available. >> thank you. join me, please, in thanking all of the panelists here for a great discussion. on the campaign trail today hillary clinton will be joined by senator elizabeth warren. the two appear together at a rally in manchester, new hampshire, with live coverage at 12:30 on c-span. we will hear from newt gingrich, van jones and patrick kennedy and they will look at ways to prevent opioid overdoses and provide addiction treatment. that's live at 3:30 eastern also on c-span. while congress is on break until after the november elections, we're featuring american history tv programs that are normally seen weekends here on c-span 3. tonight congressional history, at 8:00 eastern former senators bob dole and nancy cass a vaughan talk about congress.

then it's the history of african-americans in congress and after 10:00 eastern the 50th anniversary of the national historic preservation act. at 10:45. the dedication of the thomas edison statue in the u.s. capitol. as the nation elects a new president in november, will america have its first foreign born first lady since louise is a adams or will we have a former president as first gentleman? learn more about the influence of america's presidential spouses from c-span's first ladies. now available in paper back. first ladies gives readers a look into the personal lives and impact of every first lady in american history. first ladies is a companion to c-span's well regarded biography series and features interviews with the nations leading first ladies historians. each chapter also offers brief biographies of the 45 presidential spouses and archival photos from their lives. first ladies in paper back,

published by public affairs is now available at your favorite book seller and also as an e book. c-span, where history unfolds daily. in 1979 c-span was created as a public service by america's cable television companies and is brought to you today by your cable or sat lied provider. authors jd vance and charles murray took part in a discussion looking at the social and economic issues facing white working class americans. this hour-long event is hosted by the american enterprise institute here in washington, d.c. good afternoon, everyone.

good afternoon. i'm karlyn bowman and i'm a senior fellow at ai and i'd like to welcome all of you to the first bradley lecture program of this academic year. as many of you know who have attended these programs in the past they are usually lectures, but with tonight's event we saw a rare opportunity to host a conversation about a culture in crisis. we are as always grateful to the lined and harry bradley foundation of milwaukee, wisconsin, for making this possible. midway through this extraordinary memoire hillbilly eulogy jd vance says working as a cashier at the local grocery store turned him into an amateur sociologist as he watched what people bought, some some people gamed the system and how the owners treated customers differently. he said he began to read books about social policies such as "the truly disadvantaged" and charles murray's "losing ground." he writes that both of these

books were written about african-americans but could just as easily been written about his family and neighbors. he realized no expert or single book could explain their problems. mr. vance's description is much more than amateur sociology. it tells us what goes on in the daily lives of real people and here i'm quoting him directly, when the industrial economy goes south. he continues, it's about reacting to bad circumstances in the worst way possible, it's about a culture that increasingly encourages social decay instead of counter acting it. he echoes the concerns of many at ai over the years including the late robert nis bit who wrote "the quest for community" in 1953, peter berger and richard knew house who wrote an ai pamphlet about the importance in the fragility in the country's mediation institutions, families, neighborhoods and communities

and of course to my clent colleagues. taken to get jd vance's hillbilly eulogy and coming apart cover a country by which millions of people live by a code of self-relyons and hard work while millions don't and they have lost touch with the virtues that give our life purpose and direction and ultimately make us happy. you will be able to purchase copies of mr. vance's book after this conversation and he's graciously agreed to sign them. we will do so here after the conversation and we invite you to join us for a reception in the gallery outside. mr. vance will begin tonight's conversation about why he wrote "hillbilly eulogy" and the reaction to it. >> thank you guys for having me. charles, thank you for being willing to do this. hopefully i don't bore you after an hour and a half. so the question of sort of why i started to write this book is that i was a 30 year law student

at yale and listen to the same conversation folks were having about upward mobility and equality and i was trying to understand why it was that kids who grew up like me were so underrepresented in places like yale. it wasn't an economic thing, i recognized that i was a cultural outsider. so people at yale talked about things that just didn't make any sense to me so how they would make $160,000 a year but didn't it would be enough because they would have to send their kids to some fancy day care in manhattan and i thought what are these people talking about? where are they the ones at yale law school and nobody like me is. so the more that i thought about why it was that kids like me were really underrepresented at these sorts of places i started to think that it implicated not just something about my own life or my family's life but also something that was much more broadly shared across our neighborhood, across our community and as the title of

the book suggests across our culture. so the more that i researched, the more that i wrote, the more that i interrogated family members who graciously offered to share their lives and histories with me the more that i realized that this was a very, very real and significant problem. this wasn't just something that was unique to yale law school or middletown, ohio, it was unique to the entire white working class and to groups much broader each than that. so i started writing the book at the end of 2013, i spent probably two years writing t i was always working full-time so it was always sort of nights and weekend endeavor and the more that i wrote it the more that i realized that there were hopefully some new sociological or economic insights in the book but what i really had to offer was sort of explaining what it's like when you grew up with these problems as i write in the book hung around your neck, what it's like to grow up in these communities, what it's like to be thrust into this territory.

so that's the book that i set out to write and i believe karlyn said something about the reception and the only thing i will say about the reception that i expected is that before the book came out i told my wife that i really just hoped that it wouldn't be so underread that it would embarrass me and i think that i maybe am suffering from the opposite problem now. >> we're going to get to the deep serious topics in a minute. there are a couple things i have to ask, which is you are really frank about the immediate members of your family. those of you who have not read the book, it is not a sociological treatise, thank god. it is a deeply personal story, very well written, i'd like to know where you learned to write like that. can't be yale. and the things he is telling about his family get really personal and a lot of them are not pretty and yet they agreed to have their real names used in

the book. >> that's right. >> so are you still getting along with everybody? >> still getting along with everybody, yeah. one of the things i try to do to sort of mitigate against the fact that i was going to be airing our family's dirty laundry is make my family part of the writing process. so it wasn't just sort of my personal memory that informed the writing, it was also interviewing my aunt, my uncle, my sister and so forth. i think because of that they felt like they were part of the story, like it wasn't just my story but it was also theirs. even though it is like you said very frank i think that people feel like it's frank and honest but also said something that need to be said because one of the things that happens when you grow up in a family like this, you grow up in a community like this is that you're not totally sure why you feel the way that you do about certain things, you're not totally sure why you have the attitudes that you have and i think my family appreciates that i've sort of shed a bit of light on that but also put it in a broader context. >> i'm so sorry. that is the first phone call

i've gotten all month, i think. i do not get phone calls. >> that was me, actually. >> the thing that struck me as i was reading the book -- and, by the way, this book is one which i read from beginning to end which doesn't happen very often. i'm going to be doing a panel on a book so i read in it and i get the things i need to get out of it, but this one i was just completely engrossed in, but i was especially engrossed because i am scotch irish and i would put up my lineage of scotch irish forbearers against yours in terms of their -- as far as americans go, pretty clean scotch irish blood. they went to appalachia, the same as your forbearers did, they were in north carolina, classic place for them to be and then another classic move, they

moved to missouri early in the 19th century. they are nothing like your people as far as i can tell. there are bits and pieces that sound familiar, but the culture did not look recognize blee like the one that -- that you describe. furthermore, i have had in addition to writing about the white working class in "coming apart" i have to say my experience isn't just as a pointy headed intellectual, i lived in a town of 15,000 which did have an upper middle class because we had a corporation there, but a lot of middle class, a lot of factory workers, one high school, one junior high, best friends were sons and daughters of factory workers, that was 18 years and the last 27 years i've lived in a little town rural maryland, which is also middle class or working class, farmers, and a couple of odd balls like my wife and me

and our kids went to a working class high school in a town just down the road. here again, i can say i think with some fairness that i have had -- i've been rubbing shoulders with the white working class for a long time. bits and pieces i recognize from people we know and specific events. it looks like you are describing a culture which in your words is a hillbilly culture which is distinct from all of those. you have spent the last several weeks i'm sure getting people doing exactly what i just did, saying, hey, i have -- this is my experience. can you give me a sense of how as you look at the mosaic of people telling you about the white working class how you piece this all together? >> yeah, absolutely. first it's worth noting that if you look at the et no graphic studies of this area you find that the scotch irish are disproportion nael represented in this country, eastern

tennessee, west virginia and so forth, there is an ethnic component to what's going on in a lot of these areas. one of the things that i think is definitely true is as these scott's irish folks migrated out of appalachia, they have gone to indiana, ohio, michigan and so forth pause that's where the industrial jobs were, i think it's probably fair to say that there has been a lot of cultural intermixing. maybe some of the divisions that i draw that are very stark in my family are starting to disappear, maybe they've disappeared in generations past. so there is something where the white working class culture is a lot more homogenous than just the scott's irish part of it, but i also think that because the scott's irish part of it is the biggest part of white working class culture there's a sense in which scott's irish and white working class are increasingly commingled and meep the same thing. it's not necessarily that my family's experiences or the things that i describe are unique to scott's irish culture

and only represented there, but i do think that there is something about that particular part of america, you know, there are authors that say we should just call it the united states of appalachia. there's something to the said for the facts that the scotts irish culture is unique and regionally distinct but is also spread far and wide. >> and other authors have written about scotts irish culture, jim webb "born fighting" and the statistics on what ethnic group contributes most to the american armed forces it's the scotts irish. >> absolutely. >> i point out that our leading characteristics, though, which i learned long before i read hillbilly eulogy is being drunk and violent. we made great pioneers. >> that's right. >> perhaps because people couldn't stand us so we had to keep moving west. >> i thought you said your family wasn't like mine. >> well, as i read in scotts

irish culture there is a lot of drunkenness. >> of course. >> a lot of violence in it. >> of course. >> i compare that to fish town. fish town is the philadelphia working class community in coming apart. >> sure. >> that i use as the label for the statistical characteristics of change over the last 50 years, but there's also a couple of really good books that have been written about fish town, one was a ph.d. dissertation that i quote extensively in coming apart and the other was an actual published book that came out in the 1960s, the book that came out in the 1960s is really interesting because the way that is described is first a lot of violence in that community, but it was mostly structured violence so that when somebody came into the neighborhood and burring ld a house they might not bother to call the cops to take care of

it, they took care of it on their own. there was too much spousal abuse, too, in the community. there was a lot of violence there, but the other thing that is made clear -- and there was a lot of hard drinking in fish town in the 1960s. the other thing that is made clear is the community really functioned and so people would say to the poverty workers who came in that they liked their community, they were happy in their community, it drove the poverty workers crazy because these people refused to recognize that they were poor, refused to recognize that they were miserable. to what extent does that fit in or not fit in with the community you knew of when you were growing up in the 1990s? >> so the first thing i will say is that you mention not being willing to call the police even if people were maybe being a little violent and it's funny, i was talking to my sister a couple years ago and she knew a family in middletown where all the christmas gifts had been

stolen not long before christmas and the person, i think, posted about it on facebook or told her friends in some other way and talked about how, you know, all of our christmas gifts were stolen, we called the police, they are here, everything is taken care of and the most common refrain that they got from the responses was why did you call the police? why didn't you just handle it yourself? so there is definitely this willingness not just to engage in violence but also an unwillingness to en fwagage in involving the broader institutions of community in that violence. to answer your specific question how similar is the middletown that i grew up in to fish town. it's similar in a lot of ways but also much more accelerated in its development rights. some of the things that existed in 1960s fish town that you're writing about is, you know, maybe 1990s fish town looks a lot like 1990s middletown, i expect the answer is that it probably does. what you find in these

communities, i think, is one, they are not extraordinarily des tud. if you go to middletown, ohio, you drive down the street, go to my old neighborhood, this is not hard core poverty, there were times in my life when we fell below the poverty line no doubt about it but i never felt that we couldn't put food on the facial or clothes on our back, i felt there was some material baseline, maybe because of the social welfare state, maybe because of my grandparents' wealth they were able to accumulate. so there is a refusal to recognize that you're poor. one of the things that i wrote about in the book is that i had built this construct in my mind between the really poor white neighborhood and our neighborhood which i thought of as working class and middle class. the older i get those neighborhoods weren't actually that irch did, they weren't geographically that different, they weren't actually that different if you look at the houses but we had built this thing in our minds because i don't think people want to think of themselves as poor and there

is definitely an element of pride built into that. one of the things that i write that is distinct about scotting irish culture, we're proud of who we are and our families, one of those points of pride is you don't want to tell strangers you're poor. >> how about the differences -- you say physically in terms of housing stock the two parts of town weren't that different. even at that time, though, did they see themselves -- the people who lived in what looked to you like the poor part of town did they see themselves as living in a different part of town for you? >> it's hard to say because i didn't have a ton of exposure as a kid outside of my broad neighborhood. my sense is that no kid that i wasn't to school with, even the kids who were very clearly pretty destitute that they did not expect that they were poor, they did not think of themselves as especially impoverished. there is a recognition that there were rich people out there, middletown has a very nice upper crust doctors and lawyers part of town that's very

dis be tingt from the part of town that i grew up in. there was recognition that there were rich people out there and my grandmother was cognizant of the fact that they were rich and in some cases disliked them because of it, but there really wasn't a sense that among the lower income or the working class kids that there was a lot of class division between them. i do think that people really resented and weren't willing to say, look, we're really poor. there was always -- there was this recognition there was the rich, there were the hard working middle class folks and the poor folks were, you know, maybe somebody else, but not us. >> okay. now, let's turn to the labor market because you have lots of different interesting observations to make about the labor market. and this is one of the great things about the book, that you start out one of the narratives and you think you know where he's going and all at once the next turn of events takes you

completely by surprise. in one sense this is a classic william julius wilson stuff that your grandfather worked at the steel company. >> that's right. >> yeah. worked for the steel company, getting really good working class wages, in fact, he was close to six figures at one point, wasn't he? >> there is a point i write in the book where my family and i'm talking specifically then about my mom who worked in healthcare and my stepdad who worked as a truck driver, they probably -- they maybe didn't make $100,000 a year, i'm speaking as a kid in that part of the story, but they definitely i'm sure earned a pretty solid middle class wage, we had what i thought was a nice house, we had two cars. it wasn't that we were -- again, it's not that we were destitute but definitely that sort of economic security didn't last very long. >> yeah. >> and i think it didn't last very long unfortunately not because of the economy in our case but because of some of the decisions they made. >> you also have some interesting comments to make

about when you were working at various kinds of menial jobs, physical labor jobs and you talked about one guy who was working with you that would habitually take half hour bathroom breaks and when he did that so frequently and it got to be a subject of considerable amusement around the workplace he got fired. and at the point he got fired he is very upset because my girlfriend is pregnant, going to have a baby and how can you be doing this to me and no sense that he screwed up. so take -- put together all of these semi-contradictory pieces of your observations of people in the labor market whereby it is a weird combination of old fashioned protestant work ethic and post modern school distrivi

it's not my fault. >> this was in a tile warehouse i worked at right before i went to law school and i remember every time he went to the bathroom it got to the point where me and another coworker would call out the times, 15 minutes, 20 minutes, half an hour. and it got -- it got to the point where it was literally two or three hours of the day he was not on shift, he was doing something else. i don't know if he had an alcohol problem or what his issue was, but he had a 19-year-old girlfriend, she was pregnant, the guy who he worked for even offered her a job briefly for a time working in some sort of administrative role. the thing is he made a pretty decent wage. most of the guys who worked at this tile warehouse maybe $16 an hour which is plenty to live on in this area of the country, you started out at $13 an hour, that's what i made, and it occurred to me when this guy was eventually fired that he didn't recognize his own agency in the problem at all. he was -- it was not a made up

feeling, he was legitimately extraordinarily angry at his boss for firing him and thought that his boss had done something wrong and that was really, really worrisome because, you know, people have to recognize that they still have some control over their own lives. at the same time you see guys like that kind of coexist with people who are really hard working, who are trying to find a job and maybe they can't, maybe they were laid off from the steel mill at the age of 45 and it's really hard for them to reenter the labor force at anything like a wage that they earned when they were 45-year-old steel millworker and you see both of these things happening simultaneously. so when you are a kid growing up in this environment it's hard, one, not to recognize that you have the really hard working people, i'd say the majority who just are trying to get ahead and i think the labor market has been pretty tough on them and you have the people who are not doing what they should to try to get ahead and importantly they don't recognize t they don't recognize that they still have some control over their own lives. and this is something that my

grandma when i think of, you know, a woman who didn't even have a middle school graduate education, she left kentucky when i think she was 13 years old. she was incredibly perceptive, classic blue dog democrat, she didn't believe that government didn't have a role in helping the poor, but what she always told me was don't ever be like those f'ing losers long the deck is stacked against them and she said that as someone who recognized that for some people the deck was stacked against them so there was this remarkable perception about her where she could simultaneously recognize that things weren't always perfect but also say you can't let yourself give into the worst defeatism that exists in your community because then you're completely doomed. then you are like the kid who has a good job but just doesn't keep it. >> generational here? i mean, if you try to do a timeline of this are the kids long they have no moral agency increasing and the ones who are

working hard under difficult circumstances decreasing? >> my sense is that that's definitely true, you see it in some of the statistics, you see it in the way that people are dropping out of the labor force, but you also just -- and as i write about in the book, you see it in these communities. there was a very definite sense in the place where i grew up that for more and more people maybe their choices didn't matter. this is a destructive tendency that exists in niece communities. i don't think ittist kps completely out of nowhere. that's what's so hard about this is to sort of see the -- whatever you want to call them structural barriers maybe that life throws at you but then to still try to overcome them jen way. that's really hard to do. unfortunately i think fewer and fewer kids are able to do it. so i think consequently you see a community that is really, really struggling. >> how about marriage? because when i talk about coming apart and i'm trying to convey

to people how much things have changed i go to marriage as being the building block of communities, it's the prototypical institution of a free society and then i cite the numbers which are -- if we talk about nonlatino whites ages 30 to 49 as of 1960, 84% of them were married. and as of 2010 when i -- which were the numbers i used for "coming apart" that was down to 48%, which is just -- i mean, talk about a sociological phenomenon of incredible magnitude, that was it. >> right. >> so when you were growing up and also and to the extent you can look back to previous generations, tell me about marriage in middletown. >> so i saw very personally the statistics that you're describing, fewer and fewer people were married, i want to throw another statistic out at

you which is i believe in sweden, which is the country that has the second highest marital partners -- sorry, maternal partners it's 2.8, so the average kid will see their mom in sweden with 2.8 maternal partners. okay. in the united states i think it's 12.8, 13. so we have this unbelievable problem and of course that's concentrated in the working class, you have this unbelievable problem not just of the decline of marriage but the decline of sort of home stability, they are two sides of the same coin but it's important to recognize both sides of that. so is marriage declining? it's definitely declining. i think the really interesting question is why is it declining? why are so fewer people in this community getting married? one answer you might say is, look, the industrial economy has gone south, created all these financial pressures that exist in these communities, consequently people aren't getting married as much. i think that's a small part of it, but it's a small part of t

if you think of, for example, median wages, after accounting for transfers median wages have been on a flat but slightly upward curve. that's a problem, right, but it doesn't quite explain how we've gone from 84 to 49% and i suspect lower especially when we haven't seen anything like the same trend among nonworking class people. so, you know, the -- it's definitely there and it's definitely happening and the really difficult question i frankly don't have a fantastic answer is why it's happening. >> you have friends. >> sure. >> that are now in their early 30s. >> uh-huh. >> among the guys you know how many roughly what percentage of them have gotten married and stayed married? >> of the folks who went and got an education and either stayed in middletown to work or, you know, left middletown because there aren't a ton of high school jobs in middletown, most of them, you know, off the top of my head -- i can't think of one of my college-educated

friends who either isn't married or engaged. >> interesting. >> you know, you're asking me on the spot so maybe i'm not remembering everybody. >> it's a lot, in other words. >> it's a lot. so every single one of my grooms men, very similar story, small town ohio, went to college at ohio state, every single one of them are either married or engaged right now. you think of the folks who didn't get an education, maybe stayed in middletown or stayed in similar circumstances it's -- again, it's tough to think of a good friend who has been married and stayed married. one of the things you definitely see in the working class is that people get married sooner. so i definitely know of some folks who got married but then the marriage didn't necessarily last. and so -- wow. it's very stark because i can't -- i honestly can't think of someone who didn't go to college who i grew up with in middletown -- sorry, i think one -- one person who got

married. >> how about the women that you knew in high school, what's happened to them? >> well, you know, my sense is that from a purely social perspective not a material perspective but from a purely social perspective maybe the women are doing a little bit better than the men and part of that comes from the sort of maternal cultural aspect that is very much at the forefront of my book where you have these women who a lot of times when the men aren't working and the men aren't taking care of the kids the women have to step in and do the things that a lot of the men aren't doing. so it's not uncommon to see in my community -- i write about my cousin, for example, i think this is very much her life story who found herself in a marriage that fell apart very quickly but she had a young baby and it was the baby that not her life back on track because she had to take care of that kid. if she didn't take care of kid nobody else would. you see that story a lot of women when the family breaks down it's very rarely the men in these communities that are stepping up, it's almost always the women. >> it reminds me of this

observation that was made by one of the people in fish town as she was saying you go down the street and you see this woman with a baby in one arm and a couple of shopping bags in the other and walking behind her is a guy playing his video game. and there is a kind of dee moral zags of males using a polite word, a forgiving word, that seems, again, both a combination of what the statistics say and a combination of what i've observed in my own personal life. there are -- there is simply a falling away from the old standards of, hey, i'm the guy, i've got to put food on the table, i have to take care of my children because that's what a real man does. >> right. >> an incredible falling away from that and even though i know

you can't give me a cut and dried answer, as you think about your friends, can you come up with some even quite specific reasons why they have fallen away from that? >> specific reasons why they have fallen away from it, i mean, one thing that comes to mind is that there was definitely -- it's sort of tangential but it is a bit related, there's definitely a culture of mass could you limit in these working class neighborhoods that treats schoolwork as a feminine endeavor. that's something that i wrote about, it's a demonstrable a statistical phenomenon, but it is also something where you see where if you're doing really well in school, which of course i didn't do very well in school for a lot of my life, but you see kids use certain slurs, i won't repeat them in front of these polite people, but definitely you hear certain slurs directed at people who are doing well in school and there's a sense that hard work in school

is a feminine endeavor, but i think that can very easily translate to hard work in a lot of other life's endeavors. my sense is that psychologically the decline of the industrial economy has been harder on men than it is on women and that's something that i'm just sort of picking out of -- you know, i don't have a statistical basis in that, but my sense is that because there is such pressure on men, you've got to be -- you have to take care of your family, you have to be the breadwinner that when it disappears in these working class communities when that ethic of masculine self reliance is strong it's easy for the men to say i can't find a job and i'm not going to continue deal with this psychological impulse so you fall away from it in different ways. that's sort of conjecture. i haven't thought a ton about why menu neekly are struggling in this particular world. >> there are a variety of other

explanations, too, that i think often don't get said as bluntly as they should get said and one of them is that in 1960 the fact is that if you wanted regular sexual access to a woman you pretty much had to get married. yes, there were other -- was there sex outside marriage, sure. but was it easy? was it the same way it is now? not even close. insofar as 19, 20rks 21-year-old males really aren't yearning to settle down without any encouragement. that was a pretty powerful incentive and if that is gone you spend those years doing something else and that accounts for something of it as well. there have been a variety of ways in which -- in which the acts of taking responsibility for your spouse and your children used to confer a lot of status on you because when you did get married at 19 and 20 to

the father -- to the mother of your children, you were doing the right thing and it was seen by the community as the right thing. >> sure. >> and that status has pretty much disappeared as far as i can tell. >> yeah. yeah. >> i want to switch to another topic that i have to raise because i am prudently wrote a book on i q22 years ago called "the bell curve" and we went to great lengths to document the relationships of iq to a variety of personal characteristics such as impulse control, such as delayed gratification, the ability to calculate and consider long-term consequences of behavior. now, iq is not a problem in the vance family or your relatives on either side of your parent analogy, your mother was apparently sal u dorian of her

class and this was in an age where there weren't 25, there were only one or two so that's pretty good and she also encouraged your academics. >> sure. >> and then you yourself despite having not been a model student perhaps during your school years nonetheless managed not only to graduate and get pretty good test scores and then get into the marine corps and then get into ohio state and then get into yale law school, so i don't think you have an iq problem. >> thank you. >> let's say that's true of the family so, therefore, dick hernstein and i emphasize iq is not everything. you in the audience that have not read the book have no idea how crazy this family is and the case that -- the obvious case was that they were financially doing quite well for a while and there were decisions taken to made it extremely likely that

that financial security was going to go away and a variety of other things. so as you've had to reflect upon this in your own mind, here i am, yale law degree, out in silicon valley, what is the difference if it's not native ability between you and the others who made such very different decisions? >> well, it's very -- it's very tempting to sort of congratulate myself and if everyone wants to tell me that i have a high iq then you're more than welcome to do so, but i don't necessarily think that that's what was really going on in my background. and so i say that for a couple reasons. so one, you know, i never felt like an idiot when i was a kid, i never felt like i was one of the kids who really struggled with schoolwork but i also didn't feel much more intelligence than most of the kids that i grew up around. i felt that, sure, i did fine,

maybe i was above average but i certainly wasn't brilliant. i remember thinking especially in my hometown where not a whole lot of kids go to ivy league schools that the people who went to these schools were unbelievably brilliant, 200 steven hawkings. and i recognized three days after i got there that that's not actually the case. so to me the difference -- you know, there was this very good review of the book that was somewhat critical where one of the points that the reviewer made was, look, one of the things that j.d. vance benefits from is having natural innate ability that a lot of other kids don't have. it's great to slap yourself on the back and say i was smart and that's why i made t but my sense is the people who didn't make it who grew up in similar circumstances, versus the kids who did is that they had a couple of things. one, they had at least one really strong male figure in their lives and they had at

least one really strong female figure in their lives. they had a maternal and paternal presence even if that wasn't their mom and dad. so for me that was my grandpa and later my biological dad with whom i reconnected and of course my grandma who is this force of nature. when she died we made a cd of her favorite sons and entitled it force of nature because that's the only thing we could think of to describe her. so it was in constant temptation to make bad decisions, to hang out with the wrong crowd, i mean, when i was a kid the first time i smoked pot i was probably 11 or 12 and i remember the kid who was encouraging me to smoke and i don't think that i put this in the book, but i remember when my grand ma found out she leaned in and whispered and said, j.d., if you don't stop hanging out with that kid i'm going to run him over with my car and no one is going to find out. >> i told you. i told you. >> and i remember thinking -- you know, and most people, most

kids ignore that -- you know, parents tell kids not to hang out with the bad kids all the time, but when my grandma said it i was like, oh, my god, maybe -- maybe i don't want to get this guy killed so i'm going to stop hanging out with him. and that was really something that she -- that was her. that wasn't anything about me, that wasn't anything even about my family, that was a person who recognized that there were temptations to bad decisions and she was going to prevent me from succumbing to those temptations. i think that was a huge part of it. >> something you referred to there -- there were several things you referred to i want to follow up on and one of them is that you didn't really spend much time thinking about how smart you are when you were a kid. >> yeah. >> the children of upper middle class and especially new upper class parents spend a great po portion of their time worrying about how smart they are, partly because their parents keep

telling them, you are so smart, but it is part of -- it's an integral part of who they are. >> sure. >> not just an integral part but a central part, and that reminds me of the experience that my wife and i have had in this little town of maryland where we live where the public high school there were lots of really, really bright kids who weren't aware of how bright they were, and there was not the -- nobody was saying to them, do you know what, you could get a free ride at yale or harvard or dartmouth or stanford. >> sure. >> and the difference between that atmosphere in a white white working class community and the atmosphere in potomac and cherry chase and northwest washington s you know, vast. the other thing that i want to follow up on with that is your experience at yale because you say that you discovered that you got there and they weren't all geniuses after all.

talk a little bit more about that and the reaction of the kid from middletown, ex-marine corps, infantryman getting to yale. >> i think the sense that to make it to an ivy league school you had to be a genius was to powerful and so strong in my own life that i really expected to show up and for everyone to realize, whoa, you know, the admissions officer drank a little too much bourbon when she was looking at this application, but, you know, again, i was sort of surprised to realize that what really set the kids at yale law school apart from other people that i've interacted with is, sure, they were certainly above average intelligence, they were very smart but they were extraordinarily hard working and very ambitious. they were willing to put in these insanely long hours in the library in a way that was just completely foreign to me if i hadn't joined the marine corps. i remember the first 20 hour workday that i put in in the marine corps and i couldn't

believe t but these kids at yale i thought of as coddled, the one thing they were really willing to do was lose sleep in order to get ahead in classroom or in some other way. so that was definitely a huge difference. there is i think a cult of innate ability that we have in the upper class and lower class. i would say broadly in american culture because i remember it was the day that i asked my wife's father permission to propose to her, we just went golfing, we're eating breakfast and i was talking about -- she went to yale and yale law school and her sister is also very smart and accomplished and i was like how did you raise these really smart kids, they are unbelievable. these are first generation immigrant from india, he said they are not very smart, they are just hard working. and i couldn't believe it because where i'm from my family thinks that my wife is this like other worldly genius and i do, too, but there is this sense -- i mean, of course she's very,

very smart, but even in her own family it was more about work than it was about innate ability. so i think it's not necessarily always true, i certainly think my wife is much smarter than the gross majority of folks i have interacted with in my life, certainly much smarter than i am but one thing that is true is that she works harder than anybody i have ever met. >> i agree with all you've said but there is also another side to that join that i recall from when my wife and i were working on a book about the apollo program and one of the people in mission control was saying, you know, this stuff you're doing with i skchlt is way over grown, i didn't go anywhere until i had motivation and once i got motivation that made all the difference and i said, jerry, do you happen to knee what your iq is? he said, yeah, it's 146. motivation really helps.

there is another lead on the yale bliss that fascinates me because one of the other themes of my work is that the kids at yale too many of them haven't a clue about middletown. >> sure. >> they haven't a clue about white working class america or mainstream america and what i want you to do of course is to give me several vivid illustrations of why i'm exactly right. but you get my drift. >> yeah. no, that's definitely true. i mean, there's obviously a huge cultural disconnect and if you didn't think that there was just look at the 2016 election of course. >> yeah. >> and, you know, one of the things that was very -- when i realized this cultural disconnect was very real i was in a class, it was a national security class or at least had some national security connection and one of the students after learning that i was in the marine corps before i went to law school asked me --

she was kind of surprised, like you went to the marines? you were in the marine corps? and i was like, yeah, why is that so surprising? and her response was like i just didn't know who people that joined the military were like you, were nice, were like that. and i remember at the time thinking, huh, that's an interesting comment to make but i will just let it go. but i definitely -- you know, there is, you know, a very remarkable cultural disconnect between that part of the world and the part of the world that i grew up in. and, you know, it never really affected me in a negative way in law school, there is certainly a lot of stories in the book about how i didn't quite know how to navigate the elite world of yale law school the first time that i had a really, really fancy dinner, i didn't know what to do with the utensils so i excused myself to call my wife and said what do i -- why are there two butter knives, you don't even need one, you can just use your

finger. tell me what to do with these things. you know, she of course guided me through that and a lot of similar experiences, but there was definitely just a sense that people don't quite understand -- i think it goes both directions. the people that i grew up around don't quite understand the elites and the elites don't understand the people that i grew up around. >> the difference that the elites are the ones that make decisions that affect the lives of people in middletown. >> right. >> you mentioned the election and i'm going to ask you one last question before we go to the audience. because in this election cycle we have had the white working class be a huge story, a source of support for donald trump, and we have also had race be an enormous story and you are kind of a unique observer resource. you -- i don't know what the racial makeup was of middletown or the rest of your life, but you have observed the white working class, you have observed

in the marine corps race relations, you have been at a large public university and you have been at yale law school, the most elite of the most elite, and in all of those four areas i imagine that the issue of race and the way that people talk about it and the way people think about it has to be different and maybe in some ways the same, and i would just love to hear you reflect on that. >> yeah, so my take away from sort of my life, especially my time at yale law school is that everyone probably is probably pretty prejudiced and if you don't want to be prejudiced you have to recognize it and fight against t i just think that prejudice operates at different levels from back home and at yale law school. so big request he is how much does racial anxiety drive the trump phenomenon. my answer to that question is i think it drives some of it, i don't think it's the main thing but i definitely think it's something that's going on, but, you know, people at yale law school are still pretty

prejudiced. >> how does it manifest itself? >> well, let's say you don't know a single trump voter in your life but you say that about a trump voter he's the racist candidate that all these all th rednecks deserve. i think that's a form of prejudice and a form of prejudice that's extraordinary real and people back home feel very, very passionate about. so my grandma once told me, i don't think i put this in the book, but hillbillies are the only group of people that the media, the elites -- that's not a term she would have ever used -- you're still allowed to make fun of in polite company. it wasn't an excuse you should be able to make fun of all the other people. it was her saying, there's something weird about the fact we still say redneck or hillbilly and the way people uz it and there's not even a little pause about that. that's not an argument we should go around using racial slurs. but it is, i think, a recognition that what exists in some of these elite enclaves is

a certain amount of see collusion from people like my grandma and a failure to recognize that your pretty biased against them a lot of times even though you don't recognize it. one of the things i've tried to do since the book came out is sort of recognize that a lot of the people who hear me talk, they see me as sort of this representative of the appalachian or the white working class voter. and my hope is that when they hear me speak, they don't have all their worse biases confirmed. >> i think you're safe in not worrying about that. i'm going to go to the audience now. we have, i assume, microphones that can be taken around? yes, we do. and i see a hand up right -- the gentleman with the beard standing up right now. >> thank you for being here, very interesting presentation. i grew up in cleveland, ohio, in the' the '50s, early '60s,

cleveland was in some wes a large scale of middletown, very heavily industrialized, very heavily unionized. strongly democratic, and with a lot of folks that had moved up after the war from west virginia, the hillbillies as we disparagingly called them at that time. but even at that time, you could see the early signs of de-inductarization that took place at that time. particularly because of the heavy unionization, the work rules, the tax laws at that time, that worked against industrial -- >> we do need a question. >> right. my question is, to what extent did you see, even when you were a kid, did you see those same processes at work in middletown? and a follow-up question, when i was a kid, middletown was a great basketball powerhouse. what was the role of athletics plus or minus in middletown? from your experience?

>> yeah, so i don't -- i probably can't speak very well to the role of athleticings, plus or minus, but i do think it gives people some measure of social capital. athletics is still big in middletown. our basketball team isn't quite as good as it was in the jerry lucas stage but still sports is very important in middletown. the question about to what degree i saw the industrialization going on, i saw it, but i didn't realize what i was seeing, i realized maybe there weren't as many storefronts. maybe there were some businesses going out of business, and i definitely recognized that there was a problem -- you know, maybe not quite as many people were able to get armco jobs, but that was something i sort of recognized when i was much older. you know, as a 6 or 7-year-old kid, i think the writing was on the wall but i didn't necessarily see it. and it really hit me -- i will never forget, it was, i believe,

right after i came home from iraq in 2006, ak steel -- armco steel would become ak steel because kawasaki had bought it, there was a labor lockout. it was the first time since my grandfather had been a pretty young worker at that steel mill. that's when it hit me some of these economic pressures were hitting middletown in a real well. in some standards, middletown is lucky. it's not dying in the way that youngstown or detroit is. it still suffers from a lot of the deindustrialization problems, but in some ways it's lucky because ak steel is still around, which is something most steel mill workers can't say, my steel mill is still there. >> toward the front, right here. >> i want to press you a little bit on causality. >> sure. >> you obviously have this picture of this very sharp and recent and marked decline that everyone can take a snapshot of. and you say, kind of pointedly here and you've also said in the

book, it's a little economic, a little bit economic. and charles has a theory that's about clear marriage that had real consequences. how do you put it together what the biggest factors of causality is? i heard you saying people weren't resisting a change but i didn't hear you say causality, if that's fair? >> that's fair. one thing i don't do in the book is have a theory of causality. it's lurking in the background. i'm much more interested in what are the things going on in the hope they can provide some measure of an idea of what the solutions might be, whether they're economic or policy or cultural, whatever you want to say. you know, my sense is that the most underappreciated part of the causality story is the way religion has changed in these communities. it doesn't just operate at the level of family pressure. one of the things charles really

made me realize in the book coming apart is traditional religion practices has declined in these communities, but one thing i write about is that there's decline but there's still a weird way religion is operating. people aren't going to church as much but they still identify as conservative evangelical christians, they still wear their faith as a sort of badge of honor. and my guess is that a lot of these trends and traditional religious practice from the mega church to the church relocating to upper income communities to even subtan things like the gospel is operating on these communities in a way it's not the whole story, maybe not even most of the story, but the more i think about, it the more i think the decline of traditional religious practice is the least appreciative part of this problem. >> interesting. in the front row here. by the way, if you'd say your name and affiliation, please. >> my name is kami with the pakistani spektr.

my question is, why it's so rare to hear -- read something about poverty among whites in america. i've been in this city for more we always limpb about poverty among blacks, poverty among latino, poverty among other minorities, but there's a very real chance rear listening about poverty among whites. since majority of people are white in this country. so, in absolute numbers there are more white poors than blacks or any other minority. is that because media happened to be very elite? in the same context, does the media hit donald trump because he talks about blue-collar whites? why are people so allergic to this white poverty topic? is that the only reason they hate donald trump because he talk about average person? thanks. >> i've taken personal pledge not to say the word donald trump

from now until the election, so let me comment about the brunt of your question. the largest single group of -- ethnic group of poor people in this country are whites. i do think that an awful lot of what we have seen in the last year is the sense of the white working class of what about us? that there has been so much attention paid to a variety of very serious and very real problems that affect ethnic minorities and women and it's not just white working class, but the white working class male who is saying, what am i, chopped liver? and it's worst than that. you talk about the qui you can -- one of the few slurs can you use at a polite georgetown dinner party and get no pushback is redneck. but you can also say all sorts of things about males that are really awful.

some of them true. but you say a lot of awful things about males that aren't true and you don't get any pushback from that either. there's a really strong sense of, everybody dumps on us and then they say, we have to go out and check our anger. i think that anger is visceral and real and a consequence, in large part, of what they see every day in -- as the priorities of interests when they watch tv and read the newspapers. you want to add anything to that? >> the only sure thing i agree with that -- the only real thing i would add is why does the media not talk about it so much, and my guess is white poverty isn't politically meaningful. the poorer you are, you're less likely to vote. if you're struggling working class, you've been the property of the republican party for the past 30 years. they've consistently voted, with rare exceptions, for the

republicans. i think it takes this political moment or some other way of expression for the media to wake up to some of these problems. that's my guess. >> we're going to go to the center and to the right. >> john constata. i'd like to ask charles murray, something in parallel to what you've been talking about, about the elite in this country not understanding what's going on. in white working class america. twice this year in march you spoke to college -- on college campuses, at virginia tech and then williams college. in the case of virginia tech, before you got there, the president wrote an open letter, which you properly and quite frankly refuted about what your work means. williams college after you had

spoken there the college newspaper characterized your work again in a way which misrepresents it i wonder in both cases, did you get the sense when you spoke to those college communities that anybody was listening to you. >> oh, yeah. virginia tech, there were-r tlrl half a dozen of ij willing, meaning they were close to my age, aging faculty members with signs. and inside the hall were some hundreds of students who listened tentatively and asked questions. same thing is true of the williams college appearance. i think one of the under appreciated things is the degree to which a lot of the idiocy is driven by rel stivly small minorities of the faculty, especially in the social sciences and humanities. and driven by relatively small

minorities of students in the social sciences and humanities. you have a lot of people who are intimidated by the atmosphere that has been created. but i think they're being held hostage. i welcome all chances to speak on college campuses. because i have good experiences when i go there if i just ignore the idiots, i do. over here. and i'm afraid this will have to be our last one. >> thank you very much. my question is with the insue larty of the ivy league class. i think it's changed. my mother was a stockbroker and my father a lecturer. when i was a teenager i bagged groceries at the grocery store. my peers all did the same. we all knew we were going to university. developing that work ethic was important to studying. i get the perception ivy league students haven't had that experience when they were younger, is that true? >> that's by and large my experience.

i think that's very true. the way that i would describe this is that there was a sense that among this class of people life was a race. and the goal of parents was to give as much of a leg up in that race as humanly possible. and, unfortunately, bagging grocerieses doesn't do as much if you're trying to get ahead in that race if you're trying to prepare kids for the s.a.t., so i think there are some elements of truth to that. >> i will just add, i think that's hugely important. i have a bubble quiz that says how thick is your bubble that isolates you from mainstream america, and the most important question, i think, of the 25 is, have you ever held a job that caused a body part to hurt at the end of the day? even if it's just your feet aching from standing up behind a counter. because if you have never held such a job, you are fundamentally unable to

empathize with a huge chnk of america that hold those job every day. and you have a distorted sense of what work is. that separates you, i think very fundamentally, from the rest of the country. i can't say first how much i enjoyed the book. if it is a wonderful read that is not just saying nice things on j.d.'s behalf, it is terrific. i urge all of you to go get a copy if you don't have one, and read it immediately. j.d., you in person have been as engaging and insightful as you were in the book. it's been a pleasure. >> thank you. [ applause ] while congress is on break until after the november elections, we're featuring american history tv programs that are normally seen weekends here on c-span3. tonight congressional history, at 8:00 eastern, former senators bob dole and nancy cassin balm talk about congress. at 9 :00 it's the history of african-americans in congress and shortly after 10:00 eastern,

the 50th anniversary of the national historic preservation act. tonight the dedication of the thomas edison statue. c-span brings you more debates from key senate races. this evening at 7:00 live on c-span, the pennsylvania senate debate between republican senator pat toomey and democrat katie mcginnty. a debate for the florida senate between republican senator marco rubio and democratic congressman patrick murphy. thursday night at 8:00 eastern, republican senator yell ayotte and democratic governor maggie h asan. follow dedebates from senate and house votes on c-span and the c-span radio app. c-span, where history unfolds daily.

on lkz day, november 8th, the nation decides our next president and which party controls the house and senate. stay with c-span for coverage of the presidential race including campaign stops with hillary clinton and donald trump and follow key house coverage. c-span, where history unfolds daily. a panel of economists discuss the relationships between health care policies and measures of economic prosperity such as wages, labor force participation and national economic growth. over the next hour and a half you'll hear from jason furman, chairman of white house council of economic advisers along with other current and former officials from the obama and george w. bush administrations. >> good morning.

this is your ten-second warning. >> on behalf of the center at george mason university, i want to welcome you to this important discussion of the effective rising health care costs on economic mobility and economic well-being. my name is bill beach, i'm the vice president for policy research and on behalf of the scholars and the staff, gernaga welcome to this great event. it's not unair to our times to suggest that we live in the era of health care policy. there's little else that i've heard of in health care policy. simz like every time i turn around it's health care policy. which is fine. it's a fascinating wrish. in fact, few issues have dom natured the past 25 years like this national hoelt care policy debate we've been having.

that's clearly true of the past eight years. this policy debate largely has centered on coverage issues and that concern continues to appear in the national health care discussion as evidenced by what is happening in the presidential contest right now. at this time, the post-aca world, analysts are focusing anew on unintended effects from restructuring of insurance market polices to the economic effects of rising health care costses. this last topic is the subject of our program today. have the growth in health care costs affected the economic welfare of insured and uninsured americans? is this increase in cost offset by the benefits of newly extended coverage? has the rising cost of health care insurance affected the distribution of earnings in the united states?

these will be the questions among many others that we will be discussing in two panels here later this morning. to get us going, we are extremely pleased to have with us a person who has been commenting on health care and economic policy in this town for a long time and i refer to robert samuelson. i'll say three sentences about him this morning. as all of you know, rob either samuelson writes for "the washington post" and has been associated with "the post" since 1977. he began work at that newspaper in '69 as a recorder, left, came back. he has been known for insightful, frank commentary on economic and fiscal issues as well as general economic commentary.

robert samuelson received a bachelor degree in '67 from harvard, and has written several books. now, join me in welcoming robert samuelson to the podium. >> thank you, bill, i appreciate the short introduction. i hope you won't hold my harvard background against me. a friend of mine, rich thomas, the former chief economic correspondent for "newsweek," where i worked for a number of years, coined a law which i call thomas' law, he says all bad ideas start at harvard. before i start, let me clear up a couple of other common misconceptions. although i write about economics, i'm not an economists. i'm basically a newspaper reporter who was booted upstairs to write a column.

second, although i have a famous name in economic, samuelson, i am no relation that i know of to paul samuelsson, nobel prize winners and one. great leading economisteconomis. i'm told he does have a son named robert j. samuelson. if so, it's not me. now, let me get down to business. the subject of today's conference is actually quite simple. it's a question. can we govern the health care sector or can it govern itself? the answer is not at all clear. governing means making choices, usually unpleasant choices. if everyone agreed on everythinging we won't need politics or legislative bodies. we could run the country with a computer because there would be no disagreements to mediate. of course, we have disagreements and differences. economists have devised a

framework. they have divided most goods and services into two broad categories, public goods and private goods. private goods are regulated by the market. people vote with their feet and their pocket books. if people don't like old-fashioned newspapers, prefer to get their news from their tablets or smartphones or not to get their news at all, and newspaper circulation will decline and perhaps, one day disappear. i may not necessarily like the result, indeed, i don't, but it's the verdict of the market. its choices are dictated by consumer preferences and incomes. if you can't afford a mercedes, maybe you buy a chevrolet or a bicycle. most choices are made this way because most goods and services are private goods. but not all. we also have public goods and services provided by government. defense most obviously but also much research and development and various types of regulation.

regulation of the environment, financial markets, work by southeast and pharmaceuticals to name just a few obvious examples. how we decide how much, how little and what kind of public goods we want is by political choice. elections and legislative action. if you think government is not spending enough on this or that public good, or is overtaxing to spend too much on needed public goods, can you try to change the outcome by voting for a new set of public leaders. this is obviously a very messy, inexact and often contradictory process, not nearly as decisive as the marketplace, but it is a process. so, we have two well-defined methods of making most spending choices. the trouble is that health care belongs to neither of these two groups. though it shares some characteristics of both. about half our health care is supplied by the government or more accurately is paid for by

the government. the best examples are medicare and medicaid. this sets medical care resembles a public good. on the other hand, it also resembles a private good in that upper milgz class families are routinely described as having access to more and better medical care than poor people. this suggests that health care is a private good. but it resembles neither in one crucial sense. there is no obvious way of limiting it. people regard medical care as a right, to be supplied to anyone who needs it when they need it. this attitude stretches back for decades. a gallup poll in 1938 asked respondents whether the government should be responsible for medical care of people who couldn't afford it. the response was 81% of the public said yes. rights are almost by definition open-ended. i have a slightly different way of describing or situation. though it may just be another label for the word right. in any case, i call health care

an ethical good. it is something that in the view of most people and as a moral matter must be provided for those who are sick, injured or worried they might become so. to withhold care is immoral. unlike private goods, care should not be distributed according to income and preference. unlike public goods, we should not artificially put a ceiling on health care spending. people should get what they need when they need it to survive and enjoy life. no one should be told on an operating table that the procedure has to stop because the hospital has run out of money or is about to hit some budget ceiling or won't be reimbursed by insurance company. health care is not that sort of public good. as i said, it's an ethical good. this may seem a defensible and desirable approach for any individual, but it's less defensible and desirable for the society as a whole. it has led almost inettably to a

rapid escalation in costs that arguably represents a fair amount of waste because there is no effective discipline on spending and arguably crowds out other important private and public spending. more of total compensation is devoted to health care, squeezing wages and salary. other government programs are taxes and/or deficits are raised to satisfy the demands of higher health care spending. the original question i posed -- can we govern the health care sector is even more complicated than this implies. americans want three things from their health care system. first, they want universal coverage along the line of health care as a right or ethical good. people shouldn't be deprived of health care simply because they can't pay for it. next, they want total autonomy for doctors and patients. doctors want to prescribe whatever treatments of drugs and other therapies they think desirable without being second-guessed by insurance companies or government bureaucrats.

likewise, patients want to be able to pick the doctors and hospitals of their choice. they don't want to be dictated to. and finally, americans want health costs controlled. they don't want ever-rising health spending to reduce their standard of living, especially since most health spending goes to a very small proportion of the very sick people. the top 10% of health spending cases account for 67% of the costs, roughly two-thirds. the health spending of the healthiest 50% of the population accounts for 3% of costs. the trouble is that we can only have two of the desired outcomes at any one time. if you have universal coverage, costs will almost certainly go higher. if we give doctors and patients totally free choice, cost will almost certainly be higher because there are be no reason to withhold treatments, diagnostics or medications that might do some good.

if we hold some treatments treatments to control costs, the restrictions it's triggering will have a public backlash. the same again is true if we fail to provide universal coverage, which despite obamacare is what we've done. modern medicine is compounding these difficulties in to ways. tech logical advances in medical care are often more expensive than treatment they replace or the fact there were no previous treatments. and specialization of medicine, which often reflect these technological gains means no one is truly in charge, often means that no one is truly in charge of a patient's treatment because he or she suffers from a multitude of ail manies and has, as a result, a multitude of doctors. i don't mean to imply -- although it probably seems that i mean to imply -- and my wife is often told me that i've never seen a glass half full. i don't mean to imply the

efforts to control the health care system are inevitably futile. there are compromises to all three goals that can be made in the greater name of the good. our medical industrial complex is strewn with rules and practices that represent efforts to straddle the system's underlying contradictions. or the conflicts between goals can be obscured because they are complex and not obvious. or the conflicts can be justified because they only limit waste, whatever that is, and don't compromise quality of care. still, the job is inherently difficult, because whatever health care providers, government regulators or insurance company bureaucrats suggest is lovenlgicily bound to threaten one of the three goals that americans passionately hold. it's been a frustrating process, perhaps not futile, but certainly difficult as i suspect this morning's session will confirm. thank you very much. [ applause ]

>> thank you very much, bob. that was a great way of starting the morning. appreciate that. we're -- now i'm going to call to the podium my colleague, who chuck blahous, who is the senior research fellow and director at mercatus, who also has major responsibilities for a number of other issues at the foundation. i don't know what we would do without him. he frequently appears on radio and television. you probably have seen him. he's an expert on baseball history and that commentary is welcome this morning. chuck was a public trustee of social security and medicare from 2010 to 2015 and served prior to that in several economic policy capacities in the george w. bush administration and received a b.a. from princeton and ph.d. in computational chemistry from the university of

california-berkeley. please join me in welcoming chuck blahous to the podium. [ applause ] >> well, we are very fortunate this morning to have the opportunity to hear dr. jason furman's insights on health care policy and its relationship to the economic experiences of individual americans. it's my pleasure to introduce dr. furman today to you. as many of you probably already know, dr. furman serves as the 28th chairman of the president's council of economic advisers. he's been with president obama since the beginning of his administration, previously holding the position of principle deputy director of the national economic council. that's a very important and wonderful position, i can personally attest. and held only by the most brilliant people.

dr. furman, prior to that, has held a variety of posts in public policy and research before coming on with president obama. he's done work at the world bank, a senior fellow at the brookings institution. he has had various stints in ak deem, yeah including a visiting position at nyu's wagner graduate school of public policy. dr. furman's research covers an extremely wide range of areas, including fiscal policy, tax policy, health economics, social security and domestic and international macro economics. he's the editor of two books on economic policy and holds a ph.d. in economics from harvard university. now, some of you may already know, and others might be amused to know that dr. furman is also an accomplished juggler. and not only in the professional and intellectual senses, but also in the very literal sense of the word. this has special meaning for me, because a couple of years ago, my own wife gifted me with some juggling balls, along with an

instructional booklet and some research indicating that juggling was an excellent way to sharpen one's mind. you can draw your own inference about what was implied there. so i've attempted to teach myself new juggling tricks, but and virtually every morning has resulted in very humbling failures. so i think of this of my daily reminder that dr. furman is smarter than me. so with that, help me welcome dr. jason furman to address us. thank you. [ applause ] >> i'm not going to hold myself up against a quantum chemist. but thank you so much, chuck, for that introduction. thanks for organizing this discussion today. and i thought i would start with something really simple, because when we talk about health care, often our vocabulary flips around. i want to talk about the

difference between cost and spending. cost is how much it cost to buy something, how much it cost to buy a shirt or a candy bar or a meal at a restaurant. and in those contexts, we rarely get the word wrong. spending is how much it costs for something multiplied by how much of it we spend in total on shirts, how much we spend in total on candy or restaurants. and that depends on both the price and the quantitity. when it comes to health care, these two have somewhat different evaluations. as a general rule, any time we can slow the growth of cost, that is the growth of prices, in this case, the price of an aspirin or the price of a treatment for heart attack, that's probably presumptively a good thing and something we should be happy about.

when it comes to spending, price times quantity, it's a little bit more ambiguous. and in particular, it depends very much on the circumstances. there's been a lot of research on how much we get out of our health spending, and i think the answer to the question is, you know, it depends, and it's all over the map. some economists have talked about us being on the flat of the curve, that for each additional dollar we spend on health care, we're getting an extra screening, which at best doesn't do anything to diagnose a problem, and at worst, may even lead us to undertake some form of costly surgery that leaves us worse off because of the side effects associated with it. in that world it's possible to reduce health spending by reducing the quantities without

making us worse off and possibly even making us better off. but there's also substantial evidence that, for example, people who don't have health insurance are spending too little on health care. they're unable to get preventative care and the type of treatment they need. for them, additional spending on health care would be a positive, not a negative. so we have a health care system that, in some respects, is doing too little. maybe too little prevention. too little for the people uninsured. and in other cases, is providing treatment that may be wasteful, unnecessary, and in some cases, harmful. so a lot of the trick is both how to improve the efficiency of health care, the growth of prices, and then also look at spending and how to have, you know, more of the good health care and less of the health care that's causing the problem.

if you look at the record of the last couple of years, what we've seen since the affordable care act was passed in march 2010 is that health care prices, as measured by something called the personal consumption expenditure deflator, has risen at 1.6% annual rate. that's the slowest rate of growth of health care prices since the -- in over 50 years for comparable period of time. and that is unambiguously good news, that the price we have to pay for, you know, all the different things we want in health care is growing at about the same rate as overall prices, excludeing the volatile categories like oil, which is something that historically hadn't been the case. historically we saw health care prices increasing faster than every other price.

when we look at total spending, that's grown faster than prices have grown and premiums have grown faster than prices have grown, because the quantitity has grown. and it's grown in two senses. one is, we all get better treatments today than we did 5, 10, 20, 30 years ago. but second of all, more people are covered. in fact, millions more people. 20 million people have gotten health insurance since the affordable care act passed. notwithstanding all of that, what is really remarkable is that health spending itself has come in well below what was expected. if you look at the nonpartisan actuaries that estimate health spending, in january of 2010 before the affordable care act was passed, they projected this year we would be spending $3.7 trillion on health care.

instead, the latest estimate is that we're spending about $3.35 trillion this year. that's 9% less than what was expected. and that's despite those 20 million people that have gotten health insurance in the wake of the affordable care act. so understanding the causes of the slowdown in both health costs and surprise on the down side for health spending, what could be done to help it continue and its economic consequences i think are really important and there will be a whole panel here that can help discuss and debate that. in terms of the causes, i think there's a variety. originally people were dismisstive and thought this was something temporarily caused by

the recession. as we get further and further away from the recession, i think that explanation becomes less and less tenable. it's more likely it's something in our health system. i think a lot of things are going on. you see innovation in the private sector. you saw a slowdown in health costs going in the years prior to 2010. but you've seen that slowdown accelerate since 2010. i think in particular the way in which we reemburse in medicare has played a role. the way we've done delivery system reforms that are paying less for fragmented and often do you duplicate care, but instead are paying on a more integrated basis that encourages providers to save money and improve quality, something we're now doing for 30% of payments in medicare with a goal of 50%

eventually. and the way in which the private sector has mimicked and adopted a number of these practices that we see in the public sector, i think, has played an important role. i think it's notable that the affordable care act is certainly a divisive topic. and, you know, there's all sorts of really heat views on the question of the affordable care act. i certainly think it's one of the most important laws we've passed in this country in a very long time. others disagree. but a lot of these delivery system reforms that were in it, ways that let you, for example, design experiments that -- about how to reimburse in medicare, for example, bundling payments for gwynn treatment or reimburse on the basis of how care is better integrated.

a lot of those ideas are really bipartisan, and were supported by both political parties. and we saw a lot of those ideas incorporated into a reform of how we pay doctors within medicare that passed congress on a bipartisan basis last year and gives us a number of these same delivery system reform tools to use in the reimbursement of physicians that we already had in other parts of medicare. none of this happens automatically. a lot of what we have now are not a specific game plan of what we're going to do each year in health reimbursement for the rest of time. instead, what we have is the ability to conduct pilots, to experiment with different ways of reimbursement. and when those are successful in either improving quality without hurting costs or improving costs without hurting quality, scale them up in medicare. a lot of what you're doing in

medicare then can be taken advantage of and built on by the private sector and vice versa. so it's not self-executing. it's something that will require certainly this administration has put all efforts into it, but will require the next administration and after to continue to take advantage of these tools to try to figure out how to better provide care and do it in a more efficient manner. this all matters quite a lot for the economy, which is the topic of today's discussion. in particular, i can think of four reasons why it matters. first of all, it matters just because a large fraction of what we consume is health care. it's nearly a fifth of our nation's gdp. and right now in a number of

respects, we're consuming it inefficiently. that may be, as mercatus would characterize, distortions that come from public policy, whether it's the tax system in health care or public programs. it may be as some democrats -- or more progressives would emphasize failures in the market for health care. or additional research and development is a public good that has a spillover. so no one insurance company has the resources and has the incentives to figure out the full set of innovations, but the federal government does have that scale and can help contribute an effect to that or indeed can help expand the production possibility. so you're talking about

something that's nearly 20% of the economy figuring out how to spend your money within that 20% more wisely, will basically mean you can potentially get more for your dollars and be better off. so that would be the first economic importances inherently. second is it plays a really important role in the labor market, and in the short run, the evidence is, when health costs slow, that employers don't pass all of those savings onto employees right away. it lowers the cost of compensation and it allows employers to hire more people and results in more jobs. the converse is also true. when health care costs rise quickly, that can cost us jobs. the third economic point would be in the long run, i think the savings -- i think health costs passed through from employers to employees.

it may seem as if the employer is paying part of the premium, but they're paying you a lower wage. so really it's all coming out of your pocket. so if you slow the growth of health cost, that helps increase the pace of growth of wages and raises income growth, which is one of the challenges we've had as a country for many decades. and then the fourth and final way that health costs and health spending matters a lot is it's a substantial and growing part of the federal budget. and the federal budget, while the deficit has come down a lot over the last six years, that deficit is projected to rise again in the future, and we have, going forward, spending that exceeds revenue. to the degree that you're able to bring down the growth and the cost of health spending, you can help better align those two and

have fiscal sustainability. and that's part of what the affordable care act is a down payment on, lowering the deficit over time by trillions of dollars over the coming decades. but a lot more work remains to be done both on the health side and in our judgment in a balanced fashion with additional revenue to deal with our budget problems, as well. so i think it's through no accident that health care has been a major focus of some of the brightest minds in economic policy and public policy for the last many decades. it's a really vexing and complicated issue. it's a really important issue to the overall economy, to the job market. and to our fiscal situation. but i think it's one where we can make progress and we can

make progress drawing on ideas from across the political spectrum to inform our delivery system, to give the private sector more incentive to adopt those reforms and get more of the good spending, less of the unnecessary and wasteful spending and slow the growth of prices. in your next panel, you'll hear from four of those brightest minds helping to figure that all out. thank you. [ applause ] >> well, thank you very much, dr. furman, for getting our first panel off to such a got start and posing some very interesting questions that we'll now have the opportunity to discuss. i would like to ask our four panelists to come and join me on the stage and we'll get going.

>> well, we have a very interesting first panel for you. it's my privilege to act as moderator. i'll try to be as unobtrusive as possible and to allow our brighter minds lead the conversation. as we have talked about, we want to discuss the various ways in which national health care policy influences fundamental aspects of americans' individual economic well-being. each of our experts up here is going to start by giving brief remarks on the order of ten minutes or so and then we'll open it up for questions. and unleash what i believe will be a very interesting and informative conversation. let me introduce our panelists.

sitting directly to my left is dr. douglas aikens, president of the american action forum. he'll be our first panelist. he's probably best known to most of you for having served in 2003 to 2005 as the sixth director of the congressional budget office. prior to that time, he was the chief economist on the president's council of economic advisers, where i had the pleasure of working with him, and also where he had previously worked from 1989 to 1990 as senior staff economist. dr. holtz-eakin has work built an international reputation as a scholar doing research in areas of applied economic policy and entrepreneurship. at syracuse, he was the trustee of professor of economics, and associate director of the center for policy research. long before that, he came up through the ranks of the richland township public school system in pennsylvania.

which happens to be right next to my own high school, where his mother taught. our second panelist, dr. jared bernstein, he is a senior fellow with the center on budget and policy priorities, where he's been since may of 2011. he served from 2009 to 2011 as the chief economist and economic adviser to vice president joe biden. he's well known to many of you as having served executive task force at the white house, including federal and state. he's the author or co-author for numerous books, including his latest book "the rejection agenda: reuniting growth and prosperi prosperity" pb. he's a frequent on-air

commentator and hosts his own blog. and holds a ph.d. in social welfare from columbia university. our third panelist, jim capretta is a resident fellow at the american enterprise institute where he holds the milton freeman chair. there he studies health care, entitlements, as well as global trends in aging, health and retirement programs. before coming to aeii he had many, many years in public service. he served as associate director at the white house's office of management and budget from 2001 to 2004. again, i had the pleasure of working with him there. he was responsible for the portfolio that covered health care, social security, welfare, labor and education issues. prior to that, he was the senior health policy analyst at u.s. senate budget committee and house committee on ways and means. he was more recently a senior fellow at ethics and public policy center. he has a masters from duke university and a b.a. in government from notre dame. continuing with our theme, we

have matt fielder with us, who is currently chief economist at the council of economic advisers. he specializes to a large degree in health care economics. before entering his current position, he served as cea as senior economist. and has a ph.d. in economics in from harvard university, before that received a bvment b.a. from swarthmor college. before that he worked at the center of budget and policy priorities. as chief economist, his expertise informs not only health care policy, but every aspect of budgetary and economic policy. with that, i would like to turn it over for the remarks of our first panelist, dr. holtz-eakin. >> thank you. thanks for the chance to be here today. i'll remind chuck that if this goes poorly, i have his prom picture. >> that is true. it was the '70s, so -- >> it was a real low point for everyone, yes.

this is clearly an important topic, and i think what's really interesting is that we have these sort of two very important and inner-related problems in the u.s., one of which is poor economic growth and the second is the budgetary outlook. on the economic growth front, from the end of world war ii to 2007, we grew about 3.2% a year. but probably the important thing is that even with population growth, the baby boomers and so forth, the economy grew fast enough that gdp per capita, rough metric of the standard of live, doubled roughly every 35 years. so in one's working lifetime you could imagine seeing the standard of living double, and that was the route to the american dream, whether that was college or vacation or whatever it might be for every family. the projections now are that the u.s. economy are going to go 2% of the year. fold in population growth, the standard doesn't sdubl for roughly 70, 75 years. so the american dream is disappearing over the horizon.

it's a very pressing issue we have to deal with. at the same time, we have a budget outlook which is quite daunting. despite all the improvements that have been layered into the projections. it's still true that whoever wins the 2016 presidential election, will inherit a budgetary outlook, if left on autopil autopilot, with the deficit of a trillion dollars, well over gdp, and about 16% of that deficit will be interest on previous borrowing, so we're heading into mechanically a death spiral, which is simply unacceptable for the nation. and health care lies at the heart of both of these two troubling phenomenon. on the growth front, it's an 4 enormous fraction of the economy. it's a fifth of the economy. long-term growth in the end is driven by demographics, how many workers do you have, and more importantly, how much does each worker produce, productivity,

and the health care sector is in the low productivity sector. as jason furman mentioned, we have a health care sector that's characterized by spending, where we spend too much on some things, too little on others, and misuse a lot of spending. so that leads to a low productivity sector. as i'm an economist, you want to try to focus over the long-term on getting better productivity growth. that should be a fundamental challenge to the health sector. and one of the most important things we can do. it's also true that if you've got a 2% growth rate and roughly 2% inflation, the resources in dollar terms are growing at about 4% a year. that's roughly what revenue is projected to grow, 4% a year. if you look across the array of federal health spending programs, you see growth rates well north of, that 5.2%, 5.9 in medicaid and mode care. much faster than that the in affordable care act. we have federal health spending programs that are outstripping

the resources available to finance them. they are driving in large part the increasing budget deficits. so getting both better productivity and making sure we get growth rates that are sustainable can key challenges in the health sector. the final piece is that the private sector is contributing to this as well. we have a disguised entitlement known as the exclusion of employer-sponsored health insurance from taxation. if you get $100 in cash, you pay taxes, you have $100 in health insurance, you do not, and that assem tridrives compensation packages that have too much health care compared to wash wages. that's been a problem. will continue to be a problem. more importantly, it constitutes a open-ended subsidy to the health care sector and it's a subsidy very poorly targeted. we have a large open-ended subsidy that's poorly targeted

and doesn't hit those who need the most help. that's something that is a troubling phenomenon and needs to be dealt with as well. all the entitlements, whether on the books as spending or tax exclusion, need to be part of fixing the productivity in the health care sector. i'll close by just pointing to medicare as probably the best single place to focus attempts to change the delivery system and improve outcome at the same cost or improve the value proposition in the health care sector. medicare pays an enormous fraction of the country's bills. how you pay in medicare matters. fee for services are a bad idea and that paying doctors to do more to people is very different than paying for good outcomes. we've now decided to collectively stop doing the misguided payment policy. we don't really know where to go on the improving the payment policies. what's interesting to me is that i think there's a consensus, whether they realize it or not,

across the spectrum on what the future looks like. on one side of the aisle future has put medicare on a budget, says if medicare gets too big, have you to step in and stop it from growing. you should bundle things so they have cmmi bundling operation after operation with hips in a bundle, we're going to do all sorts of things in different bundle and they're going to build bundle by bundle for better care. and pay for quality and outcomes. measure outcomes, be serious about it. budgets, bundling and outcome -- and quality outcomes. same is true on the other side of the aisle, they just think about it differently. the budget, you go to premium support and you say, this is how much you get for dh senior with a health status in income. you have a bundle, it's called everything. you give them an insurance package and you cover everything. and you have a quality metric, the sort of medicare advantage stars program but you pay for quality outcome in exactly the

same vision as the democrats have. i'm optimistic that we can, with these sort of two competing visions for exactly the same kind of reforms question make progress in years to come and have a health to come and havin sector with higher value and productivity. >> terrific. dr. bernstein. >> speak from the podium. >> so this is a very different quick little talk here because i want to focus, bite off one little piece of this, which is the affordable care act and jobs. here if my presentation over the next ten minutes is success and i have a few flights i'm going to buzz through them because they are in tu tiff, next time you hear somebody say aca is a job killer, you'll walk away in disgust, because it's not. there's no evidence to support that. and so that's what i'd like to take you through in the next couple of minutes.

i wrote a longer piece on this a while ago called something like ac and jobs, they are just not that into each other. my motivation was partly driven by the fact when we were working on this, i can tell you the many people involved never thought of the ac as a jobs program. the idea we would defend in terms of job creator was certainly not what was intended at the time and not what i think has been achieved. i want to be clear i'm not saying aca is a jobs creator. outside the health care sector, if you're going to newly cover 20 million people, that's going to meet more demand in the employment sector that's pretty obvious. the reason i thought aca didn't have much of a case for this accusation of job killer is because the employer mandate actually affects very few employers.

about 30% of workers with firms of less than 50 fulltime equivalents so they don't face the mandate. of the 0% that are above 50 fte s-and would face the mandate and employment disincentive, 95% of them are already offered coverage and most of them take it up. if you look at the percent of workers on the margin under 30 hours a week under which the maybe date would not be applied, it's a fraction of a percent. so simply looking at the magnitudes of those who would be affected by -- whose employment would be affected by employer mandate, you wouldn't expect much traction there. then have you to ask your self about the impact of subsidiaries on the supply side. subsidies fade as income rises, negative affect on supply elasticity. on the other hand high marginal tax rate on medicaid, which

would lead folks to wan to work less so they stay on medicaid, prea krch pre-aca, that disincentive has been diminished in states that have taken the increase. long story short, it's really an empirical question. the increases five minutes i'll show you the slides that look at empirics. all you see each dot is a state. on the x axis we have a measure of obama care's penetration, which is the increase insurance, increase in the share of people in the state with insurance. that's plotted against employment growth. if you expect greater traction from obama care, greater penetration from obama care was a killer, you'd executive that correlation to be a negative one and, in fact, it's a positive one. again, there are a lot of things going on here, a lot of moving

parts. one of the thing that's happening is this is a period of job growth. the correlation is backed in the cake. ben who is here, assistant and i, took out employer sponsored insurance from each dot. now we're looking at insurance that wasn't esi. it's flatter but still a positive slope. again, i think that what you're kind of looking for here is, is there a negative correlation? so far the answer is no. another little test is to ask yourself where has job growth been? what is the comparison of job growth and states that took the medicaid expansion and states that didn't? and you can do this two ways. you can either just take each state as an experiment and say

what happened in -- that's the left set of bars, what happened in one state versus another state. the states that took the expansion, that's their growth rate in 2014 and 2015. by the way, your choices don't matter here as long as you're starting when the aca came into the system. there you see the bars are essentially at equal height. any differences there are statistically insignificant. now, you might say i don't want to treat every state as a single experiment, i want to wait by individuals. so you want to say essentially that i'm doing this experiment in the first place with the probability of scholars reaching into an urn and picking out somebody. in the first case you're reaching into an urn and picking out a state. based on whether you took the medicaid expansion or not, has your employment growth rate been different than states that didn't take expansion? the answer is no. the second case, you're reaching in and pulling out a person. it's person weighted. in that case, it doesn't make any difference.

so for all my rhetoric, the results are all the same. now, where there's really an incentive here is the idea that you have an incentive as an employer to shift people to part-time work to avoid the mandate. take somebody who is at that margin around 30 hours a week, take them under 30 hours per week. therefore, what we should see is an increase in involuntary part-time work. we should see an increase in involuntary part-time work if employers are responding to the incentive. so some people have said it's not a job killer, but it's moving people from full-time to part-time work. not so. what you see here is the blue line is the actual share of involuntary part-time workers, and total employment, and that's been falling since the expansion got under way. of course it has. it's a very cyclical variable. so you have to ask yourself, is it falling more slowly than it would were the aca not in the picture?

i built a statistical model that predicts the involuntary share. i measured the model up to before the aca began and forecasted it forward and you see it's the same. so based on a counterfactual, at least in this simple exercise, i'm not claiming it's the last word but you do need a counter factual here, based on the exercise, the part-time involuntary share is falling like it always does in a downturn. this is very interesting but dense slide. so don't try to read all the words on this. my friends at the kaiser family foundation take great slides but it takes sometimes 10 minutes to figure out what's going on. i just wanted you to look at the circled part, which asks employers themselves, from a employer survey that was just completed, so this is 2016, if you look at firms that are large firms with 200 or more workers, or all firms, which is 50 or more ftes, the part i circled, the top part shows what

share of these surveyed employers changed job classifications from part-time to full-time so that employers -- so that their workers could be covered. and in fact, that was 10% for large firms and 7% for smaller firms. so that was part-time to full-time, exactly the opposite of the predicted dynamic. and, in fact, there were a smaller share, 3% and 2%, that went the other way. so you could argue that they were responding to the incentive. but the magnitudes there are far smaller. so in conclusion, no evidence that the aca is a job killer and little evidence that it's shifting anyone from full time to involuntary part-time work. thank you. [ applause ] >> thank you. jim capretta. >> thank you, chuck. glad to be here for this very important event.

i do think it's an interesting way to frame up this question and talk about it. it's an interesting way to look at the problem and of course, i think probably the most important way to look at it, which is we don't want a health system that in some ways makes our economic prospects worse off. our economic process pecks worse off. it should be working in tandem to improve our prospects. the question is, how are we doing, what are the problems and what could be maybe done as a remedy? let me just start by saying that the obvious point, which is that an additional use of resources on health is not necessarily a bad thing. if the opportunity presents itself, and one has earned an additional dollar and the choice has been made to expend some portion of that additional dollar on more health services

for one's self or one's family, that probably, you know, more or less is a good thing, we would think, in most circumstances. so when one looks at the united states, and the united states is spending well above our peer countries in terms of use of health resources on -- use of resources on health care, it's often observed that we're wasting a lot of money and i'll get to that in a second. but that's not obvious on its face, that it turns out that the richer the country, the more that is spent on health care. that's observable across all the advanced economies. there is a correlation there. so one would expect the richest country to spend a little more on health care. so that's not necessarily a bad thing. let me just start with that. the second aspect, of course, is that we wouldn't really question this if we knew and felt and understood that the