>> [inaudible conversations] ..

as well as working journalist who is are club members. to hear applause in our audience i note to members of the general public are attending so not necessarily evidence of a lack of journalistic objectivity. i would also like to welcome our c-span and public radio audiences. you can follow the action on twitter, using hashtag, npclunch. after our guest's speech concludes we'll have a question and answer period. i will ask as many as time permits. now it is time to introduce our

head table guests. i would like each of you to stand briefly as your name is announced. please hold your applause until i complete announcing everybody at the head table. from your right, gil klein, journalism professor, american university's washington semester program a past npc president and chair of the club's history and heritage committee. janice law, former print journalist and criminal court judge and founder of the american women writers national museum. ambassador sell la, roosevelt, the united states chief of protocol from 1982 to 1989. who married archie roosevelt, jr., the grandson of theodore roosevelt in 1950. andrea stone, freelance journal ist. chuck ross, washington correspondent for the "st. louis post dispatch.." jeffrey ward, writer, historian who has collaborated with ken since his civil war series.

he has won seven emmy awards. donna lejae, reporter for usa today. a past president of the npc and vice-chair of the nbc speakers committees. skipping over your speaker for a moment. nick angilletta postalis, u.s. capital visitors center and speakers committee member who coorganized today's event with amy henderson. thank you, amy and thank you, nick. paula krueger, ceo of pbs and guest of the speaker. markham rick, washington bureau chief of bank rate, past npc president and chair of the club's broadcast committee. elaine king, professor of art history and theory and museum studies at can carnegie mellon and art critic for numerous publications.

glen ellis, a documentary news and television producer. a round of applause for our head table. [applause] more than 30 years ken burns's documentaries have presented the stories of the american experience with drama and flair. his topics have ranged from the brooklyn bridge to baseball, from mark twain to jazz. from prohibition to the national parks. remarkably, his works never become outdated. as we commemorate the 150th anniversary of the civil war, his pbs series on that war remains as relevant today as it was when it debuted in 1950. burns captures historic moments of american life and deep dives into archival materials, personal letters, diaries and newspapers. his use of still photographs have been revolutionary. he is called photographs that the dna of everything he has

done. and his evocative slow scans transformed his subjects into a sin mat i can experience. the slow-moving, the slow motion scanning technique is now reason called, the ken burns effect. his new seven-part pbs series, roots sveltes, premiered last night and i have reliable information that the ratings were extremely high and that they are sorry. the series will be broadcast every night this week. in this film he focuses on the towering but flawed figures who before they were history. were family. he was able to draw on news real footage, radio broadcasts and personal documents. notably a trove of duly discovered letters between fdr and his cousin daisy as well as on an enormous volume of photographs, ultimately, nearly 2 -- 2400 stills were used in this series.

burns has always rejected using the voice of god approach to narration. relying instead on contemporary voices to bring his subjects words to life. in the "roots sveltes" you will hear some of america's greatest actors, paulgy giamatti as thigh door, edward herman as franklin and meryl streep as eleanor. ken burns is a frequent guest at this podium because like his films he never becomes outdated. please join me in welcomeing the documentarian and press club member, ken burns. [applause] >> thank you all very much for coming. i'm so happy to be back at the press club. it has really been a home base for many, many of our long arduous promotional tours for

the film and today is no exception. i do feel compelled to edit myron, just one little bit. he had the civil war series coming out in 1950. i was negative three years old then. [laughter]. though i was already working with stills, i had not yet perfected what we call the ken burns effect quite then. i also feel, now that you brought up the civil war, myron, that, i reminded you 24 years ago in 1990, when we came with the civil war, that i reminded you what william tech couple saw sherman felt about newspapermen. he hated newspapermen so much if he killed them all there would be news from hell before breakfast. of course unfortunately you do not escaped unscathedded with the "roots sveltes" all three, he will moretwice weekly,

franklin had been an editor of the "harvard crimson" felt that made him a newspaper man himself and, loved to develop and cherish the development of personal relationships with the newspaper, men that he crowded in, men, that crowded in, 998 times for news conferences during his presidency. theodore was equally adept manipulating the press and making them feel like they were friend and ushering them into his private world though he did have a special perking tory for those people who -- purgatory, who displeased him. the anias club. anias club, which is of course from the ancient liar who was instantaneously stricken down from having told a lie and if you were compelled to the anias club, you were not in theodore roosevelt's good graces.

i'm sure that is not true of anyone here. woe walk it back a little bit. he would confide to a reporter criticized him so heavily, than when the sob owned the paper. he was merely taking it out on the messenger. first of all, i do not come here without the assistance of hundreds of people. those of you had a chance to watch last night's film there was a credit sequence that went on for many minutes that thanked quite correctly, hundreds of people. first of all, because this is public television, we are dependent not on our sponsors but on our underwriters there. is a huge and very important difference between them. and i would just like to take a moment to thank the bank of america, which has been our sole corporate sponsor since 2006 and planned to be involved through 2020. they have beenen enlightened

corporation that has helped us. i'm also grateful to pbs itself and the corporation for public broadcasting, for major funding. i'm also grateful to the national endowment for the humanities. i began this business an awfully long time ago in the late '70s and i had the great good fortune to work with its chairman, joe duffy, who turned up today, not like a bad penny but as a welcome old friend and it is great to have joe here. thank you, joe for all the support you and subsequent chairmans, there must be about a dozen now since you, that have been supporting our work. we also have sustained support of the arthur vining davis foundations. individual contributions, significant individual contributions from jack taylor and roslyn walter and we also enjoy the support of a new organization, a non-profit called, the better angel society. and john and jessica fullerton and joan newton and the gulkin

family and bonnie and tom mccloseky and the file foundation all contributed to our film and i would literally simply not be here without their support. nor would i be here without the support for the corporation for public broadcasting and for my long-time production partners, for almost 35 years of weta, which is the washington, d.c., based public television affiliate and its head, sharon rockefeller. and there are, been our production partners for that long. i'm also extremely grateful to our network. i think the best in the business. you know we live in a place which we are saturated, buried in information, a little bit more on that later but, we also enjoy one home where we know reliably whether it is our children or delving into issues of science or nature, whether it is about public affairs or

artist i can performance, whether it is public affairs or history, we have the best place on the dial and that is pbs and i am so honored, my president paula krueger, is here today. whatever you like about what we do, it's them and the pick that they set for me. these films are also not made by a single person. writers have that and reporters for the most part who are not having to blog and do video posts and all of that, have that luxury of working alone but i also have what i think is even the greater luxury of participating in an extraordinarily collaborative medium and there are many people responsible for this film, editors and producers, paul barns and pam bokam, all the extraordinary archives collect more than 25,000 still

photographs that went into the 23, 2400 made it into the final film. same two for the archives that found the extraordinary and in some case never-before-seen still photographs, moving pictures. all the sights from camp abello island down to warm springs where roots sveltes made their home. my coy elaborate tore of 23 years, yes from ward, hear happily with his wife diane and we have just been making films together for an awfully long time, beginning not again, myron, editing your text, but with the civil war but we began when we was an advisor on film we made on the celibate religious sect, the shakessers,

and next film came out in 1985, five years before the civil war on the turbulent life of the southern demagogue, huey long. we have been making history together and we have been talking together for almost all of those 32 years about making a film or a film series on one or moore of the rooseveltses. jeff himself written too extraordinarily great book on the rooseveltses. on franklin roosevelt's early life. one is "before the trumpet" which takes him from his birth to his marriage to eleanor. the second which is one of the greatist biographies i ever read, run to your notepads to jot this down, first class temperment, takes franklin roosevelt from his honeymoon to his election as governor of new york. it is a remarkable story and it is a remarkable story about extremely complicated human being overcoming one of the most

devastating illnesses that you could imagine and still managing to become president of the united states. part of the story, we want to tell. so now that i have completely buried the lead, i will be rescued by myron who is absolutely correct to say that for the last seven years jeff and i and our team have been producing a seven-part, 14-hour series on the history of theodore franklin and eleanors roosevelt. pbs began broadcasting this series nationally in unprecedented fashion last night where they showed the first episode and showed the first episode again at 10:00 and each subsequent night we'll show another episode until this coming saturday, the 20th. we believe it is the first time short of a national tragedy when a single network has shown a, taken up a entire prime time and then some. it goes from 8:00 until midnight, an hour out of prime

time, for one single show. and we're very happy with public television's confidence in the work we've done and i'd like to spend a few more minutes before the good part, where i have a chance to have an exchange with you to tell you a little bit what we're trying to do. those of you who saw last night, saw the table setting episode in which we set in motion what is the most complicated and intertwined and interbraided narrative that i think that i've ever undertaken. i certainly think that jeff thinks so as well, even though we have tackled together history of the civil war, baseball, jazz, the second world war, and are working right now on a history of the war in vietnam. we were drawn to doing all three in part because of that avalanche of information that i mentioned to you earlier. we live in a media culture in which we think we know everything. we have lots of information and almost no understanding. we are drowning and one of the

default positions of this excessive information we tend to form, superficial conventional wisdom about the subjects we think we know b either those happening today or those that that took place in the past. so it seems for almost the entire history of this country, since the rooseveltses, we have compelled to folk just on theodore and there are very good books and films on him or franklin and a lot of good books. jeff has written two of them. and franklin and eleanor, a little bit less on eleanor but no one has put it together as the complicated, family drama that it is. i guess this has to do with the fact that in that superficial glance, we look at theodore and say republican and look at franklin and eleanor say democrat and we think that we can segregate them in their own individual silos. it is interesting as individuals and certainly franklin and

eleanor as a pair, it is exponentially more interesting, if you have the opportunity to get to know them in concert and that's what we tried to do. it is a complicated, russian novel of a story that has not only these three primary characters but dozens of secondary and tertiary characters and of course a world that they compelled and a world that compelled them that is dealing with the late 19th century, coming out of the civil war, the guilded age, the age of monopolies and trust, world war i and roaring '20s and jazz age, great depression, second world war, greatest cataclysm in human history and the cold war when theodore roosevelt was born in 1858 when our series began to when eleanor dies in 1962 when our series ends this coming saturday night, we are dealing with a century, 104 years, an american century in so, in a place and a time

where so much of the modern world was created and these three people are as responsible for that world as anybody that i know. we say, and we say with absolute conviction and confidence in the opening of our film, which you might have seen last night that no other family has touched as many americans as the rooseveltses. that is true. you. if you rode out of the la gaard yaw airport that is something that, franklin roosevelt did or the l in chicago on are or tennessee valley, expect lights to come on in the northwest or southwest. traveled over thousands of bridges bills during their era. you have seen or attended thousands of high schools.

you have driven on miles and miles of roads that they originally blazed in this country. and more importantly, you will enjoy or you are enjoying cashing a social security check. you like the idea that our government takes its soldiers and pays for their college education with the g.i. bill. i'm sure you're thrilled that your children do not work in mines seven day as week, 14 hours a day. that there are such concepts as minimum wage and liveable hours. i think you're certain big monopolies ought to be at least regulated if not broken up. i think you enjoy visiting our national parks and national forests and other sanctuaries of the beautiful wildness that our country still has preserved, preserved in large part, thanks to these two extraordinary presidents, theodore and franklin roosevelt. their legacy, this is only a small, small portion of their leg ba system they of course

raised questions that are not always positive and i do not in any way want to suggest to you that the film we've made is in some ways a valentine to these three human beings. that it is in some ways hero-worship. in fact we're interested in telling a complicated portrait of their great strength but also their great weaknesses and flaws and my goodness, ladies and gentlemen, they are on vivid display with these three characters. and more important their deep wounds. and that's, i think where the subtitle of our film comes in. this "the roosevelts:an intimate history." i have to warn you this is not tabloid history. we're interested in getting to know them. we often debate in our films, the tensions, between a top down

history and a bottom-up history. this has been for many years the dynamic and the argument within history. is it only top-down? is it only about famous people? wars and generals and presidents? or is it about so-called ordinary people, women, minorities, labor, people like you and me for whom the real history of america is written. we believe that it is a mixture of the two and even in a film like this, we try to engage a top-down alongside, bottom-up history to tell something more complicated, more nuanced with undertow et cetera. but this is also an inside-out history. i don't mean to suggest this is some ways filled with psychobabble but we're curious about where these three people came from. after all, it's a family drama. we want to understand about their parents. we want to understand about their childhoods. we want to understand about their spouses. and their children and their

lives within their families and we feel that by understanding it, particularly for these three ordinary people, and ladies and gentlemen, biography has been a constituent building block of almost every film we've worked on. it is hugely important to understand the world they created and that is essentially the world we have inherited. at least in a political and social fashion in the united states. it is hugely important to understand where they came from. and just stop to consider for a moment, the topicalness of their story. the central question of theodore's time, the central question of franklin and eleanor's time, is the central question of our time. what is the role of government? what can a citizen expect from his or her government? what is the tension between pragmatism and ideology? what is the nature of leadership?

how does character form leadership? how does adversity in life create character which in turn forms that leadership? these are the questions we asked, the means testing we applied to our own leaders today and they are as relevant now as they were back in the time and vice versa. our film is essentially an exploration of their lives, inner and outer, the way they shaped this country and to try to deal on the fault line of that. now we live in an age that same media culture, whose default position is also to lament the absence of heros. we're constantly saying, oh, doing a film like this and promoting a film like this has brought out myriad comments we just don't make heroes anymore but let's just remember that we are expecting in this superficiality of our media culture today, we are, for some reason, expecting perfection in our leaders.

when we find they aren't perfect we turn away from them, say, they're just aren't leaders but let us examine the very nature of the word hero. it is, we get, from the greeks. and the greeks in no way defined it as perfection. in fact they understood heroism to be a very complex negotiation. sometimes a war between a person's obvious strengths and their equal and perhaps not so obvious weaknesses. it is that negotiation, it is that war sometimes and with tease three people, it is indeed a war, that defines heroism. achilles had his heal and his hubris to go along with all his strengths and fine characteristics. maybe what i hope in some ways, people ask, what do we want from the series? we want you to enjoy what we think is a rip-snorting good story. we might also want to us reexamine the way in which we

apply that superficiality to the people of today so that we might gain a little bit more tolerance, perhaps a little bit more civility in our conversations. everything will not be just black and white. now the roosevelts provokes this in some people but what we try to do is offer a nuanced portrait. consider the oldest of them for just one second. theodore roosevelt born in 1868 with a sickly as mattic child. he overheard in childhood as you might have learned last night he was not destined to live. he heard a doctor telling his parents that he was going to die very early on. he struggled all his life to remake his body, to turn it into as his father said, get action, be sane and all his life, theodore roosevelt worked as hard as he could to make and remake his body. he never escaped the asthma that afflicted him as a child but he

did remake his body and he became somebody. but his branch of the family, the oyster bay branch, was list susceptible to a good deal of depression. susceptible to alcoholism. susceptible to mental illness. he felt all his life that he had to be in action, not just to escape the specific gravity of his physical ailment but to escape the dark gloom that seemed to overtake him when he wasn't in a constant, frantic rush. he once said, black care rarely sits behind a writer whose pace is fast enough. black care rarely sits behind a writer whose pace is fast enough. that tells you, it is a wonderful, 11th century way of say something very understandable in the 20th and 21 czars century, which you can outrun your demons. theodore roosevelt spent his

entire life, not for a moment hesitating, trying to outrun his demons. if you look at the oldest photograph you can think of in your mind of an ancient theodore roosevelt, he looks to be 85 years old. he died at age 60 i am 61. it is an amazing life dedicated to this escaping the specific "gravity," and, he also had to overcompensate for a deep flaw his wonderful father, a man he adored more than anyone else in life had. his mother was an unreconstructed southerner and insisted that her husband not fight in the civil war. he did what many wealthy people did do, did in that time, bought a substitute, paid someone else to fight for him. this was a flaw which ate at theodore roosevelt and made him i feel we should also say despite all of his great habits, may i say, this evening, episode two, his presidency, you will get to meet theodore roosevelt in all of his wonderful glory,

all of the great things. you know he always thought if he didn't have a crisis on your hand as a president, you couldn't be judged a great president. he is the sterling example of that. david mccullough says in our film, many people thought he was the crisis. [laughing] perhaps we were lucky that we didn't have a major crisis on his watch but his presidency is a model of engagement with its citizens. you know the united states was in a period not dissimilar to now when there was huge disparity between the wealthiest and poorest. the middle class was disappearing and was under assault. theodore roosevelt rode to the rescue. he understood government had to be a an agent, a player in complex dynamic between industry that was unchecked and between the worker that was not getting a square or a fair deal. and he did that all his life. and invite you to revel in all of the great strengths and delights of getting to know

theodore roosevelt much the three he is definitely the person you go out and have a beer with or drive across the country with and i engage you to spend this week driving across the country with theodore roosevelt. but he did have this thing. he thought war was a good thing. he was reckless that day on san juan hill. he was disappointed he didn't get a disfiguring wound. . . >> with the most horrible, tragic

consequences you can remember that will make you want to weigh very carefully, and i would urge you not to make a final judgment, weigh very carefully these twin poles of one of the most extraordinary presidents, theodore roosevelt. franklin, we know his story -- we think -- pretty well. he was stricken with infantile paralysis, polio, at age 39. up to that point, he had been the pampered only son of his older father james and his much younger wife, sarah. they pampered in him, instilled in him, thank goodness, all the confidence and optimism that any child has ever had. but he was, essentially, a very lonely child and a little bit too thin, a little bit too ambitious, a little bit too charming as he tried to hit all the marks, all the footsteps of his more famous cousin, theodore, as he too tried to

emulate his unprepared-for trajectory to the presidency. it's only when he could not take another step that this extraordinary empathy entered into him and was producing -- and he became what we would say is the great itself president of the 20th century and arguably -- and for a lincoln man not difficult any more to say, but has come up to parity in my eyes as, arguably, the greatest president in american history. his opaque, manipulative, and we need to take franklin roosevelt and balance those scales in the same term. and i invite you to watch as he and eleanor, in this episode tonight and in the next one, begin to transit away from theodore roosevelt who dies at the end of our third episode, and then the four through seven is really largely about franklin and eleanor and the world that they inhabit as well as the ghost of theodore who is watching over everything

magnificently and never fails to make an appearance of some kind in each one of those subsequent episodes past his death. i am saving, perhaps, the best for last. eleanor roosevelt, though not a president, as we say in the film was the most consequential first lady in american history and arguably the most important woman in american history. she is, as jeff ward likes to say, a miracle of the human spirit. she should not have escaped her childhood. she, her father, the president theodore roosevelt's brother elliott, was a hopeless alcoholic, he was also mentally ill. he died very young. she spent her whole life, you know, idolizing him unnecessarily, i think. her mother was this exquisite beauty but very remote and hypercon dry call and was disappointed in her daughter's looks and called her own

daughter granny. both parents were dead by the time eleanor was 10 years old. she and a younger brother for whom she'd always feel responsible -- who died in her arms in the throes of delirium many years later, were sent off to grim and pious relatives where there was an abusive nurse and two more alcoholic uncles. she was absolutely terrified of everything. but out of these experiences, she began to notice that if she was useful to other people, she could be loved. and she decided to translate that problem, that fear into action. every day she got up, and she faced her fears. it's an amazing thing. i've got four daughters that i am so proud of. my second daughter was terrified of the vacuum cleaner. [laughter] whenever it was roaring, she had to be out of the room or asleep or out of the house. but one day when lily was a year and a half, two years old, she walked into the room where the

monster was roaring and walked over and sat down on it. [laughter] and in our family, sitting on the vacuum cleaner is our idea of what you do in life. you move forward, and you face the thing that worries you the most. and eleanor roosevelt sat on a vacuum cleaner every single day of her life. we made a film on the national park, and it was said, national parks, and it was said of theodore roosevelt by stuart udall in that film that he had distance in his eyes, that he could maybe see around the horizon and understand what was going to happen in the future. i believe all three of these remarkable people had distance in their eyes, and no one more so than eleanor. liberated from having to represent constituencies as her favorite uncle and her husband did, she could see all the coming issues of race, of poverty, of women, of children, of labor, of absolutely

everything that is on the front page of our discussions today, and she was right on every single one of those issues. a testament, indeed, to the human spirit. so these are our three roosevelts. flawed, wonderful, deeply wounded who all basically reduced their philosophy into one spectacularly simple equation. we all do well when we all do well. it is very fashionable today, ladies and gentlemen, to blame the united states government on absolutely everything. it is now -- it has now somehow become something other. but we are only to blame either by not voting or by voting for the wrong people for however that government is. and if you don't like it, stop bitching and moaning and complaining -- [laughter] and do something about it. that's what the roosevelts did. and theodore roosevelt said the government is us, you and me. thank you. [applause]

>> we have, we have enough questions to go for two hours, so please, i apologize in advance. so i think we'll do a rapid fire, i'll try to ask them if you could give questions -- answers just as succinct as you can -- >> i have brief nine-part answers -- [laughter] >> sure. seven parts. t.r. and fdr were strikingly different personalities with t.r. being boisterous and brilliant, fdr being charming and manipulative and elusive. which of these figures did you find harder to grasp and why? [laughter] >> that's interesting, all the adjectives describing theodore are all positive, and two out of three of them for franklin are negative, so there's a little bit of the thumb on the scale.

they're both equally magnificent. franklin roosevelt is the much better president and the much better, in some ways, human being, i think. but you will be infuriated by his manipulativeness and to passty and at least -- opacity and at least early on his ambition. but they're all complicated people. william shakespeare was described by john keats as having the ability to hold intention these things when the rest of us want to make a judgment -- good or bad, gay or straight, whatever it is we have to superimpose on the other. and the best figures in our lives and in our drama, our art, our literature is where we have held the very complicated facets of a human being intention, and i think that's what we've tried to do in this series. >> most historians rank fdr just after lincoln and washington. why does it seem the roosevelts

have faded in the public's view compared to, say, reagan and jfk? >> well, when you live in a media culture and a consumer culture that is focused on this all-consuming and thereby disposable moment, blissfully unaware of the historical tides that brought us here or the tides that will take us away, it's very understandable that we'll forget our past. but each one of those presidents that you mentioned, jfk and particularly ronald reagan whose great hero was franklin roosevelt, you'll begin to understand how they shaped particularly franklin roosevelt shaped the world we live in today. and it may be just the my develop ya of our existence that we don't have distance in our eyes backwards or forwards to understand the centrality of the roosevelts to this present moment. >> the roosevelts lived in years when public figures could preserve a modicum of privacy in their personal lives. how did this affect your research and, ultimately, your

ability to create an intimate portrait? >> well, you know, they wrote a lot. they are hugely important, and so they have been written a hot about, and we tend to romanticize as simpler those earlier days. simpler, like the 1930s when the greatest economic dislocation in the history of the world happened. simpler like the 1940s when the greatest cataclysm in history happened. franklin roosevelt was the most accessible president ever. he had 998 news conferences. those reporters who may have turned off their newsreels cameras just as he went into the process of standing up or sitting down and the arduous, sweat-dripping painful process which we would not do today, we'd be grasping for every single moment of it to feed the hungry maw. nevertheless, knew exactly what it cost him to stand up or to sit down, understood even more intimately what was going on in the dynamics of his

administration and in the pressing issues of the world. we now have a presidency surrounded by a gigantic mot, a bubble we call it that does not permit, we think, him or her to understand us but, in fact, it's the other way around. we don't understand him and so default again to that conventional wisdom. i think we know as much about the roosevelts. we also know a lot, a good deal with their private life, and that's been extremely helpful especially with regard to the letters of daisy sukely who you mentioned later. they have given dimension to what has often been a one-dimensional portrait of franklin roosevelt's personally. >> fdr and eleanor each drew on a wide circle of friends and supporters, both professionally and personally. what did they draw from one another? >> well, as much as our tabloid sensibility wants to accentuate their differences, this is one of the most remarkable if not the most remarkable partnership that i've ever come across in my

life. she was his conscience, the conscience of his administration. he was the pragmatic politician who knew how to get it done. he betrayed her with an affair when he was assistant secretary of the navy in the 19 teens during world war i, had an affair with her social secretary. be and that in some ways became a liberating moment for eleanor roosevelt, and i think it's important to understand that sometimes out of this adversity sometimes great things. it gave her already a spectacular social conscience, a kind of goad and allowed her, permitted her to go out however angry and wounded she was out into the world and do the kinds of things she did, become the kind of woman she did. but they never lost sight of each other. they knew where each other was in good times and bad, when they were mad at each other and when they weren't. they were working together and how fortunate for the rest of us, the thing that they were working on was us. that is to say they had translated their problems and

their adversities and figured out, as jeff says in the opening of the film, that it would be helpful -- and theodore's the same -- it would be helpful if you taught other people how they might be able to escape the things that afflicted them. >> we have a question, what did your research reveal about eleanor's alleged extramarital relationships? >> nothing. she had spectacularly close, we would call them intimate and passionate friendships with a number of women, some of whom were committed to one another. beyond that we don't know anything, but i would also remind you that the film details not only these relationships and their tenderness and genuineness, but also her just absolute passionate relationships with three men other than her husband, though not sexual, that were in her life. in fact, at the end of her life she was living with another man who she said i have loved more than anyone else. i invite you to stay tuned to episode seven -- [laughter] to find out what that is.

>> i'm glad we asked the question. [laughter] thank you for your answer. some press/media-related questions. fdr was famously accessible to the press, carefully cultivating his media image at press conferences and over martinis. can you talk more about his relationship with the press and how it shaped its historical image? >> well, that's a really good question, and he was famously accessible, as i describe. i don't think it shaped his historical image. in fact, the image that comes down to me is this one that i was describing a little bit earlier, a sense of how kind of naive earlier times were where they turned off the camera, that the secret service would turn off your camera or confiscate your film, or it was just a gentlemen's agreement that we wouldn't cover the degree that their president was afflicted with polio. there's discretion, but it is in no means naive. they knew as franklin roosevelt

knew, as his advisers knew, that to see this process -- and, ladies and gentlemen, there were many, many audiences when all of this was on full display for this audience. so if it was a secret, it was a secret held by hundreds of thousands of americans who got to meet or see or hear the president up close and in person. but he, this is, you know, a sort of a red herring about him. they knew about it and didn't think it was necessary. they understood that if people pitied him as you would do can if you saw and understood the full dimension, and jeff and i are as proud of that part of the storytelling as anything. to tell the full dimensions of what polio meant. most people say he got polio, and here's what the press didn't show and leave it at that. it's really important. and a good deal of our fourth episode, the 1920s, is dealing with what it took for this human being, still a human being, to actually figure out how to go

from being paralyzed for the rest of his life to being president of the united states. and it is a hell of a story. but they understood that if they pitied him, everything was over. >> how important was radio for fdr's leadership? i know you'll say it's important, but if you could elaborate on that, please, ken. >> jonathan alter has a wonderful, wonderf our film at about the time he's delivering his fireside chats. and, you know, theodore was a master at using the press and using the bully pulpit and using the great moral office that both men felt the presidency had to become to communicate to citizens about what they thought their country needed. and they were really good at campaigning for that. but as alter says in our film, every politician had -- up to that point -- talked like this when communicating with their

citizens. and franklin roosevelt could talk like this. he could lean into the mic, and he could explain to you about the banking system, he could tell you what the bankers had done wrong, he could tell you what the whole principle of banking was, he could tell you that hoarding had become a very unfashionable pastime, and he really hoped that the next day, monday morning, when the banks quit their bank holiday -- his cheery name for it -- that you might put your money back in the bank. and the run that had been expected the next morning didn't happen. people put their money back in just as their president told them to do. and a lot of it had to do with the way he spoke to them, just like this, in the intimacy of their homes, leaning in which is what happens when you lower a voice. and you create an inti macy. it's not manipulative. it's smart, it's good, it's right, and it works.

as it was said after that speech, eight days after he was inaugurated, that he had saved capitalism in eight days. and there's good evidence that that's exactly what he did. >> why didn't the political opposition use fdr's polio against him? >> well, i'm not sure they used that against him. the principal argument against him was that he was a traitor to his class, and he was a socialist and a communist, and i'm sure if they were convinced he wasn't born in this country, they'd go after that as well. [laughter] but, you know, there was concern that he was not up to the task. roosevelt had hired a journalist -- let me repeat that again -- roosevelt hired a journalist to write a report on his health, and that journalist in turn, with the urging of the roosevelt campaign, hired three independent doctors who all attested to his health.

so one of the doctors was a republican and said he couldn't guarantee above the head. [laughter] but then as a result of that article, roosevelt and his team felt compelled never to comment on it again. they would say it is not a story. and as much as people tried to bring it up -- and it became less the polio and more his physical health as he visibly decayed in front of his -- [inaudible] that became ab issue. and it certainly was an issue in the third term and a huge issue in the fourth term. but people weren't willing to throw the captain over in the middle of the second world war. >> was it wrong for the press, the journalists to cover up fdr's disability? >> i don't think so, and i think my argument would be -- and jeff and i have talked a lot about this -- that i'm not sure that theodore can -- that franklin

roosevelt could get out of the iowa caucuses today. that is to say that we would be focusing on the extempt of his illness. -- extent of his illness. we would be distracted by these superficial things and not the content of his character or the content of his programs. and we would be distracted by that. certain many commentators would say that he couldn't possibly have the stamina to get us through any crises, and this is the man who handled the two greatest crises since the civil war, the depression and the second world war. >> just a slight elaboration, how do you think fdr would have fared in today's media and political environment? >> well, you know, i say i don't think, but then again having frank lip roosevelt -- franklin roosevelt after something, it's hard to imagine. we did have a democratic senator from georgia, max cleland, who was a triple amputee from the vietnam war. we're doing a series on the vietnam war, and we've

interviewed him. and he made it to a fairly high level of political office, united states senate. and so i would never say never on franklin roosevelt. i feel the same way about theodore. you know, he was, you know, irresistibly himself, and people loved him even for his coke bottle glasses and his harvard accent, his upper crust, stuffy accent and nasally voice and rotund characteristics. they loved him because he didn't try to be something else other than he was. but he was hot and excitable, and that may have jarred with the cool medium of television, and he might have had ten howard dean moments a day -- [laughter] and maybe not gotten out of iowa. but, look, i don't put it past any three of these roosevelts of just being handed the ball and being able to run down field to the end zone. >> how were the voices selected for theodore, franklin and eleanor? >> well, you know, we have a remarkable supporting cast and

one more edit, and this is it, myron, that we do like third-person narrators. jeffrey ward has been my collaborator who writes that third-person narration all of his life, and we are very, very proud of that. and we believe that in the beginning was the word and that the word is not the enemy of images and that they can co-exist. so our films are very much written in the third person and read spectacularly after being written so spectacular by by jeff by peter coyotes. but we did -- coyote. but we did want to temper that voice of god which by itself sometimes is just a voice telling you what you know which is like homework rather than a voice that's sharing with you a process that's discovery which we would like. and so we have for the last 35 years tempered those, that third-person voice with a chorus of first-person voices, reading diaries, letters and journals. we've had theodore roosevelt has passed through our films a number of times and have had various actors and wanted very much to try one of the finest

actors of our day in paul giamatti, and i think you'll see after last night and in the next couple of evenings, he's just spectacular. his agent wrote me today and said "good casting." [laughter] and it may have been him. we agree wholeheartedly. ed herman has played franklin roosevelt, has got that hudson valley lockjaw down perfectly and has played him on the stage and small screen and the large screen for many, many years and has really taken him in. and then most fortunately we were able to get a little-known actor named meryl streep to do eleanor roosevelt, and it was a transformative thing. and i want you guys all to remember that name, streep. i believe she's really going places. [laughter] i think she has a future, and she's going to be terrific. and we just feel lucky we were able to get her early on before she broke out where she'd work for sag scale, and we'd be able to do it. no, she is, obviously, the

greatest actor of this or any other generation, and her gift to us is incalculable, unmeasurable, and we don't have the words to thank her for what she brought to our production. >> a few personal questions. don't worry. [laughter] did you get good grades in history as a young person? [laughter] >> yes, i did. i did, actually -- [laughter] and i was, it was the farthest thing from my mind of what i was going to do. i knew from age 12 i wanted to be a film maker. that was it and, you know, the fact that i did well in history, i remember bumping into somebody from junior high who said you were so good in the world history class. we all knew you were going to be a historian, and i don't even remember that. i remember the history class, i remember liking it, but i don't remember ever giving the impression that that was where i was headed. i was headed to be a film maker, but i was fortunate to bufferin into history -- bump into

history early on. i'm tutored by jeff ward and all the other advisers we employ to do this. the last time i took an american history course was 11th grade, you know, where they make you take it. >> how do you juggle so many projects at once, and how do you select your projects? and do you take requests? i apologize for a three-parter, but you can answer it that way. [laughter] >> you mean like sing a song right now? [laughter] i'm not a very good singer. i don't think you'd want to take requests. we are working, besides promoting "the roosevelts" which is itself a full-time job, we have five films in production. we are -- and they're all in various stages of production, so it's not juggling, it's just timing and management. it's like planes landing. this one has already landed and is taxiing up to the gate, and we have a couple on final approach, a history of cancer which will be out next spring of which i'm serving as executive producer and co-writer on and sort of senior creative

consultant. but i am producing and directing and writing with my daughter and son-in-law, sara burns and david mcmahon, a two-part history of the life of jackie robinson. the whole life, not just 1947. jeff and i are in the middle, actually, more than halfway through editing with our colleague sarah a ten-part, 18-plus-hour history of the war in vietnam. which will be out in 2017, early 2017. and then we are already shooting a massive series called "i can't stop loving you" about the history of country music, and we've also begun early stages a biography of earnest hemingway. we have four or five films that are threatening to go from ideas into production, and i'm already in discussions with pbs to talk about what the 2020 look like. and it's very clear jeff and i

sort of feel that if we were given a thousand years to live, we would not run out of topics on american history. [laughter] >> you have a new app that draws from your many documentaries. you describe it as not a collection of your films, but as an entirely new way of looking at american history. can you tell us a hitting more? >> -- a little more? >> well, that sounds like it was written by somebody in pr. [laughter] so we have an app, it's called the ken burns app, and it's attempting to sort of take moments, little, tiny scenes from all of the film, and it's up there, 25, 26, 27, whatever it is, and sort of cure rate them among the themes that i've seen take place, the recurring themes that i've seen take place in american history on innovation, on art, on politics, on war, on hard times and on race. and we've just added a new thing on leadership, and we'll continue to add them as we

continue to add films. it's a way to access all the films at any point, anybody can jump and look at them from pbs.org, or you can go to itunes or netflix the if it's available there and get the films. but this was a way to curate these themes from many, many different films and show the way american history, the warp and woof of american history is related. i don't think there's cycles to history, i don't think we're condemned to repeat what we don't remember as sort of lovely as that statement is. i do think human nature remains the same and superimposes itself on the randomness of events. and it becomes the historian, indeed, the amateur historian's responsibility to try to perceive some of those patterns and to reflect them back. and the app is just a way to curate in a much more manageable way the. the magazine, "wired," decided it would twaik three and a half -- five and a half days to watch all of our films back to back.

that's not including "the roosevelts," so we're into the sixth day, and this is a way to sort of get samples of these themes. >> thank you. we are almost out of time, and i would just like to make a few two-point, part conclusion. first of all, i'd like to remind you about our upcoming events and speakers. this wednesday, september 17th, john stump, president and ceo of wells fargo. this friday, september 19th, larry more ril low, president and ceo of cbs corporation, and on september 23rd, former senator jim webb of virginia. second, i'd like to present our guest with the traditional national press club mug to add to your collection. [laughter] >> i now have a complete set. >> and your new national press club membership card. >> thank you. [applause] >> and the last question, with 45 seconds left, have you ever considered doing a documentary

on the palins, and if so, where would you begin? [laughter] >> so this is a very important question. i think i would begin in russia so that i can have the best -- [laughter] the best view of the palins that one could possibly have, and this would be another dynamic american family. in fact, i just read a recent news report in which there were punches thrown at a party, and so we know it's not going to be lacking for drama in any way. [laughter] >> thank you, ken. [applause] thank you all for coming today. we are adjourned. [inaudible conversations] >> if you missed any of this conversation with ken burns, you can watch it anytime online, we'll have it at c-span.org. and turning to capitol hill

today, the house and senate are both in. the house starting legislative work at 4:00 with more than a dozen bills on the schedule including ones dealing with steroid trafficking and child care subsidies. you can watch the house live on c-span, and the senate gavels in in about 30 minutes with work scheduled on a pay equity bill, and the floor will be open for speeches until about 5:30 when members will vote on whether or not to move forward with that measure and two confirmation votes for members to the nuclear regulatory commission. those are are actually going to be procedural votes. live coverage of the house on c-span, the senate on c-span2. and last month the national business group on health released its survey on the nation's largest employers who expect a 5-6% increase in their health care costs over the next year, mostly due to specialty pharmaceuticals. the survey looked at how employers are changing their benefits and the role of health care exchanges. we'll be able to show most of this conversation before the senate gavels in.

>> well, good morning, everyone. thank you for coming. my name is brian marcotte from the national business group on health, and we're here to share results from our 2015 large employer health plan survey. the national business group on health is a nonprofit membership-based organization. we are devoted primarily to providing health care solutions and health improvement for large employers. we also support them on public policy. we are not a lobbying organization, but we do provide information, research and education. with me is karen marlo, and karen and i will be sharing this presentation which we'll be referring to the slides in your deck. and i'll start with just a bit about the survey. the survey is a forward-looking survey, and what's significant about it is the timing. we try to time the survey with when large employers make their

final decisions on plans for 2015, and that is typically around june. it gives them time to plan for annual enrollment and to get things implemented for january 1st. we do the survey at the same time so we can put in front of you at this time a really good insight as to not only what employers are thinking to do in 2015, what they're actually going to do in 2015 and what they project those costs to be as well as what changes they're looking or not just looking to do, but will do for 2015 and what are the implications for employees during the open enrollingment period. enrollment period. from a demographic perspective, this survey covers a wide spectrum of industries. in fact, just about all the major industries are covered. no one industry dominates, no sec for dominates -- sector dominates the survey, so it's a very good representation of the market.

from an employer size perspective, these are very large employers. 83% of them have over 10,000 employees, 19% have 100,000 employees or more. so large companies. and one of the significant things about large companies, they typically self-fund their health care. and what i mean by that is they don't just pay premiums to an insurance carrier for coverage, they pay for claims and they pay for medical costs and administrative fees out of their general assets, and they're fully at risk for those costs. and they leverage health plans typically to administer those plans and to, and to actually use their networks. when we look at what one of the questions we asked employers is what do they expect costs to be for 2014 and what are they projecting costs to be for 2015. and you can see in the slides that employees expect cost before plan design changes to be

about 7% higher in 2014 and about 6.5% higher in 2015. now, through plan design changes -- and karen's going to get more into some of the initiatives that employers are pursuing for 2015 -- plan design through delivery system improvements or changes, through cost sharing with employees, the net impact is roughly a 5% increase in 2015. so employers are budgeting on average 5% increase in costs through 2015. and just to put that in perspective for a large company, what does that look like? if you're a large company that spends half a billion dollars on health care costs, a 5% increase is $25 million. that's $25 million of additional headwinds they have as they look into 2015 that they have to find ways to offset either through increased revenue or looking at productivity. sometimes that relates to jobs. or it affects earnings per share.

and so it's always a big deal. though 5% doesn't seem like as big an increase as we've experienced in years past, it's still a significant increase and has a significant impact on the bottom line. the impact on employees if you think about cost sharing, cost sharing with employees, the percentage of the premium that they pay has been pretty consistent over the last several years and will remain consistent in 2015. most employers on average are paying about 80% of the premium for employees, and so if you think about annual enrollment and the impact for employees, employees can expect to see about a 5% increase on average for their contributions as they look to 2015. interesting to note that spousal coverage, employees pay about 24% of the premium for spousal coverage, and that's been creeping up over the last number of years. and karen's going to get into

some of the examples of why. but as employers look at their medical plans, if a spouse has coverage through their own employer, employers are beginning to charge more if they elect to stay on their employee's plan rather than go with the spouse's plan. so your seeing a little bit more of that. that's why you're seeing a higher percentage of the premium being paid for spousal coverage in the survey data. if we look at the top cost drivers for health care, they are the usual suspects. there's not a lot of surprise here in terms of what they are. they are typically high-cost claims, special conditions or categories, conditions such as cardio or cancers or musculoskeletal. the interesting thing when i looked at this data is we asked what the top three cost drivers for employers were. and over 50% of the employers identified either as the second highest or third highest cost driver specialty pharmacy.

now, that's significant because specialty pharmacy really impacts a very small percentage -- probably around 2% of your population. but that is being considered a second or third primary driver of cost for overall cost. so employers are very focused on specialty pharmacy and the potential impact of that as they look at 2015. another question we asked employers was around the excise tax or the cadillacs tax which is looming out there for 2018. and what employers are doing to either minimize that tax impact or even delay that impact. and when you look at the survey results here, you can see that employers are looking to put their employees in the driver's seat. they are arming them with decision support tools, they are arming them with health care shopping tools, they are moving to consumer-directed health plans or account-based plans with health savings accounts, and they're building in

incentives for or have continued incentives for wellness programs and also for health care management. so they're working with employees to engage them on how to best manage their health care costs and really partner with them on this. because the excise tax when it hits in 2018 will affect both employers and employees most likely. and so to the extent we can engage and partner with employees and help them put them in the driver's seat to help manage costs with us, then this can be a more effective way of either delaying or minimizing that impact. another area of interest over the last couple of years has been private exchanges, and we asked, we asked the employers in the study what activity or what decisions have they made around private exchanges for 2015. and we continue to see some movement on retirees being steered into private exchanges, and that's increasing a bit for

2015 as well. but we're not seeing movement on active employees being moved into private exchanges. and if you look at the survey data, there is interest in private exchanges, and you can see that as employers look from 2016 and out, a large percentage of employers are still interested in private exchanges, but they're in a wait-and-see mode. and there are a number of reasons for that. the confidence employers have in private exchange, we asked them if they had confidence in a private exchange's ability to do a number of things better than what an employer does today. and where private exchanges scored high were on items like providing more choice, managing a defined contribution environment or even handling or managing regulatory compliance. where they did not score, where there was a lack of confidence had to do with their ability to engage their employees in health care shopping or health care

decisions. their ability to control health care costs. and until we see more confidence move up the line on those particular items, i think you're going to see employers standing more on the sidelines waiting to see this develop. so they're really watching private exchanges. they're interested in private exchanges. they're watching them, they want to see how they evolve and mature over time and see how those scores on confidence improve and see if we get more movement to private exchanges as a result of that. with that, i'm going to tush it over to -- turn it over to cairn who's going to -- karen who's going to talk about the initiatives employers are implementing for 2015, and i'm going to circle back and talk about some of the things employees need to consider for this annual enroll. enrollment. >> thank you, brian. so as brian mentioned, employers are are facing additional costs for the upcoming year, and as always, they're concerned about how to control those costs.

so we asked our employers what do they think are the most effective steps they can take to control health care costs. and what we saw for the most part was a focus on implementing consumer-directed health plans whether as a forward placing meaning the only option or as an option available along with other choices. additional tactics that employers feel are are helping them to control costs include increasing employee cost sharing as well as wellness initiatives to improve employee health. in addition, related to the issue of consumer-directed health plan we wanted to understand the prevalence of these plans across large employers, and we saw a continued increase in these plans. 81% of those surveyed have at least one cdhp as one of their plan offerings, and we saw large increase in the number who have it as full replacement. last year we had 22% of our sample had a full replacement

model meaning cdhp was the only option available, and it jumped this year to 32%. so we saw about a third of large employers now in a full replacement model as a way to engage their employees to be consumers of health care. in addition, and brian alluded to this earlier, employers have really looked at their relationship with providing coverage for spouses, and they continue to focus on insuring that they provide coverage for dependents and spouses who have no other option. so we found about 29% of large employers have implemented additional costs, a surcharge for spouses who can get coverage through their own employer for 2015. they are continuing to provide coverage to spouses who don't have coverage in this other means as well as for dependent children, but they are looking to insure that they are providing appropriate coverage for those who have no other option available to them. there's been a new focus lately

for employers around what we call narrow networks or preferred networks. it's an idea of steering employees to quality providers. and so we asked this year for 2015 how many of our employers have a narrow network in place. and what we found was three-quarters of them don't have them right now. i think it's an emerging area for employers. 13% offer at least one plan that incents employers -- employees to use these provider networks, meaning maybe if you see a quality provider in this network, you would receive a lower co-pay a co-insurance amount. and very few, actually, only offer plans with narrow networks. in addition, employers continue to seek ways to move employees to quality providers, to providers that provide not only quality care, but coordinated care. so we asked employers 2015

are you going to be, do you offer and do you incentivize employees to use centers of excellence as well as networks including acos, and what we found is about 60% of the respondents do have centers of excellence for transplant wells other conditions, the ones that usually you hear most about are orthopedic, spine surgery or heart conditions. and about a third, 30% actually incentivize, meaning they may pay for your travel to go to a center of excellence for a transplant, they may waive any cost sharing if you use these centers which have been proven to have better quality care. in addition, about a quarter actually have networks with acos. very few incentivize them, and i think that's because it's an emerging area, and we're trying to learn how effective the care is that's going to be provided at these accountable care os. one of the -- organizations. one of the things that we saw a lot of interest in this year in

is telehealth, the opportunity to call a doctor on the phone for those minor health conditions that really you may not be able to get in to see your primary care doctor or you don't have time or they occur during hours that are not, your traditional physician isn't available. a way to provide access to employees and also, hopefully, steer them away from emergency room use. another area that we've seen interest in is whether employers are going to be direct contracting with providers. so are they going to contract directly with centers of excellence, providers, accountable care organizations to provide care directly to their employees. and although there's been some interest in it, we haven't seen large growth in terms of employers doing that. and that probably has more to do with that is a very complicated task for the employer. employers are really used to traditionally having their health plan play that role, and so whereas there's interest in

maybe contracting with a few critical providers for those very costly procedures, in general i think employers are looking more to incentivize their employees to use the ones that are already within the network that their health plans have provided. overall when it comes to their employees, we see again -- and we've seen this for many years -- employers are offering a large range of tools and programs to help their employees to be healthy, to get good health care. for example, we saw 85% of our respondents have a nurse coach for your, for condition management. so if you've had a heart attack or you have cardiovascular disease, these nurses are there to help you to change your lifestyle and insure adherence to your medications. in addition, we've seen 71% have price transparency tools. those are tools either provided through a health plan or through a separate entity that allows an employee to log in and say i need to get an mri, and it shows

them where they can get that and what their responsibility would be. and so the idea behind those is really to be able to drive employees to a lower cost option that provides the same quality care. brian already mentioned that one of the main cost drivers that popped up in our survey this year was on specialty pharmacy, and so we've really looked this year to understand what employers are doing around specialty pharmacy. there's been a huge interest in it this year. the arrival of the hep-c drugs has certainly brought a lot of interest to the top toic, and we know employers are seeing their costs rise in double digits year-over-year. and so employers are using a multitude of ways to insure that these drugs which are often for very complex, sometimes life-threatening diseases are getting to the right employees. and so they may use prior authorization, they may use step

therapy, things that they've traditionally used on what i call non-specialty pharmaceuticals. but in addition, they're looking at fewer way -- newer ways. so this is for people that have hepatitis c, it can be really hard to manage the disease. 30% of our respondents have high touch case management, so this is very different. this is a qualified clinician who knows the disease that these employees have and walks them through what their medication is, what they need to do to be compliant and insures that they stay compliant because these medications are incredibly expensive, and they don't work if you don't take them. in addition, some are channeling all of these specialty pharmacies through either a preferred retail network or through their pbm specialty pharmacy group, and that is really an effort, again, to insure that the it's the appropriate drug for the right patient and that the patient is getting all of the support that they need when they have these, when they have this disease and need to take these medications.

before i turn it other to brian, there's one last question we asked that i thought was particularly interesting to highlight, and that was around 42015, what are employers going to be focused on? there's so many different areas that an employer can focus in terms of healthy lifestyles, this terms of engagement. so we asked the question what are the three behaviors we're going to focus on in 2015? and what we found was, again x this is sort of a theme of the findings this year was that consumer engagement in health care decision making was the top one. 36% said it was the top behavior that they were going to focus on, and it was followed by weight management, tobacco and increasing physical activity, the sort of three lifestyle risks that we know are a major concern and how they impact our health care and our health long term. so with that, i'm going to turn it back over to brian to wrap us up. >> great. having said all that, so what can employees expect during

annual enrollment? and i would say that if there's any year that an employee was going to focus on their enrollment packet, this is probably the year. and one of the reasons i say that is that as karen pointed out, there is this movement to even full replacement/high deductible plans. we're seeing a 50% jump in the number of companies moving to full replacement/high deductible plans to. that's a different animal for what an employee may be used to if they're in a ppo. so i think that engaging and understanding what's in your enrollment packet so you're not surprised come january. employers will put a lot of education when they roll out these plans to help you understand the mechanics of how these plans work, how a health savings account works and what your opportunity is to put money in a health savings account. employers are implementing incentives to engage employees in either lifestyle management

or health care management. there's ways to maximize your benefits by engaging in those incentives. and then there are any number of great decision support tools and resources that many companies offer that typically are underutilized because they're out of sight, out of mind when an employee thinks they need them. know what those programs are. they're either offered through your employer or through your health plan or through a third party. if they know what they are, they can be extremely valuable to an employee when they're faced with a medical issue, particularly some of the decision support services which are very, very helpful and play a wonderful advocacy role. so lots of information for employees to pay attention to. in addition to the fact that costs are going to be going up the next year probably around 5% or so, to pay attention to those things. and looking at the spousal coverage. as spousal coverage increases, if your spouse is covered under your plan as an employee and if they do have coverage through their employer, you should take a look to see if that may make

more sense for them. so all of this information at the time of enrollment can help an employee maximize their benefits as they go into 2015 and have an understanding, particularly when it comes to these account-based plans as to what to expect in january when you start seeing pricing on health care services much different than you've ever seen in the past. with that, we'll open it up for questions. yes. >> tell us more about how the relationships -- i'm virgil from modern health care -- how the relationships are different in these high-touch clinician kind of relationships where especially for hepatitis c, how does that look logistically, i mean, beyond the fact i'm seeing a physician who's an expert in that, how are they being more aggressive to make sure i stay on my medication, and does it feel different than if i'm going to my primary care physician?

>> trying to get the right side of care, so depending on the drug, you can get that dispensed within a hospital setting, a physician's office and even in some cases the home. so the intent is to provide that coordination regardless of the setting with your physician and to try to get the most cost effective setting, but also to karen's point, the compliance is really critical. the other challenge with special the i pharmacy is dosing, is the dose right. and in some cases what employers are are doing through the health plans are limiting that initial dose to 30 days or so, so there's not excess waste if that dose has to be adjusted. so staying very close to the patient and staying, and understanding what other elements of care they need to access and how that's coordinated is a big part of what's trying to be done on the specialty pharmacy side. gary. >> 5% of projected -- sorry, this is jerry, business

insurance magazine. the 5% projected cost increase for 2015 is significantly lower than what many of the public exchanges are reporting their insurers are seeking. how do you explain the cost difference employers expect and what is happening in the public exchanges? >> well, i think you have -- employers have a pretty stable environment. their employees, they don't have a lot of turnover, they've got the same employees they're working with year-over-year. the public exchanges are relatively new, so i still think you're going through a shakeout period, and you're still going to see volatility in rates because of that. and so it's hard to say what those rate increases reflect. are they reflecting the true underlying cost, or are they reflecting still the jockeying in the market to understand the risk that health plans are getting and how do they, and how do they price that risk? so i would say that we've got a

couple years of experience to get under our belt before we can really understand the pricing and the mix exchanges and how -- public exchanges and how you would compare that to employers. yes. >> hi. i'm -- [inaudible] with inside health policy. i had a question about spousal coverage. you all mentioned there that might be a surcharge for spouses where they can get coverage on their own. is that a direct result of the aca saying dependent coverage does not include spouses for large employers? >> i think it's really more a reflection of trying to find other ways to manage health care costs, stay under the cadillac tax or delay the impact of the cadillac tax. and, but do it in the right way. so if a spouse has coverage through their employer, it's really an incentive to get coverage through your employer and not through the company or your spouse's plan.

and so that's really more the impetus behind it. it's not so much tied to anything else within aca. except i would say as employers are looking at the cadillac tax and what that impact will be down the road, this is one of the tactics that they're implementing to manage their costs. other questions? yes. >> hi, jay hancock, kaiser health news. karen mentioned acos, and there's lots of aco stuff going on all over the country, aco tos and aco-like organizations, pcmhs. and there's more and more talk about setting these up as all-payer mechanisms; getting the commercial insurers involved. and, in fact, that's happening in many states, at least this parts of the states. the missing piece are the self-funded large employers in many cases, and a lot of people

are trying to figure out how to make that happen and get your members in these groups with the pay, the reimbursement incentives lined up the same way as the other guys. how quickly do you see that happening with your members? >> i think the first thing about aco, and i think it's a great point that they are emerging very quickly and very rapidly and the big question for employers is how do i decide what is a good aco and what isn't. if you have health plans coming to you and say we have 80 acos in 2014, and we'll have another 30 in 2015, we'll be up to 110 acos, from an employer's perspective, i don't know what that means. you can't change and affect change within the health care delivery system that fast for it to be that much better than what you have. so i think what employers are looking for is what constitutes a good aco? what are the elements that would tell me that i know it when i

see it, that the functioning elements of this aco is better than the market? and what type of outcomes can i expect? so i think what we need to do is intuitively we get the model. we need to understand how effective that is and providers' view of of that model because reimbursement is changing in that model as well. you're moving away from fee for service and moving into bundled payments and other them nhlings. there's a lot of -- mechanisms. there's a lot of change management that has to go to accept that kind of change. so con conceptually we like thea of acos and even high performance -- >> a reminder, you can watch all of this conversation anytime on our web site, c-span.org. we'll leave as we head live now to the senate floor momentarily. they will open up with leader time, and the floor after that will be open for speeches until

5:30 eastern when votes will be held to decide whether or not to move forward on the pay equity bill. that's a bill that would require employers to gallon strait that wage -- to demonstrate that wage gaps between men and women doing the same work have a business justification as a result of the fact of factors other than gender. and procedural votes expected later this afternoon as well. live coverage of the senate herd on c-span2. chaplain, dr. barry l offer prayer. the chaplain: let us pray. lord god almighty, ruler of all nature, thank you for not leaving us solely to our own resources. continue to provide our lawmakers with the wisdom they need to accomplish your purposes.