when we have maximum chance. this was not a grand strategy. it took a lehman types of and. >> it is true. i had just become the chairman and 2007. my republican colleagues forgotten they had run the congress until 2007. two thousand 3, 2000 4 -- i was a minority. tom delay would not consult me. hank talked about this. i do not angle we could do it. here is where we were. there was partisanship. as i did not think we could do it. that was the partisanship. you have the chairman, a very honest, deeply conservative man. i spent much of 2008 defending hank and been -- ben. they wanted to have hearings.

over bear stearns. that was hard enough to get it done. i agreed with them. it was no way that the withution procedure intervention that we had in there. ss the government will come and take it over. it would not have flown. i want to add this. sometimes we make a mistake. it is driven by the perceptions of voter sentiment. the tarps a great success but hated. media, itians, the makes me nuts. the voters are no picnic either. i used to say that when i was in office. >> born had a quote. -- oh barney had a quote. the stitches are not so hot. -- the constituents are not so hot. >> you have this ideological

tremendous intervention. you step in and to get rid of the board of directors and you fire people and you take the shareholders' money. it was a hard enough job for me as chairman. i would never want to put it to a vote of the action by the fed being so active. it would've failed in committee. said youmously have never want a serious crisis to go to waste was dubbed i believe kristi -- waste. -- doubly kristi made a comment. somebody asked what that meant and -- >> i do not know. yearsiven we are five after a financial crisis, the frustration in the country, the

fact barney has said tarp may have been successful but deeply unpopular, to the crisis go to waste but mark sump -- waste? the program was not popular. >> i made two points. to talk about the financial crisis. landed on the president's desk was a crisis. in of the transition, i went to see president bush. out, $24 billion to the automobile industry. industry, the auto gm/chrysler. we are going to give them six weeks of arriving room and that is all. out the auto industry was as unpopular as

billing out the financial -- ba iling out the financial sector. the autoleaned up efficiency which was delayed for years.s old up 60 -- 30 now.are profitable more people working in the auto industry including suppliers today than the price before hand. that is a crisis and all the decisions -- making sure the financial community and the organized labor, everybody is in the game and has a hand on the bloody knife. the auto industry is a lot more competitive than it was pre- crisis. that was the crisis in use to resolve a decades long the decisions that were deferred and delayed and finally made. think financial side, i

we are far better than where we were at the beginning. there are some things that need to be done. i would include the auto industry which is more competitive than before. i will give one example. the ford auto plant in chicago added a third shift, 1200 jobs, 900 suppliers. the plant that exports to six in seven countries more than any other ford in the united states. that is a rebooted, retold industry. you cannot to do without a crisis. and i ask thist of everyone, wasn't there a way to make tarp more clinically palatable? i didn't know if would ever be popular. -- i do not know if it would be popular.

what could you have done differently? >> i did have a bumper sticker that i use in 2010. i was persuaded not to. it said things would've sucked worse without me. [laughter] slogan.tical that was true but not helpful. two things. one that people think when they have both would not have been -- it would've been helpful would i have been. to disagreements. one was whether it we should go over the bonuses will stop -- bonuses. that onle biggest point was overwhelmed us was during the aig bonuses. the mob was in the street with pitchforks. i worried about our capacity to govern. we could've done more. the only thing and hank thought

it was important to get the money out. the second inc. is why did you do more to use the money for mortgage? we had of the argument. to sell the bill to democrats. we would have mortgage relief. we have to give this money out of locating it -- complicating it. a legitimate difference of opinion. the first at 50 went out. , it isber saying to hank good public policy. 0 went out.t 35 obama said, ok. ist people should look at the extent to which this affected by the fact that some the most important decisions taken by the government was taken during a transition. people,sked the obama

the response was i got back, we only have one president at a time. i was a little frustrated. thought it was overstated the number president we had at the time. [laughter] here is the deal. mortgage.h done a the people thought it was popular is wrong. those are strong conservative argument. i pay my mortgage, why are you taking money. there were some people who bought a house. and it went up and property. and they took out a home equity loan and bought a boat. in the end, that was not much more could've make it more popular. fundamentally, there's a belief of fairness. you take a risk and you bear the consequences. we had to violate that in order to save the economy.

you violated the core beliefs and it leads to great anger. whether congress today would be to act, the fact that congress is so polarized is a result of the actions we had to take into thousand eight. not a fair question to put the congress in the position. we created this. things. you cannot take a $750 -- $750 billion bailout and make it popular. not possible. not possible. it was ugly. it was going to stay ugly will stop -- ugly. it was fundamentally ugly. you had to overwhelm the system politically because you thought the end goal is more important. -- >> can i add one thing can i add one thing? it was taken as close to an election as possible.

think this congress is a reflection of those decisions will stop -- decisions. . say this about redistricting the system is set up for the voters to take a representatives. that's why you have a dysfunction. it is turned the system upside down. >> what we could've done, we should not have chosen a four letter word to be the acronym. the term became a means of itself. the relation to the legislative vehicle. the timeframe was so condensed and the crisis so acute, we do not have the time to do the politics. if we had at the time, we could've made a good case that the folks on main street were the ones in this was about. not the banks. when you went to your business, that would not have enough business to open.

to are not to be able to go your bank, it would be close. we do not have the time. >> at the time -- >> i would like to give my time to neel. >> at the time the vote went to down, i would argue that you and the president -- and then senator were very magnanimous and supportt tarp tarp. when you tell about the popularity or not there could be an argument made that electronic wasn't the president became the a number ofe made calls calling the bankers fat cats and making a number of comments that were somewhat prejudicial around tarp and the recipients that some people would argue made of the program less popular. do you buy that? >> and no.

i saidto agree with what in a moment ago. the program was not popular. we are two months before an election. i'm a proud democrat. i put my political aside. barney, we were the two point people for the democrats. entire house of representatives. i didn't act in a sense of partisanship. >> i agree. i agree. >> number two, the president in his first speech to congress said he would ask for more money if it was necessary. not to just under tarp. we had a big debate in the white house -- we may have needed more money.

the market needed to hear that he was willing to go went get more money. to stave off the need of the pre-crisis need for that. he came to the aid of the fed. bankers are not the financial system. do not confuse the two. he was willing to spend political capital on the thing that was very unpopular and ask for additional resources. he said that in his first address to the united states house of representatives. the issue he brought up as it relates to compensation and bonuses was the first issue when we were first debating. he did not say anything that has not been set prior to that. >> i think you have the cause and effect backwards. the anger over the money being given to the banks was enormous.

a large number of people were losing their homes. intervening to help people foreclosed upon was a much more controversial issue than people thought. do not give them money. they do not deserve it. it is moral hazard if i stop paying my mortgage. why should i pay on time? obama having defended this policy of giving. we knew what was loans. the we couldn't be sure if it would be repaid. giving money to people who had been part of the problem. his criticism was probably a political necessity on his part. it was an effort to drain off some of the anger. we have two periods here. before and after the aig bonuses.

chris got unfairly blamed. he said you cannot do a retroactively. that is one all of the anger unleashed. >> but whatever political demonization happened, whether or not, myssary question, i go to you, neel, is this. originallyp. was conceived, you thought the banks were going to keep the money for how long? is reason i ask the question because they gave it back very, very quickly. some people think that's a good was nott clearly that part of the plan. >> we wanted -- our entire goal economy fromt the collapsing so we wanted to put as much capital in the financial writ large at possible and have it sit this so we it to be at least three years and have it sit there for a period of time. for politicalged reasons and pitch forks came out and they paid it back very

quickly which was like a patient giving medicine back. you need the medicine to work through the system. a lot of us were concerned when the banks paid back the t.a.r.p. they did and that was in response to politics. >> the notion that these poor we hurt their feelings, all these very rich, very well people, get over it. that's tough. i was appalled by their maybe becausety we're in a business where people say rude things about us all ale time but what i was told, two of the things that were necessary alleviate public anger, were one of the things that drove them, one, compensation restrictions and two, than anticipated their damned airplanes. i was struck by how much the fly in your own plane meant to those people and how restrictions on being able to fly around was a problem and it was also the political thing but frankly, we who had voted for it, the president who then

it, the the outgoing president, too, but frankly, we were attacked, too, it didn't occur to us to think, oh, these poor people, people are them but i believe this was not stimulated by the politicians but was genuine public anger. >> in point of fairness, the house republican leadership stepped up. john boehner, eric canter, paul ryan. all are characterizing them. >> they replaced their negotiator because they wanted be participants. >> they wanted no negotiator. >> yes, they did. and replacedce them with lund. they still had a majority voting against them. >> i understand but let's give it's due.re >> in my experience, when the house republican leadership they do better than the minority of their own party. aboutave reservations

that characterization. i think a lot of people went to the floor on that monday and they thoughtuse the leadership had the votes to pass the bill and left the floor quickly so they couldn't be gathered back in. >> those are the republicans that -- on bothnk that was true sides, by the way. much -- but --so >> nobody ever casts political side.on your one, judd, wait a second. politicians and it's about politics. since you ask political questions, you're two months before an election, this is a freebie on the incumbent party. free shot on goal without a goalie in the goal box and the party, it was a majority, voted for -- it was fact.popular after the it was unpopular while we

it and unpopular when we implemented. it was unpopular and you can't put lipstick on that pig. the majority of our party voted an incumbent with president of the other party that would actually help solve a thelem and the majority of republican congress voted against it even with their own president in party. political vote two months before an election and if you don't think that's true, you don't understand how of economics and politics work. >> rahm, i'm just stunned you're a more forgiving person. >> i am on a one-on-one basis. you.ery forgiving of i was locked in a room with you for 48 hours. senator, let's talk about what happens with bipartisanship at midnight. take us inside the room. >> can i say, judd, you had your your house colleagues where you know full well -- forget the leadership -- they were not leading their members to a yes vote to defend owneconomy and you had your

views where you realized they were not holding up their side if some ofain even them like roy blunt wanted to. plausible deniability on that issue. ini know the story, it's hank's book, maybe you can retell it for a second. you're in the room. midnight. to you might be there, too. i think barney's there. >> barney was, and so was rahm. of you. >> i would like the deniability now. >> this was at sort of the crux. this was the moment. thing was going or not going and this man, mr. paulson, i think, was throwing up he was so anxious about what was happening. >> he was concerned. rahm and i were with hank in an ante room and rahm and i went lastth barney and the issue was restitution. secretary and i made a proposal -- secretary made a

was in charge. about 3:00 in the afternoon we'd been going back and forth and neel was active in this and finally about 12:00 we couldn't agreement and we were throwing up our hands and it was just the three of us in the room and i remember rahm specifically saying, ok, and you and rahm went in to see the speaker and i don't think this story's really told. and i thought it was over. i thought we'd lost it and we the dealwe had to have that night because the asian were opening the next day. 10 minutes later, the speaker came out, looked at me said, going your way, it's done. i don't think the speakers got credit for that. i don't know what happened in room but believe me, if she had not done that, there would have been no deal and she's gotten credit for it. >> for that reason, judd gregg's on time going to leave today. >> let me go back. there's a fundamental difference is -- not just partisan. the difference between the two

it's been abeen, movement in the republican party from the kind of mainstream you, of bob of dole, of both presidents bush, not acceptthat does the notion that the public sector must play a significant role. our party's at their best, we know there should be a public sector andprivate fight about where to draw the line. >> that's not the majority of our party. that may be a loud function of the party. the partyhe part of that's intimidated the rest of the party in the house. i agree with that. but it's the perception of many house republicans, that's where the primary voters recalled turn primary and was a that was -- >> not -- >> you just saw that happen. also saw the speaker take it to the floor. >> after a great deal of crisis, the floor with a gun to his head. >> pretty big -- >> the gun was at his head. you brought it up. >> i don't want to get us off on

a tangent. not a tangent. i'm sorry, this is not a tangent. this is not a small thing. think you have a serious problem going forward to the a group ofhich republicans in the house who do not accept the ledge missy of function of the government have the agree of influence that they have and i think that was a factor. as far as nancy pelosi's concerned, her cooperation started earlier. 2008, in january, george bush need anus and said we economic stimulus, the economy's trouble and pelosi came back to us and said, we need a stimulus for the economy, republicans won't support spending, they have to be tax so i'm going to say yes but they're the most progressive tax earned income tax credits and there's a fundamental difference between

given therties today influence of the tea party on the sense of how much do you sacrifice of your own views to the government going and within the republican party in ae house today there has been scary diminution of that commitment. >> at the risk of not making my flight, you're absolving the president's role in building congress.ges to the a lot has changed since 2008. >> no, let me say this, george i were not pals. i never had a serious with george bush andwhen he sent paulson bernanke up to tell us things collapsing, we responded of it wasn't schmoozing george bush. >> i'm going to go with barney and we'll go down the line. borrowed some of my time. >> you're generous. >> he is my former chairman so i be. to >> j.p. morgan is in the midst

$13 billion settlement, in part related to assets it acquired during the financial crisis, both bear, stearns and washington mutual. i'mhave said publicly and curious if your view has changed since we last talked given emerged aboutave whether you think government be fining the company for buying -- not for buying those assets but for whatever sins happened to those assets that were purchased during the crisis with a little bit of push if not bit of push from -- >> it's been refined. i've got more facts. myould say, first of all, to recollection, the washington mump and bear, stearns were not the same. there was much more voluntary activity on the part of j.p. morganchase for washington mutual and similar with bank of america. pushed intoica was taking merrill lynch. buying countrywide was one of

ideas he had and it was his idea. i differentiate. that'sgard to wamu, no, totally there. with regard to bear, stearns, you used the word fined. i think it would be not just policy to bad public fine them for having acqueases pressure from the federal financial people to take over bear, stearns. leave aside equity, there may be federalrequest by other financial officials to a bank to step in that way and they'd be much less likely to be cooperative. to the extent that you can say made are people to be whole because of things bear, stearns did, that's different but as far as penalizing them what bear, stearns did before they were pressured into accepting it, i think that's a mistake. mr. mayor, what do you think of that? the next time the treasury bank during as a time of crisis, do they hang up on him?

whatm not -- i don't know they would do. i can't speak to that. emphasize, i want to what barney just said on this one part -- which i think is an important point -- we are at a that j.p. morgan had to get bear, stearns because you the lehman moment earlier. bear has j.p. morgan because they did something they initiate, we solicited them to do, now we're holding them legally responsible for we asked them to do on that time so on that piece of the settlement, i don't know how it specifically represents, i think that's -- i mean you're government'sthe being given the position to look back and rewrite the rules of what actually contextually happened in a way and bearing people responsibility when actually they didn't come with the idea of buying bear, stearns and absorbing

them, we asked them to do it and now we're saying you're legally culpable. it's double jeopardy. >> final question, if each of you individually could have done one thing different during the crisis, either before, after, don't care, individually on your own, what been?it have we'll start here. this a lot.out i think the communication was the hardest thing we struggled describeuse the way i it, we had one microphone but two different audiences. wanted to project confidence to the markets but wanted to let know how terrified we were to catalyze them to move but if we let the markets know we were, it would have been destabilizing. we had a muddled message. i don't have an answer to solve that but maybe better the congress with so they knew how terrified we

were. have made theld political process easier. >> rahm? >> i haven't really thought it.t i don't know if this would have worked but maybe forcing the members to pute somebody in the room with us so they would have had more final product,e may have changed the context of the vote. if you changee the context of the vote this would have been popular and publicly accepted. don't like bailing out people for decisions they had to make. >> judd? honest, i think for my part and my role and where i was asked to do it, was minor in the sense that i was just carrying senate water, it was a team genuinely -- is don't think there was ever a government,was in when i was governor, five of our largest banks failed -- i don't think there was ever a government was in

when people worked so consciously on both sides. the moste of impressive points in american history. >> we got a friendship out of it locked in a room for a long time. learned a lot about each other. >> i agree with judd and i want important point because people claiming bipartisanship is broken down. but it's notlems systemic because we're talking, but five years ago in very difficult times our structure of government worked very well. problems have been political. secondly, what i would have done -- here's one point i wanted to make. one of the things people don't understand are the limitations legislature.he you cannot lead from the legislature. it's partly political. give you a football analogy. the best blocker in the world is protects his quarterback not going to get the attention of the guy who leads the league in sax. the legislation, there is an incentive to be on the attack because if you're

supportive, the executive gets credit. so that's the leadup to saying this. regret not having fought harder for more mortgage relief in the beginning. not so much to make it politically acceptable but i believe the lack of mortgage became an economic drag on the economy, that that was a problem but i will say the i didn't was this. you have two choices at some point when you're in the you say yesbranch, or no. you don't say yes, only here. my conviction was i pushed as hard as i could but couldn't the trigger of saying no so that's my answer. >> can i say one thing? this is an historic moment. barney used a sports metaphor, i think i've ever heard that in all the time i've served with him. open it up to the audience. a hand with the bow tie in the front. stand, state your name and the question should end with a question mark.

my name is eric westham, fourth year at the university of chicago. was wondering, i know that while there are 435 members -- congress ands of 100 senators, not all of them are experts in economics and i was wondering what sort of impact that has on any sort of concerning the economy as a whole and how much that hinders effective policy. thank you. >> i want to speak to that quickly. panelist is alluding to this. people inink most congress knew this was coming. i genuinely don't think within my caucus and the senate that anybody thought this was somebody. and thisddenly woke up was on top of them. it was a fascinating situation. some of us who were involved had been talking a little bit about it but nobody saw it coming in the congress. reason was, to some extent, you couldn't alert

people it was coming without it on further. you were in that dilemma where you couldn't talk about it but to answer the question directly, the way congress usually works to there is deference experts. there are only a small number of experts on any issue. do you, as a what do member of congress, you figure the people whose judgment you trust, whose values are generally your values in terms of goals and then you follow them on the issues where they are experts. and that is often the case, economic issues. the situation here was this transcended this. this all of a sudden broke through it but that's generally what happens is on each side are people who have the expertise and they basically and the other members tend to follow. >> mr. mayor? >> two quick points. congress -- the house is set up to be specialists based on committee assignments and the senate is generalists.

same kind ofve the distinction and i think that barney -- to echo what just said, there's going to be a few people, colleagues they'll for their judgment and background. there just say also this, were not a lot of people even had an congress that experience with a major financial meltdown. recent experience as a country was a sector called the industry notoan mutual funds, banks, investment the financial system and insurance companies so we didn't the country, it didn't exist. let's be honest, we were making going on theere seat of our pants and that was true for us in congress, the administration as well as who wereutside commenting and for all that, we well.etty >> there's a question right there, sir. tannenbaum, chief

economist at the northern trust. editions of t.a.r.p. were relatively short on specifics. amory serves, it was relatively brief document with a large number in it. i have a question, first, as approval was contemplated, was the lack of detail one of the reasons why consensus was difficult? and then one of the pivotal moments i think as we think back t.a.r.p., is that it had been intended first to purchase bad assets out of the banks and find behind them and then it pivoted to being a bank recapitalization tool. at what point that was decision made and on what basis because ended up being very important. >> both points. the original bill was three was neverthat intended to be a full bill. that was a description of the authorities we needed so we sent to congress saying, here are the authorities we need, let's craft a bill. obviously, the interpretation of especially in the press was this was the full bill and it was never intended to be the

full bill. in terms of the pivot from buying assets to investing in equity. moved in lightning speed just two weeks from when we asked for the authority to got it whichen we is extraordinary but within two weeks markets cratered and we intended to buy the collapsed as markets beneath us, we had to move much, much faster awdged that's why we made the change but to our credit and congress' credit, we designed the authority to be broad enough that we could make those decisions if we had to. >> there was consensus. mentioned spencer bachus, in the meeting, he was the senior leader of the republican minority at the time and when presented with buying out the assets, he was one of the first in the meeting raise the notion infusion so capital there was consensus, no fight, secretary the authority to do whichever, either, both, some mixed so that

out of the deliberations in that room. there was necessity to do something about compensation. for reed talked about need repayment. and there was general agreement we needed some of these. became a little bit controversial but the notion of going from buying the assets to capital infusion grew out of a there wason and general agreement. we don't know what the hell's going to happen, let's give them authority to do what makes the most sense and there was no criticism that i recall when he was theand when decision made, as i recall, after the bill had passed and authority.ry had the >> when it shifted gears from a three-page document to a very long document was when a decision was made to mark up the senate bill, that was made thursday morning. it was a big mistake but that's the way folks wanted to go ofward so we spent most thursday trying to clean up the senate bill. flexibility, as i recall, the only thing that secretary paulson asked of our

the senate, in the negotiation, he wanted two things. andanted a lot of money total flexibility. those were the standards we were told to fight for. going to squeeze in a couple of more questions today. ari tandler, second year majoring in economics and science. in the past when there have been historical problems and come up andat have updated into ideology now worked for facts -- ronald reagan, it will work now. how do you reconcile past competing ideologies into making to resolve the current crisis and can pass through the government? get thatad to question. i'm very troubled right now that we're not doing that. this, a little off topic, but i am about to submit the regulators dealing with residential mortgages, very much opposing

appears to be their major proposal. we talked about this before, lookse in the process, it like, their favorite proposal is one that would effective do away with risk retention in home 100%ages and allow securitization. we set up three categories of mortgages, made it impossible make them. the great majority, you should keep 5% of the risk if you're going to securitize them ones with noer risk retention. they're collapsing, too. i'm surprised at how quickly people have in my judgment forgotten what was one of the and i'm just somewhat disappointed, hoping this sogoing to change the answer is there's no pure guide against this. there's a lot of political pressure both from the banks and the loan advocacy groups. they are channeling a "wall fewet journal" article a

weeks ago that attacked me on sub prime loans because i was keeping poor people from buying houses so i don't think we've found a way to do that effectively. >> sir? >> ken monahan. neel mentioned at the beginning of this that american democracy good at fixing problems but not heading them off and the preceding panel talked about the involvementernment in the mortgage issue that are ongoing. an you think, is it constitution issue? how should the government go about trying to address the are on thenows that horizon now, having learned what headinglearned from not off this thing. is it possible or are we doomed to repeat it? my view is that human civilizations are prone to mass delusion. it's funny but not funny. i bought a house in california in 2005. bubblet see the housing alang and i think if

greenspan, in 2005, had said we and i'mousing bubble going to clamp down on mortgage beenng, these members have outraged their members would have been kept from americanting in the dream so it's hard for one omniscient person to see else seeswhen nobody it. we have to do our best but human history is full of financial because as a society we are prone to delusion and unfortunately it's probably going to happen again. rahm? >> let me say, i don't think, to events.stion, take two in 1983, there was three months securityhe social trust fund being able to pay. it took the three-month window set of decisions that o'neel andan and tip baker worked out. judd said something, true at one level, but i disagree, more time

t.a.r.p.n the i don't think our congress regardless of who got blamed, time, wouldith more have been more thoughtful. you needed that crisis moment to move. infrastructure, on immigration. all of those are in our own economic self interest immediately in the long term. how are we doing at resolving them? to need kind of a moment crystallize and force an action beinghen you're thoughtful you can see it in front of you but you can't do it. that, unfortunately, is how the political system works. on the other hand, this gets to what barney did say and i joked it's serious. you're not going to get leadership out of the legislative branch. corrallingy good at votes. leadership comes out of the executive branch that provides a direction, sets goals that the legislative then run move peopleir -- towards the barn door and that is how the process works and

ofating that moment is part what leadership out of the executive branch can create to with solutionsp a little ahead of schedule. >> oneness? defense of democracy, i don't see nondemocracy doing all that much better in anticipating problems, either. i wouldn't blame democracy but lack of human forsight and inability to see what's going to happen. >> diane swonk. neel, you made the point about needing to invoke confidence in financial markets terror in congress. is maybe that lack of messaging that didn't happen then part of problem today in terms of gridlock and what it's costing the economy today? talkedsituation, we about this earlier, we're not at a -- the crises we're facing self-inflicted, created by political dysfunction situation isk the fundamentally different today but i share judd -- ultimately i

optimism, that i think if there were a national crisis, a real crisis, you would see together and congress act in a more rational manner. here.al question over >> stuart lucas. how do we create the political to resetnces re-districting to a point you raising earlier. >> mr. mayor? >> look at california, arizona, iowa. it out of the legislative body. to do it, if you think my analysis is right about what the problem is, that's the first question, i happen to think. then what you have to do, where it has succeeded -- california example, arizona's an example, iowa where you bring competition back in. referenda. >> you got to basically take the legislators out and put it into a court/nonpartisan analysis and that's what i would do. >> before we go, because i see you have your paper there,

barney. to tee this up for you. >> thank you it. >> you want me to tee it up for just go?u >> you tee it up. >> is this going to the floor? >> no, i -- you can't >> you were about to release a paper. >> it is an official comment on regulation before the agencies that are in charge of the statute with dealing with risk retention in residential mortgages. >> that is going on today? >> the deadline is tomorrow. legislation, we band the .ad kind of mortgages they said i was keeping poor people from buying houses in subprime was fine.

that is exactly right. you can read it. >> es copies for everybody. to the great bulk of mortgages, they were qualified mortgages. those mortgages, you would be able to secure them, but we asked for risk retention. five percent of the risk would have to be retained. that would incentivize them not to provide junk. democrats,senators, listening to people in the mortgage industry, would put in mortgageed residential , stupidly confusing. those mortgages were supposed to be a supersafe category to securitize. to my dismay, the major proposal of the five regulators is to -- to combine the two,

the other you can make without risk retention of any case. you heard that before. this is been the single biggest cause of the problem. i am hoping that they can be dissuaded and have risk retention as a rule of argument. they don't know how to make mortgages without risk retention. it apparently means no mortgages were made in america before 1980 when i came in. >> we are going to leave it there. this is been a remarkable three. thank you for the conversation and the questions. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2013] >> on the next washington journal, discussing last week's

virginia governor race. our guest is matt lewis. after that, rob richie with the group "fair vote." he talks about the gridlock on capitol hill. later, a conversation on u.s. surveillance abroad, and how it is affecting diplomacy. the council on foreign relations joins us. we will look for your comments by phone, e-mail, and twitter. washington journal is live every day at 7:00 on c-span. now called the mercedes-benz superdome. built entirely at the public expense after hurricane katrina badly damaged it. , butwas a feel-good story the public pay for all of the

repairs that put in a token amount. the public invested in today's dollars, about billion dollars of the construction of the superdome. the man who owns the new orleans saints keeps all of the revenue generated there. --hink that people rebel at one of people rebel against this? most people do not understand what has taken place. they feel is nothing they can do about it. it is based on insider deals. it is largely based on insider deals. the most recent on the was a vote in miami was a vote on whether they use public money to renovate the place where the miami dolphins play. they voted against doing that. they got to vote on it. easterbrook on q&a. >> coming up, a conversation on hospitals and the new health care law.

goldie hawn talks about ways to improve childhood education and a look back at the 2008 financial crisis. how was handled at the time by lawmakers. former health and human services -- and bill grist. this is 45 minutes. >> hello, everybody. my regrets for coming at the time i did. i was supposed to be here a little earlier. i'm delighted to be here because this is such an important part of what "u.s. news & world report" does, which is to provide information of high intellectual content and activities that is almost

unavailable in the country. i wonder if you might venture to a grade to the implementation. >> i'm glad i am a cardiologist. it has been very tough. if we not to do anything, when not to do software. to see whether this is going to rollout, which i think that it the states they're doing it themselves. they are ready have the platform . they're registering hundreds of thousands people for medicaid. the ones that are running their own exchanges have them up and going for the most part. we do not have enough of them that are running their own exchanges are registering people on medicaid. i think we have enough time that

we are going to get it right. we must have everybody enrolled. there is no way that we are going to be able to continue the cost shifting that has been going on our we are going to be will to deliver the things we have talked about unless everybody has insurance. it has to work. are justical problems that. technical problems. i haven't heard anyone say that they are designed problems. we know we have large numbers of uninsured. we know we have to get insurance. we know some of the need to be subsidized at the end of the day. we are going to have to get that done. i think there is enough time to do it by march 1. >> do not know if anyone wants to -- i will just turn attention away from the hot topic of the .ay an interesting thing in the post

this week in, it was an article about implementation of the whole affordable care act. davidited a letter that cutler sent to the administration early on after the law passed. it was interesting to me that one of the things that cited was not enough attention to provider engagement and getting the provider community bought into all of the changes ever going to have to take place. you lead one of the largest provider organizations in the country. if you think about the transition ahead, and making the changes that will be needed, how do you think about those challenges question mark how we one side oft from the river to the other? anyway that allows us to continue to bring in great care? the would amplify about implementation so forth. it is a relief. we have to be patient.

we will get everyone it needs signed up. cycle ands new instant gratification by everyone, we are all appear with our cell phones and blackberries, and we need instant gratification now. big about when medicare was introduced. i think we have to be patient with that. this is a big question about engaging with providers. comments,e kind of the doctors do what you pay them to do. ins is going to be a change focusing on delivering the highest quality care while at the same time providing excellent customer service. that is a different paradigm.

i think it is going to be an educational process, a changing of the culture. think about the large hospitals that have multiple product -- private practitioners or inside a university system, where even the university does take into account quality often times in the promotion of an appointment process. it is going to be a big change, and there would be bumps in the road. reward the bull basin quality outcomes. we have never been charged with doing that. bigust want to do as many volume cases that are cases. is going to change. one of the things that i am concerned about is when you use

volume as a metric for reimbursement, to have a level playing field to define what the quality parameters you're going to use. , data came outgs of new york that was exporting of the difficult cases west of the cleveland clinic. i think that whether by design or just by circumstance, there may be a de facto rationing built into this because we are not going to take on the tough cases and not offer the services. >> we know we need to get from one side of the road to the other. i think everybody is clear that we need to say we are paying for value. is not aware we need to go that is a problem, it is how we build the economic model.

i'm still, as we heard earlier, a lot of my business is still in fee-for-service. how do you think about managing the transition economically? >> i'm going to escape to her think the puck is going to be as wayne gretzky said. we think about the implications of how to decrease readmissions as toby was saying and how to manage chronic care outside of the hospital. i think there has to be an incentive put in place that changes the behavior of providers. as we're speaking earlier, there has to be some shift also to taking away some of the things that physicians have done in moving it down to extenders, whether it be nursed practitioners, nurses, pharmacists are working together as a team. but an incentive that drives behavior. there is a recent paper

verifying the surprise that pay for performance actually changes professional behavior. >> one of the things that here is that we have to get out of being in the hospital business and in the care continuing business. to think about the whole patient across all that sides of care. you have been a leader in your private business and in the policy world and thinking about how to rebuild out a more robust continuum of care in different settings and get patient involved. help us think about what that means for hospital. >> is your party touch on the big changes. people ask me all the time with the biggest change that we are undergoing. metalico the change today. i think the biggest change that we are seeing that can be transformed -- the shift in

risk. money flows, winners, losers, also efficiency and waste. risk used to be in the purview of government of the big pay orders out there heard with obamacare big celebration, the risk is shifted to the providers, the hospitals, the doctors. that is what is new. hospitals don't know how to manage risk. it never had to do it. now it is in the providers. so the hospitals are what we're are talking about for the next couple of days. the consumer is the new element. this consumer is going to be for you stay competitive in this new

world. you're going to have to focus on consumer-based experiences that go all the way from scheduling, how easy it is to see a physician or a team come how long it takes, how you were treated. much data is given to in your pda and your personal device, do you get laboratory tests before or after, what is that follow-up to keep you not in the hospital but out of the hospital, which means the hospital is no longer a structure, but like bob says it is an integrated system to keep people out of the hot -- the high cost to a low cost side of care. i'm optimistic about that. i think the government has made think the government has made a disaster over some very good principles in obamacare so far. time to recover, but we will

see. i think the leadership has been poor, it has been laid out poorly, it hasn't been done well here it am very optimistic and here's why it is so important what you're all talking about the next several days. technology today, ipads didn't exist three years ago. now you have a hundred million out there and we all depend on them today. 94% of people have telephones and 54% have smart telephones. the associate economic -- that empowerment of data, and data is not electronic health records. information technology is not electronic health records. government pushed a set way. information technology which is going to drive the innovation which is going to be consumer driven, not driven from above, is going to be automation, decision support to make sure the right decisions are made

with the resources that are available by doctors at consumers. it is going to be the connectivity which means an investment to get those tentacles out there to do the outpatient care/inpatient care. the big data means data mining, the sort of stuff we couldn't do before. in some ways to stay competitive you're going to have to have consumer-based experiences. the consumer is going to be technologically savvy in terms of prevention care treatment and it will be driven to the connectivity and automation in the decision support in the data mining that is available. if we use is effectively, you can stay competitive and patients can have better outcomes. >> one of the ways that consumers get to help care is through the employer and to the pay or indirectly. what doctors i can see, what hospitals i can access heard a lot of the benefit structures are determined by employers. that is changing now a lot of the way employers are purchasing healthcare is beginning to

change. employers are getting impatient with cost of healthcare in the traditional benefit structures. from your perch, thinking about benefits for employers large and small, where do you think the purchasing behavior drives a hospital business in the healthcare business. how is echoing to change over time given where employers are going? >> employers have always been uncomfortable with the rate of inflation in health care, but they've always manage to pay. are the outcomes of the aca is the excise tax cap that hits in 2018. you can complain as much as you want about the law, but gives you an out as an employer. i've yet to meet an employer is going to pay the 40% excise tax on the system that the already consider efficient. we have established a ceiling that employers are willing to pay. i think what the senator pointed out is that consumers are going to be exposed to more risk. it is going to come in one form or another. when people start to see how much more they're going to have

to pay -- tour only two ways for an employer to stay. the unit you have to raise deductibles or out-of-pocket limits. as a general rule of thumb for every dollar you try to stay under him premiums have to increase maximum exposure to participants by two dollars. if you're talking about $50 is not a big deal, but if you talk about a thousand dollars that's a huge exposure. if you're a hospital that is a huge exposure and uncollectible debt. the second side is if an employer doesn't do it by increasing exposure to participants, they're going to have to focus on much narrower networks. right now the whole network selection criteria has been make sure my doctor is in, make sure my hospital is in and make sure all the others are in, too. most of the networks around the country are established to include everyone. i think what we're starting to see on the public exchanges and we look expected an employer around is a lot more of these specialized narrower networks. if you try to go to a large

employer occupation and sarah will give you access to 50% of the providers in the community, there is an upper. if you go to an uninsured population that is had no covers before and say i'm going to give you coverage a half of the providers in the community, that is a win for everyone. i think as those networks are to get filled, people that are in these bot access net shipment of access problems of their own, you may go to a less efficient provider. so there is a lot going on in the employer community. not just about how we do it smartly because there's a plot of moving dynamics because the uninsured have access to health care. that is good to be a take issue for people. >> this change in high deductible, there are some good things about that. i does bring the consumer in. the consumers we are going to be bringing in for obamacare to work is going to be a younger population. so deductible five years ago was probably $500. now it is $2500 for most companies. so 30-year-olds are going to be

forced today, mandated to get everybody in the insurance pools who will have deductibles of 2500. plus they will be paying a thousand to $1500 and they're going to be the ones going to the pocket, pulling out an app and pushing a button and saying ok. i need an mri. i have -- my physicians as a do and push a button it is going to cost $2200 at the center over here with very well known academic health center in $1200 in green hills and $300 next- door. and the quality is the same on the same machines and this button is telling me that. all of a sudden it's going to have a huge impact in terms of the power of the consumer who is empowered with a bucket of money now, namely their own money, to shop and the system is going to have to respond. to me that is going to eliminate waste, inefficiency. 30% of the three chewing dollars being spent today that doesn't

go to federal patient outcomes, to me that his rate positive. of course i am more optimistic about the future, but technology will allow and empower the consumer to make those decisions. >> i think it is a really important trend. if you are a high-cost provider, that say a large academic medical center or a big specialty practice, you are probably at the high end of that pricing list on the app. let's just pause -- which is positive the transparent world, the prices are going to a lower level. as revenue that is supporting a lot of other things going on in medical centers. i wonder, from the perspective of the university of miami, how you think about the economic pressure that this puts unsustainability of these important centers? >> there will be tremendous pressure. particularly when the government

is reducing the amount of research money that is coming in. you have no place to cost shift to. the fact is, we're going to have to live in the real world. we are going to bring our costs down at the same time. were going to have to eliminate overhead and do all the things that other providers have to do heard i'm closer to the employer than the provider, so i see it from both sides. i don't think academic health centers will get off the hook. if we are 20% more expensive now, we're going to have to bring it down so that we can compete did i would point out, though, that most people who come into medicare have not have a lot of choice. so they're really coming out of hmos, out of narrower networks. so moving medicare to narrower network, moving medicare to less choice, may not be as big a jump as some people would suggest. i would, though, say a word about people that can't afford high deductibles. we have used -- we have to be

very careful about price sensitivity for poor people, for old people. you're bringing in a lot of young people into obamacare, but we are also bringing in low income workers. with that group we're going to have to be very sensitive about whether they're really going to have real access to health care system if they come in with high deductibles. it will be just as bad as the current system for them. that is what makes it so complicated. the different kinds of patients and people that we are doing with, some of them can live in a world with very high deductibles and others are going to have to be looking forward. or we will end up with lots of charity care for the in between's. >> i would echo what president shall ayla says. -- of what president shalala says. some of it is made up by the more prestigious places through philanthropy recruiting talented individual to get more grants.

you can never make up the overhead by just indirect costs coming back from grants. i am concerned are there has always been this healthy tension between the dean of the school of medicine and ceo of the hospital about fans blowing how you support the academic mission. that is going to be even more difficult as time goes on. i agree that in order to be competitive, the inefficiencies within academic medical centers, particularly hospitals, and a lot of it has to do with trainees responsibility and ordering too many tests are not the right tests, we're going to have to fix that. there has to be a lot of attention. i think that the really good

places will get this figured out and it is artist going to happen. toby showed the graft about the u.s. a consortium people. they're focusing on that now and improving quality and holding costs. that is going to be the ratio we have to watch. >> we took 900 positions out or academic health care center. physically there were administrative positions. we're are doing that corporations are doing. we looked at our staffing and we protected the clinical side, but we took a whole layer of administrative cost, recurring 40 of $50 million in recurring costs. we had to do that because we can see what is coming down the pike. we're going to have to be a much more efficient organization, both for employers that are sending patients, but we are employers to.

we can't afford high cost academic medicine as an institution. >> i think academic health center, as both of your very involved are, for most people in the room, we all need to define our goals. our goal today are patient outcome. we have artie said that, but now for the first time come over the next five years, reimbursement is going to follow outcome of the patient over a continuum of care increasingly with bundling and reimbursement for one year, post transplant. increasingly we are going to move to more macro bundled in person. for most people in the room, the goal for the hospital tomorrow is maximize outcome for existing resources or maybe less. your role is a little bit different because this maximizing patient outcome that you need to train the cardiac

surgeons of the future and the primary care surgeons of the futures and the nurses and the team-based approach -- >> and research. >> and the third column is research. i am academic or had been. you need to justify the $60 billion of research or 20 billion or whatever it is going to be. we need to have a team-based approach. the team-based approach where nurses are elevated, social workers are elevated very the team is responsible for a population more than the individual. if you need to train them. the time to get on the real world it is too late. we need to put a price tag on that but you need to justify that. for most people the hospital tomorrow is not going to be miami or even cleveland clinic, but maybe less so, it is going

to be the other four or 5000 hospitals out there that have to survive. i would again come back to say that survival will be patient outcomes measured heard those were the reimbursement is going to flow. it will be driven primarily by consumer engagement and experiences with 200 million people changing the system instead of just the hospitals. >> so do need 5000 hospitals in that world? >> probably not. if you say we have three trillion dollars, three percent is wasted, but teenage 5200 hospitals author -- but if you have 5200 hospitals out there, in terms of delivery of services, but how you actually go on and get your airline reservation, is not the way financial services is done today.

that is going to be the difference. if you have appropriate allocation of resources where every hospital didn't have to offer all 20 different services, of course you don't need 5200 hospitals. >> i would agree with that. but there was describing, we have seen it in our communities, this arms race of have one hospital gets the latest greatest mri scanner, then the other has to have it. that is going to be over. that's going to be over. if you look at the margins of most hospitals in the country, that's in the low single digits. a lot of these hospitals won't be able to survive, nor should they. i don't think we need all the hospitals you have to answer your question directly. it will be difficult to make that transition if you're not part of a bigger system because that's going to be where you get the critical mass and

actually, the quality of administrators and leaders to make these things happen. >> so we have to change the model of care it sounds like. >> right. >> we can't deliver care in the same high cost and we have to find a way to distribute the care and deliver more team based care and so forth. where are all these deliverers of care coming from because we have a little bit of a supply and demand going on. we don't have enough doctors to deliver the primary care over the next 15 years. we certainly don't have enough nurses today and think of where demand is going. you spent time working on health care. how do we produce enough capacity. >> let me say, donna, she's the best to answer this, 40,000 primary care doctors, two short of the next eight years and is using the conventional 40,000 doctors are needed today.

that is before, if obamacare is fully implemented, another 30 million people coming into the system who don't have insurance. when somebody comes into the system, their health care spending goes up about 50% more than what they spent through the system. we're 30 million people coming into a system that were 40,000 primary care physicians too short before factor coming into the system, donna, what do we do? >> we stop thinking just doctor and we start thinking about how people are trained and allow people to practice up to their training. e fact is that nurse practitioners can handle about 70% of primary care and we should be using well trained primary care doctors for the ambiguity. and this is the point bill has made. we've got to create teams and that means physician assistants

and nurses and pharmacists and other care providers working as a team, we have to get over the hierarchy. we have to take on the scope of practice rules state by state, ifness, because that's what re strains us from crating these teams in many ways. we have to look at how people are trained and train them better and the fact is we could handle this primary care if we can deal with the scope of practice issues in almost all of the states and if we can overcome our reluctance to talk about teams as opposed to hierarchy. will we have to train people in the future? yes. but we have to train them better and then use them up to the level of their training, and i think we can handle it. it is true when you bring new people into the system, most of them have been getting health care in one way or another probably a little more expensive. health care costs will go up initially as they did in massachusetts as people run to

the doctors to get their physicals. that can settle in with very good nurses and physician assistants and these teams of caregivers to organize primary care, chronic care management and life care. there are lots of things we can do if we can kind of break down the barriers across the board. >> i think the policy is important but it starts more fundamentally at -- doctors don't like teams. we're not going it like it, not trained. the patient comes to the door, you're the surgeon, he steps in and you've got to fix it. all the team stuff, listening in a collaborative way listening to people we want to cut, fix, get it done. hat's how we're train. in all seriousness, thesis a cheap solution.

but the practice of medicine today, you're not trained -- medical schools are not trained. business school today is trained with a team of six people, not three or four but six to address an issue to get an outcome that allows collaboration, leadership, distribution. that's not the way doctors are trained. they probably are now with both your centers, i know. but they're really not trained very well to be a team-based approach where you're taking care of eight doctors taking care of 5,000 patients and not 1,000 patients. it can be done. doctors don't need to be making all those decisions but the system has not yet responded and that's going to be after my sort of risk transformation and innovation through patient engagement, the third big transformation will be the team base approached as you described. we're not there yet and everybody in every hospital needs to encourage it. if you have a doctor's lounge you have to integrate social workers and integrate the

epidemiologist and integrate the youngest specialist and doctors just don't like it. >> economic incentives are driving us that direction, in patient safety, in the readmissions issues. we've been forced to put teams down er to actually drive those costs so we weren't penalized. i happen to think in one sense will change the culture through our trainings, through team training. we're doing more, nursing schools and medical schools are doing more training of the groups together. i also think you can drag it with economic incentives. i don't care how people are brought up. i care whether there are incentives out there that can change a drive in behavior and that's what we'll have to do. >> doctors do what you pay them to do. the other thing is the game will shift from the inpatient side to the outpatient side and to the home. so unless we're going to get a

black badge and start doing house calls which i think is a pretty cool idea but probably won't have time to do it, we'll have to deploy these other assets and leverage the training of these other individuals as i think you said , up to their level of training. because the game is going to move into taking care of patients in the home. there are even programs now to start to begin to train family members as more long-term care roviders for chronically ill people. when patients go home with wounds, oftentimes the family member takes care and changes the bandage and they're a little freaked out by that at first but learn how to do it. i think the game will shift more to the outpatient home trying to prevent readmissions will be a huge thing. >> let me come back to you for a second. i'm just imagining all your nonhealth care employer clients listening to this conversation

about a big line item on their budget and the people who provide that service. gosh, we don't like to work in teams, we have to figure out the systemization thing and how do we standardize and deliver a quality product? we've got to figure out how to use data and we are making big ingestments -- investments in data and we want to buy more scanners and more da vinci robots. how much more will the employers stick around for this story versus saying i'd rather not be involved in this health care business anymore. why don't you all do this on your own, employees? >> large employers are still relatively committed to providing the services. they actually do care about the health of their population and care and think they actually can help them do it better but they've also got the excise tax hanging over them and know that's the maximum they'll have to spend. i think employers are more inclined today than five or 10 years ago to actually partner

with these hospitals and local communities and figure out how do they position these alternative settings of care and get that out there. the big part is overcoming the sense it's only being done to bring the cost down and really trying to educate the work force on these things we're talking about improve the quality of care at the same time we're bringing the costs down. employers have gotten smart on how to position some of that stuff and will make a big difference and pave the way for these initiatives you couldn't have done 10 or 15 years ago. >> i think -- over the last 12 years, regardless the employer, 60% of all employers 12 years ago provided health insurance and is now down to 50% before obamacare. so people who pay obamacare, if that's for obamacare -- i think obamacare sets up the potential for a lot more employers to get out of the business because in the short term, the obamacare

is going to cost a lot of money. i know a trillion dollars is coming in the system and investors can make a lot of money because there's so much chaos. money is flowing into the system and all. an employer today can stop giving health insurance and give that employer a pocket of money that they can, if the exchange system works, go out on an exchange and buy a good plan. it doesn't work long term because health care inflation goes up 2% faster than g.d.p. over time, maybe not right now for these few years but over time it does and is likely to turn to that. i'm not sure. it's gone from 50% to 6 0% before obamacare and now you have more money flowing in with a better system to choose from with people making up the $65,000 subsidized by the government so potentially another 10% to 15% of employers can get out of the business. i just want to open that up because that means it's ok for the first two or three years

but after three or four years, the individual probably, because of how deductibles, isn't going to be able to sustain an inflation of 2% above g.d.p. over time. so i'm a little more concerned about whether or not the employees -- i hope they do stay in. i say consumers will drive the system. i think employers are going to drive the system because they do partner exactly what you said and they're putting wellness programs in their establishment a culture of wellness and employers have a huge role to play. i would encourage hospitals of the future to partner with their community and community employers. >> if we think why employers provided health insurance is because we want to be competitive the large employees probably won't get out but the smaller ones can't spread the risk and they're caught and all the states tried to put exchanges together for those smaller employers and haven't been able to keep the prices down. so the question is, will

obamacare do that in a way that will attract them? but i really think that large and mid size employers will continue to provide health care insurance to try to control costs because frankly, we've got to do it to attract employees, particularly those of us who recruit people from outside of our own region. it becomes increasingly important because people do ask you about that. >> to follow up on what bill is saying, i think it will shift a lot of the burden and accountability to the patients. they'll have to assume some responsibility for their health and i think we're moving more away from secure to health care, trying to prevent and keep people healthy. once each of us has economic incentives, skin in the game, we probably will pay more attention to it. i'm often shocked how much people will put into maintaining their car than their own health. when it becomes a real pain for them financially, i think we'll

see people become more educated, go to the doctor, follow the blood pressure, eat, exercise, all the things we know will provide good health but they're going to be esponsible for it financially. we'll have to have good data for them. right now i can price a car or price care because they're not bundling patients and not coft shifting in the hospital to make up for underpayment over here. so the health care system and hospitals in particular have to come a long way for consumers to be able to compare costs. >> i think that example about technology and being able to have that is going to happen and happen very quickly and people will shop. but i still think they will shop on the quality of a cost ratio, but there's been a lot of scholarly work done on this. people will go for cost before they'll go for quality. >> senator, from your

perspective as a physician and entrepreneur in this field, do you think patients even know what quality is? >> well, is it just service quality? what do we mean when we say "quality?" >> the overriding scheme attic has got to be improving patient outcomes at -- for existing resources. how do you maximize the use of resources? it's data, it's innovative technology, decision support, connectivity, data mining, price transparency, you listing prices a little bit more even though it's terrible and tough to do, that's the only way you'll have a smart consumer. on the first half of the occasion, maximizing patient outcomes traditionally we're measuring process measures. do you give a beta blocker or not? the input has been placed and we're only getting to the point

of measuring true patient outcome, part of that is patient satisfaction and patient engagement and how the patient perceives quality. we didn't even think of that until four or five years ago to today. now the patient is going to demand it. ultimately the success of the hospital of the future is going to depend on patients coming in and for patients to come in, it can't be just a patient engagement but have to be consumer engagement before they get sick and then after they get sick with loyalty coming in. let me add one other thing because we mentioned it. i know we don't have a lot of time on it but it kind of comes back to get to the opening remarks that were made. we spend twice as much as any country in the world on average, our outcomes of infant mortality and survival is much less, 26th and 30th compared to other countries. terrible. discouraging.

and therefore we need what? and that's what this hospital of tomorrow is all about. hospital of tomorrow is no longer the hospital. it is outpatient care and what goes on at the home and paltive care. the real admission is the service for it but why you have to have these integrated systems with tentacles out so you can monitor the continuum of care and see how much it costs over time for bundling. everyone is hiring doctors and will continue i believe to bring those systems in. twice as much, outcome is not as good, therefore -- the "therefore" is critical because if you look at how long somebody lives, it's 30% genetic, 15% how rich you, socioeconomic status and 5% the environment itself around you. it is 40% behavior. you mentioned the obesity, the how we live, putting on our seat belts, do we smoke?

that's not what anybody in this room historically has been responsible for. the 15% of all of that is what we are, hospitals, doctors, nurses, obamacare. ou can't fix the 15% i don't care how efficient your hospital if you want to come back and fix the problems we started with, the debt, the entitlements, the future of america, the american stream, the cost of not being able to address in education unless we come back and assist the hospital with 15% and the hospital will have to lead with 40% of changing behavior, getting in communities, partnering with employers, engaging technology that engages the consumer who is out there a year after hospitalization or interested in monitoring their weight or wearing this jawbone thing you have or the thing that tells you how much you sleep will have to be the purview of the hospital if you want to make people live longer and lower

the burden of disease and improve the health of the nation. >> i would say, too, about quality, it will be our responsibility, bill and i and toby and the heart surgeons for years had our results printed in the newspaper. you can all google it, our f.t.s., the society for thoracic surgeon calculator. when i operated on patients, i printed out about 55-70 fields that will say here, based on your data, based on your age, your co-morbidities, family history, everything, here's your chance of dying from this aortic valve replacement. here's your chance for being in the hospital more than five depace -- five days. here's a chance for a stroke? and here are my personal results in patients like you. it's inside baseball. we have to demystify all that data and empower the consumers. many of the patients that we saw would come to us with this data already but we have to

push this down into the not as educated people through churches, social programs, through schools, and start early, that, you know, a campaign where children need to know what their data is. there's a very innovative program i think a high school student in the bay area came up with and that's to go back in a community project and get community project hours in the school. you went home and took home work to your parents to sit down and say you need to get online and do this survey so we know what your numbers are. what's your cholesterol and l.d.l., what's your b.m.i., how many calories -- i think it will be an education process and we need to inform them and twist them what quality really is. >> we have one last question because i want to keep us moving along here and end with you, secretary shalala. you lead a large, prestigious institution, i have four kids at home, three are teenagers.

i'm not asking you to let them in although that would be great. but -- >> everybody else does. >> you might as well. >> i spent a lot of time with health care executives and doctors and others facing some really tough times ahead. in a lot of ways it's challenging and daunting and one population says wow, i'm glad i'm five years away from retiring and the other population says wow, this is superexciting. i can't wait to solve these problems. how -- if my children wanted to work in the hospital of tomorrow or wanted to work in health care in 10 years or if your students in miami were thinking about a future in health care, give me the optimistic case. why should they take on the challenge? why should the next generation be interested in working in this industry? >> it's a combination of things.

it's where the next adventure is. it's a major driver the our economy. there are huge amounts of new money going into it and we can't keep doing it the way we've been doing it. so for a young person who is entrepreneurial who is adventurous, who wants a real challenge, there's going to be nothing like health care. it's where the action is going to be. and really where the excitement is going to be. and that's what i say to my students. >> that's great. join me in thanking our panelists, would you, for a great discussion. [applause] >> thank you. >> 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 public service for private industry where c-span, created by the cable tv industry 34 years ago and funded by your local cable or

satellite provider and now you can watch us in h.d. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2013] >> hello, everybody. veterans day weekend is a chance for all of us to say two simple words, "thank you." thank you to the greatest generation who fought island by island across the pacific and freed millions from facism in europe. thank you to the heroes who risked everything through the bitter cold of korea and stifling heat of vietnam. and thank you to all the heroes who served since, most recently our 9/11 generation of veterans from iraq and afghanistan. now that more of them are coming home, we need to serve them as well as they serve us

and it requires more than a simple thank you, especially from those of us who have been elected to serve. i often said my top priority is growing the economy, creating new jobs and restoring middle class security. and a very important part of that is making sure that every veteran has every chance to share in the opportunity he or she has helped defend. in addition to the care and benefits they've earned, including good mental health care to stay strong, that means a good job, a good education, and a home to call their own. if you fight for your country overseas, you should never have to fight for a job when you come home. i've made sure the federal government leads by example and since i took office we hired about 300,000 veterans to keep serving their country. our new transition program is helping veterans find their new job and career. i will call on congress to do the right thing and pass the veterans job corps. put our veterans to work,

rebuilding america. our troops gain unmatched skills while serving in harm's way so we're doing everything we can to connect more businesses with highly skills veterans. with more tools to connect veterans to job openings and more chances to earn licenses for civilian jobs and new tax credits for companies that hire veterans and wounded warriors, tax credits congress should make permanent. and america's businesses have worked with michelle and joe biden's joining forces campaign to help returning heroes find jobs in the pleist sector. they've already hired or trained 290,000 veterans and military spouse and committed to hiring over 400,000 more. we're also committed to giving today's veterans and their families the same shot at a great education this country gave my grandfather when he came home from world war ii. we're helping more of them earn their degrees under the post-9/11 g.i. bill. we worked with thousands of schools across the country to set new standards and protect against dishonest recruiting

and predator lending practices that target our veterans. and we're helping hundreds of community colleges and universities do more to welcome and encourage our veterans on campus. thanks to these efforts and the efforts of the private sector, we made progress getting our vets back to work. we've got a lot more work to do and as more than a million of our troops return to civilian life, we have to work even harder because the skill, dedication, and courage of our troops is unmatched. and when they come home, we all benefit from their efforts to build a stronger america and a brighter future for our kids. so to all our veterans, on behalf of our entire nation, thank you for everything you've done and will continue to do for our country. as your commander in chief, i'm proud of your service and grateful for your sacrifice. as long as i'm your president, i will make it my mission to make sure america has your back not just on one day or one weekend but 365 days a year.

thanks. god bless you and have a great weekend. >> hello, i'm congressman todd young from the great state of indiana. in recent weeks, i've heard heartbreaking stories from many hoosiers about the impact the new health care law is having on them an their families. today i'd like to share with you some of their experiences. mike from bloomington wrote in to say the plan he has now, which he likes, is being canceled at the end of the year. this of course is exactly what the president and other champions of the law promised would not happen. mike's new plan will cost him $900 more a month. scott from salem shared his story about how shortly after being told hits company would cover the 20% increase for employee health care coverage, several of his co-workers were laid off. an annual christmas bonuses were canceled. allen from jeffersonville asked us for help with his wife,

laura's situation. for eight years now, laura has been battling a form of incurable cancer. she was getting insurance through her state's high risk pool which is dissolving because of the new law. after 25 days of trying, the couple was finally able to get on health care.gov only to discover that just one company currently offers insurance for them through the website. unfortunately, that company won't cover laura's current doctors and her out-of-pocket expenses to keep those doctors will go up by more than $20,000 a year. as allen puts it, their family basically has two choices, one, enter treatment, or two, go broke. and there's marvin from bloomington who shared with me this cancellation notice his wife, kathy, received. to avoid lapsing coverage, she

must sign up for a new plan. i health up this letter last week at a hearing with the medicare administrator responsible for the exchange. her suggestion was that marvin and kathy go to the website. well, sure enough, they tried. because the white house said the problem was too many people trying to sign up at once, marvin and kathy even set their alarm clock for the middle of the night so they could log on when there was less traffic. after a month of trying and getting nowhere, they gave up on the exchange. if now looks like they'll end up buying private insurance. they know it will probably cost more but they'd rather have the certainty and avoid federal penalties than bear more worry and sleepless nights. this is what betrayal looks like. here you have hard-working people who were repeatedly told not to worry, that their coverage would stay the same and if anything , r, their

costs would go down. just the opposite is happening. adding insult to injury, the white house, the president isn't leveling with us. he's trying to cover his traction, claiming he never really made these promises. no wonder a member of his own party called this a crisis of confidence. if the president is truly sorry about all this, he'll take steps to right this wrong. that's why i've offered a bill to delay this law's individual mandate tax. as has the senior senator in our state, dan coats. after all, how can you tax people for not buying a product from a website that doesn't work? in addition, next week the house will take up the keep your health care act which will ensure plans available today in the individual market can continue to exist. no one should have to go to their inbox or mailbox in fear of finding out they're losing a

plan they like or worse, a plan they need. and we're going to keep asking hard questions and having hearings so we can get to the bottom of this because the problem isn't just a website, it's the whole law. let's stop this train wreck now and give americans the basic fairness and peace of mind that they deserve. thank you for listening. >> congress will be out of session monday in observance of the veterans day holiday. both chambers return tuesday at 2:00 p.m. eastern. the house will consider a series of suspension bills with votes after 6:30. and over in the senate, time set aside for general speeches until 4:30 p.m. when senators will debate and vote and move forward with the nomination of ms. pillard for the court of appeals. and they may look to broaden the f.d.a.'s oversight of

compounding pharmacies. the house live on c-span and the senate live on c-span 2. for more agenda items as well as insight to the hearings scheduled for next week we talk to a capitol hill reporter. humberto sanchez is a staff writer for "roll call." congress is back in session tuesday after their veterans daybreak, off the house and senate floors where the budget conferees are holding their second meeting wednesday. what's the status of their talks and the issue they're working on? >> they continue to try to find common ground on the goal of the talks so expect a lot of positioning on opening positions on where the negotiations will begin. senator patty murray actually gives a peach what her goals are on the floor last tuesday, saying she's looking for a budget deal for the short term

basically and to roll back the -- to replace the sequester and she's hoping her colleagues go along with closing tax loopholes to do so but the republicans seem somewhat skeptical of the idea because they think that's another way of raiding taxes. >> next week senate committees are holding confirmation hearings for two of the nominees, jay johnson, to be homeland security secretary on wednesday and federal reserve chair nominee janet yellen coming up on thursday. what's the status of those conferees in the process. >> harry reid definitely wants to try to get those done as soon as possible and that they're both coming up next week and we could see action on them soon after they come out of committee, if they do come out of committee. senator and paul threatened to put a halt on janet young's nomination to get a vote on his amendment he's been pushing for a while.

with jay johnson, some republicans are concerned about his qualifications and site his background as a fundraiser for president obama is an issue possibly as well. >> on the house floor members are expected to take up a bill involving changes to the federal health care law again. tell us some of the details of the legislation. >> the law is basically authorizes insurance companies to continue to offer plans that would have been canceled due to the new standards and obamacare. the big, during president obama's debate said people could keep their plans if they like them and now doesn't seem to be the case as millions got notices their plans were canceled. and the idea behind it is maybe score political points on that but also, there's a big debate going on in congress whether there should be a delay in the affordable care act and many of its provisions. >> health care legislation is also scheduled in the senate involving pharmacy compounding and also planning to consider a

few more traditional nominations. what else is going on in the senate? >> that will be the balance of the week, we'll have a vote on d.c. circuit court judge, corneia bernard is her name. and she's likely not to get the 60 votes needed. republicans are arguing there are currently three vacant seats on the court and the caseload for the court isn't a requisite for them to fill those three seats so they are defeated one person last week and will likely go down again -- probably won't get the 60 votes needed to overcome a filibuster and then the senate will move on to the pharmacy legislation which is basically designed to expand oversight over compounding pharmacies after a fungal meningitis outbreak last year that killed 65 people due to medication that was contaminated. but the issue with that is

senator david vitter wants to offer an amendment he's been pushing for a while to prohibit staff from getting health care contributions from their employer which happens to be the federal government and also ensure that every offstaff and lawmakers and certain branch officials go into the exchanges. senator harry reid offered to have that amendment on the condition he doesn't offer it again this congress but senator vitter doesn't think it's a good idea but they continue to talk according to democratic aides. >> humberto sanchez writes for "roll call" and we thank you for your time today. >> thank you so much. >> up next, actress goldie hawn talks about ways to improve childhood education. and then after that a look at the operate financial crisis and how it was handled by government officials. later, another opportunity to watch the discussion of the health care act's impact on hospitals.