of it. we have had the supreme court rulings, but the federal election commission has issued regulations that basically have narrowed disclosure to a level that is almost absurdly impossible to meet. people giving money specifically for an advertisement. i know that you see it as a vote best the federal election commission. you're a very litigious guy. and repeated instances you have

and judges have rebuffed those regulations. but in this particular case the district court judges so and then the panel of the d.c. circuit sent it back. did you talk for just a couple of minutes about the destruction of the federal election commission and its role in the problems that we had but also the state of play in that particular -- >> and let me start with the latter. you are right best, we essentially won the case at the district court level. on appeal the court actually found against us in part but then sent the case back to the federal district court level to look at the other piece of the case. in fact, it is spending as we are gathered here now, and we have some hope and optimism that the, you know, judge will weigh all the equities.

as you indicated it's another case where the regulations do not comply with the plain meaning of the statute. very similar to the situation. what the statute says is that if you make that contribution and they spend it for -- it should be disclosed. but what the regulations, it was narrowed to say it's only disclosed if i as an individual essentially said here is my contribution, and i want you to spend it for political purposes in a particular election. us now with the law says. as the way it was to find. whirlpool that the court will again say that the regulation does not comply with the plain meaning of the stature and overturn that. with respect to the sec as you know it's a dysfunctional organization. unfortunately it has become very

polarized. obviously everyone sees the equities differently. but again when it comes to -- and was pleased that the sec did not actually challenge, if i recall correctly, or losses in that case now. maybe some of them tried, but it was deadlocked on a challenge. i don't have a very get answer to how we can resurrect. i think right now for those of us to believe that disclosure along with 85 plus% of the american people and eight of the nine supreme court justices and citizens united we will have to pursue these other areas. they have been so much in the news lately, but you also have the other five will 1c organizations, five, six. they do represent some of the other secret money flowing into

these campaigns. i mention that there are $300 million of secret money flowing into these campaigns. fact, justice roberts decided that. 256 million of that 300 million is from bottle once you for. that's what the irs review is getting at. the disclose jackets that everyone. so that's why in the simplest, cleanest way to deal with this because it addresses, frankly, the broad range of issues that the eight of the nine supreme court justices discussed and citizens united. >> thank you. what impact, if any, do you envision your legislation having on the learner matter?

>> the learner matter that is currently before congress. >> i'm sorry. this -- the legislation is not related. the issue in the learn and matter goes to this question of how the irs went about trying to make determinations about whether the primary purpose of these 501c4 organizations was social welfare or whether their primary purpose was political. and as i indicated, after citizens united you had a flood of new applications. seven years the irs, it's supposed to make this determination and the regulations, a determination that was never established by statute, as i said, and if you're the irs home, wherever

you are in the country into getting these applications, how are you supposed to go about making that determination? you have to ask the 501c4 for its documents, for what it does it lead and then you have to first determine whether it's political activity or social welfare and then under the misguided and frankly under the regulation never supported by the statue yet to determine whether that is 51% or 49%. what the irs did was they ended up getting the support. they began to put up these places to try and capture groups that we thought maybe involved in political activity more than social offer activity. they fumbled it. they went and put in the two-party and also put in progressive groups that happened to be a lot more applications coming in on the right.

they put in those keywords as shortcuts. that was inappropriate to have a key word, but my point here is the irs was never intended to be in that business in the first place. under the statutes we did not have a primary purpose test. the irs did not have to go around saying i you 51 percent social welfare or 51% political. they said exclusively for the purpose of social welfare activity. that's why it's important we get back to the plain meaning of law . we will avoid these other issues .

>> the sender for competitive politics. you speak about the broad bipartisan support for disclosure and hope that it will re-emerge on capitol hill and referred several times today of nine citizens united justices endorsing disclosure. aren't those justices and is in that broad bipartisan support for the existing regime a disposer which exists for primarily political organizations, contributions, and expenditures by candidates, parties, pacs, and super packs, is a different to do what the disclose sackbuts board to push disclosure says in the organizations that are out primarily political. is that this agreement we are seeing truly new or have proponents of disclosure just sort of moved the goal post and pushed the conversation into a new area compared to what support for disclosure was in the past? >> no one is moved the goal post if you go back to buckley the filet of them looked at these issues. they found for the reasons that i described that disclosure, not

just of contributions, but of independent expenditures in the public interest. why? because voters have a public interest in knowing who is spending millions of dollars to try and influence the vote. because transparency provides for an anti-corruption safeguard as i said, because it also allows a greater ability to enforce the other parts of campaign finance law like our law prohibiting foreigners and foreign corporations from spending money and u.s. elections. a foreign corporation can contribute. disclosure helps us and force that prohibition. right now have the no whether it isn't using the foreign corporation mines for political purposes. again, that's one of the three main reasons the courts have talked about the disclosure.

in citizens united the eight of nine supreme court justices also talked more broadly about disclosure, way beyond contributions to political campaigns. in fact i quoted the section where they also talked about shareholder, corporate disclosure to their shareholders . that's in the supreme court. current law does not require that. our disclose act would require that. it would require corporations to notify their shareholders about political contributions than making, which has eight of the nine supreme court justices said will allow shareholders to determine whether or not the corporation was pursuing their shareholder interest. there's a situation where the supreme court went out of its way to talk about the benefits of expanded disclosure that we don't have under current law. the record is clear where the court is on this. and they have discussed the issues that have been raised by senator mcconnell and specifically address and debated

the issues raised by justice thomas and have rejected them. what is different is that, as i said, but for citizens united you did not have the issue of 501 seats for spending money directly to try to elect or defeat candid it's. they were, by statute, corporations. and 51c for non-profit corporations. by statute they were prohibited from doing that. there was no disclosure regime in place. but there was -- congress made an intentional decision in a 2000 vote to require disclosure of five 2/7 that were involved in spending money to elect or defeat candid it's. but 501c4 at that time was not allowed to do it. it was only after citizens united that became a big issue, at least with respect to direct advocacy. as i indicated, there is already

a whole other issue related to say what i referred to as sham issue and sand that's a whole other conversation. but again, the court has been crystal clear that this disclosure requirement is good for democracy, not just as closure, contributions to people's political campaigns, but the expenditures of moneys to try to alight and feet candid it's. very clear. yes, i'm sorry? >> thanks a lot, congressman, for joining us. i would like to take the upper tentative think arthur for having an and the dali lama and bill gates. you are in very good company. we will assume you live the pope your soon. what do you say, sir, to people

who view metuchen citizens united as another move by the court to become very pro-business and the ways and the group said it will grant certification to? >> let me just say i mentioned at the outset that while i had issues with the final -- the ultimate decision of citizens united, my focus was on disclosure. but since you raised the issue there are serious questions that all the way back to a buckley v vallejo at which time in court the court essentially equated that the expenditure of millions of dollars by one individual wih free speech. so you have seen this, you know, steady rise of money being -- more and more money being pushed into spheres and politics and organizations. my point here today, we can have a long debate about buckley,

citizens united and the fact that it equated free-speech rights to corporations with that of individuals for the purpose of political. and i love to have that debate. what i really want to focus on today was an area where there has been political consensus in the past. and as i cited, you know, "from a lot of my colleagues the one of the three most powerful members of the house republican majority, his own statements about more disclosure is better than less disclosure, all that relates here to disclosure. and so i've really hope that -- fair minded people who actually dig down and all of the twists and turns of the story will dismiss what i think have been some obviously blatant politically convenient remarks by some people about disclosure. it's just wrong for senator mcconnell the stand at this

podium and said the purpose of the disco's act is to go after conservatives. i got the bill right here. show me, senator mcconnell, where it does not. i will work with them. the reality is that there are not any. ..

do you think that there's going to be more evenness among democrats and republicans, lamar democratic groups get involved in this? >> while a couple things, first on your initial statement, i agree few facilities based on the current position of speaker boehner who again full disclosure was against the position of senator mcconnell and enough republicans and others who are it but unfortunately prospects in this congress and the passage are not great, which is why he decided to spend the time they did on the issue of the reporters and irs regulations because it doesn't constitute all a secret spending, it can't reduce the overwhelming majority through

501(c)(4)s and that is an active issue going on right now. as i said, we reserve the right to refile our loss to. this is where the law is so clear. in the meantime, look competent nature of politics is that people will look at their opportunities in terms of how they are going to be raising money and participate in the political process. i don't know how this'll play out. as you indicated, for whatever reason, a lot of groups on the right have chosen 501(c)(4)s, but there are also groups on the left who have chosen 501(c)(4)s and it is possible that will increase over time. i don't know. all i know is i think that whether it is on the right or the left, the public purposes served by disclosure. that is why wanted to focus on that today.

thank you very much. [applause] [inaudible conversations] [inaudible conversations] [inaudible conversations]

[inaudible conversations] ! you are on the david letterman show the other night and he had then asked a guest in the past, i've got to assume ethos of the time. >> did he give you in advice for doing a quick >> well, his advice was don't do it. he hasn't done it, so i asked him if he would join the as a surprise guest. >> what did he say? >> no. i said i pay them. i have a come up with the right number yet. >> your talk to other hosts who

have peered any good feedback from them? >> none. all of them tried to screw me. it really pays me off. that's not true. they were all very hopeful. i called conan and jimmy fallon and craig ferguson and seth meyers and carrot top. already told a joke. thankfully i kind of know them and they were gracious to give me pointers on what the evening is like and all of them without speaking separately they said the same thing, which was it is the strangest, most wonderful evening company name is like no other geek you will ever do. but it is exhilarating and you were there at the president. there's no other geek in history where before you perform, there is zero break between you and the president and before that he sit next to the first lady for two hours.

it is crazy. >> so i'm prepping for any of this, have you gone back and watched with those guys have done? >> i've seen all of them before and i did watch them. yeah, there's only so much you can do before you do it, which to watch ncaa of the land and let the room looks like. so i have a definite grasp of kind of how the net goes, definitely. i'm in for their company better just to funny jokes. it better be good. >> that is a portion of our conversation with transcendent headlining tomorrow night correspondents dinner. watch on her companion network, c-span. >> in the beginning of the war, when you are pressed into it,

you are afraid of the holding gun. but when we went to the first battle. i shot somebody, does something to you. so you have very difficult in the beginning. after time went on it became easy. in the context, this is what happens. denormalized situation you can live through it because if you don't come you actually die. >> the committee for economic development out of spring conference on health care in washington d.c. thursday. speakers include health care industry leaders and executives who gave their divine the future of the health care lot and improving the quality and accessibility of health care. insurance executives acknowledged that there needs to

be improvements in the law, but agreed that it should not be repealed. this program is an hour. >> okay, well welcome back. once again, welcome to ced spring policy conference. our next panel is on health care and the impact on the budget. i think as everybody knows, the affordable care act has help certain segments of the population ever received insurance, but it hasn't helped everybody and it hasn't potentially solve both the object is that we set out to solve. health care insurance premiums have skyrocketed many states rising by 25, 50 and 100%. recently, half of ced trustees who were polled believe aca should be lifted and indefinitely and they are divided between the nature of the u.s. health care system. but it should be five years from

now. medicare also faces financial hurdles. lawmakers haven't put in place the needed reforms to accommodate the over 10,000 baby boomers who become medicare eligible at each and every day. cep has a set committee on health care that is addressing the significant challenges and the subcommittee is in the process now of developing reports on how to aca and medicare can be reformed to be even achieving the object does that were set out in the health care reform. with us today is a distinguished from the health care field and were looking forward is a two-part panel. one expert from the health care field and we will evolve this panel into a panel of current and former members of the house who have worked on health care. here to moderate the conversation is alan murray of

the pew research center that informs the public about issues about trends shaping america and the world. as we all know prior to heading pew research, allen spent 29 years at "the wall street journal," including his position as executive editor of online division. its shares on the governing council of the miller sunil for public affairs at the university of virginia. please welcome alan murray. >> thank you. thank you, steve and thank you for giving me the opportunity to conduct this discussion. there's obvious be that a lot of heat about the affordable care act in particular, how political issue, lots of advertisements. we at the coverage of the website breaking down on the coverage of 8 million people signing up. i fear it will send elmar and get these very articulate

comments from people in the sunlight they preferred the affordable care to obamacare. you should search it on youtube. it is amazing how intelligent people can sound talking about that subject. we are not going to d.c. we are not going to do noise. today we are going to shed light on the subject of where the great panel break here who can look at it and tell us how it's going. to my immediate left, angela braly, ceo will point. next to her, tim rice, ceo of: health systems. helen darling who runs the national business group on health. ron williams, former ceo of

aetna and rayond gilmartin. they have many credentials. you have their bios and i urge you to read them and be impressed, but we are going to jump into the question in here. i'd like to start with you. at the end of the day, there are will make three that matter has to access to care, cost of care and the quality of the care. so what i'd like to do is get the panel to talk about how the affordable care act, given what we know today seems to be doing on each of those measures and i'd like you to start with access. >> i think access was ultimately the goal. when you think about the provisions of the affordable care act they relate to cost and quality, they are either not in there or not in place at this point. we really haven't seen the impact of that. you are right there has been so much heat and smoke about execution and implementation and it's hard to see where they are.

we've got good data and you have all the numbers in terms of additional access. there's just been a lot of disruption. ultimately, that is the most virtuous goal of the affordable care act and one that a lot of people are striving to achieve. i don't know that we have the clarity act around the numbers of hussein, who pays their premium and ultimately what access they got. we also don't know on a net basis with the disrupted previously insured people were and i think it's going to take a couple of years before we really understand those who had previously been insured and the role of the employer. >> best guess based on what they know, will expand? is expanding access to health care? >> yes, it is expanding the number of people who are covered by health insurance benefit

plan, whether it is subsidized, provided by government or bought on the private market. >> anyone disagree with? have expanded access here? >> the missing piece in a lot of states didn't elect medicaid couch is one of the tenets of the plan. for the supreme court decision and from north carolina and they made the decision politically that they are not going to expand medicaid. that's the piece that is missing in the medicaid expansion hasn't happened yet. >> the math here, helen come you got 8 million people signed up for the affordable care act, the also people losing their coverage are dropping their coverage or businesses dropping coverage. do we have any sense of how that is out? >> i think that we don't and we don't know whether angela said

this in terms of whether a covered anything that needed to be covered. they are out of the 8 million plenty of people that didn't have coverage. so even if they lost the covers come in many instances they lost the coverage because it wasn't good coverage. is that a loss? i think probably not. we are already in certain parts of the country costing so much more than we used to cost than we are going to be used in services. we've heard he seen it. just the first quarter we saw today or yesterday and now in the first qua

and understand they will have to be at high tea, high-quality environment at some point and it is going to pay a sum point. but it doesn't yet pay. >> just to tell a story about that. knowing that be have to meet the transportation -- where it's not

volume-based. we decided to invest in developing an accountable characterization. so we have 60,000 medicare lives and we saved about $10 million for the medicaid program in the first six months of implementation. now in our region -- we didn't know this when we agree to do this, our medicare for beneficiaries 20% below the national average service, but we lowered even more and save $10 million of which we get to share half about what the government. so we get $5 billion back. we lost $47 million center hospital operations last year because we lowered emissions, we lowered ed visits. a lot of unnecessary. >> no incentive to do the right thing. >> were in this awkward position right now is trying to get ready because of their payment mechanisms for further payment mechanisms are really there. it is just a terrible time and

i'm not sure how long my board will tolerate losing $47 a year. >> the let's talk a little bit about what it looks like three, four, five years out. i've talked to people -- if you survive, yeah, i get it. all of you have friend insurance companies, providers, but i talked to people who are at large businesses that say this will be money. individuals have to pay and they will demand cost control. >> i think what our goal should be is basically dealing with an efficiency in the health care system as a way of saving money as opposed to company saving money by basically shedding their employees. >> by the way, there's a study this morning. mcgraw-hill said kevin hunt read to $800 billion will be shifted from businesses to consumers over the next two years.

>> so when you like three or four years out, what is the underlying philosophy of the affordable care act and is there a better underlying philosophy that will result increased access to cost control or if you will, productivity and higher quality. i think at ced set the stage for that with her 2007 report in which basically advocating a market-based approach. a lot of the debate within health care and i've been involved in this for 30 years, been involved when i was with the health care leadership council. helen and i have seen each other in many events at that time. up until this point, most of health policy has been in favor or command-and-control for a

planned economy type approach, having no confidence that markets actually work in health care. but i think we are seeing evidence that is not the case and i think where we have to go going forward is to close the gap between where we are now i'm at a market-based system would look like. >> a lot of confusion on this point, the command-and-control, we see this in other countries. they have single-payer plans. this whole framework that was about one of the affordable care to suppose to be america's system, was in a quiet >> it depends we consider to be market. what you say a planned economy come in some respects that the market system. with a heavy government involvement in the management of the economy. the outcomes of that and other countries as well as people with the resources and the opportunity is the public systems. >> would be stuck here just for a second before we go further eskalith you a show of hands on

the panel. which of you supported the affordable care act at the time? we have to do something. >> wait, wait, a difficult question. you did or you didn't. >> it's a little more nuanced, which is i supported the objective of making certain that everyone got coverage and we had a sustainable market-based principles. >> as someone said should i vote for this bill quick >> not for that bill. i would've said so for another bill. >> there wasn't a bill. the answer is i think most people supported the intention of the bill. tbilisi was crafted i think many people didn't expect to be passed in exactly the past. >> i've been working on this for 30 years, looking beyond the

industry which is part of the 18 years and basically dealing with the questions of helping people gain more access to care. with the different underlying philosophy. >> i'm going to come back into the second. so all of you had to do something okay, maybe we can vote for this thing. but has the workout better than you thought are worse than you thought? >> there's been concerns about the technical elements of the bill, which is what we faced and why we were recommending putting on this bill. the execution obviously you brought up in the beginning much more difficult than people anticipated. and yet to answer the question fully, there has been delay on the implementation. so we don't even know. >> is making huge changes changes in the industry.

i'll give you an example of readmission raised stuck at 25%. 25% of the patients discharged garvey admitted. now we are quality. but the quality. the changes in the bill started to penalize hospitals for readmission spirit that dropped to 17% of the two years. so the incentives that are on penalties or incentives, readmission rates, quality measures have had an impact on quality. there's a lot of nuances in there that people say throw out obamacare. there's a lot of good stuff happening that is changing the way providers think, improving quality. we are looking at access really differently for populations because we are now accountable for the care this populations. i have seen the joy go back in the practice of medicine -- we have 800 physicians in this aco. they are really enjoying this

because they redesigning health care. there's a lot of excitement oscilloscopes or other elements of the bill. >> a couple comments, when we have to remember the act had 10 titles at all to hear tonight around the insurance market components. there's a huge difference with him at the act required what produced and i think a lot of challenges can about which is a very difficult process could've been handled handled much better. it's been positive to research. we definitely more research. some groups have problems with that in with ethanol independent take effect. it's a little early to declare victory or defeat on it. it's a huge win. >> ray talked about we should go back with a different philosophy. but the next question i want to

ask you this anybody on this panel think that we should repeal the affordable character that repeal is even a realistic possibility that we should be talking about? >> so how do you get a different policy if you're starting with this bill? >> what is that look like when you pursue this with a different philosophy? you've got a more market-based approach and you say this is what we'd like to see them plays. in the ced positioned 2007, which is the same as today is to have a refundable tax credit to buy a basic policy as opposed to a more complicated system where you basically are offering subsidies. >> so you change the tax credits and subsidies interest rate refundable tax credit. >> simplify all of that. would basically make more insurance options available beyond what is on the public

exchange. >> thus restrict dave. >> tailoring to their consumer needs. and they would have different price points. more channels with which to buy this. so in addition to public exchange, there is a big growth in private exchange. more directly with the insurance companies themselves and basically once you have a need, you have money to buy insurance in a product that's it to you. that is incentive to buy. one last thing. how to get there is any question of repeal and replace. what is the best legislative strategy to accomplish what i'm describing that represents this different philosophy? >> so let's talk about that a little bit. you've got a couple of situations here. one is congress can't do as much of any pain and complicated or

as risky as opening up the affordable care act with the problems and we'll talk about this in the next panel, but it's hard to see that changing anytime soon. second coming of a political environment where insurance companies, drug companies, even to some extent provider networks are the bad guys. people don't always want to listen about how it has to be changed. how do the nose facts, given that environment, hundley gets a better place? >> i think even that discussion and ced 2007 report so focuses on coverage and that is not -- to your three points in the beginning, that is not the end-all, be-all here. if we have solutions that relate to coverage, what about solutions that relate to cost equality? what i admire about that political perspective is do we

have the ability to sustain programs that do produce quality. we have thought a company called caremark. you and i at the end of our lives is the way we want to be cared for. what we've seen over history in programs like the medicare advantage program is a political -- there is a lack of political will to sustain programs over long periods of time that are innovative. actuaries will tell you they want 10 years of data. you need multiple periods of time to pay for things that are preventive and see the results of that effort. i think the longer-term conversation we've need to have in the political round of the policy roundness how do we sustain preventive focus on cost and quality in the delivery system and see the results of her time.

>> and what is the answer? >> the answer is to focus on those things that we know work and not have unreasonable expert patients in terms of the data and let the actuaries work over some sustained period of time. >> would have to be realists take about the political situation now and the reality is very things that anything the demagogue will be in the short-term or long-term and starting over as good as it sounds and is ideal as it might be is just not practical. it's probably not going to happen. if the lower repeal than we had to start over, we'd be here for another 30 years. the last time it major legislation was 1965. it took a long time. it wasn't because lots of people

trying to make these things happen. there is a congressman. there's some here have devoted their lives to trying to reform the u.s. health care system. so there was this unique combination of elements that produced the sausage making us who refer to it. we have a law that has all sorts of things in it that are themselves dysfunctional and the regulations have been in ways that go way beyond the law, which hasn't been talked about. i guess he mentioned it. and the way to do with some of these things is to put pressure to modify and take away some of the things that are working including perhaps making those people sitting in exchanges less regulatory minded and those inside hhs who think the answer to all problems is to regulate more.

changing people's attitudes, modifying things come to keeping them from doing things that are harmful and then not try to start over. tuscaloosa say. >> i think we have some great examples that we can emulate. for example, the way the exchange model is structured today, the only way to get the subsidy for the member is to purchase through the exchange. if you look at medicare advantage, which is a highly regulated program, good quality with many innovations, the member can buy from any health care they want they are buying a product. one of the simple things we could do is simply eliminate the exchange about the point about which the purchase needs to be made in that way we eliminate another level of regulation. we have the commissioners and all that represents another layer of complexity.

the other thing we have to recognize is the whole hospital and cared for every system is going to be asked to change its business model and changing the business model in your current business model is what pays the bills to a model that doesn't provide you enough revenue is a very tricky proposition and what that means if the institutions that will fail at it will be the institutions that serve the most needy populations we have because garrity has margins. the receiving subsystems it, local and other governments. this whole question of how we as a country move to a different kind of model that is based on value created in the system and not paying for activity is a very complicated critical issue for us to make the kind of success we want to make. >> if nothing else happens, will he get there? to inevitably push us in that

direction with a lot of disruption. >> i don't think it's clear because if you look at the data and cost, even everything we are saying, which might move along incrementally and maybe even slowly is going to be blown up if we don't do something without cost. the underlying forces that are driving cost, and putting the ones we heard about and now we are going to ideally ensure many, many more people. we are turning everybody into the blank check that has gotten to where we are today the third-party payer and the government for employer. >> if mcgraw-hill is right on these expenses are going to get pushed off on the individual, then the third party payer system disappears and put

pressure on costs, don't they? >> as long as we have out-of-pocket limits and other things like that. there's lots of people who take care. until that changes in a much different way, we don't see evidence that is controlling cost you. >> in terms of controlling costs, changes his business model is is that perhaps more controversial or provocative approach is to allow new business models to enter the health care delivery system. so for example, one of the co-authors of the original ced report wrote a book who i worked with at harvard business school and the innovator's prescription to allow innovators to enter the market. meaning retail clinics, specialty hospitals, chronic care hospitals as a way to deliver health care at lower

cost settings of higher-quality outcomes. >> some of his top aide. >> we've had this discussion. my uncompensated care last year was $225 billion for taking care of people. a shift that to everybody else. that's how we're subsidizing care for one population to pay for other populations. as we allow for innovation, trying to figure out how to work with the retail clinics and incorporate them, so it's not just a one-off visit the patient record is here. we've also got to think about the safety net providers so they don't have a lot of surgical centers to teach us a surgery patient. it leaves me with the medical complex patients lose my shirt on. there's free-market and technology and those who do seem

to have provisions so we are open with a program and all that other stuff -- a surgery service. >> the key is you are saying is one could envision and the more delivery system and accountable care organizations, which are loose affiliation to integrate the delivery systems. one could imagine, yourself, or example, and integrated delivery system that had within a focused or specialized entities. and so you would be benefiting from the higher-quality cost of delivering the setting at the same time that benefit her hospital. >> we moved all ob from six hot listen to the ones on her peer qualities amazing, service amazing. we have one hospital that does give your house. we were close enough to do that.

so i absolutely agree with that premise and i also think as a nation we need to close hospitals. some hospitals don't need to be of some of these communities. i have a hospital in a rural area at another hospital for two miles away and there is no rhyme or reason to have to hospitals for two miles apart. the community starts with high school football. they would never go to the community or hospital care. we can't have an economy that supports to rojas is for two miles apart. those are tough made decisions because the hospital is the largest in both of these communities the largest employer. they are unwilling to the discussion of a rational system in county. >> coming back to your earlier question and how you've been involved with things that the medicare drug benefit and so on, i'm optimistic of the conversation has been up until this point because the things we are talking about i think would

have brought public support. the changes that have been made to the affordable care it can be just reinforces this is how it is. >> so let's stick with the political piece for a second because they're some of the things that have bipartisan support. i do know a bipartisan legislation looks like anymore. the affordable correct wasn't bipartisan legislation. do you think this can be fixed on a partisan basis, angelo? >> that is a tough question. the problem needs to be fixed through the element of the free market that are still there that could do this. so for example, what jim has to do, going back to the past when we shared risk with the providers specifically and then they make the decision if they're paid, if they're

compensated through probably risksharing mechanism, they can make a decision about well, do i need that person to go into the regional hot fiddler can i do telemedicine? and can we do it online? before we look for a legislative solution, we have to make sure that if at all we scaled back some of the efforts to regulate what i think could happen if the free market were getting into the risksharing model. >> was mentioned the sgr, so-called sustainable growth rate. here is a problem that almost everybody agrees needs fixing. it initiates the most respected role in the country, doctors. everybody agrees that it's a bad idea. everybody agrees it is dysfunctional in every way and yet we cannot pass legislation that fixes that problem and that

is politically we can pass it. we rarely have this combination of factors that are operative. so i would like to be out in this state, but i don't see if we can't solve some pain as simple as that, how are we going to solve something very complex like a whole new love that would affect the entire hope economy? >> you know, i think also along the lines of this congress nation about what changes would you make, one of the themes that i think it has been left out of the current design is a physician patient relationship in terms of this whole idea that we can expect physicians to do the right thing unless we give them contains. verizon sent this entry the discussion are intrinsically motivated to do the right thing by their patients. similarly with hospitals in terms of trying to achieve quality improvement by sort of very targeted incentives, just

walks in current practices and limits the creativity that team would have in terms of how to make a dramatic in our cross structure. american manufacturing in the 80s move

>> i wish you wouldn't use that phrase, winners. that's -- we don't exist to win something. we exist to care for our community.

there are communities where physicians have coalesced and have created mechanisms and then brought hospitals in and the hospital is part of the network. we lad to do the opposite because the physicians wanted to lead but didn't have the capital to do it. so we have a very, very strong physician organization, and i kind of jokingly say, some day our six hospitals will just kind of hang off the physician aco organization. that may be what happens. the hospital is going to be diem fa sized so much more in the delivery system of the future. we're restructuring our leadership team with that in mind we are so much outpatient focused. we have 360 employed physicians on the medical staff of 1200. it's just changed our organization. i agree that hospitals don't have to be -- i dope like this idea of member winning and losing. we have to figure out who can do what best. >> i'm reminds of michigan that a nun that i worked with once

who ran a hospital very effectively instilled in me, no margin, no mission. >> i think we go one step -- >> no margin, no job. >> i think you go hospital, doctor, let's talk about the patient. and in this model i talk about they have as many social workers as nurses, because some of the issues are very -- if you're being very patient centered and the issue is, is that senior medicare advantage member going to be at risk for a fall? then maybe you need to send somebody to their home to see if they're surfaces are going to create a fall. so, i think if we are really starting with the consumer, in this case the patient, and work backwards from that. , those are the solutions we need to allow to the free market to evolve and the healthcare delivery system. >> let me tell a story because is a exactly -- now the

incentives within the aco is to save medicare money, and you have how much medicare spent on that population in prior years is your marker. so we get to 60,000 medicare patients assigned to us and we go into the data and we find mary. mary has been to the er133 times in the prior 12 months. that's amazing. now, we have -- she was smart. her problem was she is wheelchair bound, has amputation. she doesn't have a wheelchair ramp. she is diabetic. doesn't have a refrigerator. so every couple days she starts to feel badly because her diabetes is out of control. she can't get out of the house. she calls ems. by statute you call them, they have to take you to the hospital. so everytime the ems comeses they say, which one, and we would pick a different one, and she would come in and get fed and her insulin and take hone, put back in her house without a

wheelchair ramp. so we have become accountable for mary. we got a local not for profit to build here a chill chair ramp. buy her a tomorrow fridge. work with the home, care company to work with her, we give heir insulin. mary in the last 18 months has not been to the hospital. quality of life so much better and think of what we're saving society. we turn the incentives on their heads, and mary doesn't need a lot of medical care. she mostly needs social care, meals on wheels. we have to restructure the incentives. >> i'm going to open it up to the group in a minute. let me ask you first, get a quick show of hands. on this panel -- you talked about what you think needs to happen. any chance of major legislative changes to the affordable care act in the text two years ump if you think yes, raise your hand. really. you're a below man. next four years. next four years, raise your

hand. we're getting there. next feign years. questions. >> angela, you talked a couple times -- i think tim was just referring to this as well -- about the long-term perspective. i'm not a healthcare expert but i always thought that the basic premise of the affordable care act was to give people insurance, they'll take more care early on, and fix problems. so that at the end, unless we just -- since we're still not a society that just doesn't give care, we dent have to amputate legs or deal with the very expensive things at the very end, and if that was the premise, then you would expect to see in the early years precisely what we're seeing.

is that premise right? if it is, how come we're not talking about it like that. >> a couple of things. one, it's going to take the transition in the delivery system. so, in my example, if you're paid more for the kind of disease care than the preventive care, than you're still going to end up with expensive disease care. >> mary came to the er. >> he made more money on mary before. that's the reality we're talking about. the other thing is there were attempts in the bill to actually took some of the consumerism away because they were first dollar coverage or beliefs they were paying for things up front. one of the trends we were seeing before that, though, was that consumerism was having an impact because there were accounts that people owned and paid for their health care and, so i think we main took one step forward and one step back, and that's why

we're not necessarily seeing everything you're talking about. >> so, actually, we're going to spend a lot more money and the amount of additional service use that we're going to pay for at ever higher prices will still be more than whatever we save on the marys. think about it. there's prevention by itself broadly does not save money. it saves money in individual cases. so, if you find one lump, and that person gets treatment at an early stage, that person is going to suffer less and cost less. but we're going to be screening millions of people who would never have that lump. and you can good through -- this has been well-documented. you can go through case after case, and actually in one of the things that happened with the affordable care act -- this was not good -- they said that any

service, so-called preventive services that meet certain sign -- scientific body that will be paid for at no cost by everybody that is cords. that that's good news. the bad news is that particular group is a group of scientists that know nothing about coverage decisions, about what happens when you authorize something that is in america endless in its ability to cost money. that is already happened. so we have built in a future of -- if we don't do something about it -- endless new services defined as preventive for somebody, to screen everybody to find them, and then we will pay for all of that and it will way, way outweigh what we would save for the cases we find. now, maybe we want to do that as a country, and in fact we have decided in many instance wes do want to do that. maybe the right choice.

but it is going to be incredibly expensive, and it will not save money. it may be the right thing to do but it will not save money. >> just a brief comment, which we haven't talked.much, which is really health literacy that consumers have and their engage independent their own held. when i was at aetna we took patients who had a heart attack and we said your medication is free no cost at all. we had another group where they had to the standard copay. the good news is that the group that was free did better than the group that had the standard copay. the bad news is, when it was free, we got people to take life-saving medication 55% of the time. so it gives you a sense that consumer engagement literacy, understanding the medication is a huge issue and simply because it's covered and available doesn't mean the patients take it. >> other questions. >> right here.

>> i have a question about cost. talk about costs as though it's the same across the country or even within country. it is order of magnitude difference between regions even within the same geography. to what extent is the massive release of data that cms and others doing going to change this equation and anything to help make it more productive to help influence costs and quality? >> it will expose and it that may cause some action, but by itself it's not going to do anything. we have had documented for 30 years that variation by area, and it's huge. and it's interesting. i think what is going to happen is now that the federal subsidies are required, what we will see is that if you live in minnesota, because of the prudent practice patterns and much more efficient delivery system they have there, they actually cost a lot less.

so, there will be very few people who will need a federal subsidy in minnesota because the coasts are so reasonable. you good to oklahoma city, mississippi, probably south carolina, north carolina, you will see that they're going to be lots more federal dollars going into those markets because they're much costlier systems, less efficient and have a lot more unhealthy people, and maybe when they begin to do the national analysis and see how many hundreds of billions of dollars are going to some of these places as opposed to some of those who, by the way, are probably paying higher taxes to cover those so the federal match on that will be considerably -- the minnesotans, all their healthiness and good practices are going to cost them money comparatively because they're paying for all the places that are inefficient and full of people who are very unhealthy. >> but transparency has to help,

right? transparency has to improve the situation, when people see the craziness. >> but transparency has to extend to what is the quality of okay that an institution or organization delivers there was an article the other day that highlighted the fact that a study showed were -- people were choosing hospital biz outcomes. and you can see admissions going up in hospitals that were high are quality and admissions going down in places that didn't deliver the same quality. i think transparency about health outcomes is now -- there are difficulties with that because people are concerned that people like ourselves can interpret that data, it's too complicated. hospitals have different demographics in terms of the patients they're -- i think

those can be solved, and i think we as consumers are very capable of interpreting quality data. there was a presentation i heard -- because i was involved and initiated a program called the harvard program for health improvement, and i actually -- her presentation by very sophisticated person saying we, consumers, don't understand quality and we basically attribute the quality of the food and how nice the nurse is and things like that. i think that when you have the data and realize the range of possible outcomes in terms of surgical procedures, that consumers are very sensitive to quality differences, and i found it interesting that the study said even if the information is available, there's a way that somehow we gain access to and it choose the better hospital. >> tim, you agree with that? >> i do, and i'm all for transparency. because we are the community's

healthcare systems. they ought to know what we do well and don't do well. so we put a lot of data out there. but ray -- i met with a gruesome that sews proud of our quality web site, and they hated it. it's complex. so what matters to you, when you're getting your knee replaced, is very defendant than someone getting -- different than someone having heart surgery or someone having a baby. so we have to put it out there and let people figure it out but we have nod found the holy grail. >> i get the sense and the heart of the question is about, so shouldn't transparency drive behavior? so if a colonoscopy says hundred at one place in town and $5,000 at another place intown, is the hope of those kind of tools, the hope of what the dartmouth atlas project has been working on for years, is to try to point those things out? i think at the heart of the ced proposal, even back in 2007, was

to say, in order to be incentives to use the tools and then follow with behavior, you need to have something at stake, which is the consumerism piece of health care, if my colonoscopy is free where i go to 1500 one or $5,000 one, it's not a match. >> you have to have something at stake and have to have quality data as well as price data. you need both to make a decent decision. >> other questions, comments. cries of frustration. chance of hope. go ahead. one here and then win in the back. >> tony with kaiser permanente. i wanted to thank ron and ray for really continuing the ced leadership and pushing purdue and refreshing the ideas ced has been a leader in. i will be sure to provide amp comments into the work. some supportive.

some challenging. >> i've been there. >> helen, you have been fantastic in terms of pushing the providers and carriers to look over the years and that's fantastic. and, tim, this is he first time i've seen you speak, and my goodness, we have to keep you in this discussion because you're doing the work that actually needs to be done and highlighted exactly all of the problems, and, angela, you have been great in the same way. the question i have -- i'm really glad you got to this opinion -- ties back to the point around health care as an economic entity in communities and this issue of health-related social services being used to change the nature of the health care being provided to people. how do we make that shift? because right now, there's really -- those services exist in the communities but not nearly in the kind of volume that you'd want to see to be able to spread it across the whole community. and at the same time, how do you do it in a way that doesn't

medicalize it and create the same kinds of economics that have been a challenge for us as we medicalized other things driving the cost up. >> that's a great challenge. we have a whole new piece of our strategic plan. we want to become one of the top ten healthyess communities in the country. where do you begin to chew on that elephant? i know we're not trust -- we're a big bureaucracy, so the more we cannot control something but get people to the table, and a lot of our re-admission work has been that way. we don't want to control that. we want to get the nursing homes, home care providers, hospice, let them run their organization, but get them to at the table to work with us. we have to figure out houston to crack the nut. we have a for exampled social system that needs to have some organization to help us do that. >> i think i've seen some great models where that's happened. some of the best delivery systems in the country, groups

like kaiser, intermountain, are combinations of health plans, physician groups, hospitals. a lot of the health plans are creating virtual relationships with the plans do what they do well, physicians do what they do the hospital, and they link the services together, whether it's in the workplace, behavioral health services, and create a model with the right economic incentives. the system has to be able to take the resources and deploy the resources in ways that make sense to manage the health of that population. that might be a bus to pick them up and take them someplace. might be home visits. might be a lot of things for which there is no code for reimbursement but it can result in better quality of care, better outcomes for people in that community, and i think that kind of collaboration is really fundamental to this next level of innovation. >> my new partner on our healthcare delivery team is a carpenter to build wheelchair ramps. >> there you go. one thing that will be

interesting to watch is the dual eligible pilot program. these are people who are eligible for medicaid and medicare, and so we know their needs are beyond medical. they're very social and community-oriented, and so if we create the right infrastructure, with the -- our create the right program within which people can innovate that will be a very interesting place to watch. >> last question. >> just -- my name is david young, i lived in oxford, inning lend, for 40 years so i've been under the national health service. and we have coverage here with it ma, and -- aetna and i use merck drugs here there and. i just want to commend you all because in a lay, looking at america from abroad and teaching at octoberford, if always said to my students americans are prop are problem self-ers and this is part of our dna. i want to commend you for

putting this panel together. where is the light at the end of the tunnel that the woman in the middle saying, we have to solve this, the politicians deny it. how do we do and it is the answer in what ray was saying in the private sector somehow comes in there and somehow forcing the politicians into a position where either they are seen not to do anything and not to solve it, or are they going to do something? >> it's a perfect way to end the panel and i'm going to make all of you answer it. tell us where the light is at the end of the tunnel. helen and. >> so actually, would sale the light is the private sector. for example, we talking about health services and spending and all that. the problem is we have unhealthy people who continue to make lifestyle choices that work against them, and drive a need for the kind of care we're talking about.

amputations usually from diabetes, which themselves were from untreated diabetes, medicare pays for lots of amputations. so we could stop having the maries and others if we change the way we thought about preventing through a whole very site of things. the private sector, for example, almost all large employers now have programs that, among other things, either pay or make somebody pay a penalty if they don't begin taking steps to choose and live a healthy lifestyle and it's almost universal. the number of programs are fantastic. they're exciting and making a big change. i see great hope the. >> forget washington. focus on the private sector. >> yes. and the real world. >> light at the end of the tunnel, good ahead. >> i'll second that. we have been complaining that health care didn't have the technology that everywhere else and industry had, and i think they're coming. i talked to a lot of people who

are trying to come up with a new app or the new data analytics or whatever to change the healthcare system. they're frustrated with the pace at which change happens in health care. but they're doing it. because they know there are opportunities there. so i think when they start to hit, that we're going to see some real opportunity. >> tim. >> i'm excited about the future. i'm an opt miss and -- optimist and we have chance to redesign healthcare delivery and despite what happens in this damn city, we're going to do it. it puts the hospitals, physicians, everybody, together to try to solve these problems. so i'm seeing some great things happen in spite of what might happen here. >> i think the light the end of the tunnel are really collaboration, supported by the large national employers. when i was at it ma we had 15 million members in the fortune 100.

these were sophisticated companies, cared a lot about their work force, invested in innovation, also looking for theurgies brightest solution to get their work force engaged, and i think they are really the source of innovation, at least in the care management, case management, consumerism, transparency, engagement, you name it. you couple that with collaboration on the delivery system where health plans and physicians and hospitals finds way to align incentives and there's a strong -- >> the only question i have about that, the emphasis on the employers, if they're going to offload this responsibility -- >> i don't see it. >> you don't believe the hill report this morning? >> in the near term, because employers don't -- you have the work force you have because you need them in order to achieve competitive advantage, and you don't warrant -- don't want to creatings that create dissatisfaction. >> the big guys won't do it.

>> light at the end of the tunnel, ray. >> having labeled myself as the optimist by vote in terms of legislative changes happening in two years, i think that -- i foresee an emerging consensus about what the next step should be to take this to a market-based system. i referred to that before. if you uthought it straightforward as the administrative changes made already, which recognize the fact that people want access to a variety of insurance plans that fit their needs and at the price they want to pay. secondly, that there is a solution basically to affordability through a refundable tax credit that everybody would have. the ced policy. i think that these are fairly straightforward approaches that consensus in congress could be built around. and then couple that -- what i would say, the importance of

that is that the great thing that tim is doing and other health systems are doing in terms of innovation, in order 0 to continue that we have to make dramatic changes than the affordable care act. >> this is the perfect segway. four members of the panel who say, forget washington. the interesting stuff is in the private seconder. ray sees an emerging consensus. you got special glasses there, i'm not -- but we're going to have four politicians up here on the stage next. >> when i was advocating the prescription drug benefit for medicare i was attacked from the right and left and we got a bipartisan program. >> more power to you. thank you, great panel. [applause] >> just get the -- just get the next panel up here right away.

>> join us for the annual white house correspondent's dinner. the entertain. is joel mchale. our coverage picks up saturday at 6:00 p.m. eastern with red carpet arrivals followed by the dinner remarks. we had a hans to catch up with mr. mchale earlier this week. here's a brief look. >> you were on david letterman's show the other night and he had been asked, i guess in the past to host -- ii have to assume he is asked all the time. he is david letterman. >> did he give you any advice? >> his advice was, don't do it. he hasn't done it. i asked him if he would join me. >> what did hi say? >> no. i said i'd pay him, and i also got -- i haven't come up with the right number. >> you messengered you talked to other hosts who have hosted -- >> yes. >> any good feedback from them? >> none of all of them tried to

screw me. not true. they were all very helpful. i called conan and jimmy fallon and craig ferguson and seth meyers and karat top -- i already told that joke -- i called all those guys and thankfully i kind of know them and they were very gracious to give me their -- give me pointers on what the evening is like and how -- and all of them kind of without speaking -- all separately said the same thing, which was, it's the strangest, most wonderful evening. meaning, it's like no other gig you'll ever do. it's bizarre. but it's exhilarating and you're there with the president and sitting next to the first lady. there's no other gig in history where, before you perform, with no -- there's zero breaks between you and the president. and before that you're sitting at the next to the first lady for two hours. it's crazy. >> so in prepping have you gone back and watched what has been

done? >> i've seen them before and i did watch them, and, yeah, it's -- there's only so much you can do before you do it. which is to watch and it see the lay of the land and see what the room looks like and see -- but -- so i have a definite grasp of kind of how the night goes, definitely, and then from the you just better have funny jokes. better be good. >> that's a persian of our conversation with joel mchale, headlining tomorrow night's white house correspondent's dinner. watch the dinner live at 6:00 p.m. eastern on our companion network, c-span. >> a look now at u.s. graduation rates from today's "washington journal." it's about a half hour. >> focus on the high school graduation rate now exceeding 80%. jennifer is an education adviser

with an organization called civic enterprises. good morning. thank you for being with us. >> what did you learn? 80%. >> so, we put these reports out annually, kind of measuring the graduation rate across states. and for the first time ever, we're using this new graduation rate called the adjusted cohort graduation rate. and it is the gold standard of graduation rates and actually measures individual students rather than just kind of taking a measure of a ninth grade cohort compared to them three or four years later. , it is an extreme positive. we are very happy about it. there are challenges. we want the nation to be at 90% at 2020. that is the goal.

to get there, there are a lot of factors. what is going to have to happen to get us to that 90% rate? including low income students, closing the gap between social education students and their general population peers. the big-city challenge, we still have challenges in urban areas. we want to make sure that all students are graduating. accelerate graduation rates for young men of color. host: i first want to point out that there are three states in gray. guest: they are on waivers. they have issues with their data system. they are not currently reporting.

they do report the other graduation rate that we use >> the gradation report is at 81%. so in some ways, the 80% total is there but they are not reporting until next year, i believe, once they get the issues worked out. >> in your homestate of pennsylvania and moving south into illinois, virginia, indiana, ohio and michigan and they are in light green which means what? >> they are on pace to reach 90%. light and dark green is 90% on pace. those are positive and states where we are seeing things we want to be seeing. >> new york, north and south carolina, florida and arkansas. >> those are states we are

concerned about because they are not on pace. they will have to move at a faster pace. >> among the bright red? >> they have the lowest rates now and need to make tremendous progress. >> how do they get there? >> that is a good question. in nevada, we are seeing large gaps between special education students and their general education population peers so that is something they are going to have to oversight and investigatio investigations -- overcome and close the gaps. this report doesn't address what states are specifically doing or not doing but it does ask a lot of good questions as to how can these states that are falling oh

so behind why they are falling behind and what needs to improve. >> critical areas of improvement. to close the opportunity gap between low income and middle to high income students, define the opportunity gap first. >> it is simply that we are seeing middle and high income students graduate at a much higher rate than low income peers. there is a 15% point gap between low income and non-low income. i believe it is 30% in indiana and more than 30% in a state like minnesota. >> your second point is solving the big city challenge. >> correct. urban areas historically have been home to our, you know, dropout factories, the schools that have a 60% or less

promoting power. they are the areas that we are seeing the high schools not graduating a tremendous amount and if is 50-50. urban areas are the site of where many reforms are targeted, but there is a lot of help needed in those areas. in new york city, for example, they educate a huge percentage of the new york state student population. if they don't raise their graduation rates in new york city, the state of new york isn't going to reach that 90% goal. >> the third point you mentioned focused on students with disabilities. why is that such a big program in terms of graduation rate?

>> there is a couple issues with that. students with disability make up 13% of the national cohurt so if we leave them behind we will have major issues. we see states doing really, really well and they are graduating a lot of students with disabilities. in montana, 3% gap. arkansas, 5%. hawaii and kansas have 8% gaps. but that is small. there is a 20% gap nationally between students with disabilities and the general population. >> and your final two points focus on california and deal with minority students. >> correct. california is a massive state. they educate 14% of the national

graduati graduati graduating student body and 20% of low income students nationwide. so without california moving ahead we will not reach the 90% goal. and similarly like with low income and the big city challenge, the data isn't broken down by race, ethnicity and gender. but rates of young men of color and african-american and hispanic males is far below the national average and they have to be addressed. >> thank you very much for being with us. we want to get to your calls and comments. and we are dividing the calls

between these who graduated and those who dropped out. that number is on the screen. >> host: before we get to calls, do you have a sense of those who dropped out of high school how many go back and return to get a ged or complete a high school diploma? >> guest: we know there is maybe a 2-3% i believe rate of those students. and a lot of states do measure five-year graduation rates, six year graduation rates and measure and they are strengthening ged's. i don't happen the exact rate. but we know there are more graduates than dropouts. that number would, you know -- i think a lot of people want to look at 80% graduation rate and say 20% dropout. but that is not the case. there are more graduating through other method or means.

>> host: matt is on the phone. when did you drop out of high school? >> caller: i dropped out in 2010 but i was lucky enough to use the hawaii job core problem, part of the department of labor here in hawaii, which did allow myself to actually get a high school diploma degree through a competency based program in the hawaii state department of education and i would like to say that hawaii is a model for other schools in regard to other districts in regards to the higher graduation rate percentage here in hawaii. and i believe arnie duncan the secretary of education secretary spoke out and said hawaii is a star in bringing up the dropout rate and making it a greater

rate of passing in the past. >> host: we will get a response. thank you, sir. >> guest: he is right. hawaii is a model. they are doing well in terms of their graduation rate and overall rate and in terms of the gaps i talked about. they are high on the list of gaps between now income and students with disabilities and the general population. hawaii is fantastic and congrats on going back and using these resources. that is what the report wants to hone in. how states are raising the graduation rate and how they are doing it and encouraging students to come back who may have been disconnected. >> host: our guest taught fifth and sixth grade.

dino is here from georgia. good morning. >> caller: i went to high school in the suburbs and we had a year where we merged the inner city schools with our high school and saw a lot of good results from that. i was wondering if you have been intr -- introduced that idea? >> guest: we don't get too much into those specifics in the report. you know, i know that is something that has happened around the country in different areas with mixed results. i am glad to hear there was success in this area using those methods. it is something that is going to have to be looked at. we are having success in the suburbs but not the urban areas

and we need to look at what can be learned and what is working in certain places that need to be addressed. >> host: you talk about the dropout factories and say there are 200 fewer dropout factories in urban areas in 2012 compared to 2002. but most have the graduation rate in the 60s and several in the 50s. >> guest: correct. we are seeing this dramatic decrease. dropout factories have decreased by almost half. it is a positive to see that but the majority are in the urban areas and they are persistent despite the fact there is targeted federal and state resources at these schools. the good news is that in

addition to seeing a decrease in the actual schools we are seeing a decrease in the number of students that are attending these schools. so we know fewer students are attending schools that have the poor record of graduating. >> host: another point is to make sure kids are college or career-ready. on that front, how are we doing? >> guest: that is a good question. there is not a perfect measure of college and career readiness and that is something we need to take from this report and say what can be done to make sure that students are college and career ready. is there something measuring it or does more work need to be done. there is a lot of debate around the country with what college and career ready means. i think it will take work from a lot of people coming together,

especially k-12 and higher education together to determine what that means. >> host: this tweet says is it worth it having grad graduation rates but they need remedial classes? >> guest: that is a great question. in california they saw that. we are graduating students but they are coming in and not prepared. so they undertook efforts to prepare the students more to make sure when they were in the state higher education system they were prepared. they have had great results. >> host: joe is on the phone from indiana. if the founders were listening to this conversation they would be appalled to hear after

college and career ready ballot box ready. it isn't enough to be handed diplomas for swallowing teacher union democrat brainwashing uncritically. you have to be ready to cast your ballot on election day for somebody who will keep the country safe like your last guest, i think his name was dubwitz talking about nuclear credibility. you are talking about 6th and 7th grade mind sets of people like hussein. you have to have education of ballot business other than being handed a diploma because that will not stand up to anybody like saddam hussein.

>> host: to the earlier point about what these students are ready when they go to college, workforce, grad school. >> guest: yeah. we talk about that in the report. it isn't enough to graduate them. it has to be more than that. they have to be ready to go out into the world and be successful. and you know, we talk about -- especially in this parts -- one of my favorite parts is making sure the whole child is ready and social and emotional learning and making sure it isn't just academics and they have other skills that can be applied in the real world. and that is tough because what are the stills needed and how do schools teach them and measure them. they do need to be civic ready in addition to college and career ready.

>> host: i want to talk about the phrase dropout factories and the number of high school factories has declined in the last ten years. explain that praise. >> guest: dropout factories means a school that has a promoting power of 60% or less. the way it is counted is in the 9th grade they count the cohort of students and look at the 12th grade level and 9th grade level. it isn't a 100% accurate reading but it gives you a good look to see what is happening between 9-12th grade. and these are schools that have 60% or less of their students are graduating than what they started with. >> host: how and why did you get

involved in this issue? >> guest: i have a background in education and i was a teacher and i think it is important to be involved and to know these things. i think what is is great about this report is in a lot of ways it doesn't feed into the controversy that we see in education debates. it is very much just a look at what is happening and learning at what is happening and looking at trends. it is a positive. there are positive things going on. to me, this is the direction that we need to be going in education; to look at what is going on and having an honest, open debate about getting better and bringing as many people in to get fixed. >> host: gloria is on the phone from white city, oregon. you dropped out when?

>> caller: 1965. >> host: did you go back? >> caller: i got my ged at 23 and took nursing training and i have been a nurse for 40 years. >> host: why did you drop out of high school and what impact did it have on you? >> caller: i was from a poor family. but that wasn't high. it was just -- the things i was learning were boring. sitting in school all day and then being sent home with a couple hours of homework -- these kids don't learn how to do any kind of work at home or anything because they are sitting there, studying, and i feel that the teachers are doing their job no body should be

going home with homework and i think that is why a lot of kids dropout. their are doing school work for 10-12 hours a day. and it isn't right. >> host: gloria, thanks for phoning in and adding your voice to the conversation. >> guest: she is right. civic enterprises did a report called the silent epidemic and put the crisis of the low graduation rate on the map. part of what students who were interviewed in the report said they dropped out because they felt disconnected from school. they didn't think they were learning in schools what was going to succeed in life. and that is a significant problem which is why throughout the report we give examples of

programs that are trying make sure students are not disconnected and getting the adult and peer support they need and getting more personalized learning. that they have options beside sitting in a classroom, you know, for 10-11 hours a day or doing, i cannot speak to the homework issue -- i know a lot of schools have cutback on the amount of homework but i know that is still a significant issue. we don't address that. but we address the fact we need to keep kids engaged in schools to keep them on the track to graduation. >> host: if you are just tuning in our focus is the high school graderation rate in 2012. it reached 80%. you can read the full report online at civicenterprises.net.

we have a tweet what is the number one reason people dropout now and is it different from the past? >> guest: i don't know if there is one reason. but this disconnect is one. there are other factors. there are early warning indicators and this has come out of the awareness of graduation rates. att attenance, behavior problems and course performance and they show us starting in the 6th grade a students has indicators and shows they maybe offtrack to graduation and might be falling between the cracks. and so, you know, there is all kinds of factors that factor into a student graduations. chronic absentee coming from illness or needing to take care

of family members or leaving to get a job. all of those things play into whether or not a student stays in school. >> host: lettie makes this point: i grew up in poverty in brazil and the only hope i had of improving by life was education. tyrone is here. >> caller: i am talking about the high school in new york city. i was punished for analytically thinking and critically thinking and opposing ideas because i had a creative mind ever since i was with a young person and they would suspend me for asking conforming question about the programming being passed down and i could identify it early and i was cast away because of that because of the pop culture was being ignorant and it

probably is. i graduated in 2006 and college in 2011. is there any plans to put tra transdental subjects in school like for example, job creation. these kids are not going to come out and can for a job. there is no jobs for these people. and another thing is pop culture. explaining the objective of pop culture. >> host: tyrone, thanks for the call. >> guest: i wish i had a great answer to that. we don't necessarily look at that in the report; exactly what schools are teaching. we know that schools are being held to standards and for any other number of factors there are, you know, reasons why curriculum is chosen. and we do want students to be critical thinkers and to be able to leave and be ready for

college career, like i said, earlier life and civic being part of being a u.s. citizen and being able to critically question things. so i cannot speak directly to his high school but i will say he made a point about being disciplined and we do talk about, and something the administration has brought up recently is the issue of discipline and making sure that discipline is fair and that we are not using that as a crutch and using that to get kids out of classrooms which we know leads to dropouts and things like that. so i am glad he decided to stay on the right path and graduated from high school and college, but our report doesn't go into the specifics of curriculum what is going taught. >> host: full report online at

civicenterprise.net. this is our next question: >> guest: when a child has active parents and family in their education there is fewer behavioral problems. there is fewer attendance issues, more likely to graduate from high school and go on to college. so it is a huge factor. it is something that schools need to take into consideration when they are looking at the broad scheme of things that can help them get students on track to graduate. >> host: jimmy from odom, texas. good morning. >> caller: my comment is if they would have int intelligent peop

running the schools versus educated they would have better people running the schools. >> guest: i think there are a lot of smart people in the schools trying to make better decision. >> host: this tweet from ron: the numbers mean nothing schools could be handing out the papers to get the numbers out. there is no standard. and we have the debate with leave no child behind and now common core program and people are arguing we are teaching the students to take a test, not teaching them to learn. >> guest: i think there is validity to that debate. we don't dive into that. but there is an issue of what are the students really learning. but i will say this, we have raised the standards, you know, in the past decade. we have made sure that there are

not just these diploma mills that are handing out pieces of paper and that is not an acceptable practice anymore. there is more work to be done to make sure things are changing and students are learning. this something we can learn from and continue as we go down this path. >> host: last call from ritchie in mount vernon, new york. good morning. >> caller: good morning. i would like for this lady to understand that there are two people that should be involved in the education of the people, especially the black children. and that is michele reed and ben chavis. if they were involved it would be better than it is right now. guest >> host: you know both of those individuals. >> guest: i do. i would rather not jump into

that argument. there are a lot of organizations that we highlight that are doing great work and trying to make sure that all students regardless of their background are able to succeed in school and life. >> host: we heard from the president yesterday giving the teacher of the year award to sean mccombs who group in a troubled family. his mother was an alcoholic. he is 30 years old and among the youngest recipients of the teacher of the year award. he made the point that he makes teaching fun. as a teacher, my question for you, what are the keys to teaching students successfully so they graduate? >> guest: you hear this. is teaching a science or an art? it is a little bit of both. students need to be engaged in learning and we need to make sure we are not just saying are the numbers correct and are we

graduating enough. are they enjoying their education. students do well in classrooms where they feel like they can be involved in what they are learning, that they can be hands-on and they can be, you know, be sure that -- the teachers are enjoying themselves as well. i know as a teacher i felt like my students learned the most where we all were engaged in the learning. and i think that is very important. i think that is something we need to be sure that we are hitting upon as we go through this and try to reach the 90% goal. we will not reach that if students are not engaged in the learning. >> host: will we reach the 90% goal in 2020? >> guest: we hope so. we think we are on pace. people are aware of this, paying attention to this and targeting the reforms at the students that

need this. we feel good about the fact this is something that can be achieved. >> host: jennifer depaoli, thank you for being with us. >> tonight, the supreme court hears the arguments on the case of privacy of cellphone data. and then fcc chairman tom wheeler. and the vice president talks about the entertainment industry and chuck hagel on the military alliance. tomorrow night is the annual white house correspondents' association dinner and joel mckale of the nbc show "community" will be the entertainer. we talked to him about how he is preparing. >> you were on david letterman and he