>> also with us today is redonda miller. in may redonda became the 11th president of the johns hopkins hospital. she previously served as senior vice president of medical affairs for the johns hopkins health system as well as a professor and vice chair for clinical operations in the department of medicine. redonda has made medical education and women's health a major focus of her academic and clinical career. she chairs the maryland hospital associations council on clinical and quality issues and is a fellow of the american college of physicians. as she governs she plans to continue caring for patients as she said in a recent interview seeing patients will keep me grounded and help me remember why i'm here. please join me in welcoming redonda miller. [ applause ] next we have with us gene woods,

president and ceo of the carolinas healthcare system. after distinguishing himself as president of the chris has health gene took the reins of carolinas healthcare one of the nation's largest nonprofit systems earlier this year, he is also serve as the next president of the american hospital association. in a recent interview gene likened maneuvering in the current healthcare climate to trying to play chess on a rubik's could you be, just when you get you have everything figured out someone twist it is and resets the game. gene has shown himself to be a pretty savvy chess player so we look forward to having his thoughts and perspective. ladies and gentlemen, please welcome gene woods. [ applause ] >> and leading our discussion this afternoon is u.s. news editor brian kelly. please welcome him back. the stage is yours, brian. >> thanks, margie. when i started in this business

somebody told me the great slogan of show biz never follow a funnier comedian. i have a corollary now never follow a certified genius. wow. i think we just saw the future of healthcare. so thank you very much, we will see you next year. no, we have -- that was fascinating, but we've got some people who are living in the trenches here and i think that's also what we want to do. we have 30,000 feet and we have grassroots. margie gave you the production, i want to start with probing questions for these guys. we go for the hot stuff. tom, you have been the minority leader of the senate, the majority senate twice each. what's the better job? >> can i have some time to think about that these days, brian? actually i think being in the minority is more fun but being in the majority is a lot more fulfilling. >> all right. okay. so we're going to walk through this. gene, you come from a health

system in north texas, you come to north carolina recently. cowboys panthers, who is better? >> that's -- philadelphia eagles. now, wait. wait. >> uh-oh. >> i know we are on camera so a close second is the panthers, okay? my wife is a steelers fan, my son is a cowboys fan so we have a little disharmony in the woods household. >> but that's why they pay you the big bucks. >> exactly. >> redonda, one of the great hospitals in the world, the day after the election are you anticipating a surge of people looking for psychiatric care? >> well, you know, nonpartisan aside i think we will be ready. i'm not for sure i know the answer to that but i will also say that, you know, we had some riots in east baltimore a while ago so we will be ready on that front as well. we will be ready. >> all right. it's a crazy world out there. so i want to start with each of

you. so if you think about what we've got here which are people with enormous expertise but we've also carefully chosen them, they represent the spectrum here. redonda has a first class institution actually a network, gene has also a network but also is going to be the president of the aha so is looking industry wide and tom pretty much has the whole country in his pocket. so i want to ask each of you in sequence here when you look at your piece of this what's working? a couple of things that are working that make you feel good about where we are and then i'm going to ask you what's not working. redonda, let me start with you. you look at hopkins, the hopkins system, what makes you smile when you come to work on monday morning? >> what makes me smile? i think it is the renewed focus -- not that it hasn't always been this way, but there is a renewed focus on the

patient being at the venter of all we do. everything from designing our care models to messaging folks in our electronic medical record. just trying to make care easier to access to our patients who are our customers, that makes me smile. >> okay. good answer. tom, fix the country for us here. >> i think the two most formative and most powerful forces in health today are technology and policy. technology we've just seen a clear demonstration of the unbelievable things that are happening technologically and i think the application of technology and big data is very, very exciting. so all the innovation that we're seeing through technology has got to be on the short list. on the policy side i think the one really remarkable thing we've seen is the improvement in the number of people who are insured today and the number of protections that people have as a result of policy. so we haven't seen as much movement on the policy side as we've seen on the technology

side but we've seen movement on both and i would cite those two things primarily. >> gene. >> you know, i would add we have a long ways to go with quality clearly in the field, but i see a real commitment to quality. you look at the american hospital association with the hand grant that was just received and 34,000 instances of harms averted, $300 million saved, carolinas like wise we were just renewed 13,000 instances of harm eliminated in about $76 million of cost savings. so we have a tremendous amount of work still to do on the quality front but i feel that the field as a whole is committed and on the path to that. >> okay. so what's on the down side? >> on the down side, you know, if you think about step back and look at the -- aca partly was to address access and we have 20 million people now that have access to insurance, but if you look at the nation's hospital you have about one-third that

are struggling financially, you have about one-third that are sort of in the middle there, plus maybe a little bit of break even and then you have one-third that are doing well. and those two-thirds are particularly concentrated around areas of need in rural communities and also urban safety net communities. so my concern is that while we have access through insurance i think we're entering a period of where the -- we're having uneven access in terms of providers, providers in rural america and also in some safety net areas. >> redonda. >> what keeps me up at night is the repitity of change. i think we are going in the right direction for our patients but if you are at a hospital trying to manage what is coming at you rapid fire, i'd say over the last two owe floor years and at my own institution we wrestled with launching a new electronic medical record at our

hospital and across the system, we had icd-10, we launched an accountable care organization, we have countless new quality metrics that we're trying to perform well on. it is just rapid fire nonstop change and i have no doubt that we can do any one of those really well it's just trying to balance and manage all of those at the same time. >> tom. >> brian, i think if i can could go back to my policy assertion a minute ago i think the down side is the degree of politicization around policy today and the constant confrontation. we've got to find ways to make the policy debate around healthcare more civil again and we've got to find ways with which to come to some conclusion, some reconciliation about the role of government in healthcare. that's really at its heart just as you said in your opening comments one of the big challenges. once we do that we still have a whole range of issues, we have issues around still on the fee

for service and moving to a different payment model, we have major quality issues, we still aren't as operable as we need to be and connected. we're too siloed yesterday today. i always have asserted we don't have a healthcare system, we have a collage of healthcare subsystems and they're siloed and we have to figure out a way to make them work better today. >> i promised you guys i'd tell you what to do on wednesday morning next week. gene, the quality question, u.s. news we have a little bit of experience on this, we have this slogan if you can't measure it you can't fix it. i think we have had a lot of emphasis on data, but in the government with the five star rating has made a move in that direction, controversial. so each of you give me your sense of quality measures are they working, where do we need to go with that? and just let me -- and what's it doing to your institutions because i know both of you guys are very much involved in that.

>> you can count the number of quality metrics that we have to track on a daily basis. we're talking 400, 600, 700 and the question is they don't all have -- some of them are black box methodologies, some are hard to replicate, some are not useful to the consumes in distinguishing one provider from the other vierd. we have an initiative going that says what are those metrics that really matter? part of that we've distilled it to 11 metrics that matter, including some population health statisticsen or met contribution such as obesity and diabetes, but i think right now there is -- the field is overwhelmed by all these quality metrics, some of them work, some of them do not and so we've got these 11 that we're hoping to start a conversation with insurance companies, with government, with others to say what of these can we coalesce around so we can simplify it and make it meaningful to the people that we serve. >> redonda.

>> i would echo a lot of that in the sense that i think we are at an intermediate stage right now with our quality metrics. the good part of measuring quality is that it has truly caused us to focus and make sure that we are hitting all of the cancer screenings for our patients, making sure our chs and copd care is top notch. it does cause introspection and examine our processes and outcomes. some of the metrics are not as mature as we would like. some of them end up being more of a documentation issue or it doesn't really capture the essence of quality. so i like your idea honestly about trying to focus, pick the top ones that he can with all really sort of huddle around and make sure we get those right rather than trying to do a scatter shot approach. >> question for both of you guys because you serve a variety of

patient populations and one of the issues that's come up with the quality measures is the notion of risk adjustment or socioeconomic status, sds, socio -- i can't -- i grew up in the late '60s i can't even say sds with a straight face. you know, whatever you call it, you know, people have said there is a real dell tear deleterious effect to this. how do we fix that? >> that's a long answer because, yeah, that's socioeconomic adjustment is really critical. and there has been a lot of work done on that. we try not to worry so much, though, ultimately at least in our system about those type of metrics. what we're really focused on is really how we serve our communities and those -- because some of that gets at social dee term nantz. so this if you look at all our

communities it's amazing you talked about baltimore, certainly charlotte and others how under the surface communities in need really when issues happen they really, you know, make their voices known. so what we've tried to do is look at the socioeconomic factors using things like hot spotting. we know in charlotte there's six different zip codes that have three times the ed use of the rest of the population. so we're trying not to focus so much on the methodology and the metrics, but trying to figure out how we bring better services to those in need. >> redonda, are you guys affected by this? >> yes, we are. i like to say our institution sort of has two missions, we sit in east baltimore which is a very inner city population and we were founded in 1889 to serve that community. then at the same time we pride ourselves on being innovative, high tech and attracting patients from across the nation and across the globe.

so we have two very different patient populations, we aim to serve both. embracing population health for the local zip codes around our hospital is very important to us and having some kind of socioeconomic adjustment is important. no method is important. i will be the first to say no method is perfect but it does allow hospitals to embrace these local populations and make sure we move beyond our walls to deliver appropriate care. >> tom, should the federal government even be in this business? what are they doing making consumer ratings? aren't there other people who do that? >> well, i think -- somebody -- i think -- i think when it comes to establishing value which is the goal of people in government and in the private sector, we want higher value and quality metrics are critical to reaching that goal and quality metrics today are really the wild west. there is just so much out there that i think is frustrating and

confusing and counterproductive. so we need to universal eyes, we need to simplify and we need decision-makers and i think government can help play a role in universal liesing what the metrics ought to be, is it outcomes based, performance based? how do you describe the metrics and quantify them? i think government has a role in doing that. >> i want to talk about doctors for a minute. doctors are where the rubber meets the road here. last year at our conference we had a number of folks talking about the whole issue of doctor burnout and sort of a two-part question. you know, what do you see in terms of that because we seem to be putting so much of a burden on doctors and then arguably we're also putting a tremendous burden on hospitals. is this year's theme hospital burnout? let's talk about population health, here, you guys fix the entire problem of baltimore which i know is on your shoulders, redonda, you fix the entire problems of charlotte, north carolina. start with the doctors and tell

me what are you seeing from your folks and what are we -- what do we need to do about that? and then maybe we will talk a little bit about the institutions and are we asking too much of the industry. >> i'm going to let the physician speak first. >> well, this is a topic near and dear to my heart, physician burnout and i would expand that to all care provider burnout, our nurses and pharmacists and physical therapists as well. the electronic medical record, for instance, brings such good characteristics to our care, the ability to electronically prescribe medications for our patients, the ability for patients to see their results, all good. but it decreases productivity, it loses -- it hinders the human touch of an office visit, the need to be clicking and stuff. physicians are also burdened with other administrative tasks, trying to make sure the coding is direct in the emr or meeting this regulation or this quality metric.

we are seeing some significant burnout and disillusionment. in fact, our institution is launching a joy of medicine initiative here in the next several months because it's important. how do we bring back the joy and the real reason of why we all went into medicine? >> gene. >> i think she said it so beautifully. i think the joy of work is something that i think is lost sometimes with all of the regulations and everything that people have to deal with. the one thing the simple little thing that we've done recently is we have what we call tree of life stories, it's stories of how we have affected another teammate's life or a patient's life. so i'm receiving videos and e-mails on a daily basis and i feed them back to the organization and that alone is connecting people with their purpose and sometimes that we found that that's helped. the second thing that we've really focused on is we have of our strategic initiatives about 80% are led or co-led by

physicians. so when we're changing clinical practice and changing emrs and things of that nature i think they feel they have a voice in that change and so i think that's been helpful including compensation models. we're trying to engage them more in the decision-making and reflecting back to the nurses and doctors and organization what's special about what they do every day. >> let's talk about the institution. pop a lags health which i guess everybody in this audience know knows what we are talking about, the mandate of what institutions are doing, digging deeper into pathologies and other aspects of the community. you know, the readmission metrics for one which penalize you if you are not taking care of that. do you feel like hospitals are being asked to do too much? >> as i mentioned in my earlier comments, i think the direction is the right one. i worry about the pace of which we're trying to do all of this.

i do worry about that. but every single movement, every single initiative does have value. it does. we are spending our time trying to figure out how to become a hospital without walls so to speak. we want to take care of our local population, we're investing in pharmacists to go into the homes, community health workers, trying to really hone in on all these new care models to keep people well and out of the hospitals, the hospital administrator actually saying that's a little ironic but that's what we want to do but it is a lot to tackle and it's not clear that we have the appropriate resources to make all of that happen. that's a challenge. >> tom, i want to put that question to you. from a national policy perspective do you think we're asking hospitals to do too much? >> i think in some cases we're asking hospitals to do things they are not prepared yet to be able to do. we've got to recognize that we are all in this together and when you talk about population health that's especially true.

we can't ask the hospitals to drive the entire population health challenge. when we look at what is really required is a far greater understanding of the social aspects far greater understanding of the social aspects of good health, the nutritional aspects, health monitoring and things done in a classroom, workplace, or community in addition to the hospital. so we have to realize it is a much broader responsibility than just a provider or just a hospital. we can't ask them to do things they're not capable of doing. in some cases we are doing that today. >> here's what i would add. this year alone there's been 15 how new pages of regulation. and between now and the end of the year, we will get one final auto rule every week it seems. i agree, we're heading in the right direction on this uneven path. but if you think about that, we're writing regulations that conflict with regulations that

were written at sunset. please slow down the regulation. even with aca regulations, if you're trying to do the right things in terms of trying to coordinate care, you need an exception for stark and fraud and abuse which were written when everything was for service. we're trying to navigate conflicting regulations. if we could just solve that. even when you file for an exception, that is only for the system that has requested that exception. i think this whole regulatory burden is real and it's confusing. and it doesn't have to be. so you ask if we're asking hospitals and health systems to do too much. i think in some ways with

respect to that we are. >> fix that for us. >> i think first and foremost we aren't, as i said earlier, we're not as engaged as we need to be. on a monthly or regular basis what would please me is for any administration if this one, the next one would bring in each one of the sectors and say, look, let's focus this month on the regulatory environment. how can we make it simplified? how can we do a better is job of this changing world and the changes we're in. there isn't enough of that inclusiveness. to adapt as we go on. technology is moving faster than policy in the regulatory realm. we have to bring them back in. and that can only happen with better inclusion. >> if i can just add on to that,

i think we're on the money. >> incentives between hospitals, nursing homes, physicians and i would love to bring big phrma, payers. >> is it too late for you to get in? is there a filing deadline? we'll come back to that. i want to talk health systems. both administer not just one institution but systems. you know, this conference was called hospital of tomorrow last year. but time moves on. we really made a concerted decision because we have to expand the boundaries here. you have a system that is throughout the state of north carolina. how does that come together? where is the future of that? where does that go?

>> we have about 47 hospitals throughout, 60,000 teammates. i think what we have done well as a system is, look, it's probably overused but first curve. supply chain would do extraordinarily well. so all of our hospitals and systems work well in that. i think what we're stepping back and looking at is how do we leverage capabilities or to the second curve together. cins are building up in different places. we want to make sure the analytics are coordinated, aligned, virtual care platforms. what we know for sure is we make this transformation, it is an expensive technological build. and the care platform alone is very resource intensive. so we're trying to figure out how to use the same thinking in terms of spreading fixed costs

on the first serve revenue cycle and apply that to more integrating functions at that level. >> so, and just for the record, the president of the hospital, i would hate my boss who was president of the health system to be listening in. we are a little younger in our journey toward being a system. we've been at it five or six years. we are at the point where we had a lot of shared services. purchasing together as a system. all that kind of good work. things we are embracing now, which of our six hospitals is the right place to do hits? do we need six lung cancer programs? or should we consolidate the those? what's best for the patients where we can standardized care and provide care except of duplicate it throughout the system. we have not just horizontal alignment but vertical too.

we have home care that allows us to deliver directly to patients at home. we have a community physician network. we are looking beyond an acute care hospital model. we have a lot of elements that will allows to do well in population health. >> i live in washington, d.c. i visited your fine institution with family members many times. several of your hospitals are within close to my home. it is fascinating to see. how do you translate the expertise, excellence of hopkins to the a community hospital? >> you know, it's interesting. we have a lot to learn from our community hospitals as well. so it's been a real partnership for us. we have been building our system from the ground up, engaging front line clinicians from all five mid atlantic hospitals and all children's in florida. believe it or not, we've actually learned from each other. and each have something to bring to the table. so that's how we have been approaching it.

>> so i've been in the system six months. i want to give that caveat. dr. roger ray, our chief executive, the third month i was there we talk all the cmos and clinical leaders and brought them together, including patients, and set metrics as a group and deploy that out whether you're a managed facility or your own facility. and i think for me that's created more systemness than even what i talked about earlier in terms of the first curve. that's where i get excited. we're coming together around the quality enterprise in ways i think we can continue to build on. >> i think that's another nice outcome of the quality movement in the sense we're doing the same thing. we set our goals for quality metrics at the system level. every stakeholder has a say in what the target should be. then we monitor it from the

corporate level. so we hold each other accountable to make sure we are performing well. >> you say this kind of system is eligible. what does this look like in five years? >> continue to see an evolution. for the most part we're going to see a lot more applications in health. telehealth and telemedicine is a good example. the new roles that it can play in health delivery will change a lot of the infrastructure. in the state of south dakota, my state, we have a lot of small hospitals. they are already relying on connectivity between theirs and the larger one toss provide services. if we can ever fix the operability, that can help also. the scope of practice is going to continue to evolve.

it isn't just going to be physician driven any longer. we'll see even greater roles for nurse practitioners and other providers. even farm mists as well. i shouldn't say even. i think we ought to embrace the changes and the roles, not struggle with them as sometimes we have in the past. >> yeah. >> let me pick up on that. we do want to try in this conference to be forward looking, even though sometimes it's hard to figure out what's going on next week. specifically next week. but that's my last question. but before we get to next week, i want to talk about looking over the horizon in terms of technology breakthroughs, what thing can change the actual medical clinical outcomes or the structure of the business. what do you see as really promising coming over the horizon? >> the answer i have used several times, if you go back to 1950, all the medical knowledge in the world doubled every 50 years.

now, somebody entering medical school, by the time they're done, that medical knowledge in their field might have doubled. we're in an extraordinarily and exciting and innovative time. i am fascinated by the analytics. really we're here. there's so much opportunities. the fact that you mentioned copd. i think there's 15 million in the country that have that. if you come into the carolinas, we have 40 different variables. we can predict within 80% probability whether you will be back in a year and then we can intervene in that patient's care. i think those are the technologies as we look over the horizon that will allow us to allocate resources better. in this particular case, we have an advanced clinical team that identifies the patient, follows that patient. now we know they have 40% less

cost per episode and 15% less readmission. when i look over the horizon, i see those type of technologies really helping us in a way we can't imagine at this point. >> a couple of things come to mind. i think leveraging technology to meet patients and their care where they want to receive their care. for instance, apps, internet technology, mobile technology, reminders to take medicines, how to intervene on certain chronic conditions. doing this work at the home. that will really help us move forward. the other thing that excites me on the technology is this focus on precision medicine. for instance, not every disease manifests in every patient the same way. some depends on your genetic makeup. but i would say it is more than that. some of it depends on your socioeconomic environment. it may depend on variable

aspects to your health. being able to harness the aspects so we know we can tailor the therapy to the patient based on how that disease manifests in that individual patient. first, i think you will see more breakthroughs and further cures. hec-c. cancer moon shot. i think there's really opportunities for breakthroughs. who knows how close we are. but if i could cite two other areas where i think we have the greatest need and progress it is on pallative care and infant care and morbidity. we have challenges we haven't fully addressed. i'm excited about the progress and the kind of commitment that our country is making both in the private and public sector to addressing those better in a more successful way. >> what about on the data side, electronic health records. is that -- we put a lot of energy, a lot of money into it.

it has had unintended consequences on the pro and cons side. >> i do. we just finished our electronic method across our health system. even beyond, the regional information changes, the chesapeake region information system for our patients allows us to access data from all the hospitals in maryland so we can pick up on utilization patients. >> is it still working for you, gene? >> the hundreds of dollars on meaningful use, operability. we have 20 million transactions daily in emr daily. so that's an untapped resource

there for continue to go learn about how to make delivered care better. so i think we're -- it's a tough thing. i think health care in general has been a little bit late to the table in terms of i.t. it is a good initial effort. i don't know that we have gotten the value out of it that we will in the future. >> i don't think the government has to drive it. i think it has to be a public/private partnership if we're going to get this done right. >> one of the big decisions from a public policy point of view is figure out who makes this and once we have established ownership how is it going to be handled? if we think of as a national question, the government has to have some role in articulating what that is going to be. >> now let's turn to the enter entertainment portion of our program. we promised we would give

guidance on what to do wednesday morning, a week from today. i think it's only fair, tom, for you to start off here. please tell us what's going to happen and what we should all do about it. >> it is fair to say that the race is so close right now that both the presidential level and maybe in the senate level, i hope whoever is elected they call the leaders of the other party and say let's meet tomorrow and start talk building what we can do together. [ applause ]. >> it's really not too late. >> this guy knows how to make a deal. let's be honest. i'm joking because i have to, otherwise on i'd be crying. from a practical standpoint,

though, what are the deal making possibilities here? how does that sort itself out? where is the house? where's the senate? you know the whole scenario. give us a ray of hope here. >> well, i think first of all, in health care there's a lot of things we know we have to do. we will see the expiration of the chip program. that enjoyed broad bipartisan support. next year the community health program, community health centers. we won't see them unless we extend that. medicare extenders expire next year. we have seen enormous progress on 21st century cures. but we can pick up where we left off on that. in health alone, there's really great opportunities. as i talked to members on both sides who are not in leadership,

we ought to keep everybody's feet to the floor. right now they leave on thursday, come back tuesday and try the run the country on wednesdays. and you can't do that. a five-day workweek is the way we used to do it. i hope we go back to that. >> picking up on that there is bipartisan potential here. there are things ready -- >> there's aca and nonaca. there's just a tremendous opportunity on research, telemedicine, on heating information technology and a whole array of things that enjoy broad support. as soon as you move to aca, it becomes the polarized confro confrontational. the aca is part of that repair

job we've got to do. >> change the name too. it is radioactive, right? we need to -- >> yeah. one of the areas i think we could have across the aisle agreement on is behavior health. it passed overwhelmingly. one in four in the country are dealing with behavioral health issues. if we can take those that move health care forward, that will be an opportunity to get some collaboration. >> i know this is not your day job, but do you want to weigh in on this? >> no matter who wins the election or what changes we see on the policy front, i'm remaining very optimistic that health care will continue to evolve and continue to go down the right path. i talked to the doctors, nurses, health care providers. their hearts are in the right position. they are there to make health

care better for our patients. whoever wins or loses, i think we'll be fine. >> next president, you guys get called in thursday, not wednesday. what do you tell her or him? >> i would say bring everybody together and see what you can agree to. even if it's something small. we have to restore that civility. we have to figure out how to put the election and all the politics behind this and really try to govern for a while. i'm amazed. i have to travel internationally. and it's amazing how consumed the whole world is by what is happening here. they all want to know is this real? actually, i feel real sorry for house of cards because they couldn't make up what is happening in reality. >> yes, indeed. a couple of quick things to tell

our next president. >> i would say make sure you garner lots of feedback from providers but also other stakeholders who are engaged in the health care business. i would tell them that we have to invest in order to make these changes. it does require big time health care change requires investment. and the last thing i would tell them is it takes time. so the changes we're looking for are not done in the order of months or even a year. we need a horizon of years to really effect the kind of health care delivery system we want in our country. >> gene, last word. >> we have been talk building behavioral health. 40,000 suicides every year. how do we fix that? that should be a n noncontroversial issue. how do we engage differently with our communities? should be a noncontroversial issue. let's take the things that

aren't aca, put them on a list and get to work. >> it's not that hard, right? come on. we've got the right people. we'll figure it out. please thank our guests for these insights. [ applause ]. >> thank you. i think we can all agree that was quite a spirited conversation. and thank you all for giving us an inside peek a lot your institution as well as your thoughts on how you think the future will will shake out. we look forward to examining these in our breakout sessions tomorrow and friday. now, here with more thoughts about the evolution of health care is president of siemens north america. it helps to deliver better outcomes with greater

efficiency. we appreciate siemens health of this conference. they have been with us since day one as one of our premier supporters. so let's give a big hand to david. >> thank you. thanks much. hi, everyone. how are you? a coup of disclaimers, i didn't know about the c-span2 thing, so i didn't get my hear done. sorry for that. although i didn't have much month work with anyway. dr. ventner, i'm so glad he talked about the siemens and not just the gs. thank you. now that i got that out of the way. okay. well, it's great to be here. for those that don't know about siemens, we're a broad based diagnostic company focused primarily on images.

we're also a service provider, an i.t. provider. we're pleased to announce and we heard a lot of talk about this earlier we just formed an arrangement with ibm watson we announced two weeks ago. really want to congratulate the honor rollgratulations to all o. there is siemens equipment in every one of these, or some types of siemens solution in one of these. so hopefully in some small way we help you. it is great to partner with all of you. thank you. and congratulations. so we heard from the panel earlier a lot of things around the changes in health care. the dynamics are changing and changing quickly in the

marketplace. chronic disease burden, payments, the pressure on costs. these are things we're all dealing with, right? health systems are providing high quality, personalized care, managing risk and population health. obviously everyone is trying to do more with less, right? sounds familiar? we all have a common goal, however. that's trying better outcomes and satisfaction with your patients at a lower cost. is and we understand and appreciate that as an organization as a health care supplier. we think it is important to collaborate with health care systems to ensure that this is sustainable. so we really believe the collaboration between the two of us is important to make this happen. we're big believers in. so what i want to do is share some collaboration and partnership examples that we're doing globally to address this and help in partnering.

so there's financial partnerships we're going to share with you, operational partnerships and clinical partnerships. just a few examples to share some of the ideas around collaboration. obviously from a financial standpoint we're all constrained. hospitals and health systems, and resource are hospitals are capital constrained. we worked in partnership with health care systems to help free up capital resources so you can invest where you think is appropriate and deploy your resources where you think is necessary. just a couple brief examples of that. every hospital, most hospitals i should say in the u.s. and outside the u.s. are paid exorbitant fees on software licenses. oftentimes they aren't used, so you are stuck with the capital piece of it. we have implemented many times with our high-end software a

pay-per-use model. so pay as you go, so to speak. so you can employ the dollars in other areas, as an example. smart-based risk contracting. when hospitals employ new capital equipment, whether they buy a laboratory diagnostic system from us or mri as an example, we set key performance indexes in place. ensure we have cost savings goals in place before the equipment arrives and before the installation arrives. if these goals are not achieved in terms of cost reduction, we will share that risk with you. so this way we are tied to your success together. these are just a few examples how we try to address the cost burden from a financial perspective. we're all trying to do more with less, right? trying to increase efficiencies as a hospital system. we have come up with several different models, out-of-the-box

efficiencies. i want to show how in latin america how we did this in a novel way. in sao paulo, brazil, there is a large imaging center that has a fleet of on 67 mris. their challenge was it was really hard to find qualified technicians to run these mris efficiently and effectively. also, when they found them, they were extremely costly from a salary perspective. that was their challenge. we worked closely with them and partnered on a technology solution that we created our first remote command center so all 67 of these mris are controlled remotely, from a remote location. so obviously as you can imagine we helped with the staffing since everything is done in one location. we standardized protocols and increase throughput as well as a result of this operating model. it is the first time we did it

in sao paulo, brazil. but we wouldn't have done this without the partnership with sao paulo. it was a true win-win and partnership and collaboration too make this happen. from a clinical perspective, there is more complex procedures on the rise. whether it's orthopedic surgery, oncology, neurovascular, cardiology. and we believe technology. again, partnership with health care systems we can make these complex procedures simple. we heard dr. venter in talk building 4d echo. some outside the u.s. and some in the u.s. you're familiar with taver. now try cuspid valve repair, my troe valve repair and replacement. all the procedures are complex. although great advancements in

the field. minimally invasive. there is still a cost burden. there's an opportunity to improve outcomes and procedural time. for the first time we are crossing the chasm and partnering with your institutions and medical device companies to work on making these complex procedures simple. you saw dr. venter in talk about cardiac ct. we're working on solutions the ensure that you have the right pre-procedure planning to ensure optimal device placement. in the procedure itself to optimize interprocedure guidance. all of these require imaging. but we have to work with clinicians and medical device companies to better understand what's important, what's needed, what type of specific guidance do you need as a physician to ensure these procedures are done the right way. but more importantly, improve

outcomes, reduce costs and help with the adoption of these therapies. again, it requires collaboration between a supplier like us, a medical device company or device companies and clinicians that work in your groups. so just some examples. we're on a tight timeline so i'm fast. working together to achieve our common goal which is focused on better outcomes and satisfaction at a lower cost. i'll leave you with a quote from our founding father. ideas alone have little worth. the value of an inknee vacation lies in its practical implementation. that can be difficult, so let's collaborate and do it together. thank you, everyone. take care. [ applause ].

>> thank you again, david. it is nice to hear about so many potential partnerships. rounding out this afternoon's program is lexus nexus risk solutions. we have spare headed big duty across ava right of industries. and most recently has been overseeing the health care i.t. side. we improve outcomes by bringing evidence-based content into the care process. ladies and gentlemen, please give a big hand to lee rebus. [ applause ]. >> thank you. so i speak to you from the perspective of having spent the last 10 years at the intersection of data and technology, as you said, in several industries with the last

five years with lexus and nexus risk. most recently with elsteer which is evidence-based content. i also want to share that the first 10 years of my career i spent as an officer in the u.s. army. tanks. vehicles. nothing to do with health care. the reason i share that with you is today i'm going to show you a few examples of other industries with similar missions as my own medication, serving our nation's finest soldiers. i'll talk to you about the u.s. auto insurance industry that has a great mission of helping consumers receive fair pricing. i'll talk to you about the law enforcement industry, and tie that back to how is health care similar but different. so just a quick primer as we

like to call the five vs. let's quickly define has big data. you have heard several times today this concept of massive sets of data. clearly there is a big data problem in health care that traditional i.t. systems can't handle or is otherwise cost prohibitive. the second problem is what we call velocity. so this is the rate at which data changes in your systems. daily, hourly, by the minute. the third problem is unique to health care. it's variety. so different forms of data, not just numbers. numbers, texts, video, et cetera. can you believe the insight from that data? and the last point is value.

it is great listening to the roundtable. what value do you get from the data that comes out of your systems? so let's talk about the first example, the u.s. auto insurance industry. the primary purpose is to issue fair pricing so you the safe driver aren't subsidizing the riskier drivers in the numbers you pay. the first is there are 14 million collision claims per year. so you have the volume problem. 250 million claims over five years. you have a volume and variety problem. how do you get all the sets of data over that time period, which is the typical look-back period for an auto insurer. the data is constantly changing. i will have go over it later.

change jobs, last names, et cetera. there is more regulation regulating fair cost. the cost of repairs is rising every day. we did research and looked at the cost of a windshield. think about it today versus 10 years ago. it has a rain sensor, temperature sensor, and alarm sensor. it is called a mid-range car. the cost of a mid-range honda car is double the price that it was 10 years ago. lots of data. more regulation, costs rising. sound familiar? so let's talk about how this industry has started to solve the problem. the first and most important is by aggregating data sets. you heard one example of this exchange concept. same concept. lexus nexus 95% of all auto

transactions in one database. the second is taking demographic and event data. taking other sets not just from one company but several. a typical insurer will collect motor vehicle records from the dmv. incident data. so crash data. or look at data over time so the person who has more time with one policy is actually much less risky than someone who keeps changing policies. and then using new sources of data. so what's happening in this industry is telematics, real-time data installed in the car of your choice, the rate at which you accelerate, what time of day do you drive. all of these data points helped solve a problem of pricing risk. and back to the societal miss n

mission. issuing fair pricing to consumers. so let's talk about another industry before health care. u.s. law enforcement. find people is and solve crimes. 15, 20 years ago, they would rely on the street and static data bases to find people. today the problem is not complete solved. it is still complex. but there's some interesting things happening. 319 million people in the u.s. u.s. citizens, including nonu.s. citizens. one or two million violent crimes. the average person back to the velocity moves 11.4 times in a

lifetime. and back to this thing that is here on resources. resources deployed to different geographies. 800,000 u.s. sworn police officers. that's one police officer for 400 people. i'll add one more point. there's 18,000 law enforcement jurisdictions. i grew up in alexandria, virginia, not too far from here. if you go in a 5 to 10 mile radi radius, d.c., virginia state police, arlington. guess what, these jurisdictions if they don't have an official record, criminal record, a bad guy passing through their jurisdiction, there's no way to track this individual or reconcile the person in one jurisdiction is the same person that committed an incident in another jurisdiction. sound familiar? the problem we're solving for here. so how has this industry started

to solve the problem? the first is by using demographic skpb other sources from data bases that aggregate over time. the second is by sharing data. so i.t. companies, back to the theme of technology, are helping local law enforcement agencies share data and link data with the common identifier, the same individual in another jurisdiction to solve crimes. third, just like in health care, continue to use alternative sources of data. so in this industry, one new source of data is social media monitoring. another source is video cameras installed in many u.s. cities, biometrics and so on. one quick story, a year ago he was at the chief of police conference and sat with the captain from the stockton police department. using data and analytics, they were able to deploy their

resources at the right point in time to solve one of their major issues, gun-related crime. sit a great mission on increasing safety for everyone. so let's bring this back to health care. so let's do a quick primer on numbers that you all know. this is about the volume problem. 319 million lines. 35 million emissions. 126 million outpatient visit and 929 physician offices. this is the volume problem, variety problem, a bunch of problems baked into one. let's talk about the unique nature of health care data. problem one is the data is in multiple places. even if you have one emr, the data is in multiple place. inside the hospital. different venues of care across the continuum of care you will

have data in many, many places. the data is more complex. insurance is probably the most is simplistic example. there are different types of data. and data is not just numbers. it is also the content in your system that you use to make decisions. it is is typically not standardized in your system. or you don't have the right to extrapolate at the right time. the data is more sensitive, similar to law enforcement but different from insurance. and last, regulation is constantly changing on the use of patient data. i was very happy to hear them talk about health. one of the many ways to assess someone's likelihood of being

readmitted at any period of time or adhering to a procedural cole are stressors associated with financial distress, with support systems, even simple things like do you own a car to get to where you need to go. what we have done at lexus nexus is take the dental tkpwraeufbg data sets, combined with clinical data to do a couple core correlation. we can see on the bottom prime index. related to prescribed medication adherence adjusted for age and other factors. a second example, this is the one that's obvious.

historically we have used income and education as determinants. the likelihood of them coming into an emerging department. the third and last is the average count of new addresses in the last month sorted by age is an indicator of someone's likelihood of being readmitted. so these are just a few examples of using these data sets. there's 100 more i could chart to help predict someone's propensity to come in for treatment or be reknitted. imagine if we take these, the first speaker talking about genoni kgen genomics. so a couple closing thoughts. i've been in this industry, health care industry five years. and the previous five around big

data. i believe that leveraging data at the right time and place can drive real insight into this industry. this concept of pulled or contributed data, i'm happy i heard this today of an exchange. to me that is the future of data and health care. the third is longitudinal. demographical data over time can be highly useful in assessing someone's likelihood to adhering to protocols. and the last is use the content in your systems. the world is not perfect. there's lots of data in. but leveraging and standardized that content will lead i hope, we hope to fulfilling patient outcomes. thank you for listening. [ applause ]. >> thank you, lee. the power of data seems limitless, doesn't it?

it is good to hear it can be harnessed for improvements inpatient care. join us tomorrow morning 7:30 a.m. for breakfast right back here in this room. there will be several roundtable discussions such as managing transition to risk-based payments and effective outreach after patient discharge. your program lists the very many topics. breakout sessions are 8:45. i know it will be hard to figure out which ones you go to. so review tonight to figure out a game plan. our special key note lunchon featuring athena health and microsoft. please join all of us up in the lobby for our welcome session. thank you. and i'll see you all there. [ applause ].

supreme court justice clarence thomas will make a rare public appearance tonight at the federalist society here in washington. cameras will be there and we will bring it starting 9:00 live eastern on c-span. speaking of the supreme court, the justices heard oral arguments in discriminatory mortgage lending practices. bank of america versus miami. we will that to you friday night 8:00 eastern on c-span2. national book awards took place in new york city last night hosted by comedian larry wilmore. we will show you the even this sunday 10:00 p.m. eastern on c-span2's book tv.

as washington prepares for the start of the 115th congress in january, representatives are making their way to the capitol. we caught up with one of them recently. >> we're with congressman-elect charlie crist, a democrat who won the seat. former attorney general, former state senator, former tkpwofrp governor. are you the one in the room with the most experience in this class? i don't know. i don't think what is right is that we work together. we don't separate by democrat, republican, independent but realize we're all americans. we now have a duty to bring this country together. and people are counting on us. >> orientation on capitol hill, can you describe the feeling. is it like the first day of school? >> very much e so. it is. that's a good analogy.

you're learning where your office might be. trying to find out who your staff might be. and it's very exciting time. it really is. everything is new. >> what advice are you giving to your fellow members, dealing with the press, political pressures of being in office. >> just be yourself. be true to yourself. if you just speak from the heart, then you don't have to worry about what you're saying and you'll be fine. just be honest. >> i know your opponent, david jolly, ran on campaign finance. is that an important issue for you? is it something that you feel you can make changes on capitol hill now? >> i think it is a very important issue. overturning citizens united is something that i think is very important. corporate money in politics, we have to get that out of here. they call the house of representatives the peoples house. we have to return it to the people and make sure they are the ones who are represents and we understand they are the boss.

>> speaking of being the boss, are you prepared to be one in 435 as opposed to the boss in the state of florida? >> absolutely. i'm an old football player. i played quarterback a little bit at wake forest. it is clear that being part of a team is a lot of fun. when you're governor or chief executive, it can be a little lonely sometimes. so this is a lot of fun. i'm enjoying my new colleagues stphrfplt thank you so much for your time. >> thank you. this weekend on american history tv c-span3, saturday night 8:00 eastern on lectures and history. >> the only difference between a nazi mob hunting down jews in central europe and american mob burning black men at the stake in mississippi is one is encouraged by its national government and one is just tolerated by its national government. >> jill titus on world war ii and the impact on civil rights. then at 10:00 on reel america, a

film on the black panthers 50 years ago. >> and so it is very apparent that the police are not here for our security but the security of the business owners in the community and to see that the status quo is kept intact. >> sunday afternoon 4:30 eastern, dean snow on his findings while excavating the saratoga in new york and inspiration to his book "1777" tipping point at saratoga. >> what on earth was a little old lady doing out there? she was, at the time she died, five feet tall, 60 years old, and she was a battle casualty. what is going on here? >> and 6:00 p.m., american artifacts. >> they put you in a bolario with the wings cut. second, they give you more wing and more engine and you would literally hop on the field.

when you were ready for the big day, you talked to your instructor who was talking to you on the ground, he would pat you on the shoulder and you would get in the airplane and make your first real solo flight all by yourself. >> robert boone powell takes you to the military aviation, home to one of the largest private collections of world war i and ii aircraft to learn about aviation advances during those wars. for our complete american history tv schedule, go to c-span.org. >> 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 by your cable or satellite provider. a look now at the role ohio played in last week's voting and a discussion on upcoming house democratic leadership elections. from today's washington journal,

this is 25 minutes. >> back at our table this morning, congressman marcy, from ohio. what happened? they voted for donald trump? >> i think if you look at what happened in place like ohio, michigan, wisconsin, obviously indiana is next door to us. but we're part of the industrial heartland that has experienced deep economic transformation over the last 30 years. and washington refuses to hear our message. we aren't the coast. we aren't the south. we don't have big defense bases where the government has a major footprint. we have to make it in a free enterprise economy. the region i represent is not a capital city. and life has been tough the last

three decades because of outsourcing of our jobs. literally our workers have been forced to train their replacement workers in, for example, mexico, as their jobs are shipped down there. you can go to the industrial zones in mexico and see the jobs that used to be in ohio. but this has been happening year after year after year. the average incomes of people post nafta, post china deal, post korea, a little bit before the korean deal, is $7,000 less, less incomes in our region. and the rural areas of ohio, smaller towns have experienced deep job loss. sandusky, ohio, ticonderoga lost jobs. where? mexico city. people experienced this directly. it wasn't theoretically or some sort of possible wonk in

washington. but their lives have been transformed. as we sit here this morning, a company in my district is -- not because of replacement jobs, but they are announcing 450 layoffs. in the steel industry in lorain, ohio, and that town carried for president-elect trump, they have been pink slipped because of chinese dumped steel. we have to make our way in the real market, not the derivative market created by capital or the techie stuff on the west coast. and washington didn't hear our message. >> let's talk specifically democrats, though. hillary clinton did win your district. but there's a lot of red in the state of ohio when you look at the map from the election results. why didn't democrats connect with white working class blue collar worker? >> because of the economy. the economic message was not clear. and on the trade issue, i'm

sorry to say, that the words that were uttered in our region were -- fell far short of what they should have been. and people's economic insecurities were not addressed. and social security. the fact that people had not had colas or they were .3. >> you have to explain that. cost of living adjustment. >> seniors know what it is. >> right. >> the cost of medicine has gone up. cost of doctor bills has gone up. thank god what president obama has done, the price of gasoline has gone down. that helped to cushion somewhat people's spendable income. but the economic issues were not directly addressed. and the trade agreements, like the trans pacific partnership, trying to renegotiate nafta. in our part of the country, these are red-hot issues.

i feel we fell short. bernie sanders addressed those, though he didn't carry ohio because he didn't have the staff there. ohio is a complicated state. you have to cover many regions of ohio. he brought those issues up. but they weren't carried forward in the same way. secretary clinton tried when she came to our region. she has a wonderful proposal. what happened? what happened? why didn't she talk about what that would mean for ports, highways, water systems? i represent a region where half a million people didn't have water because of the algorithms on lake erie. don't they know who we are in the great lakes region? if you look at ohio, especially western pennsylvania, michigan, wisconsin, even minnesota was almost, you know, in the trump-elect column. >> if hillary clinton and the

democratic leadership don't know who you are, then should you have somebody who represents you in leadership? does nancy pelosi need to step down? >> our region needs to have presence in your leadership. i ran against her in the past. i wasn't successful. you learn that the coasts have enormous power, financial power. and that is felt in both parties. our current speaker, obviously he's made a fund-raising a large part of what he does. those who succeed do that. but whatever you think of the money system that needs to be reformed and completely, if you look at the democratic leadership, the great lakes industrial heartland. now leader pelosi steered me one voice from the industrial

midwest. jan what chow sky is there. our part of the country is fly-over country. if you look at the republican party, the former speaker boehner was from ohio. the current speaker is from wisconsin. it's like please pay attention, democratic party, look at what's happening here. and i hope that the future chair of our party comes from our region of the country. >> well, that could be tim ryan. there's some speculation he would challenge nancy pelosi. will he? if he does, you have signed letters in support of nancy pelosi. but if he does challenge her, deceive your vote? >> i said i would have to reconsider were someone to rise. i have done that. i know the money wall you fly into when you try to run for a leadership position in the congress. i don't come from the region who have lots of billionaires. we don't have hollywood, we

don't have the new york financial systems. congressman ryan has not officially put his hat in the ring. he perhaps might do that. but at the moment, if he's going to do it, he needs to bite the bullet. >> all right. let's get to the calls. albert in chicago. hi, albert. >> caller: good morning, ladies. please don't cut me off. i've been trying to get this out since the campaign began. this election from the very beginning never should have been about change as far as democrats are concerned. this election should have been about protecting and improving upon the achievements made by the obama administration. now in 2010, democrats stayed home to, quote, teach obama a lesson and how did that work out in flint, michigan. they did it in 2014. they lost the house and the senate planned parenthood was

protected. same thing as the health care law. now, in this election, democrats, the obama coalition, by staying home, took that veto and instead on these very things, and building upon those achievements, they gave it away to donald trump. >> let's get a response from the congresswoman. >> i think that the president worked very hard in this election to help secretary clinton. i know i went to several rallies in my own state. and i think that the -- perhaps the difference is that in many places, the obama economic improvement, and there has been improvement in ohio, no question about that, especially with the refinancing of the auto industry, but that growth, that economic growth, did not reach all regions. and as i mentioned, the pockets of unemployment and of people

being pink slipped, the cost of living versus what you're earning makes people feel very economically insecure. and i think in this election, the secretary needed to be much more forceful about how her platform would directly impact the lives of people there. and i think in our region, that message was not as clear. donald trump talked about trade in almost every speech he gave. i will be very anxious to work with the president-elect if he intends to fulfill those promises. we haven't had a balanced trade for over three decades. that has come at a heavy price in regions like i represent. i gave gretta a map here and the counties that carried for president-elect trump. if you look at that, all he see places like appalachia where it

just tanked out. but without replacement jobs, without the kind of attention that should be given to regions like that. on the chinese dump steel, what, we're going to have hearings here in washington for two years before we do something in order to stop their overleveraging of the global marketplace in steel? washington is operating too slowly to meet the reality of what workers are facing in places like mine. so i think the democratic message needed to be much chris per. for heaven sake, mike pence voted against the auto refinancing. if we didn't have that through president obama, which is paid back with interest, in indiana would be a different state. >> go ahead, jim. >> caller: thank you for taking my call. ma'am, i want to know why you

democrats won't get behind this elected president, and give him support. y'all are still crying in your beer over hillary's loss. let's get together in this country. quit dividing it. >> jim, congressman, where could you work with president-elect trump. >> as i've just said, on the trade issue which he talked about so much in our region, i welcome that opportunity. in fact, yesterday, i wrote a long memo. we are going submit it to the trump administration for consideration on the economy, on the trade issue on the patent issue. the infrastructure bill he talked about. i hope the new president comes forward initially, because he is a builder. he is a developer. his whole life he has done that. and i think he will understand the physical challenges of our water systems, our antiquated energy grid, the communities that need to have water systems

improvements. he comes from the city of robert moses, a power broker in new york, and did so many things to develop economic prowess of that state of new york. so he comes from a tradition of building. i'm hoping that that will be the first bill he comes forward with. i hope the trade appointees that he has will help us heal this trade gap that has cost millions and millions and millions of jobs in this country. so i am one of those members. he seems like a fairly collegial gentleman, and i hope that he gets to know members of congress on both sides of the aisle. >> let's go to pennsylvania, dan, kingston, pennsylvania, independent. hi, dan. >> caller: good morning. like i say, it is nice to speak with marcy here, and i would like to ask marcy and every republican that was elected and democratic elected to work with

mr. trump to help him build the in from structure as y-- infras. waterways, all kinds of things like that that need to be worked on. that will put so many people, working, poor, lower middle class people to work. it will bring taxes in, which will help the economy. there is nothing but upside to this. >> let me ask you, congresswoman. if an infrastructure bill includes in it a provision to build a wall on the southern border, do you vote yes? >> well, let's see how that wall is defined. whether it is a virtual wall, whether it is drones. let's see what it looks like. i hope he doesn't do that. i hope that he tries to limit controversy, if he wants to develop that. let him come up in a separate bill.

i hope that -- i hope he can do that. i think right now, the country wants unity. they've been through this two-year campaign season. they're tired of it. they want congress to get on its with its business. i thought supreme court justice sonia sotomyer said we can't afford for any president to fail. we have to work together. i really like that statement. >> if our viewers want to watch what the justice said, go to our website. we covered her comments the other night. beatrice, gray, georgia, democratic. >> caller: good morning. the same people calling wants to give donald trump a chance are the same ones that didn't give president obama a chance, and still don't think he is american. but any way, my comment is, i don't think the democrats did a good enough job of stressing the point to these places like michigan and ohio that donald

trump is one of the people that offshored more jobs than anybody, and he needs to bring in workers, like his mar-a-lago in florida. i don't think that was stressed. they also could have -- i don't know. republicans or who, but water problems in detroit. how the republicans or whoever holding up funds to fix this water. this is ridiculous. the water is still contaminated. >> let me ask you congresswoman. on beatrice's point, the democrats, hillary clinton, did talk about these issues. why didn't it resonate, then? >> i think because we have -- we have gone through a transformation. hillary and i are about the same age. i think because of the pace of communication today, and the use of different forms of media, when you come up with a slogan

and you're used to sound bites, and you've worked in the media as president-elect trump has, you're able to phrase things in a way that are short messages, and you make your point. hillary is highly educated. very experienced individual in terms of policy. and she is very thoughtful. she is a brilliant lawyer. and tends to expound. and somehow, and i have this challenge myself, trying to get it down to five one-syllable words. we have to work harder as a party. >> jim, republican, hi, jim. >> caller: yes, representative kaptur, in the rust belt there, manufacturing is very important. >> yes, sir. >> caller: you know co 2,

whether it is generated here or ohio or china, mexico, it doesn't care, it is going to go up in the atmosphere. i think you would agree that in the united states, when we produce colburning fossil fuels, we do much more clean than other places. so is there a way where the manufacturing jobs are lost in many ways, but some of those ways that it is lost, you know, corporate inversion, it is not strictly, you know, one thing or another, certainly not a cost of employees. i think it has to do with regulations and the taxes. is there a way where, you know, people can agree that we need to find a way to, you know, protect our environment, but even, you know, even burning fossil fuels,

if we do it here, we're doing it much more cleanly than elsewhere, where some of these manufacturing jobs are going? so regulation seems to be a very important topic that if you go to extremes, you know, on one ideology or the other, we really fail to produce what we want. thank you. >> thank you for calling in. it is complicated, sir. i serve on the energy committee, on appropriations. i feel environmental standards should be in the trade agreements. that's one of the flaws. if you have a company that's located in ohio and they throw thousands of people out of work and then they move to mexico, and they pollute down there, guess what? the trade winds carry those fumes up into the atmosphere and when it rains, comes down in the great lakes. we have evidence of that. so the -- we are on one planet. we have to take care of it. so i think environmental provisions have to be part of

any trade agreement, and for years, this has been resisted by those who have the power, the few people that write these trade agreements. i want to say a word about co2, we're thinking about how doto use i -- do it. northern ohio, this is really exciting, and they are taking the co2, filtering it and putting into greenhouses we're growing vegetables that are being sold into the economy. we have a lot of fresh water, and there are at least two companies making major investments in northern ohio. i want about 1,000 of these greenhouses, we could feed the country, or at least a big part of it, using the waste co2 from the steel and automotive plants and we have to think creativity about how do we use this power of science to help invent a new energy age and a new

agricultural race. >> where is med dino, ohio. >> i think that's shar rod brown's birthplace. >> linda is calling from there. >> caller: good morning. it is beautiful here in ohio. sunny and cold. >> haven't we had a great fall? >> caller: yeah, too long of a summer but at least it is finally starting to turn into fall, you know, with the nice leaves and stuff. hooray for fresh water. my main concern, though, at this point is trump overwhelming took this area, and i was appalled, because my county, medina is pretty democratic. we've got to pick other candidates for offices like governor. i hear mary taylor, john husted,

then we have that josh mandell, who is disgraceful as far as i'm concerned, but i don't hear of any democrats running for statewide office, and that comes up in two years. and i'm hoping maybe you would consider running, because last time, we had ed fitzgerald, who was so poorly vetted, it was embarrassing. >> what do you say, congresswoman? >> maybe i can push you in a committee for drafting thank you for calling in. yes, we do have to think about our statewide elections. ohio is a great state. i happen to think, and i'm prejudice here, but i think we have the most beautiful state seal in the whole country. if you look at every state seal, we have a beautiful state. and a powerful state. a state known for invention. here in washington, we've just taken the statue of thomas edison and installed that statue

in statuary hall, the first electronic voting machine, tallying machine, he was so far ahead of his time. i represent so many magnificent companies that have -- for solar, and we have to in ohio have lauder voices for the nature of our economy and the assets that we -- thank you for putting up the ohio seal. i think it is beautiful. and so the statewide offices are extraordinarily important in ohio, and i thank you very much for the suggestion and i will think about it. >> one voice that is talking about the ohio economy is sharod, when work loses its dignity middle class workers in ohio and the experience they've

had and warns president-elect trump and the republicans that if president trump takes the path that the republicans hope, tax cuts for the rich and easing up on wall street and voter suppression, ohio workers will feel betrayed again and they will respond. brian in michigan, independent. hi, brian. >> caller: good morning. >> where in michigan? >> caller: i'm up north on the great lakes, huron, 200 miles north of detroit. >> beautiful area. >> caller: yeah, i work down in your area a lot, merchant navy before that. going back to the '80s, we were appalled when -- it is still going on today, salt water ships entering the great lakes, which should concern you and i know you know the subject matter, but we have not solved anything. they're ruining the great lakes. this is obviously money issue, because the saltwater ships only

account for a small percentage of the commerce on the great lakes. the dominant factor of the great lakes are the lake ships that never leave the great lakes, thusly we're not going to bring in foreign matter. our great lakes are being ruined, the 11,000 thaks in michigan. we have most of the surface water beyond belief. it is ruined, because someone is getting paid off. >> all right, brian, i'm going to jump in, because the house is gaveling in early this morning at 9:00 a.m. and i want the congresswoman to respond. >> i co-chair, democratic on the task force, and congressman michaelly is on the republican side. we get along. we understand the challenges to our lakes, believe me, sir, we work very hard. right now, one of our biggest issues is the potential invasion of the asian carp into the great lakes, which would change our ecosystem completely. we're working hard to create

barriers to entry, in indiana, illinois, we're trying to find genetic answers to keep them from coming up the mississippi river into our region. it is a real serious environmental challenge, probably the largest we've faced. we've placed laws not to place that ballast into that water. i respect your service to our country. and i am one of those that hopes, that when donald trump is sworn in as president, that he will modernize the st. lawrence sea way development corporation as the entity to do that modernize our locks, like the sioux lock, and the defense as well, that we will widen the locks, that we will really turn our great lakes sea way system into the fourth seacoast of this country. he could do that for our country in his infrastructure bill. i'll be fighting hard for that. >> the house is about to gavel

in. let me ask you, because democrats, caucus is meeting behind closed doors to talk about the leadership. what message will you be saying, or what message do you think should be delivered to nancy pelosi and the other democratic leaders? >> to make leadership inclusive, regionally, and also to recognize the economic realities of different regions of this country and address those. >> if they don't? >> we have to give him a bit of time to do that. they need to restructure. they need to restructure the composition of the leadership. >> congresswoman marcy kaptur, we always appreciate your voice and you talking to our viewers. thank you very much. >> thank you very much, gretta. glad to be here. thank the viewers too. clarence thomas is scheduled to make a rare public appearance tonight at the federalist society here in washington. we'll have the cameras there and expect to bring it live starting

around 9:00 eastern on c-span. speaking of the supreme court, the justices recently heard oral argument in a case involving discriminatory lending practices. the case is bank of america versus miami. we'll bring that oral argument to you friday night at 8:00 eastern on c-span 2. the national book awards took place in new york city last night, hosted by larry wilmore. our cameras were there, and we'll show you the event this sunday at 10:00 p.m. eastern on c-span 2's book tv. freshman representatives are making their way to the capitol. we caught up with one of them recently. we're with congressman elect, 15th district, for those that aren't familiar with the 15th district, where in texas is it in. >> it begins on the border, all

the way up to san antonio. eight county district. >> a district that if president-elect trump builds the wall would be very much impacted by those efforts. can you talk about the border issues in the 15th district and what the state of the barrier and mexico and united states is right now? >> yeah, well, a wall won't work, i'll tell you that. if it did, i would be for it. we've done a good job of securing our borders. the state has done a good job, we have state troopers throughout the border region. security is much more controlled than people imagine. obviously we need to continue to improve it, and make it better. just, you know, obviously a border wall sounds good, campaign rhetoric, but in terms of reality, i would invite donald trump to come down and see things for himself, and i think he might have a different point of view. >> as a democratic, what advice are you giving to the democratic leadership and congress? specifically on the immigration and border security issue,

especially now that democrats are in the minority in both chambe chambers. >> we need to find common ground and i'm here to make america better and move the region forward. we have an immigration policy that doesn't work. the policy that is in place now has divided families. we have parents and children living in different countries, husbands and wives, it is broken families. it is not who we are as a country or region. >> what did you do before running for congress? >> practicing law for two decades in texas. i'm new to politics. >> any immigration cases you've worked on, any legal issues touch on those? >> no, my cases ended up having immigration issues, because a lot of the people who i represented him gration issues, even though i represented them on civil cases. it was always a time that you know, we couldn't get ahold of one of the family members or

relatives. many times i would have to travel across the border to get documents signed, because folks who had legal actions or, you know, beneficiaries of something in the united states couldn't come across and sign a simple document. these are folks that aren't interested in moving here, just folks that needed to come and take care of business. >> what is that process like, traveling across the border for you in your hometown? >> well, you know, traveling across the border has been a tradition for hundreds of years in texas, we do a lot of commerce, they are our largest trading partner. they are an important part of our community. i'll say this, it has become more dangerous and we need to work on that, we need to engage the government of mexico, and the border to make it safer than it has before. seven years ago, and prior, it was a lot safer than it is today. i'll concede that. but in terms of security in south texas, we're one of the safest communities in the state. i feel very comfortable there.

i think people who come down and visit will tell you the same thing. >> have you thought about your committee a in soomts in congress? >> i have. we start at the top and asking for appropriations and you know my predecessor was on financial services, which he'll leave a void after he is gone. transportation is a big issue. i'm very interested in trying to implement a fast rail from san antonio to the valley, the border area into monmouterey mexico. these are all committee assignments that i'm asking for, and hopefully we'll be fortunate to -- >> thank you so much, congressman gonzalez. >> thank you. follow the transition of government on c-span, as donald trump becomes the 45th president of the united states. and republicans maintain control of the u.s. house and senate. we'll take you to key events as they happen, without interruption. watch live on c-span.

watch on demand at c-span.org, or listen on our free c-span radio app. thank you all very much. welcome to congress. i've always been a grid of america, a student of american history. and particularly, the history of its african descendent people. >> sunday night on q & a, author quinde, flying turtles, colonial ghosts. >> my uncle formed this impression from watching cinema, westerns, where this cowboys would gather together in a bar and exchange a few words, and we never understood what they were saying, then at one point, they would stare each other down and start shooting.

my uncle formed that impression, they would shoot you if you looked them in the eye. >> sunday at 8:00 eastern. now a look at long-term peaceful uses of outer space activities. officials from the united nations and a panel of international space policy analysts gathered at the u.s. state department recently. topics included space debris, space weather and regulatory guidance for countries that operate in space. this runs just under 2:45. good morning. welcome to the state department. my name is jonathan march goal lis. i'm the deputy assistant secretary of state, in the bureau of oceans and skcientifi affairs. in the oes bureau, we advance

foreign policy goals in critical areas of environment oceans health and science. we work on climate change, including the paris agreement and the recently negotiated hfc agreement under the montreal protoc protocol. we work on ocean and fishery issues, including the major ocean c ocean conference under secretary kerry. we work on zika outbreak, global health security, which seeks to enhance global preparedness and response to the threats of infectious disease. and of course, today, we're here to talk about space sustainability. for many of you in the audience, this will be your first introduction to the issue of sustaining the outer space environment. and for others today, it will be an opportunity to learn more about the ongoing effort business the united states, by other countries, and by the united nations to preserve the outer space environment. by the end of today, we hope

that one thing will be clear. with the increased use of and reliance on space, preserving the outer space environment for current and future generations is in everyone's best interest. that's true whether you're here representing a government, a business, ngo or just yourself. one of the places we work on these issues is through the un's committee on peaceful outter space. we're thankful today that mr. peter martinez, who chairs the group has traveled from cape town, south africa to share his important insights on this important work. we've grateful we have as well, ms. simonetta di pep pip poe. thank you all for coming. in june of this past year, the

u.n. committee on peaceful uses of outer space agreed to 12 long-term sustainability guidelines. we call them the lts guidelines. they represent the first of agreed best practices for safe and responsible use of space. this is work that started under the united nations in 2009 and a major milestone going forward after seven years of concerted effort. the united states believes that this agreement is a significant accomplishment, a major step forward in international cooperation in preserving. the guidelines set global norms that will maintain the space environment so future generations can get tr transformation, as well as strength and security. additionally, with the increase of private investment in space, it has become even more

important to provide a stable framework. these guidelines have best practices, including sharing of information forei enhanced spac weather monitoring and investigating new measures to long-term space debris. we appreciate the constructive efforts within the committee to ensure this first set of lts guidelines were completed prior to the expiration of the working groups, work plan in 2016. we also look forward to continuing the work to develop additional lts guidelines over the next two years. on the national level, many countries have started looking at how they can best implement these first sets of guidelines. we believe that this action taken by nation states, by member states, is an important benefit of the lts guidelines. i can provide a first hand report on how this is going. just yesterday, we held our

second bilateral civil space dialogue with china, and discussed these very issues, and some of our colleagues are here today with us from that discussion. we'll hear more from governmental issues, from private sector space experts on how the lts guidelines were developed, and their importance moving forward. one of the main themes you'll here today is the importance of international cooperation in ensuring the outer space development. copous, tackling the challenge of preserving the outter space environment. today, we've got a panel to speak to you about this. united nations expert will discuss the process by which the first set of lts guidelines were developed and next steps in developing additional guidelines. in the second panel this morning, we'll hear from government experts from across sector of regional groups on their efforts to implement the

first set of guidelines and their commitment to developing additional guidelines through copous. the third plan will consist of private stakeholders. we look forward to hearing more about their experience, and how they intend to advance and engage with copous as we move forward. finally today, we will hear from a number of individuals regarding next steps in developing a seconds set of guidelines, with the goal of creating a compendium of lts guidelines to be endorsed by the general assembly, u.n. general assembly in 2018. on behalf of the state department, let me use this opportunity to thank you all for joining us here today and thank you for them for coming to speak to us. the importance of space sustainability for the benefit of all mankind and the reasons we should work together to address this challenge. before i close, let me personally thank michael simpson

and victoria sampson, both of the secure world foundation. what you're seeing today is the work of not only the state department, but ngos and others that have brought this discussion format in an open forum and we rely on organizations like the secure world foundation to make this possible. let me welcome to the podium here, michael simpson, the executive director of the secure world foundation. thank you. [ applause ] well, for those many of you whose faces are very familiar from several acts of cooperation and consultation and collaboration in the field of space sustainability, secure world foundation probably doesn't need much introduction. for the rest, simply be aware that we have for years described

our work as seeking cooperative solutions for space sustainability. and so here we are, celebrating space sustainability, advocating increased cooperation, and enjoying the presence of so many people with whom we have cooperated along the way to make this -- to make this day possible. in some ways, i'm welcoming you to a celebration. six hard years of work has brought us 12 guidelines to support the long-term sustainability of space activities. guidelines remember that have been adopted among country whieo have not found consensus easy to achieve. from practical aftfirmations, te

sharing of critical data about satellites, debris, and weather. we have coaxed progress out of what looked at times like baren soil. to add to the celebration, we are hearing encouraging reports from the intercessional work that the copous group on long-term sustainability of space activities has been und undertaking since its success last june. these reports fuel hopes that further consensus will bring more agreed guidelines to the table next year. but of course, i also welcome you to an event that includes lunch. and it is those of us who were thrust by great writers, like

a arthur c clark, the space sector, know too well, there is no such as a "free lunch." in fact, today's program will attest, there is much work to be done. whether you see the guidelines as soft law or no law at all, they will still have to stand the same test as hard law or sound policy. they will need to impact behavior. as we review the track that brought us here, and chart the course to come, i hope we can bear in mind that the way forward will pass through the seminal work of uni space plus 50, and will carry the weight and aspiration of other broad agreements, like the sustainable development goals. the sendai accord, and cop21.

so as we get back to the hard work so many of us in this room are used to sharing together, i still invite you to think of that work as a celebration. knowing that having kept alive the principle of using space for peaceful purposes, we now get to show how together we can focus those purposes on meeting the greatest challenges of the one planet we all share. so to paraphrase our late departed mr. spock, celebrate. work hard. prosper. thank you. [ applause ]

good morning, everyone. my name is victoria sampson, i would like to add my thanks and appreciation for everyone in the audience for coming and to our speaker force sharing their expertise with us. with that, enough of the welcomes, let's get the speakers up here. could the first panelist come up, please. you should have everyone's files in front of you.

we'll start with the first speaker, simonetta di pippo. i'm very pleased to be here with you today. let me thank the organizers for arranging this timely event on the important topics of space sustainability. i would like also to take this opportunity to acknowledge recent success story about the long-term sustainability of outer space activities. as has already been stated and as my colleague will elaborate in more detail, in june 2016, the committee on the peaceful use of outer space reach aid milestone, when it agreed to a first set of guidelines for the long-term sustainability of outer space activities. this concrete output demonstrates a collective recognition by states that space is a key resource for the

benefit of human kind. the measures that could enhance sustainability and space environment for current and future generations are in the common interest. the first set of guidelines was not, however, developed without genuine effort on the part of many stakeholders. in this regard, i would like to express my admiration for all delegations who participated in the process so far. and i woulds pe especially like thank peter martinez for his outstanding role in bringing tell gatio delegations together, and david kendall for his skillful adoption in june. continued collaboration between all interested parties will be a key importance as the working group of outter space develops a

second set of guidelines, and finally, a full come pen dumb of guidelines, to be referred to the general assembly in 2018. dear colleagues, let me address interconnection and the strategic work to be undertaken under the 50th anniversary of the first uni space conference, uni space plus 50 to take place in june 2018. endorsing a set of priorities, which together constitute the common road toward uni space plus 50 and beyond. number one, global partnership in space inspiration and innovation. number two, legal regime and global space current and future perspectives. number three.