unnecessarily complex tests and procedures.

so the result is no proof of up added benefits to comprise 20 percent of surgery increasing the risk to patients and medicare spending where more is better, the most expensive way possible to do things is how we do business with health care today. one of the reasons for the higher costs the procedures according to the authors and medical device makers with the materials used in more complex surgery's which can cause $50,000 per operation. as noted it could be 10 times more for the more complex surgery with more complications. and so we pay more and get less. here is a conclusion i draw with medicare meltdown. seniors entitlement to medicare is not why it is headed over the fiscal cliff. the health care industry entitlement is what is

driving in medicare over the fiscal cliff. as a doctor mentioned i spent a number of years at the johnson foundation to bring this into the mainstream of our health care system. i am familiar with the work of hospice and social workers and others. it is a medicare benefit and a small percentage of total medicare spending. yet the trends are a microcosm overall. hospice care began as a charitable patient centers effort with the extraordinary former dean of nursing at yale and those that went to capitol hill to testify on behalf and in the '80s it did become part of the program.

it is paid on a her diem basis about one ended $50 per day. 25 years later half of all hospice is for profit and many largest institutions of the justice department rules people in hospice care that are not dying which is fraudulent use of medicare. the largest has been under federal investigation for fraud in death former manager it for those were not ill. >> hospice has been many. they hire lawyers. where does the money come from? it comes from hospice revenues for the word is that money come from? >> you're hoping to subsidize the cost of the individual. the reason i wrote the book for a public to see that his

for the money that we'll pay so we can use our democracy to advocate the reforms to help patients it their physicians. >> and the departure justice as a lawsuit operating aid 19 states the with door-to-door to find people to look labile terminally ill. put to find prospective customers this is part of the quotas. get more into more with the most complex thing possible. that is what happened to the wonderful program starting with great intentions called medicare. nurses were instructed to turn negative in the medical records even when patients were stable or improving.

and patients forgo curative care and hospice. non clinical senior managers were involved in any decisions on when a patient should be hospitalized. one of the things i learned as a private equity firms are investing in hospices. private equity is to turn them around or expand and also could be useful to cut discretionary have to and asked is what value does private equity bring to is that enough nurses and it doesn't require a lot for those who are supportive for freeing the market to bear

is important to keep this in mind with an exchange for both parties benefit. we have to ask the question what are patients in all of us who paid for medicare receiving in return for many being taken? the public is compelled to ask what is the benefit to the patient? if we break down total spending we can break it down by price and volume. when i was here last time i mention this study we reported a of internal medicine about the variation of cost of california with the uncomplicated appendectomy in 2011. the price range was from 1500 to 15,000 and they also took out the all wires only those within up to three days. so they were removed. no facility has significant data reported so the public

could not find out which hospital had the most in which hospital had the highest rates. and recently published that the senator recasts bowl win in four in operation and before that she called three hospitals to find out and said she could not find out. she said ivy u.s. senator in they could not find out how much it would cost. for those of you to read the "time" magazine article about the growth and health care cost what the impact of that is. >> host: back to the uncomplicated appendectomy charge the media in charge was $33,000. compared to the annual per-capita income of 44,000.

an enormous sum of money. when i was writing "medicare meltdown" and that is 65 year-old beneficiary from kentucky who went into the hospital for one night for a procedure he did not name but i suspect the implantation of a pacemaker and was floored by the charges which was $244,000 for one night in a hospital which is the cost to the community. medicare paid only 18,000 but that is equivalent to the per-capita income of his community. he wrote a letter to the editor in the local newspaper about his experience in the later learned the editor received a call from the hospital requesting that the paper not publish such letters in the future. we need is more public support not less because we want to change the status quo.

a challenge we face going forward how do we ensure they get the care they need? i talked to a group of legislators last summer days low all up and down the coast and to talk about the ct scans and the impact of radiation exposure veggies as they go to my doctor every three months and get a chest x-ray i am not sure why at -- settled think. he thought he was getting good care but no reason to know he would be different so all members have to be aware. i said what you going to do? he said last them why in my getting all these chest x-rays? i said that is the right thing to do. think of the cumulative

radiation exposure. >> with the extraordinarily important -- important profession and the medical community to identify the top five things that dr. is in the training program here in st. peter's. what is the next of? think we have to go to the bigger ticket items back surgery and hysterectomies and these are life changing events in reno from a report in 2008 from the national quality forum these procedures are overused. it is interesting to note that overuse was taken off as the explosive priority of

the national book club that happened not long ago. it is interesting why it happened. it is unclear but one can imagine the powerful forces not to be on that agenda. it is up to use the public. i would like to share this e-mail i received from a patient safety colleague. i thought i am coming to st. peter's i should tell you about this. this is with the mills said in part, was brought into s6000 employee hospital but they will do surgery on anyone who moves for after meeting with the cia was told they found nothing unethical or immoral about

the surgery. when i met with the sealer again, he was visibly shaken with his head in his hands" end quote. mad feeling ill " so much of what goes on troubles just under the level of awareness. it was painful to witness. i took away the moment of awakening and realization of what is really going on. how do we keep that awakening alive to have more people wake up? that is beginning when we see things change. i have worked in many fields of health care and life care and then the these are enticing topic so they can be challenged to bring to the public debate. but here is a'' from the 19th century philosopher

who said all truth passes through three stages first ridiculed the was second, violently opposed answered it is accepted and becoming self evident. i have seen this in the course of the discussions around medical errors and for decades and decades you can never talk about the fact in we have begun to open up and you will be talking to the sponsoring residents because you have a good learning environment is that is a you become good doctors. it is interesting obama used to talk about overuse with a speech he gave to congress and the first term he mentioned we have to curtail overuse. but i don't hear president obama talking about over use any more as a factor in

reducing medicare spending. so once again is the informed members to put back on the agenda and citizens will have to correct the misallocation of resources. while preparing for the talk i was thinking what are some of these solutions? was sentenced in new jersey walking along nassau street and there was a bookstore in there was a'' how democracy democracy, to fix it will need more democracy we need more informed citizens of what is aware of what is going on to have the checks and balance of the system. the biggest challenge we face is health care company's primary duty to shareholders they have to demonstrate increased revenue and profitability and has a condition of their statute in this drives it

up. this is in direct conflict as state and federal governments. here is say'' that we will keep dancing and down the music stops. one of the renowned capitalists of our time john google it is the pathological mutation for the battle of the soul of capitalism. but what is happening is we're cheating. and we have a battle raging for the soul of health care in the same mutation with the dismay of ethical decisions for and the fallout from the pressure or harm to by adverse events

and reporting some 9,200 beneficiaries and hospitals by of preventable harm. and that was a topic i brought out. so where do we go and what do we do? i propose the "medicare meltdown" we have to have a conversation about setting limits on health care in medicare spending. here is a homage to the average social security check needed to pay for premiums and copays. in 2010 a person who earned an average wage of his or her life and retired in 2010 paid 27 percent of social security checks just for part medicare b and d. that is the enormous amount of money and when it was started it was only 6% below where it is headed.

when i am old hotel much it will be? with residents become much to pay from their social security checks and now there is a debate to reduce the cost-of-living adjustment. what do we do about that? there is a of runt wonderful line from deliberation room us consider the impact of our decision of the next seven generations to consider the impact for power generation and the next generation because we don't have seven generations to wait. from the medicare trustees' report if assets were exhausted medicare could play -- a health care plans they projected hospital care funding will run out 2024. they can only pay 90 percent. should we have some limits to health care spending?

what do you think? is it time? if you think about it every system has limits every family has a budget every business has a budget. every government has a budget. a country cannot function without it. how did this all start? because of how medicare was designed almost 50 years ago. there is no limit on how much hospitals in providers can bill medicare. no market mechanism for regulatory structure. the chief design flaw of medicare when enacted 1965 called the open-ended entitlement. what do you think? do we need to install red lights? just last week medicare officials proposed the ambitious effort to limit hospital spending so it grows no faster than the overall economy.

it would use the rate setting system to keep spending growing at roughly half the recent rate of increase and in the state of massachusetts the state legislature agreed to legislation that cap total health care spending so would not grow faster from the overall economy. what do you think? should we do that? even in congress and the white house both president obama and members of congress have proposed that average gdp growth of zero point* 5%. we don't hear much about that. the both of them have proposed limits. you could say no to a trajectory but what do you think? should we have limits to how much we spend? the health care reform law has proposed the independent advisory board to be set up with 15 minutes and they

would recommend ways to curb spending based on realignment and closure commission remember we had to close military bases is very hard for elected officials to make those decisions to close the military base for their own constituencies of a seated that responsibility to experts in congress had to agree or disagree. palace the model used for the independent payment advisory board. cannot change medicare eligibility raise premiums are cut benefits and if congress doesn't like any recommendations it doesn't have to agree with any of them but it would have to come up to find equivalent savings of its own. it was repealed in the u.s. house of representatives claims that the doctor patient relationship is that what the opposition was about? the interest of patients for

not being able to seek continuing revenue? proposed in "medicare meltdown" the real reason is the desire to move -- removed any impediments for what they have to do to do business which is to keep doing business in the industry tight relationship with members of congress who did not want to take that away but remember congress has the final say. so for the public watching this on c-span the main midget mention is a public sentiment to medicare is not what is causing it to fall over the cliff yes the debate we're having is putting the onus on older adults to raise the eligibility age in raising premiums health care industry sense of entitlement is what is driving it over the cliff and as you listen to the

debate this is an issue you might want to keep in mind to decide for yourself what you think. for residents in this room and the young physicians what does the future looks like? while this gives you the reality of the overall context of what you are working you should also know that there many extraordinary places in this country where you can practice medicine but you'll have to look and find them but they are out there. i was just in name giving a talk and that the most extraordinary young physicians practicing the.medicine the way good ethical positions would have wanted young people to practice. it is possible you have to look for it. inclosing a like to remind us why we're all here, what medicare was established for, it is the patient in

this is a'' i took from mahatma gandhi tweet a little bit and here it goes. the patient is the most important person. he is not dependent on us. we are dependent on him he is not an interruption ever worked he is the purpose of it is not an outsider, he is part of it we're not doing him a favor by serving him, he is doing us a favor by giving us the opportunity to serve him. thank you very much for all the goodies you do for the patient to come to this hospital. is noble, not easy but worth doing. thank you. [applause] we have 10 minutes for questions and comments. please come to the

microphone. >> i'm in a cardiology practice for many years i was very surprised i have a patient who might have been taking care of the last many years and the doctor came to me and said i cannot take care of her love my mother to report in hospice and eyes of your mother isn't dying. she said i want her to be in hospice and i said it is

criteria of the end stage cancer or die within six months. so she left. about two weeks after that i get a form to a knowledge that the patient has already been enrolled in hospice. i had absolutely no role. they bypassed now the want my rubber-stamp and i did not sign. despite that she still went to hospice. so the question is if this is going on with is the future? i think your point* is well

taken about hospice and i was surprised myself that i call somebody after that incident this is the biggest fraud going on in america's so if they can bypass me then imagine what can go wrong civic figure doctor for sharing that. and cannot imagine what position your placed into to put a patient and hospice that is not likely or should not need hospice care and should never have been placed there i cannot imagine what that was like and i was also stunned when i saw what had happened to something that was a mission and became something else in the reason i wrote this book is so people can understand what is really going on and if this is what is happening something as important as hospice care, there's a saying in india if you have a big pot of rice you only

have to take one green to see if the whole plot is cooked. this is happening with 1% of medicare like what is happening with the rest. i believe we need more the public to be aware to have a countervailing influence the people don't know. >> the person who has never seen the patient needed decision and you have been caring for her 20 years. >> i am an oncologist in practice in my experience has not been the type is a

tiny make anything for profit it will change what is your thoughts on the book of healing in america that he goes to 67 different countries and comes back that you cannot have the health care entity with those who are for -- for-profit ones you go to wall street who have sold your soul. >> i think the main point* of breaking "medicare meltdown" to show the influence of the capitalist system has entered such profound private decisions between doctors and patients to affect how patients -- doctors practice medicine and we need to be aware and what can we do? the system will keep doing what it is doing because that is the mandate to the shareholders. the only checks and balances i can see is, and chickens

been then we have to figure out how to make best use of those resources? keep people healthy, use it for the right reasons. i it three with the underlying trajectory causing great challenges in the health care system. >> we have different issues altogether? >> we do need to have a conversation if we pay for things that work or don't work. the public expects it. serving on fda committees and the drug that are actually less effective and have course outcomes and more risk than drugs that are perfectly fine and already on the market. why? because we have to do the innovation thing to keep the business churning and producing it to say to your

shareholders this is in the pipeline, but are theny better? but the only side the public hears this is rationing, and government interference in we don't have the sufficient countervailing influence to say this is good medicine. this is good for you. we have that with comparative effectiveness and the industry screen this is government getting involved. we should have. people with good science know if they should get this treatment or that treatment. we should do it. >>. >> there was an article with few years ago which had suggestions and with the

thoroughness and people who are responsible for the next generation of physicians must keep in mind ferris is more than that the holidays can not be accomplished overnight and it has to be addressed. >> have come to the conclusion we will only get serious if we set limits and have to make choices and arrived we will keep doing what we're doing perpich thank you for trying to educate the next generation on good care, what you need and helping people get what they need, not what they don't. >>.

>> i am a urologist and i frequent this hall every tuesday morning and it is nice to hear you again. >> but give me a place to stand. >> you down needy security disregard that the message is in its entirety. >> dissolution as abc for a cruise the and some things are committed then it did not work. to follow the bashan to take care of it from the start is what we must be thinking. >> i agree progress is very,

very slow. we started over treatment and the discussion of the choosing wisely came on board. but i think the only way to take it seriously is to have limits on how much we can spend to make decisions about what works and what doesn't in what is best for the patient. the only way to do that is to let the public know where we're headed. that is why i included dead grass if we keep doing what we're doing, we will be eating grass and picking berries because there is not money to do anything else. the grammar school and when to close because of budget cutbacks because health care spending for employees of this 30,000 population town closed up. so they closed two schools now laying off 15 teachers because it -- health care went up 27%.

they're getting the message of price transparency and that is a small point* and then they extended how much we could spend at the time. thank you. >> i am jack son and a medical oncologist. i want to talk about i enjoy aid having you explain how medicare is breaking the bank but you did not talk about the medical of -- medical physical system that is the biggest one we hear coming at of washington. we can provide care but the system but one of the pieces of the information for health care budget is

essentially the universal health care system. one thing we did not talk about was the problems with private health care and it seems that is that of big of piece of the possible as medicare. >> but the reality is we spend enough money to cover everybody to provide really good care and send a rebate check to every citizen in the country. we have better outcome, lover cost and better health. we can do that tomorrow. and it is at the abuse of the wonderful system so we have to correct them as allocation of resources to utah about keeping it simple. we talked before this got started.

keep it simple and not make it so complex. i went online to see what it is like to choose among three competing health insurance plans in my community. i cannot figure it out. it was so complex in the name of choice. we were sold the illusion. all of this is so basic that the other patients will have to be that checks and balances in we have been asleep at the switch and trust of the system would do the right thing that it has gotten out of control and it is time for us to take back our health care. thank you for your question and continuing your father's work in with that we will conclude this session. thank you for coming to. [applause]

>> host: the perfect southern california day in a perfect day for us book festival you're watching live coverage "los angeles times" festival of books on the campus of southern california we will cover several of their panels today. . .