coverage has been and i also this question of expanding medicaid coverage to folks the question was starting january 1 of 2014 were we going to take away coverage at least on some basic level from adults and i will from zero to 200% of the poverty level i think that is a key point for the date in iowa. ..

>> if he'd do the right things with their primary care provider in the first year we will not only brave the premium but give you a bonus is not a new idea but the insurance companies have been trying to get people of heart medication off of them but now running the new iowa care not getting them off the heart medication and the kit bond of it -- get odd is of having heart attacks into a health risk assessment they don't have the premium contribution is called the health and behavior program

and next as quality. governor branstad absolutely refused to expand access. we also call for our population to have more responsibility but also can providers. starting the very first year real pay providers having worked with their number one insurance we don't define what quality is the private health-insurance plans are good at that because they have paid that for awhile in our state. they already know what the field looks like wiedmaier have to be the ticket that with the hospital's when i can say you agree to a one snubby will measure it up we will measure quality to have the whole population be at risk within five years. friday the governor in the legislature wanted to increase private insurance

so it is bifurcated those you have served not on the health plan but the employee health benefits that i get a and the governor gets with a little bit of mental-health added to that not only that iowans get to exchange what they want not only increasing people on private health insurance also makes policy sets iowa has seen the greatest rise a bit come over any other state really second to north dakota they have agricultural and oil money. , we have done is in rehab in comes rising as those incomes go up i want continuity of care so that makes good sense it is fair to the iowa pygmies and less

people on state programs is easy on the taxpayers that we are better stewards for those that are served with the state funds that are interested to pay for it. bruited in all these ideas to the core concept is governor branstad wants to focus on health care reform to make people healthier to invest of their own health care. it is also rooted in the same concept as costs rise a revised economic possible something cannot go on forever, it don't. it is that agreed to that simply cannot continue. so as we see this steep curve of health costs increasing copper and obesity on the rise that does not continue forever.

of the public and private sack -- sector are starting to struggle and as a look through history this is what we have tackled over the past century and not a huge fan of coaching people but it there is a book that says to another dow would a group of people can do. or something along those lines. we have seen the average life span increase by two in her capita income increased threefold and child mortality drop the cost of food has gone down 10 times the cost of electricity 20 times less expensive than one century ago and transportation would hundred times less expensive in a communication never doubt what a group of thoughtful committed citizens can do when they come together.

i leave here to tell you id iowa we are up to the challenge maybe it is midwestern optimism but we're working on right now. i look forward to your questions. [applause] >> speaking on behalf of the audience what. i hope you'll participate and ask questions of your own. on october 8 you and your group offered a series of recommendations to congress with respect to changes which the behavioral health system as it affects medicaid and could you give us a snapshot what that recommendations are and what they're used for? >> behavioral health excited start an issue important for

a very long time. we let the numbers 30% of spending is mental health related. that is staggering when you think about it. but the motivation for us coming together with the extensive recommendations with that conversations quite frankly are out of control after sandy. when it became clear congress could not come together they started to look to mental-health to do something. unfortunately what they seem to coalesce towards is mental-health is a challenging issue. we don't understand it very well so let's make medicaid do more so that is an easy

answer. the idea we were getting traction is let's create a new entitlement within medicated new provider group that has never existed before. mandate as a service to the call federally qualified behavioral health centers are along those lines. not only saying it must pay for these but to dictate in federal statute what that payment would be. were using the basis of what exists now federally qualified health centers that are the only entity of the medicaid program that has the reimbursement rate by federal statute. we said wait.

medicaid does more for mental-health and anybody else. second, this is what you are trying to fix is not a problem. and what you're doing is making things worse if you move forward. but we need to be able to say not just no, no, no but here is something else. we spend time thinking through what are the problems and what do we need? it boils down to the fact i will draw a parallel to the long-term care in general that's the issues around behavioral or mental health in this country are very deeply rooted or very complex and expensive policy

makers our afraid to have real conversations. so be do it piecemeal and that has got to stop there has to be a more cohesive federal, national, not federally funded by the national conversation what are we doing around mental health? not just sweep it under the rug but how well the exchange plans deal with this? >> with the state level it is made difficult by a contradictory and confusing federal policy. the air to find ways to break down the barriers to

enable these practices to take call. along with the behavioral health with the number of other states as well and it has to be a complex solution this isn't just a health care issue that the irony is one of the things we have struggled with for so long is a clear institutes of mental disease is what medicaid cannot pay for those is that forces the state to pay for them when hedge% maybe it made sense then but not any more.

if you really want to get at concrete ways to prove what medicaid does too, it is on the web site is about 20 pages of recommendations so be careful with that. we take it is the first step of a broader conversation that a lot of people can have a lot to benefit from in terms of support so we like to figure out how we can talk about this together to figure out the solutions. >> you want to speak to the issue of behavioral health and substance abuse parity requirements of the affordable care act? >> to match point in the state of iowa priest and 202

to $5,000 on average per person per year -- 225,000 per person per year what i saw was it cost $8,500 to make $33,000 per year to incarcerate an 225,000 to institutionalize that issam if held key incentives for people to reside with a mental illness. but the fact of the matter is medicaid exists and the political realm. politics means it is tough to close that institution in toledo iowa that employs 114 iowans in a town that is not that big.

instead we look to manage care we don't have a lot of a managed-care in the traditional medicaid population. but we do have magellan managed care in they can present a creative solution that doesn't require us to work with the legislature that i have a board of directors of 150 representatives and 50 senators elected from the state half of them hate to us and all of them think they have a better idea than us. so magellan has the freedom and facts -- flexibility to do that and we're good to integrate that care a and it has been longstanding so for over a decade we could get a

right to have the new ones when needed. that is a we have approached it. >> in the district rigo launder have large whate'er psychiatric hospitals and i was the monitor for the district for a period of time so i was involved with the down sizing and the ultimate closure as a whole to the hospital for people with psychiatric illness. over several decades to develop a fairly robust system of community-based mental health services but we still have some difficult problems of their medicaid population they are the driver of a lot of our cost. part of my job is to look at the data we have found to

seeing this that it is always mental-health and substance-abuse that seems to be the high-cost items we have looked at this very carefully but we have found we call them the frequent-flier said we have identified them but they're people who have serious mental illness or substance abuse issues that trade no longer have a long-term psychiatric hospital they used the hospitals for housing in anecdotally we can confirm because we have booked them that a lot of people are getting admitted to the psychiatric bet not because they do have a bill this but there is no place to put them in retract them and did some charts to show people being discharged from one hospital in the morning

that going into another in the afternoon so it is a housing dash -- issue and it is pretty serious. i cannot address the parity issue but i will be very interested in how those new folks coming into private insurance with that 200 or 400% fpl level prevalence rates and how insurance can cope what we have seen with the legacy groupon is behavioral health is a significant issue in quite frankly have not done such a great -- great job to address a. we are a demonstration site

for this days that allows the better care coordination so we hope to see good outcome through that with the health home cleaning grant we want to implement that program focused on the us with substance abuse a chronic illness because we see this population even with fairly good care that is out there these are people that require a higher level service and a higher level of care coordination that we have been able to provide a this point. we have integrated a orchestrations of they are one in will work together so we will see what happens. >> what of the questions the people want to know how is it going with cms negotiating those exceptions

you may speak to what those are. >> they are back to work so we were lucky talking with secretary sebelius and the white house. our plan is different not only having the employee benefit plan instead of medicaid but bifurcated the population so those on the exchange to limit the wraparound because of the base plan chosen rethinking how we pay providers we want to based on equality of outcome with the value index schiller -- score that should start with right away but then five years ago at a risk with the entire population so lucky and how

they are a part of that solution with the change of landscape in iowa. and claude has gotten most press and insights from those across the nation is premium contributions for ireland's below the poverty level not something instituted in other states before. i will speak on that i said in my remarks for those premiums we saw those as more equitable even more affordable. it was a very simple demonstration one or two or $3 levels that can easily show you a $10 per month premium there can be incentives you don't have to

pay at instead of being paid when you go to dr. then i don't have that $3 but we also found they would not turn them away but it is not worth the doctor's time for the $7.50 for the three other co pay. so those are the major waiver areas it is hard to forget how many we are very optimistic damage to the i would care population. the cover of eligibility site and what we have done

is a web site does work but what we are saying is our plan passes bipartisan support so we will try it our way we will prove to right the governor hearkens back to welfare reform and then they were to on the education requirements and it turns out that states have the garage with its each stadium that governor proposes the extremes but he likes to bring that up and repeat with secretary sebelius. >> i am told our time is up

by apologize for those who have questions. i recommend you ask these panelist on this side. also please vacate the rams we can set up for lunch. we appreciate your time and your attention. [applause] [inaudible conversations]

>> fisa are flying half staff today to honor tom foley who died today at the age of 84. serving 30 years of the house he lost his reelection bid of 9094 it's a policy released a statement saying he was a leader with authenticity in dedication and diplomacy who ever served as an example to make a difference and through public service. of his colleagues were privileged to know him as a friend. so many more their loss of this sad time. tom foley is dead today at the age of 84. >> looking back at the books that had the impact on the present what did you find?

>> that is one of my inspiration's of the book's one of the famous stories in the 1860's of poverty in west virginia kennedy was supposed to of read that book but it was from dried mcdonald with "the new yorker" article that inspired kennedy to the chairman of the economic pfizer's that could be used to alleviate and kennedy tragically died but but then to say that's my kind of program

>> this can now focus is on the insurance industry and on employers. the affordable care act to make broad changes to the way insurance is often purchased and the goal of legislation can pave the way for the estimated 32 million currently uninsured americans to receive health care by 2019. we will look at this aspect of the transformation from the perspective of the insurance industry and employers.

our moderator it isn't maggie that senior writer on health issues for both nbc news.com also produce the dignity editor of health care and technology at national journal and moderated panels that life begins like this with breaking news and for national a journal daily joining her of the stage are the panelist dr. kennedy chief executive officer at aetna and the president of the national small business association the vice president for employee benefits of government relations in the executive

director for consumer strategy development. >> i think this will be one of the most interesting panels because we have expertise into areas with the health and exchange and also a small business as well period a little bit of knowledge of big business also. given the cycle i thought we could break our discussion up into parts talking about what the heck is going on with the exchanges this week also we will transition into the of aco will change things for employees in what sort of innovation we will see in the field. again, i will introduce our

speaker is a second time dr. kennedy with aetna, that spla in national retail federation and health pocket. steve, you have a little bit of insight into this but wonder if happened with the exchanges this week? >> it is a lot of good news but over a period of time they do great deeds but there are some hurdles to get it up and running and i suppose it could have been perfected as it had bad written about for a long time but was also high demand on the federal exchange you have to go through a couple of screens

to get the information. this may take the people a while to learn how to navigate with the internet commerce they will figure that out over time but with the extraordinary demand but that also with the frequency >> you were nodding your head? >> also with the pent-up demand for what is available that drove the demand so pinterest was a good thing. >> i managed to get on health care i.m. one naphtha journalist that repeatedly get on to see if it would work but what effects will the exchanges have?

how are a they affect the small businesses right now? are you increasing this? >> right now they are exchanged for small businesses relate to be up and ready the way they are supposed it is primarily small-business employees that is a lot of people so many will welcome the exchanges to give their employees options and the incentive to stay working to do different kind of business where they have more access to coverage. it will wind up being a net positive for some of those companies. >> what about the retailer's

i october 1st through 3rd therein is a lot of time it is the six month involvement open season so those who were interested and tell them to take a breath and then think about enrollment you haven't tel jaeger first so you have plenty of time there is no particular advantage to being early. there is opportunity at least so far with my smallest employers will halt to deal with 100 fewer employees it is a relatively discreet population and this is a population that has been looking for it the

private market with more affordable coverage. the jury is out but it will be interesting to see how this develops spee mccready to broaden the exchange the federal changes but also that says today that private exchanges those not sponsored by that government but the private organization to engage even larger to have fundamental ramifications we traditionally have been that we sell our services to another business is to make plans to the employees now also with larger and larger organizations going to the model of the exchange that is fundamentally trying to reinvent so we see

fundamental impacts through the infrastructure. >> to think about very large businesses to bring 160,000 employees but with that smaller range how bad is abrogated is such a way to work with the private exchange of lot of it has to be developed. >> i would imagine there are a lot of good ideas. what are you seeing? >> many of the benefits traditionally play a role as the objective third party with the health plan's getting into the exchange that is reinvented who they are the value proposition but the same health care plan launched there of the

changes to distribute the product to the individual consumers. cc the rise of the consumers of the health care industry. >> is a that confusing for insurance companies to make up these different products for the different exchanges? >> there is no shortage out there but what is changing is how we think about the business traditionally anything over 500 for all employees but now you see i have these employees need you have some other product that only covers geography in the past they would not be interested them want to standardize but now they're

willing to say if it is consumer oriented than that is a revolution. >> then later you will get the employer choice of plans then they will have a single plan or a single level to look at that subsequent it will be interesting to see what develops. >> the long-term is the defined benefit every chance with the entity that makes them into individual choice and the changes accelerate a fair amount. some places it started with medicare advantage to select

open enrollment guaranteed issue but a period of -- a period that the individual to talk about maximum quality scores that moves in to the under 65 market in d.c. that very, very beginning of that but the private exchanges go that direction as a public exchange. >> a difficult question but talking about how employers responded to the exchange's is it true? are they cutting hours taking the employees back to beat the requirements to not provide insurance and our people put onto the

exchange's? >> the employer penalties are delayed through 2015 and more than what you would have seen in the process but we are concerned about the 30 hour issue you tend to manage to keep the costs down and that is a danger for someone who is part five working with plenty of time making less than somebody that makes 30 hours so there is a difference controlled by that potential influence of the artificial definition >> our numbers are much smaller so this does not affect most of them but those that are in the

process is a worry and creates a whole list of perverse incentives so clearly it is an area the administration is watching but also it could be more of the employer mandate and legislatively i think there is a limit of their reach but i am struck if they plan to do anything fundamentally different most indicate they will stay with what they're doing because those a don't understand how it will change so they take the wait

and see attitude and would not jump into something. they take a wait-and-see attitude smith didn't understand or they don't trust it? >> some of both. they do understand haven't will affect them but 80 percent say note they don't the data understand the basics of let it tries to do halifax the marketplace what they can apply to the employees and but that a reader will look like. >> we enter the era of

uncertainty is never lacking but there is not a penalty for not being innovative but if you do something it does a workout is a strong penalty belloc at massachusetts our most of this willis created putting people on the exchange is not a bad thing there is a process and what worries me the most is what happens to the long term process house that shifted to the individual consumer? but in the short term i think most people will be excited. >> that is interesting because there is a recent report from pricewaterhousecoopers that they are doing a lot to

shift the burden on to the employees than the costs come down a little bit so how much of that the uc? >> with the change of the marketplace when a depressant employer provided and as employers navigate it is the important benefit to attract employees but navigating the cost of coverage to get the employees to take on the responsibility to take on their choices and opportunities but people

need to attract that work force. >> yes story that you'll see in 2014 once we get past what do you do is going to be did you realize how many of these out of pocket cost you forgot? the percentage of people that help get the silver plate and that do not hit the deductibles will be very high so that i paid this and i pay that? i know of the industry is a strong word but it is an industry coming up high you those things to do start developing to headed worries of consumer those that have multiple chronic conditions that go through that deductible very fast to get significant benefits you still have the concept of

insurance what if a car accident or a diagnosis comes idd insurance but primarily how do i pay as little as possible and to the realization i would never hit the deductibles? >> but you still have the benefits under that. >> that is the big deal to get people to understand what is no cost free is not the right word but what is within your health plan. >> in players are doing other creative things as well like partner in with the big health networks can we expect to see more of that? >> i thank you will. greasy employers going a couple of directions to say

it is too complex or too costly to move to a defiant contribution type but others say i want to move in exchange that and move more deeply but the jeff or contracts with delivery systems it organizations develop that say i can bring together employers together to do a darrell network contract can in return for lower rates i thank you will see tremendous innovation i am not sure which works better. but you will see multiple new developments with these challenges. >> let's give us the chance to talk about the aco is the innovation involving the aco

>> absolutely we partner with delivery systems with the aco we have 30 nationally now. the power of the aco is you contract with the organizers of care a tough hospital or physician so they are a care system. reid of a carjacking with the system they deliver care in the high-quality way it in a lower cost way like to see technology to see what the other doctor is doing to make the process of delivering care more efficient if you don't get the of care delivery with the exchange's to allow you

to take the product of the exchange now you have transformed health care system individuals can say i'm a pick the local delivery system and now i have a direct relationship of the white paper money to and who delivers it is a when you have the direct linkage of who is, paying or providing the service. >> what we talk about now is a big deal with the opportunity to affect quality and cost so part of the exchange educational process public-private with the unbiased web sites to

help people understand these networks with the value and how to use the best ever very early in the processing and it was just be getting but there is absolutely an opportunity to look at people's physical conditions and other challenges and to do the matching that is a big deal to help them save money or get a better quality outcome. >> very much you have to put it in such a way so that you could be presented with the best choices. >> that is som something employees talk about privacy as well as make get more data that we're all very

vulnerable to having that data out there. >> when you think about quality it is related and if we attack the underlying challenges you cannot just you that the health care level that working with the hospitals and the doctors nrc some results one of the aco their physicians have understood the economics and to in and of themselves starting to be innovative they noticed the patience and a ventilator in the ico sedated the state sedated lager and stay in the eyes you locker where did not

talk to them about this is their own innovation so we will have a clinical protocol and we will not sedate our patients and they found there were discharged more quickly how much money they saved his on tens of millions of dollars that is the innovation at the critical level that will be required to get the cost comedy to be. >> is that the same one? >> there was another study that showed and also or the infection rates but it's still demonstrates that so there are some other benefits other than saving money. >> absolutely the example of how often think with the economy increasing quality

but in fact, health care it will cost more money. so increasingly improving quality for the price the real pay for health care and all that will happen to the extent we all want it but we have to make sure that incentive is right to make sure those systems are aligned but that is to save small business a lot of monday it also have benefits

>> would you read by the incentives misaligned? >> it has been to defy it -- divide more care but not what increases the quality outcome. >> if you look at one recent cost it is another man's revenue so to the revenue of hospitals and physicians if you compare our performance with the other the industrialized countries we spend 50 percent more than other countries but yet you don't see better quality or better outcomes. said the incentives are what drove them the opportunity to modify those also what it encourages is profound

seamless he teaches good or bad but hospitalization use rates come down but some may go out of business and that is a real challenge for ready communities to say that is not a good thing but in reality it could be if the system can accommodate that is all dependent on the health care system being more efficient. if it is that its data whole process. >> my grandmother used as a hospital is no place for a sick person. [laughter] but the but to provide care in the community feel accountable care organization will be see that happening? maybe we should justify and what the accountable care organization is that that is not really what it will look

like? >> i think he will see that aco take many forms the have hospital centric aco if you look at how physicians practice today they have the independent practice of a small group but they have been bought by hospitals so now 70 percent are own door of wind with a hospital what they're doing is creating that you bit of care so you will see a lot of aco also those that a group of physicians come together to say i control health care spending because i of a doctor's arrival take accountability of health and wellness indices management i will control that then use it like a store.

canada which will work out better but i see creel just have to see in the future. >> can health pockets are organizations like yours i cannot find any right now but with ready access to care. >> i share the pain. [laughter] absolutely. one of the things that hasn't been mentioned that i don't think about too much is the effort government makes to release dated to the public the health data initiative but for that a company like held pocket would not exist because the data is so valuable so over a period of time and things

like aco existence this will all be public then the challenge is much more of the use of the ability your average consumer does not want to spend the time to figure it out. vacation but it is very time-consuming. those that could help consumers navigate through the system to get through what works for their situation it is predicated on the existence of data that increasingly comes out there also allowing users to have independence from the insurance industry so in the old days you'd have to say

we need the information but now it is much more available to public use that is a great thing it will be transformational. >> what kind of data? >> plan data and early-- provider data and medicare but it it is publicly available for 50 some odd attributes some it may matter less somebody but you can do those things now stand back that with dash interface for what they need from that it is another interesting development too

many times to have somebody a quarterback that sounds like interference. >> this is what some of your stimulus dollars because that setback on the order of $30 billion but in essence computerizing what they can do and what has been very effective to get that out there is the infrastructure there that can be taken to advantage of. credible data is a 30 year-old, etc..

so there is a larger effort to building on with the standards committee to help take the infrastructure to turn into a interoperable data those benefits will complement with the aco in just now we will have real data to compromise patient choices. >> you said we have made a lot of progress but it is worse than even tried to get on to the health care exchange. [laughter] will be see that recognition? >> the problem with the technology is a lot of what

is out there today, had to get physicians to use the system and? better documentation. the government does a good job with scrubbing it. there's no personal identifier

in, you know, sort of everybody gets how important that is. that is the data come without any kind of ability to tie it back to an individual. is there a risk, sure? sure. to the extend that the data becomes so important as a prerequisite to make it work right. there are risks involved. but there's a huge upside. and then the question is how do you manage the risk down zero? and take the benefit of the upside. >> is the data -- how did you know to ask me about my big toe this morning. [laughter] >> it's like the hospital gowns that don't quite close in the back. [laughter] >> so how do -- how is it going move forward? how do we get to 2015 and beyond? what kind of changes do you see

coming. how do the exchanges play to this? how dot aco play in to this? is there going to be something else we haven't talked about make things change? >> the big question is where the employer-based system continues. there are a lot of stressors on it. the employer mandate will encourage people to manage to the 30-hour syndrome. there's the 50 employee level which we would take up to at least 100 or more. there are the individual taxes that would burden the health insurance tax. that will burden particular plan that is, you know, as much as $300 or $400 family per cost notion premiums beginning this year and moving in. so there are a lot of opportunities to -- there are a lot of costs that

could turn out to be a barrier to people getting that coverage whether it's through a company or whether it's individually. >> wait a minute, did i hear you call for a single-payer system? >> no. i didn't say that. [laughter] it would have fewer moving parts than the affordable care act. i would give you that. >> i think i need to speak up on that. [laughter] i think you are going to see tremendous changes in the health plan industry. what we're trying to do is be more what we call an info immediate area. in the past, what did the health plan do? we price the roof and had claim data which primarily the purpose was to pay a bill. in the future, when you are working with aco and contracting with aco, when they begin to say i'm accountable for a pop laying of patiences. the next question is what data can you share with me to help the manage the patients more e

freshly. and the expertize we have built over the years in managing it. i think the other thing you're going see is some health plans are going to kind of move in to just contracting vehicle. we pay the claim. i think they're going see the scope of activities narrow, and they'll kind of fade away in the background and be father that pace claims. and see others that try to get to the information age and use technology, tools to support the physician and the delivery system. the aco in total in achieving their goal, which is high quality, low cost, and better convenience. i think you're going see the health plan industry go through disruptive innovation. >> i do want to indicate that we strongly support the private sector system. i think a lot of change rides from that direction. we, meshes are honoring people. we don't line up well.

we don't queue up well. i think the aca -- how they obtain coverage and how they think of medical care and may be a future public how they get the care moving forward. we continue to think that innovation is driven from the private sector based health care system, and that's a fundament strength of our system. >> i was going say, i think we have hit an innovation tipping point. you don't seat results yet, but having done this for a bunch of years, you would get the creative ideas comet to you and you say, -- well, if we're on fee-for-service, how do you make it work? it saves money, but how do you get paid to, you know, implement the design? well, it doesn't really matter. if you can go a et na now and say the have a thing that i

invented. i can prove to you it's going save money and have a -- in a similar outcome or cost no more money and have a better outcome. if you can prove that point in an aco environment, you'll win. and this is really kind of the first time that -- we've had that opportunity. and the innovation is following. it is a bit of a lag. there's a disruptive period. but it's there. >> i don't know how long you all have been sitting here, but i'm sure you're eager for your opportunity to ask some questions. i think we'll move in to the audience with some questions. ic you have probably already know the routine. there's a microphone going around. can you please let us know who you are and who you are with. so our panel is can structure their questions accordingly.

>> i'm a practices primary care physician. i was wondering with the plans and moving parts aren't there going to be tremendous transaction costs with the new system which will also have significant health i.t. cost and significant management costs. no one has talked about the cost that comes specifically with this disruptive change. >> well, i would say there's tremendous transaction cost today. if you look at the amount of money we spend on administration of the current system, it's high. i think you are going to see costs -- i wouldn't call them transaction costs. i would call them investment that needs to be made to help reinvent how the health care system works. i think you'll see a lot of organizations making major

investment in additional technology, in care management programs, maybe in physical plans that are outpatient and community focused. i think you'll see a lot of investment. i don't think -- i don't think there's any reason to believe transaction costs will get any higher than where they are today. arguably, the greater focus -- the greater transparency on costs, you may see a renewed effort to reduce costs. i'll give you a couple of examples. some of the aco we work with, they are investing in software that help them manage their supply costs much better. others are investing in software that helps them staff more efficient sincerity -- ly to demand. which are things they don't worry about as much in the past. i think you'll see those type of investment occur. i'm not sure what transaction costs would necessarily go up. >> whafts formula they used to

give you e con 101 for restocking? [laughter] i guess we have moved past that. [laughter] are there more questions? back there. yes? >> hi, i'm sherry morgan with the national association of social social workers, and i'm interested in hearing from any of you what things you anticipate and changes or plans to implement the mental health party regulations that are anticipated to be published by the end of the year and how that marries with the affordable care act. >> i actually spent a lot of time on that issue. it's been a long road from conception and agreement inspect congress, president bush signing it, to getting it actually in to the promise of care delivery and identification and the communities. so we're anxious to see that.

we're hopeful it will not add additional cost to the system. but i think in countless ways, we know -- we need to do better. and identifying and streeting people to some of the tragedies large and small that we've -- we all have experienced in our communities. >> another question back there. am i just seeing microphones going around? >> let me ask the panelists while people of thinking are questions. have you seen anything that surprised you in particular in either a positive or a negative way? >> well, you're starting to see as it goes live. you are starting to see essentially some of the unintended consequences of the law. things that are, boy, that was kind of complicated.

so you'll see things like -- we have done some work on the subsidize issue in doing the math we saw that as a person gets older, say, 60 plus a couple. there's a cliff in the subsidizes. there's a point in which you can get a $10,000 subsidize and make $1 more and get zero. things like that -- as it comes to -- [microphone problem] i think try to be forward working. they can get ironed out and fixed. hopefully it will be the case. it's a complex law and to be expected. but, you know, i think over the next couple of months we'll see a number of those pop up along the way. >> we are long, long overdue for a technical fix, bill. hopefully congress gets past the current tantrum and moves

forward on implementation. >> i would say that's something i've been thinking about a lot about for the last few weeks as washington continues the patterns and disfunction is neil said, we already have long overdue for -- the for law and lots of things that is even the framers of the law knew even when time was passed. that need to be fixed and work together -- relatively quickly. it has been politically feasible. you're looking ahead with all kinds of things that can go wrong in the next year or two. you know, thicks that didn't get calculated just right. i think the biggest probably being how individual mandate going to be? are people going buy the health insurance or not. what will the second year look like? how does that turn back to --

that can happen in the current. >> not this congress. >> and i think the thing that has surprised me is the speed of change. , you know, usually things happen pretty slowly in the health care industry, and what i'm seeing in the private sector new investors investing in a company that raised $100 million to go out and do some very innovative things in the health plan states. there are massive investments, innovations, new companies, and the speed is just i've never seen this kind of speed in our industry before. are there more questions in the audience? yes, right here. [inaudible] this is for dr. kennedy about narrow networking and public exchange.

so whether the metrics that is going use in term of physician, hospital, and other providers. the second part if i'm a patient in a chronic disease, how do i know ahead of time what i'm thinking a plan whether or not the physician that i'm seeing is in the networking or not. >> great question. first of all the, let me distinguish between narrow networking and aco. a narrow network in the past was a designation by a health plan of a select group of physicians and/or hospitals who met certain quality criteria and cost criteria. that's not what we're doing here. what we're doing here is going to what we can call an organize care. it could be a hospital or medical group. they are deciding who they want to include the aco. not us. when we look at organizer of

care. what we typically look for does the set of physicians or hospitals or institutions or integrated delivery system. are they broad enough to take care of 80% plus of a typical p.m.lation needs. if they are, we are open to doing a deal with them. the power of what we're doing, we're getting out of the kind of dictate together physician who is in or out. they are deciding -- in some cases a private label health plan. it's their own health plan. we create transparency in the end. what that allows the physicians to do is really be empower. we introduce technology so they can take the insight and inflews the practice pattern so they can

achieve the outcomes necessary to be both low in cost and high in call quality. i see what we're try dog is both empowerment of the physicians and empowerment of the delivery system, and through the private exchange choice to be able to create a direct relationship with them. i think we have time for a quick question and have to wrap it up. [inaudible] henry i'm a researcher. i wonder if there's a way to improve coverage. you say you'll be getting coverage through the new system. it's on paper. you show up in an emergency clinic, and they don't take medicare. you have to head somewhere educational. find your physician. in some cases they may still be open for business. then you can get something done on a quick basis. another question, say, you have a hand surgeon that you've been

referred to. you show up and find out they don't take it but they take medicare. now you have another problem since you may have coverage with beth medicare -- what to go. yet another hand surgeon, they indicate that they don't really take any of these plans. they leave it to to you to try to work out something with a medical coverage you have and file your own claim. is there some way to simplify this and make it more amenable to the public. >> isn't what the aco are supposed to be doing and some of the other -- >> yeah. it's partly a system issue and fj issue -- technology issue. to the extent it's not a system issue. then the technology is really going help. which is to be able to go in to whatever your smart find or computer or your ipad; whatever. and say i need find so and so in my networking and have it pop and pop with a certain amount of quality information and

pricing. i think once you start to clear the information problem, you'll know a lot better whether it's a system problem. at which point then it becomes a quality of the carrier, a quality of the health plan issue. but hopefully you can do that sequentially. and, you know, again, a lot of that data is becoming available to work out the problems over a period of time. but it's not going happen overnight. >> great. i think we're going have to cut it short and let people get to their networking break. i would like to thank our panelists, steve, neil, charles, and -- tom. and charles kennedy. sorry. i need the lunch break as well, it's quite obvious. bruce is standing there laughing at us. thank you for helping us with the questions that we have to answer for explaining what is going on with the health exchains and the accountable care organization and predicting an interesting and innovative

future for the health care system. thank you very much for your attention. [applause] >> we want to fell you about a hang in our radio service. c-span radio is moving to a new channel on x m radio. you can listen on channel 120 today. you can keep track of public affairs in the car or away from the television with c-span radio . every weekend since 1998, c-span2's booktv has shown over 40,000 hours of programming with top non-fiction authors. >> i thought wow. there are more women in publics and things would change. so i called my editor and told her i was writing a book. >> all of us in the working class are subjected to punitive taxes, being ignored by the elite media.

not getting any special interest help in washington like the fat cats. we're in the same boat, no matter the color. that's the real problem. we're marking 15 years of booktv on c-span2.

of freedom works. conventional wisdom is the tea party and the republican party went down in flames with regard to the government shut down and what happened after words? do you agree? >> guest: no, i don't. i think it's always difficult that one person in the room who said we can't doing what we've done before. we can't keep accruing debt and fund something with borrowed money that everybody in washington agrees doesn't work. and obamacare has been dysfunctional. the president himself has either delayed or repealed at least 20 parts of this dysfunctional health care law. i think, you know, we came in and said you know what? we have to do things differently than before. from my perspective, there's been this almost bipartisan collusion where the democrats get everything they want and the republicans get everything they want. i think after 9/11 this started

to happen, and a little bit of adversarial budget would be a good things. we make trade-offs and tough choices and fund the things we can afford. >> host: what is next now this this conference committee has been set up? what is next? here is the headline in the washington "times," crews and allies are ready for the next battle with the so called surrender caucus. >> guest: yeah. i don't know what is going happen at the next budget deadline. i would predict before that the real debate between the republicans and democrats is going to be chow do we unwind the sequester savings. remember, the sequester savings predicted to be a disaster nobody noticed. they were opposed in a large part by huge sections of both parties, and yet that was the promise they made for the last increase in the debt ceiling. we keep raising the debt

ceiling, and now we try to unwind the little savings we've got. you have that part. they're going try to spend more money not less. i think the big issue between now and november 2014 is obamacare. and the implementation of obamacare and we're going focus on the individual mandate in the unjust nature of delaying for big businesses but not delaying for young people forced to the new system. >> host: do you think that it was time to reopen the government? or do increase the debt ceiling? >> guest: well, obviously at some point, we have to pay government's bills. and they accrued the bills, and our point on these two questions was there's only two points only two pieces of legislation that the democrats actually have to act on. one is the budget and the other is debt ceiling. everything else they could ignore and the house can pass a million pieces reform legislation they have. but harry reid could ignore those. the question is if you're going

force a conversation between the republicans and the democrats only a few leverage points. >> host: if you were in the house republican caucus meeting, would so you stood up with the others and given john boehner a standing ovation? >> guest: no. i think the mistake that john boehner made -- he was with us on a lot of these questions. the mistake that john boehner and the republican leadership made was an unwillingness to pull everybody together early. they broadcast quite loudly they were going whatever it took to avoid a government shut down. if you go to an dwoashes showing all of your cards to the other side, you're going lose. and they naturally lost. i think what frustrates our caucus is circular firing squad that some senate republicans and house republicans formed against the people that were trying to stop obamacare. >> host: who were some of the republicans? >> guest: famously lindsay graham and john mccain, you

know, wacko birds, mitch mcconnell, richard burr. and guys like peter king in the house. the fact of the matter is all of them voted against obamacare. all of them said on the campaign trail they wanted to defund obamacare, and our point was we're the only guys that offered a strategy to do this. they could have offered a different strategy and brought people together. but they didn't do that. >> host: what is freedom works alternative to obamacare? >> guest: i've been working on obamacare my entire career. i think instead of this big monotoes city, the big complex thing that is essentially funded on the backs of young, less wealthy people it would be a lot smarter to fix the tax code. there's a fundamental bias in the tax code that punishes individuals trying to get health care not from their employer.

you could level the playing field, i think if we want people to have health care, we should make it pretax with pretax dollars. and what young people in particular save -- or what will be future health care problems we don't do that. everything has to be controlled through washington, d.c., instead of a freedom-based approach. >> host: writing for the washington "times" as an analysis piece this morning. he said that a surprisingly -- a surprising number of prominent republicans are saying that the g.o.p. loses the 2016 presidential election the party will go to way of the wings or formally split as moderate and conservative group. >> guest: i think that's a real possibility, because you're seeing this clash between the new generation and to me, it's not just the old wing of the republican party versus the new wing. you're really seeing a disintermediatuation in politic. it's already happened with the

democratic party, it's hanking with the republican party now. grootsz activists have an ability to self-organize. to fund candidates that are more interested in. going right around the republican national committee and the senate committee. republican should come to terms with that. they want to cool things from the top down. if they do that there will be a split. it's constitutional conservatives and libertarian and tea party. it's a lot of independence that had opted out of politics because they didn't see a choice between the two parties. that's the future. i think that's what happened in 2010. they're worried that the too

much washington, d.c., and spending and too much debt was the boot on the throat of the american economy. i think we're going have that conversation again in 2014. >> guest: the -- ted crudes -- cruz and mike lee and rand paul and marco rubio and johnson. i could go down the list. understanding fully well not that all of them agreed with this on the particular squabble. i think that's the new party. it's all about economic freedom and understanding that washington, d.c., is a game played by insiders. and it may be big business. it may be public employees union. somebody else always gets to the

table first. we would like to get all of that inside trading out of washington and let people take charge of their lives again. we're making it worse. that's not what the founders of this nation envisioned when they gave us the gift of self-government. you don't like a particular policy? or a particular president? , then argue for your position. go out there and win an election. push to change it. but don't break it. don't break what our predecessors spent over two centuries building.

that's not being faithful to what this country is about. >> guest: what he's really saying is the only time the american people have a right to question their government is during election. and i know he doesn't mean that. ic this is a partisan statement on his behalf. if you go back to what the founders envisioned what george washington said in his final farewell address was that the sacred liberty sit on the shoulder of the american people. not only should we have a right to challenge the government's position, we have an obligation to do that. and there was a day when it was accepted by both political parties. tip o'neal the famous democratic leader of the house for so many years. shut down the government 12 times. and he did it to stop some of jimmy carters' priority.

there was thatted aer have czarrial budgeting where both parties had a view and fought it out and the american people participated in that. i think president obama is pushing against history. like i was talking earlier, we're in this radically democratized period in politics. internet has reenfranchised american who'd can set up the feeds and self-organize on social media. they have an opportunity -- quite often, to beat the insiders. it's no -- the president or john boehner no longer get to decide who our candidates are. they don't e necessarily get to decide what kind of health care we get. we get to decide that. that's the american way. >> skeptical doubt tweets in. if we cut entitlement to the degree you want. what would be the result in real terms to the poor? well, i happen to drk i worked on entitlement over the years. you don't cut entitlement. you reform them.

that's important as we go this grand bargain debate. if you come up with some imaginary number and say we need to achieve the savings, it doesn't work. and we've tried to do that in the past. we tried to that in the early 1990s and ever since. if you want to fix entitlement, you need to accept the fact that people already in medicare, people already in social security, people approaching retirement are essentially stuck with the system they have. they may like it, they may not like it. they can't hardly change their plans that late in life. but young people should be given option. they should be given choices. and if they know that social security won't be there when they retire, if they know that medicare will be a heavily rationed system that is not going give them the health care they need they should be allowed to choose catastrophic plans when they're young.

that's not how the system works. that are pray marely paying -- it's a huge wealth transfer. >> jim, in pennsylvania on a republican line. you're on the air with matt kibbe. >> caller: good morning, c-span. thank you for being here, mr. kibbe. because of the last caller who -- [inaudible] like around to see where the democrats far long time and what happened there arab i'm not talking about congress or the

president. i'm talking about the cityies. they are majority of now controlled dominated by liberal democrat parties. look what happened there suburbs and so what all of the demonization of the republicans the people that ought to look around and say where do i want to be? do i want to with the republicans which is what most people do when they have to send their kids to public school. or go nay want to be in the

cities that democrats have joined? >> host: i think we have a point. >> guest: you look at what is happening in detroit and the flight from california and the population growth in states like texas. it's pretty clear to me that people vote with their feet and seek out economic opportunities they seek out freedom. i live in a district of columbia and we continue to spend more and more money on a fundamentally dysfunctional government-controlled education system. kids don't get the education they want. and they spend more and more money. all of these examples, these examples you're using are exactly what is going to happen to the united states if we continue to centralize everything. an education we need competition. we don't need one size fits all. we don't need if all the authority to some third party --

and they've gotten more radicalized. they don't have a solution for -- i think it's a problem. >> host: alex in virginia e-mails. could you ask him to clarify what he means by real american on his wednesday appearance with anderson cooper. he said real americans will sport his position. he does not seek his clarification. >> guest: i love this question. people suggest that when you use a phrase like that. you're trying to define people. i think it's between insiders who have a special friend. maybe on the committee or able to get to the white house to get that special deal. the rest of us, real americans,

live outside the bellway. the left -- slice and dice based on our age and color of our skin and our income. i don't buy that stuff. >> host: turn down the volume on your tv. go ahead. >> caller: i think we should do more focus on the -- [inaudible] that's the name of the game.

so we need to learn how to seize -- save our money and stop trying to spend the money in one year. it doesn't make sense. even though we get tactsed on -- taxed on it. [inaudible] >> guest: we spent $7 billion a year we don't have. at some point, we need to balance those things. i think if you went after the special interest both in the tax code and absolutely on the spending side, you can achieve

that. in order to do that real americans outside the beltway have to insist on accountability inside washington. >> host: lead story. how to lose $24 billion in 16 dais. hank tweets in 24 billion has been lost flushed down the toilet thanks to cruz, tea party, and shut down. >> guest: i love the fact that most of the government doesn't shut down when we shut down the government. i think it's 84% of spending continues. but i wonder how much we spent rolling off the grand canyon and walling off world war ii memorial.

wait until you control the health care and you disagree with them. >> guest: we hear a lot of talk about budget tear reform about cutting defense spending or social security or medicare. or reforming medicare and social security. i want to ask about tax expenditure that get done. right now tax expenditure almost equal income tax revenue coming in that can't be sustainable. what you and your people of ilk propose do stuff like that. >> host: what would you

propose to do about that? >> caller: i think they have to go. i think these program overwhelmingly help the top 20% of merchs who don't need help. they are in the top 20%. we shouldn't running government programs to subsidize those people. >> thank you, sir. my proposal has been a flat simple tax code. i think we should have a flat income tax what about the home mortgage deduction. what about this? what about that? as long as we're using the tax code to reorganize society, to achieve social means instead of that simple function of raising revenue. guess what? the insiders and guys that hire

lobbyist and tax lawyers are going to be game the system to their benefit. i think tax reform it compelling across the spectrum. tax consults, some people like them. some people don't. it depends on who is at the substantial first when you do that. >> guest: aye -- jay from california. >> caller: good morning. my comments are directed toward the young people the millennium they are moving to retirement at rate of 10,000 a day. 300,000 a month. and they're taking the vast majority of wealth in this country with them. and they're going to be untouchable. so the millennium are going get stuck with the tab $17 trillion to $20 billion a month in

interest payments. in the meantime, we're going to stick them with the bill for obamacare and they're coming out of the schools with an inferior education and even if you do have the ability to go to college, we stuck them with $1 trillion in student loans. these young people have to realize that the republicans have the only answer to this problem. thank you. >> guest: yeah. i agree with you. economists call this generational theft. it's a combination of borrowing and making obligations that you can't fund in the future. right now primarily because the medicare and social security. there are $100 trillion in unfunded liability. they don't show up on the books. these are the costs that we would incur if we kept the promises the future generations tbfer i came down. i pulled numbers based on bark. -- obamacare. it's the immoral wealth transfer

from younger, less wealthy people to older more wealthy people that drives obamacare. that's the deal that the president and the democrats gave to the insurance industry to prop up this redistribution scheme. i'll give you one example. in alaska, where mark is up for reelection in 2014, the current price is $79 for a 27-year-old man. it goes up to the lowest new price is $25 4 per month forced to comply with the individual mandate. i think that's immoral. i think it's wrong. i think young people already salgded with the fact that the economy isn't generating jobs, already sagested with incredible college debt. they are getting screwed one more time. >> host: where do you grow up? >> guest: pennsylvania. >> host: why you have your politics? >> guest: what i was -- i actually write about this in my forthcoming book. when i was about 13 or 14, i was

listening to a new album they just bought by the band rush. they dedicated to ann rand. i no idea who it was. i went out and found a copy her book anthem and it lead me to reading economics and lead me to do what i do. but i've been this strange since i was 13. >> host: what did your parents do? >> guest: they're not around anymore. but my dad work the at general electric in pennsylvania. >> host: jo ann in illinois on the democrat line. >> caller: good morning. i have a comment to make. our country has been on shut down for the last two weeks. it's because of this man's group and people that support him and everybody has learned from the last three weeks that government is good and that we need government. ..

if i'm not mistaken i heard that this company his organization freedom works just filed for bankruptcy. so why would we want to listen to somebody like that when he can't even take care of his own organization. thank you. >> host: mr. kibbe? >> guest: we haven't filed for bankruptcy or anything like it. the fact of the matter is if you believe the government is good and if you believe like i do that the government should perform certain functions you

have to come to the terms with the fact that we can't keep spending money we don't have. now they just raise taxes you are going to undermine people's ability to find jobs. if you just keep spending money we don't have then we do crazy things like letting the federal reserve monetize that debt which essentially steals money out of your pocket because it depreciates the value of the dollars are used to buy the food that you'd eat so somebody in washington d.c. needs to be the adults in the room and say how do we balance these things? i'm willing to put everything on the table. i think we should look at defense spending. i think we should look at all of the boondoggles like the things that showed up in less budget deal and put everything on the table but we can't continue to keep even the most important promises that we have made as a federal government unless we deal with this problem. >> host: beretania and tweets in flat tax does not equalize tax burden. it penalizes those with lower

incomes. >> guest: i disagree because if you look at rich people pay taxes today you look at john kerry's tax return for instance. he famously discovered he didn't pay much in federal income taxes because they were able to find loopholes. they were able to hire a lawyer and sometimes they hire lobbyists that solve the problem for them. i think everybody should pay the same. i think that's the american way. i think we all believe in equal justice under the law. as soon as you start treating everybody differently you are giving your power to some third party and it's probably an irs bureaucrat or maybe someone at hhs that's going to pick winners and losers. we saw this with a higher scandal. it's happened under under democrats in this happen under republicans. they have gone after americans and i don't think that's right.

>> host: carol is in rockaway new jersey on the independent line. hi carol. >> caller: hi. i have so many things to to say i don't know where to begin. >> host: vita you pick two of them, carol? go ahead. >> caller: all right. obamacare. obamacare was basically written by well pint the huge health insurance industry. it was authored by a woman of -- who was one of the chief aides on the bachus committee. so the $716 billion debt as he raced out of the back medicare fund in order to support the funding of obamacare is one aspect and i was wondering at the time i was watching all of the shenanigans going on, where mr. ryan was on the republican side. he was very very quiet.

he came out of the woodwork recently again with his private accounts. my supposition of this whole circus that has been going on is that these political parties and the two wings of the same bird. they play good cop bad cop and the democrats turn was the 716 billion to the medicare program and mr. ryan comes along now with his taxation or whatever he is introducing hiding the private accounts robbery of medicare. so there you go. >> host: carol very quickly what would you like to see don? if these are two wings of the same bird? >> caller: i would like to see the corporate government that exist today completely demolished and replaced by people that represent the

american people and the american people's concerns and aspirations. >> host: thank you maam. you just talked to the progressives before you came out mr. kibbe and both of you would say we agree with carol m-i write? >> guest: is interesting because progressives always wanted a single-payer health care system. they wanted to take all of the insurance interest out of it. what president obama did in fact was he sat down with the insurance industry and the pharmaceutical industry who were major investors in advocating for that plan but this is how washington works. whether you are progressive or conservative or anything else that deals that are cut, the legislation that is written is always written by the interests that show up at the table and the obamacare plan was very much designed to pay off insurance industry by forcing young people to pay more.

in exchange for covering more people with pre-existing conditions. it's a wealth transfer scheme that actually threatens the profits of the insurance industry and if you are progressive you should believe in free markets and you shouldn't like that. we would like to unwind all of that by simplifying the tax code and allowing people to take more control over their own insurance with their own dollars in the current tax code doesn't allow for that. >> host: when it comes to what she called the corporate government do you agree with that? >> guest: yeah. >> host: notches health care but when she talks about corporate government. >> guest: i call it insider collusion, you have corporate interests and i'm not talking

about enterprise interests broadly. there is a bit fight. they're certain people that come to washington for a special deal like general electric. general electric's entire business -- is two and contracts. that is the kind of collusion we should all be posted in what's going on today and this is why i'm an optimist about the future and it's where the tea party came from and hijacked the democratic party. more people have an ability to organize and know what's

we talk about it in washington d.c. in washington d.c. and you think about economic opportunity. >> host: what about immigration? >> guest: its funny immigration is a perfect example of what i'm talking about because the deal that was cut in the senate in washington d.c. was based on democrats like dick durbin who are protecting the the union interest and some republicans who just want to

build a wall. if you want to solve the immigration problem that principle is everybody who wants to come to this country and work should be allowed to. if that that is the principle why are we limiting h-1b visas? why are we limiting the availability of people to come in legally before looking for process that's on its? i think what upsets a lot of tea partyers is the fact that he would reward people who broke the law. who is was responsible for that? i think the ins dysfunction is responsible for that and they think that union leaders and dick durbin the representative in the senate are responsible for not letting good people come in who want to work. >> host: mike is in des moines calling on the republican line. hi mike. >> caller: do you think it was worth it losing $24 billion getting nothing collects the second thing is i raised seven

children and if we did something twice and it didn't work you have got a congress that voted to abolish obamacare 40 plus times. that's a waste of taxpayer time and money that we sent them there to do a job. what are your thoughts on this? thank you and i will hang up. >> guest: well i think we will continue to work to fix obamacare to defund obamacare and to delay obamacare because as we go into the implementation a lot of people are going to discover that they are getting kicked out of the health care plans that they like against against the president's promise. a lot of young people are going to discover that they will be forced to buy something they can't afford and a lot of people are going to be discovered that it didn't herded into a government exchange when they were perfectly happy with their employer-based insurance. this is a real train wreck. this isn't a theoretical train

wreck and i think we have a moral application to fix fix it. does that mean that we should just accept it because it's the law to land a? i think that's a ridiculous argument. we have been accepted bad public policy in the history of america and we have an application to fix this thing. >> host: billy in kingsport tennessee on a republican line. hi millie. >> caller: hi. i have two things to say. social security has only been raised for so long. are you there? >> host: we are listening. >> caller: it's been a long time since social security has even gotten a raise and when they do take the raise they take two-thirds of data and put it back into medicare. as far as this obamacare when i called and got my quote they told me $7000 a year, which averages 20 more dollars a month than my social security check.

>> guest: a lot of people are getting sticker shock as they see what it is they are going to have to pay under obamacare. i think the problem with the one-size-fits-all system is that you don't get the benefit of compound interest. when you say privately that generates an income in social security. it's very much a zero-sum game. it comes from young people to pay the checks of retirees. that system is unsustainable because of the demographics and because of the lack of savings in the program. the federal government has spent the social security trust fund. the republicans did it and the democrats did it and the fact of the matter is the government doesn't save money. the government saves money. that is where the unfunded liabilities come from and we have to do something about it that we have to do something about it that keeps her promises that are made to seniors but let's young people choose.

>> host: finally this tweet from grace. this is the wrong time to cut back on spending and apparently the insider matt kibbe is not a real american. >> guest: okay. i'm not a real american but it's exactly the time we have to cut spending because if you look at what's been going on for a long time we have been borrowing so much money that we don't have and when we borrow money we don't have the federal reserve monetizes it. monetization creates corruptions in the price signals and all of a sudden we have housing bubbles and we bubbles bubbles and we are about to have a student loan bubble that will create a lot of chaos and heard a lot of real people and if we don't reign in washington d.c. real people pay the price. there is no one in this town that's going to pay the price. you can look outside and see planes everywhere. this is a wealthy town because government is growing yet we don't have the money to pay for

these things. i think ultimately future generations pay that price. >> host: finally matt kibbe your second book is coming at april 15 i think you said 2014. what is the title and what's it about? >> guest: the title is don't hurt people and don't take their stuff. i'm trying to get at those basic values that i think connect a new generation of americans who want to see less centralization in washington d.c. and less outsourcing to third powerful parties and just get back to those basic american principles. >> host: matt kibbe freedom works president and ceo of freedom works.org is the web site. thank you for your time.