that it's not because somebody said so. there is, in fact, a reason behind that. to respect the fact they might want to know what that reason is because they are going to nod their head and say, yes, this is a good idea. engaging at that level, recognizing that if we're going to give parents autonomy to make choices, we need to give them the empowerment, the information, but also the emotional empowerment to face that process and to be a parter in in that. most patients when faced with difficult treatment decisions like what breast cancer surgery to have, they're not saying, i know everything. they are coming in with questions in mind. they're coming in knowing that they are not an expert and wanting help to figure it out. if we take that perspective here, we open the door for people to say, here is how much i want to know, or here is what the pieces that i don't understand. and then to engage with them on that and to help them move forward. >> i wanted to say something

super quick. we were also really surprised and astounded by the amount of reaction that we got to the story. but upon reflecting upon it a little bit, it does make sense, because while it may be only 5% or so on the top end don't vaccinate children prior to kindergarten, there's some evidence that shows a lot of people are delaying vaccines, spacing them out because of fears. i think like we have -- run into people or many people have run into people who have at least heard from somebody who is concerned about the safety of vaccines. so i think it's a topic that many people are very interested in. >> just following up on something brian said. this isn't going to be terribly popular, but this is my point of view. what does it really mean to be informed? we say we want to inform parents about vaccines. let's take the chicken pox

vaccine. if someone comes into your office and says, havei have don research and chosen not to get the chicken pox vaccine then they haven't done their research. because if do you your research, you will get it every time. what does it really mean? usually the parent means they have read people's opinions about the vaccine on the internet. to really do your research, to really do research for that, what you need to do is you need to read articles that have been written by the vaccine. you need to understand how that vaccine is made, what are the differences between that virus and, say, the wild-type virus, what's the safety? to do that, you need at some level a background in microbiology or statistics. a few parents have that. a few doctors have that. what they really -- what we do is we rely on panels of experts like those that involve or

advice the cdc to collectively have that expertise. and then advise as to whether or not that vaccine should be given and when and why. but that's an extremely hard -- that's an impossible message to sell in the 21st century, trust us, we're experts. that doesn't work. brian is right. at some level, people have to at least have a sense that they're being informed to some extent. what informed means, i guess, is a tough one. >> can i just respond to that? i think it's important to clarify. we talk about paternalism in the early days -- years ago in medicine. it meant you will have surgery. i think we also need to acknowledge in today's world that even if we don't do that medical professionals, public health professionals do have a responsibility to help guide someone through the process of thinking about something. it's not just, okay, it's your choice, go away. you are on your own. no, no, no. that's not sufficient.

we do have a responsibility as people who are experts in the science, who are experts in the context to say, this is what you need to pay attention to. this is the piece that you may not yet understand. if you want to go back and read it, you have that right. but we can't just throw information at parents and expect they have the skills to make sense of it all. we need to draw on our own knowledge and expertise to guide them through the process. even if ultimately, we're going to turn around and say, you have the choice at the end to decide what you are going to do. it's not just a choice to read whatever you want and think that that is a full understanding. our understanding, our expertise is part of that. we need to share that. >> i would also say one thing that gets forgotten is doing nothing is also a choice. so the choice not to vaccinate is a choice to do nothing. it has its own risks. i think one of the messages

people don't often get is that doing nothing is also a risky choice. and the other thing i found interesting that by and large, one thing parents didn't understand was, if your child gets one of these diseases, for the most part, there is no cure. there are treatments and they can -- lots of interventions we can do. but there's no cure. some parents would say, if my child gets measles, i'll just take him in and get the vaccine then. it doesn't work like that. there are basic things we have to deal with. but also modern medicine -- i met one family from switzerland whose 17-year-old daughter got measles and they didn't agree to be in the film. it was too raw for them. they were wealthy in switzerland. their daughter got severe measles and long story short, she was taken to a fancy hospital in europe and she died at 17 from measles in 2011.

there was nothing this family could do to save her. one of the best swiss hospitals in the world could not save this 17-year-old girl. that's a message people don't get. it's very unlikely to get that severe measles. we know that. but it can happen. >> havei have to say though tha that understanding is something that clearly is driving the medical professionals you meet in this film. paul speaks about it very eloquently in the film. regarding the 1991 episode in philadelphia. i think we have time for two more questions. is there another question in the room? >> do you see any difference in perception between adult vaccines and children's

vaccines? do you run into the same problem with shingles or influenza? >> i think as a general, pete electricians and family practitioners are better about making vaccines part of their routine care. adult -- physicians that take care of adults are less good at that. certainly, immunization rates for influenza have gotten better over time. i think adult -- those practitioners who take care of adults have gotten better at that. there's a new vaccine recommendation for adults over 65 and certainly who have had shingles vaccine for all adults over 60. but the uptake among adults is pretty woeful. i think we're not very good, actually, about immunizing adults as much as we are for children. for whatever reason, we're less passionate about it.

>> i would want to add, i think it's a different problem precisely because for an adult vaccine, you are doing it to yourself. right? if you hear information about risks, you are taking it on for yourself. we all protect our children more than we protect ourselves. that's part of the reality here is that we will look at our children as vulnerable, as people who need special protection for very good and appropriate reasons. but that means that information about potential concerns about vaccines, about even just simple side effects of your arm is going to hurt, has a different emotional meaning when we're talking about our little infant than when we are talking about ourselves. that makes the conversation more difficult when the tradeoff between benefits and risks has to come to the surface.

>> sorry. question back there. >> i was curious, all the story telling focuses on mothers. what does the research show about the father's input? have you noticed any generational trends, millennial parents more or less likely? >> so i admit i don't know a lot of data on the gender difference that you are talking about. we know that for childhood vaccination for childhood medical decision making in general, it is more often the mother who is involved. but that is to some degree an issue of availability, of generations. and i do believe that that's evolving over time as more fathers become the primary caregiver of their children. the generational issues are

important. the generational issues are extremely important for many reasons. the experience issue in terms of what have parents actually seen in their lived experience. but also in terms of the way in which parents gather information. my generation uses the internet differently than my daughter's generation does. that's part of the process that we have to respect is that this conversation today is different than the conversation was 25 years ago and it's going to be different in 20 years, because each new generation gathers information in different ways, stories circulate in different ways. we have to respect that we have to move the conversation along with the technology and the process. >> i like to say from just a little aside from personal experien experience, my wife decides when and where the shots to take. i'm the one to bring them in so she doesn't have to see them suffer. i would describe my youngest son

as being vaccine hesitant because they try to give him a shot and he ran into the parking lot. i had to go chase him down. i just want to -- a little more serious note, i wanted to say from a generational standpoint -- this was touched upon before -- but those age 50 and older, it's unquestioning. they lived or was close enough to their generation that they saw the effects of meese measle polio. history, if you are -- you are condemned to repeat it if you don't remember. if you look back at the media coverage from the time of, say, when -- a concurring hero really, in michigan where they made the announcement. there was a famous quote from him, will you patent the vaccine? would you patent the sun was his

response. it was a -- it was viewed as heroic from people have i intere interviewed. i had never seen a modern video of a child with whooping cough and seeing that really hits home. >> one thing to get back to your question about gender differences, my experience was it did impact in a negative way. when i was -- the hpv vaccine came out, i spoke at my daughter's high school. she was in the eighth grade at the time. it was most harrowing talk i have ever given. i spoke to senior girls and asked them how many had gotten the vaccine. about half raised their hand, which is better than the average today. i asked the other half, why was it you didn't get it. to a person they all said, my father didn't want me to get it. the notion was this would increase their likelihood of having sexual activity.

full discloser, when my daughter was eight, i told her she could date whoever she wanted, whenever, but she had to wait until three days after i was dead. so i get this to some extent. >> can we go to 11:00? that reminds me of something that i actually wanted to ask sonya. you made this film initially for the australian market. and then we brought you over here, and you essentially remade it for the united states. i guess i would like to ask you, what did you discover coming here and beginning to cover the story in the american context about what's different, which stories were more important in the u.s. and perhaps less important elsewhere? >> the australian version was designed also for the european market. it covered a lot of stories in europe. we filmed in ukraine and india.

we had a very different kind of slant. the view that we took in the original was to keep it very global, even though there was about 30% australian stories, but to keep it globally focused and the ease at which disease spreads. the american context has been different because in australia, vaccination is not mandatory. you can choose to vaccinate. we have as we put it we have the carrot, not the stick. you get a child benefits and so forth and you can get baby bonuses if you actually have your child fully vaccinated. in our country, our vaccination is sitting around 93%. it's higher than here. there were different issues. what i learned about the american situation was that it's more passionately debated here. it's more divisive in some ways. i think the issues -- in our country, the issue of autism and mmr and the meeasles, mumps,

rubella debate is over. most parents have made the decision that's been put to bed. we had to explore that in more detail for the american audience, because that's still a live subject here. hpv, the uptake in our country is very high, 80% i think it is. here -- what is it? >> hpv for girls who have completed the series is 38%. for boys who have completed the series is 14%. it's woeful. >> in australia for girls it's 80%. it's much higher. there are different forces at play. i think the distrust of authority is greater here in some ways. this idea that you can trust your own opinions and your own research is more dominant in terms of a psychology here. that's all been very interesting to explore that. at the same time, you know, the

vaccine hesitant moms that appear in the film were very brave and great and very giving. i said, we won't ridicule you. we just want to show your story. and they were so frank and so forthcoming. i'm very grateful to them. i'm not sure we would have got the same thing in australia. i think most importantly though is, we can't affect -- we can't forget that beyond this emotional issue and the scientific issues, there is also the issues of convenience and the realities of how easy it is for parents to get vaccines or not. medical coverage in our country is free. we have a whole different kind of set of issues. it doesn't cost you anything to go and have a vaccine. we have completely different forces at play. i do think somebody in europe once said to me, there are the three cs of vaccination. it was confidence, complacency

and convenience. the issues that shape whether or not people are going to vaccinate, confidence main your vaccine or information you have. complacency, about the disease and think it's not a threat, that's going to influence your position. and convenience, if your government, your medical system sets up -- is set up in a way that makes it easy to get your children vaccinated, then all of those things influence whether or not you will. it's not enough just to blame things on parents. there are systems in place that also inform that. does that answer your question? >> yes. thank you. time for one more question and we have to wrap up. >> one more question. it's really quite self-serving on my part. i fully intend on bringing legislation in our next session to help encourage immunization

rates. and i understand, particularly, michael, you mentioned that nova will have some pieces around what states have done as far as legislation. if you could speak to that or if joe has a sense of that, i would appreciate it. >> sure. there's the broadcast goes out, you know, in a week on the 10th. in addition, there are extensive materials on the nova website, and they include articles on a range of topics including the legislative framework. there are graphics being done. there's an extensive effort to kind of keep the story going and create resources for parents and others who are interested. >> one of the things that i would encourage people to is if you are interested in this subject or have members of your

family or your community who are nervous around vaccines, to spread the word. i think it would be useful to have people to use their own networks to sort of have the conversation during this time. there's a window where you can talk about things that perhaps you usually side step. i guess one of the things i was really surprised by was the fact that in a lot of families, one or two people in a family that might be reluctant to vaccinate. but people avoid the issue and don't talk about it. here comes a window to talk about it. if you can use your networks to sort of open that up, that would be really terrific. >> in the very few minutes we have left, let me ask the panelists if they will -- if they have any concluding thoughts or things that you would like to add before we have to wrap up? last words? >> i will just say that i think a choice not to get a vaccine is not a risk-free choice. it's a choice to take a

different and serious risk. the time has come where we need to explain ourselves better. for my parents, for my parents' generation, vaccines were not something had you to convince people about nor people in my generation. but the younger generation didn't grow up with the diseases. you need to explain what it means to not get a vaccine. we have to step back and realize this is not something that easily sells itself. we have to make it clear why it's so important to do this. we have to be patient about making it clear. it's very frustrating when people say, i don't see this thing that's obvious to us. we have to be patient. brian makes that point. >> very short. if someone comes up to me now and says, i don't believe in vaccines, instead of jumping back and saying, no, it's not about faith, it's about science, i now ask why. and it opens a whole different conversation. i would encourage people to ask

why if you hear that. >> my last message is, we tend to focus in health education about providing facts. but in my line of work, context is everything. we need to help parents, the policy discussions understand the context of vaccination. the context as dr. offit just reminded of us is helping people to imagine how life without vaccines will be different than life as it is now with vaccines and the vaccination rates that we have. 70 years ago, 80 years ago, parents said things like, no, son, you can't go to the pool today because of the epidemic. in the u.s. today, we don't say things like that. precisely because vaccines have accomplished the goal of making these diseases rare. but if we move forward and do not as a society maintain vaccination rates, we open the door to a different kind of

life, to a return to a life in which parents have to fear, parents have to think about these types of questions in their life. it's that kind of choice that we need to remind people of as they are considering -- and weighing all the elements of the vaccine picture. >> i was going to reiterate the point about what can be done. there have been state legislatures in different parts of the country, washington state and california and others that simply just make it more difficult to opt out. it's not only a matter of making it more difficult but also -- electric what from what i understand, most of the way this is done, if you want to opt out instead of signing a form, you have to sign a form and then have a conversation with a medical professional, pediatrician, and they sign it and you have the conversation and then -- just that extra step is very helpful,

because hopefully people are welco becoming convinced with the conversation or the extra hoop to jump through makes it that they would rather just go ahead and just get the shots. that does seem like it's working in some states, according to early returns. and so that's all i have to say. thank you. >> i would like to thank you all for coming. i would like to thank the panelists for an excellent and interesting decision. i would like to thank nova for embracing and supporting the film. i would like to thank the national press club journalism institute for co-sponsoring this briefing with us. as you will see a web cast of this session in the next few days. follow the conversation about the film on twitter with a hashtag@vaccinesnova. thank you for coming.

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watch live campaign 2014 coverage tonight at 7:00 eastern here on the c-span networks. my opponent called for economic sanctions against isis. tell me how you put economic sanctions against a non-nation state. maybe we should perhaps write a letter. the issue is that isis is a danger. it's a danger. you have to have a three-pronged approach. you have to shut down our southern border. our southern border is no longer an immigration issue. a nation can that can build a canal, can build a fence. unfortunately, it's going to call for america to lead. you cannot control isis by air

alone. in the words of general conway, four star, there isn't a snowball's chance in hell that air operations will work. and i agree. secondly, limit our ground forces to special forces, to supply and support. we make sure our coalitions that we choose are watched and efficiently train lly trained. make sure eisis is destroyed. >> no one answered how we are paying for this. we put two wars on the credit card. would you support a war tax? >> there's two clearly different approaches to this situation here on this issue. i'm saying, we need to be thoughtful and responsible. no, a letter is not going to get the job done. but this is somebody who called for invading mexico a few weeks

ago because we have an american in jail in tijuana. that's not the kind of judgment i want representing me in congress. his instant reaction to the president's announcement that we would have air strikes was, let's send in more troops. he said a couple years ago that when president announced that women should serve in combat roles, he said that is nearly certain to cost lives, nearly certain, women serving in combat roles. that's not the judgement we need in congress. it's a good question. how much is this going to cost? it needs to be debated in congress and authorized. >> how do we pay for this? >> we pay for it by having a strong economy. a navy costs money. bridges, schools, infrastructure, that all costs money. paying for medicare, social security. we need a robust economy. john, i know you didn't serve.

but tiramisu is a are a mean that has been languishing in a prison in mexico for over six months. every, man and -- i served both. have i commanded both. everybody must be sure that america has their back. when america doesn't have their back like mexico, what happens is it sends a signal to every veteran, america is not going to be there did i no advocate invading mexico. i advocating the president doing his duty in doing by all available means to get the young marine back. >> watch the entire debate as well as all of the coverage of the races on our website, cspan.org.

this discussion was part of the clinton foundation's annual health matters conference in california. [ applause ] >> thank you very much. thank you. thank you. thank you. thank you. thank you. thank you and good morning. i'm sorry we're starting a little late.

but you gathered a little late. and i was told it was because of the workouts. a lot of you are nodding your head. i thought, i can just wait. we're getting into this silly season. everything is reported in a political context. i could see the headline, clinton hospitalizes atennee tt to health conference. tries to make money for sponsor. it's not a bad headline. we got two of the three hospitals out here. maybe it's a good deal. i want to thank you for being here. our third conference. i thank tenet for their support. i want to thank espn for the great town hall meeting we had last night. i don't know how many of you were there or saw it. but it was amazing. they did a wonderful job.

[ applause ] kobe bryant was great, the other athletes were great. the children were wonderful. i thank them for that. i also want to thank our other sponsors in addition to tenet. the pga tour, ge, the burger foundation, price water house cooper, california endowment. they support the conference. and the year-round work we do to try to help improve the health of people around america. i want to thank humana for working with us and the pga tour to put on this humana challenge which starts on thursday. our golf tournament, which tries to build on bob hope's legacy and keep it alive. i think bob hope would appreciate our focus on a week of wellness. i first met bob hope when he was

still just 78 years old, a young man. and i was the governor of arkansas. and he did a gig at the university. and so i went up and had dinner with him. and i said, how do you keep doing this? and he said, well, i played golf as long as i could, but i walk an hour a day no matter where i am and no matter how snowy or rainy or slippery it is. i carry every conceivable kind of foot wear and a big umbrella. and if i have to walk after midnight, i do t.it. i never go to bed unless i walk an hour. he made it to 100. what we try to do with this conference is to think about how we can have wellness in every generation. most of you here know that this

health matters idea grew out of the good results we had in trying to tackle the childhood obesity epidemic -- that's what it is. i think at the time we started, certainly our biggest public health problem, perhaps still is. and i want to thank all the people who work in the alliance for a healthier generation. i was introduced by one of our young board members last night who came all the way from miami. but after doing what we could to reduce the number of bad calories in drinks going to our schools by 90% and trying to lead the way towards what is now a new nationwide movement to upgrade the quality of health in the schools through the cafeteria offerings and working in 20,000 schools or exercise

programs, we're now moving outside the schools on that. but it was clear to me that there was way more -- way more needed to be done if we were going to improve the health and wellness of americans and bring the percentage of our income we're spending on healthcare closer to the global average. one of the reasons for growing income in america which is a dot most people never connect is that as recently as three years ago, we were spending 17.8% of our income on healthcare and no other country was spending more than 11.8% of their income on healthcare. no other rich country. so that was a trillion dollars a year going to healthcare that might have gone into not only hiring more people but raising the income of people who were at work. it also reduced the disposable

income of the virtually every american who either had health insurance and was paying for it or had to pay out of pocket for costs. i will say more about that in a minute. the good news is for this trouble in the individual market, we are now down to 17.2% of our income being spent on healthcare, because for the last four years, we have this inflation under 4% for the first time in half a century. but there are economic as well as healthcare implications to the trajectory we are on. it was clear to me that unless we started something like this, we were going to have real problems with the aging of the baby boomers. i am the oldest of the baby boomers. i hate that. anyway, there it is. so we're just getting started on this. if you live to be 65 in america,

you have already got a life expectancy if you are a woman of 85 and if you are a man of 82 1/2 and it's just going to get -- we're going to live longer. if we don't live better, we're going to impose an unconscionable burden on our children and their ability to raise our grandchildren. and reverse all the trends that are well on the way toward greater health and being closer to our global competitors in the actual money we have to i'll indicate to caring for people who are sick. so that's why we're doing this. today you will hear announcements from people designed to fill in the blanks about how we can improve the health of all americans, that include partners like humana, nanthealth, the jet foundation, the james beard foundation and many others. i am excited about them.

we are announcing today that the health matters initiative partners are making $100 million in new commitments that will impact more than 50 million people. that's one in six americans in a positive way. i want us to just keep doing this. this is something we are trying to change the whole ecosystem of america as it relates to health and wellness. and i'm thrilled about it. i'm particularly thrilled because of the commitments that were announced last year. 90% of them -- 90% of them have either been completed or are under way and on their way to completion. that's a pretty good thing when nine ourt t of ten people who t you they will do something do it. [ applause ] so we still got a long way to go.

every international ranking says that we are great at some things like cancer treatments. but we're light years ahead of every other country in the percentage of our income that we devote to healthcare. but if you measure us in terms of life expectancy, we have in every survey i have seen in the last ten years ranked somewhere between 25 and 33 of all the rich countries in the world. we can do better. we have to change it ourselves. so we are going to focus on our panel on what else can be done. i want to make one final point. chronic diseases, many of which are entirely preventable, claim seven out of ten lives and 75% of our healthcare spending every single year.

over the last generation, the prevalence of diabetes, heart disease and other chronic diseases have all risen. over the past two decades, the number of people suffering from diabetes has tripled, affecting more than 25 million people. it is now the leading cause of a number of complications, including kidney failure and blindness. the elements that play relateha environments and they result in health outcome disparities that we all see, including those that are income-based. so i'm looking forward to talking about the transformations as we kick off our conference. our first panelists have some interesting things to say. i want to bring them on now.

they will be introduced by -- when you hear one of those voices. you know what they call those voices on every backstage in america? the voice of god. if anybody ever asked you whether you should be a believer, you have ever heard the voice of god, you can answer yes. i want to bring our panelists out now so we can get to work. thank you very much. [ applause ] >> please welcome the panelists of the health transformation panel. trevor fetter, ceo of tenet healthcare, patrick soon-shiong, tim finchem, commissioner pga tour, sue siegel, chief executive officer ge ventures and healthy imagination, bruce broussard, president and ceo

humana to join president clinton on the stage. [ applause ] >> those of you who have been at any of our previous conferences will recognize some of the people on the stage. what i would like to do is begin by giving everybody a couple of minutes just to talk about what they intend to do in the coming year, how they analyze this and the point they want to make about the contributions they believe they can make to deal with this issue. want to start? >> i would love to start. thanks for having us. we have worked with the clinton foundation over last few years at humana. we're excited to say we're going to commit this year to focusing on a community that help improve their health by 20% by 2020 by making individuals easier to achieve their health. i want to point out that the

important part of that is not just the 20% improvement. but i think the healthcare system in general needs to focus on how we can help people achieve their health in an easier way. we as a society, health is hard. it's hard to stay healthy. i think it's easy to be -- form bad habits. when you look at the under resourced areas, it's hard for them to maintain health. they don't have the health literacy. they sometimes don't have access to good foods. they don't have the economic conditions that promote health. i think as an organization and as a healthcare system, partnering together with organizations that are on this stage and throughout the industry is one of our obligations. we look forward to working with you and improving the health in that community. >> thank you. >> so my name is sue siegel. i'm representing ge here. what we would like to do at ge

this year is really utilize the employer basis as the catalyst for healthcare change. we represent hemth inalth in a of ways. we have a responsibility of technology. we have our health foundation, our ge foundation. there we make grants as it relates to major issues surrounding health. as an example, the area of primary care shortage in this country. and/or under served regions where we have put our clinical health clinics in some of those areas. in addition to that, when you think about our own employer base, we have 500,000 covered lives. we have to really think about how do we manage the cost of healthcare while we continue to make sure that our employee health and the quality of their health are the same or raised? that's a major issue for us. we have been working on that for quite some time.

the thing i'm most excited about is working on healthy cities with the clinton health matters initiative. we're working close ly with the team in houston. one of the reasons why this is so interesting is houston, as you might think about it, is one of the -- has some of the best medical centers in the u.s. or in the world. yet is one of the most challenged as it relates to stats -- health stats. we're looking forward to working on this together with clinton health matters to actually make a difference. my sense is that employers are real catalysts to allow this to happen. employers foot about 50% of the healthcare bill in this country. we're a major customer to a lot of the folks on stage as an example. when customers in the room are convening, it's a mazing how people want to collaborate. looking forward to talking about that. >> thanks. i just have to say this.

houston is about to face a new challenge, too, because there's so many low income people there. since the state of texas has refused to accept a federal medicaid money, but houston's hospitals are going to lose their disproportionate share programs, they will be in a more difficult situation than before. some of the big urban hospitals in houston and dallas have actually asked the federal government if they could take their county out of texas for purpose of medicaid treatment. i thought it was interesting. government nor governor talked about how he wanted to secede. i wanted to tell him not to let the doorknob hit him on the way out. now you have big urban hospitals wanting to secede to get back in the union to get medicaid coverage. we're laughing but it's an extremely serious issue if you

are trying to manage a healthcare system and you are going to all of a sudden see an increase in your uncompensated care bill when the program for encompensated care has been eliminated because those people -- it was assumed, would have compensated care. this is a -- you can laugh. but it's -- laughing i find sometimes clears the mind. this is a very serious issue. tim? >> mr. president, let me start by thanking you for all you have done for the game of golf. i don't know if many are aware that the president is chairman of the president's cub. he has been to many ryder and president cups over the years. i remember a ryder cup in the u.k. when he came and watched the teams go off and after the last match there was a little

russell around the tee and i looked down the fair way and in the middle of the first fair way walking down listening to the applause, president clinton had stolen the show. it was fabulous. last night there was a discussion about your athletic prowess. you talked about double digits in a basketball game. i got to tell you, mr. president, i got to believe you're a better golfer today than you are a basketball player. thank you for your commitment to us and your friendship for many years. people wonder why we're involved in all this. obviously, the partnership between humana and the clinton foundation with the tournament is very important to the pga tour and to our players. from a health and wellness standpoint, activity here kind of fits with our culture. let me explain that quickly. as most of you know, all of our tournaments raise money for charity. they will raise over $130 million for charity.

80% of those efforts tournaments are focused on some health-related activity. arnold palmer medical center in florida, eisenhower medical center here, st. jude's hospital. and increasingly wellness activity as well. among our players, the vast majority of the top 150 players have their own foundations, their own fund-raising activities. last year they raised, among them, about $35 million. at least three-quarter to 80% of their activity is focused on juniors development, health, wellness and the future. and then our employees who push back a little bit 22 years ago when we announced there wouldn't be any smoking in our headquarters, today are part of a real focus on wellness.

partnering with humana, with their wellness programs. over 90% of our employees every year are voluntarily scanned. that scanning has resulted in a wide range of activity changes and behavioral changes in our employee base. and they are totally into it. initiatives and effort and energy behind things that relate to what the health matters conference is all about and clinton foundation is all about is just a natural for us. given the fact that our players walk on average 30 miles a week, they are great role model on the f fitness side of the equation. what are we doing? as the president has talked about on the global scale of doing things like reducing sugar content in drinks available to

school children, that's a mega global country-wide effort that needs to be married with lots of little activity at the local level. for us, it's effort that needs to be married with lots of little activity at the local level. so for us it's contributing to using our players as role models, telling the story of things like what comes out of this conference on a national basis. at the same time, we're looking at places in so many markets, we have almost a hundred tournaments about how we can generate more activity there. so this year we promised the president we would underwrite for the next five years as a part of the players championship proceeds. the same thing is going on in houston. ashley juarez-smith at a very

young age extremely prominent on the education side of the education side in northeast florida has agreed to take on the role of coordinator. and we will work and be behind her in supporting the effort of exchanges best practices, bringing governmental leaders together and making things happen. i think that the other thing i think longer term we can do is try to -- you know, a lot of this discussion is about defense and how much it's costing us, how it's going to bankrupt us if we don't do something, how it affects the educational system, how it increases the disparity between income levels in our country. not enough i think is talked about in terms of the positive about what can happen? relating diet and wellness and physical fitness to success. and i see increasingly young people getting that. but to me more focus on that

that we can help with i think is a goal of ours as well, mr. president. thank you. >> thank you. tim said something that made me think of something i should have said in my opening remarks, and that is this is really about getting hundreds of millions of people to do specific small things one day after the next until you change the whole structure of consumption of food and the same thing about our exercise and activities and then about obviously the changes we have gone in in health care delivery. but i noticed the other day i haven't heard anyone else mention, with almost no fanfare, the food producers of america are selling slightly fewer calories per capita to people this year than they have been.

and there was an article i read that said that, you know, if it's now like literally not an enormous amount, like 80 or 90 calories a day. if you did 100 calories a day for a year how much weight you would lose. and so i think that all these things -- there is a greater awareness. everybody needs to step up and do something. so i thank you very much. and i never -- i like to ride a golf cart. but tim has basically shamed me into walking more on the golf course. you heard that 30 miles a week thing. so patrick? >> mr. president, thank you for the honor for inviting us here. i think i was just mentioning

that the power of one man's ability to actually lead, president clinton was responsible for forming the funding for the human genome approximate and supporting technology like mist. so how does that relate to what we're doing? out of that came the human genome. we were presenting the cancer genome. we were presenting the work that we developed the first nano particle that affected lung cancer, breast cancer and pancreatic cancer. so we are trying to address i think what is going to be a major infliction in this country and the world frankly is cancer. if you can imagine now for the first time you can measure cancer from the blood, imagine if you could identify what exactly is ailing and then give the right treatment. i don't think we need to imagine that anymore. we have patients free of metastasis after having mat static disease five years out. this is very permanent to me.

i have a cousin who came to me who in canada was going to get the wrong treatment. she said she had two months. she is now 13 months and now almost free of disease. i want that confirmation for the world to see and understand through this conference i'll be describing some of that work. how do we get this kind of information into the hands of a practicing physician? and i'm proud to say there's a collaborative being formed today where the best care of such kind of very high level sophisticated information is populated. if netflix can get blockbuster, we will.

through an int gratd operating system is. so today we will announce an operating system that's 3.3 million cancer patients. it's been running the last five years. and bruce broussard will take credit for that in oncology. because we have launched that and now in real time patients will have actually information in real time at points of care and time of need, anywhere, any time. and that's the goal. but it's more than the goal. we are actually launching that in this country. [ applause ]. >> thank you. >> i love being around patrick because i feel so dumb and yet he makes me think that, like a blind man -- i was raised in the south. they say even a blind hog can find an acorn now and then. he makes me feel i have found an

acorn by funding the human genome and the first nanotechnology research we ever did. one of the few things newt gingrich and i agreed on. the first $500 million of your money in nano technology research. but i think to bring this home you should take just a couple of minutes here about the actual health care revolution you're trying to effect in south central l.a. the last time patrick and i were together was in los angeles. and he said i am convinced that we can give poor people in south central l.a. the same quality of health care you get in beverly hills. so it's a laudable goal, but how can you do it? can you give a couple of minutes on how you are trying to do that.

>> first of all, i came from south africa. lived in the area of apartheid. i was the first white-chinese person to work in the white hospital. i had to take 50% salary to have the honor of actually working in that hospital. i have been brought up in this area of oppression. i was astounded to find here that a woman went to martin luther king hospital in south central l.a., entered the emergency room and called 911 from the floor of the emergency asking for help to get her out of there. and she died on the floor of that emergency room. they shut the hospital down and said there -- the solution was have no care in south central l.a. so we were able to frankly to embarrass the university of california system to participate and help us open up martin luther king. it now will be open, i'm glad to

say, in 2015. the issue, however, is not a physical building. the issue is access to information and access to best care and education and bringing doctors to that community. and that they could have information -- a patient in south central l.a., through a software system that is ubiquitous, that transfers information about the patient's condition in real-time to a specialist saying sitting in beverly hills and have that transmitted, communicated and the doctor being educated is going live. dr. david feinberg is in the audience. we're going to institute the first institute of molecular medicine, where this 21st century medicine, whether you're rich or poor, if you have cancer, this is what you

deserve. and martin luther king, it's his birthday this week. health care is a human right. so i think this is something we will be pursuing. and thank you, mr. president, for that encouragement. i think with a voice like the clinton foundation we also have this -- the system of electronic medical records which where the electronic records unfortunately do not speak. if you're in the hospital, there's no way for you transferring your information from one hospital to another. yet the system creates a ubiquitous information. we're about to launch this into the navajo nation. so our idea is if you can address this in the poorest of the poor, we can make this work for the rest of the country. [ applause ]. >> thank you again for this opportunity.

as my introductory comments had the opportunity to say a little bit about what we do. but i would like to tie together a couple of points that have been made and elaborate a little bit on our mission. as i mentioned, we're in the business of operating hospitals. and hospitals in our health care delivery system are really the front line in providing care to people, particularly when they need it urgently in an emergency. and i also mentioned in my introduction that our company alone is spending $800 million a year in compensated care. i was pleased, president clinton, that you mentioned we have succeeded in bending the cost curve a bit in this country. we're spending a little bit less as a percent of gdp, and the

rate of inflation has reached historic low legals, probably lower than anybody in the audience can remember. so how are we doing this and what is the role of the hospital? because it is an essential role. science is incredibly important. and the innovations patrick was talking about will be transform magsal for the health and well-being of the country. in the end you know the emergency room there and you want it available at 2:00 in the morning to treat just about any condition you can think of. so our interest, in addition to wellness, which is obviously the topic today, is in providing greater value. our country spends more than enough money on health care. but the value isn't there. and i'm please said -- and we can get into examples as we go along in the panel, all sorts of innovations are taking place enabling us to increase steadily the quality of care we're

providing, the reliability of care. the type of reliability in the emergency settings in rich or poor communities that would not ever allow the kind of case that you mentioned to occur, at least in one of our hospitals. so i'm quite optimistic about the future for the health system. in this year, 2014, where we are embarking on this grand experiment in health reform, our hospitals are right at the epi center and bruce's plans as well. that laudable goal was issued by you during your administration of trying to improve access to care and the percentage of people covered by some form of insurance program. ultimately that will lead to better health very, very quickly. so i just would like to say hospitals are an incredibly important part of the equation. and i think we're doing a good job. we're improving value. we have been successful in the reducing the rate of cost. we have a lot of demographic issues putting it higher. i'm very proud of the business we're in and the jobs the

hospitals are doing in the health care system in america today. >> all these people are really smart. i don't need to ask them probing questions. i prefer to let them talk. but i want to ask you -- i want to take the next step here. and if you're basically the only layman besides me who is here in that sense. okay. we were sort of stumbling in the right direction. and science is out there, as patrick says. but we have to figure out a way to make it accessible and usable to all of us. given where we are, either in

public health or in the health care system itself and the delivery system, as concise as you can, what do you think the greatest challenges we still face are and what are the greatest opportunities, one or two of each? because i'll just give you an example. you mentioned that we needed to do more with primary care. there's a lot of worry that we don't have enough primary care physicians, nurses, health care workers. i even saw a great article the other day in one of my blogs about how we ought to look at some of these developing countries that have done a great job with trained health care workers and send them to the most rural areas of the country and hook them via the internet back to all the stuff that pat tricks wants to do. let me just give you an example that i personally saw in the

last six weeks. a friend of mine -- i just went home to a funeral. and a friend of mine went to one of these clinics in a small and remote rural area instead of going to the nearest city to a hospital. and it appeared that it was she just had the flu. but in fact, she had sepsis, an infection in the blood. by the time she got to the hospital she only lasted three days. now, she was older and also very depleted in energy.

so this is not a malpractice issue. this is if we're going to have distance health care, if we're going to have clinics, if we're going to have all this, do we have a system in america that will train people adequately to do it? that's the kind of thing i'm thinking. so what do you think the greatest opportunities and the greatest challenges out there are? >> i'll start. i think it's -- i'll put it in general. reducing the barriers. i think there's a lot of barriers we have.

i'll give you an example. a number of months ago i was in south florida, which is a large market for us. and i always find it both motivating and educational to go visit some of our members. and i went and visited one of our members that was in south florida. and i went in there, bars on the windows. a lady was in there. and i went with a nurse. i spent about an hour with her. and we went over her medicine. we looked in the refrigerator to see what her nutrition was. we do this at humana. this is part of our humana cares program. she didn't know who i was. i just did this sort of on my own. when i walked out, mr. president, there is a thing that will stay with me probably the rest of my life. she said, i'm lonely.

that was her comment. she was 80 years old. she lived alone. and i say there was a barrier in her life that she could not connect with society because of transportation, because of resources she had. and loneliness for her was a health problem. now, we don't diagnose that as a health program. we diagnose a heart condition, we diagnose diabetes. when i walked out, i said get her transportation to a social community. sure enough we did. that had an impact. when i think about barriers in health care, i think the things that patrick is doing. patrick mentioned we partner with the organization that he owns a years ago and created that. technology is a very important aspect of the future. but when i think about the impact of small things that's hard to do in health care, that's a great target for us. and i look at lifestyle. i look at social. and i look at economics being an area that we as a health care system should focus on. because i think that will have a large impact on what we do. [ applause ]. >> what an inspiring story. >> but i just want to say one thing to support you. there have been a lot of studies and several books written about societies with high percentages of centenarians. and the island of okinawa has the highest percentage. it's kind of going down because it is being penetrated by fast food places. that's the only change that's happened. the more mountainous areas, in sardinia, not yet populated by fast food places. there is an isthmus that comes out with an indian

tribe. there are five or six areas. without exception, one thing they all have in common is they don't let older people get lonely. and if their families die under them, that is their children and grandchildren, they are given almost ceremonial status within their communities with roles to play and meaningful contacts on a consistent basis. there's huge amounts of evidence to support what you said. loneliness is a health matter. >> just to add to that, but our system doesn't pay for it. it doesn't help bring it. if you think about the impact that you just talked about. >> it wouldn't be very expensive if we were organized. other societies do more simple and rural areas. >> there's many areas we can

talk about. i want to build on what you were talking about, bruce. utilizing technology to start helping exactly what you talked about. and that is, for some reason we have not allowed the likes of telemedicine or telehealth to become just part of our fabric as it relates to the health care system. it could tackle some of the issues you're talking about. it could help being understand very, very quickly it was much more serious than she thought when it became sepsis earlier on. it's a technology but it's also policy issues. it's the state allowing technologies to cross borders and being able to tackle that on a national basis is something i think we absolutely have to do. because that really will decrease cost, increase health, address some of these issues around loneliness, which you talked about which i hadn't thought about as a health determine gnat. i fundamentally believe he can do it on a national level and

execute at the local level. >> let me ask you this. patrick, following up on her comments, do you think all medical records should be stored in cloud the under certain circumstances? how are we going to do that? and are there national and local policy issues that have to be addressed? anything left that government can do to accelerate this process? >> when you talked about the challenges and the opportunities. i spent the last 10 years of my life actually trying to figure this out. and i have had this very strange, wonderful privilege of being in this country coming

from a socialized so to speak country where the the doctor saw me at home with a bag in his hand. i came to this country in 1991, gave to nci. it's 2013. it is approved for pancreatic cancer. so think about the time frame. so from the knowledge to the application. i then ran with bruce broussard and created this injectable company. and i took over this injectable company in chicago for the sole purpose to invent an antibiotical. when i took over this company as a surgeon, i recognized there were drugs that were not being made because there was no revenue for the drugs, heparin. i was the only safe supply of heparin for this country in 2008. i understood in the supply chain what was happening with that. i went and came back full circle and have gone back to academia so to speak.

and this is how i see the challenge of the country. nobody has looked at health care as a systems approach. on the one hand you have the knowledge. on the other hand, the delivery system. and the third, payment system. the knowledge is in today's world we cannot afford to wait 17 years for a molecule to be get into the hands or even the insight into the hands of a person dying with cancer that has a year to live. on the delivery system, it's completely disorganized, disintegrated. there's no coordination of care. you cannot tell where the patient at home, clinic or hospital. under payment system, and if the delivery system, however, doctors want to actually provide care by keeping the patient out of the hospital or in a home, they are disincentivized to do that. on the payment system, there's no icd-9 code for health. there's icd-9 codes for turn. so you turn.

so if you look within the knowledge and delivery and payment system and say you need to integrate that seamlessly and put that together as one unit, how do you do that? that's what i've been doing for 10 years. you need to create a seamless overarching system that allows communications seamlessly to happen in real-time. so when president obama had this $800 billion and the $4 billion in 2008, i started this program in 2005, i met with him before kathleen sebelius. i said, mr. president, please do not fund the electronic medical records system. it will create what i call medical bridges to nowhere. and unfortunately, it's done exactly that, because we funded software systems that do not talk to each other. this is proprietary not to talk to each other.

you've got to fund a middle ware, a grid computer software system that the large engines collider is running on. i then convened with the institute of medicine and he says, kathleen met with me and she said i'm going to introduce you to the national coordinator. he said i don't know anything about i.t. about this, i'm head of it. i condition screened a symposium for two days. i had the best minds, i said, fund, for less than $100 million, what's running the large headron collider and we will be able to fund the entire nation. unfortunately, it's gone completely the other way, the hospital is incentivized, we went ahead and quietly then said, we need to do this. we, meaning my family foundation, and serves as a great country, i was able to

sell both of these companies, not because i built the companies to make money, but built the company to have a product which actually then became very valuable and decided we will take a billion dollars of that and actually fund internally the development of this. so what have we done? we have actually built an operating system that currently talks to any software, whether it be epic, and it now is running 3 million cancer lives for the past three years, across the pathways, across the delivery system and we know in real time. we have built a software system that actually takes 10,000

software pro focals and tells the doctor which cancer treatment to give to the patient. with regard to technology, it is the job, actually for us is to actually make this health care system, where he makes money where patients don't come into the hospital, where we actually have patients at home, i call this icu at home, which means, you need icus at home. and then this whole world of machine to machine technology is upon us. it's right here. so i partner with verizon and att and i built an electronics company that could have boxes that could talk to each other, the blood pressure machine, pulse ox simm ters, scale, we have now adopted this and now we went into every hospital that has 6,000 medical devices, made from every different vendor, including ge, we went and wrote the apis for 6,000 medical

devices, we are now capturing -- if you got an icu in the hospital and you got the same box in the home, which is called the health box, you can then create an icu at home, we have patients, the patient that you spoke of, you're absolutely right, we can actually put a pulse ox simm ter and know what's going on with her in real time and we have created a telemedicine device on the internet where you can have four or five way videoconferencing, so if you look at this from a systems perspective, if you now can manage a patient from the home, the clinic, hospital, and through a supercomputer do the genomic analysis, we do 1,000 genomes a month. you then have an engineered system for the nation, which then says flankly you have the ability to create for rads of health care, you now have the

capability to create a building with three cardiologists, ten oncologists that can manage an entire city. >> so is this going to happen anyway, or is there something we should change about the laws to make it happen faster? >> so what's preventing these facilities? >> the issue is to actually create what i call outcomes based, value base care, what i call change the payment system, we created the co council, bank of america, mackenzie, and the

single largest barrier now is the disincentivizing care. so if you can then say your job, mr. provider is to keep this person healthy, we can measure the outcomes in real time. if you keep this patient healthy, this is your payment per month, and at the end of the year, if this patient's healthy, here's your bonus. and whether the patient's in the hospital, in fact you don't want the patient in the hospital, the patient is at home, and that's where we need to change the providers of this nation and that's what we'll be announcing up to this event, this cancer

collaborative, with the nations of the world, which have the unions also with us, and we have the food workers union. this is what this nation's going to need and this is what we think is -- -- the potential is not the potential, we're actually doing it. the opportunity is not to opportunity we're actually doing it. the opportunity is not the opportunity. we're actually doing it. the obstacle is the payment system. ironically medicare advantage was the best system you had. and it's a system that's being penalized because they don't understand the actual system. [ applause ]. >> well, there are -- it's interesting. we're doing more and more of this, paying to keep people healthy instead of paying for procedures. but there are -- and there are incentives in this health care law to do it, but there's no mandated pace to get to everybody doing it. i don't think it makes sense to pay for anything else really unless you have some hugely expensive thing that can't be covered by the size of the pool people are involved in. no question, in a much more

mundane world than the one you just painted for us, it also works. it works everywhere, not paying for procedure but paying for people to be healthy. do you agree with that? >> yeah, i would agree. i will speak from a very practical point of view. we're actually on the ground treating thousands of patients a day, millions of patients per year. we're in a period of transition from the fifa service environment, which is absolutely pervasive throughout physicians offices and imaging centers and kind of every health care node that you can think of in the system toward a system where there is accountable care and payment for health, but it's going to take a very long time. we all need to be realistic about this. the conditions have to exist in a particular community in order to enable that. now, we have some examples in our own organization where this has been very effective. so, in northern california in a farming and light industrial community in modesto, california, we've actually been running an accountable care organization now for over two years. it's been very successful. actually reduced the incidence of the hospitalization of the population there that has participated in this program. and actually we've done just fine as a hospital provider

because, you know, we've been able to earn incentives, as you mentioned, through better health outcomes. i think that is a model for the future. but i think we all ought to be realistic about how long that will take. meanwhile, there's some great innovations taking place among the providers. you know, putting in place these advanced clinical systems to even capture the type of data that we're capturing, that just didn't exist six or seven years ago. you mentioned government policy and incentives. the incentives for adopting these clinical systems has been very effective in our own company's case in total we're spending about $1 billion in advanced clinical systems and the government incentives are making that -- it possible for us to do that by offsetting about half of that cost. and although the operability and sharing of data doesn't yet

exist freely, there are other great things that are happening. so, you know, we're -- just in our company we've avoided hundreds of thousands -- several hundreds of thousands of unnecessary tests, unnecessary because they were duplicates. we've all been in hospital environments when a physician walks in and is looking for a result of a test that he or she ordered and the result isn't there, what do they do? they order another test. and we're able to avoid that. we're able to avoid medication errors. maybe the wrong dose or even the wrong medication or at the wrong time being given to patients. so these are really important innovations and improvements in safety and quality in hospitals that are being driven by this technology. everything patrick described is possible and i think it will

occur. but i think we need to give it a little time. >> let me ask you this -- i know -- you can say whatever you're going to say but i want to follow up on this. your position is, i take it, that if we completely stop paying for procedures and pay for performance for health care, that the government wouldn't have to do much more to end the siloization, if you will, of electronic medical records then there would be literally no incentive in the world to not share a medical records with, you know, appropriate privacy protections for the patients but -- is that what you're saying? >> correct. that's exactly right. i think we have completely disincentivized the system and, in fact, perversely incentivize it. you hear -- with all due respect, the incentives of getting the money to actually

put in systems that actually don't talk to another system is a perverse incentive that the government has actually funded. so, and i think when we talk about the time -- i want to emphasize, not the time, that this is not some hypothetical. we actually are installed, as we sit and speak as you said, in 50 practices -- 155 systems, 3.3 million lives, we're capturing 40 million claims a day, 3 billion vital signs, it's being adopted by the nhs as we sit and speak. the software system that is intelligent is running 70% of the emergency rooms of portugal. it's running the largest hospital brighten in the united kingdom. running the largest cancer center in brazil. so, this is not some hypothetical. what it is a will of us actually integrating a platform that gives you actual knowledge in

realtime anywhere, any time and is evidence based. but it also needs to incentivize the provider to give the best care. and the marketplace will do that if you actually provide and you will sift out. you hear problems like accountable care organization and i will challenge anybody, how can you have an accountable care organization when in no realtime can you tell who is accountable for that patient? if you have surgery and you're elderly, you see just as one person 27 health care providers. an elderly person has 19 medications. who is accountable? so, you can't have accountable care organization when you can't measure who is accountable. then you want to give this thing a value-based care. value-based care is outcomes divided by cost. if you can't measure outcomes in pathways in realtime, how can you know whether you're giving value-based care and you have no idea about the cost in realtime. so we have now built a system that can measure outcomes in

realtime and costs in realtime in st. john's hospital, a patient walks into the hospital. the minute he walks into the hospital, we know exactly where he is, what doctor is touching him, what is being used by the minute. so, if you can measure outcomes in realtime and cost in realtime, you can give value-based care and create accountable care. but the accountability gives you outcomes for health and that's how they will actually be bonused. so that's a system that i've -- i don't think is hypothetical. i think it's actually real. we just need the courage and organizations like yourselves to actually be the voice -- >> but you're saying it could be done within the existing legal frame work or we need to at least change the payment system rules? >> and the way i'm approaching it is i'm working then exactly as sue has talked about with the

fortune 500 companies and with the unions and that's what we're announcing today the bps council the ceo council, we will be taking the self-insured and in that context, build a collaborative of providers across this nation, install this system, but on one condition, this collaborative will also work with the underinsured and the underserved. and now we will bring evidence-based 21st century care to cancer patients in beverly hills or south central california and doctors can do what they do best, i.e., provide the best care. [ applause ]. >> let me just say -- and in theory, we should be able to bring it to any country in the world, right? >> correct. >> if we have -- one of the things that our foundations

involved in is this remarkable effort to the rwandaen government asked us to undertake. they want to be free of all foreign assistance in their health care program by 2020. so, they -- we worked with them for years and dr. paul farmer partners in health to design a program they can afford to run that will provide high outcomes for them. and it's basically build a good hospital in every region of the country which we have now completed doing. have one good cancer center in the country, which we have now completed doing. lot of people think poor people don't get cancer. the rates are fairly consistent across the world. and then do a network of clinics

and then train community health workers, which is why i had this nightmare experience i mentioned to you because it's really the same in america, you know? but if you have the technology, it should work. i mean, we've got 19 american medical institutions working there training these people for 7% overhead. i'm very proud of that. lowest in history. and they're going to be free of, i think, all foreign assistance. but they will only have really good care if they are hooked into a global information network that will enable people -- the thing that kills me, like in ethiopia, so there are all these people in the world that you don't think about that are still dying anonymously. nobody ever knows they lived. nobody ever knows they died. that is nobody who keeps such records. and so, i'm very interested for the rest of my life, the stuff i don't do here, about how to apply these technological possibilities to places like in -- patrick is from port elizabeth in south africa.

if you get sick in south african cities you'll be find. but out in the bush, there are still people who are dying alone. >> i'm working with -- in ethiopia and we're doing these kinds of things for africa. >> but it's true. so the point i'm trying to make if we did this in america, it would have incredible ripple effect across the world by just building the infrastructure for people to access. what were you going to say? >> i was just going to build on pat's aspect, bringing it a little bit back to the states. 70% of our revenue is medicare advantage. and it has just transformed the organization over the last number of years from -- because of guaranteed issuance. we have to take everybody. we're not an insurance company. we're a clinical company because we are highly incentive to keep

people healthy. i mentioned to you about the individual i visited in south florida. the reason why we have nurses going to their home, checking if they have nutrition, ensuring they're not depressed is because we're responsible for their health. we are paid an overall fee for their health and they stay with us for seven to ten years. and so, getting back to patrick, i think it's the integration of the technology with a reimbursement system that motivates people to take responsibility for people's health, not just the information side of that. to me, what is done for our organization is transformed our organization to be innovative about being responsible for people's health. and i think if you change the reimbursement system, you will bring that innovation as what you were saying before. >> i want to comment just really quickly on one thing and that is in rest of the world. some of the things you're

talking about, patrick, and in terms of some of the african nations, could, in fact, happen faster because they don't have a legacy system like we have. we don't -- they don't have to defend the fifa service system as we have here. a lot is self pay. in fact, the percentage of self pay -- that's what governs so much of the health care system over there. so, in fact, pilots that we're trying to do a ge surround around some of these activities that you're talking about, we should be able to do those fairly quickly in some of those developing countries. >> you are. in bangladesh and ges, they have leapfrogged. bangladesh doesn't have land lines, they have cell phones. >> let me comment on that. for me it was pretty inspiring when i learned about what ge is doing. that is, we have a hand held ultrasound. for those of you who experienced ultrasound, you have to go into the hospital or go into a system and you essentially, you know,

you have to book an appointment. there's a lot of things about the system that just is. ge came out with this hand held ultrasound and now has it connected. so now, you can just imagine as it relates to prenatal care and as it relates to decreasing the morbidity of infant death, it's a remarkable tool. and we're doing that in a lot of developing countries to be able to help this because in remote villages they all have phones and they're all connected, but they don't have the tools. and we feel like this is something you can train people to utilize very, very easily. so, as it relates to possibilities of bringing technology into these developing

countries, getting the connected world actually utilizing these in these remote, remote villages, it's happening today. i have to agree with you with that. here, we have the legacy systems. we have to break through. and i know you say it's happening already, but i have to agree with you, it's going to take a little bit of time because the policies don't allow us to do what we like to do state by state. we're still breaking down those sort of barriers that we have to do, unless you fund it yourself. >> no. so the way we're addressing, president, we're going state by state. i'm working with the governors, so we're going through -- unfortunately state by state. >> but let me just -- to make sure everybody understand, we had a little bit of a -- we got off on a little techno -- speak, the reason that medicare advantage works and the way they're talking about is it was conceived as a way of paying people to take care of people on medicare and to get a premium for doing prevention, for keeping them well. so, the idea was there's a fixed price list here. that's the medicare payment that

let's say i would get at my age for me. i'm enrolled in medicare. and if i sign up with you, you are going to get this to fix me when i'm sick. so, we'll give you this to keep me well. in the beginning, there was a lot of controversy about it because in the congress, there was almost 100% agreement that there should be more preventive care but there was the suspicion that it was being done to privatize medicare in a way that would allow the whole program ultimately to be drastically underfunded. but it was -- because immediately people began to see the benefits of the preventive work in keeping people healthy, it was obvious that it was costing the providers about $600 -- i'm making this up, but this is pretty close, about $600 a patient a year to do this and they were getting reimbursed at $1,100 and nearly everybody would do anything for an 80% markup that was legal that wouldn't send you to jail.

over time, the providers got better and better at keeping people well so the reimbursement rate could get lower and closer to the cost of providing the preventive services. eventually you're going to go into negative territory because you're not going to have people using the medicare on a per capita basis you had accepted. that's why in a funny way what started off as this big ideologic fight and a big leap of faith has led to a broad -- wide-spread acceptance of funding prevention and paying people for wellness instead of paying by procedure, which we're out of time and i want to get -- this brings me back to the conversation i had with tim when he asked me to try to co-sponsor this bob hope golf tournament and we got humana involved.

i said, i will do this if you let us have the conference at the beginning on health care because one of the things that i had to face up to when i had my heart bypass surgery is i love getting my heart fixed at columbia presbyterian. they saved my life. it was fabulous. then they had to go fix me again. but i -- americans cannot see themselves as helpless, passive creatures on a conveyor belt waiting -- and so -- because i know what you're thinking. you're thinking, oh my god, if i get cancer, i want this guy to do my genome in a hurry and find the one miracle cure that will make me healthy again and 20. we're all laughing, but i'm

pretty close, aren't i? okay. i got it. i want that, too. but the job that tim and i have -- and the rest of us -- even the providers are telling you that that's what they want now, is we are not helpless inanimate blobs on a conveyor belt. our conversation in this whole deal is to minimize the number of times they'll have to help us. [ applause ]. >> so that's why -- i'll go back to the pga. when he agreed to do this, there were an unusual number of golfers and their families who had devoted their foundations to health care.

right? but normally for perfectly understandable and wonderful reasons they were trying to help solve a particular problem that someone in their family had experienced. so, tim is a day or two younger or older. look how healthy he is. i just want to point that out. the pga took a big risk in doing this. they were trying to save this tournament. we were trying to preserve the legacy of bob hope in having -- raise a lot of money year every year that goes into the foundations. but i think the main thing that golfers can do what tim said about walking 30 hours a week, we've all contributed to this idea that you can't ask all the rest of these people to just take care of us. we have a heavy responsibility

here, personally and in our families and in our communities to take better care of ourselves. so, i want to thank tim for doing his part to send the get off the conveyor belt message to america. [ applause ]. >> anybody want to say anything else? >> i just want to say thank you, president, for all you're doing. >> thank you. let's give him a hand. they were great. [ applause ]. tonight on c-span3 a special look at journalism and national security. senior reporters and government officials debate the need for government secrecy versus the right to a free press. examining the fall out from the nsa surveillance leaks and views on the obama administration's efforts to stop the leaks. we'll have it at 8:00 eastern on c-span3. >> our campaign 2014 coverage continues with a week full of debates. tonight at 7:00 p.m. eastern on

oh c-span live coverage of the west virginia u.s. senate debate between representative republican shelly moore capitow and natalie tenant. at 7:00 on c-span 2 live coverage of the virginia debate between mark warner and republican ed gillespie. on c-span3 live coverage of the massachusetts governors debate with all five candidates including the democratic state attorney general, republican charlie baker, evan falcha, scott lively and jeff mccormick. at 9:00 p.m. eastern on c-span the north carolina u.s. senate debate with kay haguen and the state speaker of the house, republican thom tillis. live coverage of the pennsylvania governors debate between republican tom corbitt and tom wolf. thursday at 7:30 p.m. eastern on c-span, live coverage of the illinois u.s. house debate for the 17th district between democrat shirley rhode island

bustos and republican bobby schilling. later at 9:00, live coverage of the illinois governor's debate with democrat pat quinn and republican bruce rouner. friday night, live at 8:00 eastern the wisconsin governor's debate between republican scott walker and democrat mary burke. saturday night on c-span at 8:00 eastern live coverage of the iowa senate debate with democrat bruce braley and joanie ernst. sunday at 8:00 the michigan governor's debate between republican rick snyder and democrat mark shower. c-span campaign 2014, more than a hundred debates for the control of congress. a debate in north carolina's second congressional district took place monday between republican incumbent renee elmers running for a third term and democratic challenger and former "american idol" runner-up clay aiken. here is a look. >> we never ended the war on

terror. this is just an extension of it. >> can you end it? can you really end it? >> that's the question. we are talking about radical islam. we are talking about jihadists, those that believe that this is the plan for the future. it has been in place since, you know, the beginning. and we have to make sure that we are doing everything we can to keep our allies safe, working with allies, working with countries to make sure that we have a presence there and we are working with them. when we leave, when we draw down, when we say we are victorious in a land that we are not, that's when the groups emerge. we have to end that. to the point of the president and support to the president, yes. we will be doing everything we can to support the president on this issue. but he's got to stop telling our enemies what we will do and what we will not do. it's just simply not a plan for strategy. >> mr. aiken?

>> there are several things about that answer that concern me. first, a few weeks ago she spoke out and said she was not in support of sending ground troops into the region. and just a few days ago the speaker of the house john boehner changed course and decided he believed it was important to send troops to the region. now we hear congresswoman elmers saying she would send them to the region. the men and women of the military should be protecting the united states and our soil. to hear her change her tune because her party leader changed his tune is concerning. you know congresswoman elmers went on the record saying john boehner was her boss and you don't want to upset the boss. i understand if that's her mindset that's probably why she's changed her tune but the people of the second district are her boss and the military is overwhelmingly against sending ground troops. so i am not going to change my tune. i have said i don't believe we need to be sending the men and women in the u.s. military into

harm's way to protect another land. there is a threat. when we have seen credible evidence which military leaders, intelligence leaders say there is not a credible threat to u.s. soil now, we can reconsider it. simply going in and sending our men and women into harm's way because our party leader tells us to do it is not a viable reason for me. >> one more note on this. you talked about our arab allies in the region. can we depend on them? >> we have to work within those groups. we have to show support. i do want to go back to what mr. aiken has said. john boehner may be the speaker of the house, but the people of district 2 are my boss. that's exactly why we are here today. >> no, i agree. >> i am reapplying for the job. >> i wanted to speak to your -- >> what i want to clarify and this is one of the things that maybe as an entertainer you're not aware of. these things are fluid. when the president asked for his support he asked for it in a

certain way. we gave him that support. that's what we voted on. now, i think there was much debate and much concern that it wasn't quite enough. i agree. at the time we allowed the president. we voted. we came together, unified in a bipartisan fashion to support the president on this initiative. i do believe there will be much more we need to do. >> you can watch the entire debate as well as all of c-span's coverage of key house, senate and governors' races on our website, cspan.org. next, a panel of female food act vis and film makers talk about the dangers of pesticides and genetically modified foods. ways to create a healthier, more nutritious future, hosted by the commonwealth club of california, this is an hour and ten minutes the. >> it's organic actually.

>> hello. welcome to the program at the commonwealth club of california. i'm kevin o'malley, chairman of the business and leadership forum at the club and and host tonight. food fights for the 21st century. women's voices driving change. our panelists are filmmaker and director of symphony for the soil. moms across america. judy shills, founder and executive director of teams turning green and our host and mot raider is from tech talk studio and director of moms. >> thank you very much, kevin and thank you to the common wealth club. appreciate being here tonight. i'm excited to have these three powerful women. some moms, some aren't. powerful women all the same. tonight we have an exciting program about foot and what's happening with our foot. i will ask my first question

from debra garr siamp you have two major award winning films. you are quite the vocal activist and speaker. you have a famous husband, jerry garcia. how did you come to make films about food? you have been a film make are for a long time. how did you arrive about food? >> i started making films in college and because of that era, the back to the land and going natural and all that, i became vegetarian, stopped eating junk food and soda and became an organic fanatic and felt so much better and became committed to that. i knew at some point i wanted to make films. i didn't make documentaries for many years afterwards, but i always wanted to make a film about the food system and why people should demand a healthier food system. i had been informing myself about foot and social justice for many years. that first film i made was the

future of food that came out ten years ago and when i started filming it about 14 or 15 years ago, no one was talking about the food system. they were talking about the perfect pear and the lovely bread. that's important, but i wanted to make it broader and make people understand the changes that were happening in the system especially genetic emergencying and monsand monsang out the seed supply. i did a lot of outreach and i was very, very popular. netflix bought the copies and all whole foods carried it. lots of communities used it. we had this great program where people could buy bulk copies of the film. people would buy 200 copies and give it to friends. i decided to go deeply into the realm and i made the film, symphony of the soil. it's about soil. the first part is soil and the

middle part of our relationship to soil, primarily agriculture and soil in big ideas. it looks at agriculture from soil's point of view. you don't want to poison it or kill it, you want to give back to it. it's promoting this idea of healthy soil, healthy plants, healthy people, healthy planet which we need to demand. we deserve and we should get it. >> thank you. next we have zen honeycutt here from southern california. zen is a mom, executive director and founder of moms across america and a moms across the grope is taking off. every year on the fourth of july there 172 parades that happen as part of the fourth of july celebration as part of moms across america. she is a major voice on round up. she was invited to the epa a few

weeks ago because she had such a major storm that happened around the country and they asked her to come to washington. how did you arrive at food activism? >> i got involved because i love my kids and like millions of moms across america today, they had food allergies and still have food allergies. dairy, wheat, gluten, nuts and care gene an. the dairy, wheat, gluten and nut allergies, i had heard of. the care gene an was like what? it's a seaweed foot thickener that is in just about everything that kids like. hot dogs and even organic food unfortunately. when i found out it can cause ulcers and cancer, i realized that what we don't see is extremely important as well. the inflammation is the outside is a warping for what's going on on the inside.

i started it research about food and watched food inc., that was the first i watched about food. i watched ted talk and found out gmo are genetically modified organisms are foreign proteins and knew that had something to do with my children's health. i got involved with prop 37 and went gmo free. my son's allergies, a red line around his mouth that swelled up for weeks, within four months it was almost gone. when i saw my children's health improve, i got very active in prop 37 and thanks to pam leery, when prop 37, it was election night and i was sitting in the back of the room much like this room and the leader at the front of the room had done landmark, personal training and development and leadership. she had done it and i it done it, i thought why is she up there as the leader and i'm back

here. what had my role been in the campaign and cause? i had been conveniently involved. i was helping out. i asked what if i took on, i'm the to transform. not me by myself, but i'm taking it on. i knew in that moment the results would be completely different than someone who helps out. i asked myself, how can i let as many people know about gmo in the shortest amount of time as possible? i came up with the idea of fourth of july parades. not many moms are going to go to wash and march on the national mall, but we will go to local fourth of july parades where the porta potties are already set up and the mead why cannot ignore you. many are televised. we will bring our kids and tricycles and say moms across america march to label gmos. people will ask about it. everybody knows a mom's only

special interest is the well being of her children. i believe moms are so important and why i got involved in this and we have done lots of other things we will talk about later. >> thank you. >> our third panelist is judy shills, the founder and director of teens turning green. she is a mom of erin, a young whom whose voice is around the world. it started a real revolution in so many ways. can you tell us how you came to food? >> i actually all of my life changed when my daughter was born. i read a book called diet for a poison planet. in a day my entire kitchen went from conventional to organic and never looked back. i realized the child i was carrying in me needed to come into a clean world. she grew up and some years later i realized that i needed to do

for her and for her peer group everything i could do to sustain the world. we started something called teens turning green which is really much more now college turning green and so many of our students are here with me tonight. basically the goal is literally to march around to college campuses and advocate on college campuses and work with the most extraordinary young people on earth to effect change. my and my daughter's is to be mentors to identify the issues that are the largest issues in front of them and teach them how to fight the fight. i think we take on every fight there is. food this year has been a huge one for us. there is a lot of food justice initiative and policy committees as there should be. the food fed to our children by the time they are preschool through college is some of the horrific food there is filled with everything we are hearing

about. this particular year i decided that i was going to do something about food. for many years i have been talking about you can absolutely change the food in your school and this your and refrigerator, but the school piece i never saw happen. i decided we were going to focus on a school in our community, very under served marin city in marin county and set criteria that wouldn't waiver. it was fresh, local, organic, non-gmo and are z waste. everyone said you are out of your mind and this can't happen. i shot off an e-mail and said i want to change your food program, can i? the response was absolutely. it was at that moment i thought who am i to change the food system. probably an epiphany like you had. i partnered with the local chef that had a lot of buying power and well-known and he helped open a lot of doors with

purveyors and farmers and we started on august 28th. against all odds, we had them start where the lunch program started. we have done it for a year and we see healthy kids and kids that care about the land and kids that are learning about the garden and we are starting a farm on our campus. it goes back to each one of us had a passion and realized that we had a purpose and that our voices were just as powerful as anybody else's and why not? for my daughter and i, our motto is dream and do. we teach that to every student we work with. if you know you can dream and realistically do something to change the world, you don't have a choice. >> thank you. >> so debra, you had an enormous right out of the box with symphony of the soil. it premiered at the