[applause] >> next, bill clinton moderating discussion with young entrepreneurs and the health care industry. then a discussion on women in afghanistan. after that, former astronauts testify before a committee on the future of space travel. >> the clinton foundation held it mouth -- health matters conference. the opening panel on health innovation featured events in -- a capitalist that opened his own company, and a dropout that sounded a blood testing company. she is the youngest self-made

billionaire. this is just over an hour. mr. clinton: we have here a fascinating opening panel. i want to bring them out and talk about, not only the disruptions in a positive way that they have made in health care, why they do it and how they measure success in terms of people. so, let me first introduced the panelists. i would like to bring out elizabeth holmes, the founder of theranos. she dropped out of stanford to start this company, a blood analytical company that has more than 500 people employed and is valued at $9 billion. not bad work.

and, as you see, she is quite young. when i met her at henry kissinger's birthday party, with george scholz who was 92 years old, i thought anyone with that agent span has a bright future. since im closer to 92 than her age, it looked like a wise move. let's bring her out. give her a hand. [applause] joshua kushner is the cofounder of oscar health. he wants to do something really interesting, which is reinvent health insurance. and how people interact with other physical health systems. i cannot wait to hear about it. i had a highly unusual

conversational -- conversation with the chairman of a european health company who happened to be dutch. i asked him if they wrote health insurance, he said yes they do but they don't make any money on it. he said, we don't have health insurance here, we ride it, and the government subsidizes based on need. but he said, we shouldn't make money on this, we should make money on traditional insurance lines. i thought, i wonder if there is a single soul in america who would say that. interesting. this guy has some interesting ideas, let's bring out josh kushner. [applause] joe kaini is the founder of masimo corporation, that employs 3000 people worldwide. it is a startup.

it is the production and distribution of symmetry technology another noninvasive medical breakthrough. i most know joe through his commitment to build a coalition to eliminate preventable patient deaths entirely by the year 2020. he just had his annual conference not far from here in irvine. it is a fascinating struggle with so far, very good results. it is an amazing thing, it is interesting to know how we can do that. let's bring joe kiani out. [applause] and, the last panelist is jeffrey selberg who is at the

peterson center of health care. michael peterson, who is here, and his dad are great friends of mine and they have a worked for years to get americans to focus on the long-term consequences of sustainable debt and how we can bring debt, especially debt that we run up every year consuming down. so that we can invest in our future and secure it. after years of beating their heads against the wall, they look at the numbers of the federal budget and decided, all structural problems are in health care. that is combined with the aging of the population. they decided that they would try to be a part of the solution instead of just sitting on the

sidelines complaining. so they are developing a growing program of initiatives aimed to improve the health care system. let's bring jeffrey selberg out and thank the peterson center for what they are doing. [applause] let's begin with something elemental, why did you decide to do what you are doing in health care? let's ask the three reformers in the middle, what possessed you while you were a teenager to do this? elizabeth holmes: i had the

opportunity to think about what i can do in my life to make a difference. i thought the purpose of building a business is to make an impact on the world, we are here for that reason. to me, nothing matters more than the reality and our health care system today, which is that when someone you love gets really sick, by the time we find out about it, it is often too late to do something about it. and, in those moments nothing matters more. if i could spend my life trying to change that, we can make a difference in the world. and spending a lot of time thinking about that led to the relies nation that we live in a system in which people can only get a diagnostic test paid for by insurance once they are

systematic for a condition. so, the ability to create a preventative care infrastructure where people have access to the information that can change outcomes by making it incredibly inexpensive, by making it less invasive, could help realize change. that is where people would start getting access to actual health information at the time that it matters, that is what our life work is about. [applause] mr. clinton: what does it mean to reinvent health insurance? we thought we were doing good just to get 10 million more people health insurance last year. some people did. it is an interesting idea. explain what you mean when you reinvent health insurance.

joshua kushner: the vision for oscar came about when i opened my health insurance bill about three years ago, and i realized i had no idea what it meant. overeducated at the time was starting a business, i didn't know what my benefits were the doctors or hospitals i had access to, the list goes on. if you think about health insurance, in reality it is one of the most important relationships that we have, from both a human perspective and a cost perspective. the idea that we had when we set out was to use technology and data to make the experience more simple and transparent and understandable and relatable. but, what we have been able to accomplish is we have been able to take data and not only

provide a better consumer experience but also provide people better access to better care, primarily because we actually know a lot more about them. so, there is not been a ton of innovation within the first new health insurance companies in new york and 15 years. we feel grateful that we are going after the consumer market, because health insurance has been primarily sold from brokers to companies. for the first time ever, the consumer actually matters, so our mission is to create the best consumer product possible and do whatever we can to enable people to make educated decisions about their health. mr. clinton: you are marketing to the individual, in the individual market, which is about 9-10% of the total number of people with -- you could buy health insurance in this

country? most people are covered by bigger plans. joshua kushner: yes, today. but we didn't start the company because we got there was a void to be filled in the individual market, we started it because we felt that people deserved a consumer experience in health care. and health care, as we say often, health care insurance companies do everything they can to acquire customers, but afterwards, they do everything they can to -- them. we want to be proactive, give people access to care to give them things for free. it are paying people to go to the doctor, get shots, we are giving away free generic medicine, free physician visits, so being proactive is about -- what we are hoping to accomplish. mr. clinton: what percentage of your potential market knows you

exist? joshua kushner: right now we are only in new york. mr. clinton: even in new york, new york insurance is generally higher than the rest of the country and one thing that burns me up in the health care debate, everyone is saying that the government is lying about their policy, because it went away. because the health care law when it was passed, 80% of the policies in the individual market lasted two years. or less. so, i will be very interested to see how you modify the policies how you continue outreach. talk about that, because there is almost no understanding of who these people are and how they struggle to become insured. joshua kushner: sure, so right now about 10% of all those who are eligible for insurance, who signed up, are insured by oscar,

which is it decent market share for a new entrance. but the most interesting fact about us, which we have not disclose, which is that 40% of our members signed up for us because they heard about us through existing members. no pun intended, we claim to be the first ever -- role insurance company. [laughter] the best way to acquire customers is by having a really good product. that is what we have been spending all of our time and attention to a conflict. -- to accomplish. mr. clinton: joe, talk a little bit about how you moved from your core business into this audacious effort to try and eliminate every terminable death

-- preventable death in the health care system in america? why did he do it, how did you do it, why do you think you can do it? joe kiani: first of all since the topic is innovation for helping people, i want to congratulate you for your innovation. with this commitment based approach your last count has affected millions of people around the globe. i learned from that. i think in life, it is interesting to know why you do what you do. it is more important what you do and how you do it, because how you do it teaches others what to do in their own world. so, i have been around the medical space for about 20 years . i remember when the journal of

medicine reported 100,000 people were dying from preventable causes in the u.s. every year. i was shocked. a lot of good smart people jumped in and i thought, they will take care of it. i went on doing what i did making --. within a few years ago, new data came out showing that over 200,000 people were getting killed in hospitals from preventable causes. that is when i realized, maybe it is time i step up and do something about it. i have been fortunate enough to get to know companies in the medical technology space, great hospitals, amazing people like you, president clinton, and i thought if i brought everybody together, bring in the med tech companies, hospitals government, patient advocates

who provide powerful voices -- because if you think about 200,000 people dying every year it is a number that runs through your head, unfortunately. stalin said that one death is a tragedy, one million is a statistic. if you think about how that impacts a family once left behind, impacts you. we borrowed shamelessly, from the initiative, created this approach that if you will come to our meetings, you will make a commitment. from my background, we started on peeling the problem seeing what is causing these preventable deaths, from infection to medication errors, from lack of modern -- monitoring and we created solutions. these solutions, we asked the

hospitals to implement them, we asked med tech companies to share data to anyone, anyone who could use it, to come up with algorithms to predict it and unfortunately it has worked. i think we reported last summit the last two years we have gone from -- to 6000. maybe we can report next year 60,000 lives saved. mr. clinton: i will ask all innovators, before i come to jeffrey, is technology -- what role does it play in creating the health care system that we want? what, if any it economic imperatives actually block it from creating the system that we want?

of all the disrupted markets with noninvasive technology, if you have ever heard of a -- an insurance company giving medicine, all of this, how are we -- how will it all come out. how will you measure what you are trying to do and how much of it does depend your definition of success, depend on the whole system transforming itself? how much do you think about the health outcomes in america and how they are not as good as in other countries, but we spend more money. where is the end of this and where is the role of technology going to be? how do you think other people in your line of work, they say hey where is this going?

elizabeth holmes: we have only seen technology as a tool something to empower the individual because we believe strongly that the answer is to our health care, it lies in consumers and enabling people to take control over their own health and therefore their own outcomes. so what has been interesting to us about our model is we decided that we would start -- what we started our lab, 50% off of medicare reimbursement rates. increasingly, now at 90% off of the reimbursement rates. that is lowering medicare and medicaid reimbursement rates over time, by definition, based on the way that we are billing. technology can serve as a tool

for facilitating change in policy and for empowering the individual to then get better access to, in our case that i do -- the diagnostic space, 80% of decisions in health care are driven by laboratory data, so if you can facilitate that in a preventative contact -- context, you can change outcomes. we strongly believe that one of the things that this country is great at, is innovation and creativity and applying that toward helping solve issues, in this case, with our work without having to raise taxes, cut programs, to realize the same kind of changes. mr. clinton: i will come back to you. joe, you have made money and you have done a lot of good, would your medical device work -- one

of the things he said that some people in your line of work think that if they share information and we have confidence in medical records electronic medical records which is necessary to do to save lives and lower cost, how do you get other people to join? how come you think you can do this and still be successful if so many people don't, how do we break down the illusion that non-transparency is good economics, but disasters over the long run -- disastrous over the long run? joe kiani: with your help. with your help we started this movement. we have to think about at the

end, sooner rather than later, we will become either victims or recipients of a great health care system. that not only has amazing technology, doctors, nurses, but provides safety and quality care with dignity. i tried to reach out to the ceos of medical technology companies and say to them, 20 years from now after you retire how much would you have liked to have left this industry? because if we don't share data we cannot get to the superhighway where we can create predictive algorithms i can tell us where we are going. for example, if we are in a hospital and we are looking at vital signs data, that is helpful to predict where we are going, and a doctor could see it, but not everyone will see it . if we get data from electronic medical records, from x-rays from imaging from labs, smart

algorithms in the computer can predict it and we have 50 companies who have made the pledge so far. ge phillips, maximo, we need the rest. if we do not get everyone to agree to share data, there -- we are not asking for internal data, but we won't be able to get the things we're looking for. i made an analogy about -- men helping an elephant, we will not know what we are touching. mr. clinton: josh, this insurance model that you described to us, just as a normal person listening, from a naked business model point of view, it sounds like you are saying if i do this well, i can

ensure people for less money. that is what you are trying to do? so what we want to do is ensure for wellness -- insurer for wellness. since i'm a presumably -- since presumably the problems for medicare and medicaid and the federal health insurance program , if they follow your lead, if you can do this, that way you can be truly disruptive -- what do you need to happen beyond your control for your business model to have a good chance succeed -- to succeed? joshua kushner: i think it is about incentives. think there is a lot of things

we are doing that are very differentiated. to go back to the question you asked before, how does technology impact our businesses, or the industry, i am under the belief that you are -- if you are not a technology company in the next decade, you will not be a tent -- you will not be around in the next 10 years. everyone in the world needs to adapt or move on. there is so much that we can do for example, amazon and google know when a woman is pregnant almost immediately, based on what she is searching for. but a health insurance company does not know until the claim is paid three months after birth. so, you know, our ability -- [laughter] [applause] joshua kushner: our ability to

understand what is happening in the system in real-time and enables us to actually take something that is real, that we can't prevent giving away free medicine if they are sick they are sick. if we understand what is happening, we can point them in the right direction. our ambition is to work more intimately with systems and we are starting to have conversations around that. how can we work together? how can we enable you to work with customers in a way in which you are capable of doing, working together to make sure that we are providing the best consumer experience? and the best overall experience. i think in many ways, the insurance companies and hospitals are butting heads because incentives are not aligned, but hopefully that will change. mr. clinton: it is interesting you gave that example, because that is another version of what elizabeth said about early

intervention through technology not being insurable, because you do not know you are sick yet. both of you have different non-invasive technologies, that is what they do. so let me go -- jeffrey how these people are really amazing right? [applause] so, how do you propose, what would you do with what they know? in other words, how do we align the incentives and health-care system and government policy and all that said that their ideas can blame -- a bloom?

we have a system that has for a long time actually punished people who'd did what they were trying to do -- who did what they were trying to do. right now, we are almost in neutral, we do not have a pedal to the metal. we are creating a wellness system. jeffrey selberg: i want to share joe's gratitude to you, thank you for inspiring us. first thing. [applause] i say the second thing is, we believe going out and doing it is the best way. if we find ourselves in policy, inside the beltway, we will be there for a long time. it is one of the reasons why the institute of medicine says it

takes 17 years for these kinds of innovations to be fully realized. our thinking is what elizabeth is doing, she is out there doing it with walgreens and distribution. you go at it and you find a way to scale. right now, all three of these innovations i would call exemplary, they are very small. they have not scale. our idea is to get the exemplars to the community standard, from the 5% to 95%. one of the things we are doing is working with the center for clinical excellence research at stanford, we funded research and found tha primary care practices that they surveyed highest in terms of quality, lowest in terms of per capita cost, that was at 50%. they visited these exemplary practices and found 10

attributes, the essence of high-performance. our idea is that we need to find that and find ways to spread it and scale it. the advantage is you are limited to publishing, that is what we found with the lamp -- philanthropy, the spray and -- approach. we need to get out there, we need to mobilize, we need to work with all the stakeholders, especially patients to create the demand necessary to pull through this kind of high-performance. so, as we do that, as we collaborate, and i really hope that we do collaborate with all three of you, because you have wonderful things. and we find those areas thresholds after trying to scale it then we will circle back to the policies. the policy is important, but the know-how transfer is more important.

joshua kushner: just on that note, what we notice, when we first launched oscar we did some things that had never been done before. for example, one is we gave away telemedicine for free, 24/7. you could talk to your doctor in 10 minutes. if we could just understand what our customers need in real-time we could point them in the right place and it would make sense and save them money and save us money. at the time, people thought we were mad. now, a lot of insurance companies are starting to do it as well. our approach from the get-go when we submitted our first business plan, which was almost three years ago to our first investor, what if people copied you, he asked and we said, we

hope people do. if they do, it will make the system better. i think with what elizabeth is doing, a lot of people are getting inspired by the idea of working with health care. a lot of our peers engineers they want to work at the next social -- and i think a lot of people realize now, in addition to the idea of certain kanchan audis, we focus on this space as well. mr. clinton: how do you personally measure success? how do you keep score in a what you do? elizabeth holmes: for me it is about every single day, whose lives are better?

the first time i was able to be in one of our wellness centers what we called places where people give their sampled and exceed -- samples and see a woman who had taken a bus from 100 miles away to come in to phoenix, codes -- because she couldn't afford to do a test anywhere else. her deductibles or too high and she was pregnant and she needed to understand information about her body. when we were able to take care of her, watching that emotion and watching what that means in the context of one person whose life is better because of what we did, that is what we do a four. -- that is what we do it for. mr. clinton: that is what they said. you do not mind if you get competitors doing what you are doing.

you actually believe we could get rid of every death in the health system -- every preventable death in the health system by 2020. i told him a couple of days ago, he will actually get there in september of 2017, but anyway, so you basically said the same things. if you were dictator of health care in america and he could do 2-3 things, what do you think the most important things to do are? if you could change things based on your perspective, what would you do? spend more money, change laws, change incentives, what would you do with everything people do in health care? we would have to follow your

lead. elizabeth holmes: i would unequivocally make it clear that access to health information is a basic human right and i talked often about the fact that in california today i can buy a gun , i can shoot myself, but i can't order a pregnancy test. it is illegal, because somehow that information is too dangerous for me to handle, yet until we get to a point in which every person has a human right has the ability to get information about our own body, we will not change our health care system, because individual account ability can only start with understanding. i had the chance to do a lot of work in louisiana with some very sick communities, who are heavily obese. you hear people talk about folks

who are lazy, that it was not the case. they had no idea what to do to change their health. if you can empower people with information, educate you take the first step in being able to facilitate change. today, in our country, there are 26 date in which it is legal for a consumer to order lab tests. and all the rest of them, it is not. and to say that by law, an individual doesn't have access to the information is a symptom in our system. 80 million americans are prediabetic, 90% of them don't know it, and all you need is a glucose test to be able to tell you. [applause]

mr. clinton: and all conditions are reversible. elizabeth holmes: completely. mr. clinton: what changes would you make? joshua kushner: i would start over completely. [laughter] mr. clinton: good answer. joshua kushner: i think i would one, just enable people to understand their health and understand everything that they have access to. i find it amusing at times that child in africa with a smartphone has more access than you did at the turn-of-the-century and -- in the united states. i do not know how much it will cost me when i go into a doctor 's office and i don't know why i am going to that doctor. i think the consumer needs to understand why they go to one place versus the next, what they

have access to. it is a good place to start. there is a structural disadvantage to our system because the health care system is built on a b-b business. that doesn't put the consumer first, when you are selling to companies, you are not selling plants that are right for the consumer always. i know that there are a lot of people here, especially in the audience that are doing their best to change that. i think there needs to be a structural shift that is focusing on what the end consumer wants. mr. clinton: joe? joe kiani: i think innovation is the best medicine. i would create a general innovation office, before the president or congress has -- says anything, i would ask, how does that impact innovation?

whether it is new health care laws, how does it impact innovation, because we do not want to impede innovation. i look for getting rid of misaligned incentives. right now, there is a perverse incentive to make errors in hospitals. it is less now with the formidable care act, but if you go to your car a tuneup and you go pick it up next day and the car has caught on fire, they do not ask you to pay for the tuneup. they usually give you a new car. but if someone goes in for a tonsillectomy and got for bid one of those 10 things that could cause preventable death happens to them, the insurance company still gets built for that -- build -- billed for that. unless a hospital has created processes to prevent these, we are not going to pay when somebody gets harmed.

imagine for a moment what ceos would do, they would now make sure that all processes are in place, there are only 10 of them, to make sure that people do not get hurt. there are more misaligned incentives like group purchasing organizations getting paid by vendors to negotiate for the best product at the lowest price. they are getting paid a percentage by the vendors, so what do they do, they do not negotiate for best prices and best products. aligning these incentives and making sure that we do not lose the innovation edge that our country has, that the world relies upon. jeffrey selberg: i would empower communities. we have this technology now where we can wring information to people, they can engage in their own health process. we have an expert culture that is not giving up very easily. there is a sense -- this is a

just health care, this is across the ages, there is a buildup of vested interest i have the expertise i will take care of you. when in fact, we have the technology to bring this expertise on a decentralized basis. there is nothing more effective in terms of care, both from a quality and cost outcome then in active engaged patient who is surrounded by a family surrounded by in active engaged community. that is where i think we have to go. [applause] mr. clinton: i don't want to end this on a downer -- [laughter] i love this stuff. but i think it would be a mistake to conclude this without

recognizing that if all this was as easy as all of you highly intelligent, incredibly creative people make it sound, we would have done it already. so, talk to me about -- this will be good for everyone here talk to me about at least one frustration you have had in doing what you do, how you managed it and how to you, in your business, how would you recommend with us working with health care, what are we most likely to flub up and how should we deal with it? joe? joe kiani: you come up with a new smartphone and within six months everyone has it. you come up with technology that saves lives and reduce cost to

our health care system, it takes 17 years before it gets adopted. there is a problem with that and i think it stems from the third-party mentality, you know, a third-party taking care of you, either party paying for that care. a third-party negotiating for things at the hospital should use, that they should know what they want. the frustration is, how do you get rid of this 17 year cycle that, along the way, kills and hurts people. today, our technology, the first measure we invented, over 100 million people are being monitored with it, annually. at minimum, 3 million people are being impacted by it. we have another technology, like you said that by the way translates to a half $1 billion savings the u.s.. another technology that we

invented, it could save family and dollars a year. it increases blood transfusion dramatically. 90% reduction in blood transfusion, yet it will probably take 10 more years before it is adopted. what should we do about it? patient advocacy. mr. clinton: you are like the little engine that could. you are just pushing that rock up the hill. it has been a strategy in my life. the more you push the rock up the more you would like a different way. how can we -- what legal or institutional changes do we need to avoid, because it would be hard to get anybody in america to stand on this stage and say i am for this 17 year timeline, it is the best thing since white

bread -- sliced bread. it is a hard case to make. but we have lots of systems like that in america, not just health care, lots of things that no one would ever defend upfront but we all, every day shrug our shoulders and live it with such things. so, you want to go next? joshua kushner: yeah, i might get in trouble for saying this. i feel grateful that i have interacted with extremely nice people in the health care system but what hasn't been frustrating and motivating allowing us to bring on the best engineers in the world, is that there are people in this industry that are evil. they don't actually care about patient. there have been systems that we have interacted with that are so

ecstatic about the idea of a quirk in with us and creating a better experience for people who go to their hospitals, physician practices that realize they can still make a tremendous amount of money, maybe more by providing a better experience. and there are some that look at us and say, why would we ever change? we are making money and we don't care. so it is actually funny that we live in this idealistic, oscar is a great world, and we get excited when we have a meeting with one of these people because of fires me up for a couple of months, but at the same time it is frustrating that we are in a world in which we are providing a service to people where their health is the primary, the primary thing in their lives and people don't really care about them. as individuals, sometimes. so it is frustrating and motivating.

elizabeth holmes: i think it goes back to empowerment of the individual, the consumer, as a way to not have to do with sometimes the confusion that exists with some of these established entities, around something couple like, do you want to save money? sometimes these conversations we can come in and save you $80 million a year, that should be a very simple conversation especially when you are not asking for anything in return. but, the and -- the entrenchment is is so great that working through those systems, existing policies, in our mind is harder than empowering the consumer to create an infrastructure outside of that system, which by definition, will make that change because of the way that

you are empowering the individual to take ownership and because -- for example we started billing and published our prices. everyone knows how much a lab tests will cost them before they get a test, everything will time. that is making a shift in the system, by acting outside the system. we really believe in that, as a way to make change. we try to spend most of our time focusing on ways in which through individual engagement we can facilitate that change as opposed to trying to convince the existence -- the existing system to change, because that could take a really long time. joe kiani: my biggest frustration is data. jeffrey selberg: health care is so opaque in terms of performance. if i have -- the stuff i would

like to see us do is make it open source. all of it. [applause] and the idea that it is proprietary, there are other ways to compete. if you go into a grocery store, there are no prizes, you go to the cashier and they tell you the bill, that is how health care is. so, what elizabeth is doing is groundbreaking. with data, i think we can shine a light continually on best performance and consumers can see what best performance is and so can providers. the primary care and samplers that were identified, i didn't know they were exemplars. i think data is the biggest frustration and that is where i would go. mr. clinton: i want to tell you why i asked you his question. i spent most of my life trying to change things, i was always

making so many mad. 40 years in public life, but i found that the resistance to change that was self evidently good like in just the examples you cited, was often rooted in naked self interest. that is what you talked about. but also, the comfort of the way things are. people -- a lot of people do not want to think about doing things in a different way and it is -- and society is an enormous. it is staggering, the idea of change people's boxes with which we have arranged peoples reality, that is the problem. and the other problem i found this, if you want to make a

change that will make things better, but has more moving parts than the way things are that is hard. i will give you the best example, with energy. if you want to build a cool -- coal-fired plant and you want to accelerate climate change, you have to go to a contractor to provide the cole, a government agency at the state level to approve the building of the plant and you are off to the races and someone else does the rest of the work. if you want to create just as much energy and a less expensive way, by having building retrofits, a lot more moving parts. it will cost you less money save the environment for our children, and create a lot more jobs -- i have spent a long time working with my foundation, and

these electronic places, it should be 100% clean energy, but if they buy oil from one person and somebody gets it and the appropriate medical people get contributions and you have old-fashioned generators, there you go, you are contributing to climate change, bankrupting the country and it would be a lot cheaper to be unclean energy. what a way to market a --, but it is hard to do because of moving parts. we are coming to the end of this program and it doesn't matter what the policy is, if we get rid of the 17 year time delay that is the reason we need people like you. we need innovators. because rates will always be

more attuned to the comfort of the -- because brains will always be more attuned to the comfort of the president then the innovation of the future. one reason i admire trevor, the health care giant, and he gets up and he is still the little, i have known him a long time, he is the little reformer, he was as a young person and he tries to take away that and push the thing in the right direction. a lot of people don't do that. we will always be the disruptive innovators, we need you. so, that is off-topic, but it is true. i want to thank you for what you have done and urge you to get going. no matter what you achieve, you will always need somebody to disrupt what is going on.

and i thank you for it. [applause] mr. clinton: we have about 10 more minutes, people here are involved in health care across the country, a lot of them like me want to see the east coast again. [laughter] go figure. so, i want to give you a chance to close out in a totally different way. i want you to, the innovators, to ask them to do something. if you could get everybody who came here committed to developing a wellness model of health care, community by community, what would you ask them to do?

go in any order you want. joe kiani: i think data is critical, but i think action is king. and i think action is inspired by love, so if we start loving other people's children, the way we love our own, all of a sudden these incentives, these issues, they step out of the way. i hate to sound like the beatles or whoever, but just give more love to the world. [applause] joshua kushner: my would -- elizabeth holmes: my wish would be for everyone to take a minute and think about what it means to

be -- for health to be a basic human right. we have a right, everything a person we love has, the right to change what we know in this world today around having to say goodbye to soon. if we start to see access to our own health information as our own human right, then we will start to engage with it and we will start to become more interested and look through a different lens that understanding it, using it to change our lives. we should not live in a world in which we know more about our credit card data than we do about what the cell blood count on our lab report means. that starts with recognizing that we have this right, the right to the health and well-being for those we love for ourselves, that is a practical human right. and when we know that, we will

begin to change our system. [applause] joshua kushner: very much in line with what elizabeth stated, i think what i would ask, while you develop your businesses, you do not always think about your business more than a product that you want for yourself. we want to create the health insurer that would be excited and get the access that we would want for ourselves. i think that that sets the bar at a much higher level so i think that is it. [applause] jeffrey selberg: i had a mentor when he would hear me talking about these virtues and big james, he would say, so jeff,

what will you do on tuesday? i will ask the same question you all have dreams and passions, it is time to execute. what will you do on tuesday with that vision? [applause] mr. clinton: well, i will do something off the books. would anybody here like to ask any of them a question? then i will ask, how -- do you have plans to go beyond the end -- individual market and how do you get traditional insurance companies to adopt some of your changes? when will you have enough data to prove that what you are doing works, because it is not like -- there are some insurance

companies that are trying to promote wellness and they really do recognize that they can keep rate down, now that there is no cost that they have to eat, or there is less, anyway -- have you think we can move from where there is a 10% of individual insured americans to the other 90%? joshua kushner: we are expanding to other states, california and texas and we will also expand into the group market at some not our top priority right now. we do not start the company because we wanted to provide insurance to individuals, we wanted to make a better type of insurance for everyone. that will definitely happen at some point. in terms of data on what we are

doing, there has been a tremendous amount of data in terms of engagement. which we have shared publicly, which is 90% of people have asked us to do health risk assessment. we have a large amount of users speaking to us through telemedicine. our mlrs for the health insurance nerds in the room, pretty much went above the lowest in the state on the individual market. we are one of the only insurers that opt to drop prices after the initial year. we are actively doing our best to introduce new products, see if they succeed or fail, and

iterate and hopefully drive our costs forwarded to reach as many people as possible. while we have had tremendous success, we will introduce things over the next years that do not work. i think if we don't, that will mean that we are not trying to innovate enough. in terms of working with other insurers and hospital systems we are already starting to have this conversation. we are tried to get our products to as many people as possible. bill clinton: i think it is important to do a report about what works and what doesn't work. everybody will start following this. there is enough action in the insurance business that everyone will start looking at this. it is very interesting at joe's conference on preventable death, there was a lot of talk about how troubling it is when people

do not have access for their own records. and how we could store them securely and make them available to individuals and to their designated providers, people they approve it to. it is a huge issue, is the next big thing. the government made an effort last year, almost a year ago to publish the first comparative data on medicare and medicaid. there is a lot that they didn't have. in terms of what the results were in the different health-care providers. pennsylvania is the only state for at least was the first state, to start regularly reporting the impact of -- what did things cost, and the results

throughout the commonwealth of pennsylvania. every year, they found that there is no connection between price and quality. the only connection with quality is how many times you do it, whatever it is. we are almost in the stone age in real access to data and empowerment. it is the one thing i have heard, in different ways, from all of you today. that is maybe a message we ought to send out there that it only hurts for a little while when you practice transparency. pretty soon, you can't believe you didn't do it. you are stunned at how long it took to get around to it. everywhere i work in the world where things are transparent they are working well. and where they are not, it is not so hot. i went back to indonesia last

year, 10 years after the tsunami. unrecognizable. it was the first global disaster, that i believe was ever conducted with virtually 100% transparency. where did the money come from, where did it go, who got it, what did they do with it? you can get it all on the internet, from start to finish. everything should be done like that. it is an unrecognizable place now. that is the sort of thing -- i got that from all of you in different ways, but if you really want a patient citizen centered health system, you have to be able to get the information. jeff: one of the first things we did is make it ownership with the kaiser foundation to make a peterson kaiser health system tractorker on the web.

the numerator is, what are we getting from that? it is primitive right now in terms of what we are getting our comparative data, mortality by condition compared to other high income countries, but over time, when we hope others will join with us, we want to find those system measures that are really meaningful. my thinking is that is his nose adage that you don't manage what you don't measure. we need to get that, not only at eight macro level, but a micro level for each patient as well. joe: what is the internet would be like if people do not show data or interoperability --we have all of these disconnected products out there. there are so many stories of someone going to a doctor's

office thinking that they have a stomach flu. they go to the emergency room is still thinking they have a stomach flu, but their white blood cell counts are really high, heart rate was very high, and the clinicians did not connect the dots. can you imagine if all of this equipment would feed into somewhere where someone could create algorithms to see the pattern? you could save so many lives. all of us could benefit. wwhether some kid in palo alto comes up with the best algorithm, or someone like ge does it, it doesn't matter, it will save so many lives. and the rest of the industry will benefit from it. bill clinton: thank you. we have to wrap this session up. i want to propose, the governor kentucky has come here, and he is a great friend of mine. we are the only two governors on election day in november who had approval ratings of 70% of more.

and the voters of voted against everything that they did. [applause] [laughter] but they love them for it. is no one understands how the health system works, health care economics policy. and you ought to get have them talk about it. it will encourage you to accelerate what they are suggesting. the only way you can ever get the level of knowledge of the health-care system to the general citizenry is to empower them to do something they can understand, which is there health and family's health. what they are paying for, how they are going to get it, and how they are going to do it. i think you guys are great. we have an impact announcement. please get our panelist a hand. [applause] >> next, a discussion about

women in afghanistan with rula ghani:. ./ then, buzz aldrin testifies on the future of space travel. than the president of iran addressing the nuclear agreement. on the next washington journal politico's representative talks about wall street numbers. and daniel raymond of the harm reduction coalition talks about efforts by some states to start needle exchange programs to fight outbreaks of hiv and hepatitis c. and we will take your calls and you can join the conversation on facebook and twitter. washington journal, life at 7:00 a.m. eastern on c-span. here are some of our featured programs for this holiday weekend on the c-span network.

on c-span, saturday at 8 p.m. eastern, texas state senator and gubernatorial candidate wendy davis on the challenges facing women in politics. and then golfing legend jack nicholas receives the congressional gold medal for his contributions to the game and community service. on c-span twos books tv, saturday night at 10 a content eastern, on afterwards, activist and author were no west on the -- cornell west on the radical and political thinking of martin luther king jr.. and our conversation with investigative reporter for the washington post robert kessler. he has written many books. and on american history tv on c-span3, saturday at 8 p.m. eastern, east carolina university professor emeritus charles calhoun on the optical

faced and a compliment made by ulysses s grant during his presidency. and sunday afternoon at 6:00, historian hetrick schroeder takes us on a tour of the courthouse in virginia, the site of a confederate surrender on april 9, 1865. rula ghani: is the first lady of again a stamp. her husband assumed the presidency in 2014. she recently shared her views on women in afghanistan humanitarian aid and prospects of peace for country. this is one hour.