tv Washington This Week CSPAN January 11, 2014 1:58pm-3:21pm EST
1:58 pm
, i did not, because it was a night with a particular discussion with -- >> george stalling, cap the appraisals opted it irritate you george onto the show -- stalling, did it irritate you to come on the show? >> no, i do not think it was personal. >> would have been the overall reaction from what you have seen by the media to you on this book? i don't have any complaints. i am glad to be here. i hope that the book will help people to understand the part of israel and our people there from every aspect. i tried to describe in an
1:59 pm
accurate way. sometimes i found it was easier to do the things then to write about those things, but it was interesting. story in a cover "insight" magazine, which is published by the "washington times," and the cover story looks like this -- i want to show the audience, a couple of people you probably know pretty well. we talked about the fact that you were born in israel, 61 years ago, how about these two gentlemen when you look at here, mr. peres and mr. shamir, were they born in israel? >> no, they were not born in israel. >> what country did they come from -- from? >> both of them are born in poland. >> what about some of the other people we know? -- >> he was born in israel.
2:00 pm
>> golda mayor was born here, wasn't she? >> she was born in russia and came here. >> does it matter at all? yourave been there all of life, does it matter to you or others if you came from another country, whether or not you can be a part of the >> no. we live in a democracy and everyone might be elected. i don't think so. i don't think it makes a difference. all of us are jews. first of all, i am a jew before .nything else reasons i'm the writing the book, i'm looking situation where israel
2:01 pm
will be able to meet those challenges. >> are you religious? >> no, but i am a jew. i am a jew, and that is more than anything else. >> how much does religion play a exerciseand the whole of government? >> when you speak about religious here or there -- israel, when you speak about religious, you speak about the orthodox community. there are people who keep tradition but we would not call them orthodox. they are about 15% of the population. >> most of the people leading
2:02 pm
the state of israel are not religious jews? >> yes. >> i want to redo this first paragraph. samirhas it that yitzhak and ariel sharon have not spoken , thatre than six months yitzhak rabin tried to punch sharon for impugning his character in a cabinet meeting. in cap matters -- cabinet thatngs, notes were passed made derogatory comments about cabinet members. >> i think it has been exaggerated, like in every party, like in political life there are struggles and so on but they have been exaggerated. shamire you spoken to mr. in six months? >> quite often.
2:03 pm
i talked to him in the government meetings and the meetings of the likud ministers. issue that any other is important, i believe that should be discussed. terms.all on talking mostly on tactics, but not overall strategy. >> are you friends? >> no. should we be friends with everyone? >> in a recent likud ministerial whying, ariel sharon asked he has not dethroned talks. sharon, because you leak everything. sharonk, i feel contempt for what you said.
2:04 pm
shamir, you only create an ugly atmosphere. sharon, i laugh at these statements. >> you don't expect me to prove these things. >> here is a picture of you. are.you they say any event this man does not continue to be prime minister, one or the other of you might be. are you still interested in being prime minister? >> israel is a democracy. if i'm a nominated or elected by my party, i will take it. i believe i can contribute in setting those needed goals for israel, and i believe they could
2:05 pm
have been communicated in the peace process, maybe the warrior will become the peacemaker. and discussgo back the invasion into lebanon, the whole issue that eventually became a libel suit? tell us your side of the story. it was in 1982. why did you go into lebanon? it was a dismal situation along our northern border. in lebanon those days it was the plo, independent kingdom of terror headed by yasser arafat at others, one of whom is
2:06 pm
responsible for this tragedy. civilians of our northern towns hands.hostages in their they took advantage of the cease-fire which was not kept completely. that is one of the mistakes of the book. during this year of the cease- 290 terroristre activities that took place. most at the northern border, but they took place inside israel or long other borders or in europe along -- against jews and israeli citizens. lebanon they had their more , rockets, 15,000
2:07 pm
terrorist information. people moved southward. we could not take any activity against the terrorists because they would start to immediately shell our civilian population. if we accept this situation, jews will be murdered elsewhere in the world. the man was busy trying to say that the cease-fire did not include jews or any other places -- in europe or any other
2:08 pm
places, and we could not accept it. harder andon became harder until our ambassador in london was shot in his head. then israel took a decision to send our air to attack terrorist targets in lebanon. in reaction, they started heavy shelling of our settlements and. on the 16th of may, 1982. we faced a very dangerous situation and the government decided on the fifth to move to destroy the plo terrorist infrastructure, and that's what we did.
2:09 pm
those tragic events that took later,ter -- place neither myself nor any other involved in these atrocities. foundquiring commission fault in me not anticipating that the event could have .appened nobody of us to participate -- did participate in it. >> tom friedman writes a paragraph here. it goes right to this whole issue. he says, sharon knew how strong israel was and believed wrongly
2:10 pm
that this military strength could it almost mechanical conflicts, deeply rooted political problems, the tiny israel could drive the plo syria lebanon, neutralize and forcese muslims, the palestinians living in the west bank and gaza strip to .ccept israeli rule sharon did not know when to stop. he did not understand the limits of power in a fragmented, unpredictable place such as lebanon. >> i cannot find your even one thing that is correct. about the 1967 war, that israel
2:11 pm
attacked in jerusalem or attack the jordanians as a preemptive all of us know that king hussein attracted his forces to attack drizzle. -- jerusalem. we never thought about kerning man as-- crowning the president of lebanon. we went to lebanon to destroy the terrorists headed by arafat. it was a question of life and death for us. a new lebanon. that i learned about lebanon, i read about it and met with lebanese.
2:12 pm
i never thought, maybe i missed judging -- i'm misjudging. i went to lebanon secretly. north of beirut, i spent 36 hours, meeting with lebanon leaders and meeting the lebanese forces and going to the mountains to see their forces, their stronghold there. i wanted to see them in their homes, how they speak, they behave to be more sure of that. we made all the preparations.
2:13 pm
i tried to convince him to give a certain number of weapons to the shiites, and have more cooperation with them. i believe it was not the goal of our war -- >> there is a wife. >> my wife and myself visit to to meet with pierre gamayel. this is a picture -- that is my visit to beirut right before the war. i believe it was not the goal of our work, but result of the war. the situation in lebanon could have been entirely different.
2:14 pm
it would have been more understanding. representatives misled the president. i don't think they really gave the right description about the situation in lebanon. we knew lebanon. it was a major mistake to try to solve other issues through lebanon or to use lebanon to solve other problems, to get syria on the american side or to .olve the palestinian problem it was a mistake. the lebanese problem was so .omplicated i believe that as a result of the war -- not a goal of the war -- the situation could have been
2:15 pm
entirely different now. used to speak about the 3 -- jerusalem, cairo, beirut as integral parts of the world. .t could have been different in the present time, when we see that the western democracies those whocommunity, interfered should feel responsibility now. sincee done our part 1975. >> we have not even started talking about what we could talk about. leerye americans getting of the way that israel is handling the intifada? are they mad at you? >> not all the people understand
2:16 pm
that it's a war. it's a war in which different methods are used. an israeli soldier was killed. worker was killed by an arab who worked with him, and buried. before he killed him, he cut his lips and took out his eyes and skinned him. he did not feel he had done anything wrong because he killed a jew. they do not understand that we are facing a war. i saw today in the "new york of the brutality
2:17 pm
of arabs killing other arabs. they are killing them because they will not cooperate or not accept the k as the sole -- plo as the sole representative of them. i do terrible things that people oere would not -- they d terrible things that people here would not understand. we cannot judge those murderers by our moral values. it's a different thing. thise you getting hurt in country by the intifada relationship, the murders and all the things that have gone on back and forth? caused to israel. israel had to bring to an end the damage from the intifada as quickly as possible.
2:18 pm
israel should act in a more fast way to bring it to an end. i don't see any possible way to unless we will be able to overcome it. it will be peace in the middle east when it is quieter. the limit, and here's the book. david chanoff. thank you very much for your time. >> thank you. [captioning performed by the national captioning institute] [captions copyright national cable satellite corp. 2014] >> that was ariel sharon on c- span possible notes in 1989. he passed away today at the age of 85. a state funeral was scheduled for monday at the former prime minister's ranch in the negev desert where he will be buried.
2:19 pm
with news of his passing, president obama released a statement earlier saying as israel says goodbye to prominent sharon,prime minister we join the israeli people in honoring his commitment to his country. secretary of state john kerry said -- kurdish prime minister david cameron also reacting to the -- british prime minister david cameron also reacting to the news. >> 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 coverage of the u.s.
2:20 pm
house all as a public service of private industry. tvpan, created by the cable 35 years ago and funded by your local cable or satellite tv provider. like us on facebook and follow us on twitter. >> next, a discussion on the role states play in controlling the nation's health care costs. it's a topic of a report unveiled by the state health care cost containment commission at the university of virginia, which is cochaired by michael leavitt and bill ritter. this is an hour. >> good morning. thedirector and ceo of miller center at the university of virginia. announcement that must be made is a request for everyone in the room who has a cell phone or electronic device becausee turn it off, it may interfere with the c-span and other broadcasts being made
2:21 pm
at this press conference. i would like to welcome you here for the release of the miller center state health care cost containment commission, and its report entitled, cracking the code on health care costs. access, quality and costs have been at the center of the nation's public-policy challenges for much of the past likelyrs great it is that will remain the case for the foreseeable future. while the rate of increase and cost of health care has slowed over the last few years, it has still hit the tipping point. it is having a huge impact on consumer budgets. it is forcing major cuts in state and federal funding for education and infrastructure which are critical to the long arm growth of u.s. economy. there are questions about the extent to which the high cost of health care makes u.s. companies
2:22 pm
less competitive in world markets. of the commission is consistent with the mission of the miller center, which is to serve as a gathering point for nonpartisan policy discussions since our founding 40 years ago. other recent public-policy issueses -- is used -- include immigration reform and challenges facing america's middle class. unlike some policy issues where we know what to do but lack political will, health care cost containment is in its infancy. ofmust go through a period accelerated state experimentation to determine what really works. -- williamndes brandeis indicated that states are the laboratories of democracy. the commission's report provide
2:23 pm
states with a blueprint to follow during this period of experimentation. much like states have led in clean air and welfare and education reform, they are likely the level of government to lead the transformation of health care delivery systems. state's nimble in making adjustments to programs that work, but in health care most of the key policy leaders belong to states. health care solutions need to be tailored to the health care markets and cultures of individual states. the commission met three times at the miller center's washington, d.c. office and has had numerous conference calls in developing a consensus on the report and its recommendations. while we hope the federal government's leadership listens in, this report was written specifically for governors,
2:24 pm
state legislative leaders, and other health care leaders at the state level. the federal role in the area of cost containment is to support the state role by providing additional information to states and perhaps financial incentives to encourage states in taking a more active role. states have to take a leadership role in cost containment. let me introduce the members of the commission. the two cochairs, m levitt, former governor of utah and former u.s. secretary of health and human services. bill ritter, former governor of colorado. the private sector representatives, george halverson, former chairman and .eo of kaiser permanente andrew dreyfus, president and ceo of blue cross blue shield of massachusetts. glenn steele, president and ceo
2:25 pm
of geisinger health system. then we have a medicare trustee and former director of the congressional budget office and urban institute. community catalyst. several other members who were not able to be with us today include simon stevens from cohen,health, jay , and lloyd dean with dignity health. say a specialo thanks to our two major funders. first, kaiser permanente. a special appreciation to george halverson. second, to the robert wood johnson foundation represented by andy. i would like to turn the program over to bill ritter, who will
2:26 pm
outline the role of states in health care cost control and the huge number of policy levers available to states to enhance quality and reduce cost of rate increases over time. governor ritter. [applause] thank you. good afternoon. talking about the state's role and policy levers to moderate health-care cost increases, i want to make a few enteral points. are chapters in our report on the health care problem, health care act, and what the federal government can do to help states control costs. this press conference will focus on the state policy levers and are specific recommendations.
2:27 pm
although the title of the commission and report itself talk about cost, increasing quality is of equal importance to the commissioners. commission members believe we can do both, enhance quality and reduce rate of cost increases over time. though there are no silver bullets with respect to restraining health-care costs, the most important goal is to transform the delivery system as one that is fee for service to one that is comprehensive and using pay models that hold organizations accountable for qwest -- cost and quality. this report is written for governors, state legislative leaders, and other health care leaders in the state. the transformation must be led by states. health care markets and cultures differ from state to state.
2:28 pm
must be tailored to individual states. period ofa experimentation but if you look in retrospect at what states have already done, they have a pretty good track record for experimenting and being good laboratories at being able to say what works and what doesn't. governor, i have a bias in favor of states. we are also prized and really heartened as we dig into this issue and look at what states have at their disposal in terms of policy tools to control health care costs. i'm going to talk about five different buckets of policy tools. the purchasing power of state health care programs including
2:29 pm
medicaid, to some extent local employees and individuals in state exchanges. in some states local employees and individuals enrolling in state exchanges. state laws and authorities that govern insurance, provider rates and medical malpractice. affecting market competition, consumer choice, antitrust and cost and quality transparency. the authority to invest in initiatives that involve population health, programs that help lifestyle choices and personal responsibilities. the power of governors to engage stakeholders in process for change. under the first category of spending, programs administered the numbervernments,
2:30 pm
of individuals eligible for health care coverage through state administered programs will million over the next few years, far larger than the 53 million enrolled in medicare. 70 milliones patients likely to be enrolled, and includes 3 million state employees. its potential of 11 million local employees and those who can't be part of state programs. it includes another 6 million who will be purchasing health care through state exchanges. huge purchasing power at the state level which can be deliveryransform the system from fee-for-service towards one that provides high- quality, low-cost care. state laws and regulations that affect insurance, all states
2:31 pm
regulate health insurance including a review of solvency, rate increases, contractual rules between plans and providers. while a few states make rigorous review of rate increases and at times than i increases, most do not have the resources to perform a serious analysis. under state laws they have vast authority to do it. all scope of practice laws regarding what nurse practitioners and physicians assistants and other nonphysicians can do and how they are paid come from state laws. many states are redefining these responsibilities so that physicians can practice to the extent of their capabilities. have ratesetting authority. maryland is the only state right now that sets hospital rates.
2:32 pm
under the third category, laws that affect competition and transparency, all states have antitrust laws on their books though they are seldom used. increasingly, states are required to provide providers to consumers on a timely basis. report cards for hospitals to increase transparency around quality of care. to promoteiatives population health. these are being developed by states. some may be school-based. based, suchcommunity- as grants for walking and bike paths. states are paying attention to their own ability to look at wellness as one index of
2:33 pm
controlling cost increases. the ability of governors to engage stakeholders, create a stakeholder process looks at change. it can take a while for a new governor to comprehend his power. it's typically not written in any law. utilized, it's a powerful vehicle for change. that's a summary of the different policy levers that states have. you can see there are many such opportunities for states. if you look at all the ones who clear thatt became the variety of things could happen were states could have an important role in controlling health care costs over time. i am honored to have served as
2:34 pm
cochair on this commission with governor leavitt, who is also secretary of health and human services, and steeped in this subject matter area, an important policy issue for this country that we are fortunate to have a man of mike leavitt's credentials to be part of this larger dialogue for such a long time. i invite you to the podium. >> thank you. just extend some appreciation of my own to the miller center for initiating this project. also the kaiser foundation and robert woods johnson and their role, and all of you for coming to hear the report and for c- span for allowing those were not able to be here to hear about it.
2:35 pm
could i suggest three things i would like to make before we get into the recommendations? this report was done with the context that we believe market forces when utilized can reshape .he health care system trad market forces, properly constrained by the roles of government, can be the most effective way in which this is done, which plays into the subtext of this report, which is that states can have a tremendous impact on this process. marketplaceflect a because they are laboratories of democracy. these recommendations have been based on conditions as they exist with the affordable care act. if the act begins to migrate or
2:36 pm
change over time, it won't necessarily change the opportunity for states but it could change some of the things that were inherently placed in this report. this is a long-term process, a five to 10 year horizon we're talking about, not something that's going to happen quickly. talked about the policy levers. within the context of those levers, could i just roughly outline the seven main recommendations the report makes? antate should create alliance task force or workgroup to transform the care system in their state. this is a classic collaborative problem. it requires collaborative leadership. the collaborative leadership needs to be formalized.
2:37 pm
governor ritter spoke about the role of the governor. i would like to underscore that point. state needs in the to lead. in a state is in a unique position not just to use the levers of government, but also to call upon the community. it is a unique role granted a governor. in addition to the governor there are other state government officials who play a critical role. whomedicaid director typically would have responsibility for 15, sometimes as many as 25% of the lives in a state being paid for by that mechanism. typically the insurance regulates theho
2:38 pm
vast majority of the market that remains outside of medicare and medicaid. very important player in health reform, a state official. the hr example would be person or benefits person in a state. typically the state government is the largest employer in a state, and a significant part of the health marketplace falls under that persons responsibility. it should not simply be in this collaborative process, state officials. be patient, care providers, insurers. has the capacity to bring this together as a convener, with significant stature to focus the state on this problem. number two, define and collect data to create a profile of
2:39 pm
healthcare in that state. could i suggest that there is no national health care system? there's no national health care market? are 316 hospital referral regions and 60 states. states have the capacity to take the marketplace in their state and concentrate its unique characteristics. to gather that data to give the governor and community a clear picture of what the system looks like in their state is a very important first step. establishing baselines and goals for health care spending. for quality and other measures that are appropriate. states need a goal.
2:40 pm
they need to know what the status quo is producing and there needs to be a public commitment made to reducing costs within that marketplace. if you begin to look at the levers available to governors and states, they are considerable. the not only control of marketplace but also control of the regulatory environment. that gets to the heart of our recommendation number four. important, most that the powerful leverage the state has with existing health care programs such as the state ash as an employer, the state employees . there's a whole series of other levers that the states have. for example, they have the capacity to promote regulation
2:41 pm
that would begin to drive the market. that gets us to the next recommendation, which is that we reform health care regulations to promote the system effectively. handledice is typically at the state -- malpractice is typically handled at the state. the scope of practice for nonphysicians, typically done at the state level. often that's the place were not only the scope of the practice is determined, but the limit to which they can practice. the encouraging consumer basedion of high valued on information, having transparent information of cost and quality. states have the capacity to harness that data. in early 30 states, we have all
2:42 pm
payer databases where the state has accumulated information from all of the plans. those can be used to drive that kind of information. recommendation, help promote population health and personal responsibility for health. this recognizes that health is an ecosystem. it involves the health of people, which can be everything from trails and having walkable communities to clean air and clean water. all of those things are part of what allows states to have an impact. a governor should share and convene a process within states to attack the health care costs in their state. it should have data that gives them a baseline from which to operate. they need to have goals that generally have five to 10
2:43 pm
years to see the cost curve in andr state and the public private sector. they need to use state programs as the basis of that and encourage consumers to shop for value, to use the regulatory levers they have and look at this as a state ecosystem. states can have more impact than you think. i would like to encourage the members of the commission you are present to join us on this podium. her going to take some bastions. -- we are going to take some questions. i would like to take questions from the media and those of us who are here for this report, and then we will take questions from the miller center social media channels. i call onirst? -- may first? julie. >> [inaudible]
2:44 pm
i wonder if you think the way they are approaching cost control in massachusetts is an example of what you like to see in other states. >> andrew, you have firsthand knowledge of that. i'm always a bit cautious about recommending massachusetts solutions. in thethe statements report is that each state is different and each market is different. many of the recommendations mirror some of the actions that are state has taken in massachusetts. our state cost-containment law was recently passed. it has created a climate in massachusetts that mirror a lot of the recommendations of this report. more collaboration among the private and public sector, shared commitment in the state that we need to lower costs and improve quality.
2:45 pm
we are seeing costs come down. hasher key recommendation been widespread acceptance of changing the way we pay for care. whiche-for-service system the report and other experts identified as being fundamentally inflationary is being changed in massachusetts and physicians and hospitals are voluntarily adopting and agreeing with health plans like ours at blue cross blue shield and others to accept what we call global payments that include incentives for quality and incentives to control cost by independent studies experts have demonstrated that we are starting to get to that holy grail in health care, which is better care and lower costs .
2:46 pm
if individual states adopted the vast majority of these recommendations, health care costs would come down. there is passing reference to the affordable care act, but my view is that the evolution of the affordable care act makes the recommendations of this report more relevant. act hasffordable care evolved, we have watched as states have made individual decisions to take a different adoptedether they have to expand medicaid or not, whether they have adopted to run their own exchanges or not. some of the national standardization anticipated in the affordable care act has not come to pass at the same level, which i think has put a much greater focus on states as the locus of accountability for health care, which is the premise of this report. does that get to the question you asked? >> it does.
2:47 pm
a follow-up. many of these recommendations sound like they are addressing additional regulations and control by the states. how will that fly in some of the states that think there is already too much regulation in their sector? >> we need to achieve a balance between a government regulation and oversight and market innovation. although massachusetts is often state where government oversight is widely accepted, some of the most important steps we have taken to control costs have come from the togetherrom innovation from plans and hospitals. there are states with republican governors who have successfully innovated in this area. each state has to settle where they are comfortable with that balance between regulation and
2:48 pm
innovation. premise,c ms -- governments have a lot of authority and even in states which have less of a regulatory climate or history, there overseeing insurance regulation, public health departments, employee benefits. those are all opportunities to focus on health care affordability. >> i'm from the state of utah. be consideredely a different regulatory environment in massachusetts. massachusetts and utah have level ofa fairly high integration in their health care systems by comparison to most other states. massachusetts, its background is well-known. utah's background started during the 1990's.
2:49 pm
we held together a collaborative process that lasted eight years where we put together a collaborative process to every year put forward toward what we called our health print moving towards a more integrated system. you have two very different cultures in terms of regulation. both move them forward. frankly, long before the federal government did. different states with different move a statecan forward toward integration in their own unique way in a fashion that the federal government has not yet been able to achieve. >> our experience in colorado is interesting as well, probably fall somewhere between the massachusetts and utah spectrum of regulation.
2:50 pm
it's another place where you see things happening in a bipartisan fashion. , governoras governor owens gathered a group of people and they formed the senate bill 208 mission. they came too late for governor owens but we wound up implementing many of those regulations, but after i left office and the states were left with the decision about health care exchanges, one of two states in the country where they was a bipartisan agreement around a state health care exchange. colorado, which is a purple state, has been able to do a variety of things in a bipartisan way and take these recommendations from this 208 commission and get them passed legislatively and have done a variety of things to help control health care costs, increase quality and provide greater transparency. think you just heard three
2:51 pm
different states that may have some nuances and have taken this on as a state and been able to navigate the political shoals while doing it. a comment on regulation and health. regulatione the term in a negative fashion. a complex product, hard for consumers to understand. very easy for lightly or unregulated markets to produce pernicious results, excluding certain people not covering thoughts -- things you thought were covered. ist we see in regulation defining the terrain over which competition will occur, competition that improves the well-being of the consumer while
2:52 pm
preserving all of the positive aspects of a competitive marketplace. the players, responsible players know thesurance market terms on which they are competing and it is defined in such a way as to enhance the benefit for individuals. we have done here is point in the direction of the types of regulations that will lead to a vibrant market that improves the well-being of people. it's very exciting that states in the past have been the innovators around access to health care. you see state innovation moving forward and being taken up on a federal level. it's now shifting to the states to address the issue of costs.
2:53 pm
exciting to see states moving on and developing around dual demonstration projects. a number of the recommendations we have made here, one of the reflections i have to say is this commission has been not just an easy thing to come to agreement on. we have had struggles around the balance between regulation and market forces, and the idea that such a diverse group has come up with this balance with these recommendations and we all agree a reflection of what needs to be happening at a state level. to see action. people need to come together and have agreement to move forward around an action plan. the commission report has reflected that. >> we will move to another question. >> another question. >> i'm jim landers of the "dallas morning news."
2:54 pm
sure how the commission regarded some of the things that have polarized the country so much on health care in the last few years, whether or not we should universally ensure the population, whether that would have an impact on the cost of care. did you address that? that thereuded early is a universal aspiration for everyone in our country to have access to an affordable insurance policy. there are many different philosophies on how to get there , and concluded that states can in fact have an impact. this was focused on cost containment. we did not spend a lot of time in discussing -- we did it in the construct of the affordable written,as it has been recognizing that if it does
2:55 pm
change, that will change the situation. in our judgment, it probably means that more and more responsibility will go to states as it begins to change. do you wish to comment on that? will go to the side of the room and then back. we are following the microphone. llewellyn king with "white house chronicle" and he "new york times" syndicate. i was wondering whether you the difficult issue of allocating resources, who gets what, sometimes known as rationing. it is widely held that in the u.s. we tend to be generous to the old and parsimonious to the young. did you look at that issue and the costs involved? our task was to take the environment as it now exists
2:56 pm
through the affordable care act and to be able to say, what role can states play in that process. we came to the conclusion that an integrated system of care will clearly be superior in that ed system of silo care. to the degree that we can achieve integrated care, we will problem eliminate the that you .2. not entirely. care able to integrate will ultimately cause fewer of those decisions to have to be made. agreement among the commissioners that we are not getting sufficient value out of today's health care system. you will see and hear some europeanns with other nations, other health care systems.
2:57 pm
it is premature to discuss when there is efficiency -- inefficiency and waste in the system that we can improve upon. the steps we have outlined in this report will do that. we need to focus on getting more value out of the system from an integrated system in which we are paying for quality, not just for the volume of care. "governing magazine." that nearly 30 states have a database that collects any extensive provider data. what is the barrier to making that more publicly available? there's a number of different sources of data. databases. created
2:58 pm
many health systems have begun in a collaborative way to create large data systems that have as many as 70 million lives. we have got to a point that the aggregation of data is not the challenge. lives,u have 70 million you can look at cohorts of people and draw conclusions necessary to drive value. it is not the aggregation of the data. it's not the technology that limits this, it's the sociology. peoplee capacity to get together in a fashion that will begin to change the system. it isn't the aggregation of data, is the application of it. that's why we think this collaborative effort at the governor's level is so important, to draw conclusions and drive action.
2:59 pm
>> noam levy with the "los angeles times." as the only representative of a deep red state here, i have a question i want to follow up on what julia asked. clearly your recommendations are built in part on utilizing the tools that state government has, whether it's the governor of the insurance regulator, the purchaser of state health plans. unlike utah, there are a lot of other red states where there seems to be a deep hostility to using those tools to influence the health care market. could you talk a little bit further about how these recommendations could actually states to some other that are not only resisting the affordable care act, but seem resistant to the overall premise
3:00 pm
of some of the things you are suggesting here? >> i believe there was a very significant event that could a couple of weeks ago or months ago, now, when the current administration that chose to grant a medicaid waiver in the state of arkansas for the purpose of allowing for premium support to be done in the context of medicaid expansion. the context of arkansas, like many other states, had been resistant to having so much federal involvement in health care. involvement in health care. what i believe that the acceptance of that waiver by hhs signaled was perhaps the administration would be willing to acknowledge that states could develop medicaid programs and could develop exchanges and could do other things in the context of what we've talked about that could represent their
3:01 pm
own culture and own value and own view of what government's role ought to be. it was mentioned -- i think bob mentioned the fact that health care is a very complex subject and frankly, it requires government to bring order to it. that isn't the issue. the issue is what should the role of government be? should government operate the system or should it simply organize the system? states like arkansas are saying to the federal government, we're prepared to use government. we're prepared to step in and lead but we need the capacity to do so. i think that ultimately the reason this report has relevance here is we're signaling not just states, we're signaling the administration to say if you want help in creating momentum for reform, turn to the states because given the latitude and
3:02 pm
the tools, they can lead. they will lead. they will be more effective than you can possibly imagine. in fact, the exchanges have been quite a demonstration of that. if you look at the number of lives that are now part of the system, and look at what part of them have come through state exchanges and what part have come from the federal, it's a very serious conclusion in my judgment that states are critical to this entire process. now, you didn't ask all that. i enjoyed saying it. thank you. others may have a similar view. >> i think the question was some states are reluctant to get deeply involved in this kind of activity. how are you going to convince them to join the team. i think as this report rightly points out at the very beginning, states that are successful through efforts like these to moderate the growth of health care costs in that state
3:03 pm
will see their economies grow faster, will see employment gains larger than other states, will see take-home wages of employees raise faster. as the governor suggested, this isn't a two or three-year program. this is a five, ten, 20-year kind of effort. as you go along and see differences develop in states that have successfully pursued these recommendations, others will come along as they have on other issues in this country. >> other comments from panelists? commissioners? why don't we check and see if there are social media questions after that. >> i'm just wondering, there's been a pretty dramatic reduction in the increases in health care
3:04 pm
costs in recent years including a reduction in the share of gdp. i think there's been a debate about whether that's a reflection of economic downturn and recession or whether the affordable care act is playing a role. i'm curious what your view of that is. >> others may have a comment. i'll give you mine. if you were to go back to the late '80s, you would see health care costs were spiking at a level that was simply unsustainable. there was a political event called an election and we had the health reform that the clinton administration initiated. it did not pass but health care costs began to be constrained primarily because of what we knew then as managed care. people were uncomfortable with parts of that. we had another political event. they call it the patient bill of rights. coordinated care, integrated care, essentially evaporated as a result and health care costs spiked again. finally we got to 2008, we had another election.
3:05 pm
there was another health reform and we have seen a debate with a bill passing this time. ironically, it's about trying to integrate care and even before it's been implemented, we have seen the marketplace drive cost containment. i don't think we ought to have any illusion about the fact that if we don't continue to see markets constrain and push downward that the same thing will happen. we'll see an explosion of cost. we're still at 18% of the gross domestic product. i think there are lots of reasons to point to as to why health care costs may have begun to bend. let's all celebrate that. we're not in a position at this moment to take our foot off of the reform pedal because we're in a very serious situation. we have an economic imperative now and i know there will be comment on this from others. >> two thoughts.
3:06 pm
first, as i said earlier, i think if we thought we were getting sufficient value out of the health care system i think we would feel less urgency. let's assume for a second that your first statement is correct and that there has been a more permanent easing of health care inflation. even under that scenario, if you talked to governors or legislative leaders or small business owners today, they would say that health care today is taking up too much of household budgets, state budgets, local, city and town budgets and that other priorities whether it be education or public safety or environmental protection are suffering as a consequence. so i think we in the health care community have an obligation and responsibility to try to continue to slow the growth of health care costs in part so we can get more value out of the system and in part so other priorities are important to the nation can be funded. >> i'm going to echo your comments because in medicaid,
3:07 pm
for instance, it's now 20, 25, even over that percent of state budgets and that's grown significantly. it's caseload driven. states are required to put money into that particularly on states that are required to balance their budgets on an annual basis. it very much goes into education budgets, infrastructure budgets, transportation and other kinds of things. higher education budgets as well. the other point i would make is something that governor leavitt said which is we still as still put far too much on health care with far too little. it matters and matters a great deal to employers when decide to where to put businesses. it's something they take into account for state to state to at a time. while it's a global economy, states compete for jobs. they compete for job growth and
3:08 pm
this is an arena where a government will look to them to ask what they're doing to control cost. it's a percentage of gdp. to all this mitigate in favor of states paying close attention and being part of constraining costs over time. >> there are a lot of different forces that influence the cost at which they arrive. it's true that in 2008, 2009, 2010, the weak economy had a significant impact. the economy is recovering. employment is recovering. some of them legislative in the sense that we've passed the affordable care act and it's imposed a number of reforms and
3:09 pm
restrantss that have moderated the growth of costs. the fact is that employers have begun tightening up the generosity of the programs that they're offering to their employees. on the other hand we see market consolidation going among providers, which pushes up cost. the population is aging. the research community is hard at work developing new interventions, new pharmaceuticals. we've been in a lull over the last few years. if you aren't coming up with new ideas and driving for increased efficiency every day of the year you're going to see these costs naturally rise because all of us
3:10 pm
want improved health and rebelieve that is related to the interventions we receive for medical community. i think you don't look at this as sort of one factor effects the rise and fall. it's many, many factors and a mix of those factors that will determine whether we're successful over the long run and as the others have said can begin bringing down the fraction of our gdp that is devoted to health care while maintaining the quality that we expect. a cle >> a clear sense from the expert that the increase in cost sharing that health care costs have gone down and consumers are paying a higher percentage with the cost of health care. that's a two-edge sword.
3:11 pm
in some sense it may make it that consumer are more unlikely to be thinking about the value they're getting from it. i think we have to be care frl as we move forward to implimt cost ageneral dap and the impact on people. >> i'm wondering if you can speak a little more to what the federal government's role in this is. there's the example of the arkansas waiver. what kind of support or input is necessary or possible from the federal government in order for the states to really take the
3:12 pm
reins on this? sglo i think we have seen a reality set in on the administration and those implementing the affordable care act and that is how limited their capacity is to implement a national strategy. it's the reason having been the led of hss and the head of environmental agency, it's the reason that we delegate environment regulation to the state. that's the same reason we have to delegate medicaid administration to the state. it's because there are different conditions and different markets. if you look at exchanges, i made this point earlier. the administration over time has begun to grant greater flexibility to the states in
3:13 pm
order to incentivize as many as possible to become involved. we saw them in essential benefits say let's grant to the states some flexibility in how they can implement that. we have seen them allow more flexibility among the states and how they implement those. if we're going to get reform, it's going to happen at the state level and we need to give them more flexibility. there's this ongoing struggle between states and the national government. the states wanting more flexibility and the federal government trying to hold onto control. the more they hold onto control, the less able the states are to implement and reform begins to come to a grinding halt.
3:14 pm
that's the reason this report isn't just aimed at states and governments. it's aimed at administration and states saying the formula if you're going to have national standards, you've got to have local or you have to have neighborhood solutions. if you're going to have national standards then neighborhood solution s the way you implement those. the more you can provide flexibility, is more effective the federal government will be. comments. >> changing the way we pay for care and deliver care is the way we'll control health care spending in the country. however, the medicare program and federal government pays for about 40% of all acute care in the country. one way that the federal government with support the recommendations through states
3:15 pm
is to accelerate the adoption of payment models through the medicare program. we have seen to the affordable care act beginning of that through the creation of the pioneer demonstration projects, other projects. to have the federal government which has sometimes been a little slow to adopt new payment models, i think that would be important way that the federal government could partner with states to slow the growth of health care spending. >> one more question, if there is one. fp there's not, we'll conclude. ipse no further question. i say thank you for your hard work and would you have any final words. >> thank you all very much for being here. i would point out that after lunch, 2:00 here at the national press club there will be a round
3:16 pm
table discussion on federal versus state health care cost containment. i think the commission members who are here today plus some other important figures in this field of health care will be very, very stimulating participants in this important subject area. let me point out that the cost of health care has reached a tipping point as mentioned earlier as spending my individual, by governments and businesses have grown steadily in over five decades. in 1960, when some of us on this platform may remember that year,
3:17 pm
health care costs per individual averaged $147 per year. $147. by 2011 the figure reached $8,860. if the system is unchanged that in the next seven years by 2021 that figure will reach $14,000 per person. that is the scope of the kind of issue that this commission has sought to address. i think they have done a splendid job. 2:00 we'll convene here for the round table discussion. i invite you all to return. i think it will be a worthwhile and illuminating discussion. my thanks to the two co-chairs
3:18 pm
and the members of the commission for their >> the health care law was one of the first legislative items on the agenda this week for the house when members return from their winter recess. friday, the house passed a bill requiring the federal government to inform people if their personal information is breached on the healthcare.gov website, one of the first pieces of legislation considered during the second session of the 107th congress, which officially began during the new year. next week, members will turn their attention to a short-term measure that will keep the government-funded past january 15 when spending authority is set to expire for the federal government if there is no congressional action. the senate is also in session next week. they will continue work on a bill that would extend expired unemployment benefits for more than one million people.
3:19 pm
senators will also consider the nomination of robert wilkins to be a u.s. circuit judge for the d c circuit. live coverage or the senate can be seen on our companion network thomas c-span2. the house can be seen live here on c-span. papers,week in foster's steny hoyer talks about the congressional agenda and what his party is hoping will be accomplished in the new year. the maryland congressman is minority whip in the house of representatives. here is a brief portion of what he had to say. >> what can congress truly work on this year that will be able to get done? what are you most confident about? >> the answer to your question is congress can certainly get something done if the republicans are prepared to put on the floor pieces of legislation that will enjoy bipartisan support and will not simply be message bills, as we dealt with last year. we are very hopeful that the getsloyment insurance bill
3:20 pm
done, both short-term and long- term. we are very hopeful that we will comprehensive immigration reform. we think that can get done, and i think evidence of that is a got 68 votes in the united states senate. broughted by -- bipartisan support. i think it will enjoy bipartisan support in the house as well if it is put on the floor. we would like to see the minimum wage raised. as you know, income inequality has been focused on by the president. we are focusing on that as well. we think that that is a real challenge to america, that we have the gulf between the rich and the middle class, and between the middle class and the rich and the poor being as long as -- as large as it has been a very long time. we think that is not good. would like to pass a bill to
103 Views
IN COLLECTIONS
CSPAN Television Archive Television Archive News Search ServiceUploaded by TV Archive on