arrive at a different conclusion about the meaning of the imperative. an alternate account would be the best place to be poor is where you would likely to be poor briefly as opposed to respectively. respectfully. a dynamic economy with numerous opportunities to begin and switch careers or start and expand enterprises and powerful social norms that offer the poor sympathy and encouragement, qualified by the tough love that reproaches people for choices, habits, or dispositions that increase the likelihood they were their children will become and reduce the likelihood

that their children will escape poverty. in theory, these two approaches to optimizing the circumstances and prospects of the poor seem mutually exclusive. in practice, america has tried to synthesize them. much of the ambiguity reflects the nature of the american experiment, which values both inclusiveness and individualism. e pluribus unum and "don't tread on me." rejected clinton, fdr iesse dichotomy's -- dichotom so much as to call into question

true dichotomies. he was presented with two drafts of a campaign statement, one calling for lower tariffs, one calling for lower tariffs, and roosevelt's response was to turn to the speech writers and say, " together, boys." a spiritual and moral disintegration, fundamentally destructive to the national he went on to call welfare a narcotic and subtle destroyer of the human spirit. on the other, he could introduce the second bill of rights in his 1944 state of the union address. it endorses can be divided in half. the first involved individuals

fending for themselves, and then decentrequisites for a life, whose possession, in fdr's telling, had no relation to productive areas. your own with respect to housing, medicine, economic security, and education. a functionally and morally adequate safety net would guarantee these necessities to all, whether or not it appears they are willing or able to fend for themselves. much point, after all, in declaring a right to welfare benefit unless you also insist that the needs of some give them a decisive claim on the wealth of others.

the welfare state we have built to pursue these objectives now accounts for nearly three fourths of federal government outlays. the office of management and budget's human resources superfund comprises these six functions, meant to achieve the goals fdr laid out. i include in today's discussion inaccuratelyn described as middle-class entitlements, such as social security and medicare, because assisting those who are not poor is a feature of america's welfare state, not a bug. it was famously said a program that deals only with the poor will end up being a poor program. in his view, the medical viability of welfare programs, happily --roperly --

panoply. it is to crisscrossed the sky with dollars for that which is mathematically impossible with and a enormous but still finite amount of wealth, that it can be taxed and transferred in such a way that nearly every household ends up as a net importer rather than a net exporter of governmentally redistributed income. in 2014, the federal government american american on human resources programs. adjusted for inflation and population growth, that figure was twice as high as federal spending for those purposes in 1989.

three times as high as in 1974. nearly four times as high as in 1971. add five times as high as in 1968. -- and five times as high as in 1968. state and local governments also pursue what was laid out. -- governmentbers at all levels spent about on welfare american state programs broadly defined. roughly $42,000 for a family of four. statealculation excludes and local government outlays on education, which amounted to $87 7 billion in 2013. to money the

government spends to promote the goals of the bill of rights, it also fashions tax incentives that subsidize private spending for such purposes. federal tax exemptions, for medical promote insurance and care, home ownership, and economic security , costing the federal government nearly $500 million in forgo tax revenue. significant a though harder to quantify part consists of government enactments that do not entail government spending or subsidies but the use of carrots and sticks to get some citizens to help others. one example would be the american with disabilities act, minimum wage laws, rent control laws, and what requires real estate developers to incorporate low income housing into developments.

in the 72 years since president proclaimed to this, efforts to realize the goals have grown dramatically. over the past half-century, they have become the central concern of american government. to recapitulate something michael said earlier, we are left with the most interesting americanaph in politics, which argues that all of these incentives and regulations have done very little to reduce poverty, presumably the purpose of the .hole endeavor for the past 45 years, the proportion of americans who are poor or nearly four has fluctuated in a narrow band from 1/6th when it is weak. to 1/5th when it is

-- a grillring a way a bewildering array of programs. wasting money is bad, but for an exceptionally affluent nations, probably not fatal. our welfare state has grown faster than our economy, but both have grown a great deal. my own back of the envelope calculation says this would have to continue for the rest of the 21st century before america's welfare state becomes and scope.n in size that eventuality may never occur and may not be all that dyer if if its -- all that dire does.

denmarkrather live in than in some other places. has assetstate also that may not be so ample. there are those who could be contributions if we did a better job of lifting people out of poverty and preventing them from falling into it. another is the confidence americans feel about the governmental competence and .ntegrity like the wars in vietnam and genderars on poverty in -- create cynicism. with a risk to being rude to my cato institute hosts, i would describe myself as a equivocal ---- and

equivocl libertarian. the creative destruction of capitalism is particularly creative for some and particularly destructive for others, a problem that cannot be ignored if government is to be sustained and vindicated, but it is not enough for the welfare , and themean well point is to accomplish things. the contrast between growing efforts for poverty and negligible reductions of poverty does argue that a welfare state divided against itself cannot stand. i believe that much of the smerican welfare state's chao results from is the radical

incoherence. its fundamental incoherence. we have treated two propositions as ingredients in a mixture, not alternatives. the results, predictably, have been a mess. it appearscontrary, there are some things we cannot weave together. thank you. [applause] >> thank you. we will take some questions. if you can wait for the microphones to come down, we will take them. and starting off for the first question or two. back to the beginning, which is sort of what is the goal -- i want to go back

to the beginning, which is sort of what is the goal? is our goal to reduce the suffering, so their suffering is alleviated to some degree? to enable them to get out of poverty, or is it some combination? i know some will say it is both, but i ask you to weight them, and why don't we go down the line and start with ladonna? ms. pavetti: i do not know that i can weight them. i think there is an issue with changing life trajectory.

we focused on individual behavior much more than we focused on changing the structural issues at least people down the path that they take, so when we make the distinction between personal choices and structural choices, i do not think that when somebody makes a choice -- we think of making a choice to not -- that high school, that is a fair choice when they have not been given opportunity, so i think we need to think about the structural issues and what we need to do to fix them, and until we can help people move substantially forward, then i think we have to be able to thatde a minimum level allows people to buy food, housing, and to meet their basic needs. mr. strain: i think it is

helpful to postulate some normative statements. can you hear me? this is on? mr. tanner: yes. strain: ultimately, we are a democracy and can decide on these issues and should be debating them. i think we should have as a basic standard that no one who works full time and has a household should not live in a householdnd heads should not live in poverty. i hope that is something we can agree on. a jobeone can only get for seven dollars an hour or eight dollars an hour, and the person has a child at home, the rest of society pitches in. that person is doing the right thing, and society should reward that. that is one normative david. isther normative statement

that in a nation that is as wealthy as ours, there should not be extreme poverty. no matter how bad you screwup, you should not start to death. no matter how bad your choices, your children should not starve to death. perhaps that is a more contentious statement, but i think that is a statement that should at least be debated and certainly one i agree on. of tackling the problem like that, to decide what kind is, iafety net we want think, a useful way to go about answering the question. ms. vallas: i think there are a few ways we think about this. there is how we feel morally. i think if you care, as michael just articulated, about the basic principle that no one in

this country should -- i would go farther and say if someone hour --arning $7.25 an further, that someone who is working should not be haveess, that we should rejection. if you look at the cost of child poverty in this country, it is each year in gdp, so even if you do not care about the moral aspect, this is an economic issue pertaining to tanf. the argument that we need something that can protect all of us from a situation that might befall almost anyone, and that four out of five number i think hammers it home -- it is not just about mitigation and deprivation. there is a burgeoning body of .esearch making it clear

you can look at the urge income tax credit, food stamps, tanf -- you can look at the earned income tax credit, food stamps, tanf. when it comes to improved health and educational outcomes and increased employment and -- ings in a adult hoods adulthoods for those families. q&a takes ushe they're a little bit. a program i neglected earlier which really needs to be discussed, i think, hand-in-hand with tanf is unemployment insurance. statistically, it is likely that we going to see a new recession. bearergize for being a

of doom and gloom. if you look at who these anefits reach, we are now at historic low of just one in four jobless workers protected when they hit that time of need, and that needs to be a conversation hand-in-hand with tanf, because of we look at programs dealing with joblessness and helping people get back on their feet, we cannot rule out u.i. >> i would say whatever policy needs we ponder, they must be considered alongside the

political and social damage that implicitlyquietly, broadcasting the notion that if you have got a problem, we, the government, have a program that unlike what jefferson and the people who wrote the declaration of independence that writes, there could be -- rights to anything we think you should have, so in line with my more or less prepared remarks, given the abundant efforts and policy already in of mitigating poverty and preventing people from falling into bad circumstances, our focus should be not on innovations or but on simplifying

and streamlining and consolidating, doing fewer thingsand doing those better than we currently are, and my final thought is that i once the government addresses its role or responsibility in mitigating that the challenge of helping people out of poverty, togiving them the resources lives forod themselves is largely a social rather than a governmental and political function, so i believe the most acute need there is not anything that any candidate can offer but something that can work from the bottom up rather byn the top down in america, voluntary groups, by churches, by people concerned about co-worshipers who

will reinvigorate the social to help peopled along when they hit a tough patch. mr. tanner: there is one thing about keeping the safety net say, you cannot use food stamps to buy seafood, or you can only take $25 per day on tanfn atm if you are . we still treat them like they are three-year-olds. we cannot expect people who are poor to take responsibility in

their life, so we have to give them health care and housing, and we cannot give them cash, because they might misuse it. -- the poor need more moral guidance, more direction in their behavior, making correct decisions, or should we be giving people more responsibility and say, we are -- anybodylp you want to jump in on that? ms. vallas: i will. there are so-called welfare databases so we can track people, complete with their names and their addresses, who are these welfare recipients, and, thanks become a that has not gone into effect, because that would also be illegal. i think what we are seeing in this era of really aggressive your creditors entitlement, because that is what it is, is

not just something -- in this era of really aggressive entitlement, because that is what it is, is not just something -- i take exception. i will return it in kind. left is a sense on the that people cannot be trusted with their money. i think there is a sense that proposals and policies can gain medical popularity and actually be feasible to move forward. i think that is why we have seen that tendency. and i think because and consequence of the movement in this direction has been to affect people who experience hard times, and i think does that not only make it harder for us to build political and public will to assure a robust safety net that is in everyone's self interest as well as broader

economic interest, that it really labors under apprehensions about who is it who struggles to make ends meet, and i think we have to look at the reality of poverty in this to anyonend apologies i might offend, the fox news person saying it is a person eat ing bon-bons on the couch. ms. pavetti: a lot of the constraints and sort of the policies assume that everybody can go out and get a job tomorrow or that they can get help from a church or whatever, and in my 20 years plus of doing this is not the reality that i think people face. people the reality that face is that if you have one little blemish on your record, whether it is criminal, or you

have mental health issues, or you have a disability, all of those things really lock you out from the labor market, and just to give you some statistics, there is a program in new york city that was actually rigorously evaluated, trying to take people with barriers who , providing them with services to help them move into the labor market, and they had statistically significant impacts, and what they did is they moved it from 27% to about one third, so 33%, and that means two thirds were never able to find when it, and the labor market has a role to play in that, so as we struggle with -- licensing is one, but i think there are many more things that go into employment decisions that we do not take into account, and we really assume that people have much more control over their ability to earn their own income than they do. tanner: the cato institute

on this, i also wonder to what degree you can have a functioning labor market when you put more regulations -- a $15 minimum per hour, and you have to have paid family leave and have to have family health care, and you have to provide vacation, and you have to whatde sick days -- to point in time doesn't say they cannot provide the productivity to offset all of those costs -- does itpoint in time say they cannot provide a productivity to offset all of those costs? strain: the public policy to make it easier for people to get jobs, to reduce barriers to employment, similar to what you laid out, especially if we have an expectation that people are

in some sense choosing between weking or not working, if are able to create an economy to absorb those workers, and it answer to your question, we should never dehumanize a class of people, and we certainly should not dehumanize the poor and i saythem as -- this to my liberal friends about also the rich, dehumanizing them . a social policies. it is distasteful. at the same time, the money that is spent on low income programs, it does not come from the money tree. people whoom the earn that money, and the people who earn that money do have some right to exercise some paternalism. now, stopping people from buying is, at leastatever

on face value, pretty silly, but saying you cannot use this money on alcohol, you have to use this money on -- maybe we do not what you're using this money on use-cola, or at a minimum, this money on food, let's say -- i think that is pretty reasonable. i the heart of the reason why think welfare programs work is that it combines paternalism and a little bit of hassle with health and assistance and about --and thinking going forward, i think it is appropriate to create a balance there. tanner: ok, let's go out to the audience now. i am sorry. mr. voegeli: if this is about

productive america, and under the current regime, the now 20-year-old regime, it is too difficult, there are too few opportunities, the walls are too and about the premises of whether welfare is or is not a right. my question would be to the center on budget and policy and the center for america progress, if your organizations were given czar-like powers over american policy would say rough a -- approximately where we will be in january. do it generously

with not just the guarantee of welfare as an entitlement but as a much higher floor to guarantee afdc has a who is on reasonably comfortable life. >> we still have a divide in congress. we get it all? >> you are running the show. >> i am going to go to the audience. >> we will never know. we'll keep that a secret. i am going to start with right here. >> i want to pick up on the conversation we're having about what you need, having been responsible for welfare reform on the state level, what i found is that all of the things around the job. it is the flexible work hours or the flexibility when you have childcare issues or you have school issues that you have to

deal with. it's the lack of coordinated transportation and many of our communities where they welfare mom cannot afford a vehicle it all of those kind of things i have found that poor parents are not much different than middle-class parents. we want the best for our children. there are a lot of complications they have with a lot of assistance that we do not provide. >> does anybody want to us -- respond to that and agree or disagree? >> i agree. i think it is. when we think about core purposes, we include childcare as part of that because i don't think it is just preparing for work, but it is also helping them to be successful at work. everything you mentioned is a part of that. >> i would agree. one quick point is i think it often gets articulated as though paid leave is something nice to have or even permission to have a sick day, that is something it

is nice to have as a cushy benefit. your job is on the line if you miss a day of work, if you call in sick, if your kid is sick. that is what we mean when we say making choices between work and caregiving. it is not just about do i go to work today? like it is for most people in this room. oh maybe i will work from home, maybe i will take a sick day. you will lose your job, if you take care of your family. that is important to keep in mind. >> it is a cost. >> i am not saying it is not, weigh what the cost is worth. >> what ideas does anyone on the panel have on what policies we can adopt to address poverty that would address poverty by increasing economic growth and wage growth and job creation? if you look at the data, we actually never recovered to

normal levels of growth since the last recession. we do not recover to normal levels of wage growth. what is the best way to address economic policy to get the economy growing again? what ideas does anyone have to adopt policy? >> anybody? i would suggest that what we really need is a significant reduction on taxes and regulation in business in america that is slowing economic growth. i also think that we may never return to levels of economic growth. we are not going to see the labor force increase significantly. right now it is only immigration that is keeping our population even stable. i think we are not going to see those increases you talked about. michael, you talked about that already. minorities have moved into the labor force, we are not considered again.

we are moving toward automation as the tool for growth and productivity. i think we may not return to the the 4% to 5% growth of the past. to the degree that we can, i think it is going to require changes to tax and revelatory policies. -- regulatory policy. in the middle. >> have welfare programs hurt -- have they violated the strength of the family by substituting for the role of the father or the extended family? >> i think there was some believe that was what was going on. one of the things we do not have the answer to is thinking about what happened with tank, we

really did take the floor out from under people. if you look at the issue that michael raised about people being out of the labor market. if you look at the opportunity, 16-24 year olds, those are kids who grew up in a whole new world. they were not a part of the old welfare system. have we missed an opportunity by designing that right? sorry -- to help create better futures for our kids. i don't think we have the evidence. if anything we may have evidence , in the other direction. >> i would love to jump in. i'm glad you asked that. often the core welfare state gets described as the "hobby state." it is something that has been possibly for decades. i don't know if folks in this room are familiar with a book called all the single ladies by

rebecca tracer. it is worth a read as we think about the trajectory that a single woman has seen over the course of the last few hundred years. she argues that for many centuries, husbands had a wife state.y my colleague, heather, would go further and argue that american business for a long time had a silent partner in the stay-at-home mom and wife. a lot has changed. we are no longer living in the mad men era. we need to be having a serious conversation about is updating our public policies so that we recognize that we now have in in many cases to parents working, or we have a single head of household who was working who is that mother. i would argue we need to think about that. >> i think it is an important question.

there is no doubt that if we completely eliminated the welfare state, if we eliminated the assistance to the poor, that we would see an increase in private charity. that would happen. we would see more men providing for the kids and taking in a more active role in the lives of the kids. but having said that, these programs did not just spring out of thin air. they were started for a reason. we started social security because the elderly were dying of hunger and were dying in tenement houses and disease. it was not that long ago in the 1960's that there was real starvation level harvey among children all throughout the -- level poverty among children all throughout the united states. it is the case there is a sense in which men are being displaced

within the family. churches and other charitable organizations are being displaced in society. we should take that seriously. when we are thinking about moving forward, we should design programs that encourage men to provide for the kids and that encourage the organizations of civil society to provide for the communities. that should never obscure the fact that the family and the church -- as a matter fact were not enough to create the kind of society that we want. >> let me respond to that. i hear this a lot. it is a problem of nonmarital birth. my question is who are these women supposed to marry? a lot of the problem is the men available in these communities are not particularly attractive mates. they're unemployed, criminal records, criminal histories, there are a lot of issues like

that. i remember the bush administration was going to do a lot of things putting up billboards saying "marriage is good." it is not that women don't want to get married, it is often that they lack suitable partners. i just want to put that in the context of the discussion. >> what i was going to say is i think the point from the previous question is that it is important to keep in mind the evidence that rebecca showed. we have increasing evidence that , providinghe eitc snap benefits, not only has an immediate benefit of making sure there's actually income and there is food on the table, but it has long-term benefits that really extends into adulthood of people having better educational outcomes. in 20 years, we are going to have a whole new set of evidence

about the important of income and the importance of what happens in child's early years. it will shape our discussion about what we should be doing to make sure those basic needs are met. i think the positive will outweigh any negatives you think would happen. >> i wanted to speak to your question. i think another approved -- improvement i would love to see to the broader conversation is to get away from the binary view married asersus though those are permanent statuses or as though people are , giving birth to single moms. there are more married parents living in poverty than there are never married parents living in poverty. yet we don't hear a conversation about marital poverty. in the past, single versus merit

-- married and the billboard version is really important so we can be thinking about how to keep families who are together, together. you find that rising inequality declining union membership and poverty, actually -- actual material deprivation are huge drivers of family dissolution. what we should be doing, whether married cohabiting is helping family stay together and to stay strong -- whether married or cohabitating is helping families stay together and to stay strong. >> nobody has mentioned birth control. there have been some very promising experiments in colorado suggesting that much easier access to long acting reversible methods of contraception has a sanitary effect, a demand for welfare services and was certainly apply

to married women as well as single women. what do you think about that as a matter of policy? >> it is an area that we need to do work on. i think it is a tricky issue. you have to -- it is an issue of make sure that it is a choice for someone and not coercion. i think it is an area where we are at the early stages of figuring out what good it can do and what badly can do and we need to really think strategically. i think it is not that -- i think we don't know about what is the right way to move forward and to do more with contraceptives and how you actually do that anyway that doesn't harm people. >> i agree with that. on some level, it should not be

surprising that if you really encourage contraception that you will see a decline in out of wedlock birth. it renders people temporarily's darrell until the contraceptive device is removed and they can have children again. it is not surprising that if you temporarily sterilize people, they are going to have dramatically fewer children. the concern is the one donna brought up is to what extent is it voluntary. what kind of agency should be realistically expect these targeted communities to exercise when thinking about this. do we want low income young minority women having to make a doctors appointment for a procedure in order to render them fertile again. does that -- are there some issues with some normative issues there?

at the same time, there is not a shortage of more regular contraception out there. it is easy to get condoms, birth control pill, much easier to get condoms than the birth control pill. condoms work pretty well. it is not as if i knew that we have a clear understanding of what a unplanned pregnancy means. in a world where it is very easy to access condoms and knowing how to use a condom is pretty widely known. >> this good question ties to what michael says over the controversy over requirements on how people can spend government benefits, alcohol, seafood? that kind of thing. beneath that is the unresolved

question of whether how exactly welfare is or isn't a right. if it is a right, and that term is understood in the direct literal sense, then it means the government is wrong to be interfering with the exercise of that right. if i have a right to these benefits, then government should not be curtailing or conditioning that. after i moved to california, there were stories of people taking -- they provide some of the benefits on something like a debit card. it turned out that among the readers of these debit cards, they were located in casinos and strip clubs. some people apparently took this right to public assistance in a more literal way than the legislature intended.

over the years, the ambiguity about this question has been one of the defining features of american politics. the phrase often used is that welfare benefits public assistance and of various source should be given as a matter of right which is a brilliant sort of fudge. it says to people who disagree with the idea of a right, well it is not really a right and we are going to go through the motions of pretending. it says to people who think it is a right, we agree. i don't think until we really grapple with that question that things like sections on spending, things like quite as i -- quasi-voluntary long-term infertility can be addressed or resolved. >> there is a broader conversation. concerns that have been raised are valid, but we also need to be thinking about how this reproductive access and rights fit into a broader conversation

about an anti-poverty and a boosting opportunity agenda. until we are in a place where truly all women can choose if and when to become mothers, they are not going to have control over the economic futures and much else. it is critical that you brought that up. it is also why we should be suspect when people who blame single mothers on the one hand for all of society's ills, it seems on the other hand, want to ensure abstinence education only in schools and defund planned parenthood. it strikes me as talking out of both sides of your mouth. >> that is going to provoke a live discussion at lunch. i don't want to stand between anybody and food. we have food being served upstairs. on to thank y'all for coming out. i am michael tanner. you can follow along this discussion.

it is #welfare20th. that conversation will continue. thank you very much. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] [captions copyright national cable satellite corp. 2016] >> looking at our prime time schedule, starting at 8:00 p.m. eastern, president obama speaks in the louisiana after his tour there looking at flood damage. tv on2 on on book political history, and american history tv, on the u.s. presidency. >> washington journal, live

every day with news and policy issues that affect you. coming up wednesday morning, the staff attorney for the aclu national prison right check will talk about the recent justice department decision to end contracts with private prisons. then the federal patent and trademark process as well as the latest challenges to protecting intellectual property. and a magazine writer talks secretary clinton deciding to go after boko haram because of recent contributions made to the clinton foundation by nigerian billionaires. join the discussion. >> this thursday, american history tv marks the 100th anniversary of the national park service. we will be live from the robert e lee memorial at arlington

national cemetery to look at past dark stewardship and current challenges. we recently spoke with members of congress about national parks, including oregon senator ron wyden. so many special places, for example haystack coast whereoregon my wife and i were married, and it is a treasure to us. i mentioned crater lake national park. and is a real treasure enjoyed by people not just from the united states but all over the world. it is 14 years older than the park service itself, and the absolutely incomparable. it's just surrounded by spectacular recreation and wilderness. like no other.

the solitude, for example, is something that is treasured by all. a couple of years ago there was helicopters fly over crater lake and i stepped in and blocked it because of citizen outcry to helicopters that was so great. i also believe that if we protect our parks and celebrate and recognize that recreation and tourism is a huge economic engine for our country, it produces $61 million worth of revenue every single year, and i just looked forward to celebrating with friends and neighbors and guests from all because this will be a very special time at a very special place to recognize what is best about our country. party, course is the big the 100th anniversary, and it's because we have said in our country that our parks are

special places, i was especially struck during the government when there was debate about the services that are most important to americans, and our people said just don't mess with america's special places. >> just part of what oregon sayer ron widen had to about the national park service. thursday marks the 100th anniversary of the parks. focus theng we will first part of the show on the park service, that gets underway thursday at 7:00 a.m. eastern on c-span. just to recap, thursday night we will be live from arlington national cemetery is american history tv marks that 100 anniversary beginning it 7:00 p.m. eastern on c-span3. >> the one getting the most

attention is the senate race in florida. talking about what happened in contesten days of that with marco rubio trying to hold onto his seat. >> we have the florida senate primaries. rubio should have no problem winning the republican nomination. he has one challenger, a wealthy homebuilder. people may have thought he was vulnerable. florida is a very expensive state to campaign in but he hasn't really gotten any traction before rubio decided to jump back in. he clearly pretty much knocked all the other republicans out of the water when he decided to come back in. he has clearly shown a major ability to fund raise. his polling numbers are good despite the potential trump effect in florida.

on the democratic side, the outcome is not really in doubt at this point either on the democratic side. patrick murphy is a young house grayson.against alan congressman murphy has been democrats, president againstice president i grayson who is at issues of his own. politico reported last month that he's had domestic abuse allegations leveled at him by his now ex-wife. we expect murphy to be the nominee in that race. once we head into the general murphy andason, the rubio matchup will be one of the closest watched in the nation.

general, incumbents running for reelection have done very well in the primary soap or. are there any possibilities of incumbents losing their seats in florida or arizona next week? pressure right that incumbents have done well this season. there's only one who has lost his seat because of a reason that was not related to redistrict ring and that was the congressman from kansas. over in arizona which also has primaries next week, were looking at the primary of senator john mccain, the veteran armed services committee chairman, the 2008 presidential committee for the republican party. he does have a primary challenger, kelly warren. he's taking every campaign seriously and working hard but -- he has $10

versus kellye bank ward who has not gotten a lot of traction with the outside conservative group. we will see what the last week of the campaign hold. kelly warren has gotten some endorsement from rivers of congress, particularly thomas and from kentucky oklahoma. we will see comes senator mccain will be going up against ann kirkpatrick. >> the senate always expected to be in play this cycle but mounting concern among republicans about whether the houses in play or not. politico had a story yesterday about a new super pac launching a 10 minute dollar effort to

protect the house gop. talk about that. >> that's a super pac that's closely aligned with house republican leadership. the cycleding into much earlier than they typically would and targeting these districts that are in play. we knew before the rise of donald trump in the presidential race that of course the senate majority was going to be in play in a matter what or who the thatee was, considering it's more favorable for democrats in this presidential year. at the house for a while did not seem to be in doubt. republicanss point still do have a very good chance of keeping the house but it definitely seems that trump could drag down the senate and house races. republicans would have to lose 30 seats to lose the majority,

which would be a pretty tall order. what was interesting also is that you're having powerful republicans say on the record that maybe we should diverge resources to the down ballot races. hastor jeff lake of arizona been a very vocal critic of donald trump. station overpbs the weekend in arizona that let's forget about trump and put our time and money and effort into saving the planet and saving the republican majority of the house. >> we appreciate you walking us through the latest. we will check back in later in the cycle. >> the house and senate both return from their summer recess on tuesday, september. on the agenda this fall, federal 2017,ng for fiscal year legislation that funds research and prevention programs for the

zika virus, and measures on defense programs and policy. it's possible the house could consider impeaching the irs commissioner. watch the house live on c-span and the senate on c-span2. >> for campaign 2016, c-span continues on the road to the white house. x we need serious leadership. this is not a reality tv show. it is israel as it yet. america greate again. ahead, live coverage of the presidential and vice presidential debate. monday, september 26, is the first presidential debate, live from hofstra university in hempstead, new york. governor mike pence and senator farmville,ebate in virginia.

on sunday, october 9, washington university in st. louis host the second presidential debate, leading up to the third and final debate between hillary clinton and donald trump, taking place at the university of nevada las vegas. live coverage of the debates on c-span. listen live on the free c-span radio app or watch anytime on demand at www.c-span.org. >> last week at announced it was dropping out of the health care stateslaces in 11 of 15 it is operating in. here to talk about what that are our guests. that vistalow is parked her to the affordable

care act? >> i don't think it is a huge blow. news,'s not exactly united health care was the first to say they were going to drop out. humana dropped out in july and now we have aetna. the problem, of course, is why are they dropping out? the answer is there are problems with the law. host: ron pollack, when you are here a few months ago after united health care dropped out, you said it was much a do about relatively little. is the aetna departure a story that's going to have a much bigger impact? guest: it's much ado about a little more. i do not think it's a big deal for the following reason. aetna had altogether 911,000 subscribers in the exchange . they're going to keep a bunch of those. when you take a look at what they comprise in terms of the

total number of people in coverage through the affordable care act, it's about 6% of the total load in terms of those who may lose coverage. it is a problem, but it is not a huge problem. yet understand that there are a number of insurers that still find it quite profitable to participate and some are expanding coverage. you have got groups like cigna and kaiser permanente. they are all participating and find it worthwhile to participate. an interesting question, john, i think to ask is that mark burda ertollini, the president and ceo of aetna, talked about it was a good deal. not only was he not attending to contract or reduce aetna's participation, he wanted to

expand it from the 15 states to 20 states. host: he was also looking at a merger at this time as well. guest: absolutely. in july, he wrote a note to the department of justice, saying that if it wasn't approved, he would reconsider whether he was going to stay in the exchange. so there is more at issue here than just aetna feeling that they cannot do well in the exchange. host: do you buy that? guest: no, not at all. first of all, he did not know how that things were going to be this year when he made that statement. second of all, it was a political statement. he was speaking to washington. he was not speaking to his stockholders. this latest move comes on the heels of the revelation that the $700 billion losses that they sustained last year are to be increasing.

guest: you might take a look at the letter itself. in april, which was not that long ago, he actually talked about why it was a good deal. he was talking about the cost of acquiring customers and he said this was a good deal. host: you talk about other insurance companies that are finding this profitable. why didn't united health care find it profitable? why are some of these larger companies not finding it profitable to operate in these markets? guest: some of the companies, like united, the individual marketplace is not the marketplace that they have excelled in. united, for example, their big line of business is with employer sponsored insurance. some of these larger insurers has not been in the individual marketplace. it is the companies that have done fairly well with respect to

the individual marketplace or in medicaid that are finding and staying in the exchange and the -- in the exchanges is not a good raining. host: we are opening our phones if you want to join about the discussion of the health of the affordable care act in the wake of the news last week that at no would be leaving 11 of the 15 states that their operating in next year. if you receive insurance through the affordable care act, the number for you is (202) 748-8000 if you have employer-provided insurance, it is (202) 748-8001. if you are uninsured, it is (202) 748-8002. those of the phone lines and you can start calling in. joseph antos is our guest and ron pollack has talked about the group. what is families usa? guest: families usa is a national organization for health care consumers. we have been around for about 35 years. we actually did push for health reform for a long time.

our mission is to try to make sure that everybody has access to the high quality affordable health coverage and care. we are supporters of the afford -- affordable care act, no surprise. while we think that the affordable care act is a story accomplishment it is not , perfect. there are a lot of things that we can improve and it is our intention to help make sure that happens. host: your areas of expertise? guest: i work mostly on health policy, but i am a budget expert as well. ron's proposals are going to cost the taxpayers an enormous amount of money. host: we will be talking about it for the next 45 minutes this morning, having this roundtable on the affordable care act. robert is our first guest in harrison, arkansas. he gets his insurance through his employer. robert, good morning. caller: yes, i'm from arkansas. when this all started, arkansas

went together and came up with what they call the private option. it has been successful. now that we have gone through a huge election and the democrat governor turned to a reposting -- republican governor. they looked at it and turned around and did it again. we have legislators that got together and made everything work. now we have men like this mr. antos sitting there. he gets his insurance subsidized. is amazing that he finds himself in the circle for insurance, but other people getting it is socialism. my point is we should be looking for insurance for all. those that have it should be thinking about why they have it and we should give it up. businesses get expense

deductions. public employees have it. nonprofits have it. why is it when you help the other people they become socialism? thank you very much. host: do you want to talk about your insurance plan? guest: i never said anything like that, robert. you are completely wrong, of course. i, like most people, think that everybody ought to have access to insurance. the problem with the affordable care act is that it's not affordable and it's not the kind of insurance that a lot of people like robert thought he was going to get. it is not the kind of coverage that people with big companies -- i'm not with a big company, but people with big companies typically get. that is part of their compensation. guest: robert made a very important point. arkansas tried to do something on a bipartisan basis and they succeeded. there were a good number of conservatives in arkansas who did not like the affordable care act, yet they found a way to extend coverage particular for

low income people. i believe that we are going to see such bipartisanship in the not-too-distant future. the reason for that -- let's assume for a moment that right now hillary clinton is winning , at least all the polls seem to say that. if she is elected, i think it sends a clear signal and it tells people like joe and others that the affordable care act is here to stay. it is not going to be repealed for eight years, probably longer than that. i think that encourages bipartisanship, which has not existed for quite a long time. hopefully some of the affordables that the care act has experienced, that people who have different points of view can come together and say here a reasonable fixes to the affordable care act that will make it better. there's a pretty important historical lesson here. when the social security act of

1935 past, and it's one of the most important pieces of legislation in history, it was heralded as a major accomplishment. however, the 1935 legislation failed to protect over half of the women and the workforce, two thirds of people of color in the workforce. those things got fixed over time. you should look at the affordable care act the same way. it is a historic step in the right direction, but it's not perfect and it can be and will be improved if we get the kind of bipartisanship that i think will happen. host: i will give you a minute to respond, and specifically to that point of it hillary clinton wins the election, does that give some political stability to the affordable care act? guest: she has to be willing to make changes that are absolutely necessary. i think that liberals like ron would agree on some of the

changes. he would disagree with many of the ones that are absolutely necessary to make it stable. i'm more confident that if she wins that she will actually come to congress and try to make a reasonable deal with republicans. if she does not do that, then she can forget about it. she has to realize that it is a two-party system and that it is up to her to make the first move. guest: she does have a history of that kind of bipartisanship and she has already offered a variety of proposals. i think we are going to see something different than what we have seen since 2010 when the legislation was passed and the republicans saying no, and democrats saying yes, yes, yes and very little possibility to do something in between. guest: if you look at what republicans have actually proposed, even though the first line of every proposal says repeal obama care, all the other lines basically say we're going to start with the structure that

there is, and we're going to make reasonable changes. guest: i've heard a lot of repeal and not much replace. host: for viewers who want to hear about republicans have proposed, joe had a blog post at health affairs.org running through the house republican plan if you want to look at that. jim has been waiting in florida. he gets his insurance through the affordable health care act. caller: thank you for taking my call. host: go ahead, jim. caller: i'm 72 years old and in pretty good health. when you have auto insurance, you're penalized by how you drive and if you're safe driver. health insurance should be similar. if you take better care of yourself, i do. i do not go to the doctor very often. i go for my yearly checkup, but i take time to take care of myself and stay healthy and eat healthy.

if insurance companies offer that incentive and programs like health programs for their insurance, it would be more affordable for everybody. in other words, if you take better care of your health, you should not be paying the same amount of money as people who abuse themselves and did not take care. >> ron are the , programs that incentivize good health? guest: one of the afford the things that the affordable care act does is that it provides preventive care pre-deductible. it keeps themselves healthy and it does provide help. one of the big advances of the affordable care act was we said we are no longer going to allow the insurance companies to discriminate against people who have a pre-existing condition. someone who has asthma or diabetes or high blood pressure or history of cancer, they were

denied insurance in the first place. i do not think jim is suggesting that we go back to that, although some of the republicans when they talk about repealing the entire statute would go back to that. but i do think that incentivizing good behavior in terms of eating well and taking care of oneself and exercising, i think there is lots of room for trying to provide incentives for that. host: i will give you don in new jersey. he also gets his insurance through the affordable care act. caller: it just seems kind of ridiculous and amazing to me that a large company like aetna is unable to make a profit in a market where other large corporations and not so large corporations are doing fine. it really kind of boggles the

imagination to think that they are that bad of a company that they cannot me for profit and a market where everyone else is making money. guest: i'm sure that mark feels insulted. the reality is that most insurance companies are losing money. none of them thought from the beginning that they were going to make money for the first couple of years. the reality is that people are losing money. if you look at bob, he has a blog and he's an insurance expert. he documents just how much money most of the companies are losing. it is true that the medicaid typical plans, they are the ones that are making money. here's the reason. the reason is that they already have very low costs and very tight networks because they are medicaid plans. they basically paying medicaid rates.

medicaid is the worst payor in the entire health care system. you have united and aetna going and they are the highest payers. you go into a big health system and you negotiate this with whoever is in charge. they have control over that market. if you are molina, you can say that we can bring in a lot our customers and we can pay you $10 more. if you are united or aetna, you can say we can bring you more customers and we have to pay you $50 less. it is not a good marketing position. guest: here's one thing to take into account. when you have aetna or particular united, which really do not specialize in the individual market place, there is a learning curve that has to take place. some of them quite frankly underpriced their premiums. that is not an unusual thing.

when you start in a market you want to get the largest market share. most of these companies that didn't have experience in the individual market place were not sure what to charge since usually the name of the game is get me market share. some of them underpriced. some of them have to make corrections. the companies like united that had the least experience in the individual markets are the ones that had trouble. host: let's talk about the market next year and what it's going to look like. the new york times column looked at the number of carriers in different counties and states around the country and what that marketplace will look like next year after aetna's departure. the states and counties in purple on this map are the ones that will only have one carrier, one insurance provider as the option in the marketplace. .he pink will have to providers

talk about pricing in those markets that have just one provider and what's going to be happening next year. >> one thing your viewers need to understand is when you have one company that is providing coverage, it doesn't mean you have only one plan to choose from. most of the companies offer a variety of plans. from a consumer perspective, there are two sets of issues that we hear about. number one, and joe touched on it a moment ago, we want to make sure that our provider is in the network of our plan. the fact that there are going to be numerous plans offered even by one company should take care of that. the issue he raised is a little more difficult and that relates to price. it's good to have competition. that helps to bring prices down.

from the consumer perspective, the consumer cares mostly about what does he or she pay out-of-pocket. one of the things your viewers , somethingerstand those on the affordable care act right now probably do understand, is that there are significant subsidies provided to people all the way up to 400% federal poverty level. for a family of four, were talking about income below $97,000. these subsidies are provided on a sliding scale. federal poverty level. for a familythe lower your incoe higher the subsidy. the bottom line for individuals is what do i have to pay out of pocket after the subsidy? the bottom line for individuals what you're going to find is majorityoverwhelming people are not going to find a significant change because as

the premium goes up, so does the subsidy. majority onthis is the one county that has no health care providers expected to be in the market next year in the exchange. in the exchange. there will still be blue cross in the nonexchange market. the insurance commissioner is trying to get blue cross which is losing >> blue crossarizona to go into. it probably will because that buys them goodwill with the regulator and maybe it will give them a slightly higher increase in the premium. let's be clear about this. if are speaking as everything is going to be just great and we don't know that. the leading expert on measuring premium increases estimates that

right now it looks like it's going to be a 24% average increase across all the plants in the exchange market. you are right. there are subsidies. the key thing that we saw last open enrollment, hhs was saying look around and find another plan. the plan you are in is probably going to go way up. people are going to have to work their way down from a plan they may have been happy with to a plan that likely is much harder to deal with. host: todd is waiting to chat with you both in ohio. he gets insurance through his employer. caller: what i find you are all missing although i understand the logic -- you are all missing the problem is the individual mandate is an intensely evil maneuvering scheme that should be -- and be thrust upon private citizens.

participate and decide you are going to be subjected to the fine of 600 plus dollars or more which goes up every year then you decide you are not going to pay that you basically had six jeff did yourself -- subjected yourself to prosecution. people should do the experiment that i did. most of my personal affairs are in atlanta. you take cleveland clinic in cleveland and university hospital in cleveland" $1000 aside and walk through what it would cost you to get a good physical. get a dentist somewhere and teeth cleanings and your eyes checked. maybe some additional blood work such as a pregnancy test or std test. prostate exam. you will find at the end of that $1000 you still have a little

bit of money left. you find out everything you need to know if you are an individual who takes relatively good care of themselves through exercise and live a low risk lifestyle and have a low risk job type lifestyle and live in a neighborhood where they don't have to be too concerned. you don't have to be a participant in health care insurance. you will subject yourself to the possibility of something bad happens that you need insurance four. then you should have to suffer the consequences of that. but if that doesn't happen to you you should not be subjected to a $600 fine. host: let me get a response from ron pollack. guest: the argument that todd is making you hear from a number of young invincible's in particular. are healthy and exercising and doing all the right things. why do i need health insurance? reason anyone wants

insurance whether it is homeowners insurance or any other insurance is because you can't predict the things that are going to happen in your life. god forbid todd has a major accident today or an illness. he's probably going to impoverish himself in terms of the cost. it is a concern. what the affordable care act did was said we are no longer going to allow insurers to deny coverage or charge discriminatory premiums when people are sick. that means that obviously people who have health problems are going to go into the marketplace. that is what has happened. if on the other hand you don't have younger and healthier people join the marketplace what's going to happen to the premiums? they are going to go up. penalty wasof this to make sure that those people who might want to take a free ride and hope they will do ok

attracts more people. it is the least popular part of the affordable care act to be sure. but it does help to make sure that the marketplace has a greater balance of risk pool. host: i will give you an a in arizona. guest: it doesn't work. that's the problem. if the mandate really had teeth and it and people were seriously afraid not to buy insurance than we would have had a more balanced risk. guest: you would have wanted a larger find? guest: i would have wanted a more effective approach giving insurance companies the ability to sell insurance products that people actually want to buy at a price they are willing to pay. it has to be subsidized. na.t: let's hear from an caller: good morning. i'm a project manager at an insurance company who is a

participant in the affordable care act in arizona. i have not had worse insurance in my life than i have being the affordable care act even working for an insurance company. what impact did the supreme court have when it -- it did a couple of things early on. employers tothe put them off having to participate to a later time and they made some decisions about the states having to expand was supposed to be a part of this and many states were able to opt out of the expansion. what part did the supreme court play in those rulings that might have made the participation less profitable? she is raising a question about what happened with the first supreme court ruling.

in that case what she is referring to is a part of that case was the court held that the affordable care act's requirement that every state expand medicaid program was impermissible under the constitution. it converted what was a mandate to expand medicaid to a state option. most states like arizona have actually picked up on that option. 31 states plus the district of columbia have accepted this option. 19 states have not yet done so. arizona is a very interesting case. because the governor at the time, jan brewer, very conservative governor. she decided it was a good thing for the state of arizona to extend medicaid. she had all the local chambers

of commerce say it's a good idea and it's going to be very helpful in terms of jobs. arizona opted into expanding medicaid. we still have 19 states that haven't done so. . host: did you want to jump in? guest: that is really the only significant part of any of the supreme decisions that affected normal people. after the election i think we will see maybe all of the 19 states signing onto the medicaid expansion. especially if hillary clinton is cutted because she won't back the extra payment to states who do that. if it's not hillary clinton they may change their mind. host: we have about 30 minutes left. joseph antos and ron pollack are our guests. you are stepping down from that position.

guest: i have been at families usa over 34 years. i think the organization could use some young leadership. we're in the midst of a search process and i'm going to move on. i'm not retired. hoping to work in economic fairness beyond health care. host: we are talking about the health of the affordable care act. -- aca insert viewers insured viewers, bill is on the line for those who get their insurance through their employer. good morning. caller: when bill clinton became president, hillary tried to push through hillary care and republicans stopped it. becomes president

you have a republican president andcongress and senate health care costs went up 140%. by 2008 it was $12,000 a year. 05-06 in one year. 140% --are has gone up has health care gone up 140% under obama? it didn't become an issue until ronald reagan and george bush senior became president because the republican congress about -- sold out the medical community to the insurance companies. not-for-profit hospitals and medical centers. au used to have to have medical license to own and operate a medical facility. no longer. now it is all owned by insurance

companies. obamacare was so popular was because after you took 140% beating and republicans did nothing they were willing to do anything to stop that. then the employer was smart by dumped it on the workers. this lady talked about how bad her health care is now. let me give our guests a chance to respond. clear about the national statistics. he may be talking about his personal circumstances in new york. nationally from the mid-90's to about 2003 the average growth rate in health spending was about 8% year. the average growth rate in the economy was close to 3%.

we have seen that for decades. it is faster than we would like to see. then we have the great recession. everything slowed down. health spending slowed down. that happened before the aca. a lot of people want to say the aca is fully responsible for the slowdown in health care spending. it's not really true. we are coming back up. it is a big challenge. even these numbers that seem smaller are very large when you translate it into people's taxes and premiums. do have a problem and unfortunately part of the aca was supposed to slow down health spending. that was something that was put interest of

increasing coverage. host: ron pollack is shaking his head. a few things. bill was recounting some of the history about health reform. it goes back well beyond that. wanted to pass major health reform and wanted to include as part of the social security act. the american medical association was strongly against it so he jettisoned it in order to protect the social security act. in 19 49.an tried again the american medical association opposed it. ronald reagan got some of his public start right being a spokesperson in opposition to health reform. right -- i like to

tell joe he is right periodically. seenve clearly increases in costs that preceded the affordable care act and after. really interesting is that even though the affordable care act did remarkable things about extending coverage to over 20 million people who didn't have health insurance we have our lowest rate of uninsured in the history of the country. at the same time one of the things we have learned, dhhs recently released data that shows in terms of the cost of health care that have really decelerated. are they where they should be? no. but they have decelerated. host: angelo gets his insurance through the affordable care act. good morning. good morning. i think something you are not

touching on is for profit medicine should be not only illegal, it's immoral. i don't understand how a ceo and all of these people in the insurance business -- if it was up to me there would be no more insurance companies. there would be medicaid for all, single-payer. it's that simple. why should you work your entire life and have one catastrophe come along and wipe out everything that you put away? it's completely absurd. i don't understand this. angelo's want to take comment. guest: he's right. everybody needs health insurance. we have to start from where we are. is a privateare insurance system and a private health care system as well.

those who argue against for aofit misunderstand that not-for-profit status is a tax status but they still have to make money. and they do. blue cross plans are not-for-profit. end of the't at the day make a substantial net gain over their expenses they will be out of business. aren't there cap's on how much the companies can make? guest: there are on how much of a premium dollar is spent on things other than providing care. it's called the medical laws ratio. to spend aty have least $.80 out of the dollar on actual provision of health care. theothers it's $.85 out of dollar. profitn't particularize but includes administrative

costs marketing and advertising as well as profit. insurers are not happy about that. they would like to have no caps on things spent other than care. it does provide greater efficiency to make sure most of the premium dollar is actually spent on care. guest: you have a different definition of efficiency than i do. among the several things in the 15% are patient management costs which i think most people in the especiallyuld agree for high-cost patients and people with chronic illnesses you need to be efficient to minimize the resources to produce a healthy patient. you need to have administrative costs. the patientsanage and the doctors. if you don't do that we're just going to blow through the money. guest: i agree.

the question that preceded this was are there some caps on profit. i think in a capitalistic system anyone in the marketplace wants to make a profit. in terms of using taxpayer dollars effectively we don't want our taxpayer dollars to go to insurance company profits. we want to make sure they go for good care. host: let's bring in a taxpayer from virginia. he gets his employer -- insurance through his employer. good morning. caller: thanks for taking my call. i live in virginia and work in maryland in a number of paid clinics. i'm not an owner. i get my insurance through my employer. i wanted to make some comments about the fact that i know we are talking about providing insurance to everybody which is great. i think it's a really good thing.

i have been involved with the ama. we have to find a way to pay for it. we pay into the hospital insurance trust for medicare is not going to cover all of those costs. the supplemental insurance is still ok. with regards to obamacare i think a lot of the insurance companies are pulling out the markets because they are not making enough money or they are losing a lot of money. continue to go that way because there's a lot of sick people out there and they are a lot bigger and they are going to stay a lot sicker and stay in the system longer. i don't see a good solution for all of that. with regard to direct medical cost i think the lobbying interests involved in the health care including doctors and insurance companies and hospitals and pharmaceutical

companies -- the pharmaceutical lobby is the strongest and they continue to churn out really big profit. they are taking the majority of the money. the weakest lobby is the doctors. host: let's talk about that. joseph antos. guest: anybody involved in business in the united states lobbies congress. that is not a surprise. insurancedes companies and doctors. they are all lobbying. and pharmaceutical companies as well. runcription drug costs around 15% of national health pending. they're not getting the bulk of the money. the bulk of the money is going to hospitals. it's about 40% going to hospitals.

it's really hard to say where the costs can be cut back but it's clear that the incentives in most hospitals have systems is fees for service. if you don't provide a service you don't get paid. that is one of the fundamental issues. the way we pay everybody in the health system promotes the use of service is even when the services provide marginal usefulness. host: a couple of tweets. agreeing with ron pollack. aetna leaving the exchange is retaliation for the blocked merger with humana. a question. insurance companies complaining when the aca mandates that people must buy their product? guest: i don't think they are complaining so much about the mandate.

i'm not saying it's a popular thing. surveys.ok at all the the mandate is least popular of all the different provisions. insurers know that when they are prohibited from denying coverage to people who are sick or have a pre-existing condition they have to get healthier people into the pool. the mandate helps achieve that. joe raises a question is it done as effectively as possible. it could be improved. no doubt. part of important trying to make sure the pools don't have as much risk in them. let me say one other thing. this really goes to the future. those whowe've had are opponents of the affordable care act have really so far of used to seriously engage in

trying to improve the affordable care act as if it's an act of sacrilege. i think when hillary gets elected assuming she does i think it's really important some of the things we can do to improve these risk pools so we keep premiums down. here's an opportunity. for example the republicans really liked so-called medicare part d which is the prescription drug benefit in medicare. it has certain mechanisms designed to keep costs down. kindkes sure there is some of risk adjustment for those plans that have sicker people and they get some protection. so far republicans have not been willing to do that kind of adjustment to the affordable care act. my hope is that we can make those kinds of changes after the election.

i am puzzled why the democrats didn't put that in the first place. they do have those mechanisms but some of them expire. that was the democratic decision not the republican one. guest: i look host: forward to your support of our extending them. we have 15 minutes -- host: we have 15 minutes left in the segment. waiting in fayetteville, arkansas. good morning. caller: good morning. i have a question. createsrdable care act adverse selection for insurance companies because people are sick and that's who's going to buy the policy. why not just have medicare for everyone? hillary clinton is proposing lowering the age to 55. medicare operates at the least expense ratio of any of the providers. that way everybody will be in the plan.

we will be a big boy country. host: medicare for everyone. guest: medicare does not operate substantially less expensively than private insurance. one of the things people don't seem to understand is the medicare administrative cost runs through the center for medicare services. the social security administration does the bulk of the work in signing people up for medicare. that's where you go. the social security office. is expensivee up and keeping track of who they are is expensive. medicare administers the building. they pay the bills but they don't have the rest of it. you also have to look at the ratio of administrative costs per dollar spent on benefits.

a veryly you can get small percentage if you ignore many of the costs and then you say on a per person basis is very low. but the reality is that medicare people spend probably two or three times the money that operates through the private sector. it's not really true. one other point about hillary's proposal. this is a great idea for the aca. 55will transfer sick people to 64 into some program which will simply have higher subsidies. if you really wanted to do this you could cut through that and just give higher subsidies to people's 55 to 64. host: ron pollack. guest: we have not called about the so-called public option. the public option which is more akin to what hillary is proposing is that for certain age groups they will have the

option to buy into a public plan. i think that's a good idea. you are raising before that county in arizona. it would be a lot better for the people in that county if there was a public option so that if no private insurer was willing to provide coverage that the affordable care act is not the rest of opportunities to provide coverage for folks. i think there is going to be a debate about the public option. i don't expect republicans to support that. perhaps there is a compromise. the compromise might be in those areas where there are precious that there be some opportunity to increase the options by having a public option. host: caller on the line for those who are uninsured. joseph in delaware. caller: good morning. thanks for taking my call.

i'm trying to figure out -- i keep hearing this 20 million people covered. what is the difference between coverage and care? there are so many doctors here in delaware who don't want anything to do with the aca and i take care of my 80-year-old mother who is not affected by that. she's terrified by that. it doesn't really affect her. you are with aetna. you are good. i keep hearing this. no dr. in delaware will take aca. my mother calls it the bomber care.- bummer she's just waiting for her premiums to go up because no one is involved in it. i pay the extortion myself every year at tax time. would you like to comment on that? i think it's a sham.

host: ron pollack was shaking his head. are lots of doctors accepting coverage through the plans and the affordable care act. joseph asked in the beginning about the 20 million. theree's referring to is are over 20 million people who were uninsured prior to the affordable care act who now have health coverage. that's a remarkable achievement. we have the lowest rate of uninsured in the history of the country. patientsre accepting in the affordable care act. there is a more difficult issue with respect to the medicaid program. some places doctors are not accepting medicaid patients. medicaid enrollees are getting coverage and they are getting care. kentucky gets her

insurance through the aca. good morning. caller: kentucky's plan is pretty good. the only reason i'm on it is i am disabled and in between -- i and nown employee plan i'm ready to get on medicare. now thatike to say people are having to pay for insurance they are going out and seeking treatments that they might not have sought out before. they are using their insurance because they have to pay for it. another thing i have seen it is we need to get the media out of health care. i'm referring to the advertising. i have worked in health care my whole life and come from a long

line of doctors. people see it on tv and they think they have to have it. a lot of these medications are very expensive. contribute tog health care costs, baby boomers are getting older. i told rand paul that when he was here in town speaking. host: thanks for the topic. guest: mary is right. when you have insurance you are more likely to go to the doctor. that's a good thing. on the other hand there is the question of access. what the previous caller might have been referring to is it's my doctor i want to see. i don't want to see a doctor i haven't seen before. that's an issue. fact is you have to shop around and your doctor may not be in any of the aca plans.

but some doctor will. her point about the population getting older, absolutely. this is something ron and i look forward to. the fact is health care costs are going to be rising much more rapidly as baby boomers age. host: stephen in maryland gets his insurance through his employer. caller: just a couple comments. i think getting 20 million more people on health insurance is a good idea. i think a better idea would be provide 20 million jobs where people can get their employment through work. lunge toward be a socialism in this country. the government is not a provider. this is not liberty and the provision of happiness. this is the pursuit of happiness.

i got a couple notes. i'm 65 and i have to write things down. $500 billion a year wasted in tobaccontry on alcohol jobs and obesity. we need to address that problem. i got tri-care for life. i was in the military for 20 years. the reason we can't have a military program for everybody is because you have an seo and officer oversight. if you sham you are thrown out. i have heard it costs $10,000 to have a child. a lot of people think babies should be provided through social programs. people don't realize it takes $250,000 a year to raise that child. host: we got your point. i'm glad steve has gotten

the benefit of tri-care. he's now going to get the benefit of medicare. we do want a safety net for people. we still have a private health insurance system for good or for bad. we want to make sure people don't fall through the cracks. between medicare and medicaid we take care of seniors, people with disabilities, people who are too poor to get health insurance. thing. a good i hope we expand that coverage so everybody who needs care can actually gain access to it. host: our last call is from jack in minnesota. you are on the joseph antos and ron pollack. caller: good morning. i googled in my trusty ipad what the ceo of united health care makes. here's what i came up with. ceo stephenh care

$66 million inme 2014. he took it in an eye watering $102 million in 2010. corporateone of the hierarchy in that company that are taking home of seen amounts of money. physicianlaw who is a works his tail off and makes it can't even be called a fraction of the. he does the actual providing. i was a dentist. i also made a minute fraction of that. the reason is because the providers take a huge haircut to

the parasitic insurers. takes the way the patient a big haircut to provide these bscene amounts of money. the cost of all the paper shufflers to have to and eric a the labyrinthine idiocies of in thestem we have united states. it is rotten. it needs to be changed. there are better systems in the world. in europe they have better systems. they pay half the money we do and get better outcomes. host: that's jack in minnesota. 30 seconds each. jack has the belief that if you go to england you will get better care and it will be cheaper. it will get cheaper in terms of what you paid directly to health

care but your taxes will be much higher. it's a very difficult calculation to make. as far as high corporate salaries are concerned, that's true. for majortrue hospital systems. look around. the doctors are not getting paid millions of dollars. unless they own hospital systems. . that's true. i would say we are reaching a turning point in the turning after thehat sometime elections this debate about the affordable care act is going to come to an end. my friend joe is going to have an epiphany about working so that with democrats we can actually build on what the affordable care act has done , make it better. we who support the affordable care act will work with people like joe to strengthen the legislation in such a way that it really works for all americans all across country.

you are right. i think the next administration if it is democratic will be a lot more amenable to coming up to the hill and talking to republicans. the: joseph antos is with american enterprise institute. ron pollack is with families usa. the executive director. >> c-span's washington journal, live with news and policy issues that impact you. aclu'sttorney for the national prison project will talk about the recent justice department decision to end private prison contracts. deputy under secretary walking us through the federal patent and trademark process, and protecting intellectual property. our spotlight on magazine segment, world magazine writer

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