together and all of the failures. jim crow, trail of tears, the greatest hits and everything else. it is also true at the same time that there are ways to talk about issues that a reasonable person will be healthy or toxic. there are school districts such as madison, wisconsin and massachusetts, they separate their children by race to talk about these issues. for my money, this is nothing more than jim crow brought back to life, it is racial segregation and it is defended as a manifestation of creative race theory. what i reject that characterization. for me it is bringing back to light some of the most reviled behavior in our nation's history. when we talk about critical race theory we do ourselves a

disservice and we do better off to think about what are the things that we agree we want schools to teach about history and where are their practices in interpretations that we think are problematic. host: frederick hess is the educational policy senior fellow and director for the american>>. host: we turn our attention to health care policy and what republicans have promised in their commitment to america agenda. joining us is marilyn serafini, a health program executive director at the bipartisan center. let us begin with what the republicans laid out last year. their commitment to america in health care includes personalized care to pvide affordable options with better quality, lower prices through transparency, oice, and

competitio invest in lifesaving cures and improve access to telemedicine. what is the impact on these priorities? guest: they are talking about a lot of issues that really are actually bipartisan. we have democrats and republicans who have consistently been focused on lowering costs, specifically drug costs coming from the american people. the american people say over and over that they are just extremely concerned. they are concerned about prices and cost in general. there was a super interesting results that came out yesterday from gallup, nearly 40% of people said that either they or a family member actually delayed care in 2022 because of the cost. now, this is something that gallup has polled over a long period of time, but this is by

far the largest percentage of people who had actually delayed care because of the cost. this is one of the reasons you should -- he will see republicans and democrats focusing on cost. a lot of the things you mentioned will be tougher republicans really to get into and democrats, whether we are talking about the house since the republicans control the house, or the senate which is closely divided but run by democrats because of the cost. everything costs money. host: how does on that second bullet point, how do you lower prices through transparency, choice, and competition? guest: so, transparency is a big one particularly when it comes to prescription drugs. we at the bipartisan policy center are about to put out a blog on this topic because we, and we have had recommendations to this point.

the process by which the drug gets from the manufacturer and then to the various middleman including the pharmacy benefit managers, like the caremark and the others that you see on your prescription card when you take it to the pharmacy, there is not a lot of transparency. we do not exactly know what deals the fired -- the pharmaceutical manufacturer and the pdm are cutting. the pdms work for the health insurance, that is the employer, but we do not really know what is happening and what kinds of discounts are happening throughout that process. so by the time your -- you pick up your drug at a pharmacy we have no idea who has gotten what and what has gotten into the price we are paying. so republicans and democrats alike really do want to see some

transparency in that process and maybe democrats more than republicans. again, this is something we have been talking about for a long time so i am not sure we will have more progress this year. we have been trying. host: when republicans say they want personalized care to provide affordable options and better quality, what are they talking about? guest: here we are talking about, again, we do need to have better quality and affordability. and in terms of improving affordability they have been talking about competition. that is in everything across the board. again i will bring this back to transparency because it does go beyond prescription drugs. people need transparency in the prices they are paying for services. they need to know what it costs them and, therefore, what it

will cost the insurance company if they go to x hospital to have their hip replacement or y hospital to have their hip replacement. it is just something that they need to know. let us talk about competition. we have been very concerned about competition for a long time. one of the things that we are concerned about is consolidation in the health care marketplace. now, this has to do with hospitals buying out other hospitals and hospitals employing physicians and large groups employing physicians so that we have a real consolidation. we know that some of the health care markets in terms of hospitals that over half the markets in the u.s. are considered highly concentrated, which means that they are so

built up and you have a major player and there are real concerns. we are not sure how this happened and how the power is in the federal -- the powers in the federal government allowed so much consolidation. but it is here, and what we know about this much consolidation is that a lot of the time it results in increased prices. host: let us turn to our viewers and get your thoughts on what the republicans are proposing in their commitment to america and what your health care experience is like and how you want washington to address it. democrats, 202-748-8000. republicans, 202-748-8001. independents, 202-748-8002.

text us with your first name, city, states, and thoughts at 202-748-8003. let us hear from jeff, an independent. your thoughts. caller: thank you. the nation just went through losing 1.1 million people and 6 trillion dollars in losses from the pandemic. i would like to point out that this was not something very often referred to as a black swan event. other countries like south korea more than 20 years ago especially after the 1915 pandemic and actually the best in the world have never had a national shutdown and basically had 1/6 of the mortality on a per capita basis in the united states. the problem i am having with this is that we recently passed

a pandemic prevent act, which sends $35 billion to be spent over five years for this person -- for this purpose. that seems to be to be an incredibly small amount of money to save $1.1 million -- lives and 6 million -- $6 trillion in losses and not at all commensurate with the military budget which have not saved 1.1 million lives and have not lost 1.1 million people and we spend 552 billion dollars each year on defense as of last year. this is completely unbalanced. how me lives to be saved and how much money to be lost. we talk about the debt and health care. this needs to be addressed. caller: your thoughts. guest: thank you. so you raised a very good point. and i have two responses.

one is that it will be harder than ever to spend federal money in the next congress. this congress in particular, the new republicans in the house have committed to paying for everything that they spend. or cutting other programs. they do not want the expenditures in the federal government to rise so that in order to spend more money they need to cut in other areas. it is not impossible and it can happen. the whole philosophy of that is not too different from what we already have. the point i am making is that it is hard to spend money. the need is great. we have a public health system that is severely underfunded at the local level. we have incredible work or

shortages in the public health system. this year congress does need to -- they have a reauthorization coming up for the pandemic and all hazards preparedness act and that is one possible -- it is going to be -- they are going to do that. it is very likely that they will be successful in doing that. it is not like the issue is disappearing. it will be up for reauthorization. host: here is a tweet. "anything river guarding -- regarding health savings accounts, maybe even the federal government putting $2000 a year for citizens of every age. who can afford paying off -- out-of-pocket health care costs after paying for the insurance? aca is largely insurance focused, not health care." guest: ok, you bring up an excellent point. i am sorry i do not support hsa

for all, that is not what policymakers are talking about even though this is a part of our fabric now is having -- now that employers are offering hsas as an option. what you bring up is the cost issue and this is cost of the individual. even insured individuals are having a lot of trouble paying for their medical care. and this goes back to the gallup poll where 40% of people had to delay care because of the costs. a lot of this has to do with high deductibles. so even if you are insured, and this does tend to go hand in hand with the hsas, they are typically high deductible plans, although they are in some tax

preferred money going into those accounts so that the person had a lot more choice. the deductibles, or really they are anywhere from the high deductible, $2000 and some of them go up as high as 6000 or $7,000 so people regularly need to make the decision about whether to spend the money out of their own pocket, to have medical services until the coverage actually kicks in. but the hsa does help with some of that. and so that is why we are seeing them growing pretty naturally in the private market. host: chris in maine, democratic caller. caller: i was just reading your website at the bipartisan policy center, are you -- my correct?

caller: thank. so it comes from both angles. my comment is that here in maine , i recently lost my previously only primary care physician working inside the two hospitals and they control 100% and that is almost literally impossible to get a new -- to get new insurance. the median is a court of a million dollars a year and that is pretty low income. the administrators make over 1 million and health care companies are seeing 8% profits and about 20 billion a year. we wonder why the cost is so expensive. there are pretty obvious reasons. doctors make staggering amounts of money. and there is no incentive to change that. because the incentive is to get rich. if i understand this correctly

under the recent bill that passed they said a rule that said the federal government can negotiate drug prices with drug companies. i said republicans wants to repeal that and i'm wondering what the policy center's position is and why republicans are so obsessed with getting rid of negotiated drug prices. guest: most republicans have been against this and play because they want to see the market competition play out and they fear that if medicare and medicare is such a huge buyer of drugs that if medicare gets involved in the drug negotiation that this will artificially tamp down the prices of drugs and therefore are you going to have research and development and drug industry. they are concerned about the governance having too much power

in this respect. now this happened already a little while ago that congress passed this and certainly the house would have the numbers to turn this over, but it is unlikely to turn over in the senate with a democratic majority. it is unlikely that this would happen. in september the administration will actually begin implementing these negotiation appeals. i wanted to bring something else. you are talking about the workforce and it would be terrible if we did not talk about it. that health care workforce right now is really struggling. during the pandemic we had problems with nurses and we are

the direct care workforce, the people in the nursing homes and rehab facilities and coming into the homes. they are not nurses, they are -- they have less training at that. these are people taking care of people who need more care and we have a severe shortage of that. you talked about maine and we do a lot of work in the rural states and we work with both democrats and republicans defined common grounds and where they can come together to move forward. we visited maine with the former senator and we understand that in rural areas in particular that the ability to see providers is very difficult. now people in rural areas get

most of their care through primary care because there is even more severe shortages of specialists, everybody from cardiologist to neurologist. there is a lot more in primary care. this is why refocusing on the workforce --this is why the need to be focusing on the workforce and telehealth which is a bit of a problem in rural areas because a lot do not have broadband access. but during the pandemic the federal government allowed more flexibility for people to get services via telephone. and that is possible in rural areas. right before congress left for the year they extended all of those flexibilities for two years. while we do not expect to see action in congress this year on telehealth, we will the following year.

so it is very important now that we are looking at water the most important pieces and cost-effective pieces of telehealth that should continue and i expect to see a lot of research coming out with evidence this year. host: scott. billy marilyn. independent. -- bowie, maryland. independent. caller: i have been in the pharmaceutical industry and two acronyms. ipa when a group of doctors negotiate prices based on how me patients they are going to see. a lot of hospitals started buying them out so i am surprised that this is a shock to those in congress because the bigger these hospitals become, they need some type of legislative oversight. once they start partnering or dealing with cvs and walgreens

and i only mention those two because they bought everyone else out. another monopoly that i am surprised that it is coming as a shock. it is more of a smokescreen. this is what the caller in maine is mentioning about. it is not that the doctors are making x amount of dollars or medicare is making it cold. the population is aging so most pharmaceutical companies are focusing on the 60% of the pie. the idea that the cost is because we cannot get health care workers in order research and development does not hold weight. we have the best medical services. we have the best products. in terms of dealing with medication, the u.s. has the worst mortality rates versus other industrialized nations. so i just want to hear what your guest has to say because both of these issues or multiple issues

are smokescreens. this is about making profit. unfortunately there are drugs that cost x amount of dollars here cost pennies and other countries. host: we will take your question. guest: so, the reason it costs pennies as of russian other countries is because the government basically did hate the price. they say pharmaceutical company if you will sell your drug in our country we will only pay this price. that is not the kind of system we have in the u.s. and i do not expect that to change anytime soon. so it is really a struggle between competition and, you called it oversight, but the government stepping in to do something. this is what we are seeing with the medicare drug negotiations that will take place. this is why those who supported

that wanted this to happen. they wanted large payer leverage to be able to bring down some of those prices. and part of the reason that our prices are so much larger is that if the drug companies are not making their money and other countries than they are looking to the u.s. where they can get that money to do this. but also, again, this is just a matter of the medicare drug negotiation and getting leverage. whether you support the government doing it or not they will have that kind of leverage. so we might see some change. the overall statements about consolidation and competition, that train has left the station. we have, not we but the federal

government, has allowed for this to happen and so we are where we are right now. and the question is how do we work with and how do we handle the systems in states that have already become very large. and there are some ways to do it and here at the bipartisan policy center we have opposed looking -- proposed looking at highly concentrated markets and somehow eliminating -- limiting the prices they can pay so they are more aligned on the same level and -- as areas not highly concentrated. host: marilyn serafini, is there an opportunity for a disrupter into the health care industry that could up end the structures that have been in place? guest: i think we have seen the

disrupter, technology. telehealth exploded during the pandemic. but it is not even telehealth. it has to do with other types of technology, like remote patient monitoring and digital therapeutics. these are areas that are growing by leaps and bounds to help, one, people get access in areas that are underserved and that have fewer providers. this is a way to bring them providers, it is a way for providers to talk to providers. for example, a medical provider in a rural area to talk directly to a specialist. at the cleveland clinic or the washington hospital center, or

anywhere to get the information that they need to treat the patient rights there in the community. so technology will allow providers to come to those areas virtually, but right now we are struggling with how to make sure that we are doing this in a value-based way so we are really focusing on what is the most -- where we are going to get the biggest bang for our buck, and what will be the most meaningful. host: new york. bill is a republican. you are talking with marilyn serafini of the bipartisan policy center. go ahead. caller: good morning. i have enjoyed what the other callers have had to say. i have to say i am also disappointed to hear so much discursive kind of pr copy being offered as bipartisan policy.

i would like to ask the guest what the gop plan seems pretty thin what it has to do with folks like me who have pre-existing conditions and how that might in the short term, especially after covid have some -- how some of our pre-existing conditions would be covered in such a competitive marketplace, as one might say. i am sure the guest has pre-existing conditions that might not be covered with things like medicaid and such. host: alright. guest: so, look. what the republicans in the house have proposed is what they want to do. and this is through their commitment to america.

you know, it will be hard to do anything this year. it will be hard to do anything beyond what we know are pieces of legislation that are not controversial. some of the areas that they have listed in terms of telehealth and that is not really helpful until next year. so drug costs, we have tried to do that before and i know preparing for pandemics we have the one bill that really requires reauthorization. and something with a doctor/patient relationship. and proving affordability. these are really hard issues and we have been trying to do this stuff. let me just tell you where the areas of bipartisan interest are. and when i say bipartisan interest i really do not intere, i don't mean the democrats and republicans agree on how to do

it, but they agree these are priorities for them. one area we have not talked about is behavioral health. i'm including both mental health services and also substance use. there is an enormous gap in the need for services and what we have available. this is an area where i do expect we may see activity this coming year because the interest is so strong from both parties. the other area we have not talked about which possibly could get some action this year is the end of the public health emergency. this is happening. the question is what happens after the end of the public health emergency. you mentioned medicaid. this is one of the top issues folks are looking at because in

april those people who have been on medicaid but no longer qualify after the end of the public health emergency because during the emergency they were able to be on medicaid because the eligibility was expanded and they did not check on people regularly. they kept them on. there is going to be a question about what happens to those people. millions of people who received medicaid during the pandemic, or tens of millions of people, could find themselves off of medicaid in april. some of those people will be eligible for the affordable care act insurance through the marketplaces and some of them will get pretty substantial subsidies to help them pay the cost.

these are some of the things that we expect to see some attention to whether or not we get bills passed and executive action, that is to be determined. these are the areas i do see the democrats and republicans working together on this year. host: marilyn >> c-span is your unfiltered view of government, we are funded by these television companies and more including cox. >> homework can be hard, but squatting in an internet honor for homework -- internet diner for homework, is harder, that's why we are providing affordable access to internet so homework can just be homework. >>cox funds c-span is a public

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