american health care and how to fix it. as always we take your calls, and you can join the conversation on facebook and twitter. washington journal is next. [captions copyright national cable satellite corp. 2019] ♪ good morning, welcome to washington journal. president trump wants to ban most flavored e-cigarettes, fighting a rise in teen youth and death related to e-cigarettes and vaping. they were billed as a way to stop smoking, but some say the new proposedocess ban is moving too fast, and it may cost the lives of those who vape as a way to stop smoking. do you support the ban of the sales of flavored e-cigarettes in the united states. we have a special line open for you, parents and teachers are on the front line and your line is

(202) 748-8000, health care professionals we want to know what you are seeing, your line , e-cigarette8001 users, this is about you and we want to know what you think about this ban on flavored isigarettes, your number (202) 748-8002. if you don't fit in those categories we want to hear from you as well, your line is (202) 748-8003. we can always be reached on , and you canbook also now text us from your at (202) 748-8003. be brief and beyond topic, we will get you on the air. so president trump on wednesday thatout publicly, and said

he and the trump administration was considering a ban on flavored e-cigarettes, on most of the flavors. here is what president trump had to say. >> we have a problem in our country, it's a new problem -- [captions copyright national cable satellite corp. 2019] -- [video clip] >> we have a problem in our country, it's called vaping, especially as it pertains to innocent children. they are coming home, saying mom i want to vape. ,nd parents don't much about it nobody knows much about it, but they know it's causing a lot of problems. we are going got to do something about it. one of the reasons we are meeting today is to let you know .hat it is out there and we want to have parents understand that we are studying it carefully. , and potentially very bad.

there have been deaths and a lot of other problems. easye think it's an solution to cigarettes but it has turned out to have its own difficulties. host: here's a bit of the story that was written by usa today about this press conference and the government movement. the food and drug administration said in a statement that it would release details on a policy that aims to remove unauthorized flavored e-cigarettes products from the market. the products we have made in reducing used -- youth tobacco use is jeopardized. to see children becoming addicted to nicotine, and we will continue to use our regulatory authority thought leanne thoroughly -- thoughtfully and thoroughly. data,ency released showing more than one quarter of high school students use e-cigarettes -- use e-cigarettes

in the past 30 days. the overwhelming majority of the use vapers site of fruit, menthol, or mint flavors. the product is sold under an fda waiver. there is some opposition to this movement coming out of the white house, gregory connolly, the president of the american vaping association had this comment after the statement. are deeply disappointed in the president's decision to take direction from anti-vaping activists like plate -- mike bloomberg by attempting to ban the sale of nearly every vaping product on the market. a ban will remove life-changing options from the market that has been used by several million. -- several million american adults to quit smoking. in the history of the united states prohibition has not worked and a flavor ban will create another multibillion-dollar black market which will operate with zero safety controls.

thinkt to know what you about president trump's proposed ban on flavored e-cigarettes. parents and teachers, your , healths (202) 748-8000 care professionals your number is (202) 748-8001, e-cigarette users, your number is (202) 748-8002, everyone else, your opinion matters as well, you can call in at (202) 748-8003. norths calling in from carolina. good morning. good morning, thank you for c-span. definitely hope they will do a vapinge research on this , it's mainly geared toward children.

that they get hooked on this, and we have already had children die from this horrible legal drug. we hope it will be removed from the market. the factting aside that children should not be smoking at all anyway, would a ban on e-cigarette flavors, with that hurt the adults trying to use e-cigarettes to stop smoking real cigarettes? which everyone knows are really dangerous? wouldn't that band turn off some adults that have been using some e-cigarettes to stop smoking? but the information we are learning more and more about with e-cigarettes, is that they are more dangerous than regular cigarettes. tot's why the product needs be removed from the market.

it's dangerous and it's only getting worse. we are hearing more and more effects thatible e-cigarettes are having on our society. read the heard me statement from gregory connelly, the president of the american vaping association. banrding to them if we flavors, that will create a black market, and people will be able to buy them anyway, they just won't be regulated. any concern about that? caller: you always have concerns events thatative occur in the situation. but we're dealing with a legal substance here that we are , andng out is very harmful could kill our children and adults.

i believe needs to be taken off the market. host: have you smoked at any point in your life? caller: yes, i grew up on a tobacco farm, i don't smoke anymore and i don't want anyone else to smoke. but i've never smoked in e-cigarette-- and -- an e-cigarette read all the information i'm seeing and hearing suggested should be taken off the market because jurors. i pray and hope that because it is dangerous. i pray and hope that it's removed. host: kathleen is calling from parent,, are you a teacher, or both? caller: a parent and teacher. host: could you speak up please? caller: i'm a parent and teacher. host: what are you seeing? a lot of things that are

affecting the children, and we are legally using -- legalizing all of it. we are creating a very ugly atmosphere for the kids. differenceu see a between kids using e-cigarettes and kids using cigarettes? i know it's really difficult for a teenager to hard -- to hide a burning cigarette, with e-cigarettes they are much easier to hide. as a teacher are you having a harder time at the school catching kids using e-cigarettes? or is it prevalent? caller: it is definitely harder to hide. or easier to hide e-cigarettes? caller: much easier. host: tell me what you're seeing. muchr: i'm seeing too freedom for people to take advantage of their health.

they are not talking enough about it in the schools, how dangerous it is for kids kindergarten on up. dangerson't realize the , the same with alcohol. they go to college and get loaded and get crazy and they have consequences. they are still not getting that message out. host: what grades you teach? caller: kindergarten to eighth grade. host: do you see seventh and eighth graders vaping? , but i we don't know yet am seeing behavior that's very inappropriate and we don't know what they're doing. ok, let's go to orlando, calling from the bronx, in new york. good morning. caller: good morning. how are you. host: i'm fine. go ahead. caller: i called a few months

ago when you had a health official from the drug agency of the government. vaping,ndered about because it's very similar to crack cocaine. knight told her, anyone who knows about crack cocaine -- and i told her, anyone who knows cocaine, once you had any kind of -- it becomes --. i have been on vacation and i have seen people vaping all day long. it's nothing but a new crack pipe. people don't realize the chemicals that these people are using to hook you. to understand that a lot of people in this country use pharmaceuticals and any kind of stuff like that to hook people and make money. it's the biggest drug dealer in

the money, they called pharmacy and tobacco. and it's crazy. host: it sounds like you would be in favor of a ban of all notng and e-cigarettes, just the flavored ones, do i hear you correctly? what i'm trying to save is people have to understand how they are being manipulated by this system. robert is calling from louisiana, he is an e-cigarette user. good morning. plan do you stand on this -- ban of flavored e-cigarettes? vapers should have the age limit raised to 25.

kids even up to 21 and 22 are still really gullible when it comes to certain things like this. in the age of 25 gives us some better understanding. have you been using e-cigarettes and why did you start using them? agoer: i started six months , to quit smoking. since i have been using, i don't use the flavored, i use the regular. smoking -- i'mit sorry, ever since i started using e-cigarettes i have not smoked a cigarette in seven or eight months. host: how long do you think you will have to use e-cigarettes before you can stop using those? is there an end in sight? caller: yes actually. it won't be long.

with the way i have been cutting , because the nicotine is a lot lower than cigarettes, and it's easier for me to put down. is calling from california. are you a parent, teacher, or both? caller: i'm a retired teacher. this did you see any of before you left the teaching profession? really, it's rather new in popularity. was how i feelon about the ban, i think. host: the banning of flavored e-cigarettes. this, this proposed ban,

is it subject to a deal that he can make with e-cigarette manufacturers? with the nrahas and gun manufacturing. if they pay him when he abandon it? host: i don't think anybody can answer that but people from the white house. , yous a former teacher have dealt with kids your entire life. do you think just adding fruit flavors and different flavors to a product that kids are not supposed to be using, do you think that's what attracts them to things like e-cigarettes? might be what holds their attention for a few it.tes, the novelty of the attraction to doing orething different,

something akin to this particular generation. it has nothing to do with the flavor, though for years, candy cigarettes,de candy and they think it makes them look smart or adult like to do. but that is what attracts them. and they are wanting to stand out. that's what attracts them, it has nothing to do with the flavor. think about it. for years, young people were attracted to drinking alcohol that tasted horrible. they did not do it for the flavor, obviously, but the effects. and they should be campaigning to make them understand that the

worse than the immediate gratification. host: let's read a couple of tweets. starting with a tweet from president trump on vaping. here is what president trump tweeted, while i like the vaping alternative to cigarettes, we need to make sure that this alternative is it safe for all. let's get counterfeits off the market and keep young children from vaping. let's also read the tweets from our viewers who are tweeting in and talking about the issue on facebook. here's one from leroy who says no, it's not up to the government to regulate what we do with our bodies as long as we do not harm others. it sounds like tobacco has passed out a few bucks to favored charities. harmed those who cause partake from the black thc vape market, how has the government done on the war on drugs?

,nd here's a text from vicki from wichita, kansas. i don't support a ban, but i support regulation of these products which may be tainted or dangerously produced in china. and another text from nathaniel in new jersey. the question should not be whether there is extensive testing done before this vaping came into existence. that's what we should be asking. , frome more from eric north carolina. if you ban vapes, then then tobacco,- then ban hypocrisy. president trump talked about this with the first lady, here's what they had to say. [video clip] business, and we cannot allow people to get sick, and we cannot have our kids be

so affected. this woman has a son, beautiful young man, and she feels very strongly about it. a lot of people are reading it and people are dying. we are looking at it very closely. this -- andlse, parents will be a lot tougher. a lot of people think it's great, it's not. that's one thing i think we can definitely say. it's not a wonderful thing. it has big problems. .t is still new phonelet's go back to the lines, max is calling from chicago, he's an e-cigarette user. good morning. caller: good morning. host: what do you think about

the proposed ban of flavored e-cigarettes? smoke: so i used to regular tobacco. 1.5 ounces per day. with the vaping to the equivalent of two cigarettes per day. that innted to mention the process of this, my breathing became better. hypothesis, as an amateur , is that the pulmonary effects are certainly still .here when you smoke

but the other may or may not be. cancer -- am not saying anything about that. but i mean the other harmful effects. max, does the loss of flavored e-cigarettes, losing those mango and fruit punch flavors that have been advertised, will the loss of those flavors turn you off of e-cigarettes? or will you continue to use in what flavors will be left? i will certainly migrate to the few flavors that are left . but i heard somewhere that it could save 400,000 lives

world,y throughout the who statistics. and because of that, as a 21-year-old, you understand that this is just flavored candy to make it so that you can get your nicotine fix, and go back to , drawing, sketching, or riding a horse. what's good about, from orlando, florida. good morning. caller: good morning. the vaped manufacturer mentioned it being safer than cigarettes.

but i'm old enough to remember that cigarettes were not supposed to do you harm, and were advertised to be good for you. but as time has gone by we have learned better. the tobacco industry has been with the government, and it's a for many revenue states, and i don't want to speak out of turn on the federal government. i get my cigarettes somewhere from korea and i think they are having an effect. my personal view is to ban both of them. i don't think they would be a big black market, i think that's the only way i would quit. host: you said then both of them, you talking about e-cigarettes and cigarettes? or e-cigarettes and flavored e-cigarettes? caller: and tobacco.

are using the slippery self that they are safer and we have these kids in the hospital, they are not taxed, e-cigarettes are taxed in some locales and some -- and not others. and you have all these products and you cannot tell what's in them. there are some localities, i think georgia, where kids were getting sick and they just arrested the people and found that stuff out. trump span on gun stocks put people out of business, it will work through the courts and we don't know how that will work out. expensive,tes got so and these e-cigarettes aren't. this tax money supposed to help us quit smoking.

and that lady, bless her heart, she doesn't make me quit smoking. that'sink, with me, and my own view, they ought to be banned. if organist are banning things, -- if we are going to start banning things, this is something that kills people. so high, i'ms getting my cigarettes from korea and i think they are doing something to me. i don't know. it's my opinion. but the one thing i do think inns -- is intelligent on my part is that they do need to limit what's being offered. too much is being offered and there are too many packages out there. it's not regulated. people are making their own .tuff, putting thc in it

and the addiction on that might just be psychological, but who knows what else they will put in there. whatever could be vaporized could be put in there. host: let's talk to tom, calling from new york. are you a parent or teacher or both? caller: i am neither. that theation is rationale is to wean people off cigarette smoking. then why don't they make it prescription? if the rationale is medicinal, make it prescription only, eliminate the flavors which are clearly used to induce young people, and make it harder. it's not impervious to getting into the hands of kids because we have seen that with opioids but it makes it more difficult and it makes it available.

that's that. host: that's an idea i haven't heard, making it a prescription to get an e-cigarette. do you think that would reduce children getting their hands on e-cigarettes? because we know that there is a prescription drug crisis in america and kids are getting their hands on those drugs anyway. do you think a prescription will stop, or even reduce kids getting their hands on e-cigarettes? caller: i actually said that upfront, it's not impervious to getting around, but it does make it harder. host: are you proposing that for all e-cigarettes, or flavored? caller: i don't think there needs to be flavored e-cigarettes, the rationale is tobacco. combustible it is simply supposed to be a health benefit, so i don't think you need butterscotch, cherry,

strawberry e-cigarettes to transition off of that. that's a way to induce new users, it's obvious. users, entice new particularly young users. there's no question that this is a delivery mechanism for me nicotine -- for nicotine. it's a drug. andme there is a rationale benefit for people who are using combustible tobacco. no question about it. but we should try to limit it to that use. and i think a prescription mechanism, while not perfect, wooden narrows the usage into that lane. -- would narrow the usage to that lane. host: during the first day at on the rise of youth vaping, the cofounder of jewel labs

testified about the origin and purpose of his company. here's what he had to say. [video clip] complexis a very company. in large part, empathetically, i want to really express this. it's not my favorite thing, to .e here today, but i don't mind because this is extremely important. i very much understand the skepticism. this is an industry that has done wrong for a long period of time. and we are changing that from the inside out with products that are delivered from innovative people from a company that is 100% committed to changing the fabric of this market, to eliminating cigarettes for good. we are seeing that these tools actually work. thethis was stated by

chairman extremely well at the beginning. we don't want any underaged consumers using this product. we need to work together to make sure that no underaged consumers use this product. it's terrible for our business, for public health, our reputation, none of this is good. we want to get on to the business of eliminating cigarettes and saving lives. host: there's actually a political part of this argument as well. in an opinion article in the washington examiner, paul blair writes this. commonriking blow, the sense and well-being of millions of people, president trump that his on wednesday administration was moving forward on a rule to prohibit the sale of all flavored e-cigarettes. this misguided move will kill more than 10,000 small businesses, eliminate nearly 90,000 jobs, and forced millions

of adults who use e-cigarettes to reduce and eliminate their dependence on harmful cigarettes to seek out vaping on the unregulated black market or return to smoking. towardse, this march prohibition will do irreparable harm to the coalition needed by republicans to secure victory in 2020. on the basis of public health alone, the ability for adults to hit -- two -- is an unjust assault on consumer freedoms. the global scientific consensus nicotine, it vaped reduces the harm associated with smoking by at least 95%. without combustion, there's no tar. smoking is deadly because of lighting something on fire. like the former

mitchmmissioner and zeller agree with this assessment on the potential health benefits of adults making the switch. while the evidence about the net public health benefits of vaping over smoking for america's 34 million adult smokers is overwhelming, and onslaught of orchestrated attacks against the vaping industry has convinced some people that vaping is the most dangerous thing known to man. lost in the debate is the question of what exactly people are vaping. of the six deaths attributed, most involved illicit street thc, and unknown oils from the black market. for the use of illegal marijuana street like it driving asming opposed to alcohol.

this is described as a misinformed moral panic. once again, we want to know what you think about the proposed ban of flavored e-cigarettes. parents and teachers, you are on the front lines with teen smoking. we want to hear from you at (202) 748-8000, health care professionals, your number is (202) 748-8001, e-cigarette users, this affect you personally. we want to know what you think at (202) 748-8002. you haveone else, if an opinion on this topic we want to hear from you at (202) 748-8003. we are on social media, twitter, facebook, and keep in mind you can now text us. we started accepting comments and questions for guests via (202) 748-8003,

include your first name, city, state, be on-topic, brief, and we will get you on the air. messaging and data rates from your carrier will apply. let's go back to the phones and talk to mike, from washington. he's in e-cigarette user. good morning. caller: good morning. host: what you think about the ban on flavored e-cigarettes? caller: here's my opinion. you have flavored cigarettes that are on the market, now you have flavored e-cigarettes and everyone is making a big hit send mont about it because it's easy to get. ,ids are getting a hold of them because they are doing something they are not supposed to. whatost shops regulate they sell. that does notshop

sell anything out of the continental united states. they are very big on checking people's id and making sure they are of age. are doingowadays stuff they are not supposed to, like a type challenge, were these other stupid things that kids come up with. the ban on e-cigarettes, nobody are they getting them at a vaped shop, or what you get at a gas station. host: how long have you been using e-cigarettes, and do you use the flavored or the regular kind? and do you think a ban on flavors will stop you from using e-cigarettes? caller: i started using them when they first came out. i worked in a vaped shop, everyone says it's combustible, no, it's actually not due to the

fact that the only way you can make it combustible is by adding something to it that has the properties of combustion. that's why they stopped allowing shops to make coils for customers. we don't some of us know, what's a coil? a coupleou now have different styles of vaped pods. when it originally started, you could sit there and build your , when it started it was wires in a different gauged number, you spin it into a coil and putit on the deck

some cotton through it, known as wicking and then you add juice. they were popular for a while. people had issues with not being able to keep enough juice on vapingr them to continue . so companies came out with premade coils that were better encased, and they actually have tanks theys, and the have hold juice, so a person is not driving down the road trying vape mod.ice onto a so they had their flavor. a lot of these companies like and others actually

pay attention to what they are doing, so they don't worry about having a model blow up. see thatnt -- looks to the last time it blew up was five years ago because somebody had built their own custom vaped mod. host: let's talk to samuel, from chicago. good morning. caller: good morning. host: go ahead. say is what i want to that i truly believe that the government must protect the people, the little people, the children, from their distractive habits. and the government must do that under the contract of the general welfare clause, which says that the government is set up to promote the general welfare of the people. especially the little people who

do not have the will to defend themselves and protect themselves. let's look at some of the numbers we getting from the government from tobacco and e-cigarette use. in 2018, more than one in four high school students and one and 14 middle school students use a tobacco product in the past 30 days. for e-cigarettes, 85% of e-cigarette users ages 12 to 17 used flavors. that's the market that president trump is trying to get at with this ban of flavored e-cigarettes, trying to get those 12 to 17-year-olds who use flavors to stop using electronic cigarettes. social media to followers and see what people on

social media and texting have to say. says if arles, who preponderance of the evidence demonstrates that such products are harmful they should be banned. otherwise they are preferable to combustible tobacco, which has already been proven to be harmful. ,ere's another from larry texting in from maryland. smoke 54 years, stopped three years ago when my wife got cancer. it's a good product. here's a tweet from jody who says when i first quit smoking cigarettes i could not find a cigarette flavor that tasted like cigarettes. that was what i wanted. i found hazelnut, and slowly decreased in unit -- in nicotine over years and now don't use the pen. now it's in a drawer. let's read one more text from lynn who says banning flavored cigarettes will not do a thing.

a lot of people use their vape pen to put liquid thc and other drugs in, that's the problem. let's go back to our phone line and talk to james, calling from new york. are you a parent or teacher or both? neither.'m actually i called this line because i could not call on the other lines because it's busy. go ahead, but remember we have these especial lines for parents and teachers. caller: in essence, i'm against the ban. i'm a former smoker, i quit. but i did not use any of those products. but i do know people who do use the e-cigarettes and they do stop smoking, or it's not to stop smoking or as an alternative to smoking. as far as i can see, it does help people who use this product. and by then using this product, they are not purchasing

cigarettes. not purchasingby cigarettes as we know it, this is taking revenue from the tobacco company coffers. i'm totally against the band because i believe with freedom comes responsibility, kids views the products -- kids who use the products, that's just a fad, i started smoking at 14 because adults were doing it and i was finally able to quit smoking. host: so james what do we do ,bout the people who are dying was deaths have been linked to e-cigarettes? what we do that start happening to children? to the that goes back responsible thing. but it's being said now that certain other additives are being put into these apparatuses

to do whatever. but more so than not, i would say the people who first put the product on the market did not have these other additives, and that's another issue. young people who pick a product out, that is something different . i will put it this way. good things come about for good purposes, but you do have these people who take these good things and use them for bad purposes to make money. , fromlet's talk to clay california. you called in on the health care professional line, what do you do for a living? guest: either pediatrician -- caller: i am a pediatrician. this is my first time i've seen your show, thank you for taking the call. host: what do you think about the ban on flavored e-cigarettes?

i have a bunch of mixed emotions. in california there's a lot of stuff and like it on it's the hip sort of thing. process,'s no thought they are doing all of this stuff, not knowing what the outcome will be. so it's obviously a big concern. another big concern is back in the 50's, before we knew what smoking was, there was advertising all over the place, magazines, commercials, billboards, whatever, and at some point they decided you cannot do that. they pulled -- they told marlborough you cannot advertise in a magazine, that sort of thing.

new tolike we are very this -- i don't want to say drug , but the snoozing we don't know a lot about. it's a scary point for anyone who has kids, family members that are jumping in on this thing. and they really don't know. so when i see the president up there, i feel like he was genuinely concerned. but it's not a great alternative to anything. like smoking, in any situation, is bad. whether it's vaping, tobacco, crack.

. smoke cigars i'm not an unbiased person for , but i think it's not a good thing to smoke at this point. and i don't know that banning just the flavors is a good decision. maybe we need to look beyond that and ban a little more than that. i don't know, what you think? host: let's talk to jim, calling from clarksburg, west virginia. what do you think about this proposed ban on flavored e-cigarettes? caller: i don't like it. i don't know why donald j. trump interfere with my god-given first amendment right to smoke what i want. host: how long have you been

using e-cigarettes? caller: since they came out. host: are you using them for enjoyment? to stop smoking? caller: i used them to help quit , but theyhich it did say they are worried about these kids. something happening to our kids. how come you're not worried about when our kids are getting guns.p with why isn't there a band? he million dollars from the nra is live. million from the nra is why. i'm not an educated man but i'm smart enough not to vote for that idiot. host: the fact that flavored e-cigarettes will be on the market anymore, will that stop you from using e-cigarettes at all? caller: no sir. i'm gonna smoke my marijuana in it.

what should be done to keep these away from children? just be responsible parents. it starts at the house. and i love it.en but i have no guns, because i'm not scared. dick durbin, on wednesday, reacted to the new effort to ban e-cigarettes and went to the senate floor to talk about it. here's what senator durbin had to say. [video clip] >> a few hours ago in the white house the president and first lady, secretary of the health and human services and commissioner of the food and drug administration made a historic announcement when it came to vaping and e-cigarettes. they just finished the 2019 national youth tobacco survey and they found that in a one-year year period of time,

the number of our kids using these products has gone up from 20 million to 27.5 million. in the previous year had gone up and it's continuing to skyrocket because it's an addiction which is so popular with children. our kids don't know better, they are being told by juul and other companies that it's a healthy alternative to tobacco cigarettes. that has yet to be proven. the food and drug administration challenged juul to come up with clinical proof of that statement before they repeated again and again and again. in the course of the last several years, the sale of e-cigarettes and vaping products has mushroomed dramatically, just ask any school principal, teacher, and many parents. they will tell you what is happening. kids don't understand that these flavors that they are buying, like unicorn milk, gummy bears,

bubblegum, they sound like sweet candy treats. but when you inhale it into your long you run the risk of real damage. so far over 450 american kids have been admitted to hospitals because of lung problems from vaping. six have died. these young people don't understand how risky this is. host: let's take a few more calls, let's talk to greg from cape coral, florida. good morning. caller: good morning three thank you for taking my call. i want to dispel one bad comparison, 80% of the guns used in mass shootings were handguns. anyone wanting to ban rifles, assault rifles are banned, so let's focus on the issue. i'm a teacher, i work in education. it's almost every day that at least seven to 10 kids get

referrals or get busted using vapes. not to mention a lot more than that. the problem is that they are not detectable in schools. it used to be when we were in school people were smoking and you could smell smoke and identify it. i have for case is a smoking in the classroom while teachers were in there but the teacher did not know they were smoking vape.e they sneak these companies are targeting young kids because these look like highlighters and jump drives. there's a real problem, listen to the teachers and the administrators in schools. these kids are over consuming with e-cigarettes. that's the problem we are seeing. host: what ages are you seeing? high schoolers? middle schoolers?

i sincerely hope you're not talking about elementary schoolers? >> we are talking about high schoolers -- caller: we are talking about high schoolers but it will trickle down into the pipeline, into the middle school and yes into the elementary school. but i can only say from a high school teacher perspective is that we are seeing it increase if we were kids are doing it in the bathrooms, classrooms, just in general. i passed by another school on the way home and i see kids , there's almost a line. i thinkon't understand it's like a weed phenomenon and people are saying -- those people who say that marijuana should be legal are thinking that they -- vaping should be legal. i'm not talking about personal freedom i'm talking about kids 18 and underwear their brains are scientifically not

developed. when we're talking about giving people autonomy to make decisions about their health, they over consume. that's been proven with alcohol, tobacco, and vaping. i don't want us to lose the seriousness of this issue because there's a political issue. host: let me jump in, based on what you are seeing, obviously no children should be smoking. are you seeing more boys or orls doing the vaping, both? the surprising thing i'm seeing is that it's both. girls. a lot of boys and when you see the referral , you don't see girls

see as many minority students weing as white students, and can talk about it being an epidemic issue. issue andhas a big there's no epidemic about marijuana amongst our youth and their should be. i'm not saying we should ban e-cigarettes, i'm not saying we should ban flavors. but when these companies start ,argeting children, and they do as winston did with the flintstones in the 1950's, we have to do something. i applaud the president on doings thing, i hope it does not infringe with the adults. and the adults who do vape could make the risk lot -- take the responsibility on educating young kids on why they should not, and convenience store , maybenot sell these

that's the first step we can make into fixing this, because it's an epidemic in the classroom. abigail is calling from new london, connecticut. good morning. caller: good morning. thank you for taking my call. host: go ahead. i'm a young citizen, my point of view is that i agree with trump. ,he government should ban it cigarette smoking is an addiction that could affect our health. and that's what the public needs people aboutung that cigarette smoking can alter our bodies, it causes diabetes, and we can see

that it's affecting not only the kids, but also the adults. ,he e-cigarettes have nicotine so we need to educate young , which isut nicotine insulin resistant. we should look at the bigger picture. folks shouldlder , ip bickering and arguing think trump is making the right decision for young people. , fromlet's talk to nancy austin, texas, she's in e-cigarette user. what do you think about a proposed ban on flavored e-cigarettes. caller: it's a horrible idea. i wanted to ask, there's all kinds of misinformation going around. a lot of it stated on this show.

you had someone from the american vaping association -- if you had someone from the american vaping association, it would be great. most adults use flavors. about 10,000 small businesses in the u.s. would close. thousands of unemployed people. most adults use the flavors. that's what they quit on. as far as the names go. maybe they should use better naming, this is for adults, that's why they were invented. think about the alcoholic mixers , strawberry daiquiris or piña colada's, were they created to attract children? of course not. are we supposed to only drinking everclear with alcohol? do you want to get rid of the mixers? that's the same as getting rid of flavored e-cigarettes, they've been around for 10 years , used by millions of people around the world. of uk's oral institute

physicians deemed it 95% safer. not completely safe. so for people to get off of cigarettes, so they are not getting copd and lung cancer, they have been very successful at that. ban needs to stop, that's not the problem and there are so many issues being conflated. the hospitalizations have nothing to do with nicotine. it's from people who went out and purchase black-market thc that was mixed with something. new york state figured out it was vitamin e acetate. >> and how to -- host: how do we stop at 12 to 17-year-olds that we know are vaping? caller: the company marketing towards them, the one company was juul. , it's ahe one company closed pad system. so when dick durbin gets up

there with his different flavored bottles, trying to conflate them together, a closed put theeans that juul liquid in the pod. when it's done you have to put in a new product so they cannot keep adding. so any other e liquids on the market don't go in. that's one issue. split theu have to issues apart. those hospitalizations were not from nicotine, they were from black-market thc and has nothing whatsoever to do. you have to remember that vaping is a delivery vehicle, like meals. you can put in good things are bad things. if you put heroin in a syringe it's a bad thing. if you put antibiotics it's a good thing. same with vaping. nicotine and thc black-market are different things. nobody wants kids using this stuff. industry foraping nicotine is very tough on making

sure that you are 21 before you can purchase anything. i think we need to focus on you don't want to send people to get lung cancer. this is a harm reduction deal. it will save a lot of lives. host: we like to thank everyone for their different calls on this topic this morning. coming up, the trump administration is proposing changes to the nation's housing finance system. 's have the r street institute alex pollock. and a critique of america's health care system from someone in the health care system, surgeon dr. marty makary will talk about his new book, "the price we pay: what broke american health care and how to fix it."

first, this week on "newsmakers," neil bradley was interviewed. he talked about was happening to u.s. businesses as a result of tariffs the trumpet administration placed on china. >> have these tariffs got to the point where they are offsetting the benefits? >> they are dampening the benefits of the tax cuts. there are two aspects to the tariffs in terms of impacting business. the first are the tariffs in place and they are a cost for business. the second is the uncertainty of additional tariffs. that is playing out over the next several months with respect to china and automobiles. if you are running a company -- it is not just large companies. you're having difficulties planning. you don't know the cost of the goods you are buying either to sell to consumers or to put into something you are making in the united states. that is a real problem.

it is not just tariffs on our imports. --is the tariffs and pours imposed for retaliation. there is a lot of strength. we have record generational low unemployment. wages are rising. 3% well over inflation. people have money and want to spend it. you go to the business side and you are seeing a downturn in fixed business investment for the first time in three years. manufacturing is slipping into a recession. it is not just large companies. one progression is we have seen for the last nine months fortune 500 companies concerned about the tariffs. we are seeing midsize companies, those with 600, 700, 1000 employees. it is affecting their business and ability to plan. the next phase is it slips into small businesses and consumers. what we are worried about in the next several months is a weakness and uncertainty on the business side from large

businesses and midsize businesses and small businesses to consumers, and that's the recipe for recession. we think the next several months are pretty critical. policymakers making the right decisions to keep the economy growing and wages rising. they make the wrong ones, they push us into a recession. >> washington journal continues. host: we are back with alex pollock, the distinguished senior fellow at the r street institute. we will talk about the future of fannie mae and freddie mac. good morning. guest: thanks for having me. host: tell us what fannie mae and freddie mac are, and then tell us what the trump administration is proposing. guest: fannie mae and freddie mac are the biggest financial institutions there are. than j.p.bigger morgan and freddie is bigger than citibank. factors.the dominant

one think the administration is doing is trying to figure out freddieet fannie and with her $5 trillion of risk better capitalized and in a more competitive state. host: for those of us who don't really follow this, when you say fannie and freddie have no capital but they have $5 trillion, what do you mean by this? guest: fannie and freddie guarantee mortgages. they are the biggest concentration of mortgage credit risk in the world. t dollarsn with a they are on the hook for. failed in 2008 and disastrously from guaranteeing and making bad loans they were taken over by

the government. since then they have run 100% backed by the taxpayers. between the $5 trillion in risk and the taxpayers there is no cushion of capital. a fundamental financial principle is you want private capital between whatever risk the taxpayers are up against in a crisis. these are huge companies with huge risks. host: most people interact with fannie and freddie only when they are buying a house, correct? guest: they don't even see fannie and freddie. they see their local lender. the lender ends up getting a loan guaranteed by fannie or freddie, or about half of all the outstanding mortgage loans. host: explain to me why the normal taxpayer who either is renting or already has a house should care about this?

guest: because if fannie and freddie run into problems again, which cyclically is likely to happen because we know things go up and down in economics and finance, their taxes will be on -- hook the payoff fannie pay off fannie and freddie's losses. they proposed a program where fannie and freddie's capital standards will be much stronger, a good thing. the capital they would have to put up is the same as what other competitors have to put up so you get a competitive effect. treating competitors the same, which would be a good outcome. protection layer of between the taxpayers and the risk. that is all good. the reason it is not there is

because of the collapse in 2008. one of the reasons they collapsed was because they had so little capital. we talk about leverage in finance, how much risk you have compared to how much capital you have. fannie and freddie were always allowed because of their special government connection to run at what i call hyper-leveraged or extremely high amounts of risk relative the capital. because they had so little capital that was one of the reasons they failed. abysmally in 2008. host: let's say you are looking for a house right now. how does this trump administration plan affect you? does it affect you? guest: it doesn't affect you directly, but for anybody out looking for a house there are a number of things. you want to be a good credit. you are able to pay and you will

want to be able to finance that. for that, i think the best thing to have is a competitive market that is giving you the most alternatives possible. we hope this trump plan would move towards a more competitive mortgage market. i think it would. when we think about the mortgages in general there is an interplay between house prices and the amount of credit there is. sectoru push credit at a through government programs you have a tendency to push the prices up. house prices now on average in the united states are higher than they were at the top of the bubble. you don't want to have a financial system that is causing house prices to inflate. this is one aspect of this problem that needs to be understood. credit't want to push that is excessive and therefore

may prices of the house you are trying to buy higher than they would be in a competitive market. lessis works right, we get house price inflation. very prices are inflated and that something to worry about. host: we want to open up regional lines for our conversation about fannie mae and freddie mac. if you were in the eastern or central time zones, call in at (202) 748-8000. mountain and the pacific time zones, we want to hear from you at (202) 748-8001. for or you are looking recently bought a house and want to talk about this trump proposal to reform fannie mae and freddie mac, we want to hear from you. your number is (202) 748-8002. we are reading on social media

and twitter and facebook. or you can text us your comment. give us your first name, your city, your state, be brief. 748-8003. andnd us how fannie freddie were affected during the housing crisis. what the government did, and what changes specifically this trump proposal will move them back out of government control. guest: as the housing bubble proceeded from 1999 to 2006 and in the boston 2007, fannie and freddie while the expanded. they expanded on a hyper-leveraged basis, very little capital. they took on a lot of bad credit, of bad loans.

when those loans went bad and house prices came down, which means if your mortgage lender and you foreclose you will have losses. if you're a homebuyer, you will end up owing more than your house is worth after the housing bubble. there losses were immense. fannie and freddie lost more money in 2008 and 2009 than they had made in the previous 35 years. they lost all the profits they have made since the 1970's, and they lost their capital and they were broke. the administration at the time, led by then treasury secretary paulson said of these companies are allowed to fail it will create a global panic. fannie and freddie's obligations, debt and mortgage-backed securities are held all over the world. they said we have to bail them out and they did. the treasury said we will put enough taxpayer money into fannie and freddie to keep their

capital at zero. we will not let it go negative. we will bring it up to zero. that was the bailout. under the terms of the bailout the treasury ended up putting $190fannie and freddie billion. that is with a b. host: right. guest: their capital had gone so negative you had to put in $190 billion to get it back to zero. that was in the conservatorship in 2008, which triggered this investment. that is where we still are. the government still has its money in fannie and freddie. they put fannie and freddie into conservatorship. the federal housing finance agency completely controls fannie mae and freddie mac to this day.

host: what does the administration want to do? guest: they want to change. we've had 11 years of this conservatorship of this zero capital. can we now get turned around and -- itack towards a more will be normal yet, but in more normal situation? i think it's a good direction. the key is there are things the administration could do itself, and there are things that would take an act of congress. in my opinion the probability of getting congress to pass something on this is zero. is that because we are getting close to an election year because congress does not really move fast? guest: congress has been trying to pass something on this since 2012-2013. -- it getsy

partisan. and, we have a big election coming up. there are things that the administration could do on its own. the two biggest things are the federal housing finance agency could set better capital standards, and the treasury and the housing finance agency could change their deal, the bailout deal. it was a deal between two parts of government. the regulator in the treasury. -- and the treasury. they without congress can change that deal, and i should mention this, the deal originally was that fannie and freddie would have to pay a 10% dividend on the investment, the taxpayers and their stock, to bring them up to zero capital. 10% dividend. plus, pay a fee for the government's backing up their

credit, for the taxpayers backing of the credit in other words. that deal was changed in 2012 where the government said instead of that, just give us all your profit every year. that was highly contentious. they can change that deal and make it something else. when they do that, that would freddie toe and retain earnings because they are profitable again. fully backed by the taxpayers and that allows them to be profitable. it allows them to exist with zero capital. that deal could be changed. as an administrative action, and that's what's being talked about a proposed and i think it's a good idea. host: let's let our callers doing the conversation. debbie calling from new haven, connecticut. good morning. caller: good morning. he just said something that just kind of threw me.

they goes to what i was saying. 2006 anded my home in i was doing mortgages at the time. december -- i bought in august but by december everything was starting to go by the wayside. the big fall was beginning to start. the mortgage companies were closing. we started a deal on wednesday and by thursday or friday they would call and they were packing up already. the businesses were just falling. what happened was -- i can't remember for the month was. i think it was the following year when obama took office, what he did was he offered, and i do believe this is factual, he offered the banks that would loan to redo the loan. a lot of people don't know and i

didn't know if you had a cancellation of debt -- mine was $295,000 when all the fees and taxs was added -- an income on that money. what he did was he made it so that you did not have to pay taxes on the cancellation of debt. that was 32012. in 2012.y -- that was how things change. get -- he offered the banks the $4600 if they would redo. deutsche bank took it because i had deutsche bank. , went from nova star who died and deutsche bank held the paper. i was curious.

wouldn -- where did that money come from? it really works for me. they never advertised this would go on. i happen to do a lot of digging. because i was at the business and i really wanted to hold on to my house. i lost my job. it was horrible. i went into daycare afterwards because i needed more stable income. where did that $4600 come from and what does that have to do with fannie and freddie? guest: it came from the government budget as part of trying to address the collapse of the bubble. let's go back to the bubble because you are right. 2007 was when things came apart. the peak of house prices was 2006. the most destructive thing you can do in a financial market is to create a debt-financed bubble. you've experienced it yourself

or the prices rent far over their fundamental values or their trend values. based onh prices were a flow of debt which was unwise and a lot of it was -- one that unraveled the prices come down. the debt is still there, as you experienced. the price of the house was down but you still owe all the money on the mortgage. that,ou get a crisis like and in those days a lot of subprime mortgage brokers were failing, other lenders were freddie,and fannie and the biggest government-sponsored enterprises, formerly extremely powerful and profitable, extremely prestigious, unquestioned, failed. that's a result of what happens when you pump up inflated

housing bubble with excess credit. that would be nice not to do again through the reform of fannie and freddie. once you get into that crisis government try to do all kinds of things to try to smooth the crisis and survive. thehe payment to get -- and payment to get mortgages restructured and refinanced from the government was part of that. historically governments often do things like having a moratorium on foreclosures. there are a lot of social and economic issues involved in a bust of a bubble. that's why we don't want to have bubbles. part of that same payment by the government was a much bigger payment. $190 billion to bailout fannie and freddie themselves. is coming from chestnut hill, massachusetts.

good morning. caller: good morning, alex. we met several times prior to the crisis and the failure of fannie and freddie. one of the things i observed and i think you probably did too was that fannie and freddie became so powerful, not only in the marketplace but they were able to bully their competitors and try to take over more and more of the business environment that they worked in, but they had a huge amount of power in congress. many local congressman almost feared them. guest: that's a great point. host: it became difficult for some of us as a result of that. executives were able to claim they were both public and private at the same time. and they became very enamored with their own stock prices and their own bonuses more than

their public charge. i worried if they were brought back as private market players, or do you think that the trump administration will understand this and how can they prevent new chief executives and senior fromtives of those giants becoming so arrogant again and not serving their public purpose? i wondered if you could comment because i know you shared a similar experience as i did. guest: it is good to hear your voice. your comments are extremely well-informed about the history and what happened. thisf the dangers of sometimes thinking you are private and sometimes thinking where the government is exactly the excess little power and the

arrogance and the bullying tactics that were characteristic, especially of fannie mae, exactly as you say. congressman jake pickle 30 years ago said about fannie mae and freddie mac the profit is private and the risk is public. that was true. that is a terrible pattern to create. do, ands proposal would the details in the trump proposal are not there but directionally is make fannie and freddie have much more capital. one of the reasons the prophet could be private in the old days and all of his public was that theirpital was so small, capital was so high, as you know. we definitely don't want to

re-create that. what should never be done, and i think everybody agrees on this, is to re-create the old fannie and freddie. we should never do that, exactly for the reasons that you so articulately stated. andg forward, will fannie freddie be too big to fail? yes. like a lot of other too big to fail people. what they should have to have in between the taxpayer risk, which is what too big to fail means, and the risk of their assets. a lot more capital. they should not be able to buoy the market, for bully the be in a much more competitive state. i think that is the right direction. re-creating the old fannie and freddie would be a disaster. host: you have written a couple of books, "finance and

philosophy: why we are always surprised." someone is texting a finance question. lola from washington. how will all of this affects someone who is trying to refinance their home to get a better interest rate? will this have an effect on that at all? host: -- guest: it might. if it moves in this direction, you will have a competitive market. competitive markets exist to figure out what the right prices for things are. no one can say in advance what they are. but we know that over time the competitive market is what gives us the best outcomes. we will say that. it will still be true and things for mentioning my book. we will be surprised by financial markets. we hope we will not be surprised with another collapse of fannie and freddie. in the situation with a lot more

capital, with awareness of the systemic risks that fannie and freddie represent we hope we won't get the big surprise that we had in 2007, 2008, 2 dozen nine. -- 2009. 2012 was the bottom of the u.s. house prices. they went first seven years, down for six years. now they have gone becca for seven years -- gone back up for seven years. i guess they are too high. we will see how all that plays out. host: i will get back to the calls in a second. a lot of republicans are saying they are focusing on this reform because of the growing risk to the housing mortgage system. do you see another crisis coming imminently? guest: we are always surprised. we are surprised when we think it is imminent and it turns out

to be later. we are surprised when we think everything is fine and the next thing we know the government is doing bailouts. i think there is definitely a risk in the very high level of house prices. in the very low level of interest rates together. if interest rates do normalize woulde, and what normalize mean? a 10-year treasury rate of 4% or 4.5%. if that happens, house prices will fall. what nobody can be sure of is credith, and how much damage that will do. what we know is that the higher the leverage in the system is, the more risk there is relevant to the capital, the more damaging the bust will be.

it is always good to look for where the excess leverage is and try to do something about it. host: walter calling from baltimore, maryland. good morning. morning, c-span. here is the way i have seen it. when barack obama allowed fannie mae or the government owned, semi owned c-span. here is the way i have seen it. industries to bailout neighborhoods, not just washington, d.c., but around this country, we are underwater. i totally agree with you. it was not freddie and fannie. their mission was to control, or as we would at the consumer finance board protect the investments of america. industries to bailout, and i

will specifically speak to washington, d.c. because i literally watched that city blow the heck up. -- $5,00000 to buildings to $40,000 buildings. they had to put a coat of paint on the building. then up to $200,000. you cannot find, and i will challenge you and your audience and your previous comrade to find a house in washington, d.c. under $300,000. it would be very difficult outside of a shell defined a structure in washington, d.c. that is not a realistic price. that is fraud. the mission of freddie and fannie was to defend that fraud. i'm not a socialist but i'm saying the idea it was freddie and fannie's fault -- it was not. it was the greed of the capitalist system that allowed

and where the lady at walmart just visited house and she was a walmart clerk and got a $1 million loan. they were able to flip that mortgage under freddie and fannie because that was their mission. is all thewith today bankruptcy president, his specialty, is allowed to ruin this economy. host: go ahead and respond. guest: let's take one part of that which is a good observation. the height of house prices. bubble or credit overexpansion you have house prices that are too high over their fundamental values. what does that mean? the house price is high. if you happen to own it and it's gonna, that feels good -- and

you happen to own it, that feels good. if you renew by your, that makes it harder for you to buy. if you do, you have more debt. that is one of the systemic things we need to think about with housing finances. this interplay about the house price problem and the flow of debt. sinar as greed, greed is a and it's always here. it is in booms and bust. in my judgment that is not the cause. explosion ofan credit and leverage and prices which everybody thinks they are doing something smart, but it turns out in the end we have all done something stupid together. -- thatfascinating fascinating element of financial cycles is what we have seen in the bust.

the key part of that is how high prices of things go relative to how much debt there is. when you get very high prices with a lot of debt, you are setting yourself up for the fall. fannie and freddie helped create that situation. we would like to reform them in a way where they can't do that again. host: let's talk to bruce calling from charlotte, north carolina. good morning. caller: good morning. i am hearing a little bit of criticism here, basically it was the government that caused some of these problems. things wasnding of that when they bundled the mortgages and sold them on wall street, this was probably the major cause of the collapse of the home housing system.

could you enter that please? -- answer that please? have causesroblems and everybody is in on the game. the government included, but also in this case, as you rightly say, the whole subprime mortgage sector, borrowers themselves who lied about their loans as the previous caller said, all the people who benefited. what is dangerous about a bubble, if you want to have a discussion, is while the bubble is on everybody feels happy. everybody is making money. let's take the housing bubble. realtors, house builders, fannie and freddie, wall street, ordinary people who think they are making a fortune, house flippers, people getting liar loans, brokers and politicians are all happy.

they all fail to see the big bust coming. it is a fascinating phenomenon in group human behavior which i find very much worth study. as you're trying to look forward to say how you control the buildup of such systemic risk, that is what you are trying to think about. systems thateate make that at least less likely or more damaging when it happens? fathers anda lot of failures and orphans, but the buildup of bubbles and financial busts have a lot of fathers had a lot of contributing causes. from ohio.s calling pronounce the name of your time for me. town is --e

i was in the mortgage business for a while. i ended up closing my shop in 2008. pollockous what mr. thinks was the reason why the whole crisis occurred. i have my own thoughts. i always thought the spread between people with good credit and bad credit got too close. there wasn't enough penalty in the mortgage rate for people that didn't take care of their credit the right way. the bigoticed a lot of banks had their own subprime units. i started out working for a company called uc lending, a company -- if you could fog a

mirror, you got alone. you pay for it dearly because they charged 10 points on the backend of the loan. it was incredible. i only worked for them for a year because when i figured out how bad they were treating people i walked away from it. i got involved in companies that had a paycheck -- fha. that seems more like what a first-time homebuyer loan should be. i noticed the subprime units were allowing cash back at closing. when i learned this business there was never supposed to be anything like that. i apologize for being long-winded but i will hang up and let me see what mr. pollock thinks. guest: what he thinks is your comments are very much on the mark. one of the things that happens in the bubble -- i should mention that we talked about the recent housing bubble but there have been bubbles in financial

crises and panic throughout history. they are cyclical phenomena. they go back hundreds of years. they happen with some regularity and they have certain patterns. one of the patterns is exactly the one you point out. credit becomes riskier and riskier. there is less and less differentiation between the solid credit. you have a high probability of paying as agreed on the loan and the ones which are much riskier. the riskier loans, that is to say becoming the bad loans, filled up and this could happen in any sector. it certainly did happen and can happen in housing. why does that happen? one of the reasons is because you are inflating the house prices. during the bubble people look -- youand i think we will have seen this yourself

although the loans look risky, like cash out at closing which should never happen, but they still don't default. you are having low defaults and no losses. that's because the house price inflation means the higher house price always bails out the lenders so the borrower cannot pay and you sell the house for the higher price and everyone is happy. as long as the prices keep going up, but the prices don't always go up. someday they come down. then the cost of this buildup as you so correctly say of riskier loans comes out and that's exactly what happened inside fannie and freddie. there was a huge buildup of riskier loans. not only in them, and the system feelseral, but also it good until the prices come down

and when the asset house prices come down and the losses follow as we experienced. host: one more quick call or comment from ken from woodlawn, tennessee. can you get something and quick for us? caller: i had kind of a quick question. did dodd frank have to do with freddie and fannie? guest: dodd frank had little to do with fannie and freddie. as dodd frank set up in 2010 after the crisis. what always happens after a crisis is there repeat political reaction. they might do some things that are good and some things that are excessive and not so good. as they were trying to put dodd frank together, they could not agree on fannie and freddie. dodd frank did not address fannie and freddie.

that is why we still have the conservatorship and how to reform fannie and freddie today. host: what is the next thing we are going to see on the trump administration plan? will we see something out of treasury, the white house, congress? guest: i think you will see more work between the treasury and the federal housing finance agency. or threel be in two ways. first of all, better capital standards. that is in the regulator. that is purely within their jurisdiction. then redoing the deal, redoing the bailout deal, which was a deal between the treasury and the federal housing finance agency. they will think about revising that. the third thing is they will think about doing -- they are

thinking about doing something they should do, recognizing fannie and freddie as systemically important financial institutions. things that are so big that they can mess up the whole financial system, which they have already proved they can, and they can do financial stability council taking up their systemic importance as well. host: we would like to thank wishpollock, dissing senior fellow at the r street institute. thank you for being with us today. coming up, your phone calls about the rising costs of medicine in america. stick with us. we will be right back. ♪ our c-span campaign 2020 bus team is traveling across the

country visiting key battleground states in the 2020 presidential race, asking voters what issues they want presidential candidates to address during the campaign. >> i think a pressing issue is health care. there is a lack of health care in the country right now. affordable health care at the very least. some people are not going as far as i would like to go into the details of how they plan to handle that. i hear a lot of general ideas. i like to see where that goes. >> i would like for the candidates to discuss how we and bermalize ourselves a leader in the free world. and inader in democracy, values around the world. to know theire ideas on nuclear energy.

and the reinvestment of technology in every state in the country. i would like to know if they believe it is a sustainable, viable use worthy of the investment of our nation. >> i'm concerned about the climate crisis and gun safety legislation. those are two essential things that have to be addressed by the election next year. i wish they would be addressed by congress before that but it doesn't appear the senate will move on that. get back tory to enforcing the constitution. whoever becomes president should obey the emoluments clause, should conduct business with integrity. should not ridicule minorities or handicapped people, or agent or anyone else. we need to restore integrity and the need to restore a sense of something to all the people.

>> voices from the campaign trail,'part of c-spans battleground states tour. >> washington journal continues. host: for the remainder of the show we will talk about rising health care costs. we will open up the phone lines to you right now to talk about what you see in rising health care costs. here is a story we saw earlier from kaiser health news. as voters think about the high cost of health care, politicians have been targeting two well-deserved villains, pharmaceutical companies whose prices have risen more than inflation and insurers who paid millions in salaries while raising premiums and deductibles. although the democratic presidential candidate have the more copious airtime for debating health care, many of the country's leading policy

experts have wondered why they have given a total pass to arguably a primary culprit behind one-way medical inflation, america's hospitals. stat -- data shows hospitals are by far the biggest cost and the $3.5 trillion health care system. spending is growing faster than the growth domestic product, inflation and wage growth. spending on hospitals represents 44% of personal expenses for the privately insured, according to the rand corporation. hey report this year from researchers at yale and other universities found hospital 42%es increased a whopping from 2007 to 2014 for inpatient care, and 25% for outpatient care. compared with 18% and 6% for

physicians. we want to know from you what are you seeing out there on health care costs? are personal bills rising or reducing? are you be affected by your insurer? we are opening up the phone lines. if you're in the eastern or central time zones, you can call us at (202) 748-8000. if you are in the mountain and pacific time zones, your phone number is (202) 748-8001. and if you're in health care-related financial trouble, we want to talk to you and hear what you have to say. your number is (202) 748-8002. keep in mind we are always reading on social media, at twitter, and facebook. you can text us a comment on your smartphone at (202) 748-8003. include your first name, the

city and state where you live, and be brief and to the point. let's go to mike who was calling from wheeling, west virginia. good morning. caller: caller: yes. i'm a veteran. i'm a vietnam veteran. i got out of the surface in 1969. i was with the veterans administration for my health -- march of60's 2003 whengh march of george w. bush became president and he changed the meta-money you are allowed to make in order to have the card. i am single and i live by myself. i had a small pension through social security. they came to about $42,000 a year. they took my v.a. health card away from me. i got very sick and had two cancer surgeries and had a lot of medical debt.

years, iafter 50 finally got approved for an aging expenditure. i just got that a month ago. -- that make me a disabled vet. i'm able to get back with my v.a. health card. at least i will get medical. i will be able to get out of the -- to go to the va hospital in clinics. host: how will you keep up with these medical bills? caller: i don't know. i have taken out mortgages on my house. the previous guy about fannie mae and freddie mac, don't listen to that guy. they allow places like new day usa and first federal savings to suck the veterans in. my house is worth $160,000. they appraised it at $240,000.

i fell into that like a dummy. i used that the pace of medical bills and now we have a huge house payment and will probably lose the house. is the veterans are getting better. at least they are getting more extra. i don't know what i will do about paying my bills. i have tried everything. i have tried congress even and they won't do nothing. i don't know. i just go from day to day. i'm 73 and that's it. host: joe from new mexico. good morning. caller: i love this conversation. cost, thederstand the tests and some of the procedures. i can drive down to mexico,

about a two point 5 hour drive hour drive from here. i had a root canal for $250. it would have cost me $10,000 here out-of-pocket. i don't understand the difference. the doctors were wonderful. the clinic was amazing and clean and modern. i don't understand the cost of medical tests. you can get an mri in mexico for like $600. between $6,000st and $10,000 here. medicare and medicaid have negotiated these prices with these entities in america. you go down to mexico and you can have the same test done with the same machine and the same trained technician for a fraction of the cost. that is my comment. i don't understand how they can

negotiate these prices. host: let's talk to bill from northbrook, illinois. good morning. caller: good morning. you can talk about this subject all day. are not the problem because if you go back maybe 30, 8% ofrs, physicians were the total health care tab. i think they are down to 4%. the problem is there is no competition. i will pick up on what the woman previously said. i am the health care field. -- i'mder an mri associated with this hospital. it's easy for me to get the results, et cetera.

what the mria this womani know commented you can get it for $600 in mexico. radius within a 10-mile of where i am you could get this mri anywhere for $5,000 to 00 andere between $6 $72. the doctor does not know what it costs. the patient does not know what it costs. if some but he told me you need an mri and i'm on the hook for it, i will shop around. somebody said there is a better mri. this may be better. you can always make that argument. there is tremendous cost differences in all entities. i'm not pushing costco or

walmart or sam's club, but you can go to some of these pharmacies and say i have no insurance. monthn buy a drug for a and it cost $10. you may have insurance and your co-pay will be $30. the whole system is insane. the problem is when you go to medicare for all it goes completely insane because you have promised everybody everything. nobody cares about the price and what happens is you have to have rationing. you can talk about this forever. thank you. host: let's talk to judd from california. caller: good morning. following up on the last caller,

i am in favor of some credit medicare health care system for everyone. it has got to be viable. the politicians want to give people free health care. i feel that will just result in everybody -- you will have professional patients who are just going to go in for things they don't really need. 1000 where you take a person's adjustable taxable income and divided by 1000. that is there monthly premium. co-pay. monthly no matter how many times they go to a doctor, they pay that co-pay. that makes it affordable for everyone, but also makes it viable for the health care system itself. in when people going they really needed, but they take care of themselves when they don't need to. host: lance from fort

lauderdale, florida. good morning. caller: how are you this morning? host: just fine. go ahead. caller: i think i bring a different perspective to this. i'm a disabled person. my medical insurance cost me nothing. i do notice if i show up at the hospital for a test or for an appointment. if, i show up at the er i'm always admitted. the reason i'm always admitted and they run those tests -- partly it is because they worried about me. i'm an elderly man with a pacemaker. in the time i've been in the er they have had 10, 20, 50 people they know can't pay. this is why we have to look at this. anyone that shows up at the er we will take care of and that's a good thing. i don't think anybody would want to change that. you can't run a hospital echo business if you can't turn people away. butnot saying we should

somebody has to pay for it. for someone like me, if i show up they will take care of me but they will admit me because they know they can run this test and this test and this test to pay for all the people that were uninsured they came after me. the first thing we have to realize is that we you when to take care of people, but a hospital cannot be run like a business. host: let's read a couple of tweets from the viewers who were following this conversation. werein the day most people grateful and appreciative of any health care they received. a sign of the times people take a granite their ability to walk around at that their lives. just saying. doctors deserve compensation, as to support staff, but an insurance company? people sit in the doctor's waiting room for over an hour because they have a cold. it is ludicrous.

says,re tweet that daughter has three plus years of medical school to go and $70,000 a year. let her get on the health care gravy train before any reform to costs occurs. allers.e of more eva from california. --ler: i have a history with in 2007, i allowed myself to be on a study. 2008 toas on the study, 2014, my hospital bills were so high up. i was at the hospital every month. they would try all kinds of medications for my blood pressure. i complained if it was for the study, please stop it.

from april of this year i picked up my medical records. i go to the hospital and wanted to see my lab tests. what i discovered was unbelievable. my record, it wasn't me. my family history, it wasn't me. i couldn't figure out how to do a study without really being me. i have agreements with the hmo. it is hard to find legal advice. wondering what medicine means in america. they don't know how to check records to make money. that is what i want to say. we need to check the hospital bills very carefully. from hot springs,

arkansas. what do you have for us? caller: good morning. it is my pleasure to talk for you. hing bad toave anyt say about people. about mying prescription drugs. cheap becauselly i'm 80 years old. i have been taking this one blood pressure pill for like 15 years. it was recalled. the doctors and nurse would not tell me why. i found out from my niece who works in the city and had a computer to find out. it was recalled because it could cause cancer. then the prescribed another one that i have taken. i'm kind of afraid of it because i peeled the label back and what i was taking was recalled and

made in asia. is madewhat i am taking in india, and i am afraid. , i was in a kroger store, and i bought a bottle of $18 for a it was bottle. when i got home, and it was made in india. why theyunderstand have to buy our stuff like that from other countries. host: we will continue this conversation for the last hour of the show. after the break we will be --ned by martin met carrie who will talk about his book "the price we pay: what broke american health care and how to fix it." in may, president trump spoke about the issue of surprise medical bills. this is what we had -- what he had to say. i am talking about

principles to end surprise medical billing, and the senators and congressmen and women are leading the charge and i appreciate that they are here. thank you all for being here. this is fantastic. will be successful. we have bipartisan support, which is rather shocking, which means it is very important and good. that is great. first, in emergency care situations, patients should have. should not have to bear the burden of out-of-network costs. balance billing should be prohibited for emergency care. pretty simple. second, when patients received scheduled, nonemergency care, they should be given a bill upfront, meaning that they must be given prices for all services and out-of-pocket payments for which they will be responsible.

this will not just protect americans from surprised charges, it will empower them to choose the best option at the lowest possible price. notd, patients should receive surprise bills from out-of-network providers that they did not choose themselves. fourth, legislation should protect patients without increasing federal health care expenditures. legislation, any should lead to greater complication, more choice, and more health care freedom. charge patients to be in and in total control. to address an effort surprise billing. what we do is all kinds of health insurance, everything, we want everything included. no one in america should be bankrupted and unexpected -- or

unexpectedly by health care costs that are absolutely out of control. no family should be blindsided by outrageous medical bills, and we have a long way to stop that. with dr. martyck makary, the author of "the price we pay: what broke american health care and how to fix it." thank you so much for being with us. so, what broke american health care? guest: the story that nobody is talking about is pricing failures. doing the research for this book , there were three fundamental reasons why health care is so unaffordable that all of the research pointed to, and that is not what the politicians are talking about. the research suggests that it is pricing failures, middlemen, and inappropriate medicare -- medical care. we need to talk about how to fix

the broken health care system because people are getting crushed. people are getting hammered. touredd the country -- the country and met with hundreds of folks. patients in their homes listen to them about how the health care systems devastated them, and it is a mess. i do not believe we are divided country and i do not think the choice is put before spy health care -- by politicians are the right choices. there is tremendous consensus and the consensus is that we need to address pricing failures. us after theilled flight they would be gouging us. if airlines did not have to show a price, you would simply fly, and then they would send you a bill, and they would be gouging all over it. that is what is happening in health care.

it is ironic that hospitals are the center of scientific genius but we cannot give you a price, that is starting to change and it is the many disruptors who are starting to give optimism that is the reason why i wrote the book. host: we just heard from president trump back in may, in fact, we could see you right over his right shoulder. what role did you play in the administration's actions? guest: they asked me what i think about health care. they like meeting with academics. if somebody asked me about what i think i need to do, i will tell them. issues,ose three pricing failures, middlemen, and inappropriate medical care that they need to address. they acted. they had that event on surprise billing, several announcements came out. i brought patients with me who told their story to the secretary, one of the smartest

people i have met on health care, and president trump and the others were there. they listened and they announced the executive order owned -- on price transparency and that is one of the biggest stories in the last five years that has gotten almost no media attention. the secret negotiated prices between hospitals and insurers is part of the problem. i'm a doctor and i love it, but i do not believe in kickbacks and in secrecy. secret prices are enabling the price gouging that is going on. these money games, and predatory billing practices that threaten the great public trust in the medical profession. book,reading through your i was amazed at one of the stories that you had about your surgery,nd his tendon where you asked how could one ofpital -- it was thousands dollars, 15,000 dollars or

$20,000. you talk to another hospital and the price went down. talked to the surgeon who sent you to another hospital where the bill was $1500. it is amazing that the same surgery done by the same surgeon could have such a wildly different price at such different places. how do you as a consumer deal with this? guest: that was a crazy story and it was my friend's son. basically one doctor said, i do not know what this will cost you, as the hospital. when they gave you outrageous prices, the surgeon said i will do the same operation at another hospital and it will be 1/10 the price. people need to know that there is a lot of tools they can use to navigate the system. we are starting to see a revolution in tries -- in price transparency regardless of if the government does anything. that is patient mag is -- navigation tools. you can look up on websites like

fair health what the going price is your medical bills are often highly negotiable. it is insane. there is a researcher who called 100 hospitals that do heart surgery asking what is the price of the standard open heart bypass procedure. 50 gave him a price. price,50 that gave him a it ranged from $44,000 to $500,000. he compared it to the outcomes of the centers using the most mature quality outcomes database in the country called the sds heart surgery database and found no correlation. there was no correlation between care, quality, charity despite the many claims at most centers. ist is happening right now the lack of transparency is enabling price gouging in the

marketplace. we need to call it what it is and stop talking about health care costs and talk about medical prices. host: let us let our viewers join in. we are going to open up regional lines. that means if you are in the eastern and central time zone, 202-748-8000. in the mountains or pacific time zone, 202-748-8001. careu are in a health related financial trouble, we want to hear from you, you are at 202-748-8002. and keep in mind that we are always reading on social media and on twitter, face -- and facebook. at you can text the show now 202-748-8003. remember, we need your first name, city, and state you live in, and make sure you be brief and on the point. let us go to cliff from tulsa, oklahoma. good morning.

caller: yes. cost ofnt would be pills. my wife and i just changed her medication to time release medicine. $.12 to $22 a pill. host: that was something i did not have him talk about. talk about pills and prescription drugs. caller: input -- guest: employers are paying for health directly, sometimes not even using insurance, they are just self funding. pharmacy benefit managers, in claiming to be an independent fiduciary to manage their pharmacy costs, they will actually gouge the employer's with medications that the employers do not know the names, dosages, or frequencies.

in the book, i show an internal document that demonstrates the spread pricing, what they are gouging on the employers and charging versus what they paid a pharmacy. this middle industry has put a gun to the head of pharma companies and said if you want us to carry your drug in our plan, you need to pay us a kickback. it is called a rebate, it is not called a rebate, but this is not like a rebate on cornflakes. it is a kickback and it is only legal because in 1997 congress passed an exemption allowing this to take place, otherwise it would violate the anti-kickback statute. there are many money games that bms play, there are a few that are more honest and pricing and we have listed some of them at

restoring, met -- restoringmedicine.org. we have seen a lot of talk about getting rid of rebates and just allowing rebates to go 100% to the patient, at a 100% pass through. suppliers and hospitals do the same game. they do those kickbacks and those are called purchasing organizations. they set up pay to play fees, and that is why we have medications that we have had in the hospital for 50 years spiking. that is one of the reasons, there are many, but there is no one villain in health care. pie,one has a piece of the and i want to explain health care to every american so that we can create health care literacy, employers can get a better deal, a better deal on their pbm and employers are $500,000.saving the big short dated for the

banking industry, i wanted to do it to health care. host: surely from -- shirley from winter park, florida. good morning. caller: thank you for taking my call, and you are right. fell walking out of work on a wet floor that had no sign, broke the kneecap, dislocated it, overextended tendons, two now have aater i kneecap with no cartilage. there is constant pain. comp, i being, workers would love to see president trump do workers comp like he did the veterans. they use every angle they cannot to pay what is needed, i could not walk. they told me go back to work. i had to go out on my own and get an mri.

i called the hospital, how much is it? pay it.can i go to the hospital and asked the lady, this is all i have to pay, is there going to be another hidden cost? no. are there any other fees? no. a couple of months later i get this huge bill in the mail which i argued up and down and they finally dropped it. employer insurance, which i pay $800 a month, and i have a good disability insurance on top of that. i pay for that, a premium every month, they do not kick in anything because it is a work-related injury. i cannot go to them for squat. the other piece of this puzzle are the attorneys, and i am sorry, they hide behind everything.

you see these ads on television all the time round up or whatever it is, and they rake in 40% sometimes of people's misery. they get 40% of whatever the person is due. i am all for the attorneys being able to sue the company's because they are negligent. that is a florida state law clearly violated, and that needs to be upheld. honestpeople deserve prices. i cannot mow your lawn and send you a bill for $400,000. people want honesty and health care, and one of the exciting things i learned about is that there is a movement for more honest billing and pricing in health care. look at the surgery center of oklahoma, they have a menu of prices and it does not matter if you are in and of spirit -- an

insurance company, individual, or a small business, it is one price. if somebody is having a heart attack and we are going to do trauma surgery, you're not going to give you a price, but 60% of medical care is shop a bowl. airlines can give you a price even though they do not know if your flight is going to be delayed, canceled, or if you will consume a beverage. that creates a competent sometplace, even though people will not use pricing information if it is available. proxy shoppers keep prices in check, and in health care though shoppers are health plans, employers, a high deductible and uninsured individuals paying directly for care. i do not shop for every law -- lemon and orange in the grocery store by price, and her mom does. her and her friends keep prices in check for the rest of us. host: one of the things -- one of the places you focus on is new mexico.

why, what is going on? guest: i have a lot of patients who contact me who feel like they have been wronged by the system. the story caught my eye, of jennifer, a mom with kids for special needs. one of them went to the hospital and got a hospital acquired infection. jennifer could not afford the bill in the hospital sued her and garnished her paycheck. when she contacted me and said that many people have been sued, i went to this town, carlsbad. cnn did a piece on it. i wrote about how this town has the only hospital in town has sued hundreds of people to garnish their paychecks, and i spent time in the homes of these individuals. they garnished -- they sued the judge in the courthouse because -- they sue indiscriminately.

the hospital does not provide itemized bills. many of these are overpriced. i've compared them to to prices hopkins, andn these are threatening the trust of the medical profession. people deserve that are. one of the waitresses who i met in the hotel i stayed at is a single mom of three kids. she had her minimum wage paycheck garnished for a morning sickness when she was pregnant seven years ago and could not pay the bill. she has been sued, and people have been sued multiple times. i went to her home, she does not live like me. god has been good to me, i am a licensed surgeon. she is like the other half of america in that they have less than $400 of cash in savings. that is how half of america lives. i think sometimes the medical establishment becomes disconnected.

she had insurance, this is not her fault, this is our fault. suing patients is the most extreme violation of the great public trust in the medical profession in my opinion. we will defend these people in court, i will be there pro bono expert and we win 100% of the time. wasll the judges that there no legal contract and the patient was not given prices. if the hospital does not show prices they have no reason to garnish wages. the movement to restore honest prices is alive and well, that was the exciting thing about writing this book. from ae have a question social media follower who wants to at -- wants me to ask you, how much taking personal accountability for your health factors into the overall cost? guest: that is number three out of the three fundamental drivers of our cost crisis, number one pricing failures, number two,

middlemen, and number three appropriate medical care. 23% of medical care is unnecessary according to the 2100 physicians that answered the survey. that is 25% of diagnostic testing, 22% of medications 11% of procedures. we have been doing too much. there are two problems, overtreatment and under treatment, but overtreatment dominates. it is driven by a culture of people demanding auto buyout -- antibiotics when their kids have sniffles and perverse's incentive system. the opioid epidemic is just one piece of that problem. physicians prescribed 2.4 billion prescriptions 10 years ago. last year it exceeded 5 billion. did disease double? no, we have a crisis of appropriateness.

i get into the many folks trying to address that, reducing unnecessary medical care, and one of those big efforts is relation based medicine, which emphasizes spending time with patients. primary care that addresses the root causes, clinics that teach cooking classes for patients with diabetes, teach food as medicine and address the micro biome, and they are saying we can maybe treat more back pain cases with physical therapy and ice, than surgery and opioids. host: bob from illinois. good morning. caller: hello. i want to vouch for the surgery center of oklahoma. 10 years ago my daughter, who lives out near south lake tahoe went to the reno hospital after she was diagnosed with thyroid cancer and she was quoted $25,000 to $30,000 for thyroid surgery.

we went to the surgery center of oklahoma to $62,000. i had a colonoscopy in february, and the hospital billed my hmo $7,300. norman and two copy will do it for 16 -- $16.50. building quality is medical quality. financial toxicity is a medical problem. treating the patient includes treating the higher person. the exciting thing about the surgery center of oklahoma, and these many doctors and centers who are saying that we want to give you an honest, -- an honest price is that they are disrupting markets, and it was a real privilege to be able to profile this exciting work of honest, fair transparent pricing that is disrupting markets in the book. here's another question

from our social media followers who say, "rather than try to untangle the current billing scheme, why do we not just move to some flavor of universal care like every other first world nation?" is that a solution. we have seen some candidates talk about medicare for all and other flavors of universal care. guest: people are suggesting this with good intentions, it is a very noble idea to expand coverage through some government-sponsored initiative. the problem is that a research study we just completed with our business school and a professor of accounting is that we already spend -- all of the expenditures in the united states, 48 percent goes to its health care in its many hidden forms, full -- social security checks being used, the defense department's health care system, v.a. health

care system, the insurance benefits federal tax dollars paid for for the 9 million federal workers. interest on health care spending and test debt. if we are spending 48 percent of spending, what are we really proposing we increase that to? 60%, 90%, we have to cut the waste. if we can get better coverage through competitive markets, if we can clean up the price gouging by simply having a disruptive marketplace by those who show prices, is that not the better solution? if you make $52,000, you are spending one third of your earnings on health care without even using the system. year, youe $250,000 a are spending 50,007 -- $57,000 a year between insurance and your

federal tax dollars that go to health care. that is a disgrace. throwing good money after bad into a broken system is not a solution. let us let competition work. any system that has had this universal coverage over time, it always guaranteed dials down the spending year after year and 10 or 20 years into it you have a massive dilapidated system. it is with good intentions that people suggest it, but we already spend enough money to give every single person in this country goldplated insurance, we just have to cut the money games and waste. host: let us talk to chris from texas. good morning. caller: good morning. i have not read your book. jesse was the show, talking about hospital cost as a percentage of health care and it

was significant. i think you said it was over 40%. my comment is, i live in the dallas area, and parkland hospital is huge and beautiful. it is probably the best hospital in texas and maybe in the country. i think it was 2015, 70% of the babies born in parkland were to illegal aliens. we are talking about hospital costs, and nobody talk about this. and i as a person who has had insurance all of my life, when i walk into parkland to have a surgery, i am probably going to pay at least a 60% premium to pay for one mexican child born in that hospital. if your book does not talk about this, i probably will not go and buy it. tell me if it discusses this? host: this was on a previous segment and i want to remind people of what i said.

this comes from kaiser health news, "data shows that hospitals are the biggest cost in our 3.5 trillion dollar health care system. spending is growing faster than the gross domestic product and wage growth. representedpite -- 44% of personal expended for the privacy -- privately insured. a report from researchers at yale found that hospital prices fromased 42% from two -- 2007 to 2014 for inpatient care and 25% for outpatient care. those are the facts according to kaiser health news. amused bym politicians talking about piling onto insurance companies while hospitals have been getting a free pass. what i love about this article by"the new york times,"

elisabeth rosenthal is that she says the reasons that these to my credit candidates are not talking about hospital prices is because they are getting a lot of campaign contributions in their districts from the hospitals. hospitals are run by good people, i believe that. i have met leaders who are good people working in a bad system. this crazy game of jacking up prices so they can give discounts to insurance companies is part of the reason we are spending a ton of money on health care, and hospitals, despite the cries that they are run on razor thin margins and are the bank -- are on the brink of closure, large hospitals are on track to make the largest profit margin in human history, 5.1 percent that translates over to $100 million a year. at the same time the small and rural community hospitals are closing. honest, fair, and transparent pricing, just like we got nutrition labels for food

in the industry told us they could not do that. now they are competing on the basis of ingredients and nutrition. hospitals need to be competing on the basis of value, quality, and price, not billboards at nfl games and valet parking. american safety net hospitals are doing a great job. i know people at parkland hospital, the surgeons they are friends of mine. illegal immigration care is not 70%, it is about 10%. hospitals, historically, have always taken care of those who cannot pay. with these record margins, certainly that can be part of the mission. when american hospitals were built were meant to be a safe haven. many were billed by churches for their community, and their charter states that they take care of anyone regardless on " race, creed, or ability to pay." that is the great american

medical heritage. that is what i am proud to be a part of. i am proud of the man who sold the insulin patent one dollar. and the man who refused to get a patent for the polio vaccine. that is our great american medical heritage. today these money games and the price gouging, and predatory billing is threatening the great public trust in american hospitals. host: from columbus, ohio, sent in a comment that says, "the core problem is that the patient does not pay. every patient wants the best pick care, -- the best care. what if car buyers did not pay? on that havent 30% nothing to do with health care. what we have seen is a fleecing of everyday americans. when you have united health care

on wall street, they are reporting in their quarterly report a 25% increase in earnings, how does a company that is an actuarial business that is supposed to pass along cost of health care to individuals through insurance, how is that going up 25% in one year? they set on the call that it was in part due to the pharmacy benefit manager, one of the middlemen. we have good people, but they are working in a bad system. we need to take a close look at the waist. i -- waste. i believe we can do it by getting rid of secret pricing and getting rid of -- host: let us talk to christopher from daytona beach, florida. good morning. caller: good morning. love c-span, fantastic program.

i was slightly taken aback a little while ago. you are speaking to the specific or anyhat any procedure, kind of visits is plausibly negotiable, and i was with all due respect, you are a doctor and i was a layman, and i was stunned that you would say that. it is probably my ignorance, so forgive me on that. i go into the doctor on a regular basis, since i turned 40, and i have had several serious procedures over the course of my life, a broken neck, a concussion, but i have always had pretty good health care through my employer's. -- employers. and i strive to take care of myself. i just -- i would not know how

to do that. i would not know do -- know how heregotiate if i am hurt or away. i was at the mercy of where i went. saddleback fixed me up with my surgery and grafted my neck, and i am doing great these years, -- medical billsmes, are negotiable, you have to get to the right person. i do not speak on behalf of my hospital, but when i interviewed people in charge of getting the bills paid on the hospital side, the revenue cycle or finance department, they would often tell me if somebody claimed a hardship, they would cut off 10% or 20%, or they will put somebody on a payment plan.

beware of the payment plans or discounts, because sometimes they represent discounts off of a bill that is 200 percent or 700% higher than what the same hospital would except for medicare or an insurance plan. if you want to find out what that hospital will accept from a commercial insurance company, you can look it up at these websites, health care bluebook and fair health. one of the sites that you can use to actually price shop is mdsaves.com. the hospitalent to in carlsbad, new mexico where there is a lot of price gouging and i have been representing patients. by the way, two hospitals already announced that they will stop suing patients. we sent letters begging them to remember that why we went into medicine. this receptionist in the basement of carlsbad medical center said that, the cat scan

you are asking about costs $5,000. if you go to this website, mdsave.com. you see it listed for $500 at the same hospital. there is this date and switch with these crazy prices that are not real prices, and these platforms that are creating a true market for real prices, which is what we need to address the massive price gouging that is crushing every day americans. host: we have been doing a lot of talk about we can do as consumers. what would you suggest doctors do about this problem. this affects them to. -- affects them too. what should doctors and medical professionals do to address these problems. guest: at the hospitals that have agreed to stop shoot -- suing patients.

mary washington hospital had sued 25,000 people in a count of 28,000. the hospital announced that they would stop all lawsuits against patients. part of it was the doctors saying this is not right, and we want this to stop. we are going to uva where that hospital has sued people who live paycheck-to-paycheck, and even students over unpaid medical bills. this is an institution that takes public funding. fellowtalked to my surgeons there, because the surgical community is small nationwide, they were livid when i told him there patients are getting sued because of their services. get as can do a lot, you bill that is egregious, take it to your doctor. bring us your bill and let us become your advocate. we need public accountability. that you canys negotiate or fight your medical

bill. your financial life away when you come to the emergency room. hospitals are required to take care of you regardless of your ability to pay. card inive your credit the emergency room, hospitals are required to take care of emergency conditions. host: jerry, from virginia. good morning. caller: good morning. i have been listening to this conversation for the past half hour, and with all due respect, i do not think giving prices to people is going to solve the problem. people in their -- when they are sick, when they go to an emergency room they cannot crawl to their pc and see what their procedure will cost. we have to have a medicare for all system. the board sets the prices and they have a board of medical providers and dock errors and

they set a fair price. that is the only way you are going to solve this. leaving it to the markets is not going to solve nothing. we had it with the affordable care act and does not working. -- it is not working. withhave health care plans $10,000 that are subsidized by the government. guest: i would say let us give markets a chance because 20% of doctors are not accepting medicare. the trust fund is unsustainable. we have reimbursement rates that get cut every year relative to inflation. the idea of simply applying medicare for all does not work with the current medicare system, let alone what it would look like in the future. let us give markets a chance. hurt and went to the local hospital, they got massively price gouge.

was that because there is so many uninsured and homeless people at the ski resort? no. couching is because they do not have to -- gouging is because they do not have to show prices. if airlines build you after the flight they would be price couching you. it is absolutely correct that everybody will not use pricing information. -- pricinge price information. my mom does, and when she price shops and that small fraction of people who compare grocery store to grocery store keep prices in check for everyone else. proxy shoppers will cut the waste because -- attributed to , and employers want to see those prices.

an employer in boston had their employees delivering their babies at different hospitals, and the price ranged for an uncomplicated labor and delivery from $7,000 to $41,000. if i'm an employer and paying for these, i would like the women delivering to go to the hospitals that charged $7,000 and not the one charging $41,000 because they are both of equal quality and harvard affiliated. he decided to let his employees know that if you deliver at a $7,000 hospital, he will give you free diapers and wipes for a year, and guess what, everyone is going to the $7,000 hospital even though they still have choice. that is the power of markets when we get to see honest pricing. host: you have been writing and talking about this for a while. in addition to your book you wrote ": unaccountable how

trance -- unaccountable: how transparency can help health care." is there something that congress should be doing? what are they doing, is it possible that we will see something coming out of congress? guest: we need every day americans to say that we are getting crushed by our medical bills. that is what i saw when i traveled the country, and that is what i am hearing. every day americans are getting hammered by the high cost of health care. raising deductibles for insurance is not innovation. that is giving more share for the patient to pay. members of congress need to do a couple of things specifically. they need to address surprise billing, create incentives for billing quality. we need ways to be able to say, if you provide honest and fair are on a sixthy

grade reading level, delivering a baby should have a price. not machine-readable, giant codes that are outputs. we need honest and fair prices in english so people can understand them. willnt navigation tools create good ways so there is competition. we need congress to repeal the safe harbor exemption that allows kickbacks in the domain industry is, and we need the full implementation of president prices executive order on transparency that discloses the secret negotiated discounts between insurance companies and hospitals. if you go to a restaurant and say i would like to see the prices on the menu and they say, who is your employer and we will give you a special price with secret prices that you cannot cannot see what the next table has on their menu and you are getting charge four times more. we would say the lack of transparency enables price

gouging. i was disappointed to see many of our physician lobby groups and washington, d.c. oppose all forms of surprise billing legislation, and i realize that trade groups do not represent its members 100% of the time. the members of congress need to hear from every day americans, so you tell them about your surprise bills and all of these nightmares that almost everyone has a story about. 57 americans have received a surprise bill. it is affecting everybody. oft: i am seeing a version this comment over and over again. the comment is basically, when i am sick i do not have time to go shop around. i need to get well and i need a doctor to deal with my health. i need to deal with that instead of the cost. is this something that we should be doing in advance.

if you are alone and sick you are not thinking about what it will cost. what will you say to those people that were saying if you are in the middle of a health crisis you are not thinking about the cost or comparison shopping, you are thinking about getting well. what would you say? guest: if somebody is shot or having a heart attack, we are not giving you a price. we should be taking care of you. you should not be doing price shopping. over 60% of medical services in the united states are highly shop double and they are elective. we are talking about that gigantic market and somebody who has a knee replacement and gets a $70,000 bill that is the insurance negotiated price when the federal market price is $28,000. we are talking about price gouging. just as an observation and doing the research for this book, and going to one of the area hospitals in virginia, it is loaded in the emergency room with ubers and lyft.

why? people are afraid of the gouging of the ambulance, ground and air. people are already afraid of price gouging. pricesls can show their to proxy shoppers and a small subset who will make decisions. we are not going to address pricing for emergency care with price transparency, most of medical care is shop double. host: let us talk to him area from -- let us talk to mary from pennsylvania. good morning. caller: i have been listening to the doctor, and he has basically correct. this is a problem that congress needs to fix, and this is under the emergency medical treatment have uninsured

citizens in this country, undocumented people who go to the emergency ward, and it is billed to taxpayers of medicaid. this is costing us a fortune, and if you are uninsured, and under medicare, then medicare only pays 80% of your hospitalization. assets available to , the 20% yourance would have to pay, your assets are taken away. i worked as a state worker for 45 years, in philadelphia county. takewe would actually people to court because the hospital mandated us to do so. they were losing money, and we would take your assets away from

you as a citizen. we cannot do this for undocumented people because they are not paying into the system. it should be mandated that anyone who is in this country has access to a payment plan that will pay for their health care. host: go ahead and respond. guest: medicare does in fact have co-pays and deductibles. people think it is free, but the medicare trust fund cannot support all of the medical expenses, so they have set and regulated prices. some doctors do not accept medicare because they think the prices have dipped too low. entirely free entitlement. if we are already spending 48% of federal tax dollars on health care, what are we suggesting we increase the number two? how much do we need -- the

number to? how much do we need to increase taxes? the u.s. capitol building is a church where my team was tipped off that doctors were in their doing unnecessary health screenings to recruit patients for needless procedures. they are still procedures -- stint procedures that were featured in the wall street journal and i write about in the book. entirelys going on an funded by medicare two miles from where congress meets, throwing more money into the system will not fix it. let us give honest and fair price print -- price transparency a chance, and we will see what we have seen in the small sectors of health care that has price transparency. look what has happened with with cosmetic surgery. these are areas of health care that have had price.

-- price transparency for decades, and what do you see? a reduction of prices and healthy competition. let us give it a chance and restore medicine to its mission with fair billing practices. host: let us talk to charlie who is calling from new york. good morning. caller: how are you doing. are important. .e cannot go to las vegas we need to stop bernie sanders single medicare for all. host: we are losing you coming in and out. i think i lost charlie completely. guest: i think i got enough pieces of what he was suggesting. know, there is broad consensus in my opinion in the united states on health care. not listen to the echo chambers

of cable news. i know they are part of the funders of c-span. let us block that out and look at what the american people believe in. they believe in honest prices and americans are united that they do not want corruption in the government. there is broad consensus on some of the basic stuff we can do, and i think politicians need to hear from everyday americans are getting hammered with their medical bills. host: let us talk to larry from south dakota. good morning. caller: good morning. this is so interesting because i'm going through a situation with two bad knees. having two bad knees, there is not an easy way to do this. bonenot a 70-year-old saul cutting off my legs -- saw bone cutting off my legs. they have stem cell regeneration, and insurance companies will not give you a

nickel, so you are going on your own. that is one thing. the other things a friend of his combinet out of in the middle of the night, crawled to his car, crawled to his house and called to a friend who took him to the hospital. he got there, they looked at them, and found out that he dislocated his hip. they kept him there for three hours and said you are ready to go and he went home. he went home and he got a bill for $14,000. that wiped him out. he drank himself to death a year later because he was out of money. that is another deal. of then you talked about all the big hospitals are constantly -- they have all this great technology and little hospitals are going broke. guest: people are getting hammered with medical bills.

what is happening is that about 1/5 of americans are making difficult decisions about their personal finances including paying for groceries because of their medical bills. it is a disgrace. field, 1/3 of women with stage iv breast cancel -- with stage iv breast cancer report being harassed by medical practitioners. one quarter of the people of diabetes of these report rationing their insulin because of costs. we have people who do not trust us. at johns hopkins we have great researchers sometimes my colleagues say, why are you interesting and health-care care costs and billing practices and the stuff about transparency? i tell them, we can have the cure for cancer and these great technologies and operations, but public does not

trust us, they are rendered not good. we have to regain the public trust, and the money games of billing and predatory price gouging threatens the trust in the medical profession. host: i want to read a quick quote from your book that you wrote. "once a person admits to the mildest leg cramp or soreness it triggers a chain of events. the patient might as well be picked up and placed on an assembly line. it starts with the tests they did. if that warrants further checkup, that is also a subjective call, the doctor says let us take a look with an ultrasound probe. i the time they are done ringing the cat -- by the time they are done ringing the cash register medicare has spent approximately $10,000 per person. private insurance will pay up to triple that amount for the same procedure. you mentioned the church affairs

earlier, talk about what you are talking about. you would assume that doctors aking people to come and get checkup and make sure that your health is ok at these events would be a good thing. this does not make it seem like that. guest: most doctors do the right thing or always try to. we do not want to create hysteria. what we found doing the research was that, at this church two miles from here there was a pattern of doctors going in and doing these unnecessary screenings, and it was predominantly from a national study that we did to follow the observation, predominantly in minority and low income communities in the united states. that was offensive. i grew up going to church, i love going to church. to see that the house of worship would be root -- a recruiting ground for doctors to -- who can get a hefty payment from the medicare system because of what they are doing.

within two miles of the u.s. capitol building. i think that shows how disconnected the politicians are from the frontlines lines of american medicine. it shows that simply throwing more money into that system is not really the answer. doctors are good about nudging patients. no workarounds and how to document things so insurance companies will pay for things. most doctors do the right thing and always try to. a small fraction are extreme outliers, and in the book i talked about the improving program where we are now addressing outlier physicians in a civil fashion so that we can shunt the resources used on a blanket basis against doctors like pre-authorizations and pay her to pay her calls, -- and calls, to the

outliers. let us do not -- let us not bother doctors and let them practice medicine and spend time addressing outliers, doctors with an 80% c-section rate for elected uncomplicated deliveries. stints who dos tint -- with a practice pattern that is egregious. backe who do elective surgery. doctors who do spine surgery routinely on patients who have never seen a physical therapist once in the year preceding the elective surgery. these are patterns, and a new way to measure quality that does not have a recording burden and it addresses the appropriateness of care, not just the complication rate once you do something. host: let us see if we can get a couple more in. remember, people briefed with your comments or questions so we can get as many people as possible.

, from morgantown, north carolina. you have something quick for us? caller: i work for health care and i have been in health care for -- host: go ahead. caller: i have been in health care for more than 25 years. with transparency in pricing. as a patient, i have insurance but cannot afford to go to the doctor. colonoscopy, and it is supposed to be a routine, because i just turned 50 years old. now i am getting all of these bills, pathology bills and these other bills. it is supposed to be just like less than $500, but bills are coming, so i think it is better to have transparent policy in health care costs because you do not buy a pair of shoes without

knowing how much it is. your: thank you for service and working in health care. we attract amazing people. the sort of person in high school that says i want to be a nurse is different from their peers. folks interviewing for middle school school -- for medical school are impressive, the altruism and wanting a purpose above themselves. we attract great people, we have good people working in a bad system. we need honest pricing. , sick should be at home and scared to come to the doctor's and that is exactly what i saw in telling the stories around this book. host: we would like to thank dr. marty makary, author of "the price we pay: what broke american health care and how to fix it." you so much. guest: it is great to be with

you. host: i want to remind everyone that "washington journal" we'll be back tomorrow morning at 7:00 a.m. everyone have a great saturday and thank you for watching. [captions copyright national cable satellite corp. 2019] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] >> next is the house judiciary committee considers guidelines for future hearings related to possible articles of impeachment against president trump. after that, president trump speaks at the house g.o.p. retreat in baltimore. and then iran and terrorist financing.

to oday, joe biden, wife -- help open a field office for the 2020 biden campaign. watch the event and her remarks tonight at 8:00 p.m. eastern on -span. [captions copyright national cable satellite corp. 2018]] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] >> senator elizabeth warren this new york city today to speak with voters on washington square park. watch live on c-span at 7:00 p.m. eastern and president trump holds a rally in rio rancho, new mexico, just outside of albuquerque. ♪ >> campaign 2020. watch our live coverage of the presidential candidates on the campaign trail and make up your own mind. c-span's campaign 2020, your unfiltered view of politics. ♪ >> the house judiciary committee

met thursday to consider a resolution on the guidelines and scope for an impeachment investigation into president trump. the resolution was adopted along party lines by a vote of 24-17. this is just under two hours. mr. nadler: the judiciary committee will please come together. a quorum being present, without objection, the chair will declare for recess at any time. the chair may postpone further proceedings today on the question of approving any measure or matter or adopting amendments for which the yeas and nays are ordered. pursuant to notice, i