expanding social security, having more benefits for beneficiaries. donald trump does not support raising the retirement age for social security. on social security i think the recourse is calling your lawmakers and pressing them on the issue. i don't

so we don't keep doing this again and again. i think that is always very difficult, and it is going to be a different dynamic now with donald trump in the white house. stephanie in missouri -- democrats line. caller: i have a few questions for you, if you don't mind -- maybe a few statements. mr. trump has legality issues, and as a president elect, and/or a president -- how does that come about -- i am the familiar -- i do not know if we have had precedents on this. does that wait until after his term -- something we have to take care of now -- as far as rico charges, if you could comment about that, i would appreciate it. ceiling inebt december, which should be taken care of, hopefully, but march,

2017, we have the debt ceiling coming up, and with the freedom caucus, you know how that gets when the time span comes up, ted cruz, etc. -- how will that work with mr. trump? also, i hear this day infrastructure dale that he wants to do, which is great, a boost for jobs, construction. however, i am not sure that will fly with the freedom caucus going around with that. ending.and cuts for if he bloats the budget, i think we will see a conflict. i also hear a lot about bringing jobs back from overseas and nafta. i never hearings anyone explain is we have gone to the increased technological infrastructure, automated age --, the computerized

and a lot of those jobs are gone. they do not exist anymore. a robot or a computer has taken the job over. it no longer exists. unfortunately, nobody has come up with examples of what to do for a job after that. host: thanks, stephanie. a good list there --you have touched on them already. caller: there are a lot of losses. remember, -- andelcome to the douglas sarah ellis auditorium. those of us -- those of you join us on c-span tv -- we remind everyone in-house if you would be so kind to check that mobile devices have been silenced or turned off as we prepare to begin. it is always appreciated. for those watching online, you're welcome to send questions anytime, simply e-mailing heritage.org.

it is also my privilege to welcome at this time -- the one gentleman, needs no tradition, senator jim demint. senator demint: thank you, john -- thank you all for participating -- our panelists, those joining us via c-span. what a great event. you.mend this preserve the constitution piece that has gone on with great events, such as the event with justice thomas -- the opportunity to talk about a constitutional republic and the things that make this country great -- it has been a great series. today is the wrap up. i am the warm-up act. i will not pretend to get into the intellectual discussions are established panelists will be talking about, but i didn't want to talk a little bit about a perspective that comes from someone who has actually done in the house and this -- who has been in the house and the senate

with the purpose of applying constitutional principles to lawmaking. i frankly think that what just happened in this election may have preserved our constitutional republic. ms.now the intent of clinton, and she talked a lot about it, what her belief was about a constitution, and we know donald trump has talked about the importance of the constitution, and the list of supreme court justices he released gave us at least some positive indication that it was his intent to select justices that would actually carry out the original intent of the constitution. there are a lot of ways to talk about the constitution, and you will hear a lot of that today. you will look at what the constitution actually says, what it means, what it originally meant. that is an important discussion.

you will hear a lot today about how do you take those ideas -- those principles and apply them to lawmaking, regulation, civil society as a whole? but there is another layer of discussion i hope james will get into somewhat today. it is why do we need a constitution at all? why do we need a sick set of principles --predetermined set of principles? this may seem so basic, and we assume it, but i can tell you one of the big problems in our country today is those who make the laws in many who vote on those that make the laws do not understand the need for a fixed set of principles that drives a rule of law nation. one of the great ironies of freedom is that you have to be willing to obey the rules in order to have it. republic,ot have a

made up of constituencies who willingly follow the laws, no wes can constrain them, but also need lawmakers who understand the importance of operating from a set of principles, particularly in our case where the constitution is to limit with the federal government can do. i found a disturbing situation in the house and the senate -- our only oath of office when we comment is to protect and defend the constitution. we do not make any oath to bring money back to our states, to do what is best for our states. to defendis commit that constitution, yet when you leave the room after that original of, it is rarely mentioned again. if you stand up, even in a republican conference, and we are talking about a bill, and you say this is not constitutional -- it violates the enumerated powers, you will

get people look at you like you are crazy. that shouldn't be. if our purpose of being there is to act and defend the constitution. i hope these panelists, as they look at this new administration, will talk about how we can use this teachable moment for a new countryt, trump, and a as a whole, to remind them why this country is based on a constitution that is predetermined that allows us to willingly build a constitutional republic on those basic ideas and what it means -- how we can apply it in a new administration, because i believe this is an opportunity of a lifetime for us to reassert the importance and the need of a constitution in this country. -- i challenge this panel james, as you said about this today, not just talk about what

should be, but the way things are, and how do we move from the way things are in congress and america back to a constitutional republic that limits what the federal government can do. james, whooduce would be monitoring today. james swanson is a senior legal fellow. at the cato foundation, he was a senior fellow and the founding editor and chief of the cato supreme court review. he is the author of the new york best time -- new york times bestseller, manhunt -- which i understand is being developed into a nine-by television series. he is a graduate of the university of chicago and the ucla school of law. during the administration of president ronald reagan he clerked on the d.c. circuit, served as a legal advisor on the u.s. international trade commission, and in the office of

legal counsel at the legal -- u.s. legal department of justice, where he worked on supreme court nominations, which we will desperately need now. thank you james. thanks for moderating. .hanks again for the panel [applause] mr. swanson: thank you, senator demint -- your comments remind me of "the opinions of the u.s. supreme court should be understandable to the average educated american, and how many hundreds of years ago did the court abandoned the rule? perhaps they abandoned it at the outset. we have an all-star panel, and i will begin by introducing them. michael mukasey served as the 81st attorney general of the united states -- the chief law enforcement officer of the nation, an appointee of president bush. 2007rved from november until december, 2009 and oversaw

domestic and international law. he practiced law in new york for 20 years and served as an assistant u.s. attorney. he served as a district judge on the u.s. court of appeals for the southern district of new york, becoming chief judge in 2000. he is currently in private practice in new york city. and he received his law degree from yale. judge mukasey: llb. llp.wanson: we also have edward meese. [applause] mr. swanson: simon york is a

lead correspondent for "the washington examiner" and a fox news contributor. he is written on every aspect of the obama administration and the presidential campaigns of 2016, 2012, 2008, 2004, and 2000. is that enough -- the author of the vast left-wing conspiracy and account of liberal activation. a former white house correspondent for "national review, his work has appeared in the wall street journal, the washington post, foreign affairs. of the graduate university of chicago, and he now lives in washington, d.c. john goldberg is a fellow of the american enterprise institute, a best-selling author. -- nationally seller syndicated office of his regular you number hundred newspapers across the state. he is also a weekly columnist for the l.a. times and the member of the board considers to the usa today and a fox news conservator, and also on fox

all-stars and "special report."he is the founding editor of national review online. here is identified as one of the top 50 political commentators in america. among his awards, he was named the robert novak journalist of the year from the conservative political action conference. he has written on politics, media, and culture, and has appeared on numerous tv and radio programs. he is the author of two new york times bestsellers -- the tyranny of cliches and liberal fascism. john, you, as a professor of law -- a professor of law at berkeley, and the enemy of my law school, ucla. >> not in football. mr. swanson: we had the better team. >> his most recent book is --berties medassets --"

"liberties medassets." his other books include crisis."ing terror he has published numerous articles in america's top modules and contributes regulate to "rush to post," "new york times," and other newspapers. he has served as general counsel of the u.s. senate judiciary committee under senator orrin hatch, and he was a law clerk for justice clarence thomas on the supreme court and judge lawrence silverman on the u.s. court of appeals on the d.c. circuit. ale lawuated from y school. >> j.d. [laughter] host: -- mr. swanson: and from harvard.

i will pose this question ashley decided they will not make presentations. we'll get into the conversation. does donald trump's victory represent a victory for the histitution, and what will presidency mean for the rule of federalism,pect to civil rights, criminal justice, environmental law, labor law, foreign affairs, and the president's war-making powers? what about the first amendment and free speech, and the power of the administrative and regulatory state? presidencyrump's mean for the commerce clause of the constitution? a liberal interpretation causes a wellspring of much of the power of the federal government. what will donald trump's presidency mean for the supreme court of the united states? i will join the panel now, and we will start with that.

>> if hillary clinton had one this election, her supporters appointmentrst would have brought the conservative era to an end, and reverse several issues hated by the left. mr. trump's victory puts an end to those plans, but what can we expect? how will he feel the scalia vacancy? how should he approach this? his first appointment will not be as transformational as hillary clinton's first appointment could have been. his appointment will return the court to the traditional 5-4 split, but how mighty transform the supreme court with -- how might he transform the supreme court with additional appointments? decisionsect little to be overturned during the trump presidency? i will ask general mckissick to

leadoff. judge mukasey: i have one serious occupational defect that mercifully a shared by everyone here -- i've never been a supreme court justice, so i cannot tell you how they will be deciding cases after the election of president trump, however, i think it is pretty clear from the list of people that he has already proffered, , in we are going to have the foreseeable future, and theaps beyond, a return to notion of a constitution with a meaning -- a definite meaning that was put there originally. that is not going to be scrapped with the criticism that the constitution is old and short, and therefore we have to get on

with someone -- something else because society is more complex now, and the founders could not internet,ioned the jet planes, television, or any of the other wonderful things we have, and the real function of it, which was pointed out before , is to take it at its word, to form a more perfect union, to and to ensureice, common tranquility, so that exercise the freedom that they have to develop in their own way, and according to their own likes. i think we will see much more emphasis on that than a so-called living constitution that essentially means whatever a justice says it means because the criticism of the constitution being old and short

carries the day. ,r. swanson: john -- let me ask we surprise, to constitution and the vision of the court figured in the election? have we seen an election like this before, where so many people were talking about the so many people were talking about the court? i am delighted to be here. -- mr. goldberg: i'm delighted to be here. [laughter] [indiscernible] mr. goldberg: i am going to push back a tiny bit -- i agree that the supreme court in the sense verye scalia seat loomed large, particularly on the right ofng people were skeptical trump, or even harsher, as i was, that the court overpowered

all other considerations for a lot of people. whether that was always the intent of mitch mcconnell, to turn this to a referendum on a court-appointed or not, basically it worked out that way. i -- in that sense, i think trump's election is great news. i think, at the very least he -- even i, who very much and may trump scuff them, and confident he will honor his first promise to put the first appointment as a conservative. i think he has to do that. i think all hell would break loose if he did not. on the broader of -- broader question -- it is absolutely true that hillary was a grave threat to the constitution, great threat to the court. the opposite is not necessarily true about donald trump. his commitment to the

constitution rhetorically has been quite good as a member of campaign boilerplate, but he also said there were 12 articles of the constitution. i do not know that he is deeply enamored with the text. [laughter] mr. goldberg: he also has views on things like eminent domain that a lot of people are nervous about. he also has views on the first amendment that a lot of people in this room either are nervous about or should be nervous about. i think the question among conservatives and constitutionalists isn't so much what is in donald trump's heart -- that remains to be seen. surrounding him in creating the incentive structure whereby the information flow, the political decision-making process all point him in the right direction. this brings up a larger point senator demint was getting at. i agree with him entirely -- it is infuriating to me -- they be

the lawyers here -- i am not a lawyer for reasons out of deference to my eternal soul -- but it infuriates me how we have come to the point where we think the supreme court is the only guardian of the constitution. it is a guardian of the constitution, and in certain, formalistic situations, it is the last guardian of the constitution, but anyone who swears and no to uphold the constitution is a guardian of the constitution, and the citizens from home constitution derives its authority are guardians of the constitution. we have gotten into this place where we basically say anything goes unless the supreme court, like a hockey goalie, stopped it. that is something the conservative movement, places like the heritage foundation, magazines like "national review" doing much better job at in terms of creating the incentive structure from politicians.

the point of the conservative movement is not just to elect conservative politicians. it is to move the zeitgeist and the understanding of issues so that it is in politicians interests to do the right thing, and i think that is the first task for donald trump and the conservative moment -- to make sure the arguments he is hearing, the incentives push him in the right direction. i think he is open to it, and he is made promises that commit him to it. mr. swanson: can you stick to that? >> first of all, i do not think this is something donald trump thought about a whole lot. it was not a big deal in his life. he only principle in the constitution he delves into was eminent domain because it played into his role as a real estate developer every now and then, but i think the roots of his approach to this go back to the early days of the republican primary, where he is trying to consolidate the support of conservatives.

he has ted cruz, who has argued a bunch of cases before the supreme court. he has governors -- he has a lot of people who have a lot of lawrience in government and running against him, and trump is extremely sensitive to the reaction of audiences. he loves the rallies. he really notices -- do they go for this, do they not go for this -- everybody sat on their hands when i talked about this, they went crazy when i talked about that. he saw the interest that conservatives in a republican primary electorate, not the general election -- a republican primary had in the supreme court. he saw the questions that conservative organizations, publications like "national review" had about him, and the way he consolidated support was to actually release this list of justices or judges that he said he was going to appoint one of these people to supreme court.

it was uniformly well received because it was a great list, and the objection of the never-trumpers were it is a great list, but he might not do this -- i do not trust him to do this. the other thing to remember about trump and him not really thinking about these issues is perhaps his key supporter is senator jeff sessions. jeff sessions being the first senator that comes out in support of trump, kind of legitimizes the campaign, almost. he has one of the great living well is best revenge stories ever, because as a u.s. attorney in alabama he was appointed -- nominated to a u.s. district , and thanks to the kindness of joe biden and ted kennedy, he is turned down by the senate, accused of being a racist, goes back to alabama,

gets elected to the senate, he takes his seat on the judiciary committee alongside ted kennedy and joe biden. he is -- trump hiredmp, and stephen miller, a top aide to jeff sessions. rick dearborn has done work. officeart of the approach to move them toward the campaign -- talk campaign. that is good news it is good news -- four people that want to see move into the supreme court and the other courts that make a difference. mr. swanson: john, can you talk about this? >> i'm surprised so many people are here because i thought everyone at heritage was working at the transition headquarters. there is a difference, when i got to the airport i asked the

tactic cap driver to take me to trump transition head quarters, and he dropped me off here instead. [laughter] yoo: it is also interesting to spit in a panel named after senator meese -- one of the most consequential attorney general's point -- it is not just supreme court justices who are important, but also who attorney generals are -- how the administration will interpret and enforce federal law in some ways live much more immediate importance about the constitution. if you are a number general give awhen appointed, famous speech where he called for jurisprudence of original intent, which was seen as a radical concept in the late 80's. i did a study a few years ago and after general knees gave his speech, there was wide criticism

from my colleagues in the academy and their colleagues in journalism. i do not want to claim their in journalism, and citations to the federalist papers went up 500% than before. that is, in my mind, just as consequential and could have an impact on the supreme court as actually being nominated. i want to recognize general meese for that, and i think that is what we could hope for from the trust administration. [applause] the supreme court nominee is important, and the proposal i had was that if trump really wanted to shore up his support among constitutionalists and his party, if i were him, i would pick a supreme court nominee now, before he takes office, and say this -- if i were him, i would pick someone who would be easily confirmed.

i agree. a lot of the judges would be great justices, and it shows what a deep bench and how much george w. bush cared, and reagan cared about ceding the bench with these great lower court judges, but if you were paying politics, he would want to nominate a senator because only one senator, ever has been turned down for confirmation for any job, and that was john power. if he wanted to appoint senator mike lee now, i imagine he would get readily confirmed. it would not lose a republican seat in the senate, and he could keep his promise to the conservative wing of the republican party. the important thing, as he said, this is not going to change anything. it will keep the status quo on the supreme court. the 5-4 decisions that conservatives have been losing obamacare, one,

and on, will still be there because justice kennedy providing the fifth vote with the liberals, but you also have to look at who does president trump picked to be attorney general, white house counsel? because the real, important fight is going to be when the next justice retires, and if you am aat the age ranges -- i lawyer, not an insurance actuarial scientists -- if you look at the ages, justice ginsburg is 82, justice kennedy is 80, justice breyer is 78. you have to project out how long are they going to be in four years? is justice ginsburg going to stay on the court until she is 86? i do not think so. i think president trump will certainly have another pic, and that one will be the big fight. if you are conservative, you care about the constitution, you want to see who president trump is going to put in place for that seat. and there, we do not know. mr. swanson: that leaves an

interesting question about the next 1 -- recently, a new york times op-ed accused conservatives of plotting what is called a coup against the supreme court by scheming to obstruct all nominations that president clinton would have made to the supreme court. now, can we expect democratic senators to attempt the same sort of coup to attempt to block all supreme court nominations by president trump, and if that is attempted, what will set it public and do about it? -- theukasey: i don't democrats retained the filibuster for supreme court nominees, i think, against, just that possibility, although it is certainly not unprecedented for a nominee not to be voted on when there is a change of

administration coming up, it is unusual, i think to the point of being unprecedented, for them to try to block any confirmation. i think that would send -- that is a political loser from their standpoint. i do not think they would do it. that is the short answer. mr. yoo: you know, if you were president trump or a new attorney general, i think you would hope the democrats try to filibuster the appointment. i think we should also recognize senator mcconnell pulled off one of the great political maneuvers of recent time in the senate by not confirming mayor garland -- merrick garland. i think at the time, people thought this is low possibility success of working out, and instead he has really preserved the possibility, even, for us to have this discussion.

>> i think you have to take into account democratic anger over this because the judicial wars since board cap had a ratcheting up effect -- kill five hours, we will kill kind of yours, and you have a situation where democrats felt they insulted the president. scalia dies in february, and the seat is still open. i would not be surprised if democrats were inclined to try to block something, at least for some period of time, at least to get back at this. if there's one thing that is true about the united states senate, it is what goes around comes around. i like the point about where senators get confirmed -- where i thought you would go is appointing ted cruz cruz to the supreme

court, and it would happen arab magnanimity, with his -- an admin minute he with his father having killed kennedy. [laughter] there are a lot of senators that give good treatment, and there are a lot of senators that would like to get ted cruz out of the senate, and on the same principle that the only reason teddy roosevelt became vice president, the new york political machines wanted him out of new york. you can see how democrats feel he has helped me, and in the other hand -- on the other hand, i won't see him in the cafeteria anymore. the problem is i do nothing ted cruz wants it. mike lee might. he is great. >> the point on the filibuster -- if i were a republican senator, i would say we should

overrule the filibuster for supreme court nominees for the same number of years that democrats overrule the filibuster for judicial appointments. otherwise, it is a ratcheting up effect. you will never stop this derogation of the rules of the senate, and the way to restore the filibuster is to show what would happen if it is not followed. the other points -- already does not apply to lower court appointees. trump would be able to fill the bench not just the supreme court nominee, but a lot of the people to, who were also held. >> and republicans would not want to go back on that. the filibuster is not part of the constitution. it is just the senate rule. when the founders meant for

there to be a super majority to make something happen, expel a member, pass a treaty, they specified a super majority. the rules of a nomination and confirmation are simple majority vote. is one question -- can a minority of the senate prevent a civil majority from consenting a judicial nomination? can, mukasey: sure, they sure,ven --mr. goldberg: they can cap -- judge mukasey: sure, they can come and given the complexity, i think it is important to preserve that. at times, confirmation hearings lasted less than an hour. it was a long time ago, to be sure, but, i mean, it was considered insulting to put

substantive questions to a nominee. all of that ended when the supreme court, again, with the active cooperation of the legislature started expanding the range of cases, and the nature of cases that it would take to the point where political issues, instead of being resolved within the legislature to compromise and back-and-forth were handed off to the courts, the courts, of course, who would say bring the store biggest problems. we are here to solve everybody's problems national case, too big or too small, in that -- no case too big or too small, in and out by 5:00 p.m. that trend has continued, party much uninterrupted. given that, and affected be a long time before we pared back the scope of cases in the nature of cases the supreme court takes, it is going to matter who gets appointed, and as long as it matters who gets appointed,

that decision, given how long they sit, has to be one that comes only after overcoming great obstacles, if necessary. mr. swanson: john, or anyone else? mr. goldberg: the point i would make about the filibuster -- why it is important for conservatives to still supported is a symbol of how it is hardwired into the constitution. the way the senate -- it is not proportional representation. the filibuster, in a way, is a symbol of that. it is taking it further. it is important to recognize donald trump would not be president or will not become president if it were not for federalism. the other place you see this is the electoral college. hillary clinton will win the popular vote. the only reason donald trump's president is the electoral college gives more of a say over the selection of the present

than it would if we had a symbol majority election simultaneously throughout the country. it has been the liberal project for over 100 years to get rid of everything in the constitution that limits direct democracy -- against filibusters, attacking the senate, the electoral college. i think conservatives -- the original design of the consultation was it was important not to have a direct democracy, to slow down the ability of the government to act rashly. even though it may hurt us temporarily, picking supreme court nominees or lower court nominees, i think conservatives should be in favor of these kinds of checks on direct democracy like the filibuster. i would return it back to lower court nominees and legislation after the same number of years at the democrats -- [laughter] mr. yoo: use the filibuster rule for this many years. mr. swanson: guys, anymore on this?

i would disagree -- i'm sure john does not disagree, but the framing of it -- electoral issues -- the subject is to carry the ball wherever the field is open. so, when congress was the best vehicle for achieving progressive ends woodrow wilson talk about congress was important, and when he elect to be president, the presidency. the only reason i bring it up is if you look at things which are stake in all of this, let the administrative state, there is nothing democratic about administration state -- it is unaccountable. unconstitutional government violates the fundamental principle that defines conservatism, arbitration to arbitrary power, and it is unaccountable, -- completely unaccountable, and progressives have no problem building that out.

their relationship to direct democracy is entirely an argument about expediency, the acquisition of power. if direct democracy started working against them, they would stop being in favor of direct democracy. host: -- >> the last thing, the judicial issue for trump brings the team together. not every member of the senate was that enthusiastic about donald trump, but when it turns into a fight with a judge with a nominee, the team is going to be on board, and obviously the house does not have a role in that, but they will be voting for it as well. this is one area -- obviously trump has said lots of things blew upd of conservative orthodoxy on things like trade, immigration, or foreign entanglements. this is one area where the team

is together, and that will be useful for trump. mr. swanson: let's move on to a couple of other issues -- presidential power and the migratory debate. during the campaign, donald trump criticized president obama for abusing executive authority and ruling by fiat, often through executive orders. can we expect president trump to overturn many of obama's executive orders on his first day in office, and if he does, does that suggest he will be more sensitive and self-restraint about using those powers of presidential power. >> those words are used all the time about him. [laughter] mr. swanson: as a corollary to that, it has been said that congress on bended knee has surrounded to excessive presidential authority. leaving congress, not as opposition to trouble rising up against trump, do you think is possible that congress make --

might reassert its role in divided government. it is to say we are back, suppressed for eight years. first, the executive authority of the president, and what will trump do, and do you think congress will take this as an opportunity to reassert its role in government? everybody who is going to be around the president will have a list of executive orders -- in fact, i'm sure it is part of what the transition team is doing now, going through the presidential executive orders, drawing up a list of that will be written off on day one. it is going to be a long list. that said, i don't have any evidence -- i do not know of any evidence -- i would love to hear some from people who have covered this that donald trump

has thought on this issue -- the issue of presidential power, the issues that are presented by the administrative state at all. it is going to depend largely on who white house counsel is, who attorney general is -- who essentially surrounds him for what we can expect later on. as far as day one, executive orders -- those are going. i think that is fairly obvious. john question mark -- john? mr. yoo: i agree with what judgment casey said. to -- the judge to repeal all executive orders on january 1, 2009, and then go through them and see which ones you might keep, he could go further and say the president could say all regulations enacted by the federal agencies

since january 1, 2009, are no longer to be in first -- and forced, and then we will go back and see if there are any we want to keep. now, there would be a lot of people that would be upset about this, saying the president is not enforcing the law, overstepping his bounds, but i think president trump has to use executive power in the same amount president obama did just to restore us back to the proper path. the way i think about this is if you have someone that is driving any case you can miles and drives you into a ditch, you still need a car to get you back onto the road. i have no problems with a president when it uses a can of power to reverse the harm of the last eight years. one thing he could do that i think would be ok, which i think the president could do under executive powers, to make the iran agreement on the first day of office. mistake by made a not seeking congressional consent for the iran agreement. in fact, a majority of the house and senate were against the iran

agreement commend president trump could say he is doing what congress wanted. he could also say i am restoring immigration enforcement back to the normal amount. he does not have to make a change from what it used to be. he just says i'm repealing the? orders and restoring immigration informant to the normal priorities, which was focused on felons. i think he should restore normal criminal law enforcement, although there is a wide and -- radical idea that he should pardon hillary clinton for the idea of being the past behind us, and also make clear that she committed crimes. [laughter] judge mukasey: interesting, if she did -- if he did pardon her, she would have to accept that. i am deadly serious about that -- he would essentially have to acknowledge that crimes were committed. maybe if enough detail were recited in the pardon of what

she was being pardoned for, it would save us all a lot of time and trouble we might have to take to explore precisely what went on there. jonah, byron, let's hear from you on that? mr. goldberg: on the pardon? mr. swanson: on any of it. james swanson on the pardon -- mr. goldberg: on the pardon part -- something he does not have to stick to, he will do a special present you are on hillary clinton -- it depends on how bad you think the crimes hillary clinton committed actually were, and how intricate barack obama -- implicated barack obama is, but there is significance that it could force barack obama to pardoning hillary clinton. the pardon is a brand -- it is not quite walking through kings

landing and saying shame -- sorry "game of thrones reference" -- he would be a problem for you. politically, it would be kind of brilliant. partrms of the previous about trump and the idea of his commitment to these issues -- again, look, i'm entirely open to giving donald trump the benefit of the doubt. the never trump thing is over by definition. [laughter] >> i do not know if it is over for him, though. i. goldberg: tell my wife love her, if i suddenly disappear. [laughter] is youdberg: the issue have to surround the guy with the right personnel, and most of these problems get solved that way. i know this is a cool by you moment for the right, but i was

deeply troubled during the primaries during the debate where after months of donald trump talking about waterboarding and worse -- much worse -- and not for interrogation purposes, just as a sort of, we're going to punish these guys -- they are cutting off heads, so we will do bad things, too, which i did not think was an active statesmanship, when confronted about the fact that he would be asking his military to commit war crimes that have no statute of limitations, his instinctive response was to say "they will follow my orders." i do not like that instinct. i do not trust that instinct, and this gets us back to where i started. we all guardians of the constitution. i do not like it when george w. bush said he thought parts of mccain-feingold were unconstitutional, but he signed it anyway. that was a violation of his old. it depends which donald trump shows up, and at some point this

is a guy that trust his judgment and instincts over everything else, and his commitment to constitutional norms, i think -- the most generous i'm going to say is they are notional. that is going to require some strong will from people around him to stand up for principles they believe in, even when the commander in chief is telling them something else. i hope it does not come to that. i think a lot of the other stuff can be fixed through the bureaucracy, the staff -- he has told people he will not be a hands-on, day to day guy, but there will come a time or his commitment to these kinds of things will be tested, and it will require men and women of good will to do the right thing, and how that plays out, i don't know. i think it will happen, and we should be on guard for it. the nature of, campaigning for president is not consistent with the idea of

limited executive because the candidate says i'm going to do this stuff -- do this, do this, do this, and there is not talk of if congress lets us do this, if i can get over a filibuster in the senate, blah blah blah. with trump, that is another issue because he has actually been an executive in the business sense of executive. a group of liberal billionaires who got together during the bush years to try to create a new liberal group to funnel money into fighting bush, and they fire the newly hired executive director because she told a billionaire joke at the first meeting -- what is the difference between a terrorist and a billionaire. the punchline was you can negotiate with a terrorist. [laughter] so, if you are a billionaire, you are not used to

having people tell you you cannot do this, you can do that. on the one hand, you have that with trump. on the other, a lot of the things he has pledged to do are entirely consistent with republican doctrine on these things. he talks a lot about the and-regulation of business, he is talking to audiences, small businesses -- not his own, but small businesses. lot abouthe talks a judges that will respect the constitution. he talks a lot about obamacare, and the burdens that it has placed on business. jonah says what about what he says -- a lot of the things he says is quite right, and we have gotten an idea nudges per se, but from people around him, that he realizes he -- idea not from him, but from people around him,

that he realizes he has to work congress, and after his win, which was a shock to many republicans, they will get on board, and working with congress will not be as hard. paul ryan,u saw yesterday and say the name donald trump repeatedly -- something that almost never passed his lips before -- indicates that trump will come to washington as president with a lot of republicans who will be willing to vote for his agenda, in other words, to do with the right, constitutional way. mr. swanson: does anyone else want to pinpoint any other constitutional issues under the trump presidency that are of interest to you, or think we should look out for or talk about? john? mr. yoo: ardent hillary, terminator ron agreement, restore immigration enforcement -- iran agreement, restore immigration enforcement. i think the other issue, his

relationship with congress -- are nothing would be a bad thing for president trump to let congress take the lead on how to repeal and restore the health care markets in this -- in our country. i think that is the original constitutional design -- if you look at the way it is designed, it does put the president in the place of the initiative on foreign policy, but on domestic policy, the president's real role is to have a qualified veto over legislation. the constitution designed congress to the initiator and primary weight of gravity in our system for the passage of domestic law. so, why not -- a president trump could be quite magnanimous, and also restore the constitutional balance by saying i will let paul ryan's plan be the blueprint -- which i believe is a national healthcare voucher, or block grants to states, but let congress -- it would allow him to look at the whole thing

after the sausage is made on health care -- he could do that with a lot of other areas. welfare reform, infrastructure bill, cutting taxes. as a president, it would be wise to let congress to the messy job of making the compromises, and then toward the end of the progress that process, since the president and the congress are on the same party, he could then intervened. i think there would also be important because it could potentially allow the states to restore them to their proper constitutional role, especially as the ryan plan -- the framework they put out in their election were to be followed looks to turn a lot of federal programs and to block grants for the states, which allow president trump of -- to get out of the messy business of saying health reform has to have these five things. let the states decide,, the constitution be restored to being -- allowing the

constitution -- the states be the laboratory of democracy. judge mukasey: one area where i did nothing he will be able to leave it to congress has to do with electronic surveillance program, and terrorism measures. there, i think leadership will have to come from the executive, and i have not heard a whole lot about what he intends to do, but -- ournow -- we have interrogation program is limited to the army field manual, and we stripped away a good deal of and will probably strip away more from the nsa, check think was a mistake. i think the: 30,000-foot approach that john was talking about, since trump's approach. he is not thought deeply about reforming health care.

in the second debate -- he talked about obamacare, and the lines between the states -- something he used in republican debates, and it is kind of clear that his understanding of it had not really deepened since the republican debates. so, it had been months, and he is time for a general election debate. obamacare was a big deal, and he still had not. the question is what is -- his actual inclination is once he finally is the president. if you read "the art of the deal" he talks about in detail what kind of marble he would use here, the metal here, the windows in another building their he was actually quite detailed--- building. he was exley quite detail oriented and a lot of these things. i cannot tell you what his approach is going to be because he will be approaching issues he never dealt with as a private citizen, and of course a lot of presidents are the same way -- they never dealt with this issue. byron raises a

good point that touches on the constitutional issues, but a lot of the issues. to -- what is in his nature? one of the few things we know about donald trump is he likes to build really big things, put his name on them, and take credit for them, even when other people build them. and he likes to make deals. one of my concerns from the very beginning has always been -- you look at the infrastructure saying, which i think is going to be the equivalent of his no child left behind -- he has talked to pelosi, schumer -- it is a deal he can do that shows he is bipartisan, all the rest, gets people working, and build lots of things he can put his name on. i do not think it is going to happen for the first supreme court justice, but i have always worried that down the pike chuck schumer says you

want another $1 trillion for bridges and airports, and we will name the new airport the trump international airport, and we use the best marble -- [laughter] mr. goldberg: all you have to do is meet us a little ways on the next supreme court justice -- it does not have to be a liberal, , and sinceouter -- he does not care about these issues, and every thing is a negotiation, the potential for a deal, i worry about his reliability on these things. i hope to god i am proven wrong, but that is -- he is a lifelong democrat from new york who likes to cut deals. that, again -- i know i am a broken record on this, -- requires very good signaling from the right about the deals he can get away with and the deals that he cannot. the relationship that the conservatives have now with

donald trump much more reminiscent of the nixon administration, which is fitting, because he is surrounded by a lot of nick so means, uses the rest. richard nixon hated the buckleyites, the right-wingers. he said so in numerous interviews. but he also knew he had to deal with them. in my view, once the honeymoon is over, conservatives need to be set up in a situation where he has to deal with us and get our approval on the important things. then everything else can be a negotiation. >> we will leave it on that because we have save time for audience questions. we will do about 10 minutes of that. we have microphones, they will come to you. you must ask a question. if you choose to make a statement, i will move to the next person who really wants to ask a question. wait for the microphone.

my name is joshua. professor, you spoke about the valley of a filibuster for supreme court nomination going forward, even if it short -- hurts us in the short term. harry reid was saying before the election, if the democrats took the senate, they would get rid of it. i don't know anyone with confidence that the democrats will leave it in place, so what is the value of that? i want to be clear, i was in favor of repealing the filibuster for supreme court nominees. i actually would like to get back to a state where there was a filibuster. the senates he said has its own rules. the only way to get changes in the senate is tit-for-tat reciprocity. until you get the democrats to

see what the world will look like when the republicans have a non-filibustered senate, they will never be persuaded to go back to how it was. right, in the end, republicans like having a non-filibuster world so much they go to that. in the longer run it, it is better for our republic to have a filibuster rule in the senate. the democratsntil get a dose of their own lesson, they will not. wiser heads may prevail. questions? there was some discussion about the electoral college. trumprse, president-elect will not be president-elect until the official vote on december 19. there is some talk about

electorates changing their vote for hillary clinton and the penalty is a small fine in each state and the clinton people would be glad to pay those fines. [laughter] besides the unlikelihood of that happening, what do you think about that in terms of the structural place of the electoral college, to allow that to happen, and also the fact that donald trump himself in 2012 said the el toro college would be abolished when the run the election was going on? jump on the grenade. as a matter of conservative nostalgia, i long for the day for more robust, small r republican institutions. i would be happy to get rid of the direct election of senators. as a person who actually lives in the 21st century, this particular medical climate and context, where we have had a populist president running on the claim that the system is

rigged, to have a bunch of rent-seeking corrupt party hacks and bribed into stealing the electoral college from donald trump seems like you would hear it a deafening click on the safeties of rifles across the country. it seems ill-advised. [laughter] >> my name is did kaufman. i'd like to follow up on a point that general mickey z made -- general mukasey made about our national security, one of the places in the constitution where the president is clearly in withoutf that, with or congress, except in treaties, and so forth. our national security is kind of

a mess right now. the military is in trouble. our foreign affairs in the middle east, are in my view, a mess. where, in your view, does donald trump go in this area, the security of our country, our people? counterterrorism is clearly an important part of it. i have written books that no one has read about this. [laughter] the one thing that i think historians will say is remarkable about the obama years the thingsa lot of that he things will be his legacy are so quickly reversed. that is because he chose not to work with congress. the president has the initiative in foreign affairs but it does not stick on this congress agrees. the first day in office he said on closing guantanamo bay. -- from whaten donald trump has said -- will be open, and he may franchise it to friends and other countries, put

his name on it. [laughter] >> i think it is going to be a casino. a lot of these powers are in the president's hands to start with, but even with surveillance, it took congress and these amendments to put them on firmer footing. you will see a lot of presidential power, and part of -- because he's did not in a quick congress. his major legacy is going to be the effort to make peace with iran. president trump could even reverse president obama's choice to recognize cuba. that is also within presidential power. but he still needs congress' cooperation. the obama years saw a dramatic cut in spending on the defense and the readiness of the military. president trump cannot just ordered the military to get

bigger. the constitution gives the power to congress. even if president trump wants to restore our defenses, he needs the republican congress to boost defense spending. >> [inaudible] >> i think it is still on youtube. take a look at president obama in his first day in office signing the order closing guantanamo. he staggers through it, reading it -- by the powers invested in the -- and he signs with a great flourish. greg, a reference to his white house counsel -- do we have another order saying what we're going to do with these people? this is for real. a voice off-camera says, we will

have procedures. you need to think it through really carefully. >> i question involves regulations that carry criminal penalties. there is no -- we know over criminalization is a hot topic now. do you see a trump administration rolling back some federal regulations that carry criminal counties, specifically epa velti's -- penalties? >> i would think that is at the top of the list of anyone to do, anyone that has been close to him. i think a lot of them are going to go. >> one point that was made

earlier, we can talk about restoring republican government and so on, but the big aberration of our constitutional system is the administrative state. what we have had for the last eight years is a president who doesn't want to control it. what we saw in the obama years was an administration that let things run wild. actuallyident clinton saw in his all actual interest to keep some limits and control in the administrative state. one thing that a president trump can and should do, as reagan did in 1981, is to come into office and say regulations are choking on economic growth. it is almost like an emergency measure. i am going to call a halt on regulations and subject -- in the white house. liberals went nuts when he did this. they said he was overthrowing

constitutional government but that is a key thing that president trump has to do. all of these regulations we are halting enforcement until we can get a handle on which ones make sense. i will subject all of them to a top cost-benefit review. easing criminal penalties goes way beyond what is the pale. an administrative agency can define criminal law and the penalties as a violation of the original constitution. trump'sit is also in electoral instance, it he was elected by people not experiencing economic growth, cutting regulations is a great way to try to jump start the economy. >> what you describe is consistent with what he says on the stop. that is what he says he will do. >> did i see somebody in the back? there was somebody in the last

row, in the corner. >> going back to the topic of supreme court nominations, wondering if any of you could comment on the possibility that republican senators would invoke the nuclear option to bypass the filibuster, and any ramifications that may come from that? >> 1st united a filibuster that actually works. that democrats would do it. they get 41 senators to do it, they would only have the eight. it is not clear to me that they would do that. as i said before, i think they will want some measure of revenge for the american garland thing. i don't know what form that would take. unclear, but getting the trunk nominee, the scalia

seat nominee onto the court, could take a while because democrats will be in no hurry. isn't that elect early dangerous for democrats? with so many seats coming up in the senate, if you are a republican politician, would you be glad if they tried to sel filibuster? this could be like 2002. inthey are up in 23 states, 2018. on the other hand, this vacancy is already there. it has been stewing for a while. the next election is not until two years from now. i think a lot of democrats can think they can do this and it will be a big problem. someone on the back wall. i think this will be the last question. regulatory front,

given the democrats are so apocalyptic about president trump, do you think they will actually work with the republicans in the congress? the judiciary committee and others pastor legislation. do you think the democrats actually might work with republicans in congress to pass these things, to reign in the executive? two, are we sure president trump would sign a bill to rein in the executive authorities in independent agencies? >> the smart answer is i don't know. it.ink he would sign it congress put together a serious thing, particularly one that has democratic buy-in. why wouldn't he signed it? at the beginning of your

question, you raised an important point that touches on byron's answer about the supreme court fight. we have already seen it in the last 24 hours, and it will get worse. i am trying my best to say we only have one president at a time. if bernie sanders, hillary clinton, and barack obama can give donald trump a chance, so can i. i hope i'm wrong about everything, and that would be great. i thought his victory speech was a nice start. but we should prepare ourselves for the fact that the left is going to lose its mind about donald trump. last 72 hours -- there is a school on the upper west side of manhattan where all the kids are singing "we shall overcome." of teeth andhing rending of clause, people looking to see if the hudson is going to turn to blood.

mayidea that the left create an incentive structure opposeocrats to just trump on every single thing, and that includes the supreme court justices. there is going to be a popular culture fight about donald trump , where hollywood and the left are going to try to make it seem like this is 1932, and he must be stopped. dangerous, and, b, profoundly hypocritical. i was told the last eight years that any opposition to the present was racist. i've been told in the last two weeks that any talk about saying how the results of the election are unfair or should be like this in turn the founding fathers.

now we have people openly going saying, he isews not my president, he is not the president of the united states of america, hillary clinton won the popular vote. it seems it is ok to question as long as it's a republican. anyway, get ready for a madhouse or a while. how that plays out in the senate fights and all the rest, whether he signs bills, whether it gets to donald trump's head and he has to move to the center to placate people, i don't know. >> it will unite republicans more. the national review will be cheering on president trump in that congress. any final comments? >> let's thank our panelists. [applause] [captions copyright national cable satellite corp. 2016] [captioning performed by the national captioning institute,

which is responsible for its caption content and accuracy. visit ncicap.org]

the heritage foundation wrapping up a discussion on policy implications of the 2016 election as president-elect donald trump arriving in washington, d.c. today for talks with president obama and congressional leaders. here is a headline from politico. trump's first test as president-elect. the billionaires pat day in washington is his first chance

tophow he can do america's job. a look at reagan national airport in washington as the trump plane lands, bring the president-elect to washington, for this first day really of the transition period to the trump administration. after their meeting, the president, barack obama, president-elect trump, spoke briefly to the media in the oval office. we will take a look at that now. >> tell me when you are ready. ok. opportunity to have a conversation with president-elect trump. it was wide-ranging. we talked about some of the organizational issues in setting talked aboutuse we foreign policy, we talked about domestic policy, and as i said

last night, my number one priority in the coming two months is to try to facilitate a transition that ensures our president-elect is successful. encouraged by,y i think, the interest in president-elect trump wanting to work with my team around many of the issues that this great country faces. i believe that it is important for all of us, regardless of party, recurrent this of political preferences, to now come together, work together, to deal with the many challenges we face. in the meantime, michelle has had a chance to greet the incoming first lady.

we had an excellent conversation with her as well. we want to make sure they feel welcomed as they prepare. most of all, i want to emphasize president-elect, to want to are going do everything we can to help you succeed. if you succeed, the country succeeds. >> thank you very much, president obama. this was a meeting that was going to last for maybe 10 or 15 minutes, and then we were going to get to know each other. we had never met each other. i have great respect. the meeting lasted for almost one hour and a half. as far as i'm concerned, it could've gone on a lot longer. we discussed a lot of different situations, some wonderful, some

difficulties. i very much look forward to dealing with the president in ,he future, including counsel to explain some of the difficulties, some of the highflying assets, some of the really great things that have been achieved. a president, it was a great honor being with you. i look forward to being with you many more times in the future. >> thank you, everybody. we are not going to be taking any questions. thank you. >> president-elect donald trump and president obama in the oval office after a meeting. as you heard, lengthier than originally expected. mr. trump in washington, d.c. today also meeting with congressional leaders.

he was to have met with house speaker paul ryan a short time ago at the capitol hill club, then was headed over to the capital to meet with senate majority leader mitch mcconnell. leader mcconnell tweeting this earlier today, looking forward to meeting with the president-elect donald trump and vice president-elect mike pence this afternoon. that meeting set for the capital. of "theet from sarah ," that houseimes minority leader nancy pelosi and today ande by phone agreed on the need to find common ground. we continue our coverage of reaction and analysis of the election, 2016, of donald trump office of 45th president of the united states, to take office in january.

6:45, up this evening at live coverage of a smithsonian associates event. thatpundits, journalists have followed the presidential elections will talk about lessons learned in the 2016 election. live today at 6:45 eastern time here on c-span. futurist andre author ian morrison and state medicaid professionals from florida and hawaii talk about the future of the health care system and medicaid. >> good morning, everybody.

how are we doing? thank you. welcome, good morning. see on day twoo of the public session, day three for the state folks, technically day for for the people on the been a longit has day, fantastic conference. extremely well attended, extremely informative, insightful, and hopefully educational and entertaining conference. on the last day, which is election day, we still have it looks like pretty close to 1000 people here, which is fantastic. it means the appetite to learn about medicaid and the opportunity to think about the future of medicaid and the health care system is still relevant and interesting and a

priority for all of you. i am personally very pleased and happy about that. again thank you all for being here. i will not take up too much time the nextreally tee up session which i'm excited about. just as a preface, similar to the session that we kicked off , therday with sam discussion around the dreamland, the next session is part of the brainchild of our board , who is always pushing us to do something a little ,ifferent, more provocative something more thoughtful, interesting, and not just a panel of people talking about an issue. withid, let's engage thought leaders, let's think about the future. i started thinking -- who might that be?

the name and the person that i kept circling around to is a dr. ian morrison, who is a noted author and futurist, prognosticator of all things .ealth care i have been talking with him on and off for a number of months, trying to find the right opportunity to do this. fortunately, he was able to be here on election day. the is not going to be future of what happens after the election, that is not the crystal ball we are doing today, but we are looking out to the near and somewhat distant future of a lot of important health care issues. he has a number of slides, he will talk through, and i remember i was talking to the plenary speaker at the upcoming , and i was telling

her what the agenda was going to look like i said we would start the morning off with the health care futurist, dr. ian morrison. she said, he is fantastic. he had him come over and talk to us, it was wonderful. so i'm super excited about this. going to have, dr. morrison will come up here and prognosticate a little bit about the future of health care. to then we are going to turn two reactors to be able to listen to what he said, take it all in, and then either agree, disagree, but ground what he has been saying about the future with the reality in state medicaid programs today. so our two reactors will be justin senior con medicaid director in florida, interim

health secretary in florida, and judy mohr peterson, the medicaid director in hawaii, prior to that the medicare director in oregon. they are both long serving medicare directors, long serving members of the namd board. they bring a wealth and a breadth of experience not just as blue states and red states, not just east coast and west coast and pacific coast but also a debate about who has got the best beaches and who has the warmest states and who has the best state to move to. the two of them will take turns reacting to what we have seen, and unmoderated and back and forth amongst the three of them to take some of these things forward. i'm really excited about this.

i will get off the stage and out of the way and turn the microphone over to ian morrison and say, welcome, thanks for coming. [applause] >> thank you very much. what a pleasure and honor to be here on a momentous day. i am a professional futurist. my definition of a futureist is an economist who couldn't handle the calculus, basically. i'm in the sweeping generalization business. a lot of people ask me, how exactly did you become a futurist? my major was geographic and economic change in scotland, 1580 to 1830, which is incredibly useful. [laughter] as useful training, i've been a student of structural change in society for 40 years.

i left scotland in the late '70s, moved to canada and they let me in partly because i had an urban planning degree. they didn't need them in vancouver where i moved to. they needed them in the yukon. i was not going to the yukon. i ended up getting a job with the management engineering unit 13.1, which was the canadian equivalent of the kgb, spent seven years in an academic medical center doing clinical reengineering before it was called that and working on my doctorate in health policy and health economics. then i got an offer to join the institute for the future, the modestly entitled institute for the future to work on a project called looking ahead at american health care. the robert johnson foundation sponsored. i basically have been doing that ever since. i have been looking ahead at american health care at the

institute for many years. i ran the health program there. i was ceo in the '90s. for most of the last 20 years, i have been a free-floating radical. i come in for a day, insult people and leave. it is about like newt gingrich but at a lower price point. i don't consider myself a deep expert on medicaid. i work mostly with the private sector players, whether provider systems or health plans. it is an honor to be here. i care a lot about medicaid. i was on the board of the california health care foundation for a decade. obviously, we were very interested in that. i currently serve on the board of the martin luther king hospital in los angeles. medicaid is the gold card for us, mlk. i sit on the long-range planning committee at the stanford children's hospital. i do care a lot about medicaid but i don't consider myself a deep expert. let me share with you the basic

rules for futureists. you should make forecasts for things that are far off so people can't tell if you are right or wrong. make so many forecasts one of them have to be right. never give people a number and a year in the same sentence. that's a very important one. whatever you do, don't talk about elections the day of an election. [laughter] it is kind of a stupid thing to do. i'm going to violate that by talking about the election. i want to give you a sense of what i think is going on in the field in health care, more generally. i think we are making progress. i'm more excited now than i have ever been in my 30 years in the u.s. i will close by giving you my, as an outsider, the takeaways for medicaid and then we will hear from our distinguished colleagues. elections matter. i'm in a partnership with the harris poll and the harvard

school of public health for 30 years. harvard always says that elections matter. by the end of the day, which is by the way, the most overused phrase by pundits on cnn. at the end of the day, we will know whether it is a blowout for hillary clinton or whether it is brexit. brexit is particularly poignant for me as a scot, because you will recall that the scot's voted overwhelmingly to remain in the european union. as been the londoners. it was the rest of britain, particularly england, that voted against it. i will remind you that donald trump visited turnberry not by accident, i would say, the day after the brexit vote just arrived in scotland. the place is going wild over the vote. about to take their country back, just like we will in america. no games. you have to remember that the

scot's voted overwhelmingly to remain. my scottish colleagues raised the bar in terms of profanity and creative use of the english language. if you go on twitter, i wouldn't read them all. they were not particularly impressed by that. it is instructive to look at what happened with brexit. a vote about the future and the people that overwhelmingly voted for this were old people. they are not going to be in the future very much longer. yet, the vote was amongst young people disproportionately towards remain. what we saw in the brexit was the places with the most elderly people and fewest college graduates and people identifying most as english, set a nationalism measure where the areas that went towards brexit. there may be a metaphor and mr. trump has said brexit times five. we will find out by the end of the day.

as i mentioned, i've had this partnership with the harris poll in harvard for a long time. my colleague, bob landon, who has this great new project he is doing with politico, did a survey a few weeks ago, which really captures the differences and the deep divide in the country with regard to how the electorate think about the affordable care act. trump voters disproportionately think it is going very poorly. clinton supporters are on the other side of that argument. it turns out according to bob's analysis that the fundamental dividing line is attitudes towards the role of government. if you believe that government should play a bigger role, you think the affordable act is doing okay. if you believe the government should play less of a role, you think it is doing horribly. it is not like you have made a systematic judgment based on evidence. it is more about the attitudes towards government and the role of government in health care. that spills over into what should happen to the affordable care act.

people that are supporting trump generally want to repeal it or scale it back. people supporting clinton want to build on it or go even further. so those are the divides in the country. as bob taught all of us, those of us that have the opportunity to work to work with him over the years, the only time you see major changes in health policy is when you get one team running the table. the question is, is that going to happen this time around? let's just play the extremes. if democrats were to win and win the senate, unlikely they will win the house, you would probably see an expansion of subsidies to shore up some of the affordability issues. you would probably see subsidy to shore up in the deductible issue. perhaps expansions for groups previously not covered. more funds for prevention and certainly attitudes nationally

favor action on pharmaceutical pricing. the cadillac tax, in our view, the group that i work with basically, is not ever coming back, no matter who is running country. there may be a lot of talk about public options and single pare but they wouldn't do anything. the real question, i think the question for the country that will be decided by this election maybe more states will expand medicaid. we will hear from our good colleagues in a second as to whether that is real or not. if republicans were to win and run the table, i think they are going to get rid of obama care. they are certainly going to change the name. i can't imagine trump is going to talk about it. it will not be hugely popular to call it obamacare with trump in the white house. it is hard to know what they would do really if you want to go on my website, i did some fake interviews with donald trump i found amusing. anyway, again, i think the mandates would be gone.

it would be shifted to the state level. we are going to get rid of the lines and it is going to be beautiful, beautiful, beautiful. i'm confident in that. the real question is, are rich people going to keep writing a check for poor people? are we going to see coverage continue and subsidies exist going forward? the best analysis i have seen by various reputable sources, if hillary wins and we have team "a" in the white house, coverage might be expanded by a further $9 million. if team "b" wins, we may lose 20 million uninsured. that would be sad. i think we have made significant progress. like it or not, obamacare has reduced the uninsured across the country. i spend a lot of my time in board rooms with large provider system. you can see it, depending on which state you go to the impact this has had. it has been achieved through both exchanges which have had a

rocky time in this third or our third year now. mostly, through medicaid expansion. that is the big story. very few hospitals will say, i have seen a huge number of exchange people coming through. not so much in florida. it is a big deal in florida and texas. what they really have seen is an expansion of medicaid. you have heard from the officials at cms and other experts, is this massive move toward payment reforms, which i think is irreversible and will continue under any political scenario. partly because it has been reinforced by the behavior of people on the grown. the people i work with, the large integrated delivery systems are quite committed to a move away from unfettered fee for service. let me give you two signal conditions. the fact that dan malton runs memorial herman is retiring and was replaced by ben chu who ran

kaiser. similarly, joe allison, the great ceo of baylor, scott, and white, is retiring and they have recruited jim hinton, who ran presbyterian in albuquerque, one of the large integrated systems in the country. that is a signal that the boards of these major institutions see a future very different from the past. the other thing we are seeing is this massive consolidation going on across the country. i will say more about that at the plan level, but more importantly at the provider forgetand we sometimes that there is this indoor miss long-term secular shift away from inpatient to the annual tory environment. i drop my wife of at the hospital, i waited till she was out of the o.r.

i had to go to another meeting and a friend picked her up. she was back home by 11:00. if you had knee surgery in scotland, when i was a kid, i would be in hospital for six weeks. so the world has changed significantly. the other big change we sometimes miss that was really generated by the affordable care act -- not the affordable care act but the stimulus bill on the high-tech act was the ubiquitous deployment of electronic health record. we at least got into the 20th century, if not the 21st century. the work that needs to be done in my view is enhancing the consumer and provider experience in health care. what we have seen is a megatrend, particularly in the employer-sponsored insurance market, is the shift toward high deductible care, which is a very blunt instrument in my view and has not been particularly effective. it has been effective in containing employers cost but it has not necessarily been the best thing for the people who are receiving care. the other point to note is that

we in health care, we don't exist in a vacuum. i live in menlo park, california, ground zero of google and facebook and venture capital. a massive amount of money has been put in consumer facing apps, partly because we in health care -- think about how you run your own life. everything you consume or interact with your family or reservations for travel or restaurants is done through your phone. yet, when you have to deal with health care, you have to step back into another century, deal with people who are writing things on white boards in babylonic cuniform and faxing things to each other. the fax machine should have been out of business 25 years ago. yet it is the life blood of , american health care. you have to show this in some states to prove that obamacare did work in terms of reducing the uninsured. the biggest reduction in the uninsured since lbj.

i need not tell this group the , uninsured reduction was more significant in states that expanded medicaid than states that did not. that, i think, is the important back drop on this election day. so from my perspective, here are the stories i'm seeing and hearing in my travels across the country. some of this is just based on what i'm hearing. also, this partnership i have with harris and harvard, we survey every year doctors, consumers, employers and hospital leaders. i am going to give you greatest hits about those and spend a little bit of time on shallow pocketed consumers. the reason why i think it is different this time with all this health policy stuff is a pretty simple fact. the average american family cannot afford the average health insurance premium. you think about that for eight nanoseconds, that's a wee bit of

a problem. the average french family can afford the average family because it costs half as much. median dpo policy for a family of four in the employer market is $18,142 in the employer market. does not compute. what we have done is see this she wanted increase in unaffordability of premiums. the green line is workers contribution compared to the blue line, health insurance premiums generally. the green line being above the blue line means there is cost shift to the employees. the boston two lines are overall workers earnings and inflation and, of course, they are way, way, way less than the increase in premiums. again, the average family, therefore, hasn't had a wage increase, any increment in compensation came in the form of health benefits. this is the point we are at now where the kaiser family

foundation, up around 18, 142. including what employers and workers pay. that does not include out of pocket costs. if you use the millman numbers, you are up around $25,000. what is corporate america's idea? to shift the cost to consumers. we are at the point now where 50% of the workers have a deductible of $1,000 or more, 29% of a deductible of 2000 or more, 20% of $3,000 or more. why is that significant? median households don't have $3000. they don't have that in financial assets. that's why what we have seen is that they forego care. this is not our data but data from the commonwealth fund. if you look on the right-hand side of the chart, this is people who have jobs, who have health insurance, who are doing it right. they just happen in the case of the dark blue line to make less than 200% of the federal poverty level.

if you are in that category, about half of folk in that category have foregone care of one type or another. had a problem but didn't go to a clinic or fill out a prescription, skipped a test or treatment and didn't see a specialist. it would be lovely and convenient for economists, and a beautiful thing if they were only foregoing unnecessary care. but that is not what happens. when i was on the board, we gave the rand organization $3 million to prove the obvious, which is when people have to pay out of pocket, they don't get stuff. some of that matters to their health. let me just say, when it comes to consumers, i hate satisfaction surveys. just hate them. why? because they don't move. we waste acres of real estate doing these satisfaction surveys an they don't move over time. why is that? americans are nice people. you want to see dissatisfaction, go survey the french. [laughter] they're pissed off about

everything. the reason we do it, occasionally you see a movement. we did see a significant drop in the last couple of years in the percent of americans that say the insurance plans meets my family's needs very or extremely well. that was particularly acute for exchange folk. i would point out that people on medicaid are as happy as people on commercial plans with this. they are much more positive than people on exchanges. in fact, when we look -- what we like is not satisfaction surveys. we put together this emotional scale that we ask consumers about and the question is, how would you describe your feelings about the health care you received today, including how much you pay for it and the benefits you receive? please select all that apply. this is going to come as a complete shock to the men in the room. you can have more than one emotion simultaneously. [laughter]

women understand that. men have a great deal of difficulty with that concept. they have trouble coming up with one emotion at a time, let alone more than one emotion. you see what you would expect as a social scientist. you see a normal distribution around the stuff in the middle accepting mutual re-sign. you don't see many saying they are empowered. a surprising number say they are powerless, depressed and angry. i put the california numbers to brag about as a californian. the reason the numbers skew more positively in california is we have kaiser. we have hmos, which are generally not high deductible and we have a much higher penetration than most other parts of the country and we have medicaid that's huge. a third of californians are on medicaid. all of those reduce the out of pocket cost burden which i think tracks to satisfaction and we know when we break this out in our survey by class of

insurance, it is ironic that the people who skew more positively have public insurance, not pry private insurance. fewer people with commercial insurance are hopeful and as many are powerless. the numbers for public insurance, rather, tend to be slightly better on the positive side and less negative on the negative side, which may be a function of expectations. one of the things we know from consumers. we have a very big sample in this survey. one thing we know about consumers that is sort of interesting. the role out of pocket costs plays. 28% of americans have received a balanced bill for care they thought was covered. if you are in that category, you have much less to say you are powerless, depressed and angry. similarly, about 8% of americans went to see a bill for hospital services not in their work --

network, even though it was in that work. the ultimate example of this was a woman went to see her physician. he said, oh, yes, i can take care of that problem. she made sure. she had a ppo, went to choice, made absolutely sure the doctor was in network. she had this problem. the doctor said, i can take care of that. go to my surgery center on the second floor where he suddenly was out of network and sent her a bill for $18,000. didn't resolve the problem clinically. she had to go to a hospital. this time, she is really making sure that the surgeon is in network and the hospital is in network only to find that the anesthesiologist and the second assistant surgeon were out of network. they sent her collective bills for $24,000, all perfectly legal. this has caused some states like new york to pass the no surprises law which tells you you have to inform the patient in advance they are going to be screwed by the second assistant surgeon.

i am sorry. transparency is not a solution here. that's wrong in my view. these hospitals are conspiring to defraud patients. so the other thing we found in our survey with regard to this out of pocket cost stuff, we found a group of patients, about 10% of the american public who use the health system and have trouble paying for it. another word for them would be patients. almost anyone admitted to a hospital or has a serious procedure done and makes less than $150,000 a year is going to be in this category. they are not all on medicaid. in fact, fewer than average are on medicaid. they are disproportionately uninsured to be true. most of them have employer-sponsored coverage. if you are in that category, you skew very heavily to the negative end of the spectrum of

powerless, depressed and angry. what do consumers want? in a word, they want cheaper. we put them through a tradeoff exercise. i will not bore you through the details. basically, you can have this or that. you can't have both. which do you prefer? you do that over a big enough sample and you reveal relative preferences. what they tell us is give me low premiums, low deductibles, low co-pays, and i will trade off choice for cost. that is basically what the story is. one of these things we found is the one thing that seems to have bipartisan support amongst those that vote republican, democrat are independent is reducing out-of-pocket cost. that will certainly be a focus if hillary clinton i elected president. i am not going to go into as much depth as the other stories. i want to hit on a few of the trends we think are important

for the market to watch and have some implication for all of you and your roles. the first has to do with consolidation. we are seeing this at the health plan level, although i think one or two of these mergers might not be consummated because of resistance from the department of justice. i was talking to a liberal group of doctors at ucsf a couple of months ago. i said, the good news for you liberals is, we are going to have a single payer system. the bad news is, it is united health care. [laughter] i'm not really that worried. the doj lawyers called me. i said, i don't have a problem with it. as long as there are three of them, it's fine. what i'm much more concerned about is what i see in every market i go to. i go it a lot of board retreats with a lot of hospital systems across the country. what we are seeing here is the creation of 200 large, regional, integrated delivery systems that are coming to dominate the

landscape. when i say dominate, it doesn't mean everybody is going to work for them. certainly, we are seeing doctors running to hospitals to huddle for warmth. we are seeing hospitals consolidating regionally. we are seeing the role of for-profit and private equity money driving some of this. the bond market thinks it is a good idea. there is a positive up side from this integration, which is, if you think about a managerial success where you drive out inappropriate clinical variation and you improve quality and reduce cost, that would be a win for the world, a win for the health system. unfortunately, the data don't support that. the tendency is to use pricing power to raise prices rather than yield true efficiencies. by the way, this isn't going over well with the people who pay the bill. i don't just mean medicare and medicaid. the people who are the life blood, financial life blood of

the american health care delivery system are private employers. i'm an adviser to the pacific business group on health, which is a coalition of large employers. pacific is a misgnomer. it includes walmart and disney. their view of the world is not donald trump's increase view. their view is 4%, 2016, 4% increase. the good news about employers is that -- the good news is, they are not leaving. they are not abandoning the field. it has been surprising positive effect of the affordable care act that the number of people with commercial health insurance has remained relatively flat as the cbo had predicted. what we track is the red line, which is the percent of american employers that say my company is actively exploring ways to get out of providing health insurance to our employees. you can see that red line. you don't have to read the

numbers. it just went up and came down. the reason is that they took a look at private exchanges. they took a look at exiting the field. they made a determination that there was really fundamentally their responsibility to ensure their health -- that employees' needs were met. that's the 87% number at the top. they are not leaving. that's the good news. the bad news for the delivery system is they are not leaving. they are going to be in the face of the delivery system going forward. that's what we have seen and hear anecdotally this year. employers putting pressure on their health plans to get zero premium increases or zero price increases from these provider systems.