shall security and medicare are social service programs. social security is paying out more than it is taking in. it is adding to deficits. it will increasingly active deficits in the years ahead. medicare is in much worse shape. it has been paying out more than it is taking in for a number of years. social security unfunded is about $11 trillion. of the $70 trillion, $11 trillion is social security. social security and medicare are very different from welfare programs. welfare programs are not universal. as we have heard from several callers, there are perverse incentives we have to address discouraging people from working or doing things they should do. as far as the taxable wage base cap, my personal view is one

thing we ought to do as part of reform is to increase the cat. right now, is about $110,000. i think we should increase it to $150,000 or so. if you eliminate the taxable wage base cap already done for medicare, you would be raising taxes 12.4% above that. we need additional revenues. we do not need all the revenues for social security. we're spending about 40 cents -- $1.40 for every dollar we taken. we need to take to make social security solvent and secure. we can do that. we have other problems. the biggest one being health care. host: new york city, fred, independent line, you are on with david walker. caller: i wish someone would tell the truth about how dysfunctional congress is. what do we do?

we need a new congress it seems like. we have not addressed something very important to address. there are all these government agencies. these people are sitting on their hands. most are political appointees. medicare has lost so much money on fraud over the years. the cumulative amount they lost is probably more of the reason why it is going into the slope of bankruptcy. there are people collecting from everywhere. there is no waste, fraud, and abuse control whatsoever. what do we do? a band-aid approach when we need a new set of leaders in this country. it is unbelievable the excuses they come up with with the ivy league education and advantages they have. my united states of america is

on its knees right now. host: david walker. guest: you have to recognize congress is a committee. nobody is in charge. you have the speaker of the house and the minority and majority leaders. they are in charge of their caucus or party. but you do not have a chief executive officer. there's only one chief executive officer in government. that is the president of the united states. the president has a disproportionate opportunity and obligation to leave. i think it is the biggest deficit we have. it has been this way for a while. is a leadership deficit. we do not get enough people telling us the tough choices we have to make. we do not get enough solutions about how to solve it. that is why it is critically important the presidential election be about solutions. we need to make the economy and jobs top issues. we need to do the same thing for

the senate races and house races. one thing we will do on this have a we're going to serious 7 pamphlet. that will have a number of questions that should be posed to presidential, vice president, senate, and house candidates to separate the wheat from the chaff about who is part of the problem and solution, whether they know what they're talking about, and whether they're willing to work together to make sure our future is better than our past. we need political reforms. that will take time. some will take constitutional amendments. we do not have that much time. we need to make progress before we get to that point. host: david walker is a former comptroller general of the united states. have you thought about running

for office? guest: a was considering running for the senate. i decided not to do if. how do not think will ever run for elected office. i have given over 15 years of my life to public service. i think it is an honorable calling. i might give some more. you do not have to do it in elected office. you can do it in appointed office or in the not for-profit sector, which is what i am doing right now. host: actin rouge, you are on -- baton rouge, you are on "washington journal" with david walker. caller: they are talking about a pipeline that will create 60 million jobs -- not million

jobs, but thousands of jobs. we cannot get a jobs plan el. the summer is almost gone. nobody has done nothing for the construction workers that need to be put to work this time of year. guest: here is the challenge. as i mentioned before, the last stimulus bill was oversold and under-delivered. it tainted the water of the willingness of congress to do more. here is the key. we need to take additional steps to invest in the short term to help bring unemployment down and stimulate the economy. it needs to be coupled with a clear, credible, and enforceable plan to deal with the larger deficits ahead. you need to do it in a coordinated and integrated

fashion. you need to do it of the same time. the idea that it is one of the other is faults. you need to do both. until both sides recognize that, we're going nowhere fast. we need more leadership from political leaders, especially the president, whoever that is. george walker bush did not provide leadership in this area either. we will continue to see gridlock. that is unacceptable because things are not going well. they're getting worse with the passage of time. host: about 10 minutes left with our guest. he is in stamford, conn. when does the bus tour start? guest: it starts in september. we end on october 9 in washington, d.c. of all the cities we're going to go around the country, there is

only one that does not have a main street. guess what, if it is washington, d.c. just another example of how out of touch washington is with the rest of the world. host: you can go to the website to see the group set up by the comeback america initiative. you are on the air with david walker. caller: anything the american consumer puts out, china gets the exact information and floods the american market with similar products.

mitt romney is affiliated with the chinese government to undermine the american workforce. guest: is no question we need to have a free-trade policy. we have some. trade problems. a lot of our free trade agreements do not have enough protection to make them fairer. there are legitimate questions with regard to whether or not the currencies are properly valued. let's recognize the reality. the world is getting smaller all the time. we're not going to go back to protectionism. the last time we did that in the 1930's, it resulted in the great depression. we have to recognize we cannot compete on wages. if we try to compete on wages, we will be undercut by china, indonesia, whatever country it might be. we have to compete on innovation, productivity, value- added, the things america has a competitive advantage.

we have to do more research and development. we have to improve our education system. we have to reform our immigration policy. we have to reform our tax systems and regulatory policies. we need to start treating the disease rather than the symptoms. host: the next call, dallas, pat, independent line. good morning. caller: i am very concerned about your agenda. it is my understanding social security and medicare, the trust funds, i am 71. my payroll taxes have gone into the trust fund just like everybody else's. what has happened, i believe i am right, beginning with the reagan years and subsequent

presidents and congresses after that, they borrowed our money and used it for other programs. they secure the debt with treasury bills. you are advocating defaulting on the debt? is that what you are saying? guest: absolutely not. i was a trustee of social security-medicare. let me help you understand. since the beginning of the social security programs enacted into law in 1935, effective in 1940, since the beginning, to the extent their revenues in excess of expenditures, by law, these have to be invested in u.s. government bonds or other debt securities backed by the full faith and credit of the united states government. it has nothing to do with ronald reagan or any particular person. it has been that way since fdr. what happens is for a number of

years there were surpluses. those were invested in u.s. government debt. the money was spent on something else. that debt is backed by the united states government. it is guaranteed on principal and interest. it is guaranteed by the 14th amendment to the constitution. it is several trillion dollars. we will not back away from that. there are a lot of the promises made that are not backed by those bonds. we have gone from having 16 people working for every person retired in 1950 to now about 3.1 working for every person retired. we're going down to take a person working for every person retired. because people are living longer, the numbers do not work. we need to reform it to make it more sustainable. if you are 55 or over, little to no changes. the younger you are, the more

you will be affected. this is one of the areas i will be talking about on the tour. i have gone to 49 states doing events. in the last year in talking about potential reforms, they get 95% plus support. host: a few more minutes left with our guest. time for a few more calls. shayna from new york. caller: it is lovely to be on. i have admired your message for years. i was hoping i could entice you and other groups to look at what our universities are doing to our agriculture policies along with the u.s. government and state agencies of supporting farmers who want to take firmer welfare and destroying the fiscal responsibility.

it is very disturbing. it is not look that -- looked at and putting a huge burden because the government and universities are pushing farmers with illegal alien help as opposed to individual farmers. please look at it. guest: i will try to find out more. i am not an expert. i will look further into it. thank you for the suggestion. host: the last call for david walker comes from keith, a republican in florida. caller: think you for your service. i have seen you on msnbc, cnn, everywhere. i talk to inform people. they are still not getting the message. in 2000, we were $56 trillion ahead. president bush gave a tax cut. supposedly only the rich got that.

how did we go from 56 trillion dollars over and in 10 years $56 trillion under when the tax cuts were only $4 trillion in that 10-year period? guest: at the end of 2000, we had $5.60 trillion in debt. the unfunded liabilities were $20.40 trillion. today we have about $16 trillion in debt. the total liability in unfunded promises are about $70 trillion. things have spun out of control since 2000. both parties have controlled congress during that time. both parties have controlled the white house. things have particularly spun out of control since 2003. in 2003, three things happened. the second round of tax cuts

could not afford returned to deficits. we invaded a sovereign nation without declaring war or paying for it. congress passed and the president signed an extension of trillion andded $8 when medicare was already underfunded. you cannot spend more money than you make up the rate we are, charge it to the credit card, and not expect to have a day of reckoning. it is not too late to turn things around, but we need to make major progress in 2013. to do that, the president house to exert extraordinary leadership in the house to exert extraordinary leadership. we need to put pressure on the house and senate to work with the president to make a comprehensive reform plan that will keep us from having the debt crisis over time so our

future can be better than our past. there needs to be tough choices that might cause some short-term pain but much greater long-term gain. host: once again, why do you think your approach will be successful? why are you taking this on? this has been tried before. guest: this has not been tried before. there has never been a nationwide bus tour. we're going to swing states because the candidates and press will have to spend time there. they will decide the presidential election. you can have a greater impact there. my experience is the people can handle the truth. they are just not told the truth very often. they are willing to accept tough choices as long as it is part of a comprehensive plan they deem

to be fair. i am trying to help fill the void. we need more truth, leadership, solutions. we need our next president, whoever it is, to lead. host: what is the best web site if people are interested? guest: 10aminute.com host: we have one more segment left in our washington journal this morning. this is our weekly "america by the numbers." we will be looking at child- bearing and fertility in the united states and its effect on public policy. we will be right back. [captions copyright national cable satellite corp. 2012] [captioning performed by national captioning institute]

>> i started as a copy boy at the "new york times. " i was in a training program after the army for the "wall street journal." >> this sunday, he talks about his various jobs as a journalist, his views on u.s. spending overseas, and his criticism of the defense department budget priorities. >> the $4 million facility with a band that has 40 people.

it has room for everybody. if you spent $4 million on an elementary school -- >> war on sunday night at 8:00. -- more on sunday night at 8:00. >> if you want to come to america illegally, do not waste your time going across the border through the desert. it is dangerous. get on an airplane and fly here your visa.stay the total number of undocumented has been going down. we have not solve the problem. we saw of the problem by having our economy creature. people do not come here to collect welfare. they come here to work. if there are no jobs, they do not come here. america is not a good place to sit around and think the state will support you. somebody has to create the business that he is going to work for.

all the numbers show -- rupert is an immigrant. it cannot be easy to come to the other side of the world, given. friends and family -- give up your friends and family and everything you know, and start out from scratch. that is what people are willing to do. of course, immigrants will be more aggressive and risk takers. that is why they come here. >> mayor bloomberg is joined at this event by rupert murdoch. you can watch the entire discussion at 8:00 eastern on c- span. >> "washington journal" continues. host: it is time for the chance to look at statistics about our nation. this week, we will be looking at child-bearing and fertility rates in the u.s. and their effect on public policy. we want to introduce you to

stephanie ventura. she is the chief of the centers for disease control, national center for health statistics reproductive statistics branch. what do you do? [laughter] guest: our program collects data and operates the survey of family growth. we have two major data collection programs. we do a lot of research and analysis of the data. host: why? guest: it is important to have good data. some of the building blocks of statistical information you want. fortunate people have a birth certificate. it is so important. there is so much information, public policy and public population information that

derives from the birth certificate. things like low birthweight, and the mortality, a whole array of topics. host: let's go through some of those numbers before we introduce our next guest. let's start with this chart. women are having fewer children today. in 2010, 1.9 children per birthing woman. that is as opposed to 3.8 children per mother in 1957. guest: we're looking at a big change in childbearing patterns in the united states. the baby boom years were from 1957. that is when many women were having children. some women had postponed having children. they did not have them when

their husband was in the service or whatever or they did not get married until after the war. we also have people who were just getting into child-bearing ages. both of those resulted in birth increases. then we had a decline. host: personal choice, legalization of abortion were factors? guest: the bottoming out of the birth rate was in 1976. the pill had been introduced in the early 1960's. abortion was legalized in 1973. there were changes in the population. women were advancing education. there was a postponement of marriage. a lot of things were converging where we saw this drop-in child bearing.

host: there is a green line. it is what you call the replacement level. what is that? guest: 2.1 is the number considered what we need for the population to replace itself. not to grow or shrink, but to stay level. it is 2.1 because some women do not have any children. 2.1 is the demographic marker. 1919 was the last year we were at that level -- 1990 was the last year we were at that level. host: teen births have declined sharply over the years. there are two lines running through here. first of all, the birthrate. it goes way up during the baby boom. it is a big peak.

it goes down. it goes back up in the 1990's, the purple line. it is down here now. then you have the number of births. this has almost come down to the level it was in 1950. this is teen births. guest: one thing that is striking is the peak in 1957 of the teen birthrate which was more than double it is now. people think it is a big issue. it still is even though we have made progress. used to be a lot higher. host: were the women married? were they married in earlier? guest: exactly. in those days, women and men would finish high school and be able to get a job with a high- school education. they got married.

much right away and started families. only 13% of the teen births were to unmarried teenagers. now it is 39%. a total change. then you have the increase in the late 1980's. i think that is what generated the major increase in concern where public policies came in. the teenage birthrate seemed to be going up. there was some increase in teen sexual activity. i do not know if people really got a handle on what was causing it. it did generate a lot of concern and programs. there was a national campaign to prevent teen pregnancy and unplanned pregnancy. there was a variety of public,

state, church, school-based programs around teen pregnancy. it had a big effect. the decline since 1991 is a major public health success story. host: this goes from 1920 to 2011. in 1920, approximately 3 million children born in the u.s. every year. you can see it drops down during the depression. it seems to go up during world war ii. maybe you can explain that a bit. the rate is down lower than it has ever been. the number of children is about the same as it was in the mid- 1950s. guest: this is an interesting story. the rates did go down in the depression years. they went back up right after world war ii.

they peaked in 1957. after dropping sharply until the 1970's, there is not much change in that rate. the number of births was parallel to the trends. the trend since 1980 has mostly up because there are more women of child-bearing ages with a much lower rate of child bearing. we have 4 million births in 1957. a lot fewer women were having those children. host: now we want to introduce you with adam thomas. he is with the georgetown public policy institute. we want to talk to you about the policies. you have heard this discussion. why is this important for public policy?

what do you foresee in public policy given the trends? guest: from a policy perspective, the fertility- related and outcomes we should care about are most likely to be correlated with disadvantaged children. women who experience unintended or out-of-wedlock pregnancies are more likely to have poor educational and labor market outcomes. children whose births were unintended or born out of wedlock are more likely to have poor education outcomes, were likely to grow up in poverty, more likely to have health problems. all that this correlation of. we try to do a good job of picking apart whether the correlations are causal. it does appear family structure, non-marital childbearing, these kinds of dynamics do have an

effect on childhood outcomes and societal outcomes. these dynamics are correlated with crime rates, government spending. we spend billions of dollars every year on medical care for unintended pregnancies. one statistic i have been studying that is still stunning is that half of all pregnancies in the united states are unintended. 40% are out of wedlock. both of those are holding steady. there has been an increase in both over time. from a policy perspective, i think they should be focusing on what we can do to reduce non- marital childbearing, unintended pregnancy. the government does play a role in a variety of ways. first and foremost, we spend about $2 billion a year on subsidies for family planning services, contraceptive --

contraception, primarily for low income women. studies show that has had a notable effect. we also spent about $200 million a year on evidence-based teen pregnancy prevention programs. the fact of their evidence-based is important. this is an area where social sciences have done a good job of determining what programs work and why they work. the obama administration has done a commendable job of funding the programs specifically for which there is a strong evidentiary base showing they were. those are to the areas where the government is particularly active. there are a lot of political debates about whether we should continue to be active in those areas. spending has been holding steady

despite attempts in the house to cut that spending. on the family planning front, that has been an issue of debate since the president was inaugurated. host: what about social security and medicare? for a long time, social security was surplus, and still is technically. and fewer babies being born fewer workers coming in, how does that affect things? guest: fewer kids means fewer people paying into the system. i want to make a point. the evidence shows that for every dollar you put into evidence-based programs that prevent unintended and non- marital childbearing, the government saves a substantial amount of money, between $2.60 dollars depending on the program. -- between $2.60 dollars

depending on the program. one way to reduce government spending is to invest in programs that ensure parents are more likely to have children when they are fully ready to become parents to give them more control over the timing of the child bearing. host: a few more statistics from stephanie ventura and the cdc. teen pregnancy rates at historic lows. teen childbearing down. women starting families at older ages. out-of-wedlock childbearing rates stabilizing. births to cohabiting women are rising. guest: is a woman living with a partner but not legally married. there has been an increase in that living arrangement. host: we have numbers on the screen in case you would like to

talk to our guests. start dialing in. we will begin taking calls in a moment. first births by age. in 1975, 1.3 million births in the united states. those ages 20 to 29 gave birth to 60%. those under 20, 35%. over 30, 5%. today, 56% between 20 and 29, still the dominant group. age 30 and over went from 5% to 25%. under age 20 dropped to 19%. guest: this is a portrait of the change in first births. that is a critical marker, when a woman has her first child. the proportion of first births to women 30 and over has

quintupled. that is a dramatic shift in childbearing patterns. you have a new norm of one in delaying their first child until the current -- until they are in their 30's or '40's. host: the first call for our guest comes from pat in camden, new jersey. caller: did morning, america. love c-span. i was wondering if the cdc has statistics on if there is a link with women having abortions and then kneading in vitro fertilization or getting pregnant in the future? do you have statistics on that? guest: that is an interesting question, but i do not have information. guest: odierno in general for a

typical abortion, there is a brief -- i do know in general for a typical abortion, there is a brief period of infertility. the medical literature suggests that is relatively brief. i do not know if repeated abortions have a cumulative effect that lasts longer than that. host: abortion rates have dropped in this country according to the cdc's charts. how would you describe the one we're looking at? guest: this shows the abortion rate. host: this is for teens. guest: this shows, the point is to show the trends in the birthrate are compensated by the abortion rate.

i think you can see that except for a brief time in the late 1980's and early 1990's, there are declining in parallel. at some times, the abortion rate has declined faster than the birthrate. guest: to add to that, a point that stephanie made in her charts that i believe are available on your web site and that we may come back to later is that a big piece of the problem is concentrated in groups other than teens. a lot of people think we are talking about teenagers having kids when we talk about non- marital child bearing. most of these pregnancies occur

to non-teenagers. if you look at unintended births and childbearing among women in their early 20's, the trend would be in the opposite direction. we have made a lot of progress in reducing teen pregnancy, but there has been a modest uptick in unintended births among women who are a bit older. i think the group of young woman is a group particular policy importance moving forward. that is the population within which there has been an increase in non-marital and especially an intended childbearing overtime -- over time. host: most births are not teenagers today. the number of births to those 30 and over has risen.

the next call comes from francis in franklin, tenn. caller: i need a statistic on how many people are on social security and welfare. host: when it comes to children, do we have stats on that? is that something you maintain? guest: those statistics exist, but that is not our area of expertise. host: carmichael, california, hi, ed. caller: is there a correlation between the drop in unintended pregnancies with abortion or better education? the decrease in the crime rate in the last 30 years? guest: that is an area of some controversy. some of your viewers may be familiar with "freakonomics."

one of the hypotheses in that book that was so popular is that a reduction in childbearing brought about by abortion caused a reduction 20 years later in the crime rate. there are really smart economists and social scientists on both sides of this debate who feel strongly about their positions. i am not prepared to take the position one way or the other, other than to say i think this is an area of a certain amount of debate. i want to make one point. legalizing abortion, abortion reduce unintended births. they do not reduce unintended pregnancies. in my view, our goal ought to be reducing unintended pregnancies and making the demand for abortions diminished

over time. host: stephanie ventura, this week from victoria. the pill changed everything. how important is it today? guest: it was a tremendous change. you could be prepared all the time. that was a huge change in women's ability to control their fertility. now we have many more methods that are even more effective. , if you do not take every day, it will not be affected. there are other methods that are less intensive in terms of women's involvement. there are patches and so forth that prevent pregnancy. it made it possible for women to prevent unintended pregnancies.

guest: want to emphasize the importance of the new message. they are really enormously effective. the pill is incredibly effective if you never miss a pill. it is still affected if you only miss a few. as the no. mr. increases -- as the number of pills missed goes up, which is a pregnancy goes up. the new methods are so effective. people feel very strongly in a perfect world, we would move more people to these long acting methods, which are particularly effective. host: i want to show this chart from the cdc. stephanie ventura is in charge

of the group that puts these steps together. out-of-wedlock childbearing has risen over the past several decades. you can see the number of births in the thousands is the green line. the percentage is the purple line. both are under 10% in 1940. it has shown a steady rise, let me know if i am interpreting this correctly. 40.8% of all births in 2010 were unmarried or out of wedlock. the number is nearly 60%. guest: 1.6 million in the last year. a lot of things have been going on. some of the things you have talked about. women are delaying. that caused an increase. huge numbers of women were born and decided to get their

education. they did not get married. there were more women at risk of having a pregnancy while they were unmarried. there has been a change in social accidents of non -- social acceptance of non-marital childbearing. since the 1980's, both increased sharply. it is only in the last couple of years, we have seen a stabilization in those measures, but at higher rates. they have been accompanied by other changes. births to cohabiting women, which i think we will be talking about later. host: adam thomas, the policy angle? guest: we talked earlier about the fact women are having children at later ages then they were a few decades ago. what is going on at the subgroup

level is potentially somewhat distressing. well-educated women are postponing marriage and childbearing. less educated women are postponing marriage but not childbearing. there are a lot of scholars who talk about family structure as a major new divide in american society, a new class delineation. there are a lot of heroic single mothers who do an amazing job with their kids. they are at a disadvantage. yhere are important policie shifts with these trends. we ought to be focusing on figuring out how we can empower parents to ensure that they wait to have children until they're ready to become parents.

two things need to be true for a single parent family to exist. you need to have kids and the parent that is not married. we know a lot more about how to prevent non-marital childbearing than about how to encourage people to get married. i think the former avenue is the most promising and the public policy perspective. host: st. louis, cliff. caller: it seems to me the introduction of the pill and the abortion increases have more to do with the numbers on the graph. i think if we could have seen those numbers over time, it would have been an eye opener. it seems the people having children now are coming into work force where they cannot make the money. the baby boomers are going to be

in the hard way to get the money need to support these people with the low wage earners and low numbers of births combined. that is all i have to say. host: stephanie ventura? guest: the decline in births has the potential impact of your citizens available to support the aging population. i think a lot of people are concerned about that. the other part we are not showing much about is the role of immigrants. their children are not included in the statistics if they have them outside of the country. adoptions are not included. if their foreign adoptions, they're not included. if children were born in the united states, they would be included in the statistics. it is an area we need to know more about. host: the replacement level of 2.1.

this is a wide variation in the number of children by race and ethnicity. all races currently at 1.9 child per mother level. hispanics at 2.4, the highest rate. guest: it is important to note their rate has dropped a lot in the last decade. their fertility patterns are beginning to mirror those of women born in the united states. less variation than there used to be in this measure. host: marietta, ga., christine. caller: to the study infertility and miscarriage rates? there seems to be an excessive amount of miscarriages and repeat miscarriages. is that the statistic i have

looked into? guest: do have data on miscarriages. it is not as solid as the date on births. we have a variety of sources. we have a registration system that captures late fetal deaths. we have the survey of family growth that has information on pregnancy outcomes, pregnancy histories. one possible reason miscarriages seem to be more prevalent is that people are able to identify when they're pregnant at earlier stages of the pregnancy. a lot of miscarriages may have occurred when the women did not know they were pregnant. there are a lot of over the counter tests people can use to know that they're pregnant. some of the. increases may reflect that. -- some of the apparent increases may reflect that.

older women are more at risk of having a miscarriage. that is another factor. host: adam thomas, from a policy perspective, do you think the birth rate needs to be higher? guest: that is a little outside my purview. that has to do a broader discussion about entitlements. i think we need to have fewer non-marital and unintended births and pregnancies. in terms of the ideal, costs and consequences for mothers and children. that is not the same thing as saying there should be fewer births. i am simply saying when a birth occurs, it should be to a parent really ready to become a parent. the child will be better off. the. will be better off. society will be better off. host: lectin birth outcomes, in the green, mothers 20 and over. mothers under age 20, those are

the blue bars. preterm birth weight, low birth weight, and infant mortality and birth rates are all significantly higher for mothers under 20. cordova, tenn., gail, you are on with stephanie ventura and adam thomas. caller: i have been listening to you on the federal government helping you figure out why people have babies and what the studies have shown and approved. i am trying to figure out when we decide it is the individual's responsibility. in today's society, you can go into any state and town and go to a clinic and get birth control and education without spending millions of dollars on this every year. it is a burden on a young mother to have a baby out of wedlock. it is also a burden on taxpayers

to keep funding for that and for all of these programs. this country, we're not a bunch of stupid people that do not know what contraceptives are or how to keep from getting pregnant. as a taxpayer, i am tired of paying for it. i am almost 60 and have never gotten anything from the state for having babies. i have three children. host: let's leave it there. let's start with public policy. guest: find would argue -- i would argue the programs i have talked about this morning but funding for family-planning, contraceptive programs, i would argue that kind of public policy is all about personal responsibility. it is about providing people

with the tools necessary to achieve the kind of personal responsibility we would like for them to achieve. the caller also mentioned that in her view, people are not stupid and understand contraception. the level of misunderstanding about basic issues related to fertility and contraception is stunning. let me give you a few statistics. stephanie mentioned earlier the national campaign to prevent teen unplanned pregnancy. they have done studies of young adults. we're not even talking about teenagers, young adults. they found that 60% of young adults think they are probably infertile. the actual number is closer to 10%. 1/3 of people responding to the survey say they know little or nothing about condoms. 2/3 of people responding said they know little or nothing about the pill. perhaps most staggering, 90% of

people in the survey say they have all of the information they need to protect themselves from unplanned pregnancy. when you put those numbers together, you have a big problem related to lack of knowledge and understanding about basic facts. we have solid social scientific evidence showing public policy can make improvements on those fronts. the final point i want to make is the caller and understandably is concerned about the way our tax dollars are being spent. i can assure viewers that tax dollars spent on these programs will save taxpayers money in a reasonably short term. if they are spent on evidence- based programs, they and will reduce unplanned and out-of- wedlock births and pregnancies. those are the kinds of births and pregnancies that tend to cost taxpayers a lot of money.

these are net savings for taxpayers. host: do you have anything to add to that? guest: about 75% of the teens who have a baby in the survey said they did not intend to get pregnant when they did. that is a huge proportion of all teen births. we did the analysis of the decline in teen birth rates and what it has accomplished. we found additional berths were averted because of the decline in the birthrate. teen childbearing, some studies have shown $10.9 billion a year. it is not just the other costs. it is also the health costs. babies born to teen mothers are at greater risk of poor outcomes.

not just at birth, long-term for the child's life. stephan host: interest is the chief of the reproductive statistics branch -- stephanie ventura is the chief of the reproductive statistics branch at the centers for disease control. adam thomas teaches courses in quantitative methods and desist development. he is also one of the developers of familyscape. guest: it is a simulation model developed while i was at the brookings institution. i still collaborate with my colleagues there. it is a simulation model we developed to look at the causes of pregnancy and childbearing and the potential effects of policies related to that. host: if you would like to continue the conversation, go to our facebook page. you will be able to find a link

to all these different charts we have tried to show you today. there are more charts we have not gotten to that you may find of interest. stephen from seattle, you are our last caller. caller: hello? am i too loud? thank you for c-span. i am a former child development educators wondering what the comparison between gay and heterosexual couples would be. are there more that are conceiving babies? what are those statistics? host: stephanie ventura, let's start with you. guest: we do not have good statistics on that. the certificates do not identify. to the birth certificates and identify parents. they do have a diversity of allows two parents to be registered.

the statistics are not where they need to be. it is a growing area because of different legal issues. host: you have not been able to measure whether gays and lesbians are adopting or having? guest: we're able to measure, but it varies from state to state. in the sample survey, there may not be enough of them. host: thank you. i want to show one more chart quickly. these are teen birth rates. for some reason, it is higher in the dark green in the south. new hampshire is the lowest, up in the new england area. why? guest: that pattern has been around for decades, as long as we have been measuring it. a lot of it does vary because of the composition of the states, the demographic composition.

we know birth rates for blacks and hispanics are higher than for whites. states that have a lot of blacks and hispanics would be expected to have higher birthrates. there are other factors. there are differences in education and economicthat woule variations. host: stephanie ventura and adam thomas has been our guest in "america by the numbers." thank you for being on c-span. thank you for joining us this friday. enjoy the rest of your day. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2012]

>> later today, live coverage of an event looking at dental care in the united states, hosted by the alliance for health reform. speakers include a representative from the american dental association. it gets away deep under way 12:15 p.m. eastern on c-span. and we will have more recent speeches from the national press club. remarks from filmmaker kan burns on a decent documentary on provision. in an hour, later more from our "q&a" series. the focus on the military but the editor of military.com, as 7:00 p.m. eastern on c-span2. >> if you want to come to america illegally, don't waste your time going across the border and through the desert. it is dangerous. get on an airplane and five deep fly here and overstay your visa. we have no way to check. the total number of undocumented

in this country has been going down a long time. we have not solved the problem. we saw the problem having the economy -- people come here to work. and if there are no jobs, they don't come here. if they can't find a job they go back home. because america is not a very good place to set around and think the state is going to support you. in the case of your son, somebody's got to create the business that he is going to work for. and all of the numbers this up -- show, immigration -- i think it is because of a self selection thing -- it can be easy to leave australia and come to the other side of the world and give up your friends and family and everything, everything you know, and start out from scratch. that is what people are willing to do. so, of course, immigrants will be more aggressive, of course more risktakers. that is why they come here. the mayor bloomberg is joined in this event by news corp. ceo

rupert murdoch. you can watch their entire discussion tonight at 8:00 p.m. eastern on c-span. >> this weekend on american history tv, 75 years since amelia earhart's failed attempt to circumnavigate the globe, former u.s. air force flight surgeon and crash investigator shares his findings on her life in disappearance. also this weekend, more from " the contenders," our series that looks at the political figures that ran for president and lost but changed political history. >> i draw the line in the dust and toss the gauntlet before the feet of tyranny and i say segregation now, segregation tomorrow, and segregation forever. >> the sunday, former alabama governor george wallace. american history tv, this weekend on c-span 3. >> c-span, created by a mayor

composite cable companies in 1979, brought to you as a public service by door television provider. -- by your television provider. >> next, the independence institute 10th annual alcohol, tobacco, and firearms party. it took place at a colorado sporting club and a featured remarks by david martosko, executive editor of the daily caller and dave kope from the independence institute, the research director. they talk about personal freedoms and gun rights. this is an hour. pick. >> can i grab your attention, please? all right. all right. settle down. plenty of booze later. boo. i want this group to behave. we have loiters in the crowd.

-- lawyers in the crowd. listen up. we have a few things i want to tell you before we get rolling. number one, there are actual media here with cameras. [applause] moon now. afterwards we will have some questions and answers. feel free to stand up. there is a funny looking guy carrying a microphone. he is obviously compensating for something. do not worry about him when he puts the microphone to run the. i am president of the independence of institute, andwelcome to the 10th annual alcohol, tobacco, and firearms party. i cannot believe we have been doing this for a decade. c-span is here. there is somebody there who is on the floor and can i get up to change the channel. i thought we might ought to explain the what the party is

all about for them. the alcohol, tobacco, and firearms party was a great brainstorm we had over a decade ago when we saw what was happening with the growing any state. -- nanny state. the perks of adulthood started slipping from us bit by bit, piece by piece. we need to do something not just to rally around the perks of adulthood, but to actually celebrate the perks of adulthood. what better way to celebrate drinking, smoking, and shooting then drinking, smoking, and shooting. gladly the lawyers -- the lawyers do not let us do that in the same order. but we are working on it. it is not just about people who do not want you to have your 64 ounce soft drink.

but all by a big gulp. it is not just about not eating trans fats, it is about people so very intolerant to they want to use government to get you to live the way they want you to live. they want you to be so much like them they feel comfortable using divisive government to take away the perks of adulthood. they are very tolerant of people with different lifestyles as you should be. but if your lifestyle is to smoke a cigarette, we do not tolerate you. if it is somebody of your same sex as a life partner, that we tolerate -- and maybe we should. all i am saying is that in america, having a drink, having a smoke, like eating a nice fat the doughnut, drinking a big slur p are whatever your decision is should not be perverse. government should not be there to take it away but to protect your rights to do so.

[applause] every year we celebrate the perks of adulthood. this started out with a handful of us getting together. now it is known throughout the country as one of the must attend parties. i cannot tell you how exciting it is to come out here to colorado to one of the best sporting ranges around and play 10 holes of shotgun in and then come back for brandy and cigars. what i have realized is, what hacks off the left so very much is to see the right having fun. if i could encourage you this afternoon, grab the alcoholic beverage of your choice, a good stogie from our friends at smoker friendly, some margaritas from coyote gold.

the official margarita of the alcohol, tobacco, and firearms party. kick back and remember, every time you are having a good time and smoking a cigarette, there is a liberal out there who loses a little part of her own heart. to talk about the freedoms that we enjoy and the freedoms we want to protect. freedom is not allowing people to do things that you approve of, freedom is about protecting people's rights to do things you find it distasteful. let me introduce dave kopel, our second amendment research extraordinaire. -- research director. we cannot do what we do without him. ladies and gentlemen, sir dave kopel. [applause] >> thank you. what i would like to talk about

today is two things that come together. one is, what is wrong with michael bloomberg and the second is what is wrong with john caldera. i will wrap up and you will see how it fits. michael bloomberg is the head of this faux grass-roots organization called "mayors against illegal guns." it finances the center of the gun prohibition movement in the country today. very wealthy with lots of lobbyists in d.c. and state capitals around the country. they have some bucks. it is not exactly what it seems. they have 12 people who got their names off this list when they said, i never signed up for this, you put my name on it without asking me. or you told me it was against

illegal guns. it turns out you are against guns and general. -- really not too many people before the who are for illegal guns. but it turns out you are against guns in general. there are also 19 people -- 19 mayors who have now left office because they were under indictment or because charges are pending or they have to resign or the prosecutor did not bring the case. there are 19 criminals in "mayors against illegal guns," and that means they have a higher crime rate than people who carry permits to carry illegal weapons. -- to carry handguns for lawful protection. the proper way to refer to this group is "illegal mayors against guns."

i would say on the other hand they have done one important service. there are a lot of people who wonder if there is an afterlife for not and how could you know for sure. one mayor who was in this group passed away. yet after words "mayors against illegal guns" was distributing letters signed by this now deceased mayor. if there is any doubt, the governor proved there is an afterlife. >i am not sure it is the ideal way to spend it. what we see out of michael bloomberg and his crowd consistently and including their attempts to exploit the recent murders in aurora and wisconsin and every day is it is undifferentiated hostility toward gun ownership and people

who own -- especially people who own firearms for protection. we know this is rather hypocritical because when michael bloomberg says people should have guns for protection, i guess he has his fingers crossed. if you can get the entire new york police detail to follow you around with machine-guns. that is okay because he is not personally owning a gun for protection. maybe he feels there is a difference there. they put out these terrible libels against people including saying the only reason a person would own an ar-15 rifle is because they want to be a mass murderer. what a horrible thing to say about millions of americans who have made the ar-15 the best selling rifle in the united states of america. what a malicious falsehoods to say about our police who frequently carry an ar-15 in their squad cars in

circumstances where they might need a rifle for backup. a lot of civilians use them for target shooting, some defense, for hunting game up to the size of the year. -- deer. not terrible enough for something larger than that. the police don't have those firearms among others because they want to harm a lot of people. they have them for legitimate purposes, and especially for protecting themselves and other people. what we do at the independence institute in our legal work on the gun issue is almost always we file a joint amicus briefs with police organizations, with a huge coalition. our amicus brief was filed not only for the independence

institute of for the two major organizations that train law enforcement in firearms use. these are the trainers for the rest of the police, the international educators and law enforcement firearms. and what we consistently say with the police is there is one key principle that has two manifestations. guns in the wrong hands are very dangerous. we need stronger laws to try to keep guns out of the wrong hands and to punish them and put somebody away so they can not in danger somebody. at the same time, guns in the right hands protect public safety. they help civilians protect each other. we also need strong laws to make sure there are guns in the right hands to protect the rights of law-abiding citizens to purchase, own, use, and carry

firearms. 40 years ago there were virtually no gun laws in colorado and most of the united states of any sort. the reason that the gun debate in this country has finally settled down after four decades as it has in colorado and after all we went through after columbine is we have come to a consensus based on common sense and we have added a lot of laws to strengthen trying to keep guns out of the round hands and a lot of laws to protect the rights of law-abiding people. the most important of these laws in colorado -- which is the same thing we are fighting for in maryland -- is the right to carry. colorado's right to carry law was written by the sheriffs of colorado. it ensures a lot of biting the

-- law abiding adult who has a safety training class and obtained a permit to carry a handgun for lawful protection. that is our single most important colorado reform. deep post-columbine reform. [applause] we worked on this issue for over a decade to make it become a law. what a difference it already has made. you know what happened in december 2007 when an evildoer went into the sanctuary of the new life made a church and colorado springs. -- in colorado springs. 7000 people there. he had already murdered four people and he came in their intent on mass murder. because of the county sheriff's of colorado and our right to carry, a church volunteer was lawfully carrying a handgun in the church. she stopped the killer.

the pastor said she saved over 100 lives that day. [applause] we want laws like that everywhere in the country. we have them in 48 states. maryland is coming soon. it is the essential that -- the protection of the right to bear arms be protected nationally. as of national civil rights should be. one of the things we are going to be promoting very much of the independence institute is stronger laws on the mental health. there is lots of ways government spending can be cut starting with corporate welfare, which is illegal by four different clauses of our colorado constitution. we ought to cut that out. one of the things we want to promote from here on in including the next session of the legislature is better funding for mental health services. not only sensational crimes in aurora but a lot of homicides

that happen that never dig camera crews from around the country are committed by people who are seriously mentally ill who 30 years ago or 50 years ago would have been institutionalized. there are no beds for them now and no support system. we want to take money out of the hands of corporate welfare -- of the special interests and put them into the community interests of a strong system of mental health in colorado. [applause] so we know what is wrong with michael bloomberg. let me tell you what is wrong with john caldera. he was talking about -- >> on the mental health thing? >> your not supposed to talk about that part. when he referred to our alcohol, tobacco and firearms day as the perks of adulthood. that is fine to characterize alcohol and tobacco in those terms.

it is not right on the firearms side. let me tell you about two places in the world. one is western australia. there was a study done of aborigines who were in prison. they had been convicted of crimes. one group of aborigines had -- to both of the criminals had guns. one group of the imprisoned criminals had misused guns in a crime. the second group -- these were people in prison for committing felonies. they had never misused a gun against a human being. what was the difference between the two? it was the ones that have never misused again have been taught about guns by a father, uncle. they learned about shooting sports and acquired an attitude of trading guns with -- t

reating guns with responsibility and saw them as something you use to shoot some game and not something you used to harm an innocent person. another study in rochester, new york, they did a study overtime and tried to find 16 year olds most likely to become juvenile delinquents. that means they did not study girls at all. if you want to study crime, you only have so many people, you focus on the males. they tracked them over the years. the youth who at 16 and illegally owned a gun -- maybe they bought it from somebody on the street -- had a very high rate of being arrested for serious crimes including gun crimes. the youth who legally owned a

gun. it said they had a shotgun and it went hunting with their dad or where rifle shooting with their uncles. they had essentially no crime rate of any kind. how young people are socialized about guns is hugely important in future outcomes. contrary to this positive socialization that some of the young people in western australia and rochester had is the tremendously negative association that comes through too much of our media, particularly television entertainment and the movies. people who produce these horrible pornographic obsession with violence, like quentin -- celebrations of violence -- tarantino movies. they say that has no influence on people. i am sure that is true for the large majority of people. sitting in has no affect on what people ever do, is it kind of out -- is it odd they sell

advertising. what a waste that must be. because apparently something you watch has no effect. how strange is it these movies and tv shows have sold product placement. coca-cola pays us money and we will have a character drink coca-cola. on the other hand, it never has any affect on them. likewise, the reason that now with the culture war against smoking is you are not supposed to show characters smoking in a movie that young people are going to see. on the other hand, what people see does have an affect. hollywood will say we make sure when a 15-year-old goes to a movie he will never see somebody lighting up a cigarette but he will see this massive violence and gun amiss use. -- missuse.

i do not think it is fair to say that never has an affect on anybody. we are not for censorship, but we are for counter programming. that is part of what atf day is about. introducing some of you to the shooting sport, giving others the opportunity to participate more often, and hoping all of you go out and spread that concentric circle of introducing your friends, your co-workers, your neighbors, and especially young people you know to the responsible shooting sports, which as you know is a culture of safety, responsibility, self control, discipline, and really so many things that exemplify exactly what is right about america. one of the things we are handing -- [applause] out is from our friends at the nra since 1871, america's oldest civil rights organizations and a mass education organizations as well.

they have been teaching people about shooting safety with a focus of young people ever since 1871. there are lots of materials you can take and we encourage you to do that. one is the nra qualification program. it is about the size of a magazine. it shows you how on your own whether you like your guns or sporting clay or 22-caliber -- 22 caliber rifles. or revolvers, or what ever. courses oftarget shooting you can go through and earned the school patches and metals as you work your way up in proficiency. everybody can do it. we encourage you to do it yourself and hope as many people as possible -- you bring in as many people as possible. on this issue, we are not only on the pro-choice side, we are on the pro-life side as well. what we are doing here every

day at the independence institute is to fight for those life-saving values of safety, responsibility, american constitutional rights. we're not just protecting those rights in colorado. we are making sure the rights are protected as we did in the macdonald case. we look forward to the day where even the people in the most oppressed parts of the united states under the sweltering heel of michael bloomberg will regain their rights to smoke a cigarette or a cigar, to drink a big gulp of soda, and to own and carry a handgun for lawful protection because it is a civil right of every american. [applause] >> we have always had a tradition -- a terrific tradition of bringing great communicators to the party every

year. we have had occurred just -- christopher hichens, fred moore. andrew breitbart, mary catherine ham. i appreciate having steve moore who i swear has never touched a gun in his life. as he was shooting somebody said it "he says he works for the wall street journal, but it looks like he works for the new york times." the media is changing. the way we get our information is changing. online publications are more and more important and valued. there is one little site that has the people at huffington post looking over their shoulder every day and that is the daily caller. it is one of the best portals for news in the country. [applause] one of our longtime friends there, the editor of the daily

caller has been a great friend of ours and freedom and a real enemy of nanny is some as long as i can remember him. let me introduce david martosko. [applause] >> i guess some of you read "the daily caller." actually, i have a major announcement before i really get started. it is always breaking new ground on news reporting. since we are smashing barriers all the time i would like to announce who will inaugurate a new section -- lgbt section, lasagna guns beers tobacco. we are the only ones with a guns and gear section.

-- beer section. i am writing a cigar a column called "cigar hunter." we have a wonderful the senior editor who reviews the years. i suspect right now tucker carlson is cooking marinara sauce. i am glad to be back here. i spoke on a panel in 2009 with andrew breitbart. i will never forget riding around in a van and the window was open and he was howling at the moon. i don't him and said, what is with the hooting? he said, if you are not having fun and letting it all hang out, there is something seriously wrong with you. he became famous and maybe even more so after his untimely death for heating big government hides to tell us what we should do and how we should do it. what we sometimes forget is that brietbart despised the nameless, faceless bureaucratic

nightmares to try to control what we do behind dark curtains. i hated them, too. i really do. i hate that they are smog. -- smug. they believe they can tell us all what is best for us. i hate to they have tax payer funded jobs to tell us what is best for us and to do it outside the cold truth of common sense. i even hate the sleep well at night, do you not a little bit? i think i know what brietbart is up to right now. i think he is rollerblading around heaven and probably doing it with cs lewis. not because he finally found religion or he read "the chronicles of the narnia." in the 1948 lewis wrote an essay called "the humanitarian

view of punishment." part of that included people who inflict punishment on each other for no good reason. this is what he wrote. of all tyrannies -- a tyranny exercise for the good of its victims may be the most oppressive. it may be better to live under robber barons than under omnipotent moral busybodies. the robber barons -- their cruelty may sometimes sleep. for those who torment us for our own good will do so to no end because they do so with the approval of their own consciousness. they may be more likely to go to heaven, but more likely to make a hell on earth. i am not drinking, but i am

smoking a cigar to cs lewis. dave is right. it sounds like breitbart meets oxford. basic freedoms are crumbling all around us. somehow michael bloomberg manages to never be photographed in his nanny costume, but i think he dresses like that on weekends. first he went after salt at restaurants. people who are allowed to have access to a salt shaker without supervision. who is bloomberg to tell us what to put in our food anyway? if you are on a major dose of hypertension drug and you go around slurping soy sauce and licking margherita glasses, you are a moron. screw you. being a moron with a modicum of freedom beats letting some know-it-all create a nerf planet for you to live in.

that is what they are trying to do. bloomberg has decided a soft drink bigger than 16 ounces should be beyond the reach of men and women. absolute idiocy. we should mark this and reticulate and come up with silly names for it. here is what i love about the controversy. this tends to bring up the best in americans. we rally in against it and do something. a friend of mine at the patent and trademark office tell me something remarkable. she said shortly a few weeks after bloomberg announced his soda crackdown, somebody made an injury to find out if a new kind of soda had been patented yet. it is a cylindrical paper cup. it is not tapered at all. it has a movable bottom. you go to the counter at subway and they sell you a 16 ounce soda.

it can only contain 16 ounces because the bottom is halfway up the cup. you take one shove with a straw and now you have a 24 ounce cup. that is a big screw you to michael bloomberg. the animal rights people always -- it is like when the city of chicago band but liver. -- banned duck liver. the animal rights people always get their undies in a twist about something. the problem is there was some nincompoop in city government whose mind was so open and he had such an open mind that his brain fell out. the important thing is these candidates, they did not outlaw consuming it. they did not outlaw cooking it. the outlawed selling it. human ingenuity kicks in.

there was a group of eight restaurants, fine dining restaurants. they called themselves "the duckeasies." here is what they started to do. previously they would sell you a $50 plate of foie gras and call it the complementary crustinee. here's what they did. they sold you for $50 -- they sold you the plate and gave the foie gras to you as a garnish. eventually the law was moot. -- neutered. even the mayor said let's cut our losses. the repealed the law. back in the new york they have not gotten the memo yet. the department of health and human hygiene, the next thing -- mental health thing -- mental hygiene. the next thing that comes up is movie popcorn. there are going to limit the size. after that will come the size of your milk shakes and frappuchinos. you cannot be trusted with

these things. he may be right. and it michael bloomberg telling hospitals to put away the baby formula. that is not a joke. he may be right. breast feeding might be healthier. both of my daughters are breastfed. fine. whatever. i suppose the next it will ban breast feeding if there is more than 16 ounces in there. [laughter] am i a little nuts for smacking around michael bloomberg so much? the latest polls show 65% of americans are against limiting soft-drink sizes in the new york. why all the fuss? my question is, what is wrong with the rest of the 35% of people? they are probably the same idiots who think it is a wonderful idea for the u.s. be a to change the menu in their cafeterias on mondays to celebrate meatless mondays.

this is the federal agency that inspects and grades stake. -- steak. they said the rules and regulation for how you sell bacon. because of a bunch of vegetarian activists, the only cuisine you can get on monday is a salad with tofu. i am eating somewhere else. i speak from experience. i tried to be a vegetarian once. it was the longest 45 minutes of my life. [laughter] but they are very good for comic relief. if you want to be a vegetarian, a unitarian, a libertarian, i do not care. just keep it to yourself and do not force it on people. once on "the simpsons," lisa the daughter announced she was going to be a vegetarian. homer's said, wait a minute. you are telling me you are never going to eat animals

again? what about bacon? and she says, no. ham? no, dad. porkchoppers? those all come from the same animal. and he says, sure a magical wonderful animal. i never liked lisa simpson. she reminded me of every anti- everything person that i enjoyed mocking at a safe distance from dartmouth college. in the late-1980s. i realized later in life why we would tell jokes at their expense. not because they were different or mysterious or because we were threatened by them. it was because they were never happy about anything. never. they were at an ivy league school is about to have the world by the proverbial cajones. it did not give them pleasure. how many people have the scene

-- peta people you have seen who are generally happy people? how many gun control activists are content with their lives when not controlling yours? how many and tie sugar crusaders minutes to go through life -- anti-sugar crusaders do you see going through life without a constant scowl on their faces. they are scared some where somebody is enjoying a lollipop. i do not know any anti tobacco nazis ever cheerful in the morning. i am not cheerful until i have my breakfast cigar. but that is just me. enjoying freedom and your own course through life is fun. sometimes you work without a net, but it is fun. isn't it? [applause] we are here to shoot guns until the air today.

i shot some really badly. smoking cigars, drinking something handcrafted for the sole purpose of enjoying it. the simplicity of it all, it is making everybody in this room happy. i can see it. you are enjoying yourselves. i know for next year -- the only thing that will make it better next year is we need an ice- cream sundae station over there. we need a chocolate river back there with some oompa loompas would be great. you have to understand there is a logical argument be made for the anti-social, anti sugar, anti meat nannies, michael bloomberg, the humane society of the united states. it is peta with a nice service to watch. they are saying not smoking, not eating meat is the patriotic thing to do because as health care changes and we all start sharing resources and it becomes a public thing, they say my

cigar smoking will put health expenses on all of you. that is nonsense. fat people and smokers are the most patriotic people in a america. but that may, i am not a skinny man and i write a cigar column. i will die six weeks early because of that and i will save the health-care system hundreds of thousands of dollars. they should name a street in ohio after me. i am a hero. why worry about being overweight? 200 years ago, if you did not have junk in your trunk they did not want to paint your body. that meant you were not part of the peasant class. you were not starving. that was a good thing. back then,the rich and the famous, their life expectancy was 45 years old.

i checked this last night,the un says the life expectancy average four american adults is 78. i think we are pushing the limit of the human body's ability to bounce back from things. at a certain point if you prevent yourself from dying of lung cancer you will go from alzheimer's disease. the point of diminishing returns has been reached. anxiety is a health risk. he to break it to you. happiness, psychiatrist will tell us, can be as beneficial to bring chemistry as the best drugs that can get out. -- to brain chemistry as the best drugs they can give out. even better than the healthy food our first lady pushes on sesame street. where did this all come from? they came from the modern public health establishments. the public health movement. more than a not, i think it is a cplete miss an obstacle to our happiness. -- dennis and optical to our happiness. -- manace and obstacle to our

happiness. originally it was about curing and stopping epidemics. 100 years later, we cheered and eradicated measles, mumps, the black plague. something that used to kill millions of people. now it is never heard of. now, you have to reinvent yourself to stay relevant because there are millions of government grant dollars at stake. there are college professorships -- if you price yourself out of the market by being irrelevant, the money dries up. the public health people had to find something else to do. public health mostly has become -- aids and cancer, that is what it should be. but it has become a social science instead of a hard science, and that is the problem. we have a lot of quasi-academics who cannot cut it in the laboratory. instead of doing hard science, they are regulating ourselves in taken shrinking our dessert portions because that is all they know how to do. i used to represent an organization called the center for consumer freedom. they tell me now that there is

a professor at the university of san francisco who is on tv claiming that sugar is so dangerous and toxic the government should regulate it like alcohol. on tv, he nods in the approval like he received some great wisdom from the man on the mountain. it is sugar for crying out loud. brush seen people air cigarettes out of movies. i cannot wait for the next remake of willy wonka where they will all be eating broccoli. of course the public health theocracy is coming after cigars. they have been working on a rulemaking procedure that would take cigarette regulations and apply all of them to cigars. you get the tax increases. no more buying a cigar over the internet.

the rationale is that 16 year olds are spending $16 of their disposable income. -- on cohibas. that is what they say. we have to keep cigars out of the hands of children so we cannot buy them on the internet. because he cannot show an id. nobody is arguing about whether or not the fda has the authority to do this, because they clearly do. that is no excuse. it is not. compared to the nutty osha regulations they have to deal with every day of the year, maybe restricting cigars does not seem like a big deal. these things never seem urgent until it is yours. and then you carry lot. eventually something you care about will be scorned by the government. and then you will care and talk about. do what john suggests.

talk to people about this event. it is a heck of a lot of fun. i do when you to know a little bit more about the daily caller. it is unlike any other news organization in america. our reporters are fearless, hungry. editors do not have any sacred cows. during the primary process we went after an awful lot of republican pretenders. i think we did a good job. we did that take marching orders from campaigns, political parties. -- we don't take marching orders. that puts us in a shrinking minority of u.s. newsrooms. i would like to leave you with this thought. most of the problems in the nanny culture -- and that talk about social science versus hard science -- most of the problems arise because those two branches of discipline operate like very different pieces of machinery. hard science, the kind of say, -- that says, gee, what causes

cancer, they operate in a way that is very good and honest about rethinking conclusions on the basis of new evidence. galileo, einstein, stephen hawking -- we may not always understand what they are talking about but we trust they are playing fair. we trust if they get something wrong, the next generation of scientists will correct them and not try to cover it up. there is a built in humility and hard sciences. -- in hard sciences. there really is. born of the recognition that the natural world is far too complex or wonderful for any one of us or one generation to truly understand. social sciences are an awful lot like political -- they move in one direction only. -- political progressivism. they don't want anything back ever. nobody has ever apologized as far as i know for the great society and said, we should do this in a different way or outcome based education.

remember that one? the self-esteem movement among that little kids, a total failure. nobody has pop -- has apologies -- has apologized for that. the marriage penalty, i am waiting for an apology because i am married. nobody will ever apologize for telling college kids that a degree in ethnic studies or wind studies will make them unemployable. [laughter] if that describes any of you, i am very sorry. i am not sorry for saying it, i am just sorry. social sciences are subjective. the definition of success can be whatever you wanted to be. there is nothing oppressive to point to, it is your contention is that count for everything. -- it is your intention is to count for everything. michael bloomberg is practicing social science. it's been in large soda's does not make the body mass index card down, he will say i tried. -- if banning large so this does not make the body mass index go

down. i will always remember the and the paper cup with removable bottoms. government cannot change human nature as much as it tries. they can make themselves feel good and purposeful and they can do it with your tax dollars and hold press conferences and issue reports and guilt trip ordinary americans into being less happy and content. do not get sucked in. the best revenge against a nanny culture does not come when we piss and moan and put up a fight. it comes with a smile and acknowledge you are happy and they are not. i am sincerely happy to john for having me come out. -- grateful for john for having me out. i would be happy to answer questions but the most important thing i did tell you is visit the daily caller on a daily basis. our average puts us above the boston globe, the rolling stone. "the new yorker" and "the

atlantic." [applause] if america, we are changing the face of online news month by month, step by step, reader by reader. if you do not read it, download the ipad app. i am filing cigar columns twice a week. how cool is that? i was here in denver at a place called cigar on 6th. what a cool shop? they have a barber shop in the back or you can get a haircut while you smoke. is that not cool? i will read a column about that -- i will write a column about that and i will probably read about some of the people i have met today. i just wanted to be a positive day. i am so grateful to have met so many of you. to all of the clay pigeons i missed, i will get you next time. thank you very much. [applause]

john said i should take your questions. i would try to do that and hopefully not offend tucker carlson in the process. >> one wonders sometimes why god gave us canine teeth. the answer to that is, he knew someday we would have to tear plastic. [laughter] >> that is not really a question but i will tell you on the subject of vegetarians. i have relatives who are vegetarians. fine. do your thing. i have been in the situations where vegetarians will look at the menu and said what is the vegetarian entrees. like it is such a big in position. i have never seen anyone at a vegetarian restaurant say "where is my lamb chop?" we do not do that. we are far more tolerant. i wish people at peta would wake up and smell the coffee.

question for either of us. >> why is it that so many republicans seem to favor freedom for alcohol, tobacco, and firearms but oppose things like colorado amendment 64 that would legalize marijuana or oppose medical marijuana initiatives that help people with their pain. >> i think not enough of them have smoked it yet. -- not being a republican for office i am not sure i can answer that. do you have any thoughts? >> being a lifelong registered democrat i can tell you lots of times republicans are wrong. >> i will be very honest. i tried marijuana in college. my roommate paid for his tuition by selling it. he felt generous one day.

i think it is a fine cause. we should write something about it at the dialy caller. >> if you had a chance to read the editorial that blames governor romney for the fact that the media ran with senator reid's accusations of the taxes paid for 10 years. what that said about journalists if you saw the editorial. >> i think it is fair to say that the romney campaign did not respond terribly aggressively. it was that it had to be people -- saw -- sad that it had to be surrogate ands three degrees of separation away from him. it would be nice to see republicans with enough piss and vinegar to call someone a liar to their face. what is also true is the online the world, they responded very

quickly. within three hours of him making the accusation, there was a meme going around. by midnight that night it was the number 1 trending thing on the twitter. if you do not know what a pederast is, it is a man having relations -- let's just say it is jerry sandusky. now, the urban dictionary has now inserted a new definition of harry reid. i will leave it to you to go and read it or read the piece we published last monday about it. that stuff is not going away. people do not put things out there for political gain, come on, talk about it. -- just like the tax thing, we have not heard him deny it yet. is just as silly as the tax thing. i think the romney campaign

could have responded more forcefully. it is a long the campaign season. they have 90 days to go. and a lot of other things to worry about. >> do you speak at college campuses? what is the reception you get? >> it has been a long time since i have spoken at a campus. >> i speak at law schools often. there are lots of open-minded people interested in ideas. it is a good thing. colleges are not as bad as you might think reading the forced to media reports. -- based on the reading the worst media reports. >> with that said, we are both available. >> would you comment on global warming. >> you first? >> i think it is at a unique crossroads of hard sciences and social science. gradually speaking,the hard scientists are coming to the recognition -- the founder of global warming said we were

overzealous. hard sciences are coming forward gradually setting, we overshot the runway by a lot. the problem is the social scientists that are relying on the early judgments for their programs are not walking back. al gore will die 1000 deaths and marry a republican before he will walk that back. the hard sciences started to evaporate. you are left with hanson from nasa saying i was right all along. but most people with ph.d. in hard sciences are saying,they are saying, no, you are wrong all along. it will come to one of those things as one of the most aggressive and deceptive hoaxes in the history of science. that is what i think. >> let me take a more gnostic position, i am an associate

analyst at the cato institute in washington, d.c. i defer to cato's expert. a former state climatologist for virginia. in his view, there is some global warming. it has been hugely exaggerated by professional hysterics. like james hansen. the responses to that likewise often really do not make much sense. saying this is the reason we have to take over your entire life because of this alleged crisis. the ones i know and listen to say at the least be cautious about people who say this is a new reason why you have to give up all of your freedoms. >> anyone who has ever bought a carbon credit, i have a wonderful mormon temple in israel to sell you.

dirt cheap. >> how many reporters do you have? >> including reporters, editors, and people who do both -- i do not know. i think the editorial side is around 20 people. they are all highly energetic people. a lot of people a very young. -- a lot of them are very young. not -- a lot of people who are not journalism school graduate so people who are not tainted. i have not spoken to tucker carlson. when i see -- journalism school, right in the shredder. we also have the business side to the daily caller. every news organization in america, you may think they are in the business of telling you the news, but they are in the selling ads business. do you know why newspapers have gone the way of the dodo? craigslist.

it was not too long ago that they meet 30%, 40% -- they made revenue on classified ads. you can do that for free now. that is why the new york times shrink their page. "the new orleans times picayune -- they are stopping their print edition entirely. "post-intelligencer close quote from bailey to several days a week. that is the way it is. the nice thing is we are on the cutting edge. we are going directly to consumers. i think numbers show we are giving them mostly what they want. >> what will the daily caller think of the paul ryan pick? >> i would just say it is a great indication the romney campaign believes the election will all be about economics and not much else.

paul ryan brings economic, budget, and job credentials to the table. i think they made a calculation. we will see if they are right that economics and "it is the economy, stupid" will be everything in november. we will have to see if they made a good calculation. >> one of the things that will happen in november is the ryan pick will cause a national conversation about doing something serious about the fiscal crisis this country is heading towards. it is important to that if mitt romney is the next president that he come in not just because people got tired of obama or this or that, but they come in with a mandate to work with congress. the congress knows we really have to do something before we end up like greece and

california. we're not far away from that happening. i will go back to being a democrat. if you believe in the legacy of franklin roosevelt with social security and say -- we have burned through a lot of money and the country collapses financially and they are gone. if you believe social security should be around not just for this generation but for the generation after that, that is something that provides long- term stability in the united states and you want that to be there for your children and their children, you'll support paul ryan. he will fix them so they can last in the long run. obama will drive this country into a fiscal disaster which will kill social security,

medicare, along with the rest of the economy. [applause] i cannot wait to see paul ryan debate joe biden. it will be interesting to see. that will be fun to watch. back to your host. >> i want you to stick around. we have door prizes and all sorts of shooting prizes. eric does not want to leave. i cannot believe we have been doing this for a decade. it is something that a lot of americans do on their own. we should celebrate this daily freedom we have while we still have it. i'm thrilled. i know this is not the average

committee room someplace in a d.c. basement or some panel someplace but this is how america lives. we're out here in the beautiful colorado land and a lot to think the folks here at the sporting club for their hospitality and what they do. i want to thank the great sponsors. smoker friendly has provided us with these great stogies. i want to thank everybody for being part of this. take a step outside. it is ok to turn off c-span. grab a cigar, go up to a gun range, maybe having a martini because you're an adult and you get to enjoy those freedoms.

i want to thank you all for being here for the 10th annual out all and tobacco and firearms party. let's say goodbye to the country. >> we will give you a chance to see this event again this afternoon at 2:00 p.m. eastern on c-span3. we will follow that with your phone calls and comments. we have a question on facebook -- what is the role of government in regulating what people eat and drink. nicholas smith has a response. "the government has no right to say you can consume the product." we are also looking at tweets.

daniel. a tweet from mcdanie go to twitter.com/cspan. >> if you want to come to the country illegal, get it an airplane and overstay your visa. we have no ability to check who you are and get you back. have we solved the problem? people don't come here to put their feet up and collect welfare. they come here to work. if they cannot find a job, they go back home. somebody has to create the business that he will go to work for. all the numbers show immigrants -- it cannot be easy to leave

australia, come to the other side of the world and give up everything you know and start out from scratch. that is what people are willing to do. of course immigrants will be more risk takers. that is why they come here. >> you can watch the entire discussion tonight at 8:00 p.m. eastern on c-span. >> i started as a copy boy in "the new york times." i was in a training program after i got out of the army for "the wall street journal." >> this sunday, on c-span's "q&a," "washington post" columnist walter pincus talks about his various jobs as a journalist, his views on extravagant u.s. spending overseas, and his criticism of the defense department's budget priorities. >> and they built a $4 million facility for the band, which is

about 40 people. it had separate rooms for everybody. if you had spent $4 million on an elementary school, i bet somebody would raise questions. >> more with columnist walter pincus sunday night at 8:00 on c-span's "q&a." >> which is more important -- wealth or honor? the economy, stupid. it is the kind of nation we are. whether we possess the determination to deal with many questions including economic questions but not limited to them. all things do not flow from guelph or poverty. i know this firsthand and so did you -- all things don't flow from wealth or poverty.

>> we have the lowest combined rates of unemployment inflation and home mortgages in 28 years. look at what happens. 10 million new jobs. 10 million workers getting the raise they deserve with the minimum wage law. >> c-span has aired every minute of very major conventions since 1984. you cannot live coverage, every minute of the republican and democratic national conventions live on c-span, c-span radio, and streamed online at c- span.org, beginning on august 27. >> exploring ways to fight obesity in the african-american obesity. when discussion focused on health disparities -- one

discussion focused on health disparities. they talk about environmental factors that can influence behavior and the media. this is just over an hour. >> thank you for participating and for attending this panel. for the next hour, we will discuss solutions for eliminating some of the health issues caused by obesity that have a disproportionate effect on our community. our esteemed experts are sheree crute, an award-winning writer and editor who covers a broad range of health topics and specializes in multi-cultural health. a veteran journalist and a contributor to "the root," she was the founding helath editor for the nation's first publication focused solely on the health needs of african american women.

she has literally written the book on how to cover health disparities in the media. next we have eleanor hinton hoytt. she has been president and ceo of the black woman's health imperative since 2007. as president, she has been committed to advancing the core values of social justice and reducing health inequities, engaging black women to become advocates in the fight against hiv-aids and breast cancer, and advancing black women's well- being by promoting reproductive justice, expanding contraceptive access, and encouraging healthy sexual behavior. finally we have dr. michelle gourdine, the ceo of michelle gourdine and associates, a consulting firm that crates policy solutions and improves the health of underserved communities. she is the author of "reclaiming our health, a guide to african- american wellness." a graduate of the johns hopkins school of medicine, dr. gourdine is a clinical assistant professor at the university of maryland school of medicine and senior associate faculty at the johns hopkins school of public health. she is the former deputy secretary of health for the state of maryland. thank you all so much for

joining the panel. we appreciate it. all three of you cover a wide range of health issues in the work that you do. can you explain how you are attacking the obesity epidemic in your work? >> i would like to congratulate the group for bringing this obesity to the attention of so many. this is an issue that we have dealt with in our almost 30 years of being in existence, making sure that we be the voice for black women's health and dealing with the real experience that black women have. being overweight and obesity is part of our cultural heritage. we try to hear the stories and we are the voice at the kitchen

table, everybody's a kitchen table from congress and the administration, policy makers and others so that we can move this issue beyond the individual woman, to take into consideration the social health determinants and the environmental and food industry. we are the voice and we here and share the stories. you'd be surprised of the many stories we get from black women who cannot get care, who are refused care and cannot get quality care. we worked very hard on the affirmative care act, making sure that there were provisions that took into account the preventive measures that you now find in the affordable care act

that will provide at either no cost or low-cost -- low-cost and no pay for many of the essential benefits. i know other people do much more. one of the things we understand is that weight is not weight itself. you have to deal with the psychological barriers and would deal with some of the environmental and try to get doctors to be more sensitive. we talked about that. we have something called self-

help sister circles so women can share their pain and shame and trauma of being refused care by some physicians or not getting the kind of care by some physicians and also the shame of being black and female as well as big. >> underlying all the things i've done, i am a doctor. my job initially was to treat some of the outcome is of carrying extra weight -- the high blood pressure and the diabetes. i was treating those conditions and we sawncts children with more adult problems. when miller call adult onset

diabetes -- we no longer call adult onset diabetes because it is happening in children. i wanted to do something to be able to help people live healthier lives and not get sick in the first place to be treated by a doctor. ing myl in a write-i my book is to provide education, the need for us to understand what it means to live healthier. it goes beyond the education. you have to have the resources that you need to be healthy. you need access to the healthy foods and the ability for your children to go outside and get adequate exercise. you have to be able to have

health insurance so you can see the doctor if you need to see a doctor. sometimes we need to do that. we need to understand some of the underlying issues -- stress is a huge, huge issue and we do not talk enough about that. understanding of those issues and translating what is happening on the ground in our communities into language and policy options and solutions that our officials can understand and develop policies that transform our societies into environments that he'eal rather than environments that seconicken. >> my approach is a little bit different. my personal mission has been to

try to communicate all the health-care disparities that affect african-americans and african-american women who i have written about most of my career in a way that is fair and balanced and respectful and it does not stigmatize us or perpetuate stereotypes that are on helpful in a struggle to try to address the health problems we face. i have attempted it through my own work and also through talks with much larger groups like the of health care journalists. many of the people who write about health issues do not know us and do not know those issues and do not know our culture or

committee community. they may even add to the stress, and to the self esteem issues and also limit our access to resources. i make an effort to try to make an effort that the work i do and with younger people, that it doesn't make those mistakes. >> thank you. you touched on it a little bit, that you were treating children for adult diseases. is our health care providers and locally trained to help their black patients fight some of these diseases and fight obesity? >> no. i was trying to think of a nicer

way to put it. i know how we are trained. doctors are trained to diagnose and treat disease. when you encounter a doctor, you are already sick. this is up but i had to learn along the way in my career. i think our medical schools are attempting to teach that, but we have a long way to go. teaching people how to be well. dealing with the individual issues that impact an individual's behavior. when we talk about eating in a particular way or getting and particular amount of exercise, it requires a level of motivation and desire on the part of the individual to do that. that is something you can facilitate.

if there were something that is lacking and needs to be nurtured in terms of training of our health care professionals, it is coaching people. the root of the word "doctor" in latin is teacher. that is an important aspect of what we do, to begin to teach and to coach. not to be paternalistic. sometimes we tend to be too paternalistic and say, "you should do this and you should do that." theseheard colleagues say " patients or those patients." who are you to tell them to do anything? we do not have a good

understanding of the environmental factors that play into individuals making decisions about their health. individuals who do not know us may not be able to relate in such a way that would encourage people to want to eat better or to understand how people eat. i am a southern girl. i was practicing and a nutritionist was giving a sample diet plan to one of the patients. i took a look at it and i chuckled. i said, i would not fall this either -- i would not follow this either. decibels like string beans were caught in meet -- vegetables like string beans were cooked in

meat. it might have allowed the nutritionist to provide a more appropriate option for that individual. we need to be able to understand the culture within which people live which influences how people live and we can be more effective as health-care providers in helping people to live better. >> i would assume you know about this from the patient perspective. >> i do appreciate doctors. i loved doctors. i recognize their limitations. that is what we have to do. doctors are not doing so well themselves. particularly black women

doctors. we should not depend on them always to guide us in this. we should enter into a partnership. there has to be a partnership. the other thing is self care givers. i have friends who are self care givers and who are overweight and obese. they need to be good learners because they have -- many of them have forgotten where they came from and many of them internalize some of the difficult images and are judgmental. this is not anecdotal. i'm telling you -- we have the story. if we don't have them written,

they tell us. thatne thing i'm hoping the affordable care act -- can see i'm a big proponent of that -- as is our one chance if we can figure out what it does and what it will mean for our community and for our population. this is the opportunity that we will be able to shift the dialogue from disparities to equity. it has obesity counseling. it has diabetes screening, even for kids. it has mental health counseling in it. it has the preventive health screenings for gestational diabetes. that is one of the things we try to do, it is to relate obesity

to the diseases of weight. diabetes and heart disease and cancer all relate directly and indirectly to obesity. doctors do not do a good job of relating -- we understand the interrelationships. that's why i am pleased to work with a lot of the medical profession groups, that we can help them understand some of the cultural dynamics as well as some of the gender specific issues that are going with the black women who struggle daily in maintaining a certain lifestyle, including healthy weight management. >> the big story is the affordable care act.

the big story is kind of the battle around it and not so much what is in it. what are some of the things in the affordable care act that could help to combat obesity? >> there is a significant prevention in obesity fund. i believe in the range of 7 $4 million that is targeted specifically to obesity and fitness, and includes michelle obama's initiative. there is also a prevention fund that has an obesity component. from the media perspective and looking at the coverage that i have seen, most of the coverage is very political. it doesn't talk about how grassroots organizations -- how

you can get to that money and how that money can be brought to low and african american women so that it can be put to good use. but it is there. any of you with connections to local government, i would say get on the phone because there is a big pot of money and a complex pot of money but it is there. >> let me speak to that. some organizations will not be able to get to the money. it is $60 million 4 diabetes and hypertension. we decided not to go for it. the american heart association and all the other big boys are

going for it. i was talking to someone whose husband is chair of one of the reforms and she said, i cannot agree. and not able to agree to partner with you because my husband going for that. we're competing with the big boys. that is $16 million for diabetes and hypertension. there is a hypertension fund as it relates to heart disease and diabetes. we are going for those. we have a good chance for the diabetes because we have had it before. we have less of a chance getting the cardiovascular because it is open to everybody and that is $20 million.

$3 million per grant up to eight to 10 grants. we are writing the proposal -- i have somebody in my office as we speak. we are partnering with -- the requirement is from 10 to 15 organizations. five media national organization. we will be given subgrants from $100,000 to $200,000, depending on their reach. the good news is that if we get the grants as a national organization and a only for-

profit and academic institutions and research institutions qualify. so we can be with johns hopkins. they get it and we do not, even though the black woman in baltimore asked us to come in and partner with them. .hat's the politics of it i will be calling you when we do not get it. if only white organizations get this grant, they cannot focus on the black community. we need to raise hell and i'm on tv. >> sheree, we talked earlier about how cultural differences are affecting coverage of black

obesity in the media. what do you think of how black obesity is covered? >> i'm here today because i'm not happy with how it is covered. there are many people in this room who have spoken and are familiar with the same piece in the "new york times," an article about how black women like to be -- are happy to be fat to please our man and to honor a are large grandmothers. "the new york times" quite a bully pulpit and the reach. i think it was an interesting choice to choose to put that piece out there that way.

another piece followed in three weeks from a university in england. it was a study that said adolescent black girls could not benefit from exercise in the fight against obesity. the analysis of the research is important but there were critical questions that none of the coverage ask. they did not say the data was self-reported by teenage girls. they or basing their analysis on race -- they were basing their analysis on race, which there is no genetic basis. these articles along with one on child abuse -- childhood sexual abuse being higher on black woman and being linked to obesity. that is the same relationship to white women and women of other

races. that received coverage on abc news, nbc news, "the l.a. times." at the same time that did not make any of those publications -- a descriptive study of african-american women's success lot weight-loss maintenance through lifestyle changes. this study was done at baylor college of medicine and was also released in june. it was mentioned in the last paragraph of the huffington study. it was covered mostly on small blogs. i guess we have to ask ourselves, why? "the root" wants to have this

conversation. this is not a helpful way for our story to be told. >> you raise some critical issues. i do not know where to start. the article about the black girls not benefiting from exercise raised my blood pressure tremendously. i have major problems with it. we have to learn how to be critical thinkers. be careful where you get your information from. question the motives from the people who are providing that information. this article was brought to me by my husband. "black girls did not benefit as much from the exercise as white curgirls."

the article did not provide a lot of details. there are so many issues with this article that were inaccurate that i didn't know where to begin. they tend to point to a number of stereotypes and probably contribute to either covert or overt bias that we experienced as african americans when we encounter at the health-care system. the first issue has to do with the fact that the data that was reviewed in the study is follicle secondary data. it was data that was collected for some other reason and they analyzed it and came to certain conclusions. secondly, it was self-reported data about physical activity.

the conclusion of the study is that they'll look at black girls and white girls who got the same level of physical activity and after a year, black girls were more likely to be obese than white girls. most of the data was self- reported data. ould your data be yo if you reported it. it lends itself to the possibility of inaccuracy. we know that exercise helps lower blood pressure. it helps lower blood sugar and helps with mental-health issues. it lowers your bad cholesterol and raises your good cholesterol. there is more than one benefit. what am i supposed to do with

that conclusion? am i supposed to pick out the patients -- race is not genetic. and my supposed to pick out the ones that i think are black? the issue of race being genetic and the implication there is a genetic inferiority among african-american girls irritates me. this is social -- race is s ocial. please understand that. if you look back, there were a lot of so-called research- papers being written about the genetic inferiority and a

proclivity towards disease of african-americans. some of us have internalize that. this paper tends to feed upon that. this paper and its conclusion tend to support that you wrote his train of thought. we need to be very careful about the coverage that we pay attention to as journalists. i would hope everybody would be as consciences in providing coverage that is accurate and information that is accurate because people will walk away with that information and it can cause a great deal of harm. that is the last thing we need will try to fight obesity in our community. [applause] >> the point of this whole day

is to be solution-oriented and to figure how to move forward. can any of you share any examples of health care providers that are winning or have found a way to break through some of these barriers? >> well, the first thing i want to say is there is a national movement of smart young black women who are fighting obesity in black communities in america. i want to acknowledge. one of those ladies is sitting in the second row. her organization is i believe 10,000 strong. ok. this is a national organization

that brings black lady together to walk five days a week for 30 minutes to get started. they also have a serve division where they talk about healthy living. there is a division which sends young fellows out into the world to discover adventure and fitness vacations. we have an african american girl who was hiking in alaska and water become back and tell others what that experience is like. >> that is incredible. >> there is another organization called black women to work out. it has its own website. she has 16,000 members, women who share their pictures and

dietary stories and work out on her website. her face the page has -- her ook page has 263,000 likes. , isher is black girls walk centered here in d.c., 45,000 members. one woman said she was a size 22 and is now a 12. means black women who have low self esteem and are uncomfortable about being out with their bodies. their motivation is to get black

women together to support each other to be fit and to be strong. those are three of the organizations that are out there and three stories that i hope people will start to share. >> we have had a program, walking for wellness, for about 20-some years. it is -- one of the things we just supply to get a great non- profit award about a month ago. we asked people to tell us what you think is good about our organization. one woman wrote me and said, walking for wellness saved my life 20 years ago.

i was 300 pounds and i am now 160 and proud of it. that is an example of some of the things that are going on all over the country. we have one program in boston with the boston women's health institute, just in boston over 1,000 womeon meet and give support to each other. -- 1,000 women. it is about supporting each other and a healthier lifestyle. we are talking about lifestyle changes and these are the stories we need to get out. we have an incredible website. we would like to feature you on our website so that our members can no you are out there doing that. i like to switch from the individual and center this

discussion were i think it should bay, which is at the societal level. i know that sheree mentioned the initiative and that is work we need to go, being involved in healthy communities, making sure we have more farmers markets, making sure we can walk to grocery stores, which means you have to come to the table and demand a grocery store. making sure our policy makers can put streetlights and walking paths and bicycle paths in your community so people can feel safe to go out with others or alone in order to be fit and have the healthy lifestyle. to reduce secondary smoking

which kills and has a direct impact on cardiovascular disease and diabetes. we have to move it from the individual and with all of these clubs and walking groups and running groups to bring you to get it so that you can figure out how you can transform your community into a thriving and safe community and then take on the food industry. we are not fat because we want to be fat. corporations have a super sized us. >> i have a suggestion if i had a magic wand and have one wish that i could command and it would happen. it would be for us to slow down. the obesity epidemic in our

communities is not limited to any particular in, or social economic class. it transcends all of that. one of the things that couple gets all that is our complicated lives. we're running 24-7 all the time. that creates within us and an environment where we're under a chronic level of stress. i cannot begin to emphasize to you how damaging have been that chronic level of stress and the -- and it does contribute to obesity. not only if you lived in a community where there is violence and you're concerned about your safety.

if you're in a white-collar job annually blackberry and it is golan of 24 hours a day and you're expected to respond to every time it goes off. or if you're stuck in traffic and the road rage begins to build up or you have multiple obligations where you are taking care of your children and their elderly parents and you have church obligations and you have civic obligations and all of this stuff going on contributes to chronic stress. i once told my kids, when i was growing up, around midnight, you would hear the national anthem on tv and you would see the flag back and forth. then the tv would go off. [laughter] they were amazed. "really"?

now it does not. it is on 24/7. african-american women are impacted by this more than any other group in the country. look at how in general we are a culture and acclimated. we tend to take on this person on will have a big red s on our chest and we tend to be independent and caretakers to everybody except ourselves. creating an environment where we allow and say it is ok for us to take some time out for ourselves to refill our tanks, because you cannot give what you do not

have, and to allow us to realize that we deserve to be healthier than we are. i think that has a significant role to play in the whole obesity epidemic, especially how it pertains to black women. the policy issues are extremely important. we need to look at what we need to do to support ourselves and create a space in which we can slow down and begin to think about how we will take care of ourselves and believe that it is ok for us to think about it. self-care is not selfish. we have brought where we're told that. if we could slow it down a notch. andou're a boss at a job,

allow an opportunity for your ext thetm -- do not tax th at 3:00 a.m. and expect them to answer. that would be my wish. >> thank you so much. we can open it up to questions if anybody has any questions. >> thank you. yes. this is addressed to the doctor. can you speak about the role of insurance reimbursement in the obesity issues? are the providers incentivized properly to prevent this issue? >> no, they're not. reinforced -- reimbursement is a

huge issue that we need to address. we're talking about how doctors get paid. you either get paid for procedures if you're a doctor who does some type of procedure like an operation or something along those lines, or you get paid per volume. you only have 50 minutes to see your doctor to get in and out -- you only have 15 minutes. you did not get reimbursed for providing the ongoing counseling that is needed to help people through whenever lifestyle changes they need to make. we know from research that one of the most effective ways to help people lose weight is multiple opportunities to be engaged in counseling that

walks them through that process. not going to the doctor and the doctor says, you need to lose weight and come back in six months and i will weigh you. figuring out where you are at the moment. you have to meet people where they are. they need to eat better and exercise. getting 10 minutes in a of walking a day, so start there and you walk them through that. the reimbursement system does not support or reward our billet to do that and that's something we need to begin to work on. >> over here.

who do we have first? >> i want to take the opportunity and tip my hat to you incredible women. thank you for talking about the silent conspiracy that black people walk around in and creating those sacred circles to address the issues because of obesity, a lot of times has a lot to do with what you're holding and what you're feeling that you do not have. thank you for being vigilant. i would like to ask you many questions but i know this is not the format. thank you for being a revolutionary in the medical field. we need more physicians like

you that are transitioning into teaching because that is what doctors -- that is what "d octor' means. thank you very much. >> we work with child victims of sexual abuse. i like to hear about the relationship between obesity and unresolved sexual abuse in the black community. people self-medicate in a number of ways. if there is research that you have seen, anecdotal -- we think there is a relationship. >> want to give the reference to hurt the black woman's health study is the people behind the current research on child the

sexual abuse and the obesity link in black woman. i think it is on their website. >> in general terms, you are correct. we do know about the link between abuse and obesity. it is not surprising given the fact that other stressors, this is a major issue in an individual's life. it causes people to deal with the pain that results from that in ways that might not be healthy. we know there are many different causes, abuse being one of them, of pain in an individual's life that they choose to self medicate through what we call emotional eating. emotional eating is a major issue in our community. people are reading food to try to stuff the feelings back

down. another issue is a cultural. weak growth work we do not put our business out in the streets -- we grew up where we did not put our business out in the stet. absolutely, that is a major, major issue, especially among black women that we have barely scratched the surface on. interested in looking at how we can feel businesses behind health because a lot of black women in, but we do not class. to go to a yolo claga can we fuse the business world

-- if the go to anacostia -- how can we shift the way people think about money? >> i can repeat myself. i think we're just beginning to do that. i'm not sure that it is going to be easy to change the behavior in terms of how we spend our money. i think that is deeply rooted that hair or lack thereof needs something -- means something to us. the media plays into how we think about ourselves. they control the notion of duty and color. we talk about it a lot.

i would suggest that you go on our website, blackwomans health.org and go into some of our podcasts. we have had conversations about and emotional eating over the past three years. i really, truly believe if we are going to achieve equity -- i'm so tired of talking about disparities, chains differences between blacks and whites. when i'm talking to women's groups, i encourage us to help white women understand that they should not be the gold standard by which we are compared because they are not doing that good,

either. and so if we shift that dialogue and talk about building healthy families and help the healthyties and help the city' s -- in my neighborhood, you don't have the chicken shacks or the liquor stores. i am looking forward to moving into the district in my later years and i want to be part of the solution of getting the billboards and the liquor stores out of georgia avenue. so that people can feel safe. i truly believe that the standard should be healthy

cities, a healthy communities, healthy families, and have equal healthy women who then have healthy babies. correct my question, and on with the national wildlife federation. a lot of the work i do focuses on the outdoors and getting people outside. talking about healthy cities and communities, a wanted to ask all of you, you tell people to exercise and to take the stairs and there are many different ways we tell people to get fit, but we never really talk about the outdoors as a free solution to getting fit. i wanted to know your thoughts as a doctor and health writer

and being part of the black women's health institute on what you think of utilizing the on doors and getting more black women and people more active? >> it presents a wonderful opportunity to get fit. we need to make sure everybody who is outdoors is equally safe. that's one of the major problems. we need to pay much more attention to community design than we do, so that people don't have to get into a car to be able to drive somewhere to get to a safe part of the outdoors or drive somewhere to find sidewalks they can walk on or adequate street lighting or all sorts of amenities that make it more attractive for people to come outside. so we have a ways to go in terms of equalizing that. especially when talking about all your income communities, trying to get them outside. you really do have to make sure the safety issue is addressed,

because right now we have some issues. i used to work in east baltimore. my patients' parents were reluctant to let their kids go outside and play and i cannot say i blame them. it was not safe for. once we work on those issues, it's important to emphasize if you should not have to pay in order to be able to be physically active. what we resorted to doing as communities where it's not necessarily safe to go outside its offer indoor options. but it would be great if we were able to offer all of your options everywhere. >> in san francisco, i believe, there's an organization called outdoor afro, black people living in nature. letting people know more about organizations like that, that's also part of not writing

stereotypes. it's a natural thing for us to do to rock climbing and hike and trek. >> i think we can take one more. we don't have one more. we do. over here. >> i brought up an issue earlier, but i don't recall if i got a response to the earlier panel because i got emotional. i live in anacostia. my goal is to become a registered dietitian. you made a great point. being from oklahoma, what motivated me was the need to have a culturally competent nutritionist out there serving their community. and so, i am curious about you all, do you incorporate

nutrition's in the work you do as a partnership? i have good friends that are very at resurgence. i am having to provide personal chefing for them because they cannot get it right. there's a group of black nutritionists in the academy that i recently joined. i know they have not been part of the conversation. i even questioned the leadership, are you on capitol hill? i am curious about how can we create partnerships beyond certain groups or should we create another group that target black nutritionists and get them involved? >> i must say that we do partner with nutritionists in all of our chronic disease programs.

and we have our health experts. in our previous diabetes program, i think, most of our experts were nutritionists, dietitians. also, pharmacists, we partner with them. so don't assume that community and national organizations are not partnering and building that team in order to bring about change, because they are there and we do work with them. having said that, there's room for improvement, definitely. there's a great need for nutritionists. as a medical professional, we have not relied on you enough, honestly. again, that gets back to the attention being paid to helping people change their behavior set. one of the things that the mayor brought up that hit home with me because i see it is when he was

talking about how we have lost three generations to crack and we have kids who have not learned from their parents. of the things they have not learned is how to cook. kids are parenting themselves. i was speaking to an audience several months ago and one of the body of members said it is so expensive to elp. so i gave an example of of it does not have to be. you can buy a bag of beans or $1.29 and make a soup that will last two or three days depending on how many people you are feeding. you can see the critical look on that person's face like how do you cook beans? [laughter] it's true. we have a generation of individuals who are now parents who have lost the cooking skills we learned from our parents back in the day. mississippi back in the day i used to hate it when my mother would bring home a bushel of s and we would have to sit

on the floor and snap beans and so forth. but i learned from her how to prepare meals. that's almost a lost art. being able to cook for yourself is essential to eating healthy because you control what you are eating and you are not at the mercy of others preparing your food. we definitely need to talk more. >> thank you. i found out we have time for more questions. over here. >> i write for jack and jill politics. a little shout out for outdoor afro because we featured them on our blog. about how i found out glamorous camping. i am just going to throw this to the entire panel. there was some discussion about

being culturally sensitive, doctors being culturally sensitive. one of the things i did when i lived in san francisco and worked for the department of health, we had to develop a cultural and linguistic competency programs for our health care provider contractors. one of the things that we really had to emphasize was how to culturally deal with diverse communities that we served. is there any type of initiative that is being done here in d.c., especially with regard to how medical professionals should talk to black women, make them feel comfortable, because a lot of them don't like going to the doctor unless they absolutely have to? we had a large arab and moslem community in san francisco. it was on the hills of 9/11 and a lot of people did not want to go to the doctor. so we had to tell doctors you

cannot just tell a muslim woman to take her clothes off to be examined. in their culture, being asked to destroy like that, it is shameful. so we had to do that type of education. i wonder if that type of initiative is being done here. >> i cannot speak specifically to nbc because i am based in baltimore, but there have been initiatives of that type that have attempted to teach medical professionals about different cultures. -- i cannot speak specifically to the d.c. we don't want to pass people think all people in a particular group are all the same. i tried to teach mutual respect as a foundation of relating to anyone of any culture and in

that being able to communicate with them and listened more than talk, to hear what's important to them. the other thing that i tried to point out to everyone -- and all of us are guilty of this -- is we tend to have the underlying stocks and assumptions about a particular culture. and if we hear about a particular practice or belief that we don't agree with, we tend to be judgmental out it. a year-and-a-half to two years ago, getting back to black women's hair and exercise, the surgeon general was in atlanta at a big hair show that in atlanta. she spoke to the group about the importance of not letting your hairstyle get in the way of your health, essentially.

and there was a strong reaction from some individuals in the public health community, namely one individual who was a white male who basically said there are much more important issues and that the surgeon general should not tarnish the status of her position by commenting on something as unimportant as this. that is what happens when you tend to make judgments and values statements about an individual's beliefs rather than accepting what an individual values, understanding how that might create a barrier to adopting a healthier lifestyle, and helping them get beyond that. this is cultural competency. we have to learn to be able to accept the cultural values and beliefs of other people without judgment. and beyond learning all the important things about how to treat people of certain

cultures when you encounter them, being able to accept their cultural values and beliefs without judgment and help them to get beyond whatever barriers might be blocking them from obtaining alternate maximum help is what's really important. >> one of the things that we do in particular as it relates to reproductive justice is due primarily contraceptives and working with diverse populations, particularly non- english speaking populations and those with cultural values of disrobing openly with people that you don't know. and so, what we tried to do is integrate the standards that hhs -- i think it was the office of minority health --

trying to make sure we acknowledge without judgment the cultural and linguistic differences. once again, because we are part of the women of color reproductive justice network, we integrated into the affordable care act those measures that would help with the language. also, when we do focus groups and roundtable and we want to know about issues -- are latest study was on contraceptive use and compliance and noncompliance -- we translated it into spanish, but we also had latina and black and girls from 18 through 29. so you will find pockets of it all over, but particularly, i'm sure you will find your best practices and best examples practice-based rather than evidence-based practices would

be as it relates to reproductive health. >> thank you so much, dr. gourdine, eleanor hinton hoytt, sheree crute. we really appreciate your participation on the panel. [applause] everyone, there will be a short break before the solutions panel. there are snacks and refreshments in the corner. thank you. everyone, we will reconvene in about five minutes . [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2012]

>> we will take you live next to capitol hill, where the alliance for health reform and the robert wood johnson foundation will be hosting a panel discussion on public access to oral health care and was covered under the new health care law, just getting started. live coverage here on c-span.

>> i am ed howard. i'd like to get started. welcome to this program about a very much neglected aspect of health and health policy in the united states and that is oral health care. you probably heard and will hear more today about the fact that the most common childhood disease in the united states is cavities. poor oral health is linked to serious physical conditions like diabetes and heart disease. but that connection is not very widely recognized. in fact, i was listening to a presentation about dental needs a week or two ago. speaker felt compelled to remind the audience that "the mouth is part of the body." we have had a lot of reminders about the sorry state of oral health in america from the institute of medicine, from gao,

from former surgeon general , from the kellogger foundation, from rwj, and did gaps in our current system. today we will try to update the story, take a fresh look at the problem and that the policy options being considered to deal with it. as we were talking just before the program started, nobody is more pleased than jay rockefeller, are honorary chairman, that we are discussing this topic today. there's a story that he tells about coming to belittle town of emmons, west virginia as a worker in 1964. a vista worker. someone in our office transcribed what he said a couple months ago in describing

that experience. these are his words. "when i arrived, i was shocked to learn that there was absolutely nothing school-age children living there could get in the way of dental care. they had never been to a dentist, never heard of a dentist. there were no dental services available. we saw a teenager is whose mounts were already beginning to go bad. we worked to get a bus to bring children to this grade school in charleston to receive dental care. i remember that after the dentist checked some of those young teenagers over, he said, it's a nice thing for you to do for them, but it really is much too late. you don't get the baby teeth right, anything else that follows is going to get bad and get worse. -- going to be bad and get worse." the senator has been working on

this ever since and the alliance has been working on it. are pleased to have as a partner in that briefing the robert wood johnson foundation, which has been helping america enjoyed a healthier lives and get the care they need for 40 years and i have a button to prove that. it says 40. thanks very much to dr. david krol and his colleagues at the foundation for their help in thinking through this topic and helping pull the briefing together. david krol is a pediatrician. is a team director and senior program officer for human capital at the robert wood johnson foundation. we're very pleased to have him co-moderating today's briefing. >> thanks and thanks to you all from the foundation for coming today. we appreciate the alliance is taking on this topic and that you all are interested in this

topics. oral health is an integral part of overall health. if we believe that to be true -- and i do -- that statement told us with its an abundance of talented and opportunities. in many ways there are racial, ethnic, geographical disparities of disease and access to care. there are financing challenges. are issues of determining and maintaining quality of care. and there are workforce controversies, just like overall health. the opportunities are great, however. one really great opportunity, and i would like to see this, is that all conversations on health and health care if will naturally include oral health. while we have taken the time to have a specific alliance on oral health, it would really be nice to see future alliance

forums that talk about medicaid, talk about financing, fill-in the blank, remember that or will help is a part of that. oftentimes it is forgotten and not just by the alliance but even by our foundation at times. as we continue to recognize factors influencing health are expressed at individual, family, and community levels, we can develop regulatory, legislative, educational, clinical policies to improve oral health and health care. another opportunity is that funding schemes for prevention and treatment of disease will naturally include oral health. that is important for us to remember. when now we are failing miserably in medicare where we don't have coverage for dental disease and dental services. you can argue that there is some coverage in certain parts of medicare. but we don't do as good a job as we should. finally, and perhaps most

importantly, and if you learn nothing from me today it is this, but there's a great opportunity in remembering that all makes and models of patients, providers, and policy makers can play a role in improving oral health. i hope that you will leave with that in mind as you go out into your work, whether it be as a policymaker, policy influencer, a patient, or provider. thanks very much for your time. i will enjoy listening to the rest of this form. thank you very much. a couple of logistical items. there's a lot of good information in your packets, including biographical information about all our speakers. there is a sheet that lists additional resources that you can use for further edification. and all that is also online at our website. allhealth.org.

on monday you will be able to look at a webcast of this briefing on the web site of the kaiser family foundation, which we are grateful to for providing that support. there will be a transcript available in a week or so on our website. if you are watching on c-span at the moment, you can go to the seeance website and you'll the presentations and the rest of the background material, if you have access to computer at the same time. you can see on the slide behind me that there is tweeting going on about this briefing and at this briefing with the hashtag oral health if you care to join in, in one way or another. i want to get to the program. we have a great lineup of folks

with a lot of different experiences to share with you. and -- as soon as i get to my tospace in the notes i will introduce our initial speaker. lynn mouden, dr. lynn mouden is a dentist and -- i got confused because we had shuffled to the order -- shuffled the order -- you don't care why i did that, actually. [laughter] she is from the center for medicare and medicaid services. -- he is. of panda.ounder before joining cms, he spent 16

years in private practice, 20 years at the state health department. he is a past president of the association of state and territorial dental directors. serves as the american dental association national spokesperson on family violence prevention. we're very pleased to have you here with us today. >> thank you, ed. i think you are the keeper of the quicker -- clicker. the want to thank the alliance and robert wood johnson for putting together this forum today. it gives us a chance to opt out about oral health and some of our successes. i am sure many of you have talked about the cms triple aim of better health, better health care, and reduced cost. this particular briefing gives us a chance not only to address the triple aim but to show how oral help is making greater inroads in addressing those. cms has an oral health

initiative. we have two goals specific to dentistry. the first being that we will increase by 10 percentage points proportion of medicaid and chip children who have received a preventive dental service in the year. it's interesting to note that is 10 percentage points and not an%. it does not mean going from 20% to 22%. it means going from 20% to 30%, for example. it's not only a national goal but a goal we have set for each of the state's. this information is based on the form now as the reporting for the state. the base line for this goal is 2011. we anticipate that we will be addressing this goal, hopefully, nationally and within the states by 2015. the second goal is to increase by 10 percentage points a

proportion of these children who received a dental sealants on a permanent molar tooth. you understand the combination on appropriate children and that community water fluoridation can prevent virtually all tooth decay in children. of set this as our 10 percentage point goal for the nation and for the state. we will be phasing in this particular goal as the data comes in for this year. the cms oral health strategy will help address these two particular goals. is, we have the opportunity to work with states on developing an oral health action plan. we will talk. more on that in talk. it's my pleasure that i get to work with various states in their medicaid and chip programs in providing a technical assistance and peer to peer learning as they develop action plans and move forward in

addressing the two goals. we work a great deal in outreach to providers. without providers, there's no oral health care. you're also working on outreach to beneficiaries. we will be having the second cms learning lab, an oral health webinar dealing with outreach to beneficiaries and successful programs that will be held september 26 at 2:00 p.m. eastern time. my contact information is available at the end if you want more information at the web, please contact me. we get the opportunity to work with our many other partners in health and human services not only through the oral health coordinating committee but also in various other issues and programs as we work with our partners in cdc, fda, and the list goes on and on, of all of us working towards oral health. the state action plans we are

asking the states to develop on a voluntary basis to help us address the oral health issues, we are asking them to do this action plan and hopefully to address both of the goals by 2015. stakeholder participation is extremely critical to this process. addressing these goals is not something that a mitigated state agency can do on its own. it requires bringing in of the state partners and advocates, all those interested in improving oral health for our children. we are going to be aligning efforts, not just sue the state action plan, but also through state oral health plans, which most of the states have developed. some at the centers for disease control and prevention at the centers of oral health. of course, there are healthy people 202goals. we're fortunate that each iteration of the healthy people goals continues to of issues

that address oral health for children and adults. and we also worked pretty closely with our partners as the work on the their performance indicators, again, addressing oral health in the states. the action plan template that we have produced, offering to the states as they develop their action plan, as several the regards to it that will help us get to not only describing what is going on, addressing the issues, but also in how we make these improvements. first of all, we're asking the states to identify existing access issues and barriers. we understand that every state is different. there is no way to develop a national action plan, as each of the state's work for their individual issues, their individual problems, their individual resources, and, frankly, their individual politics. we want them to describe in detail the state's existing oral

health delivery system, providing data on providers. that is not only dentists but also non-dentists as well. we appreciate the contribution of dental hygienists and other members of the team. we recognize the fact that there is some oral health services that can be provided in a physician offices as well. talking about fluoride varnish application and risk assessment for young children. we want the states to talk about what they have done for oral health improvement, things that they have done, the results, their analysis, their evaluation of the effectiveness of their programs. we want to know what succeeded, and we also want to know what may not have been quite successful. we would ask that the state's compare their 416 data against the measures that talk about whether a person has had an annual dental visit.

reimbursement rates are always at the top of the discussion. i was a medicaid dentist for many years in private practice. i know what it is like to get paid 23 cents on the dollar to provide care for these patients. i know that state budgets continue to be an issue as we are funded medicaid treatment and delivery. but by the same token, i think there is something that can be done at the state and national level that will help address these issues, specifically when we start talking about eliminating administrative barriers that makes it easier for dentists to participate in medicaid. we want the states and their action plan to talk about what they have done to address specifically the placement of dental sealants, a proven method for preventing tooth decay. to describe their collaborations with dental schools, dental hygiene programs, because without the providers, there is no dental care.

finally, to describe the status of the use of electronic health records. electronic dental records are a little slower coming on, but we know under the provisions of the affordable care act that we will be moving closer and closer to electronic health records. what might they do to address these specific goals? first of all, we want them to describe the activities that are underway or planned for implementation, to describe these goals and how they're going to achieve them. providing specific details on these activities, which will then give us the opportunity to share that impression with other state programs as well. again, to describe barriers to success. not everything we try always works 100% and that is all part of the learning process. and these lessons learned can be extremely valuable, as other state programs or to their model what has been done or take on that issue and modify it to their own uses.

the template actually provides some examples of some successful programs, things about reconfiguring reimbursement rates which is not necessarily the same as increasing rates. reducing administrative barriers and showing state examples were have the -- where they have done that. and a chance to develop and improve collaboration and partnerships, because state medicaid programs do not work in isolation. they work along with the other partners in the state that are also addressing oral health issues. so the technical support we're providing from cms to help address these goals and the state action plans, working with them specifically on their partnerships and collaborations. i had the opportunity to visit with one of the state programs this last week who has taken on the initiative of building a state oral health coalition in a state where one does not yet exist. we have an opportunity to the partnership for alignment project, which will go ahead and

tell you has often been called the sandbox project because we know that people want to learn to play well in the sandbox together. but not making light of it, this project is an effort that will put public health programs and state medicaid programs in closer partnership to share their resources, to share the ideas, to share the ways that they can improve access to oral health for children. we're working with the medicaid chip association on the best practices project, a formal project. not just to recognize promising programs by going through a rigorous evaluation to decide what are, in fact, best practices for state medicaid programs. we're working with the states to connect one state to another to share these successful models. i was asked to highlight one part of the affordable care act which talks about the demonstration projects for

alternative dental health care providers. part of section 5304 talks about community dental health creditors, advanced practice in height dentists -- you can read the list. because we all realize there issues of access to dental care in every state. there are parts of the population who have an extremely difficult, if not impossible, time accessing dental care. and we need to be looking at these various other models that may be useful in addressing these access issues. with the affordable care act does is call for demonstration projects where these different models would actually be proven one way or the other. in the act, there is a list of eligible entities. it obviously includes how your education, dental schools, health departments, and such. it says these programs must be accredited by the commission

which accredits all dental and hygiene programs in the country. i appreciate the chance to talk about these issues and what cms is doing to address them. please feel free to contact us anytime as you were either at the national level or the state level as we all work to improve oral health for children and, yes, for adults and the elderly. thank you. >> now we're going to turn to dr. monica hebl. she practices general dentistry in milwaukee, and she is the elected chair of the american dental association's council on access, prevention, and interprofessional relations. she's also a past president of the wisconsin dental association and agendas been involved for her entire career in extending access for dental services for underserved populations. thank you for being with us. >> thank you very much for allowing me to address you this

afternoon. as you have already heard, oral health often takes a backseat to medical, and good oral health is integral to all overall health. i appreciate the time you're taking to learn about oral health issues. it will take a paradigm shift for oral health to gain enough factors to achieve lasting improvements in optimal oral health for all. the ada is working hard to increase the focus on oral health issues by partnering with many groups and organizations involved in oral health. you just heard a little bit about my background, but i would just like to put a little flavor on it, local flavor. i am a private practicing dentist, so this is an unusual experience for me -- a little nervous. i got involved in dentistry as a 14-year-old dental assistant in my mentor's office.

i still work at the same practice along with my brother- in-law. in 2000, we moved from our central city location to the northwest side of the city, and we chose to remain on three bus lines so we could continue our mission to continue the legacy of taking care of those in need. we devote about a third of our time to assistance even though it is economically challenging. we also produce it in charity care programs. i have been involved in organized dentistry since i graduated from dental school, and i worked tirelessly to improve access for the underserved. it is difficult, complex problem that requires activity on multiple fronts. there is no silver bullet dissolving access. poverty, geography, lack of oral health education and transportation, language and cultural barriers, fear of dental care, and the belief that

people who are not in pain do not need to seek care are some of the factors that affect a person's ability to access care. it will take a collaborative approach of all stakeholders to approve the nation's oral health. ada as many programs and activities to address the access issue. recently, we made it a priority to tell every with others, to leverage our activities for greater gains. i am going to highlight a few of these programs. the cdc named one of the tin a significant public health achievements in the passenger. the cost 7 cent decrease in disease is significant. it is unfortunate that we're spending so much time and energy fighting for such a great public health measure. we have worked with state and local dental societies, as well as pew, to ensure the high quality side of the information is available for those were fighting for fluoride on a local

level. here is a map that shows you just how hot this topic is the 43 states have some type of fluoridation activity, and a lot of it is protecting it. even though medicaid programs are chronically underfunded, efforts to improve access by streamlining the administrative processes of medicaid programs have achieved increased access for patients and participation by dentists. states that have successfully improved their medicaid programs usually have many stakeholders working together, and by doing so, they achieve greater gains in excess. thate're thankful for focus in cms. collaborative efforts that include increased reimbursement, education, care that is ongoing instead of episodic, and involve public-private partnerships yield the greatest results. each state medicaid program is different, and each state has different issues to solve. here are a few examples of

reforms that demonstrate gains in taxes, but i am going to only highlight one is due to time constraints. michigan's healthy kids in is a partnership between the state dental association and the commercial dental plan. the streamlined administration and reimbursement is the same as the commercial plan. access for kids enrolled is approximately 70% for seven to 10-year olds. efforts to expand the program are under way. there many volunteer programs that ada members are involved in throughout the year. we recognize that volunteer programs are not an adequate health care system due to their episodic nature. therefore, in 2006, our give kids a smile efforts changed from providing care on one day to establishing a dental home. ada is increasingly involved in

it in their professional activities, because we realize the advantages of expanding the number of health professionals capable of assessing oral health and the importance of linking dental and medical homes in an effort to reach kids before they have the disease. there is increasing activity across the country in the area of er utilization due to potential cost-savings. one successful program in michigan, calhoun county, is modeled by habitat for humanity. they provide care free of charge to low income individuals who perform community service. this has led to lower costs for hospitals in the area, and it is a win-win-win for the community. oral health education is prevention at the most effective level and has the greatest potential to yield the best results in improved oral health. ada is proud to be part of the

partnership for healthy mouths, healthy lives, a coalition that has resulted in the launch this week of an ag council campaign with an oral health messages. the message will encourage bridging two minutes, to rise today. there are other successful messages that you might remember including the crash test dani -- crash test dummies. it is exciting. we're very excited to see the results. we are in the evaluation stage of our pilot to create a community dental health coordinator. this new team member is a different approach, and it is modeled after community health workers. the goal is to break down many barriers for patients and provide a link between the patient and the dentist. there will educate patients and help them navigate the system. in addition to tasks like helping them find in home,

secure child care, and arrange transportation. they will also be of to provide limited, mainly preventive, services, rather than focus on treating disease. the cdhc is based on some of the ada's key principles of breaking down barriers to care. education, disease prevention, and maximizing the existing system. in addition to the ada website, we're launching a website for the public. mouthhealthy.org. i would like to thank you very much for allowing me to be a part of this panel, and we look forward to working together on initiatives moving forward. >> thanks very much. we're going to go now to julie stitzel, a manager for the children's dental campaign on the states where she focuses on workforce issues.

pew directed a really heavy amount of attention toward improving kids' access to oral health services. they have issued reports including on how well kids oral health needs are being met. we're happy to have her with us today. >> thank you. you have heard repeatedly that dental care is the single greatest unmet health need among children in the u.s., five times more prevalent than asthma. a lot of times when talking about health care reform, we focus on medical. it is board to focus on in as well. our research and advocacy efforts focus on four efficient cost-effective strategies. one is ensuring that medicaid and the children's health insurance program work better for kids and for providers to make sure that insurance translates into real care. the second is kennedy water

fluoridation. the third is increasing sealant programs for kids who need it most. the fourth is expanding the number of professionals who can provide high quality dental care to low income kids. a lot of you might be familiar with our work. we released two state reports that essentially used eight benchmarks to evaluate oral health access. if you have not looked at where your state stands, i highly recommend it. these are the grades from our most recent report, making coverage matter, which is defined on our website. a lot of folks in this room have used these reports as policy levers to increase oral health access in your states. earlier this year, pew released a report on the emergency room utilization for preventable dental conditions. we examined a large sample of emergency room data collected by a federal agency called the agency for health care research

and quality. we then suggested the national number of emergency room visits by identifying the specific hospital codes for dental problems that are considered to be preventable. unfortunately, this data is not available from all 50 states for two reasons. first, not all 50 states to mandate that hospitals submit their discharge records. but also, some states, er data, but they're not required to interpret it or report it. here is an example of our overall findings. you also have a call police -- have a copy of this. what we found was preventable dental conditions were the primary diagnosis in more than 830,000 visits to the hospital emergency room nationwide in 2009. children accounted for nearly 50,000 of those er visits and many of the visits were made by medicaid enrollees or the

uninsured. so states are paying a high price for the significant number of children and adults seeking this type of care in hospital emergency rooms. it could have been prevented and injured and more effectively elsewhere. it is -- what is really tragic about this scenario is that the kind of care that folks are receiving who go into the er with a toothache generally will not provide lasting relief. you traditionally do not have a dentist in the er, and their responses to describe a pain medication or an antibiotic, and in this is not actually solving the problem. so it is the wrong care at the wrong place and in the wrong time for desperate patients. the the more than 830,000 visits to the emergency room represents a 16% increase from this number in 2006. that is the bad news. the good news is that there is a

real opportunity to save money, because these visits, again, are totally preventable. we know that getting treated in an emergency room is much more costly than the care delivered in the dental office, and states are bearing a significant share of these expenses through medicaid and other public programs. two examples. in florida, a dental-related visits to the emergency room produced charges exceeding $88 million in 2010. about one out of three emergency trips were paid by medicaid. in washington state, dental problems were the leading reason for emergency room visits by people who were uninsured. and here are more examples from the report that showed that essentially taxpayers and consumers are paying a high price for this and complete care delivered in the emergency room. why is this happening?

well, it boils down to access. the current system is not working for everyone. this chart is from the american dental association. while it uses the 2000 census data, it shows that roughly one- third of americans lack access to dental care in the u.s. this is in line with what we're seeing from the 2010 data. the logical next step is to look at the dental safety net. well, the dental safety nets are at capacity. they are only able to trade 10% of this third of the population that is left out of the system, so something else needs to happen. in addition, many people lack dental insurance. and even if that is not a problem for you, a lot of people have trouble finding a dentist. many people have to drive 20 to 30 miles to access a dentist. currently, more than 40 million americans live in an area with a shortage of dentists. what can we do about it?

as you heard, there is no silver bullet when talking about increasing access to care. it is a pretty complicated situation that requires multiple solutions. but a lot of states are taking a look at evaluating the existing make up of the dental work force by talking about allied providers. i do not know how many of you guys are new to the dental world, but when i first started, i thought allied providers were just one provider, but it is a larger umbrella. we talked about the committee dental health coordinator. we are going to talk about the advanced dental therapy program in minnesota. but there are multiple models we're talking about when we say allied providers, including the dental health a therapist in alaska and the advanced digital- practitioner across the u.s. it begs the question, why are we having this conversation now? in addition to research showing

that this is a viable solution to increasing access to care, we cannot afford not to. while it is clear that states are bearing the cost at the consequence of folks not having adequate access to care, and in certain circumstances, the consequences can be much more dire. a lot of people who are not new to the dental work are familiar to the tragedy of the maryland boy. this is continuing to happen in my home state of ohio. we recently had an recentlydad is passed away at -- we recently had an unemployed father who passed away at 27 because he did not have access to care. this map is constantly changing, but it gives you an idea of which states are talking about work force. the blue states have authorized new providers. alaska, minnesota.

the green states are states where pew is working, states where kellogg is working, states or the american dental association is working, and states that have taken the initiative on their own. i commend them for doing this, because it is not an easy conversation to have. i also appreciate the alliance and the robert wood johnson foundation for making this a focus today. if you like to keep up with the information on what we're doing at the pew dental camping, please sign up for our in news and views. the information is right there. we're happy to share what we're doing monthly. here is my contact information if you have additional questions after this briefing. thank you. >> terrific, thank you. finally, we will hear from christy fogarty who is a licensed dental therapist, one of the first two people in the nation to receive this recognition.

she started as a dental assistant and then became a licensed dental hygienist. last year, she finished two years of training as an advanced dental therapist and received a master's degree as an oral health practitioner. she works in minneapolis, and some of you may have seen her featured in the recent pbs documentary on oral health work. >> thank you so much for having me here and allowing me to share the minnesota story and what we're doing there, the project we have going on up there. i am going to cover a few topics rather briefly. i will talk about the advanced dental therapist and what we do and talk about testing and training. i will tell you about where i work and the demographics i serve. and a little bit about the model that we are developing. i have been practicing for about a year. i am also a licensed and dental

hygienist and a licensed dental therapist. that serves me well for this community. i will talk about what is going on in the future and what we're looking at in minnesota. i will talk briefly about what it dental therapist is, in mid- level practitioner. much like a nurse practitioner but in dentistry. i can do just about any kind of feelings. i can do extractions of primary teeth, baby teeth. i can do stainless steel crowns. i can do a root canal on a baby tooth. and i can do maintainers. their two types of therapist in minnesota, dental therapist and advanced therapist. dental therapist are required to have a bachelor's but many have a bachelors. advanced dental therapists are required by legislation to have a master's degree.

at metropolitan state university, where i attended school, is the only school that teaches advanced dental therapy. when prerequisite is that you're an experienced hygienist. i had to have worked at least 2,000 hours. i had 13 years of experience, and was probably right in the middle of the level of experience. after i complete 2,000 hours, which is like a residency, i will become an advanced and dental therapist. the board is trying to figure out what they will do to test me when i hit that number sometime in november this year. the biggest difference between the two is this a revision level. dental therapists have to be in what we call in direct supervision. a dentist needs to be on the premises at all times while different types of procedures are being performed. once a become an advanced dental

therapist, i can do general supervision. i can do everything within the scope of practice, but i can do it without a dentist needing to be on site with me. that is a huge event is -- a huge advantage, especially when talking about mobile dentistry. if i can get to patients who are not in the same building as me, it will open up care significantly. one thing i always like to make sure is that people understand that might do allow center allows me to do a lot of things by legislation. what dental therapist and advanced their tests cannot do a simple cleaning, the cannot do para work. i can do both. you want to do as much as it possibly can. it is not uncommon for me to do a stainless steel crown, a couple of fillings, clean teeth, and do sealants. for the training and testing that we go through, i went through 27 months in a master's

program, metropolitan state. in my scope of practice, i am tried to the level of a dentist. this talks about the 75 pages that dentists are licensed to do. there are six pages that i can do. their three i can do as a high dentist. i am trained at the same level as a dentist. the testing we are given is the same that the test -- that the dentist does. after i have received my license, i was able to get into a agreement where i work. i m in collaboration with nine separate dentists. there is different levels of

supervision they give me. they have to be in the building. they see some of my work. most of them want to know what i'm doing now. last year we provided care to 28,000 children. this year, we are on track for 30,000. we work with mobil equipment. we are in about 300 sites statewide. the majority of our care is not done at our headquarters. it is done at community centers, schools, and different types of permanent sites we have established. you can see we take anyone with any insurance. we have a sliding scale. we turn away no one. we see children under the age of 21 from birth to 21 and pregnant women. we also work with children with

special needs. i see a lot of children with autism, wheelchair bound, the whole spectrum. we also at the headquarters can provide quiet rooms where we can decrease stimuli and help those children who struggled to get care, to be cooperative with the care. we have surgeons -- dentists who do surgery in hospital care. we have one dentist who comes in twice a month. since december of to does 11, i have seen 900 patients. you can see the demographics there. i like to tell one story because it brings home why i do what i do and what i believe so much we need to work on access to care. when i first started therapy, working in the clinic, there was a t-year-old little boy, with a

sad little face, was in so much pain. he had fallen the week before and bumped his front teeth. she spent the entire warning -- morning being told we do not take public assistance insurance. you have heard it is expensive. they would have given him an antibiotic and told the mother to try to find a dentist. she was grateful our clinic was willing to see her son. i work with my collaborative practice dentist and determined that the teeth needed to be extracted. it was pretty awful for him. he had not slept and he was in pain. you can imagine for a child out awful that was. the mother was so grateful to get him out of pain, and because

i hygienists, i think about preventive, i said please come back next week, make sure there is nothing else going on. a week later, i am in the hallway and i see this boy come around the corner, a grant with a big missing tooth and he takes off onto a sprint and wraps his arms around my leg. the mother said you are the person who took the pain away. this is why i do what i did. the mother was grateful for the care, the child needed daycare, and if cuts have gone so awful for the child instead. excuse me. a little bit about the finances. this shows a manager that gave a presentation about dental therapy.

one person raised their hand and said, that is great. you save about $1,200 a week. it reduces the number dentist's we need a hat. how do you get a grant funding, funding for paying her salary? how do you up for her? we were confused by the question because he had not put this light up yet. the slide shows i produce more than the majority of dentists in our office. there are key to be zero reasons for that period, i work and the headquarters. two, amazing dentists who let me work hard and complete a lot of work. because i am not disturbed by a therapist asking for my checks or during exams -- i will not be able to do that until i'm advanced -- that helps a lot as

well. my boss says this is an unfair slide because it shows you are the third highest producer in the practice, but the reality is you should not be compared because your scope of practice is not the 70 piping -- 75 pages i was talking about. it is an important set of pages, but the dentist would have and a bandage and production because there are more expensive procedures they can do. this is the highest i have ever bed. i sit in third, fourth, or fifth every month. my numbers continue to rise. i was the fifth highest producer and july. the question that he got, you do not need grant money. you need to work them into the

practice in a proper way. for the future i continue worker in toward my 2000 hours. what actually did not mention, a-minus.a had an if the question that i get a lot that is important for people to know is what has acceptance ben liked? i think got every day for nurse practitioners because it is easy to explain what i do. in one year practice i have had one parent say i prefer my child to see a dentist. the acceptance rate is extremely high. you're talking about a population that needs care, and they are so grateful to have the care. it is an important message to get out there, that this is one

great tool. there is no silver bullet. you need a great a toolbox to solve access to dental care, and what i say dental therapy is a great wrench you can use any type it works. thank you. >> thank you. we get to this part of the program, and you get a chance to ask our panelists what you want to get out of this conversation. you have the opportunity to ask questions or early -- orally, and you can take out the green card in their packets, write a question, told the court up, and we will bring it forward, get a chance for that person to respond to its. i invite dr. krol to join in the questioning. i wonder if we're getting started if i could ask dr. hlbl

about it gives kids a smile program you were talking about and the effort you described in 2006 to focus on continuity of care and establishment of a dental home. how do you do that in a volunteer situation? >> training opportunities and best practices so that programs that provide care on the one day and found ways to get dentists to accept the patients on going, it was a trained-the-trainer kind of thing, and dentists are generous. if they build that relationship, a lot of them are willing to take those kids on.

>> ok. question for julie. i was looking at the map that you were displaying about the impact of the emergency department visits, and i wonder if there is much of a variation from state to state among the states that you were able to get data for, you had 800,000 of these visits a year out of a total number of visits, like 140 million, and some of these percentages are just stunning in the context. >> we were only able to gather data from 24 states, so is not all 50 states, but the general take away is that people

utilizing it of emergency rooms because they do not have access to care. it is an issue. >> ok. uden.question for dr. mo what are the efforts to broaden the provision of dental benefits for adults? what do you see on the horizon? >> as we learned after the supreme court decision recently, we are in a position where states can provide dental services for adults under medicaid or not. that has not changed. we are concerned that once an underserved area, a child as dental services until they turn just cut themakwe loose.

unfortunately, we are in a position that it is up to the states individually to decide whether or not they will provide adult dental services under medicaid and with competing priorities of state budgets, it be a concern. >> have there been discussions about the benefits in medicare? >> in my office, there have been those discussions. [laughter] as i get within a couple of years of that magic number, it is amazing when people turn 65 in this country we no longer care about their oral health. being a little flippant about that. this tremendous unmet needs we have of seniors and their oral health is a huge discussion for budget issues. i can only hope that maybe medicare will catch up by the time i get there. >> a question for christie and may be truly. can you talk about the prices that minnesota went through to

get this legislation passed? >> the process -- say it is like making sausage. you do not want to see it. it was like that. i had a lot of great advocates out there working hard, and the best thing minnesota did is prior to goading to legislators and presenting their case about why it is so important -- if you look at jolie's information, minnesota it was not the state most in need of dental care. we created a huge collection of people. one of the biggest advocates we had was a pediatrician. he said it dentists do not fix this, we will have to fix it. which do not have solutions. the best thing we did was creating a band of pediatricians

and dentists and a broad spectrum of people from brought back grants to say we agree this is something we want to try, we want to expand the dental work force, and this is how we want to do it and we need your support. >> it was not easy to have a conversation, because you have a lot of perspectives, and it is important to understand where people are coming from to respect where the air coming from and try your best to build some sort of consensus so that it is not just a policy win, but you have an infrastructure in place to sustain that policy and have lasting change with respect access. >> before the legislation was presented, metropolitan state university had an entire program approved by minnesota. the education peace was always -- already approved. as soon as the legislation was

passed, it was a ready to go. >> if i could follow up, you folks did have a wonderful a valuation of children's dental health policies, and as i understand it, after the death of -- maryland made major improvements. they did not show up on your map here with respect to dental therapists, but what did they do and how did that happen? >> with maryland, and she might be able to talk about what they did, they focused more on -- let me touch on the benchmarks. the a benchmarks we used, three focused on prevention and one is focused on work force and other on medicaid reimbursement rates.

maryland tackled more of the prevention and the reimbursement rates on access, not necessarily the work force plants, but others might be able to add to that. ok. >> a follow-up on the number of students, how many students are enrolled in the program? what is the pipeline? how do things look going forward? >> the first class i was in was 7. we're small in numbers. the seco c is halfway through. they are 4. my understanding, their first class at minnesota was 9, and the second class was seven. we're looking in the 20-member range in the next 12 months. >> other than minnesota, can

they practice in any other state, including alaska? >> minnesota is the only one that has dental therapy as part of the state statute. it is part of our dental practice act. someone on the panel can speak more authoritatively. i cannot practice in any other state. we have had several people moved from other states to minnesota, including one of the first from the university of floor era. -- florida. we cannot practice in any other state now. >> a question, it grows out of the presentations as we heard them.

it is directed to dr. hebl. what is the american dental advancedon's take on dental therapist like christy, nd are they in the ada's view providing proper pre care at the proper level, and how do you feel about minnesota becoming a model for other states? >> i knew i was going to get this question. the ada believes that with the scarce resources available to improve access to oral health, we believe and what more can be done to fix the current delivery system. we have demonstration projects all over the united states, and healthy -- kids in michigan is just one. there are a few other successful programs.

we believe that providers are there. we need to fix the system around them. which cautioned against a rush to create new work force models that are allowed to perform irreversible surgical procedures, especially with the scarce resources. they could be directed toward dentist's providing the care. to me toupside down have the sickest people treated by the highest train. i do not thinking a two-year an abscess is a simple operation. it seems like i have been inundated with some difficult extractions. primary teeth, the hardest attraction i have had in the last two weeks. a woman who i take it o - i

took a tooth out that had a bleeding emergency. we would like to see dentist's be involved in not cutting saw tissue. we think it can happen. all this working together to make that happen instead of diluting the message and have a be on this divisive issue works. >> do we need more dentists as well? >> there are 20 new schools in the pipeline, and when you look at christy's train in, that is six years of training, and medical school is a. it takes a long time. i do not know if that is necessarily going to be an immediate help, and we need help now, so we should find ways so

we can involve all the people members of the team and use them to their fullest capacity. we have hygienists and dentists who are not busy right now. it is an economic issue, and when you work in a subsidized system, you can make things happen, and we need to figure out how we can make the health care dollars for oral health work in the system that exists. >> we have some folks who are standing at the microphones. we would ask them to keep their questions as brief as they possibly can and to identify themselves. >> with the institute of social medicine and community health. i think dr. mouden mentioned medicaid pays 20% of the private

pay rate -- >> at me stop you there, because i was speaking for my personal experience practicing in misery. that is not a national data by any means. >> my question is, how could medicaid as a federal agency allow states to pay so much less than the private insurance market or the private-pay market bears? the medicaid statute says the medicaid program is supposed to ensure equal access, and that usually means paying a rate comparable to private pay, i am surprised that states are allowed to pay less, but i am curious what percentage of dentists she's not to take medicaid patients -- dentists choose not to take medicaid patients and why that is not allowed as a licensee issue.

shouldn't states use their licensing authority to ensure that dentists are making these services available to their population in their areas? >> i will give those a try. what you have asked about our two state issues. there is something called sufficiency in the medicaid program, where access is to be equal to what is available in the private market. that is a state issue which is dependent on budget. the second thing he asked about is licensing. very much is the issue. whether any health care provider, be it the best, nurse, otherwise, is required to take public assistance programs is a discussion that i do not think i am allowed have. -- to have. >> anyone else?

go ahead. >> i am the executive director of the association of clinicians for the underserved. thank you for an informative panel. i have worked on this issue of oral health for a number of years. it was the first topic that brought together people across disciplines to look at early childhood care. my question is directed to christy. what is the cost of your preparation for your advanced dental services, and what are the opportunities for some state and federal loan repayment in the future? >> that is a good question, one that is a struggle in minnesota. the answer is education becomes -wrecker- as i already have a bachelor's in dental hygiene. we're talking about six years of education. we have an educated hygiene workforce right now doing work.

it is not another six years. just the dental therapy program at the metropolitan state is about $70,000. a dentist i've worked with, she was about $350,000 in debt. we are among the most expensive professionals to be trained, dentists and hygienists and their guests. it is an expensive practice to train s. the second answer to the question is i was able to apply for a loan forgiveness. however, it is a national program, and i qualified because i am licensed by janice. dental therapists are not eligible for the program. unless you go through a program that starts in a foundation of hygiene, you will not be eligible. >> do we know anything about the total cost to the program as opposed to the cost to students?

in either case, whether we're talking about this or any of the other professionals. >> i do not have the numbers, but i can get them. >> do you have any idea? >> if we can get those, we will post them on our website. >> yes. >> i am a reporter. my question is basic, and i apologize. i would like to know why is there a shortage of dentists? what are the factors? why is the answer to getting more therapists and why not recruit more people to become dentists? >> do you want to start? >> is a mal-distribution. there are not enough dennis in rural areas because it cannot economically -- there are not

enough dentists in rural areas because he cannot -- you cannot sustain a practice. we just had a pediatric dentist that had to sell his practice to a hospital system because he could not compete. he does not get the subsidization from the government. he could not keep dentist employed. they would leave and go somewhere else. i think that is where i was talking about, the system we have with 20 new schools opening, we have the capacity, and baby boomers are not retiring like they were before the economy downturn. the professionals, hygienists that are already on the ground that we could expand the scope of what they do, and utilize them to their fullest. even dental assistants. we think the capacity is there. it is just where they are

located is the problem. >> also, 40 million americans live in an area where it they do not have access. the research shows that is the fact, and the reason we believe dental therapy is a possible solution is because it makes economic sense. pew released a report that showed that adding this dental therapy -- at the time it was a theoretical model -- but it does notproof affect the bottom line of the private practice. our model focused on product -- private practice. the reason is because it increases access to care the population that is currently left out of the system.

>> i am with a group that represents the american dental association. thank you for holding this briefing. i want to respond to something that was at that scene to call into question the safety of the irreversible procedures provided like at that -- like advanced dental therapy. more than 50 other country for nearly a century had used non- dennis for these irreversible procedures, and studies say they can effectively provide these services. there is rigorous research that demonstrates that non-discussed can deliver care reversible procedures. i have never seen the study that shows anything contrary. i do not know if dr. hebl has

studies to share with us. >> my response would be that whether we have christy out there, anybody, unless we get people navigate it to those places -- medicaid it to those places and teach them that they be to teach prevention and they need to brush and floss their teeth, it almost does not matter who is out there. >> i agree that oral health literacy needs to be improved, and i think advanced therapists they know when a person needs to be referred to a dentist. because they're not enough dentists, we need to supplement the care provided by dentists.

>> thank you. >> thank you very, very much. robert wood johnson for organizing the session. and for all the speakers. i would like to change the direction of the discussion a little bit. my perception of what we talk about is who gets to hold the drill to fill all that we could have prevented. this is so unfortunate. we know and this has been stated by at least three of the speakers, how to prevent tooth decay, and that is the disease we're talking about. we can prevent tooth decay. we are focusing on who is going to hold the drills. why aren't we sharing more information about general public, especially low income, people willow out illiteracy,

they do not know this disease can be prevented. we have data in maryland that demonstrates that low income, though it educated, do not know what fluorite is, never heard of something that has been used for 75 years, sealants. it seems to me where we should put focus is on trying to educate both health-care providers, because they did not know the correct information either, as well as the general public. which brings to mind a question for dr. helb, on your slide where it said what the new campaign is about, and ada put several million into that, it's as toothbrushing two times a day

for two minutes prevent tooth decay. there's no evidence. you have to put fluoride on a toothbrush. that word is not even used in any of the documents that are online -- available to the general public. this would be a major step ahead if even use that word. thank you. >> sure. >> the ada was part of that huge coalition, and the group that does that does a lot of research in focus groups, and we had to take a step back a little bit and take off our hats, wanting to try to control that message and trust them they knew what they were doing in the marketing world and that this was to their focus group research that this was an

appropriate message to get what you are talking about. i agree it seems like is this going to work? they did a big part of this campaign is to measure the results, and if it does not get results, it will not continue to happen. it could be tweaked, and that marketing firm that does this is the same one that did the messages of the little baby in the crib, e-trade, and they put out some effective campaigns, so i'm hopeful this is the first up and we can get to the point you are talking about. yeah. >> a couple people have talked about prevention, both fluoridation and the sealants. where is that any national policy cents? is it covered by any of the

medicaid programs proved to the private insurance -- is it covered by any of the medicaid programs? do the private insurance companies provide that service where is the opportunity for progress? >> medicaid is support of of sealant programs which is what application of one sealant is one of our oral health goals. we cover the provision of fluoride treatments, including fluorite varnish and varnished provided by physicians and nurses. especially on toddlers. whether there is a national program on communal fluoridation, we leave that to our colleagues at the cdc.

i am thankful to some of the private foundations that have helped support community water fluoridation across the country. >> at pew, that is one of our areas of focus because we know 74 million folks on the private water system did not have access to fluoridation. we are working to create the national home base with the website ilikemyteeth.org provides a tool kit for folks who are interested in fighting rollback a tense or increasing fluoridation. it is a tricky topic because of the antis are effected in planting a fear factor that you have to then come back with science and you lose people that way. finding the right balance,

communicating education and providing tactics so people can effectively keep their water for dated or get their water for dated is a challenge. >> could i add on that? i jump around. i recognize what you are saying and i agree with that. here is a major problem. but all of the bottled water available, including in here, most people are not drinking tap water, and a large part of it is because they do not know that fluoride is in it and it is good for them. we need major educational campaigns about water fluoridation and get it from the tap. it does not do any good to have water in community water fluoridation if it is not being consumed. you've got to drink it. you cannot just washed the car with it. -- you cannot just wash the car

with that. >> is there a national oral health plan or a national strategy for oral health and are there opportunities for groups like the u.s. national health alliance or other organizations to help push a national oral health agenda? >> the oral health coordinating committee, made up of the representatives from federal agencies, is discussing now what could be called a plan, but we tend to not use that word because there have been too many. whether it is called a strategy or whatever, getting the different agencies to work together in a combined effort to improve oral health and access to oral health care. beyond that, we have the healthy people goals, our fourth

iteration, and we continue to seek oral health a major focus in healthy people. now healthy people 2020. we want everybody represented in this room and everybody else watching to take this seriously. they are not just high in the site, they are things that can be done to partnerships, federal, state, and vocal. >> we have a repeat offender here. >> i had a couple of follow-up questions. based on my previous question on wide dental care is not readily available in certain low-income areas, the question is then, does that mean dental care is too expensive for most people? the question is why? if we have more to the therapist as part of the solution, can only address a few

of the procedures, not the full spectrum of dental care, so if a low-income person needs more advanced care, it is expensive, how do they get access to that more advanced care? what is the affordable care act doing addressee kettle care? what kind of larger solution is there for low-income people to have access to the full range of dental services, not just a small piece that dental therapist can provide? how do we get care to everybody, the full spectrum of care? >> under the aca, we have been essential health benefits that would be covered under the various insurance entities, whether it is the exchanges or private pay insurance. it will be a basic passage that

includes dental benefits. >> i will take another small stab at it. that is why prevention is so important, because this is a disease that does not have to happen. while there are those out there that need expensive care, if we can change the perceptions and the home care and the attitudes and get people to go for prevented visits and ongoing care, we can get them healthy so their costs are much less. that history has always been an industry where there are out of pocket costs. it has been treated at the discretionary income kind of thing, and this is why the downturn in the economy has been so tough for private practice because people can put off but to the dentist, going to the eye doctor, and the advantage is that there is transparency in the cost of oral health care as

opposed medicine, where there is not a lot of transparency. that is an advantage. when think we do not think is transmitted to the medical world as well. it is why so many people need to figure out how we will do this and how we will find it fairly and effectively and make sure the most appropriate person is treated the most appropriate patient. >> the aca act creates an $11 billion for community health centers. >> the demonstrations that dr. mouden was talking about, are included in the aca, but they are subject to appropriations. >> that is correct. not yet appropriated. >> we're getting toward the end

of our time with you, and i would ask listen to the exchanges and questions and answers that you bring out your green evaluation form -- make that the blue if i wish and form, and fill it out said that we can try to respond to the topics and the kinds of speakers and kinds of formats you would like to see in these briefings. >> can someone explain the difference between the dental therapists, the different types, and which are limited to a state, but expanded function dental assistants who seem to have some similar work scope, but are widely used and accepted by dentists and organizations? >> i can take a stab at that. nationwide, assistance, hygienists have different scopes

a practice -- of practice. they can allow certain types of procedures to be done. prior to being a therapist, i was what is called a restorative expanded functions dental hygienist. a dentist can go in, prep the tooth, and then i to the filling. it allows the dental team to a work more efficiently and open access for dental care. there are those types of allowances and lots of different states. not all states allow it. another thing i am it is i am make collaborative practice dental therapist which means i work as a hygienist. i may go to school and place dental sealants without a

dentist being present. that is under the collaborative practice agreement that is allowed in the state of minnesota. that is what they are talking about. it varies from state to state, which is appropriate. >> the difference is the cutting of hard and soft tissue. a dental therapist can cut the tooth and do the surgical part of it, and an advanced dental assistant just restores at and does not cut. >> i want to come back to the question of rates and compensation, and there are a couple questions. one is for christy, the at this like you despite showing you the third-ranking producer in that practice, what is the

mix of pairs? are there any private insurance numbers in that list? >> wheaton have a small amount of private--- we have a small amount of private-pay patients. we have a large number of people who move in and out of the system depended on employment. majority of patients are on the type of public assistance program. we have a sliding scale. >> what percentage -- how able are you to respond to the level of need for folks in it vulnerable populations, either without any coverage at all or coverage through medicaid? >> you mean in mice the practice? >> in terms of the number dozens

of minnesota and in need of those services? >> we have 300 sites, we go over all of minnesota. i have been 60 miles south of my home. we had people going all the way north to the iron range. that is 500 miles from our home where we can go into a community for three or four days. it is not ideal. is not a dental home, but we try to be consistent in getting there at least once a year for people who have access in activity have access. we have a permanent home in duluth and st. cloud. does that help? >> we try to go to the people because of one of the biggest obstacles to access is getting to the dentist. we try to go to them.

>> some where there are 47 million people who are not served by your kind of an agency or any other. >> correct. thank you. >> what about the national health service corps and federal resources that flow from it? this is more of a -- question, you mentioned your connection with your colleagues. >> i apparently said too much. i know very little about the national health corp. -- corps. there are loans available for practitioners gone to those underserved areas. i know there are hundreds of national health service corps sites looking for oral health care providers. >> i see that vacancy number is

much lower than it was before the economic downturn. amazing what a recession will do to those programs and getting people involved. one of the things that happens is you do not find out if you get that loan forgiveness until after the fact because they put it in hopper and shovel at a route. also, if you take the amount of the forgiveness and you have a dentist providing the services, if you took the write-off for the medicaid program, it basically is a wash. we always say in wisconsin we need meaningful loan forgiveness programs to make a difference. >> i think what we have demonstrated today, if nothing else, is this is a multifaceted area of inquiry, opportunities,

and challenges. what you have heard today is a rich description of both the challenges and some potential options for dealing with those challenges. i want to thank our colleagues at the robert wood johnson foundation, particularly dr. krol, allowing to get us into a topic that we did not get into enough. i want to thank you for showing up on a beautiful august day, and sticking with this discussion, and i want you asked -- i want ask you to join with me in thanking our panel for a basic discussion of a very complicated discussion -- topic. [captions copyright national cable satellite corp. 2012]

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>> later today, more recent speeches from the national press club. you will see remarks by ken burns who talks about his film on prohibition. that is at 6:00 eastern on c- span2. an hour later, more from our "q&a" series at 7:00. >> if you want to come to america at illegally, and not waste your time coming across a dangerous border. just get on an airplane. the total number of undocumented has been going down for a long time. have we solved the problem?

we had our problem solved by having our economy crater. if they are here and did not find a job they go back home, because america is not the place theit around and thinkin state is going to support you. it cannot be easy to leave australia, come to the other side of the world, give up your friends and family and everything you know and start out from scratch. that is what people are willing to do. immigrants are going to be more aggressive, or risk takers. that is why they come here. joined byloomberg is a joi

rupert murdoch. >> 75 years since emil it earhart -- amelia earhart's attempt, findings. >> i draw the line in the dust and toss the gauntlet before the feet of tyranny, and i say segregation now, segregation tomorrow, and segregation forever. >> this sunday, the court costs , -- george wallace, this weekend on c-span3. >> john pistole talked about

security screening and security threats. this is an hour and 10 minutes. >> good morning. i want it to begin by saying thank you for your service, because i think someone in your position does not hear that a lot because of the feelings that clark was describing. we will get to that. let's start talking about aviation security with the big question. we can break it down from there. how safe are we when we fly put out the uss the threat, and what keeps you up at night? >> thank you, terry, and thank you for having us today. the context for what we do is important. tsa created in the aftermath of

9/11, and we are safer now than we have been. we are part of an interconnected global supply chain. we will talk about cargo a little bit later, but passenger security is what is on most people's minds. how we engage with our partners to rot continuum for national- security, because i see tsa as that nationalist tradition. we have this collectors, nsa, and a foreign security, forming what we do on a basis. local, domestically with the fbi, the local law enforcement officers here, all concerned citizens -- all that information comes int to tsa so we can take

that information and translate that into something where we can help prevent the next possible attack. we are at the other end of the continuum from the collectors overseas and the great work we have heard about in terms of what dod has done, promoting safe havens, so all these things have contributed the place we are today so we know where the threats are, we know we face a determined adversary regardless of how much they have been affected tthrough dod and other actions. as we have seen recently with the underwear bomber. >> they are still very keen on

airlines. it is such a spectacle. 9/11 at such a demonstration in effect. let's talk about those threats. what keeps you up at night? what kinds of threats are you most concerned about? >> the focus for tsa is domestically, with people who you meet. there are about to hear the 75 airports that have nonstop flights to the u.s.. we set the standards for all those airports, and those errors chute -- airport security agencies in terms of the baseline minimum they have to have before we'll will allow passengers and cargo to come to the u.s. one of the challenges and concerns is that sometimes, for what ever reason, it could be somebody who is taking a payoff

to accept drug shipments to come through, they think they are allowed the drug shipment to come through, but they are materials with explosives. that is what i am concerned about. there is that interest in trying to do something in a plane, whether it is a passenger, a suicide bomber, cargo, as we saw in the plot in 2010, if they can achieve that, then all the billions of dollars just in the u.s., an industry, in terms of trying to raise the bar to detect and deter a terrorist, they will have succeeded. we saw from "inspire" magazine, after the karpov, they said it only cost them $4,800 to ship those devices