answered and i hope it will be as we move forward. here?, right >> joe coopersmith. recently the director of the --earch program in the v.a. one thing that everyone agrees upon is that costs have to come down and no matter how that is done, distribution, efficiencies, what not, it means money in the system for hospitals and other aspects, less people employed, with a certain amount of economic change for the institutions in the community, because hospitals are among the highest earners in many, many communities in the country. i wonder how you see that aspect of it. you are absolutely right.

the change that has gone on in the american economy is such and the growth of the american health-care system is such that in communities run the country, hospitals are the major employer or certainly one of the major employers. cedars-sinai is the sixth largest private employer in los angeles county, just as an example. at the same time, all of us have to recognize that as organizations, we are going to have to be more efficient. we are going to have to figure out how to deliver care in ways we have not thought of until now. technologies are that are coming along, whether that technology is in the form of new discoveries around molecular medicine and other things that allow total cost of care. we have to work on the issue of total cost of care, not just the unit cost. we have to work on both, keeping in mind what is the total cost of care. over time, using the international comparison that john mentioned earlier, if you look at what are the reasons for

that, i think your observation is correct. those who work in the health- care system, whether you are an executive, nurse, pharmacist, those who work in the pharmaceutical industry -- all the related industries, the compensation levels in the united states compared to other countries is much higher. the question will be, as we solve this problem, what will the impact on those kinds of things be? it is a little hard to see with the light. >> i might just add a point to what tom just said. we can get some efficiencies very quickly. one month ago, we had 35 sponsors. we now have over 135 sponsors of two bills on the house. we now have good studies showing that if patients with cancer and other chronic diseases get good a palliation, you get better outcomes. it costs less. they have a higher quality of life.

we need to implement and make systemwide things that we already know how to do. if we do that, we can get some real results. when you reflect total costs, you're talking about costs that occur at the end of life. we have to have an adult conversation about that and determine what people really want. we have good evidence on that. they want good palliation. >> right. do we have another question? ok. yes? >> i'm from the potomac research group. i could start with pfizer but go down the line -- i'm wondering how you think the new law will impact innovation. it is particularly striking this week in the drug industry that cutting backouse, on research, but there have been

some points made up their that there are some incentives for innovation. >> thank you. it acts as an accelerant to change is already going on in the marketplace. the marketplace has demanding more value at less cost for a while from all of us. has beenn r&d happening for a while across the board. most pharmaceutical companies -- yeah, thezer recent event of the merck layoff is another good example. there are parts of this law that really encourage innovation. the fact that the health insurance marketplaces are patients haveopa choice. that is something we saw through medicare part d. it encourages people to look for value. when they look for value, they look for value in their medicines as well as other services. demand demand's -- can

more value. measures can also go in a way that are shortsighted and purely cost based. inbelieve if the measures the system continued to develop an emphasis on quality and value for medicine that pfizer and other pharmaceutical companies will be well-positioned to deliver and recoup their investments on r&d with the medicines we bring to the market. it is a challenge. there is pressure. that is across the board. >> i actually think that innovation will be pushed by consumers of health care. it becomes more out-of-pocket for folks, there will be more questions about -- is this the best thing for me? is it worth it? is it valuable? isn't there another way to do something? it is going to push all of us to really look at doing things

differently and probably more efficiently and more effectively. it will be demanded. >> i just want to second what she just said. innovationlong with is the demand for creativity. of efficiency and improved efficiency and all asked picks of the system, i think, israel and necessary if we want to solve the problem we're talking about, especially on the cost side. i think that the research community will not be exempt from that. thee is evidence within research community already, a lot of discussion, about how to change the clinical trial process, each think many people find cumbersome from a number of different perspectives. there is opportunity within this challenge. we will see forces encouraging different kinds of innovation. as jean talked about earlier, innovations in the way that we think a lot -- think about our provider workforce and the team approach to delivering care, i

think as more people get coverage, there will be more of an interest in keeping people healthy. so, we will see innovations in that area. >> ok. we are going to wrap up there. thank you very much for a very interesting discussion. we have much more ahead. [applause] with the federal government shutdown headed into a new week, house speaker jon and treasury secretary jack lew are on the sunday talk shows. next, the speakers comments from abc's "this week" and nbc's "meet the press." >> the debt limit is right around the corner. wantresident is saying, i to negotiate. i won't have a conversation, even though president reagan negotiated with democrats who controlled the congress back then, even though president george herbert walker bush had a conversation about raising the

debt limit. during the clinton administration, there were three fights over the debt limit. you and i participated in several of those. even president obama himself in 2011 went through a negotiation. now he is saying, no, i'm not going to do this. i will tell you what, george. the nation's credit is at risk because of the administration's refusal to sit down and have a conversation. >> they are saying it is at risk because of your refusal to pass a clean debt limit. >> we are not going to pass a clean debt limit increase. isold the president, there no way we are going to pass one. the votes are not in the house to pass a clean debt limit. the president is risking default by not having the conversation with us. under no circumstances will you pass a clean debt limit? >> we are not going down that path. it is time to deal with america's problems. >> what would it mean in this country if we are not able to pay millions of people in social security and time? what would it mean if we are not able to pay hospitals for medicare and medicaid on time?

there would be liquidity crises at home and in businesses and in important institutions. it is just not responsible. it is reckless and you're responsible to say, will bring all of that down if we don't get our way. then we need to negotiate. the president wants to. >> let's do the bottom line. is the president ready to watch the country go into default rather than negotiate with publicans? >> the president believes that the responsibilities of congress , this doesn't need to happen. they have a majority to do the right thing. >> will he not come to the table at all even if they risk default? >> i know leaders of congress, republicans and democrats. i do not believe any of them want a default. they will have to look, how do they let a majority in congress work there will? -- their will? >> both chambers of congress are back in on monday. the house gavels in at noon eastern for speeches before returning to legislative business at 2:00 p.m. a number of short-term spending business -- spending bills remain to be voted on by

members. meanwhile, the senate returns at 2:00 p.m. eastern for general speeches before considering a pair of judicial nominations. a votes are scheduled for 5:30. lawmakers of both parties and in both chambers are still searching for ways to resolve differences over how and when the federal government should be reopened. live coverage of the house on c- span, the senate on c-span 2. >> on monday, the senate homeland security and governmental affairs committee will hold a hearing on possible fraud and abuse in social security benefits for the disabled. officialsd former from the social security administration will testify, along with several doctors. it will be live on c-span 3 at 3:00 p.m. eastern -- eastern. >> good leaders, really good leaders are often impatient.

they are often somewhat intemperate. they are sometimes arbitrary. the leader who always listens to everyone, always listens to all the viewpoints wants to make sure that everybody is convinced before he or she finally makes a decision. you just lose valuable time. i think a good leader does have a sense of impatience, is inpatient and overly long meetings in which a lot of make contributions to demonstrate their knowledge as opposed to actually advancing the cause of the meeting. a lot of leaders then violate good management behavior in that they say, stop talking about that, please. we have heard it before. if you don't have anything to say, just keep quiet. we need to get this over with. >> what defines the great leader. idiots."on "icons and at 9:00 p.m. eastern on "afterwords," part of book tv on

c-span 2. >> how living longer can impact social society. officials examine the challenges of living longer and what it could mean for the economy and the potential impact on marriage. the new america foundation hosted this discussion. >> i want to commend you for not using your slides, but explaining that in conversational terms. in thisre interested sort of, what happened when longevity increase last time, i want to plug a great series we did in slate last month, which was written by lauren hellmuth. it really looks at this vast transformation in the middle of the last century. we got people to think about and actually to write in what they would have died of if they had been born in 1900 instead of

more recently, before antibiotics. would you have died of appendicitis? would you have died in childbirth? all these curable and treatable ailments and infections and so on. thes this sort of ghoulish game if you lived a century earlier, what life expectancy would have meant in human terms. weto our final panel -- can live long and prosper? andill explore private other institutions increasing longevity and health. will, one of my oldest colleagues in journalism -- we withtogether for 28 years one gap of a few years in between -- will is the other person you have to read in slate if you want to sound smart. correspondentonal for slate covering science,

technology, politics, and society. [applause] >> thank you, jacob. i also want to say thank you to bob and kevin. that was awesome. that was like car talk about your body. [applause] i would love to hear an hour- long show every week about what you should actually be spending your money on in terms of your payoff. i don't know about the rest of you, but i came here in part hoping to find out some secrets of longevity, and i heard of lot of talk appeared. talk is cheap. the actual behavior is. i have been watching the people from prudential. they are eating the fruit. [laughter] you know who you are.

we are kind of the dogs at the dinner table group. we get what is left. our mandate is, we are going to talk to a little bit about public and private institutions and how they should respond to some of the trends that we talked about at the personal level. here --a trip the group a terrific group here to talk about this. at the far end is gary can make. he is director of security at aarp's public-policy institute. be -- his work focuses on social security, retirement savings, retirement accounts, and the tax policy. he used to be an economist for the joint committee on taxation in the u.s. congress where he specialized in employer-provided pensions and retirement plans. i was talking with kerry last

night. he was there during the shutdown of 1995 and 1990 six. he swears he has nothing to do with it. next to him is wilhelmina leigh. theis senior associate at economic security civic engagement in governance institute, part of the joint center for political and economic studies. she has taught at harvard, howard, and georgetown. she has done work throughout her career in the areas of health policy, housing policy, income security, and asset building and labor market issues. she is also an elected member of the national academy of social insurance. she used to be a principal analyst at the u.s. congressional budget office, but again, as far as we know, had nothing to do with certain events years ago, or certainly the ones not. let me get to michael burt. of the center for sustainable health at arizona state university. prior to that, he was senior vice president at the national

bureau of asian research and the founding director of the bureau's center for health and aging. he was also the founding executive director of the pacific health summit, which welcomes 250 top leaders from science, industry comment policy to discuss how to realize the dream of a healthier future through the effective use of scientific advances and industrial innovation. we had a fourth panelist. we are bummed he could not be here. the chief actuary at the social security administration. steve is a shutdown casualty. i told him he could only do with the checks. being with us here was not essential. we called them and try to explain to the socket -- to the social security people that we were here to talk about raising the debt ceiling, but apparently, the hearing of older people is better than it used to be. they snuff this out. [laughter] we will try to cover for him as best we can. sit down and just a

second. i'm going to throw it open to the group here. we've heard a lot of topics during the course of the day, and i will just mention a couple of things. i'm going to let you guys go, whatever interests you in this group. we have been talking about the general phenomenon of longer retirements and how to deal with that. there are the two scenarios people have been debating, the drooling on your shoes versus living long and prosper in. are there health policy changes that we should consider in regard to trying to avoid the drooling scenario and get the prosper scenario? the gaps between blue and white collar employees and their prospective retirements. the phenomenon, of widows, the phenomenon of greater likelihood of divorce potentially with longer life. savings culture versus culture. do we need to change the culture in this country? are there policy ways to do that?

i guess i will invite michael to start us off. we have been talking a lot about this country, but we really haven't talked that much about the global perspective, what we can learn from other countries, what are the global trends? what are the comparisons? michael is the author of a tryptic piece that is in slate right now in which he talks demographicsnging of greater population proportions at the higher ages and less at the lower levels and some of the implications of that. he also has tremendous experience globally. michael, i would like you to talk about the global context. >> thank you. let me start with asking the audience to questions to get a feel for the audience. one, how many of you like roller coasters? not many. ok. a few. how many of you has been to tokyo? -- have been to toyko?

beijing? taipei? eoul? let me try to connect those two questions. coaster, i love roller coasters. that moment, you are moving up. imagine those cars as you are going up, that the leaders of each of those countries is in a car. at the front of that line is japan. then it is korea, taiwan, singapore, and at the back of this five car train is china. you know that moment when you are on the roller coaster and it is ok, ok, and you get to the top, and then it is that omg moment when you realize there is really no way off this roller coaster. you are on it until it stops. omg moment, orat

omfg moment -- [laughter] that is where japan is right now in terms of longevity and aging. this is going to have a profound impact on us. we are seeing it play out in something called abenomics. i don't know if our economists are still with us. japan is literally rolling the economyits future as an , as a society, as a culture. that it can handle the issues around longevity in a way that would be positive. but if they get it wrong, they are literally at the moment when all of us will pay the price for them. if you don't know this, you should study it a bit. japan's debt burden compared to japan isd states -- 240% of its gdp in government debt. japan is an absolute population

freefall. it has lost 2 million people from its population. those numbers accelerate dramatically. it looks at the roller coaster. 40% of japan's population will be over the age of 65 in 2050. even more remarkably, japan's population over the age of 75 will be at around 25% soon. japan's birthrate is actually fairly high, 1.2 or so. if you start looking at those other cars behind japan, taiwan, the birth rate is now less than one. replacement is 2.2. the birth rate in shanghai is 0.68. these societies -- korea is about 1.2 -- these societies are accelerating. it is going to do this. it is going to have an impact on us.

i first went to asia in 1975. when i went in 1975, chairman mauer was still alive -- chairman mao was still alive. singapore still had riots in the streets. away was still 20 years from being the world's poorest country. can you imagine? japan was just really beginning its economic growth. what has happened in asia, for those of you who have been there, it is literally real-time compression of all of these issues we're talking about that are happening there. well beyond what we are experiencing now. what they don't have that we have -- we think of it as a problem -- immigration. theimmigration problem in united states. this is not a solution available to any of these countries. or what theyacing, are facing, is an absolute

decline in population long-term. japan is already experiencing this. rapidly aging populations. for economists, productivity is a factor of how many people working how hard, and that is your gdp. how do you sustain that kind of economic growth, that kind of future when you have an absolutely declining population? --t japan is committed to do that downward momentum -- it has an explicit policy to print as much money as it will take in order to create 2% inflation a year. that is its policy. wrong, if itat defaults on its government bonds, if it can't grow fast enough to pay those debts, the impact on the global economy is going to be profound. to show you just the back of the train, how much has changed -- if you looked in your clothing labels recently, you probably started noticing it is not made in china.

it is made in indonesia. it is made in vietnam. why is that? something i could have never imagined in asia when i went in 1975 is that there is a shortage of labor in china, a shortage of low-paid labor. labor prices are going up. low-cost producers are moving elsewhere in order to have those products made. indonesia, vietnam, southeast asia. aging, while longevity has its individual impacts, the way this is going to play out on a global level is already hitting us here. it is real-time. we are not sure what it is going to be. it is not just u.s. policymakers deciding what happens in the u.s.. u.s. going to be how policymakers respond to what is happening in aging populations around the world. >> thank you, michael. todaywe have been talking

, a lot of folks have been talking about retirement savings and social security, some of it at a personal level or corporate level. what should we do at a policy level? what reflections do you have on what we have heard? >> one thing i just want to touch on what michael said -- we are talking about longevity, but part of the aging of society has to do with this drop in fertility. i heard the solution earlier today, and that was baby factories. i don't know how we do it. we heard earlier in the panel before us, we know that people are going to need to save more. whatever the scenario ends up being, we know that people need to save more. lives will have to be part of the solution. in terms of savings, we are seeing something that we know is working. for example, one thing is automating the system. electd of having people into a 401(k) plan, have them automatically enrolled. they do not really opt out very much.

there are ways to perfect that, because right now the way it typically works, you auto enrolled him at 3% of their pay, which we know is not enough. we are that is where seeing a lot of promise. more companies are doing it. we need even more companies to do it. at the baseline, we need more topanies to offer a plan save. that is the most efficient way for people to save. so, we need to get this 50% that was mentioned earlier up either through carrots, sticks. we don't like to talk about a mandate, but maybe we have to go there to get more people saving more money. >> a mandate? that should be interesting. [laughter] you might get a couple of shutdowns over that. [laughter] wilhelmina, we have been talking today a lot about the existing -- we've heard the numbers

30 years and 50 years thrown around -- are those trends increasing? is there a prospect of them growing? what should we be doing in terms of all of our policies, whether it has to do with health research or asset building or incentives provided by the government, to deal with that problem? >> thank you. question,very loaded but i have been listening all morning and have plenty of food for thought to bear on that. if you look at the gaps that gaps -- if you look at the that existed in life expectancy between blacks and whites in 2010, and if you look at causes of death and which causes of death were the major factors in causing those gaps and life with they, you come up usual suspects, some of which

the previous panelists talked ofut in terms of the values research and the values of life -- you come up with things like diabetes,art disease, homicide, and believe it or not, paranasal disorders. those are what you come up with as the cause of death factors that have bearing on the difference in the life expectancy. nchs thats done by looked at this. i'm not going to stop there. i'm going to say, ok, these are the major causes of death of everybody. most people die from heart disease or cancer. those are the number one and number two killers. if these are the major factors that contribute to the gap in life expectancy between blacks and whites, and these are the only two groups that were

mentioned, by the way, in 2010, then something else is going on there. everybody dies of the causes that i named, except for homicide, but there's something else going on there. and askthrow that out us to think about this in terms of, how do we deal with closing that gap so that perhaps all of us can live longer and prosper? the world health organization had a commission on the social determinants of health in 2008. i'm going to quote from them, because they say it better than i do -- the circumstances in which people grow, live, work, and age and the systems put in -- into deal with illness other words -- the conditions in which people live and die are

shaped by political, social, and economic forces. if you look at the context of people, there are, as have been saying throughout this session, there are places where there are huge gaps in life expectancy very near to each other. for instance, the city of , the poorest have about a 25% shorter life expectancy than the wealthiest. place matters. the social determinants of health matter. the gentleman in the previous session made a point about education. stop and think about the census tract in which the schools are not adequate. food deserts. even if you want to eat right, you cannot. there is no transportation

system public that can get you where you need to go, either to jobs or buying better food. it is not necessarily safe. people don't have jobs. they become more like reddit spurs than human beings. -- creditors than human beings. is such ay homicide big factor among life expectancies. my point here is, if we want to think about moving forward to that option c, live long and prosper for everybody, then we have to think about focusing on whether the social determinants of health and doing something to close those gaps that make areas like those census tracks that i talked about, or even places in appalachia, which are not healthy and people have shorter

life expectancies than in other parts of the world, were people on american indian reservations who have shorter life expectancies than others. the short answer -- going into the future, i think we still have gaps. i think what we can do about it though is focusing on some of the broader social, economic, demographic place-based types of issues and addressing those. >> thank you. we have several different frameworks we can talk about here. i would like to start by -- with a very concrete question, which is, when we look at these numbers of increased longevity and increased health spent, i believe the retirement age in this country has moved from 65 -- is on its way to 67 that anywhere near where it should be, and if it is not, iat we need to do to change

the retirement age for social security or some other policies around that program or programs such as medicare? , the fullial security retirement age is 65, and it is now 66. born ining up for those 1960 or after. this happened because of a policy change in 1983. it was to address the shortfall we had at that time. i think we are still seeing what the ramifications of that are. one thing wilhelmina mentioned thisf we are seeing increase in life expectancy for different socioeconomic classes, i think there is a question -- what is the right policy? one policy may not be the right policy for everyone. earlier,ed this working longer is going to have to be part of the solution. it is part of the solution for people's individual security, but also for our society as well in terms of the stresses in

these programs. we had this question earlier -- some people may not be able to work longer for health reasons, for job reasons. what we are seeing now in this economy is that if you are over 55 and you lose your job, you are out of work, seeking a ploy meant, for almost a year. those are folks were still looking for a job. we know that if you lose your job later in life, you're going to have a tough time getting job, and making up for those lost years. there are a lot of things that need to go into that consideration of what we do in terms of how we address these programs to make them sustainable. >> michael, are there things we can learn from the way other countries have dealt with these policies? >> i think so, but i would also like to make a comment about using age grading as we get older. we live in a very age-grated society. we all enter elementary school at the same time.

we get a drivers license at the same time. the drinking age is the same age. we have had the 65-year-old retirement age. out, the health- adjusted life expectancy in the united states has gone up to 68 years old. i think it is that average age when we first have our -- when we first have our chronic disease. we are falling behind the rest of the world in the process. we are lower in the international rankings than we were 10 years ago. we have improved our health life expect -- healthy life expectancy, but we are not doing as well as other countries in that respect. challengee biggest for society in dealing with this issue is not to use a one-size- whatall approach to longevity looks like. as we get older, the very human

variability accelerates. people at 65 are dead. i have friends who did not make it to 65. to try to create that one-size- fits-all retirement age simply does not take into account the phenotype, genotype, our life experiences, by their very definition, create individual variability. what society needs to be creating, and maybe the --dential folks and others the value of this is to provide different responses so that people can live different kinds of life as they age, rather than loveg to find -- i would to have had our social security howarial person yohere -- do we increase choice rather than decrease it? >> i have to say this.

part of our mandate is to talk about policy. when you say, we don't need -- i always hear politicians say, we don't need a one-size-fits-all, but if you're making policy, does kind of your job. he have done policy. first of all, -- we have a couple of folks who have done policy. just say, how do we deal with the problem of one-size- fits-all? we have to make policies about retirement and health-care spending. given what everyone has observed, which is the enormous increase in variation, as michael points out, what do we do about that? >> i think one of the things that would help is if we could consider being much more flexible in the workplace. when i say flexible, i mean, when someone gets to the age of 65 and they really can't get up and get to work every day and they really can't do a full days , theyfive days a week should have the option to work four days a week or three days a

week. there are ways to prorate whatever benefits they get to go along with that, but seldom does that happen. --re are a few employees employers that offer that kind of option. in terms of policymaking, you could pass a law that says, the workplace fox ability can be established. it can include things like this without a mandate. i think setting those hard and fast age limits -- i understand it for budgeting purposes for forrams -- but setting them telling an employee that he or she has to stop working when they may feel perfectly capable of continuing to work, but perhaps for three days a week instead of for five days a week, and making the workplace that.

>> when you are talking about this, how much of this is economics, and how much a visit culture? do we need to change workplace culture? is there some way that politicians -- perhaps not amended -- how would a policymaker go about getting employers to think differently about people at age 55? >> i don't know how you can get people to think differently about people at age 55, but i do think that it is sort of like the law that was passed that transformed the signing up for in to an optan opt out. as i understand it, the way that law was framed, it gave employers the option of establishing the opt-in as out forto the opting the sign-ups. it wasn't a mandate, but a law

was passed that said, yes, an employer could change their program so that someone -- so that employees would have to opt out. that has made a world of difference. you have found lots of employers have gone all the way with that. that is the way i think you could framed something. -- frame something. >> in thinking about this, i think with the increase in longevity, people are at risk of outliving their resources. there is a lot more uncertainty. i think there is uncertainty now, but i think there will be more uncertainty. it is a for retirement, simple question of how much should you save for a secure retirement? it is a competent question. you don't know. you don't know how long you're going to live. tell me what you think you're going to get in return. i think there is a potential role here for policy, and it could be private or public solutions.

so, the longevity risks -- if you can do something, maybe in social security or maybe in something else, where when people reach a certain age, their benefit actually goes up, higher than inflation, that is in some ways taking care of that tail risk of increasing longevity. it makes the problem of solving how much i need to live to 80 a little bit simpler to solve. >> interesting could -- interesting. there is one more question that i am dying to throw out to the panel. i don't know if anyone here feels comfortable addressing it. if you don't want to, you don't have to. the scenarios schedule presented at the beginning, when i think about the drooling on your shoes versus the live long and prosper, i wonder -- i have seen lots of politician stand up over the last 48 hours of talk about nih, funding and research is

very important -- i wonder whether there are smarter ways of allocating money we spend on medical research. are we spending too much on the kinds of research that lead us to the drooling scenario and not enough on the kind that leads us to the prosperity scenario? terms,ut it in computer are we spending too much on the hardware and not enough on the software? eiko, did you want to -- >> this is a problem i face daily. i used to be the interim director of the bio design institute. the u.s. has this magnificent engine for what is called discovery research. that is what the nih funds. we have great scientists. we developed world-beating technologies at the discovery level, but what also sideways -- the u.s. is not an exception -- we lack the ability to translate that discovery research into the kinds of daily applications that really make a difference in people's lives. -- itatistic that is used

takes 17 years to take a discovery research finding and translate that into practice. think of that. even if there is an invention or a drug for alzheimer's invented that is already there right now, it is 20 years before it actually gets applied. the lag time and this translation engine is a huge problem that we are not facing and are less likely to face now because of sequestration, shutdowns, and that ceiling issues. folksyou can see, these know everything. ask them any question you would like to ask. i believe we have a question better to start with. >> alan abel. could we get back on the roller coaster? let me propose a scenario. immortality is unsustainable. people keep having children. you cannot have an infinite

number of people alive grid from a policy point of view, could there ever come a time when governments would have to say, there is a tough cut off at how long you're going to get social security? we will pay you until you are 125? not necessarily put the grand -- the grandparents on the ice and pushed them off, but is there an upper limit? euthanasia, but benefits and policy, when you are 160, you're on your own. could you ever see that happening? >> i don't see that happening. i don't see how that happens. 150,er someone is 100, they are someone's parents, grandparents. i can't see that happening. we know that right now as people age, they are more likely to be in poverty. john mentioned earlier, a lot of these folks are widows. i can't see us getting to a point where we say, ok, enough is enough. you have had your fun. that is it. i don't see this going there. >> x question.

-- next question. the microphone is coming. it seems to me that there is an area of social research that has been neglected. that is, how to get people to defer gratification. what i understand is about half the population is capable of deferred gratification and half is not. when we make social security available to people at 62, we should not be surprised that the majority of people actually take it then, even if it is not in their long-term best interests. i don't know that medical research is the research that we most need if we are really going to improve quality of life and healthy years. maybe we need more money into education throughout the lifespan. maybe that would have a bigger

impact than curing cancer, which we all want, but which would only add a very tiny increment to longevity. >> i heard from both will the both wilhelmina and gary, opt-in and opt-out. a mandate. would something like that be able to do with the problem of deferred gratification? do we need a broader policy changes? >> one of the parts of the social determinants of health is clearly, people, and if we put our money into looking at those causes of the life expectancy gap, then yes. it is education to make people understand why they should make choices of a certain type or why making choices to get your money at 62 might not be your best interest. -- in your best interest.

that should come along with educational programs that are better overall. >> can we tinker with the incentives? >> i'm not optimistic about delay takingple to social security benefits. we have tried. i think we could probably do more, but i think there is a temptation there to grab it while they can. when you have conversations going on about social security being cut, it is not going to be there, it doesn't really engender a lot of confidence in the program. i think there are things we probably can do that we can borrow from to change it from and opt-out -- from and opt-in two and opt-out. reframing what we call the early eligibility age grade i don't know. it is an issue that i think we need to get people to wait as long as they can to claim social saturday benefits.

-- social security benefits. it is even a better deal right now to wait. >> in answer to your question, john, it is an area of huge interest in behavioral change. asu is right in the thick of this. , thiss like fitbits integration of physiological and behavioral metrics that will be around behavior change in order to intervene earlier so that it is not a cure for cancer -- it is a delay of cancer. a delay of disability is the real game we are in. we are not going to cure these diseases. you die of something in the end. how long can you delay disability is what an actuarial will point out. behavior is part of all of those diseases. the biggest part, absolutely. that is the exciting area of research, i think, and it is

really fun to see what is happening right now. >> i think we have one other over here. thank you so much. it has been wonderful. regarding policy issues, a lot of unhealthy food, i understand, is subsidized in our country. looking at the disparity issue where the poor and minorities don't have access to healthy food, what are your thoughts on policy changes to actually bring what we know is healthy to the citizens that need it the most, in addition to education, medical care, and things of that nature? thank you. >> one of the things that has been experimented with, experimented in places like where there isan

lots of land -- houses have been torn down, there are not that many people living in so many areas -- is to develop urbanm farms. there is a program, and i don't , to what they are called encourage people who are living there to grow their own food. there are programs to also get schools started, kids growing food. once people see this and once they taste the real difference in the quality of food that has been thrown in your backyard without a lot of pesticides and transported hundreds of miles, once people taste the food and once you make it more readily accessible, people will buy into it. one of the other things is co- ops, farmers markets, people who

come from nearby farm areas into .rban areas, food deserts -- one of the policy measures that is a good thing is what used to be called food stamps is now snap. many farmers markets except those now. -- accept those now. that is a step up. it allows people who may not have had enough money to buy at whole foods -- it gives them an option. >> one comment i want to add to that. from what a lot of what i heard ofay, both the convergence lifespan or the diminishing gap between socioeconomic groups, and also the increase from 1900 to 2000, infant mortality, the biggest bang for the buck in

efficiency is to target populations with the lowest lifespans. on a sheer utility basis, it would produce the biggest gains for the money. is that fair? >> i would say targeting the areas where they live. matters" "place approach. targeting those areas and bring in resources that people do not have on their own to help them make choices. one of the previous speakers indicated that he was coming to washington, and he wanted to see a specialist, and he called them up two weeks in advance. i thought to myself, how many other people do i know who would think to do that? then be able to get to see the hip specialist? normally getting medical care and things of that sort you know, you have to get in a line. it doesn't come that quickly and easily. there are things that can be done to help give people

resources to empower them to think about things they can do to improve their health, and thereby, lesson that life expectancy gap. >> we have a question at the front table right here. john turner of the benson policy center. this was mentioned by lisa earlier. something called bump up benefits. technically, it is called longevity insurance. considered desirable because it provides tail risk. it is really insurance benefits. i think it is a great idea myself. earlier,king to jamie and i asked him why prudential does not offer this type of benefit.

he said they thought about offering the bump up then if it were longevity insurance -- bump fit ora fit -- bene longevity insurance, but they just did not see a demand for it. i wonder whether there could be some discussions about this type of benefit, a bump up benefit, and why it would be desirable or not, and who should offer it. >> would anyone like to feel that? -- field that? >> john knows that annuities are not very popular. don't want to give up a lump sum of money to get a small stream of payment for the rest of their lives. it is not surprising to me that people are not demanding those. it is hard to think -- i find it hard to think about what things might be like when i am 82 and what my needs might be.

i'm not surprised that there is not the man for that. this may be a case where there is a need for government to step in and to fill that gap. i think there is a need, even the people do not recognize that there is a need. i think there is this tail risk that is a problem for people when they are planning for retirement. again -- yourlity suggestion is a bump up. the man in the back of the room was talking about a bump down strategy, which also would kick in. [laughter] >> there were a couple more of you with hands up. we are out of time. till free to come up afterwards and ask any questions. is there anything else you guys wanted to add before we concluded? thank you very much. [applause] thanks to this panel. jewel, a few parting words. >> thank you very much, that was

terrific. a lot has been made about behavior modification. thesehearing about all of savings, how great savings is. i was thinking of the two stock market crashes that my 401(k) went through in the last 15 years. i was surprised nobody brought up the idea of putting wall street out on the ice float. that is for another day. [laughter] there is going to be -- as james said, there will be more coverage about one jodi on slate. -- about longevity on slate. have a video of this up on the new america foundation website soon. god bless c-span. that means you are going to be able to watch this at 2:00 in the morning for the next 150 years. [laughter] a few thanks to the incredible people who put such tremendous effort into bring this together. faithlessness, -- faith smith, becky.

a special thanks to prudential for helping underwrite this. thank you all. have a good day. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2013] >> on monday, the senate homeland security and governmental affairs committee will hold a hearing on possible fraud and abuse in social security benefits for the disabled. current and former officials from the social security administration will testify, along with several doctors. that will be live on c-span 3 at 3:00 p.m. eastern. >> i have been asked periodically, when were you most afraid during your government service? my service in government spanned the entirety of bush 43's administration, from january 20, 2009.o january 20, including 9/11.

when asked, what was the scariest moment, i think people are always expecting me to say 9/11. in reality, for me, it wasn't the scariest moment. there were more than one. 2008mber and october of when it is genuinely appeared, and probably was true, that the global financial system was on the verge of a collapse comparable to or worse than what was experienced during the great depression. >> this weekend, part one of our conversation with former white house chief of staff josh bolten, tonight at 8:00 on c- span's "q&a." >> c-span -- we bring public affairs events from washington directly to you, putting you in the room at congressional hearings, white house events, briefings, and conferences, and offering complete gavel to gavel coverage of the u.s. house, all

as a public service of private industry. we are c-span, created by the cable tv industry 34 years ago and funded by your local cable or satellite provider. now, you can watch us in hd. >> congressman jeb hensarling, republican of texas. part of the republican leadership team in the house of representatives. thank you for being with us. >> good morning. >> let me introduce our reporters. from "usa today" and washington bureau chief for "the washington journal." we are all interested as the debt ceiling date moves closer, what you see as the endgame for what is going on with the standoff on the budget in washington. how do you see this all coming together and ending? >> regrettably, my crystal ball is a little fuzzy. house republicans have now put one offer on the table, a second offer, a third offer, a fourth offer.