hospitals that have a large percentage of the uninsured patients may be hurt financially by the health care law. later, we'll have a conversation on the witnessur, protection program. "washington journal" is next. host: good morning and welcome to "washington journal." here is a live shot of the supreme court building. to renderset a date decisions on a handful of cases. we may see them announce one that is in the news and is being closely watched, including gay marriage, the voting rights act, and college affirmative- action. on capitol hill the senate works on immigration reform and members of both chambers took to the sunday talk shows yesterday. -- the country is

allowing him safe passage. we would like to comment on u.s.-russia relations. here are the numbers to call -- you can also find us online, send us a tweet, or join the conversation on facebook by looking for cspan. you can also e-mail us, it is journal@cspan.org. the headline in "the chicago tribune" --

"the associated press" is watching where edward 7 is traveling to. here is the latest. he was booked for a plane that just left, it says in this story, a cuba-bound flight. moscow butrted for has not been seen on board. "the washington post" used the

headline -- we are looking at the relationship between the u.s. and russia. the into " the washington post" -- "the new york post " has this on

its page -- let us get your calls, what they'd have to say from tampa, florida are now republicans line. caller: good morning. -- he put thatst out there, this is what the government is doing to you. here is is going on. i don't think he leaked any top- secret information. he is just saying, here is what they are doing to you. here is what is going on. do you want to do anything about it? i do not think he leaked big secrets. host: should that be up to russia and the international community to decide or should they send him to the united states so he could face judgment here? caller: i heard they rejected

his passport so he is no longer a u.s. citizen. i say just let him go wherever he -- he is dead if he comes back here. let him go wherever he wants to go. host: a democratic caller from millions bird, new jersey. caller: hello. i think russia and the united states are very similar in one regard -- many years i have heard about russia living behind the iron curtain. the government told the people what they wanted to know and they could not know anything other than that. our media, being owned by the super rich and wealthy, often skews the truth and fax about many things. -- and facts about many things. many of us are living our lives by what we are told rather than the facts of what is going on.

there is the college money for students at onetruecollege.com. host: we are talking about u.s.- russia relations. here is from "the chicago tribune" - a state department official said washington told countries in the western hemisphere that snowden

should not be allowed to proceed in international travel other than is necessary to return to the united states. u.s. senator chuck schumer, democrat from new york, - we saw him weighing in on this yesterday, let us take a lesson. [video clip] >> what is infuriating is prime minister putin of russia aiding and abetting in his escape. the bottom line is simple. it allies are supposed to be treating each other in a decent wage. putin seems eager to put a finger in the eye of the united states. that is not how allies should treat each other and it will have serious consequences for

the u.s.-russia relationship. host: folks are weighing in on our facebook page -- i' let us here with tom have to say in reno, nevada. to say inmmy has reno, nevada. caller: i agree with tom.

how to reno we can trust him? -- how can we know we can trust him? i do not think we should trust him at all. kgb.s in the st. augustine, florida, republican. caller: i don't think many people remember after world war two general patton warned president russo about the russians. think snowden is a patriot. all of the rhetoric of him saying he is doing this for the country, he sure could not wait to get out of here. think if russia was an allied would have stopped him and have sent him back here.

i think the televising of the media between president obama and vladimir putin showed clearly that those to do not like each other -- those two to not like each other. host: we reading that from their body language for things they said? that they sat. i do not have-- any training in human interaction. it was pretty evident that they did not like each other and there did not seem to be any cordiality in their interaction. of presidentimages obama and vladimir putin as they met last week. these are on the google. looking at the path and were

snowden has taken we can track his movements. "the associated press" says the flight he was scheduled to take to cuba from russia has taken off and there is not a confirmation that he is on the flight. here is our it began. this is from "the washington post" -- the question is where he will go from here, which we are watching. orsibilities are ecuador quito. is he was know heavily watched and waited for in russia.

you can see the front page of --e new york times" one of them showing this passenger and pictures, waiting to see if he has anything to say. let us hear from chicago, illinois, a democrat. caller: thank you for having me on the line. not aot a communist, i am socialist, but when you realize that this is a person who was asking -- the united states recording millions on all of its citizens. if this happened in china or russia, somebody was taking information from their citizens, and that person would go to the united states, we will take them in a harpy. i do not understand why we have this whole situation where the

united states is trying to make this person into some kind of demon. russia and the united states roles are reversed. in the cold war will have a situation where people try to get out of russia and go here. in this situation it appears att almost -- if you look from international perspective the are protecting the sky leaking secrets, that in -- protecting it this guy a leaking secrets, that in my opinion need to get out. host: matte from new jersey, independent caller, good morning. caller: good morning. russia did warn us and they were good enough to warn us about the terrorists, if you remember, in boston.

also, they are against these al qaeda supported rebels in syria. it is wrong that obama is supporting them because they are slaughtering christians villages over there. if these listeners want to know what the irish folks think of this they should type into youtube "claire daily." host: here is an image looking at edwards snowden's troubles so far. tony in detroit, michigan, a democratic caller. hello. caller: happy to be on. i think the world is a lot more complicated. everything with the perspective of what happened during theirreland

years of turmoil. think that is something everyone here needs to take into consideration. these are extraordinary times. occurred inthat i have personally -- i think a lot of americans need to realize that these are extraordinary times. i hope we will return to some kind of normalcy and trust in our government officials. i think the behavior of our congress and the behavior of our political party, vis-a-vis the african-american president,

probably scares' all of us. host: those questions, are you african-american? caller: yes i am. host: did you serve in the military? you said you came behind and ied? caller: yes, i did. host: what experience did that give you? caller: the and reasonableness -- the on reasonableness, the orror. at the to get upset occuring shootings in cities. most of us do not live under that kind of fear. for the rest of the world that fear is constant. it calls for sometimes

regretable and extraordinary measures. i do not think the english and irish wanted to give up their civil rights but they wanted to solve the problems that occurred in northern ireland and england. host: that was tony in detroit. we heard from republican senator lindsay gramm of south carolina speak up on the -- lindsay carolina south speak up. [video clip] >> i hope we will change some of -- we will chasten to the ends of the earth. >> i was going asked about that, it was a key decision over the next 24 hours, should we put pressure on them right now? hold him in moscow? >> absolutely. they want to be part of the world community, they want a good relationship with united

states. they should hold this felon and send him back home for justice. host: let us hear from robert from stockton, california. a republican caller. caller: thank you. you do a really good job hosting your show. we appreciate that. host: what are your thoughts? caller: my thoughts are if our fourth amendment rights were not taken away in this incident this man would not have anything to run around the world with. somebody give him the tools and somebody gave him the opportunity to do what he was doing. i think the guy is a hero. he is exposing -- they want to put drones over america? the enemy should not be here. the enemy is there in afghanistan. it is almost like the americans are being spied on more than the enemy. that is my thought on this. host: what you think about the

u.s.-russia relationship in particular? caller: it has been deteriorating for a long time. it has been deteriorating since the obama administration. look at president karzai, he is secratary ofr state. it does not look like we're doing a good job working with the rest of the world. host: you find that a reflection of the u.s. than russia? caller: it is both. look at ronald reagan. time when they were help releaseher to some of the tensions of the cold -- many of thee president worked together to keep a cohesive relationship. this is a fresh story --

olympia, washington, our independent line, we are talking about u.s.-russia relations. i think with the syria ,- us trying to arm the rebels that is bad. russia and other countries were telling us not to go into a iraq at one time. voted.. it seems like we are going out on our own. we are supposed to be the light, the people that beer countries want to

like. i don't know what kind of contract that fellow signed where he is working. as far as i'm concerned i don't think the press has been doing a very good job for a long time. our relationship with russia is doing very good right now. host: so the u.s. should be held to a higher standard? caller: i would think so. when they get here, they are americans. let us all be americans. that is what i would like to be. host: thank you for your call, fred. here is a tweet --

we saw that congressman mike rogers, chairman of the house intelligence committee, on nbc's "meet the press." let us take a lesson. [video clip] he looked at in a flight from moscow, many believe to cuba. there is air traffic from moscow to cuba. then on to venezuela. when you look at it every one of those nations is tossed out the united states. if you could go to north korea and iran he could run out his government-oppression to work. -- tour. let us go to charlie in

new york on our republican's line. good morning. we have a former kgb operative back in the syrian government. who want toblicans back the rebels. stevens,sador, chris was in benghazi trying to buy that hillary clinton gave to them. host: relate your comment back to russia. caller: we have a former kgb operative who was the prime minister. how you think our relationship is going to go? host: are you watching syria as a barometer of that? are you watching what is happening with edward?

caller: apparently the christians are backing th siyrian government. our president abandoned out allies in egypt. the muslim brotherhood is running the country. christians that have lived there for decades are being murdered. could obama scrub this country any more than he is now? -- screw up this country anymore than he is now? host: we will go to rockland, maryland. good morning. caller: hillary clinton went to russia early on and she had a reset button. it set the tone for the obama administration's failure with russia. i think when mr. obama lied to mr. plimpton regarding libya --

--mr. putin regarding libya he said he will not allow a fly zone in syria if we just do not bring nato in. obama said ok. russian war ships, for the first time since the soviet union, are in the mediterranean. they are aggressive and we are leaving them behind it does not bode well. host: here is twitter -- "usa today" has the headline --

nick from victorville, california, a democrat. what you think? [indiscernible] we need to be protected and i think this is the government program to do this. host: study from nashville, tennessee,, caller: we do not even trust our

own government and we have good reason. we are spying on americans, but i do not think anybody is shocked. it has been going on for years. our government is just so out of whack. president,ust this it has been going on for years, the republicans and democrats. none of them say what they are going to do it -- and of the -- none of them do what they're going to say to do. know why anybody would be shocked at anything that is going on with our government. there's a lot more that should be revealed that is not. open "the new york times" report says that --

dianne feinstein of california was on "face the nation." let's listen. [video clip] >> china clearly had a role in this in my view. i do not think this is hong kong without chinese acquiescence.

his choice of moscow was interesting. what is interesting is he was taking off in a car and luggage in a separate car. seeill be interesting to with moscow does with him. clearly was aided and abetted, possibly by the wikileaks organization. i heard a rumor he was tracked -- he was traveling with someone. dianne feinstein yesterday. let us look at some other news as we allow your calls to come in on u.s.-russia relations. here is immigration reform --

we will be watching the u.s. senate on c-span2 today. we are expecting them to take a the at 5:30 p.m. on one of amendments. this one referring parin particr to border security -- "usa today" looks at arguments for the bill, including impact

on the economy. there are arguments against the bill, including a trade on the government services. that is the public's perception. turning to the supreme court. this from "the baltimore sun" -- we are watching to see the courts on issues including college affirmative action, voting rights, and the marriage. we will be watching to see if they render decisions in any of these cases. the wall street journal says the court is shifting legality in gay marriage. there are two in play. you can see demonstrators chanting in support of gay marriage, and

supporters of traditional marriage are also pictured in the bottom photo, people who are demonstrated by the court as they heard the arguments months ago. it is just about time for the decision. thelso see a story about secretary of state john kerry. he is plotting to cut greenhouse gas and missions. he urged yesterday to address climate change. we expect to hear more from domestic climate change issues from the white house tomorrow. this from "the wall street journal."

powee the family of a speaking out about their son's plight. you can see the parents in the picture above and their son -- he is the only known prisoner of war held by the alabama. -- by the taliban. we are talking about u.s.-russia relations and what you think about the impact. fromve a republican caller oregon next. hello. caller: i have so much to say. i want the parents of our power flagow that i can fly that out in my porch. it is a lousy time to be .egotiating roo

we are getting out of dodge. in regard to russia and our ilationship, i do not think and soer seen america many countries -- we have been such a chump don't we remember russians on the syrian border -- and i got the wrong border. when we went into iraq. there were civilians driving survey these -- driving mercedes benz. they were russians. don't we understand these wars? china and russia are behind

them? --na is stripping the world going into the poorest countries, raping their land, not giving a dam about their people. we just sit and watch. i would send russia a big message, i hope we pay a visit to iran and make more than their basement leak. host: joseph writes -- is up next from virginia on the republican line. caller: how you doing? lastted to comment to the lady. is she going to volunteer and send her children off to the next war? is she going to send her ar?ldren off to the next wer the problem we have is we are

in too many countries. it all goes back to ron paul. policy,derstood foreign especially non interventionist , they only draws down, the warmongers cannot understand that. think they built the greatest nation in the world. what is going to happen is they are dying off 10,000 a day. when they check out who is quickly in all of this trash up the left behind? . the baby boomers have done nothing but run this country into the ground. let us take a look at what senator rand paul has to say about the relationship. he said that snowden should not

cozy up to russia -- michael from los angeles, an independent caller, hello. caller: thank you for c-span. you are one of my favorite host because you are professional and prepared. regarding the russian relationship, it has always been this way. from being aone

sellout to being a political pawn for russia and china. it does us count the people would call him a hero. he is a whistle-blower. hero he would come back to the united states and face the charges, put what he has on the table, that would be heroic. being used as a political pawn, it is astounding to me people would call him a hero. int: let us go to david flint, michigan. say russia andto u.s. relationships have never been that great. i do not think they ever will be. had a good job. why he did what he did come i cannot understand. i know times are bad and they

need to catch these terrorists. newink we have a lot more york bombings -- i do not understand all of the citizens calling in the saying they support him giving out of this information. they hate him -- they hate obama so bad until they are trying to protect this trader. that is my opinion. think the u.s.t relationships have been good with russia. do we keep russia on their toes, do they keep us on our toes? how would you like to see the relationship be? wish it would be better so russians would not be supporting countries like syria and keeping wars going. i wish our relationship was better when we could have more peace in the world. michigan.d in

a tweet -- llamar in virginia, an independent caller. caller: i think people are putting too much on snowden with their relationship issue. our relationship has always been . problem we can expect russia to turn around and be representing .merica's agenda snowden, everybody is talking about him not being a hero. i believe what he did was open the eyes of americans. they do not want to have their

eyes open. for him to step out of the country, i do not agree with that. we cannot blame it on russia, we cannot blame it on china. there is no way we can go to them and say they did anything wrong. there is no extradition laws with us in our country. we have to give them as much respect as we would want respect from them. in return i think that would open up the relationships for us and russia. there are countries that are looking at our country now. host: bill tweets in a response from an earlier comment --

a couple of other stories in the news, we mentioned we expect to see talk of climate change legislation this week. the president also plans to channel -- to travel to africa -- the goals of his trip, boosting economic partnerships and engagement with the u.s., promoting democratic development the costn nations -- is largely to do with the security force that will trouble with the first family. news from africa, nelson mandela, his health has worsened and his condition is now called critical. the four south african's condition deteriorated and took a critical guest today. the news was met with concern by

many in south africa. tom -- we will go to tom in -- an independent college. about the nsa leader passing through russia? caller: i think the relations are going to get worse. the reason is i think there are a lot of people in russia and china that know a lot of stuff that would like to come to the united states. get to feel they can safety over here they will come and they will bring their information with them. areink russia and china making a mistake. that is all i have to say. north carolina, democrats' line. caller: my comment is sometimes there is an old cliche that says

what goes around comes around. andeference to afghanistan the clinton administration, sending missiles over there -- why russia was in that country, they have forgotten about that. for the man that called and talked about how good reagan and russia's relationship work, i recall right before bush had left office he wanted to place some missiles inside of a place called georgia over in russia. theia quickly overran country with troops. when i look at snowden, my waser was born in 1909 iand a world war two soldier. he had words for those calling him a hero. he has two words for what they in d do to those men

19 world war two. "firing squad." host: what you think about members of your own party's? caller: firing squad. host: on twitter -- mike from boston massachusetts, an independent caller, hello. caller: how are you doing? i am wondering if there is a possibility china and russia approached him prior to this and wants to use him to obviously get information. maybe he is being used as a spy and the whole thing was conspired prior to him coming out? what would that mean to you in terms of snowden's

motives or u.s.-russia relations? of syria think because the relationship is going to continue to break down. i think they are going to use him, china is going to use him, and venezuela to get as much information and get as much of a power play, concerning syria and other mutual interests we may have. go to dave on the independent line. welcome. caller: how are you doing? good. what you think of u.s.-russia relationships? stave: i think they can back the syrian rebels. i just cannot see us having anything to do with people that

have hurt so many of our soldiers and kill so many of our soldiers. we should not be slapping russia in the face. host: what you think about edward snowden seeking passage through russia? we do not know if he has left russia yet. what you think the bearing that has on russia relations? caller: i do not think it can get any worse than it already is, with us doing what we are doing or fixing to do by aiding those rebels. i am thankful the young man has , letting whole life up the american people know what goes on in our government.

k i s ademo -- kay is a democratic caller. caller: thank you for taking my call. i am upset by dianne feinstein. where are all of these people when we had bush and cheney and congolese a rise in power? congolese a rice in power? -- we would know what these terrible people were doing. syrian -- what their government is doing there. it is terrible, the killings that is going on. we killed a million and a half people in iraq. those are the people standing up and demanding that bush and

cheney ought to be arrested for war crimes. it is mindboggling to me and it is so sad for our country to think that we have allowed these people to get off scot-free for what they have done. you mention wikileaks. the founder is in the ecuador and see in london. the headline of the story in "the new york times" -- talk withnext we will jonathan alter about his new book. willr on the david gruber look at what will happen to patients as the federal health- care law kicks in. we will go to a live shot outside of the u.s. supreme court building. folks are waiting in line to get

a seat inside and be able to hear the decisions rendered this morning by the court. the court has a number of decisions they still have to come up with. we will see if those announced today. ♪ >> first ladies have a capacity to personify, if they so choose. this is a pattern of american women in politics, famous or not. it is two things -- one is they are women, real people, who actually do things. there is the secondary capacity of being a personifying, charismatic figure. i think many first ladies have

come into becoming first lady in realizing this was larger than life -- that is something dolley figured out. she became a figurehead of her husband's administration. she fostered the attachment to the capital city. a lot of this happened in 1808. in 1814 the british are going to burn the capital city and all of this work she put in to helping the public identify with this house the called "the white house" is going to pay off. >> our focus on first ladies continues every monday night and our next program features -- features historian and author on why we studyr first ladies. tonight on c-span. >> "washington journal" continues. host: jonathan alter has a new book out, called "the center

hold." we wanted to get your insight into the president's second term agenda. you had a piece in which you write -- the first debate he had in gives some insight into the challenges he is facing right now and the way he conducts business as he faces a lot of tough moments. how does that provide insight? -- er: that answer exert -- what i tried to do there and elsewhere is provide the back stories, what happened in debate preparation that left him going john kerry playing

mitt romney in those mock debates. he was really stumbling, not able to connect. all of his debate coaches knew for sure he was going to lose that debate because he just seemed disconnected from his own race for president, as if he was somehow above the process of debates for which he has. he did terribly in that debate. this is what is relevant for what is going on now. he was able to make a major comeback in both the second and third debate. it was almost like a different candidate showed up on the stage for that second debate. that might tell us is there tends to be a sense of

everything is going to go in the same direction it is going now. people are saying obama's second term is a disaster, does he have time to recover? these are nonsensical questions. he has plenty of time to recover. he has proven time and again he can come back. it would be a huge mistake to count this president out. just a year before the election 2011, as i of reported in this book i would book thatple in this a well-known opinion research analyst in the new york times had an article and said that if things did not change much he had a 17% chance of being

reelected. we know that turned out to be wrong. it is a dramatic story of how he came back to win that election inpaign and there are clues that come back as to how we can come back today from his very rough last six weeks. host: and you right -- what are the toughest is use facing him right now? -- issues facing him right now? is it trying to get the immigration reform? we hear about climate change, tried to get some traction there, or is it the politics around washington? guest: the politics are connected to these two big issues. i think the controversy scandals, whatever people want

to call them, as important as they are i am not going to be as they are they are not going to be permanent ravishes on his administration. big issue for 2013 is immigration reform. getting blocked in the house i think it is going to get through the senate -- if that blocked in the house, would take away from the president a major accomplishment for his legacy. here is the thing that makes the politics more interesting, it would also make it extremely hard for republicans to win the next presidential election. they have to do better than 29% of the latino vote, which is what mitt romney got in 2012.

if they cannot improve on that, and they will not be able to improve on that if they cannot get the immigration bill through, it is going to be very rough sailing for the republican party. many republicans know this. this is why so many republicans are in favor of immigration reform, setting aside the merits of the issue. they realize their party needs to do this. libya is a great example of what about 2012 and is relevant to what is going on now. romney managed to even , the2% of the latino vote jam -- the campaign manager of barack obama told me in 2011 obama would have no way of being reelected, no matter what else they did. if they cannot get close to 60%

of the latino vote they were through and the president was going to be a one-termer. it is a fascinating and largely untold story, one of many i tried to tell in this book. almost a subterranean campaign that the media largely where a famous person in the spanish community, and anger -- an anchor, she is dubbed the latina oprah. she cut as with michelle obama that pursued the popular in the latino community. there were other things where the campaign went to soccer matches, they went to

naturalization predict to nationalization ceremonies -- to nationalize asian ceremonies. nationalization ceremonies. it would not be where it is. everything that is happening with immigration is an outrage of the 2012 election. that is why it bears scrutiny. it is worth devoting a whole book to. jonathan alter is a contributor for nbc. he spent 21 years at newsweek. you can read his work. in the "newheadline york times." the white house open a campaign

to support an immigration bill. have inls a room they a senate office building where the white house is working out but they are are not doing it in an overt up seeking way. what does that tell you about, lessens the resident has learned and the strategy they are taking for that issue which you set will be a key when? they used to say about dwight eisenhower, a call to the hidden hand residency. i would not go that for about a rock obama. know that if he raised his profile to high it would raise more opposition. sometimes on the deficit whence hecommission, was for it -- whence he was for it, the republicans were against

it. he understands he can become an pediment do something he wants. to somethingment he wants. indid something like that the first few cases. they were some complaints he was not active enough in shaping a healthcare reform bill. he let congress take the lead. is he thought there would be a better chance of passage. taking a step back on that, and also work on ending don't ask don't tell in the military. incident is taking the lead on gays in the military, he had admiral mullen and the joints chief of staff make statements

on it. they would have to change the law to make the change possible. at the endwas made of 2010. now you are seeing a similar situation. he is trying not to get to out front. his people are very involved quietly on the hell in getting immigration -- on the hill and getting immigration reform through. high-profileing a position. i think that is politically smart of him. whether it is enough to get the bill through the half -- house with the politics of very complex is not clear. the interesting thing politically is that while he thes it for his legacy, crass truth is it will be better if the bill fails.

it would not be better for latinos. it would not be better for other immigrants. it do not be better for the democratic party long-term. not would be seen as accomplishing something important they have promised. the latinon in community will be severe against the republican party if they block this bill. we saw what happened in california with governor pete wilson years and years ago push through some legislation that was punitive toward latinos. ever since.n blue the chance for republicans respectively to compete in, or near. very difficult for the republican party to compete in states like colorado, othera, nevada,

battleground states. they will need it moving forward to recapture the white house. it'll almost be impossible for them to compete in those states if they do not move a bill in the congress. a lot of republicans understand this. billis why we see o'reilly and sean hannity, and a lot of republicans are now supporting immigration reform. they understand the political realities. host: joyce says i am far more concerned about the future than the president's legacy. that is only relevant to him. we are share their opinion. point.that is a great

i think he makes a great point. this is something that has always other to me as people talk about what is the president legacy. mitch mcconnell said my priority , thethe next two years first priority was to get rid of barack obama. when they hear journalist , what is theway minority leader in the senate, the national reaction is what about our priorities? you have an unbelievably well- informed audience.

i can try on every single page to tell those inform all thathing they do not know what happened behind the scenes. cannot give people a moneyback guarantee. i do have a promise that you you will find something on every page that you had not known before. jeff joins us from the republican line. caller: the individual doesn't in a tweet is right on point. i am assuming the reason you're here is for your book. you are doing exactly what the individual is saying. the average american person doesn't understand how politics work. when obama came into office there were specific issues facing this nation.

totally by the wayside. you all are more focused on politics. how long have you been in dc? have you had a job outside? out here still struggling struggling and trying to do everything we can. i have a job now. i'm not making the money that i used to make. you are perpetuating something that is so irrelevant. obama is no different than any politician along the way. you have to stop focusing on the specific days that are germane and irrelevant. please stopl in, talking about being pro- republican or pro-democrat. obama is no different than bush.

they may have different philosophies. hold them all to account. media, stop taking sides. thank you. you reflect a lot of people stealing's. -- feelings. guest: i do not live in washington. i live in jersey. you are absolutely right. my purpose for appearing is to sell my book. i am on a book tour. that needs to be a full disclosure of why i am here. too often everybody including the news media get caught up in the politics rather than in the substance. that is a perennial problem in washington.

it is part of our job to sort out myth from reality. on something unlike what obama's record is on helping people find work, it is part of what i do. it is to puzzle through who is telling the truth. incan be very hard to tell the middle of this noise machine. larry is up next. democratic caller. , ther: telling the truth reason i am calling is i feel like there has been a confusion

between the blame game. president obama is getting credit for things that the senate and the house of representatives are in control of. the budget.ntrols they control where the money goes. president obama does not have any control over that. of blame for the inactivity immigration is being placed on him. where this is to blame. goes with the house and the senate. this is what happens on

capitol hill. happens to beever president at the time. this is a democrat or republican presidents. and a lot of this depends on what happens on the other side of pennsylvania avenue. the president will either get credit if it passes you will get some credit for stepping up. what has president obama done for me. they need to look at the -- what has president obama done for me? if they need to look at it before they can make a subtle and accurate textured analysis

of what happened. there's a lot of concern about the democratic side. we are back in the same old thing we were in before. what they fail to recognize is the ryan planke that were genetically redrawn -- dramatically redrawn change , rolledonsiderably back the relationship between the people and the government to where it was the pre-new deal era. all of that went from being a serious possibility before the election and now it is a

fantasy. it is not going to happen. repealing obamacare, or 100% fantasy. until 2017, nothing that will take america sharply to the right will happen in the united states here is that is not get pointed out in the. my book is titled because we 2016 a centrist nation. we will not be moving further to the right. we're not going to be moving far to the left. let's go to roger in new york. independent line. taking myhanks

call. i wanted to comment on day -- on the gop obstruction. i think that is pretty important that people take notice of how much has actually like how muchere, have been for not almost because of the opposition. i think we can all agree it is more partisan and washington than it has ever been. i am 40. i have never seen anything like it is eerie people have always had opinions and gone back and or the embattled a little bit. it seems like things have generally gotten done or certain things past.

.t is so partisan it is almost childish. we cannot have him be successful at anything. we had to take away everything. with this immigration bill it is probably going jump on the bandwagon saying this could be political suicide. perhaps they might pass it. i am not holding my breath on that. guest: it is going to be fascinating to watch. 9 -- 2009 inand the end of 2010, the first few years of the president's first term, a lot got done in congress and in the house with republican.

we had not had this kind of gridlock. the republican party faces a choice. they can grit their teeth, go along with the senate bipartisan compromise that they fashioned on immigration reform which includes $30 billion to bolster border security, republicans go along with that and that to join with democrats and get it through the house. with the understanding that the president will get much of the credit that they can get that off the table and go about trying to get latino vote in future elections. or they can slit their throats. if they want to have another election where they get 29% of the latino vote, it is growing very rapidly and this country. aey can condemn themselves to minor party status for a very long time.

that is a question that all republicans must face about the future of their party. is it relevant to the merit of immigration reform, what they actually believe about the bill? absolutely. people have to take the positions based on principle. if you are in politics you have to look to the politics. the billok closely at that is coming out of the senate, reasonable people will conclude that there are a reasonable compromise. the whole issue of compromise is so fitting about the last couple of years. in the first chapter of my book i remind people that john boehner went on 60 minutes right after the 2010 midterms when he was becoming speaker. my caucus isy said not believe in compromise. he could say, ground is ok.

you do have an element within the republican caucus that some republicans have caused the purity caucus where it is their way or the highway. they do not feel they were sent to washington to compromise. that is at odds with what people read beer, the founders believed was necessary for us to do. >> a couple of tweet that have gone tooobama has thin. he gets one agenda item per year max that he should focus on. obama has already screwed up guns and immigration. is there a second term agenda or a continuation of the first term with some elaboration? guest: both of them are good points. we feel done then safety.

i do not like to use the word "gun control." they're going to come back at it again. i am not sure it is fair to say you made this at obama's feed him he could do a better job. he could do a better job. republicans were opposed to common sense gun safety legislation that even conservative members like pat .oomey were for he decided to be considered for whatever reason. immigration is too soon to say that he is failed on this. i actually get it slide out of assets this year. in terms of whether is it clearly in some ways he does. he will come forward in the next few days with climate change of policy, some of which you will do unilaterally without congress. that puts a new emphasis on a

second term. the immigration issue as well. he admitted to latino leaders when they went in and profited, he did not get it done on that issue in the first term. what is a little puzzling to me is why he is not returning with jobs agenda. he did press hard for a jobs bill. he included a12 lot of proposals for job creation that republicans had supported in the past. he was for it. they were against it. they obstructed this effort to get a jobs bill through in 2011/2012. i would argue that he needs to return to that as a first-term agenda.

a return said that and will be talking about that more in take the case to the country of why we need to rebuild america with more infrastructure. "thes book is called center holds, obama and his anima in a maze." also a book about fdr. the selection of his newsweek column. let's hear from terry. republican. caller: good morning c-span. you hit it right on the head. obama and his enemies. being part of the republican party i am one of the enemies. through the election harry reid accused mitt romney of not paying no taxes with no proof

whatsoever. mitt romney killed somebody's wife. we have paul ryan being accused of get killing someone -- feeling someone's why. guest: i miss that. what it comes down to is trust. how can i trust democrats to give me the healthcare under obamacare. and the republican in this country ought to be scared to death. guest: here is my take. a lot of doctors are republicans. let me try to clarify a couple of things that i think have been really misunderstood. this is people say

socialist, this is a government takeover. in truth if you look closely at obamacare, and it has lindsay of flaws and needs to be fixed and amended and there are technical things wrong with it like any major piece of social legislation, there are things , just to to be fixed it is a bill that is almost identical goal to a bill that republicans introduced in the early 1990s. it is very similar to what mitt romney implemented in massachusetts. it is based on private insurance. it is not a government takeover from healthcare. what it does do is for the are itmied in american history says just because you get sick

it does not mean you're going to have to necessarily lose your survivoram a cancer myself. it gives me great peace of mind. i think it gives equal a great peace of mind. they're going to have to sell their house to pay for healthcare cost that their insurance company does not cover or if they do not have insurance there will be a worse situation at all on be thrown at the mercy. that area is in the past. we have now entered an era. wasybody out there he still mad about obamacare, give it up. move on. try to fix it. -- in termsn times of trying to repeal it. it absolutely will not be repealed. by 2017 it'll be so embedded in our system that even a

republican will not be able to repeal it. that is over. it is time to move on and appreciate that it does provide 40 million americans, even those with health insurance, a new piece of mind that if they hit sake they are not going to go bankrupt. we will talk more about that law later on this morning with david gruber. what the health-care law means for their bottom line and patient care. health insurance education blitz begins. obamacare marketplaces that open in 100 days. it details the education efforts. some criticize the administration and say it is starting late in the game. let's hear from laura. caller: i know the reason i

voted for obama is the has i did not like the fact that nothing was getting accomplished. people were losing their homes. he walked in to the because ms. -- the biggest mess i've seen this country go through. katieot understand how pay for things if you do not have taxes? how can you pay things? where is the money coming from? you have to have taxes. i am 56 years old. i have pay taxes but whole life. you should be down with loopholes, not taxes. it gives people these bigger write offs and these companies right out for things they do not deserve. host: let's get a response. you make a great point.

a chunk of my books have a chapter called "strangled in the bathtub." a comment that likes to say.t he wants to make government so small it can be strangled in a bathtub. is to keepdo that cutting taxes. he got almost everybody in the senate and the house to sign his famous pledge. he extended it to close the loopholes which he called a tax increase. even just closing loopholes. even very conservative senators say what is that?

why is it a tax increase to close the loophole or in the tax favor for ethanol? it put a choke hold on the whole it gave the lie to the idea that the republicans stand for deficit reduction, for lifting the burden of debt on our children. one of the key moments in the campaign came from a fox news debate that many software a fox anchor asked all the republican --didate to were lined up candidates who were lined up during the primaries, could you support a 10-one ratio of spending cuts to tax increases? $10 in spending cuts for every one dollar in tax increases.

every public in on the stage said no. in other words, that would balance the budget very quickly. they could not accept it because they do not have any tax increases at all. wealthye taken very people back to the tax levels they featuring the clinton years which is a very prosperous time. that was the deal breaker for them. the republicans were about one , cutting taxes on wealthy people. the only issue that united everybody with foreign-policy issues or immigration. there are all kinds of issues. the only thing that unifies every republican was more tax cuts for wealthy people. we arty solve the it did not create job growth.

it does not yield job. you have this image in your book. you are just talking about the other photos. let's get one last call. these are just things that happened behind the scenes. abc news called the election for president of, and she is standing in a suite at the fairmont hotel. what i try to do repeatedly was take people behind closed doors.

there was the suite were mitt romney was on election night. many other such scenes where it is very hard for the public to go. 200 interviews interviews for this book to really kick behind the scenes of that campaign. i try to give some historical context. thank you so much for joining us this morning. we will look at the federal health-care law and its impact on safety net patience that held up i do not have insurance. we will look at our your money segment and focus on the

witness protection program with its founder. >> he says that interfax claims the edward snowden is most likely beyond the borders of the russian federation. he hadrry says that evidently placed himself above the law, having be laid his -- delayed his country. he says the former contractor who leaked information about the u.s. surveillance program must be brought to justice. viceepublican parties 2012 president joe candidates is the given to hong kong and possibly ecuador and it is moving embarrassing. itwent on to say that

complicates relations with countries with which the u.s. has extradition treaties. he says the leaks raise troubling questions about the wide-ranging electronic surveillance, saying the program is more than i thought was occurring. immigration will be voted on today in the u.s. senate. president obama convened a meeting's and seek -- of ceos of the benefits of an immigration bill. the afternoon meeting is scheduled does -- just hours after the senate held a key vote. a pathway tode citizenship for many of the 11 million people living in the u.s. illegally. you can watch this live on the senate floor or you can listen to the debate here on c-span radio. that all begins at noon eastern. looking at the week ahead,

president obama delivers a speech tomorrow on climate change. when say he heads to africa. stops include tanzania and south africa. one country he will not visit is can you, the birthplace of his father and home to many of his relatives. it comes up concerns about kenya's political situation. the new president is facing charges of crimes against humanity and the international criminal court and is accused of orchestrating the violence that marred the country and the 2007 election. an update on nelson mandela. reports say he is now in critical condition. the government says the condition of the 94-year-old is deteriorating. he is being treated at a hospital in pretoria for a long in -- for a recurrent lung infection. >> there are about 1400 monuments on this battlefield.

this is the 1880s. they are getting older. sure they are remembered. they are going to this by building monuments. that is howe days they commemorated the service. these are monuments to the soldiers and their leaders. help usments really interpret the story. they are placed on the ground. most of the monuments are union monuments. it is going to be a union victory. by the time the war ends, there's not a lot of money in the cell to go monuments. especially in the northern states. coverage of the battle of gettysburg starting at 930 eastern with historian speakers.nd

at 8:00, the commemorative ceremony with the keynote speaker. joe matta greetings from eyewitness accounts of the battle. host: this morning weakened. the series on the health-care law. this morning we focus focus on

safety net hospitals and what the law will mean for their services and bottom line. our guest is david gruber. he is with the healthcare industry. thank you for joining us. start by telling us what a safety net hospital is. guest: it is a hospital that serves a disk portion it -- a disappointed numbers and medicaid. need to beof these primaries. host: we are talking about a mix of those of not-for-profit. defining these characteristics?

guest: would be non-for profit. 40% are in rural areas. they vary in size. the hospitals tend to be smaller. urban hospitals tend to be larger. a common attribute of all is the population it serves. a lot of medicaid populations. publicly owned. there are some not for profit. we see a division of those. half of those have less than 100. how do these make money. guest: their goal is to break even. if you look at the national association of health systems,

the average has an operating margin of seven point two percent. the look at the national association, it is about two percent. hospitals are actually unprofitable. they're very much dependent on federal federal as well as state and local subsidies to survive. host: you authored the safety net hospitals at risk. how things are going to to change under the federal health-care law. . our system is grossly ineffective across the board. .hey're going to be challenged

the first thing they do is to increase access by raising this from 100% to 130%. they will get insurance coverage. unexpectedly, 26 states will take advantage of that. there are also states that will not be expanding medicaid. there are a bunch so on the fence. why is that an issue? there are also some other changes that are going to occur. there is going to be a reduction in medicare entertainment. they do those are disproportionate. a go for the hospitals that treated no -- low income people. there is thetly,

medicaid dish payments. this is going to $5 billion. 700 hospitals are dependent on that. the low been from income populations. there will be a reduction in the basket. historically it has been this. the change will go from one percent to two percent. interface a significant change. purchasing.s the it those who are unfamiliar will involve three areas. it involves the region missions, hospital acquired conditions, it involves patient satisfaction. the way it works is the goal here is to reduce region admissions.- re-

to start it is 1% of full medicare revenue. we will go to three percent by 2016 or 15. they are in the lowest quartile. 31% either had the highest penalty or the next tier. that cuts margins even further. gethe uninsured people insurance, now they are able to go elsewhere. there is risk of volume decline of patients go from the safety net to other institutions. he put together a scene on the of financial challenges. hospitals are very dependent on

subsidies. host: david gruber is our guest. he has a medical degree. he is looking at safety net hospitals. the report says the hospital say -- see more than half a million medicaid patients each year. you can give us a call. you mention one thing i want to put into more laymen terms. how hospitals get rated and the affordable care act take into account what patient

satisfaction is. hospitals may have a tough time hitting the goals of satisfaction. they tend to have lower patient satisfaction. explain to us a little more in layman's terms of how the satisfaction will work and why they matter. ok.t: in terms of patient there is the question near. what it rates is the user experience within the hospital. it looks at the quality of nursing care. s. looks at your a couple of things to look at. you have to look at the population of some of the safety net hospitals.

it may be low income. we may have complex medical conditions, lifestyle issues. there are a whole slew of social determinants that really influenced outcomes. the other parts are that the hospitals are usually short on capital. the net result is you have a more complex patient population coming into treatment. have a primary care doctor with their pre-existing relationship. you go out and you have to rate your experience. it has to be more challenge. quality in the past has not been

a focus. they are saying we have to reduce it's missions. we have to look at that. where patients coming into the hospital. the have to look at the transition from the house and go outside the hospital. host: it sounds like they want to get rid of care. even the safety net hospital also gets a great majority of .heir funding and medicare it is about 80% of medicare.

guest: will they eliminate indigent care? no. the intent is not to eliminate indigent care. the problem is we're running out of money. the federal government pays for 57% of medicaid. many states are under a lot of pressure in that regards. he go to louisiana there has been some cutbacks. it very state-by-state.

a number of the hospitals are at risk. they're very much dependent upon the subsidies. when you look at institutions of low levels of profitability and somewhat negative, every single dollar makes a difference. this not really the number. you have some commercial insurance at eight team percent. the big problem for safety net hospitals is the commercial percentage is far lower than the average hospital which would be about 35%. the reimbursement

for medicaid is roughly there. the reimbursement rate is higher than the cost shifting. yeah a couple of issues. haveey go into play, we more patients covered under medicaid. that is the lower reimbursement. that has some financial stress. from the commercial standpoint, it it is a relatively low percentage of the total. for the dollars they do receive they usually get reimbursed at lower rates within a given market. the safety net is freight. in some states it will be particularly so, especially if they do not move forward. >host: welcome. have two questions. the first has to do with the cost of health care.

a fixedand japan have use scheduled. my second question has to do with health i.t. and the fact that proprietary systems and hospital change and not communicate with each other. i wonder the benefits when you have electronic health records, why they do not communicate. guest: i think you asked us: -- x: -- i think you asked excellent questions. germany and japan, germany is probably about 12%. japan is about 10% or so. despite the fact that they have are older populations and we do, we spend a lot more money. why is that? we are inefficient. we are highly fragmented. we do not do well the transitions.

we do not have good care coordination. our prices are far higher in terms of pharmaceuticals. the other thing is they are very much focus on primary care, much more so than we are in that regard. single-payer. what we do know is that there our prices between commercial and single-payer. germany and japan are much different. your outcomes are better than ours. i am sure there are things we can learn in terms of what they are doing. terms of healthcare i.t., this is been a big surprise. money was made available. enterprise systems were put into various hospitals. here is the thing. as system as it appears they develop more for process of care and administrators, it seems to have an administrator

function. a lot of systems do not like this. they believe it takes them longer to input the data and review the chart. third also be huge cost savings that occur. there's a certain amount of of of coding that occurs in this regard to increase reimbursements. potentially to the hospital. what the act should have mandated back in 2009 or 10 was open architecture. it would have allowed the easy exchange of information across physician groups. iom a capitalism standpoint, am not sure that is what they want. you keep it proprietary. it is yours. there's information liquidity. guest.avid gruber is our we're talking about safety net hospitals. others?e more than

guest: absolutely. you can look at new york and texas. you can look at the number of uninsured. texas 24% of the population is uninsured. in new york and new jersey the numbers are far lower. it is really a question of political he in that regard and the role of government. there are big differences in terms of the reimbursement that may be provided. ofseholds received a lot support from the states. it is up to them to define what are the central benefits. one of the big hold for all states and i think it is a big flaw is the dual eligible population. it means these are people who

are eligible for medicare as well as medicaid. they're eligible in the united states. 50 to 65% of the growth. it is a huge unmet need. five percent of people have come to 49% of healthcare costs. 60 four percent. the key is case management and what you need to do. you need to transfer from the hospital to the nursing home. have to have peer collaboration. you need to engage the patient needs. host: let's hear from johnson tennessee, democratic. caller: thank you very much for

taking my call. we have read and seen on the news where some of this dies. what is your prediction of meeting the needs of people the frontdo not have to continue to provide health care for all? , the assistance is available. how in the world have they refuse to help them at the same time they are getting lower upfront for healthcare? how will they take care of the people?

it will give us some systems. guest: the assumption we use is the solution to all problems is throwing more money at it. i fundamentally believe we could do a lot more with less. we have embedded inefficiencies in terms of care delivery. we have hospitals. we have regulatory services. we have all of the services offered. there are these other issues as well. mental health was a huge issue. there was substance abuse. there was the employment issue. they are interrelated. how do we do more with less? case of process reengineering. we have to redesign the care system. care are models of delivery out there. a number of different areas.

they have integrated systems. they have primary care clinics. extend into the schools. in some of the schools they have specialty clinics and the like. the other piece we have to look .t is engagement of the patient we have an obesity epidemic in the united states. for the five percent, three percent are overweight. obesity will lead to diabetes. 90% of the population still smokes. we need to work on the risk factors. people music accountability of their own health. the answer to your question is number one, it is going to be a

problem. i believe the situation will get worse before it gets better. .tates pacific, locale specific there's a a sin tommy a financial challenge. he cut the payments, -- there is tsunami ofnee -- financial challenges. we need to take care of ourselves a bit better. 50% ofdo not realize healthcare costs related to patient decisions. that includes the awareness of their situation and went out and receive care. host: we see on the front page af "the new york times" patient -- clinic that is racing to adapt to health care overall. it says the debate surrounding

the clinic and how to deal with changes and care was just one expression of the tensions ripping through medical offices around the country in the countdown to january. it will require most americans to have health insurance or pay a tax penalty. what are you watching to see that some of the safety net hospitals and clinics do over the next couple of months to get ready for the changes on the horizon? well, the bottom line is there are changes, tactical requirements, and then there is the long-term strategic need for leadership. i really want to focus on the later, how do we do more with less? how do we focus on primary and secondary prevention?

the huge need for primary care. they're using physician assistants and using practitioners to extend the reach of the primary-care doctors. how do we enhance the relationship between the clinic, safety net hospital inpatient? if you are a safety net hospital, what is critical is the outpatient activities? if you're not really expanded outpatient capability, you will be in trouble in that regard. how do you extend reach into the community? because it will become more competitive world. the medicaid patients previously can now walk with their feet. if they're not happy with the care they are getting, they can go elsewhere. previously it was the care site of last resort for many. now there will be a bit more mobility. the basic business model has to

change. that so that if patients do not rely on the safety net hospitals as much? why is that a problem? guest: i think it is a good thing. i think in the competition is a good thing. the thing about the safety net hospitals is the role within the community in terms of supporting some of the local stores. in terms of the local merchants get supported. also, it is the focus of employment. historically there has been a political element in terms of the safety net. you have to go back to more of what the mission is, to provide cost-effective care to the population with and the local community. i think that is very doable, but there are challenges. there is the challenge of funding. a lot of bureaucracy associated with that.

lastly, we cannot forget that it is a difficult population often times. a complex chronic disease patient. you may have language issues. frail elderly. psychiatric patients in the united states. safety net hospitals are the last repository for patients with severe mental health issues. gruber is author of a report looking at safety net hospitals. going to buffalo, n.y. on the independent line caller. caller: good morning. i would like to think c-span. my issue is i have been self- employed for 30 years. i did not understand why george bush jr., senior, and reagan,

held insurance skyrocketed. in i did not hear anything about it. health care costs has gone up 25% in four years. -- i did not hear anything about it. if we do nothing like the republicans did, health care could increased 12% in the next 30 years. we have to do something to curb the cost. the try to teach clinton, by -- but my comment is health-care costs have skyrocketed and no one has done a thing.

>> how to you get your health care? do you have a primary care physician? have you ever use the safety net hospitals, hospitals that are willing to take you as a patient even if you do not have insurance in mind? caller: right now i am starting to collect medicare. people that knock social programs, what would they do? i am just saying the cost of health care has skyrocketed. ont: getting a perspective the cost of health care change over time and insight on the federal health-care law relating to that. sure. this is not a democrat or republican issue. an american issue. you're absolutely right. 2012 the numbers 15,745.

8% per year compounded. is, why has health- care skyrocketed? the reason is we have disparate stakeholders with their own interests. the system that has developed is dysfunctional. it is inefficient and ineffective. you talk about the slowdown in cost. we have imbedded in efficiencies. costs have gone up 3% per year. a lot of that is utilization. the core economy has kept people from going out and getting care. they are not buying the drugs, seeing doctors as often as they have in the past. if they can avoid it, they will not do it. that occur and downs periodically. the question is, where do we go from here going forward?

what we believe is there will be a real celebration of premium growth going forward. the fundamental issue is reimbursement. the republicans nor the democrats have not been willing to target reimbursement. and we are in a volume-based system. the more you do, the more you get paid. an unintended consequences is you have to do more consequences. volume pace. in that regard. what we need to do is change the reimbursement system and put more people at work. the lobbying of health-care companies in washington is $500 million per year. 500 million per year. more than the financial services industry, more than the defense industry. the reality is cancer drugs

are not $10,000 per month. you look at the specialty drug or look at some of the medical devices or you look at hospital costs, and what people are not aware of is there is a huge disparity in hospital prices. it is like the airlines. there is no economic relationship between what you pay and health care and hospital who -- in the hospital in the value on the other end. that is the fundamental issue. we did not manage the 5-10 percent of people that account for 65% of cost, and we do not manage the average population in terms of primary and secondary intervention. we also allow for disparity of network pricing. i am sure a lot of listeners are not aware that in alabama blue

cross blue shield has a 90% market share. tough to negotiate when there is only one player. companies across the united states, leading market share is 54% on average. you will have to just three players and a lot of the major medical device segment. what you are seeing in the health-care industry today is consolidation. the goal here is pricing power. a flaw of the accountable care act is this, when you look at the way it is structured, the highest risk patients can only be charged three times the rate of the lower-risk patients. the differential and pricing is a factor of 10. the net result is the lower- priced patients will have to pay higher premiums. the other thing is with pre- existing conditions -- there is

no more pre-existing conclusions -- exclusions. if you are sick, you buy health care. if you are not sick, relatively well, you will take your chances. penalty is $95 the first year. a certain percentage of income. maybe $1,000, $2,000. you go to theick, exchange and sign up, and now you are covered. beexpectation is there will ratcheting up of insurance premiums going forward. gets the government together and focus on cost and focus on value, because it could be done. there are excellent delivery systems out there that could do both. host: vivian says if more people were covered by medicaid, would that help the safety net hospitals? guest: you would assume so.

here is the counter intuitive parts. when you are uninsured, there is no choice. you go to your safety net, emergency department. if you have insurance, the you want to sit around in the emergency department for hours? to go to a facility that may be sub-par relative to another hospital 2 miles down the road? the assumption is you look at the physical plant and that may affect the quality of care. that is not necessarily the case. safety net hospitals provide excellent care. once you have the insurance card you know how mobility that you did not have otherwise. host: ohio. harold on the republicans line. you,r: i would like to ask you made the comment about a certain amount of money comes

from the state, and a certain amount from the federal government. it is my understanding all the money comes from taxpayers. i would like to know which is more efficient, the central government or state government in the administration of health care. thank you. experiencehas your been with health care? have you ever gone to a safety net facility we're talking about? and on i am 80-years-old medicare. actually, i am on an advantage plan. it is a very hard question to answer. the way i think about health care is all whole -- all healthcare is local. every market is different than other markets. they are e balding at different

rates. you have progressive states that are more interested in the efficiency of care delivery and those that are not. policy makers have a significant role in terms of driving care delivery. i would view it from the macro standpoint. what we have with the government is confusing. all of these regulations and rules. talking about medicare dish and medicaid dish. disproportionate of care payments are many. the medicare-payments. it is roughly $13 billion. 2019 it will be reduced by $100 million. 3200 hospitals get the money. the general accounting office are had a report saying only 25 percent of the money gets allocated to the hospitals that really need the money. the first question is we're spending all this money for

what? who is it going to? is point number one. 3200 hospitals get it. 4900 hospitals in the u.s.. $9.9 billion. it is being cut to $5.4 billion by 2019. medicare-cut by 100 million. medicaid being cut in half. absolutely critical to their survival and it is getting cut. why? those are the sort of government decisions were i throw up my hand to say why? it is a question of influence in the government. a lot of hospitals influence the safety net. the money will be allocated. there is the messaging component and reality component. the reality is the united

states health care delivery system is broken. needs tofficient and change. we do have the performers. 5-10% of institutions that do well. there is a lot we can learn from them. the other piece of it is that we as americans do not take accountability for our own health. the obesity epidemic, smoking. lifestyle has a huge impact. the other piece is we need to enhance communications between the provider and patient. literacyo recognize levels are the six grade level on average. we need two-way communication to make sure it is relatively understood in that regard. one last call. and from north carolina. democrats call. -- anne from north carolina.

caller: i think one of the main pro -- problems is republicans do not want the program and are doing everything they can to prevent it from becoming affected. one of the main proponent is the more people enrolled in the program, the more effective it can be. thatu have several states are not going to participate, you are making it less affected. i do not understand why the guest would see a problem with you were safety net hospitals. on safety you relied net hospitals for care? caller: i have not. i know there are some hospitals to provide less adequate service.

in the work i was and we could get a reading of different hospitals. i know that there are differences. i do not understand why your guest is seeing it as something terrible. i think you make an excellent point. it is not only for safety net hospital but health-care delivery in general. the hospital occupancy rate is 62%. let the strong survive. the question is, who is the strongest and will they provide the necessary services to the population? what safety net hospitals do is provide trauma care. they provide i see you, neonatal intensive -- intensive care. they provide care to the mentally ill.

they of low margin that no one else wants to provide. so i have no problem with consolidation. i think a number of hospitals have to close. the important thing is making sure the needs of the community are being met from a health-care perspective. in terms of the accountable care on access.cus was we're talking about increasing coverage for the uninsured, expanding medicaid, creating a new entitlement program in terms of a tax subsidy. families before that earned up to 92,000 per year. allowing the children of uncovered employees to be covered. no lifetime caps. no annual caps. i think those are all wonderful. do is raise cost.

someone has to pay for that, and we will. increasess that it access. value purchasing is a start. they did not touch the dual eligibles. not touch reimbursement. and what until we change that, costs will go continually. the reportd gruber, is safety net hospitals at risk. .ur guest is research director thank you for joining us from new york this morning. yourg up next, our regular money segment takes a look at the witness protection program with the founder. first, a news update from c-span radio. today supreme court meets

for the last-scheduled session before summer vacation. but still has 11 cases to revolve. waiting on a decision in gay marriage and affirmative action. c-span crews are outside the court waiting for reaction to any decisions that may be handed down. secretary of state john kerry speaking earlier at a news conference in new delhi says conditions for talks with the taliban have not been met yet. the united states and the taliban are exploring peace talks in an effort to end afghanistan's 12-year-old war. they are helped behind-the- scenes of pakistan's military. last week i warned that any reconciliation should not refer legitimacy on in certain groups.

more on the fallout from the nsa beaker from new york republican congressman peter king. speaking earlier he said troubling issues have arisen over the granting of security clearances to contract employees. congressman king is the top- ranking republican on the homeland security committee and says the refusal from hong kong to grant the extradition request seems like a totally political decision,". he went on to say he believes president obama should adopt a tougher attitude towards countries that fail to cooperate with the united states with extradition cases. says the united states in such instances must step back to say business cannot go on as usual. holding a press conference call to comment on edward snowden.

taking place at 10:00 eastern. hear it here on c-span radio. been focusedways on what is important in the business. 1996 as an example of a more recent time. 1997 we're rolling out digital video. residential telephone services, commercial services and bringing a bundle to the market. our customers responded very positively. newere able to get into businesses that others did not even dream about because we got in there so early in we were rewarded for that. understands sports is the sweet spot of media. almost the only thing you have to watch live. that has increased the value.

live sports on cable networks. everyone understands sports rights are quite valuable. take a more of what is happening in today's cable industry from the cable show with two of the largest leaders of the communication company's. that is tonight on c-span to. on mondays at this time we look at your money, how federal dollars are spent. what the programs are that they fund and how the programs work. our guest is gerald shur joining us from philadelphia and a founder of the witness protection program. thank you for being with us.

we read about it and read about it in novels or television shows, but what is it in real life? guest: taking individuals in danger because they're cooperating with the of the government or state government, and will wind up being killed, frankly, if they testified. we needed a mechanism where we could put witnesses on the witness stand and make sure they will survive after the testify. created, and what was your role in it? -- how was it created? used: as a young child i to hear my father talk about organized crime interfering with the business he was in. he worked in the garment is as -- business as a labor negotiator.

he used to come on to talk about how it interfered with negotiations. through high school i got interested in organized-crime and began to research it and continue through college. schoolortunate after law i went into private practice and sell a fellow named bobby appointed.ng i went on to my wife -- home to my wife and said how would you like to explain to washington? she said you think you can get a job? i said i do not know. she said fly out monday and find out. i got hired. i was assigned to work organized crime in new york city. for the older listeners you

might remember the name joe valaci, the first member of the mafia. the first person to tell us who are the members, and the first really cooperating witness in the organized crime. i began to work with him. othern to work with mobsters in new york. it occurred to me we need a mechanism to protect people if they're glad to testify. my colleagues were assigned elsewhere in the country running into the same experience. we need ad to me system where we can take an individual who is willing to cooperate and immediately relocate the person and their family. host: what was done funding to the prior of the wit -- prior to the founding of the witness

protection program? what happened to them and their families? guest: what happened was the local police or local agents, or drug enforcement agents, they would almost chip and and move someone from one place to another. what there was not was a system where they could pick up the telephone, call washington, say i have a witness in office and are willing to testify, what do i do with them? we will say we can have that wind is protected as of now. we needed to develop a mechanism where we not only could move the family, but then what do you do with the family after they have moved out of town?

what this program did was establish a mechanism where the prosecutor, agents could make a single phone call and have this whole process begin to work. the federalng about witness protection program with the founder of gerald shur . here are the numbers to call if you'd like to share your comments or ask the question -- our guest co-authored the book sec." the cost of the program in 2012 was $9.7 million. here are details.

new identities and documentation. they also get financial assistance for basic living medical, we will assistance and living. much help do these people get to start their new lives? how much is hands on and at what point are they put on their own? hands -- guest: it is hands on from the beginning. the moment you agree to testify we would have a witness security inspector who is in the marshals service come to you and explain to you how the program works. at the same time the federal prosecutor would make the request of my office, office of enforcement operations -- i

should say my old office because i am now retired, but they would make a request of my office to say that we have a witness, here is the pace we want them to testify and here is how important their testimony is and how many other witnesses we have been the case. we could make and a valuation as to whether or not the witness is really important. at the same time the deputy marshal explain the program. would have aime we psychologist to a psychological examination over -- for everyone over the age of 18 to determine whether or not they would be capable, fit in, handle the regulations and commit a crime in the future? are they likely to be violent? all of that would come back in the psychological report. we would have the evaluation of the headquarters of the federal

investigative agency. not only the field office giving a judgment, the office at .eadquarters, fbi headquarters whatever agency is involved in the investigation. they would submit information. my point is, as a considerable amount of data is submitted before the judgment is made to totally disrupt a family and move them from one city to another. mentioned heshur started his career as an attorney in corpus christi, texas. he served as a trial attorney in the racketeering section of credit -- recruited under robert kennedy. as he mentioned, he is retired. joining us from philadelphia this morning. our first calller on the independent line.

in regardsas calling to when the witnesses goes into the program for life and it becomes difficult -- i will give an example. i'm howard stern fan. host: what are the rules and requirements for staying in the program? what is the code of conduct? guest: this is a voluntary program. the witness can choose to enter or not enter the program. the witness can leave the program any time they choose to. they could say i do not want any more to do with you, i am on my own. there are roles that are set down. the witness can choose if they beat to it -- the witness can choose to leave at any point in time. they must look for a job. we will help them look for a job. they must stay out of trouble. they must not communicate with

people back home, which can be very difficult when you tell a teenager who is in love that they cannot communicate with their boyfriend or girlfriend back home. there are certain set of rules they must follow. if they find that too difficult, they can drop out at any point they want. at that time any financial assistance we give them will stop. i mention the financial assistance. that is based on a formula depending on a number of people in the family in this city in which the people are located. corpusrson living in christi may get less money than a family living in new york city if we relocated them there because of the differences in the cost of living. this is not a reward program and should not be confused with that. to get by ononey

until we're able to find employment for the witness. anthony, a democratic calller from new york. caller: my question is into degrees. one would be you seem to be an expert in organized crime in new york. have you not noticed -- just since the kennedy era there seems to be an infiltration of organized crime, or the money and influence in government. i was wondering if you could step but said the box and comment on that. also, with this new wikileaks, they owden, aren't basically whistleblowers? they seem to be bringing forward violations of the constitution. are trying tomen rise to the challenge of pointing out to the american

people that we're being led down -- path of host: you are going little bit off topic. can, with this respect. i do not think -- there are about 2.5 million federal employees. i do not think the government's secrets should be dependent on each individual employee deciding on their own whether or not they should provide a secret to the rest of the world. for example, if a person went to decide we will give a new name every relocated witness in print that in the newspaper, that would be highly dangerous and lead to the deaths of witnesses and their family. ati draw the line

individuals on their own deciding to go public with information that is classified. i do not think we want several employee deciding that. -- we want every employee deciding that. host: a woman in her 30's named jackie taylor shared her story of being a child and put into the witness protection program because her father was in hell's angels and turned witness. as she shares her childhood experience in talks about the challenges she faced, we have questions on twitter. radical dallas writes how young -- how old was begun this person to be put in protection? are now dealing with grandchildren in the program. the program goes back 1970 or a couple of years before that. there was an official act of

1970 that started the organized- crime program officially. we are dealing now with children and grandchildren. those children are affected to the extent that they may have to supply background information for employment or security clearance. they can call upon the federal government on the witness security marshals to give them assistance in any obstacle they may encounter. host: they could go forward with their lives with that documentation? guest: yes, they would have complete documentation. we ran an undercover wedding early on in the program. eyewitnesses child wanted to get married.

the witness insisted on having a wedding and insisted on inviting friends from the old neighborhood, precisely the people that might want to kill them to the wedding. we went ahead and told him he would -- that would be all right as long as it was done under our conditions. he arranged for a hotel and ceremony. all the guests were invited to a hotel. when they got to the hotel they found out they were at the wrong place where we had buses and united states marshals put on buses. we were driven to the wedding where it really occurred and driven back to the hotel. they never knew the new name of the person and never knew where the wedding was going to take place. that way we kept them secure. out early ont before week -- before we forget,

a good portion of the program involves prisoner witnesses. today over the past several years more people entering the program are prisoners who have agreed to cooperate. there are certain prisons around the country, and they serve their term, could be five years, 10 years, and when they are ready to be released, there is consideration given a good to whether or not they are still in danger and then they would be relocated like any other witness. quoted inld shur was saying heom cnn works with someone about to receive witness protection eligibility.

when you ask them their favorite place in the united states and they say hawaii, that is where you do not send them. going to exotic destinations they always wanted to visit? people entering the program are very apprehensive and should be apprehensive. i asked the marshals service who worked with the witness is very early on to tell them this will be an extremely difficult process. just transferring from one city difficult, those are processes for people to go through. not being able to see grand not anymore. not being able to attend a funeral of a relative or visit someone in the hospital. we lay thattremely

out ahead of time. and what they also know is they will survive. the marshals service has not lost a single witness in the almost 40 years or so that this program has been operating. so they will survive. we tell them after a year or so they will adjust. occasionally there are problems along the way like a child wanted a car and told the parents that if you do not give me the car, i will go out and tell everyone who you really are. we addressed that problem by having a dental check between the witness security officer and a child. but there are difficulties just in a normal transfer in a normal life and you compounded with the fact that you have to be looking over your shoulder for several months until do are comfortable with the fact that no one is

koin to find me. object, getting to go -- getting the witness to the point where they do not look over their shoulder. is our next calller. independent falls church, virginia. caller: good morning. as a government to reach a government attorney, i was involved in the program back in 1970's. one of the problems we encountered is he and his wife and daughter were issued said security cards in sequence with the numbers were in sequence, which created a security problem for them. i was wondering if that issue has been resolved since then. i happen to be familiar with the case. i think we have slightly different facts about it. it was not a mother and father.

they were in laws being relocated, and we were told by the sun and all but the in-laws would never be working. it was the very first case we had where we obtained social cards and we had help of another agency to secure so- so security cards. since the in-laws were not born to be working, he secured consecutive numbers thinking it would never be a problem with it. ultimately the sun and lot put it in false names on of business he was running and used their social security numbers and cause them to be disclosed. that is a non issue and has never come up again. host: gerald shur co-autheor of

"witsec." our guest is the founder of the witness protection program. we're looking at the federal program and how it is funded and what it does. next calller. good morning. this is my first time hearing about you. i am a retired investigator in louisiana. i was part of the witness protection in louisiana. we did this under the local district attorney's office. i find that they have a lot of .laws with the witness program they had a lot of troubles with victims and witnesses because

they would promise them certain things to get the case solved. i found they were wasting a lot of money. how do you control the spending as far as getting the witness to court? that enters witness the program was signed a memorandum of understanding. outs a document that lays everything the federal government will do and will not do for you. timeitness knows ahead of how much money they will receive for a time of up to six months. they know what kind of assistance they will receive it so long as they are willing to make efforts to find a job and cooperate with the service and ultimately testified. programs inve many the federal system now and have not had for many years.

two a lot ofr or things were new. for example, one of the very first witnesses we were taking into the program, i mean the first five witnesses. we were sitting in my office and i said to the deputies, we ought to take into an area where we can show him -- where we can show him a house. we should show him a house and show him what it looks like. when he is transferred says wherend someone you from, i can say annapolis, maryland. worded to shop? >> that is the set up. the with this is driven -- the marshall says where should we take him? drive him past my house. i give them my address.

we say to the witness and wife, this is where you're going to live. red brick house, colonial. the white says what, live in a house like that? never. witnesses are a little difficult to deal with. i mention that to my wife and she said maybe we should consider moving. the witnesses did move. they lived elsewhere. they did live happily ever after. calller talked about witnesses entering the program. how are victims dealt with compared to people who enter the program who are themselves criminals? >> we have very few innocent people entering the program. well over 95 percent are people who have been involved crime.

either have committed a crime or knowingly dealt with criminals, like bribing someone. probably 2-3% of the 8000-9000 people have entered the program are truly innocent people. for them it is even more difficult than it is for the other witnesses who are gaining some benefits and that they have been involved with crime. maybe they have gone to jail and are being released afterwards. maybe they have gone probation and are being rowboat -- and are being relocated. person it isent extremely difficult. on the other side, what happens if we do not relocate them? they cannot testify. you get to a horrible choice of having to ask someone to

testify, take a murderer or murderers off the street and the sacrifice of having to move to another community. host: roy the next calller from louisiana in morgan city. i have a question. do people get relocated to countries are outside of the and i did states? we tried that on one or two locations. -- one or two locations. i did not like relocating people outside of the united states. for one thing, if they needed assistance, who were they going to call? obviously they will speak out.

so as tended not to relocate people or want people relocated of said the united states. one or two occasions it was done and it was successful. not something we would ordinarily do. host: independent line. go ahead. caller: what a fascinating subject. thank you very much, c-span. aren't you it a great deal of personal danger by disclosing this information? guest: i could -- if i could find an effective design to discuss this week i am wearing, i would use it. i am not in danger because the number of years that have gone by, i do not know where anybody is hidden. there is no information i can supply to anyone. there was a time when we were in danger, and in fact, my wife,

there was a plan to could not my wife at one time. my wife is a school teacher. gangombian narcotics intended to kidnapper or me. supply i would information about where a particular week -- a particular witness was relocated. as i indicated, i never knew where witnesses were relocated. that was by design so i could never give up the information. office and received a telephone call one day. there is a table full of agents from different federal agencies. plot and indicated that was his purpose.

my wife was teaching. i immediately called the school and called the principal's office, got my wife on the phone and said to hurt someone will come out to see you shortly, go along with what they say. talk to you later. that was the conversation, and she understood. a few moments later a deputy u.s. marshal, a young lady she appeared to be, recent college graduate, showed up of the school. went to my wife's classroom and from there they went to the principle and the deputy explain to the principle the situation and said they believed there was no danger whatsoever and the school. the danger was going to and from the school and therefore the deputy with like to state my -- stay with my wife and the school while class is were on.

classes were on. my wife refused to leave. she said she owed to much to the children. to marshals service agreed have this young person served as her students assistant and a tie. the principle put out the story that the bomb in helping -- that the woman helping was a graduate who decided whether or not she wanted to go into teaching. so only the principal knew the true story. what nobody realized it she always wore a long jacket because she was covering her gun. my wife recalls a phone call that she received on her wife hearsn which my her say to the boss, i cannot copyright now, i am busy grading papers. i will give back to you.

were in a witness protection program ourselves for a time. i continue to work. deputy marshals would follow me part of the way, call me on my cell phone and tell me i was not being followed and then proceed to my home. we temporarily moved to a hotel outside of the place we were living so could not be found there. that went on for two months. there were occasional baby jurors. occasionalre dangers. my teenage daughter picked up the phone and she was asked the question, have you ever thought about death? we recognize who the person was and i had a chat with him the next day in my office. the chap was very simple. i said you have now become my daughter's insurer and you should feel very comfortable when she gets home safely,

because if she falls down and gets hurt on the way, you are the one i will hold responsible. host: this was someone in the program? guest: this was someone in the program. host: our guest is gerald shur if you would like to ask our guest questions, republicans -- arizona. gerry, a democrat. go ahead. i have had experiences twice where they went off the witness program, and both of them ended up dead. mainly because they had trouble handling their new locations. at one time i'd think it was trying to be a little too brave.

one had to do with -- both of them were drug smuggling. actually tried to kidnap my to keep him quiet. he finally came back. within a month he was dead. that was all there was to it. the other one was a name you might be familiar with, i used to fly a whole lot, and here in -- here in arizona i met a man by the name of various seals. -- barry seals. i will get off the phone and let you answer that one. you should be familiar with it. guest: i do not speak to specific cases, but i can tell you this, all witnesses are offered secularist -- if

psychiatric assistance. if we see something that would suggest they should see a psychiatrist, we arrange that. if they wish to on their own, we arrange that also. when they seetold a psychiatrist that is the one person they may tell their entire truth of the background because we feel that is necessary for them to receive the kind of help they need. host: a twitter question asking if the clients's debts folow low them? guest: all witnesses are expected to pay what debts they owe. we asked them to list out what they owe. we asked them to make payments on those. they are responsible for the debts they have incurred before relocation. in the event that a creditor

wishes to sue the witness, we have our arrangements by statute and by practice in which the creditor can file suit against the hidden witness and actually filed suit against that person and treat them just like any other debtor would be treated. so we can do that safely. it keeps the witness alive and lets the creditor receive whatever legal rights they would have. host: one more call in pennsylvania. on 9/11, we have learned that there has been a lack of communication and cooperation between state and local -- host: is this having to do with

the witness protection program? we're almost out of time. time?: lap of the we are out of time. i see. think you. the calller touched on coordination. guest: coordination is excellent in the witness protection program. you were dealing with so many federal investigative agencies and the coordination is absolutely excellent. that is why there is the success rate of not a single witness in this program that has been killed that has followed the rules in the 40 years of operation. so the coordination is excellent. information is passed freely from one agency to another when it affects a witness in the program. of theerald shur founder witness protection program. now retired.

guest: i would like to point out one more thing, the benefit of the program, and that is tens of thousands of criminals that are in penitentiaries' now as a result of this program. for the 10,000 or soalmost 10,0e program there are tens of thousands of defendants that have been convicted that would otherwise be out on the streets committing crimes. so the program has proven to be extremely beneficial in all types of cases from terrorism to counterfeiting to murders, etc.. host: thank you. that does it for ""washington journal." thank you for joining us. we leave you with a live shot outside the u.s. supreme court building. you can see cameras and others gathered there as we watch to see what decisions the court hands down today. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2013]