leaders of their parties. but look how pronounced it is among the republican identified voters. 60%, close to 60% say that their leaders are not -- mitch mcconnell and paul ryan, we're looking at you -- are not doing a good job, particularly on government spending, i.e., getting rid of obamacare, illegal immigration, and same-sex marriage. so that opens the door for a candidate who, from the start, signaled that he was angry about mexican immigration in particular. didn't make any bones about it. challenged political correctness, which i think if you listen to working class people talking, that's one of the things they like best about trump. that he says what everybody's thinking. and he doesn't worry about it. and the fact that he's challenging republican elites, along with media elites in the democratic party, is a big plus in their eyes. now, let me quickly say something about the two anti-party insurgencies that we saw in this election. you know, bernie sanders, when he first emerged, got just as much derision of the pundit

class as donald trump. but he hung around, didn't he. he was there for several months. and in the end, in the final weeks and months of his campaign, was deliberately targeting the democratic party as a rigged establishment, as we all recall. so there are some similarities and differences that i think we need to be clear about. these are fueled by male anger. something that susan talked about in 1996. i think we can say we're in an era where white males are angry. and about a lot of different things. but these two candidates in some ways tapped into that male anger. and as somebody who, it won't surprise you that i'm an older female democrat. i'm a clinton person. i've been a clinton person all along.

and every time i would talk to women in my age group during the primaries, they would all describe the terrible attack e-mails they got from sanders supporters who were young men using sexual epithets to describe their support for hillary clinton. where did that anger come from? i don't know. but it was there. of course, the difference is that sanders supporters were disproportionately college educated, or in college, and younger voters, whereas the tilted male group for trump is older and tends to be without college degrees. they both had populous appeals. the economic populism, the core of the trump challenge despite gestures on the trade questions, i would argue, has been an appeal to ethno ideaism. bernie sanders always said he

was disadvantaged, but as a matter of fact he got a lot of coverage. he was never subject to attack ads, either from the clinton campaign that didn't want to waste the funds. the sanders challenge presented itself as a revolution. but, you know, i studied revolutions. i know revolutions. this was not a revolution. this was the kind of challenge from the left of the democratic party that we see regularly in, you know, bill bradley, howard dean, barack obama, and only one of them has ever succeeded because it put together white liberals with african-americans. and that's barack obama. so this is a routine kind of event in presidential contests in the democratic party. it was certainly also a campaign that perfected the dean-obama model of the repeated salary donor contributions.

these are not small donors. these are people with middle class incomes who give repeatedly. but it is a way of raising resources that can generate huge resources in a different way than going to cocktail parties with very rich people. on the other hand, the sanders campaign, like the trump campaign, channeled most of its resources into rallies, and into media. in the trump case, mostly free media, but in the sanders case, they spent a huge amount of the money they raised on ads. it failed in the end, the sanders challenge, with very little appeal to blacks and latinos. and it has had an impact on the party agenda, but democratic party institutions were able to handle this challenge. and i don't really care what was

in the wikileaks leaks. that was small potatoes. they showed that a bunch of staffers at the democratic national committee were irritated at bernie in april. i can tell you every democratic party person in the whole country was irritated at bernie in april. so it would have been surprising if there haven't been some kvetching in those internal e-mails. in its public stance, the dnc maintained their composure, made some concessions all the way through to the convention, and managed to incorporate sanders, and i would say most of his voters into the coalition. and we'll give them a voice after the election if democrats control congress as well as the presidency. let me close my remarks by just

asking the question that i think has been on everybody's mind, including donald trump who has brought neofarage over from britain to campaign for him. i was in britain just before the brexit vote and i know that everybody in the establishment there said, oh, this isn't going to pass. i think there are some similarities and differences. white identity politics at the core. immigrants of a major part of the population targeted in the campaign. in britain, they were not just muslims, but poles and italians. but immigration in britain was really not tailing off. it has leveled off into the united states. and more to the point, an appeal -- a candidacy that appeals to nativism, and tries to reprise the 1968 law and order campaign, just faces a very different situation in the united states than in britain. in britain, minorities are just not a major part of the electorate. but look at the difference between 1968 and 2016 in the united states.

the gray there are whites without college degrees. they were 80% of the eligible electorate in richard nixon's time. now they're, you know, less than half of the eligible electorate. whites with college degrees, who have trended very heavily against trump throughout this entire campaign, and are more so now, are now about more than a third of whites. and we have large blocks of asian-americans, hispanic-americans and african-americans eligible to vote. now, i did put in parentheses there the turnout rates for these various groups in 2012. that's why the end of this election is so bitter. in many ways, it's a turnout battle in which the trump forces, to the degree they have a rational strategy, are trying to up the turnout of non-college whites, particularly males, and the democrats are trying to

reassemble and deepen the coalition that reelected barack obama in 2012. and there's a little bit of a struggle there, because hispanic americans, only about half of them voted in 2012, of those eligible asian-americans only about half. a lot of those who are eligible to vote are young. and have been, shall we say, slow and reluctant to come to support hillary clinton. the big divide in this election is among whites, between the college educated and the non-college educated as well as between racial groups. and we've seen in this last phase, that what may be the death now for donald trump is the divide between men and women.

the gender gap that's emerging is the highest gender gap we have seen. we'll see if that turns out to be true at the polls. my friend, allen fitzpatrick, has written about women's quest for the presidency for over a century and points out hillary clinton now has what all of her predecessors through margaret chase smith and shirley chisholm lacked is party support, money, and foreign policy credibility, all of which has been held against her, of course. but she has it. and chances are, despite the demonization that has occurred in this campaign, and most recently commenting on her

looks, which don't measure up, i think she's probably going to assemble the final piece of the puzzle, which is the high turnout among women, including women like my waitress, who is a non-college educated woman, whose girlfriends are all for hillary. okay. i stop. [ applause ]

what a speech. that was so wonderful, thank you. >> who am i? i am marvin kails. why me? because i was a good friend of sue's, and i think that's the principle reason. if there are any other, it's that i have been a reporter for a long time with cbs and nbc and for the last 30 years have been associated with the senator up at the kennedy school, and now i am a senior adviser at the pulitzer center here in d.c.

i want to start with something about what sue had writtin about in her book, this line, where is i am mad as held and not going to take it anymore, and the wonderful thing about sue's use of that, as a scholar she was capable of the most serious scholarship in all of the data that scholars go by, but she linked it to something that people can understand, who are not scholars, and that was a great gift that she had and i wish more scholars had that. i think the question is still very much with us, and we're still not quite sure what happens now that this window has been opened. remember, she raised this question 20 years ago, and we're thinking about it now again, and

donald trump takes pride that he doesn't read books. it's the ingredients of the voter anger changed, and if that's the case n. what way. i don't quite understand to this day, that donald trump got to where he has got, and is voter anger the reason i doubt it. was it the reason bill clinton won, and was re-elected in 1996, and it was a major issue then and it's a major reason now, and

i think the panelists are -- i don't want to say uniquely -- because here around washington, we have lots of panelists from morning until night, but they are awfully well equipped to be putting all of this issue into voter anger into a proper political context, and i hope when they do it, they will as well incorporate, perhaps, some of the ideas that thea presented in her keynote address. she is the author of "rise of scott walker." next to her, pat choate, and he

was involved in the candidacy of ross perot. and then tom epsall haorbgs is a professor at the columbn pwagrae school, and the resident scholar at the institute of governmental studies the uc berkeley. i would like to start and ask katherine to talk to us about three or four minutes of opening comments, and dealing with that central issue of voter rage. please.

i think it's interesting that we are here to honor professor tolchin, how interesting those two things are coming together, and as was eluded to, the withdrawal of educated white women from the republican party in the past month or so or at least since early august, it's quite remarkable. i am represented to represent the midwest, and so since 2007, i have been spending time in primarily rural wisconsin listening to people, and inviting myself into conversations in gas stations, for the most part, and hearing what i have called resentment

because i see it as this slow-burning sentiment. part of it is about economics and it's about many things, about not feeling that we are not getting our fair share of taxpayer dollars, that our taxpayer dollars are being sucked in by the cities and we don't see it in return, and it's also about not getting our fair share of power or decision making, and people in many rural communities talk to say all the decisions are made elsewhere based on urban values and ideas, and so i will leave that for

now. >> thank you very much. >> pat? >> thank you very much. >> do you want to hold the microphone. >> as a background for my comments, let me note that i have -- it's on. okay. good. during my half century career, i have had appointed policy positions with three governors, four presidents and have been involved in six presidential campaigns, three republican, two democrat, and one independent.

sue opens this book, and it's a really good book, i re-read it coming out here and it's a wonderful type of paul gee and i would recommend it to everybody, and she begins the book with a quote from john adams, and basically she says politics as a practice has always been the systematic organization of hatreds. the genius is to take and control and channel that hatred into a democratic process where there could be anger, and the

visceral hatred which we are now seeing in this campaign has been a series of disastrous policies over the last 30 or 40 years, and i was sitting and listed some, and vietnam, we were lied into vietnam, and the afghan and iraq war, and the 8 million foreclosures of houses by that. we had 8 million homes taken away brutally by people, and $16 trillion of bailouts with the

federal reserve, and thank goodness to bloomberg for their question, and we spent billions on t.a.r.p., and we had 50,000 plant factory closings since the year 2000, and we lost one-third of our manufacturing base, and 5 million jobs. these job losses are following on people who do not have college educations. it is the source of the inequality that we're speaking about. and we have had our banks fined 248 -- our top ten banks fined $248 billion and no one has been held accountable for this. we can talk about how this happens and what we should do about it in our discussion. my point is, there is very good reason for people in this country to be angry. >> thank you, pat, very much. tom? >> it's an honor to be here. and an honor to speak at a forum dedicated to susan polchen. the book she and her husband

wrote about patronage is still important to me as a reporter. i was very surprised to hear marty's description where he said he was paying the check for marty that seemed to be a very unusual thing. [ laughter ] no, that's not fair. he's a very generous person. but i just wanted to give him one wisecrack. my contribution to this is that i think that what has happened is that among white voters, the two parties have flipped on their heads. and under trump, the republican party has become the party of the underdog, and the democratic party has become the party of the overdog. this is really among white voters.

this is a huge shift from the democratic party that i grew up with, which was supposed to be the party of the working man, woman, joe six-pack, the blue collar guy riding the subway in the morning at 6:00 a.m. now -- and i mean that not just economically, and i think economics does play more of a factor than people would suggest, this is also true of the culture in general. the evangelical conservative christian sees the united states has tilted against them. they see themselves on the losing end of the cultural war, that the moral majority no longer exists as a majority.

i think they are actually dead right. if you look at television, the changing attitude towards gay marriage, they've lost that war. and they feel it. and they are angry. and you have combined that with their joining to the republican party and discovering in 2008 that this party could not save them from the devastation of the 2008-2009 collapse. that basically created a revolt that did not find expression until 2015 with donald trump. and that process is now ongoing. how that's going to affect politics after 2016 is the real question. what's going to happen with this bloc of votes that's roughly 40 to 50% of the republican party,

where will they go, what will the republican party do, how can the two-party system adjust to this really internal upheaval within one party? those are going to be the major questions that we face going forward. with that, let me pass it on to the genius of politics, tom mann. >> to the other tom. >> you mistake me, that was thomas mann. marty and karen, thanks for including me, i really appreciate being here. and thea, you nailed it. i just think you got it right. the whole story right, in all of its rich dimensions. i'm convinced sue would have been very pleased to listen to that argument. an important part of it is the fact that some people say, well, it's all economics. john judas, by the way,

continues to believe it's a story of entirely economic nationalism. but the competing claim is, wait a minute, this goes back a long time, and it has cultural roots. and the identity politics has changed its meaning. moving from the identities of newly emerging minorities to the concerns and fears of a threatened, declining white majority, which is working its way toward being a minority. dylan matthews at vox has summarized some of the research that thea referred to, and i think it's important to keep in mind, of course economics is

important. the broad context is economic. but there are a lot of people who came through this okay, who are champions of donald trump. so it sells us there's a tribalism at work here that transcends personal economic well-being. reinhold neibur, the favorite philosopher of e.j. dionne and barack obama among others, wrote a piece for "the american scholar," believe it or not, in 1937, called "pawns for fascism: our lower middle class." now, that's not something you might expect from neibur. but in fact he laid this out very clearly. a shrewd democrat may catalyze a mass movement by preying on their social anxiety, partly based on racial resentments, but also national prejudice, is an

equally strong force. i think the coming together of the changing composition of our society has made a tremendous difference. second point, i've written about and said enough about, and thea gave me credit, but the story is explained by -- in part by what was happening in the republican party. for three decades, they didn't mean to get trump, but in effect they made it possible. we've faced populist demagogues throughout our history. they tend to be marginalized, effectively. trump was the first to come forward and garner the nomination of a major party and

scare the wits out of a whole lot of people in this country and around the world. with parties being so strong, that lent him a base that made it possible for him to be elected. it wasn't ever likely, but it was always possible. we're coming through this, but it's scary. and it reminds us that our democracy is vulnerable, just like northern european social democracies are vulnerable, with a very generous social safety net, to forces of tribalism built around race and nationalism that can be quite potent. even in a country that is a

nation of immigrants, is facing this head on. >> thanks, tom, very much. in listening to the for you of you, and thea as well, thea mentioned this, but i didn't get it from any of the four of you, and that was the role of the media. and i mentioned that particularly because from the time sue wrote her book in 1996 until today, we have the birth of msnbc, we have the birth of fox, we have really the flowering of a radio right wing culture. and i'm going to you, catherine, to ask, when you go to the gasoline stations and talk to your people, if there were no television 20, 30, 40 years ago, and if they lived in their own world, and were not instantly connected to every argument taking place everywhere in the

united states, especially the arguments up on the hill, where you could listen to them for a while and have the feeling that nothing is happening here, it's just words, argue that people would not have the feelings they're having today. i'm wondering for all of you, but starting with you, katherine, take the media, inject it into your analysis, and try to seek some way of understanding the broader context of where they are. >> what i have to say may not sit very well with many people on the panel, but what i learned led me to believe that we overstate the role of the media, and that most of what people, the way they were understanding

the world, was not parroted back from something they heard on fox news, for example, at times, but much of it was their own reflections that they had created together when visiting one another. oftentimes there would be one person in a coffee klatch of regulars who paid attention to the news, and he or she would communicate to everyone else. instead, the think they were most often talking about was their own personal experience and their own economic struggles and their own anxieties about the coming cultural changes, that's my term, not theirs, that yes, they had heard glimmers of through the news media, but it's not as if their interpretation of public issues was something that they had gained in isolation from news media. does that make sense? there's much more interpretation in their own specific location going on than i think we

acknowledge. >> thank you. thank you. thank you very much. pat, would you have a comment? >> i think people attempt to take their situation and put it into a context. and in doing that contextual construction, i think they're very influenced by the media. i think what has happened in our society and why we're seeing the politics that we're now seeing, is we've lost the vetting functions. at one point, the political parties would have vetted donald trump out. he would have been gone. but that has gone, that vetting function has gone. when the print media was much stronger than what it was, the print media and the three major networks and pbs, vetted out what was a legitimate discussion. we've had the rise of talk radio

and now cable television that is driven by rage and cash. donald trump got that much exposure on the networks for a simple reason that the cable networks were able to charge $5,000, just regular cable. when trump was on they were able to raise that to 200. >> made an enormous amount of money. >> enormous amount of money on that. that's why i'm totally convinced that trump and ailes will form a network -- i think he's going to lose the election, i hope he loses the election, but i think they're going to form a media network to try to cut into that

billion dollars a year that fox news is making. they're going to get to the right of fox. they're going to -- trump is now building his audience for his tv network, his media network. but again, rage is profitable. and that's what he's capturing. >> the idea of setting up a network is not an easy thing to do. i mean, the first thing you've got to have is hundreds of millions of dollars. he's got to get that from banks. and banks these days are not in bed with trump. they're quite reluctant to deal with him, as a matter of fact. the second thing is carriers. if you're going to have a successful network, you have to have stations all over the country carrying you. and there is -- there have been

so many efforts to set these things up. so he may try. but he may be spending a lot of money and wasting it. tom? >> i'll simply say, he's going to enter the market with 25 to 30 million viewers who will be solid viewers. he can get that money, marv. >> he can get the money from russia. [ laughter ] >> we've already got the call letters, w.p.n., white people's network. i think, one, that the media has lost its credibility because of polarization, and the media, or the vetting media, now are all seen as left wing media. there's been a shift in the way "the new york times,"

"washington post," the networks, all of them are seen. and they're now easily dismissed as, that's just those lefties mouthing off. secondly, the financial problems facing all the media have created this situation where trump could run roughshod, because he produced viewers, just like he produced hits on the web. when i would write a column about trump, it would get three times the hits that a column on inequality would get, ten times the hits. there's money in trump, for the media. it's a tough situation. and the market is now defining the media, where is it used to be the media had so much money, it could define itself. that's no longer the case. >> tom, go ahead. >> listening to tom, one demurral from hilary. she didn't quite see that left wing bias of the traditional

media. if anything, they were very late to coming to the guts of this campaign and the stakes of this campaign, and only in the last weeks have you seen the kind of reporting on trump that might have been done last year. and the kinds of things that they covered on clinton were -- i mean, unusual. but that isn't what i want to say. i think reality tv is -- has been more important to trump than the media, news media. it was his basis of visibility and popularity and attention that allowed him to short-circuit all of the other processes. and i think that's really important. and was masterful in playing the media during the primary process. he knew how to do it. but what i come to believe is that in this world of asymmetrical political polarization, the media, the traditional media hasn't done a thing to help the public understand what's going on and why we had gridlock. and it's not just the washington establishment. their search for equivalence has in effect neutered their important role in our politics. and therefore they weren't present in a serious way until very late in the campaign to

help us cope with the most serious threat to our democracy since the civil war. >> we could have a wonderful discussion about the role of the media in the coverage of trump and the entire campaign. but i don't really want us to go there. what i would like to do is go back to sue's book. and all of us who have taken a look at that book appreciate what it is sue was dealing with at that time. she was writing and researching in the early part of the 1990s. and the book comes out in '96. 20 years have passed. where she here to do an update on that book, what are the issues that have emerged in the last 20 years that she would now spend a couple of extra chapters writing about or rewriting what it is that she had done earlier?

catherine? >> i'll pick a general one that i found very striking when i reread the book. and this was her pointing out that at the time she was writing the book, americans had it better than at any time in history. and i thought, in the 20 years since then, that's not really the case anymore, in many of the ways that thea pointed out. and one thing i did was to look up this question that gallup has asked for many, many years, at least since 1994 and probably going back earlier than i was able to find. and it's just about general satisfaction in life. and it goes like this. in general are you satisfied or dissatisfied with the way things are going in the united states

at this time? and not long after her book came out, gallup's estimate of this put -- in 1999, it was at nearly a 20-year high. at this point in time, in 1999, 71% of the american public said they were satisfied. now it's reversed. so that 72% say they're dissatisfied, and 27% say they're satisfied. and i would imagine she would, you know, make something of that. she pointed something out that we needed to pay attention to. and i think this election is a great reminder, that if left unaddressed, it comes to a crisis or near crisis moment. >> two things i think she would focus on. one is the '96 communications act that in effect allowed the agglomeration of the media. prior to that any individual owner could only own a set number of tv stations, a set number of radio stations. now it is possible to homogenize that and own 1500, 2,000

stations, and be able to deliver a rush limbaugh or an alex jones and their message to the whole of the country. that's new and different, i think she would focus on that. i think the second thing she would probably focus on, because it's significant, has been citizens united, and the whole question of money. perot ran the '96 campaign on $135 million. you can't do that in pennsylvania today. and we wind up with a situation today where a massive amount of that money is dark money. we do not know where it comes from. we do not know the agendas of the people behind it. those two things, the media agglomeration, and this massive flow of money, i understand the 6 or $8 billion in this campaign, i think those would be

the two things. >> excellent. thank you very much. tom edsall. >> on the second point, i disagree. trump ran a campaign that was actually low budget, relatively speaking. he's gotten a huge amount of free media, like $2 billion, as i think thea shows. but he has raised and spent much less than hillary, and especially in a primary. beyond that, even his advertising in every given state. i think this election, if anything, shows that citizens united has not had the overwhelming consequence that we thought it would have. i think the other things that sue would note would be, one, in 1999, at the high point of when everyone thought everything was hunky-dory, that was the high point in the economy. the '90s were golden years in this country, and they were golden years for everybody across the board. low income, high income, middle

income. everybody rose, all boats rose. since then, we've had a very slow growth period. we've had rising inequality with very little growth at the middle and down below, if not no growth. that's a big difference. if you're going to get pessimistic, there are real grounds to be pessimistic for the majority of the electorate. there are a lot of other points, but i'll leave it there. >> i think sue had the categories all there. it's the context of each has changed. the economy, she had seen the stagnation of wages, but that then continued, and we saw increasing economic inequality. and then we had the worst global financial crisis and recession since the great depression. so this unleashed, you know, a

lot of the other forces and factors that she herself addressed. and i think she would have, after viewing this, sort of looked at the two parties, not together but separately, and try to see what's happening, with all the racial minorities clustering in one party and the other party being predominantly the right party, that's the kinds of thing that has a way of really exacerbating divisions that we managed to dampen at times in our history. >> and the issue that comes right out of that is, of course, the presidency of barack obama. so i would like to raise this question. if we are discussing the heart and soul of voter anger, to what extent, i don't want to sort of

prejudice my question, to what extent do you believe that the presence of the first black president in the white house in the last eight years has led to the depth of anger? or is that irrelevant to the depth of anger? >> it's totally relevant. and i was going to raise my hand and ask if i could add in a second thing that i think is so important to the context in the past 20 years. and it is the presidency of barack obama. and also our heightened attention to racism in this country. i think the events of the pass few years have been -- i mean, i believe it's largely because of cellphones, and that white america has seen in an inescapable fashion the kind of violence that's going on in our country. i think all of us are trying to

make sense of the many bewildering things going on in this world. and i think when people are given a story and targets of blame, it rallies emotion, including anger, in a very kind of effective way. and i think the manner in which anxiety about the changing cultural composition of our country has been rallied or targeted toward barack obama, is a very big part of the story. he has become a target for a lot of the angst and emotion about the fact that we are no longer a white country. >> anyone want to pick that up? pat? >> i think that what we have seen is a code word for racism in the attacks on barack obama. and the whole question about birtherism. i find it astounding that something like 60% of republican voters believe that this president was not born in the united states, which means they believe he has not a legitimate office holder to the position. at the same time, i think what we're also seeing here is

misogyny on a massive scale in the reactions to hillary clinton. and again, it is deep seated misogyny. this is deep seated racism. and we're in the process of moving our way across that. i would like to say to tom, on the question of citizens united, it is true, i agree with him on trump, he has been able to do earned media magnificently well. but the influence of that money has felt itself in this campaign downticket, inside the republican party. the very fact that an mcconnell and that a ryan and other republican leaders are intimidated to not say anything lest they lose their funders has a major role. i mean, what we should have seen is the republican establishment responding forcefully to many of the statements and attitudes that trump has put out.

it's that fear of the dark money that holds them away. >> would one of the toms like to comment on the role of barack obama in explaining the depth of the voter rage? >> i mean, you just think the fact that he is black and you have the enactment of obamacare, which is a redistributional program, shifting benefits and taxes downward to a population that is disproportionately minority, contributed to this idea. the two echo each other. he becomes the embodiment of liberalism and he is black. the two conflate. so you then get a higher level of what pollsters call racial affect. >> i agree with that. but obama's more than that. i think he's also the epitome of a meritocracy, someone who goes

to good schools and learns a lot and speaks, you know, in very refined ways, not like a lot and speaks in very refined ways, not like hillbillies speak, that it -- [ inaudible ] yeah, a professor. this is a, so -- >> only for a brief time. >> the race is an important part, but it by no means limits the sense of cultural alienation -- these are the kind of people that are taking over our country, and it has -- racist is a part of it, but it's also gender feeling. this is -- obama doesn't act like strong males, assertive males are supposed to in many ways, you know? and that has, i think, opened an

avenue for trump. >> another question that theda raised in her presentation that has to do with immigration, and the number of people coming into this country, number one, a very high number, but number two, of them, many of them are not white. so, that adds to the perception and the problem. and i'm wondering if you put those two together, the immigration itself, without any linkage, could be a very significant reason for the rage that does exist among the white, male, not college-educated supporter of donald trump. >> yes. >> is that right? >> yes. and i think immigration is a great example of the way in which cultural anxiety and economic anxiety are intertwined. because so often the conversation about immigration is about certain people taking

our jobs or free trade being a bad economic idea. so, i think the fact that, that great map that theda showed of so many states, the largest immigrant population coming from mexico, i think there again, it's a very kind of clear, blatant target for people to tap into. so, i absolutely agree. >> tom? >> yeah, it's probably important to remember that even when the immigrants were primarily white, once they moved to southern european, and when they involved jews, things got pretty, pretty nasty in our politics back at the early part of the last century, but i do think -- and that's the point theda was

making that we've -- you know, the period of rapid integration and its changing composition has returned us, given us a problem. and now in many ways our party system isn't able to manage it as well as it had before, for various reasons, and i think that contributes to it. one last thing that may be one of the scariest things about what's going on. there are people who are angry and then there are people just filled with hate and have been for decades on end that have hate groups and neo-nazi groups and white ssupremacists.

and what's stunning is in their conversations on websites and now we have good investigative reporting going on following these social media channels and everything, and the extent to which the, you know, the alt-right, as we call it now, has come to feel they've been brought into the mainstream of american politics by the trump campaign. it's really scary. so, a lot of this stuff has been around before, but this time it broke through from the fringes to the mainstream. >> and the mainstream, of course, is the fact that donald trump represents one of the two major parties in this country. >> exactly. >> just to share something with you all that's kind of interesting, i think. last week, trump did a speech down in florida which was different from most of his other speeches in the way in which he delivered it. it wasn't a teleprompted, but he

did it in full sentences, full paragraphs, long words, very complicated thoughts. and i was saying to myself, this is not donald trump. so, who is he? and on a hunch, i went and read up on some of the editorials that breitbart has been publishing over the last six months. much to my astonishment, the phraseology was exact. the long phrases were simply pulled out of editorials that had appeared on breitbart. so, here now we have a major candidate who is expressing something that is not within the normal range of our politics but has broken out of the normal range. at least that's my sense of it. and i wonder if you share that, you panelists, share that view. tom? >> i'm a little less pessimistic than you on this, and tom.

i think it's possible that if you bring alt-right into the mainstream, they're going to be the ones who have to compromise. they're going to have to start dealing with a larger political reality. when they were in isolation off in mountain cabins where they are keeping their, you know, antinuclear devices all wound up, they are totally separate and they're totally isolated from society. if they have to get engaged, they're going to have to learn a little bit about what the real world is, or else they're just going to get pushed out again. >> but if that was the case, tom, we would have found its political expression now in trump becoming more a movement toward the center, and he seems to be in the last couple weeks hunkering down now and exaggerating the relationship with the breitbart people, rather than putting any distance between himself and them.

[ inaudible ] >> yeah, i mean -- i'm talking about the alt-right in terms of stormfront and these kind of places. >> the montana militia. >> the montana militia. those people have separated themselves, insofar as society in general, they've become part of it. i think it's possible. i'm probably candy-eyed on this point of view, but that they will be possibly become a little more reasonable than -- >> well, you guys on "the new york times" are so sensible. that's wonderful. ca katherine, did you want to say something? >> i do. and i'm sort of puzzling through this. i'm not sure i have this right, but i don't think -- i don't think that people -- i think we are setting ourselves up for a bit of a disaster if we discount these people as so far from the

mainstream. so, for example, may i read you a quote from a conversation i heard not that long ago among a group of trump supporters? so, this is a man who is just a regular member of his community, who gets together with a group of his pals every morning in a service station. sorry. and i happened upon -- i was visiting them early one morning a few months ago. and he seems like a very reasonable person to me, but this is what he said. when i was asking about their support for trump, he said "it's time for the reckoning. these politicians, they're going to lose their jobs because they haven't represented us and they've put us in debt. do you even hear from the democrats so far as how to clear the debt? all you hear is free education, and that can never happen," and he goes on and on. he says, "i think if a guy like

that" -- trump -- "got in there, it would probably start to straighten things out so we don't have to keep working so hard and maybe pay this debt back some day. everybody's sitting in their old age in their 70s, their 80s and their 90s. they're fine and dandy, but everybody that's behind us, "meaning younger people, "brace up, because we're heading for a third-world country. we're getting there." so, a pretty regular guy telling me armageddon is coming, basically. so, the point is that alt-right perspective is not just recluses. it's among mainstream people. >> the conspiracies have gone mainstream. and if birtherism can, as you said, continue to attract that percentage, there's a lot of people that believe this stuff.

and that's, you know, that's what's scary. what's scary is the rejection of evidence and facts and science. and in fact, you know, they -- people -- you were saying this earlier -- now follow conversations like this. they'll listen to hours on c-span and think it's the same old people, ignoring, you know, throwing this stuff at us, and they don't, you know, we know what's going on. they don't know what they're talking about. and we can't ever get in a situation where we can actually sit down and talk it out, because they won't do it in congress because there's not an inclination on the part of republicans to engage in that kind of an effort now. >> i think there is too much demonization of the right in

this situation, in that if these people are inclined to see birtherism, there must be something underlying that. they're not ignorant, dumb people. there must be something about liberalism and the democratic party that lends itself amongst some people to producing this kind of idea that the head of the democratic party, barack obama, is a sort of alien, non american. to them -- i'm not justifying that point of view, but there must be something going on. unless you're going to dismiss this, say 30% of the population, as a bunch of mentally ill people. >> how would you describe them, then? >> we're not saying that, tom. >> but unless you start thinking about what is it that is prompting them to be -- >> well, what is it? >> i think that there is a lot of deep resentment at the democratic party having what

ronald reagan tapped into years ago when he said i didn't leave the democratic party, the democratic party left me. you see this throughout white working class areas. you see this anger at the left and liberalism. you see it in hillary clinton's e-mails, the e-mails where she tells goldman sachs one thing, when she says another thing when she's debating bernie sanders. >> which politician does? >> she actually really didn't, but -- >> no, she says things about dodd/frank and about -- >> it really isn't, yeah. >> it is. >> read the follow-up stories. >> wait a minute, wait a minute, hold on. theda, we don't hear you. this is on c-span. you want to -- >> okay, i'm just -- we can argue this -- >> no, no, no, would you like a microphone? come on up. >> but there is this huge sense that the democratic party is now the party of elites, and that's how the party is perceived.

and if you look at the democratic party, who the activist wing of the democratic party, what it is made up of, it is elites. i'm part of that elite. i mean, most of this room is part of that elite. but that's what the party is in many respects, and it's going to be perceived that way. so people are going to see the party in ways that are not going to be nice, and sometimes they're going to be kind of off the wall. but people better do some introspective. >> hang on a second. pat, you wanted to come in. >> i agree with tom -- >> hold the microphone near your mouth. >> i agree with tom on the whole question that there's going to be a moderating force, i think, on the right, and it's going to be about the dynamism that's going to occur after this election. i think there's going to be a three-part civil war inside the republican party. there's going to be the

alt-right with trump, there is going to be the libertarians with the koch brothers, and then there's going to be the traditional white-shoe republicans, john kasich, et cetera, and it's going to be very brutal. they're going to have to find compromise with each other. the only thing that they're going to find compromise on is they all hate hillary clinton and the clinton administration, and i think that they will go into excess. so, i think the dynamics here is going to have a leveling effect on the right. they are going to, i think, make it possible, because she's a very skilled politician, very skilled. and just look at the comments of the senators, republican and democrat, when she was a senator. i think it's going to create a dynamic where she is going to be able to do deals and compromises and have accomplishment and set herself up for a nice rerun in

2020. >> we've got about ten minutes left, and i'm delighted that you have jumped ahead to my final question, because i'm very interested in what you all feel, given the emphasis on the background and the reasons for the voter rage. what is going to happen on november 9th? does the voter rage then just stop? does it get more intensified? what are the reasons? what happens at that point? and with that easy question, katherine, give us the answer. or try. >> well, i'm worried about it. i guess i'll answer with a question, and the question in my mind is just how much establishment politicians, elites, from both the democratic party and the republican party come out in the next few weeks talking about how this is not a rigged election and sort of setting us up for those claims

when mr. trump, assuming he does not win. i think it would be extremely dangerous in terms of fomenting further anger and disruptive anger to somehow claim it's been a fraudulent election. i've been very happy to see so many people coming out in the past few days saying it's a legit election, and we'll abide by the results. >> mm-hmm. i'm going to jump you, pat, and go to tom, tom one, i'll say, and ask you that same thing. november 9th. what is it that in your judgment is going to happen at that point, in terms of just voter rage, in terms of where the politics may go? >> all right, if hillary clinton is going to be able to accomplishment something, i think she's going to have to have both branches of congress, and i don't think she's going to. odds are that the house will

stay republican. and the odds are that, if anything, the republicans who remain will be more conservative on average than the ones who are there. the middle of the road is always what gets hurt in elections. i foresee, frankly, another four years of gridlock and very unpleasant and people getting angrier and angrier at inaction. and i think the prospects in 2018 in the senate are not good for the democrats. and even if they take back the senate in 2018, they could lose it, so that the idea of a government that can coherently do something is going to be problematic. if the one thing, if they get the senate, i think there's going to be a lot of pressure to change the rules on filibusters, on supreme court nominations, in addition to federal appellate

courts, because it looks like the republicans are going to take a very hard line, even on supreme court nominations. and i think that might be someplace where there would be -- and there might even be changes in the filibuster rules more generally speaking. >> tom mann, before you go, let me interject a question. >> okay. >> assuming for a moment that hillary clinton wins, is there anything she can do to head off the future that edsall has just described? >> yes, by following edsall's advice and putting everything she can into electing a democratic house as well as a senate. i mean, tom is absolutely right on this. and the notion that sort of an individual, because she has experience in a different context, in the senate on second

or third-level issues, having had some success working with republicans can't match up with the structural forces that are at work here. and so, all this talk about, oh, i read in the paper, it's so awful! well, hillary needs to spend her last weeks laying out a vision so she has a mandate. hello! there are no mandates! there are unified governments and divided-party governments, and she needs troops and she needs control, and then she needs to do and make clear that while the democratic party is changing, it's more educated, there are more higher income people, it still, one, represents the lowest income whites as well as virtually all

of the minorities, and that the prime policies being pursued by the other side are -- i mean, paul ryan's attractive in many respects, but he's still sing ing the i'm rand himmel. it's stunning how much the program of the republican party is unresponsive to the concerns, and it's so cynical, the opposition to government, the demonization of other people, withholding legitimacy from the normal democratic routines. this has really been an antidemocratic effort to stir up, and it started with the party, and trump pushed it along further. and that's why if we have divided party government, i

think the sequence tom laid out is exactly right. >> i know, but what tom laid out was that you have to have a clinton victory of the presidency and the democrats taking control once again of the senate and the house. but let's say that doesn't happen. where are we then? and i'm trying to get some image of where this country is going to be in a year from now. pat, maybe you can provide us some help. >> several things. let's assume that clinton wins, that the democrats take the senate and that the republicans control the house. i think that's the most likely outcome. so, the question then is how do you craft a strategy that you can implement between inauguration and august? that's the only time she's going to have to do it. you make your changes then and then you hang on to it. so, in the senate, i totally

agree with tom, you've got to change the rules of filibuster and confirmation. clinton will have i think many judicial slots, including one supreme court slot, if they don't move on president obama's slot. so, she'll have that, so she'll have a major influence in the courts. there's a lot of trade iing to with that. second thing is inside the house, the republican congress is deeply split. . i agree you'll have the freedom caucus and the hard right caucus. they're going to be very tough. they're going to be after paul ryan, and you're going to have the alt-right moving to take ryan out for 2020. ryan needs some accomplishments. and so, it is up for the president to use the bully pulpit to take and find some issues where there is common consent, like rebuilding the infrastructure would be one. find two or three issues, such

as that, and then cut a deal. and some of these deals you may have to make in private, but it is possible for her to have real accomplishment by working the politics inside the house. >> that's what she'll try to do, and i think you're right. and i think ryan will be tempted. the problem is that he won't remain speaker. i mean, he can't survive with a strategy like that, because republicans don't do business with democrats. >> i think that could be to his advantage. he is not going alt-right in 2020, if he runs. it would not be to disadvantage to have the alt-right throwing him out. it would be to his advantage to accomplish something, and then that gives him up in the civil war that the republicans are going to have.

>> it would be good, but then why is he proposing a tax plan in which 99.5% of the benefits go to the top 1%? >> funders is the answer to that one. [ inaudible ] >> in koch. >> let us say that it's going to be a tough time. i think that's a fair -- a fair decision and a fair conclusion. but in wrapping up, let me first thank the panelists who have been quite wonderful. and i thank you all very much for that. and i want to thank theda skocpol for her marvelous keynote address. thank you very much on that. and let us all bear in mind that we are here to commemorate the work and the person of sue

tolch tolchin, who was a friend to many of us, and as we have already heard, a wonderful mentor to people going out for ph.ds, but not just that, but people who wanted to be educated a little bit about what this country is all about. and the books that she wrote, many of them with her husband, marty, right here, have been great additions to the literature and the politics of our time. so, thank you all very much for being here and thanks to the george mason university for having us, and thank you all, c-span, for covering us. we've got more from "the road to the white house" later today with the two major party candidates. donald trump will be speaking at a rally in johnstown, pennsylvania, which you'll be able to watch live starting at 4:00 p.m. eastern on c-span. and later, his democratic

opponent, hillary clinton, will be appearing in cleveland in advance of the world series in that city. watch her comments live at 4:30 eastern. it will be on c-span2. also, join us tonight for a look at race and justice in america. a panel of activists and political strategists from both sides of the aisle discuss how the next president may handle race and justice issues. participants include author and history professor mary francis berry, director of coalitions for the jeb bush presidential campaign and a former aide to president bill clinton. you can see that tonight starting at 8:00 eastern on c-span. if you missed any of the presidential debate, go to c-span.org using your desktop, phone or tablet. on our special debate page, you can watch the entire debate, choosing between the split screen or the switch camera options. you can even go to specific questions and answers from the debate, finding the content you want quickly and easily, and use

our video clipping tool to create clips of your favorite debate moments to share on social media. c-span.org on your desktop, phone or tablet for the presidential debate. this weekend on american history tv on c-span3, saturday evening, just before 7:00 eastern, ohio state university's michael les benedict talks about the 1866 supreme court case ex-party milligan, where the court ruled it unconstitutional to try civilians in military courts while civilian courts are operating. >> the milligan trial was part of this debate designed to prove to the public that the danger was real. and therefore, the military trials were justified. and as you know, it worked.

lincoln won the election of 1864. >> and at 8:00, george washington university professor chad heap on the origins of the gay rights movement. >> the gay liberation front, right, it's playing on and building on all of the lessons that the whole other array of social and cultural movements from this period are developing. the antiwar movement, the civil rights and black power movement, women's liberation movement. they're taking the best aspects of those and building upon them. >> then sunday evening at 6:00 on "american artifacts," we take a tour of the woodrow wilson house in washington, d.c., with its executive director, robert enhelm, where the 28th president retired and died three years later. >> he responded to that crisis by sending food aid to armenia. the armenian people were very grateful, and a group of armenian women touring the united states raising money for armenian charities were here in 1917, just after we declared

war, and presented this painting to president wilson. >> and at 8:00 -- ♪ you like ike, i like ike, everybody lykes ike for president ♪ ♪ bring out the banner, bang the drums, we'll take ike to washington ♪ >> neil oxman, president of the campaign group incorporated talks about the history of presidential campaign ads, beginning with dwight eisenhower's tv jingles through the 2016 presidential campaign. for our complete american history tv schedule, go to c-span.org. the u.s. chamber of commerce held its fifth health care summit here in washington, d.c., earlier this month. speakers including experts in health care technology, doctors and health administrators outlined new innovations aimed at moving outcomes from a fee-based to a value-based service. this is just under three hours.

♪ wide open spaces, room to make big mistakes ♪ good morning! i got "wide open spaces" up here, and i'm glad to see very few down there. welcome. good morning. thank you for joining us here at the u.s. chamber of commerce for our fifth annual health care summit, health forward, part of the chamber's foundation future state series. my name is katie mahoney, and i'm executive director of health policy here at the chamber. this year our theme is "health forward," a very appropriate title as we look towards the coming year and new opportunities to drive positive change in our health care system. we have a wealth of experts here today who will talk about everything from personalized medicine to how employers are investing in population health to what the next five years of delivery system reform may look like. before we dive into the rest of the program, we'd like to thank our novant health for sponsoring as our gateway host this year and thank bayer for serving as co-host for the event. we're also thrilled to have blue

cross blue shield and fti consulting as our partner-level sponsors. we appreciate their support and yours. we're so lucky to have you all here today. it seems like just yesterday we were working on our first annual health care summit, and now here we are five years later. looking back, we focused on improving transparency and rewarding innovation, harnessing efficiencies to increase value and improve outcomes, advancing delivery system reform, and optimizing the next generation of health care. and this year it's on our app. today's event, "health forward," builds on our summit's history of highlighting private-sector innovation. while the theme is similar, we are focusing a bit more today on technology and data and their role in targeting personalized treatments through custom analytics and digital health as well as assessing the needs of different communities and populations in order to best treat conditions and manage health. speaking of how far we've come, please don't forget to download that app on your phones.

just search for "health forward" in your app store. within the app, you'll find today's agenda and speaker bios as well as a lot of great content from our speakers. given the focus of this morning's event, we're honored to have bob pearson, president of w2o group, kick off our event with some insights into how to accelerate innovation. bob has had an esteemed career in communications, technology and health, and is globally recognized as a marketing visionary who is driving pragmatic disruption in social commerce. at the chamber, we take pride and applaud pragmatic disruption and could not be more pleased to welcome you as our first speaker to the stage. bob? ♪ cha, cha, changes ♪ >> pleasure to be here. i come out of the pharmaceutical industry, originally for novartis, then the technology industry at dell, and then today we work with over 100 health care companies, many tech

companies, and i would say the majority of the venture capital firms. so, what i did is i thought, okay, let me consolidate the thinking of what we're learning from all these folks into a 20-minute talk and see how we do here. so, three things are driving innovation in our business like never before. and what we're seeing is this convergence of technology and health care that we all are aware of, but i think the future is unbelievably bright for this country. with big data, everyone knows about big data. but what's really happening is we're going to move from having an app here and a tool here and a platform here to really starting to think more like an information genome. how do we actually capture this data through multiple systems so we can actually use it for the benefit of transforming health. artificial intelligence, machine learning and neural networks has tremendous potential. i'll show you one example in just a little bit. but the ability to allow software to understand what is

happening in these bodies that we have is going to lead to breakthrough that we can't even imagine today. and with science, we're well into the human genome, right? that's been going on for a while. but there's something that's interesting, and i write books on this topic, and i think all the time about how science evolves, and you have to go back and realize that patience actually matters. and so, when you think of the web or the human genome project or artificial intelligence, they've been around for a very long time. but what happens is, eventually, enough areas mature that they collide. and when they collide, amazing stuff can happen. so, let's just actually take a look and see what is happening and where are we today in terms of innovation. so, one example is this. what if we could actually combine a semiconductor technology and pharmaceutical technology? what would that do? well, there was a ceo of a company that i met a few years ago. we met and he was explaining

what he was doing here and i thought, this is amazing. this is something we can do very broadly. and that is proteosdigital health, right? they have a small sensor, a small, biodegradable chip that you actually take with your medicine, you can actually get through a patch, the pharmacokinetics of the drug. you can see the heart rate, pulse, where the drug was manufactured, everything. it's just the very beginning of what we can do when we put biodigestible sensors into our body. but the thing that's immediate is if you're caring for a loved one 3,000 miles away, we can now see if they took their medicine. we can actually call them and say, hey, mom, you need to take that medicine right now. i saw that you didn't take it at 10:00. what if we could figure out how to edit disease? we've thought about this for years. is there a way that if we can identify genes and we have all this knowledge on the genome, what do we do with it? and actually, now we have that ability right in front of us that's crisper, that's cast

nine. and so now what we're able to do is have a system where scientifically, we can find the places where we need to snip, edit, and actually improve the function of a gene. that just completely changed the game in terms of how we look at treatments and diagnostics, basically medicine in general. bayer and crisper therapeutics have gotten together to do a jv in this. this is an example where what we need is we don't need biotech trying to do this on its own. we need pharma and biotech, and quite frankly, health systems pioneering stuff together earlier. right? because innovation is going so fast that we cannot go in a linear path like we have for many years. it just will not work. so it requires a heck of a lot more teamwork than we've ever had. and the bayer/crisper jv is an example of this happening. what new medical disciplines will form as a result of the technology and health care converging? there are many things you can think of, but one i saw recently -- i was speaking at

the phoenix medical device meeting to about 75 ceos. and so, they were featuring new technologies. and one of the ones that really hit me was bioelectronics medicine. it's a totally new field that's emerging because of technology in health. and chad boden, who's up at the finestein institute, what he showed was by basically putting implant in the brain and actually having the brain waves measured and basically using ai to look at how to scale the knowledge coming out of the brain, they were able to allow the person who's paralyzed -- the person's paralyzed -- to think and start to move their hand for the first time. and then over time, actually pick up a key. and this is all by understanding the brain waves, understanding what they're telling us and able to make that motion go right through to have the person do a motion. showed video after video of this. it's enough to bring tears to

your eyes, because you can see if we could just apply technology in health in different ways, what is it that we can't do? right? we can change gene function, we can change how a paralyzed person sees their life. there's a lot that we can do if we partner together more effectively. next thing. what is the promise of virtual reality in health? so, this is an area that, of course, a lot of hype with oculus rift and many other things. we all think of it for our kids and what could we do there, and that's great because we will innovate faster by allowing all the gamers of the world to play with virtual reality and augmented reality. but what we're already starting to see is that you can change positions anywhere in the world. so, we can actually up the level of medical care worldwide through training through virtual reality. that's huge for the world. burn victims. it's already showing that if you actually allow people to think of different things, like they have scenarios where they're

thinking of being in the antarctic and, you know, going through cooler areas, their pain actually goes down. it really does work. and so, you can start to see, how do you help people deal with their pain. there's new ways that they're looking at how you can deal with post-traumatic stress syndrome. so, things that are part body and part mind are starting to be able to, where we can make an impact through virtual reality and augmented reality. so, it's really -- i look at the line here. it's a matter of our applied imagination. the issue is not is the technology available. the issue is our readiness to think through what is possible, test it and figure out where we can go from there. the immune system. the immune system's been something that, i mean, i've been in the industry for 30 years and we've been talking about the immune system forever. when the monokroebl bodies came out, they were acute, nobody knew in they would take off and here we are today.

with the anti pd-1 immuno therapy blocks the pathway so the immune system can do its job. it's ready to do its job. we just needed science to step in and show how you can actually allow it to do its job. and this is leading to a whole new generation of medicines, but more importantly, it should lead to our lack of need to use toxic therapies so early in the treatment of a cancer patient, right? so, there's benefits that go way beyond even the initial science. . now, how can technology and machines improve what humans do? let's look at an example here. intuitive surgical. unbelievable company, robotic-assisted, minimally invasive surgery. so, you're not doing robotic surgery. what you're doing is you're helping surgeons do a better job through robotics. so, what that means is if a surgeon is guiding surgery, if

they're doing it themselves, your wrist can only bend so far. but if you're in there with robotic-assisted surgery, you can bend in an unlimited way. there's just all kinds of things that you can do surgically with this that you couldn't do before, and that's the beginning of what we'll see there. what new minds are tackling health issues? this for me is very exciting. i had the opportunity to talk to jeff huber, who is at grail. and jeff is the guy who was -- well, there are many people involved in this, but he was involved in building google's ad platform, building google maps. and basically, what sergei and larry needed to get built, whatever that would be, jeff would end up on the project and the project would end up going pretty well, right? so, jeff's wife died of cancer. and he said, i'm out. i'm going to figure this out. so, he left google. he partnered with illumina and

they formed grail. a couple people have gotten behind this. and he's looking at how do you actually build essentially search for our body? so, in other words, you can see signs at the earliest stage and detect cancer way before you would ever see it today in a standardized test. so, he wants to completely revolutionize diagnostics. will he suck seat? i actually personally believe he will, from knowing a little bit about jeff and the resources he has. but the more important thing is these are very doable scenarios, to be thinking we could be building the equivalent of google inside ourselves to figure out what's really going on. now, what if all or most of our health data could be inteintegr? this is something where most of us are involved with this every day. and my goodness, it's all over the place, right? so, what we're doing, at the same time that science is moving very fast, technology is allowing us to dream in ways that we never could, we're still struggling with basic stuff. can we get data to talk to each other? can we get systems to work

togeth together? we need to move a lot faster and a lot more intelligently to figure out how we harness power. and i look at it like a data immune system. if we put this stuff together, the insights we have on how to change behavior will grow exponentially, but we've got a ways to go here. so, if we look overall, personalization is being redefined. our body is an untapped data source. i look at it like the amount of data coming out of us is unbelievable. the question is can we actually tap into it? we have the technology that allows us to innovate. and when you think of any disease or disorder being fair game, we only have to look as far as personalization to see how much rare diseases have taken off. i remember a time in the industry where rare diseases were something that no one paid any attention to because you couldn't make any money. now with enough incentives, we're revolutionizing how we actually look at rare diseases. and we'll do the same thing with many other sub topics of health as we go.

so, when i bring it back to the chamber of commerce, very conscious of the stage i'm on, this is an unprecedented opportunity for this country. with silicon valley and the medicine chest that we have here, if we combine those two, we're going to lead the way in the world for the next couple of decades. there is nowhere else on earth that has the kind of intelligence we have in our great 50 states. it's a question of how we decide to use it. and when i look at technology, here's some things that we know are true, as i end this talk. one is that technology acceleration as we see it today is actually going increase. it's not going to decrease. it's going to increase. so, we're going to be bombarded with all of these different opportunities that we have. we also know that organizations will struggle with this mightily. how do i actually change? are we changing fast enough? what do we do? we'll always be behind the curve, and that's normal, but we've got to acknowledge it and

realize that, really, the onus is on us to innovate faster. and then if we go to the last one here, this is, you know, just being honest, political change is the slowest. regulation is the slowest. and so, we have to think through how do we do this. well, i get back to, what do innovators really want? so, if i am not here and i'm talking to venture capitalists and start-up ceos and ceos of life science companies, what do they really want? i break it down into this -- they want clarity of rules. they're not necessarily saying i want all the rules that i want for my company. they're saying, please, just give me clarity so i understand the world that i'm playing in. they want clarity of payment. don't hit me later on and tell me i can't get reimbursed. i can't make models on that. give me more direction in terms of how i'm going to get a return on investment. ability to learn together. i've seen in the fda some

fantastic innovation that has occurred in terms of thinking through pharmacokinetics. we're thinking through -- sorry, pharmacovigilance. we're trying to think through social media. we need the fda and we need the government overall to learn with industry, right? so we need to do a better job of saying, can we just all not try to sell anything and just come in and teach each other so we actually go up to speed at the same pace? that will help us with regulations, it will help us with everything we do. and then the ability to evolve together. we absolutely will need new regulations, you know, in terms of what we do with all this data. what does technology do? if you have the ability to search inside your body, what do you do with all that data, you know. so, if we're learning together, it's not going to be that hard to do. if we're not learning together, we're going to hit these wall after wall after wall. and the problem with that, as you know, is that patients are out there, they're counting on us to succeed. they believe we're all smart enough to do this. and so, really, it stops with

us. can we actually do it? can we take advantage of this unprecedented opportunity to innovate? so, i think i have a few more minutes here. and if anyone has any questions, i'd love to take them. early in the day. any questions at all? yes. [ inaudible question ] >> what is the best way for employees? >> employers to provide benefits -- oh, thank you. what's the best way for businesses that provide benefits to their employees to help advance these innovations? because these are important to us from a cost management perspective and health of our workforce. >> yes. so, this gets into what we find when we look, we work outside of health care. and when you work with big

consumer packaged goods companies and that. what they're learning is, if you say this is what we need people to do, i'm going to now tell them what to do and then we're going to measure if they do it. that's old-school. that doesn't work. so, what you have to do is just say let's go out into the world and say the people that we're trying to reach, this group of employees, what do they do online? where do they go? what content do they care about? what keywords do they use? what language do they use? what channels do they go to? who do they respect? and then i need to say, okay, from there, how do i start to talk like that inside my company? do i bring some of these experts that they revere on nutrition in to speak at our company? do i bring some of the content that they care about into our company? so, if we bring the world in to them, now we're speaking to them kind of like we are now, and we're having more of a conversation. but companies are, as you know, are very poor at that, and they say, well, these are incentives. we have to get people to do this thing, therefore we'll say this and we'll jam it out. they didn't do it.

how come they didn't do it? program didn't work. and it's this never-ending cycle. we actually try to teach people how to think about it differently, get outside of the normal box. yep. >> thank you for being here this morning. i'm paul kelly with the federal group, and these are some really interesting and exciting innovations that you were talking about, but there's a great concern about privacy that's come up in recent years, of course. so, i'd just be interested in your thoughts on what these companies are doing related to privacy and just that environment generally. >> yes. you're absolutely correct about that with personally identifiable information and where you store information and all that. the candid answer is i think that there needs to be a lot more work done in terms of how we actually make sure we have the right privacy standards. i think most of them right now are fairly top line and are fairly basic. and what you see are companies intuitively do the right thing.

so, they regulate themselves to figure out what they should do. the most progressive privacy that we see is in europe. and so, you know, if we're over there, i mean, you have to be exceptionally clear of how you use data and for what forum and all of that. so, i think we have work to do here in terms of what we do with people's data, but in my view, it's not a hard problem to solve. this is about having rules as opposed to a technology issue. the technology part is easy. you can take data, you can store it anywhere, you can protect it at whatever level you want. that's not the problem. it's do we allow people to use this data for any other purpose and is it clear what purpose it's for and are we aligned with the person who we got the data from, right? and that's where things break down. i think there was another -- either that or you're just flexing your hand. >> so, where do you see innovation working to help

employers, particularly large employers, connect locally with community-based programs? >> yes. so, in this day in age, you can see -- let's say you have 100,000 people that you're working with. you can actually see what they're doing online, you can see what they care about. more importantly, you can actually see exactly what providers are doing online. so, you can see what cardiologists or oncologists or general practitioners are doing, who they respect, who they're listening to for advice, how your employees and providers are talking to each other. so when you actually look at the actual world of what's happening, you can start to say, hmm, how do we shape that, right? because again, too much of what we do is to say, inside our company we will share information, rather than say, okay, who are all the physicians who are in the network that we're in? what are they doing? how do we actually have a better relationship with them? and that's pretty easy to do, because you know, doctors are online, they have an mpi number.

you can actually see exactly what they do. and i think of, like, i'll just give you one example. like, i probably could say this. a big clinic, a very famous clinic you all know actually looked at what their providers do versus what they think they're doing. and i can assure you that what they do and what they think they're doing are not the same thing. so, we have to also start with how do we actually impact the people who are prescribing medicine or implanting devices or doing things to make sure that that whole ecosystem is actually working together as opposed to just shaping the views of patients. and we see this over and over and over again, that that's a big issue. >> can you address the issues of hipaa and political resistance to privacy? because i think those will both need to be looked at. >> yeah. yeah. i don't know that i could solve that for you in 30 seconds, but i do have an opinion on it,

which is that we have to stop, i wouldn't say politicize things, but stop talking emotionally and talk factually about what we can do. because if we look at what we can do in terms of guidelines and the storage of data and what we do with it, it's really not that hard. but we get all worked up with, you know, is this something that's going to be misused, right? so, i don't know if that is addressing at all -- it's not addressing at all what you said. okay. well, it's a good way to end. yeah, yeah, okay. you just raised one of the hardest things out there on the planet, practically, other than saying how do you, you know, cure poverty, right. okay. i'm at the very end, so i think i should stop and thank you very much for having the time to listen. ♪

♪ hi, i'm joanne kenen with

politico. we have three people from all three positions to talk to us about population health. i'm going to introduce them. i'm going to tell them, have them say what they do, and then i really want to spend a couple of minutes just defining population health, because it's one of those i am eye of the beholder kind of thing. we don't have common definitions. let's start with dr. catherine baase from director of services at the dow chemical company. she's in charge of keeping everyone there healthy, right? >> that's true. so, in that role, i'm responsible for our occupational health, health promotion, epidemiology research, health policy, health benefits, so the landscape of health, with really the mission to accomplish better health for our people, because that's related to all of our other corporate priorities. and when i say our people, we

think of dow people broadly, the employees and their families and our retirees, and to get better value for the dollars that we spend. >> okay. then we have dr. steve peskin, executive medical director for health at horizon blue cross blue shield of new jersey. >> so, i'd better know what population health is, right? good morning, everyone. thanks to the chamber for organizing this. i'm a general internist by clinical training and lead our efforts in population health, which we'll get into much more deeply and at horizonbluecrossblueshield. we're the largest health insurer in new jersey. i somewhat jokingly or seriously say my ford fusion american car is my office because i spend most of my time out in our clinical ecosystems from solo family doctors up to our largest health systems in the state on a whole variety of efforts around consumer engagement, physician behavior change, and efficiency and quality of health care. >> and we've got dr. george

isham, who is the chief health officer and plan medical director at health partners in minnesota. right? >> right. >> okay, and your role here? >> so, i have been since, for some time, the medical director and chief health officer at health partners, a large integrative care system and financing system in minneapolis/st. paul in minnesota 37. i also co-chair the roundtable of population health and improvement at the national academy of science, engineering and medicine and that's another perspective i bring to this conversation on population health. >> and i notice when i was reading your bios, and as we've talked before, all of you have been involved very much on the metrics of health care, defining quality and figuring out how we measure it, so you're able to speak your experiences both in this very granular how do we know if we're doing the right things and what are the goals we're trying to set and do they mean something, as well as this larger topic of population health. and i think not everybody here is in health careful time.

i think that when you come to the term population health, people often confuse it with public health and the traditional fighting tb, things like that, or whatever the modern equivalent is. it isn't the same thing, and yet, we don't have a common definition. so, i think all of you have an internal population that you're responsible for or employees, members of your health plan, but all of you are engaged in sort of a larger sense of what coming to terms with what is the health of our population, how do we become healthier. so, why don't you each use your working definition? start at that end, george. >> well, you know, the common usage talks about subpopulations, such as employee groups or groups that are cared for by a health plan or patient clinic populations diagnosed with diabetes and so forth, but population health, the formal definition by is the health outcomes of a group of individuals, including the

distribution of such outcomes within a group. and those are primarily length of life, its quality, and as i said, the distribution within the group. total population, sort of a little addition to that would be geographic population, like the health of the people in the city of washington, d.c., for example. >> and for horizon, what is your -- >> yeah, it is a multifaceted, right? so, dr. isham's definition certainly resonates with me. when we think about it, we think about all of the four of us are individuals, so all tus at once each of us individually and how we map to certain areas. so, it might be geography. in the case of horizon, we're all about new jersey all day every day, but there are broader populations. so when we think about our population, we look at persons with a certain clinical condition, like diabetes and how

we stratify and measure health improvement in that group. so, as individuals, we might be young, healthy 20-somethings, and they're a part of our population as well. so, what we do as well. what we do with young, healthy 20-somethings might be high risk behaviors, health behaviors, preventive services. think of population health as not forgetting about your individual identity. that is well in position with us and with the health systems we work with. that said, we look at and are able to take -- pull together certain groups of persons to say how we're doing with that particular group. as george said, a subpopulation within broader population. simultaneously, you as an individual what your issues, concerns, needs, social, behavioral health and how you

fit in to some population which may be around clinical condition, which may be around the need for certain preventive services, which may relate to month your employer is. so that's how we view it. >> adele, what is your population? >> we're, as i mentioned, focused on our employees because those are the people that are driving the success of our organization and their health matters. we think of it in the classic health organization, the state well-being from a physical, social, he emotional. but it is not nearly the absence of disease. we think of health as a very positive construct on a continuum. and we also think about all the people that are in our health plan. that's bigger than our employees. our employees are only 20% of the people in our plan. their dependents and retirees are a much bigger group. and we think about the

communities with which we operate as an important population. because that influences the health of our employees and their families. >> traditionally, as many things in our economy, we thought in very short-term ways. it is hard to think in a society of people changing jobs and changing insurers and changing -- the investments in health may not bear fruit for decades. even in government. it is hard to the get the vbo to score a diabetes prevention that might not save money for 30 years out. we think in much shorter windows. either how is the system enabling you to think in longer terms or how are you getting around that system that is encouraging short-term? what are some of the -- maybe you have a stable workforce.

it is still a problem. i don't know the longevity of the workforce. maybe more stable than your typical one. how do you get people to think of this long term. you understand it, but not everybody you work with might understand it. let's start here. >> i don't think that we said we're going to think long term versus short-term. we're looking at both. one of the most important things was to understand clearly how health benefits the individuals and the company. and what we've done is create a line of sight to each of the corporate priorities. so how does health of our population impact our safety performance, our workers' comp. . how does it impact our engagement and job satisfaction is and all of these human capital metrics which are important. in fact, it impacts our ability to tract and retain talent.

the way we focus on health is one of the most tangible symbols how we value the individual people in our organization. and so it really has a really broad value proposition in addition to keep healthy people healthy and getting others healthy helps us keep our health care costs at a lower level. so it actually is connected broadly to a broad set of the priorities of the company and would make a sustained investment in that to achieve those outcomes. and we're measuring the health of our people. and frankly we do see benefits on a shorter term basis because of the connection to all of these other priorities. >> as a health plan in a rapidly changing environment, changing incentives, changing rules, how is population health changing? how do you think of it differently? how do you act on it

differently? >> so we are simultaneously looking at inter year. non-for-profit health care systems out there would appreciate. that said we have, in my view, taken a very positive step toward -- we fortunately have a very stable population. so working with our clinical partners and our employer groups as my friend ed fisher there are a lot of people from north carolina, unc chapel hill school of health. 365 times 24. it is over 8,000. most of us are not spending our time in doctors offices on health plans or health systems. we are increasingly thinking about the community and how do we reach our members, our patients, our customers. i like to think of it as persons centered care.

how do we work with employer groups, faith-based organizations, taking a broader view of health and well-being as just opposed to the sickness construct. i'm pleased to say we're making progress here. >> minnesota is a state that is further down the road in terms of integrated care and having some exchange problems at the moment. the rest of the country is a few years behind what happened in minnesota. can you talk about the ethos and approach. >> we have been thinking about high quality care and more recently the cost of care. but also the health of the people that we serve. and to your question about the mobility of individuals versus the interesting place, most businesses and most communities you set downwards and you can

live there. and they are invested in that community. with respect to health care, there are factors that drive that outcome of a long life with about quality. how good health care is critically important. but experts would estimate only 20% of the impact comes from health care. the second is health behaviors, whether i smoke or not, whether i am active in terms the of exercise which i want to be more of, and whether i follow good nutritional practices and don't abuse alcohol. those are the top in rank order from the cdc. they set a priority list in terms of what we ought to be doing in terms of encouraging personal behaviors. half of the factors are dependent upon the context and the community in which we live. the social determinants. those factors have us now more interested in how we play a role in linking those kinds of interventions the personal

interventions. because we want to see everybody thrive as individuals but collectively we also rise or fall together. there's good science to is suggest that. that's the sophistication of thinking about it not only immediately in terms of what you have control in your personal life and what you can do tomorrow for your employees is only half the story. the other learning about this pathway. >> several of you mentioned diabetes. every employer in the room is dealing with this. diabetes 2, not the prevent -- the more preventable. not always preventable. it is is huge. it is hitting younger. it is is more the obesity epidemic you can get your arms around diabetes.

there are warning signs. some of which are personal behaviors. so let's talk a little bit about the intersection of how do you -- what is population health in your three spheres in dealing with this one prevalent disease. how does it change in the last -- because we have begun thinking about workplace, incentives, privacy barriers and challenges to get around. there is also morin sentives to get it right. and more of a conversation about getting it right. what are you changing. what are you able to do now you haven't thought of a few years ago, on or you thought of but hadn't been able to oefbg the obstacles. >> well, diabetes is a great example of a chronic condition. the majority of the money we spent goes into chronic conditions. 75%, 80% of the dollars that are spent. focusing on a chronic condition

is important. and our focus has been moving upstream. we want people who have diabetes to get optimal care. we are looking at how we stem the tide of this epidemic we have been living through in our lifetime. so we have really been advocates of utilizing the national diabetes prevention program because it is an evidence-based intervention. it's got a package out there that you can count on. we've used that within our company on a widespread basis. it is be able to anybody on our plan an opportunity to participate in the diabetes prevention program. in addition, we have worked in the communities where we have a significant presence of population to create sustainable system change and looked at the availability of these upstream actions that can identify and