ron paul. then on saturday of a live coverage of the national book festival from the history and biography pavilion. speakers, interviews, and viewer call-in with author. sunday at 9:00 p.m. eastern after words with william burroughs. talking about his book the astra threat. on american history tv eight massive -- nasa documentary of the 1969 apollo 11 moon landing. saturday on the civil war. a look at election laws and the supreme court case. finer television schedule at c-span.org and let us know what you think. carlos. in dallas. join the conversation. like us some facebook, follows

on twitter. >> now part of a recent hearing on the future of the u.s. postal service. this portion is 40 minutes. >> good morning. the committee will come to order as is traditional with in the oversight committee i would like to start by reading our mission statement. we exist to secure two fundamental principles. americans have a right to know that the money washington pays them as well spent. second americans deserve an efficient and effective government that works for them. our duty of the oversight and governor reform committee is to protect these rights. our solemn responsibility is to hold government accountable the taxpayers because taxpayers have a right to know what they get from their government. we will work tirelessly and partnership does this is what to stocks to deliver the facts to the american people etched and bring general reform. this is the mission of the oversight and government reform committee.

at this point would like to recognize myself for an opening statement which is in a different book. >> i edited it. a staff suggests one. it is not always 100 percent right. today let me examine recent efforts by a number of private-sector companies and start-ups to develop innovative postal products. while the internet has been a boon for the national and global economy it has been a mixed blessing for the postal service. mail volume is down more than 33% from its peak in 2001 and continues to drop. however, package volume is growing rapidly thanks to a commerce. americans are rapidly changing how they communicate with one another and the postal service has struggled to adapt. however, that does not mean we are living in a post postal service world. the postal service as a vital role in our economy and nation. connecting -- affordably

connecting even the most remote parts of the country. that is why innovation and a postal service is so important. we needed infrastructure in this country for moving mass, not as stated. the postal service had begun efforts to preserve existing volume and possibly streamline the way mail is handled. these efforts started every aspect of the postal service operation includes innovation into design, postage, e commerce, return logistics' and greater consumer targeting for advertising. today am looking forward to hearing from private sector government and discussing their efforts to develop new postal products and services. specifically the problems they encounter along the way working with the postal service. developing implemented now is the top of the postal service to embrace innovation.

private sector companies are more than willing to skim millions of dollars to test and implement new products and design and help bring future revenue to the postal service. in the tech community often use the were disruptive. disruptive is not necessarily a bad thing. it is a change. my wife and her junior league days used to refer. and we have got to be very wary of falling into the trap of that is the way we have always done it. if companies continue to be shut down or steamrolled before they get a chance to get off the ground feature innovators will look elsewhere. in addition i up to your success stories from private-sector companies to work with the postal service and how future entrepreneur is and innovators can create more marketable and open environments and the postal service. there is need for innovation, whether it's cluster boxes or better access to postal

databases. many areas ripe for innovation. my fear is with cal reform and innovative new post apprise the american people will be left footing the bill for a taxpayer bailout. that is the last thing we need right now. i look forward to hearing from our panel. there really are smart ways the postal service can lower its cost and improve its service. i'll put can bring them to life today and find a way to move the postal service closer to internet speed. before i recognize mr. lynch for his opening statement i ask unanimous consent that our colleague from texas is allowed to participate in a hearing. without objection so ordered. >> of want to thank you for holding this hearing to examine the development of innovative postal products and services by the united states postal service

like to thank our panel of witnesses for some very innovative individuals for helping the subcommittee with its work. in november of 2013 the postal service entered into a strategic partnership with online retailer amazon to test sunday package delivery in select markets otherwise known as seven day delivery. the amazon pilot program has proven wildly successful and is a prime reason why the postal service has recently demonstrated the ability to grow revenue in the face of the most difficult financial conditions. in its quarterly financial report released on may 9th of this year the agency recorder revenue increase of $379 million of the same reporting last year. its third straight quarter of revenue growth to in large part to a 2,502,000,000 or 8% increase in shipping and package revenue. in light of these results sunday package services expanded to several other cities across the country, and the agency is

working to establish similar partnerships with other countries. this serves to illustrate that the agency can experience positive financial results when it capitalizes and builds upon what it already does best, utilizing an unparalleled and universal network that is derived -- excuse me, that is driven by hard-working and dedicated work force. as an example of immigration, we would be well served to take a similar approach as we consider undertaking the critical task of reforming to this postal service . as evidence by yesterday's markup chairman i say continues to put forth a variety of misguided proposals the presume we can enhance the financial viability. degrading the very services i simply do not agree that we can reform the postal service for the better.

mandating the wholesale conversion of delivery address is to curbside sidewalk delivery or by asking postal customers to pay a so-called legacy feet. such proposals would only place the postal service and a greater disadvantage and severely damage the long-term viability. instead, we can encourage the postal service to build upon its existing postal products and services in order to further set us up. i commend ranking member cummings for his strong and continued lead in this area trend ramp up to co-sponsor his legislation, the enervate to delivery act. this thoughtful and alternative approach would establish chief innovation officer with the postal service to lead the development of innovative postal price of services that fallen line with the emerging information technologies and changing market trends. would also require the chief information officer to ensure that such products maximize

revenue. postal innovation will be a key and necessary component to meaningful postal reform and mail delivery. i understand that there are a variety of perspectives on how best to facilitate that innovation in a manner that will place the postal service on more solid financial footing. accordingly i very much look forward to discussing the issues with their witnesses. i look forward to your input command i yield back the balance of my time. >> thank you. members will have seven days to submit opening statements for the record. we will now recognize our panel. the chief information officer and executive vice president for the united states postal service . excuse me. chief executive officer excuse

me, chief legal officer. director of engineering and technology at impact systems. and chief operating officer of new logistics' incorporated. pursuant to a committee rules of witnesses will be sworn in before they testify. would you please rise and raise your right hand. >> stage of use always wear or from the testimony you're about to give a bid truth of truth, nothing but the truth? but the witness reflect that all witnesses answered in the affirmative. thank you. you may be seated. just a little housekeeping matter. if i understand it, the house will have totes around 1040. it will be a rather long series of votes. want to get everything covered. if we can get it done by 1040 you don't have to sit around for over an hour. i might deal to make an earlier flight.

a gives you five minutes. testimony. your entire written testimony as part of the record. for recognize for five minutes. >> good morning. >> should morning. members of the subcommittee, thank you for calling this hearing on examining innovative postal box. my name is tom cochran, and chief information officer and executive vice president of the united states postal service. i oversee the integration of technology innovation and all aspects of our business. during my 39 years of the postal service have developed a broad perspective on the business of how we serve the marketplace and our customers. his business acumen is essential as technology now plays a foundational role in virtually every postal products and service. emerging technologies, while exciting, oftentimes also

challenges with potentially disruptive effects, effectively traversing this merging continuum is my responsibility and a matter of survival for the postal service. the postal service operates one of the largest technology of the structures in the world supported and code developed by some of the most respected technology companies as well as many small businesses that brings fresh insight. our goals are simple point it every day we focus on how we can innovate with technology and new partnerships to generate revenue, reduce expenses, deliver consistent, reliable service and a world-class customer experience. our goals are simple our business model is complex and diverse. for nearly 40 years the postal service work share programs and shared responsibility for efficiency and innovation with business partners. this is granted by the premise that our profits and brand are enhanced from our partners a profitable and our joint customers receive an increased value proposition. printers, software vendors of health service providers, a

transportation companies and parcel into letters all play a vital role, and together we have built an industry around the market need. disruption in the highly competitive package market is an excellent example of our customers evolve and adapt. there's been a dramatic shift to more ground-based solutions. an innovative product developed sense of that market demand. a worker program that leverages the world-class processing and transportation network of consolidator such as the logistics' with the unmatched reach of our delivery network providing a great customer solution. also enabling the concept of competition creating a win-win for shippers and consumers. the package market is continuing to change in the fall same-day delivery, some of the liver, delivery test and costs in real time tracking requiring that we

began to adapt. helping become more and a valuable. financial incentives, mobile optimized male creating but it is a reflection of of hard copy and it is of action for response . we welcome creative ideas from individuals, companies, and entrepreneurs regarding a business concept and technology. our unsolicited plaza program provides a public a venue to submit new technologies and ideas. in order to be adopted these ideas must align with the postal service mission, have a clear path to profitability and generate postal revenue to and they must not damage our respected brands or conflict with existing products and services. the postal service receives ideas from a variety of sources,

not new, some already being pursued internally. some could not be adopted. the postal service is changing at a rapid pace. citizens a using a wide range of technologies. how fast we can evolve. remain guarded to bind the nation together and a commitment to provide the value and service upon which american businesses and consumers depend changing mailing and shipping mean-spirited lover, efforts are severely limited by an outdated legally restricted business model. we do not have sufficient authority of flexibility.

such legislation to offer new products and services that allow us to take full advantage of our current infrastructure. placing further restrictions on our ability to innovate and compete proposal service compete vigorously but we also compete fairly. consistent with legal obligations. mr. chairman, we look forward to continuing to work with you and the rest of the subcommittee to accomplish legislation and continue to deliver innovation to the american public. i would be pleased to answer any questions you might have. >> thank you. >> thank you very much. >> mr. chairman, members of the subcommittee. >> bring the microphone a little bit closer. members of the subcommittee, the postal industry has a long history of working with the private sector and others to spur innovation. historically mail address work

shall. postal applications, handwriting recognition technology. they act as a platform presorted and mail-order industries the postal zip court to the benefit of businesses and resources. the ungovernable internet as change the world. great opportunities in enhanced capabilities. forces of logistic system. the infrastructure like the postal service is to support citizens and businesses to compete and position themselves and it also insures efficient market forces prevail and are

not undermined. to continue understanding the world and rapid adaptation are increasingly critical endeavors. the postal service faces the tricky challenge of modernizing traditional product as it provides support for emerging technologies. there will lazar depend on the ability to innovate and embrace the innovations of others. as a result continued strengthening of the postal service for innovation. seeking to understand the frustration and the needs of commerce. the entry point for an of bears and providing staff to join and innovators in navigating the huge postal structure and to remain with them until the proposal is resolved. strengthening your skills and assessing the financial viability a proposal, developing the ability to engage in rapid prototyping of new products and

operational innovation and for taking its intellectual property in respecting that of others. in pursuing innovation partnerships of the private-sector her important. any new ideas. competencies'. there are several areas for innovation opportunities seem particularly rich. support for e commerce and the help and government transactions of the front-end and identification and providing access to drizzle currency exchange. at the back end the shipment of parcels, using micro warehousing and virtual post office boxes and e-platform services to help small businesses and innovators with logistic and shipping solutions and providing physical and drizzle access to postal service that works for the

public and commerce by ranking together its website, post offices command digitally enable carriers and conducting digital analysis for the vast data not generated throughout our network for operational efficiencies and revenue ideas, and business intelligence. together these up attendees can tighten the integration of data streams and their supporting matters. the internet costs are devices, search engines, and klaus storage have laid the foundation for a changing world. an aspect of what will come next atop this foundation will likely be any closer through this continues to be on governable and chaotic with abbas changes, learning curves, and some sense of creative destruction. the ability of society to propel rather than retard progress in these areas will depend, in part, the competency of the puzzle of a structure to support american commerce and citizens through the coming era that will

combine and applaud major technologies that include an additive manufacturing also-3d accounting to the internet of things, augmented realities and smart device for data analytics, advanced robotics that incorporate machine learning and nanotechnology. the world posts were slow, adapting their role in the early stages of the digital age and were partially constrained from doing so legally. the next phases of this is a technology will likely be more disruptive. the postal service must be highly agile and develop an intuitive sense of the changing role and the new challenges facing american businesses and citizens. a key aspect of the postal service's ability to transform must include stronger currencies from breaking and implementing innovations. thank you, mr. chairman. >> thank you, mr. williams. it will now move to some of our private sector folks.

thank you. >> innovation. it is in the title of today's hearing and i feel the need to go a bit of script. a movie is the only thing that comes to mind, one of my favorites, the princess bride. and they're is a scene where a meal montoya is caught up with a band of criminals. there's a criminal mastermind. he keeps using the word inconceivable. inconceivable. all of his plans don't go as planned. and he looks at him and says, you keep using that word. add to that think it means what you think it means. and that's a little of how i feel today about the word innovation. ..

and general electric. one single company. all those other companies are gone. they are destroyed. but for all of it, destructive capability, there's almost an effective pursuing innovation. it is indeed the narrow road, the narrow path of putting off business models and secure cash flows and grasping for something

that is uncertain. and the promise of innovation comes in the form of new jobs, new marketplaces for every job, every company, every market that's destroyed through embracing innovation, to more pop up in its place in markets and in ideas and new concepts and new workforces that could simply not have been fathomed. but what happens in that destruction process is incumbents usually fail. they usually die off. they go away of all those companies on the s&p 500. so as we are talking about innovation of the postal service, we have to understand that truly embracing it means a fundamentally different postal service. it means that in 10 years it looks almost unrecognizable from

the postal service today. but that doesn't mean that it is worse off. in fact, it doesn't mean that jobs have to be destroyed with a new postal service. it means that new ones can be created. button make no mistake, -- but make no mistake, innovation will come. destruction will come. in that regard it's a bit like junk mail. it's coming whether you like it or not. and so as we talk about innovation and embracing it, we need to understand that it means hard fundamental core changes to the business model. embracing it means destruction, but it also means new markets, new jobs and new opportunities. thank you. >> thank you. mr. weisberg. >> thank you, mr. chairman. i am from stamps.com, the leading pc postal company. pc postage is internet-based software that allows customers

to print their own postage using their existing computer and printer. stance, serves over 500,000 registered customers, primarily small businesses. in 1999, we became the first company to offer a software only pc postage solution. enabling customers for the first time ever to print real postage from any internet connected pc and standard printer. just seven years ago pc postage account for one quarter billion dollars in annual postage sale. last year it accounted for over three and one quarter billion dollars in postal service. steps that composted growth alone with more than 35% year over year. that is consistent and up to build a sure double digit growth every year even to the heart of the recession. virtually all the priority and expressed growth surge in recent years is generated through the

pc postal service job at a recent study showed revenues through the industry pc postage channel cost 2 cents per dollar of revenue compared to 47 cents per dollar through usps owned retail outlet. pc postage produces secure, center identify the mail which is important for security against biological or other attacks. pc postage provides customers with cutting edge technology without the postal service having to pay for research, development, support or maintenance. stamps.com has launched an enterprise service targeted to organizations with multiple geographic locations. it features enhanced reporting that allows a central location, such as a corporate headquarters, greater visibility and control over postage expenditure across their entire network location.

and e-commerce merchant with multiple stores can use stamps.com to consolidate all their orders so they can ship them out with ease. with one click they can directly import all of the order data from the most popular online marketplaces and shopping cart software, and then automatically print the shipping label. all of the shipping date including usps tracking automaticautomatic ally puts back to the web store. stamps.com also automatically keeps the buyer informed, orders the carrier pickup, send an electronic manifest to the postal service, and generates a scanned forms of all the carrier does is scan the form once, and all of the packages are automatically in the postal service's computer system. pc postage is based on a public-private partnership with the postal service regulating participants. our products must complete an extensive usps testing and the

other wish and in the areas of operational reliability, financial integrity, and security. the postal service also partners with the industry to achieve mutual win-win goals of improving the customer experience, increasing revenue, and minimizing cost. the p&d, the cio sitting on this panel, and so many of the dedicated postal veterans who were able to work with us for many years deserve much credit for the success story that is a partnership between the postal service and the pc postage industry. we believe public-private partnerships are the best path forward as technology innovation becomes increasingly important for the future. having the postal service create its own technology is not the best approach. instead, it should provide incentives for industry innovation. this allows customers to pick the best technology solution for

their needs. pc postage provides jobs both in industry and the postal service. every package produced is ultimately delivered by a city or rural letter carrier. growth npc postage has more packages deliver, more letters to deliver, more volume to service. thank you for the invitation to testify today. >> thank you, mr. weisberg. mr. eidemiller? >> thank you. >> my radio days come back. you are up for five minutes. >> thank you. good morning mr. chairman, and members of his audible committee. my name is patrick eidemiller and a director for m-pack systems. we are a small start up company that produces a better -- called impact. impact was invented by a 71 year old navy veteran from a small town, volcano california population 85.

this is impact. the flat pharmacy file. this is a traditional box. this is our file, traditional. m-pack has many advantages. the most important are this file is ever of it. this file is not. this bottle of water is tamper evident. this prescription is not. entire drug supply chain we have more security in this than we do in this. hard to believe. we also have a lot more label space so it's much easier to read. and lastly, much more space efficient, more compact. m-pack has made in united states in theory pennsylvania. we are adamant about u.s. production in producing onshore. we have another finish and that's what i'm here today. the usps provides a favorable rate, what's called a machine the bull flat. this is a machine the bull flat. this is a partial.

29% savings to the taxpayer for every prescription medication that gets sent out in the u.s. if it is classified as machinable flat. so realizing what we had the flat file and considering the u.s. government is one of the largest users of prescription by mail, we sent opportunity really to take taxpayers money and provide safer while to the mail into the post office. so working with henry and manufacture in new york we develop this envelope which means all of the mechanical requirements. we tested it on the siemens test equipment in fort worth, certified that it worked and we received our approval on june 17, 2011 that our mail piece has been approved.

over the next 18 months we continue to improve our product. and refined and refined it. we came back to product that looks like this. smaller, lighter, cheaper. more weight is more costly because two ounces out of this envelope. we put a package together we could do in 50 a second. this one is 15 permanent. we put a lot of work, 18 months of work believed are not to go from this to this. we resubmitted our package. this package, plus some of the internal improvements, we also went to retest your our packages were rejected. not only this new package, but the existing form factor as well. we were shocked. this had been approved once. for a completely different reason. and it was not the fact that it doesn't meet the mechanical requirements of machinable flat which is been a like this, then like this, to mention, with. it was that a box in an envelope

is not a machinable flat. that's why we were rejected. we were surprised and shocked. we already been approved. we went back. we solicited, sent a letter to the father of the flat box. i love the flat rate box. i use them all the time. but we had sympathetic ear. we got a very curt response that basically said, and i quote, thank you, especially for your persistence. unfortunately, the piece with its current contents qualifies as a partial. if you change the content, please contact us again. if we change the content, from this to this, contact us again. yet the entire point, i'm sorry, is not this. the point is this. this is a better, safer while but because of its shape, it is 29% cheaper. that's the point.

after really feeling very frustrated with our entire express with the post office, and we went to the post office for a reason to the post office provides valley. the post office is the only agency that can legally but prescription drugs through the mail slot in the mailbox. and not limit on your doorstep. that's an important factor in safety, an important factor leading drugs on a doorstep. we want to work with the post office. we asked them, we begged, pleaded. we will change your package. we will tested at our expense. we want to use the post office. and it fell on deaf ears. completely fell on deaf is. we went to the private sector, ups. said, you know what? we will take it. no questions asked. because we know how many of these we can put on an airplane, save space and give you second a service, 1 dollar apiece. and that's why i'm here. thank you, members of the committee. >> thank you very much.

mr. everett. >> good morning. today i will describe for the subcommittee have the united states postal service is partnered with and helped to make it possible for my company, newgistics, develop innovative products respond to these of direct consumer because can manufacture, distribute and logistics service providers. thank you, mr. chairman and members of the subcommittee for allowing me to speak on behalf of newgistics at today's hearing. my name is todd everett enema chief operating officer a newgistics, a privately-held company based in austin, texas, with over for what people on our payroll. we were formed in 1999 on the premise we could develop a better way for consumers to return merchandise to because. today we are a leading provider of technology enabled solutions for direct to consumer retailers, manufacturers, distributors and logistics service providers. our success is due in no small part to the postal service and its wiin work with companies like

newgistics to develop innovative solutions. more specifically we offer national integrated parcel delivery, postal delivery and return service for customers. we are able to ride cost-effective, reliable and convenient shipping solutions by working with the postal service for last mile delivery and for smile pick up. when newgistics was founded we did ourselves as a technology company. that would provide information retailers regarding the current packages. soon, however, we evolved into a returned logistics company handling returns to retailers making use of innovative technology. we concluded customers wanted them to return packages easily and retailers want to make their returns more efficient and cost-effective. thereforecost-effective. therefore, we developed a proprietary intelligence return solution making use of barcodes in our newgistics smart label. those barcodes provide a set of customers with detailed information that quickly enabled customers to manage their transportation and return processing resource.

as we default we discussed with the postal service the possible the upgrading and you can be the process for handling returns of large shippers of merchandise that made use of the newgistics smart label. this based upon our collaboration with the postal service, the usps delivered, develop one of its most innovative products, the postal return service, prs. prs is a postal service program under which approved providers like to just excel tha but retre return parcel to elect -- directly from -- early retrievals enabled us to fight advanced data and customize return services to retailers. we found the postal service was very receptive to working with us. beginning in late november 2001 with numerous meetings with the postal service. following those meetings in may 2003, the postal service sought permission from the postal rate commission to test your wrist, approval was granted in september of '03 and testing begin in october of '03.

after two years of successful testing in october 2005, the postal service sought permission for prs to become a permanent class of new. postal rate commission improve prs on about march 3, 2006. on the point we were able to implement a return solution in conjunction with prs program. our intelligence and post return service developed in collaboration with the postal service simplifies the return process by offering consumers prepaid returns, postal service pick up at their home, workplace or drop off any mailbox or post office. that is the our solution packages and into our system through postal service's fast retailing collection it would. we give consumers returning the product confidence their return will be handled expeditiously. in addition our personal return solution is able to expand our product offering to include parcel delivery, fulfillment and e-commerce solutions to our customers. quick summary, the postal service has been and continues

to be a willing an important partner in our efforts to develop innovative solutions that bring significant value to our customers and their consumers. likewise, prs has been successful we believe from a postal service perspective based upon the most recent available data, prs service continues to grow. in the postal service fiscal 2013, they handled more than 50 million prs packages and generate more than $120 million in postal revenue. mr. chairman, members of the subcommittee, thank you again for the opportunity to testify before you today. >> thank you very much. >> is what they today o on c-span2. next, another congressional hearing. this went on former chronic illness. later a 2016 political outlook from "washington journal." >> here's a look at some our primetime programming tonight.

join us on c-span tonight at eight eastern for special look at voting rights and election law. we recently recorded a panel of endless discussing the topic. here's a preview. >> let me doing a sort job and put a little context of why people come to different conclusions on the same topic. republicans generally have a view of the purpose of an election which is certainty. the purpose of holding an election is that we never one. and that we are clear as who won, confident as to one and there's no question as to who won.

so anything that in a sense cleans up the electoral process that gives us that certainty is a burden worth paying. because that's the purpose of an election. democrats generally believe that legitimacy and elections involve participation. anything that limits the participation of all those who could vote from voting undermines the legitimacy of the outcome but even if that means that the results may be a little messy on the edges. these are both legitimate positions today. this is a perspective towards the purpose of the election, of voting. but each perspective opuses us on a different answer to the question of what is a legitimate burden for the state to impose upon voters in the voting process. and, of course, underneath this is that not so secret dirty little secret that, of course, each side takes a position that is recoverable with outcomes that will help them.

the broader the electorate, more generally the better it is for democrats. and there were the electric generally the better it is for republicans. that's not saying they're doing it for that reason. it's just always easy to the right thing if the end result is the one you want. >> that's a short portion of tonight's program on voting rights and election law. you can see the entire event starting at 8 p.m. eastern on c-span. >> earlier today we asked "washington journal" viewers if they thought mitt romney should run for president again. we spoke with a reporter about the possibility. just over five minutes. >> jillian is following this story. is a professor and also a contributor to cnn.com on the issue of mitt romney. joining us live on the phone to thank serving with us combat thanks for having me. spent a lot of speculative based

on comments governor romney said. we'll hear from just a moment but you say it is not out of the question that mitt romney could run and could potentially get to 16 nomination for the gop. why? >> caller: part of it is about him and part of it is about the republican party. so there are moments in history where candidates have remade themselves like richard nixon was able to come back after losing the presidential race in 1960 and the gubernatorial race in 1962. so romney could follow that model. and part of it is some of the fragility of the republican party. many of the major candidates are extremely vulnerable and untested. and so it opens or for someone who is more familiar and someone who has been out there since running last time, and continuing to make a name for himself. >> host: let me go back to these which by the way is a bit of online cnn.com that republicans would naturally be

jittery about selecting a candidate who could make it through the primaries in 2008 and it crashed and burned against the president in 2012. you asked this question. so how does someone recover from this kind of loss, how could romney end up as the next republican nominee? your piece available at cnn.com. will mitt romney run for prez in 2016? how do you answer that question? >> caller: he has done in some ways what richard nixon did in the 1960s. he made himself a key factor in fundraising, endorsements, and throughout the campaign trail during these midterm campaigns. and that's been very important in terms of rebuilding himself. and so he has kept himself alive as a political player, and shown that he consolidate on the kind of money that some of the candidates have not been able to do. and with chris christie, is problems and other candidates like rand paul still had the questions. it keeps alive speculation that

perhaps he would be the one that the republicans go to again. >> host: is the indexing analogy to all of this? >> caller: various. he's following some of the steps of what nixon has done. of course, there's great interest in the context is a different. but he has followed the path of candidates who have taken a loss, and rather than vanishing from the public stage, made themselves integral players to the party. so the possibility if the party needs them, they are still people who can prove how effective they can be. >> host: we're talking with julian zelizer, professor of history and public affairs at princeton university. he's also a contributor to cnn and cnn.com, writing about the speculation renewed agenda this week about whether or not mitt romney might seek a third presidential bid. i want to share with you a poll that came out from iowa also the

of online that politico.com. romney, this poll shows he is a huge lead among 2016 i would republican caucus voters. the source of the polish "usa today" suffolk university release yesterday. 35% of likely gop caucus voters would vote for mitt romney in 2016, and then down the list is chris christie and rand paul. many of those in the single digits. julian zelizer, your response to that call mike i mean, i would take that with a grain of salt only that he is the most from a republican still, and so i do think a poll like that is registering just what people remember from last election and a lack of knowledge about who the other candidates are. that does reflect this idea that if he decided to run, he still would be safe because his name brand in the gop, and he

provides primary voters and non-primary voters with some comfort level in terms of understanding what kind of campaign he would run. and that means a lot to republicans who are very determined to win the white house in 2016. >> host: you follow this closely. what's your gut instinct? do you think he will go for it transferred my gut instinct is i don't know. i'm not sure if he and his son wants to get into it again. i do think the speculation would be attractive. is a person committed to public service, and my gut is that it would depend on the other candidates rather than him but if there's a sense there is a strong candidate, he would be the kind of person interested in dealing with this party and getting into the campaign raise. but if one of these other candidates is to be stronger, if someone else emerges, i do think he would step aside. >> host: by the way your

latest book, when is it coming out transfer its coming out in january. >> host: thanks very much. and, of course, we will follow that on booktv. julian zelizer, professor at princeton university and contribute to cnn.com. his piece on whether not mitt romney will run again in 2016. thanks for adding your voice is foreign to the program. >> caller: think you. >> host: >> this weekend on c-span networks, friday night on c-span, native american history. then on saturday live all day coverage from the national book festival science pavilion. saturday evening from bbc scotland a debate on scotland's upcoming decision on whether to end its political union with england. sunday q&a with judge robert katzman, chief justice of the second circuit court of appeals. he shares his approach to interpreting law passed by congress. on c-span2 friday at 8 p.m., in depth with former congressman ron paul. then on saturday, all day live

coverage of the national book festival from history and biology between. speakers, interviews and viewed collins with authors. and sunday at 9 p.m. eastern on "after words" with william burroughs. talking about this book, the asteroid threat. on american history tv on c-span3 friday, a nasa document about the 1969 apollo 11 moon landing. saturday on the civil war, general william tecumseh sherman's atlanta campaign. sunday night a look at election laws and supreme court case of bush v. gore. find our television editor at c-span.org and let us know what you think about the programs you are watching. collis at (202) 626-3400, on twitter use #c123. or e-mail us at comments@c-span.org. joined c-span conversation, like us on facebook, follow us on twitter.

>> a hearing now on chronic illnesses and some of the shortcomings in the health care system for treating them. members of the senate finance committee heard from the heart disease patient and a woman whose husband suffers from alzheimer's. from earlier this year this is just over one hour 50 minutes. >> the finance committee will come to order. today, the finance committee focuses its attention on what, in my view, is the biggest challenge ahead for medicare and the future of america's health care system. that is, managing chronic

illness. to understand why this is a growing issue, one need only to look at how medicare has changed over the years. when the medicare program beganr in those early days i was codirector, oregon grayhe cance, panthers, had a full head of hair and rugged good looks, and medicare was mostly about cariny for seniors who need to go to the hospital. if a senior slipped on the the kitchen floor and broken ankle, for example, they would head to the hospital, get treatment andi they would headta home. in 1970, nearly 70% of medicare spending was for hospital care. now that number is closer to 40%. .. how medicare is very different than it was for four decades ago. other than broken ankles or new

money medical care is dominated by chronic conditions such as cancer, diabetes and heart disease. more than two thirds of those on medicare i'd dealing with challenging multiple chronic conditions. that care accounts for almost all, 93% of medicare spending and we are going to hear today that it is not just seen years who are affected by chronic illness. half of all american adults have at least one chronic condition. these diseases account for 70% of deaths, limit the activities of tens of millions more americans, and cost the economy billions each year. the problem is only going to be calm counted as chronic coles become m as chronic illnesses become more common. there are a number of experts have warned this generation could be the first with shorter lifespans than their parents and this isn't just a health issue

but problems is also a major driver of health care costs that are putting a growing burden on the government, business and family budget. here is my bottom line. the way healthcare in america is delivered has got to change. and i will repeat that. it has to change. doctors and hospitals often don't work me to care or talk to one another. patients received medication for one disease that conflicts with another. peter records to be spent on burdensome red tape creators even data showing the caregivers of those with chronic disease have higher rates of stress and depression and higher mortality rates. virtually all americans get touched by these types of issues. and certainly those suffering with chronic disease are hurt most the most by the flaws in american healthcare.

we will look at those problems faced by americans every day as they try to navigate america's chaotic system of treating chronic illness. the committee is going to hear how the tragedy of the disease is exemplified by a single mother who before her 31st birthday had major heart surgery, can no longer work or even drive a car because of the onslaught of these diseases. we will hear about those that were left on their own to shuttle themselves between a hole of a of different providers that often are located hours away from each other. what do harry struggled to take her by husband with alzheimer's to make sure that the doctor's appointments are kept, medication is taken into the marriage is intact.

we all understand this isn't something that that this isn't something that is going to be solved overnight. this hearing marks the beginning of what will be a bipartisan effort to address the problems in america's health care system and that practically everyone over the last decade has managed to ignore or eat in the months ahead of the committee can find bipartisan solutions to meet the challenges and strengthened the healthcare system and very much committed to working with senators on both sides of the aisle and let me recognize senator hatch. >> i am pleased we are covering the healthcare committee today. we should have more hearings on health care. we although the implementation of obamacare has come under intense scrutiny but for good reason in my view. it is imperative that the senate start exercising proper levels of oversight to determine whether the law is working as it is promised. i don't say this out of politics

or partisanship is because because the taxpayers and policymakers deserve honest answers that said the committee has an opportunity to delve into the important topic of illness. this is one area if we choose to work together to committee can find real bipartisan solutions that not only improve care coordination that lower the overall healthcare costs and would also be better tools to more effectively manage and navigate the health care system. the advisory commission has long said the fee-for-service medicare creates silos incentivizing providers to deliver more care not necessarily higher-quality coordinated care. it prevents them from the private plans as a device to manage care across all settings. the traditional medicare fails to encourage providers to engage in the labor-intensive and time-consuming patient care

toward nation is 14.5 million patients and that number represents 20% of all medicare enrollees. even with these advances today's health care system in a fragmented and there is significant evidence that communication between providers is lacking both in the medicare in the private sector. the medicare payment advisory commission estimates that the patients with five or more chronic conditions and still an average of 50 prescriptions each year so there's no surprise patients with high-cost chronic conditions visit specialists and medical histories and tens receive inconsistent medical instructions do not get help transitioning from one side of care to another and use more expensive care settings when it

may not be necessary. today one remarkably brave patient as well as a devoted and loving caregiver would share their stories with us. their testimony will show the current healthcare system is not serving all patients while. but there is hope. they are also going to talk to a medical provider and employer about the promising efforts underway to address the unique needs of chronic care patients. i applaud these innovative approaches that we all need to know that there are no easy answers. developing and implement a policy designed to improve disease management streamline care coordination, improve quality and reduce medicare costs is a daunting challenge. based on past experiences with that medicare program in particular there is still much work to be done. for more than a decade of the centers the centers for medicare and medicaid services have tried numerous demonstration programs

to find out what does and does not work to improve care coordination or patients with chronic diseases. these demonstration programs have asbestos shown mixed results. according to the congressional budget office, there've been 34 programs and six major demonstrations to provide disease management or care coordination services in traditional medicare. on average, the 34 programs have little to no effect on the hospital emissions or medicare spending. in 2010 obamacare created unaccountable care organizations to allow certain providers to work together to coordinate and integrate medicare services. these provider groups must need specific quality standards in order to share any savings they itchy from the medicare program. the initiative is relatively new. there is no definitive data to

prove that they've improved quality. if they show any promise to save the money or if they are simply failing. while the jury is out obamacare also gave the secretary of the services broad authority to create and implement medicare pilot programs. the center for medicare and medicaid innovations into the obama administration is conducting terror court mission programs in the settings. my hope is that the research will yield results and as we all know the healthcare costs place in an honest strain on the budget and identifying cost effective data-driven ways to improve patient health policymakers can better target scarce federal resources to get more value for the dollar spent. u.s. healthcare spending grew 3.7% in 2012 reaching

$2.8 trillion or $8,915 per person. it consumes 17.2% of the nation's gross domestic product or gdp. adding insult to injury last year the medicare trustees issued a report showing the trust fund deficit raised $23.8 billion will be exhausted in 2026. given the current fiscal reality, we have to find ways to provide high-quality care, greater value and labor cost adding to the deficit. i'm glad we are hoping this first hearing to understand the problem but we cannot stop there. this must be the start of a long-term transparent discussion with additional stakeholders including the administration, cbo and others that will allow us to work together to identify solutions in an open and transparent way. thank you mr. tremaine for

holding the hearing today. i look forward to hearing from the witnesses. let me recognize your years of advocacy in terms of trying to come up with fresh creative approaches in the healthcare and for the witnesses you should know that i am essentially flanked by three on this side, senators who have roots in terms of challenging the status quo and let the fresh approach isn't a chronic disease and health care services and the same is true on the other side. so 6% in the united states senate that cares passionately about these issues and i'm very pleased all of you could be here. now, we are going to hear from stephanie dempsey a chronic disease patients from georgia. ms. dempsey is currently taking on coronary artery disease, lupus seizure disorder, arthritis and we very much appreciate your being willing to

come. margaret lehmann is here as a caregiver by another taste and doctor bornstein is the chief quality officer for emory health and finally cheryl the president and chief executive officer for the ally in its year ended the alliance is a cooperative of employers who focus on the delivery of health care benefits. i also want to note that the president and ceo of blue cross blue shield scheduled to testify many of us and we know his good work about as well as late last night the sky burst open and he is not able to join us. we have two witnesses from georgia. you've done a lot of work and i

appreciate it. if you introduce these dempsey to the committee. >> thank you mr. chairman. two of the full witnesses today i'm very pleased to introduce both of them to the committee and the audience. first a relatively new citizen of georgia that lives in the capital of the blue ridge mountains in the multiple conditions in the rural area of the state determined as individuals as individuals we have met before because he was at our rollout if i'm not mistaken. he was at the home of one of the teaching hospitals in the united states and a major system that provides healthcare to a significant portion of the template to citizens in georgia.

i think the committee would like hearing from somebody that just talks about doing it distorted and implemented successful systems and we are glad to have him here today. >> thank you mr. chairman. i literally could go around the room and point out the efforts of every senator that's here and i very much appreciate your leadership. let me also say to the witnesses that your written statement be included in the record automatically that you put together for the return statement if you could perhaps summarize the view for the oral presentation that would be very welcome and we will start with you ms. dempsey. >> i think it is going to be hard to hear you. is the microphone on? if you will speak right into it

you have an important story to tell and i do not want people to miss it. >> is that better? >> perfect. >> members of the committee thank you for allowing me the opportunity to testify today. my name is stephanie dempsey. i'm 44-years-old and i live in blairsville georgia and i've been battling multiple chronic medical conditions for much of my life. i've always considered myself a middle-class american. i had a well-paying job. i owned my own home and was happily married. unfortunately this is not the case today. the very illnesses that i battle every day have taken it from me. i've lost my independence, my five agile security and most importantly my family. i hope my story can help you to better understand what people with chronic medical conditions

faced day in and day out and i hope my story gives you some sense of the challenges that i and so many others go through daily. i would like to take a few minutes to share my story with you. i was diagnosed with coronary artery disease at the age of 21. my heart disease is hereditary and has infected all of the women in my family. my only sister died at the age of 28 or heart disease. my mother who is 69 underwent a quadruple bypass surgery at the age of 48 and my maternal grandmother died at the age of 72 from coronary artery disease. at the age of 30, i underwent a quadruple bypass surgery for severely blocked arteries caused by high cholesterol. since then, i've had the placement of 27 stints. another bypass surgery and countless other medical

procedures. i take 15 different medications in the morning and an additional four in the evening plus a multitude of supplements recommended by my doctors. at times as you can imagine it's very difficult to keep track of all of my medicines. so i use these different baskets to keep track and every one is labeled by condition with my -- >> can i ask a question? that basket is what you have to navigate through on a daily basis? in absolutely every day and every night. they are labeled by condition so that i can stay organized because there are so many. in addition to heart disease i'm fighting the effects of lupus, arthritis and seizure disorder all of which have become debilitating. i can no longer work although i would desperately like to and i depend on my parents to help care for me.

i always believed as i'm sure some of you have that you would be taking care of your parents and i always knew i would be taking care of my parents as they grew older. instead they are taking care of me because i simply had no other choice. this has been difficult to accept that this is my reality. battling a number of complex illness that has not only taken a toll on me, it's taking a toll on my entire family. as you might imagine, my medical expenses are significant and are becoming more significant by the day. we fell behind on our mortgage and we were forced to sell our home. it was difficult to make ends meet. at the time the first priority was to buy medicine that my son who is now 20-years-old needed for his own health condition. this required us to scrape money together to make sure that he

had the necessary medicine that he required. paying for my numerous costly medications was out of the question. therefore i was unable to purchase them. as a result i was hospitalized five times over the course of six months which resulted in five additional stands. as it became more difficult for me to manage the growing burdens became overwhelming for my husband. and after 21 years of marriage, she decided to walk away. i had no choice but to move from south carolina to move to georgia with my parents. i now live in georgia and although my primary care physician is nearby, i've had to travel over two hours to see my

specialist. and because of my seizure disorder, i depend on my parent to take me to my appointment. in addition to my primary caregiver, i also must see the full doctors. i have a cardiologist that helps me manage my heart disease, a urologist and a neurosurgeon that helps me manage my seizure disorder, and i have a rheumatologist who helps me manage my olympus and arthritis. i interact with countless other healthcare professionals such as nurses, physicians assistants, therapists and others. although my doctors are all well intentioned, they often don't talk with each other or share information about my care. this ultimately leads me to be my own health care coordinator. to give you an example, my lupus disorder keeps my body in a constant state of inflammation for which one of my specialist

prescribed me a medication to reduce the symptoms. unfortunately, that medication can cause seizures. he didn't remember my seizure disorder and the medication caused me to have an increase of seizures. after a visit he took me off the medication knowing the seizure side effect. getting this result of days and countless phone calls and much persistence on my part not including the increase of seizures. issues like this happen frequently and although i consider myself an educated person, navigating this is very difficult and exhausting but it is my life at stake and i do not have a choice but to be engaged. to give you another example, i recently had to change to a new primary care doctor since by former doctor is now only accepting private pay patients.

this has been a challenge as it will take some time for me to become familiar with my doctor and for her to become familiar with me and my medical history. in an ideal world i would want my primary care doctor to manage all of my care but i've come to realize that this is not realistic because i require specialist physicians. for a long time i was privately insured through my employer and later through my husband's insurance policy however when my husband was laid off and his health benefits terminated, i was left without insurance. fortunately i was able to qualify for medicare in 2004 because of the federal disability act although it took two years of fighting to qualify for medicare program has been extremely helpful but still leaves me constantly struggling to pay my portion of my medical bills.

my last surgery in september of 2012 cost $51,000 for an overnight visit. medicare covered all but $1,138 of that fee. i have encountered countless challenges along the journey and i'm extremely fortunate to be here today to share my story. i'm confident that you will not forget me and countless other people dealing with chronic illnesses when you develop policies that will help all of us. our goals are all the same, to its live long, healthy and productive lives. i think you for giving me this opportunity to share my story with you. >> thank you. you have delivered a powerful and eloquent wake-up call that speaks to the dimensions of

chronic illness and i want you to know that i think the strongest richest country on earth can do better by those that have these kind of chronic conditions and you ask that you not to be forgotten. you've got senators hear democrats and republicans committed to making sure that does not happen. welcome from minneapolis minnesota. >> thank you. everybody has a microphone there. >> and then we go. good morning chairman, ranking member hatch and members of the committee on behalf of caregivers for individuals living with alzheimer's disease and other dementia thank you for

the opportunity to testify before you today on the topic of chronic care. alzheimer's is a devastating, progressive and ultimately fatal disease. it currently impacts more than 5 million americans living with the disease and the 15.5 million caregivers. these men and women living with alzheimer's are men -- husbands and wives, mothers and fathers, sisters and brothers, business leaders, medical professionals, republicans, democrats and my husband of 50 years is one of them. i am honored to be here today to share our story and discuss the issues facing individuals with alzheimer's and their caregivers the more we share our story and talk about alzheimer's the less of a stigma it will be for

others facing this disease. while ken is fortunate to have a partner to advocate for him and a definitive diagnosis, initially a care plan to ensure that he lives as well as possible with alzheimer's was not available to us. our journey to get here was long and difficult. there are many that live with this disease that never gets the care and support the need. his tentative diagnosis came in october of 2009. however, i became aware of changes in his personality and behavior as far back as 1995. it was then i began to notice his withdrawal from family, friends and social situations having the difficulty navigating familiar places as well as challenges and executive

functions involving problem solving and reasoning. his judgment was often compromised especially in regard to the finances. he communicated to me that he was having difficulties at work particularly learning new contributor programs. we were both patients of a well-known and highly respected internist for 30 years and over the years i reported my observations to him. they've brushed off my concerns that the science might be something serious by responding with well, these things can happen or it might just be part of his aging. i would tuck away my fear of the next time and the next time. the wake-up call came however when my love told me we have to

file for bankruptcy. his compromised financial judgment had escalated to financial failure. subsequently, we moved our home as well. i was left thinking how could this ever have happened to us? i encouraged him to see another doctor to learn the reasons why. after seeing for doctors and three interests in a year and a half, he was finally diagnosed definitely with alzheimer's disease in january of 2011. our story is not unique. many families struggle to get a definitive diagnosis of alzheimer's disease just like we did. following his diagnosis the second internist told him to return in a year for a checkup.

after receiving the diagnosis, he went through what he called the three d., denial, depression, despair. i was devastated and desperate for more answers. we were given the diagnosis, but no information on what to expect or how to deal with the symptoms or how to even manage his atrial flutter along with the alzheimer's. after three appointments with three different urologists we were finally able to find one with experience in treating people with alzheimer's. today he's a patient he is a patient at the center for memory and aging and interpol with doctor michael rosenblum. and along with the alzheimer's association, we have developed a plan not only for kenneth to live well but also for me as his caregiver. maria shriver's hbo documentary

the alzheimer's project, reports that 74% of caregivers do not survive persons for whom they are caring. it is not only the person with the disease that needs care and support, but the care partner as well especially to reduce stress. from our networking with others, we have also learned that our story in our financial hardship associated with the disease is not unique. in many ways, i see my role as his care partner much like that of an operations manager. i try to make sure he can be as independent as can be. we make a concerted effort to engage in social activities, to have a healthy diet, for ken to exercise his mind and body and for him to engage in creative expression. ..

when it comes to dealing with alzheimer's. onlyith the wahysicians are not far too many positions are not familiar with the warning signs of alzheimer's or how to properly advise patients and their caregivers. additionally, there is a lack of communication and coordination among physicians.

can the season internist, a cardiologist and an urologist to deal with various conditions. he carries a list of his beloved medication and supplements to reach event to ensure that each position is aware of what is other health providers have prescribed for him. sadly, this is more the case of the exception for many individuals with alzheimer's and their caregivers. thank you for the opportunity to testify today. i appreciate the steadfast support of the committee and its focus on chronic care. alzheimer's is a disease that not only impacts the diagnosed person, but also relies their loved ones. i ask congress to address chronic care tissues around all favors of the same bipartisan collaboration demonstrated in

the passage of the national alzheimer's project act. just focus on quality dementia care will help individuals living with alzheimer's disease than their caregivers on the country. an epidemic is well upon us into many families are in situations like ours, facing a fatal brain disease that currently has no way to prevent, cure or even slow its progression. and we are left without a support system to guide us. as a nation, we cannot afford to wait until alzheimer's bankrupt the nation just a severity has for so many hard-working families in utah and across this country. we must make the smart investment now to realize a better, healthier future for our families and our nation.

right now, i'll see how this hope. she is your master. next thank you, in addition to hope we have you and i see a size seven halo over there by the witness table and listening to your story also very much exemplifies what my mother tell with. my mother had alzheimer's and dementia, got a masters degree from yale in the days when no woman got a masters degree and we thought very much the same devolution and they very much appreciate your coming. we've got a number of champions here on this committee on both said that the outcome of democrats and republicans who want to follow up on alzheimer reforms so we thank you. dr. bornstein, welcome.

>> thank you. thank you, chairman wyden, ranking member hatch and members of the senate finance committee for inviting me to discuss health care effort related to caring for chronic health care patient. i also wish to extend a special thanks to senator johnny isakson who is a senator, good friend and strong supporter of our work. as the chief medical officer of emory health care in atlanta, that is a practicing endocrinologist, i know firsthand the challenges faced by our patients with multiple chronic medical conditions of which you've heard eloquent testimony. many of my patients had diabetes in most patients with diabetes have other medical problems. hypertension, coronary disease, kidney disease and many others. many of these patients the multiple specialists. they may be seeing me for diabetes or cardiologist for the coronary disease, neurologist for care of the kidney disease. everything that each of us does

as you've heard this affects the location. many problems like elevated lead pressure and elevated cholesterol overlap each of her specialties. each of us tries to take a patient centered a perch to treating a set of problems, but the challenge is how we make sure that all the cares scored native so we can take a patient centered approach to the care of the whole patient. at emory, we have a highly sophisticated single electronic medical record system that fails our hospitals and outpatient clinics so that all providers can see the entire medical record. however, coordination of care requires for the technology and good intentions. it requires reallocation of time from face-to-face interactions to time devoted to coordination of efforts among providers and a non-face-to-face interactions providing continuous care of patients. thought addition, we are hiring and training nurse care court maters.

we embed these primary care practices and feed them data identifying the highest risk patients. coordinators stay in touch with those patients come out being to make sure that they are doing well and monday are not providing them the care they need. however as you know, care coordination and technology infrastructure are expensive. when these investments are successful, they help keep our patients out of emergency rooms in hospitals, thus reducing revenue of the health care system. under fee-for-service, i am in the awkward position of asking our health system to fund efforts that will reduce the revenue within a context of declining reimbursement like the 2% sequester cut and the ever looming specter of sgr. to try and deal with these challenges proactively, we have formed a clinically integrated network, emory health care network or ea chen, which is our organization that provides

infrastructure and support for positions of collaborative and quality-based environment that drives outstanding performance and improves care coordination and enhances outcomes and controls costs for patients to our community. ehn is contracting with payers in ways that liberate us from the constraints of fee-for-service and move us towards better alignment of faith among patients, providers and payers. we have a shared savings contract with la crosse blue shield and are negotiating similar contracts with other commercial payers. under shared savings affordable to lower the total cost of care and improve quality to better coordination of care, we share the savings. shared savings can all savings can help offset what would otherwise be negative financial consequences of the investments needed to improve patient care. the cost is in the range of six to $10 million annually to run ehn and that does not fall include the cost incurred by private practices to connect to

our emory health information exchange which would require for their participation in ehn. as the leading academic medical center, we care for some of the most complex cases in the country. emory has been remarkably successful at working within current constraints. emery is the only health system to more than one hospital ranked among the top 10 academic hospitals in the prestigious university health system consortium quality and accountable scorecard. indeed vote eligible hospitals, every university hospital in midtown has in midtown has been in its content for the past two years and are ranked number two and number three respectively. we are proud for this achievement, most importantly because of what it means for patients. however, we are by no means satisfied. we need to apply and extend achievements across the continuum to achieve the tripling of better health, better health care and lower cost for the population we

serve. we can only achieve this are better coordination of care. our physicians and staff that's really want to take it or care to patients. that's why the practice medicine. structures great frustration among providers as well as patients. our primary care teams feel this frustration is most acutely in these contribute to the relative lack of interest in primary care and other non-procedural specialties. frankly it is easier and more profitable to do procedures and to try and coordinate care in our current system. our nation's capacity to grow the workforce is predicated on doctors being able to do what the internet is interview, care for patient needs. american health care should in a golden age. we have so much to offer patient and so much more than a few years ago. to deliver on this promise we need a free market removes barriers and rewards high-quality courteney to care.

thank you personified in the challenging issue comic in care. i look forward to questions you may have paid >> thank you for the help you've given the committee and highlighting how flawed the incentives are in today's system. we look forward to questions. ms. demars. >> good morning, chairman. good morning, chairman wyden, ranking member hatchet members of the committee. i am here today to represent the alliance, which is a not-for-profit cooperative on by over 200 employers in wisconsin, illinois and iowa who together provide health benefits for over 90,000 employees and their family members. employers who remember members of the alliance are working to address chronic achieve this by creating help you with laces, by reducing the financial burden to patients for value-based benefit design and by raising the bar on our expectations for health care

delivery. our efforts in wellness and design are important, but loans are insufficient to address the problems we face in health care. the efforts that we have made so far are resulting in in results that are too modest and too slow. so simultaneously, we need to use our role as purchasers of health care to make faster progress. i'm not the idea behind a new initiative we are developing called quality pass. through quality pass, we will move market shares to high-value positions on trade physicians and hospitals and in doing so overcome barriers to faster progress, specifically information to help understand the performance of individual physicians and incentives misaligned or nonexistent for patients and providers. here starting with high cost

schedulable procedures in cardiology and orthopedics because those are the areas where members spend the most money. here is how the program will work. first, quality pass will value the individual doctor and hospital hearings. consumers, patients, want and deserve information to help them understand the performance of their doctors. get sufficient specific hospitals, physician public reporting remains elusive goal and the promise of the physician compare website is yet to be realized. we will address this on consumer need by requiring physicians to disclose performance on quality measures as part of the quality pass application process. second, quality pathless sa high bar. we intend to make a real mic difference in health care and so have carefully chosen criteria that we will use to designate

quality pass providers. we have relied on input from clinicians to deliver the care and their specialty societies and have aligned with leading-edge public and private sector initiatives. the most notable is the mmi funded smart care project, which was the ballot by the leadership of the wisconsin chapter of the american college of cardiology and the wisconsin medical society. doctors and hospitals that receive the quality pass designation will score high on quality measures, will avoid exposing patients to harm associated with the overuse of imaging tests, will consult with patients and respect multiple truth and i shouldn't available. and we will talk with patients about future care needs and documented their wishes for end-of-life care is appropriate.

finally, quality pass will lower costs for employers and patients. we will be negotiating more aggressive lower bundled prices with warranties. this person will only be available to employers, our members who agree to implement substantial financial incentives for their employees to choose quality pass providers. that way quality pathless simultaneously reward patience they seek high-value care in the providers that deliver it. quality path relies on access data and the flexibility for purchasers to renovate and that is where the federal government can help. employer organizations like ours and the databases we rely on the access to medicare data to enhance physician level management. we also need flexibility to design plans reward high-value care.

and we need partners. market-based efforts like quality path will may succeed if there is a significant business case for providers. state and federal government act in their hall of fame players and purchasers can join with private sector after his two amplifier signal strength. data driven innovation holds great promise for improving the value of care and thank you for letting me share employers suffers to make that happen. >> it's helpful to have that employer input. senator hatch has tried to be in two places at once this morning and he's very much needed in judiciary. senator hatch, please type the start. >> well, grateful to all of you. your testimony had home here and we want to do everything we can to help. i'm sorry i'm such between two committees. and i'm very in everything you said and everything you

suggested. with that i hope you'll forgive me for having this burden of two committees going to the same time. thank you. >> senator hatch, thank you. you can't quite be clogged so it's great to have your leadership. that may start with a question i've been struck by having watched the odyssey of those with chronic diseases over the years beginning in those camp verde is and over the years. when you bump up against first is the staggering burden, but truly staggering burden on patients and families. they have the disease and then they have to figure out how to make their way through as you, ms. dempsey said so eloquently and you, ms. lehmann to make your way through the maze of treatments and medications and

appointments and it just strikes me like the system put this gigantic holder on your back, this overwhelming burden on your back when you are trying to deal with chronic disease and patients have several positions. they've got this i always called it a mountain of prescription, but i guess i've got to rename it now that i see try after trey over there on the witness table and i guess they just delivered a phone book the other day to this staff and people shall have medical records beside the phone books. the first question i would like to see if we can get her arms around as we try to move forward and as i've indicated, the senators here who have been really passionately interested in these issues. senator staff and now, for example and a mentor to me on this alzheimer's issue.

senator casey looking a chronic disease for young people and said under isakson teaming up and a lot of senators who care about this issue. what i am struck by is that the outset how valuable to me in the kind of seat of my pants it would be to have one individual, one single individual, whether it is a nurse, a physician, another individual from the health care system who basically would be the go to person for coordinating the appointments and keeping track of multiple doctors and making sure that one individual.or communicate with another. i was the whole point of the electronic medical record. you didn't want dr. three have to repeat all this stuff.or two and one d