grutter's reaffirmation that student body diversity is a compelling interest that can justify the consideration of race in university admissions. colleges and universities have relied on that principle. it is a vital interest to the united states said they continue to be able to do so. they are insuring that the nation's universities produce graduates were going to be effective citizens and effective leaders in an increasingly averse society in global markets. >> does the united states agree that african american and hispanics from affluent backgrounds deserve a chance? >> here is what is going on with respect to the admissions process. i think this is a bit of context.

the top 10% plan produces some diversity. the university cannot control that diversity in the same way it can with respect to the 25% for the holistic process. my understanding that the universities are looking to do is not to grant a preference for privilege but to make individualized decisions about applicants to look directly for the educational mission. they will look for individuals who will play against racial stereotypes just buy what they bring. the african-american fencer. hispanic students as master classical greek. but also look for those with a demonstrated track record. >> you have two applicants that are the same in every respect, they come from affluent backgrounds come up educated

parents, one falls into the group with a preference in the other does not. the last position available under the texas plant, one gets in and one does not. do you agree with that? >> i think there is a automatic preference in taxes. this is right on page 398a of the appendix. they describe an applicant's race only considered that the student will contrary to the boulder diversity. >> the two applicants are entirely the same in all other respects. it is the ability to get a racial preference means anything, it certainly has to mean that in the hypothetical given by justice alito, the

minority student gets in and the other does not. this is common. >> it is a matter of two equal and all other respects. what is the racial preference mean if it does not mean the minority applicant winds and the other one loses? >> there may not be a racial preference. >> i do not understand this argument. i thought the whole point is that sometimes race has to be a tiebreaker. >> i think it functions more subtlety. >> it does not in every case. findings from both courts say the district court found that

race is indisputably a meaningful factor that can make a difference. if it does not make a difference then we have a clear case they're using race in a way that does not make a difference. it has to be the race is a determining factor. unless it is a determining factor in some cases, it they are using race when it does not serve a purpose at all. >> it does not make a respect to every minority applicants. >> and it is different in some cases. >> it does. >> this is exactly right. it is not a mechanical factor.

with respect to the implementation of this compelling interest, it is clear in he is challenging this. this meets every requirement and addresses this. there is no quota. everyone compete against everyone else. it is individualized consideration. they do not monitor the racial composition. >> the supposition is surely a possible -- impossible under this. there are not identical mechanical factors that except the 10% plan.

the factors are so varied intentionally set that no to applicants ever could be identical in the sense they hypothesized. >> the specific individualized judgments. >> as i understand it, braced by itself is taken into account. they take race into account. the district court found that race makes a difference. >> and makes a difference by casting the accomplishments of the individual applicant in a potential flight. what the universities are looking for with respect to this consideration is what is this individual going to contribute to our campus? race can have a bearing on that.

this is what they can bring to the student governments or to the campus. >> if there are ever to applicants with the gpa, the grades,, leadership, activities, awards, community service, economic status, family responsibility, single-parent home, s.a.t. score, if he had a situation where those things work absolutely identical then the person would be admitted on the grounds of race. >> not necessarily. >> let me ask you another

question. can you explain your rotc argument for me? >> our military effectiveness depends on a pipeline of well qualified and well-prepared candidates from diverse backgrounds who are comfortable exercising leadership in a diverse set in. >> you have a marginal candidates who wants to go to the university of texas and is interested in rotc. how does this impact the military?

>> the point of educational diversity is to create an environment in which everyone develops inappropriate sense of citizenship and the capacity to lead in a racially diverse society. it will benefit every rotc apple can. 43% of the court comes from the rotc. it is a significant part. >> what is your view when the university has obtain critical mass? >> it is not a number. it would be very ill-advised. >> i would like to know what it is.

we have to decide if it is tailored to achieving critical mass. >> i do not think this is a situation in which the court of boards complete deference to the university's judgment. does the level of diversity it needs. they have to make their own independent judgment. the way to go about it is to look at the information that the university considered it. that could be information about the composition of the class. it could be a backlash and diversity.

it could be retention and graduation rates. it could be specific to the universe the context and history. but the court has to do is satisfy itself that the university has substantiated its conclusion based on the information it has considered that it needs to consider race to further advance the educational goals that grutter has identified. i do think as the number of enrollees tire, at the university can do that. it will get harder to meet. i do not think there is a number. i do not think it is prudent to suggest there is a number. >> which probably stop calling it a critical mass. critical mass assumes numbers. >> i agree that critical mass has taken on a light on its own that is not helpful.

it is not focused the inquiry where it should be. it is important to the country that our universities have the flexibility to shape their environments and their educational experience to make a reality of the principle that justice kennedy identified. our strength comes from people of different face, creeds, uniting to a more perfect union. that is what the university of texas is trying to do. it should be upheld.

>> thank you. that is more than i expected. we are seeking a level playing field. there are three things i want to touch on. there has been a lot of back and forth on standing. that really relates to marriage. we do not accept the premise of the footnote that she would not have entered under any circumstance. she was considered for the summer program. >> incentive relief and the return of the money. is that what is limited to? >> no. the point when we were writing it -- >> we said any and other damages is too speculative. is what you actually see injunctive relief and the return of the $100?

>> we never had the opportunity. did you ask only for injunctive relief and the $100 specifically? >> the only specific number was the application fee. >> you would have paid that no matter what? >> you would have returned it for a free assessing of the application. because of the way it was bifurcated, we did not develop the additional damages.

what you he pointed out is there other kinds of financial entries that were not ascertainable at the time it was filed. >> she is going to get a better job because she went to a different university? >> that is one thing suggested. the court made this clear. let me go to another issue that i think i never concluded my answer. we recognize that there is an interest. it could be recognized it at all that what we are concerned about is universities like you'd see and others have used it as a green light to use race, no end point, no critical mass to something that can be reviewed.

as long as you do not cross determinative points and fixed quotas, you are ok. we do not think that is the way grutter was intended. it raises all kinds of red flags. make a determination whether your interesting critical mass >> you're not suggesting that of every minority student that bought into a university -- got into a university only got into a physical education program that the program includes all the star athletes.

every star athlete in the school happens to be black or hispanic or asian or something else. they have now reached critical mass of 20% that the university in the situation cannot use race in the holistic way that grutter permits? everyone of their students who happens to be minority will end up in the program. do you not think the university should consider it needs a different diversity? >> the factor is a choice. you have a critical mass of students. they choose to major in

different things. that is the problem of classroom diversity. what are they not in the small classrooms? why does that happen? you would say that is an aberration. what is causing it? >> are facing the same thing when we are looking at the holistic measure we are looking for the student who is a nuclear scientist? >> no. it did not take into account the interests. they are not going to use you in major physics. they do it in a way that is premised on academic indexes. the have a two-tiered emission system. what we see is that grutter has been perceived as a green light. it used race. that unchecked use of race which we think has been spawned by misreading of grutter needs to

be stopped. >> is any different from how race is used in our military academies? >> those are two different questions. the harvard plan is a very different world. is a plan about individual missions to establish the platonic ideal of a class. i am not the mixing people. i am admitting categories. in the way they do their system,

you can figure out that two people would have had the same pai score. it allows them to boost be pai score. there are many candidates who'll score the same pai and a new boost some of them. ut says we do not boost all the minorities but we want to boost the ones we like. they give points in the same system for socio-economic disadvantages. they cannot even say at the beginning we do not have

critical mass, we do not know what it is, there is no judicial supervision. there's no in point to what they are doing. what we have said goes back to how much you write it. you can clarify it. you can say it grutter requires you to do this. we said it would be satisfactory. to the extent you have the surviving side by side, there could be enormous confusion. >> you want me to look at the critical mass, look at exactly how it is being done in taxes which has charts. i will then find enough of a difference and i can write some words that can be administered by two or 3000 federal justices as they try to do with programs. >> if you then look at some of the other deficiencies and clarify the consideration of reasonably available

alternatives a necessity, even to read the weakness of the program to the absence of those factors. this is a narrow window. >> once you reach a certain number then you cannot use race anymore. >> i do not want to get it. that is unacceptable.

unacceptable. >> thank you. the case is submitted. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2012] whethercussion on medicare is the problem or the solution when it comes to the cost of health care. recent protests in brazil affecting the country's plans to host the world cup. >> we came out of those buildings and we could see a sea of humanity coming from union station.

there go my people, let me catch up with them. [laughter] this sea of humanity pushed us. we started moving toward the washington monument. it was a wonderful period in american history. >> the fourth of july on c-span. civil rights pioneer john lewis shares his experience on the march on washington 50 years later. visitedthe places we and historians we have spoken with during the first series of our season on first ladies. pulled surprise wedding photographers display their work and talk about their coverage of pulitzer prize-winning photographers display their work and talk about their coverage of world events.

a panel talks about what it is to be a modern-day american citizen. gun violenceon of and mental illness from stanford university. -- this is a little bit more than an hour and a half. >> good afternoon. . am a forensic psychiatrist joe and i were trying to plan this year back in december 31. we decided it was difficult to --e -- without including

marriage as between one man and clocks one of the deadliest campus shooting. there has been a tragic shooting incident today at fort hood in texas. several people have been shot at a grocery store in tucson, arizona. >> at least 14 dead, 50 injured after a lone gunman opened fire in a theater outside of denver, colorado. >> back to our coverage of a shooting in a temple early this morning. a frightening scene unfolding there. >> at least 27 people have been killed at an elementary school shooting in connecticut. >> at least 27 people killed, most of them children. it was an elementary school at a small town in connecticut.

>> senseless slaughter, the openedin a long -- has the subject of gun control and the second amendment. >> there is no doubt the debate over gun control will heat up in the coming days and months. >> i believe that my role will be more to raise questions for our speakers than to try to answer any of them. where gun related violence comes from, looking at the issue of mental illness and the question of -- mental illness. in america, we have about 3 million guns. every 100 people.

guns --er of related these numbers are equal to about three deaths every hour. all taken together, taking into consideration the vietnam war, or 58,000 people died ,and.one woman for the purposes ,hen you think about children children about 16,000 and teenagers were injured with firearms. when we think about violence and we think about how people die,

it is clear to see handguns probably the leading cause of that. there is some data to suggest the availability of guns go down, the incidence of homicide would go down with it. anotherke industrialized country like japan, where all guns are banned , compared to the united states, where we have a right to bear arms, you can see there are dramatic differences in gun related homicides between the two countries. those are statistics that are difficult to argue with. homicide is not the only part of the equation. victims aref those going to die from homicides. there are 49 gun

suicides every day. the majority of the children who are dying are dying from using guns they obtain from family or friends. there is a question about whether more restrictive laws could do something about this. i want to draw the attention that we have laws. the question is whether they can be enforced and whether they are enforced in a sustainable way. it has been said that mental illness is probably one of the causes of the violence. there are many instances on tv where people have directly said that only crazy people kill. if you look at the actual numbers, rental illness only increases by a bare minimum. less than five percent of american crimes involve people with mental illness. those numbers are difficult to

sustain. i have questions for our speakers. i am sure they will address it at some point. how we will is define mental illness. -- thereago, the apa are questions about how that will be affected by the community. there are questions of label mentally ill.e if we do that, it is easier to say that only mentally ill people commit these crimes. the final question, how do we differentiate pure malice from mental illness? those are the questions for our speakers. i would like to introduce our first speaker. a currently senior fellow at the center for the american and a former special advisor to mayor

bloomberg and director of mayors against illegal guns. he received his bachelor degree from harvard college and a law degree from harvard law school. he is a native new yorker who lives in washington, d.c., with his family and he tells a compelling story. you should be looking at last week's new yorker. [applause] >> thank you. i will also start with some numbers. 32, that is the number of people who were killed in the largest mass shooting in american .istory at virginia tech

the shooter in that case was someone who had been adjudicated in toledo i have court -- mentally ill by a court, but the state of virginia had failed to provide that record into the background check system and that failure meant he was able to go into a gun store and buy the gun. number oferage americans who are killed with guns every single day. 323, that is the number of people who have been killed in mass shootings over the last four years. over the same. the00 iod,

amount of people who have been killed in all shootings. that number is the number of americans who died in gun suicides and gun accidents in that four-year period. the vast majority of those were suicides. about the aggregate toll over many years, if we take the year 1968, which was the year that bobby kennedy and martin luther king were assassinated, more americans ore been murdered with guns killed themselves with guns or died in accidents in that period than have died in all of the wars in our history since 1776.

with those numbers in mind, i want to talk about for things today. as scopingd define challenges, how do we think about guns and mental illnesses? the first question is, should we think of people who are mentally ill as perpetrators of gun violence, as victims, or potentially a scape goat? to gett question i want people thinking about, what is the problem that we are trying to solve? mass shooting's, everyday shootings, or suicides? or mental illness for that matter? the third thing i will talk about is background checks, that has been the focus of the debate in congress. what might some other solutions be to this intersection of mental iness and gun violence?

the first question, are mentally ill people significant perpetrators of gun crime? this is one measure of it. this is a graphic that describes people who are rejected from purchasing guns when they go to gun stores and what portion of the people rejected are in the various categories of people who are prohibited? the biggest category are people who love been convicted of felonies. those are most of the people rejected. a very small portion of the people who go into a gun store and are denied the ability to purchase a gun are in this category of people who are mentally ill. the facthat relates to that many mental illness records

are missing from the background check database. your chance of being killed by a schizophrenic person is about one in 14 million. that is one type of serious mental illness. you are more likely to be struck at lightning than that. another way to think about ,ental illness and gun violence this is a category of people who are victims of gun crime rather than perpetrators. mental illness is very widespread and it is a problem that affects many americans. i would focus on the last number, which shows that people who are mentally ill are more likely to be the victims of crime than everybody else. i think there is a third way

that mental illness has come into the gun debate, articulately in this period since newtown. this -- that is as scapegoats. this is a quote from the nra. on december 23 of last year, we haves after newtown, a completely cracked mentally ill system that has these monsters walking the streets. we have to deal with the underlying causes. , is this theis problem that we need to solve? if mental illness the cause of gun violence? that brings us to the second scoping challenge. what is it we are looking at? mass shootings, everyday shootings, or suicide question mark when we think about mass

shootings, there is probably a compelling that -- compelling case you can make that mental illness is quite involved in mass shootings. a mother jones magazine analysis of 62 mass shootings looking at , some of the court documents, most mass shootings involve some degree of mental illness. if we think about some of the most prominent recent mass , or was a significant record of mental illness and a number of those shootings. what we think about everyday shootings, everyday gun crimes, we see that people who are -- have serious mental illness tend to commit crimes at a lower rate than the overall population.

they are responsible for a lower portion of crime. likewise, when you look at crimes with weapons, which most times will mean guns, again, crimes committed by people who are mentally ill is underrepresented. it is worth pausing for a moment to think about how does the u.s. fit into this picture of everyday shootings? we may not have a gun crime mental illnesshe component is exceptional, but the gun crime problem is exceptional. uniquely criminal society. we are not a uniquely violent

society. but we are a uniquely deadly society. the level of homicide in the u.s. is unusual when you compare .t to similar countries we have a level of homicide that is seven times higher than comparable countries. is way higher.e we do have a big -- and .xceptional gun crime problem when we think about these everyday shootings, until illness does not seem to be deeply involved in it. that leaves us with suicide, which is the majority of sudden deaths every year in the u.s. we know that suicide attempts that involve guns are far more likely to be successful. to commit use guns suicide are the people who are

really seriously wanting to succeed. it also may be that impulse suicide, people who are in a particularly low moment, this is the mechanism that is much more when people have this mechanism available, it is more likely to have a deadly result. there is this question that mental illness and suicide are related. before i talk about background thats, the bottom line is mass shootings, guns, and mental a nexus.there is suicide, guns, and mental illness, there is a nexus. illnesscrime and mental

is for the most part -- it is a nexus.ere is not when you think about some of the nass -- mass shootings and background check systems, that has been the subject of the debate in congress, a number of some of the most prominent mass shootings have involved gaps in the background check system. it was aia tech, shooter who had been adjudicated , but the records had not been put in the system. columbine, it was going around the background check system by buying guns from a private seller at a gun show. that was also the case in the shooting in brookfield, wisconsin, in october, or the

perpetrator got guns online from a private seller, no questions asked. lochner had a history of -- he had a history of mental illness. he had a history of drug abuse, which had prevented him from entering the u.s. military. that record was not provided by backgroundy to the check system. that could have been a disqualifier. why is fixing background checks important? it is probably especially nexus twonot in its mass shootings and mentally ill, but to its nexus to everyday gun crimes. there have been prisoner surveys which suggests that the vast

majority of people who commit fromrimes get guns transfers, purchases, or getting it from a friend that do not involve background checks. itut a question mark under because it is just one data source. it is very hard to know much about this secondary market for guns. sold after the gun stores have sold them. sometimes from somebody who says they are just a collector, but might be selling 100 guns at a gun show. sometimes that of the garage, sometimes online. have,st statistic we which is almost 20 years old, suggest that maybe it is around 40% of gun transfers every year. solution is to require these

private sellers and private -- to go to a gun store and do a background check to provide a little context, in our country, we have 58,000 gun dealers, almost as many gun dealers as we have post offices. mcdonald's and starbucks combined. this is something that would not be a great inconvenience. there is a good study mapping all of the gun stores. 97% of americans live within 10 miles of the gun store. issue was this issue of records not getting into the background check database. have been a significant amount of improvements in virginia tech.

it was just under 300,000 records in virginia tech -- before virginia tech. now there are over 2 million. 18 states, six years after virginia tech, have continue not to supply records into the system. one of the things the legislation and congress would have done had it passed was .ough and -- the sticks do background checks matter? it is a hard question to answer. crime overall and gun crime has gone down a lot in the u.s. in the last 20 years. but it is very hard, people do not agree what causes the drop in crime. it is very hard to think about outcomes and what causes an

outcome, but there is a fair amount of studies of particular enormous amount of circumstantial evidence to suggest that gun laws do have a substantial impact. different states have different laws. here in california, very tight gun laws. other states, very weak gun laws. if you look at states that have universal background checks, you is them murders of women basically very similar in non- .irearm homicides if you look at gun homicides, it is lower. the portion of the legally trafficked guns in states that have universal background checks

are much lower. did at thedy we center for american progress, we looked at the 10 states in aggregate that have the strongest gun laws and the 10 states who have the weakest gun laws. of guned at 10 outcomes violence, 10 measures of gun violence. you probably will not be able to read the text, but you can see the pattern. on each of these measures, the states that have stronger gun laws have substantially lower rates of gun violence. aggregate, it is half the level of gun violence. , whens the correlation you see correlation over and over again, it suggests pattern. my final thought is, as we think

violence, gun laws, mental illness, we should think about what is the problems we are trying to solve? vary, but there are things we can do beyond that -- beyond background checks and things that could be quite effective. one thing, for example, what happens when somebody fails a background check? they are rarely prosecuted for that. that has something that has been talked about quite a bit since new town. the federal government does not have a process to tell state and local law enforcement when ill peopleentally are rejected from a background check. what would've happened at

virginia tech had the sooner -- had the shooter failed ?he background check >> h he might've gone to a gun show that weekend. were the campus police and virginia tech or the state mental health authorities been alerted that is seriously mentally ill person in virginia attended to by a gun. alerting law enforcement and mental health authorities when people are rejected for background checks would be one good thing. another thing that would could make a difference is effort to recover guns once people become prohibited persons. been convicted of a felony or when you have been adjudicated mentally ill, you are no longer have a right to

buy a gun. what about the guns that you may already have? some states, some cities have undertaken efforts to make sure that when people become prohibited, law enforcement it's to those people and get back their guns. california just passed a law that will provide funding to do this for 30,000 people in the state of california who are prohibited, but there have not been the resources to go to their homes. there are cities and counties in california who was had very effective programs in recovering those guns. even red states like indiana have laws in place to do temporary actions to recover guns from people who are mentally ill. there are a number of things we can do, but as we think about

what to do, we should go back to the first set of questions. what are the problems we are trying to solve? are we trying to have a better system for taking care of people who are mentally ill? there's a lot we can do. are we trying to reduce gun crimes? there is an enormous amount we can do there. -- in the end,o it might be somewhat of a less important problem to solve. what happened in newtown was a , but if yougedy lose a six-year-old in a single victim shooting, if you are the parent, it is just as bad. nobody is going to pay any attention. short local news story,

but it will disappear. when you take those single victim shootings in the aggregate, you are talking about a new town, virginia tech scaled massacre every single day in our country. thank you. [applause] >> we are going to leave all the questions to the end. we would like to introduce jeff swanson. he is a professor of psychiatry and behavioral science at duke university. mental health services effectiveness research. -- received numerous awards for his outstanding contributions to mental health research and has written numerous papers.

175 comes to mind. perhaps the country's leading authority on the link between violence and severe mental illness. [applause] evening,you and good everyone. it's an honor and privilege to be part of this important conversation at stamford. i would like to thank you all for coming. i would like to speak with you for a few minutes tonight on the link between violence and severe mental illness, gun violence and mental illness. my slides are automatically advancing. sorry about that.

in the context of the other causes of violence in our society, with such an understanding and what it might for it to be both more in terms offair reducing gun violence but also avoiding and reinforcing the stigma that goes with the unfortunate understanding or belief in the public mind that all people with mental illness are dangerous. because of a great deal of stigma and social rejection. how do we think about balancing , publicportant concerns safety on the one hand they are the civil rights on the other?

i would like to start by putting .his in a big picture is first of all, let me quickly acknowledge some of the sponsors of the research i will be presenting to you this evening. the national institute of mental health, the national science foundation, the sociality program, the robert johnson foundation. forink it's very important grantmakers to courageously sponsor research in this area. all of you have been to the national mall and you have seen what a sobering sight it is to 58,000 names carved in a granite wall. that is the number of american military deaths in vietnam over approximately a 10-year period/

build awe were to memorial monument to commemorate all of the american to have died in the last 10 years as a result of a gunshot? if we were to build such a memorial, it would have to be five times larger than the vietnam memorial. i present that to you not only to show you something about the magnitude of the problem, but also to take it apart a little bit. it turned out 39% of those arehs are homicide that 57% suicide and 4% are other situations, law enforcement action or accidents. i have done some calculations and made some assumptions about the prevalence of mental illness of the attributable risks homicide and suicide that's associated with mental illness. calculate that, roughly, if we were to reduce all of the risk

of mental illness, we could by aboutat number 100,000. we may be able to bring it down. 95% of that would be from reducing suicides. why is that? well, you know, if you think about the relationship as someone who studies the problem of violence in populations, not , there areduals three ways of working at this. schizophrenia, bipolar disorder depression, those who engage in is 7%. behavior, that 93% of them would not. if you think about it from a comparative perspective of relative risk, people a serious mental illness are three times more likely to engage in violent

behavior in the same year that violentho do not have illness. this takes into account relative with the riske factor. if we were to lower the risk of violence in people with mental illness, not to zero, but to what it is with people without it, how much would it go down? the answer is about 4%. there is a link between mental illness and a moderate risk but it's a pretty small contribution to the overall problem. it's not the place you would start if you wanted to address the problem. respect to suicide, it's a different story, as you have just heard from a few previous speakers. this is a meta-analysis or a summary of 14 studies of the attributable risk of suicide associated with until illness.

contribution of the disorder, mood disorders such as schizophrenia, depression, schizophrenia, bipolar disorder, the evidence average about 26% on and in the female, as high as to a effectivee disorders. it is a much drunker vector and it is also a treatable illness and, if treated, it could have a big impact on the overall suicide-related firearms problem. what about this link between violence and mental illness? are violence and mental illness related? it depends. it depends on what we mean by mental illness and what we mean by violence. this slide shows a bunch of average estimates of how many people with mental illness

engage in violent behavior, the setting by which the studies were done. thecan see on the left of x-axis, outpatients and treatment, stable outpatients and treatment, about 8 or send would engage in minor or serious violence in one year. some of these are in treatment and some not. there, it's about 10%. if we look at discharged inpatients, sometimes in the hospital because of issues of violence, 13%. present emergency departments with mental illness, involuntarily committed, the criteria for inpatient commitment is higher. look over on the right. first episode psychosis, patients who come in for the first time to a hospital or a treatment facility, 37% of those people have had some issues with the violence or were threatening

to harm others before they were seen. strategy that is supposed to identify people at ofk by searching for records a gun-disqualifying mental condition but these are people who have not been touched by the system. these are not necessarily different populations. they could be the same people at different moments, different stages in their treatment. there are those people who are prohibited from guys who maybe were at risk 20 years ago and there are those who are at risk but not captured by the policies. reduce gun violence in people with mental illness? what ourbe nice to do peer countries do, broadly limit

legal access to guns. some say having a gun for your own protection is just too dangerous. let's not let people have so many guns. we cannot really do that. we may have a gun violence program but we cannot change it just because of our second amendment to the constitution. struck downme court the handgun ban in washington, d.c., and chicago, it basically says the constitution confers the right. they left in place a long- of firearmshibition for felons and people with mental illness. about how weink keep guns out of the hands of dangerous people. that's complicated to do. people are complicated and violence is complicated. there are two reproaches i would like to mention and they are not mutually exclusive.

to assess risk, predict atlence, prohibit persons risk from accessing firearms. this involves the assumption that psychiatrists are able to predict who's going to be violence and who's not and using involuntary commitment to confine people and then categorically rid them from firearms and that is where the background checks come in. that is one approach. another is what i call the social therapeutic approach. let's try to prevent the unpredictable. it turns out they are pretty lousy at predicting who's going to be violent. let's try to get upstream and address the factors that are mentalted with poor health outcomes and let's try to address the social and economic determinants of violence. reducingething about the risk of youth violence and fact is like a child exposure to

trauma. then let's provide effect of treatment. we wereot know preventing violence, but we would not care because we are preventing the unpredicted. two different approaches. one is a long-term project and the other is maybe more short term. law,respect to the federal which is basically embedded in what states do and they are all over the place, the law categorically exclude some with mental illness from accessing firearms and we have this term, when people are committed the idea is if they are ill enough to require involuntary commitment that they should not have a firearm. they have been afforded the legal protections of a civil commitment. also part of it.

adjudicated, legally it means that has been in authority who determined that someone, as a result of mental illness is incompetent to manage their own affairs. been acquitted by reason of insanity. keep guns out of the hands of people like this, jared bochner, and these other perpetrators of mass shootings? this is why we are talking about this tonight, looking at it through this prism of these terrible tragedies. can they keep guns out of the hands of people like this? the people with mental illness actually look like the people in this room and they have a whole range of risk factors for violence that range from your harmless grandmother to your

neighbors not so harmless intoxicated boyfriend and everything in between. how do we think about that? do background checks work? there are a lot of reasons why they might not. one has to do with access. they cannot predict violence very well. states may not commit people and other states do. it could be that they do not have to submit to a background check. lots of reasons why they think they might not work very well, but there is very little research that's been done to actually evaluate that and i will show you some of that right now. we have a study just completed sortnnecticut and this is of the punchline for the study. of peoplene 23,000 who had a serious medical illness, all of whom had been hospitalized, and we brought the records from the criminal justice system and we looked at

the risk every month over and ofht-year time as a function whether they were disqualified from purchasing a gun and lots of other predictors. these two lines you see here, i call them involuntary's versus the voluntary's. involuntary are those who have had a gun disqualifier on the health record and you would expect them to have a higher because oflent crime commitment. they do not have a gun disqualification of mental health record and as you can see, from 2002 until 2006 or so, the rate of violent crime is after 2007,and something happens. the state of connecticut began to report records to the criminal background system.

people try to buy a gun and they don't disclose it, it will be known. you can see there that are are -- they are where the lines come together. let me just try to put this in perspective. of thes out that 60% sample were not disqualified. they did not have any kind of disqualifying record. disqualifying criminal record. only 7% had a record in the mental health arena, in mental health adjudication record that would prohibit them from purchasing a gun. a little overlap there of 2%. the analysis i had shown is just looking at the people who were susceptible to that mental health policy. it turns out that 90% of violent crime in the group was committed by people who did not have a disqualifying mental health record.

perspective and what the effect is it prevented an estimated 14 violent crimes per year in this 1100 people. it is a small group of people, the overall impact on violent crime was pretty small, 0.5% reduction. you could say it works in a 53% decline in those who were disqualified and only 34% in the comparison group. but, you know, it's on the margin, but is not the whole answer certainly. with this.ike to end it really is about the guns. here is a scatter plot that betweene relationship state gun laws restrictiveness

as measured by the brady score. you can see there is a correlation. states with more restrict the gun laws have lower fatality rates, but there is also a relationship between household gun ownership rates, so states with lots of families living in a house with a gun, those states also have higher firearm fatality rates. it turns out there's a relationship between those variables. if you look at the relationship between the law and the fatalities, you see a strong relationship in states that do not have much of a saturation, less than 35% of the households with guns. the gun lawsive are in terms of gun safety in the cell one, unless the fatality rate. thatu move up to states just have a lot of guns around, those laws tend to have less of an effect and you can sort of see why.

to think about this comprehensively, not just one solution, but we need to think about a lot of different things. partially about the guns, really reducinghe legality -- the legality. strengthening background checks. part of it really is better mental health care. there are a lot of solutions being contemplated and enacted at the state level, but quickly i would just mention these and a close. what about the idea of having mental health professionals being mandated to report people that they see in the community and private psychotherapy who they are concerned about. should the report them to the police? has a law -- new york along those lines. what about mandated outpatient treatment? should we force people into community mental health care? that is controversial from the point of view of civil rights.

should we just expanded background check definition? should we make this boundary boundary of who was disqualified much broader? idea of seizing guns from people considered to of angerous irrespective mental illness or if they have him committed. should we does predictably and and i think this puts stakeholders in a bit of a bind. we want to think about improving mental health but we also want that.id we need to find a balance between those concerns. thank you.

>> our last speaker, joe bank bankman. andirector of psychiatry the law. [applause] >> thank you everyone. this is part of a course we decided to open up, so i will continue to play professor here arei will assume all of you just sitting in. you know law professors call on people, so stay awake. the problem of mental illness mentalme -- excuse me, illness and violence and guns is really part of suicide more than

and it's really quite right. i noticed that the suicide is dramatically understudied. jeff is doing some exciting studies in academia on the of gun control and suicide and you had a slide that on that. something maybe later we can ask you to look at that? here's a question. if most violence is not a function of mental illness, if that is not suicide, does a mental health scholarship have anything to say about that? only about 4% of homicides have anything to do with mental illness, is it a scholarship

issue? it's true that violence is not causing serious mental illness and now we are thinking things like schizophrenia. jeff did a good job of showing us that there might be a agencieship with the that are so low to be significant. offenders have a high degree of mental disorders as so defined and their much more anxious and depressed and psychotic. we do not think there is a causal relationship there. there are social behaviors and cognitions around them.

those of you in the audience who have else with offenders with that population would probably be nodding your head. i think it's a commonplace observation. it is one frequently made. first of all, if we think we can stoppingomicides, access to firearms, we are not a questionve people to see if they're going to be the impulsive type. these are just bad people with bad traits and maybe we need to wait for them to age out of the violence. that is a caricature, and exaggeration of where the

analysis could lead. scholarshiphealth give us any alternative? i'm going to go with the answer just going to be no. i think there should be something in evidence-based therapy. same wayting than the drug therapies are tested with random control trials. they seem to address these they go by a lot of names. we will just call them anger management to take one of the more prominent therapies used in these settings. doesn't work? -- absolutely somewhat. therapy is short-term.

group therapy is relatively popular in part because these lots ofead to dysfunctional behavior, so dysfunctional that people who have the behavior exhibited. also, it's really unpleasant to be angry. think of the last time you are really pissed off. how did that feel? while, but for a after a while, you wish you were not. these people are angry all the time and they would love to get that monkey off their back. they don't have problem in person admitting -- in prison admitting you have an anger problem. group there be in prison is often oversubscribed, so lots of people jump into the therapy. hundreds ofre are randomized files laying out there and a broad summary. yes, it does work somewhat.

the standardse of deviation. if you take a control group, people who go through maybe half , less standard deviation angry by some measures, but doesn't work on recidivism? if you look at the analysis, yes. if you look at others, yes, but less. many talk about these therapies, you often think of risen and that is really where it started. looking at this from the prison perspective, you who becomehat people offenders are identified in school and they get in constant fights. school counselors know who they are and the same therapies that work in prison work about as well or maybe even a little better in school.

i know as i look out in the outence that some of you there has a daughter or a son that has some of these traits. this could be a great, loving person who can do awful things and you wonder where they are headed. most of your looking for controlling violence and gun control in part of the talk is to say that we don't actually the 3 millionp on prisoners or the at risk youth. part of it is saying that if we are looking for solutions to gun violence, we are going to have to look at partial solutions instead of one solution and while i understand the import of distinguishing violence from mental illness because we're are worried about stigmatizing one as seriouslyicans

mentally ill, the schizophrenic are the best example, and those were voluntarily committed, it's an overlapping group. this is ay to look at little bit different and challenging, but look at people who have these traits which are very dysfunctional and have a lot of the characteristics of mental illness. if you have these traits, you're are halfway to some personality disorder, so look at them as a kind of mental illness and ask yourself if you want to invest the resources and treating that and improving treatment modality. you don't get a chance, but i will not give you the chance right now, to clap at that little commentary, but what i would like to do instead is invite all of the speakers at and time up on the platform

i wanted to give our two principal speakers a chance to respond to each other and after that, we will come to audience participation. we have some experts in the audience and that we will take questions. we all have microphones. you can only arrest. excellent points out some of the challenges here. that's light on connecticut where you see that remarkable dip in crime among the when they go in the database but then the limited impact because so few

people are covered in the of people deemed mentally defect is one of the problems. joe, as you were saying, gun violence is a very complicated .roblem pardon the pun, there is no silver bullet to solve it. i think you rightly point out that there are many solutions that are not gun law solutions but in the range of solutions that are gun law solutions, there are many, many things that could be and there is good evidence they are effect it. checks themselves are part of one element of a system

you would want to have worked. there is enormous debate around in theund checks commentaries are very pointed out. background checks on this group of people talking about these whorally prohibited people are in the two categories of .ental illness, fugitives there are a lot of people it doesn't include who are quite and a lot of people it does not include who are probably not dangerous. if you are convicted of a financial fraud felony 37 years dangerousay be less than most felons, but if you have been convicted of multiple violent misdemeanors, you're

probably more dangerous than federalyear ago fraudsters and most states have taken action on exactly those questions. ifcalifornia, for example, you have been convicted of a violent misdemeanor, you lose your rights to guns for 10 years and there are studies to say exactly that approach has been very helpful. even if you have a set of laws to try to keep the gun access away from people who you have good reason to believe are dangerous, you have to have smart policing, innovative enforcement and, again, that is only the gun law and enforcement side of a very complicated multi-factored gun violence situation. >> i appreciated your presentation a great deal. showed the complement

of advocacy and research. i think you effectively used a both thembers to show scope and magnitude of the problems but also its complexity . some kinds of competing conversations here. there is a conversation from the point of view as an epidemiologist looking at the public health-public safety issue. from that point of view, we would like to figure out how we get people to stop behaving violently and how we live at their violence with legal means.

then there is a discussion about mental health and the definition of mental health is wide -- it is quite variable. we could look at violent behavior has symptomatic. then there is another conversation that is important to not only framing the right research questions but framing the potential advocacy solutions and look at the role in advocating people's lives and how active they should be in their policies and do we care more about limiting people's rights or do we care more about preventing themselves from injury? we are looking at this whole with needle in the

haystack events but they have a far disproportionate affect that translates into political will to do something. hand they are important. the people who engage in mass shootings are very atypical of people in psychopathology. moment too use this try to focus on what can be done. i think this is a hard thing to do and i appreciate everyone coming out here to help think about this. we need to look at critical details for policy and advocacy together and i hope we can do that. just a few minutes. we have some people in the who have written on

this or who have a perspective and i wanted to give them an andrtunity to say something ask questions. maybe i will ask john donohue who has written extensively on that guns could actually reduce crime by keeping bad guys in their place. but we are going to follow the gun debate. >> a great presentation by all of the speakers, so thanks for that. i just want to inject into the discussion something that did not come up, the comparative restnce of u.s. versus the of the world. you willesting thing

hear the nra-type talk about is the need for guns for protection and in a society who would take away the guns would be overrun by criminals, it is counter to what we see in modern industrialized nations in europe , for example, or japan, as was mentioned. interestingly, for most countries, the pattern is rarely established that the wealthier you become, the less murder you have in a society. the one great outlier of that relationship, which is a very robust relationship, is the united states. we are a uniquely homicidal country. as the nra advocates have

have more guns than any other society. beyond that we spend so much to suppress crime in ways that other countries never need to express. wethe united states, incarcerate at about seven times the rate of europe, which does suppress crime in a very costly manner, but we would look even worse if we incarcerated in the same ways that these other countries did. i would imagine the relative rates of schizophrenia, of course, are rather common across major industrialized nations, but perhaps you could speak to that as well.

>> i will take a crack at that. is if youiking to me and at patterns of crime countries over the past 50 see is the crime rate in the united states is about in the middle. it's not that much higher, lower, sort of right in the middle. but then when you look at homicide, as you suggest, we are seven times higher. we are way up there. to me, it just makes a lot of to deal with the issue of firearms. if you do not have people behaving in criminal ways, you

would not have gun violence. other countriedon't have nearly as many guns, they still have crimes and people still try to harm each other. they are not as lethal. you have to look at the leth ality of a gun. successful of being in a suicide attempt by gun is about 80%-90%. to me, it is a no-brainer. it changes our landscaper policy .olutions we have tried it. we look at reports of a study -- done in d.c., it affected d.c. and not neighboring jurisdictions. they said it was not

constitutional. >> we don't have an unusual crime problem. we have an unusual murder problem. we don't have unusual rates of mental illness or tastes in cultural products. first person shooters are very popular in other comparable countries. in our movies, what's different is we have a lot of guns and weak gun laws. the question is if this is only a problem that can be solved by getting rid of guns.

it is politically impossible, or is it a problem that we can solve by accepting that we have a gun culture in our country and we are going to have a gun culture where we make it much more difficult for dangerous people to acquire guns, misuse them, hold people accountable for illegally possessing them before they shoot someone. can that work? space, thereative is some evidence that it could. some have not as high rates of gun ownership than the united states but significant rates of gun ownership. germany has about one third the rate of gun ownership, but that's way higher than others. switzerland has a high rate. they also have a somewhat higher than comparable country rates of gun deaths, but they are way, u.s. becausen the they also have very significant laws.

we have a car culture. people love their cars. we have found a way to make our car culture much safer. in the last 50 years for every one mile traveled, the death rate has gone down by 80%. not one thing, drunk driving laws alone. else, not air bags, seat better signage, but all of those things. we managed to do that without making cars exorbitantly expensive. it.anaged to do you still have the car of your choice and we made this car thinke much safer and i there is a opportunity to do that with guns.

the politics are a bit tougher. >> great. why don't we just take questions. i think the way this works is they have a procedure down where someone comes by with a microphone when i point you. c.ere is your mi >> good evening. i want to thank all of you for your comments tonight and i am particularly grateful we have gotten to the conversation around the scape goat that goes on with people who have severe mental illness. we did have a bit of a natural fixation on trying to label and blame these particular individuals. and,uestion that i do have forgive me, because i had to ofte this down is the issue violence as a larger if youogical turmoil,

will. we got into this a little when we talked about youth violence and violence in communities. when we look at last year, the mass shootings that occurred and it took a strong interest in , chicago had as ken issues to this problem all summer. black and brown boys killing and it was not really talked about in the media. surely they are contributing to psychological malfitness. andwe talk about policies how they could properly intervene on that and help to deal with these issues of violence?

>> i would like to start by agreeing with you that violent has a lot of causes and many of them really have to do with social disadvantage, exposure overe's the life course too bad .nvironments the people with mental illness are subject to the same risk factors. stuff we did not show you from is thaty in connecticut the strongest determinant of violent behavior in these people a serious mental illness are age, gender, sex abuse, and minority racial status which is

a proxy for all kinds of social this advantages which we were not able to manage to measure. the demographics to the social determinants and interventions that could improve that are very important. as a political solution, that is something that is a long-term is a lot longer than the elected term of a representative who is under pressure to do something right now. it is a lot easier to do something to change background checks than it is to look at all of the causes of violence and fact is innogenic society.

it is not either or. it is both. who have aeople mental illness, it is seldom in the case that the psychopathology is the master explanation for the violence. people who engage in violent behavior often meet criteria for other symptoms of mental illness besides schizophrenia and bipolar disorder. there are other types of things that joe mentioned. in addition to thinking about improving our communities and having less social inequality and all of these types of things. thank you. >> what makes these mass shootings so different than gun violence, the perpetrators and the ends in the mass shootings

-- and theus on victims are white. they are often in wealthier communities. newton was one of them. they also tend to be months long planned attacks. most gun murders are not planned attacks. , of course, every disproportionate share of perpetrators and victims of gun violence who are not white. think, is thei gun is an ingredient that makes the situation that is challenging, difficult, life ruining for both parties.

18-29 is the core demographic and the person who pulled the trigger is probably in that demographic, too. that's a life where lerner. ruiner.is a life do we need to address all of these underlying circumstances? absolutely. it makes those things that are from crimessirable like that and illegal drug .rafficking, selling one thing we can try to do is make all of it less fatal. >> i am pointing to the person and green. was presentedwhat and the tones through which the facts are being reiterated in the panel discussion, i'm searching for a ray of hope and

i'm not getting anything. i'm getting the sense that the facts are what they are. they write have guns. the fact that guns make this country -- the right to have guns, making more fatal violent crimes. as specialists, what should we be hopeful about? there's nothing here that i'm hearing that's going to change the landscape of what you have the pick it as statistics which, frankly, are just statistics and numbers but they really reflected very sorry state. >> you are in a political arena, so maybe if we can just give that one to you?

>> or there is a fair amount of data to suggest that laws make a difference. there is an enormous amount of research when you put it together that strongly suggests that gun laws can matter in legislation has stalled in congress. not just in new york and connecticut but states like colorado, which passed a comprehensive set of gun laws a and nevada is, one of the houses of state legislature who just passed universal background checks. there is some movement and there is evidence that there is some

movement and it matters. lives will be saved in states and i thinkountry this will put the pressure on to do more of this at a federal level. >> there is a lot of variability .n the rate of firearm deaths what is it about the states that have not as serious problems? .hat may be the key to optimism it is not that it is bad everywhere. there are areas where the problem is far less. >> i would like to throw in the this tot if we expand

include suicide, which is a majority of death, my guess is that the research is going to show that, not surprisingly, if forave background checks people who fall into a certain category of mental illness that we will get more of an effect there. we just have not found it yet. i think that is a cause for optimism. study done here in california showing that people who tried to jump off the 5% wereate bridge, only stopped and eventually committed suicide. there is no reversal of believing that.

>> thank you again for having this forum as part of the class. works with those who have mental illness, can you comment a little bit on the stigma? with mental those illness, there are studies done in the american journal of psychiatry and also the stigma for those who might seek treatment and how policies and even this discussion, how it might affect those people? >> there is research literature on public opinion of people with mental illness. there are a few things there. about 60% of adults in this

country believe that people with schizophrenia are likely to be dangerous which is a huge exaggeration of the actual evidence for it. it's a little lower. it's about 40% if you think about anyone with a mental illness. that's what people believe. second, that attitude is ofually tied to the desire social distance from people with mental illness, tied to support for coercive policies. there is a nexus of attitudes that are related to the stigma and they are damaging the people ath amount of illness -- with mental illness and they have an effect that is the opposite of which iswould like keeping people from disclosing that they have a mental illness. i think it's very important to think about that when we consider policies. there is a policy in connecticut

that will expand the category of prohibited persons to those who have been voluntarily admitted. there's reasons for concern about that. it might have a chilling effect and drive people away from services or keep them from wanting to disclose their .anting to harm themselves reinforcingsults in that everyone with a mental .llness is a concern thatly, there is evidence mediate the trails actually -- there is evidence

about sensational mass killings that are more likely to think that people, everyone with mental illness, is dangerous and have this negative attitude. there is this phenomenon of a self stigma. this is an important part of the problem that we certainly need .o think about >> you were talking about the ofue of mandatory disclosure providers. as you think about that, two potentially negative things would come about that. not tellpatient would the therapist that they were having any eventually dangerous thought because then the police would come over and sees them or their guns. the other one for mental health they would be liable if they suspect did that something may be happening.

those two parts of the spectrum, it could be very difficult. >> yes? >> good evening. my name is nancy stern. i'm retired but i had a 20-year career as a psychotherapist working in mental hospitals so i have a lot of experience with mentally ill people. i have several comments to make, not questions really. why we haveroblems such a stigma against mental illness is, number one, insurance companies don't cover it as they would other illnesses . right there it's being differentiated from having diabetes, heart trouble, or whatever. i think the government needs to do something to make sure that mental illness is covered by insurance companies.

we are talking about a lot of people not really understanding what mental illness is. i think this is something that can be taught to children in school, how i can give you a specific example. my former daughter-in-law is mentally ill and she became psychotic. i happened to tapppan with my granddaughter who was 3 at the time when this happened. she kept saying i'm sorry as if she had done something. i was able to talk with her. your mom has a sickness in her head and she has to go to the hospital. going to thehe is hospital to see a doctor.

nowranddaughter who is eight refers to that time as one mommy was sick in her head. move out of the area. a lot of people still live with their parents. people who care about them, there is a whole different nurturing community. i think a lot can be done. i have friends to say this person is schizophrenic. i say to them do you understand what schizophrenia's? people, mental illness is such an enigma to most people. tohink a lot could be done educate people so there would not be so much of the stigma and it could happen to anybody.

>> keep it short and we can get everyone in. >> there is hope that the brain institute is being established. we supplied taxes so we can do the research. we know that all behavior is due to brain activity and adolescent animals throughout the world. is ampulse control neurological problem, it seems to be. the connections are not right

and we need to study aggressive animals which are different. aggressive dogs are different than quiet dogs and a guide dogs. we need to study people in the same way we can visualize their patterns, we can see what is going on. moneyuld spend a lot of and trying to study these people. mental illness, teenagers, people who commit suicide, brain trauma. to see why the connections are there or what why there hormel stresses. hormonalare stresses. restricted. be

zed more.ublici >> when you have described and thejury well emphasis and priority that the national institute of mental health places on research. -it sounds3 much like very much like let's solve this haveem and then let's better treatment. i think that is important. i agree with you to an extent i would say this. even if we understood that and we had the magic molecule now to vastly improve our treatment. we still have we still have many people who suffer from serious, disabling mental health

conditions and cannot receive the trigger we know works now. there are evicted or they're homeless or they're in prison or they do not believe they are mentally ill and they do not want treatment. until the great hereafter we need to focus on research and policy. and have a system that is not so fragmented and ineffective. >> i'm going to let some other people talk. >> the problem you're describing the i would describe

political problem as a complete distinction between the discussions around that problem. every person counts as one whether there is a suicide or their kids in the inner city. whether there were killed in a single murder or mass murder. badobjective is to prevent things from happening. not to wait till the happen and respond to them. this is in such utter tension policy responses that people have in this country. note's nothing bad if i do see it. there's nothing bad it has not happened yet. an area -- the policy area is

killing us. the question is whether you think there is a way focusing on the gun issue, a way to bring public discussion and public awareness closer to a public health perspective on this issue. or if we are stuck with taking in terms priming event of what really matters. these mass killings and trying to squeeze something at that event. there is an enormous amount of what you're saying that is right. if you look at the post- two of whichies, related directly to what

happened in newtown. the two that related there an assault rifle ban and a high sapacity ban. ose proposals have moved to the state level. this would not have been covered under any version of the universal background check legislation because he got the gun from his mom and took it without her permission. was that a sensible from a public health perspective policy priority, i think it was. there are a lot more deaths that you can prevent with universal background checks that you are likely to prevent with assault rifle bans or high-capacity magazine bands. it would prevent some with both those measures.

of the speak to some advocates, some of the people, who of the policy-makers thought this is the one that makes the most sense. if you look at assault rifle -- it iscity magazines in the high 50's and low 60's. including mass of support from gun owners were to do not say. thesome ways the focus of discussion has been around a policy priority that does -- is in place where publipolitics and public health need. no,t a sufficient junction,

but it is the best we can hope for in contemporary washington. we can stick around a little bit longer. we get kicked out and the lights go off. before that happens, i would like to thank our panelists that came in to talk to us. and thank the students and thank all of you who were students for a day in our class. the good days, i am an easy grader. thank you. [applause] >> as large numbers of protesters continue to demonstrate, egyptian president mohammad morsi was ousted wednesday by the military.

in a statement president obama called on the egyptian military to give authority back to the government as soon as possible. >> this is a live look at the reporting of egypt, courtesy of al jazeera. .e've got a statement let's listen in. or turn a blind eye to that at the egyptian people to live up to its role and responsibility. the egyptian armed forces was the first to declare and is still the clearing and will always declare that it is the standing distance for the political process.

itsarmed forces based on inside unless, of hills that the egyptian people is calling for help. to hold the reins of power. to discharge responsibility and the demands of the revolution. this is the message received by the egyptian army forces. including villages and towns. and in turn, this call was heeded by the egyptian army forces. closer to the political scene. ing terrace trust

and responsibility. the egyptian army forces over the past month have exerted concerted effort, direct and indirect, that contain the subway station -- the situation within. including the president seeing -- the presidency. last, they have called for a national dialogue, yet it was rejected by the presidency in the last moment. many calls followed. many initiatives follow. [indiscernible] the egyptian armed forces similarly on more than one

occasion presented, which contain the most imminent challenges, as the social and political level, as the patriotic indication to contain the cause of the vision, and the challenges to exit the current crisis. as we close, the command of the armed forces melody presidents in the residential palace in 2013, wherein presented the opinion and rejection of the

armed forces of any assault of the state institution. nationale penned on reconciliation, a roadmap for the future, whereby stability are the fuel for the people. living up to their aspirations and hopes. yesterday,esident and before the party, they will not meet the demands of the masses of the people. it was necessary for the egyptian armed forces, based on its stability, to consult with certain political and social figures without finding any

fault. the meeting parties agreed on a roadmap plan, whereby a egyptian coherence is achieved without marginalizing any individual, political party, and putting an end to the state of the vision. suspending the constitution provisionally. the chief justice of the constitutional court will declare before the court the early presidential election, where the justice of the court will have an interim. [indiscernible]

-- during the interim, a government will be formed. having full power to run the current affairs. and committee, including all thecommittees to review supposed amendments to the constitution, which is provisionally suspended. the supreme constitutional court will address the draft for the palm entry connection, and prepare for the farm entry election. and draft a charter securing the freedom of -- [indiscernible

-- having accepted, the egyptian army, the egyptian people, steer away from violence, which will bring about shedding theon and blood of the innocent. the armed forces warned that it will stand up firmly in cooperation with the interior ministry security personnel, to any act be getting from this based on his responsibility. [indiscernible]

formay god save egypt, and the defined people of egypt. may peace be upon you. leahy senator patrick said --

the chairman of the house foreign affairs committee said -- and a few moments, a discussion on whether medicare is the problem worse -- or the solution. and a form of how recent protests and brazil are affecting the country and its plans to host the world cup. and a debate whether there's a connection between mental illness, guns, and violence. will talk with major-general mcconville from bagram air

field. liveington journal" is every morning on c-span at 7:00 a.m. eastern. d -- they thought if they came west they would leave behind the racism. even a more cruel kind of racism. a smile on the face. dagger behind the back was how they describe california. it were not allowed to live in any of the cities, not even the small towns. they were locked out. the only land that was available for them were these patches of alkali land. when you look at it it looks like it is so salty, it looks as if it snowed there. this is the land that was

available to them. they build their wooden shacks here. no water, had to go into town to fetch the water. no city sewers, they had outhouses. no police room this area. it was a no-man's land. african-americans who migrated to bakersfield from the south. historyv and american to be on c-span3. opposinglists have views on whether medicare even as the cost of medical care. by paul howard.

>> good evening. please take your seats. i'm a senior fellow and director of the manhattan institute of center for medical progress. i will be moderating our discussion. there is health care. are paid,health care byzantine, and only rarely visible before after the fact for people who are using the system, the patients. prices vary widely from one provider to another. for similar patients with similar conditions, not just street werehe same sitting across the street from each other. we brought together two policy leaders and analysts to discuss

is dysfunctional and what we can do about it. he delves deeply into the absurd hospital charge master. revealing the pricing system as incomprehensible and absurd. charging the highest prices for people who were least able to pay them. he pointed out that the only force disciplining hospital pricing was medicare. let medicare do what it already does well. we could bring some more to the system.

there will introduce our speakers before we began. is a feature writer for the new yorker and time. he founded the yield journalism initiative which recruits and trains journalists and found [indiscernible] "class warfare" thehow america confronted september 11 era. here is a member of the border of directors for the leap frog group.

he is the author of " catastrophic care." history.a masters in will askboth of our speakers to state in four to five with the central arguments are as to why health care is a dysfunctional and whether medicare is the solution for the dysfunction. the coin tossnk should be two out of three but i will start anyway. thereyou and thinks -- would be more drama. thanks to manhattan for hosting

us. it has been great fun to have a conversation with you. as many people in the audience know, medicare and medicaid were massive. the deck co. introduced the first non-mainframe computer. to give you some idea, the onrage american spent $200 health care that year. let's fast forward to today. muchone is carrying a box smaller than that computer. billion and a half smart phones on earth. the amount 40th of americans will spend on health care today.

in 1965 you would have thought computers were the most complex, opaque, impossible product you ever imagined every person honors carrying. in 1965 you would have seen health care is the most personal service on earth. in some ways is the most important. it would have been inconceivable that the average person would carry something 140 is the cost of health care. happened? one of the things that happened was pointed out truly brilliantly by my counterpart. we have an nonfunctioning price system and health care. it is important to understand to me what is the most interesting thing about this article, it these areparpoint that prices.

i'm going to argue that health care gets us to close. it gets us to look at one aspect of health care and cso and curb weight broken because everything and health care is so incredibly broken that we attribute too much to that particular thing. i'm going to argue that we step back. what you're going to save is the reason health care has been unbelievably expensive while having an adequate or erratic service. true complexity so the average person cannot understand the system at all. both industries were following the underlying incentives.

and health care you make more money by making it more expensive, by not controlling quantity or quality. i'm going to argue that medicare is central to that. the medicare has lower prices and private insurance but the flip side is that it encourages excess care leading to medical harm. notgoing to argue this is just a matter of money. what matters is the of type and reliability of care. with health-care we failed to take advantage of the changes in communication and information. to make health care better, cheaper, and ubiquitous.

>> i'm not going to argue anything. >> i will this get the notion that the smartphone or guillén device that you carry is more complex than medical care. i also will argue that if you look at the various players and compare them, there is all kinds of easy comparisons. $28 to process a claim. it costs medicare 84 cents to process a claim. by every measure, medicare is much more efficient. let's come back to that. the places like to start is how i got into this in the first place. contrary to your introduction i am hardly the four most

analysts of health-care policy. my experience extends to this article. i approached it with no preconceptions. no preconceptions of the kind they came out with. this.s i should confess if i had preconceptions' this was what i reached. the parallel is the public education and the united states costs much more than it does anywhere else in the results are no better, in fact, a lot worse. same thing with health care. i was thinking when i went into this, maybe it is the union's which is the culprit in public education.

the reason i failed is the way i decided to approach this is not from any kind of from a political perspective but just by following the money. during the debate about the president's health care reforms, what i was frustrated by was the debate was all about who is going to pay the exorbitant cost of health care. how do we shift the risk, what kind of insurance should there be. who is right to pay this high cost. the parallel would be the debates we see all the time. you have a terminal patient at the last six months of life will cost a million dollars. is it worth that to keep the patient alive. how come it is $1 million? if that was a $50,000 debate it would be a different kind of debate. how did i approach it? i decided to follow the money

and take a bunch of bills. and see where things cost so much. not where i was came and. where -- where i came out was and this is where i agree with david. there is no market. and the reason they cannot happen is on like everything else except in certain instances, maybe plastic surgery, maybe lasik care, nobody volunteers to become a customer. no one has the information and no one has the leverage. you do not wake up one day and say i think a watered-down to

the emergency room and say what they have on sale today and check out the doctor's and see what their right to charge rav4. how much my insurance is. that is not a voluntary marketplace. that iake the first bill found. here is a man who was diagnosed with non-hodgkin's lymphoma. his wife decided that he needed m.d. anderson center. it is a fabulous place. whenthey arrived, he was told , he had ance he had game. skin in the

$2,000 a day.d to there will not even when you for a $2,000. anderson said we do not think that insurance, you have to pay us in advance. decider treatment regimen will cost $45,000. they had to write a check for $45,000. your first dose of your additionals an $39,000. the had to get their credit card for $39,000. when the credit card did not go through he was kept downstairs sweating and nervous and upset. he had a tumor growing in his chest, everyone knew this. he had to wait for the check to clear. a $4,000 if our remember. $13,700bill was a

charge for the transmission. anderson pays approximately $3,500. the drug company that makes the drug, it costs them maybe $300. for a box $77 charge of gauze pads. when you follow that money, had some a patient who chest pain. she thought she was having a heart attack. , sheours and $21,000 later left the emergency room. her health insurance had lapsed. it turns out when you follow the money in stamford, connecticut the local hospital is the biggest employer, the most prosperous business. it is a bigger business than the

city itself. it takes in more revenue than takes and in all r their taxes. the exception happened to be medicare. the problem was not that there were overhang. , a problem was if anything lot of medicare patients are under paying. they have very low costs and they keep going to doctors even if they do not need to. i had one patient who had 300 $2,000 worth of bills. a lot of it was for serious stuff. he had a heart attack. a lot of it was to get a bunion removed or to go to an eye exam.

to or three times that year. the barn and cost him 19 cents and cost of medicare 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 at it down the middle. god knows there should be medical malpractice reform. that will take away from hospitals the excuse of over testing people with a cat scans and everything else. works.e medicare pays the right prices and anyone who thinks that hospitals lose money on medicare needs to drive on any highway and look at the billboards for all the ads for all the hospitals that are expanded.g that had who are they advertising to?

medicare is efficient, it works. most of medicare is the private sector. sectorre has 8000 private- employees who are contracted out and maybe 700 other people whose supervisors work for the government. questions. of exactly how efficient is medicare? let me let you respond. couple ofstick with a things. i am sure we will have time. private does rely on contractors. it relies on several private insurance companies.

does it seem strange that it would cost medicare so much less to contract out to have -- why is that? i have been a contractor. when new contract out something like ad sales, you give yourself a better deal. that blue cross would charge medicare so much less a processing a client? but we need to understand is medicare of and medicaid, a private insurance are fundamentally different payments that encourage different business models.

what private insurers do, is the do very careful analysis of claims. medicare is a public and political body. in ans for everything undiscriminating way. that means access treatment, and low prices. mcdonald's mixed tons of money under that model. sutta hospitals. medicare looks better because the prices it pays lilooks less.

it is a great business. the head of medicare is the one who says hospitals make my and medicare. let me tell you a story about the efficiency of insurance companies. you abouteed to tell the inefficiency of insurance companies. let's take another example. one of the patients i left -- this article was 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 network. he was working the emergency

room at the passaic hospital. $10,000ed his rates to for half an hour of treatment. aetna patient shows up with a respiratory illness. for ordered $10,000 or six weeks. he billed $3 million over 10 years. aetna pays the bills. i am on the phone with their lawyer and spokesman and now g to get in court suin

their money back. $58 theyd a claim for send it back for $42. pay the doctor $3 million for 10 patients in six months, how did that work? >> we cannot look at every clan. >> i said that is true but could you do something in your system so a bill goes off in the office it is more than $1,000 for half an hour of a doctor's time? we have not been able to do that yet. spent a lot of time at medicare. nearly one of the few reporters who is interested enough. they have terrific computer systems all designed and run by the private sector.

insuranced the other companies do not have. they are really good at it. i know that sounds wrong. they're really doing well. i did the reporting, you did not. bank lookake a efficient by a firing all the security guards but i need to put in the cost of robbery's. the fact that it can process a piece of paper quickly is irrelevant. >> where are you getting $54 billion? >> it is one out of every $11 which adds to 9% to the cost.

the more important for it is i am not saying medicare is an efficient. they are more efficient and private insurance. these are different businesses. medicare is in the business of saying yes to everything. there are no real limits on care. medicare had said we will pay for health care. thia lot of that need is medically [inaudible] the idea that they pay for access care is inefficient on its face. is customer service terrible. the private insurance business marks of the cost of care and sells it to private companies. , there oughtth you to be a federal regulation that you cannot sell insurance

so people who are above the poverty level do not have the percent of skin in the game. econd, you could argue that there are all sorts of abuse in payments. people to catch this stuff and you talk to doctors and honest hospitals, they will say medicare can build -- bureau big pain when they do an audit. the solution i thought i heard you say when we were on a television show recently is that people should have told skin in the game. if i had to pay for everything myself i would be much more

efficient about it. that does not work because i do not know what i am paying for. i have no idea and i have no leverage in the marketplace. getting rid of medicare is not going to solve any problem. thatu're both agreeing hospitals are making tremendous amounts of money on medicare. geren of? >> they're making money. >> they make their costs and a little bit more. drug companies make a lot of money on medicare. >> congress, democrats and republicans alike, have not allowed medicare to negotiate the prices of medical devices or drugs. go back to the leaders in congress and ask them why that is. issues.st one of the it is a political football. it is extraordinarily hard for

congress to keep its hands off or to let the right forces operate. >> the football you would prefer -- >> i can answer that. have ourwe will health-care system determined centrally, the more the incentives will be perverse. it will create -- we will freeze in place institutional arrangements. the question was if we did not have medicare, would we have general hospitals? they exist because medicare part a pays general hospitals. point is that if we assume that health care is different from everything else, ncentives haveentive

driven -- they can put those incentives and. and they should be put in. you're suggesting the alternative to medicare but since you and i agree that we should get rid of the private insurance companies, is what you're suggesting again -- >> we can talk about that. >> let me read you an e-mail i got today -- had a fear we would have the same the billing problems with medical bills.

we made extra sure that the hospital we were using accepted our insurance. despite our best efforts, such a problem has now developed. my wife had an epidural. the doctor who administered the epidural seemed like every other doctor and it did not occur to was that he was not a resident or we would be liable for the out-of-pocket expenses for his services. we had no idea what the bill would be. we could not have asked a -- you canout imagine our shock we found out that the doctor did not participate in our health insurance in the bill would be $3,400. you want to leave people on the roane -- one thing you raising your book.

>> every business would like to be so [inaudible] i got a bill from independent contractor. the hospital swears it has nothing to do with the bill. i have to pay this independent contractor. everyone in the hotel business would love to do that. no one can do things like that except in health care. >> you volunteered to go to a hotel. seen -- yould have would have seen ads for cancer centers. what has changed in health care is there is a deliberate choice by a patient. it would hurt our business if they did. we view it as a cure. [applause]

3 out of four studies confirm it. we talk about health care the where we talk about a tire blowout on a highway. there's nothing you can do. the fat part where most of the chronic being spent is condition management, long-term treatment of things such as cancer, and various replacements we have. for hundreds of years and had to be centrally controlled because everyone would starve to death but health care as changed. it is not what it was 50 years ago when our need was a rare and urgent and catastrophic. this is the biggest industry in the country and the developed world. the idea that because you might

have a blowout on a highway we should govern the entire auto .epair business is absurd because they can get away with it. not because health care is inherently different. >> let's talk about the cancer treatment centers of america. they do spotlight one thing. disease.ofit the drugs cost so much money, everyone is on that gravy train except maybe the doctors.

that is all good i think it is a bit naive to think that someone who has just been told they have going to make the same kind of decision that you're going to make an half an hour about what restaurant. they cannot make that informed decision. >> that is the problem. they have to make that choice. idea is someone who calls you up and said, concerned over that spot, we can check out is absurd. it is just not -- two men, why we created the system in the first place. natomas is in the best position to make those decisions. the problem is, no one else is someone else is paying for it. enormous amount of money to

fund it. one million to $2 million per 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. the way the economy functions -- >> assuming cancer treatment and the network, they are not getting in the way of the decision. peoplee just providing with economic security that they can make those decisions and not have to make them based on cost. cancere thing the treatment centers in america as they are --

>> the only potentially deceptive thing, you may not know it will cost you the same thing as the philadelphia place. >> economic security is another illusion of the healthcare system. >> you have not mentioned the tax treatment. backside that we agree on that. >> i bet we do. it pays people salaries just of a utility infield for the yankees in the bronx.

he said, well, 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 fundamental incentives of the healthcare system, they are for- profit or not-for-profit. tonight, 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 and not a business?