television all night long every night? there seem to be a fair just toout there are many good shows and i do not know how you get enough of an audience, high enough ratings for enough good shows. i worry about it a lot. >> numbers are always in the back of your mind. the truth of the matter is that the beauty of cable is that you don't need those huge numbers to be a success. i come from the feature world where reopening weekend means beauty of whathe we do now, as long as you have interesting characters and good, compromising situations and you label it with a lot of irony, you will have an audience. you will have an audience that will justify your being. >> are you sure you go >> positive. trust me. johnson,herry, mark you forberg, thank

joining us. ♪ heading nearare the end of the show, i just wanted to come out and say i hope you agree that this has been an extraordinary few days. [applause] made a promise. we told we would give you a glimpse of the future, and i think we have. the future of ultra high-speed broad and, new cable platforms connecting to the cloud that will provide delightful new experiences for consumers coming to a home near you. you heard a challenge for the secretary of education, with whom we hope to work to meet his needs, and we are beginning to pay a debt by helping our veterans find new career opportunities as they hang up their uniforms and join us in

the civilian world. we have impacted the lives of many young people who have come as millennial's to be a part of the show. theehalf of the staff of national cable and telecom association, the best in washington, the board of directors of our wonderful association, i want to thank you. it's been an honor and a pleasure to put the show on for you and i look or were to seeing you next year. [captions copyright national cable satellite corp. 2013] [captioning performed by national captioning institute] released ae house statement about the situation in egypt. we are deeply concerned about the incision of the egyptian -- throwces to extend out the egyptian constitution. i call on the military to return full authority to a democratically elected government as soon as possible. i have also directed the relevant agencies to review the applications under u.s. law for our assistance to the government

of egypt. leahy alsorick released a statement, the chairman of the subcommittee in charge of foreign aid. "our law is clear. aid is cut off when a democratically elected government is deposed by a military coup or decree. my committee will also review future aid to the government. >> just after egyptian president mohamed morsi was removed from power, the army chief addressed the nation. here is five minutes of his remarks. >> as we close the monitors and follow the current crisis, the commander of the armed forces met in the presidential palace on june 22, 2013, where it was presented the opinions of the armed forces of any assault to

also because of the egyptian people. national on reconciliation on a roadmap for the future whereby stability are secured for the people living up to the aspirations and hopes. yet, the address of the president yesterday and before the expiration of the 48 hour thematum, he did not meet demands of the masses of the people. basing it on the spot stability, we consulted with certain political and social figures without any part where the

meeting parties agreed upon a future roadmap which will include initial measures whereby a powerful, coherent, egyptian society is achieved without marginalizing any individual political party and putting an end to this state. this roadmap includes the following. the constitution provisionally. the chief justice of the constitutional court will aclare before the court presidential election where the justice of the judicial court unitrun the state affairs until a time where a new president is elected. the chief constitutional justice would have the power to hand out

presidential decrees during this interim. a coalition government would be formed, capable and qualified to run the current affairs. the fullee including toctrum to review the amends the constitution which is provisionally suspended. the supreme constitutional court will address this for the parliamentary election. they will draft a charter of ethics securing and guaranteeing a freedom of media giving priority to national interests and make sure that emergency

measures are taken to empower you to take part in this institution and be a key player in the decision-making process through our different positions preparing for the reconciliation a having accepted representative of all parties. the egyptian armed forces have met with the spectrum to maintain the administration. steering away from the violence that would bring about further tension and shedding the blood of the innocent. warned thatd forces they will stand up firmly in cooperation with the interior ministry security personnel to any acts under the rule of law based on its historical

responsibilities. extend thatrces should the egyptian armed forces willudiciary personnel have a continued sacrifice for maintaining the safety, security, and well-being of the people. may god love save egypt. may god's peace be above you. -- be upon you. now a look at online earning educationpact on k-12 . a discussion on a massive open online classes open to anyone, usually free of charge. this is 20 minutes. >> thank you all very much.

these are to develop my heroes. let's give them a round of applause. anant is a professor of electrical engineering and computer science at m.i.t. who created a great course called circuits. in theory, once you have done that, you should be in charge of having everyone put things online. he is in charge of the harvard consortium, one of the three major mooc's. what's a mooc? "m?"s tehe >> massive. >> dave is the cofounder along with kip. he is the multiple charter operation in the country.

in new orleans after the storm, we try to reinvent the school system and have them bring in competing charter school operators. i think he came in with five pretty early on and that's the way it should work, scaling success. let me start with that. tell me how you think these online courses will transform education. around the world, we see two big issues. one is education has been remaining stagnant for 500 years. the last biggest innovation we saw was the textbook that came out of the printing press. after that, what do we have? blackboards,bout but that's about it. we have not had much in the way of innovation. quality has not changed and access has been a real problem. i just saw this picture in one of the bloomberg articles about

a teacher conducting a class in india where the students sitting this as ang blackboard. the real challenge with access to high-quality education for students in the world, i think what massive open online courses, and online learning in general, is to genetically improve the quality of education and, second, genetically increase access to education as well all in one fell swoop. there's a real opportunity for us here. a do you need to blended into classroom model so there is still on site campus teaching? >> there is two ways of doing it. one is the mooc. anyone around the world can't take it and it is completely online. it is already good quality. what they can do on campus is one better. we can do blended learning also

called a flip classroom where students can watch the videos and online virtual labs in their own dorm rooms and then they come to class and there they can have them person interaction with the instructor or. they can collaborate among each other and do in person labs. the blended model has been very successful. offered aple, we blended class at san jose university and the silicon valley last fall. were verys encouraging. traditionally it was a circuits aurse on campus and it had 41% dropout rate. with the blended class, results improved to a 9% dropout rate. that is not something to take to the bank, but it is encouraging. i read this in the harvard

crimson, so it may or may not be true, the philosophy of some professors who refuse to take his justice force -- course and refuse to help teach it because they thought it would help them and they made the english department tried to teach it. do you see massive resistance at places like san jose state? these online courses are a new tool for instructors. they collectively add value to the learner. we should keep our eye on students and the world, and the quality of education. we call them the next-generation textbook textbook. if you are an instructor completely your choice. if you want, you can use a textbook in your class or you can use one chapter or you write your own, or you don't. it's completely up to you.

tell the author they should not be writing a book. i think authors should write books and people are free to use them in whatever way they like. >> do you think this will help equalize a place like san jose state, a community college with harvard and berkeley? or will this widen the divide? onlineke to think of learning as a rising tide that will improve education for universities,l even students who don't go to universities. the way to do that is imagine if i have a small university and since i'm from india, take india. hire people with bachelor's degrees to teach courses because they do not have enough teachers. imagine there where you're getting your degree and you do not get a great education, but imagine if they could license a

textbook-like course from berkeley. a course on software as a for that local campus and now they have access to a great course. you tell me. as i bring the university closer together were further apart? i grew up in a small town in bangalore, india -- mangalore. a small with an "m," town on the arabian sea coast. if i have a chance to go to my neighborhood university to take a berkeley artificial intelligence class were crossed the indian ocean and the to university in the u.s., where do you think i'm going to go? does it bring them closer together were further apart? >>

among other things, dave was a teacher, if i remember correctly, and then before you academyated the whole empire. as a teacher, how do you see these types of tools changing the classroom? hello, everybody. i have a lot of friends out here. we are excited. is thatise for teachers you now have the ability or you will have the ability to really differentiate based on the needs of each kid you had. challenge when you have 25, 30 kids in a class is how do you meet the kids where you are and group them in small groups by need?

where i see the promise is where sees them entering the profession. they have been teaching five, 10, 15 years and for everyone starting to teach, the analogy good one.ook is a it is a tool that they should be expected to figure out how to use well. teachers inof your kip academy would take a video that to let me use explain this concept of algebra as exposed -- as opposed to trying to teach it on a blackboard. >> we have 125 schools serving 20 state in the district of columbia. we have about 3000 teachers , and at eachs kip level there is different availability online.

throughout all of our schools, if you went to any of our middle schools, you will see teachers using the academy with some group or collection of and the challenge, which i think is hard -- based coming to the's new york ideas festival run by the atlantic, i'm assuming it's people like to learn. the challenge for groups like this, if i was to say to you how many people in this group like to learn, how many people would raise their hand? great. the vast majority of the world isn't like you. [laughter] i mean that including myself up until about 18. as teachers, our challenge is

how do you reach and inspire everybody? right now, what exists online, and i have signed up to teach a of creatingpower positive classrooms is delivering content. it works for people like this audience who receive content and make use of it. are 32%graduation rates across all demographic groups. socioeconomicse and others, but what they do not talk about is the actual mechanics of learning as fundamentally broken across all demographic groups. until we deal with the mechanics of learning, but i think you will see is that the online potential will better serve, lift all boats, for people who learn in that way. >> when you talk about it that way, as a content delivery , the next wave of the

something like an amplifier for a wireless generation is like news corp.'s way of creating a whole new curriculum that has games, role-playing games, assessment tools for the teacher. is this something that you think is the next level of something they might adopt? doing, amplify is they're trying to figure out the mixture of guided and independent practice that is absolutely essential for learning, for everyone outside of the 20%-25% who can assimilate directly. the interplay using games, role- technology,ctive not to take two clichés and make

them into a third, which is always risky, it depends on whether you think science fiction is inaccurate redactor of the future. whether or not you believe that matrix," orht, "the the holideck. little pod your own and you learn kung fu. the holideck is an interplay independented and progress. mooc's, how are they guided and independent as opposed of lectures where we just watch 17 minutes? these mooc's on edex.org, and these are complete

courses. they start with video and courses,ve assignments, exams. we bring a community and to it. at the end, they get a certificate that they passed a course from ut austin-x. these are complete courses. learn fromtudent can a textbook completely by themselves, if i am and some remark corner of -- or remote corner of china, i could simply learn a subject. if i went to a high school or university with a great teacher who would mentor me along with the book, i would imagine that a learning experience would be better. we are just replacing that with the online for these person. a number of high schools around the country have begun using e

courses. over one dozen students are offering a number of them from berkeley, harvard, m.i.t. on their campus and a number of students have mastered whatever ap courses they have. they do not have those teachers to teach these richer sets of courses. some of them have a mentor on side and some don't. they are getting high school credit for those courses. a number of those schools are talking about doing the same thing. it depends on people using what they can. schools are having that exact same experience. it can significantly provide opportunities beyond the doors of any one particular school. >> and it can provide opportunities, but can it also exacerbate the divide between privileged and poor kids? if so, how?

>> on one hand, you can take the argument that it will close the divide because it do monetizes -- demonetizes access. hand, you can take the argument it increases the divide because of who actually has access to use the tools and technology. i think there is a real question there. >> you've seen it. academies in new orleans, south bronx, whatever. than to just rub it on their own to get out. >> you're combining many atables, but when we look the kids that we serve, not everybody -- people used to talk about digital divide and they don't really anymore. the vast majority of our kids don't have individual computers

or tablets at home. in this respect, or even individual computers at school, while the promise and potential is that it could impact all corners of the world and america , if you don't have the materials to use it, there are issues there. andovernk schools like where there are one-on-one computers right now, you have the advantage over schools like ours where there's not. will everyone have one-on-one computers in the near future? >> you need to have internet access at home. >> almost everyone, i think, has internet access. that has almost become ubiquitous. whether it is always reliable, at speed, available to them individually is another story. that hase with all been said, but i believe that with the right level of

investment, the right policy, i believe this can really narrow and really democratize education. the reason why i say that, i will give you an example. some of the countries talking about investing and creating 1000 new brick-and-mortar colleges and universities. , theyd of doing that should think ahead and invest in tablets and massive infrastructure in terms of internet access and it would be to access allway this content and streaming data without creating more bricks and mortar structures. in india, for example, many of you have heard about this new tablet. it's being made available to kids all over the world. because of the new content being i woulde with mooc's,

really encourage nations, the world bank, other policymakers to think -- what should be be investing in? invest in infrastructure, not andks and mortar, but bits bytes. that will narrow the divide. >> i agree with the investment in having a policy that will get tablets and computers in the hands of as many kids as possible. ready where i have seen that the software exists that convinces me for the vast majority of learners that great teachers aren't necessary in some type of environment. i won great teachers and tablets. >> can you define what a great teacher is? [laughter] andt redefines what they do the tools that they have.

it redefines how you think about the physical space altogether. it doesn't exist yet. every science fiction movie basically presents a version where it is not necessary. we have not seen it yet. for the next generation, particularly for the kids we kipp, we that -- at need to have a great principle in every school, a great teacher in every classroom as big a priority if not more than a tablet and everyone's hand. >> whether it redefines teachers or not, what the mooc movement will do is bring more great people in the teaching profession. what technology has done is bring technology to the front of .he eso's -- the ethos.

when was the last time you saw them write about education and learning? it becomes exciting. great people come into the teaching profession and we get more teachers. along with good content, it will improve the learning experience. >> the one caution with that, particularly in public schools and in k-12, there is this old slogan that says people don't leave jobs. they leave managers. this idea that we need to create communities of teachers with principles and prioritize it, it has to be coupled with any vision of how technology plays. a k-12ink there is version that is not fully united yet. >> thank you so much.

this is an amazing time in the transformation of education partially because of the two of you. [applause] >> in a few moments, a debate on whether medicare is a problem or the solution. an event hosted by the manhattan institute. later, supreme court oral argument in a case of affirmative action and college admissions. is a connection between mental illness, guns, and violence. >> we can see a sea of humanity coming from union station, and

we knew it was going to be big. we were supposed to be leading the march. people were already marching. it was like saying there go my people, let me catch up with them. [laughter] this sea of humanity just pushed us, pushed us. we started moving toward the washington monument, on toward the lincoln memorial. it was a wonderful time in american history. >> this fourth of july on c- span at 2:20 p.m. eastern, congressman john lewis shares his experience on the march on washington 50 years later. at 4:45, some of the places we visited and historians week spoke with during our series on first ladies. prize-winning photographer display there were. -- display their work.

bill clinton and new jersey governor chris kit christie natural disasters. >> a forum on hospital and health care costs. opposing views about whether medicare causes or ease is the cost of medical care. they were at the manhattan institute in new york for an hour-long debate, moderated by paul talbert, former health care advisor for the romney presidential campaign. >> good evening. please take your seats. i name is paul howard and i am a senior fellow and director of manhattan institute's center for medical progress. i will be moderate drinker -- i will be a moderating our discussion this evening.

prices and health care are opaque, byzantine, and only rarely visible before or after the fact to the people who are actually using the system, the patient. it varies widely for similar patients with similar conditions, not just in the same state or city but across the street from each other. we have brought together to american's latest -- leading health care policy advisers an why this soxplain dysfunctional and what we can do about it. inphen kicked off the debate a recent and widely read article for "time" magazine where he delved into the absurd hospital charge master, revealing a hospital pricing model as absurd, they charge the highest prices to the people who are least likely to pay them, the

uninsured. he pointed out his point of view that the only force disciplining it is medicare, which still guarantees wide access and quality medical care for beneficiaries. to thed bring more system and save patients a lot of heartache and expense. says our system is so dysfunctional because medicare distorts pricing in ways that produce perverse payers. for allow me to introduce both of our speakers before we begin. stephen designed a company to create a viable business model for journalism to li. he is a feature writer for magazines and trains journalist brill's content

magazine. he is a graduate of yale and yale law school. the chief executive officer of the game show network, seen in more than 7 5 million homes. a member of the board of records, an organization dedicated to hospital second transparency. is the author of how american healthcare killed my father and how we can fix it. he graduated from harvard university and holds a master's in history from new york university. to start our discussion this evening, i will ask both of our to state in four-five

what the central arguments are for why health care is so dysfunctional and whether or not medicare is the solution to this function. still thinkall, i the coin flip should be two out of three, but i will start anyway. [laughter] banks hit -- thanks to manhattan institute for hosting us tonight. it has been great fun to have this conversation with you. as many people in the audience know, 1965, medicare and medicaid were enacted. thecidentally in that year, pcp 8 was introduced. it cost a mere $19,000, which

was a tremendous amount of money in 1965. the average american spent about $200 on health care that year. let's fast-forward a bit. let's fast-forward to today. everybody in this room is carrying a box much smaller, much more powerful than that pcp 8. there are about 1.5 billion smart phones on earth, at an average cost of $235. they are 1/40 of the amount americans will spend on health care today. in 1965, you would have thought that computers were the most complex, opaque, and possible product you would ever imagine every person on earth carrying. in 1965, you would have seen health care as the most personal service on earth and in some ways the most important. it would have been inconceivable that the average person to carry

of health1/40 cost care without read -- without all of us having got a computer science degrees. one of the things that happen was pointed out brilliantly by my counterpart in his article in time magazine. it is important to understand what is the most interesting thing about the article, it makes the point that these are prices, not's. they are what people charged for services. i am going to argue that health care seems to bring out the inner wonk in all of us. gets us to look at one aspect of health care and see that is so incredibly broken that we attribute too much to that particular thing. i will argue that when you step back and compare what has happened in health care over the last 50 years to what does happen with everything else,

what you see is that the reason health care has done unbelievably expensive, while at the same time having inadequate or erratic access, terrible enormous amount of sloppiness, and true complexity, so that the average person cannot understand the system at all. the most complex problem occurred became cheap, ubiquitous, easy-to-use and accessible. in computers, like every other business, you make more money by making it cheaper, better, easier to use, more accessible and more consumer friendly. in health care, you make more money by making it more expensive, by not controlling quality or quantity, and by under investing in service. i argue that medicare is central to that, that medicare has lower prices than private insurance, but it encourages excess care

leading to medical harm, a completely undisciplined health undermined that has the health care economy. i argue this is not just a matter of money which is the way we often talk about it, but a matter of the quality of care, a type of care and reliability of care. in health care we fail to take advantage of the fundamental changes in care, technology, communication, and information to make health care better, cheaper, and ubiquitous, which was the real opportunity of the last five decades. >> thanks. i am not going to argue anything. the notion dispute that the smartphone or a game the months that you carry on your hip is more complex than medical care. save that for another time. i also will argue that if you look at the various players and

compare them, there are all kinds of easy comparisons. it cost the typical private health care insurance company $28 to practice it -- to process a claim. -- by every comparison medicare is more efficient. the place i would like to start is how i got into this in the first place. contrary to your flattering introduction, i am hardly the four most analysts of health- care policy. my experience extends to this article. it with nod preconception, certainly no, preconceptions of the kind that i came out with. confess, if ild had any preconceptions they were

sort of like the conclusion of reach when i wrote a book about the education reform movement, and the parallel there is public education in the united states costs much more than it does anywhere else in the results are no better, in fact, a lot worse. the same thing with health care. i was thinking when i went into that maybe it's the unions is the culprit in public education and maybe i could write an article that the manhattan institute would sure like when i wrote about education reform. the reason i fail this, the west decided to approach this is not from any kind of political perspective, but just by following the money. theng the debate about president's health care reform, what i was frustrated by was, the debate was all about who is

going to pay the exorbitant cost of health care in the united states. how we shift the risk, what kind of insurance should there be, who is going to pay this very high cost? the parallel would be the debate we see all the time about, you have a terminal patient in the last six months of life, is it worth the million dollars to keep the patient alive for six months? i hear that debate and say how come it is a million dollars? but that was of $50,000 debate, it would be a different kind of debate. how did i approach it? i decided to follow the money and just take a bunch of bills and see why things cost so much. again, my suspicion was not where i came out. where i can not was that -- this is where i will happily agree with david -- there is no market. institute'sof the

health care policy is to connect the marketplace to health care. guess what, that has not happened and is not going to happen. the reason it cannot happen is unlike everything else, except in certain instances, maybe plastic surgery, nobody really volunteers to be a customer. when they become a customer, nobody has the information and nobody has the leverage. you don't wake up one morning and say i think i will wander down to the emergency room and see what they have on sale today and check out the doctors and see what they are going to charge me. that is not happening. it is not a voluntary marketplace and that is not a marketplace by anybody's definition of the term. let's take the first bill that i found. here is a man who was diagnosed

with non of -- non hodgkin's lymphoma. his wife decided that he needed anderson the m.d. center in houston. her father had been there and had been treated very well there and prolong his life. it is a fabulous place with fabulous care. when they arrive, he had insurance, he had started a small business. the gamelot of skin in because his insurance limited him to coverage of to thousand dollars per day at the hospital. they will not even way you at m.d. anderson for $2,000. m.d. anderson said we don't take that entrance, you have to pay us in the event. just to decide what your treatment regimen is going to be is going to cost you $45,000, and they had to write a check

for $45,000. then, your first transfusion is an additional $39,000. they had to use their credit card for $39,000. when the credit card did not go ,hrough, it was kept downstairs sweating and nervous and upset. he had a tumor growing in his chest. herybody told him this, needed this urgently, and he had to wait for the check to clear. he needed $80,000. charge bill was $13,700 for the transfusion. when i follow the money, i found out that m.d. anderson pays approximately $3,500 for that. the drug company that makes that drug, at cost them maybe $300. $77 for aa charge of box of's pads.

when you all that money, and i do this with all the patients, there was a patient who had some chest pains and thought she was having a heart attack in stamford, connecticut. two hours and $21,000 later, she left the emergency room, her health insurance had lapsed, and it turns out when you follow the money in stamford connecticut, as with many other places around the country, the local hospital is the biggest employer, the most prosperous business. it takes in more revenue than the city of stanford takes in in all its taxes. what i found was this alternate universe of everybody except for the doctors and nurses making all kinds of money. the exceptions happen to be medicare. the problem of not that they were overpaying, the problem

was, if anything, and i agree with david on this, a lot of medicare patients are underpaid because they have very little cost if they have a supplemental program, and therefore they just keep going to doctors, even if they don't really need to. i had one patient who had $350,000 worth of bills one year. a lot of it was for serious stuff. he had cancer, he had a heart attack. he had an eye exam and a bunion. because medicare with their discounts over $60. that is the kind of thing we have to correct. i do not look at this as a right or left issue. we have to look down the middle. there should be means testing for medicare. should bethere

medical malpractice reform, which, if anything, will take away from hospitals the excuse of over testing people with cat scans and everything else at exorbitant rates. but medicare works. prices, pays the right and anyone who thinks that hospitals lose money on medicare needs to just drive on any highway in florida and look at the billboards for all the ads for all hospitals that are advertising how they have expanded, they have new services. who are that advertising for in florida? they are advertising for medicare patients. they make money on medicare. medicare is deficient. it works. most of medicare is the private sector. has 8000 private-sector employees who are contract the maybe 700 other people who supervise it -- who are

contract it out. up just a couple of follow- questions before we open it up to the fore. the big point of contention is how efficient is medicare? david, i will let you respond. thingse are a couple of i would love to talk about but i am not sure we will have time. medicare does rely on private several private insurance companies. doesn't it seem strange that it would cost medicare so much less to contract out to have a claim filled, then the contractor would play it would pay for their own claim? -- then the contractor would pay for their own claim? i have been a contractor. i have run a business.

contracted to you always gets the worst deal. why is it that a bluecross would charge medicare so much less for processing a claim that it costs itself? what we need to understand about the health care economy is that medicare, medicaid, private insurance are fundamentally different payments that encourage different business models. steve and i are in complete agreement that hospitals make money on medicare patients. medicare has reported that hospitals lose money on medicare patients, inpatient and outpatient, for eight years in a row. that's go back to why the difference in processing costs are so different. is veryvate insurers do careful analysis of claims. high-priced, low-volume. medicare is a public and political body that is supposed

to show no bias. it pays for everything in an undiscriminating way it was implied very low prices. diagnosis creek, access treatment, and low prices. mcdonnell's makes tons of money on that model, and so do hospitals. the prices it pays look less, but the amount of treatment it of view, from the point of private institution, it is a great business. >> first of all, just for the isord, the head of medicare the one who says the hospitals make money on medicare. that me tell you a story about the efficiency of insurance companies. in some ways i probably don't need to tell any of you about the efficiency of insurance companies, if you have ever tried to call one.

let's take another example. one of the patient's side left out -- if you can believe it, this article is actually cut. one of the examples that i took out was the example of a doctor in new jersey. he decided he wanted to go out of the aetna network and work on his own. his rates that day from $350 for a half-hour of treatment and he was working in the emergency room at hospital. he changed his rates from $350 to $10,000 for a half-hour of treatment. inflation, everything, rates go up. an aetna patient shows up in the emergency room with a

respiratory illness, new money, and the patient ultimately died. the doctor billed aetna for that $410,000omething like over six weeks, and he build them something like $3 million .ver a 10-year period aetna paid the bill. with at the's lawyer and spokesman and explaining -- i am on the phone with aetna's lawyer trying to back.s money if i submit a claim to aetna for $68, they send it back for $42, and i cannot get someone on the phone. how did you pay this doctor up $3 million? >> we cannot look it every claim.

can you do something in your computer systems so that bell goes off in the office said it is more than $1,000 for a half- hour's time? we have not been able to do that yet. let me finish. i spent a lot of time that maybe one of the few reporters it was interested in digging into the bowels of the much maligned bureaucracy. they have terrific computer systems, all designed and run by the private sector, that aetna and the other insurance companies don't have, and they are really good at it. i am sorry, i know that sounds wrong. but they really do it well. reporting,did the you didn't. >> medicare is $54 billion a

year in improper payments. i can make a bank look really efficient by firing all the security guards, but i really need to put in the cost of bers.t >> where are you getting $54 billion? in fairness, it is medicare and medicaid. >> it is one out of every $6 or $7. point, ire important am not saying medicare is inefficient compared to private insurance. your. is there more efficient than private insurance. my point is, these are different businesses. medicare is in the business of saying yes to everything. there are no real limits on care. medicare has said we will help

pay for all healthcare people need. it has caused a lot of massive inflation in need. the idea that they officially pay for excess care is inefficient in its face. a customer service is terrible. their control prices is terrible. the private insurance business just marks of the cost of care and sells it to private companies. >> here is where we can agree. i agree with you. for supplemental insurance and medicare, you cannot sell insurance to people who are that the poverty level will worry about their excess care. second, you could argue that there are all kinds of abuse in payments. let's put this in perspective.

medicare has a zillion different strike forces, inspector general's. if you talk to honest hospitals, honest doctors, they will say medicare can be a big pain when they do an audit. abuse,l get all kinds of but the solution that i thought i heard you say when we were on the television show recently was that people should just have total skin in the game. if i have to pay for everything myself, i would be much more efficient about it. that does not work because i don't know what i am paying for. i have no idea and no leverage in the marketplace. getting rid of medicare is not going to solve many problems. agreeing thatboth hospitals are making tremendous amounts of money on medicare. fair enough?

that make their costs and a little bit more. drug companies make a lot of money on medicare. not allows has medicare to negotiate the price of medical devices or drug. some go back to the leaders in congress, republicans and democrats, and ask them why that is. >> it is a political football. it is extraordinarily hard for congress to be hands off or let the right forces operate. >> it depends on what football you prefer. >> i can answer that. the more we have our health care and to track system determined incentives, the more they will be perverse. they will produce way to much

care. i was with a group of health care economist at dinner the other night. the question was if you don't have medicare, would we still have general hospitals? the basic point, i think, is that, if we assume that there is such a thing, that healthcare is so different than everything else, that you can not be subject to some of the discipline to everything else some of the incentives that have driven higher quality, low prices, better use of technology, more transparency, then i have to agree. [indiscernible] >> you can put those incentives in. yes, you can. they should be put in. i stillill not can -- cannot figure out what you are suggesting to medicare.

you and i agree we should get rid of private insurance companies, is what you are suggesting again. >> we can talk about that. >> let me give you an example, let me read you an e-mail today i got from someone. this is about how our system works. i'm getting a dozen of these are day. even though we had insurance through my wife's employer, when we read your article, we had a fear we had the same billing problems with medical bills than when my wife gave earth. hadade extra sure before we the baby the hospital we were using accepted our insurance. despite our best efforts, such a problem has developed. wife wasife was in -- in labor, we were built. every doctor and nurse in the hospital. it did not occur to us we would be liable for any of the out-of- pocket expenses.

we had no idea what the bill would be. intense wife was in pain, we could not have asked a question about the participation, even if we had wanted to. you can imagine our shock when we found out the doctor did not anticipate our health insurance and the bill would be $3400. you want to leave people on the run -- on their own? >> is there a customer -- >> that is the point. that is the symptom, not the cause. for an independent contractor for a service for discharge for the hospital. a hospital swears it has nothing to do with the bill. hotel business would love to do that. we cannot. no one can except in healthcare

-- healthcare. >> why, because you agreed to go to a hotel. on my television network, you would have seen ads for cancer .enters getting cancer is not voluntary. what has changed in healthcare, although we never talk about it when we have political debates, is that most healthcare is now the result of a deliberate choice by the patient. [indiscernible] view it as a cure. [laughter] three out of four studies confirm it. [laughter] y echo the reality is, we talk about all healthcare the way we talk about a tire blown out on a highway. there is nothing you can do. your examples are often that. we know people who have been through that. of the money is being spent, where all of the

growth is, is chronic condition management, long-term treatment of things such as cancer, and various replacements we all have. those all involved a decision a customer wakes -- makes. for hundreds of years, it had to be centrally controlled. healthcare has changed. it is not what it was 50 years ago. this is the biggest industry in the country and the developed world. it is something we use all the time. a blowoutu might have on the highway, to take care of that is absurd. had a tireou have blowout on the highway, a guy beforet say, let me see you blowout your tire.

they do it because they can get away with it. >> the as you have all seen, they are intriguing. a spotlight one thing you said. disease. high profit the drugs cost so much money, everybody is on that gravy train, except the doctors. i think the fact they present information, and if you go to their website, they talk about survival rates. -- caused hospitals to list survival rates. that is good. it is naïve to think for someone who has just been told they have cancer, is going to make the same kinds of decisions you will make in a half hour of what restaurant you eat at. you cannot make that informed decision. i am not against those kinds of choices.

>> that is the problem. you are right. there is no one else to make that choice. this idea of health system, someone who calls you up and says, i am concerned about that spot on your i let's check about it we are all on our own. none of us are in the best decision to make those decisions when we are in a tough diagnosis. , no one else is making the decision. someone else is paying for it. not just this enormous amount of money to fund it. permillion to $2 million person. it is also the lack of a healthcare system that treats us, as opposed to the large bureaucracies that are the customers. we do not make great decision.

we make terrible decisions about everything. -- way the economy functions >> assuming cancer treatment and they are not getting in the way of the decision. they are just providing people with economic security that they can make those decisions and not have to make them based on cost. the same thing the cancer treatment centers in america as they are -- >> the only potentially , you may notng the sameill cost you .hing as the philadelphia place

>> economic security is another illusion of the healthcare system. >> you have not mentioned the .ax treatment backside that we agree on that. >> i bet we do. it pays people salaries just shy of a utility infield for the yankees in the bronx. i had this debate and mentioned $197 million. , they do all these wonderful things to help with the clinics and provide all the scare and they do this and do that. they said, that is right.

when they get finished doing that, they still have $197 million. they should be taxed. their prices should be controlled. something needs to interfere. >> i think it is important. when i talk about the incentives of the healthcare system, they are for- profit or not-for-profit. they are the same. they are the same as any sort. >> that is a way in which the tax code spends a lot of money on our behalf but does not give up the ability to discipline in any sense.

let me just open the floor to questions. please just wait for the microphone to come to you and then please state your name and affiliation. thank you. in the back there. please stand up, too. .> i am a member of this group i do not understand something. when did being a doctor stop being a profession that -- profession and not a business? they wanted to have a presumably steady income. now, we have doctors who own portions of a hospital, the radiology lab, this and that. they are in business. -- that is part of the problem. that is to say, doctors do not -- they are not the ones getting rich here. i think it is completely wrong.

>> it is completely right. thank you. in small areas, in country .ituations, it is a problem there is still, if there is anybody, a country doctor not making much money. in urban centers, i do not think that is true. >> i am counting on my fingers the numbers of doctors my family has been to in the last year or so. it is probably a dozen. none of them is a consultant for a drug company or at a clinic. the vast majority of doctors, as i point out in the article, and the nurses, they are the only ones who do not live in this alternate universe of being on the gravy train the rest of the country has not enjoyed for the last decade. it is just a fact. priorities, i would care more the regional

sales manager is making a half- million million dollars a year than i would the doctors are making half $1 million zero or a million dollars a year. >> that is part of the pricing system? >> that is crucial. before about how medicare's choices affect the practices of medicine, not just the cost. one of the most important is by medicare has done underpricing the services of general practitioners relative to procedures. it has caused over two generations to disappear. in the country. 6000. you may have thought, medicare expansion going from 500 billion, that is serving sieges -- seniors. medicaree reasons

prefers procedures and tests and major operations is because it is easier to justify spending money on them then somebody else's time. what do we have among seniors now? less than one third of appointments seniors have would twoors now of pediatric -- thirds are now for specialists describing specific procedures. i want to be careful not to talk about excess care as a matter of money. lance published a great study a year ago looking at every medicare patient at the year of their death. what they discovered was shocking to almost anybody in this field. one out of every three medicare beneficiaries -- one out of every 590-year-olds had surgeries.

most doctors will tell you there is almost no reason for a 90- year-old to ever have surgery. when i talk about problems in medicare, it is not really about money that the type of care being driven for our seniors. risk --h, diagnosis risk, and what really matters is we are subjecting our seniors to an enormous amount of care that does them harm. >> i agree completely the incentives for general practitioners and doctors are just completely reversed. overl add in the debate the obama care reform, there was varioust to add measures which would allow to opine over whether

someone with terminal cancer should have hip replacement a month before they would die. that became part of the betsy mccoy death panel and everybody just ran for the hills rather than try to pursue that form. >> old people should depend on medicare. they like that program. he will not get rid of it realistically. if aetna tried to do that, they would go after that, too. >> a different point there in terms of how the politics get in. it is almost impossible -- >> not quite. to take an example, there are

medicare. that mimic medicare says if the drug is fda if thed -- congress says job is fda approved, they have to pay for it. various state laws mimic it, especially when it comes to cancer drugs. even if one drug cost eight times as much of another drug, to be licensed to sell insurance, private insurance, in that state, you have to pay for drugs. i do not think you get rid of the politics of this if you get rid of medicare. >> i say we cannot get rid of congress. [laughter] that is right. what i am proposing is not that we get rid of government supports. creatingrence is, by more of a market in routine services, we create other

.ncentives we try to balance it. the reality is everything you are saying is absolutely right. my point is, we have one .isease dialysis is regarded as the most corrupt, poorest quality, highest cost, most complex, and ultimately the most dangerous part of our healthcare system. -- ceo is one of the my point is not that we should get rid of all of governments involvement in healthcare. my point is, let's turn the safety net into a safety net. what we have now governs the medical economy in such a way that creates perverse

incentives for stuff. people are suffering. we can look at low prices and say, it is about low prices. not if care is genuinely interest. not ifare taking -- people are taking too many drugs. but if they are doing it in an environment -- i saw it happen to my father, the type of sloppiness i would not expect anywhere else in our economy. since i have joined the board, what i am aware of is that they do not have the right discipline. they do not have the right accountability. i would like them to balance that. i do not think it is either or. entertainers at the end of the day. [laughter] class keep entertaining the crowd. any other questions? >> the guy with the google glasses? >> are you sure you can interrupt yourself and talk to us? [laughter]

[indiscernible] [laughter] one of the things [indiscernible] , thisg with medicare results in the best doctors. just ask their patients. does this not cause us to end up having giant hospitals, the hospitals doing a lot of medicare [indiscernible] i am trying to get this in the right spot. are doing well because [indiscernible] hospitals do well because they can handle the insurance system well. doctors can handle the insurance. >> hospitals do well because

they do especially well in places like connecticut where .hey are the only game in town then they tell the insurance company what they will pay. >> there are still economies of scale in healthcare. one is leveraging in insurance. with medicare it has a single diagnosis. 65% percent of hospitals have an exemption to it -- an exception to it. another 25% are completely. >> they are really not material. >> they are material enough to lobby heavily. the second economy scale is very important. which is administrative. if you look at i.t. and healthcare, that is the worst of any consumer facing industry. very heavily in

billing technology. the major economy scale and administration in a hospital is dealing with regulation, insurers, and payment. general hospital's long ago stopped being the best way to treat people. and their political powerthe my enormous advantages in the administration have prevented small, specialized institutions from competing effectively. the average doctor spends 20% of his time in paperwork. you're taking the most expensive and value part of the system and into insurance clerks. >> they are happy to sell their practices to hospitals so hospitals take that over. >> next 10 in -- next able in the back? -- next table in the back? >> thank you for putting out

doctors are not the one making money on drugs. i am an oncologist. >> you get a little bit of a .arket >> you are actually losing money. people in private practice is a much more because hospitals are getting massive discounts and that is why they are able to buy up practices. it is much more expensive than the hospitals. people who think doctors make so much money, residents age 31 and 32 coming out with $200,000 in debt and getting about 130 or 140. i would worry about who is taking care of us in the future. that is my big worry now. , explain to me why the choir got the salary he got when he required -- retired. got the salary got when he retired. he still want up with about 1 million and one half dollars. that is one of the reasons we

have art of our healthcare cost. everyone catch genital -- tangential -- >> there is no competitive healthcare market in this country right now. there is not likely to be. you will see above market salaries. hospitals are good at things they do a lot of. depending where you are, if your hospital does a lot of specific 's success ist greater. when you look at the world hospitals protected by congress, you may have seen this study in health affairs two months ago. for most conditions, they do so few procedures in a hospital, you are better off flying to a

city. it is cheaper. general hospitals do not exist because they are good at everything. they exist because they are general. they are like big department stores. they not so good at things they do not do a lot of. we would be much better off having the type of competitive advertising leaves see in other things. we do not have it in hospitals. it is unfortunate because the presumption because it is big and does everything, it is the right place to have my hip replacement or my bypass or what have you is not a presumption that is met by the evidence. most consumers do not know that, just like they do not know there are massive differences between the safety records. [indiscernible] >> sure. for me, ital thing is something we agree on, the political influences major in these things. part of my argument for moving more dollars through individuals is to move some of it away from political decision- making. if you look at something like dialysis, you see the influence

of political contribution and how medicare pays for dialysis. if you have much more transparency, it is probably the only way you will fight the fact the healthcare industry spends something like 3.5 times what the much bear military complex lobbies in washington, which is why nothing we are talking about a peer will change. unless you get people really angry and the way to get them angry is to give them , to tell them there .s a $77 charge this hospital is doing a lousy job, this hospital advertises,

those are the kinds of things to get people aware of this so they can counteract maybe what the forces are in washington. -- onenow in new york last short question. he young lady in the back? two really short questions. i just want to make sure i understand what the solution is. are we talking single-payer, all payer employers driving the change to high deductible plans demandingning -- more transparency? is there any country in the world that has the model -- >> don't say [indiscernible] there is something wrong about that. [laughter] singapore -- he will say singapore.

they point to finland to change the american education system. anyway, i purposely did not expound on a master solution. i do think what you need to restore or create israel leverage in the market place. part of that is the market has to intervene. you can have all the transparency you want. when you tell that cancer patient, who is waiting and to say, the transfusion costs over $13,000 and only costs the hospital less than one fourth of that and it costs the drug company a couple hundred dollars. you can have all the transparency in the world, but he needs the drug.

this government, this country, , has to or another intervene in that part of the marketplace the way every other country in the world does. there are all kinds of possible solutions, but they all involve the same thing, which is a lot of transparency, and some kind of intervention because you have to ignore its the fact this is not a free market -- to acknowledge the fact this is not a free-market. >> i i am glad we are greeting. my -- agreeing. we need to take advantage of what healthcare can do in this country. our healthcare will get far more personalized, far more responsive, far more integrated. the amount of care spent on the urgent cases declines every year. healthcare will be our major consumer industry. the question is how do we

organized. right now, we are organizing it the way we first thought of it in the late 19th century. your house burning down. guise of, under the home ownership, home insurance, we are paying for, what happens if your house burns down, all of the utility bills, and your furniture going out of style. the problem is not, that makes us that consumers. it makes the industry that providers. consumers do not drive any consumer driven industry. providers do. the providers come out with a new phone, a new car, a new this every month and try to convince you to buy it. we found a discount m.r.i. in my family by calling around and asking. in every other industry, they find you. that is why we are in the media business. so they can find you. healthcare will look more and more like most industries in terms of what it can do but we continue to structure it in a way that is old-fashioned. y echo one of the reasons is

that we look at the rest of the world and say, look what they are doing. how come the europeans can get similar, better mortality data on less spending? one of the ways to get less spending is by spending less. we are never going to do that in this country. congress has never been able to do it. everything is subsidized one way or another. another reality of america is healthcare spending has nothing to do with mortality at this point. drivers are diet, drug use, smoking, alcohol, income, and education. >> and playing too many video games. [laughter] >> which my kids argue will increase their lifespan but it is a shortening mine. [laughter] we say, they are doing so much better than that.

they are not. no country is confident on their ability to handle the growth of health-care spending that comes out of the statement of, we will pay for everything you need, cause the industry response to the net -- to the statement, the amount of healthcare we need will get bigger and bigger as we get healthier and healthier. guess what. there is no way to fund or discipline that. i like symbol for -- singapore. i like it for one reason. they did a lot of things that would be hard here. it is the only country on earth that does one thing very differently. it separates out the role of under and payer. we have forgotten they are separate. an insurer can write you a check and you can be the payer. in singapore, you are the consumer even if the government is paying 95% of the bill. you always make the purchase decisions. they found the affect to be extraordinary. they have healthcare just like everyone else in the world. perfectly good.

lowerless demand and prices. >> you left out the fact they have price controls. >> i did not. there are tons of things singapore does we would have a hard time doing here. withll never have control congress. it is not an option. it will never happen. what can happen here? this is a country where we are leaving things to consumers constantly. i am not going to -- for 100% of the market. let's take 1 million and one put half of itd in a catastrophic care system that is national, universal, cradle-to-grave, and that the other half go back to healthcare. we will see in industry where the providers have different motivations. steve mentioned cosmetic surgery. anything not touched by health insurance, including carefree documented.

, documented,y operates on a competitive cash market. it has nothing to do with the type of care. it has to do with the type of payer. what i am calling for his understanding. treating healthcare as one thing. recognize some of it as catastrophic. need intervention and insurance. if we build a whole system based on the worst cases, we will have more of what we have now. incentives doing the wrong thing at high prices. >> i disagree to a little bit on the definition of catastrophic. who had chestord pains. they thought it was a heart attack and did not have one. you want to put her on her own. another patient who fell down on her backyard and broke her nose

nose and had cuts on her face, you want to put her on her own. even if it is, collective knee surgery, there has to be controls because you do not have the free markets you have for lasix surgery. >> we have it in undocumented care. >> you ask the people who provide the healthcare in east l, they will be the first to tell you those people are undeserved -- underserved. they are driven deeper into and are not getting the equivalent healthcare other people would get. >> i do not want to put people on the rhône. the average working person in this country who has a family and is fortunate enough to have health insurance, is putting about 25 to $30,000 a year into our health care system directly through taxes and their

premiums. if a catastrophic care system that $3000 a person, means that prison is on the rhône on $10,000 a year. we have got to get some idea of the scope of money. the 2.7 train dollars we will spend on healthcare this this year did not all come from somewhere else. 350 million people are not all being paid for by somebody else. we are all paying for it. will pay billions of dollars subsidizing medicare. you could give 100 million people $8,500 a year for their care. that is $34,000 for a family of four. when you build a system inefficient on price and allnistration and you are paying for it. >> you left out the fact the people who are the beneficiaries of medicare have medical needs because of their age