i spent time with my granddaughter today, i get to do radio and a lot of great people to the right or the left or the middle, they get their voice out there and they tell people a story of their government. so i am very happy. i am not a person that is unhappy or angry and i want to get everybody. as my grandmother always had, sometimes it just takes a while. i want to thank everybody for coming. i thank you.

[laughter] >> next, rosemary gibson presents her thoughts on the future of medicare. she argues that the health care industry more so than the public is dependent upon the medicare budget for annual spending. this program is a little under one hour. >> the topic for today is medicare and where we are headed and what it means for you and your patients. today in washington dc, the obama administration is releasing its federal budget proposal tomorrow that will have changes proposed for the medicare program. you might think that i am not over 65, what is medicare have to do is meet? medicare has a role in the lives of all it is, including residence. the presidents proposal debates

the future of medicare. both democrats and republicans propose raising medicare's eligibility from 65 to 67. others have proposed that seniors vying to help exchanges that will be coming online during the health care reform. others proposal emanating fee-for-service medicine and medicare entirely and having everyone and roll in a private insurance plan. these topics are hotly debated. we are debating the topic that show up in the mainstream media. here's why medicare matters. or 50 million people is who are covered by medicare for their health insurance today. this hospital and every hospital depends on medicare for a substantial portion of its revenue. for those of you who are residents in training, you may not know that medicare pays your residency. it pays for faculty salaries.

it makes residency training possible. all of us pay for medicare. we will all be covered by it, so it's something that we all have in common in the united dates. here's a graph from the congressional budget office. it projected using historical trends in medicare spending and where we had it. in 1996, about 2.5% per per semester credit was spent just on medicare. by 2082, we will be spending 25% of the countries gdp on medicare. from that same congressional budget office, we haven't seen much light of day, but i think it is important for the public to know this.

the country will be spending 99% of our gdp just on health care. this is why there is urgency around medicare and health care to find mechanisms to limit how much we spend. that is the purpose of the book, "medicare meltdown: how wall street and washington are ruining medicare and how to fix it." not only is medicare entitlement for seniors, it is also a big business in that is part of the force driving the trajectory and the kind of care that patients receive. in that respect, it shines light on aspects that we don't hear much about. this includes bloomberg news and other news to find out what is happening in health care. we need to talk about where it's going, who is getting it, and i think that the public has the right to talk about it.

those who are on medicare for the premiums that they pay as well. once again, we look at the outside influence of the health care industry on medicare. it is an entitlement for seniors. it is also the largest taiwan-based industry in the united states. let's talk about the size of medicare. if medicare were a country, it would be the 20th largest economy in the world. it is enormous. medicare spends $560 billion since 2011 for 50 million people. this dollar amount is more than the size of the economy and double the size of ireland's economy. just medicare is one portion of health care. so no matter whether democrats or republicans prevailed in shaping medicare's future, it turns out that medicare has become very crowded by the year

2030. every year, 10,000 people sign up for medicare and 33 million people will be on medicare by 2030. this number is equivalent to the combined populations of hong kong, israel, and sicily to the medicare program. hospitals and doctors and nurses and the entire delivery system are and will be under increasing pressure to take care of everyone. are we ready for that? medicare pays for residency training. they pay for almost all of it. they pay for teaching physician salaries and other expenses. medical graduation is certainly on their minds as many things are. it was funded by $9.5 million in medicare, 5.8 million in medicaid, including accommodation of federal money. as well as state money. it is being scrutinized.

i can do three things this morning. identify where the money goes and how it is being used, second, what it means for patients for incentives of the program including physicians and many of you, and i would like to make the case for medicare spending to sustain this program for current and future generations, for those of you who are young people. you want to count on medicare and ensure that it is there for you. so where does medicare's money come from, and how is it being used? in 1965 ,-com,-com ma medicare laid the foundation for the establishment and growth of the health care industry. in the past 50 years, we have seen an explosion by medical advances, dramatic innovations and therapies for surgical procedures and tremendous successors content successes in medicine that was once considered fatal. it has also affected are economy

and on president of ways. here's a graph on international spending from 1980 until 2007. i will just direct your attention to this graph on the right. these are total health expenditures as a percentage of gdp for a number of developed countries. you will see that the black line is way out ahead of all the other countries. this has enabled health care services for millions of americans that have benefited. who pays for medicare? it turns out that we all pay for medicare. all of us who work pay for medicare from a 2.9% payroll tax deducted from your paycheck. if you look at your pay stub, you will see this amount deducted every paycheck. you also pay for medicare for your federal income tax they pay. and seniors over 65 years old pay premiums and copayments as well. just as a reader commented to

"the new york times" in response to a column, federal programs such as medicare and insurance premiums and not by federal tax revenues should not be a political football in congress. while these programs need to be reviewed for their future sustainability, they have not contributed to the federal budget. 44% of medicare spending is paid for by federal income tax revenue. medicare does contribute because the federal government does not collect money for all of its medicare bills and have to borrow money and pay interest on that debt. yes, medicare does add to the federal debt. this means that when bills are sent to medicare, the federal government doesn't have the money to pay all of them and it borrows money from places like china. it exceeds $16 trillion, and that is an enormous sum of

money. most people think of medicare as an entitlement for seniors. and it is. medicare is also big business. health care businesses and facilities around medicare for $565 billion in annual revenue. the amount that medicare spending the year. in 1965, there were no health care companies listed on the fortune 100 list and today they are 15 health care companies that are on that list and are dependent upon medicare and other sources of funding for their revenue. this has a powerful influence on the debate for the future of medicare. there is a debate over whether medicare should be privatized to 4 feet from service to private health insurance. already medicare is partially privatized and most people don't know that. 25% of seniors, some people in this room belonged to a private health insurance plan for medicare coverage.

certainly they want as many customers as they can and a 33 million new baby boomers will be enrolling in medicare between now and 2030. let's talk about medicare waste and abuse. it is estimated as of last september that 30% of all health care spending, include content including medicare is lost. we were talking earlier about the cost of billing. it is an enormous sum of money. of course fraud and abuse. $170 billion is the size of the entire economy of new zealand.

he is a dedicated pediatric neurosurgeon i've had the pleasure of knowing since i started in health care. he talked about how physicians should be good stewards of health care resources. he asked about how much it costs, because he never knew. silly cfo said in over a financial person and they went through all of the inventory. what they found was $700,000 was a surprise. 10% had expired and had to be thrown away. $70,000 were thrown away. and he said i only needed $295,000 of that $700,000 for supplies. he was astonished and he had no

clue. he said that the hospital was ordering the surgeries that he could do for $35,000 less. so he encouraged them to order the less cost costly product. he told the ceo that he thought he discovered a gold mine for the hospital, this is a way that the hospital could save money and keep the money for patient care and other things. he set up a meeting with the ceo, and he did a back of the envelope calculation about the millions of dollars that the hospital believed they could save if they used equipment that was bought for cheaper prices. it turns out that he had a noncompetitive, nontransparent market for hospital supplies and equipment. it was a 200 le in dollar market that accounts for 8% of total health care spending. in the 1980s, this market had an anti-tax exemption from congress that started off as a model where people can buy

products and services and it had turned into one of the most expensive ways possible to purchase anything on the planet. recently i asked him how things are going and he said that he went to buy a piece of ultrasound equipment and he found it online for a certain price to manipulate the cost of had to purchase it through its own channels and pay 100 times what i could find on the internet. for the one piece of equipment. i would like to discuss the impact and what it means for patients and their physicians. as we see it every hospital in the country, research at mayo clinic surveyed 7000 doctors in 46% had at least one symptom of burnout. this includes one factor with

doctor burnett in his unhappiness. some of you may have seen the 60 minutes segment that aired a number of months ago and these are emergency rooms positions it appeared, employees of a hospital based in arkansas. they were expressing deep concern about the quotas they had to admit patients from the e.r. into the hospital to keep the revenue growing. sixty minutes reported on this system, that they allegedly pressured their doctors to admit or patients regardless of medical need in order to increase revenue. the director reportedly told the e.r. doctors that have been told to replace you if you don't meet your numbers. for example, physicians found it appropriate to send a doctor home, and therefore they questioned the decision. positions were concerned about

whether or not to admit patients to the e.r. .. a. >> what about the person who

shows up in the emergency room? they suspect they're getting good care when they are admitted to the hospital they think they're getting good care and taken well care of its intention is very different. quota and productivity are becoming more pervasive around the country. once again patients may think they are getting good care. in fact, they don't know they are placed at risk by it being admitted to hospitals risk of complications and also they bear financial burden the annual hospital deductible for medicare is more than $1,100. they play in -- and pay a 20 percent co-pay every day there in the hospital there placed a risk and also pay for it to. this is the new medicare.

hospital is being investigated for the practices and the fbi estimates up to 10 percent that medicare spends is lost to fraud. $60 million roughly. meanwhile the talk of raising the eligibility age is so extraordinary in light of all the waste. this amount ejido of alleged fraud is equivalent to the lifetime contribution to medicare from 1 million seniors every single year. this is part of the waste of medicare. as the business grows so does dual loyalty. those that have question of all cultures to create challenges and the for-profit facilities have a primary duty but those to

practices and organizations he or she recognizes he/she that he/she as a primary duty to the patient and there is the inherent conflict in that. here is the example of overuse from the medicare program. from the oregon health sciences university there is extraordinary search of back surgery and published the study in the journal american medical association over the back surgery on people in medicare and he looked at billing data from 2002 through 2007 for spinal stenosis and there is a link while the overall rate did not increase, the percentage of cases in which complex procedures would use climbed from 1.3% of that 20 percent.

the use of these more complex and expensive approaches were correlated with a higher rate of complication of a greater risk of death and more than three times greater hospital charges. this is a topic i discuss the unnecessary tests and procedures. so that that has no added benefit to comprise nearly 20 percent of surgeries' increase in the rest the patients of increasing medicare spending. and in the most expensive way possible was how we do business in business today. according to the authors and medical device makers with the material moved used a more complex surgery's which could cost $50,000 for the operation.

and it was noted that it could be 10 times more for the more complex surgery with more complications. so we paid more and get less. here is the 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 one is driving medicare over the fiscal cliff. as the doctor mentioned i spent a number of years at the foundation to bring medicine into the system so i grew familiar aha with physicians and social workers and others. as a medicare benefit it accounts for a small percentage or 1% of total medicare spending. yet the trends are a microcosm of what happened to medicare overall.

it began as the charitable patients entered whose extraordinary former dean of nursing at yale and she and other colleagues and physicians and nurses went to capitol hill to advocate and testify to the medicare benefit. and in the '80s it did become part of the medicare program. hospice is paid on the her diem basis about $150 per day but 25 years later half of all hospice is for-profit and many of the largest have settled with the justice department to enroll people in hospice care who are not dying which is partially use of medicare. the largest for-profit has been under federal investigation for fraud, a former manager at accused of throwing people were not terminally ill. the parent company is roto-rooter company plumbing.

they hire lawyers to do this. where does the money come from? hospice revenue. word is that many come from? if you pay payroll taxes from your paycheck you help to subsidize the cost to defend the indefensible. the reason i wrote this book for the public to see the connections between the many that we all pay, where it goes, who was getting and how it is used so we can use our democracy to be informed and advocate for reforms that really help patients and their positions. in 2012 the department of justice have a lawsuit against the arkansas based hospice operating in 19 states according to kaiser health they went door-to-door in public housing projects to find people they could label terminally ill and enroll them. also meals on wheels volunteers to find prospective customers.

this is part of productivity and quotas get more common do more, do the most complex things possible and this is what has happened to this wonderful program started with great intentions. nurses were instructed to chart negatives even patients were stable or improving to justify hospice continuing to get the $150 per day diem. nine clinical senior managers were involved in any decisions on when patients should leave hospice. one of the most extraordinary things is private equity firms are investing in hospices. private equity is used to bring working capital to organizations to help turn around or expand and also could be useful to bring management expertise to enterprise is but the question may have to ask is

what value-added does private equity bring to the labor intensive equity is the lack of nurses in for the enterprise that does not require specialized management and a market-based economy works well when all parties attract transaction for those who are supportive of bringing the market to bear in the health care is important to bear the principal in mind there should be an exchange were both parties benefit. we have to ask a question question, whether patients and all of us to pay for medicare receiving in return for many? if the public is compelled to ask what is the benefits? 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 that we've reported in jama about

the variation across the hospital charges in california for the treatment of the on complicated appendectomy. the price range was from 1500 of 782,000 and researchers took out the all buyers only for those within three days they spent in the hospital. mill facilities specific data was reported so the public could not find out which hospital had the lowest rates and which have the highest. and we recently published the fact that senator mitch castle went in for a knee replacement operation and before and she called three hospitals to find out how much it would cost and she said she could not find out she said i a u.s. senator in they could not find out how much would cost. and if you read the "time" magazine article of the growth of health care cost and what the impact of that

is the ec more members of the public who want information on price. democrats and republicans have introduced legislation calling for price transparency and health care. the back to the uncomplicated appendectomy charge the median charge was $33,000 compared to the annual per-capita income of california 44,000. the enormous sum of money. and when i was writing "medicare meltdown" i met a 65 joe beneficiary from kentucky you went to the hospital for one night for procedure which he did not name by suspect was the implementation -- it implantation of a pacemaker face he was floored by the charges $244,000 for one night in a hospital which is the cost of a house in his community. medicare only paid 18,000 but that is the equivalent to the per-capita income of

his community. he wrote a letter to the editor and i later learned the editor received a call from the hospital requesting the paper not publish such letters in the future. we need more public discourse on these issues issues, not less to change the status quo. a challenge we face going ahead is how we engage patients to ensure they get the care they need and not the care they don't? i gave a talk to a group of legislators last summer in new jersey at the state level up and down the east coast and i was talking about the overuse of the ct scans and the impact of radiation exposure in the state legislator who was the speaker came up afterwards and said i'd go to my doctor every three months. i get a chest x-ray every time.

i'm not sure why. i don't have anything wrong with me. he thought he was getting good care but there is no reason he would know any different. so all of us as members of the public have to be aware. bryce said were you going to do? he said i will ask my in my getting all these chest x-rays and i said i think that is the right thing to do. think of the cumulative radiation exposure that he has. there was delighted to hear steve weinberger from that acp came to talk about choosing wisely with the extraordinarily important initiative where the specialty societies are identified the top five things that we should be doing less up and i am delighted to hear the doctor is going to put choosing wisely into the curriculum here at st. peter's. what is the next up? we have to go for the bigger ticket items the overuse of

a heart bypass, hysterectomy , like changing events and we know from what physicians have said in a report under the auspices that these big ticket procedures are overused. it is interesting to note that overuse was taken off as the explicit priority of a national group called the national quality forum. that happened not long ago and it is interesting like it happened and it is unclear but with those forces that no one to overuse on the national agenda in will be up to the public to put it back on the agenda. to have the pleasure of working with progressive and thoughtful people in other procession lahn negative professions i will share this e-mail that i receive from a safety colleague

colleague, just a few weeks ago and i thought i should tell you about this. here is what is said in part, i was right into a 6,000 employee hospital to assess the culture. the cardiac surgeons will do surgery on anyone who moves but after meeting with the ceo was called i upset him greatly with my comments that they we're doing unethical and immoral surgery's. when i met with the ceo again, he was visibly shaken with his head in his hands and feeling ill. so much of what goes on travels just under the level of awareness and it was painful to witness. what i took away from this is that moment of awakening, that moment of realization of what is really going on. how do we keep that awakening alive? and have more people wake

up? that is the beginning of when we can see things change. i have worked in many fields health care, over treatment and a life care in these and not enticing topic so they can be challenging to bring to the public debate. but here is a'' from the 19th century philosopher who said all truth passes through three stages first it is ridiculed, second of violently opposed and third it is accepted as being self-evident. i have seen this in the course of the discussions of patient safety around medical errors for decades and decades naked never talk about the fact be harmed people the that has changed and we have begun -- began to open up to now they will come and talk to the debt residency training program about patients' safety

because as young residents you deserve a good learning environment because that is when you become good doctors president of bomb used talk about overuse with the species talk to congress he mentioned it popped the title here president obama talk about overuse anymore as a factor to reduce medicare spending. so once again it will be the members of the public to have to put it back on the agenda. they have to correct the misallocation of resources because it will not solve correct. while preparing for the talk i was thinking what are some of the solutions? was imprisoned in new jersey couple weeks ago and there was a bookstore and a'' about how democracy, to fix

our democracy be need more democracy, a more informed citizens who are aware of what is going on to serve as a countervailing influence of the counterbalance. the biggest challenge we face is health care company's primary duty to shareholders they have to demonstrate increased revenue and profitability as a condition of the corporate statute and this drives price and volume of van this reality is in direct conflict with our needs as families, employers, state and federal government to do the exact opposite. here is a'' from charles prints the ceo citigroup we will keep dancing and tell the music stops. that was the theme over the battle of health care. one of the renowned capitalist of our time it's the founder of vanguard mutual funds, john google talks about the pathological

mutation in his book the battle for the soul of capitalism and if it cannot be made honestly than what is happening is we are cheating and i believe we have a battle raging for the soul of health care that saved backup -- pathological mutation and the fallout from the fresh pressure older adults and medicare are harmed and the ig reports the beneficiaries of the diet of preventable harm. that is what i brought up. so where do we go and what do we do? i proposed in "medicare meltdown" we need to have a conversation of setting limits on health care spending and medicare spending. how much the average social security check is needed to pay for part b premiums in

2010, a person who earned an average wage and retired in 2010 paid 27% to social security check for medicare part b and d copays and premiums. when it was started it was only 6% but now look at where it is headed. when i am old look how much it will be. for you young residents will come much you will pay from your social security check and now there is a debate in washington to reduce the cost of living adjustment for social security. what do we do about that? there is a wonderful line with every deliberation we must consider the impact of our decision on the next seven generations. and health care we have to consider the impact of our decisions for the next generation because we don't have seven generations to

wait. from the medicare trustees' report of assets were exhausted it could pay health plans only to the extent allowed by ongoing tax revenue and a projected funding for hospital care will run out in 2024. yet they could only pay 90 percent. should we have some minutes to health care spending? what do you think? is a time? if you think about it every system has limits. every system every family has a budget every government has a budget. how does this chart? it happened because of how medicare was assigned almost 50 years ago. there is no limit on how much hospitals and other providers can bill medicare. no market mechanism for regulatory structure to place limits this was the

chief design flaw of medicare when enacted in 1965 it is called the open-ended entitlement. what do you think? should we change it? do we need to install red lights? last week medicare officials proposed an ambitious effort to limit hospital spending so it grows no faster than the overall economy and use the merriment setting system to keep it growing at roughly half of the recent rate of increase. in the state of massachusetts, the state legislature and governor agreed to legislation that capped total health care spending public and private so it would not grow faster than 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 paul ryan has proposed limiting average

medicare spending to the gdp growth of zero point* 5%. we don't hear much about that. but both have proposed limits because they know that trajectory that we are on. what do you think? should we have limits to how much we spend? the health care reform law proposed the independent advisory board to be set up with 15 members appointed by the president confirmed by the senate and members would recommend ways to curb spending and based on the realignment and closure commission remember we had to close a lot of military bases it is hard for elected officials to make those decisions to close a base in their own constituencies so they ceded that responsibility to experts and congress had to agree or disagree. that was the model used. it cannot change medicare eligibility or raise premiums or cut benefits and if congress doesn't like any

of the 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. but what happened it was repealed in the house of representatives and claims of rationing and government interference is that what the opposition was about? was about the interest of patients or the interest of not being able to see continue revenue growth? i propose in "medicare meltdown" the real reason for the opposition to remove any impediments to what they have to do as a condition of doing business which is to keep doing business. also the industry has tight relationships with members of congress to do not want to take that away to give that to non elected officials but congress still have the final say. so for the public watching this on c-span the main

message is the public entitlement to medicare in my view is not causing medicare to fall over the cliff. but the debate we have in washington raises the eligibility age to increase the premiums. health care industry since the entitlement that i believe is what is driving medicare over the cliff and as you listen to the debate in the coming months and years this is an issue you might want to keep in mind and 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 were working you should also know that there are many extraordinary places in this country where you can practice good medicine. you have to look and find them but they're out there. i was just in maine last week giving a talk i met

some of the most extraordinary young physicians who were practicing medicine the way good ethical positions would have wanted young people to practice to have a career like that. it is possible but you have to look for it. inclosing a like to remind us of why we're all here, what medicare was established for and the patient and this is a'' i took from muhammed honda -- gandhi a patient is the most important person on our promises. he is the dependent on us. we are dependent on him. he is not an interruption in our work. he is the purpose of it. he is not an outsider in our business. he is part of it. we are 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 good you do for patients that come to this hospital is noble work. it is not easy but it is worked worth doing. thing keogh. [applause] we have 10 minutes for questions and comments please come to the microphone over here. one. >> i amanda cardiology practice for many years i was very surprised about the hospital's avocations, i am a little emotional, i have a

patient who i have been taken care of the last many years and the doctor said that i can take care of her and another to be put in hospice is it your mother is undying. she said i want her to be in hospice. and i said a hospice is for the end state cancer you cannot take care of yourself. so she left. about two weeks after that that, i got a form to sign to with knowledge that the patient was already enrolled in hospice. i had no role.

i did not sign a. in spite of that she was still in hospice. so if this is going on, what's the future? . .

and became something else. the reason i wrote this book so people can understand what is really going on. if this is what is happening and something as important as hospice care. there's a saying in india, if you have a post rice all you have to do is take one grain to see the whole pot is cooked. if this is happened to the 1% of medicare. what is happening to the rest? thank you for sharing that. i believe we need more of the public to be aware so we can have a checks and balances system. people don't know. we have to start telling them. [inaudible]

[inaudible] even taking care of the patient for twenty years. >> thank you. >> yes, sir. >> thank you for an excellent talk. i want to make two comments. one i have a -- [inaudible] has not been the type that, you know, and any time you make anything but profit -- [inaudible] the priorities will change. tell me your thought on the tre and the healing of america. similar along the line of -- [inaudible] he talk about the fact of seven different country and -- [inaudible] and come back with the fact you cannot have a health care entity companies for profit. once you hitch wall street in some form or another -- [inaudible] >> i think the main point of writing "medicare meltdown" to

show how the influence of the capitalist has -- effect how physicians practice medicine. we need to be aware of it. and say what do we do? the only thing i come -- the system will keep doing what it's supposed to do. that is what it's supposed to do. the only check and balance i can see is setting limit how much we can spend and within that we as a society have to figure out how do we have best use of the resource? reduce overuse and proof prevex. keep people healthy fop use it for the right reason. i agree with that underlying trajectory that is causing great challenges in the health care system. >> what do you think the united kingdom -- [inaudible] >> i think we need to have -- whether we pay for things that don't work. the public expects it. why are we paying for thing not effective.

i talk to physicians serve on the fda committee and the fda is approving drugs that are actually less effective have worse outcome, more risk than drugs perfectly fine and already on the market. why? we have to keep doing the innovation thing. you have to keep the business turning. you have to keep producing it so you can say to the shareholders inspect is in the. pipeline. i think they are right in the side. the public hears it's government interference. we don't have a sufficient counter vailing uninfluence to say it's good medicine. this is good for you. behind the scenes screen it was government getting involved in medicine. we should have people determine good science to determine whether they should be getting this or that treatment. it's good medicine.

we should be doing it. >> yes, sir? hi, -- [inaudible] which had several -- [inaudible] among -- [inaudible] and with the -- [inaudible] i think we as people who are -- [inaudible] for the next-gen ration of physicians must keep in mind that it's limited with -- [inaudible] there's more than that. tort reform is an possibility part of it top. all of these things are which cannot be accomplished overnight. but i think have to be addressed by people like -- [inaudible] and the government. >> i agree about the storm of overutilizationization. i come to the conclusion we'll only get serious if we set some limit and have to make

comoises. otherwise i think we'll do what we're doing. 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. yes, sir. -- [inaudible] i'm a neurologist, i frequent this every tuesday morning. nice to hear you again. >> thank you. solution is already at hand but in the conduct of give me a place to stand and -- [inaudible] is what we don't have. we need some sort of environment in this regard -- [inaudible] some of the things you -- [inaudible]

in the entirety. if a solution has a, b, c, some of the things -- [inaudible] the solution will not work. to take care of this right from the start is what we must be thinking. >> i agree that progress is very, very, very slow. we started overtreatment. a decision in this country about that choosing wisely came on board to move that very quickly. but i think the only way we'll take it seriously if we have limits on how much we can spend to make decisions about what works and what doesn't. what is best for the patient, what is not. the only way to do that is let the public know about where we're heading. that's why i include the graphs. if we keep doing what we're doing, we'll be eating grass and picking berries. there won't be money to do anything else.

i grew up in suburban new york and the school i went to closed in part because of budget cut backs. why? the health care spending for the employees is 30,000 population town keep going up. they closed school last year. two schools in the school direct. this year they are laying off fifteen teachers. why? the health care expense went up 27% in one year. i think the public is getting the message about price transparency. we need an organizing principle about it. i think that's part of it. and the next step is setting limit is how much we can spend as an society. thank you. thank you for this talk. i'm the -- [inaudible] what i want to talk about is -- i enjoy how you explain how medicare is breaking the bank. what you didn't really talk about is the whole medical system in this country and how

the mit is that -- mit is ha we provide the best medical care in the world. i think is one of the biggest millionth -- myth out of washington. as a system it's failing. one of the pieces of information that i think is very interesting, the health care for people over the age of 65 it's better in this country than most other countries. because that have is because of the system of medicare which is certainly lay universal health care system. one thing you didn't talk about is the problem with private health care. and it seems to me that is as big of a piece of the puzzle as medicare and the failings in medicare. do you have any comment on why we should go with medicare in the future? and should it be expanded? >> well, you know, the reality is we're spending enough health care in the united states to cover everybody and extend a

rebate check to ever citizens in the country. we have better outcome, lower cost, and better health. we can do that tomorrow. and we have to we have abuse of the wonderful systems, we have to correct the misallocation of resources. what you're talking about is population health for everybody. keep it simple. we talked before this got started, let's keep it simple. and you're absolutely right. let's not make it so complex. i went online to see what it's like to choose among thirty health care plan. i couldn't figure it out. we made it so complex in the name of choice. i think we have been sold an allusion of choice. what we need is simple. it's so basic. as you as physicians know, the patient and the bedside. let's take care of them. and not lose sight. it's the patients and the pub atlantic have to be the check and balance on the system. we trusted the system could the right thing.

it's got, out of control. it's time for us to take back our health care. thank you for our country. thank you for the legacy of your father's work. i think with that we'll conclude this session. thank you for coming today. [applause] we would like to hear from you. we are conservative political action in washington, d.c. with author john, my book talk about the lack of restraint in modern economy and how it become frenzy and out of control. what we talk about the need to return to the fundamental of family, community, and faith and normally keep the economy in

balance. that's what "return to order" is about. it's a look at the present economic crisis and we propose real solutions based on timeless principle. >> how do the social parameter affect the economy? >> definitely affects the economy. what we lost in the economy is what i say in the -- we lost that human element that creates the bond of trust and confidence that make free market possible. social capital. those necessary bonds of truces that make create an at fear for -- prosperity to happen. what are your thoughts on the current budget issue? i think it's a symptom of the problem. i coin a term in the book and it talks about this lack of restraint. this idea that you have it have everything now regardless of the consequences this restless

spirit in modern economy that have implications blood pressure what was your fix? >> our fix somewhat we call organic christian society. it's a society where people are treated like living beings and not machines. a society rooted in community, family, and faith with a lot of social ties and natural relationship and inspired by christian -- [inaudible] the author of "return to order." an organic christian society. rd thank you.ng the >> in is no word the process tod industry hate more than th, "a word "addiction. i try to use it sparingingly. tn they rather convincingly argue s there are some differences between food cavings and narcotic cravings. certain technical thresh hold. however, when they talk about ate lure of their foods. their language can be talk revealing. their

they use words like craveble, ue snackble. on online book club meets tomorrow night.able, you can watch the video on booktv.org. plus read what others have said on twitter at #b tv look club. join it tomorrow night on 9:00 p.m. eastern. now on booktv. talk about the memoir in the body of the world. she recounts her time working on women's rights issue and the democratic republican of congo. and her experiences dealing dealing with cancer. it's about an hour. [applause] >> hi, everyone. [cheering and applause] thank you. thank you.

[applause] thank you so much. i'm happy to be here. it's such a really wonderful. the energy is so good here. thank you for the wonderful introduction, and i'm such an incredible tour, it's i get more emotional every place i get. i think it's because this book is, as you said, a book that kind of burned through me like a fever, and it's so physical of my body and in my body. i'm sure there are plenty of the media activists here. thank you for the amazing work you've been doing for is so many years here. [applause] we thank you to all the women and men working on the front lines every day to stockpile -- stop violence against women and. thank you for doing the work. i want to start today, i think i want to say about