our series on health care continues from the virginia hospital center at 9:00 eastern with rabin at norman, their chief financial officer. "washington journal"is now next. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] .

host: "to the washington post" front page is where we find the story. the afghan situation is labeled as serious. she writes -- host: other stories talking

about this report may lead the way for more troops. we want to ask you if that might be possible. the numbers will be on your screen. we will take those calls momentarily. as we do, to give a perspective of what is going on there, aunohita mojumdar -- afghanistan correspondent for christian science monitor. the stories talk about the training of afghan security forces and police forces. can you give us a sense of their readiness to provide stability in the region? guest: the national police have been one of the most neglected sectors of the reconstruction in afghanistan. the army needs a little more

help, especially from the u.s. government. they are extremely under resourced. it has been increasing, but so has the violence and the insurgency. host: is this a manpower problem, or is this a weapons problem, or is a combination of several factors? guest: i think it is a combination of several factors. there has been no regular army in this country for many years. everything is being built from scratch. they're short of resources in terms of equipment as well. the major problem is also in the military strategy. that has become an extremely under question over the past few months. general mcchrystal has provided

his review to washington on what he thinks is the best way forward. host: what is the current strategy? what could be improved upon given the general report? guest: we do not have the details of the general's report. general mcchrystal has been stressing not to approach the insurgency as an issue of body count. one of the recent statements he made -- if you killed 10 militants, that does not leave you with 8 militants. it is welcomed that the american military has stopped looking at this as an issue of body count.

he has stressed the need of protecting civilian opposition. that should be made a priority of the u.s. forces, as well as nato. he has been here just a little over two months now. there's a lot of talk of integrating the military. a lot of humanitarian and aid agencies are stunned. there is this distinction between the civilian and military. host: is the concentration of violence in the helmand province? are there other areas affected? guest: the provinces in the south are extremely affected by insurgency but over the past few months, the violence has spread.

it has gone to the neighboring provinces as well. these areas of the country that were earlier stable, like the center provinces, and the provinces in the north, we now see sporadic violence. in the north, there has been repeated insurgent violence in the past month. the previously stable area it is now experiencing the violence. host: the concerns about the results of the afghan election. reports here say that president karzai still remains in the lead. what do think this will do as far as stability in the region? guest: we do not have any official figures.

it has been more than a week. we still do not know how many afghans voted. as we wait, there are reports of fraud in some parts of the country. it is a bit of a state of limbo. people are getting angry. it does not look like is being addressed. we have to see whether they can actually deal with this. my concern is if these allegations are not addressed, any government that emerges will emerge from this. -- with reduced legitimacy. host: is there anything else you think is important for our viewers to understand?

guest: there's a lot of emphasis on the fighting and the military strategy. i think the aspect of aid and the humanitarian needs of afghanistan are being neglected enormously. everybody talks about the corruption and how difficult it is to provide services. our longstanding humanitarian aid agencies have been working in this area for years. they will tell you that they are not getting of the funny. their funding is increasingly getting cut. -- they will tell you that they're not getting any funding. the number of afghans below the minimum level has decreased over the last couple of years. it is quite a shocking number. host: aunohita mojumdar, afghanistan correspondent for

christian science monitor. you can see her work on their website. thank you for your time. guest: thank you very much. host: as the papers talk about afghanistan, one of the things that does come up is more troops assigned from the united states. we want to ask you if the president should consider bringing more troops to the region. you can call on the three phone lines. from florida on the democrats' line, good morning. caller: i do not think the president should send any more troops over there. the people over there have been fighting for so long. i think this war is not winnable. i think the troops are untrained wilable.

i do not think we can win this war. it is time for our military to come home. host: wisconsin is next on the independent line. caller: i keep hearing reports on mercenaries fighting a huge percentage of the war. mercenaries fighting over there. blackwater and other such troops are fighting our battles. if we were to get a true picture of the level of troops we are paying for in afghanistan and saw the actual number of troops we're fighting, i may or may not back farthefurther u.s. troops. i want to give a truer picture of what is calling on -- of what is going on. host: camden, tenn. on the republican line.

caller: i think obama sent in 21,000 extra troops this month. this month has been the deadliest month since the whole eight years of this war. no. i think they need to get out. i think they need to get out of their. -- i think they need to get out of there. i do not know what is remaining for them to even be over there. i do not agree with it. thank you. host: democrats line, tenn. caller: the day we took els saddam's regime out, and pakistan expected us to do what we did. we lost secular iraq to the

islamists. we failed to get bin laden and failed to get the taliban leadership. it is just a matter of time. host: this is from "the washington times" this morning. this is from bruce ridel, who headed the administration's afghanistan-pakistan review. host: he also has an op-ed on this very topic of afghanistan. this is also from "to the washington times" this morning.

host: just a couple comments this morning as we ask you about the possibility of more troops for afghanistan and if the administration should consider this. we have a tweet.

oklahoma, bill on the independent line. caller: yes, i would like to mention that obama won the election. the promise was that he would bring the troops home. now they're talking about building up more troops. we have had several million criminals cross our borders. we need our troops here protecting our own land. we need to stop policing europe and the far east. we need to take care of our own country and stop all this nonsense. our country is losing our jobs. we're losing all of our finances. and even credibility among other nations by getting into other people's business continually.

host: chicago, illinois on the republicans line. caller: thank you to everybody that is working this morning. i really enjoy c-span. i want to concur with everyone else who has said that this is spiraling out of control. i think "the new york times" released some information that the white house has decided to focus its attention on civil rights issues and so forth. the afghanistan war is probably going to do the same thing that the russian war against afghanistan did. one collard previously indicated -- one caller stated that these military cannot be trained. i believe that's true. they believe in chopping the heads of the people and doing atrocious things.

sometimes people say it is just young soldiers. it is soldiers of all ages that are losing their lives. once again, the united states is not showing a clear vision. what is our purpose right now? host: the caller did mention "the new york times" this morning. the from the store looking at the justice department and the shift to civil rights. he says that as part of the ships, the obama administration is planning a major revival of high impact civil-rights enforcement against policies, in areas ranging from housing to hiring. host: it goes on to talk about this story.

host: back to the topic of afghanistan. georgia on the democrats' line. caller: good morning. i think the president needs to pull out the troops. i agree with everyone else that we need to fight what we have over here in the united states instead of being a big bully somewhere else.

it's like we're fighting a war that we cannot win. we're not going to win. even if we do pullout, even when we do pull up, they're still going to fight over there. the president can just take care of his home and what is over here rather than what is going on over there. that's about it. host: the longtime republican from wisconsin will undergo radiation treatment for prostate cancer. host: new york city, independent line. caller: thank you for c-span. i'm in agreement with most of the callers this morning. we should get out of the board.

they should be left alone. they can fight forever. i do not think the united states will be unable to keep up with that. we should bring our troops home and we should use our money here to take care of this country. we would be fined if we could leave everybody else alone. host: honor democrats line, walter from florida. caller: we should honor the request of the gentleman. we have them over there in afghanistan. if you want the troops to be there, you need to support the general's request. host: "washington times" this morning about climate change legislation to the headline says it has been postponed again.

host: and still, alabama on the independent line. we're asking if the obama administration should consider more troops for afghanistan. caller: i think that the bush administration [inaudible] i think that 20 escalatwhen youe the troops, he will run into problems. that is just the way the war is. host: let me stop you there because the connection that we

have is breaking up. new jersey on the republican line. caller: yes, i think obama should put more troops in. we owe it to afghanistan to rebuild that country after all those years so maybe we can support an ally of ours on the war on terror. on 9/11, it was their headquarters. we were able to get them out of there. i think the fact is that we should not pull out. we should have a draft. we should have more people come in and try to stabilize that country. host: a conservative columnist this morning writes about this topic in "the washington post." he says u.s. forces are being increased, bringing the coalition total to 110,000.

host: new jersey on the democrats' line. caller: thank you for c-span and thank you for allowing me to speak on this. here is my position. i think we should pull out of afghanistan.

if america was fighting the mexicans, or if americans were fighting the canadians, i think we would be fighting for a particular people. this taliban regime is more like an idea made up of several different types of people from different countries. we do not have a war in afghanistan. if he is afghanistan people were hurting us that is not the case. the war in afghanistan is a myth. we're over there trying to fight an idea that happens to be located in the country called afghanistan. host: los angeles, california. james on the independent line. caller: we're in afghanistan because of israel. we were attacked on 9/11 because of our support for israel's brutally treating palestinians.

i am in california. the fires are burning like crazy. we do not have the money to fight them. here we are with legions overseas in afghanistan and iraq. host: john on the republican line. my response to the woman who asked a question rhetorically about whether it was about life. it is about money. my prediction is when they come back from break, he will vote for the health-care. and it will break this country. the polls -- most of the soldiers over there are conservatives. host: does that factor in? how does that factor into the discussions? caller: i believe he will keep

sending troops to a afghanistan because he is not concerned about lives. they're expendable to him. you have elected a monster for president. host: from twitter this morning -- host: guesttexas, dorothy on the democrats' line. caller: thank you for c-span, the only channel that you really get the truth. i grew up in world war ii in germany. america, france, and russia had

a particular enemy. we do not have a particular enemy in afghanistan. first, you cannot win against a mountain people. imagine yourself going into switzerland and trying to fight the swiss. impossible. also, yugoslavia. the germans and russians respected him because it was impossible to fight this man. it is impossible to fight mountain people and people who can run across the border. imagine yourself if the germans could have ran every time across to switzerland, france, in spain. that war would have gone on for another five years. host: "usa today" this morning on a domestic story that the president wants a 2% cap on federal cost-of-living raises.

this is richard wolf this morning. host:. host: one more call on this, fairfax, va. caller: good morning. i called because i disagree with what most of the callers

are talking about today. two simple reasons why we are in afghanistanone i. one is the pakistan the holding the islamic bomb. if we get out of afghanistan, the kids in this country will not be safe. çó==two, afghanistan does not d more troops. itñneeds a legitimate government. unfortunately, the iñir --ñrçó leaving and scan thexdçói -- it is no need to even talk about leaving afghanistan. host: coming up on this program,

we will take a look at our continuing series looking at hospitals and how they deal with everyday issues. you'll hear from two guests. in the second segment, we will talk about the security of online health records. in a little bit, william mcgurn will talk to us. next, we will talk to michael wilson, americans for democratic action, national director. we will talk about democrats and the fall agenda, as well as the legislative agenda. we will be right back. >> as the debate over health care continues, c-span's healthcare hub is a key resource. wash the latest events, including town hall meetings, and sharing your thoughts on the issue with your own citizen

videos. and there's more at c-span.org/ healthcare. >> c-span's original documentary on the nation's highest court. here's some of what you will see. >> mr. chief justice and make it please the court, the government concedes that the destruction of documents in anticipation of a proceeding was not a crime in the fall of 2001. >> something different is going on here than what goes on in the capitol building or in the white house. we need to appreciate how important it is to our system of government. >> this is the highest court in the land. the framers created it after studying the great history, and taking a look at what they thought worldwide was important.

>> i put in as much blood sweat and tears on little cases as i do in the big ones. we do not decide who wins. we decide who wins based on a lot of people have adopted. >> if four of the nine of us want to hear any of these cases, we'll hear it. we're here to decide things. >> why is it that we have an elegant, astonishingly beautiful structure? it is to remind us that we have an important function. and to remind the public of the importance of the centrality of the law. >> i think the danger is sometimes you get into a building like this and you think it is all about you.

that is something that i do not think works well with this job. >> supreme court week, starting october 4 on c-span. >> "washington journal" continues. host: joining us is michael wilson, americans for democratic action, national director. what is this group? guest: the historic liberal advocacy group, founded by eleanor roosevelt. we have supported liberal and progressive candidates. host: what kind of activities do you involve yourself with, and what is your main focus these days? guest: we have members in every state of the country. we have thousands of members around the country. they advocate for health care reform. they advocate for peace and

justice issues. they advocate for economic justice issues. they advocate for average, working folks around the country. more recently, we have had a focus on two major areas. one is unemployment because the unemployment rate continues to rise and millions are out of work. secondly, marriage equality. host: you talked about historical background. what does the word progressive mean to you these days, especially with this administration? guest: for us it means to fight for the things that matter most for most working americans. whether it is having a job, being able to protect your family, being able to earn income, having health care, and being able to live the bill of rights and the constitution the way our founders meant. host: in the front page of "the new york times" there's a story looking at eric colder

expanding efforts -- eric holder expanding efforts. what does this mean for your cause? guest: foreign longtime, we have had a drawback of civil rights -- for a long time. we know there is still discrimination in the workplace and in housing and a lot of different ways. the best way to prevent that is real enforcement of the federal level. we lost that effort by the attorney general. host: what happened during the bush administration? guest: it was more trying to get along with the folks. there was not as much stricter enforcement there is an effort here to talk about enforcement in a way that we can prevent that going forward. host: what does enforcement look like to you? what kind of activities need to take place to make this effective? guest: it is a case of doing the walk and doing the top. -- the talk.

i think there are those who may have gotten away with things in the past, and they may change their behavior. this will be a welcome step for those who follow the law and done the right thing. host: our guest with us this morning, if you want to ask about his organization, it is -- democrats, 202-737-0002. republicans, 202-737-0001. independents, 202-628-0205. you can also send us an e-mail and twitter. there's a chart this morning by an organization looking at midterm elections. specifically looking at democrats. according to analysts, democrats

could lose 20 or more house seats in the congressional elections. this is connected to a story this morning looking at health care issues and especially talking about what has been going on in town hall meetings. what do you think it has done for the democratic party? what do you think the political ramifications are? guest: i think this shows that the original strategy that the president put forward was the right one. that is to do health care in a broad, progressive, strong way, want to do it in a timely manner, and to try to pass health care and to move it forward this year. not to rush it through. we have dealt with health care issues in the congress for years, for decades. there's a clear plan and strategy to move forward. the tactics by some in the congress have left that to the point where people now have this

information -- disinformation. there's an opportunity for congress to move forward and put some truth into this about what health care reform is, and to move forward in a progressive way to get this done. without doing health care, i think democrats will get in trouble. host: does that strategy need to include the public option? guest: i think it does. we have historically supported the single payer. i think it has to include in public option for all the reasons the president has said. you want to include everybody. you want to bring down costs for everyone. and you want to make sure we of quality health care for everyone. the public option helps bring those schools to fruition -- brings those goals to fruition.

from everything i've heard the president say, it is clear that is a strategy in his mind. i think the challenge is to try to do the best we can in the senate so that when there is a senate-house conference, we can have a proposal that really is the best we can get. host: what does the recruiting strategy look like in your mind when legislators return to the house? guest: it is less a recruiting strategy than it is to continue the strategy they were on. the house needs to move forward. we need to be able to pass the bill out of the house in short order so we can have them move forward. the senate will have to make a decision. the senate is the place where we have the strategic question. it is a question about republican leadership, about whether they want to work with democrats to move health care reform, or if they want to stop health care reform. in which case the democrats will have to decide whether they want to use the reconciliation rules

to move forward without them. host: do you think they will? guest: i hope they keep that strategy a life. it may be the only way to move forward, unless republican senators are willing to be a part of this. host: who are the key people as far as republicans are concerned that they need to engage? guest: they have had conversations with senator grassley and senator snowe. they need to engage as many republicans as they can engage. at the end of the day, if they are not willing to engage, and there's not to be bipartisan cooperation, then democrats will have to move forward and figure out how to do this anyway. host: portland, ore., our line for democrats. you are on with michael wilson,

americans for democratic action, national director. caller: if obama uses reconciliation and it does not turnout because elections are coming around the corner -- will that do his presidency if health care does not go as planned? nothing works perfect, even in washington. guest: nothing works perfect anytime you of humans involved. the president's leadership has been clear all along. the pressure is really on the congress at this point. the president has laid out a plan. he has laid out his goals. congress has the responsibility to step up to the table. the reason they have to consider reconciliation as a possibility is because the congress is not of one mind.

you have 535 members who will both and make decisions. target clearly in the senate, where you have 40 republican senators, some of whom may be willing to engage, most of whom are not, we have to ask how we move forward. reconciliation is one of the things we have to consider, but it is not the only way. there have been long discussions of a bipartisan solution. the elections will take care of themselves. for democrats, they have to get health care done and they have to get it done in a meaningful way. host: you talked about taking time of making sure it's done right. does this have to be done this year? guest: i think it does have to be done this year. given what you saw in august with people very upset about things that were not true, and misinformation campaign, i think it is important for the country that we get this done this year.

not only for the people who do not have health care, for the budget, and for all the reasons this country needs to move forward. we need to move healthcare forward in 2009. host: talk about that effort without senator kennedy. guest: he was a champion for health care and many of the things that ada stood for. we will miss his leadership and his ability to work across the aisle. there's no replacing senator kennedy. that said, there remain 99 senators who were elected to do this job. we're calling them to move forward. the senate has to move forward. host: is your organization will be meeting? guest: we have been meeting with elected officials all around the country.

we have talked about the importance of doing health care now, about the importance of doing healthcare the right way. you cannot just do anything and call it health care reform. you need to a serious, substantive, robust health care reform. deal with cost and access and the problem of universality. host: next call is new jersey on the independent line. caller: thank you for taking my call. i'm calling about the issue of education. i have not heard any mention of that yet. i wonder what your guest sees coming down the pike in terms of the child left behind. it may take a backseat to health care right now in terms of people's thinking. what we have seen happening since duncan was appointed seems to be a continuation of the

strategies he used in chicago. it concerns me a lot as an urban school teacher here in new jersey. it is framed as a civil rights issue as a matter of fact. you hear that a lot, that school reform is really a civil-rights issue now. what they seem to be doing is pursuing closing schools and privatizing education. i am wondering where the profits in in terms of where you see the democrats going -- i am wondering where you see that fitting in. guest: as you know as a schoolteacher, much education ipolicy has been at the state ad local levels. i would agree it is not specifically a civil rights issue. i would have concerns about privatization. there are a lot of things that need to be done on the education

level. people need to reconsider the child left behind. i know congressman miller has concerns about that. i know congress will look at that. it is not exclusively for the obama administration to make the decisions about this. i am hopeful that thoughtful governors and local school boards will work on this. those are the folks who are closest to schools and school students. and the way the education system works. host: on the independent mind, santa barbara. caller: hell? host: g -- caller: hello? host: go ahead. caller: i am republican, not independent.

that is what i told the screener. i was very proud of that united states finally selected a b lack president. i'm a little confused why the justice department feels the need to resurrect the old problems of discrimination. and go forward -- we need to take advantage of the gains we have made rather than go backwards and resurrect racism and discrimination. i'm wondering what you think about that. guest: i think you're right. we were all proud of that we elected the first african- american president in our history.

i think that says something about him and about the people of this country. not only did we elect the first african american president, we also elected a democratic president. his administration is going to be a little bit different than the bush administration. looking forward, not just backwards, but forwards -- we want to make sure we have equal opportunity for everyone. there are still problems. there are still vestiges of discrimination. there are still vestiges of things our country would not like to have. despite that election, we need to keep moving forward in lots of ways. what the justice department is doing is not looking backward, but looking forward. host: this is the headline from "the new york times" this morning. as you look at that, charlotte,

n.c. on the democrats' line. good morning. caller: i'm concerned about the possibility of the public option being dropped just for the sake of passing the health care legislation. i hope president obama will stick to the platform that he ran on with regard to health care reform. and did not back away from the public option just to pass the bill. if it fails with the public option, then let it fail on the backs of those yellow dogs in congress who do not have the guts to stand up and give the people what we need with regard to health care reform. guest: i think you've hit on a key point here. i only have one slight disagreement. that is that the president has stood strong for the public

option all along. i think you're concerned about people in the congress and their attempt to try to modify or compromise this. that is the place we ought to place the pressure and placed the attention. the president has said all along that he saithe public option neo happen. we have said that the public option is necessary to move forward. it is one of the bare bones that we need. you talk about it in the right way could we cannot have health care reform just to have health care reform. we are trying to have health care reform so we can reduce cost, so we can have universal coverage, so that we can have quality and affordable health care for everyone. host: david brooks writes this

-- ñrguest:ñiñi i think mr. brookss for the other 35% who do not want to do health care reform. the president has made it clear that this is an important thing for the country. it is one of the things that he ran on. it is one of the things that he was elected on. i do not think it is a minority as mr. brooks said. when you do the legislative process this way, it always breaks down that people do not want something in particular. if we can get health care done successfully, for generations people will think this president

and this congress -- thank this president and this congress. host: detroit, michigan on the independent line. caller: i really enjoy this program because so many divergent suggestions and ideas and the way people think. we have a good president. he is half white and half black. pick whichever side you want to take. the problem is we have too many cooks in the kitchen. to many people are trying to ñitell the president to do their his job. host: like who? caller: you know, he said we

should get out of afghanistan. the same guy who said when he went into iraq -- this is just sickening. we have these people who have these suggestions. a lot of them are draft dodgers, like detainee, for example. -- like dick cheney for example. i bet my house, my god, my house, my wife, and my motorcycle that he cannot prove he saved one life, but he still gets air time for all this baloney. they think this is funny. guest: the troy, mich. is my home town. i want to say hi to all the folks in detroit. -- detroit, mich. it is my home town. the vice president has said many things.

he has the right to say them of course. that's why we have a. first. -- that is why we have a first amendment. a lot of people think of the vice-president as the past. the recent past, but the past. this country to a large degree turn dictates and wants to move forward. at americans for democratic action, we want to move forward as well. we have our own web site, ada action.org. it is a very interesting debate. people feel like they can tell the president what they want him to do. frankly, we have done that as well. we like to think that when the president does the right thing, we want to encourage him to move in that direction. and when he does the wrong thing, we try to move into the right place. host: how do you think the

president should address unemployment? guest: we were having a debate in our office just the other day of what is the real unemployment rate. the rate of 9.5% does not include people who are discouraged workers, or people who are working part-time who want to work full time. we know it is a much bigger number. what the president needs to do, along with -- the with when the economy is as bad as it is and there's a question about whether or not it is getting much better -- we need to look at the ways we can continue to stimulate the economy and move forward so we can help bring back jobs. that is the real leading indicator when we have the recovery. host: wood is the most efficient way to do that? guest: i do not know that there is a single most efficient way. health-care reform is part of the way. people who do not have jobs often do not have health care. in addition, there on the state

medicaid rolls. healthcare is a part of the way we will do that. there are direct public investments we could make. there are public works that need to be done. there are millions of things that the country could do in that we should do. we have talked about -- in unemployment for young people, we may need to increase funding for peace corps or for job corps in ways that we can have people coming into the jobs and doing the things that our country has always wanted them to do, to be ambassadors in other countries, and to do the work that needs to be done in this country. host: our guest is michael wilson, americans for democratic action, national director. he gave you the website. it is adaaction.org. guest: we also have a quiz that is how liberal are you?

we have a variety of issues from economic issues to social issues. people can take the quiz. host: what was the importance of putting that on the web site? guest: we have always thought that many people are liberal in some ways, whether it is that they think we should not have gone into this work, or whether there should be a minimum wage, or whether there should be civil rights laws, or whether there should be a marriage equality. we have encouraged people to look at the whole landscape of issues and figure out in which way are you liberal that you did host: not think you were. as far as the group is considered, looking at the fall, how do you factor in the blue dog democrats and their influence on making policy? how do you reach out from them? some of them come from conservative states.

guest: in talking to members who describe themselves as blue dogs, even amongst blue dogs, there's a wide divergence of political ideology and perspectives. in a lot of cases, people believe what they believe in spite of being blue dots. i know that 1/3 of the blue dogs are in support of the public option. they're not easily broken up into one group. we like to talk to people in their homes where they are. we have done that with their membership across the country. we will have a program over the next year. we will have 60 organizers on the ground to talk about these issues of unemployment and talk about the issue of healthcare, and talk about the issue of jobs. we will be educating folks and talking about those issues. host: republican line is next. bobby from indiana. caller: thank you for taking my

call. on your web site, you should ask what percentage of people are socialists. you have mr. jones who can now two years ago about communist. a lot of people get caught up in words and word play. a lot of people say progressive. a lot of people do not understand that. we get all caught up in democrat or republican. i am a constitutionalist. small government and large freedoms. we're starting to get caught up in to a movement that the government is the answer. i submit that the government is the problem. we have a lot of social issues in this country. we have a lot of economic problems. we cannot look at this government as the hero. we need to have independence and freedom to go back out like the pioneers did across the country looking for gold. we need to ask the question.

i want to ask you, as a democrat, do you acknowledge in do you support mr. jones as the freeingreen czar saying he is a communist? i do not understand. . guest: i welcome the opportunity to talk about this question. there's been a lot of talk about the terms of communist and socialist. i'm not sure why that is happening. i will not blame this caller in particular. to some extent is name-calling. americans for democratic action, when it was founded, was also found it as an anti-communist organization in the 1940's. i do not know to what extent we can do anything more to address the question for folks.

for many of the people that i deal with on a daily basis, particularly young people, for them communism is a term of the past. .

in st. louis this sunday. basically, this is how i see it. the country is divided. we% of the country just has a different ideology. they believe the government cannot be involved. there is a percentage of the country, maybe 45%, that believes government can and should have a role in different issues. i do not think our police force should be run on a profit basis. i do not think our military should be run that way. i do not think health care should be run that way. we won the election. what bothers me is the democratic base, and the independenct base elected barack obama president, gave us these huge majorities in the congress and senate, and they will be so

disappointed if the democrats cannot bring themselves together to bring forward meaningful reform. at this rally, there were other democratic representatives there, and they were afraid to use the word "public option." basically, at the end of the day, we are not necessarily interested in bipartisanship. there are people who believe we should not do this. the republicans represent those people. guest: i think you raise a good point. there are some in the congress, mr. demint comes to mind, who says that they want to use health care and use it as a defeat against the president. i think by partisanship is

valuable, but it is not the goal. the goal should be to achieve victories for the american people and for the country. if we do that, if pipe on a chip can get us there, ok, but if -- bipartisanship can get us there, ok, but it is not the goal. i think you are talking about having to shout to democratic members to use that phrase, that is something we have to do. there are members who have not faced this type of pressure before and are finding themselves caught between people who do not want any reform and people who want meaningful reform. it will be up to them, and to

groups like us, to stiffen their spine. we need this victory, not just for the democrats, but for the country. host: there is a story about their cost of massachusetts' health care plan and its stability. are you worried about this aspect, and how will we pay for this? guest: i am worried about the sustainability of health care if we do not do anything. the cost of medicaid, a private insurance -- i said on a private insurance board and i have seen cost double. i worry about sustainability if we do not do health care reform. second, the massachusetts model was flawed. their goal was universality alone, and they wanted to

require everyone to have health care. that is not necessarily the solution because we need to also bring down cost. host: as far as bringing down costs, how do you do that without compromising the level of care? guest: it is difficult to do at the state level, but if it is done on the national basis, then you have the opportunity to ratchet down the cost. that is why the public option is so important, to have someone to compete with private insurance to reduce the unnecessary costs. host: florida on our independent line. caller: you are very articulate and i enjoy listening to you. i would like to ask a few

questions, particularly about dan jones, and whether or not you agree with having a racist in the white house. do you agree with eric colder's stance with what he did with black panthers in philadelphia? also, why has obama not kept his promise that everything he does will be on c-span? if he did that, as he promised, we would know what is going on. people are scared of obama. they are scared of what they do not know. he promised us. it is going to be on c-span. we want to see what is happening on the inside. host: just to clarify, we are not funded by any means by the federal government. when the president talked about

transparency, the efforts that his own administration may 2, we have no connection to that. guest: on your question about eric holder and the black panthers, i do not know what that is in reference to. i do not mean to dance around that. with reference to the president putting the entire legislative process on c-span -- and i do not specifically remember him making that claim, but to the extent that he did, it is not possible to put everything on c- span that happens in washington, d.c. in the legislative process. i worked on capitol hill. there are many hearings, many meetings going on all the time.

it is literally impossible, even with its three channels, 4 c- span2 cover everything going on. in the congress, it is possible to cover some of it. i hear the fear that he talked about, about fearing what they do not know about. the only thing i can say is, historically, in this country, we know that we never know everything. c-span is doing a good job burning more like to this issue. the internet as well. it will not be perfect, i think it can be better, but to the extent we can bring information to you, that is helpful. i do not mean to dance around, but i do not think it will ever be perfect. host: just to clarify, we are an

independent affairs channel. waterloo, iowa. caller: just a quick deal. you talked about cost and bringing it down. part of that cost we have is a defensive medicine, due to, i believe, malpractice that doctors have to pay. i would like to know your opinions as to tort reform that goes along with health care. they do not talk about that, in regards to democrats. trial lawyers, like what howard dean said. for your organization, what is your thought process on getting some sort of tort reform to bring down the cost of health care tutu malpractice -- due to

malpractice? guest: we have tried to focus more on the main goals of health care reform. part of the challenge here is when you write a bill that is going to affect this large of the american economy, it is difficult to deal with every piece upfront. part of what i am hopeful that the congress will do, when they deal with this, in terms of addressing some of the specifics, is looking at reducing the cost. host: from maryland. democrat line, elaine. caller: good morning. i have followed ada for some

time and i have a deep respect for the organization. i am wondering, under your leadership, how is the ada going to move us in a progressive direction in this country? guest: ada has been around for more than 60 years, some part of the challenge is lending what we have done traditionally in terms of reaching out to people in the country with the modern technology of things also available. we have updated our website. we are doing things on the internet that we have not done before. we created a fan page on facebook, so people can join that and interact with us there. we are doing e-mail messages, e- mail alerts to many of our members. it has been are particularly good way for much to reach

younger people. we have to move in a way that left us blend the things that we have done well, with the things that we will have to do better in the future. that is a critical part of what we have to do. another way to do this is to talk about issues. we have a store if we talked about the issue of civil rights. and it is not just a question about race, but real civil rights. one of the founders of ada was one of the founders of the uaw. when he put those groups together, that was a good thing for the country. ada has always fought for marriage equality. we will be one of the largest non-lgbt groups that will be fighting for this cause. host: stockton, california.

larry, on the independent line. caller: i want to talk about the public option of health care. it is being promoted as constitutional this, socialized that -- a lot of language is being put out there, but it is really about money. no more, no less. what i want to say it is, insurance companies have made a lot of money off of the way it is running now. but a lot of people of or in on the take. a lot of americans have their portfolios and 401k's tied to this thing. if theris there any question onr website asking people if they

have a stake in this public option winning? guest: that is a good question. we do not have that question on the website, but we do have a way for people to communicate with their members of congress. our position on this is fairly clear. we do not have a financial vested interest in getting this done. the point you raised about money is a crucial question. the question is, who should profit from health care, and who will profit from health care? it is our hope, to the extent there is profit, that it goes to the american people. host: michael wilson, thank you for your time this morning. in a few minutes, we are going to speak with william mcgovern of the "wall street journal" serving as an editorial board

member. he says the obama presidency needs to move more to the right in order to get an agenda done. first, a news update. >> president obama starts september with a briefing on the h1n1 to one flew virus. hhs secretary kathleen sebelius, janet napolitano, and director of the cdc will outline the government's plan in response to an outbreak. later on, there will be a dinner highlighting the contributions of muslim americans, and celebrating ramadan. the recommendations, after a year-long investigation of the air ambulance industry, following nine helicopter crashes from december 2007 to

october 2008. more on the release of the convicted lockerbie bomber. a columnist is responding to remarks by chuck schumer who suggested that sanctions be imposed against britain for the release. he says the senator's comments are deeply on helpful and insulting at a time when more than nine dozen trips are fighting shoulder to shoulder with u.s. troops in afghanistan. those are some of the latest headlines. >> as the debate over health care continues, c-span's hub is a key resource. watch the latest events, including town hall meetings, and share your own issues and opinions. there is more at c-span.org

/healthcare. host: and joining us now from new york is william mcgovern, with the editorial board of the "wall street journal." -- mcgurn, with the editorial board of the "wall street journal." could you make the case that the obama presidency needs saving? guest: let me be clear. when i said about moving right, it muswas more about moving moro the middle. moving more to the ideological right and the copying president clinton after his own experience with health care. moving back to the centrist ideas that he campaigned on. host: take us back to what

president clinton did, and one does it apply in this case? -- why does it apply in this case? guest: democrats are quick to point out these excesses of the clinton administration, but there were two different stories to the administration. the president mostly appropriate parts of government programs that he thought were popular and he became successful. host: as far as the current president's campaign on health care, do you think he is losing? guest: it is pretty clear. they could pass this in congress if they wanted to, because of their majority in congress, but the more americans find out about this plan, it is sinking. it is not looked at as a blank slate.

the first few months we have seen all lot of spending, cap and trade, we now see the investigation of former cia interrogators. people are not looking at president obama as a blank slate, but much more liberal and he had let on in the campaign. host: if the president adopts what president clinton did, more centrist strategies, the you think more liberal supporters of his will be accepting of the move? host: no, -- guest: no, i do not think so. many of them complained in the clinton years as well. as we can see, the country is very polonized now over health care. -- polarized nell over health care. host: if you want to get

involved in the conversation, republicans, 202-737-0001. democrats, 202-737-0002. independents, 202-628-0205. you can also reach us at journal@c-span.org and twitter.com/cspanwj. our previous guest was talking about the need to reach out to republicans in the senate that may bring some bipartisanship when it comes to health care. where do you see republicans in this process, and should they be part of this process, as far as a bipartisan effort should be concerned? guest: i think most of them feel like they have been shut out, particularly senator grassley. now with the august recess and town halls, they are seen this is an unpopular provisions and they are afraid to put their names to it. host: what has been the real

effect of town halls, particularly from progressives who claim that these are organized and events from interest groups and things like that? guest: in washington, when a policy like this fails, when you do not succeed in selling it, a lot of people's first reaction is that our sales pitch was off. we hear a lot of people questioning president obama, that he gave too much leeway to congress. that had varying degrees of legitimacy, but the overriding issue is he has a substance problem that people do not like. they did not like this in 1992, and the more they find out, the less they like. what people fear is that something is being stalked past them. why would we act on something so big and have it done before the august recess?

the sneaking suspicion is that the people who are for this bill do not want the american people to read it. host: what happens once congress reconvenes next week? guest: i do not know. they can try to ram something through with their majority. even that is pretty shaky. they have a progressive basis, but they also have some people further to the right into the center who are nervous about this. generally, as a rule, i agree that bipartisanship is overrated, but for something this big, if it is going to have staying power, you need to have both sides on the issue. host: so where does the reconciliation process come into the debate? guest: as i said, they have the majority. if a crack the whip, they can do it.

it will be interesting to see if the blue dogs go along, even if it has provisions they don't like. and two, if it does not have a public option, how much support the progressive side shows. host: first call on the democratic line. della, go ahead. caller: you say that president clinton was wise in moving the democratic party to the center. you are wrong. he moved them to the right. even alan greenspan called him one of the best republican presidents we have had in years. it may startle you to learn the first president to speak about a national health-care policy was teddy roosevelt, a republican. how can you say we do not deserve a national health care policy? even if it means going against

the people who do not want it. you are in the minority. you lost the election. remember that. we have had two democratic presidents in 40 years. neither one of them did anything to move the democratic party to the left, but we have had multiple republican presidents who have moved the country to the right. even clinton the regulated the banks. he deregulated the banks. he passed -- repealed that bill -- the glass stiegel act. that was repealed under the clinton administration. host: we are going to leave it there. guest: i generally agree, president clinton moved in the right direction, and the result was a lot of prosperity, a

general peace and prosperity in the country. if you look back, free trade, welfare reform, he had a very credible program. on national health care, i do not agree that people want it. if people wanted it, this democratic congress would be out there pushing it through, but they see the reaction and they are nervous. they see the president's approval ratings coming down, particularly with independents. host: next phone call on the independent line. caller: i am a resident of south carolina and i agree with jim demint. if we can beat obama over his health care plan, we can destroy his presidency and when the next presidency. -- win the next presidency.

host: does it come down to that? guest: i think it would be a big defeat if he lost, but president clinton covered -- recovered and won re-election. i think president obama could do that. we should not underestimate the powers of the presidency, but he has to be moving in the right direction. host: dover, new york. david on the independent line. caller: i think a big part of the problem is a huge amount of disinformation that is being strewn about about this health care plan. from watching the news media beat this plan up with totally fabricated stuff, i think people should instead find out what it

is all about. thank you. host: i want to read the editorial page of "usa today" talking about the stimulus affect on the economy. the editors write -- that said, i wanted your thoughts on the stimulus package, especially what it did for the economy. guest: when you have all lot of spending, it is going to have

some stimulative effect on the economy. but let us remember a lot of that money has not been disbursed. just because something happened after the fact does not mean that it prevented from something happening before. the economy could have been on the road to recovery itself. some are concerned that this spending is something that we will just have to pay for through inflation, or some other way down the road. i think the jury is still out. host: what would make up your mind to decide whether or not the stimulus worked? guest: there are a lot of things. including the forestalling of depression. it was very controversial. the immediate steps in the fall were more justified than later steps that came after, and probably did avert a crisis. it is a very complicated thing to untangle. host: you mean steps by the bush

administration? guest: both. there were steps taken by both to alleviate this. but economists will be arguing cause and effect for decades. host: appalachian, new york. roger. caller: mr. mcgurn, with all due respect, that is quite a delusional comment that the stimulus package might not have done what it was supposed to do. you are saying that maybe the economy would have recovered. it was obvious we were headed for depression. i do not understand where you think we would have been if nothing had been done. also, the polarizing affect over

health care, i think that is mostly due to republicans putting a lot of disinformation of there, making the country worry about something they should not be worried about. if everyone just read the bill, i think there would be more security and a lot more stability, and the agreement about the bill. it probably would have passed already if everyone knew what was in there. host: did you read the entire bill? caller: not the entire bill, but the parts that are being communicated incorrectly. that penn us, all of that stuff. i cleared that up for myself. -- that the panels. -- death panels, all of that stuff.

guest: there is a lot there. again, most of the stimulus money has not been spent. a lot of the money just goes to traditional spending, and we are going to have to pay for this later on. there are a lot of things that went into the economy recovering, and it is too early to declare the stimulus the reason for the recovery. on health care, on misinformation, first of all, there are several different versions in congress. i think quite the opposite. the more people are reading, the more they are concerned. there was concern about these death panels, but if it was just a matter of explaining it, why don't they just explain it? but even president obama said in a town hall, the fear of people making decisions might have a financial concern for them.

finally, for good about what republicans say. the congressional budget office said he cannot expand coverage for all these people without raising cost. that is the problem. you cannot just say republicans are polarizing it. they do not control the cbo. host: this morning in the "washington post, " they talk about the lessons learned from president clinton policy experience. he says --

what is your response to that? guest: i think a lot of people are saying the opposite that the president's mistake was to differ too much to conference -- congress. i think they should have been open to a few more things, like tax equalization of health benefits. they could have gotten something to the said it easier. it is much harder to walk back from where they are. but again, i think the real problem is substance. if you look at the reaction years ago when president clinton tried it, people do not want this. host: tacoma, washington. reed on the republican line. caller: i have been reading a book called "liberty and tyranny" and the author has done quite a lot of research.

basically, in the book, and they sathey say the treasury secretay for friend and roosevelt said, we are spending more money than we have ever spent before and it does not work. after eight years of this administration, we have just as much unemployment as when we started. these are the words of the treasury secretary at the time. this is not spin or the media. how anyone can attend that franklin roosevelt pulled us out of anything, when he was just simply a radical, and packed the court -- and now we have president obama. he is a progressive, just like roosevelt, just like hillary

clinton. the more you get on the internet and the more you read, the more you understand there is an underlying agenda going on. health care is not about helping people but consuming 10% more of the private sector. once they get over that edge, you have some many government workers voting based on their government paycheck, everything will be over. hostguest: the caller referred a book called "the forgotten man." it is an excellent book, and author chronicles how difficult it was for the economy to recover. i think we look back at the new deal as a coherent set of policies from the outset. if you read the book, there was a lot of jumping back and forth at that time.

her book was very controversial and it gets to this point. she was not writing about president obama, but we will be arguing about this for decades to come. internal argument that democrats have is if we did not spend the money, things would be worse. well, that is hard to prove. not only is it hard to prove, until we something sesomething t will continue. tax incentives are key. can you just keep taking it help from people at the top without harming the economy and without going down lower? you saw the dispute in the obama administration a few weeks ago when some of the financial figures implied that they may

have to tax the middle class. then, of course, the obama administration spokesperson refuted that. but there is simply a limit of money that you can take from the top 5%. when people hear tax the rich, they know that sooner or later, it will hit them. host: next phone call. caller: i wanted to point out one clear example of how an introduction of a public option provided not only a level playing field but tremendous coverage, reduced cost, and insurance companies flourish. in the hurricane season a few years back, on the gulf coast, insurance companies, homeowner

insurance companies in florida raised their rates nearly 600%. a $400,000 home in florida had homeowners insurance of $200,000. it went through the roof. the state offered a public option called citizens insurance. private insurance companies made the same claims then that there are making now about health care, how they would be put out of business, how they would lose their profits. they claimed they would have to leave the state. but they offer the public option anyway. what happened? insurance premiums came down to where they were previously. insurance companies state and competed, and a flourish. -- and how they flourished guest: i do not know about that.

what i will say it is you have the government as the pair of last resort. people living in areas susceptible to flooding are not bearing the risk. they are building in places they would not otherwise build. if they are assuming the cost, that is one thing, but in the end, we encourage the government -- the example that i would go back to him is the president talking about private companies having trouble. he cited the post office. that is a good example but it rather goes to my point then to the president's point. it is having a lot of problems. i do not think the government will be able to manage something this big and cut costs. host: our guest is the vice-

president of news corp., previously the speechwriter for president bush from 2005 to 2008. a story about the white house engaging in efforts with the civil rights department in the justice department, specifically saying when it came to minority hirings, president bush's appointees, he preferred to look up the individual cases of discrimination. as a whole, what do you think about this? guest: i am not up on the current efforts of the justice department. it seems sensible for president bush to have focused on, but and discrimination where there is actual evidence. to me, that is a sensible policy. host: bob on the republican

line. caller: the stimulus plan is not working. all that has done is held corporations who were in trouble so that they could turn around and send jobs overseas. chrysler was bailed out and then sold the company. chevy is cutting thousands and thousands of jobs. what we need to do is find a way to bring the corporation to have moved overseas, back to america, so that we can bring back the jobs that we have lost instead of creating these $8 per hour jobs, bringing that companies like levi's and things like that. all we are going to do is do the same thing we did eight years ago with the financial crisis.

all we did was pass it along to the taxpayer. host: mr. mcgurn? guest: i share his skepticism about spending and what not. i have an article today talking about investing in people who do not necessarily go to college. there is a shortage in the u.s. our system does not encourage people, for whom college is not the answer, to find a trade, start your own business, the live a life of dignity and purpose, and it be a full participant in the american dream. i think we need to do more on that. employers will complain about a shortage of qualified workers. host: does that mean the government should pay for job retraining programs? guest: there is some of that. the easy answer is the

government should do this, do that. we have a tremendous system of colleges. we do have to get a hold of the health-care issue for small businesses. i do not think the public option is the way to do it. i think incentives in the current proposal would need a lot of people to dump current proposal, and wash their hands of it. there are a lot of things that we could do if we were more imaginative. host: washington, d.c., republican line. caller: there have been several people in the last hour that have called in and made statements such as, you lost the election. there is a mandate on health care and you are in the minority. and then there is the other point that people have made, that the reason the health care

issue and obama agenda in general is not being accepted it is because of the disinformation coming from the right wing conspiracy is. two point against that. there was no really a mandate in the elections. if you look at the numbers, we are talking about 35% of eligible voters actually voted for the candidate. if you look at the population as a whole, that is 19%. both of those numbers are actually inflated. i did some studying in my college days. somewhere between two-thirds and three-fourths of voters do not really know what the issues are, but there are voting more based on charisma. those numbers are actually pretty inflated. guest: i agree with the caller.

the idea that republicans are leading this -- i think republicans are following the people. i do not think they are leading this. if this were a republican-led effort, it would flop. we are just seen anger being uncorked. i do think the president came in with his mandate, and it was more of the promise of a post- partisan agenda. i think 20 moved into office, he moved to the left, -- one tce he won and moved into office, he moved to the left. what you find when you get in the white house is those people in congress do not always have

the power to help you. they have powers to stop you and make it difficult for you, and they will use that power, if they can. no one need to listen to me or to republicans. president obama is not likely to take our advice, they won. but even with a majority in congress, they are having trouble, and that tells you that the american people are nervous. host: how could he learn lessons from president clinton, and how he did that? guest: president clinton was a political genius. he also had something very important. he had many years as a governor. when you are a governor and an executive, the bear the consequences. -- you bear the consequences of your decisions. a factory that moves into your

town and creates 300 jobs, that is a big deal. president obama does not have that experience. the senate is a different place. you can give a speech and get something passed, but you do not have the same sense of responsibility. now he is finding that he does not like a lot of this responsibility. host: charlotte, north carolina. caller: i'm sorry, i will have to disagree with you on a number of things that you specifically just said. your last statement was pretty against what middle america feels and why we voted for president obama. one, republicans made the argument that president obama did not have the history, background, did not feel like he was confident enough to become president. obviously, years of education

and his experience has spoken to the majority of the country, or he would not be the president now. i was calling in reference to this medical reform and how we need to definitely have a public option. with town hall meetings and everything else going on, it does not speak to middle america to hear a majority of the anglo-saxon americans portraying their anger about things that they are fearful of, which allow of what i am finding is simply misrepresentation of what president obama is trying to put in place. middle america does not have health insurance. middle america is paying all the taxes and bearing the weight of

most of the wealthy. guest: with all due respect, i think this is exactly what the obama warehouse is saying. the key characterizing things as misinformation, but the cbo reported. the idea that people may have to lose the insurance they like is not misinformation. if their employer changes coverage, they will lose their insurance. there are concerned out there and it has nothing to do with republicans. to the contrary, when people are informed, they do not like it. the president is not going to listen to me. the reason the democratic party is nervous is because they are taking the pulse of the people, and we see that in the extraordinary drop of popularity that the president has suffered in the last few months. that is a dangerous thing for the president to do. if we had this conversation back

in february or march and if we could predict that the president's popularity was wary it is, you would think that i was crazy. host: next phone call. caller: i think you have an elitist attitude that you need to disregard. second, you came from the bush administration, so we know how you think. with regard to what health insurance is going to cost the country today, in overtime as we move on -- at the same time we are paying for a war in iraq and afghanistan. billions and billions of dollars. i am from new york city, you represent the "wall street journal." for you not to have a problem with that means war is about money. get off this idea that obama's phone numbers are down.

that is 1500 people. the bottom line is, this is the united states of america. we all have opinions, some matter more than others, but we need a healthy nation. without health, we do not have strength. guest: i will answer the last part because the first part was purely ad hominem and had no substance. we want health reform. a lot of people like me -- i think of myself more as a conservative than a republican. we are looking for things that save costs and coverage. portability in insurance and so that you can leave your job. the biggest thing is creating an individual market, which these reforms will not do. one of the things the president has been successful in, to a degree -- although wrongly -- everyone disagreeing with him

and of healthcare as defenders of the status quo. no one at "wall street journal" is happy with the status quo. we have third-party payments that just drive up costs. there are a lot of other reforms out there and there are different ways to achieve it. the way congress seems to be going down is the bad way. host: what is the importance of pulling in your mind? your op-ed was based entirely on poll numbers, and the caller just brought up the argument that they are not always dependable. guest: actually, it was not entirely based on phone number. look, no one wants to say they are governed by the polls, and that is right, but we were told four months on end how popular the president was, based on his polls. if you live by them, you die by them.

the recipes in poll has him at 46% right now. -- rasmussen poll has him at 46% and right now. that is troublesome. host: minnesota on the republican line. caller: i wanted to make a point to what you said. you mentioned something about being conservative. on full disclosure, he works for news corp.. they own "wall street journal" and fox news. for the good of this country, i am a conservative. i believe in this country first, not as a republican. for the good of this country, i think fox news, "wall street journal, " should provide information that is accurate and

fair, also, facts, not lies all the time. when you consistently lie and you give your audience the wrong information, you are not serving the public. fnc is supposed to give correct information to the public and let the public decide the facts. not lies and spin. this guy calls himself a conservative but he is a partisan individual and she is not helping our country. guest: again, just a very telling and ad hominem attack. i do not work for fox news, i work for the parent company. ratings are through the roof now. obviously, they provide something valuable. we hear the same thing over and over, accusations of misinformation, without actually

showing what that is. just attempt to denigrate the services. i am proud of the "wall street journal" and fox news, where i work. i think that they provide some excellent news. you cannot just get on a show and accuse it of lying without providing evidence. host: how often do you contribute to the journal? guest: about twice a week. i used to work for them but i still contribute. host: what kind of topic you engage in? guest: all different ones. i used to be an editorial writer. it runs the gamut. host: next phone call. caller: thank you for c-span. i want to echo the last caller. she is absolutely right. there was an article in "news

whip" i talked about two parties, the obama party and the fox party. how can anybody in this world take these people seriously? these people acting out at the meetings as an indication of public opinion? they are motivated and they are not happy that obama and the democrats are in power. they would be angry if it was health care, they are just angry people. i do not believe they should be listened to at any level of sophistication. two other points i want to make. one, when that person called about florida private plans for insurance. he did not respond to that answer and went over to katrina, which is another situation. that was inappropriate. also, teh cbo admitted -- the cbo admitted that they cannot

score this health plan. guest: again, there is all lot in there. florida, i am not familiar with the insurance plan. when insurance is not priced correctly, you will have problems. people will be doing things that they should not be doing in dangerous areas because you cannot rewrite the laws of economics. and there is just all lot of libel about the people showing up. we hear that these people are un-american, like people in congress calling them nazis. when people turn on the tv and they see grandparents and ordinary citizens who are angry, i think they are specifically angry about health care. anyone who has been in politics knows that it is hard to get a crown. i think they are motivated and they have a passion. president obama was a community

organizer. that is what he did before he was president. nothing wrong with that. it is just a sad day when we have to attack people showing up and voice in their opinion. these people are having a tough time finding direct access to their leaders. i think it is a good thing when leaders have to stand up and your questions from them. host: last call from san clemente, california. democratic line. caller: i do not know where to begin. he started off by saying the republicans have been shut out of this health care reform debate. i can tell you that is absolutely not true. i have seen some of the subcommittee meetings. they are there, present, and giving their opinions. also, republicans have a

tendency to say what the american people think. i believe president obama won because of health care reform. when john mccain was running, he said that he would stop spending all together, except for the military. i would hate to think where we would be right now -- host: i apologize, but we have to leave it there. guest: i think the caller is right. they promised a lot of things in the campaign, and they were pretty vague. i think progressives thought it would be a very progressive agenda. people in the middle thought it would be more centrist. now they are seen the details of this. republicans, yes, are part of the debate, but not about writing these bills. they have been shut out of different meanings. legislation really does not reflect their input.

i do not think the public is mad that republicans are not being included, but they're just mad at the substance of this. people do not have issue with me or their hoboken party, but this is about the american people. . .

>> the president said . > the president said >> this from the new york post former governor elliot spit jer zer is -- spitzer is going to run for a bid for state comptroller or a seat held by

kirsten jillbrand. >> set to be released after serving seven years for bribery and racketeering. he was voted to be expelled after his connection. he maintains his innocence. those are some of the latest headlines on c-span radio. >> we continue our series on health care from the virginia hospital, centered in arlington, virginia, 10 miles east, northeast of the u.s. capitol. it is a 350-bed medical center which revenues 288 million a year. today, we will look at the health care costs with the chief financial officer and online medical records with the chief information officer.

here from our set in the emergency room at arlington -- virginia hospital center is robin norman, the chief financial officer. ms. norman, what is your job and how would you describe it? >> i'm a member of the executive team here at the hospital. guest: my specific focus is finance in the hospital. that is the same as any other corporation. worrying about borrowing funds if we need to borrow. day-to-day finances of the hospital, which includes collecting funds for billing. also includes pay. we have substantial payroll, supplies that we purchase. all of those normal accounting and finance functions you have in any corporation. with all of the complexity of health care. host: how do you remember the coast of things here at the -- the cost of things here at the hospital? guest: it is easy and it is not.

with cost at the hospital, we're not making wiggets. not a -- widget. i expect every widget to cost so much. how much supplies, which specific supplies needed for that patient. allocate the overhead as in any cost accounting system in other organizations. so we're able to determine, down to the patient level, the cost for each service that we provide. >> prior to a patient coming into the hospital? >> no, not prior. i think one thing that is very different about us and manufacturing is, you know, if i were the cfo of a widget company, i would expect each widget x to cost about the same to me. if it wasn't costing the same, i would be unhappy with our operations people as to what is going on, where is the variability coming from, why isn't the process working. in a hospital, we don't make widgets we treat people.

when you treat people, there wide variability in cost. certain things you want to do as routinely as you can, you know, still, you came here, you had a hernia repair and i came here, we're different individuals. i might have blood pressure problems, you might have a different problem. neither one of us may have any problems. coming in, before you walk in the door, we don't know that. my guess is we may not know every underlying condition that could effect that surgery even if we're knowledgeable of our own medical history. host: behind you are a lot of different supplies, it looks like syringes and tapes and everything necessary in an emergency room. do you know the set cost of those things? guest: we know the individual cost of the items. for each emergency, each person that walks in our emergency room, they will be different

items. we track those. we don't track every small band-aid. any supply that has a more substantial cost we track by patient. we put a charge through for it, primarily for knowing how much resource we used on that patient and as a way to help us determine the cost. host: put the numbers up on the screen. we divided them differently for the series. we divided by insured, uninsured and health care professionals. we have the cfo of the virginia hospital center with us to talk about health care costs and reimbursements. here are the numbers ... host: dial in. we will take the calls in a moment. robin norman, is there a set cost if somebody walks into the emergency room?

guest: there is an initial charge. we see everything from head falls to coming to the emergency room for that, all the way through extremely sick patients with serious medical patients. host: what is the base charge? guest: i don't know all of the charges. the initial visit which is an admission, it is wrapped into that number. even the emergency room portion of it can be over a thousand dollars. there is such a heavy overhead, we're prepared for the worst. for the sickest patient, for the disaster patient. but we also do treat people with lesserilness. host: let's talk about reimbursements now.

where does the $288 million a year come from? >> the vast majority comes from either the government or insurance companies that we bill on behalf of the patients who come to see us. we do have some fund-raising activities here in the organization, but they bring us a little less than 1% -- toç offset the funds. host: when you say "the government," medicare, medicaid? guest: yes. host: yesterday, they talked about losing money on every one of the medicare patients? guest: that is right. we pay less than what it costs to provide the service. host: how do you make up the revenue? guest: we have no say in what we are paid from medicare, medicaid. we have a negotiation ability with our insurance companies.

we break even or have a small margin. host: the insurance companies are aware they're being overcharged in a sense? guest: yes, absolutely. they understand how it works. i have been in this business for 30 year, not always at this level. there was a time when medicare paid the full cost. host: no matter what it was? guest: that wasn't effective or efficient from the government's perspective. they changed methodology. the intent was to pay costs until it was a reduced cost. that worked. there was a time when we got paid cost. the last decade, it hasn't been like that. host: so when the government is setting the cost and the rate reimbursement, do you follow the group that sets that closely, during their deliberation? guest: honestly, no. there is little i can do about

it. i focus here at virginia hospital, to make us the most effective place we can be. since a have little say in that, basically, when it comes out, i pay attention for the next year's budget. but typically, we have zero to small increases every year. my costs go up more than that because i can't retain nurses and good stuff. we have a great staff here. they're well-trained, highly skilled. you know, they need to be paid appropriately. and if i don't keep up with that and keep up with the market, and the payment increases we get from medicare over certainly the past several years haven't allowed me to do that, then what i have to do again is go back to insurance companies and get more. host: before we go to calls, as a health care professional, you say you aren't able to affect the rate reimbursement charges. can you lobby your congressman or hhs or do anything along

those lines?t( guest: i don't mean to say i ignore all that. a true variety of mechanisms including the state hospital association we belong to, we can and will do that. we discuss that we lobby and certainly a lot of minds that are on that piece of it, to help represent us. host: robin norman the chief financial officer here at the virginia hospital center. theç first call comes from pau at palmetto, florida, on the insured line. go ahead, paul. caller: i had a spinal surgery done in 1997. i was in the hospital for approximately 36 hours, and i go in 10 years later and i have an outpatient surgery, which i had done four andç a half hours, i

outpatient, most of the time inç recovery. the bills were pretty muchok -- almost the same within about $1,500 of each other. i'm curious how health care can justify -- i know the doctor didn't want to tellko what kindf money he made. but how the health care, how can youñrçq sayçsó? thatçó we ca this kind ofççpç[w3çóçw3 in cost and it be any kind of sustainable? thank you. host: thank you, paul. guest: you know, i think two things, i would comment on first. first, it was 10 years apart. simply, if you think of what happened to salaries even at a reasonable increase of three or 4% every year, that alone would raise the cost. i think the more important point is, in the majority of the cost of a surgery is approximately -- the surgery itself is where the

cost is, not in the stay that happens afterwards where you are recovering. yes, you are getting care, you are getting important care from nurses and there is some cost to that. most of what happens in your surgery happens in the operating room. it is possible, obviously i don't know the details in your situation, but it is entirely possible that there were implants involved, especially in your first surgery, those can be extremely expensive. the impact cost -- even in spinal surgery is $20,000, simply to buy what is going to go in. that adds dramatically to the cost, as opposed to other where there may not be an implant. most of the cost of your care occurs in the operating room. host: next call comes from the uninsured line from edward in newburgh,ççi] indiana. go ahead,v:ççzv edward. caller: ççhello, ms. mynorman

host: please go ahead. caller: i have three quick points that i wouldç likeçw3 ç out. i am not going to take too long. i agree with the last caller. the costsçç are ridiculous. this is coming from someone that is insured. i want toç@g"vemçç you theq perspective from someone that iç uninsured. zudn in aç while. mine, i havet i talked to him briefly. we were in walgreen's. i was like man,w3 what is going on. he looked a little different. he said man,ç iç had brain ca. to make a brief, get to theç point, ok, this man good friend of mine has incurred bills that were almost half a millionçç dolla dollars. and the crazy thing is that guess what he had to get? he had to get on medicaid. because basically, he was a dead duck. i don't mean to sound insensitive, but i don't really

see, because we had senator ted kennedy pass away from brain cancer. to me, i think brain cancer is like a deadly game of routet. hardly anybody gets away from brain cancer. host: if you can focus on what your question is for robin norman. caller: the other point is this. i myself was in a car accident with somebody else. i toreçw3ç a quad risept musc] to seeeóvçó a çççt(çççç. my question is, why do people who don't have insurance have to pay two to three times more than the average person that does

have insurance. she went to the hospital at the same time. host: thank you, edward. robin norman, how would you respond to that caller? guest: i think in a couple ways. for the most part, people with no insurance, we do provide discounts to make what they pay, closer to what an insurance company would pay. secondarily, the vast majority of people, especially with a serious condition, like brain cancer, can't ever pay the bill. it doesn't happen. they just can't. we know that, we understand it. we try to work with them, facts are that we typically would get medicaid if that is a possibility. so we first work with them to getteíññrç someç source of pa medicaidt( being mostu! common that w3i]t(w3situation. atxd%qçó whichmy case?j aveçñrt(çw3 anything else toa5óbç pay and get the c. frankly, we wouldn't stop care

or do anything different even if they never can pay us. that is what happens. that is really the way it works, which is another thing that the insurance companies do subsidize. host: just want to clarify, if somebody doesn't have insurance they pay at about the same rate as somebody that does have insurance? guest: at least here. i can't speak for everybody. at virginia hospital we provide a discount that is close to what we would get paid from should some insurance companies. host: which is still overcharged. guest: still more than medicare and certainly more than medicaid. for most people that are uninsured, we take huge losses. we get next to nothing. because they said -- it is overwhelming. you can't pay a half a million hospital bill. again, i don't know the details of the situation. it probably cost them at least

lf of what the charges were on the bill, but they didn't get 250,000 from medicaid in that situation. 0gnqe÷ñçd yç[;wçxoo3 ç aboutm3çqmyw3çñçb>çxdç unreimbursed medical costs, that is often fromç uninsured çzvç guest: correct. host:ç anybody that walks in h to be treated? guest: that's correct. host: isç that state or federa law? guest: i think it is federal law. caller: i have managed large programs for employers of large size for all types of employee groups, but certainly medical. one thing i found in my experience is disturbing and not well known is that hospitals

very often charge for every piece of equipment in any vicinity of the patient in the room, in the emergency situation, wharf it may be -- whatever it may be. in some cases, the machinery is brought in, then a charge is put on the bill.ç this machinery or technical machinery may or may not beç ud on the person.ç to make a specific example, which happened toç a childbir there are çós3doctors,w3xdç a, as a matter of fact who countermandç ankçç don't wanç monitors. this is a minor example.ç but usuallyd8 involves at least 15%ç ofw3ç÷ç the billu!ç whk monitor, inç thatç case will

charged even though countermanded byçxd the doctor ç and almost impossible for the insurance companiesçó to prove they wereçó not ççused?ççç] guest:çjf well,çów3 we don't m practice to use fort( things th aren't usedç onç patients. charges for mechanisms is complicated and zvçcomqéex.ç youi] can ççñrwfkimagine,ç jç aren7i]çççu3çmade,]i7joñok. when tlly'reç pointed out, we correct them.çç we don't make that practice hesu at virginia hospital center. since you brought up insurance companies, i would like to go ahead and comment on some of the things from the hospital perspective andi] working with insurance companies. i will do it in this way. i'm going to pretend for a minute that i own a painting

company. you walk in my shop, you say i want my house painted. when you do that, you know -- oh, i have x insurance for house painting. do that. >> let's see this particular day, i'm the owner of this paint company, i'm not there. i decide to take a day off. i have a clerk there. that clerk forgets, makes a mistake and doesn't do all the bells, whistles and hoops to make sure we get paid, by putting a call in, put something in the computer. which is different for every company we deal with. even though you are insured and i go out and paint your house and do everything i agreed to and i rendered the care we may not get paid or fully paid because of something called a technical or administrativeççk denial.vomç ççó certainlyq|pç[oçym onew3 mes çç

saveççç money inç health ca reduceç the administrative burn that goesçw3 on. there are a number of people tl;ç workç here that do nothingw3 -- charity ççcare.ç i havew3w3ç paidi];3 people time to help people get medicaid orok qualify for charity. they have to go out and do all the workç to make sure it is te or i can't show it on my financial statements. what happens is we don't get paid and it comes out as a bad debt. either way i don't get paid. to classify it properly there is work to go through. with insurance companies to get paid on the front end and back end, there are multiple people that work here that do nothing but work on that. simplification, theç insurance company reformç thatç would h b system. host:ç why is it that there ar

so many levelsç of bureaucrac] ]áp+eççç m. they findçz(ñrççñrw3ço6k w. i could make a less cynical statement to say they need to know what was doneçç to a pai toç do itñrçt ççç çproperl3 if they made açó mistake and bi forr.ç things that didn't exisr that patient, that is not right. on the other hand,ç most of ho we are paid isn't necessarilyç based on the charges, it is based on the disease process and the case rate likeç medicare ps a case çrate. i could have charged for the fetal monitor and gotten paid the same by most of the insurance companies. we are paid a case rate to take care of the mom while she delivers the baby. host: manyçç çcases, fee for

service o really gone offq to the side,çççxdççç is that statement? guest: absolutely. i think lessç than 10% charges have anything to do with how we get paid. host: would you change it back to fee for service. guest: it would be easier to how we actually provide care. if we got it right and charged everything appropriately, which we do vast majority of the time, that would be more)sense. but that is not what ittesh volved to at all -- evolved to at all. host: would you rather deal with medicare or blue cross blue shield. guest: i get paid better from blue cross blue shield. we have to deal with them, either one. caller: good morning, good

morning, ms. norman. what you just suggested is correct. i'm on medicare and i use the va health system also. they take my $96.40 every month. [chuckling] the point is and what you are talking about, i want to a town hall meeting and i addressed the fact that do we need health care reform or do we need to put some control on the insurance industry. they seem to be a fat calve. looking at c-span yesterday, one of the doctors had a wife that was a doctor. the insurance companies were getting some money for him fort liability insuranc+zxdw3w3ç anç they have to go and get aç supplement çinsurance.çç thatçç costs another somewher 'u'dredç andç $3,000 extra. evenod even if you get a cheap one.

in texas, there were six different insurance companies with the spectrum of 108 to $171 as an example. for some senior çcitizens, tha only getting seven or $800 social security, that is almost half of the social security benefit paid off in insurance. the other end of it, when you were the administrator at the hospital facility, billing medicare or something, as an example in my own case. i had a doctor that sent a bill for $155 and medicare reimbursed 85. so somebody is taking a hit. that insurance cost me, at that time almost $200 a year. they were only paying 85. so i'm getting sort of ripped.

the doctor office, they got ripped. so i think we need -- host: all right. we'll leave it çthere.çw3w3mç çkó guest: i agree with what hew3 said. that isçç exactly what is happening. içç think insurance reform ar part ofo4/ñ the charges ta]ç a necessary and improvement to the health care system are important. host: doug in florida go ahead for robin norman. caller: yes, sir, good morning to you two. my question is last year my wife was insured. she had an operation that cost $72,000. she had to pay 400 for her two-night stay in the hospital. theokxdw3 insurance company pai little under $1,000. what percentage went tow3 paidç her procedure and what percentage went to pay for

i willxtk listenç to the answç tv. guest: i would say roughly 20 to 30%w3çó of it went to cover the uninsured or the shortfall of government programs. host: what percentage of people walk in herew3 without insuranc? guest: here, five or 6%. host: is that çlow? guest: it is. it is expected that if you live in arlington county, most of the people that live here have jobs and good insurance. that is why. we certainly do take all comers. host: from cecil, ohio, angela, a medical professional. you are on the line. guest: i'm a local registered nurse witht(ç a degree. i'm looking to go to a bachelor career. i was wondering, if health care reform goes through with the

public options, would it help to payç for thew3 nursing and the medical professionals and thet( we there are master's, bachelors and degrees such asi]w3ç nurse-practitioners. wiatç would tjo the registeredç nurses and als the doctors andok whatnot? guest: market forces wyl8i] control that. i think thew3ç more education obtain, the more youçw3ççó wió we're going toç needçi]ç nur. we willç need çphysicians. if anything, i see a shortage coming as baby boomers condition to age and need health care services. i think education is a smart move. i would doç that in your shoes host: robin norman, would your job be different if you were working for a for-profit

hospital corporation? guest: might be different. might be paid better in the for-profit world. that doesn't trouble me. i enjoy working for an organization that does so much good for the community. host: when would your goals be? guest: the focus would be on the bottom loin. we have to run a business. it is my role as the cfo to be the business person. i have to focus on cost and a lot of the things that my piers in the for-profit world would. i think the difference is, we are trying to make a little margin to have enough to continue to invest in technology as opposed to answering to shareholders and also make a profit that returns to them. i think that would definitely change the focus. host: other revenue streams at the hospital, are revenue streams, we talked about doctors

on staff or doctors leasing or renting offices here. is that a revenue stream that you have here at the hospital? and how significant is it? guest: it is a revenue stream that is not terribly significant. probably less than half a percent of our revenue. the vast majority, 99% plus, comes from patient-care revenues. host: robin norman is the chief financial officer, senior vice president here at the virginia hospital center. thank you for spending about 30 minutes with us. as we continue our series, looking at health care through the eyes of a hospital, up next, we will talk with the chief information officer. the focus will be on online medical records. electronic records. privacy. we have heard about this on the national level for years. in the debate we will find out what virginia hospital does with it and what they think about the debate of online medical records. part of our series, we talked

with doctors in the hospital. this is what they're hearing from their patients about health care reform. >> in the last three weeks patients asked to have imaging studies moved up. for example, we have set timetable for patients who will need a mammogram or need an mri. the past three weeks i have patients who needed them in january will do it in december. they're worried there will be changed to preclude them from having it done. breast cancer patients have anxiety anyway, baseline. there is anxiety regarding will they have theç ability toq maintain their health with everything they are going through. it is an acute, palpableç feelg in the office. they want to talk about it all the time. i can't blame them. >> certainly it comes up a lot.

i actually have a lot of people who work on the hell, are consultants, lobbyists, et cetera, we get into a more professional level of conversation about it. lately issue in the last month, i'm getting a lot more questions on 69 flu, the anxiety over the swine flu pandemic and when will it impact, who will get the shots. that is foremost. there is a lot of curiosity. obviously health care reform is so nebulous and up in the air and so much rhetoric, it is hard for people to get a handle on it and really know the future. like stephanie said, it causes a huge amount of anxiety. i don't think we have a clue yet what will come out of the hill. >> as the debate over health care continues, c-span's health care hub is a key resource. go online, follow the latest tweets, video ads and links. watch the latest events

including town hall meetings and share the thoughts on the wish with your own citizen video, including video from any town halls you have gone to. this is more at c-span.org/health care. host: as we continue our conversation here at the virginia hospital center in arlington, virginia. 10 miles east, northeast of the u.s. capitol. we are joined by david crutch field. he's here on the set in the emergency room. i hope we're not holding up any people who really need help out there. but we're here to talk about online health care roars and medical privacy and things like that. mr. crutch field, what is your job here at the hospital? host: cfo vice president. i have information services. i do strategic planning and the hospital's strategic plan.

we select systems, implement them and support them after the fact. we initiated the electronic records project in 2005. a search for the system. we included about 200 folks across the hospital. various folks in the search. we chose our system at that time. since that time, we have really been involved in process redesign. so that is really looking at all the patient care processes. all of our business processes and breaking those down and comparing them to sort of industry best practices, if you will. and streamlining those and getting ready for the emr system implementation. we have been busy. host: if somebody walked into the emergency room here, they still have to fill out information on a clipboard, usually, correct?

guest: yes. host: why? guest: good question. information doesn't flow from one facility or organization to another. if that patient is encountered there before. we have a considerable amount of information in the clinical repository on that patient, which can be brought forward. it becomes more of a verification process at that time. honestly, what we're trying to get to is a situation where no matter where a patient encounters, that information from their most recent visit, wherever they were, are available to that provider organization. and that's -- it's a pretty good haul from where we are today to reach that point. host: do you support that idea, anybody with a visa or mastercard sort of, can go anywhere in the world, swipe it, and off you go. guest: it is a wonderful concept, whether it is a smart

card approach or whether information flows from one facility to another through some data standards, if you will, which is reallyçó kind ofç the approach that is being taken now. there are several different ways to do it. preferably, the government approach is to utilize health information exchanges to collect information in standard formats from various facilities and be able to pass that information to the next facility, based on a course obtained information for that patient. host: do you support that? guest: absolutely. do medicare patients have a smart card of any kind? guest: they do not have a smart card. they have identifiable information that would allow us, if they have been here before, we can quickly locate nem the system and be able to move them along. host: only if here before, not to george washington or george

town hospital in the district, six miles from hero so? guest: that's correct. host: we're talking about medical online records e-records, medical privacy. if you have a question specifically about that issue, dial in. you can see the numbers are divided by insured, uninsured and medical professionals. host: if you called into c-span program in the last 30 days, please hold off soiw5 others ca get çin. what aboutq privacy issues õen it comes toxdç onlineç me records? guest: you have to respect the patient's right tot( privacy. there are strict rules and ç regulations. çç guest: health care information

portabl[ portable availability act. it ensures to secure patient information such that only those who have been authorized to access that information can access it. so privacy is extremely important. we have to always protect the patient privacy. the patient has to provide consent and authorization to access their information. and that will continue to be a challenge. particularlyçó asçi] informati moves, between these facilities as we talked about earlier. host: is hipaa a good thing, in your view? guest: it certainly is. it is important to bring organizations along in terms of securing their environments. and we all know there are folks out there who would try to break into and acquire patient records

for various reasons. so it is veryw+bxdço+@)s(vtanl precautions are taken toxd secu the çççx5/ñóm]çt(w3

host: my doctor who happensç t be at this hospital carries a laptop with him. he plugs it in from port to port and carries that instead of paperwork and clipboards. is that common now? guest: it is. i have a device here that is now an example of what our clinicians would be using. the approach we take is have this device in the patient room so the physician, the nurse can access it.çéd family more in the care process. so the more activity that is happening at the point of care, to collect documentation, to involve the family, and also to use it for medication administration is very important to have a device at the point of ca care. host: what does the device do? can you give a quick demonstration? guest: sure. thisç is multifunctional.

it --çç one of the main funct in the patient roomç is medication administration. so what we will do is deliver medicatiofs to the patient'si] bedside. those will come on a ringok tha is similar to this. the medsç areç barw3çóqçç ct dose level. those are packaged by a pharmacç robot to começ to the patient room. at the timeç the nurse administers that medication, this tabbet -- there is a scanner onç the side here that allowed the nurseçó to scan the medication, to scan the patient and pull up theç original orde physician order.ç and confirmç that allw3 the fi right things are there.ç right frequency, right route, right patient and so forth. medication administration in a closed loop kind of system, where physicians are placing the order and meds administrationçs happening at the bedside with

the five rights being confirmed almost virtually eliminates the medication errors. which is a big problemç today. host: let's take our first call. cherylt( on theç insured line. go ahead. caller: i have two questions really quick. i want to ask --let first question isq i haveççow3t,çldç- > çó ç m insuranceyçm ;[y public option? a lot ofok things i'm curious about, a lot of the callers seem not to understand that the private insurance is what keeps the hospitals going and keeps them able to have theçç sophisticated instrumentsçi]0 insteadççç of a lessçxd invç cut. host: all right. thank you. guest: the information on the

first question, is the information safe within the health care organizations? generally, the answer to that question is yes. they're very -- your information is very çsafe. as i said earlier, hospitals and other health care providers have been working for a number of years to put in various ®;enek5 i4lude.9e,e3%oz8re in a health care organization as it is anywhere. host: next call from californiaç roseanne. caller:ç thank you,s3ç c-spa. my question is, i understand that when a patient is admitted to the hospital, part of what you sign is the release for insurance companies to be able to go through all of the medical records under the umbrella of a cost verification. i am wondering with the talk

about health care change and what helps are dealing with, do they consider they have access to÷ a person's entire lifet( medicee history. i kind of worry about that and concernedçó if somebody wentmç through in their younger years, postpartum depression. that that would still be on the medical records 30 or 40 years later when considering the 4tv2]6 much. çyç david?ok çyç guest: the concern there is valid. however, as it is now, organizationst( only maintain da for certain periods of time. there isç 25çó years or so of nowi]ç that is kept. thatçç çinformation, untilç really getç to a point where i is reallyqç freelyw3vççççç isç probably -- probably a lite

as a patient, i think it is important to read the print in the consent forms, look at that clearfully. if you have issues withok that, bring those issues up with the facility that you are working with. and make sure that you feel adequately protected in terms of the permissions that you're granting at that time. host: do you foresee a nationwide medical online sharing system in the near future? guest: the near future, no. i wish the answer was çyes. we have made progress inç term of interoperate act. there is a push to create interoperability through the stimulus funding for emrçw3xd products. will help.

there is a level of infrastructure investment, if you will,xd that is,ç right no simply not enough money to create the health information exchanges that is needed to be the intermediary, if you will between the facilities. so considerable more investment is needed. host: has the virginia hospital applied for stimulus funds? guest: we have not to date. we plan to. as weç initiated the electroni project, the stimulus funds were notç available. the virginia hospital made the decision to make the investment in theç electronic records because it was the right thing to do. fortunately, this high-tech funding option came along. we do plan onç applying for the funds. and based on where we are in our project, we're well ahead of the game and should be extremely share. c goingsto payç for it yourselve

but now possibly some federal ñç is that it? guest: absolutely. folksask, is itu! enough to pay for it? no. it is more thanoç aooçvdk dropq b]cjet,)vnjrokç çsure.i] but it does notkw3 coverç thu cost ofçw3çñ3 implementing the. host: are there strings]i attad if you take orç gett( federal money? guest: the strings areç define in meaningful use definition. you need meaningful use of uçñr getymñr the money.ç so as it is now, that meaningful use criteria is fairlyç wellç defined as of the end of the summer here. there are pretty clearw3 metris on how that money can be earned over the next few years. and so that is right now,çó faiy and so that is right now,çó faiy well definedç andç asa

believe that we're well ahead oç the curve, fortunately. we don't have to play catch-up to earn our share.w3 host: steve on the uninsured line, you are on with david crutch field, the chief information office at the virginia hospital. caller: i'm an uninsured an unemployed senior tax ç administrator. i installed systems when i was on contract for ge health care throughout the north central u.s. and a lot of nonprofitç organizations for sure. i didn't hear you speak of anything to the c-span audience of houston important and powerfulw3ççóçç packs is. pictures on communicationç systems.çó

david, you are implementing the hits and risks of hospital information system and radiology information system with the packs system, so when the individual comesç into the hospital, theok electronic medil records are passed through. of course, there is aç ton of packages out there. host:çzv thank you, steve. let's get an answer. david scratch field. guest: packs systems are medical imaging systems. we invested in packs systems a number of years ago here. we're well down the path and very matureç in that protect s, fortunately. and that is, obviously a digital image and being able to bring those into the electronic medical record, to form the complete picture, if you will oç a patient's situation, it is critical. fortunately, packs is already in

place here. very solid. radiology information systems integratediwith packs. now we're in a position to be able to leverage that to pull in a large percentage of our medical images directly from packs into the emr slugsz. host: can you define what that is? guest: it is the x-ray films and other digital images taken through mri or ct. it is a digital image of that is stored versus films or theúoed way we used to handle images. it is very high resolution, digital images that are stored in very large storage systems. host: you might detect a slight southern accent with mr. crutch field. he earned his master's in

alabamaç alaba alabama. guest:çñrç yes. host:çó where? i spent quiteçóç a few yeaps ernst & çi]young.t( host:çç how did you getçç i care? guest: i wound up in health care by mistake asç some of us do. in. there was an opportunity forbh p:ov)ammer in a ççw3xdçhospi. i took that wc(opportunity. asç i got my master'sw3 degree learned more about health care, ixd discoveredç it isi] where wanted to çóçbe.ç enormous opportunity.w3 peopleç that work in health ca, as youçç okknow, like health because they have aw3 chance to make a difference in people's ç lives. and that was very appealing toq me as çwell. host: there are a lot of cases

where people accidentally fall into health care. we learned this fromwmo jim coa otherv: folks talk aboutñró73 h accidentally fell into$qp&th care. is thatç aççç good thincw[ guest:ççç i guess çóçso.w3ç folks choose health care as well. there areq certainly nurses tha enter theç field because they' very -- they want to make a difference, too. theyçóv:@g choose health care. p@ youok areko onç with david crus chieflrç information officesk caller: is it tough to identify

information guest: good question. from the standpoint of social security numbers, many institutions have taken and we are as well, the step of eliminating a social security number as a direction of patient identifiers just as we have national provider identifiers at some point in time, we will move as we move more to a national system, we'll have national

patient identifiers that is a unique number for identifying a patient, but is not -- does not involve theç social security number. host: who has access to somebody's medical records that has been here at the virginia hospital center? guest: who has access, it is people the patient has authorized. obviously, the physicians that care for the patient, admitting physicians, consulting physicians, essentially those that have been authorized by the patient. in addition, obviously, the folks who provide care to a patient have to have certain access. with the hipaa security and privacyw3 rules, essentially, i is saying that the information that is available to any individual in the organization cannot be anything more than that person needs in order to do their job. so that is essentially the way that theok security is handled d

it is largely handled at a data level. and a very comprehensive security mechanism within the application systems. host: and who is the insurance company? who would have access there? guest: insurance companies obviously have the ability to access certain records and certain information to verify the billing ands correct billing and that sort of thing. so again, it is a business partner-type of a relationship with many of the organizations where the business partner arrangements and the roles and responsibilities of thoseç partners areç clearly defined that business partnerççpgñ agr. so those connections are provided through that mechanism. host: what about when it comes to the federal government if you are a medicare or medicaid patient isn't. guest: if you are a medicare or

medicaid patient, if you are any kind of patient, you have the right to access to the information that is in your medical record. today, as part of the movement to the next step, and somexd of the things that the federal government is trying to do, for example, through meaningful use, is to provide electronic personal health records. so if you encounter at the hospital what is going to be recorded is that which a lot of some folks can do today, others can't, you should be able to walk down to medical records and ask them for an electronic version of your patient health record, and they are, they're going to need to be in the position to provide that to you. host: time for a coupleçóç mor calls. hope from kansas on with david crutch fooled. caller: thank you. it is ar-kansas city, kansas.

a little town. my question is, i agree with you that we need the çe-records.ç i think it would gow3 a longt(ç trees. but the fact that you can go to one specialist and have certain tests done but he said you need to go to another one. and then you have to wait for that specialist to get all the records that he's done to the other one before you can see him. and if you can have a digital version, you could go from doctor a to doctor b, whether he lived in one state or a little bitty town of timbuktu. host: what do you do in the medical profession? do you worry about privacy çó

records? caller: i am a senior health aid. the paperwork i do is astronomic astronomical. i see eight patients a day, five andç six days a week. i do a lot on the internet upon iç do haveçi]ç someq concern privacy act. when it comes to costq and the social security numbers, i do agree, really shouldn't be on the e-things. but if you have a certain id number, then that kind of elimina eliminates exactly -- because there are lots of people with the same name. but that kind of eliminates some of the privacy issues there, i think. host: thank you. david crutchfield? guest: i think your point is a good one. it is a terribly inefficient