federal government's activities, is that the federal government has told us that we know best on standards, we know best on teacher evaluation and a lot of teachers and schools are saying, no, you don't. >> so at this time i do want to ask folks in the audience here if you have any questions, we will have someone coming around with a mic and i would like you to introduce yourself and -- and try to make it a question. i mean, we were interested in thoughts but to try to make it a brief question, and i also would invite folks participating in the webcast to enter questions in the webcast platform and we will try to get to as many as we can. does anyone have a question to any of our speakers and introduce yourself? >> thank you to the panel. my name is robert, i'm the executive director of rural school and community trust.

of course, we focus on the 12 million children that are in our rural and remote schools and in indian country. i agree with you all that we heard very little about the policies that either camp is putting forward in any detail but we hear nothing about what's happening in rural schools and districts and communities where you have a very different context. your comments and observations about why it's so important we focus on these children as well? >> so rural education, lili. >> i taught in utah, salt lake city is the big city and out of 40 counties, 38 of them are quite rural communities. for a lot of those folks it's charter schools and vouchers will never take off, they're not practical to come up with those kinds of innovative schools when you have so few children. so for us, we've always concentrated on the system.

we've always said what is it, first of all, that we are trying to establish and -- accomplish, collaborative thinkers and i've actually been to some of the utah school that is are k-12 schools in the same building with maybe two or three hundred kids where one teacher has to be an expert of teaching four to five subjects. as the federal mandate came down highly qualified teacher and all of a sudden you couldn't offer a class at all because someone didn't fit in a particular box. it's a problem. >> teacher recruitment is a problem in rural areas. anyone else wants to talk about the challenge particularly? >> i think that's where the standards of accountability comes in. and also economic class and

making sure every young person whether in rural community, suburban community are meeting standards they need to be college and career ready. we have to intervene in such a way and provide resources and the support so that our schools, you know, can take the kids to the next level. >> just briefly that i admit to being part of the problem, i think too long federal policy gave too little consideration to the differences of rural schools and how a lot of federal policies were affecting them. most people don't know how many millions of kids are in rural schools, poverty rates rates are similar to urban areas, they graduate at higher rates from high school but graduate from college at lower rates so there's questions about what is being taught, whether teachers can stay. if you look at a map and i think brook has done some of this

where there's least economic mobility in the nation, if you were born in the lowest higher quintile, the places where poverty is the stickiest in america is often in rural communities, native communities and deep south. i think we have done too little as policy makers. >> so i would turn now to online audience and my colleague eric, i think you have a question from our audience. >> yes, i do. the question is about predicting who might be named education secretary under either a president clinton or president trump. >> we've heard a lot of names. anybody want to put some names to go out with the rumors or maybe more than rumors, solid information, inside information?

>> the person who makes that decision to be hillary clinton and i think everybody thinks of someone for us, we are looking for someone who actually knows what it's like to be in that classroom and not think tank, not someone who sits in an ivory tower. >> you said classroom. the department of education also oversees, think about all of the student loan apparatus. >> everything. and the truly understands role. it's not to be the super, superintendent of the country, congress was not designed to be your school board. but the federal role is to make sure access and opportunity and the civil right to have that pursuit of happiness be able to be realized.

>> you didn't name anybody? >> no. >> are you going to name anybody? >> no, i'm going to agree with my colleague in the sense that i hope, we are working hard to make sure it's secretary clinton makes that decision with the full range of the department. higher ed, pre-k, student loans and k-12. we do think it's important for somebody who has experience in this work. >> we want to make sure secretary clinton makes that decision -- is that -- >> that's correct. the interest group that ought to drive, that ought to come out of department of ed should be children. it shouldn't be any other interest groups that are focused on the priority of adults. the whole point of that office as my colleague said, to ensure there's equity, rural communities, sa suburban communities but the interest of children has to be at the heart. >> i don't have any inside intel on this by any means, as a matter of fact it will tell us a

whole lot of mr. trump and prioritizing should a list of names start to get leaked. if i had to guess and based on my whim here, the next secretary of education is probably going to be a governor or former governor. i think we are in this era where not only has the federal government given a lot of authority back to states under essa but issues like trying to balance the issues of rural communities, needs often with saburban or urban communities of how do you balance school choice and democratic control. the folks who are often best equipped to deal with are the ones who have been going through the tough process in their state like, maryland, for example, relatively small state but has urban communities like baltimore, western maryland which is rural, governors are the ones who are dealing with these issues. >> right. >> that might be the next step. >> thank you, other questions in the room? yes.

right here. jamie. >> i'm jamie -- [inaudible] >> glad to have you. >> i guess the mic isn't working. i'm so sorry, yeah. turn it on. >> is that any better? okay. again my name is jamie, among other things i'm the chair of the news maker committee here at the press club. >> i've collaborated with you and thank you so much. >> my question really relates to the fact that, you know, it seems like political cycle, we have seen people in both parties turned off by government. you have a situation where you have one candidate that's saying the system is rigged. there are language used in presidential debates that get you kicked out of high school and high school debate. i have three teenage kids and i

find that a lot of my friends -- a lot of my kids' peers are turned off by this political campaign. do you think that one of the legacies of this election cycle will be people will be asking questions of civics and education and how we reengage students in the political process, maybe democracy has been taken here and people will be turning to schools for answers? >> we have had -- i'm so glad that you put that into the room, really, because we've had a disturbing number of phone calls from members. if you read the post lately, it's not just schools, it's entire communities, a grandmother who threaten by anonymous hate mail from her -- from her neighbors because she has mixed race grandchildren living with her and they're not to be in our neighborhood, but

what we are hearing on the school level an increase in bullying, an increase in kids feeling unsafe and donald trump's name gets wrapped into it. when trump pks president he's sending you back to méxico, religion, race, and this feeling that it's okay to say these thicks that often have a violent context to it. so this is so much more than just civic education, that absolutely for me is one of the key enterprises of public education. it was what it was designed to be to bring diverse communities together to be this democratic institution but now we are dealing with kids who as you said are hearing things that are so disturbing that it's frightening them or animating them to actually act and i'm on

donald trump's side and we are going to hurt you. >> i don't think presidential campaigns have never been tea parties, no punt intended. people haven't worn kid gloves with one another. andy, what do you think? is this something different that we are seeing or the typical, you know, tough talk that we -- that we've always heard during the heat of electoral battle? >> this seems very unusual to me and painfully unusual. i have a 6-year-old and 10-year-old twins. i try to be humbled in this country that are hurting and are hurting badly and politics

reflects the times and so i'm doing my best to recognize that there are a lot of people who are angry and hurting for for a whole host of reasons. i think civics education has a good bit to do with this. we need to teach what it means to be in the public square, there's differences and legitimate differences but what i have seen, the language that i've heard, in my professional career i have not seen this. >> as a lawyer, profession where you really watch the words you use, what do you think about whether this is going to lead to kind of more focused on civics education and how to -- >> i would hope so. i think the media since we are at the national press club could help. we don't hear stories of plane landings but crashes. i think media discourse is the

most extreme elements on deny -- on the way of the polls of a political question and, so, you know, we have one side that says government can't do anything right and everyone is corrupt and we actually need to tell more of the stories of the public servants whether teachers, police officers, firefighters, state government workers who go to work every day and do good things for the people. i think that will help kind of furnish respect. >> both educators and journalists have a role to play here. >> absolutely. >> and make civil tone of public discourse. >> i believe so. >> do we have any other questions from the online audience? >> question about the role that federal government in educational technology and whether that would change under the new administration? i believe that the clinton campaign has some -- >> right.

yeah. computer science education among others in innovation platform. >> what i love about hillary clinton's ideas is you really can go up on her website and find all kinds of details. that is not -- you can't do that with -- with her opponent. but one of the things that she has committed to, i think, in every aspect of education is she has talked about access and opportunity and when you take a look at how our schools are funded and the way they are not funded equitably so that children in the most challenging situations that have so little in their home lives and community lives and if they don't get into the public sector, they won't have it. absolutely exist and that she is committed to equity. so i think that that speaks well of her plan. >> well, we only have about five

more minutes and i thought we might bring the issue of beyond the presidential election if there are races -- certainly we have the congressional races and there's a lot of talk about whether the senate might actually go flip to the democrats. i don't know what kind of -- what you guys think as far as what the odds are on that and whether you think there would be much of an effect on education policy if that happens. anything to say about the senate? >> i would say something about the governor's race. >> fair enough. >> i think you're right. there are down ballot races that are -- and people are tremblg with -- trembling with the unintepped consequences. but there is a role in that state and local race, i like in

montana where you have democratic governor who has invested in public schools and looked to invest and doing very well in otherwise red state and you look at north carolina where you have not done that, where they have done the opposite with huge tax cuts, with corncións not paying their fair share and not investing in public schools and he's very vulnerable to democratic challenger who is talking about public school funding. i think we have a story to be told there. >> i would definitely agree with lily on the question of governor s' races. this isn't always the most

dramatic kind of election but in this era it could be the most important when it comes to education. the federal government has loosen the reins on testing issues, accountability systems. states are wanting to know what to do in rural schools. i'm interested in the massachusetts charter ballot race which is huge. on the more subtle questions, state policy makers are going to be driving the train over the next five years and who is sitting on each of those seats is very important. >> are you following the charter issue, the ballot measure in massachusetts? and if so, maybe explain a little bit what's at stake there. >> yes, yes, we are involved in that. we are actively involved in that. that's effort to lift the number of charter schools in that state. >> the cap on the number.

>> the cap on the number of charters. unfortunately there's artificial barriers on the growth of public schools. we have jurisdictions where families are clambering on the opportunity and caps that indicate the interest of political interest versus of children. we are fighting to raise the cap. the parents make the choice. it means that the decision-maker is a parent or caregiver and not a politician. >> are there questions from the audience? >> i'm with arizona pbs. in arizona and in nevada there's a huge debate about scholarship account. where do you see the accounts

going and do you predict them expanding more with children with disabilities? >> andy, do you want to take that? >> are in some senses vouchers times two or times three. this caught me unprepared. i didn't expect their growth to take off the way that it has so in the southwest it's happening but other states like tennessee that are considering this. essentially and it depends on which students are eligible for it, it is a family gets to access their students share of state funds and use that money for a private school for tutoring, some other kind of extra circular activity. this -- the reason why this is so important is it expands the idea of vouchers beyond low-income kids, kids assigned in under-performing schools to

middle-income families or rural families and i didn't think it would take off in arizona but it has. i wouldn't be surprised if we see battles, debates about this in another five or ten states and this goes to my very first question that i raised, like we are in an era of trying to decide who needs to have federal government, is it state policy makers. families needs to make the choices. >> the families that are left in the system that really choose that public system, they want the public system by having all of these ways no matter how nicely you package them, you are taking resources from the system to have aa student a handful of students leave the system with the money you still have to pay the light bill, you still have to pay to heat the building, you have costs that don't leave with that student.

when you talk about things that like in massachusetts, there are caps, arizona is one of the examples that doesn't have caps and it has a huge number of fraud mismanagement poorly run chartered schools, chartered schools that locked doors on students. those are also the stories that need to be told. when the caps actually help manage how you're going to oversee, how you're going to hold them accountable if you cannot control, how many you have to oversee and so i think arizona is an example of where there are huge problems and it's hurting the students in the public system. >> so this is an example of school choice and we have heard donald trump talking about school choice and we've heard -- we certainly have parts of the, you know, democratic platform talking about charter schools and sort of critical way than

we've certainly seen i'd say from the obama administration. i would be interested in your view sort of charter -- excuse me, voucher-like education savings' accounts where families can make decisions about where the funding for their child's education from the state is going, what do you think about that? >> well, we focus on expanding framework. i'm not familiar with that program. our focus is on expanding parent options through the public framework, public charter schools. on the idea that the caps are connected to managing performance, that, i think, frankly is unwarranted. for every one school a regulator may have to oversee that's a charter you have hundreds that are districts schools. we had district schools where one in ten children can read at grade level and for some reason

we don't close those schools or intervene but if you have a charter school, people want to close. if a charter is working the rules, enforce the law. that's why we have regulators. that can be done easily on a targeted basis as opposed to the blanket cap that is are denying families options that are changing the lives of their kids. >> i think we are getting toward the end of our time but do we have a question from online audience? >> we have a question about if you discuss the implications of the senate where it appears that the balance could flip from republican to democratic control, what implications does that have on an education agenda and also in general to what extent will this next congress serve as a reality check on a new president? >> we talked about -- i mentioned that issue and you all

talked a little bit more government race. >> you may have significant pressure to either allow waivers some of baseline commitments. >> every student succeeds act. >> the multivariable assessments whether schools are performing, whether it's the mandatory obligation to intervene and persistently underperforming schools. i think there would be significant pressure pursuant to federalism imposed that republicans have to just let the states take the money and then do what it is which would hurt kids in urban communities but also students in rural areas as well. >> this is the most interesting dc education story at the moment, which is senator lamar

alexander, chair of the senate education committee who is pushing hard his interpretation of essa is that it was slapping the wrist, slapping the hands of the federal government, back up, we want to give state governments more power now and he is often at odds with secretary king and the obama administration of the regulatory process. can the federal government dictate more than senator alexander and republicans are saying that the federal government ought to do. if the senate were to flip, this is actually a really important flip. if senator alexander is no longer chair, for example, bernie sanders, chair, what a lot of republicans were hoping. >> are you worried? do you think the senate is going to flip? >> i think it's a flip of a coin right now which way it goes.

this is probably the most k-12 ripple of the decision -- of whether or not hillary clinton or donald trump is the president, how are they going to have the u.s. department of education interpret essa and how much flexibility do governors and state boards and districts have. >> and this is that and -- this is so much bigger than that. we now have a very dairntle -- dangerous precedent with the leadership saying we are not going to hold a hearing on a supreme court nominee that was dually nominated by a sitting president a year he was going out of office, i don't care if it was five days before going out of office, they just like said, no, we don't like him so we are not going to do it. what would make them say anything different to a president hillary clinton? they've already said this precedent and you can't make me. >> you're saying the supreme court hasn't made --

>> the supreme court, even cabinet members, they could throw our country into chaos. remember when we used to have nine supreme court justices, good times. yeah. >> so any other questions that we have from the audience? i think we have one here. we only have about two more minutes so quick question and very quick answers. thanks. >> i guess it's kind of a question for lily. i think it's interesting that hillary clinton voted for no child left behind but doesn't come up often. did that come up in your discussion? >> already did. >> no free passes, i'm a teacher. i do a report card. [laughter] >> and that was a big question. one of public education heros ted kennedy was the mover and the shaker on the democratic side, this was great bipartisan

and it was a mistake, it was wrong. i want to know if people learned from their mistakes and hillary clinton asked the right questions, what are we going to do better next time and maybe we better listen to the educators before we put -- >> is that the right lesson to take? >> there were some intel historic, every child has to be college and career ready and we are going to hold schools accountable by looking at subgroups. anyone who says they care about equity in young people to just kind of throw wholesale it's frankly a contradictions. >> that element has been >> it's critical. >> this is the thorough

government's on k-12. the teachers get upset by it, families get upset, state leaders and district leaders get upset by it we think the hypothesis is a better version of this to be determined. >> well, andy, you get the last word then. i hope you'll join me in thanking our speakers. i think they did a fantastic job. so thank you very much. [applause] >> we have a short break and we are going to be coming back at the top of the hour to talk about higher education, what's at stake for post secondary education in the election.

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>> a short break in this conference on k-12 education programs and college eligibility. up next panel of education and current political race. the coverage continues in just a couple of minutes from the national press club here on c-span2. while we have a quick moment, reminder of campaign 2016 primary coverage. in florida debbie wasserman schultz and senator marco rubio face primary challenges and we will follow what's happening in arizona with senator john mccain running for a sixth term. we will hear from the winners and losers. it'll be live tonight on c-span.

[inaudible conversations] >> the hill is reporting today the state department is arguing in court that it cannot meet the republican committee request until after the november election. two-thirds of the records held at the reception room during years at the state department can't be made public before election due to current workload. the rnc has declined an opportunity to narrow the number of functions of which it wants information. the department has also maintained that it can't find any visitor log or other records of visitors to hillary clinton's department.

the state department argue that is the battle should be delayed until next spring. rnc pushed back against the department in a joint court filing on monday. read more about that story in the hill.com. [inaudible conversations]

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[inaudible conversations] >> again we are live at the national press club this afternoon for a discussion on education issues and campaign 2016. up next it's the intersection of education and the current political race. the next panel should start in just a couple of moments. very quickly, from philly.com,

governor chris christie vetoed to increase minimum wage. according to to the associated press governor cristcri described the proposal as heavy hand of government and would hurt small business. all of this sounds great, raising the minimum wage when you're spending someone else's money the governor said when announcing veto at an event in new jersey. he also called a proposal a radical increase and slammed the democratic legislature according to philly.com. [inaudible conversations]

>> welcome back, for those of you just joining us this is an event that is jointly put on by the education writer's association and the national press club, specifically the news maker committee. i'm caroline, executive director of the ewa and we are the national professional organization for members of the media who cover education. just the earlier part of the program we had a panel looking at the issue of education and

how it's playing in this presidential election and also in some of the other races going on around the country and now we are going to turn our attention to higher education. we've got a great panel of speakers to look at this issue which has been a pretty hot topic during the primaries certainly and is still playing a role now as we get only 69 days from election day. so heading our panel we are very lucky to have an ewa member michael vázquez joining us. mike is -- he leads the proeducation team at politico and came to politico recently after 14 years at the miami her herald. the last six he covered education and year long investigation of florida for profit colleges called higher ed

hustle won multiple awards and that included the second annual eddy prize, prize at ewa seminar and recognize it is best work on challenges that low-income students face getting to and through college. so mike, i will turn it over to you. >> thank you very much. is this working? let me make sure i have the microphone close enough. so i have to say after covering higher education for six years and sometimes seeing the very important pressing issues fall through the cracks in terms of what politicians care about, it is vindication to watch this presidential campaign. it's a small victory. everything else going on in the campaign sort of makes me want to crawl under rocks but a small victory seeing how student debt has been elevated to a place where i think it probably deserves in terms of public attention.

i can recall as a reporter in the state of florida that you had so many years when states across the country when they hit a recession the knee-jerk reaction was to hike tuition and in the state of florida they changed the rules where you had automatic 15% tuition increases year over year and i had conversations with colleagues, 2009 and 2010 basically saying this can't continue. the way the public is, the way voters are, you can only step on people for so long and then here we are today and you have this tremendous human cry over the cost of tuition over the, you know, growing student debt issue and the growing debt number and so i'm glad that we are here to kind of dive into sort of separate fact from fiction and maybe hopefully get folks some ideas of how to cover this race smart and aggressively. let's get to the panel. we have an all-star cast.

we will start with courtney hagen, senior lobbyist at progressive change committee, she works with the legislative -- tongue tied. legislative affairs team to engage members of congress and their staff, before that she pent a decade working in politics in washington including as several top lobbying firms and moving right along is jason, a resident fellow at the american enterprise institute where he works on higher education financing with an emphasis on student loan programs and previously he was at new america as the former director of the federal education budget project and resume goes on. senior analyst on the republican staff of the us senate budget commit you where he put a key role in developing education. last but not least matt owens, administration at the association of american universities which for those who

don't know a collection the nation's elite public and private universities and he's responsible for oversight of the association, federal relation activities, office operations, finance, he was previously at stanford university. so happy to have you guys. let's kick it off. since i mentioned the push for debt-free college, i kind of wanted to tap courtney first. how we got here, got to a place where tuition-free college begin unifying moment within the democratic party? >> sure, thanks. i'm courtney, and i've been working on debt-free college. i think that debt-free college has been a central theme in the presidential election and in down ballot races. we are excited to see where it is at this point. it's been incorporated into the

democratic party platform. we have candidates running on it up and down the board and hillary clinton ruled out her new college impact calling for debt-free college and that is one of if not the biggest proposal to date. i want to take a step back and talk about how we got here. in 2014 democrats had losses at the polls as we know and our team sat and talked amongst each other and saying how did this happen, why didn't people turn out to vote, why did democrats lose and that was the launch of what we called a big idea's project where we asked the public to submit ideas that they would like to see candidates campaigning on and then we asked the public to vote on those ideas. over 2600 ideas were submitted and over one million votes were cast on those ideas, we took the top to 50 ideas and did two polls across the country.

the first was for 2016 likely voters across democrats, republicans and independents. the second was for 2014 democratic dropoff voters. voters who were expected to vote in 2014 didn't turn out asking them if candidate had campaigned on these issues how much more likely would you have been to turn out to vote. debt-free college was popular in 2016 voters democrats and also independents. 56% of republicans and 61% of independents. and then in the 2014 democratic dropoff voters it was the number one most motivating issue. so this spoke volumes to us. student debt is an important issue across a large swath of the electorate and it's something that we really felt we could be successful enchanging. we met with congress, worked

with think tank, got a coalition together and said we need to make a push in 2016, this is the polling that we have, this is are the ideas and debt-free college popped in all of those meetings. it's something that resinates. everybody has a student debt story. it can be your debt story, parents, thinking about your children, colleague. this is raw common theme. so that really informed us about where we wanted to ingoing in 2016. we worked with coalition to have resolutions introduced in house and senate calling for goal of debt-free college. resolutions have over 100 members of congress who have signed on at this point and we were able to take that momentum, go to the presidential campaigns, talk with them about debt-free college and get to the point where all democratic presidential candidates had embrace that had free college and put forth some plan of their own culminating in hillary clinton's college compact which is one of the boldest proposals

that she has had in her campaign. we have been excited to see where this has gone. this is going to continue to be an issue from now until election day. hillary is running campaign ads on this, house and senate candidates are running ads on that. we plan to continue to keep pushing on this and believe in 2017 if democrats win it'll be in part the electorate went to the polls thinking about debt-free college and the people who were fighting for it. >> thank you. that was really fascinating. i always like to get behind-the-attended stuff. today it's on the record. jason, so i wonder how you feel about tuition-free college and debt-free college. image you might have different thoughts. do you have any thoughts specifically on who wins and who loses in terms of students if

college becomes tuition free? >> so i do want to point out that barack obama and joe biden also campaigned on affordable college. i will read you the 2008 platform just to point that here we are again. the platform is barack obama and joe biden will make college affordable for all americans. okay. by creating a new american tax credit, refundable credit will provide $4,000 per year towards college. it will cover two-thirds the cost of tuition at the average of public college and the other part that it would be advancable. you you would get it before you filed taxes and recipients will have to complete 100 hours of public service each year in order to get this credit.

>> so we -- i guess we could all assume that because of debt-free college is still a campaign issue that the tax credit never got enacted, right? well, it did get enacted. i remember there was a democratic majority right after president obama was elected, and they passed the tax credit, congress scaled it back, democratic majority scaled it back from president obama's ambitions at a time when democrats in congress were scaling anything back. they passed this as part of the stimulus. so i think this is important to reflect that here we are again with the candidate promising to make college affordable and we already have a policy from before that was suppose today make college affordable but it appears to be still an issue. >> do you think because it polls well, are we trying to fix something that's not broken? >> i mean, i think that, you

know, the cost continue to rise, right? so tuition, median tuition at a public four-year college in 11-12, all grants, $2,600, right. that's before i'm factoring this tax credit which ended up being $2,500. so in that regard, right, this is a solved problem. now living expenses, median living expenses at a public-four --year college was $2,700. the debt-free college is actually tuition-free college.

it's going to cover the $2,600 that's left and doesn't cover any living expenses. and i think that might be part of the issue here, a lot of the costs are wrapped up in living expenses. that's what people are borrowing to pay. it's expensive to pay rent and feed yourself which has nothing to do with essentially the price of tuition and state is investment and all the things you're hearing about. on another piece of the clinton plan, the interesting requirement, you saw this an important theme that comes up, 100 hours of community service. and the reason why these things are always included is because in some of the focus groups what happens is people who are developing these things, you can't just get something for nothing, people need to work, work for it. and so people developing plans throw in some line about work requirement, so you see that hillary clinton has -- has a lot of conversation about this saying, well, you can't get something for nothing, you need to work, people who are willing

to work for it so she requires ten hours of work a week, right, at minimum wage. that's about $3,000 a year. so median tuition is $2,600 before getting any tax credit and she wants people to work at minimum wage for ten hours a week and eastern 3,000, that would appear to be covering the $2,600 so -- and i think the reason that debt-free college is really popular because part of it has to do with graduate students. people with most of the debt, the really big debt balances are people who went to graduate school, what a great voter group, sort of the debt-free thing is a basically off the shelf government ready policy subsidize upper-middle-income families.

and so it's graduate school debt that has fueled this sort of notion that there's this student debt crisis, right, and so i think that transforms into well, there's student debt crisis even though it's graduate students and so if we made tuition free at public universities and we wouldn't have the student debt crisis and so i'm not -- i'm not really convinced that that's -- that's the way to the solution. yeah, i think this is important. people always want free things. courtney said, hey, we offer something for free for people and really popped, well, yeah, what wouldn't? debt-free housing would be awesome too. but i want to run down a couple more things about the clinton plan for sort of the reporters in the room to chew on. so if you enroll in college,

let's say this gets enacted and you enroll in four-year college and that's free, that's great for you, but if you just graduated this year from a public, four-year college, do anybody know what the clinton plan is for those people? she would allow you to reduce so that you save 20 bucks a month. i mean, that seems problematic, that seems unfair and so i'm sort of waiting if she was to be consistent and i think for courtney's group to be consistent they should be calling for forgiveness of all student debt to finance four-year degrees. so i thought to be interesting on the clinton plan and also people on the left that giving out outstanding student debt is a bed idea like i happen to, they think it's a bad idea but gunning for debt-free college.

it's sort of a strange inconsistenty. a couple of points, require state to increase funding a lot on higher education. this is a sort of a partnership where the federal government kick in more money but states would have to kick in a lot more money too and would go to public universities where they would keep tuition low and the language around this and from the communities that states disadvantaged spending. on per student basis spending has been declining or flat or slightly growing and so that's considered disinvestment. so states are increasing spending and it's not as if they've been cutting spending and reverse this. if you look at the budget situations in the country they're not exactly swimming in cash. and i will add -- finish with one interesting point here on

how the clinton plan changed because this was a plan from about a year where it was going to be affordable college or debt-free college, i'm not quite sure what the phrase was, but it was not free, it was debt-free, which meant that families would have to pitch in an amount that was affordable for them. so not free, but an affordable level. but the evolution after winning nomination is to now free, so zero for everybody. not an affordable amount. always zero. i think that's an important distinction. i'm not quite sure what the thinking is on the differences there and how that happened but i think it's an important one for people who are looking for ideas and stories on how that change occurred and exactly what it means. >> thank you, jason. i'm the eternal optimist where you mentioned the unfairness issue of getting 20 bucks, i

thought to myself, 20 bucks, 20 bucks, potentially. but i should probably be more angry about the rest of my debt and not being served in some sort of way but to take it down to matt u one of the things -- a really couple of things that i wanted to ask matt about, i know that you have pressed the presidential candidates to address innovation, to address college affordability and i believe there were four key areas and i'm curious if you've seen any reaction from the campaigns, if there's been any communication. ..

thank you for the invitation to be here. we've had some mild feedback from both campaigns, they acknowledged receipt and we're looking forward to some policy discussions and perhaps even the candidates as we get further into the election cycle o. the $70,000 lar question, i would say that anytime, any student takes on debt. i think it is a fine one. some of the highest debt levels are being held by graduate students and their earning power is a bit higher than those who just hold an undergrad what the degree. they do see the potential to find a career path, that will allow them to repay that debt over time and there are many financiering options now, if

they choose a career, teaching, that may not have the greatest sallerries. so there's that. and the other population that has been affected are not all, but, there are many students who attended for profit institutions who have very significant levels of debt. higher than that of public or private university for your institution. so, those are the two populations that have incurred the most debt and you have to remember, looking at washington posted today torre he will here, recent says that, 44% of students at two and four year institutions do not borough at all. we need to keep that in mind. there's a significant population of people attending college, who are not borrowing anything. they're paying as they go. they're working and they're

paying that and maybe they are receiving federal student aid. and that may be in the form after pel grant or federal work. so we have nearly half of students, are finding a way to not incur this debt. so one of the things that i was asked to do, was to talk about the proposals that you referred to, that a.a.u. has put forth to the campaigns. this election and, whole season makes me think of something, that my 3 year-old son said to me, he had had so much fun and he says, dad, i just could not stop the fun from coming. and politics is, a sport, in this town, and, i said to him, you know, why would you? if you ask that question about this election, why can't we stop

the fun from coming here? i would not give that response. education is among those. and, we need policy makers, and, trying to follow that, so that's part of them, thinking about all the challenges, and the research universities that comprise a.a.u. they have an educational mission and that benefits society. so some of the areas are affordability, and, on affordability, we're looking at things like the pel grant and hoping that the candidates will restore it, in the proposal right now in congress. if that's unsuccessful, we hope they will go back. that's serious issue, and we can get more people borrowing less.

that's one way that we can see making college more affordable. we're research and we care about federal invest ments and, policies affect that go that promote innovation. we talk about keeping the global innovation leader. we are the leader, but there are many other countries, china and many others, who are increasing the pace of their investment. we are not. if we want to remain the leader and have those scientific discoveries that become technology, and, start new industries, think about a gore rhythms like google. there's a proposal called

innovation and it outlines a number of things. but among that, speaking to federal investments it is calls for sustained 4% annual regrowth for key federal agencies. health and science, and department of defense, and energy, and there's a host of these type of programs. this is where the federal government makes investments. this initiative, this is spearheaded by industry leaders. over 500 organizations have sign order to this initiative as have to date. industry leaders, individual businesses, start upcompanies, and chamber of commerce, and, universities, and my own. that's one hope they will pay attention. and we care about that research policies and some of the programs that look at that

so-called valley of death. when you're trying to bring a product to market, so, let's say you super a great discovery, and you can see a new piece of technology and you're not sure what that will turn into. and an actual product. industry is not willing to take that chance, and look at that so-called death. so if we put a little bit of money at the right spot, to encourage maybe a proof of concept, if we could just prove this concept, then, industry will partner. and then the next thing you know you are producing something, that brings itself to market. we leave a lot of property that's sitting there. we get off the shelf, and, we hope the next president will look at these policies, and perhaps put some investment in that area. >> i talked about affordability,

two other areas that we're expending, immigration policy, in particular, but also not just looking. we want to make sure that our homegrown talent, and math, that we're doing the best we can. we're retracting all people of all back ground and bringing them through. so we want to do better, and there are a lot of programs in the federal government that are doing excellent work. we have our own initiative, at a.a.u., that are looking how we do better. we know we have a responsibility. there's a federal role as well. so we like to see progress. on the immigration side of that, we we want to attract and retain them. one of the great things, i think

our country, is that we do attract. we're hub for some of the most brilliant minds in the world. they want to come here. they understand the freedoms. they want to do their science here. we want to continue to attract those folks. there are a lot of other attractive places that's getting more competitive and we want to give them, if they want to stay here, we want to give them path ways to sit sen ship. science technology, and, engineering, and, as well, as others. so that's another area that we think is very important. lastly, to the next president we've been thinking about reducing higher education and research regulations. floor lot of regulations. they may be the most regulated entities in this country. just because of the scope of

their activities. they work with them in research, and financial aid and the irs and whole host of federal regulations that affect them. state and local. but one of the things we found is that, in many cases they don't coordinate. so there's appropriate regulation. we would like to see some places for some streamlining. i'll read you a stat, the cost of inefficshouldn't regulations, they reduce productivity, and there's a study done, by a group called the federal demonstration project that showed that 42% of faculty time spent on research was actually spent on administrative duties.

they're not thinking of the next best idea. >> the federal government must pay a lot, if it is still worth it for them to take the money. >> god bless uncle sam. so there was one thing that matt mentioned, that i wanted to run by, for folks who have questions, we'll get there. but just one sort of quick thing, that i noticed, given that when i was down in miami i wrote about for profit colleges and the current narrative about a student debt crisis, may be in some part fueled by for profit colleges. i recall in my conversations with students, that there's a rage and an anger for folks who

are in death, and there was a woman, her nephew had 80,000 in debt and talk to my nephew, he's losing the will to live. it's a very reem think when you buy a 50,000 car with no engine. how much, when we talk about the debt issues would it be more accurate to focus on for profit college student debt issues? >> there are bad actors, the colleges argreat example of that. and great work done to help address those concerns. but a lot of work needs to be done and students will continue to suffer, of bad actors in the system. so this is not to say that for profit colleges are into the problem. they are one of the problems, of the student debt crisis. i think everybody, i don't know

about everybody in this room, i borrowed to go college and my parents borrowed and i look at what it would be now, and it's a lot more expensive. there are a variety of reasons for that. just because for profit colleges are bad actors doesn't mean that there's into the problem in the public college space, it's not correct. we shouldn't be act to go address, the concerns even if they are not as great. >> what is your thought on the for profit industry and student debt? >> the number you gave, 80,000 in debt, is exextremely rare. that's -- i mean, the percentage of under graduates who are leaving school with 80,000 in debt, but, it's something like

2%? maybe 1%. so that's just extremely unusual. what is more typical actually, and by the way, the higher, the more debt you have from college, and graduate school the higher your earnings, this is why they say college is worth it. but, then they complain about how much debt. >> my issue is, the if it is worth it, we can't also be concerned about how much debt people have. because if they have too much debt it wasn't worth it. i also point out, on the debt, and the borrower issue, the balance of

borrowers who default is 8900. there are 8 million people in default. it is about 8,000. these are not being crushed by debt. 80,000 or 70,000 those exextremely rare numbers. for graduate students those are much more typical. but that's not at college access issues and that's a graduate school issue. that's not what this conversation is about. >> in terms of it being worth it, and the expenses of college are worth it, if you do graduate. if you don't, then you don't reap the benefits. that's also why if the default rate, is 78,000 dollars, okay,

but ad versus impacts of default rates of smaller debt can be felt more with students that did not complete their degrees. >> so, would your organization allow people to borough more so they could avoid it? because it is worth it. >> our organization is advocating for debt free college. >> it's worth it. >> okay. we are add vote candidating for debt free college. >> this is the inconsistency, it's worth it, but it's bad to borough for it. which is it? >> a higher education, is something that is worthy of having. everybody you this ever should have the ability -- >> not you should not have to go into crushing debt and you shouldn't only be able to have it if you come from means already.

>> on that note, any questions? >> thank you. so, i'm the congressional reporter for the hispanic outlook magazine. i covered both conventions and my assignment was not only covering hispanic delegates but, we focus on higher education and immigration. so it was interesting comparing the platforms of the two. and they are quite different. so the republicans are very focused on tax reform, and, the cost of regulations. they have a whole section called college costs. the democrats don't talk about costs. they're concerned about debt.

so i find that, both of those extreme. because the reason people enter debt is the because the college costs are so high. where are the programs to reduce college costs? >> sure. >> from our perspective debt free college, there's three legs, it's aid to states students and then bringing down the overall cost. level of innovation and accountability. that's something that is still being discussed. we work with 58 lie's the hill and the clinton campaign, and their plan, too. >> those are different.

they can be different. >> we have some questions -- both sides of the room there. >> since we're talking about the election, what i wanted to know is two things. one about the higher ed act. what do you think the outlook is going to be in the next congress with either administration and if the senate flips, what does that mean? second thing is, we have heard names discussed for secretary of education. i believe one, was saying that perhaps the secretary might have a higher ed background.

i don't know if you have heard that. >> matt? >> i'll address the part on the possibility of the higher education act. i think it all depends on two big things, one is, will there be a debt free tuition plan? if that's the case, under a clinton presidency that may move separate from the higher education act and that might be a socker a lot of attention in, that particular administration. it's unclear, we haven't heard a lot from the trump campaign, what it is. this is supposed to be education week and we'll see some more details. we're waiting to see. and, what that means. so, there's that factor. i think, regardless of who the

next president is, there's probably going to be a discussion, of the new administration. that's when you deal with tax there's a lot of things that is reflect on tax policy. if some of those type of provisions are addressed, and there's discussion about higher education, they may feel as though they need not take on the higher education act immediately in the next congress. so, to me, there's a lot of questions to be answered, those two factors will have some bearing what we see. but i don't see higher education act making significant legislative process in the first year of the next congress. >> jason?

>> i really don't know. i feel like we've been talking about the higher education act for a long time. so, i really don't know. we were talking, before the panel here about how you know, there are really important issues that need to be dealt with, and they would not rise to the level after debt free college discussion debate and policy. and i think that's one of the risks, that that debate and discussion sucks out the oxygen in the room. restoring your own pell grants. and, student loans and there's some agreement on. but, none of that would happen if all the focus is on a

different piece of legislation. >> courtney, if you want to weigh in and maybe we have reporters who are asking for this information, are there particular things going forward again through the crystal-ball aside from debt free college, or are there things, so we don't just chase that one issue? >> i don't know the answer to that. i think that, to their point there are good things, that do need to be addressed. i don't know the answer to what may be moving or not, i know it does deal with some aspects of what it would include but there are other areas that should be addressed, and i don't know. >> so, i would throw out something that, none of the lawmakers are talking about, and i really think it's too bad.

this is where the crisis is. 8 million people who are in de ssalt. so these are people who dropped out, which is why they have low loan balances, and, we're not talking about them. in the wrong way, about trying to make college more affordable. and we don't know if it was the problem. there's no discussion about how to move these borrowers out of default. 8 million people. that's shocking. the obama administration, they don't have a plan. some of them face like bizarre, i mean, circumstances in trying to restore their loans, paperwork they have to fill out and they have to sign things on paper.

they can't do it electronically. so, it's just very complicated. nobody seems to really want to talk about,000 move them out of default. there's some discussion about preventing future default. but 8 million people is a really big number. >> i'm in 100% agreement. >> if you sort of have that motivation, to fix that situation, i think, the federal government does somethings well, simplicity is not one of them. so it is what it is. do we have any questions online? >> we do have one question online. we've heard a lot of critique of clinton's plan, what do we know about donald trump's plan?

[laughter] >> good luck, have fun with that one. >> this will be a great place to say break that news. but i have none. i will throw out there, there's nothing that i know of. i will throw out there, jeb bush when he was running, i did a lot of work with some other folks on his plan. i think that's a great place for republicans to start, to pick up some of those pieces. around reforming student loans. the plan was to simplify the federal loan program. do away with a principal balance and interest and 100% would o cour your income taxes. this is a cleaner plan, that i don't think is getting enough attention.

there is always plan for people to access their grants. one of the reasons why people drop out of college is because the federal government has these complicated rules that trickle out the money. you have to advance a certain amount and take more credits to get more aid. and, it seems if that was much more flexible, i think we would prevent a lot more people from dropping out. it's just flexibility. those are some ideas that the candidates could pick up. i would, if i were the candidates, i would make the platform, on higher education and throw it out the window. because it's basically junk. talking about restoring private lenders. i don't understand how that helps anybody. >> i wondered, was there any silver lining?

i've yet to be convinced, that there was any redeeming qualities, not to forgive the difficulties. was there anything good? >> no. i mean, no. nothing. i fought for years quite hard to do away with that. because there was no value, it created complexity. it was a lobbying bonanza and it cost taxpayers a lot of money, to make the same loans that are being made today. it was a total waste and here we are some 6 yours later and republicans think that's a winning strategy. i comment bed it, it is a loser issue. the democrats will be saying we'll make college free for you and, republicans will say, we want bank for make you loans.

>> we're just about out of time. >> lightning round. i wanted to ask, yes or no. we'll go down the line. we spent a lot of time, it's a very interesting topic, talking about hillary clinton's plan for tuition free college. i was at the office and there was some discussion about how we thought about that, and, there was some pestimits in the room. question is, could that ever get through congress yes or no. >> yes. in the congress in 2017. >> i'll let two or three words go. >> no. >> yes, if there's a power shift in the senate. >> i think we're wrapping up.

well please join knee thanking our panelists. thanks. [applause] i just want to say a few words. thank you, for all who joined us. ew a..org has a lot more resource's the education, and the election. so, please, check that out. we have another event we're going to be doing here, november 14th after we know the results. so i hope you'll all join usthe. so, we have supporting community members, we would love to have you. we have some events coming up, higher education seminar is

happening shortly, next month. so if you were interested in what you horde this panel we're right on the deadline, so ew a..org. higher education seminar. >> look on our website and thank you all. i hope to see you in november. thank you. [applause]

>> he talks about the dynasty

that ruled russia. also coming up on book t.v., starting at 8 eastern. her book enter helen. the invention of the modern single woman. duncan clark, and, the house that jack built. fair labor lawyer, the remarkable life of supreme court advocate, from the roosevelt reading festival. buzz aldridge, no dream is too high. that's all tonight on the book t.v. on thursday we'll preview four key issues, federal funding to combat the zika virus. >> inspect to make sure they have the ability to not get pregnant, because the mosquito's

ravage women. >> but they turn down the very money that they argued for, and they decided to gamble with the lives. >> the annual defense policy and programs bill. >> all of these folks are very vital to the future of this nation in, a time of turmoil, and, a time of the greatest number of refugees since the end of world war ii. >> gun violence and criminal justice reform. >> every member of this body, wants to celesgun violence. >> we must continue to work the work of non-violence, and demand an end to senseless killing everywhere. >> and the resolution for congress to impeach irs commissioner. >> how resolution impeaching

john andrew, commissioner of the irs. >> we'll review the expect eddie bait with susan, senior correspondent. join us thursday night at 8 eastern on c span. book t.v. visited capitol hill to and members of congress what you are reading this summer. >> i just picked up a book called white donkey. it's by a veteran. he has a very famous comic strip. so, it's a story that he wrote about the experiences that he went through, in iraq and his friends went through. >> what drew you to that book. >> well, as a iraq war veteran, i'm trying to understand, what i

went through and others went through. for me listening to some friends they thought that would be a good book to read. >> got anything else on your list? >> hamilton books as possible. and, i was in chile, and i have been reading a lot. >> one of the things i'm starting with is, the constitution. and, so many of my constituents are reading through the constitution and the declaration, they're doing that with their kids and we're going to have some fun with you that. do some things. i think that's exciting that so many families are going back and looking at those first principles. so, that's what is at the top of

the list. >> bringing out the best in people book. i think every once in awhile, you know, to get a new perspective on how you lead a team. i always say you lead people, and i have always been a big fan of the could have have i books, with the leadership principles. i read a view view of this and i think that's going to be a good one to read. there's an interesting book, too , and it is fluke. it looks at the science behind occurrences, and i want to read it. i think it's interesting how sometimes something happens.

>> let's see, this summer, i have poured through couple good books. i'm in the middle of a book, i've been reading a book called end zone. been a great, if you're a michigan fan, it's been a great read. i also have a favorite that i go to, and that's the master of the senate by robert that i find,. i'm a history nut. that's my favorite book. >> well i've been reading three books. been reading dead weight, the book about the sinking. i just finished three felon is

felony is a day. >> including sam johnson, about what their experience was like in vietnam. >> what drew you to those three books. >> i read all kind of different things. i many bit after history buff. and the authors of those books draw me in. larsen wrote in the garden of beasts. so, he's been good. and then the one on three felony's a day, i wanted to just make sure that when it comes to criminal justice reform and getting those things right. >> book t.v. wants to know what you are reading. tweet us your answer or you can

post it on our facebook page. up next the affects of america's aging population, including added cost of long-term care, health insurance and end of life issues. [applause] >> thank you all for coming tonight. start out, introduce our panel and talk about the topic at hand. so, the main question we're looking at tonight is a simple one but not so simple. the baby-boomers are they going to bust the healthcare system? it's one of the most important questions. you might not know it from the debates. and public square is here to fill that void. >> the share of the population

that's 65 or older, is 16%. and more than 70 million people. around that same time the medicare hospital trust fund as many expected to run out of money. so that's a major policy issue. but this is a very personal issue for all of us. it will affect us, our parents and our children. will we get the care that we want and how much will that cost us and our families? we have a great group of people to tackle these questions. >> john is president and c. eo, and he's a long time veteran.

aarp.^ larry atkins is executive director of the long-term quality alliance. and he was the staff director, on long-term care. he worked in the pharmaceutical industry. >> keith is the c.e.o. of the physicians. he's the arizona market president, and the chief executive officer. healthcare, we generate more akron anyone's, and.

>> one good exception that we're going to go have to allow, and i think we need call the centers for medicare and medicaid receives. cms. so that's one that you'll hear. hopefully it's the only one we'll have. >> we're going to kick things off with the chicken little question. is the sky falling? how worried should we be about the aging population and healthcare system? what are the worries? >> john. i don't think the sky is falling but do i think that healthcare, like global warning is something that we berta seriously or we can get inundated. population aging is happening. we know that we need to make

health care more affordable and response we need to. there's so much of that we spend today, that's not beneficial. 30% of our healthcare dollar is waste. so many, many opportunities to move us toward a more efficient system. if we can do that, we should be able to offset the rising topic of older people that would put it on the system. >> it's not that bad now. it's not in crisis now. but, the thing is, the sooner we act on it, we know it is coming. the he's ser the fix is. our medicare system was designed when life good peculiar teny were 75 or 80, now they are much longer.

we make to make some easy changes to the system now. if we wait it's going to be surgery. >> i just, our percentage of the population will be the same as what japan and germany has today. look at them, and i don't think you see any capacities there. but from the mental challenge, very substantial health-care costs, we haven't gun to, the cost growth has been slow but there's challenges. and as we compound that, across a larger population it will be significant. very significant effect on the budget. but it's going to effect

everybody, out of the pocket and everybody's insurance that we're going to have to deal with it. >> ii would add that the sky is not falling. we have an absolute tsunami warning. that warning is going to come full fit by the time 2030 comes and there's doubling of the number of american residents, that are greater than 65, and that, 70 million medicare beneficiaries at that point and time. that's 60% will have two plus, and 30% will have disease. so that tidal wave is going to be an incredible increase in demand. so the warning is there. now we very many to take that warning to heart, and, this is the time to put in place change.

>> if i could take issue with the tidal wave. it's like rising sea-levels the real pressure going to be almost impossible year-to-year. but over time it is going to be compounded and with the change from acute problems, to chronic, where people have diabetes and arthritis and mental limitations that, require ongoing treatment, this is going to be different kind of healthcare challenge than in the past. so, it is something we know is coming but very gradual. >> another aspect, this is the fastest part of the american economy. and it's a major area for new development. that is big part of the economy. so it has a challenge, you also have to recognize we can't take

an act, because it is fundamental. >> along those lines, next question is can american seniors continue to have it all? people in this country, do not like being told no, they want, if they want therapy, they want it. if they want that newest drug that isn't proven, they want that. they expect that to be paid for. is that a model that we can continue to have or think about something more like what national held service does, there are choices made and judgements made about what is worth covering? >> the short answer is no. it's not sustainable. and we can't continue to have it all.

rationing is going come. if we want a system like national health system until britain, where it comes by, through the government. they make the decisions, on what is going to be provided within the system or about we want to make it. i can't imagine in the u.s. that we'll be happy with the government. we'll super to start making it possible for individuals to make those kind of decisions, in their interest to make sure that the care that they're receiving is quality. >> we do have a budgeting, a global budget function in our healthcare economy. it's broken up into managed care plans. we do the same thing, that governments that provide government health insurance. youyou have an amount, and peope get care.

the organization is providing care at risk. that's not a bad model. the problem is, we have not proliferated. medicare advantage. >> yes. >> i'll make two points, we ration care today. people who are poor don't get the same quality of care as middle class people. people who are rich have much more choice and access to top therapies. so, let's not pretend that there isn't rationing going today. second point is, there doesn't need to be rationing, if we're smarter about what services are valuable and which are not. we have too much of some kinds of care and not enough of others. and if we can be more clear about what provides value, and contributes to well being, then

we can marshal our asset that's would be at accurate. but we're not doing that now. >> we removed the equation with the purchase of healthcare and the cost of care to the beneficiary. once we begin to address that, at the same time, of making sure that we have communicatedded, the chin cal based evidence, that is a sport the treatment alternative that are available. we're all sound consumers. if we begin to look at the way health care is delivered more like a conassume mer based business model we'll change the inputs that will help the patients mat informed decision.

they don't have the information that's necessary. and we don't, they don't have a care navigator that's going to help them. >> are you talking about giving the beneficiaries, one more and they have quite a bit. but, more financial skin in the game? >> larger deductibles. q.part of it is, once you have evidence based proposals in place, and, if the option is to prove it, and the guidelines, that there is as economic implication, to take that decision. >> one of the things that i think very few people understand, is there is no out of pocket cap on medicare on how much you have to spend out of pocket. you can go bankrupt and ab medicare beneficiary, unlike

most people who are insured, under 65, so out of pocket costs who has chronic condition and who has to see a regular basis can be quite substantial. the average income for people who are 65 and over is only 25,000 a year for family. so, i think we have to be careful when we talk about skinning the game that we don't take all that skin from the people who need it most. >> well, with respect to the structure of medicare, it's really, a odd kind of insurance. what we want is insurance that will cover for the catastrophic costs. we want to replace the car. medicare, leaves 20% of the cost, and it can be huge left to the beneficiary.

so if we get skin in the game, it needs to be more upfront. we don't need more -- routine, a higher deal duckable. >> but, not with medicare. >> so, if you want people to get preventative care, deductible can be a real problem. >> since brought it up. 30% of beneficiary are in medicare advantage and there was a study published in health affairs, that looked at folks who needed nursing home care, and, who needed home care. and they were more likely to

opt-out of medicare service, and, once they had the high cost needs. when there was talk of voucher system there was a lot of political talk about that. so, how you balance do things? >> medicare advantage does not cover long-term care cost. so, people who are in medicare advantage and going into a nursing home, that's all out of pocket for them. so one of the things that i think we have to move to is a fully integrated benefit. but i think also, the other challenge, we have, people, many people want to be able to maintain a relationship with their own physicians. a lot of times, so we maintain this principal of medicare choice and people are choosing

to either opt-out, when they are in the -- stay and keep the service, in order to maintain that relationship. but i think people, overrate their -- the importance of their own personal relationship with their physician, where they don't exist in the same way. >> i think a relationship is really important, i think it's important to treat the whole person and not just the symptoms. if you have a relationship with someone who understands you, and understands your situation, that's really worth something. so, i don't think we should get in the way of that. but, the attention between these choice rhetoric and the need for continuity and co-organization.

>> they are the more important values. >> let's get to another issue, hot button issue, drug costs, something that a couple have been dealing with. the cost, for pharmaceuticals. doesn't seem to be any sign it will change. the total tab is likely to rise even more. what should we be doing about this? direct negotiation? >> government intervention? are the drug companies the problem? what do you guys -- what would you like to see? >> yes. [laughter] >> no. [laughter] >> speaking, as the economy mist, the industry is one we love to hate.

but, they are not what's driving the health-care costs they're only 10%. >> but they're rapidly rising. >> well that's interesting because over the last few years, i keep track, and they have been right around 10%. if we need to do something about health-care costs we have to look at health-care costs and physician cost, and drug cost will not bring it down. even though drugs may be expensive and we pay a lot for them, it still a cheaper way to treat many health conditions, than in the hospital. so treating the heart conditions with drugs is cheaper than having somebody go in the hospital and having bypass surgery. so drugs are lowering the cost of treating particular conditions. i wouldn't say that the

pharmaceutical companies are the culprit. >> one is pricing, which is just that there are organizations, that are making the decision to raise prices, on products because they can, without too much regard for what the consequences are for people who are dependent on those. you know, i think, but i think the other thing is, we are in a world where drug development is far more expensive because science is far more complex. we're developing products that have very great utility and people with specific characteristics. >> we have to get better at measuring the value that we have, and pricing to value. it's not a terrible thing to price, c. drug at 100,000, if it is going to somebody that is going to contract liver disease

and who will be able to cure the hepatitis c. with one treatment, and, one period of treatment of 100,000. but when you generalize it, with the return, it is not going to be as great the problem is we have a lot of very expensive drugs, and we don't have good mechanisms, diagnostics. >> i agree, we need to pay for value. that's not where we are today. >> drugs are priced at whatever the company things the market will bare. since there is no functioning market that's no restraint, and we have seen drugs increased overnight by 5,000%. what more evidence do you need is so i think that there's a real need for action. my organization released yesterday, a set of

recommendation that's move us towards paying for value, and, i hope we can move on that very quickly. but, really, it's a dilemmamt we need strong efforts and we want those, the promise, that drugs may come, that could lower health-care costs, and some might in the future. on the other hand, it has to be affordable. we're at the point now where it is not affordable for too many people. we do have to have a better balance between continued innovation and affordability. >> one way to get there, would be to take a look at the billions of dollars spent, on advertising. and we're one of the few country

that's prevents that and i have to question whether it is valuable or not.

but if you slap price controls you've got to like the price you have because you're not going to get a new one >> let me go on the negotiation issue. we have a system in which we are negotiating prices with healthcare party and it is the federal government contracts with health plans who negotiate prices, they are the drug companies. it's relatively effective but if you replace that with a single governmental negotiator , you have to have the ability to deny access to the market. in other words, the plan that negotiates where we won't cover you if we don't get a good deal, we are not going to cover you, go to your competitor, the government cannot do that. it cannot deny access to markets but it has very few tools to work with. they're very effective getting mechanism in the veterans administration to give the contracts to one company and have a national contract that gets very good prices but you have to be