you can see it on college campuses. people do not have to encounter an idea they did not agree with without a trigger warning. if you do not encounter ideas to you to that already know, i don't know why your parents are paying tuition. it is wrestling with ideas you didn't know or agree with. it is important to distinguish in politics political polarization, which is a problem, but also political disengagement, a bigger thing that is happening among us. we tend to think because washington and political nerds are addicted to assuming the jersey you wear is the most important thing on yo policy position on any given topic, we are not representative of 320 million americans.

we know what teams we belong to. if you think the biggest problem in america is the other political party, and the political party you are a part of has all the answers if you could think wish the other people from the field i have people to introduce you to. washington, d.c. doesn't have good answers now. the moment of disruption we are entering is not just one side is right and the other is in the way. one is enlightened, one is retrograde, it is we don't have the right policy conversations for the magnitude of what we face. most of the challenges are not easily reducible to core democratic or republican platform positions. i will name two or three and then you can tell me where i am wrong. if you tried to make a national agenda at the political level of what is urgent, what is

important that we are not tackling, we do not have a national security strategy for the age of cyber and jihad. we have a view of geopolitics since the 1640's. we have had a view of national security about state actors. let's be clear, letterman putin -- vladimir putin is on the march and wants to take advantage of our weakness. let's be clear, china is buyers to turn the south china sea into the south china lake. there are a lot of state actor problems out there. what is really disruptive over the next 20 to 50 years for us is that lots of national security is not primarily about the interplay of 200 nationstates that have a monopoly on violence in their own territory. if you spin the globe, look at the borders, and treat them like

we are equal in terms of being nation states, you make a mistake, because only two thirds of those countries control their territory. about one-third of the countries on the globe are more like afghanistan, syria, libya, or lots of places in north africa where there might be some entity that has more power than anyone else -- think the taliban on the eve of 9/11 -- but we were not attacked by the taliban. we were attacked by al qaeda. all a lot of what is coming in the world, which is tom friedman's world is flat, is accelerating every year with miniaturized nuclear technology, and the kind of global and i.t. technologies we have, and how rapid and easy transport systems are, and how easy it is to have forged documents. we are headed toward a world -- where the distinction between al qaeda and the taliban is a distinction all americans understand. a lot of people will self

radicalized in place and create terror networks instead of having to go somewhere and -- be trained. we do not have a national security strategy for the age of cybersecurity jihad. i am not his to talk about the presidential campaign, but it is ironic the republican party a year and a half ago -- you would have that the party i am part of wanted to take entitlement reform seriously. 17 candidates -- 15 of them would have given credible, honest, verifiable answers about the entitlement crisis we are facing, and we ended up in a place where the republican party is appearing almost as indifferent as telling the truth about entitlement as the democratic party. i will not parse the numbers. if you are one of those folks that likes to regularly cite the $19 trillion number, the public debt number, we should go back to the drawing board because the

$19 trillion number is almost irrelevant. it is the sum total of intergovernmental transfers and the publicly held bond debt. the number that matters is the unfunded obligations, and it is more like $75 trillion. even when we try to be serious, we use a number that is less than one-third of the real number we have to tackle. third, and finally, the topic we talked about a little bit -- economic disruption and the policy implications -- cultural, familiar, social network implications of figuring out how to navigate a world of lifelong learning and job disruption are far more important than policy responses, but there are a bunch of downstream policy responses space, higher education, and job training. we are not at any of these conversations. they are not there. the american idea that we have to pass along to the next generation is when we get to this new, disruptive world --

fourth world of the digital economy, what will entrepreneurship look like -- what will cultural pluralism and a robust defense of the first amendment look like? what will it need to be able to say the meaning of america is still centered in institutions that look like the rotary club, where people actually live, they know and love their neighbors, and actually want to do good, and not where tribal labels about a distant fight in washington, d.c., that isn't anywhere near up to the task of the moment we face. that is the challenge before us. thank you. [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] in 1979, c-span was created as a public service. it is brought to you today by your cable or satellite provider. a portion of today's washington

journal now with the author of a book about the health care law. a bloomberg article says 1.4 million people will lose their current health care plan caused by several large insurers pulling out of the markets. donald trump said he plans to repeal the law. now is betsy mccoy, the former lupin -- the former lieutenant governor of new york and is the author of the book about the obama health law and is here to talk about health care policy in a trump administration. thank you for joining us today. guest: i am delighted to join you. there are so many questions in everyone's mind about what's coming next. host: you recently wrote a column outlining the myths about repealing obamacare. can you give us the highlights? right, you hear a

lot of fear mongering going on. that worries me because people who have pre-existing conditions or our newly insured should not be worried about what's coming next. everyone in the trump administration and in congress as well is determined to make a change that will help the 200 million people being clobbered or experiencing the negative effects of obamacare or the affordable care act without abandoning the few million people who are actually being helped by this law. hear again 1 -- you and again from the president and advocates for the law that more than 20 million people will lose their coverage if obamacare is repealed. that is definitely not true. let's look at the numbers -- of the 20 million people who

have newly gained insurance coverage because of obamacare, 16 million of them are enrolled in medicaid, the public program for low income residents of the nation. medicaid is not going anywhere. we have had medicaid since 1965. the obama health law allows states to decide whether to expand it and a half the states in the nation have expanded their enrollment. those states will not do a 180 and shrink enrollment. that congress and the trump administration will probably turn the funding for medicaid into block grants which will give the states more flexibility to administer the program well. but that does not mean it's going away. it's needed because over the last three years, spend --

federal spending on medicaid has gone up 43% and we have not seen a big improvement in the health of people in medicaid. that is the goal. we need to make some changes. i am quite confident that those 16 million people will still have their coverage after whatever congress does this spring. we will talk more about medicaid in particular in just a moment. i want to make sure our callers know where to call to be a part of this discussion. we continue our discussion with former lieutenant governor betsy

mccaughey about health care. you noted in your piece that president-elect trump -- iest: let me just explain, want to explain what happens to the 20 million. 5 million people are left who are newly insured because of obamacare. they are in the private health plan sold on the exchanges. some of those people have pre-existing conditions and they will definitely be taken care of. others are young people or people who have not bought insurance before. they are technically covered but they are having a hard time. even with subsidies, a lot of people are finding it difficult to go see a doctor under those plans because the dockable's are so big. for thee and dollars bronze plan which is less expensive -- $6,000 for the bronze plan.

they will lower the deductible and give people a broader range of choices in the trump administration. couples without children are paying for pediatric dental care for example or women over 50 who are still paying for maternity coverage. if you ask me, i will explain what happens to the people with pre-existing conditions. host: we will get there, i promise you. as you noted in your piece, there are some aspects of the affordable care act that resident electron has said he might keep including coverage for pre-existing conditions and things of that sort. as lawmakers on the white house looks into health care, do you think there will be more compromises that may be made on president-elect trumps previous

vows to repeal obamacare entirely? guest: i am quite confident it will be repealed. when you say replaced, let's use the word duplicate. there are certain things in the affordable care act that needs to be duplicated in new legislation. wise keeping children on their plans to age 26. as donald trump pointed out, it adds to the cost of plans but it has become so popular that even without a law come insurance companies would be doing it. it's a big seller. another important one is devising a way to protect people with p existing conditions. -- with pre-existing positions -- conditions. the trump plan will guarantee that people with pre-existing conditions are able to buy insurance and they can afford it. here's the difference -- under they rammedre plan,

together to groups of people in the insurance market. healthy people who had not previously bought insurance in many cases and chronically ill people, people with very serious conditions like diabetes, heart disease, parkinson's disease. when you put these two groups together in one insurance pool and tell the healthy people that they have to pay the same price as the very sick people, the very sick people need about 10 times as much health care. suddenly, the healthy people in the individual market are facing premiums under dockable's like they have never seen before. the deductibles are so big because they are designed to prevent these healthy people from ever getting anything back on their insurance plan. the money they pay in premiums has to go to care for the very sick people. the trump proposal is quite different. he would take the chronically ill people and design a special insurance pool for them where

they would be able to buy coverage. insurance companies would put a higher price and that coverage but taxpayers would subsidize it so the actual consumer buying in that high risk pool would not face on affordable premiums. instead of forcing the limited number of people in the individual market to soldier the whole burden of caring for the sick, it would be spread across the nation. everybody would be helping take care of the cost of chronically ill people and that's a fair way to do it. you will see premiums and deductibles in the individual market go way down because of that change. host: we have callers eager to jump in. delia iscalling -- calling in from tacoma park, maryland who has employer provided insurance. caller: good morning. guest: happy thanksgiving. caller: thank you, happy

thanksgiving to you. host: go ahead. caller: my name is celia. what you are describing is very much like what i would call a public option. is this administration considering that? would you also consider removing the part d of the pharmaceutical restrictions where we can use the u.s. government to lobby drug costs and cheapen it that way? are twohank you, these very different questions. which public option pertains to people under age 65, that was discussed extensively when the affordable care act was passed in congress rejected it. they created something similar, co-op.

,6 of them around the country they were publicly funded. in many of the states, these codes were designed to do with the public option would have done, compete with the commercial insurers providing competition and choice on the fear that that would hold down the cost. havetunately, the co-ops been almost uniformly a disaster. almost all of them are bankrupt or going out of business soon. in the process, they have wasted billions of dollars of our taxpayer money. i don't think the public option becauseconsidered again it was not successful in the form of co-ops. moving to the second question which pertains to medicare, there are three parts to a,dicare, the hospital party going to the doctor which is is yournd part c pharmaceutical coverage.

i believe she is asking whether under a trump administration, there would be consideration of the federal government negotiating lower prices with drug companies so are part d drug benefit would be cheaper. that is a possibility. i heard donald trump say that on the campaign trail many times. ast: let me ask you about "washington post piece." it said president-elect donald trump is waffling on health care. part of the piece says -- care out-of-pocket. such a deduction is worth more to people with higher tax rates. by a without coverage repeal are lower income individuals with tax rates that are already well.

the benefit they receive from the deduction does not come close to the financial hit they would experience from the repeal. it would cause 20 million people to lose coverage. is he wrong? are people who are lower income at risk? guest: he is. the figure 20 million people will not lose their coverage. millionon of those 20 are the low income people to whom david cutler refers and they will not lose coverage. they receive medicaid. medicaid is not going anywhere. in terms of the other 5 million, some will receive subsidies if they are in the high risk pool. the federal government will step up to make sure they can afford , despite pre-existing

conditions. that leaves a couple of million other people. for them, congress and the trump administration will negotiate if there will be a refundable tax credit, or a taxed adduction for people who choose to deduct the cost of their health insurance. what many lawmakers are trying to do is to create an even playing field. if you get health insurance with your job, the way 155 million most popular, the way of getting coverage under 55, if you get insurance on the job it is not taxable to you. it is taxing them. lawmakers are looking to even the playing field so people who buy their own health insurance, a small market, but they want the same advantage. they want to buy health insurance with pretax dollars. host: you have private insurance

and are on with lieutenant governor betsy mccaughey. c-span, are you totally serious? do you even venture your guess? this lady, i've been watching on cnn make a complete fool out of herself. guest: i don't think that is the appropriate conversation. we want to talk about health care. host: they want to be respectful of our guest. i am only being truthful. everything she said from the beginning is untrue. donald trump has not voiced any health policy. she says -- guest: excuse me. let me correct you. donald trump has talked extensively about health policy. he had health policy proposals on his website.

to go there.you i want you to see everything that president-elect trump is putting out there, and i thank you for your call. host: let's look at the policies president-elect trump has proposed. points that says with the assistance of congress and working with the states, the administration will protect individual conscience in health care, protect innocent human life from natural death, including the most defenseless and americans with disabilities. advanced research, reform the fda to focus on the needs of patients, and for new innovative medical products, modernize medicare, and maximize flexibility for state. a lot of these may prove costly. talk a little about how the proposals -- guest: right.

let me start individually. the fda. donald trump has been clear that themuld like to see approved more quickly if they are safe. the mission of the food and drug administration was to make sure nothing got on the market that could harm a patient. everyone agrees with that. over the years, hurdles have been erected, cost-effectiveness, comparative effectiveness, different ways of looking at drugs. they all have merits, but if you are facing a terminal illness, or have a child or anyone you care about facing a terminal make sureou want to if there's a possible cure it gets through the fdi in an expedited way so you benefit. trump,president-elect

and other people, there are patient advocacy groups that want to make sure that happens, so things are not bogging down in the bureaucracy. i support that effort. ensuring the fda expedites approvals would be important. another example of a high priority, i think. hospital infections. 75,000 people die every year of infections they contract after they get into the hospital. this is something we can work to prevent. years ago i launched a national campaign to do this called the committee to reduce infection deaths. we advocate for more effective disinfection, better cleaning, helping patients to understand what they can do to reduce their

risk when they go into a hospital. here is an area where taking action will not raise costs. it will reduce costs. we are spending over $35 billion a year treating infections we should never happen to begin with, not to mention the lives we are losing. host: we are talking to former new york lieutenant governor betsy mccaughey. columnist for the new york post and author of "beating obamacare" and beating obamacare 2014." withcarrollton, virginia employer-supplied health insurance. good morning. guest: good morning. caller: good morning, lieutenant governor. feel.is a simple, i i'm a retired civil service worker. i am insured under the federal

employees program. do, thiseed to insurance i am under covers 500 insurance companies, goes across state lines, is the best insurance you can have. guest: i agree with you. is underhe premium $200 a month, my deductible is low. under obamacare i would not be able to afford anything. pay the penalty and forget about it and pray i don't get sick. if thet is president-elect is serious about fixing obamacare, he needs to repeal it to start. guest: he will repeal it. expanding thell federal employee's health insurance program to everyone.

have the state insurance serves as and opm consultant to answer questions on how they may do this. as far as individuals, treat it as a group insurance to start. then, you don't have to worry about pre-existing conditions. it would be affordable. nt on the obama with care site, obamacare site -- guest: i agree. what a waste. this is an important call and i want to address it. terrific model and was discussed in congress by republicans before obamacare was passed. i believe what president-elect trump would like to do is duplicate that type of thing.

consumers need choice. right now everyone is being told they have to have the one size fits all, washington-designed benefits package. that is passing a law that everyone has to buy a four-door sedan. what it does is presumes the consumer is stupid. consumers are not stupid. they know what they want, and not everyone wants the same insurance plan. one benefit is choice, a broad range of choices. as donald trump has said, we have to allow insurance companies to sell across state lines. unwiseates have very insurance regulations in place that push up the cost of plants. new york state, massachusetts,

new jersey, you pay premiums far higher than california, for example. lieutenant governor, on my first day in office, i saw a long line of lobbyists outside. number one in line was the chiropractor lobbyist. 3, the acupuncture lobbyist. they lobby state government to say we want you to require every health care plan includes unlimited services of what we sell, acupuncture, chiropractors, wigs whatever it is. out except for the consumer that is stuck witht bill for the mandates. it is important to sell across state lines so people trapped in

states with unreasonable insurancelaws can buy plans in other states. you can buy a car in any state, a bottle of wine in any state, a dress in any state, why can't you buy insurance that way? host: and uninsured viewer. you are on with former lieutenant governor mccaughey. affordablearding the care act, before the affordable company the insurance had us at $700 with no pay existing. with my four i pay children if i buy insurance on my own? if i can afford 700, i don't need any help. hitn the numbers, do not

around the bush, give us the numbers. guest: are you asking what he will be paying currently under the affordable care act or when it is repealed and replaced? host: in a trust administration, what will the cost be? guest: it will be lower. in the individual market two reasons it will be lower. number one, you will have a choice of plans. number two, you will not be unfairly burdened with the cost of caring for the chronically ill. that will be spread over the nation instead of the small number of people in the individual market. that is a major change. that is the most important change. we want to make sure chronically ill people are cared for and their existing conditions do not keep them from insurance, but the burden should be shared with the nation, not those buying insurance in the individual

market. that is being done now. you will find lower premiums and lower deductibles. that is the goal, affordable health insurance. medicaid.s talk about in today's "new york times" it says president-elect trump proposed converting the program states to grants for give them latitude over how the program is run, jiving with many leading republicans who wanted a medicaid overhaul that hands control to the states. a move is likely to expose divisions among republicans over how significantly to repeal for 12e protections million people who gained medicaid in 31 states and washington, d.c. that has expanded the program. "right now republican governors expanded medicaid and will fight to keep it. says you haveon

to assume there will be some need for a solution for the 20 million people that are off are under and most medicaid." talk about the risk on the issue of medicaid. guest: 16 million newly enrolled in medicaid. know well.ubject i when i was lieutenant governor i was responsible for proposing a redesign of medicaid to do exactly what president-elect trump would like to do, give the states more flexibility. so much of this is being run from washington dc. want to do in new york state with our medicaid dollars is different from what you would find in a more rural state where you would need to reach into the countryside, providing community health clinics.

giving states more flexibility will mean dollars are spent more wisely and make it to the spent onn set of being bureaucratic fighting between the federal and state government. host: according to the kaiser family foundation, 32 states and washington town have adopted the expansions. we can see them on the screen. carol from illinois, you have affordable care act insurance. you are on with lieutenant governor betsy mccaughey. guest: good morning. happy thanksgiving. caller: thanks. a i was nothe ac able to buy my own policy. as far as choice with my medical hmop, i was forced into one because blue cross blue shield did not offer any tpo's.

it was blue cross' decision on what to offer. programis a republican out of the heritage foundation. it is basically what is going on in massachusetts. 28 ceos from various health care insurance and pharmaceutical companies. i am looking at the salaries of the ceo. the low is $6 million. the high is $36.6 million. you could say spread out over the insured people does not cost that much, but it is insane to have that salary when that money that is paying them is supposed to pay for health procedures for people. what we need is a single-payer

like medicare with additional insurance and supplemental policies. path that the republicans chose not to make certain fixes when the law passed, which is common, congress fixes things, at every turn they refused to do anything. host: let's give the lieutenant governor a chance to tackle this. guest: let's address the bigger issue. i think one of the most important is the issue of single payer. for those watching who have not heard that term recently, single-payer means government provided health care, the government owns the hospitals and all of the facilities, pays , hospitalrectly administrators, and health care providers directly. the british national health

service or canadian health service are two examples of single-payer. why don't i think that is a good way to go? i look at the cancer survival rate. they are lower in single-payer countries. the united states has the most kinds of cancer, highest or second-highest cancer survival second-highest cancer survival rates in the world. great britain has the lowest cancer survival rate is western europe. why does that happen? in a single-payer health system, medicine has to compete for the , schools,s with roads and social services, capital infrastructure expenditures, it is a political battle. sometimes the patients lose out. the british national health service, many cancer patients

wait longer for diagnosis and longer for treatment. it is not as aggressive. in the united states it is different. give youics to examples. in the united states, a woman diagnosed with breast cancer has over a 90% chance of surviving. it is not a death sentence. in europe, her chances of surviving are lower, especially in england. a man diagnosed with prostate cancer in the united states is not a death sentence. in england nearly one out of every four men diagnosed with prostate cancer die from it. from -- for me, that is a measure of which estimates better. i agree that medicare is an excellent system and is single-payer for the elderly. the reason medicare does so well

onbecause it is piggybacked the commercial system. the government pays $.94 for every $1 of care for a medicare patient. the reason doctors can accept $.94 for each $1 is because they push it to the younger people in the commercial insurance market. we help keep medicare afloat. i hope that answers your question. times," "the new york they report the house gop is expected to seek changes in the way medicare works. donald j. trump once declared campaigning for substantial changes to medicare would be a death wish. with election day behind them, house republicans will move forward on an effort to shift

medicare from the open ended commitment to pay for medical services to a fixed government contribution to each beneficiary. the idea rarely came up during the march to the white house, the future ofver medicare could roll washington during his first year in office, whether he wants it or not. in "the have a piece new york post" tomorrow on this issue. it is understandable that house republicans, like speaker paul ryan, and budget chairman tom price, and would want to piggyback on donald trump's popularity and political clout coming into office to push through their agenda. my advice to congress is support donald trump's agenda. his agenda is repealing and replacing obamacare, cutting

taxes and regulations to make sure job growth gets jumpstarted . he is working very hard on that. of course, improving national security, protecting us from terrorism. those are top lines of priorities. building infrastructure programs, roads and bridges, which needs to be done. i would urge the trump administration not to be dissuaded from their agenda to support other efforts. i know speaker ryan and budget director tom price have proposed exempt nature of employer-provided health insurance. i would not do that. i can see union workers have swapped cash raises for health plans. they do not want to be slapped

with a tax on those plans now. there you have it. host: like from houston, texas healthployer-provided insurance. you are on with lieutenant governor betsy mccaughey. caller: good morning. guest: happy thanksgiving. caller: happy thanksgiving. i heard callers voice support for the single-payer system. i am puzzled by that. it differs power and control to the government. imagine what it tells doctors in practice, how many patients they have to see per day, how fast, and the costs associated we don't see as a patient would impact us dramatically. what i like about the free market system is when i go to the grocery store i have 20

options in orange juice and toothpaste. all around us the shelves are full of options, selections, and price. it is amazing. we are so lucky. guest: that is what we should have in health care. -- host: i want to add one thing. would president elect trump continue a public option looking into how the replacement plans for obamacare? guest: let me explain, as i did a moment ago, the public option was part of the affordable care act in the form of 26 co-ops. 17 have gone bankrupt. it did not prove to be a viable option and we spent billions of dollars that could have gone to patient care on these experiments. i would not recommend a public option.

medicare for the elderly and medicaid for low income people. i do not believe there is a reason for a public option for middle health care consumers. the caller raised an important point. bytors have been beleaguered the affordable care act. if he went to a doctor, instead of having a conversation, your doctor is forced to have his or her eyes on the computer filling inboxes and making reports. it has gotten out of control. uncle sam is in the examining room telling the doctor what to do to get paid here in, the patient, are an afterthought. i talk with doctors that are struggling with this. they could not do a better job preparing for patients then the

doctor standing next to the patient in the examining room. host: good morning, karen. caller: good morning. you are wonderful. i don't have insurance. i tried to be legal. i'm 63. they wanted $300 a month for catastrophic, a $5,000 deductible. i only make it hundred dollars a month. i had to tell them i couldn't do that. me, i have tended to myself. i would go to the low-cost health clinics, my co-pay was $10. as in is the affordable care act with income it was $35. that is quite a bit to me. what gets me is i know the government is mostly what they

are catering to to charge what they want to. what gets me is i've lived in norman for 7 years. the lady across the street from me is a legal. she had 2 kids. now she has 6. doesn't pay a penny, doesn't go to work, gets over $1000 a month in food stamps. my son is a wounded warrior and he cannot get decent mental health care. how she can have six or seven kids and not pay a penny, yet my son who served and worked 16 hour days in the air force cannot get mental health care. host: let's let the mental health -- let's let the lieutenant governor say -- guest: this caller is saying at all. that is what happens when the government gets too big and takes the power. a tope son should be

priority. he served the country and should get mental health care. donald trump will make sure the veterans administration looks out for every vet. we have had enough of the dysfunctional veterans administration. one other issue that is important, the newspapers, cable television networks, focus on the few million people who have been helped write the affordable care act. it is important, we will look out for them. what about the 200 million people clobbered by the affordable care act. who getion people employer-provided health insurance have seen their deductible skyrocket 49% because of the affordable care act. 11 million people paying the penalty for not having the affordable care act. they did not sign up because they did not think it was

affordable. they are being slapped with penalties. 55 million seniors hurt in the pocketbook and when they go to the hospital because cuts to medicare pay over half of the law. you have first time workers who downseen hours pushed because employers are trying to stay under the affordable care act. a used to work 30 hours, now they have 20 hours. you cannot support yourself with so few hours and try to cobble together two or three jobs to make ends meet. lots of people will be happy when it is repealed and replaced. host: betsy mccaughey former lieutenant governor of new york and author of "obama health law: >>