we have a lot of potential with the government. state, local, and federal governments occupy 1/3 of the airwaves. i give the administration high marks were looking to the federal warehouse spectrum. they found 180 mhz in the spectrum. they are going to auction that off. technology is advancing and ourer fishtsi advances every day. frequencies that we thought weren't usable are actually usable. i think that trend should continue for a while. one silver lining for a spectrum exhaustion is that it will spur innovation.

they're going to squeeze more efficiency out of the air waves and give us new technologies that weapon can't even fathom. >> one of the biggest users of the spectrum are all the new apps that are out there. when it comes to the issue of privacy in apps, new jersey is prosecuting or looking to prosecuting a couple of creators. how much attention is paid to the issue of the f.c.c.? >> the f.c.c. does not have a lot of direct jurisdiction over the trade issue. under a section 222 for common carriers, there's a restriction on private information and that's our limit. i would say peripherally we

operate in that space and have the bully pulpit. but there are other things that govern the privacy issue. >> one final question. >> the government is facing a possible shutdown as we speak. are you an exemptive employee? are you going into work. >> there's a potential zhount which i'm still optimistic it won't happen. yes, the f.c.c. commissioners are considered essential employees and i say it with a smile on our face because our staffs are not. each commissioner office has its own staff and operates independently. there will be a skeleton crew at the commission focusing on public safety and the most critical of issues.

but five commissioners are are supposed to show up for work but our staff it's apparently against the law for them to show up to work. it's going to make for an interesting day when i have to walk into a cold, dark building and make those decisions. >> robert mcdowell one of two republican commissioners. thank you for being on "the communicators" and thank you as well. >> thank you. >> sunday on news maker, republican reince priebus on fundraising. that's at 10:00 a.m. and 6:00 p.m. eastern here on c-span. aetna president 15eud that the federal health care law was necessary to improve our health care season but that it did nothing to reduce health care cost and affordability. he made that comment at the

eighth annual conference of the world health care congress. this is almost an hour. >> george, please? >> thank you. good morning. how are you doing? ooh. scary. it's a great pleasure to be here at the world health congress. i'm going to talk a little bit about health care reform issues and the issues that we're facing in this country today. starting with the fact that health care in this country is consuming in massive amount of

resources. u.s. health care consumed $2.7 trillion dollars in revenues last year. and to put it in perspective by itself, the american health care economy is larger than the total economy of every other country in the world except china, japan, india and germany. so we spend more money on health care than other countries spend. the average premium for a family, kaiser family foundation research is $14,000. a full-time worker who easterns the minimum wage in this country makes $14,000. so we fit the plight where a full-time workers spending their money on health care will not be abe to pay their premium next year. to put it in another

perspective, the complete salary in bang lower is $12,000. -- bang lor is $12,000. so we clearly have a cost issue with american health care. we need health care reform in america because we need much more affordable care. so what should health care reform look like? health care reform to be done well has to have four elements to it. one of them is coverage. we're the only industrialed country that doesn't cover everyone. we need to do that. there shouldn't be 1.7 million people getting infections. we need better care and we need half as many people who need heart transplants. we need to fix the cost of care and i'll return to that in a second. but if we have half as many transplants that's going to bring down the cost of care. and we really need to improve

pop -- population health. if we leave it out of the equation it's a huge mistake. we need to focus our attention on achieving affordability by taking care a lot smarter. the first focus opportunity that's really obvious is that 75% of the cost comes from people with chronic conditions. only 25% comes from acute conditions. we were talking about cancer care. cancer care is less than 5% of total health care dollars. if we eliminate cancer we would save less than 3% of the total health care dollars. diabetics consume 32% of the spend of medicare. the opportunity if we're going to be thinking about this in an intelligent way is not on those very few, very high cost

things. it is on the vast number of people in this country who have chronic conditions and utilize health care. we also need to look at who's utilizing health care. those people spend a lot of money on care. and then 10% of the population is about 80% of the cost. and that's a huge opportunity because if we can focus on the 10% and intervene in an appropriate way to keep them from moving down the care continuum down that 1% category, we can save a lot of money. we need to think systematically and strategically and not just consume and spend money in the same way and delivering care in the same way. we need to focus on better care. we also need to look at prices in health care in america. >> this is the world health care forum.

we have overwhelmly higher than any place else by a factor or two or three. we pay more for each piece of care than anybody in the world. if you have an office visit in canada, the doctor gets paid $40. and if they charge $41, they lose their license to practice in canada. in the u.s. an office visit is anywhere from $60 to $150. if you look at physician fees for a nor nal delivery. a domtor in -- doctor gets paid $503 but in the u.s.a. itself quadruple. >> one of the bizarre things in this country is that we're talking about rationing access to scans when we're paying two or three times more with the

same technology. rationing before ennearing or repricing is an absurd strategy. if you look at the price continuum in the u.s. there's more than enough range in existing prices to make it adepordable if we just move -- if we just make it affordable. c.t. scans, same kind of distribution. we pay two or three times as much as anyone else in the care. hospital charges -- one of the misses that we hospitalize people too much or too many hospital beds. the truth is we have fewer hospital beds than anyone. we have fewer admissions than anyone. we have shorter lengths of stay. there's not one country in europe that charges more than

1,000 dollars a day for hospital stay. so if we're spending three times per day that's why health care costs more in the u.s. bypass surgery is particularly interesting. incredibly important surgery, very important. has a great outcome. when you look at prices on that surgery, most of europe is charging at a very low number. no one's going over $20,000. most are under 10. if you go to india, bangalor they're doing it for five. in the u.s. is up to $150 and the average is quadruple the rest of the world. sage surgery, same outcome, same safety levels but difference in pricing. the same ratio is true -- actually they point to surgeons

and say we only charge twice as much. they only charge four times as much. we're under pricing. they could legitimately make that point because drug prices are also significantly higher. and if we paid in this country the price that the dutch play or the swiss play, we could give seniors $50 a month in take home pay that they could use for vitamins. how important are fees? >> if we paid the same fees they do in canada, and if we deliver the same care, the same visits, same scans, same drugs, everything. same hospital days, we could spend 18% down to 12% and resolve the issues. what do we do about that? one of the things we need to stop buying care by the package buying it on a piecework

process where there's an incentive to race each pace makes little sense. and if we're going to continue to put fees, use fees to pay for care we should do it like the french do and have a flat amount per c.t. scan and if the c.t. scanner wants to charge more than the $500 that's the benefit if you want to charge 15, 16. and what that does it forces the market to the $500 scanners and there is people in the country making a profit at three and two. that's not going to bankrupt the market. we put out deductibles between the 1,000 scan. and the consumers have no reason to bring down the price of the benefit package. >> if we're going pay by fee

let's pay by fee in a reasonable way. the better thing to do is buy a package and let the caregivers do the right stuff. the things at permanent te the things we've done to bring broken homes by half. in three of them there is no bill that we could charge if there is an insurance company. but we're prepaid and we get to use the presource and not deliver fees. we also need to improve health. we have a population that is increasingly overweight, increasely inactive that we have chronic conditions growing every single year and the primary driver health care costs are healthcare conditions. i'm here to tell you that it can be done. we need to move in the

directions of getting our kids to eat better and our societies to eat better and a healthier food. physical activity is the sweet spot. and walking is our best hope and our best strategy. if we're thinking as a society about what we can do to make this population healthier, we need to look to walking is an outcome. the fins, scandinavian country went from the most country to the least activity. walking is the most accessible you can do. it is the most likely to succeed because of it actually works and because the neuro chemicals generated by walking are pleasurable and the miracles generated by dieting are not pleasurable. >> it's a fast sweem. so the benefits are walking

have huge values. when you walk -- walking actually prevents. it managing diabetes. it prevents and treats depression and anxiety. hit allly lowers the rate of cants everies. and you don't have to walk like in the old days. waubling all by itself stirs and creates all of these benefits. it can cut the new cases of diabetes. we could safe medicare if we can solve the new cases as well. and you can stee some of the data. the really good news and the things that makes the strategy even more doughable and more practical, more functional is that the new science shows that you can do the 30 minutes into

15's. the human body is made to walk better than we walk. the bio chemistry is more than we walk. everything instead of being a nerd at 2:15. one in the morning. one at night and one in the morning. you can get the benefits from walking. so i'm going to -- so we need a national agenda for walking. we need our kids to walk. we need walking -- to walk like that. walking has incredible benefits and it is the only logical thing that really will help the population that we can get our moneys behind this society. so i'm going to close with, we need affordable health care on this country. we cannot afford to be on the

pay that we're on. we need to have better care. er also need to go for war. people think that care fees are absolutely off the table relevant to any reform agenda. people believe there is some legitimate prices. every caregiver know tls process. they now have a half of dozen different pry sys. there is nobody to give them pry sess. we need to make pry sess a park part to cake care an we need pro act to reduce the need for care because we don't that we we'll care.

thank you very much. >> while george walks back to his seat, we will love to get this perspective on bending the health care cost. >> good morning. i have three headlines for you and i'll touch -- i'll spend a couple of minutes on each. the first headline is that the headline didn't happen to the industry. it was absolutely necessaryy. secondly the affordable scare act is a reasonably good approach to it. so let's talk about the first. the small group in individual

markets in the united states have been in decline for the last 15 years. more employers and individuals have dropped insurance and the cost has risen dramatically during that time. so there was no other way to impact those markets unless we reform them. as a matter of fact with the under mains of medicare and the head cade as well as the next cline. it's the large group employer base market was in trouble as well. just didn't know he had. 84,000 a year are on the backs of employees who pay for their insurance. so the market needed to be changed. back in 2009 came out with an insane nation and calling for it across d industry.

and in 2006 came out with a 10-point plan called a transforming hard in reck. which is a blueprint that we've put together. both the administrations and the last six years. so that leaves us to the afordable carkte about. which we believe to be a good, market-based approach for provided health care insurance. it does not to address quality and and affordability. and if you saw d news this morning, the changing on medicare, why we change the financing of the health care system sls we get that the underpinnings of equal fi and affordable -- affordability. >> this country over the last five years of the increase and

health care cost to employ years have been shifting for both reduction in money. employee trends are running at 31% for the health care cost on average across the united states. so more of that will continue unless we get a quality and affordability. they must now focus on quality enfordbility. providers togethering in unique ways to create whatever version you want to call him of an aaccountable chair organization. now if you see one aco. you might have seen them. we're still poring through them. if you want to see some interesting videos and look at

them. still very ill-defined by et na was very active in trying to find the opportunity to create a different level of relationship with the provided community. so far example. why negotiate when we can ensure manageable property. and doing cap tation. we'll call it global payments. how do we get together to work data? >> nurse katy -- and it would be unique and a potential that we would have a health care exchange in 2014, 2015 but it would be a hospital system powered by a health insurance

exchange, redefining the notion of keeping what you have where you get to keep your hospital and your physician instead of keeping your health insurance plan. it would redefine the health insurance motto where we no longer be partnering with our providers and we wouldn't be selling members. we would be converting it to health. this problem is that we have increased access to health insurance. but we have not increased access to health care. as george so noted managing is one par. but we are short 160,000 fe --

physician with have little hope to help them up. individuals will need access to their health care once we turn on the spict and put 30 million more people under the system. if you think we have a two-tiered health care system now. if we do not address the issue of capacity there will be people who will pay handsomely to get access to the best health care. and by the way they would have gotten it. so we need do do a lot in the way of capacity in order make a change. the second piece is to have payment reform. so that we can put the proper incentives in place where we can have indeed a win-win situation and we're experimenting with this across the country where it can work. and finally, my last point is that for 80% of the users use a

commodity stop service. another example until the city of san francisco a routine colonoscopy cost $7,300. i'm not sure what you get for a $7,300 colonoscopy but it shouldn't be that way. what we need is complete transparency in the system. think of open table for restaurants. for exarvings-rays, for vaccines, for shots. they will redefine equality for the routine services that they got. that will do more to redefine between a.c.o.'s and a consumer marketplace. more to redefine the shape of

our system and the cost structure and pricing in our system than any that is contemplated. so with that i'll turn it over to our next speaker. [applause] >> well, he is going up. let me remind the audience that you have a require opportunity to ask questions of so please, i think you go to world conk.com and we'll make sure that we have to answer that as soon as we can. >> good morning. i spoke to transparency and prevention and the need for improvement in health care as well as a system where the lines are there to produce that. i want to thank the world health congress for bringing us together to call all question and the cost is because i want to speak directly to the issue

of the relationship between quality and cost. if we could have the first slide. i want to talk specifically about the case of the million dollar babies. everyone used the best evidence. evidence exists today. how a billion dollars would be saved. more importantly would save would an unsnessly riss -- unnecessary risks. i want to talk to you about what can encure and how learning can turn, drive film the cost that was alluded to in both of the previous discussions. well, if you look at the top graph, that is a normal distribution of turner. well, where did the evidence

come from? it comes from an area from the western societies, in the bible. the marker of fine months or nine lunar sigh ls from the last menstrual period may not be great. one sees that that normal distribution is moving to the left from and average around a little over 39, 40 weeks back to 38 weeks. so a normal distribution but in fact, anything but normal. if one looks at the risks for that outcome they will work on the left. it did i increase those. so there was this tantalizing

question -- would delivery -- elective preterm delivery postponed hold or holding deliveries. better life. the ginecolji director came -- can you put some data together? over a three month period, looked at a number of hospitals with practsically representing population that's hetero genious. we found out that the -- it was not the safest and not the most efficient. in fact, babies have effected

early presterm, either in inducting. and at four weeks there was a 400% chance greater risk of going into the newborn sbessive care unit. intensive care unit. suggesting that we needed to revise the definition of term. that term really wasn't term earlier than fine weeks. what we found is the intensive care correlated with that early delivery because of immaturity of one, fe tall distress and a more intense care unit admissions. we have to ask the question -- are there potential longer consequences. anik yo is a whole lot spexive than a regular post-partum.

well if was created the evidence one has an operate to use it. on the right and the yellow what one sees is the soft intervention. in the blue second part you can see that there is -- it was called a semihard stop which was done providing the physicians about the findings. an associate at xff vice for dave. and that was fast us but over at the last year or so. and against the national backdrop of somewhere blaun

between with compliance. well, what are the lessons that we can take away from this? is that when one thinks about these sorts of questions and questions what's always been talking us -- to us and going to be challenging. they didn't do as well as 38 years old. it's that that doctor is going to find the power to find the differences. if a doctor says smeg's is any my first ferns. case after case, we've had

four. 's not evidence. we are looking at the sirches in outcome. using that sort of learning to drive improvement. let me discuss this. they will please with the study, the joint issue will be looking 2008 at you us. the true of the matter is that druth doesn't hend up. the right thing morally. it's pushed as far as it can do. but we have to be able to call these questions through transparency, bring data together and very challenging and system maket redefine the standards of excellence.

done this to eliminate of high level of beelli. after c sections. we've hadley had the data to look at the right windows for intervening. we need incentives that links the alternative with best practice. the alternatives are damaged. texas, a bill to legislate when delivery occurs. right intention but difficult of a lack of flexibility. but the end is this -- good quealt should always lose big

business. and in an environment of transparency. and if all providers qur onboard with this, it can pay delst $1 million. you -- the compassionate health care would be improve idea. >> thank you very much. [applause] >> the title of our panel here today is spanning the cost. i guess i would like each of you to address a specific question and let me get to some numbers here. are we talking about spending the trend? or going to a new way. how much does that need to be if it's a any one. what is that trend likely to be zph are you talking about both. if you're out in the tri,

you're here. i've got to get the c.p.i. we haven't actually settled on what are we takingability here. mark woods? >> well, i'd start with a very real example of what's been going on in the industry over the last five years when the push administration put forward a change to medicare voong. one of the questions we were asked is how can we get you take. we started with that kind of program and after the first year realized that they were brought in.

they offered them more benefits. where today they can get a plan for 50 to 80 dollars would be $270,000 a month. we did 47 different pilots across the country where we paid physicians 125% of the service. we put, embedded case management nurses into their offenses and we delivered acude at missions by 34%. and then had a dramatic hey care effect. so i think we can do more than just bend the trend. we're going to have an underlying hit in the health care line if we're able to work together. how do we scale to a level where we're going to have that.

today we talked about the population of those established a chronic illness. 16% use 85% of medicare. when it was alureded to keeping people at work and managing the business. my we really. one needs continuity so that one co support it over the longer hall. a cup of young, well, we talk bd about 1-6 americans being sured. -- insured. colon cancer was detected in 1996.

it was in advanced stage. by 2004, it was almost earlier stage. come back to safety and effectiveness and compassion, all of this above but not to disregard. it was a whole lot less expensive and more efficient to care for veterans with polyps than with advanced diseases. >> i think it's possibility to get a rate of increase and care down to the c.p.i. over a number of years if we actually do a really good job on identifying the patient who is really need team care, collective care, better care and deliver that care for those people and then don't allow the marketplace to price up care for the remaining population.

we have to have half as many heart transplants because we have great care up front and then we need to pay the same about of transplant and the combination of that could get us down to the c.p.i. then, what we need to do is have a payor environmentment that channels patients to best care. and then we need environmental. and if it's not rewarded it won't happen. the only people that can create the business model are the buyers because that's where the money comes from. so if the buyers restructure the business model, your delivery will follow. they are very, very nimble in

responding with changes. sop in a lot of creativity but it is not going be channeled until the business motto changes in a couple of basic ways but once that happens, there's way too much -- too many people having asthma attacks. it's not just been the trade something. we can get down to a c.p.i. number but we have to do sam matically across the board and we have to stop the cost shift. if we leigh let fee and inflation eat up, they will be gone. we have the lowest admissions in this country. we have way less hospital care and we spend twice as much on hospitalization than anybody in the world because we've upset with any -- we're upset with

that. doubling and triples cry sick. even of you have talked about even in the face of reform in effect using market-making mechanisms to try to help with this issue. we have a question from the audience, apparently some of the earlier speakers said that they feel don't expect. if you're seen one. you've seen one. >> a lot of the a.c.l., first generation of acl research were accountability, were prepaid. we have a full date about each patient. the a.c.l. mo zell trying to get to actually a sort of various versions of us, not closing us but looking like us. and the people who route --

wrote the final days of law they are trying to give the country like it would function in that way. so now the rest of the world is trying to figure out how to headache advantage of that. they help create the business model of what's an a.c.o. thrive. it's going to be a very early thing. the plark, how do you? i'm interested how aetna picks us this issue of this relationship. is ate strategic -- is it a

strategic thing? >> the structure and the mechanism payings well but it's just been difficult to get that many dole scale anywhere else. and so our approach has been how do we find the scaleable model? how do we anyn't about retro fitting? the current system to impact what we have in the united states in a way to gap towards the model that george has innology california. that's a big task i would argue that in countries of china and industry, you have a bet -- things that are retro invited and a whole host of other things we have the sandyus. we're literally involved in movering to the infra situation

chur of creating sustainability systems of data and intellectual property around managing risk. we're trying to pick our partnerings -- partners so that we can show what scales and doesn't scales. obviously, it's coming at it now the pliverly system. in particular the physicians, how are you working with the facilities? most of the world is not organized much as the world is

organized as we are that has heard the voluntary practices around us. i think the great lieser is the information system that allows to to create imaging and making sure it is used appropriately in hospital service as well. this information becomes the great equalizer to manage the care in one sense but also to manage the sense around risking the other. i think it changes the possibilities from being restricted to what has already been established as a per inquire. as to the accountable organization, i'm not sure that i've seen one form where we're interested in the regulations that came out this week. but in the commerces there.

it's just that relationship, people. to go at risk, we're promised a better outcome with research utilization. there's been a gre the audience about -- question from the audience about the doctors, regulators, about who really controls the cost of care? >> i actually think that the business model needs to change to reward bending the cost curve and the business model change can only happen from the payer. pay orcontrols the vev knew. mayor needs to identify ways that the cash will flow if those golds were met. you can't expect providers to create team care and informs all kind of resources for team care. i mean, we need to make the

first test which is the pay yor, provider. we have to start with the money. >> can we do it without c.m.s. coming along? >> no. i think c.m.s. is essential in corporation with the mayor community in order to make it happen. you've seen it happen so many times. they changed. and the cardiologist practices with -- line up at the hospital to line up for the system. the up coming changes, create an opportunity for the mayor industry to partner and stay there. i think if we figure out how to do it we act in.

that's the tailback following them through. caring for this country is about to be getting much safer. the fact up to now this business motto has beened her in the street. and the reward for crash tpwhr the car was that somebody bought two mull pairs of hospital decor. you 1.7 in innexts. when c.m.s. will care will change very quickly because you change the revenues. so if you -- how many folks in the independence yens are from provider organizations. show of hand. pretty good number. if all of you were add vising a local community hospital 3rks00-bed well-run favor.

what would you do about all this? what would you say? >> don't talk to george. talk to me. >> in 2002, 25% of physician practices were run by hospitals. that number's now 55%. and our view would be that it's going do approach 80% over the next five years. so the institution is going to become the nexus of world as happens in a lot of ways especially for the sharps in the world. so i think that is going to have a fairly dramatic impact of how you think about it. so if you're a small community hospital and a small community, it surrounds.

it will depend if you can create a strong enough model. i would argue and i go all the way back to my days in michigan. that when i went out to leland hospital -- you can just have a conversation because it's all one community. and you all have to talk to one another about what makes business sustainable and comes up with a perfect reimbursement. if you're close to a major metropolitan area you would have to use that system would be my point of view. >> let me ask you your question, kerry. first the hospital is part of the community, and the hospital in the community is substantial. but that community is responding to the pressures of the cost of businesses local

and state government. it points out to the comments the leagues have made earlier working with other providers and employers towards wellness keeping. with those individuals with chronic disease, the disease has actively imaged to help. working with employers and payors to create that kind of incentive for health and for deliss management and with the we're in that environment where there is a history of cost-shifting. this current environment -- from medicare is that it's negative.

while many have looked to ground health care, what better way to get us the real value than driving the quality of care. because at the owned of the day product with a health delivery is health care. actually used to lower utilization. better processes, better oncomments in terms -- better health and better value. >> if i was advicing the next hospital about next steps, i would say find partners that you like who do the things that you don't do to be in this world. find health plans that can give you the back room infrastructure and do the parts that you do really well.

and they do it as partner model. if individual hospitals go time-out the insurance world, they have to go to acclaim shot. they won't do them well. and they'll do it at a high cost. if they focus on delivery and team. then you've got aetna. 20% need care. and the problem westbound that it would help the 20%. they didn't care. so unless your hospital -- there's a region where we need to building a hospital and then call us up and see if you want to be a player. >> i think we have time for one last question and i'm going to change this up a little from looking forward. doll you dee what aye ites going to -- do you know what

we's going to happen with the continuation clinically that the united states has been for the last 40 years. >> if we start focusing on rewarding better outcomes, we're going to see an explosion of creativity. i think we'll see innovation becoming better. absolutely. i agree with that to invest in one of the pest areas of the united states by medical sector. the pressures will lead to innovation, adaptive mechanisms to meeting the challenges and environment both in terms of organization but also in terms of technology, so better patients and get the right diagnosis the first time. a medication that's given today in cancer is matched exactly to the specific disease needs of that patient. but even for things that

ubiquitous like high blood pressure. it doesn't work 40% to 60%. better outcome for patients, better resources. >> there will be losers in this because the system cannot produce some of things that it produces today. for some it will be painful. for other who is have ideas like were mentioned by my two colleagues here, i think we're going to have a huge opportunity to invest in a system and will be focused on the right things. but there will be consolidation among the community definitely in a number of ways and causes us to think about our business model. the drug manufactures we've already seen that happen in the pipeline of world medications that are focusing on biotechnology we have to think

about how they fit in the system. the taller order for all of sus where we have the right dialogue to find out where this works. who are the players that can come together and actually demonstrate that kit happen and create the momentum to have appear different system. >> great. mark, jonathan, george, thank you for an enlightning dialogue. appreciate it. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2011] >> the president greeted surprised tourists and told them because congress was able to settled its differences this place was open and everybody is able to enjoy their visit.

>> how are you? [cheers and applause] >> i just wanted to say real quick that because congress was able to settle its differences that's why this place is open today and everybody's able to enjoy their visits and that's what kind of future corporation i hope we have going forward because this is what america's all about. everybody's in different places . it's wonderful to spend time with you guys. i hope you a good time. [cheers and applause] -- i hope you a good time. -- i hope you a good time. [cheers and applause]