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it tells how much support there was for enrollment assistance. there may be a time and this is where we are coming at with this paper that we wrote, there may be a time to be thinking about

something broader than just fixing the affordable care act. so we have presented what we are calling -- because we couldn't think of a better name, the healthy america program. we are happy this program have another name if anyone would like. it is really a comprehensive reform that would getse tore universal coverage. we think i would increase cost containment while really limiting the disruption of a medicare for all type approach and not lead to huge increases in government spending. we built on aspects of medicare advantage program and the affordable care act marketplaces. one of the things that we did seems a little bit probably

contin controversial is we would bring medicaid acute care and chip into the nongroup market. so they would all- so current medicaid beneficiaries and people currently purchasing in the nongroup market would all be choosing from the same set of plans. we would not do anything to the employer market even though i rally understand all of the problems with the tax exclus of employer contributions. i'm not a fan of them. we would leave that aside and ave a i is also. so our idea is to develop sort of a medicare advantage style marketplace with a public plan that would be fee for service just like traditionaled

but also have private insurer options as you have in medicare advantage. we would cap medicare provider payment rates within that marketplace ated rates. so both side and out of networks, that's all that could be -- that's all that providers would receive. we could include premium and cost sharing. now that's big concern about if you're not eligible you're exposed to really hig premium. we would go up the income distribution as far as you want. no one would have to pay more th an 8.5%. we wouldrobably keep the individual mandate. instead of having a tax penalty we would probably have it more as some of the expansion of the

standard deduction would be at risk if you remained uninsured. we would have a very large marketplace. we would have 117 million people in the marketplace. so insurers would see a large group of people and participate in the program. about 69 million would be former m medicaid. ther would be someeople cong from we would allow people feceven i they are under the affordable

care act to move into the marketplace. there would not be a fire wall and continuing to nongroup coverage. we think federal costs would increase. employers would save money and households would save money and expansion of medicar rates, providers might lose a little bit relative to the current marketplace rates but that would be offset by increases in payment rates for all of the medicaid people that would be going into these new plans. wil

bright news building. >> that's extremely depressing, steve. >>. >> they sell the sizzle but there is no steak. if you can't make the current system work then throwing another 100 million people into the system, it's not a little knick. it's a big knick.

and so really this kind of a proposal which i agree with you thought out politically than most of the other medicare for all ideas. nonetheless you're talkingbout a politically important but economically important and in terms of health care extremely

important the fact is you have to start where you are. it is a very different world than where you are suggesting. >> i had one question about provider payment. i think that providers would like to tell you or like to convince payerst t way they are structured in terms of their cos and expenses is something that immutable. >> this is something that it was a comment before about some of the productivity incentives are not really likely to be reflect gains that are possible. i think these i alms a sort of a nice way of saying we are

putting pressure on provide ergs to change the way they d bu soenow whee look at international health care and spending in other countries that prices, the high prices in the u.s. system are at the heart of the high spending we are having. we are not willing to take that on. we are not going to solve the spending problem.

you mentioned the exclusion. i always felt if all of those ys actlly get together and agree to take that on that we would actually be far ahead of where we a now. i remember talking ryeinhart tht said it was the most aggressive agenda ever offered during that period of time during the rlly 90s.

the thing is that, you know, the power of, you know, organized opposition to this kind of a change has created i think an awful lot of problems tohe point where we ended up with the affordable care act largely because people who lost their jobs did not have health insurance. they had to buy the health insurance. it was after -- you buy health insurance. if you it you could pay be 25n and 60% more. place somewhere -- sounds t like west side story. there's place us.

don't know what the current i estimate is b my guess is more than 70% of health care spending is labor. d so if you're cutting prider revenue you're cutting peoples wages. i'm reminded of what a per of mine that had started said.

in capitation they are cost centers. it explains a lot of behaviors. it requires inkre mental improvements. just to conclude, i remember running health care in san diego in the mid-90s which had the distungs of tdi distinction of the lowest capitation rates. the market had changed very

dramatically. every friday afternoon they reviewed every single referral that went outside of his group. they are a lot than medicaid rat et that roughly offsetting is an interesting question. i think you and your colleagues have done impressive work in that. this is a very tough issue. it comes back to be careful what you wish for. if you don't have the price right people figure out how to give system to their advantage.

>> so many of the changes that could be considered, you know, are no doubt -- and this is -- we all understand that health care is complicated. if you talk about ideas such as a defined contribution let's say going in the direction of premium support in health care the issues around risk adjustments will ore portant in that kind of a situation. then traditional medicare would end up being risk adjusted. if you talk about raising the age of eligibility for medicare then you to think about what is the implications to that assuming it stays in pl so that's lot of domino effects there that happen. >> yeah. but look. we did a lot of price regulation beginninge 1980s. we adopted that. it was designed if i recall

correctly, we didhat in the reagan administration. the idea was to introduce some kind of market discipline in the hospital pricing. all of the good intention wer there to restrain the growth of these prices. you'll recall that the carter administration was talking about hospital cost containment. it didn't go any where the point is when we did that one of the first big effects was a massive cost shift from in patient to out patient. we had -- they pressed down balloon and we found ourselves with an explosion of out patient costs. it was not surprising throughout the rest of the 1980s that the actuaries and reagan administration were basically sweating blood over the question of what we are going to do about the explosion in part b and we

ended up creating this resourced relative value scale that looks like it was imported out of east germany. we imposed that on the system in 19 a lot of folks were looking back at that and saying really there's -- the bloas basically faded on that rose. we are back to this whole idea of trying to redo physician payment again and we have something that looks like it is collapsing. it is the medicare payment prm that was enact today the point where the proposal and they say we should get rid of it. you know this whole idea we are going to set the right pri seem t me to be the problem. i don't think we can design the right price for all of these

complex procedures. there is of course the market. we haven't had market in a long time in health care. we may not getne should intensify and create a market and establish some kind of a level playing fld >> mymentould be i tak a different lesson. >> this require lats l less of

history. the kinds of policies that the general ner immedicare for a people talk aut sit moving out of the hospital and having people go to the proper site of service at the proper level of care is a good thing. m how do you that is the problem. by the same token, the trustees report also has the same

character. it is an explanation. so you're not going to find the y thing you already knew 20 years ago. that's not a bad thing. that's lot more work to do in policy. can we have a question from the audience in hi. i had an argument that 2 to 3 mel people would age into medicare for the rest of the century. so i talk today former ak wares.

nry was right. i was wrong. my numbers were too low, not too high. we are already at 3 million people ageing per year and actually we are not at 10,000 a day. it doesn't happen until 2019. for the boomer generation the average is 10,000 a day. they overtake the agents toward the mid-ofl century. because of increase in deaths it

will effect the market for funerals, that sort ofthing. in the 2020s because of increase in death and assuming one-thirdover deaths occur in hospitals which is historical average the number of people dying inri p ye will go back to more tn a million per year. it hasn't been that high since 1982. hospital finances are going to be effected because all of people will be in their last year of life. many of them will be in hospitals. my recollection is it used to be 46% of hospital revenuecame

from cos. itould go to 60 or more. i suspect it will have an effect on him. it will stir up things. >> rig. >> ctainly true. i think i detected investment advice. >> yeah. >> but more broadly what you're saying is that the whole nature of the health care system will have to change.

>> i think we all have to worry about the explosion of hospital costs. as we all know health care is complicatend lot of different things can happen. there is a gener d dissatisfaction with end of life care. you ask people what would you prefer? people say well, i would like to die at home. i would like to be sure that i'm comfortable, my family is around and i have the opportunity die

at home like our grandparents did routinely. a large number of people are starting to take advantage of that. i think as far a public policy is concerned one thing that we certainly can do in medicare is to encourage a new benefit not necessarily hospice that would guarantee people an option to take advantage of the services that a now in medicare part a and medicare partb. it is very fragmented care. it is very sj.

if we created such benefit we would have a differentare delivery for the massive number of baby boomers were wlo are going to be verydisappointed to find out that they too are going die. , we could probably actually reduce costs. >> right. that's the critical thing. >> adding a new benefit isn't necessarily the answer to anything unless there is a shift towards a more we official shent. >> ght. 25% of the total cost. we have to stop now because of our other viewers outside the room. so please join me in thanking the panel for an insting discussion. [ applause ]

sunday on q and a film makers discuss their documentary hit and stay, a history of faith and resistance about the actions of the catholic activists that protested the vietnam war. >> so here were miit was sort

of a turning point. >> their action didn't techb cement war. i don't see how can hp. >> we are live on capitol hill this morning. more than 200 amendments have been filed. committee chair pat roberts released the thousand page bipartisan bill on june 8th. it does not effect food stamps. it includes income verification

and could keep current work require ms and. total benefits exceeded $63 billion and went out to more than 43 par it pants.