it allowed the students to prevent or threaten to prevent the united states senator with whom they disagree from speaking on their colleagues -- the college campus. what the administration did that was wrong was caving into that. is, youshould have said may not attend, you may cross your arms, you may even turn around and look the other way. her speech and prevent others from hearing her, you will be punished, because it -- because you have no right under the first amendment to do that. >> senator alexander also served as education secretary during the bush administration. you can watch the entire discussion on campus free speech tonight at 8:00 eastern, here on c-span. >> listen to c-span's weekly podcast. this week, part one of a two-part interview with three

nationally known presidential historians. douglas brinkley and richard norton smith, to share historical context for the trump presidency. somebody who has impeachment swirling around them as somebody close ort able to he'll a racial divide in the country. >> there is a real animosity between the press and the president. as early as john adams. he is a person who is pushing toward the sedition act of 1798. what that does is, it actually tries to prevent criticism of the government and of the president. >> find it on the free c-span radio app under the podcast tap, or wherever you go for podcast. >> for conversation about the future of health care, joined by

susan dentzer, editor of the new walls,alth care without a roadmap for reinventing u.s. health care. what is health care without walls? >> it's a concept that health care really ought to move outside the classic institutional settings we are all familiar with. doctors offices, hospitals, and is much as possible, should move closer to people in their homes and communities and worksites, schools, etc. closer to people where they are living most of their lives. this.l health care can do if you're in a terrible car accident, you want to go to a trauma center. a lot of health care is not about that classic laying on of hands. is about exchanges of information. what we argued in our report is health care ought to move the way the rest

of society has moved. we are comfortable exchanging remotely -- information reveille, whether it is over internet or phone. there's so much of health care that could move in that direction and people would find it more convenient, it would be closer to where they are living their lives. we think it is the case it could be made less expensive than it is now. john: it is about telemedicine? and what is that? susan: that is having a normal visit you would have with health care providers but in some remote fashion. over skype, that could be can -- considered telehealth. technically speaking there are , lots of other ways you could deliver care of remotely. virtual check-in's. they are another version of virtual care.

emailing your physician. which many will still not do because they do not get paid for it. it could be considered an aspect of virtual care. and other remote monitoring devices, that you could put on to record your blood pressure and that information could be transmitted to your health care provider. all of that, collectively, we consider virtual care, and that is part of what we are talking about. john: how far we from virtual care? years or decades? susan: it started to percolate about the 1950's. back in the 1960's there was an arrangement struck between boston logan airport and massachusetts hospital for travelers. that was in the 1960's. some of us are old enough to remember the jetsons when they

were consulting their physician because it was already possible to do that. what has happened is it has taken a 60 years to take it vantage of technology. in the interim, technology has gotten much better, it is easier today, a lot of viewers being -- are skyping their friends around the world. it is odd we have not been able to do that with our physicians. we have not figured out a way to do that quite yet. john: our phone lines are split up by how they get their health insurance. if you have employer health insurance (202) 748-8000, if through the affordable care act (202) 748-8001, if you are uninsured (202) 748-8002 all others can call in at

(202) 748-8003. we are having that discussion until 9 a.m.. you talked about the jetsons, you said there is a joke that it delivers star wars medicine and in a flintstone's delivery platform. explain that. susan: flintstones and that it is far behind the times. he was in a car that was blocks of stone rolling along. that is equivalent of what we are doing now. in the sense that we really have not harnessed the full potential of a lot of these technologies into the health care system. probably everybody who is listening in is going to physician's office waiting for long. -- waiting for a long time to be seen by physicians. the health care system has been organized around an industrial model is not organized around the patient or customer.

it has really been organized to the convenience of health care providers. it does not work well and is not have to be that way. we are all living very busy lives. we do not one to be completely hostage to the health care system. we are used to being able to go online and order tires or anything like that, so it is odd for many of us to say, how come i cannot have that conversation will a health care provider. john: from the american telemedicine association, there are currently 200 telemedicine networks in the country, nearly a million americans get cardiac monitors. in 2011, the veterans health administration delivered over 200,000 remote consultations using telemedicine and over half

of u.s. hospitals have some form of telemedicine. how does that compare to other countries and their use? susan: it depends on the country. there are countries that are smaller that have more centralized health care systems that have gotten here faster. some of the scandinavian countries right now. the fact of the matter being the u.s. has state-of-the-art health care medicine and it is strange we have been so far behind on this pure aspect of how we deliver health care and what our expectations are. where people are going to be when we give it to them. john: questions about health care, the phone lines are split up by how you get insurance. through your employer (202) 748-8000, through the affordable care act (202) 748-8001 if you

are uninsured (202) 748-8002, and all others. susan is our guest. president and ceo for network for excellence in health and innovation. susan: we are a national, nonprofit, nonpartisan group made up of members from across all sectors of health care. we have provider systems, health care payers insurance companies, , pharmaceutical companies, patient groups and technology companies. we get everyone together to talk about how we can innovate more in health care. they do not always agree, but they can often find common ground and meaningful solutions. that's what was behind our report. john: why put this out now? susan: there will be enormous potential to make changes.

we've called for a number of federal experiments to do this. one of the main areas of the , country that the benefit from these approaches are rural areas of the united states. every state has a rural area where people live either far way from providers, do not have them at all or may not have access to specialists. in this day and age why would , you not expect you could get online with the provider maybe three or four hours away to have a consultation. we have to make that happen. the technology is there. the technology is not a barrier. the barrier is the rest of the health care system. john: in south dakota, is that one of the rural areas? caller: yes. we have hospitals within 25 miles.

everything she is saying is right. they need to get the greed out of medicine. there so much money. we should go to single-payer. we have to get prices marked so people know how much things cost. about this kavanaugh deal the , president is trying to bury this thing. and the killing of the guy, you're talking about morals, killing this guy, we are lowering our morals. this, this is sending a message around the world that is terrible. you guys are the platform, you should be putting out and looking into their eyes and take some of that blame. john: you bring up a lot of issues, we'll keep it on health care. you started talking about single-payer, is that something

the network for excellence in health innovation has taken a we do think there is an ability to get a lot of greater efficiency out of the health care system, and that is part of what we're talking about in our report. but with respect to single-payer, we will simply point out, the united states already runs the largest single-payer system in the world . it is called the medicare program. john: in michigan. insurance through the aca. go ahead. caller: the problem relates to the financing of these things. no longer a not-for-profit organization. blue cross and blue shield have been a not-for-profit but now they have changed and there are no nonprofit organizations

related to medicine. we have done away with that. we need to go back and make them non-for profit. back and make themeed to go non-for profit. a lot of the blue cross blue shield plans remain not profit. some have converted to for profit. most remain not profit. we are not in that fight at the moment but we are talking about taking the money we spend already in this country and figure out a way to use the money in a different way. nothing happens in health care unless it is paid for. there are lots of rules around payment that have constricted the way care is provided. one example is physicians get

paid for an office visit. they have not historically gotten paid for remote visit in many respects. we are talking about reorienting the payment system, the regulations and other issues to make this possible. recommendationhe , if you could have a virtual consultation go to the local .ospital to have the surgery how do you figure out how much you owe each of those customer those -- those? make: there are many who those decisions about what gets a four. if you think about the medicare -- this isicare on what isegulation allowed to be paid for.

medicare has taken steps to pay for some of these things. they announced next year they will pay physicians to do virtual check ends. if you have artie had surgery, you have to do a quick check in with your doctor. instead of going to the doctor's office you'll be a do that virtually. the doctor will get pay for that. john: the doctor should be paid the same for one of the virtual check ends as opposed to an in office visit where they can conduct whenever they need to? susan: most people recognize the doctor is under pressure to see patients. even if you go in for visit it could be -- we have this pretense that an person is better and virtual will be inferior.

the evidence does not show that. for example, a large national study done of consultations with people with parkinson's where they have an person visits but also virtual visits so they vastly are for the virtual visits to the in person. if you have parkinson's, it is a pain to walk. office,rd to get to the a caretaker has to take you. or you can stay in your home and have a consultation. if they are remote, they could be as fulfilling for patients and providers. is there any estimate, fl health care without walls is instituted, how much that will save in the system? susan: it is impossible to make the calculation. what we're arguing is there is a lot of money in the system. we do not think it would cost

more to do this. it would be lots of savings. it is thinking about who benefits from the system? payingot a question of providers differently, think of the cost and productivity of people driving to doctors offices and spending an hour or so finding parking and sitting in waiting rooms. the university of virginia has been doing telemedicine across dozens of specialties for a long time. they calculated they have saved patients 17 million miles of --ving by virtue of the fact we do not think about the cost for everybody else in the system. thinking about away to streamline all of that and capture those efficiencies is an important part. conversation,a

the network of excellence in human innovation. if you want to check her out online. our call from california. i got my premiums for january for me and my wife, it is over $2000 a month. we make $74,000 a year. we are going broke. in january, one of us will have insurance and the other will not as we cannot afford it. it was only $375 a month. 2012 it went to $750 a month. this yearrs progress, we are paying over $20,000 for insurance. we cannot afford it. john: how are you going to make a decision? susan: we artie made it.

i will not have insurance. we are ready it, i will not have insurance. more than 80% of those buy coverage through the affordable care act exchanges are eligible for subsidies. many are not. we have this expensive health care system. in addition to being ridiculously expensive, it is inconvenient for many. we are arguing, there are better ways to deal with this. one important piece is expanding the workforce that we allowed to do certain aspects of health care. states license health care professionals and license them in many instances differently. if there are nurse practitioners who can do things in some states and cannot and other states. by expanding the ability of

health care professionals to work to the top of their licenses, we can bring more people into providing health care and lower the price and make it more convenient. debt is another important part of the recommendations we issue. john: other states that do not allow doctors to do virtual health care from other states? could someone from california give a consultation to someone in maine or hawaii? susan: if you are in the state and a license as a physician in that state, if you provide telemedicine into another state you have to get a license in that state as well. about half the states have signed on to an interstate compact where if you are licensed in north dakota and want to do telemedicine into south dakota we will help you get an expedited license.

but only half the states have signed onto that which means positions want to do interstate telemedicine or telehealth have to go through the process of getting licenses. nurses have made that easier but doctors in about half the states are try to protect their turf. are the international compacts? susan: no. not that there is not international telehealth and telemedicine, because they're most likely is. it is not likely to be reimbursed officially in the united states. john: in louisiana, good morning. caller: good morning. ask, do you think health care be addressed by congress? all i could get, was they want to subpoena and investigations

and do not seem to have health care on their agenda. on duringhat to run the midterm, but i heard more of let us do the investigations and subpoenas, and destroyed trump. let us drag up every bad thing they could. having healthhem care as a main i think health care is actually very high on the agenda, especially for the democrats who are now in control of the house of representatives. actually, there is i bipartisan core of people in the senate, also, want to see some changes for example, with the obamacare act.

a desire to continue to stabilize the health insurance market. in particular, discussion about even increasing subsidies for higher income people to get coverage through the affordable care act. i think there is a willingness to address some of these issues. of course, there's not universal agreement on what to do. a rock. is always but we will you be going through a process in a year where we will be discussing changes in the affordable care act and also more broadly. as you know, a number of those elected to the house of representatives who are democrats are very much in favor of a single system and we will see whether they want to push to have a vote on that or not. but health care be, i think, topic a in the house of representatives. host: for excellence and health innovation, with us for the next half hour, we're talking about health care without walls. how long have you been at the

network? guest: been here just under three years. host: and what did you do before that? guest: i was a senior policy advisor for the robert johnson foundation and before that, the editor-in-chief of a journal and health policy. before that, i was a health correspondent for the pbs newshour. host: how long have you been covering health issues? guest: a long time. over 30 years. calls, waitingur in illinois. employer-provided insurance, go ahead. i actually am retired from state police, california, so i retired with full medical. i getan army veteran, benefits, so i had insurance my whole life. thatbelieve for the record everyone should be insured through the government. background is wide and varied.

different parts of the health care system, but one thing i noticed you are not addressing, i was a self-defense instructor most of my career. and i have maintained an athletic lifestyle at 65. and my question to you is, have you seen what america looks like on the ground? do you know the statistics of the obesity levels in this country. and the reason i ask, we can't possibly have any kind of health ise system if every corner filled with fast food slop that people are shoveling in seven days per week. i hate to put it that way, but that's about as low as a gift. this country will never be healthy if we promote the lifestyle that you see. if you go to different parts of the country like i've been, it's sad to see young and old and the condition that we are. what do you think of that? is utterly true that we have an obesity crisis in this country. we have essentially two thirds of the u.s. adults overweight or

obese. , it canome populations be even higher. we know that obesity is a driver of many chronic diseases. for example, diabetes. and we know that obesity will increasingly be the primary driver of cancers in the united states. obesity is linked to about 16 different types of cancer. so, there's no question about it. we do have poor health in a lot of the u.s. population and that will be an enormous contributor to chronic illness, premature death, as it is already. host: ashburn, virginia. go ahead. caller: i will be real brief. i would like to settle on all of these people calling in about health care. i'm a prior service member. and it was pretty well-known that most doctors in the military weren't -- i hate to put it this way, but there was

problems as far as their abilities went. because there's more money in the private sector. i'm not pretending to have a solution to this situation. to take anow you need look at countries like great britain, where my neighbors son had a friend in college and if a baby was born prematurely before the 26 week, and this actually happened and made the newspapers, they will not assist the baby and that survival. they sat there and watched it expire. people thatfor the want to call in and say morality or refer to god. i think it does not get any more barbaric than that. that's all i have to say on the subject. thank you. guest: again, in our report we were not addressing various ways of financing health care, single-payer or whatever.

at this point, we are staying out of that argument. again, i don't know. single-payer is not government controlled health care. it is basically government financing of health care. like the medicare program, which we have in this country, where essentially, we as taxpayers are paying for bills primarily for medicare. we ask beneficiaries to pitch in some money as well. but the care is provided privately by privately employed physicians and others. of healthhe future care that you do talk about in the book, health care without laws or roadmaps for reinventing u.s. health care, do you talk about the training aspect for doctors? now you are asking doctors cannot just be experts in their own profession, but to have a technical expertise to go along with that. guest: to some degree, that's right. we all watchhand, television and it's not because we all completely understand how

a television works. we know we just have to turn it on. same thing will go for telehealth and telemedicine. there will be a degree of pushing a button and having it happen. won'te do say is that we need to make a number of changes in our health care work was collectively. not just among physicians. first of all, train people how to provide care in these virtual ways. .t does take some adjustment we are all human beings, we are used to reaching out and touching somebody. what happens when you can't touch somebody? how do you compensate? it can be done, you just have to learn how to do it. host: to doctors want to do this? guest: a number do. i will just mention one clinician i just spoke with last week who has been providing care for patients with parkinson's disease. he says he has not been in a physical clinic for five years. he conducts all of his business now virtually. therefore, he's able to reach

patients who would not otherwise see a neurologist. 40% of people on medicare with parkinson's do not have neurologists. partly because it's hard to get to them. we don't have neurologists on every corner of america. if you could have a visit with somebody who is an expert in the field, even if it's virtual, you want to have that. this clinician is very host: satisfied being able to provide that. host:from the teaching perspective, are there statistics about the level of trust people have? people wanting the physical visit to the doctor versus a and the the computers ai and everything that goes into telehealth? guest: one example that i just cited is a good development to the story. they tried to recruit patients into a clinical trial that was studying this, they had to do some explaining. how does this work? yes, you can stay at home.

yes, your loved one can be there with you. homewe will use your laptop computer. we get that set up for you. it often takes some explaining but as an mentioned, one of the big takeaways of the clinical trial was that patients actually theer the virtual visits to in person visits. is borne outhink by a number of other studies as well. if you can actually meet people when they need the care, they like it better than the conventional situation of having to go on someone else's terms to a different location. of thee are talking future of health care and health care without walls or roadmaps. from reinventing u.s. health care. waiting in cleveland, ohio. go ahead. yes, i've been sick most of my life.

i'm 52 now, i've been sick since i was 15 with crohn's disease. now, i'm a dialysis patient. i finished dialysis patient for over 23 years. recently became visually impaired. the doctors want a dialysis patient who is supposed to go see the doctor every three months. i go see my doctor once every two years. simply because when i go into i'm just leaving my dialysis appointment. they checked my blood pressure every 15 minutes at dialysis. they check my weight when i first go in, again when i leave. when i go to a doctor's appointment, they check my blood pressure when i get there, they check my weight. i sit down for 30 minutes, wait for the doctor, the doctor never touches me, she asks me how am i

doing it, how do i feel, do i feel that my weight is right. that i leave. so was the purpose of going to the doctor's office? it's a waste of money, a waste of my time and a waste of the public money. so, on top of that, they have a doctor to come around at the dialysis center once a week and they charge us for a full doctor visit. people, onething four shifts. , the doctors cad people. that's just a waste of money. thanks for talking about your situation. out ini will point norway, for example, the telecommunications company have the goal of trying to get a third of the population that needs dialysis in norway to be able to have home dialysis. you bring a piece of equipment

into the home, and that is where people will get their dialysis treatment. it's totally possible. we have is equipment today. a number of people in the u.s. are getting home dialysis, but not nearly enough. and given what we are facing with the obesity and diabetes crises, we need to get on the stick. as a country, and provide care in a way that is much more around the needs of individuals such as yourself. some very enlightened health systems are taking steps now to make sure that people have transportation to their health-care appointments. when they have to go to a physical health care location. but, historically, the health care system has not dealt with these issues. they have left people like you very much not at the center of the system and having to conform what you need to do to the needs of the system. what we are really talking about is turning the health care system inside out, getting it to

the community. there really is no reason why you should not be able to have home based dialysis as a community health worker to make sure that gets done. it is really just a question of making these kind of things happen. host: pennsylvania, rob, good morning. caller: yes, good morning. thank you for taking my call. i worked in the health care field for four years. most of what we see in health care in terms of what we have to treat is self-inflicted. the world health organization just came out recently and used the percentage, 80% of health issues primarily in the major areas could be prevented. what is your thought on ,ducation in the schools starting in the first grade, teaching students how their bodies work, how they function? and how to stay healthy. and what about health care

providers? involved in using technology. education.nd increased on health. thank you. as people have said repeatedly over the years, americans don't have a health care system we have a sick care system. art of the reason that we have that is obviously, we have a lot of every sick people. that's the way we have configured our system. we have paid people to be treated when they are sick. we have not invested as much as we need to do to actually cause people to be healthy. what we know from years of research is that the number one and number two determinations about your health in life is your income and your level of education. it is arguable that the best thing that we could do to create a healthy population is to make sure and confirm that well-educated brains are developing from ages 0-3, etc..

then, as you say, having education about what people need to do to protect their health. not just children, but families and others. abilityupporting people to stay as healthy as possible is what we have to do as a country. and that is part of what we are laying out in health care without walls. how do we mobilize the health care sector back into the community to help people protect and preserve their health? host: peggy is uninsured. good morning. caller: yes. i'm peggy. host: go ahead, you are on. caller: i'm calling because i have a daughter that has no insurance. she has no job. she has no money. how is she supposed to get any medicine? she has to go to the emergency per yearral times because she feels sick. she can't stand it.

the only other alternative i have is to send her to the emergency room. , she getspay anything a job and is always a part-time job. and she gets sick. and then she gets sent home or just, it's bad. she can't get insurance because she does not have any money. why in understand america, we don't want to have healthy people. we don't want -- i don't know. if you get sick anymore, like if you have a bad something and you go to see one doctor, he will prefer you to another doctor. everyone of those doctor visits cost about $400 or $500. how many people, if they don't have any money, they don't have a job. they want people to have jobs. host: thank you for sharing your story. guest: i don't know much about your daughter's specific

situation, but this is part of the reason why we are trying to build up the health care safety net in this country. for example, through the affordable care expanding the medicaid program. unfortunately, 32 states have done that and the numbers -- a number of states will do that at the consequent and of the election results, but we don't ly good safetyl net system for everybody in your daughter's situation. host: what about the concern that telemedicine, virtual medicine, benefits will only go to the wealthy in this country? you need a computer, you need high-speed internet to do was being done to make sure that it is shared across all incomes. guest: we actually argue a very important point, it should be a major thrust to federal policy. theother countries around world are taking steps to make sure that there was universal internet access, universal broadband. plan to geta has a

nationwide internet service which we don't have in the united states. it does not necessarily have to be internet. cellular, if we had universal cellular service which is technically possible to do. that would be a very good standing as well. just the way the nation made the decision years ago that we april a lotve, say, of vacation, a world telephone service. we need to go the step to have universal internet broadband and universal cellular service accessible for all americans. this is the way we are going to run our entire economy, not just our health care system, in the future. was moving through congress right now that would promote what you argue sure in this book? guest: not much, to tell you the truth. there have been things that have moved. a major piece of federal legislation is -- did

incorporate some telehealth into the medicare program, so that was a positive. but we really think, even going back to thinking about rural parts of the country, we know we have large numbers of closures of rural hospitals. we have communities with a lot of chronic disease. where there is not a lot of access to health care providers. it should be a national imperative to extend better health care to rural settings. and we think rural areas are a perfect place to start to try out these different ways of providing health care. we think the congress ought to way into this. and, basically, think about a whole structure of federal grants or other forms of support to really get behind efforts to change the way health care is provided, especially in rural areas of the country, which could benefit so much from these initiatives. about 10 minutes left. our topic is the future of health care. the book is "health care without

walls: a roadmap for reinventing u.s. health care." ashley, tennessee. who get their insurance through their employer, go ahead. wondering, in this health care talk, it seems like people conflate the term health care and health insurance. and i know if i go to the er, they have my bill and then they come around and offer cash which is usually less than half of what the bill is. and i was just wondering, you know, between this kind of medicine and the expanding world in health care, it seems like since mandatory health insurance they aree a thing, wanting to provide less service but still be able to charge the same amount of money now that they have a monopoly. thank you. well, i'm not sure

exactly where to go with that question except to say that it is true in the u.s. health-care system that there is not a lot of transparency around prices. people don't often understand what health care costs. there are different pricing structures based on whether you are in an insurance plan that has negotiated special rates with doctors or with hospitals, etc.. and it's extremely confusing for individuals. with some ofthink the changes we described, efforts to have greater transparency and health care prices. some people will be familiar with the fact that cbs and edna have a plan to merge. of thinking lines is to reinvent the front door of health care. so the kinds of places that you would walk in the door if you had an initial need for health care as you can today,