sometime -- i'm trying to member . 1820's or something like that. that has had a remarkable effect. seeking class action status and so on, and trying to the asymmetrical costs that benefit them, that they could costs and force them to deal with literally , thatns of documents could generate settlements just in terms of cost avoidance for the corporation. but there is no incentive for the corporation to really duke it out. lawyer, the class lawyer, may lose the case. there is no financial penalty

because the prevailing party, i.e. the corporation that got the case dismissed, cannot impose any fees. shouldterprising judge look for a crack in the american rule doctrine so in cases which are brought solely -- >> sessions brought solely for the economic interest of the lawyers , these i think in many cases are pretty apparent, a judge can maybe bad faith, but that thate a bit of a stretch, the plaintiff lawyers will have or someurse the company part of its legal expenses. there are judges who might be willing to do that. one of my pet peeves in the class action system, which we have not touched upon, the lone star. a big word that simply means,

the number of hours you worked times the hourly fee. book that some of the lawyers have fees that are out of the world. only 24day on earth is hours, some of the lawyers bill on saturn time, where it is 704 billion hours. i have seen bills with 72 hours billed in single days. not that uncommon. the lone star is on an honor system basis. frankly, i think there is an enormous amount of cheating that goes on. if you are sitting down and writing yourself a check, you have a choice. you do not write the check to $1000 to yourself or $10,000 or $100,000. this is tough. i have to decide which one i will do. judgess a way in which could go behind us. because if want to

this was really exposed, it would be an embarrassment to the judiciary. but if the judge required not just the fee request of a law form -- law firm, kush -- which ,ould run thousands of pages many in one firm working on the matter, but if they required the firms when they put in a fee request, to also put in the hours their staff people, their attorneys, have worked on all class actions, as well as all other matters. this could be done electronically so that is it -- it is a very simple coding process. depth of find out the cheating that goes on in terms , myow many hours worked seat-of-the-pants sense is we're talking about anywhere from 25 to 40% of the hours claimed in the lone star are simply -- i do

not mean the kind of hours where you meet with your partner. i am talking about real cheating. >> it is fascinating. we could talk about all night but we are running short on time. we have talked about discovery and potential bounties, lone star reform, shifting, any other policy ideas before we wrapped up? >> i agree with everything said. you are doing public awareness. getting the story out there and people understand it. you're looking at the company, what would they think and know about the suspect -- the subject and how impressionable with a b iso the bush -- the book out fantastic. i think a lot of good things are here. judges, making sure we elect good judges in a hold them accountable is really key. >> all good ideas. the one idea not feasible is to .lone ted frank

but he is an american treasure. for those of you out there in the national television audience, how do they get in touch with you, ted, if they want to send you a case or send you a check? classactionfairness.org. here, if youou out have a bad notice in the mail on one of these or you think this is a problem and ted needs more than four lawyers to fight all the cases out there, give him some help. let's thank our panel. , mr. norton.an and again, those of you in the room who want credit, sign and return your evaluation form. thanks. [captions copyright national cable satellite corp. 2014] [captioning performed by national captioning institute]

>> coming up later today on the first religious affairs correspondent for the bbc talks about the connection between media and religion at a conference hosted by the university of colorado. that, the clinton foundation hosts a panel discussion about the abuse of prescription drugs by young people. among those beacon, patrick kennedy of rhode island. he spoke about his own struggles with addiction. here is a look. >> we need to reorient our culture, ultimately. our culture needs to be reoriented to stop keeping silent about this. enemy is the silence. it is the pathology of not being

able to talk about the elephant in the room. suffered from severe and persistent mental illness and alcoholism and we never talked about it. my family is pretty progressive, liberal minded, and never breathed a word about it. then she disappeared to go to treatment. in hisrites about it books. the biggest challenge here is we need a conversation. i love the fact mtv is trying to break these barriers down, but it is the stigma that is our most insidious enemy here. this is not just about prescription drug abuse. i could have been addicted to anything. i was a genetically predisposed -- had an environment that encouraged it. it was oxycontin for me for a while. i was hospitalized for it. then i came out and could not sleep.

you could give me anything and as an addict, i would abuse it. we need to get to the bigger picture. it is not the name of the drug. , ass the underlying issue you said, about mental health. as our culture goes forward, we do not have the nomenclature to talk about our emotional and psychic development, the spiritual development that is so crucial to us as human beings. kids and leadr out this important piece that part of their development is being able to be social and not be stuck on their phone or ipod. i love technology. part of the problem is we are more connected and yet we are more disconnected. atformer congressman patrick -- patrick kennedy was part of a panel discussion. you can watch the entire event tonight starting at 7:15 eastern here on c-span.

>> tonight, we conclude our series, "first ladies," with a live two-hour program. martha washington to michelle obama. >> she brings financial resources to the marriage, as well as her managerial skills. vernon a successful operation makes it possible for washington to be away for eight years fighting a war. >> there was something about saw thelincoln that she potential and encouraged it. and helped develop it. lessons in etiquette in the dining room that helped polish them up for washington society. the political parties they had where they invited a lot of important people. she will did a lot of power, both over mr. lincoln and where he was going. >> the involvement of mrs. roosevelt in the political career of franklin roosevelt was right from the beginning. she becomes much more active in her role after 1921 when

franklin roosevelt contracted polio. she would encourage franklin roosevelt to continue with his political ambitions. ladies," tonight at 9:00 eastern live. we will start the evening with a conversation with richard norton smith about the first ladies and their contribution to the nation live at 8:00. >> the clinton foundation recently hosted its third annual health matters conference in california. .ill clinton moderates this is about one hour and 15 minutes. [applause] >> thank you, very much.

i am sorry we started a little late but you gathered a little late. everything is reported in a lyrical contest. i can just see the headline -- "clinton hospitalized as ,ttendees to help conference tries to make money for sponsor." [applause] [laughter] trevor was just saying it's not a bad headline. i want to thank you for being here at our third conference.

i do not know how many of you saw the town hall meeting, but it was amazing. they did a wonderful job. kobe o'brien was great. the children were wonderful. i think him for that. -- i thank them for that. i want to thank our other sponsors. they all support the conference. and the year-round work we do to try to help improve the health of people around america. i want to thank the pga tour to put on this which starts on thursday. our golf tournament, which tries 's legacy.n bob hope

i think bob hope would appreciate the focus on wellness. i first met him when he was still just 78 years old. a young man. arkansas governor of and he did a gig at the university. i went up and had dinner with him. i said, how do you keep doing this and he said, i play golf as long as i could but i walk an hour a day. carryter where i am, i foot conceivable amount of well and an umbrella. i i have to walk admin night, do it. never go to bed unless i walk an hour. so it is not a00 data subscription. what we try to do with this

about how is to think we can have wellness in every generation. this healthknow matters idea grew out of the good results we had in trying to tackle childhood obesity epidemic, and that is what it is. we started our biggest public health problem. i want to thank all the people who worked. i was introduced by one of our young members last night, who but all the way from miami, after doing what we could to reduce the number of bad calories and tricks going to our schools by 90% in trying to lead the way toward what is now a new nationwide movement of the

quality of health in schools, through the cafeteria offerings, and working in 20,000 schools on exercise programs, we are now moving outside the schools on that. there was wayo me more that needed to be done if we were going to both improve the health and wellness of americans and bring the percentage of our income we are spending on health care closer to the global average. for ourhe reasons growing income inequality in is a. most people never connect, is that, as recently as three years ago, we were spending 17.8% of our income on health care and no other country was spending more than 11.8% of their income on health care. that was $1 trillion a year going to health care that

otherwise might have gone into not only hiring more people but raising -- it also produced a disposal income of for chile every american who either had insurance and was paid for it or had to pay out of pocket. the good news is, for all the trouble in the individual market, we are now down to 17.2% on health care, because for the last four years, we had inflation under four percent for the first time in half a century. but there are economic as well as health-care implications to the trajectory we are on. wewas clear to me unless started something like this, we would have real problems with the aging of the baby boomers. i am the oldest of them. i hate that. [laughter]

so, we're just getting started. if you live to be 65 in america, you have artie -- if you are woman about 85, or a man about 82.5, it is just going to get -- we are going to live longer. if we do not live better, we will impose an unconscionable and theirour children ability to reverse these trends towarde now on their way greater health and being closer to our global competitors in the actual money we have to allocate to caring for people who are sick. that is why we're doing this. today, you will hear ,nnouncements from people designed to fill in the blanks of how we can improve the health of all americans. that includes partners like

mtv, and manyok, others. i am excited about them. today theouncing health matters initiative partners are making 100 million dollars in new commitments that will impact more than 50 million people. that is one in six americans, in a positive way. i want us to keep doing this. this is something -- we are trying to change the entire ecosystem of america as it relates to health and wellness. i am thrilled about it. i am particularly thrilled because of the commitment announced last year, 90% of them , 90%, had either been completed or are underway and on their way to completion. that is a good thing when nine out of 10 people will tell you they do something do it. [applause]

so, we have still got a long way to go. ranking saystional that we are great at some things, like cancer treatment, but we are light years ahead of every other country in the percentage of our income that we devote to health care. if you measure us in terms of life expectancy and health and on everyindicators, international survey i've seen in the last 10 years, we have ranged between 25th and 33rd of all the richest countries in the world. we can do better and we have to change it ourselves. so we are going to focus now on our panel on what else can be done. i want to make one final point. chronic diseases, many of which

are entirely preventable, claims seven out of 10 lives and 75% of our health care spending every single year. over the last generation, the prevalence of diabetes, heart disease, obesity, and other chronic diseases, have all risen. the past two decades, the number of people suffering from diabetes has tripled, affecting more than 25 million people. a is now the leading cause of number of complications, including kidney failure and blindness. the elements at play relate to our habits and lifestyles, our environments, and a result in the health.com disparities we all see, including those that are income based. i am looking forward to talking about transformation as we kick

off our conference. our first panelist has interesting things to say. i want to bring them on now. -- youll be introduced hear one of those voices -- do you know what they call those voices on every backstage in america? the voice of god. i want to bring our panelist out now so we can get the word. thank you very much. [applause] panelists.elcome the the chairman and chief executive officer, and the family oundation --

to join president clinton on the stage. [applause] >> most of you who have been at any of our previous conferences will recognize at least some people on the stage. what i would like to do is begin by giving everybody a couple of what they talk about intend to do in the coming year and how they analyze this and the point they make about the contributions they believe they can make to deal with these issues. >> i would love to start. thank you for having us. we have worked with the clinton foundation over the last few years and we are excited to say we will commit this year to

focusing on a community to help improve their health at 20% by 2020 by making individuals easier to achieve their health. i want to point out the important part of that is not just the 20% improvement, but i think, the health care system in general needs to focus on how we could help people focus on their health in an easier way. we as a society, health is hot -- hard. hard to stay healthy. it is easy to form bad habits. when you look at under resourced areas, it is hard for them to maintain health. they do not have health literacy. they sometimes do not have access to good food, they do not have the economic conditions to promote health. as an organization and as a health care, partnering together with organizations on the stage and throughout the industry is one of our obligations. we look forward to working with

you and improving the health in that community. >> thank you. representing ge. ist we would like to do utilize employer bases as a catalyst for health care change. we represent health in a number of ways. one as one of the biggest medical device manufacturers. addition to that, we have our health foundation, our ge foundation. itre, we make grants as relates to major issues surrounding health. the area of primary care shortage in the country, and or underserved regions where we put our clinical health clinics in some of those areas. in addition to that, when you think about our own employer-based, we have 500,000 covered lives, we have to really think about, how do we manage the cost of health care while we

continue to make sure our employee health and the quality of their health are either the same or raised? that is a major issue we have been working on for quite some time. the thing i am most excited about is working on our program, healthy cities, with the clinton health matters initiative. closely with the team in houston. one of the reasons why this is so interesting is houston, as you might think about it, has some of the best medical centers in the u.s. or in the world, and yet, it is one of the most challenged as it relates to staff. -- stats. we are -- working to make a difference. my sense is employers are real to allow this to happen. we are a major customer to a lot of the folks on stage. the room ares in

convening, it is amazing how people want to collaborate. looking forward to talking about that. >> thanks. houston is about to face a new challenge as well because there are so many low income people there and the state of texas has refused to accept the medicaid money, but houston's hospital lose their portion to share payments, they will be in a much more difficult situation than they were before. i know some bigger urban hospitals in houston and dallas, principally, have actually asked the federal government if they could take their county out of texas for purposes of medicaid treatment. i thought it was interesting because the governor of texas used to talk about how i wanted to succeed from the union. i wanted to tell him not to let the doorknob hit him on the way out. [laughter] them wanting to

secede from texas to get in the union. we are laughing, but it is an extremely serious issue. if you are trying to manage a big health care system and you all the sudden see an increase in your uncompensated care bill when the program for uncompensated care has been eliminated because those people, it was assumed, would all have compensated care. left -- but, but this is a very serious issue. >> let me start by thanking you for all you have done for the game of golf -- [laughter] i do not know if many are where , chairman of the presidents cup, he has been too many presidents cups over the years. remember a couple over in the

u.k., when he came and he watched the teams go off and after the last match, there was and fivearound the t minutes later, i looked down the theway and at the middle, rider kept walking down and listening to the applause. president clinton had stolen the show. it was fabulous. last night, there was a discussion about your athletic prowess and you talked about double digits in a basketball game. i have got to believe you are a better golfer today than you are a basketball player. tonk you for your commitment us and your friendship for many years. people wonder why we are involved in all of this. obviously, the partnership and the clinton foundation with the tournament is very important to us. from health and wellness standpoint, activity here kind of fits with our culture.

i will explain that quickly. as most of you know, all of our tournaments raise money for charity this year. they will raise over $130 million for charity this year. 80% of those charitable efforts and tournaments are focused on some help related activity. arnold palmer, a medical center in florida, st. jude's hospital, and, increasingly, wellness activity as well. among our players, the vast majority have their own foundations, their own fund-raising activities. 35t year, they raised about million dollars in at least three quarters, 80% of their activity, is focused on junior's development, health, wellness, and the future. then, our employees, who pushed back a little bit, 22 years ago,

when we announced there would not be any smoking area arequarters, today, they part of a real focus on wellness, partnering with humana , with their wellness programs, over 90% of our employees every year are voluntarily scanned. that scanning has resulted in a wide range of change in our employee base, and they are into it. energy behindd things that relate to what that health matters conference foundation, the clinton foundation is all about is a natural for us, and given the walk 30t our players miles per week, they are great role models on the fitness side of the equation. what are we doing? as the president has often

talked about on the global scale, doing things like reducing sugar content in rinks available -- in drinks available to school children, that is a colossal effort that needs to be married with lots of little activity at the local level. for us, it is contributing to using our players as role models, telling the story of things like what comes out of this conference on a national basis, and looking at the places we play tournament, and we are so many markets, over 100, about how we can generate more activity there. this year we promised the president we would underwrite for the next five years at as a part of the players championship row seats the same thing that is -- proceeds the the same thing that is going on into sin. and a person from jacksonville,

and from a very young age has become prominent in the education side of the equation in northeast florida has agreed to take on the role of coordinator. we will be behind her in supporting the effort of exchanging best practices, ringing leaders together, and making things happen. -- bringing leaders together and making things happen. we canger-term things do, a lot of the discussion is about defense and how much it is costing us and how it will encrypt us if we do not do something and how it affects the educational system and increases disparity between income levels in our country. in enough is talked about terms of the positive about what can happen, relating diet and wellness and physical fitness to success. i see increasingly young people getting that, but to me more

focus on that that we can help with, i think, is a goal of ours as well. mr. president, thank you. >> thank you. tim said something that made me think of something i should have made in opening remarks, that this is about getting hundreds of millions of people to do specific small things one day after the next and so you change the whole structure of the production, delivery, consumption of food, and the same thing about our exercise and activities and the changes that are going on in health care delivery. but i noticed the edit date something that -- noticed the hing hasy that somet nobody mentioned, that food producers in america are selling ies this fewer calor

year than they have been. there was an article that said if it is down gosh no -- not an anonymous -- not an enormous amount -- if you ate fewer calories per day, how much weight you would lose. there is a greater awareness that everybody needs to do something. so i thank you very much. like to ride a golf cart, but tim has shamed the into walking more on that golf course. we heard him, 30 miles a week. patrick -- >> thank you for the honor for inviting us here. mention that the power of one man's ability to lead, president clinton was

responsible for forming the funding for the human genome, the nanotechnology programs in this country, and responsible for the technology like nist? how does that relate? was came out of that the human genome. our work, and we committed to the partner with the clinton foundation, is address what is a major inflection of the country, and the world, cancer. imagine that you could now for the first time measure cancer from the blood, that you could identify what exactly is ailing and give the right treatment. we do not need to imagine that anymore. we have people with pancreatic

cancer without metastatic disease five years out, and this is personal to me. who came to me who in canada was going to get the wrong treatment, said she had two months. she is now 13 months and almost free of disease. i want that kind of information for the world to see through bes conference, and i will describing network. the problem is the science is so complicated, the information is so fast, how do we get this kind of information into the hands of a practicing physician, how do we get a decision in south-central l.a., in the novel home nation, or to have the exact same treatment as they would in cancer centers? there is a collaboration where the best care of very high-level netflix cand -- if

outdo blockbuster, we can do information exchange throughout the country and we can do three clinical operating system. today we will announce an .perating system we have launched that, and now in real-time patients will have actual information in real time, point of care, in time of need, anytime, and that is the goal. we are launching that in this country. [applause] >> thank you. i love being around patrick because i feel so dumb, and yet he makes me inc. that like a blind man -- he makes me think that like a blind man, even a

an acorn.finds funding the nanotechnology research, the first we ever did, one of the things newt gingrich and i agreed on. you shouldis home, take a couple of minutes here health caretual revolution you are trying to effect in south-central l.a.. last time patrick and i were together was in los angeles, and he said i am convinced that we can give poor people in south-central l.a. the same quality of health care you get in beverly hills -- [applause] it is a laudable goal, but how do you do it? could you give a couple of

minutes on what you're trying to do that? >> the first thing, i came from the erarica, lived in of apartheid, so i was the first white chinese person to work in a white hospital. a 50% reduction in salary. i was brought up in this area of our -- era of oppression. i was astounded that a woman went to martin luther king hospital, entered the emergency room, and called 911 rumble floor of the emergency room asking for help to get out of there him and she died on the floor of that emergency room. they shut the hospital down and said -- their solution was to have no care in south-central l.a. we were able to friendly -- and i know david is in the audience

-- embarrass the university of california system participate and help us open up martin luther king, and it is now scheduled to open in 2015. the issue is not a physical going. it is access to physical information, access information in education and bringing doctors to that community, so they can have information. a patient in south-central l.a., through a software system, that is ubiquitous, that transfers information about this nation's condition -- this patient's condition in real time and have that information transmitted and communicated and their doctor being educated, going live. dr. david feinberg is in the audience. molecularute of

edison is a place where this haveof medicine, if you cancer, this is what you deserve, and martin luther king, his birthday this week, that health care is a human right. will besomething we pursuing. thank you, mr. president, for the encouragement, but with a voice ike the clinton foundation -- like the clinton foundation. we also have a system of medical records where the electronic records do not speak -- if you're in a hospital, there is no way it can transfer it to another, but this system has created ubiquitous information. we are about to introduce this into the novel home nation. if you can't address this, the poorest of the poor, we can make this work in the rest of the country. [applause] thank you again for this

opportunity. comments, iuctory had the opportunity to say about what we do, but you tie together some of the points that have been made and elaborating a little on our mission. as i mentioned we are in the business of operating hospitals, and hospitals in error livery system are the frontline in providing care to people, particularly when they need it urgently. my so mentioned in introduction that our company is spending 800 million dollars a year in uncompensated care. i was very pleased that you mentioned in your introductory comments that we have succeeded in bending the cost curve a bit in this country. we are spending a little bit less as a percent of gdp now, and the rate of health care inflation has reached historic low levels, lower than anybody

in the audience can remember. how are we doing that, and what is the role -- because it is any central role? role? essential you want that emergency room they're available at 2:00 in the morning to treat any condition that you can think of. our interest in addition to wellness is in providing greater found you. our country spends more than enough money on health care, but the value is not there, and i am pleased that we can get into examples as we go around in the panel that there are all sorts of innovations taking place that enable us to increase steadily the quality of care we are providing, the reliability of care come at the type of reliability in emergency settings that would not ever

youw that kind of case that mentioned to occur, at least in one of our hospitals. i am quite optimistic about the future for the health system, and i think particularly this are embarking upon this grand experiment in health reform, our hospitals are at the epicenter, insurance plans as well, in trying to make this work and trying to pursue that laudable goal that was yourated by you in administration to improve access of care and the percentage of people covered by some sort of interest program. alternately we know that will lead to better health very quickly. i would like to say hospitals are an incredibly important part of the equation, and we are doing a good job. we are improving value. we have been successful in reducing the rate of growth in

cost. we have a lot of democraphic factors putting it higher. [applause] all these people are really smart. i do not need to ask them probing -- i prefer to let them talk. i want to take the next step , and tim is basically the only layman besides me who is here, in that sense, but we are stumbling in the right direction. let's posit that. and sciences out there, as patrick said, but we have to accessible and usable to all of us. , either in we are

public health or in the health-care system itself and the delivery system, as concisely as you can, what do you think the greatest challenges we still face are and what are the greatest opportunities? one or two of each. i will give you an example. you mentioned we needed to do more with primary care. there is a lot of worry that we do not have primary care decisions, nurses, health care workers. i even saw a great article the toer day about how we ought look at some of these developing countries that have done a great job with training health care workers and send them to the most world areas of the country and hope them up by the internet to all of the stuff that patrick wants to do. let me give you an example that i personally saw in the last six

weeks. mine -- i just went home to a funeral, and a friend of mine went to one of these clinics in a small and remote wirral area instead of going -- toal area instead of going the nearest city to a hospital, and it appeared that she just had the flu, but in fact she had sepsis infection in the blood, and by that time she got to the hospital she only lasted three days. she was older and also very depleted in energy, so this is not a malpractice issue. have distanceg to health care, if we are going to have clinics, if we are going to have all -- do we have a system

in america that will train people adequately to do it? what do you think the greatest opportunities and the greatest challenges out there are? >> i will start. will put it in general -- reducing the barriers. i think we have a lot of barriers. an example, a number of months ago i was in south florida, a large market, and i found both motivating and educational to visit some of our members. i visited one of our members that was in south florida, and under resourced area. in there, bars on the windows, and a lady was with the nurse, spent an hour with her. we went over her medicine, her nutrition. caress part of our hmumana

program. i did this on my own. when i walked out, there was a thing that will stay with me the rest of my life. she says, i am lonely. that was for comment. she was 80 years old, she lived alone. barrier inhere was a her life that she could not connect with decided -- with society because of transportation, the resources she had, and loneliness for her was a health problem. we do not diagnose that as a health problem. we diagnose health conditions, diabetes. when i walked out of that room, i said get hurt vegetation to a social -- get her transportation to a social community. when i think about barriers in health care, i think the things mentioned, we partnered with the organization that he owns a number of years ago and created that. very important

aspect of the future. when i think about the impact of small things that are hard to do in health care, i think that is a great target for us. andok at lifestyle, social economics as being an area where we as a health care system should focus on, because i think it will have a large impact on what we do. [applause] what an inspiring story. >> i want to say one thing to support you. there have been a lot of studies and several books written about societies with high percentages of centenarians. and the island of oconomowoc has the highest percentage, -- of inawa has the highest percentage.

there is than its mist that comes out of costa rica with an indian tribe. without exception, one thing they all have in common is they do not let older people get lonely. if their families under them, their children and grandchildren, they are given almost ceremonial status within the communities with roles to play and meaningful contacts on a consistent basis. i just want to -- there is huge amounts of evidence to support what you said. loneliness is a health matter. >> our system does not pay for it, does not help bring it in. be veryuld not expensive if we organized it. societies do this in more

rural areas. utilizing technologies to stop -- to start helping, and that is for some reason we have not allowed the likes of telemedicine or -- to become part of our fabric as it relates to the health care system. if you could tackle some of the loneliness issues you're talking about, it could help the issue around being able to understand quickly that it was much more serious than what she thought when it became sepsis earlier on. int is something that is technology, but also policy issues. it is the state allowing technologies to cross borders and tackle that on a national basis is something that i think we have to do, because that will decrease costs, increase health, --ressing visit issues

addressing these issues as a health determinants he, if you like, and i believe it is something that we can do on a national level and execute it on a local level. following up on her think alldo you electronic medical records should be stored in the cloud, how are we going to do that, and are there national or local of policy issues that have to be addressed? is there anything government can do to accelerate this process? >> let me address your question when you talk about the challenges and opportunities. i spent the last 10 years of my life trying to figure this out, and i have had this very strange, wonderful privilege of being in this country, coming country likeized south africa.

, came to this country 1991, anddeveloped in it is now 2013, a procedure approved for patriotic cancer. think about the timeframe, from the knowledge to the application. creating awith -- company, and i took over this company in chicago for the sole purpose of -- when i took over this company, i recognize there were drugs not being made because there was no need for the drug. this country, i was the only 2008.upply of heparin in i then went and came back full circle to academia, so to speak, and this is how i see the challenge of the country.

nobody has looked at health care as a systems approach, where you have on the one hand knowledge, the other hand, delivery, and the third hand the payment system. we cannotge -- afford to wait 17 years for a molecule to get into tha3e hands of a person dying for cancer. it is delivery system, completely disorganized, no coronation of care, you cannot tell whether the patient is home. on the delivery system, they diss incentivize to do that. on the payment system, there is health.for there are codes for multiple procedures to -- if you look at them, the

knowledge and the delivery and the payment systems, we need to integrate that continuously and put that together as one unit. how do you do that? then you need to create a system thatrarching allows communication, things to happen in real time. when president obama had this --in 2008, i saw this program in 2005. i met with him. i said, mr. president, please, do not fund the electronic medical records systems that tol create medical bridges nowhere. unfortunately, it has done exactly that, because we have funded software systems that do not talk to each other. you have got to find a grid-

computer software system that collider isdron running on. i convened with the institute of she said i will introduce you to the national coordinator. i said i was a public health guy. i said we will give you cover. we will have the institute of medicine -- i convened a symposium for two days, brought and said fund, for less than $100 million what hadronning the large pag collider. unfortunately, it has gone the other way, and doctors and hospitals are incentivized with a used which are processed issues, not outcomes issues. we went ahead and quietly then

this, weeed to do meaning my family foundation. i was able to sell both of these companies, not because i wanted to make money, but to make a product that became valuable, and decided it would take a billion dollars of that and actually fund internally the development of this. we have built an operating system that currently talks to is runninge, and now across the pathway, across the delivery systems, and we know in real time. we have built a software system that takes 10,000 cancer protocols and provides to the doctor in real time the knowledge of which cancer protocol to do give to the patient in real time. it is now in 8000 oncology

practices. with regard to technology, it is the job actually for us to make this health care system where he makes money where patients do not come into the hospital, where we have patients at home. i call this icu at home -- [laughter] atch means you need icu's home, and that this whole machine to machine technology that is right here. i built a electronics company where we have now adopted this and we are now in every hospital. 6000 medical devices made from different vendors. we are now capturing 3 billion time,signs real

self-populating medical records. you have an icu in the hospital and the same rocks in the home, the health ox, you can create an icu in the home. you spoke about this elderly , they, you are right can know what is going on with her in real time. and we have created a device on the internet. you look at this from a systems perspective, if you could manage a patient from the home instead of the hospital , enter a supercomputer to do the analysis in seconds, which is been accomplished. genomes at a1000 g time. you then have the ability to create a building with three

cardiologists. 10 oncologists. to but i'll adjust. and they could manage the entire city. >> is there something that is going to happen anyway, or doing need to change something about the laws. createissue is to outcomes based care and change the payment system. we created the council and bipartisan center, which , anddes bank of america the single largest barrier now is the disincentive i think care, ironically. job, ifan then say your you give this person healthy, we

can measure the outcomes in real time. if you keep this nation healthy, this is your payment per month. at the end of the year, at this patient is healthy, here's your bonus you don't want the patient in the hospital. to changeere we need the providers of the nation. that is where we will be announcing this event. this collaborative with the nations of the world. we have the unions also with us. this is what the nation is going to need. that we are actually doing it. the obstacle is the payment system. ironically, medicare advantage was the best system. it is being penalized because they don't understand the actual system.

[applause] it is interesting. we are doing more and more of this, paying to keep people healthy, instead of paying for procedures. there are incentives in health care law to do it, but there is no mandate for everybody doing it. and all think it makes any sense, unless you're some hugely expensive thing that can't be covered. , in a much more mundane world of the one you just painted for us, it works. it works everywhere. not paying for procedures, but paying for people to be healthy. >> it is a practical point of

view. we are on the ground treating patients, millions of patients per year. for is a time of transition the fee-for-service environment, which is pervasive throughout the imaging centers. and throughout every health care node that you can think of, they are turning toward a system of accountable karen payment for health. it is going to take a long time. we all need to be realistic about this. the conditions have been set -- have to be set in order to enable that. we have some examples where this is been effective. h industrial, and community we have been running and accountable care organizations for over two years. it has been very

successful. we have done just fine. earnve been able to incentives, as you mentioned through better health outcomes. that is a model for the future, but i think we ought to be realistic about how long it will take. meanwhile, there are some great innovations taking place among the providers. putting in place these advanced clinical systems to even capture the kind of data that we are capturing that didn't even exist six years ago or seven years ago. you mentioned government policy and incentives. the incentives for adopting the clinical systems has been very effective. we areown company's case spending over $1 billion in advance clinical systems.

the government incentives are making it possible for us to do that, by offsetting half of the cost. although the sharing of data does not exist freely, there are other great things happening. company, we avoided unnecessary tests. we will been in a hostile environment when a physician walks in. what do they do? they order another test. we are able to avoid that. we are able to avoid medication errors. medication being given at the wrong time. these are important innovations in safety and quality. everything prescribed is possible. it will occur. i think we need to give it a

little time. >> let me ask you this. you can say whatever you're going to say. your position is, i take it, that if we completely stopped paying for procedures and pay-for-performance for health care that the government would to ende to do much more the silos of medical records. there would be no incentive in the world to not share medical with appropriate privacy protections for patients. is that what you're saying? >> correct. >> it is exactly right. de-incentivized the system. there are the incentives of getting the money to put in systems that don't talk to

another system, is a perverse incentive. time, italk about the want to emphasize that this is not a hypothetical. said, installed, as you in 50 practices, 155 systems, 3.3 million lives, we are capturing millions of claims a day. it is being adopted by the nhs. the software system, that is intelligent, is running 70% of the margin rose and portugal. largest group in brazil. it is not hypothetical. it is the will of us integrating the platform that gives you actionable knowledge in real-time, anywhere anytime. it is evidenced-based. they need to incentivize the

providers big is the best care. .he marketplace will do that and you will sift out. you hear accountable care organization, who will challenge anybody, how can you have an accountable care organization when in no real-time can you tell who is accountable for the patient. it has shown that if you have surgery and your elderly, you see, just as one person, 27 health care providers. an elderly person will have 19 medications. who is accountable? have an accountable care organization when you cannot measure who is accountable. and then you once a value-based care. that is outcomes divided by cost . it you can't measure outcomes of pathways in real-time, how can you know when you're giving value-based care. and you have no idea about the cost in real-time.

system that can measure outcomes in real-time and costs in real-time. in st. john's hospital patient walks in, the minute he walks in, you know where he is, what doctors touching him, what it is costing him, and what is being used by the minute. if you can measure outcomes and costs in real-time, you can do value-based care and create accountable care. but it gives you the outcomes for health. that is how they are both nused. that system, that i don't think is hypothetical, israel. real. we just need the courage. >> you are saying it can be done within the existing legal framework. or do we need to change the payment system rules? >> i am working with a fortune

500 companies. that is what we are announcing today. the council will be taking the self-insured and, in the context , build a collaborative of her writers across the nation, install the system, but on one condition. this collaborative will work with the underinsured and underserved. we will bring evidence-based 20th-century caret two cancer patients. the doctors will be a will to do what they do best. [applause] -- and injust say theory, we should be a will it to any country in the world. one of the things that our foundation is involved in is the -- they areffort

still a low income country, they want to be free of foreign assistance by 2020. we worked with them for years, and talk to the partisan health group to work on providing high outcomes for them. it is basically, build a good hospital and every region. centers one good cancer in the country, which we completed doing. a lot of people think the poor people don't get cancer. the rates are fairly consistent across the world. ,hen do a network of clinics and then trained community health workers, which is why had this nightmare experience that i mentioned to you. it is really the same in america. because of technology, it is

just work. we have 19 american medical institutions working in training these people for seven percent overhead. i'm very proud of that. the lowest in history. they're going to be free of foreign assistance, but they will only have good care of their hooked into a global that willn network enable people. the thing that kills me, like in ethiopia where we work, there were 700 clinics and the 60,000 villages, so there are always people of the world that you don't think about. they are dying anonymously. ibo never know they live. d. people never knew they died . i am interested in how to apply the technological possibilities. patrick is from porto lisbon,

elisabeth, right? of these doing some kinds of things for africa. the point i'm trying to make is that if we did this in america it would have incredible ripple effects across the world. say?ll read going to what were you going to say? >> it has transformed the organization over the last number of years because of guaranteed issuance. we are not and insurance company. we are a clinical company. we are highly incentivize to keep people healthy.

the reason why we have nurses ifng to their home, checking they have nutrition, and ensuring they are not is because we are responsible for the health. we are paid a fee for their health. they stay with us for 7-10 years. the technology and a reimbursement system motivates people to take responsibility for people's health, not just the information side of that. our it did for organizations transformed our organization to be innovative about being responsible for health. if you change the reimbursement system, you will bring that innovation, as you were saying before. i want to comment on one thing. some of the things you're talking about, patrick, and in terms of some of the african

, happen could in fact faster. they do not have a legacy system like we have here in they don't have to defend the fee-for-service system like we to hear. a lot of it is self-pay. that is what govern so much of the health care system over there. pilots that we are trying to do with ge around some of these activities that you are talking about, we should be a will to do those fairly quickly. i was working in bangladesh. ge is there with the ultrasound. they don't have land lines. they have cell phones. >> let me, on that. comment on that. >> it was pretty inspiring. we have a handheld ultrasound. for those of you experienced ultrasound, you have to go into the hospital, and you

essentially, have to book an appointment. there are a lot of things about the system that just is. g came out with a handheld ultrasound. now, you can just imagine as it relates to prenatal care, and it is it relates to decreasing morbidity of infant death, it is a remarkable tool. we are doing that in a lot of developing countries, to be a will to help this, because remote villages do not have funds. phones? . . we feel this is something you can train people to utilize quickly. anding the connected world organizing these remote villages is happening today. i have to agree with you at that. here, we have a legacy system. we have to break through. i knew you say this happening already, but i have to agree it

is going to take time. the policies don't let us do what we want to do state-by-state. we are still breaking down barriers. >> we are going state-by-state. we are working with the governors. we are going through this, unfortunately, state-by-state. >> to make sure everybody understands, we got off on some techno-speak. the reason that medicare in the way they are talking about is that it was payinged as a way of people to take care of people on premium and to get a for prevention and keeping them well. there is a asked price here. that is the medicare payment

that i would get it might age, for me. i'm enrolled in medicare. if i sign up with you, you're going to get this to fix me when i am sick. we will give you this to keep me well. beginning, the was a lot of controversy about it because, in the congress, there was almost 100% agreement that there should be more preventive care, but there was a suspicion that it was being done to privatize medicare in a way that would allow the program to be drastically underfunded. because immediately people saw the benefit of the preventive work, and keeping people healthy, it was obvious that it was costing them providers about $600. i am making this up, but it is

pretty close. about $600 a patient to do this, and they were getting reimbursed at $1100. and nearly anybody would do anything for an 85% markup that was not illegal or would not send you to jail. over time, the providers are better at keeping people well, so the reimbursement rate could get lower and closer to the cost of providing the preventive services. eventually, you're going to go into negative territory because you're not going to have people using the medicare on a per capita basis as you accepted. that is why, in a funny way, what started off as an etiological fight and a big leap of faith, has led to a widespread acceptance of funding prevention and paying people for wellness, instead of paying by procedure. we're out of time. this brings me back to the

compensation i had with them when asked to cosponsor this bob hope golf tournament. involved.ana i said, i will do this, if you guys have a conference of the beginning on health care. because one of the things that i had to face up to what i had my -- i loveds surgery getting my heart fix at columbia presbyterian. they save my life. it was fabulous. but americans cannot see themselves as helpless passive creatures on a conveyor belt waiting. i know what you are thinking. you're thinking, oh my god, if i do cancer i want this guy to

my genome, and i want her to find a miracle cure, and him to find the thing that would make me 20 can. [laughter] i'm pretty close, huh? ok. i got it. i want that too. but what they want is, we are not helpless people on a conveyor belt. we also have our responsibilities to minimize the number of times that they will have to help us. [applause] that is why -- i will go back to the pga. when he agreed to do this, there was an unusual number of golfers , and their families, who had foundations to health care, right?

for perfectly understandable and wonderful reasons they were trying to help solve a particular problem that someone in the family had experienced. look at how healthy he is. he has not lived his life as a conveyor belt. i just want to point that out. the pga to the big risk. a were trying to say the tournament and reserve the legacy of bob hope. all lot of money goes in to help institutions in the valley. but i think the main thing that saidrs can do is what tim about walking 30 hours a week, is we up to contribute to this idea that you cannot ask all the rest of these people to just take care of us.

we have a heavy responsibility here, personally, in our families, and in our communities to take up better care of ourselves. thank you for doing your part for getting out the, get off the conveyor belt message to america. anybody want to say anything else? you just want to thank president for all you are doing. >> thank you. >> let's give them a hand. jane littleh, and of the bbc talked about same-sex marriage. also talked about social media and her own views about covering religious issues in her career. here's a clip. religion was held to a different standard. i to prove it didn't have an agenda. i had to work extra hard at the

morning meeting to show why his story was relevant. and others could reveal personal not, in ways that would happen with an peace or warm politics. i do not want to make my collie some stupid. they definitely were not. they were older, schooled in 1960's britain, and had not embraced the hypothesis. society, as it developed, got educated. they would relegate us to the back session of the bookstore. in those weeks, i was often stopped in a fourth floor corridor by one partisan hack with the same joke, how is god today? [laughter] thin.ke soon wore at the other end of the spectrum, there were those it may morning meeting who took my

subject seriously, indeed, as to seem as a theologian. i will never forget 19:00 a.m. with mostly middle-aged men, in those days, and they were exchanging views on how to cover the death just announced of the cambodian dictator. local journalist turned to me and suggested that i write a one minute news piece on the problem of evil. [laughter] all eyes were trained on me, the new girl on the block. i took a deep breath, and said i thought we might need a four-part documentary for that. i think many in the room saw the suggestion as a test of my judgment, which i guess i passed. for men, things got easier.

i was on a mission to prove that religion that was as interesting and relevant as politics, and it overlapped and undergirded political events. i had four weeks to prove it. >> that was part of an event held last month at the university of colorado in boulder. you can watch the entire event later today at 6:00 p.m. eastern here on c-span, or any time online at c-span.org. tonight, we conclude our first lady's influence and image." she brought financial resources to the marriage and her managerial skills. it made it a successful operation. it made it possible for washington to be away for eight years fighting a war. >> there was something that abraham lincoln that she saw potential and encouraged and developed it.

>> there was an etiquette in a dining room that helped polish them up for washington society. he they invited a lot of very important people. the strawberry cream parties talking with the wives of the very important gentlemen. she will do a lot of power, both of mr. lincoln where he was going. >> the involvement of mrs. roosevelt in the political ,areer of franklin roosevelt is right from the beginning, where she becomes more active in her role. gotr 1921, when roosevelt polio, shooting occurred franklin roosevelt to continue with his political ambitions. "first lady's influence and image" tonight. we will start the evening with the conversation and story about the first lady's and their contribution to the nation by that 8:00. next, a look at the role of

the first lady and how it is changed or in the course of american history. this is about 40 minutes. we are joined by robert watson. he is a professor joining us this morning. guest: my pleasure. talk to us about the role of the first lady plays in the presidency. guest: she plays an important role in the presidency. most presidents have been married. all but one of them has been married. james buchanan, our 15th president, was a lifelong bachelor. all the rest were married, and most of them had a wife with them and the white house during the presidential years. a few of the more widowers. most for the ladies have been

assertive in active. andovers a broad gamut here for example, in recent years, when we take public opinion polls on presidents and first ladies, what we have seen is that most first ladies enjoy higher approval ratings than their husbands. first ladies oftentimes help with the image factor. the patriarc of the country so it helps with image. there is the difficult areas to measure. many of these presidents and first ladies have been married for years and not decades before they entered the presidency or the white house. very few presidential aides can say the new the president very well before he even got into his political career. the first ladies have served as a sounding board, a confidant, a counselor and i interviewed eddie ford once and she talked about this role.

i was asking her about being jerry ford's counselor and confidant. she said she had this regret that her husband did not appoint more women to the bench and she says i regret not lobbying him harder on the pillow. this is like if your grandmother gives you the birds and bees talk. i did not know what to say. i thought it was cute and a ghost of this notion of what i call pillow influence. person he sees when he gets up in the morning. at least let's hope so. with the marriage comes an transcendsle that even that of the chief of staff or the president's most senior aides and advisers so there is a broad array of roles and responsibilities that we expect for the first lady. evolve?oes that role

lady is not an office per se. constitution does not mention the first lady. article two of the first lady does not mention the first lady. the framers did not contemplate a role for the first lady. there is not a statutory authority. she does not have a particular profile or set of roles. what has happened is that the first ladyship has evolved. through the precedents and the action of some of the previous first ladies. if you look at the older ones, there were three in particular that helped to shape a set of duties for the first lady. even going into the modern times. that is martha washington, a public figure. people called her lady washington. the soldiers loved her. there was a military unit named in her honor. lady washington's dragoon.

she was once in philadelphia and her carriage had to stop off because of the crowds. the onlookers came out to see her. she was quite surprised. she even said in one of her letters that it is as if i was a great somebody. she waved informally and said some words. it was probably the first time the first lady gave a speech. martha washington was a public figure. she would get the 21 gun salute. she was also a hostess. she hosted weekly get-togethers and functions to represent her husband and the country. that role has stayed with the first lady ever since. i think that also comes with a history of sexism or sexual norms. it was felt that the wife was responsible for the message of hosting and all things in washington or all things in the white house. abigail adams was the second first lady. she was an associate president and political partner to her husband.

john adams trusted his wife's advice. unhappily for them, fortunately for us, they spent a lot of time apart. they wrote a lot of letters. this letter survived. the adams family correspondence is rich with detail. john adams sought her counsel on all things. one of the problems with members of congress is that they might've said this or that, but then he would say, what do you think? he took her advice. she was willing to give her advise. she was a well read and gifted woman. we have seen since then this partnership kind of role. she is a policy advisor or counselor. then we bring in dolley madison, james madison's wife. the fourth president. she was the third first lady. thomas jefferson, his wife had passed away 19 years before his presidency. dolley madison emerges as one of the great hostesses in the

history of the country. she had a wide arrange of activities and roles. she helped thomas jefferson during his roles. since his wife is deceased, she helps to host for him. she hosted for her husband's two terms. james monroe, his wife suffered from poor health. dolley madison hosted for him. she was a great hostess. a political powerhouse. a public figure. i think we have seen these roles and responsibilities of the first lady -- in recent times, first ladies have been expected to appear on the cover of magazines. grant interviews and conduct what some people call pet projects. i see it as social activism. everything from barbara bush advocating family literacy to lady bird johnson advocating beautification.

or what we would call conservation. first ladies have had pet projects and social advocacy issues that they have championed. they grace the cover of every magazine. they are in front of the media and they travel around the country. we have seen the expansion of the social advocacy and this project role. host: our guest is robert watson, the author of "the presidents'wives." if you would like to join our conversation, the numbers are on your screen. i want to ask you technically about the office of the first lady. how much staff is there and what the budget is like? guest: good. the first lady that hired someone was john tyler second wife, julia, back in the 1840's.

she was very young. one of the youngest in the history. she was only 24 when she married the widowed president. she was very elegant and popular. she was a hostess in the mold of dolley madison. her events were so well attended that she hired a journalist to come in and help her write catchy lines, something that she could say in a toast or a greeting. that was the first informal hire. the first first lady who really had staffers was teddy roosevelt's wife, edith. shortly after coming into office in 1901, she was so popular and teddy roosevelt was so popular. he was a charismatic person. the press could not get enough. mrs. roosevelt was also inundated with letters and requests that she simply could not get to in a full day.

theye reassigned a clerk from the war department by the name of isabel hagner james, on salary, and reassigned her to work for the first lady. that was the first staffer to work for the first lady. what we see in terms of staff -- the advent was really under jackie kennedy. jackie kennedy decided early on that she was going to restore or renovate the white house. she did a magnificent job. it was a historic renovation. returning the white house to it historic western grandeur circa 1820, the monroe years. the wonderful federalist decor that we see today. jackie kennedy had roughly 40

people at anyone one time working with her or for her. art historians, architects, a variety of scholars to help restore and renovate the white house. since jackie kennedy's time, what we have seen is that first ladies have had between 12 -- that was barbara bush, on the low-end -- to betty ford had about 24. all first ladies have been between 12 and 24 since then. laura bush had 16 or 17. hillary clinton around 19. michelle obama, maybe 22. they have been in that range. the consistent since then. they have offices or staff -- like a chief of deputy chief of staff, to help with scheduling. a press secretary, a speechwriter. betty ford, in the 1970's, was the first to create a role of project director. first ladies have all had that

to help them with their special projects. rosalynn carter even hired a management consultant to help her with the structure and make efficient effects of structure for the first ladyship. the first lady also benefits -- all of her staff is associated with the president's -- her folks will coordinate with the president's staff. her chief of staff will coordinate with the president's chief of staff. the budget authority comes to the president's chief of staff. they are rather tightlipped about how much money they spend on the first lady's staff. no one wants a story saying how much money is spent on the first lady. that would seem to appear to be frivolous. the irony is there is a catch 22. the first lady is criticized as she is to active and she is criticized and she is not active enough. we expect her to appear everywhere and assist the

president and promote projects. for that, one needs a staff. we have seen that in the east wing offices of the first lady ever since jackie kennedy. host: in rhode island, jim is on the line for democrats. caller: hello, how are you doing? enjoying the program. i have a scenario that we all know, which may play out in 2016. suppose hillary clinton runs and get selected. how will the role change of being married to the president and you are a former president and would mr. clinton, bill clinton, president clinton, have to take less of a role because of his history? your thoughts? guest: that is a great question. women have been elected all around the world. our closest allies, like england and israel and canada, have all had women at the helm. all over the world, europe has had multiple women. women have been running for the presidency in this country since the 1800s. 1872, victoria woodhall.

more recent years, elizabeth dole -- sarah palin, geraldine ferraro were vice presidential nominees. part of this book is "anticipating madame president." it is not a matter of if, it is when. at some point, we will elect a woman who is married. we have not thought what the title would be for the husband. would he be the first gent? the first guy? sarah palin joked about "the first dude." we are not sure about the title. but we can be sure, because of sexual norms, the husband will not be asked to do all of the things that are first lady is asked to do. a first lady is expected to decorate the white house.

she is a white house manager. this is the people's house. it is a spectacular museum. it rests with the first lady to make sure it stays that way. i do not think the first man would be responsible for that. the first lady is expected to greet heads of state and help the president with that custom. i do think the first gentleman would be expected to do that. we could see him doing that. i do not see bill clinton or any first husband serving scones. i do not think because of sexual norms that we would expect him to do that. we have even seen an ivy league educated lawyer, like hillary clinton, or an ivy league educated lawyer, like michelle obama, serving cookies.

we can expect a first man to participate in social projects. he would play a role in the easter egg roll. he would probably help welcome guests to the white house. the other thing we can be sure of, if you look around the world, women have served as head of government. we have had governors in this country. the husband has not had to do a lot. we have also allowed the husband to have his own job or career. first ladies have not had a career while serving as first lady. elizabeth dole, when she briefly ran for president in 1999-2000, bob dole is a longtime senator and republican nominee -- elizabeth dole said that in respect to what her first ladyship would look like, she said she suspected she would continue working. this is a former two-time cabinet officer. she served as secretary of transportation and other roles. she said she would continue working. i remember several folks in the media had a big fit.

a big hulabaloo over that. i think that the first man would be able to go out and play golf much of the day. i think he would not be able to keep his job, but he would play some role. what you see in the white house is it is such an enormous response ability. we have seen the way that presidents have aged and the stress on the wife and the first kids. as bill clinton said in 1992, speaking of hillary, you buy one, you get one free. two for the price of one. we have been doing that since george and martha. in new york city when the country was founded. i think there would be a role for the first man, but clearly it would change. it is highly gendered. there are feminine parameters for the first lady. host: laura bush made reference to the idea of the first man when she was asked about the role of the first lady.

let listen to what she had to say. then i went to get your take. [video clip] >> there are plenty of perks. believe me. a chef, that was really great. i miss the chef. i do not think that. i think that the interesting question is not should they receive a salary, but should they be able to work for a salary at their job. that they might have already had. i think that is what we will have to come to terms with. certainly, for a first gentleman, they might continue to work at whatever he'd had. if he was a lawyer or whatever. that is the question. should she have a career during those years that her husband is president? in addition to serving as first lady. host: your take, robert watson? guest: i had a wonderful opportunity last spring at a gala for the presidential museum

that was hosted by laura and barbara bush. i had a chance to participate in that and speak at it. she was saying the same sort of thing then. she raises a great issue. we have a conflict of interest concern. imagine if a president's spouse is working for a defense contractor. the contractor would have been on a contract that provides the military with tanks. they were to get that contract. there's always conflict of interest concerns. they do have to be taken into account, in the case of a spouse of the president, man or woman, continuing to work. i do not think that we will get to the point where we will pay the president's spouse for what they do. i say this the most difficult unpaid job in the world.

their unelected, and appointed, unpaid, but they are expected to have a job. i do not think we will get to that extent. there are a few legal parameters. one was called the bobby kennedy rule. john kennedy hired his younger brother, bobby, to serve as his attorney general. there was some lawsuit and concern about the parameters of nepotism and hiring a direct family member. there was a lawsuit that was brought by physicians who were opposed to health care reform under bill clinton and hillary clinton in 1993 when clinton was pushing health care reform. hillary clinton was nominally cochair of that task force. people said that she was, as a first lady, this was a conflict of interest and she should not be in such a role. the court supported mrs. clinton, and i think rightly so. they recognized the long history of service from first lady to our asked to sacrifice greatly to live in what is basically a public fishbowl. the whole world watches your

every move in the white house. they have done this sort of thing. i do think that it is not if, but when we will have a female and a working age has been. we will have to cross that threshold limit get there. i suspect he will be allowed a job. i suspect he will be concerned about potential conflict of interest. that could blow up on the president. host: a primary know for our viewers. tonight is the wrapup of the first lady's series. as at 9:00 eastern. if you have missed out or want to take a look at that, you could see the whole series on our website at firstladies.cspan.org. let's take a call now from arkansas. mike is on the line for independents. caller: thank you. i draw a va pension. i think that the wealthier people in this country are out of touch. let me tell you why.

i live in a rural area. my neighbors are elderly people. they are trying to raise a garden and they are unable to do it. they are too old. they are on food stamps. they are on medicare and medicaid. these people are starving. we did not elect any president's family. we elected the president. the family should have no political aspiration. they are not appointed to do anything other than be the wife of the president. why should we pay for her to hire a staff? we have people that are starving. we are so out of touch with the american people. it saddens me. it makes me disgusted. i fought for my country.

i am sorry. i'm sorry that i went over there. this is not the country that i fought for. i did not fight for people to drop dead like they are now. guest: first off, thank you for your service. we should congratulate and recognize veterans who served. many presidents or veterans. most recently, george h.w. bush was a naval aviator in world war ii. many presidents have served this country. harry truman was a veteran. first families, many of them have recognized and remembered veterans. the current first lady, michelle obama, one of her projects is advocating -- she has been tireless in her advocacy for military families. making sure the military housing is improved. better body armor for soldiers in afghanistan.

support for military families. george h.w. bush, when he was president, established the department of veterans affairs. you see all the way back to martha washington, when veterans would come to the white house. this was before social security and medicare. before food stamp programs. these programs would make sure that there is a social safety net and that individuals in this country do not slip through the cracks. of course, there are cases of strife in arkansas and elsewhere, where folks do -- we can always do a better job. we need to do a better job. a lot of times, it is coordination at the local level where it is not getting through. the federal government is funding these programs. it is where the rubber meets the road. veterans would come to george washington -- the great general. martha would give them money. she hated to see a veteran who

have lost a limb and had no means for supporting his family. as they said, the day and age before social services. martha washington personally give the money. mary todd lincoln struggled right alongside her husband with the pain of the civil war. losing thousands and thousands of men in the north and south. mary todd lincoln would take donations and provide them to soldiers. she would organize donations for former slaves and runaways then moved to washington and were living an abysmal conditions. before there was public housing and things like that. i am sympathetic to your concern. i have always been an ardent advocate of veterans affair. medicare, social security programs. childhood vaccinations and things that make sure that all americans have a decent quality of life. i guess, i do not know if the words help or not, but i can assure you that we have multiple first ladies who have been champions.

eleanor roosevelt, as much as anyone, visited soldiers in combat zones. independent of her husband, who was wheelchair-bound and unable to travel. she was the eyes and ears. she visited soldiers and hospitals. she took great concern. paid great personal attention to this issue. host: now to providence, rhode island. jack is on the line for democrats. caller: hi. i agree to a certain extent with the gentleman from arkansas. my heart goes out to him. i worked on wall street for over 30 years. i know this to be so. unfortunately, it does not matter who gets in the white house. either republican or democrat. i worked for these people as a small to midsized, wealthy -- i am financially well, international financial elite that is immensely wealthy.

they pretty much call the shots. a lot of people do not realize that the previous democratic administration -- a lot of the money, most of it actually, went to the democratic body. i am a democrat. i think one third of it went to the republican party. it was two thirds, one third. i could be wrong. it went to these two parties. for example, hillary clinton, she is very close to wall street. bill clinton is very close to wall street. i do not think he will be the nominee, but governor christie, he is close to wall street. someone like brian schweitzer would be a good man. he is very bright. not that connected to wall street. you never know. the influence could jump on him too. have a nice day.

guest: i like brian schweitzer. a former governor of montana. a real advocate for the common man. an accomplished individual. a rugged individualism. kind of a reagan-esque personality. strong individual. on the one hand, i would agree. all presidents do have connected interests. i do not want to sound flippant. we know how powerful these moneyed interest are. they have support from wall street that benefits them more than the average american. in a way, they need to have connections to wall street. we need to make sure the stock market is strong and that business hires. we need to support american businesses and exports. when they cross the line, that is another problem. i think all of us would agree that we need some sort of campaign finance reform.

to make sure that does not happen. i would respectfully disagree that it does not matter who gets elected. i would strongly disagree. i spent 20 five years researching and writing and teaching about the american presidents and american history. if you take someone like a harry truman, he -- his strong advocacy for veterans and integrating the armed forces to support african american soldiers and the great tuskegee airmen who could not enjoy quality reforms despite their contributions to world war ii. and the japanese soldiers who but fought on behalf of these -- this country even though we had japanese internment and jewish-american soldiers who they knew if they were captured navajo code,

talkers. extraordinary and i do not think anyone would suggest they would have done all that. fdr's leadership during the second world war and the great depression are extraordinary. if reagan was not in office i do not know if another person would have cut taxes to the extent of ronald reagan or restored america's image from around the world. presidents have mattered one way or another. anything -- i don't think anybody would defend a war in harding's presidency, which was disastrous. it does matter who is office. the first lady does not have a formal authority. she cannot introduce a bill in congress. what we do see is whether you are the wife of a general or a ceo or a mayor or the husband of any one of those, your spouse is going to consult to. i do not make an important decision without talking to my wife and asking for her feedback. we all do this.

there is an informal influence the comes. it is impossible to guess or suspect or to require that a first lady not exercise that influence. the public wants her to be out reading to school kids and advocating on behalf of veterans and helping with nutrition and diet for america's children. we want her to do this. she does need a staff. i want to see the staff any larger than it is. i think the taxpayers don't want that either. i think it is about right where it is right now. host: i want to ask about what is going on in france. the french wonder if the role of

the first lady is passé. the french are having trouble dividing with the status of the first lady should be. what implications do you think this situation has for the united states and how we view first ladies. guest: the french leader was guest: i do think the implications and the french leader was just here and it caused the american press to take a look at this. sadly, his extra matterial dalliances have taken precedence or priority over u.s.-french relations or some or a concerns in europe number of them. what you do see is around the world the -- most countries around the world do not have such a prominent role for a first lady or fixation on the first lady as we have here in this country. i don't know if