this one in six that are food insecure, hunger and obesity coexist in the same community and same person. i was on a panel last year in these the, and the gentleman who runs the largest food offered in the united states, he had this slide. he said this is something that california -- exhibit a about

what we're talking about. this is a field of lettuce. the interesting thing is this is after the harvest. what is appears about to get filed under. why would be plowed? what happens is they go out and measure when the average head of lettuce is the exact right size. why? most romaine lettuce is grown for a bag. you go to the store, to trader joe's or whole foods, and if you notice, the top is intact. as a result, nature does not grow things perfectly. some are short, some are tall. the only thing wrong with the food is it is too small or too large. that is it. the other thing you may know --

emily and her team did a wonderful job. they put out a report on the challenges we face on display codes being mistaken as expiration dates. settled by -- "sell by," and "best by," are confused. you know what the code is for honey? forever. this says best by october 2015. there are americans that would throw this out, not put their

kids at risk, not use expired honey. this is the example. a truck with 7000 pounds of mingles, they were almost ri pe that was the problem. almost ready-to-eat. this is what we are talking about. the table is designed around tackling a part of the market that i saw two banks weren't tackling. this came out of harvard research and talking to the ceo of feeding america and discovering one of the key issues is this one right here. to me, it is dollars not

distance. it is affordable nutrition, not food deserts. you can put a trader joe's, a walmart, target, whatever you want on every corner of america and as many as one in six cannot afford to buy produce, dairy, or protein. it is not so much accessibility but affordability. other one is this one here. 30% of our clients that are eligible for our services won't use them. why won't they use them? dignity. allies presented -- a large percentage of the population particularly the economic lower strata, they don't want a handout. they don't want to feel that they are being held up.

they want the feeling of providing for their family. the dignity issue is a really big one. i was trying to think of if we are to come up with a sustainable solution as a society to feed 49 million americans on an ongoing basis and we will give them affordable nutrition, that we have a problem. the entire food system is designed around cheap calories -- start with high for just conserve, and everything else. it is tough to find ways to have a sustainable system that is designed around affordable nutrition. designing around the idea of recovering some wasted food -- by the way, i actually think that we would do ourselves a favor, by never using the word " food waste" again. food is a modifier of what kind

of wasted is. waste is something that the sanitation department is designed to handle, and they do a good job at it. if you take the two words and flip them, nobody thinks it is a good idea to waste more food. we're talking about wasted food. food that is excess. mingles that almost ripe, let us that is the wrong size, food that is at itself by day, but have another week or two weeks or more. daily table is about going around and offering for pennies on the dollar. the reason we are selling it is twofold. customers have told us they want to shop. they want to be able to buy this, they don't want a handout. if you are selling something i don't care how cheap it is. it could be bundles of kale for

$.10, chicken soup for $.99. it's ok, but we are buying, it's a treasure hunt. second is that cornell had a bunch of research that said if you can choose something, you will use it. the idea is at retail, can we know nudge people to try things and eat a diet, moving them towards a healthier outcome. the third is this issue of no time. economically challenged -- when you are poor, you are not just for economically, you are short of time. all of america suffers from shortage of time. virtually, that is why more meals i.e. outside of the house been in.

as you moved on the economic pyramid, it is tougher, tougher, and tougher. in the focus groups i have done in inner cities, and neighborhood meetings, these issues come up over and over again -- we don't have time. when you're getting off the bus at 6:00 or 6:30 at night, the kids are tired, and hungry, i can't go and pick up stuff to cook, i'm expected to walk through that door with dinner ready. it changes the model from a grocery store to competing with fast food, competing with robin go meals -- grab and go meals. you can't eat there, and the reason is because we want you to you with your family, at home. there's a lot of research on that.

so, this 1, 70 5%. that is the percentage of executive directors time that is spent in fundraising and america . if you are a nonprofit fundraising is the only way. to me, i didn't want to build a model that had so much energy and time raising funds for a mission, no matter how pure that mission was. i would say, in all honesty there is not a food recovery, or hunger relief agency that i know of, that does not have a phenomenal mission. the challenge for each of them is funding. the idea at the daily table is if i can find some way in which we can get revenue instead of for delivery of mission, then in some way, i'm not competing with the dollars that are out there and those out there don't have to look at me as competing and

taking money out of the charitable pool that is already out there. it also allows me to do scalable work. the daily table to a partnership -- did partnership, it opens april 14. it will have a teach-in kitchen, a retail floor, a lot of kitchen space. this is where we have children after school. this is a picture, by the way, this is not daily table. we already have a number of schools lined up and find out for bringing kids after school for free to learn about nutrition and education, and feed them at the same time. the last photo for me -- i think all of us were gathered here because the really big picture is that we go it -- food is a

precious resource. whether you look at from the environmental standpoint, what happens to wasted food and gas or the human side, and we know it's right kids and grandkids that we are utilizing this precious resource so that everyone, every kid in america ought to get an opportunity to be the best, glee -- neurologically develop and have access to affordable nutrition. [applause]

ms. leib: this is important. we are getting food from farms and farmers markets to people in need in many different ways. some of it for free, some of it for people who are able to purchase the in a way that provides an dignity, but there are a lot of laws that actually get in the way of that. i will skip this because i want to explain what we do a little bit. producing options for food recovery is one of our key areas. i think to start here, a lot of those people think, what is the role of law in the state? there's actually a lot of impact that our laws and legal system have on the attempts to reduce food ways, and improve options for food recovery to get them to people in need. part of this is across all of

our food systems. we have been doing business as usual for so long, and treating our food as this cheap thing, as doug talked about, our food america in america and cost less than in any country at any time. because it is cheap, we throw it away, we don't think about people who don't have it. we don't make great decisions. this is just one area of that context where i think our legal system has developed in not forcing people to make better choices, and in fact not allowing people like daughters sasha who have creative ideas to use those creative ideas. as one example, current laws restrict opportunities to innovate. i will talk about a few examples of exact policies, but this is something we have been working on. how can we encourage more dogs and saucers to be out there being innovative, and making that possible to say, it is great when food makes its way to

food banks, but there's still a lot of food getting lost around the edges, being wasted, and not used in ways that are sustainable. our laws failed to incentivize the reduction of food waste. there are some incentives, but we don't say to people, if you reduce your foodways, if you get it to people who need it it spend that extra little bit of time to make sure that food gets to the right place, or get someone to your farm to claim it, we're not giving people enough rewards to make it possible or easy. our laws fail to penalize people making healthy choices. we are throwing away this very valuable resource that we spentd a lot of water, oil, pesticides to create, and any third away. laws can also help to scale up

successful experiments. if we find something that really works, we can create a policy system that makes that possible. that is all ways that affects the system. i want to hopefully give you a sense of how, as people interested in this topic, you can advocate for things that would make this more possible. i would like to start with this picture. this upside down pyramid which is created by the epa. it is meant to give us a sense of how best to use our food resources. i think it is really important -- everybody knows that l landfills are at the bottom. as we think about how we can put in place policies, that we stand these top levels. i think both people mention this, we don't want more

foodways. even if it is really great food that sasha is picking up, or the lettuce that doug mentioned, we don't want more of this. the first thing we should do is reduce at the top and recognize this is a valuable resource, and be more thoughtful about what we are producing. if we are not doing that, we want to feed hungry people because people -- their summary people in need. beyond that, feeding animals and so on. i think a lot of the laws we have in place now are not thinking about this. they're not remembering that we want to start at the top of the spirit and work our way down. let's start with our work on date labels, which doug mentioned. he said, we want to sometimes be able to use food that is close to or at it states, but the laws

will not let us do this. he said, why would the law not allow that? what is going on with those dates? what do they actually mean? we embarked on several years of research about as to this report. i will tell you little bit about what he found. every group that looks at the labels as a driver of waste say that date lev labels are causing waste. this is a challenge that we took on, and is a great project for legal clinic because it looks at laws. let me to you about the findings. date labels are undefined in law and they're just a suggestion by manufacturers of when food is that it's peak quality. for those of you who have thrown food away, i will not ask you to raise hands, because i think most hands will go away, but if you ever through food away because you -- threw foods away

because he thought a person would get sick if they were to either, that is absolutely wrong. if companies do any testing at all, it is just taste testing. it will have people need food after one day, two days, and so on and they will find a date when people say, it does not taste as good as it did yesterday. to be overly protective, they will set the day a few days before that's a to make up for shipping, storage, etc.. some companies do not do any testing, they just pick a day and put it on there. there is no enforcement behind that. it is funny to be at a conference thinking about this. there's this frame being put on all of our food that we are all following and throwing a foot away at that date, instead of actually thinking about it and say, the date past, but the food

tastes fine. for honey, vinegar, bottled water, they have dates on them but nothing happens to them. bottled water will always be water. there is no federal standard for expiration dates. that ties into the first point about dates not being defined in law. there is no federal law that defines them or requires them to be created in a certain way. in fact, the fda has chosen to not regulate dates because they say, and these don't have to do a safety. therefore, they are not within our mandate. this is really important. the next thing we found, which is quite interesting, is that the federal government doesn't regulate. states have stepped in and regulated. this was a big piece of our research, looking at what states require in regards to date labels. many states, 41 states require

that at least certain foods t have a food label. again, this has nothing to do with food safety. a further that consumers got from the farm, consumers said they wanted an indicator. states took up that charge and put together all these regulations. what is most in just this is the state regulations are totally different from one another in terms of what they require. the second map shows 20 states including massachusetts which actually restrict the sale or donation of those foods after that date. let's think about that for a moment. we said that the dates have nothing to do with safety -- someone is very angry about this, i am also angry. we just said that these states have nothing to do with safety then you have states like massachusetts saying, we will require states on all foods that

are perishable or semi-perishable, any food that would go bad within 90 days is required to have a date. other foods can have dates if they want to, then we will make it very difficult for you to sell or donate that food after the date. the food is winding up in the trash. it is helpful to think about what these differences are. i will give you the example of milk. some states require that and state level -- milk has a date label, some amount of days after pasteurization. the dates are really linked to science or safety. massachusetts has some of the strictest requirements for dates .

by koch of, new york, the state of new york which has the earth city, a very big city, doesn't require dates on any food. new york city used to require date labels on milk, and the government of that into is a 10 because they said this doesn't make any sense, it is not linked to safety, it does not make anyone safer and our state of avenue requirements, they eliminated it. this is really important to keep in mind. obviously, the foods with expiration dates on them are often packaged foods and processed foods, but also the foods that we took the most energy to create. we put them in a package, we spent refrigeration energy to hold them in the store, and then we're just going to throw them away because the stat dates are unclear. this is a study from industry which shows no matter what the label is, whether it is "use by ," "enjoy before," which is one

that doug and i have l left that before, 90% of consumers throw food away after the date. this is really impacting the way consumers use food. this gets to where policy comes into this. we have said, the federal government does not regulate states do, and not based on science. they did not require the label to be something specific. they do not require that there be any method behind the setting of the dates. they are just saying they want all foods to have dates on them. what you end up with is very confuse consumers. they are either restricted from giving it, or do not give it away because they are concerned with keeping people safe. what we are having him for is a

label that makes sense so that we can avoid the amount of food we are wasting. preliminary focus groups that we conducted at johns hopkins, we found that a term that says "freshest before" is the one that makes sense. some of these other days, people get confused. "freshest before" makes sense to people that it is about quality and that is it still tasted fine and smelled fight after that day, you can still eat it, it was a choice. you don't have to fear that you are your family will get the. we also think that for the small, 1% of the food supply where there might be some risk, and these are foods like deli meats that could be previously contaminated, and because we don't cook them, they could increase the amount of listeria

contamination if they are previously contaminated, we are telling people about those risks either. those could have a separate label. the fda knows what those foods are, let's tell people what they are. once we put a label on it that makes sense, what we educate people, then we don't have to worry as much, we don't have to have all these people concerned. i want to think about one other -- these are two areas where the law is really important, by want of the about one thing that ties into our discussion and is really timely. going back to this hierarchy. i think expiration dates really impact production because it means we are throwing away less food before he gets to people, but also impacts getting food to people in need and feeding

hungry people. the other way impacts is in terms of the protections for food donors and the incentives for food donors. this is a new area that we have been working on. we talk a lot about this, how may people i need. if we reduce related -- redistributed 30 percent of food that is wasted, a good fit it could feed all americans. yet, only 10% of food is recovered in the u.s. this is for a lot of reasons. it is about liability concerns which i circled theirrw. companies want to do business and they want to do business as usual, and they don't want to give food to someone with the fear of being sued. this is huge. we have food

protections in place, but they could actually be broader and protect people more. other big issue is cost. this came up a little bit. let's say there is a farmer that is on the last field of beans, as fossett talked about, and it doesn't make sense for them cost wise to send their labor is out to get those beans to market. this is an area that we have worked on a round tax incentives. at the federal level, there is a tax incentive that would pay a food donor for donating that food. the problem is this incentive right now is limited to only the biggest corporations. for many years, it was expanded and open to anyone, so farmers, who are generally not they corporations -- small mom-and-pop restaurants could get this incentive. that has expired. there is an attempt to get that

incentive back out there. it comes up a lot. i think of it a lot in the context of farmers. farmers often, especially small farmers, are working at such profit margins that any extra profit they get will help them keep growing food. it is often getting wasted in the field for reasons that we heard, not good reasons, not linked to safety or even expiration dates. it is really the economics are getting of the people in need. that is what issue that only corporations right now are eligible for, this tax reduction. the other big issue, going back to the point of making some of these food recovery effort sustainable, a lot of people have good ideas right now about how they can get a revenue stream, and are people who are willing to pay money for this

food, or process them into something that people would buy, but right now, the tax incentive goes away if any money is exchanged. i think this is an old-fashioned way of looking at food waste and food recovery, thinking that everything has to go through a big food bank, when in fact there are opportunities for innovation, new models that we could be encouraging and allowing if we said, we want to get this rude to people in need and we went to devise new people coming to the table, new businesses and farmers trying out new levels. several states have state-level tax incentives, but i think we could do a lot at the federal level. the other areas around liability protections. i think the biggest issue here is that we have some great routes, and yet every corporation that is not donating food says it is because of their liability concern. we have a awareness problem, and

an education problem that not only can they donate as consumers don't want to shop at companies where they are throwing away all their food. i think there's a lot that we can do there. this is new work for us, we are working to better understand the barriers, and align the policies so that we can try to figure out how to get to a better future where we are not wasting 33 percent-40% of the food that we produce in the u.s. with that, i'm excited to have a conversation and your russian. [applause] ms. balkus: as people get out, i will ask the first question. in a timely way, our keynote speaker said something to the

effect that i'm paraphrasing -- poor people don't want your food waste. it was very timely because this was actually my first question anyway, but she really gave us a punchy sound bite for it which is that there is this pushback about -- if recovering food that wealthy people waste distribute to local communities, is that insulting to those communities? i would love to hear feedback on that statement. ms. purpura: i will start. food for free was fascinating when i started. i learned that a large part of our staff are recipients of the emergency food system.

basically, people want to work all day to take the food home. food for free is not wealthy people giving anybody the food waste. it is people in the community saying hey, look at this insane thing going on, what is that going in the trash when our community could use it? they are stepping up and collecting that food, and eating that food, and sharing of food with others in the community that those in need get it. i think, for food for free there's nothing about outsiders giving poor people food waste. it is people in a community making a sensible decision and saying, look at that, i will get it, i will use it if i need it and i will share with my neighbors. my husband wasn't rich, the farmers are, the folks at whole

foods giving us the food are not rich. this is a community of people working together to solve a problem, and at least in my experience it has been a real community building event. this issue has not come up which is great to see. mr. rauch: i have a slightly different take. not one contrary, but having perhaps the development which is in my work, going down into working in the bronx, new york. first of all, i absolutely resonate with the statement. i think it is fair to say that if you go out and asked someone if they want food waste, the answer is no. if you ask people, we are going

to go get some stuff out of the trash, would you like it? the answer is no, of course not. if you're going to say, there is some perfectly healthy good food here, that is going to go to waste, that was mingles almost ripe, would you like a mangled it is almost ripe? yes, i would like a mango that is almostr ripe. we feel that we don't want to get and be treated like second-class citizens. it's an issue of dignity and feeling that we have a right to something more than that. that is why at daily table -- maslow's that if you are a hammer, the world is a nail. retail is a solution for everything. one of the things about retail that i like is when i'm down

there and i say talk about affordable nutrition. we understand that we are having a hard time struggling. you have discussions with groups twice the size of this group, and they ask you some really top questions because they are struggling. what is affordable to you might not be affordable to me. who defines affordable? here is the nice thing about affordable -- about retail. if i sell you something, it you tell me what is affordable. you will choose what you want. you will choose it if it is tasty, is a convenient, whether price right, doesn't seem safe, doesn't look nice? that is the other thing, we don't want a store that looks like it is second rate. we want a first rate looking store.

and does not look like it is a solid operation. that is not what we want. i think there is some truth to the fact that if you just simply frame it up, it's like, you've heard the story, how may people are in favor of obamacare? as soon as you call it that -- and how may people like affordable care act? affordable care act, yeah, i like that. poor people, do they want food waste, no. do they want access to affordable nutrition? absolutely. do they think food is a resource that should not be wasted? absolutely. i think a lot of it is how we frame it, how we presented, and it is truly as sasha said, about

the community recognizing it is a story of us, not them. to the degree that i am perceived as an outsider coming in to solve the problem, it is not embraced. to the degree that we are empowering and creating, it is embrace. ms. leib: who do you think is impacted by our agricultural system? who is most negatively impacted by pesticide runoff, fertilizer runoff, climate change, all of these sort of negative environmental impacts? people who are poor and in less well resourced communities here to the extent that we are not eating 40% of our food, we're putting all of these costs on to the communities to that just

throw the food away. i think the food justice component starts all the way back there, before the food even finds a home at the ends. the more we can tighten the system up, and make sure that after we and these resources to grow that food, somebody will get the unit. that is so important. on the other side, looking at some of the things that we talked about, and we said, yes food in america is very c cheap, but there's still some cost to all the food that we throw away. at the retail level, the stores to that some amount of food will always be wasted. at that of the night the store feels like they still need piles of medicine apples and whatnot. they have to factor that into their model and charge more because of that. there are all sorts of ways that no matter who ends up with the food, we are benefiting and we benefit everybody by making sure the system does not have that many externalities, that food

costs what it is supposed to cost. what is so interesting in having worked with doug, so many people want to shop at the daily table. it is meant to serve this community, but there's so many people who say, i want to buy that food because i also want a more sustainable food system. it is not food that not everyone wants, it is great to get it to people who are in need of it, and the fact that many people are interested in buying it and eating it. the more we can put in place things where people are able to access back, to show that this is good, healthy food is really important. >>.com and this is a question for you. the daily table sounds like an excellent idea. i'm curious as to a couple of things during what is what percent of your cost you anticipate covering by the retail revenue in the first few years? or, how will your revenue model work?

also, since it seems like it is a mission german organization, are you planning to hold the organization accountable for specific health outcomes of the population you are serving? beyond the numbers of pounds are served, or people that come through. mr. rauch: for those of you at harvard, i learned all about the logic chain, and all that stuff. first and foremost, very few companies, and certainly not the size of the daily table, can afford to do the thorough social impact sort of stuff. that is extremely difficult. even outcomes are tough when you talk about one factor in an ocean of factors. at daily table, if we are able to get customers regularly eat dinner, nudging them, and

helping them, but it is difficult. in the focus groups that we did we were told to things. one, who can shop your? -- shop here? the question was who can you shop p or? and someone said, i don't want to be seen by my neighbors. interestingly, our model was really designed around trying to be a trojan horse for health outcomes as retail. meet them where they needed to be met. and, that they did not want --

they said, i do not want this to be a program store. i was originally thinking that on edited we can have someone to come appear and measure your bmi, take cholesterol, kind of like the health clinic store -- it was like, no way, if you do that, i'm not coming. i don't want to be reminded of my problems when i come in here. don't talk to me about illness morbidity issues obesity, that the food is killing me. if you do that, i'm not coming. instead, talk to me about my kids are going to do their best and feel their best. i have come up with two lame marketing things. one is that we create food to die for, not die from. and, we are creating food that moves you forward, doesn't hold you back. don't talk about nutrition -- the andn word.

someone said, don't use the n word, and i thought, did someone use that word? yet, nutrition. it is such a learning to me, what the sensitivities were in this particular population. in this community, where we're going in, that community had a real sensitivity to who would shop there and not feeling like part of the program. as it turns out, it is a membership store, and if you are not in zip codes that are economically challenged, you can't shop with us. anyone in those zip codes, and they include areas that have million-dollar homes. are plenty people who are economically middle-class or higher, but the majority of the population by far is our target

audience. because we are going to have free membership, we will be able to track. it is kind of a backdoor, but the idea is this is how we are able to provide this service to the community, just give us a zip code that you live or work in, and a phone number, you don't need a membership card. now, we will be able to know how may times you come, what you buy, and we will be able to come back and follow-up with harvard. ideally, economically we will break even. it is a nonprofit. our intention and mission is not to make money. our intention and mission is to deliver affordable food. i hope we do not have to do much fundraising, other than the initial brick-and-mortar. i hope he gets up and running and we are able to recover costs

that are close to what they are. we want to pay people well, give the benefits. we are paying at or higher than what is competitive in the marketplace. you can either get a job at kfc across the street, guess what, you can work for us and get better benefit. we haven't opened yet. when we open and rubber hits the road, it will be interesting to see if it works. >> thanks. >> my question is for emily. i just wanted to mention very briefly, i moved to london a couple of years ago, and i remember the first time i went to the market, i was looking for an exit. i was looking in the refrigerator section, and i couldn't find them. i said, where are the eggs? they said, they are over there on the shelf. it blew my mind because for me,

eggs are refrigerated, and that is required. over there, they don't refrigerate their eggs. my question is when you have these findings about the meetings behind -- me anings behind the date, is anyone working to spread the news about that? is there anything we can do to help? ms. leib: great question. thank you. what was so interesting -- our report, when we came out we are at a law school, very focused on law and policies, we wrote this great report that went through all these things, and we said, here is the policy change. it got a lot of press. there was a lot of news coverage, it was great. all of the news coverage is about the consumer, how to whip up food. the problem with a one-time thing about that is that it does

not change things over time. it is not like every year, we can have more news reminding people about that. one of the biggest challenges with our current system -- i will even, the system because it is not well thought out -- it is impossible to do consumer awareness because all the dates say different things, and they may look different in different states. there is no education that we can put out a message on a federal level. that is one of the benefits if we change the policy to have one standard label. then, we can say to everyone, americans, here is this label, here is what it means. if you see another label this is what it means and what you should do. you can see when the usda -- i think the usda has the best guidance on labels which

is, if your food expires on this day, and it is refrigerated, it should be good. that helps people, but it has been hard to do consumer awareness. that is why we are working on legislation. we were approached by some congressmen and representatives asking, what can we do, we want to change this? we went to try to reframe -- want to try to reframe this message and make it about policy so that it is win-win for everyone. we are working on a small film right now. we're excited to do this opinionated documentary talking about this and tried to get that message out. that will hopefully come out this year and will be alongside this campaign to get this policy change at the federal level. mr. rauch: you mean educated and informed, not opinionated. ms. leib: and opinionated also.

i'm glad you asked because we will need as many people -- everyone in this room, and your friends and families to push and say, this doesn't make sense. this is just the beginning. in the u.s., we are so far behind other countries and looking at food waste. we are doing very little -- you mentioned london. the u.k. has campaigns and are tracking data, and saying, we have a national mission to avoid this. france also has a national mission to avoid food waste in the u.s., we don't have a national mission to do much as far as food. ms. purpura: in the u.s., we watch the eggs which make them more susceptible, which is why they tend to be refrigerated. with farm fresh eggs, you can live leave them on the counter forever because they don't have processing. mr. rauch: for the first 12

years of trader joe's, they were not refrigerated. somewhere in america someone had an issue with eggs and salmonella, so everyone refrigerated their eggs. now, you would be terrified to buy an egg in america that was a refrigerated. >> it was a great panel. i want to think all of you for the work that you are doing. emily, when you're talking about legal barriers to sharing food and nutrition, i was thinking about pr breast-feeding, which is an area that i do some writing on. one of the problems is when women have trouble breast-feeding, is not easy to access excess breast milk from other women. there are huge regulations in place where it is incredibly expensive.

i was wondering if that is anyone there anyone has approached you about? ms. leib: that is a great question. actually, that not sullied as the present in our work, but we have a fellow in the mississippi delta. i mentioned that that is where i got started doing food related work. our fellow there has been working a lot on breast-feeding policy because it is so important, and particularly in low income communities -- it is free food they can get tickets that is so important and nutritious. those same communities are often the communities they get the least resources, knowledge, and advice about breast-feeding. on this topic, it is not something that i know a lot about, but you are right, we're tight about food all across the food chain and for all ages. that is something that is worth looking at, and what the regulations are, and how do we make sure we are doing it justly.

>> thank you for taking the time to talk to us today. i am a student at the business school. i'm really curious if doug and saucer can talk about the tension between having nonprofit models doing this, and competing for dollars, versus for-profit models, and if you have seen other models that can capture more food waste either on the nonprofit or for-profit side that you would consider. mt. tar. rauch: daily table is nonprofit not because i think nonprofits are better, or more pure, or they are just an for-profit companies are unjust. it was because of the section 170 enhanced deduction that if we weren't a nonprofit then those who will give us food couldn't take advantage of that

enhance deduction. there was also some feeling that in the community, coming down as a nonprofit would be a little easier to be embraced with the idea that we are not trying to make money off of them, selling them food, that at the time i thought i would have to push hard on this expired food, stuff past its display code. it turns out that the vast majority of the food will be within code because we are cooking it up fresh in the spot. i know the people that started the bel-lab, the social contract -- i think there are 31 states now that allow for-profit corporation to have a social benefit charter that says that

investors can get a return on their money, but then it is tied to a certain percentage -- is almost like social contract bonds. i think it started in england. there are a lot of ways we can hybrid. thepanera, for instance, panera cares -- you can walk in and pay what you want. they are not in the tough parts of town, but on the edge got away 20% of the shoppers come and pay more 60% pay whatever you ask, and 20% pay nothing. that model works well to even. it is a hybrid. panera cares is a nonprofit within panera, which is for-profit.

to me, would it really is about is are you efficient, are you effective, are you utilizing -- are you meeting customers needs? it is all market-based stuff. at the end of the day, funders run, and get fatigued, just like investors. if you have a for-profit not getting traction for giving customers what they want investors also get fatigued and go, we're done giving money. funders are the same way. as it looks like you are making a significant contribution to the challenges, funding tends to be a tough market. i think each of the models can be great. it depends on how you approach her, what your purpose is, and what the design is. ms. purpura: i think if you are serving the people that food for free is serving, for example and the people that doug is

serving -- if you are serving up a vibration that doesn't necessarily have money to make that profit for you, you are taking some risk that you are setting yourself up to have that tension -- these people pay me without money is a challenge not to say it can't be done. i agree that whether or not you are for profit or a corporation is not necessarily the point. there is the funding coming from. one of the things that i think longer-term could potentially happen with the help of laws or incentives, if you look at the retail stores, the supermarkets that we go to, they get significant tax reductions for giving us the food that they give us. they also stop paying significant waste hauling costs and composting costs.

my opinion, running a nonprofit that takes all that food up, there is some money right there. all of that benefit financially going back to the retail store and not towards covering any of the costs to getting that food back into the community. i don't play the retail stores as it is, that is how it is set up. enter by profit and shareholders the rate i do think there's plenty of room there to get more creative about how we, as a community or nation, i just food waste as a national challenge, not as these poor people be the food. that is not the issue. the issue is that the food waste affects everybody. it is the responsibility, as a nation, to deal with it. that is where i think there could be some room to at least deal with the funding, whether it is a nonprofit or for-profit.

ms. leib: i wanted to jump in. it is not about the middleman what sasha and doug do, but on the retailer or private actors themselves, massachusetts has passed a really adjusting law that went into effect this fall. they now ba and institution from sending more than one tonn of food waste per week to landfills. this is an interesting relation. our other states that have ones like this. the idea is that this is the responsibility for everyone, and we will put the braided back on those private retailers to say, you can't just keep sending foods to landfills. once it is in landfills, it is one of the biggest contributors to methane. it has been an adjusting law because they are saying, we will

require all of these private businesses to change their habits reducing the amount of waste they have in the first place, getting it to people in need. one of the challenges is a lot of it was a dove and compost which is great, much better than a landfill, but i think all of us here are of the mind that the more of that that can go to people, the better. this law does not have an incentive -- they don't care where the food goes, as long as it is not the landfill. maybe we start with this as the baseline, but also, you will get fined if you have this waste -- to come in and say, let's set up these systems and get it to people who need it. >> my name is andy. i'm serving as an americacorps volunteer. first, thank you, i love the work you are doing.

it is mostly for doug and sasha, you are doing great work, and in what you are doing, you will inevitably have waste of your own. what do you do with it? i'll start because we are already doing something with it. timely question. so, our building -- if you know central square, there's a house right behind city hall, and that is where we are housed. it's owned by the cambridge economic opportunity committee. we do have a compost pile in the backyard, but there were bad issues, among other things. many of my drivers would go to hold the down the street and put the compost there. they compost some of it, they

give some of it to us. some of it really is not good enough to pass on. we have to get rid of it. there's another step there, so there is waste along the way. we were trying to bring it down to the whole foods composter and it was too much. should not matter, right back up it was their food to begin with. the city of cambridge is starting a program where they are covering composting for us. we share the building with a food pantry which a lot of our food goes to, and it is amazing. where talking about reducing this waste. coming out of that food pantry is far more compost than ever leaves my house. we are at least composting it. it's not a lot. actually, one other thing we do in the summer is when we go to the farmers market, we bring a bunch to a pig farmer so that that person can take it back but there is at the end of the day organic waste, and it's not

food at that point. it's food, but it's not edible food. >> we talked a lot about this. we want to make sure we are not going around spending money to collect food and end up ourselves tossing it and wasting it. one of the keys as emily talked about his we have to change customers' perceptions of what a store should look like an hour before they close. in england, first time i went to marson spencer the place looked like it was going out of business. it was gutted. i went up to someone and found a place, and asked what was going on. cuban missile crisis? did i miss something? they said come on tomorrow morning, stock will be full.

i said but right now -- and he said that isn't that great? we sold out. i said it's great, but you're missing sales. that's retail facing. customer facing, as emily said as sasha said, if you are there and you are not stocking the product at 8:30 at night, i come back several times and you don't have lettuce i'm going to your competitor. we have a commitment among our team that we will produce only what we think we can sell and get rid of, and we will have dynamic pricing. because we are designed around nutrition, and we have already done studies -- by the way, fast food is not cheap. big breaking news to everyone. what do you actually get at kfc and burger king and all this stuff? forget about the cost per nutrient. caloric the, what you pay, it's not that cheap.

our goal is, our promise is we will be less than that. more importantly, if we get out a batch a product and it's 3:00 in the afternoon everyone comes and gets one free because we need to get rid of this. we want to get rid of this. we also believe that if someone goes home and tries this product, they will think it is delicious. by this, get one free because we've got too many. we are committed to try to make certain that we have as little as possible -- there will be product. wherever we get it we will get product come back, and you cannot cook it, you cannot do anything with it, it will become organic waste. there's nothing we can do. we have right now storing for when we opened about 40,000 pounds of what we gleaned from farms, produce, etc. we've covered about 70,000 pounds of which we cannot use because they have given it to everything. we have been given to other

agencies everything from food bank to kneecap that can use it. our intent is to try to reach out and if we get something we cannot use, who else can use it? we get more than we can use, instead of saying we cannot deal with someone else, because they might go directly to our source, no, let's call somebody else that can use this product. i think the more that we as organizations that are in this field stop sideloading, working together in ways that make sense, not being pollyanna-ish, ways that make sense, i think we strengthen each other, and i think system it's health works better. >> thank you very much. -- the system is itself works better. >> thank you very much. >> right before you guys leave

-- yes, thank you to our wonderful presenters. a quick plug, and a couple of weeks, a new documentary about food waste, it is touring the world right now, and produces are coming monday 5:00 to 7:00 p.m. here in the law school and we are really excited to have them here. thank you. narrator: this month, c-span radio takes you to the movie. here the supreme court oral argument from four cases that played a part in popular movies from this summer's "woman in gold" to the free speech case for the 1996 movie "the people versus larry flynt," the watergate case from "all the president's men," and "the loving story" about the landmark civil rights case invalidating the laws prohibiting interracial

marriage. saturdays in august at 6:00 p.m. eastern on c-span radio. listen to c-span radio at 90.1 fm in the washington, d.c. area, online at www.c-span.org or download our c-span radio at. >> current and former health care officials from both political parties marked the 50th anniversary of medicare and medicaid. this is about 45 minutes. >> good morning everyone. i'm delighted to be part of this rich conversation and to be joined in that conversation with nancy and bill, and am going to make the bold prediction that everyone in this room knows their history, and it's also

published in your brochure, so i will not go into great detail, but they were both, of course, administrators at cms and beyond. i'm going to contribute a little bit of history to the first panel that got us going. when i was at the kaiser family foundation, we decided to produce a documentary to mark the 40th anniversary of medicare and medicaid, and i had the great treat and privilege of interviewing the ama president who mrs. rob referred to and his name was dr. edward ennis. i interviewed him in 2004. he was 9491 at that point. he was spry and dynamic. [inaudible] that medicare was going to create what he called a socialist yoke around doctors'

next -- necks across america. he was very passionate about it. he is now deceased, but it was a treat to see him. i say that to make the point that passions run high about these programs, even today, 50 years later. part of the political passions we have seen played out on a regular basis is [inaudible] coming from a background in journalism, i cannot ignore the headlines of the day. this annual exercise we all go through may be finished so i would like to turn to both of you to ask for just a quick analysis of what you think of this legislation that was passed. >> i think it is a terrific

accomplishment. sitting him reflecting on the role of the ama and the passage of medicare and medicaid, with respect to the so-called talk fix -- doc fix, the ama and its leadership was instrumental in working for the past decade on this reform package, and i think it's good and will help strengthen medicare, and we will have similar effects in positive ways, moving towards paying physicians for the value they add to the health care system. ms. wilensky: i have a particularly pleasurable response to the passage of this legislation because i was the administrator on hand when the relative value scale was first implemented and also for the 25th anniversary celebration of medicare and medicaid. it seemed at the time a better strategy than what had been used previously in terms of using

what was in the insurance world, the usual, customary the schedule -- fee schedule. what we have seen over time is that focusing on very small units of service to bill with a spending limit laid on top of it both pushed physicians in unhelpful directions, not being rewarded or encouraged, or sometimes even easily allowed to focus on the best clinical outcomes and the most deficiency, and engaged in the worst form of collective guilt because if spending grew too fast, all fees for physicians for all services were uniformly reduced. it was just inherently unfair. most of the time, congress would intervene just before the reduction was to take effect and topic, but the uncertainty caused so much frustration that

ama was focusing way too much time on the policy fix a not being able to focus on the bigger issues unlike when medicare was passed, actually found the ama very helpful in expanding and doing outreach for the relative value scale when it was introduced. i'm sure this will be a much happier time. there's many more things to come now that we've gotten this far. ms. judo: it's always important to bring it back to the beneficiary side. what impact will this have on the beneficiary's? is there cost shifting involved? ms. deparle: i think beneficiaries will know they have a stable system now, and it will encourage physicians to

look more broadly at their care and providing preventive care and the things they need as opposed to worrying how the pay will get cut. i think it should also give them and give all of us real encouragement that -- on a bipartisan basis, pretty overwhelmingly, congress was able to get together on this issue and find common ground and that has been important. different things have been tried. it has been an incredible laboratory for trying to advance health policy. different things are tried. sometimes they work, sometimes they do not. congress and the administration have been able to get together and work on the next iteration next solution, and this is an example of that. ms. wilensky: other than not having to share physicians, the distressed about the potential reduction of 21% in their fees

which i think they knew was not going to happen, beneficiaries should not be very directly affected. as best we can tell, health care professionals, especially physicians, have tried to do the right thing for their patience all along, but we had a payment system that made it really hard. you had physicians billing for very small units of service. a lot of talk about how we wanted to increase value and improve clinical outcomes and encourage efficiency, and then we had a payment system that really puts you in the opposite direction. fortunately, most of our professionals ignored those incentives inherent in the fee schedule with the spending limit and did as best they could the right thing. i would hear so often medicare and then i chaired the commission for its first four years, of having physicians say "you guys make it so hard for us to take care of patients the way

we would like to, trying to spend some time talking to them if they have diabetes or other chronic diseases and not feeling like we are pushed financially to do things as opposed to just delivering the best health outcomes." there are a lot of issues we'll still have to resolve. updates will, how much more physicians should be paid and what counts for bonuses and what counts for penalties. we will be busy for many years to come. ms. judo: let's step back from the days headlines and take a slightly longer view. the pace of change in both of these programs has so accelerated over the past decade , in part under your watch, new models of care new payment schemes, and i'm wondering -- i would ask each of you what in these pioneering models do you

see that have legs for the next 10 or 20 years? it does not fundamentally address some of the critical issues we are facing. ms. deparle: i would star -- i cannot help sitting here as we are celebrating medicare's 50th anniversary thinking about sitting with my grandmother, who was one of the first beneficiaries and was 67 when medicare was passed, sitting at her kitchen table in tennessee. she had a little box of her bills on the table, and she was talking about if medicare would help her, and i think it definitely has. i think as we looked what the future, it is really important to remember the stories. for me, it's my grandmother. for other people here, it is someone else in their family. as we look at the stories and as we look to the future and where the president is going to always

hold fast to the best of what medicare has done, which is provide a stable affordable system of health insurance for seniors, and my grandmother lived to be 98. i'm convinced that one reason why she did is that she did not have to worry about her health care costs, and it also afforded her family members the ability not to have to worry, so that is huge. whatever we do, we have to keep that in mind, and i think we will. gail alluded to the new programs being developed now and being implement it around the country to try to move toward more team-based care, towards what is called population health, caring for a group of patients, trying to help them get better, showing outcomes as opposed to just the fee-for-service a la cart payment system we have had in the past. medicare advantage plans have been growing apart because that is part of what they can offer at their best to medicare beneficiaries. i think those are models that show a lot of promise. the great news is that not only

our hospitals and physicians and other health care providers not opposed to them, they are embracing them and working to take them to the next level. private sector insurers are doing the same thing, so i think we are all rolling in the same direction here. ms. wilensky: i'm excited to explain a little bit about the new models being tried in what we know and do not know. there's an effort with the ms -- centers for medicare and medicaid -- services trying to encourage groups to come in and put bundles of payments together. mainly, that is hospitals or physicians, hospitals with postacute care, home care, or skilled nursing facilities. sometimes all of the above together, and juice the if this improves value, that is the clinical outcome to the patient, improves patient satisfaction, and also reduces cost. there's chemical care

organizations, which are kind of a baby step towards a more integrated delivery system getting physicians and hospitals to agree to combine services and efforts, and if they can show some savings and quality metrics -- very important -- then we get to share the savings with medicare. one of the problems we need to record highs is that the pilot projects that we are trying -- very good idea. try it before you roll it out to 44 million, 46 million seniors -- voluntary. there's a big self-selection bias. the groups that come in to try it may be the most innovative the most entrepreneurial, the most organized, and what they find -- ms. judo: and probably the least frail. ms. wilensky: if their populations are more or less

frail, can be measured. risk adjustments. they are ok. not bad but not perfect. the question is if we were to adopt this for the country, for all people, with the results be the same? the answer is it is hard to tell unless you try to expand successful ones and see if they can be scaled up. one of the big surprises i have found as a former researcher mostly policy person, is that what works on the small does not always work on the big in this country. you might have a private project worked really well in a few areas of one state but when you try to replicate it and see what happens if you try it in eight states, sometimes it just does not work the same. it may be the self-selection. it may be that trying it on a lot of places just introduces problems. you did not anticipate. we're going to have to make sure that what looks like it has legs, so to speak, producing

better clinical outcomes at lower cost can be scaled and replicated, and we will have to really drive that. i'm a little jaundiced about if we will find things that work and the nothing happens, maybe because i lived through what was a very successful project of paying a single amount for heart valve replacement and bypass surgery. i worked really hard to get this pilot off the ground, much harder than i thought i would have to. i would say, "let's get this done," and it would happen i assumed, but 18 months later, it actually happened, and i was yelling and screaming all the way there. actually, by the time her term had been issued, she expanded it, continued it and then it just kind of died away. we're going to have to really drive these changes because it's

not clear what's causing the slowdown if it will continue and with all the baby boomers coming on, there is going to be a financing challenge even in the highly unlikely event we saw the slowdown continue into the future. we are really going to have to take advantage of some of these we think initial successes. it's kind of too early to know if they really -- [inaudible] ms. deparle: in part because she is right that back in the day, i was therefore the 30 fifth anniversary of medicare and medicaid and you were there for the 25th it sounds like, so back in our day, when you did a demonstration program, it was small, very contained, usually. these demonstrations are very widescale. as many as 10% or more of medicare beneficiaries have access to one of these, so we will know sooner rather than later if they work, but

secondly, if they do work, if they are able to control costs and also increase quality, than the secretary has an ability to roll them out nationwide. that is not something that the secretary has -- had when you and i were running medicare. i think that was built into the law because congress realized that we want to encourage the private sector to change. why would you have an incentive for one of these demonstrations if you thought it would be like the one that i did before and it would be a few years and i would have to put everything back where it was? i think it sends a signal to the private sector as well. >> a lot are really struggling. as i said, i think it is a fine way to see when people have not been working together work together. a lot of the experience of the so-called pioneer aco's that

were willing to take risk of loss and gain and some of the ones in the gentler version of the a.c.l. are struggling. again, this is not a criticism. they are trying something new. if you do not have failures, you are not trying the right things. driving this change will be important. ms. judo: part of the title of our panel is lessons learned. building on what they'll set about her frustration of seeing success and seeing it kind of tail off what lesson did you learn when you were in government about how when you see success, you make it stick and grow and go to the next phase in a system as complex as this? ms. deparle: one example is this very one. i, too, have the experience of a number of services that were quite small, quite geographically contained, and then they would die.

an experience i had taught me that -- and i think president johnson could have told me this, probably -- to be successful there needs to be more than one person's congressional district. you need to have not just the senator from virginia but the senator from texas and the senator from idaho invested in looking at the success seeing why it is helping medicare, and helping us strategize about how to expand it. that is one thing i learned. ms. judo: we cannot have a conversation about medicare without talking about the baby boomers. you just alluded to it. i think i heard last night that enrollment in 2030 will be double what it was in the year 2000. these are mind-boggling statistics. how does the system absorbed all of us? and what are the financial signposts we need to look for that this can be paid for and

contained? ms. wilensky: it will be an interesting trajectory. it is not a linear increase. we are going to go to about 78 million or so on medicare by the time we get to 2030. it is in two bulges. we are in the middle of the first, not hard to imagine when you think that these are the people who were born between 1946 and 1949. all the fellows at that time came back from world war ii, had time to say hi honey and started having babies. then there is kind of a leveling off, and then there is another bald that occurred in the late 1950's, early 1960's. not quite sure about that one. but it means that we are going to feel the financial effect of this rush. 10,000 people signed up a day starting in january 2011.

i think that's the phrase i heard. it will put pressure on how services are provided. i just spent the last hit of years on a graduate medical education. a a lot of concern about will we have the right mix of physicians? will we have the right mix of physicians and practitioners and other nurses and can we get them to practice in teams and be ready to take care of chronic care? we will both have challenges in terms of who is coming into medicare and the numbers, the financial challenge is going to be a lot of the general revenue side because almost half of medicare spending now comes out of general revenue. we tend to think of it as finances, hospital care, but it's actually almost as much coming out of general revenues.

my guess is sometime around the end of this decade, maybe 2018, we will see an awful lot more financial pressure coming on board as this first wave is. the good news is they seem to be healthier people coming in, and we have to be a little careful not to project the experience of two or three decades ago of people who were 65 to 70, how healthy they were, what kind of health care services they used because many of the people who are aging and now are healthier than their predecessors. good thing because they appear to be likely to be around us for a long time. the other end, we will have a lot more what are not very kindly called the old old. it will be both financing, but

the actual provision of care and figuring out how to take care of chronic care population with a health care system that is still very much focused on acute care. >> gayle mentioned the year 2030 is the big influx of people, --ms. deparle: gail mentioned the year 2030 is the big influx of people, where medicare will double. the good news is look how far out that is. it's because the rate of medicare spending has been slowed over the past three or four years. i think i saw in 2014, the per capita beneficiary spending increase was zero, 0%. it is at historic lows. as an economist, you are right to question if it can continue

and what if it will, but i see very positive signs that there have been structural changes in the way that providers are operating. to early to tell if they will continue. the position payment lends further optimism to my belief that we will be able to change the way they are doing business in such a way that it helps to slow even as new people become introduced. i think we have reason to believe that can make a difference. if they have been getting preventive care their entire lives, getting access to the care they need to prevent hospitalizations, that would make a difference. we've also made huge strides in

quality. we have reduced admission rates by 10%, reduce hospital acquired conditions by, i think, 17%. all of those things make me optimistic that we will be able to work together to figure out what the changes are we need to make to accommodate the seniors who will be joining medicare. ms. judo: let's talk for a few minutes about medicaid. in this video i talked about before that i did or the kaiser family foundation, it has been updated to reflect the changes of the past decade. 's available online if any of you want to see it or use it in conferences or classrooms, but in the updated documentary, the point is made about medicaid that for many years, medicaid was synonymous with welfare.

the words were almost interchangeable, and that linkage has really been broken in recent years. i would first like one of you to take that issue on and give us a long view of how medicaid has transformed its health quite radically. ms. deparle: -- ms. wilensky: if you think back about how medicare was set up, it was specifically tied to the receipt of welfare. it was not an accident that people thought about medicare and welfare as being synonymous. it was the major reason you had medicaid. when i was around, people would complain to me about all of the low-income people who were poor, sometimes very poor depending on their state and with the income cutoff was, as to i medicaid was

such a bad program like that. my response was that it's not fair to criticize medicaid for being something nobody structured it to be, which was a general program to support people because they were low income. that began to change most noticeably in the late 1980's. very active work by henry waxman , who was head of the committee of energy and commerce, a passionate supporter of medicaid, who used in what was regarded as not a very friendly, hospitable period, all the strategies you could think of to break some of these linkages. initially by having women who became pregnant become eligible for medicaid up to a very high income level. having all children who were under 100% of the poverty line

become eligible for medicaid coverage. it is that gradual change with a big push with what is called the welfare reform program that president clinton signed into law in 1996. it was that further change between the receipt of welfare and the eligibility, but obviously, the affordable care act, which expanded medicaid coverage up to those who are 130 8% of the poverty line, irrespective of other characteristics, to be eligible for a program like medicaid that really most has transformed this to the program that is now on the books for people because they are low income. i would have preferred some -- personally preferred that as a senate bill at one point

allowed, the people below the poverty line have a choice about medicare or medicaid or be able to take their money, but the fact that we as a country allow for coverage if the state by zen -- that is really the final decoupling of medicaid and welfare receipt as i see it. ms. deparle: the other thing that happened, and i was reminded of this last week when i was talking to a student who was writing his dissertation about medicaid, was writing about 1115 waivers, which is a provision of the law that allows for states to do experimentation with approval of the hhs, the agency running medicaid. that provision was around since the beginning of the law. it was in there in 1965, but it really was not used until the

1990's. in allowed states to do quite a bit of experimentation, which they used to build on some of these changes and expand their coverage, and it led to things where medicare dollars were used in tennessee to cover more uninsured people, a population that had not been eligible for medicaid. it led to things like a massachusetts connect during that health care reform, and you can draw a straight line between that and the affordable care act. the state experimentation, the states as laboratories of health care, really was enabled by the medicaid program, and that is part of what led us to where we are today with a much broader program that is really an indelible part of the fabric of our society. ms. judo: i think secretary

sibelius may have referred to it as a two-tiered system with some states expanding medicaid under the aca and 20 or 22 other states choosing not to. what are the implications of having a system like that in place, especially for the recipients? ms. deparle: we had something like that with the beginning of medicaid. in that it was a voluntary program, and states could decide if they wanted to adopt medicaid if they had a financial stake in it, and it took 10, 15 years for all states to finally decide they would have a medicaid program, even with the state children's health insurance program that i helped implement. that took a handful of years for every state to finally decide they would adopt and have a children's health insurance program.

some of this is just what happens with these new programs. it's part of the passions around the issue, part of what you talked about, but, look, it makes a huge difference. i'm not going to be able to find all the studies, but we are already seeing evidence that it makes a difference if you live in a state that has expanded medicaid and you are getting early lab tests to determine if you have diabetes or not. that makes a difference in your life. it makes a difference for hospitals in terms of their uncompensated care. that is why i'm confident that over time, all states will have this expanded medicaid program. ms. judo: i was going to say, it sounds like that is what you believe. ms. deparle: i do believe that. i don't think it will take 10 years. ms. wilensky: we are clearly

seeing more states that are signing on. i thought, as angry as governors and republicans were at the afford care act, i think it is almost impossible to understate the level of anger -- i have been in a few meetings where it has bubbled over, and i was somewhat taken aback. i assumed there was so much money on the table they would take it, but i was wrong. 2014 came and went, and a large number have not, but you are seeing in their own way a number of the red states, if their legislature as well as their governors willing to find ways that are acceptable -- and i agree with nancy in that i think you will see this continue, and it will depend a lot on what happens in 2016, after which i would assume most people that look out will say there are some

significant modifications that are going to happen to the affordable care act. not necessarily bad modifications, but modifications, or they are not, depending on what the election produces, and maybe then settle down and looking at things as they are, but not having expanded coverage is a problem. it's a problem for the people who are uninsured. it's a problem for the communities where they live, for the physicians and hospitals that ultimately provide them services because among other things medicare says to a hospital, turn someone away and they are not medically stable, and we will get you. medicare does not enforce all of its rules, but the so called empower rules, which is what this is under, that is one of the ones they vigorously enforce , and trying to get coverage, and we can debate how much coverage and where you should buy it and who should fund it,

but that coverage is really important. i think that is becoming more accepted with a lot of debate about how either it should be or should have then, but at some point will be it is clearly the law of the land, and people are going to move on. ms. deparle: you asked what we learned from the original medicare and medicaid, and one was the flexibility that was built in, and you are seeing that happen now with a number of the republican governors who are choosing to try to work the administration to expand coverage and asking if they can do it in slightly different ways, and democrats, too, if it's offering private plans or you know, some variation in co-pays and that kind of thing and i think that is healthy and will continue.

ms. wilensky: i'll give the administration credit in being more flexible and some of the requests that come their way than i thought had might be the case. trying to encourage interest. sometimes republican governors take the rap. it's actually in some cases the governors would like to make the expansion but the legislatures are adamantly opposed. the fact that we be responsible for 10% that is not an irrelevant issue. the question will be -- can you find a way to expand coverage as much and to as many people as possible? ms. judo: i want to open up to the audience right after this question. you mentioned 2016. we are entering an election season. what are your expectations about if parts of medicaid or medicare will become part of the political discourse of the next

year? ms. wilensky: of course. they always has been. one of the guarantees anyone running medicare or medicaid has is that when any election comes up, this will be an issue. it has been as long as i can remember. it's hard to really accept we are already into the 2016 election cycle as much as we are. there is no question that medicaid, the affordable care act, the state of the health care system in the u.s. will be an issue if it's as much of an issue in the primaries as it becomes in the final election, the regular election or not, that depends on the parties if it is really what is motivating their candidates. ms. deparle: and how the supreme

court rules. ms. wilensky: well, that is no small issue. there will be a scramble in washington if the supreme court supports the defendants -- or the plaintiffs. if not, there will still be a lot of response, but of a somewhat different nature. ms. deparle: i think health care is always an issue in elections. it is just something people care about, and it be an issue. i do not think candidates will want to spend a lot of time talking about medicare. i just don't. except to say they support it, but you have a program that has -- i don't know what the approval ratings are but there got to be two or three times any politician i've seen recently. ms. judo: that's a low bar. ms. deparle: perhaps.

but it is a very popular program, and it should be. people have stable, affordable for the most part, coverage. their providers are changing in ways that i think are helping to bring down the rate of cost flow . the program is solvent until 2030. there is no house on i are here. we need to work together on a bipartisan basis to make sure that we are improving and strengthening medicare for the future, and i believe we will. medicaid could be an issue. i agree with gail that the four double care act seems to be always the issue of the day, so i do not see that changing. ms. judo: any questions? very quiet audience. [laughter] y'all need some lunch, i think. no? then let me ask you each a final

question. the previous panel speculated about what folks sitting on the stage could be talking about 50 years from now. i think that is too far out. let's talk about 10 years from now. what do you think will be said about these two historic programs? ms. deparle: 10 years from now, we will know a huge amount now about this experience in health care decimals was experience in health care we have just gone through. i think actually in 2018, we will know a lot that we do not know now. in terms of how much of a slowdown we have been seeing, which has been very important for medicare as well as health care in general, is a drag from this very long, very deep recession, or some early successes from some of the changes being tried, but not necessarily either sustainable or sustained, by 2018i think we

are likely to have seen three or four years of robust economic recovery, and then we will have a much better idea about if there is some real change going on. the second thing we will know by the end of the decade is if -- most of the savings and medicare are not because medicare cost less, but because it's being reimbursed at lower rates as a result of the afford will care act and legislation. having someone get paid less does not mean it costs less. the hope is it will drive hospitals and physicians to figure out how to do it for less money with some of the pilots or whatever, but we do not know that. it's why the actuary in 2010 said he's not sure that these reductions that are legislated in law will be able to play themselves out because they've a big to have too many access

pressures for seniors, which congress will not tolerate -- has not, will not in the future either. by the time we get 10 years out we will have had a lot of baby boomers retiring. they will be very focused demanding, as they have been every phase of their life, and have a much better idea about if we really have figured out how to slow down in a sustainable way the spending. very slow spending and a robust economy and after that decade it all went away, and that was because the kinds of changes

were not sustainable. i will mention the reason we have the uptick in medicare rates -- medicare advantage rates announced a week or two ago was because the actuary said spending is going up just a little. not a big issue. just a reminder -- we do not know yet what is happening. i think a decade out we will have a much better idea and i assume that people will have gotten over the affordable care act one way or another. either we will have modified it, or they will just accept it as a fact of life. ms. judo: no more repeal votes. ms. wilensky: exactly. i will be for that. ms. deparle: i think the economic and fiscal issues will still be with us.

people sitting on this stage in 10 or 50 years will be talking about those, and also about equality and making sure the families receiving medicaid are getting good quality care. all those issues will still be here. i cannot give you the specifics but i will guarantee you one thing -- we will still all be celebrating the creation of medicare and medicaid, and the brilliance and compassion that led president johnson and our other leaders at that time to bring these programs to be part of the fabric of our society. ms. judo: that's an appropriate final word. thank you both very much. we appreciate it. [applause] >> thank you all very much and thanks to all of our speakers panelists, moderators, and to

the robert johnson foundation. please join us for lunch on the second floor and thanks, most of all, to all of you for attending today. thanks again. narrator: the jobless rate held steady last month. the labor department is simply -- reporting u.s. employers added 215,000 jobs while the unemployment rate held at 5.3% for the second straight month. the government says the monthly average of people seeking unemployment benefits remains near a 15-year low. narrator: this weekend on the c-span networks, politics, books, and american history. saturday night at 8:00 eastern professional profiles with for congressional members -- 4 congressional members. sunday night at 9:00, with elections coming in october, we will show you a debate among the numeral or national party

leaders in canada. on c-span2 charles murray argues that through the use of technology, we can rein in the power of the federal government and sunday evening at 7:00, susan souther talks about the city and people of now the morning was bombed on august 9 90 what he 5, 2 today. this weekend we commemorate the 70th anniversary of the bombings of hiroshima and nagasaki, japan, and the end of the war in the pacific. our program starts with a conversation with harry truman's grandson, and later, we will visit the american university hiroshima now the sake of thomas bomb exhibit with the director of nuclear studies. sunday morning at 10:00, our coverage continues with a documentary on the making of the atomic tom and later, interviews with two survivors.

get our complete schedule at www.c-span.org. their reader: the senate energy and natural resources committee has been looking into wildfire management. the chief of the u.s. forest service testified before the committee about communities that are prone to wildfires. this hearing is about two hours. >> good morning. roll call to order the energy committee hearing this morning. welcome to everyone. we are discussing logistics here because we theoretically have a vote at 10:15. it is my intention to offer my opening statement, turn to the ranking member for hers, and if in fact they have called it at that point in time, i think what

we will do is just take a quick rate, go vote, so that we can come back and hear the testimony from our witnesses this morning. obviously, a very important issue to all of us around the country. we are here to examine our wildfire management policies ink looting the impacts of wildfire on communities and current wildfire operations. unfortunately, today maybe a day where we struggle to find a whole lot that is positive about all of this. over the last 50 years we've seen a rapid escalation in the size, frequency, and severity of wildfires. the most often cited causes are severe drought changing climate, hazardous fuel buildup due in part to decades of fire exclusion, insect, disease devastation, and an explosion of non-native invasive species. these are big, daunting problems and problems that are not easily going away. we have already seen the consequences unfold firsthand in

my home state of alaska. last may, we had the river fire just about this time, actually mid-may. burned through a national wildlife refuge, spread smoke as far away as fairbanks, more than 500 miles away. the fire burned nearly 200,000 acres or 300 square miles before it was finally extinct. it was the second largest ever recorded on the peninsula. it forced residents to evacuate. we are all thankful that there were no apparent for tallies. it was likely started by human activity, but the area has also changed dramatically in the last 20 years, due in part to grasp replacing forests and they are sibley was susceptible to fire -- due in part to grass replacing forests, and they are simply more susceptible to fire. already this year, the concern

is that we will have an aggressive fire season. we've had very low snowfall throughout the state. it is right, and i was in fairbanks this weekend. i cannot recall a time on the first of may when not only the rivers are out but there is no snow pack anywhere. the same factors we are seeing up north and in the peninsula that are increasing the size, frequency, and severity of wildfires are also driving up suppression costs both in actual dollars and in terms of the budget of the forest service. beyond that, the expansion of the wild urban interface and fire operation strategies and tactics cannot be overlooked. according to a recent usda inspector general report, 50% to 95% of forest suppression costs were attributable to the dense private property, much of which is located in the wild urban

interface. it is looking more and more like the forest service is morphing into an emergency fire service that throws everything it has at every wildfire, if effective or not. last year was a good example. the forest service spent $200 million more on suppression than it spent on average over the last 10 years despite there being less than half the number of fires, less than half the number of acreage burned, and less than half the number of homes burned. we need to see a paradigm shift from fire control at all costs to actual fire management. it's my hope we can implement a wildfire policy that responsibly funds wildfire suspect -- suppression needs, inns -- ends the practice of fire borrowing and makes investment in a full suite of fuel treatment. these will be my policy goals in the committee. it will not be easy to achieve them, but if we do, i think create fire resilient landscapes in which wildfires can occur without such devastating

consequences for our land, community, and budget. i look forward to the testimony of our witnesses this morning. thank you all, and we now turn to you for your comments. >> thank you. i come to, want to thank the witnesses for joining us today. irc's and is upon us, and we look to tell us how we can better prepare for this fire season. for some time, the committee has heard time and again that hires are getting noticeably worse. we have extreme weather conditions, the amount of hazardous fuel and our forests sub optimal management schemes and an increasing inner urban wildland interface, as the chair was saying, combining to produce more lethal fires. the people in my state are all too familiar with this and want to do what we can do to better prepare. throughout the country, we saw iris but i think the state of washington probably was most hard-hit. icg tidwell nodding his head. more than twice the average

number of acres burned across the northwest. last july, washington suffered the carlton complex fire, and we spent many times talking to people in the community. this fire alone burned 149,000 acres in a single day. a burned an average of five acres per second or 24 hours straight. the combination of extreme weather combined with this fire over 353 homes were lost. despite many efforts for people to coordinate and resources come the people in those towns lacked the power of communication for weeks. because of downed telephone lines, homeowners were not able to call to warn about the continued encroaching fires. instead, police had to drive around from town to town calling for evacuations from their vehicles using a megaphone. one thing i will be calling for is better coordination between the forest service and fema on

communication responses during these natural disasters. if they are becoming worse, we need better memorandums of understanding that require communications be set up right away so that our communities can continue to deal with these disasters. i know we can get a head of these issues. we need more hazardous fuel reduction in the inner urban interface. and we need to figure out how to use -- to offset these costs. i look for to the testimony. i am eager to hear from the witnesses on more prescribed fire burns. we also need to address fresh ideas on how to fund service efforts to protect our communities. senator wyden is going to introduce legislation on this. i'm happy to look forward -- i'm looking forward to discussing that. the scientist telling us wildfires are not