opened -- as a physician, i ran an emergency room and i guarantee you if you are unconscious in an emergency room, we will pick your pockets and call your mother, we will call anyone we can to get any information about you to save your life. the highest duty of a physician is to save a life. privacy gets pushed aside in that case. but one of the things that is important to understand about somebody unconscious in the emergency room is we should not built a system where everyone's records are open all the time to everyone except to us. . for that rare one and one million cases where you are unconscious, what we need are systems that work for us so that we can protect our information and selectively share it routinely. that is what most of medicine is about.

it is about routine visits that are scheduled where we are awake and conscious and we can decide to share. that is the kind of technology we should have that let each of us make the choices about what is shared. the other thing about the emergency situation is i guarantee you that if you come in their unconscious with no records, we have a protocol. breathe, cardiac -- we know what to do to evaluate how to keep you alive long enough to figure out what is going on. it's very possible when you come in unconscious that you have something that is new that is not in your old records. people forget that records are not everything because your health changes and particularly, there are emergencies. there are new conditions that emerge. they are obviously not in your old records.

that's the point of getting trained in medicine that you diagnose and try to understand things that you don't have all the information about yet. peel is a graduate of the university of texas and the medical rants at galveston. krupa tweets - -i'm a little confused. host: you referred to the fact that medical costs are not because of sick people necessarily. that aaying it's true few of the people in a plan use most of the benefits. yeah, of, well ,

course -- some of us are sicker than others but it's not sick people that are causing the excessive costs in this country. i'm sorry, it's the people charging us these excessive rates that are far beyond any other country and the rest of the world. amazing hidden monopolies. the health care industry uses our data in ways that we don't even know because we cannot even get it. we cannot even get our electronic health records which we are supposed to have a right to get since 2001. imagine if we could get our all of and could pool our different treatments from different hospitals and doctors. we are the only ones that would want to use health information so that we could get apples to apples or head to head comparisons. a cost from a

hospital. a hospital will have 20 or arty or 50 different costs for the same thing depending on which health plan you are him. we don't actually even know what the costs are much less the quality. who cares about that? i think it's us. i think it's the parents. i think it's the moms in the dads and the people who are trying to keep their children and their families and their mothers and fathers healthy. i think it is us. we are the citizens who care about what this really costs and where the money is going why the costs are skyhigh. when these industries are making so much money, we have got to and get the off data so we can actually learn what works, what is cost-

effective, who the best doctors and hospitals are, and what is inflating these costs. it is not being set. other countries can deliver much better health care at much lower cost than we can. there is something wrong with what we are doing. pat: the last call is from in new york. with mostou i agree of what the doctor says as far as not being blocked from getting health care because of records that are x posed. i live in europe for 10 years and it worked well for me and 60,000 other american servicemen. mythe area of mental health, ex had borderline personality disorder. how do you not sure that information in a court of law where it affects children, spouses, the information needed

to be shared. interferes with the broken system of justice in this country when it comes to father custody. host: we will leave it there. guest: i think those are complex questions. when are times psychiatric diagnosis might be an issue in custody. it might have to be discussed. i think mostly the courts and particularly the divorce courts try to have effective evaluations, neutral evaluations, of the parents and the children to try to understand what is in the best interest of the children. i personally do not believe that every mental illness means you should not be able to be a parent. i think that's absurd. thing butcomplicated i think part of what you are

getting at is there are times when we need to know if someone has a mental illness that prevents them from being a good parent, something like that is important to know. i would like to think that the courts try to get neutral evaluations in the best interest of the children. is ther. debra peel founder and chairman of the board of patient travis he writes, thank you for your time. caller guest: you are welcome and go to our website and we will will tell you of updates for your rights. host: up next, a segment on hunger in america. you're watching "washington journal."

♪ ♪ >> one of the things that we about -- there are cyber attacks, but there are physical attacks and what i always think is what keeps me up at night when i think about what can happen next. wonder what your greatest fear attack. a physical our country. general? >> i would answer that by two things -- on the cyber side, i think an attack against our critical infrastructure that would have potential damaging effects in our transportation or health care and financial is an area we have to pay close attention to our energy sector. on the kinetic side, there is a range ofgeneral? >> i would answer that by two things -- things that keep me up

at night. these attacks like what happened in a mall in nairobi -- what happened during the boston marathon -- those are the kind of things that we have continue to work together to make sure we are working as seamlessly as possible to ensure hadything

little through 2012.

what are we seeing here on the screen? what can we extrapolate from this? guest: there are two lines on here. this is how we measure and the terminology we use. the blue line on top is the percentage of households that were food insecure. that is close to 15%? guest: yes, it was around 11% a for the recession. it went up quite sharply and since then, it has not changed much. food, for most households that are food insecure, this means in adequate in terms of quality and variety of diet. the red line, the more severe range, that's below six percent currently, those are households where the respondent to the survey reported conditions that

indicated they were not able to get enough food. it's not just cutting back on quality. the bottom line is where household are more likely to occur. most of the households told us that at times during the year, he or she was hungry but did not eat because they did not have enough money for food. conversation our is caroline radcliffe. when you see this, how do you interpret these numbers? he also has the unemployment rate which can be high. unemployment has come down some but if we look at other measures rate, we sawverty this mimicking food security. we saw big increases in the poverty rate. it has been relatively flat in recent years. we have families that are struggling with high poverty rates which leads to high food

insecurity. we've got these pieces coming together that create a lot of instability and insecurity. host: food insecurity issues. seem to be centered down here in the south? guest: mark, did you want to comment? guest: there are substantial differences in food insecurity, these are statistics from 2010 to 2012, our most recent late released statistics. with the highest food insecurity were mississippi and arkansas in this period. 21%. were around the lowest states, north dakota and virginia were around 9%.

states with the higher levels of food insecurity tend to have higher unemployment rates. they tend to have especially higher housing costs. this is not true of all states, most of the dark blue higher insecurity states have one or more of these traits. lower than average wages, higher tax burden, state differ in their tax structures. a highert impose burden on low income households tend to have higher rates of food security. at the we look broadly u.s., when you look at debt, financialernative services like payday loans, you generally see much worth south.eristics in the just --

host: what kind of government programs, we have all heard of food stamps. how effective are those programs, caroline ratcliffe? guest: there are three main programs, supplemental nutrition assistance program, snap -- host: which is food stamps. guest: that is really the cornerstone of the usda's food program. there is free and reduced school breakfast and lunch, also women infants and children nutrition program. research is from that the programs have been effective in reducing food insecurity. most of the research has been focused on snap, the food stamp program. we have done work at the urban institute finding that dissipating in the food stamp program produces the likelihood of being food insecure by 1/3.

from 20%earch puts it to 50%. there is also a work that looks at the amount of benefits. riley, what we are seeing is that the snap program is reducing food insecurity. the same as school breakfast, school lunch, and that wic program for the mother and the children. mark nord, does usda agree? guest: yes, i will talk later about research we did around the recovery act, the stimulus bill. that many other things were in that bill, increase snap benefits about 60% on average. 16% on average. the graph you have now, talk about it a little bit. it helps shed light on the snap

caseload. you can see looking back a couple of business cycles -- host: this is the chart? poverty is the top line. snap participants, food stamp or participants is the blue line. unemployed is green. guest: this goes back to food insecurity, snap participation goes up following the recession as food insecurity increase. looking back over this period, it has basically followed the trend of the poverty rate and the unemployment rate. it tends to take it a while to come down after unemployment. host: we see the snap participation rate, caroline ratcliffe, going up, up to 45 million americans who use food

stamps. why? does that seem extreme? guest: no, it does not. people have voiced concern about the increases in the snap caseload, that so many people are on this program. i would frame this in a different way. stamp program was really designed to help families in a time of need, we had the great recession, lots of families with lots of economic hardships. the program is doing exactly what it was intended to do. rise, thef this deep congressional budget office has estimates that suggest this is going to be coming back down, this is not expected to be the new normal. that over the next 10 years it will come down significantly. point, people

worry about big caseloads. when we look at participation in about 75% of the people who are eligible for the program participate. the people who do not participate tend to have smaller benefits. we are talking about a program where people are eligible and we want them to take up these services to help children in the family's. that is a good thing. host: i am not sure who to ask this, this is a tweet from @boringfileclerk. in, how many who go hungry our children as opposed to adults? mr. nord? guest: we publish separate statistics in our report. usda's economic research service publishes a report annually on experienced food insecurity and households. one of the statistics is the

percentage of households with children in which children are food insecure. households in which children experience this, they are cutting back -- parents are cutting back on the amount of food available. protectedend to be until things get pretty severe in the household. the percentage of households with children in which adults food security is higher than the percentage where children have low food security. ofis a little over 1% households with children in which children have low food security. host: caroline ratcliffe, do you want to add? upst: i am glad you brought children, that is very important in terms of getting food and nutritional food to children.

early in life, research looks at poverty and these earlyity, years are times when children are developing, their brains are developing. for future outcomes, for their future health, ability to focus in school, all these things are important. here are more statistics from the u.s. department of agriculture's economic research service. more than half of snap recipients are children or elderly. 46% 18 yearsen, old to 59 years old. elderly receive 9%. james tweets in, can you be food insecure and obese? guest: i will jump right in. yes. can be going on here, mark mentioned the types

of food. we know that-- healthy foods are expensive to purchase. you can be food insecure where your consumption early in the month when you get your snap benefits, you do not feel insecure, as the money dwindles, you are food insecure. people are that making, particularly with the fact that some of the lower quality foods are less healthy, can result in people being obese. host: let's take some calls for mark nord with the usda's economic research service. he is a sociologist and the food assistance branch. is a seniorcliffe fellow at the urban institute. both monitor food insecurity, hunger in the u.s. rich from massachusetts. go ahead. caller: good morning.

i am calling about -- this is my first time accepting food stamps. i got laid off of my job, i was at my job for almost 20 something years. i was embarrassed to go down and ask for food stamps, i am very independent. i do not need a handout. go to thehoice but to food stamp office and get food stamps with my three kids. we are suffering really bad. this is embarrassing. that is all i have to say. host: thank you for calling. experience is what many families have experienced. people lose their jobs, food stamps -- a lot of people have instability in their lives. they might have two part-time jobs. they are expected to work 20 hours a week at a job and it gets cut down to 10 hours.

people need assistance, let me also say that people who work full-time at a minimum wage job, they are eligible for the snap program. their incomes are low. people who lose their jobs but also many working families. host: mark nord, i went to compare two charts. food insecurity worsened in the recession, prevalence rate, 14%. down here, the very low food security rate pushing 6%. snap participation is blank -- snap participation is way up. wouldn't these rates come down as this rate goes up? helpful to look at it another way. if you look at the red line and the green line on the top chart. coming into the recession, from 2007 two 2008,

coming into the recession. food insecurity, low food security went up in parallel to unemployment. unemployment continued to go up in 2009 and 2010. but the prevalence of very low food security -- host: went up. guest: we have some research evidence that is the safety net be partin, snap would of that. there is unemployment insurance. add income tax credit. all of the pieces of the safety net that help keep things from getting as bad as they might when the unemployment rate went that high. host: caroline ratcliffe of the urban institute. we have had all these government programs for hunger since lbj's great society.

why are they working? -- aren't they working? guest: i would say they are working well, we have had declined in food insecurity. without these programs, the levels will be much higher. also, these programs have though: the short term of reducing food insecurity. -- these programs have the goal through the short term of reducing food insecurity. they have long-term benefits, children who have access to the program early in life have better outcomes as adults. looking at obesity, heart disease, high blood pressure. we have the benefit in the short run and the long run. in the long run for women, greater self-sufficiency. earnings, income, less reliance on public assistance. the programs are working, they

could be expanded to improve outcomes. host: do you see evidence that food banks and private charities put a dent in food insecurity and hunger? guest: families supplement government programs with private programs. and other particularly during the great recession, there were lots of families that were using food banks and other nonprofit services. that ai might expand on little, households -- the two types of programs tend to complement each other. the private programs, food banks and food pantry is, they can respond very quickly. you practically do not have to demonstrate eligibility or anything. if you show up, you can get food.

quickly.ond very the federal programs might take longer to get into and get assistance from, but when you get the assistance is longer-term. aboutderal programs are 10 times the size in terms of amount of food delivered. about 10 times as large as the private, but the private fill an important niche. host: what is the total spent on food security issues by the federal government? guest: snap, i have this is to i have theap, statistic. in the fiscal year 2013, the federal outlays for snap were $79 billion. host: what is the budget for 2014? guest: i do not have that number. the program is an entitlement, the budget for it is a guess at how many people are going to be a logical. -- going to be eligible. host: how many people use snap

use snapof -- benefits today? guest: you can see it has leveled off in 2013. graph like this correlate directly with the economy? see the numbers move together when the unemployment rate goes up or down? guest: there is a strong association over longer periods, it typically takes a while for come downaseload to after the unemployment rate comes down. there's a bit of a lag. host: do you know the figures for wic? size, theterms of school breakfast and school lunch falls second after snap.

about30 million children, 20 million of those have free and reduced. you have lots of kids going to school and getting school lunches that are paying full price. for that wic program, about 8.5 million people are served, host: could you explain the school figure? guest: the number of children who get school breakfast and lunch is about 30 million. host: total. guest: but will we look at free and reduced price school breakfast and lunch, which the usda supports, that is 20 million. host: so 10 million of those children are paying for themselves. jerome in california. caller: good morning. i have a couple statements. cards,about the ebt snap cards.

they arencerns about used in convenience stores and gas stations. people could better use them if they were related to grocery stores. host: why does that matter? the cost of, one, food in a convenience store is higher. healthy?t always no, convenience costs money. that does not mean i'm going to get healthy food. i will get full and fat food. host: we will start with caroline ratcliffe. guest: you are making a good point. make here isant to that we have food deserts, for example. areas either -- we think of them

in inner cities. we can have them in rural areas. a food desert means people do not have access to healthy fruits and vegetables. big supermarkets. some of these convenience stores and smaller locations are the only places where people have access to food they can purchase. by the that is taken up smaller stores. guest: i might add that we have pretty good information on where snap benefits are redeemed because of the electronic system. the food and nutrition service, agency that operates the program reports on this. about 80% of snap benefits are redeemed in supermarkets or larger stores. but concern is well-placed, as dr. radcliffe mentioned, for some people, convenience stores

-- they might supplement their purchase by picking up things or it might be practically their only choice. mark nord, are you seeing trends that children on food stamps continue to be on food stamps as adults? guest: i do not have that research handy, we have done longitudinal looks at that. host: caroline ratcliffe? that foodthe extent insecurity is connected with poverty, we can say something about that. we have done some work looking at children who are born into poverty. what we see is that just by looking at that one year, those children are likely to the poor throughout their childhood, multiple years. more likely to be poor as adults. to the extent we see the connection between poverty and we expect that,

children who are born into food insecure households are more likely to have this food insecurity throughout her life. ratcliffe, how many people in the u.s., 340 million or so, is that right? how many people in the u.s. go to bed hungry? guest: i guess this goes to about the food insecurity and then the very low levels of food insecurity. 6%at would be closer to your to 7%, families that are more likely to have children who are food insecure. host: are we talking about 18 million people in the u.s.? guest: keep in mind that is at sometime during the year. we make estimates, we do not have quite as good a measure of

daily occurrence. daily occurrence is much lower. talking about people going to bed hungry every night, that would be a good delaware. we are concerned about food insecurity, even occasionally. that is what our programs are intended to address. that is what we measure. guest: can i add, when we look at food insecurity and you are saying going to bed at night, i went to bring it to the morning when kids get to school. the school breakfast program, particularly some of the programs, breakfast in the classroom. principal of to a an elementary school in southwest colorado where lots of their children are poor. they instituted breakfast in the classroom, a lot of teachers were not interested. kids are messy. what they found after a short board, teachers were on children were much more focused on learning, they were not thinking about lunch. they were more secure in their

situation in school and able to learn. some of these programs are very critical. host: as a policy person as well as a researcher, caroline ratcliffe, we have been putting not,nus on you, i should if you could design a feed security program, how would you do it? what would you do differently? guest: i think we are doing a lot that is good. mark has done some research, he withed to it, the snap, the stimulus package that snap benefits increased, research shows that reduced food insecurity. snap benefits increased, those benefits were allowed to erode over time. we find that that reduced food insecurity. why is that so important? it tells us that the snap

program is operating in this area where increased benefits will lead to reduced food insecurity. so that putting -- we have got a really great, solid programs out there. and resources, the resources are very important. more resources would reduce food insecurity. host: mark nord, are there a lot of people who used snap, wic, and school lunches, all three? guest: there is overlap between them, but households without children are not eligible for thatr wic or school lunch, whole group is not getting assistance from either of those. households with children, especially with low incomes, many of them do use all three. host: peter in iowa, you are on the "washington journal." caller: hello.

i have a couple things. i have been watching and listening. something about our food stamp program that i think is totally flawed, it is in the farm bill. we have farmers that are paid not to grow food. making .25is million dollars not to grow something so someone can be hungry. the other thing, and anything with high fructose corn syrup is stamps.under food coca cola, general mills, all profit from food stamps. i don't understand is that we know what-does corn syrup does and what it can do to your body. pushed, we hadts reagan, the dairy farmers got more than regular farmers.

the sugar farmers, the corn farmers. boom, now, all encompassed in that farm bill. host: i will ask you about the farm bill, caroline ratcliffe, do you think it is a good idea that snap is included in a farm bill? guest: i don't have a strong opinion on that. i would say that with the farm billm, there have been lots of talk, the house measures had cuts in snap. come into play in the final legislation. i am march, there were some cut -- by in large, there were some cuts to snap, it came through in pretty good shape. nord, is it true

about high fructose corn syrup, you can use a stock benefit if it is included in a program? coke, mountain dew? guest: that is true. the type of sweetener does not make a feed in eligible for use of snap benefits. ist: i am not sure understand, i apologize. can you use snap to buy candy bars? guest: yes. ofst: there has been a lot talk about this in the news, new york city tried try to get rid of -- you could not use snap benefits to purchase soda. there has been farmers markets, for example, programs where if you use your snap benefit at the farmers market you get more. in new york city, for every five dollars you spend in the farmers market, you get a two dollar coupon. it is trying to encourage people

towards healthier alternatives. bring it to aally program where if you are using your snap benefits to buy whole grains or whole food, fruits and vegetables, there could be a benefit. we know those foods are more expensive than some of the processed foods. tweeting in, i thought snap was separate from the farm bill? guest: there was discussion early on, but in the end -- host: it came back. guest: it is part of the farm bill. host: ruth? caller: i was visiting salt lake iny, an incident took place a school lunchroom. some parents were in arrears with school lunch accounts. they were not, in a timely

manner, informed of this. underas served to kids these circumstances. minutes later as they were eating their lunches it was taken away from them because -- in a very public manner and thrown away. was welanation for that waste the food once it had been distributed. impacts,the political what are the influences on these programs? leaning on them to suddenly take food out of the mouth of children? these cafeteria workers who were having to do this, some of them

were crying. host: i think we got the point. caroline ratcliffe? guest: i would say that some of these free programs, particularly snap, did come under attack when we think back to the last presidential election. all sorts of talk about snap. as i mentioned, in the farm bill, the house had lots of proposals that would result in deep cuts in that program. social safety our net, tax assistance, that has really not been, it has not picked up slack with the great session. -- the great recession. some of the programs have gotten smaller, snap is now the largest. i think politically it ends up getting more attention. host: tweeting