>> anyway, the question that i asked is, are you surprised? you've made comments suggesting that you are surprised, shocked, upset, or something by the "chronicle's" tone. >> well, i read the "chronicle" every day. i want to know what's going on in town. i never read the editorial page. i could predict the editorial page. i don't need to read it. i read "the new york times" every day, and "the wall street journal." i don't get my information off the internet, like everybody else does. i think i know a lot more than people who do get it off the internet, but that's a matter of personal opinion. >> you also mentioned to me earlier that you've noticed a difference in the reaction you've gotten in the last handful of weeks, between people who email you on the one hand and people who comment about you on twitter on the ther hand. would you share that with everybody? >> it's very interesting. i've received a huge number of letters and emails, all very supportive of my position, 100%. the twitters are all pretty negative, and it's an age difference. older people use email and younger people twitter.

>> my last question for you tom. you were asked -- >> when they're not playing video games. >> you were asked recently in a television interview if you feel you're connected to reality. during that interview, you talked about your expensive watch and the yacht that you used to own. your response to the question of whether or not you're connected to reality was, i'm paraphrasing, "i give a lot of money to charity." >> well, i do give a lot of money to charity, but that has nothing to do with my connection to reality. i think, philosophically, probably no one can prove that they are connected to reality. >> i'm in the same boat with everybody else. how about you, adam? you're a celebrated interviewer. are you attached to reality? >> my guess would be that one

of the ways you answered the question was also that, although your immediate family is doing fine, you have relatives who live in trailer parks. i think the point you were making was you know poor people. >> well, i wasn't born into the %. i used to be a paperboy, which is now of course illegal because of child labor and minimum wages. >> i used to bag groceries and babysit, etc. that's outlawed, but so it goes. >> we have a wonderful, vibrant audience here with a wonderfully vibrant interview subject tonight. i want to invite you to stand up and go to the microphone to ask questions. i'll remind you that these need to be questions. if they aren't questions, i will apologize in advance for being rude to you, to remind you to ask a question. sir, please, go ahead. >> yeah, thank you for coming tonight. i appreciate you visiting this audience.

with socioeconomic disparity or dis-inclusion, however you want to say it, particularly in cities, being really the civil rights issue of our time, and you being so connected, too, you're a brahmin of financial value creation. you being connected to people like google founders, not to mention the vc community that you run in. would you be willing to be part of, say, a fund in which you give 1% of your money to, and help manage that fund and the use of that fund that harnesses the entrepreneurial talent of san francisco, to address urban poverty issues that the tech economy or the emerging economy t large is exacerbating? >> i think i heard most of that. i'm not part of such of thing, but such a thing is being organized by ron conway and marc benowitz. >> benioff. >> benioff, excuse me. i'm not familiar with the details of it, but they are trying to do exactly what you

have said for the benefit of san francisco. >> i don't know if you caught it. at the very end of it, the tail end of his question, he injected the premise that the tech community is exacerbating the problems of poverty in san francisco specifically. >> well, they're not. they're just making enough to pay higher rents, but i don't see that as exacerbating the problems of poverty. >> thank you. i wanted to say as a reminder to our radio audience, this program is presented by the commonwealth club's inforum "connect your intellect." for more about inforum and its upcoming events, please visit us on facebook or follow us @inforumsf on twitter. tonight, we're hosting tom perkins, "the war on the 1%," and we have another question in the audience. please. >> hi, mr. perkins. i'm a student at stanford law school, and in my free time from playing video games, two of the things i do are --

>> well, we started electronic arts. that's great. >> one of the things i do is work in the community law clinic, mostly with spanish-speaking people from east palo alto. the other thing i do is i teach a class on california's finances. from these different contexts, i've gleaned, first of all -- >> we need to have your question. i'm sorry. this is a question for tom perkins. >> what do i tell the people i work with in east palo alto? if you could speak to them, what would you say? >> thank you. >> i feel very sorry for them. i wish that the war on poverty had not been such a fiasco, and then they wouldn't have the problem that they now have. the solution will take a very long time. it depends a lot on education, which is getting worse because

of, frankly, the teacher's union. it's making it impossible to have quality schools in the inner cities, and so on and on. there are no quick answers to these kinds of questions, i'm afraid, at least not from me. from barack obama, yes, they flow. >> over here, please. >> hi, hello. well, good evening. thank you very much for coming and sharing. you made a lot of statements of, frankly, the teacher's about pointing fingers, but one of the things you didn't address was the role of financial literacy, the role of access, and the role race plays in a lot of these things. if you could, just highlight maybe your thoughts. how are you bringing financial literacy to a lot of these communities? what are your thoughts on some of the ways you've contributed to that, or just opportunities to do that? >> yeah, i think i got most of that.

silicon valley is a meritocracy. it is simply a meritocracy. race has nothing whatsoever to do with it, but blacks are underrepresented in silicon valley, unfortunately. now, there's a group here in san francisco. they're successful black businessmen of all kinds. they've formed something called wall street wizards. what they're trying to do is teach young blacks about business and how to succeed in hat. last year, during nation black awareness week -- that may be the wrong title -- i agreed to speak to that group. all of the mentors showed up, and not a single student, not one. it must come from the individuals.

it can't all come from the government or a program. if the individuals don't want o learn, they won't. >> please? >> yes.

>> i would encourage you -- i have learned that you are able to form an opinion on almost anything, tom. it is your opinion that the war on poverty has been a failure, but that is not accepted fact. >> oh, wait a minute. now, come on. >> no, you don't know that there are not factors, that things would have been even

worse without the things that were done. >> that's conceivable, but -- >> i think he's asking a fair question, which is broadly speaking, what would have been the better policy route than the policy route that was taken in the johnson administration? >> well, i think johnson had absolutely no idea that what he was doing was wrong. it looked good and everybody approved it, but it had the result of destroying families. it just did. then that destroyed the education of the children in those families and so forth, so it had a cascading effect. the rate of poverty is higher now than it ever has been in history. there are 77 million americans on food stamps. there's no way -- i don't know how bad it could have gotten. i don't know. >> i'll take a shot for you. instead of the programs that the johnson administration did put into place, if the johnson administration and the nixon administration instead had focused on deregulation and making government smaller, that we would have less poverty today. >> that's a trap and i'm not going to go into it. i think if money had been spent on improving the educational standards -- let's face it. e are, i don't know, 64th or something among the nations badly educated. we've totally underinvested in education. we've made it very, very hard to get a good education in the united states. if i had to pick a single thing, that's what i would pick that should have been done differently. >> please? >> could you comment on the fact that your own example of fiscal responsibility, norway, is a social democracy? are you advocating social democracy for the united

tates? >> i'm a knight of norway. i've got to defend it. there are no tall no tall oppies in norway. we've totally underinvested in education. >> no tall what? >> no tall poppies. well, it's the old adage, the tall poppy gets cut first. everybody is pretty much the same. there's no poverty. there are no rich. they've left norway because they didn't want to pay the taxes. >> no tall what? it's not an ideal example. i just threw it in because they've been so extraordinarily well in husbanding their resources, namely their oil. norway has been the number-two oil exporter for decades, next to saudi arabia.

they've saved the money. some day the oil will be gone, but they've got the money. ook, if i were 20 years old, of course, i think i'm in my midlife crisis now, anyway. >> if i were 20 years old, i'd try to go to with australia. australia is, to me, i've spent a lot of time there, the way california was, when i came here in 1957. it was upbeat, positive, can do, unaware of all kinds of problems. that's the way australia is now, and all we do is worry about our problems. >> when you do go down to mountain view, you don't think of that, or when you walk around market street, you don't think of that as an upbeat, can-do environment? >> well, not seventh and market.

that's a good place to -- >> we're getting too local on this conversation. go ahead. >> hi. i work at genentech. i'd first like to thank you for creating my job. >> secondly, knowing a little bit about genentech, i know a huge chunk of our revenue comes from medicare payments. you had mentioned earlier cutting entitlements. that would significantly cut our revenue. that's one example of a public-private revenue partnership or whatever. there's also construction, infrastructure, and education you mentioned. f this revenue that is being spent by the government isn't going to create jobs, what is it doing, if it's not helping keeping people employed at genentech? >> hang on. i think medicare is great. great. going to create jobs, what is it doing, if it's not helping keeping people employed at genentech? >> hang on. i think medicare is great.

great. >> it's one of the biggest entitlement programs there is. >> it is. it's just underfunded. >> you want to make this entitlement program bigger? >> no, i want to make sure it doesn't go bankrupt. there's a difference. >> i don't understand. >> you don't understand? >> if we need to cut entitlement programs, then we need to cut entitlement rograms. >> adam, medicare will go bankrupt. it's inevitable, so taxes have to be spent on medicare. i am for that. >> the entitlements that you're against are? >> i didn't say i was against entitlements. i never said that. >> you said they needed to be cut. >> yes, because that's the bulk of the budget. there's very little discretionary cutting you can do. the military and a handful of this and that, but entitlements represent most of the udget. if you're going to cut the budget, which we have to do because we're so deeply in debt, you've got to start there. there are good ones and there are bad ones. >> the bad ones are? >> i doubt that 77 million people need to be on food

stamps. >> food stamps, ok. next question, please? >> hi. i have a speech impediment, so in case you don't understand, i'll be happy to repeat myself. i'm part of the 99% that aspires to be the 1% some day. i work 70, 90 hours a week to make sure that some day, hopefully, i'll become the 1%. do you think this could be potentially an image problem or the 1%? there are billionaires out there who we love, like steve obs, musk, bill gates. do you think that instead of calling this "the war on the 1%," if we could actually address it as the race to the 1%, things would be a lot better for everybody? >> i think that's a brilliant re-branding. i totally subscribe to it, but my message is the demonization of the 1%. i think that's true, and it's new. it's, frankly, new with the obama administration.

we never used to have a demonization of the 1%. we wanted to be in the 1%. we admired them. i can remember when i was a little kid, john d. rockefeller would go around and give dimes to the little children. i thought, "how wonderful. i'd like to be john d. rockefeller and give imes. this whole tone has changed in the last very recent years under this administration, i think. >> do you think it's because of obama or is it because of the 1% not being philanthropic enough? >> not being philanthropic enough, is that what you're asking? >> right. >> i've discussed the taxes. the 1% is carrying the government. at least the top 10% is carrying the government. we've talked about that. it's not bad to be in the 1%, obviously. i think people, like yourself,

still aspire to it and should. hard work and so on can get you there, plus the right venture capitalist. >> over here, please? >> the president has proposed a lot of commonsense ideas around immigration reform, around infrastructure spending, but at every turn, he's been road blocked by the republicans in congress failing to want to agree with him on moving a policy agenda forward. what are your thoughts on simply the politics of no, as opposed to proposing an alternative agenda? >> i'm neither a republican, nor a democrat. i've gone both ways. i voted for jerry brown, which then he raised my taxes 30%. >> president obama made an immense political mistake. he's not a politician. he's a brilliant leader in a

certain direction. the mistake was to push through obamacare without a single republican vote. no other president would have done that, because it just wiped out any hope of cooperation with the other party. in spite of all his talk about reaching across the aisle and so forth, nothing has happened. you can blame it on the republicans, but i blame it on a huge strategic political mistake. >> it's the president's obstinacy in wanting his agenda passed that is to blame for the other party's intransigence? >> i think it's what you get when you elect an amateur president. >> tom, is that really air?

>> he's a politician who was elected by the people of the united states, not once, but twice, so why the name-calling? >> i've looked at his resume. >> you've never met an entrepreneur who had never been an entrepreneur before, or a venture capitalist who had never made an investment before? >> i wouldn't make him president of the united states. >> over here, please? >> hi. you just said that it's not bad being in the 1%, but you're also talking about the demonization of the 1%. we do know exactly what happened to the jews in europe, so i'm actually curious what the fear is. it can't possibly be ghetto-ization, or deportation or extermination. >> i get your question, but we're almost out -- >> i do want to understand what the actual fear is? >> the fear is wealth tax, higher taxes, higher death taxes, just more taxes, until there is no more 1%. then that will creep down to the 5% and then the 10%. the money is in the middle. that's where the money in america is. to pay for this government,

it's going to have to come from the 99%, not the 1%, in the form of taxes, value-added taxes. i promise you, higher taxes, everybody. >> to be fair, i'm sorry to tell you that this is tom's penultimate word and he will get the last word. your point is, to her question, that your concern is a decrease in the overall quality of life in the united states, including for rich people, but not only for rich people. >> no, that's right. >> as opposed to ghetto-ization, extermination, and other horrible things. >> i'm talking about economic extinction, not physical extinction. before coming here, i was told that every speaker gets a question on how to save the world. >> the precise question is, and this is the way that inforum ends all of its events, "what is your 60-second idea to change the world?"

>> i've been thinking about this as i was listening to you ramble on. >> i've got it. it's going to make you more angry than my letter to "the wall street journal" did. >> i highly doubt it, but let's hear it. >> you're not ready. thomas jefferson, at the beginning of this country, thought that to vote you had to be a landowner. now, that didn't last very long, and the vote was given to everyone, but the basic idea was you had to be a taxpayer or a person of property to vote. that went by the boards. margaret thatcher tried to change that in england, in what became called as the poll tax. the idea was that every single citizen of the uk had to pay something in taxes, even if they got it back in subsidies elsewhere. if you didn't pay something in taxes, you couldn't vote.

she was thrown under the bus by her own party for trying to push that through. the tom perkins system is, you don't get to vote unless you pay a dollar of taxes, but what i really think is, it should be like a corporation. if you pay a million dollars in taxes, you could get a million votes. how is that? >> you're right that i don't agree with you. you're wrong that i'm angry. i would point out to you the flaw in your argument. since everybody pays sales tax, and anyone who drives a car pays taxes for that, then we're right back where we started, in the wonderful place where we've evolved since thomas jefferson, with everybody having the vote. >> that's not income tax. >> not income tax or property tax. i, for one, have enjoyed this conversation, immensely, despite my rambling. tom, thank you.

please, everyone in the room, join me in giving a big round of applause to tom perkins. >> and now this meeting of inforum and the commonwealth club is adjourned. >> you did great a great job. you did great a great job. [capty national captioning institute] [captions copyright national cable satellite corp. 2014]

during this month c-span is preezed to present the winning student cam documentary competition. encouraging middle and high think tudents to critically about issues. the question we asked students to base their documentary on was what's the most important issue the u.s. congress should onsider in 2014? second-prize winner is a junior jenchings high school.

he believes the farm bill is the most important issue.

the reason congress should be concerned with the farm bill is not only does it play a significant role in terms of budget issues that congress and people are facing right now but it also is a piece of our food production system that needs ome attention. one specific example of how the farm bill is helping folks originally goes back to its origination when roosevelt proposed this as part of the new deal durp the great depression we were expeernsing oversupply of certain commodities. so this was implemented as a way to manage that supply in our food system while also keeping the people in agriculture employed and in business. >> so if we look at how farmers are those in production agriculture benefit from the farm bill the picture would be drastically different than what we would have without the farm

bill. an example people might say if they were to experience some significant weather volatility that may fail a crop. not only are they going to provide risk management options for those in production agriculture. it funds a lot of the conservation efforts for different resources around the country. and it also even looks at funding research, helping with financial assistance and lending practices. and so with all those things together they really tie together to help promote agriculture and make it more efficient. >> however, the farm bill doesn't just affect farmers like me and my family. the farm bill also contains the snap program. the snap program is more commonly referred to as food stamps. food stamps cost the american axpayers over 74 billion a year and it helps provide food for over 46 million people roviding for their families.

you would think that the farm bill only deals with food. but in fact it also deals with the fuel industry. regulates ethanol subsidies given to producers to buy corn and produce ethanol. this costs the u.s. $45 billion and nobody understands the effects of these subsidies better than my dad and american farmers. if, for example, the farm bill subsidizes a certain crop over another crop, it incentivizes the farmer to plant that crop. and in the end, you may actually end up with more supply of that grain or product than what the market really needs. and you see that over and over where we subsidize or the

government will subsidize a certain aspect of production and guess what, we'll produce that and then we end up with ware houses full of product that goes unutilized. and then you will see the government have to step in and bail out somebody who actually went bankrupt because the price wouldn't support that much product. >> a modern farm bill should not create planting,, marketing, or international trade distortions. let me be clear. prices should be decowlled and government should not set that guarantee profit instead of a risk management tool. >> i echo what's been said on minimizing that ought to be their decision based on the productivity of the land and not what the market demands and not what the government

proposes. >> our government needs policy that makes sense. we need regional equity that allows the same opportunity in protections for all types of commodities, not just in certain areas. we need an e.p.a. that helps farmers comply with the necessary regulations and not aggressive police-like agency bent on punishing those who are just trying to yield a crop. >> it's violetly important to the farmers and ranchers of georgia as well as the farmers and ranchers all across this great nation that we uphold the strength of the safety net that american agriculture depends on in this farm bill. >> as we've seen time and time again, farmers are the back bone of america. without us, life as we know it would not be possible. however, the volatility of the economy and congress' inability to pass a new farm bill is creating a lot of uncertainty for the future of the agricultural industry.

that is why congress needs to sit down today to plan out a better farm bill that will benefit the future of america. >> to watch all the winning videos and to learn more about our competition, go to c-span.org and click on student cam. and tell us what you think about the issue this student wants congress to consider. post your comment or tweet us. >> now, a discussion about how the health insurance industry is responding to the affordable care act. from "washington journal," this is 40 minutes. this segment will discuss how the health insurance ry is responding to the affordable care act. thank you for being with us. about how insurance

companies are responding to the latest news. guest: they have got all these new customers. it is a lot more than a lot of people expected at this time. open woman for the affordable care act for these folks buying individual covers directly from the insurance companies," he urged. on march 31. they're trying to find out who they are, how thick they are, and that will affect the rates is coming up in terms of filings they have to make. they know the affordable care act prohibited insurance companies from discriminating with pre-existing conditions. that effectively prevented them from finding out whether or not people had pre-existing conditions when they were applying for insurance and when insurance companies were accepting that.

not have a really good idea what sort of conditions these folks have, and they're going to cost, how that is going to affect rates for next year. they are all china figure that out, seeing who they signed up, trying to figure it out from early claims coming in. they really have to quickly beure out what rates will for 2015 because the filings are starting to be due in the next couple of weeks. class a number of insurers are expanding offerings. i am typically interested in the largest insurers in the country and what they're doing. class the largest is united. toy decided for this year goingt really easy on into these exchanges. a lot of insurers were quite in there willncerned would be a lot of disruption in the market this year, that you'd

get a sicker pool of people than they had planned on, a lot of insurers had concerns about whether software is going to work, which turned out to be very well-founded. united stood back. some of the other big ones, at no was very cautious is here. also very cautious. the one large for-profit insurance company that did go in in a big way was wellpoint. californian, basin in many markets there, better known by their and some, blue cross. they have a lot of blue cross lands. blue cross was the one umbrella organization that went into a big lake.ges in blue cross was already in the individual health insurance market and they had to protect that market.

they were sort of the league players in just about every state to do that. in 2015, now that the industry has seen this pretty big turnout in the first year, 8 million people signed up as the president announced last year, they are now figuring out what they will do for 2015 it looks like customers signed up. it was reconsidering it and looking at expanding its presence in -- next year. one of the few plans, blue cross plans to sit out, 2014 was the plan in north dakota. they said they would be in those states. it looks like we will see more .fferings than we had this year some states will offer significantly more selection if into an even

increase. some states had only one or two insurance countries -- companies . we might see that get better. class when you're talking about the strategies for different some are holding back and waiting to see what happens. >> depends on whether they are in that business to begin with. we are talking about individual insurance, which you buy through the exchange. of the a direct customer insurance company, rather than the health insurance we all know, which we get through our risk --s or employer employer-sponsored. if you're in that business, you want to protect that and not just sit aside and comments like

that business away. companies in that business tended to want to stay in it, be in the exchanges, have offerings when you went on healthcare.gov they wanted to be there on the menu so you could pick from them and hopefully, from their point of view, at a competitive price that was financially responsible. there were new entrants this year. health-care co-ops which were not profit, private plans that .ot subsidized in half the states, you have a co-op. these, by definition, wanted to be in the market this year. some did very well. some did not so well. they priced too high, which was the case in connecticut, or in were very dead

computer problems, worse than those on healthcare.gov. for example, maryland health connection did not work well and never got fixed the way it should have been. the co-op in that state had some problems getting members. it had trouble getting the word out because people had trouble getting on the exchange. these larger insurance companies , individual insurance is a business asf their a proportion of total business. we are talking about united. multibillion-dollar companies. united as an entire provision about health care services and not insurance. individual insurance is a small piece of their pie. they could afford to sit back and see what 2014 would look

like. seen all the have new entrants, they are starting to look at that again and say, maybe this could be an area of growth for us. and maybe we ought to be there in a bigger way into thousand 15. seniorguest is the correspondent for kaiser health news. if you would like to join the -- ersation, i want to ask you real quickly, if i am a consumer and am looking for health insurance under the affordable care act, what does this mean for me? guest: let's say you are a consumer who is still uninsured. you do not have insurance now and you did not sign up for

health insurance. depending on your circumstances, you might have to wait until late this year to sign up. time endedrollment march 31. there was wiggle room for people who had trouble signing up, if you are on one of the dysfunctional computer system, they gave you extra days. there was a big rush at the end, as a lot of people expected. big crowds on the systems. unless you have a special circumstance, you have to wait until the november enrollment time, or january 2015 covers. a lot of exceptions. if you are in a special situation, if you have coverage now but you lose it between now and the end of the year, if, for example, you are with an employer-sponsored plan, you lose your job and you lose the can go to these exchanges. the open enrollment has an

exception and you can go on the exchange and get coverage. if you get married, other exceptions let you get on and get in outside the open window that most of the people have to adhere to. there are also exceptions. it is not widely known but the administration has allowed exceptions to the individual signte, a requirement to up and get health insurance, or pay a penalty. there are some openings there. for example, there are specific religious exemptions that will allow you -- you do not have to do it. had --re, if you remember the president said, if you like your plan, you can keep it. a lot of plans were canceled. rule that said, if you lost your plan in that circumstance and you find the replacement plan is

unaffordable, they will again give you a waiver on the penalty. consumers,dividual the sign-up has passed. not nearly everybody signed up. the next opportunity to do so will come late this year. >> the first color for this segment is in new york. hello. guest: i was in glen falls last month reporting on health care. i hope the weather has warmed up since i was there. >> it has finally. we can play little baseball. i just wanted to say, i am an independent. i pick up my own insurance. this is helped me a great deal here monthly, from around 1100 to 800.

i have a friend who is a farmer. i -- i have a friend who is an independent trucker and it helped him significantly. premium prices were rising, long before the aca, every year, continually, the co-pay went up and up. to say for us, in states where they are trying to make it work, it is working. >> you saw your premium go down. what kind of plan did you get, if i can ask echo class a silver plan. the middle of the road. i am not really super well off, for sure. quest that is very typical. the sober plan was expected to be one of the most popular. for listeners who do not know, there are metal grades of plans. the bronze plan was the lowest cost plan. then there was silver, gold, and platinum.

the silver plans turned out to be among the most popular. -- itemiums came in varies widely by state, but you can get subsidies. kyle sounds like he has a family plan. i would mention to the caller, he said health-care prices have been going up and up. there is no guarantee it will not continue to happen. a lot of people sought relief under the aca. the caller sound like he was one of them. it sounds like you got some subsidies. there are tax credits applied instantly when you buy the coverage. one of the concerns now, and we may talk about it later, is, what are premiums going to look like for 2015, will the co-pays and premiums keep going up, that

is one of the big questions of the affordable care act. now, the question is unanswered. we will have to wait and see. host: an article recently reports statisticians working for next year's insurance premium rates, expect to see an average increase of seven percent, well below the feared double-digit increases making headlines. >> that article was based on an interview with one guy. he was basically making an educated guess. a very smart guy, but nobody really knows at this point what 2015 will look like. we are getting all these mixed is sort ofich, complicating the problem. we have insurers, actuaries like the one quoted in the article,

saying, it will be mid to upper single digits, which sounds like a lot, heck of a lot more than the overall inflation rate is right now, but, in the history of health care premium increases, is pretty tame and everybody would be pretty happy with that. on the other hand, we have wellpoint. toldlue cross plans, who insurance analysts on a conference call a couple of weeks ago that it is expecting inble-digit less increases its health insurance exchange premiums for 2015. this could just be a game of expectations. insurance companies typically ask for a higher rate than the state insurance commissioners and other regulators ultimately give them. this could be wellpoint -- they could be planning a negotiating flag here.

nevertheless, people still do not understand, insurance companies are still figuring out what their costs will be this year. there have been early reads on what has been going on. the first table the common when you are an insurance company, drug claims. hospitals take weeks and months to get reimbursed by the insurance company. drugs tourists put their claims in electronically. they are starting to see these claims come in for patients who enrolled and got drugs prescribed in january and february, and, some of the information coming in indicates some fairly ill, fairly high-cost patients who signed up for the plans. insurers can figure this out based on what kinds of drugs are being prescribed.

if you see drugs related to diabetes and aids and hepatitis, you know these are folks with who typicallys cost more than your average insurance and rowley. insurance --, insurers are saying, maybe we will have significant costs, maybe louisville have to raise premiums by double digits next year. on the other hand, folks are saying, look at the rhythm of enrollment here in the insurance plans. the people, there was a six-month enrollment time, and it stands to reason people who have chronic illness who need insurance coverage and want to go to the doctor to have insurance, you pay for that, would be the first to sign up. perhaps the early claims coming in are disproportionately from folks who have higher illness. the thinking is a lot of these folks who rush at the end of

up would ben younger and healthier and would counterbalance out some of the early claims coming in that suggest high-cost. in fact, we are also hearing anecdotal reports that that is that young folks waited as long as they possibly could to sign up. they are younger and healthier and that may fulfill the hope come a lot of people were wondering, the people would sign up to bounce out the risk pool. some folks are suggesting that may happen. insurance companies are just really coming to grips with this right now. to say what we know premiums will do for 2015, it is really just a guess at this point. >> president barack obama toss about the newest enrollment numbers at a nuke -- news conference last week. let's listen to what he have to

say. >> i do not think we should apologize or be defensive about it. there is a strong story to tell. with the other side is doing and what the other side is offering would strip away protections from those families and from hundreds of millions of people who already had health insurance , but never knew if the insurance company could drop them when actually needed it, or women who were getting charged more just because they are a woman. puzzled why the sole agenda item when it comes to republicans -- it is curious. what i intend to talk about is what the american people are interested in hearing. plans for putting people back to work. plans for making sure our economy continues to innovate. , training people for

the jobs out there right now and making better use of our community colleges and linking them up with businesses, and how we will continue to bring manufacturing back, the way we have over the past several years. and how we will put more money in the pockets of ordinary people. if republicans want to spend all of their time talking about repealing a law that is working, that is their business. what democrats should do is not be defensive, but we need to move on and focus on things very important to the american people right now. take? guest: a lot of people describe what he was doing there as a victory lap , because they had already declared victory a couple of weeks before when they passed the white house's target, the congressional budget offices original perjurer -- projections, 7 million. inn they hit 7 million

mid-march or so, they proclaimed victory. the last-minute rush we talked over 8ctually put them million. that gave the administration and the president leading it occasioned to really take credit for something that a lot of people, democrats and republican alike, but was not going to happen. never in october and november how completely dysfunctional healthcare.gov was. it really was a mess. people were revising expectations downward. the fact they got as many people signing up is surely trumpeted , as we justrats heard, as a signed this is working in the law is here to stay.

have not seen is how these people will like having it. the plans are very comp gated. it is not clear people really know what they have signed up for until they start using it. a lot of these plans come with high deductibles. are prettyone substantial. a lot of people get subsidies to pay for them. what they have not seen yet is what happens when they try to use it. the congressional budget office reported recently premiums are lower than expected. subsidies will be lower than expected. revised downward their estimate of what obama care will cost. one reason the premiums are lower than expected is the provider networks are narrower than expected.

when people use their plans, they may not see the doctor they like in it, they may not even hospital they want to go to in it. they also see very high , typical deductibles for a silver plan for a single person coverage is $3000. who do not follow health insurance, the deductibles what you have to pay out of your pocket before the insurance plan kicks in. $3000 deductible for bronze plans that we mentioned, the cheapest plan you can get, the deductibles $5,000 for an individual. if you have a family plan, it is $10,000. those used to be called catastrophic insurance where you are basically paying out-of-pocket the day today cost

of going to the doctor, getting tests, and so forth. unless you get very sick, the insurance does not kick in. it is not clear. it is interesting to see how people will react. thosea lot of people sign up fod and platinum plans with lower deductibles. a lot of people like our caller from upstate new york are very happy with their plans. but i think we still need to see startople react once they using the plans. as a nation, in terms of the nation, my colleague at the kaiser family foundation, take a poll regularly on how people are thinking about the affordable care act. it is still pretty unpopular politically. when you use that term. now we are here, we are in it, people have signed up, we have got customers, now they will road test it and we will see how it goes. host: calls coming in, rachel in

texas. she has health insurance through her employer. caller: yes. for the first time, my sister has insurance at a cost her $36 a month. is on medicare. she is 80 years old. she is in chronic pain. she gets phone calls from groups telling her she will lose her medicare. it has got her scared to death. they just want donations but her phone rings all the time from these people. thed you tell me what part prescription drug programs will cost us? guest: i cannot quote you

figures but it's fair to say passeddicare part d under the second president bush was one of two extremely expensive, significant benefit laden social welfare programs passed by congress in social health welfare programs. it was passed by congress in recent decades. they both added hundreds of billions of dollars to the federal budget. you mentioned the talk about medicare because of the affordable care act. thats a big talking point republicans have been trying to take advantage of. ande are some reductions

what providers get, what hospitals get, and insurance companies get from the federal government under the affordable care act. there is no reduction in benefits. in particular, the affordable paymentsrequired that under the medicare advantage program which are private medicare plans run by insurance companies -- insurance companies have been collecting a premium on those programs. the happen costing taxpayers as for privatemore medicare advantage plan than regular medicare that most people get. every year the department of health and human services is having to ratchet that down and having to figure out how they are doing it. this year, the insurance companies went on a huge publicity and lobbying campaign to minimize that reduction.

part of that was reaching out to that medicareying is being eroded because of the affordable care act. medicare advantage was already getting a premium of what other medicare debts. have not beenits changed by the affordable care act. in florida, anthony is on the line. morning, my question to you is what is going to be done about those folks who are trying to get onto the plan in order to get the subsidies to get the plan? we talked about everyone posturing in regard to which direction should we go regarding health care and how it is

administered. one of the things i find concerning working and purchasing in my career for over 20 years is that when i received my bills working in a surgical center, i am surprised by the cases beingere are billed to me at $1500 and if i did not look and ask for the billing, if you multiply that times all the patients out there who don't do that, who is checking that and taking care of that due diligence to reduce actual costs? guest: thanks for the call. you are talking about how people will get care in the states that have not -- that have blocked the subsidies. i assume you're talking about medicaid. obamacare, the affordable care act, had several measures to

expand coverage but the two main ones were expanding medicaid which is the program for low income folks where it's like medicare for seniors only you in insured by the government a state and federal program. medicaid had a pretty restricted eligibility criteria in most states. the affordable care act expanded that to include almost all adults under a certain percentage of the federal poverty limit. andsupreme court considering the affordable care act struck down the part of the aca that made medicaid expansion mandatory and it gave the option to the states. right now, we are at about 26 okayed medicaid

expansion and the other ones have said no or are considering it. some are on the fence like pennsylvania and virginia. what happens to those folks who are stuck? offersordable care act subsidies to go buy your own health insurance on these computerized exchanges if you are over a certain income limit. it is 12 or $14,000 if you are a single person. if you are above that threshold and you get the subsidies, you lthcare.govy on hea or if you are under that, you qualify for medicaid in every state unless you're in one of the states op that did not to expand medicaidt in that case, you are in a coverage gap and

ins one of the larger gaps the way the affordable care act has been implemented. there is still health care available to folks in this category. there are community health clinics that see folks who are uninsured. hospitals are required by federal law to take anybody in the emergency room and stabilize them whether they have insurance or not. have is anon't insurance plan where they can go to the doctor and be assured that they have full coverage. your other question was about prices which we could talk all day about. it is a great point. one problem of the health-care system is when somebody else pays the bills, the actual customers, the patience, you and me, really don't have an incentive to look at the charges and see if they are the right charges and shop around for the best deal. many people want to change that.

there is a lot going on in health care now to increase the transparency of these prices. hospitals are starting to pledge to let people see what the cost of their coverage might we when they go to the hospital. a normal concept and any other retail business but for hospitals it's pretty radical. a couple of weeks ago, the federal government started publishing what private doctors are charging and making for health care. employers now are making prices available to their employees in their health plans for certain procedures, typically radiology. they will give you a particular price and say we will pay $500 for an mri and here are the places to go. here is what they costing you can shop around but we will only give you $500 so you make a decision. that is changing slowly. it is a problem and one of the

marks of success in five years or so will be to what degree we have a much better sense of what's in our health care bills and what exactly we are paying for and how does that compare with other people who are offering the same kind of product. georgiac,laudette gets her insurance from somewhere other than her employer. are you with us? on and gog to move instead to lisa in shreveport, louisiana. caller: how are you? i am from shreveport, louisiana. i have a problem. i am single and 55 years old. my health care will cost me $400 per month. i lost my job. i cannot get medicaid and i have no idea what to do. i am just sick.

guest: you say your health care is $400 per month? caller: that's what they said it would cost me is $400 per month. guest: so you went on health care.gov and try to sign up? caller: yes, sir. guest: it sounds like you did not end up getting that insurance. caller: no, sir, i cannot afford it. bobby jindal is my governor and he did not expand medicaid. i could not qualify for it so i have no idea what i will do. guest: do you have an income now? caller: i have no income whatsoever. they said i did not qualify for medicaid so i don't understand. you are in the category of people we just talked about. caller: yes, sir. i heard you were talking about that. i don't know what to do.

i am really scared. it's tough if you lose your job and you are in a position like that -- recently lost your employment -- there is always an option called cobra coverage after you leave your job in which case you can pay the premiums and keep the coverage that you just had. and your case, it does not, that's an option even if you were still in the cobra coverage window. you've got to sign up within a certain period of time after you leave your job. $400 per month on the exchanges too much than the cobra premium is likely also too much. you are one of the folks unfortunately who is in this coverage gap we talked about. louisiana did not expand medicaid.

if the caller had an income even relatively low like if she made $50,000 per year or so, she could go on the exchanging get the subsidies. -- $18,000 per year or so -- she would qualify for medicaid and the in's -- in an expansion state. it's an unfortunate situation and it's got a be worrisome. as i mentioned, there are community health clinics. i'm sure there's one in shreveport. that sees folks who are uninsured if they have an issue. sometimes there is a waiting list to get him. that is one option. unfortunately, many people are still using hospital emergency room's as their caregiver of forst resort -- of first resort because hospitals are required to see people and it's expensive and inefficient way to deliver health care.

willf the marks of success be of the system is fixing itself to reduce those but right now in some states like louisiana, that is the first choice for many people. host: last call from this segment comes from cincinnati, ohio. hello, i'm talking about reducing health care costs. it's called tort reform and malpractice. my suggestion is they should get rid up unitive damages -- get rid of punitive damages and pain-and-suffering and to compensional damages and go after these trial

lawyers and pay back the excess amount of money they have been rewarded for three years. pay that money back into the health-care system. right, i think both conservatives and liberals would agree that the american tort does add to health care costs in this country. doctors tend to order more tests and be more careful because they're concerned about eating suit. sued. while they find that malpractice costs do add to the expansiveness of the american health care system, it is not the main thing wrong with the system. we are talking about a few percentage points in any given year. if you did wholesale tort reform

the way some on the right would like to do it, i forget the exact number but is somewhere in the single digits like five or in healthent gain care costs for one year. and thatone-time gain is basically what health-care inflation has been at the bottom and for year after year. a lot of folks agree that we do need to do tort reform. as a one bullet fix for health care costs. i think most disinterested experts would tell you that that would not solve the whole problem. host: that's all the time we got for this segment and jay >> on the next washington journal, miami guinness --m

macguineas will talk about deficits and spending. votersleague of young executive director robert baker looks at the role of young voters. lust, your calls, tweets, and facebook comments. -- plus, your calls, tweets, and facebook comments. >> chris christie is the keynote speaker at new jersey chamber of commerce's congressional dinner. our coverage starts at 7:15 p.m., here on c-span. i want to thank our distinguished member for all of the work that he has done this week. a lot of us have looked at the situation. when secretary paulson came to

us, he gave us a three-page bill that said give me a blank checkbook and put $700 billion in it. i was offended. what happened since then? headed 107 pages of taxpayer protection through that bill. we understand the gravity of the situation and we were with our -- and we worked with our colleagues. we made sure that when this happens, one profits come to these companies, we get their stock warrants. thoserst person to get profits is the american taxpayer. we make sure there is an insurance program that make sure that wall street shares in the cost of this recovery plan. we also made sure that the executives that made these bad debts do not profit from this rescue recovery plan. we cut the cost in half of this bill.

congress will have to approve the second half next year. why did we do all of this? iss wall street crisis becoming a mean street crisis. it is quickly becoming a banking crisis. what does that mean? why does that matter to us? matter tohat janesville, wisconsin? if it goes away, it could go. that means credit shuts down. businesses cannot get money to pay their payroll, to pay their employees. students cannot get student loans for next semester. evil cannot get car loans. seniors may not have access to their savings. are we standing at the edge of this of this? nobody knows? maybe. it is very probable. this bill offends my principles.

for this billvote in order to preserve my to preservein order this free enterprise system. this is a herbert hoover moment. he made some big mistakes after the great depression. we lived those consequences for decades. not make that mistake. there is a lot of fear and panic out there. this is about getting fear and panic out of the market. i think the white house t bumbled this thing. they brought this up to a crisis, so that all eyes of the world market are here on congress. it is a heavy load to bear. we have to deal with this panic. we have to deal with this year. colleagues, we are in the moment. this bill does not have everything i wanted.

things inot of good it. we are here. we are in this moment. if we fail to do the right wing, heaven help us. if we fail to pass this, i fear the worst is yet to come. the problem we have here is we are one month away from an election. we are worried about losing our jobs. most of us say this needs to pass, but i want you to go for it, not me. a majority of us are going to have to vote for this. we're going to have to do that because we have a chance of arresting that crashed. maybe this will work. for me and my own conscience, so i can look myself in the mirror tonight, so i can go to sleep with a clear conscience, i want to know i did everything i could to stop it from getting worse, to stop this wall street problem

from infecting main street. get on my airplane, go my three kids and my wife and know that i did what i thought was right for them in their future. i believe with all of my heart, as bad as this is, it could get a whole lot worse and that is why i think we have to pass this bill. i yield. >> find more highlights on our facebook page. america'seated by cable companies 35 years ago and brought to you today as a public service by your local cable or satellite provider. over 35 years, c-span brings public affair events from washington, directly to you. but in you in the room at briefings and conferences. we offer complete gavel-to-gavel coverage of the u.s. house as a public service of private industry. we are created by the tv

industry 35 years ago. watch us in hd, like us on facebook, and follow us on twitter. >> congressman tim murphy has introduced a bill to improve access to mental health resources. he talks about the bill at the american enterprise institute. this is one hour 25 minutes. >> thank you for coming today. i am a resident scholar here at aei. our discussion is on the role of mental health and the role of the government and mental health policy.

we typically think of mental health as a state responsibility. to a large extent it is. the federal government can have a very influential role in shaping services and policies for mentally ill patients. there are huge gaps through which mentally ill patients fallen to the street and into jail. it is heartbreaking situation. today we have representative tim murphy.

the panel discusses helping family and mental health crisis act. it addresses persistent problems in mental health care systems, among them, the shortage of psychiatric beds. there was just a hearing two days ago on that. the inadequate education of evidence-based treatment. small problem of violence and mentally ill, outdated, involuntary commitment laws and the questionable priorities of the lead agency within hhs that is responsible for funding the services for the nations mentally ill. everyone on the panel will respond to his comments are deeply dedicated to the patients and to the families who love them. i will first introduce representative murphy. i will introduce everyone. you have much fuller biographies at your desk.

i will be brief and then we will begin. representative murphy is currently and has six terms in congress, representing the 18 district of pennsylvania. he is a former psychologist, i guess you are still a psychologist, with three decades of experience. the chairman of the oversight subcommittee of the energy and commerce committee. the cochair of the mental health rockets and founding member of gop doctors' caucus. he authored the seniors access to mental health act which ended the practice of charging copayments to seniors on medicare anti-introduced and passed into law the mental health security act for america's families and education which was instrumental in getting college students who are suffering from depression or psychosis the help they need before a tragedy strikes. next will be dr. jeffrey lieberman who was the chairman

of psychiatry at columbia university college of physicians and surgeons, also the director of the new york state psychiatric institute. his expertise has been in schizophrenia and psychopharmacology. this sure he is a president of the american psychiatric association. next is patrick j kennedy, the cofounder of one mind for research. he served 16 years in the house of representatives and was the author and lead sponsor of a mental health parity and addiction equity act of 2008. finally, the professor of psychiatry at the uniformed services. he is specializing in

schizophrenia and policy and infectious disease in schizophrenia which is a very interesting theory. he is the juncture of the family medical research institute. he has co-authored numerous papers and 20 books. that is our distinguished panel. we will start with mr. murphy. thank you very much. >> that is convenient. thank you, sally. i didn't know how to get the slides working. does anybody? anybody know what we can do here? we will move into 21st century technology in just a moment here. good morning. thank you. it is an honor to be part of this distinguished panel. and have so many distinguished colleagues in the audience.

i wish i could say you're getting continuing education credits for this. that would be nice. we will move forward. i want to talk about hr 3713. i had committed to the parents from sandy hook elementary school that we would have this bill introduced before the anniversary of that tragedy. our nation has been rocked by several of these tragedies. although those with mental illness are not of the vast majority likely to be violent, it is an area of grave concern. some of these have been committed by someone with untreated mental illness and that we need to deal with these things. let's see if i can make this work. some is going to have to sit there and make it work. i have no idea how to do this. it does look fancy nonetheless. ok. all right. let me keep talking here.

let me give you some numbers. without this, nothing else is going to make sense to you. there are about 60 million americans, about 20% of our population or so, with some degree of mental illness. from the mild, transient acute problem of anxiety or sadness to severe mental illness. about 9.6 americans have a serious mental illness. about 3.6 million are without treatment. it is extremely important to understand what happens when someone is without treatment. if someone is without treatment they can be more likely to exhibit some violent aggressive tendencies. when they are in treatment, there is a 15 fold decrease in the likelihood that they may become involved in violence. some with mental illness have about three to four times more likelihood that they will be victims of violence, rape, assault, robbery.

this is whether someone is imprisoned on the street or at home, independent, whatever that might be. children who are mentally ill, three times more likely to be victims a sexual abuse. those numbers are staggering and should move us toward action. the problem is the actions that have been taken are very much wasteful, are misdirected, and we are not given the services we needed. the federal government already spends about $125 billion toward mental illness. most of that is for disability, medicaid. very little is for research. iny little is given out terms of early treatment and access.

what seems to happen, however, is -- where do these people go? 20% of the people in our prisons are mentally ill. if you look at the next life you will see that as we close the hospitals, particularly in the 1950's and 1960's, with 550,000 beds for a population of 150 million. as they close down we now have about 40,000 hospital beds but where have the patience gone? we have filled our systems. while state budgets are bursting at the seams and paying for growth and expansion and overpopulation and small prisons, it is no wonder why it is not the crime that is expanding. it is that we have traded the hospital bed for a prison cell. we've also traded the hospital bed for a mattress in the flophouse, homeless shelter for a blanket over some subway grates in our cities. it is inhumane. it is immoral.

it puts us in something of a third world status. even when we do take some action such as a typical situation when a seriously mental a person is having some acute breakdown, aggressive, threatening, the police are called. they take them to an emergency department. what happens? an ill-staffed emergency room, which is not designed to do with a mentally ill patient is brought here. they tie them by their wrists in their legs to a gurney, too often lead them in a hallway or a room surrounded by a sheet for some visible cover. if the person get out of control they sedate them. what could be more inhumane than putting someone in jail, leaving them in the street or physically or chemically handcuffing them to the bed and calling that treatment. it is wrong. it's about time our nation woke

up and faced at the turmoil of the family feels about facing this has to change. in pursuit of this over the last year i held a series of hearings. here's what we learned. we learned there is inadequate inpatient treatment options. simply not enough beds. there is inadequate outpatient treatment, too. our system is far, far away from helping people get better to recover, to get jobs again, to get independent housing. we know this can happen. the treatment has been out there. there are a number of supportive services from health that can help. there are community wraparound services. unfortunately, there is not enough of it. there is a huge shortage of psychiatrists overall, particularly those who treat serious mental wellness.

-- mental illness. when you talk about 7000 child psychiatrists for 15 million children, and we need 30,000, that is a serious problem. people cannot get help here it when there is no help there is no hope. when there is no hope, people feel the stigma of going from place to place, emergency room to emergency room. it is no wonder they feel a stigma. we are part of the society that maltreats those with mental illness. another problem we found is that the health insurance privacy act is also the right to privacy act are subject to a great deal of confusion. they are supposed to be there to protect confidentiality of records. i agree. to make sure that people are not getting school records and other records that do not need to be out there. what they have become is another barrier.

people, for fear of releasing anything, often released nothing. we have testified where parents were in a hospital trying to convince someone else "i need to tell you about the history of my son or daughter" and people say we cannot talk to unless we have permission. you cannot give permission for someone who does not know where they are. they are so severely involved in paranoia and delusions. they do not know who they are. we're telling people "until we get their information we cannot tell you anything." that is wrong. it is a misinterpretation of the law. if you're in an auto accident and you are unconscious or you have a stroke and you are incoherent, no one says "we have to wait until you get better before we make a decision to treat you." we do not do that. why do we do that with someone who is in the middle of deep depression, deep bipolar disorder or psychosis? it is wrong. you cannot get the history. if you cannot get the history for a psychiatric disorder you

cannot diagnose or treat it. it is akin to telling an orthopedic surgeon "we want you to diagnose if there are any fractures but we are not going to give you any x-rays." we have to provide access to information. we start to follow all the ethical rules of every profession. we also found that it is an imminent standard that has existed that said the person has to be in imminent danger to themselves or someone else. then you can, without their authority, put them in inpatient care against their will. again, the standard is to this level of someone has to be basically slitting their wrists am overdosing, holding a gun or knife to someone else's throat before we believe they need help. do we do that with any other medical illness? do we wait for someone to say "i cannot treat you until your cancer has advanced to stage four?

i cannot deal with your cardiovascular problems until you have a stroke?" no. somehow we have this with psychiatric illnesses. we have to wait until the person is completely deteriorated before we do something. we need to step in and help them. that is a better prognosis of -- in assisting them. it is also important that we have evidence-based treatments that really work. there are treatment out there. what happens as we see a lot of federal dollars in state dollars going to work programs. it is more along the lines of many elected officials saying "let's just fund this and put it away." it is america's big secret. we say let's just fund these programs and no one asks the question. does it work? in some cases, they do not work. some of the money is spent on silly things that will make your

blood boil as a taxpayer. why is that federal dollars go to pay for a conference where literally the topics are such things as "interpretive dancing" or "making a collage" or "getting in touch with your inner animal." when we see millions of dollars going toward those things and telling people "we do not have enough people to provide help for you," that is wrong. we are not going to put up with that anymore. it goes to this point of weak accountability for federal dollars. what does it do? we empower parents and caregivers with making it very clear definition of refining the definitions what hippa laws are so family members know. we want the standards to be

clearly defined. we want them to have access to history when they need it. it fixes the shortage of inpatient beds. right now there is a 16 bed rule. how do we figure out we're not going to address you if you have more than 16? most have a critical bed shortage. this has to change. we also want to make sure they're are alternatives to institutionalization. patient human has found to be extremely states. very few states do appeared new york has found that incident -- that instead of putting people in involuntary commitment, in new york were things work with the family members or the district attorney

or the judge and come up with an agreement for the patient to stay on medication and treatment. what they found that the costs for imprisonment fell 64% overall. in many of the areas is as much higher. some areas exceed 80% of those going into jail. or homeless. the other issue is it encourages states to adopt a need for treatment standard instead of just waiting until someone is going to kill someone else or their cell. we look at the need for treatment as a standard. it reaches patients just be on the emergency room. the cms recently came up with the ruling that they were going to limit the type of medications available for someone with psychiatric illnesses. we had a rather emotional hearing a few days ago on this. a representative from ems told us they would limit the type of drugs that were available. i had to read out loud a statement from the american

psychiatric association which clearly said the cms distorted the analysis. in that, one of the comments that was made was about ssris. i said can you tell me what it is? the response was "i was not briefed on that." if you do not even know what you're talking about, it is clear that you will draw conclusions that have nothing to do with reality. i am understating my concern for the decision that was made. i pointed out that they have another standard with and that that says if you are not rehospitalized it is ok to change it. they were limiting the type of drugs so severely that i thought it was going to greatly impaired physicians abilities to prescribe appropriate medication. when you're over age 65 and you receive a diagnosis of chronic illness, you are twice as likely to face depression.

those that were depressed and chronically ill, you double your health care costs. exacerbation of physical symptoms, less likelihood to comply with other treatments. i reminded him that when seniors commit suicide, 20% of them do it on the day of the doctor visit. 40% the week of the visit. 70% within a month of their last doctor visit. recognizing that many of these antidepressant drugs take 2-6 weeks to become effective, to tie a physician's hand and say you cannot use this until you have tried other ones that have failed, it puts the patients life at risk. i'm happy to say a couple of weeks after that hearing, cms refers their decision. this bill would say we would not leave it up to the whims of whoever sitting in the chair but we will make it part of the law. same-day billing issue is quite

important. you cannot have two doctor bills on the same day. we know that a family is more likely to go to a pediatrician or internist when they are beginning to exhibit severe mental illness. we know the average is 112 weeks before a person has their first visit to treat mental illness. what happens if a mother brings her teenage son to a doctor and the doctor says i am very concerned but we need him to see a psychiatrist now. that is right. you are on medicaid. can he come back tomorrow? that is inhumane. we're not going to have it anymore. there needs to be allowance for same-day billing. more access to tele-psychiatry. physicians can access by calling a number or allow more tele-psychiatrists.

we know it is a very effective mechanism to do it. they can talk under a vehicle screen. it is in barriers to eliminate. medical research is important. the authorized a brain incident to involve a lot of research on the brain, the last frontier of the human body. a very effective program for early intervention for these problems. we also want to integrate mental health and primary care. that is where the first appointments tend to take place. part of this is a bill that has been put into the bill that was passed yesterday. i had also put in some funding in there which was approved yesterday in the house bill. i am sure the senate will do that too. $60 million to help with outpatient clinics. it is a cause for celebration. more behavioral health it,

medical records are moving into the 21st century where they are electronic records. not for behavioral medicine. why would that be? we have to have an integrated care model where the brains functions are seen as part of the body and not distant from. not something you put in jail or call the police for or kicked out of your office because you don't want to deal with it. physicians can work as a team. another part of this bill is to our community health centers, to allow mental health care professionals to volunteer. here's another thing that is so absurd that only the federal government could come up with it. if you work in a community health center, marvelous places that provide low-cost services to underserved areas, you are covered by the federal tort claims act. malpractice insurance is low. they can provide integrated care.

they are all working together. great. that is what you want. unfortunately, a lot of them are understaffed. if you are employed there, you are covered by this. if you are at a free clinic and you volunteer there, you are covered by the act. but, if you are a community health center and you volunteer, you're not covered. if you are the free clinic and paid you not covered. wait a minute? people will give of their time to work at the centers, a day a month, and afternoon a week in the very valuable. we will take away that barrier and allow people to be the good samaritans, want to help out and give up their time. quite frankly, this will probably be about a billion

dollars worth of free care in this country. next is the department of justice reform. a lots of prisons is guesstimates. we still do not know a lot of what happens in the federal justice system. we want to know what happens with serious mental illness. it is a disjointed model. they may have some care. they may have a different kind of care in jail. we do not know if they have follow-up care. we want to make sure we are tracking that. the team awareness is extremely important. we want to understand that serious mental wellness and what the symptoms are so they are not afraid of it. this is extremely important. of all this money spent, there is nobody that looks after what happened to the department of defense, veterans affair, department of justice, department of health and human services, and maybe even department of labor transportation. a lot of money is spent in

prevention and treatment services for mental illness. a lot is not evidence-based care. dod has done some marvelous things. throughout the military they have done tremendous initiatives to try to create more care for our active duty guardsman out there. 20% get appropriate help. 20%. waiting lists is not good treatment. we want an assistant secretary of mental health specifically

designed as a clinical psychologist. this person's job is to go through every nook and cranny of the federal government and find every dollar can say is it evidence-based care? if not, eliminate it. if it is duplicative, merge it. if it is great, expand it. gather information from states. this is what this bill does. it is very comprehensive. it is not something i can explain in a thumbnail sketch. quite frankly, there are three things i think have happened in the last 50 or 60 years in this nation to change mental health. one, the changes president kennedy made with regard to how we need to close down our asylums and stop warehousing

people. two, they made sure we have mental health parity. these other reforms still need to happen. the federal government finally stood up and made some reforms and change the barriers. none of us want to see any more headlines of another tragedy of a victimization of a person with mental illness or violent committed by a person with mental illness. let's bring this issue out of the shadows. thank you very much. [applause] >> thank you very much. thank you very much. thank you very much. in conclusion, i would like to

thank -- i have spent my career really being a scientist and a laboratory doing research on the psychology of schizophrenia and acting as a clinician and treating patients as well. in the past, maybe decade, i, and the chair of the largest little help care provider in the metropolitan area. i've gotten drawn into the legislative political dimension of things. it has been an interesting but sobering experience. when sally called me to participate in this event, i noted that it was smack in the middle of a vacation that i take every year to go and watch the sony tennis open.

i said, after thinking about it and hearing who is going to be here, i'm going to come. i missed roger federer playing yesterday. it was for good reason. this is an opportunity at a time that can really be the tipping point or a turning point. we are here today, an issue that has been in front of us for decades. if not more. many people have been talking about it, railing about it, even my good friend and colleague. congressman murphy has stepped forward to assume a role that is really doing something important. he is not alone in doing this.

there have been champions for mental health in congress seriously. -- congress previously. paul wellstone, gordon smith, john porter, patrick kennedy, his colleague and his father. as time went on, they move on and we are not sure who is going to follow in their ways. congressman murphy has stepped forward to do so along with other individuals who are so gratefully working in this way such as senator stabenow and your cochairperson in colorado. and the neuroscience caucus. and so forth. we really have a chance to do

something now, given the fact that an individual has the vision and courage and a platform to step forward to do so. i have some slides. as a researcher, you cannot talk without having slides for too long. i thought i would pick those up so you could follow along. it is not going to be easy. the reason is because our system of care, which is admittedly fragmented and expensive, is trying to adjust at least three distinct populations defined by type of illness, severity, and venue of treatment. the one that we hear most about and is the most urgent priority are the serious and persistently mental, schizophrenia, recurrent, psychotic depression.

they are treated largely and mental health care facilities. then that we have the people who are receiving medical and surgical services that have comorbid psychiatric illnesses. this portion of the health care population is one of the biggest cost drivers. we have a third group which is individuals who have mild of mentalforms illness or worried well or working addictions that are treated in clinics or practice settings. we have three distinct situations. we are all talking about slightly different emphases on these different populations or settings where people are receiving care. we have opportunities. there is an obvious need in

addressing the needs of the populations to several things. one of them has become the new buzzword, collaborative or integrated care. what that means simply is psychiatry needs to be embedded in the primary care system. there cannot be separate faces. -- places. they have to be embedded like journalists go to war. similarly, psychiatrists do not take on general medical care as a new part of their responsibility. primary care professionals need to be embedded in the clinics that are treating the spmi populations. that is a no-brainer. they have huge benefits. if we really want to get serious with this, and this is the next thing we will try to push congressman murphy on, is we need a public health initiative for mental health care.

just like you have hypertension screenings, diabetes screening, tb screenings. it will not be as easy. there needs to be mental health efforts that move out of clinical settings into the community whether it is primary care, the educational system, the work place. faith-based organizations that is where mental health care needs to move, also. it is a new frontier. this has historically been a stepchild of medicine. there are reasons for that. apart from those, it is something that the government has seen fit to need to step in and do something about. people with mental illness were

not taken care of in ordinary ways in which people had their help taking care of. the government had to step in. it largely has fallen to the state or local government. you do not have a state health system. you have a mental health statement. the federal government initiative came as the book of american psychosis brilliantly depicts the government effort to try to take on mental health care. it started with the community health act. we're struggling to recover from it. the recognition that mental health was somewhat different as some kind of special attention. that is still the case. in addition, our challenges are obvious. everybody is well aware of the fragmentation.

the tips of the iceberg of the neglect and the failed mental health policy are seen enumerably. it is the jails that are 30% or 40%. it is the cost of care that is driving up the percentage of gdp that is spent on health care. that is driven by this. we have opportunities here. these are not more of the same type of opportunities. we have a convergence of things that is going on. the truth be told, one of the reasons that people have stigmas is because stigma can be deconstructed to discrimination on one hand or mistrust and suspicion on the other. they have reasons to mistrust it. we did not have much to offer.

now we do. there are evidence-based treatments, the science of the brain is the new science. it has given mental health of a traction it never had before . combined with this is the legislative initiatives that are really being pushed forward. even though it does not perfect, the increase of social awareness. we have a real opportunity that historically has not occurred. as we move on, i think what will happen is that people who are involved in mental health care on the provider side, the policy side and even the stakeholder side need to put aside their parochial interests and realize that this is not competing for

market share. we are not competing until we get the largest portion and the other group does not. what is the optimal model of delivery here? what are the roles they should play in that? how do we configure it in the context of services that are distributed into different venues or settings? how do we finance that? what are the reimbursement fees? these are knowable things. we do not have to find a gene or have a break through drug to have a huge impact. this is the way it can be orchestrated. i am usually not rosy, theme -- pink glasses kind of guy. i am feeling even though the challenges are significant we have a historic opportunity.

no matter how much we know or how much we think we can do it will only work if we can really orchestrate the logical process in an effective way. thank you. >> thank you so much for your leadership. i've gotten a little wary of not having to turn on microphones for three years since i have been out of congress. excuse me for being a little rusty here. i really am honored to be here with you. i am so thrilled that you are amassing the kind of energy that needs to be placed in this area and to try to get the federal government to pay attention to how do we move forward effectively? i just want to say to all of you, i am honored to be here with all of you. i am a liberal democrat. mental health knows no partisanship.

my dad and i were the principal sponsors. in 2008, george w. bush signed into law and it cannot and do without many others. in this town today, we are polarized by ideology. this is one area where we can put our ideology aside and understand there will still be those with ideology on either side and that the large majority of us can work together to find common ground. i will use a metaphor to kind of explain what jeff has been trying to explain in his academic and medical lingo. he talked about the tip of the iceberg. we have the titanic. we are taking on water. now we are trying to think how do we avoid hitting the iceberg again?

we could build more life boats to care of all the people who will be displaced because of this disaster system we had in place. in other words, the answer to the persistently mental ill is not only to treat them but to prevent people from becoming severe and persistently mental ill. to liken it to diabetes. we are all about discussing how to conduct more amputations. as opposed to getting people the kind of primary care that will catch their being early candidates for diabetes and trading them aggressively early on so that they never have to develop the symptoms that necessitates such draconian responses.