. >> rose: welcome to the program, we begin with new developments in cancer research, my guests are robert stone, stephen rosen and stephen forman. >> we still don't having said that, we start to understand the genetic make-up of cancers, the way they express, the better understanding of what regulate it is expression of these jeans, and then the key proteins that are responsible for whether a cancer divides or invades or spreads to another organ. and this knowledge is allowing us to create strategies that would allow for both more effective therapies but also prevention strategies. >> rose: we conclude this evening with al huntington story, talks about the issue that will drive the campaign in 2015, and his conversations with yuval levin and neera tanden. >> this election like past

elections, where again you -- is going to be about the future and who has the better answer to toe struggles families are facing and we live in cynical times, but both sides are going to have to bake through with real ideas. >> rose: cancer research and new ideas for the 2016 campaign when we continue. funding for charlie rose is provided by >> rose: funding for "charlie rose" has been provided by: >> rose: additional funding >> and by bloomberg, a provider of multimedia news and information services worldwide. captioning sponsored by rose communications from our studios in new york city, this is charlie rose.

>> rose: an estimated 1.6 million new cases of cancer will be diagnosed in 2015, there is, however, increasing hope for those touched by the disease. advances in molecular biology and genetics are transforming prevention, detection and treatment of cancer, city of hope stay research and treatment center in duarte, california, it is focused on rapidly transforming scientific discoveries to benefit patients with cancer and about life threatening illnesses, joining me now is robert stone, he is president and ceo of city of hope, stephen rosen, is provost and chief scientific officer and stephen forman, an expert in lieu keep i can't, limb to ma and bone marrow transplantation and also serves as chair in hematology. >> i am excited to have all of them here, because of all the lives i know that have been touched by cancer .. so let me begin by talking about the city of hope. tell me, you know, how it was

created, what it does, what makes it effective. >> all right. well, thank you, charlie for having us. some of the basics. we are one of the top cancer centers in the country. one of only a handful that are independent and designated by the national cancer institute as a comprehensive cancer center, which means that is the highest designation and our doctors and our physicians, are experts in laboratory research, in clinical research and in population based research. and we bring all of those back together. the way we got started is an interesting story, we are over 100 years old. we started as a tuber you lo sister sanatorium on the outskirts of the desert in california, as we look today, there are 17 million people who live within an hour drive of .. duarte, which is 20 minutes from downtown los angeles, 100 years ago, it was the desert and the end of the train stop, and a

garment worker saw someone die in the streets of los angeles, and decided that no one should die alone and form -- took money out and bought ten acres of land and formed a tuberculosis sanitarium, we started with no water, no electricity, no telephone, just hope that stayed with us to this day, and to understand us completely, you need to know where applied science, which is translation-al. >> patient and family experience of treating the mind, the body and the soul and a founder, gentleman by the name of samuel golter, penned our credo that stays with us today, there is no profit in curing the body if in the process we destroy the soul. >> and destroy the soul means what? >> it means treating everyone

with dignity. it means treating everyone as an individual. so much of the work that doctors rosen and dr.s forman and their colleagues do is dealing with people who are at a crisis in life, they have been diagnosed with cancer, and it is not just a clinical approach we take. it is also an approach to making sure they have dignity and their families are taken care of. >> rose: give me an idea of where we are in cancer research. where is the cutting edge and how rapidly are we meeting success in those areas that are the most challenging? >> there has been a revolution over the last few decades. not just in the modern therapies which we refer to as biologics but even advances in radiation therapy, we can be more precise, surgery where we have robotic treatment for many entities,

that no longer require extensive incisions, more rapid healing. chemotherapy is still exxon he used and very effective in curing many diseases. but the most exciting advances have been the biologic approaches. these are targeted therapies. where you know the molecule that you want to interfere with and then you can actually kill the cancer as a result of disrupting that rose. and there is a spectrum of approaches i recently gave a presentation and i had listed a dozen different alternatives raising from monochrome antibodies to toxins to. the car therapy you will hear about. these are all very exciting, ran piddly evolving and have had a profound effect in the clinic, either prolonging life, procuring the disease and most importantly, often with modest toxicity. >> rose: what is the biggest

challenge cancer researchers face, steve? >> it is several levels, first the challenge of understanding the cancer cell has been a life's work for rosen and myself and many people across the united states, i think whatable, it has revealed the clues we use to develop targeted therapies or immune based therapies, last year, on the cover of, the prestigious science magazines was immuno therapy now is the fourth partner in the way we treat and cure cancer, besides surgery, radiation, chemotherapy, are now immune based therapy, we are using a person's own immune system to help in that fight .. and i think all of that has been derived from basic research. i often will tell patients that there is no therapy that we are using on them that wasn't derived from somebody's idea, in some laboratory working late into the night, and so the other challenge i think is maintaining a certain level of funding so

that all ideas that are good get a chance to see whether they are going to help someone. >> rose: so part of the challenge is finding funding for somebody who is working late into the might to develop either treatment or cure? >> that is correct. i think because steve and i have been doing this for a long enough time, i think we are all very sometimes painfully aware of what we can do now had we known it then who would be with us today so there is a certain tyranny of time that comes with our work and why we want to move faster and i think as robert was saying one of the things we pride ourselves on is trying to take that focus and idea, use the laboratory and move as quickly as we can to the bedside and i think people come to us and other cancer hospitals are the same way, for that purpose. >> rose: how long is that process, formally? >> well, from an idea to a drug, historically has been sometimes seven to ten years.

i think what we try to do is shorten that as quickly as we can with some of these biological therapies by, you know, grant, partnering with pharmaceutical suit castle, other cancer centers because the patient is sitting there looking at you in the room that day, and i think that is part of the personal, where people talk about personalized medicine there is the idea that we want to give you the right therapy for the right gene and the right cancer you might have. but motte expense of depersonalizing the experience. i think for all of us who take care of people with cancer, it is a person to person relationship. and we are grateful for the trust they place in us to take care of them or their family member, because it is very much more than a one person experience. >> rose: what are are the big questions we don't know? >> there is an enormous amount we still don't know. having said that, in the last ten years, we started to

understand the genetic composition of cancers, the genes that are expressed and the genes that aren't expressed, we have a better understanding of what regulates the expression of these genes and then the key proteins that are responsible for whether a cancer divides or invades or spreads to another organ, and this knowledge is allowing us to create strategies that would allow for both more effective therapies but also prevention strategies, once we know a gene that may be associated with a carbs, cancer we may be able to say if someone carries the gene how can i prevent the cancer from developing? >> rose: and how are we doing with that? >> probably the best example would be the brca genes in breast cancer and if you carry the gene you have a very high risk of developing breast cancer. there are a variety of difficult decisions you may have to make that range from having a mastectomy to prevent the breast cancer to very active

surveillance, to taking a hormone that may be, may decrease the risk. >> rose: the complexity of how many genes for any specific cancer has always been one of the huge mountains to climb, according to my understanding. >> that is correct. >> rose: and what made it feasible for you to do what you did is in part because you are talking about one gene? >> so there is a disease that is sort of a poster child if you will for all cancer, the, called .. chronologic and many worked on that disease and found there was a single gene mutation that drove your cell to become leukemic but it also gave the opportunity for other people to develop a drug that works for that disease. the problem is that -- it is a wonderful story and saved a lot of people's lives and made in some cases other therapies unnecessary but most cancers are

not a single gene disease, and, therefore, to sort of focus on one gene, i think we have all learned, unfortunately, it is evasive a and tricky how the cancer cell is and how it works around whatever we know, so it is a battle that is ongoing all the time. >> and do cancer cells get smarter? i mean, as you develop therapies, they get smarter? >> unfortunately, that is the case. they either co-op part of the body's normal functioning, like the immune system for its own advantage and we work on ways to interrupt that or for any drug we may give or biologic we may give they figure out ways around it, either by selection that kills off most of the cancer, but not all of it, or the cell mutates again so that what was effective is no longer effective. that is often why we do things in multiples to try to box the cancer in. >> rose: what is the

breakdown, this is an obvious question between genetic and environmental in terms of cancer? >> it has been said about 20 to 30 percent of cancers have a direct genetic link, somewhere the gene has been identified, we know others run in family, environment plays a very significant role. tobacco and that was the number one cause of cancer related deaths. now we have an epidemic in obesity and it is a concern that the cancer incidents as a result of obesity will exceed that of tobacco use. and .. there are sexually transmitted diseases associated with cancer, human pap lo ma virus, hepatitis virus and .. some melanoma has gone to alarming proportions due to solar exposure, radiation. >> talking about prevention, there are three cancers in particular, like the sun, and

protection we should all do, the hp cvac seen if we vaccinated all the boys and girls before the age of ten, we would eliminate that cancer and cervical cancer. >> because about have of half and neck cancer is hpv related, so if you are immune to the virus and it is unable to sort of take hold in your body and take hold -- do. >> if everybody was vaccinated before you are ten. >> those diseases would become t's with why when we talk to parents about hp cvac scenes when it first came outpatients were hesitant about much less measles, but hpv about -- so we helped them explain to their children that even though it was a sexually transmitted disease, this was a cancer prevention gene, and parents are more comfortable and the kid was more comfortable that they were, what they were being immunized for, but i think that's why we push

so hard for this to be a part of what kids get, because it is ultimately down the line, now hepatitis b would be very similar one, there are vaccines for that, and worldwide, we can affect liver cancer in a major way if everybody was immunized. >> that's in the context of prevention in terms of vaccine. >> rose: turning back to the institution, so what is it that -- what is your message about this city of hope? >> everybody is touched by cancer, charlie. everyone. but they don't appreciate what it takes to actually move the treatment field forward, so education is part of it. raising funds and going around the country, we are blessed with a network of volunteers and donors that run in the hundreds of thousand across the country who provide resources and donations to fund research that wouldn't have other funding.

>> rose: let's talk about precision medicine. where are we and what does it mean? >> rapidly evolving components have existed for many years. what i think of precision medicine is personalized medicine, it is being able to customize for the treatment of each individual patient based on the signature of the individual's tumor, and that signature is based on the genes that are mutated and the genes and the proteins that subsequently appear. i will give you an example. in breast cancer if you press receptors for hormones we use hormone natural therapy, if you express -- use an about body, antibody, we are now able to dissect the genetic composition and look for abnormalities that may potentially be targets for therapy. >> rose: this has enormous potential in the short-term?

>> it has enormous potential but there are a lot of hurdles, not so much on defining the abnormalities but developing the therapeutics that can address those abnormalities, we have known the defect in sickle-cell anemia for decades but haven't been able to change the course of the disease on a molecular basis, so in concert with understanding the abnormalities in the cancer cell we have to be developing more effective therapeutics. >> rose: and what other diseases will most likely respond to specific medicine. >> all cancered, blood cancers often lead the way in terms of our being able to develop effective therapies. >> rose: like leukemia. >> like leukemia, myeloma, limb to a ma where there is incredible progress in the last decade .. in some enhances in prolonged cures and pro loning life significantly with a better quality of hive. >> rose: and the potential for immunotherapy is -- # growing i

growing. >> immunotherapy is a big hot topic in cancer research and cancer meetings and it is covering -- >> rose: and that is -- how long has that been true, that it is the hot topic? >> i would say in the last these years is really when it has taken off, before as steve was talking about we had antibody therapy and the two most effective .. about yod, antibodies developed in the city of hope, antibody used for limb to ma and breast cancer. and it really made a difference in curing a lot of people. that was our first foray into immune based therapy with those antibodies. in the last few years, there have been two things we have seen. one is tabling the person's own cells out and modifying them in some way. >> rose: reprogramming them? >> reprogramming them by introducing new genes. >> rose: right. >> that will target specific cancer and growing them up and putting them back in has been incredibly exciting with the

patient whose have done amazingly well, and really almost at the end of their disease. where there was no other therapy to be done and i think we are working on trying to expand that, to a number of decides and earlier in the course. the other has to do with what we talked about earlier with what the cancer does in the body to co-op your own system. we have, we get asked a lot why didn't the immune system take in this care of this is? why do i have this cancer. we get asked a lot and wonder about that, but in fact the cancer does inside that prevents your immune system from recognizing and reacting against the cancer and in the last two years we have developed what are called the checkpoint inhibitors, drugs that actually suppress the cancers effect on your immune system to allow it, and we have seen some remarkable results and diseases that were very hard to treatment, melanoma, lung cancer, so i think for us, to try to maximize

that impact is to develop these engineered t-cells or other drugs that effect the so-called microenvironment of the cancer and let your immune system do what it is intended to do. >> rose: it is primarily from limb to ma and leukemia? >> so right now, the most dramatic results have been seen in a certain type of leukemia and a certain type of limb to marks lymphoma and i think we have taken up the challenge .. to expand that beyond those two diseases to include brain cancer, breast cancer, 0 varian cancer, cervical cancer, we want to try to make that not a one trick pony but a field .. >> i know you hope -- >> yes, very, trials are opening this year that will answer some questions about other diseases that are as problematic and as scary as those. >> rose: those are interesting words. we have some trials coming up that will answer other questions about other diseases. what is the question they will answer. >> they will answer whether a car t cell can cause remission of a person with brain cancer. a it can it cause --

>> due do you believe that is possible? >> we do based on the preclinical work we have done we have have seen in our studies cancered -- cancers disappear. >> is it being used today? >> those trials are under fda supervision and -- >> rose: the trial is getting fda approval. >> all of these that involve the engineering of cells require fda approval and they are a partner of sort and one has to do the right thing in the safest way possible, but we are, as steve was saying, certainly we are anxious to move as quickly as we can and people are waiting and we get calls. >> rose: someone told me that brain tumors are one of the most difficult cameras to treat. >> that is true. >> rose: why is that? >> in part because of its location. and the effect it has on the person who has the cancer. it -- some cancers, steve was answering more indolent behavior in the body, you can live with it and with treatment you can keep it at bay.

brain cancer is not one of those at the present time. it grows rapidly and because it grows in a space -- you know, a lot of people have to wait for the cancer because it spreads all over their body. that is not what happens in brain cancer, it spreads throughout the brain and -- >> rose: and the brain controls everything -- >> everything it defines where we are and the seat of the soul, seat of everything that we define as our humanity in many ways. and before it has been predominantly surgery and radiation, a little bit of chemotherapy but now there is immunotherapy coming for that and will be injecting genetically engineered t-cells directly in the brain to make it go away. >> rose: let's talk about stem cell therapy. >> the stem cell therapy we do is, we take cells from a person. >> rose: right. >> and we put them into another person to change their blood from what it was to somebody different. and we do that predominantly to try to cure diseases like

leukemia, limb to marks it was started back in the seventies and has now become a therapy that for some patients is the curative therapy for their disease and we do it with curative intent. it is not to pal latif or have them live longer but to get rid of the cancer .. and the city of hope has a very large program, people come to us for that particular therapy. it is a therapy that when i first started you didn't do it over the age of 30 and now we, we routinely do the other piss in the early eighties, it is to replace diseased bone marrow or immune systems. >> rose: it started out as being called a bone marrow transplant. >> yes because we would remove the cells from the pelvic bones but with research, we found that those cells actually circulate in the bloodstream, and so we

can collect it from the bloodstream and infuse them into the patient. >> rose: would you say that stem cell is the silver bullet because in terms of dealing with cancer? >> placenta transplant is predominantly for diseases of the blood and immune system. the vast majority of the cancers we take care of are really not, the therapy. >> does not work. >> is not -- >> rose: why is that? >> because the cancers of the immune system are particularly sensitive to this immune 0 logic effect that comes from the donor, on the other hand what we have done is taken the analogy of that immune system effect on the cancer and that is in part what led to the car t-cells, let's make the immune system only recognize the cancer as opposed to maybe the whole body j. >> rose: right. so developing engineered t-cells that react against leukemia, brain cancer, breast cancer, derived from the observations that first the immune system can in fact react against and cure a

cancer and what we want to do is make that as available as we can to everyone, and in some situations make a transplant unnecessary. >> rose: there is also this idea of alternative therapies, which is a broad category. but i have had conversations and sometimes it brings up the name of steve jobs, because isaacson's book, a program i did with david kelley, at stanford, who also had cancer and who told me that steve told him when he, david developed cancer, go get the toughest, strongest treatment you can get. don't, don't let yourself be a fooled by alternative therapies, essentially. is that an issue? >> i think for those of us, steve, all of our colleagues it is an issue, because patients

bring stuff to us. >> rose: everywhere, on the internet and every yes else? >> yes. >> rose: and varying -- >> the point i hear in the conversation is not to saying alternative therapies, may very well be alternative therapies that have some value the point is how do you make sure that you are not being lulled into by what also may come under the umbrella of alternative therapies? correct? >> correct. many of the alternative therapies may be complementary, they may help the individual get through the therapy we are doing, whether it is massage or acupuncture or mind body approaches, nutrition is clearly key in helping people deal with cancer in different stages. i think where there is more controversies in the use of herbs or other compounds in that scope, because there, there is, there are side effects, it is not that they may not just work, they may cause toxicity and i personally had experiences where

well-meaning physicians physicians or friends have given an individual a specific herb to use in combination with the therapy we are utilizing and they develop significant liver toxicity as an example. so you have to be cautious. >> rose: first two things here. one, suppose we come back five years from now, what are we going to be talking about? >> well, i believe we are going to be talking about more cured people with less toxic therapy, and moving on with their lives. i believe what we have seen in the last 35 years tells us that it can be done moo and is there an increasing velocity of results? >> >> or not? >> oh, i would say without question. just the patient's life. >> rose: because of the accumulation of more information, more technology -- >> we gain more knowledge in a week now than we used to gain in a year. >> rose: that's my point. the sample is so much bigger? >> information is more

available. as steve pointed out i think the challenge is all the genetic information we have is finding the right drug, if you will. >> rose: is there -- i mean, is there any hope that there may be some -- we have talked about precision medicine, we talked about how stem cell is effective with blood related limb to ma and leukemia. but is there some one breakthrough that would change the game totally? >> i think we would all be pursuing that if we knew the precise breakthrough but there are at least a dozen approaches if not more that hold promise in, and they are rapidly evolving -- >> rose: give me several of those. >> so as an example, there is a waste dissuppose i disposal orga cell cause a proto toe cell it doesn't work in lung cancer or breast cancer but if you have multiple myeloma it is a home run, dramatic response. there is a marker on is surface

of a limb to ma i have an interest in that carries a number, seating 30, if you have that marker on the surface of your cancer, we can put your disease in remission greater than 90 percent of the time and cure a significant percentage. the field is so rapidly evolving, and some of the advances which i would never have predicted have turned out to be remarkable. >> rose: see that's the thing. >> and an example actually would be the checkpoint inhibitors, that took me by complete surprise. i never had, even though an animal model suggested this i never thought that our cancers were actually being attacked in human beings to the point where if you just interfered with that blockage you would see dramatic remissions. and you had brilliant scientists, who had competence in their, confidence in their work pushed it and pushed it and they were right. >> we often talk about there is not one, cancer is not one disease. >> rose: right. >> it is 35 to 40 different diseases. on the other hand, i think what we are seeing, i think what

steve was talking about, there are clues we get one cancer that become applicable to another and i think part of our jobs collectively is to not get so narrow in the focus that we miss something that could be helpful. a very good examples of these checkpoint inhibitors which were very pacific in melanoma and now in lung cancer and then most recently very dramatic effect in hodgkin disease, limb to marks lymphoma, so i think we borrow from each other .. we learn from each other -- >> this goes back to your point earlier of is there another talent in the field. there is enough talent that is giving that talent to look at each other and look at the problem from a different way. i think both is the cancer centers that is one of the special things. they are really designed to be think tanks for all aspects of cancer from the molecular biology to the immun immunologye care to how a person gets back and forth to the hospital, what

their life is like. it is really to see it in the context of a human suffering and doing those things that will relieve it either by cure or by taking good care of them. >> rose: here is what you wrote. there are few among us who have not experienced loss of a friend or a loved one, often without warning or like those of us who hear of people of cancer after a link everything illness. it is a time when emotions run high and deep and as time passes from the moment of loss we often hear how important it is for those who are most directly experienced the void to gain closure and move on with their life. we use that closure as a way of tidying up, fearing the moment of that person or a well-meaning comment may provoke unintended pain or undue what time has healed. to the reality is, closure is a myth, we never close. >> i get goose bumps when i hear you reading that, because i think i have been doing this for

a very long time, and i think my sense is that even after the rest of somebody passes away and friends and family go back to their life, the person who had thathat loss carries it with thm forever. in talking to people i have leveraged in their own quiet way, they move on in life, that's with what we try to help them do, but you know, there are people we know, people that we remember and we make up the fact of our life and those memories are often as important as the people sitting in front of us. i think in taking care of somebody with cancer, and had an experience like i have had over the years, i think the trainers have been doing this for 80 years, part of the job of taking care of someone is either to try to cure them or if you are not to help their family move on in their life as their loved one would have, so that's part of

our job too. >> rose: thank you for coming here. >> it is our honor. thanks for having us. >> rose: thank you. >> rose: there is no more important economic and political debate in america than what to do about the struggling and shrinking middle class, which once epitomized the american dream. the players in the 2016 presidential race, editor the national affairs, the neera tanden, the most conservative journal in america, brooks calls him the most policy intellectual, advisor to paul ryan, marco rubio and recently consulted with jeb bush and neera tanden who was the chief policy advisor in 2008 the presidential campaign, in the obama white house and the center for american progress, the most individual liberal think tank in american. >america. >> the shu-sugar ray leonard, we

are pleased to welcome you both. when we talk about the shrinking middle class, the problems of the middle class, is it income inequality, wage stagnation, is it lack of social mobility is it all of the above? how do you define it yuval? >> i think mobility is ultimately the best way to think about it. what you are seeing both parties are coming around to rhetorically talk about mobilityable where for the democrats that is a move from inequality talks to mobility talk and for republicans i think it is a move from an abstract focus on growth to more possess a concrete focus on mobility. i do think for thousand, the move is largely still refor al and remains to see what that turns out in policy terms but i think it is a hell this i move and mobility is a good lens to look through our challenges to see what has happened in recent years and seems to me at least that inequality equality distorts more and clarifies and growth is not enough. it is a prerequisite but not the

sum and substance of what the middle class is missing. >> anywhere i are your take. >> i think all of those challenges are a challenge i would talk with the mobility, it is a challenge in our economy, but i also think we are suffering from really massive inequality, a level of inequality we haven't seen in several generations but i think in real people's lives what they are most concerned about is really stagnant wages and we have had some real economic transformations that are creating downward pressure on wages, particularly in the area of -- and it is fascinating to learn over those several, last several years is that more americans phenomenon than other countries so i completely agree that mobility is a challenge but i think these are inner locking issues, wage stagnation is one of the reasons why families can't move up the economic ladder. >> but social mobility is also is worse in america, is more of a problem in american than it is

in places like canada and sweden and other places and has gotten worse. >> well, it is a complicated story, see, the thing about mobility i think it makes sense to divide it -- >> i think you are going from the bottom -- >> if you look at relative mobility which is that, do you move from the bottom to the top relative if, the relative to society as a whole it actually hasn't change much in america in several decades but it has been poor for several decades. a child born in poverty in america at any point since the 1960s has about a 30 percent chance of ever getting beyond the bottom quinta and less than five percent chance of getting to the top that has been true for several decades so in essence we have a significant problem and as we say america is not better in this respect than other developed countries, it is worse than some, it has been worse in canada for most of the last half century. you can also think about it and i think we have 0 in terms of absolute mobility, is your situation better than it was, is your situation better than your parents were at your age, say

and in that sense the picture is complicated, and if you look generationally, the vast majority of americans are doing better than their parents were at their ayn, but they are not doing better than similarly situated people were ten years ago and 20 years ago. the median family income is not improved over the last 20 years. >> and that is what feels like a squeeze, which feels like running in place to a lot of people. >> in addressing this, neera, what is the role of government, whether wage stagnation or economic mobility? how important of a role does government play? >> i think we have to impact that. there is really two sides of the wage squeeze that are significant challenges and challenges around mobility, one is do people have the tools they need to move up, which is an education challenge, and also, you know, are there particular economic risks they bear, healthcare, other issues and i think there, there is a role, we may disagree about the role but i believe there is a role for government. i do think we have broader challenges in the economy, which is we have companies, particularly in the last several careers which are very profitable, in fact, profits in

the u.s. for companies are sky high, really, they are doing very well relative to the rest of the world. and we don't have pressure in the u.s. economy particularly to ensure workers benefits from those profits unless they have in the united states a super, very tight labor market. so, you know,, i think we are trying to think through, can you provide, is there some room for incentives with companies. companies that are doing well, to ensure that they have -- that companies that are profitable create, have some incentive to make sure that workers are doing well as well. i think that is the big challenge we have had in the last decade. >> and the specifics would be. >> ensuring -- providing incentives to companies to profit share, you know, high value firms that have real investments in human capital, use profit sharing today that generally supports economic growth and higher productivity in their firms, i hope this is an idea those conservatives and progressives can will if with and this is a way to ensure that

you are incentivizing profit sharing. >> you may have problems getting conservatives, though, on your call for stronger labor unions. >> yes. >> i can see how that might be an issue but i think one of the things -- >> why is that important? >> because if you look at what other countries that have had economic growth, those economic growths and stronger prosperity for most americans, where median wages have moved up as they had higher productive at this, they do have, productivity they have higher participation in labor participation. >> they have helped people in the bottom rung of the economic scale move up. >> and loss of unions in the united states has had an impact particularly on low-income workers and working class workers people that are below the 50 percent of wages. >> i want to jump in on that but also what you believe to be the two or three most important -- >> well, i think that in a way, both parties have been ignoring some key realities in the 21st century in trying to find excuses to advance the agendas

they are used to. and a lot of our economic debate ms. the last years have looked like that, to where the attempt has been to think about the america of the late 20th century, which is not long ago, after all and which was successful in many important ways, and make that america work, but one of the important things that have changed in the, in the last 15, 20 years is the beginning -- beginning of a change you not only see in the economy but in the culture and media, is change there large institutions running things together to smaller networks enabling people to succeed. it is a long-term trend in american life but one we haven't really grown accustomed to. we think of america in term of large corporations, big labor, big government, big institutions working together and the success is navigating those institutions successful any, that that is just not the america we live in now and when a young person comes out of college, saying, and thinks about a career trajectory that person isn't looking for a job that will start him up in a company that

he will then retire from 40 years later, simply nobody .párrgks that way and yet a lotf the way we think about labor, a lot of the way we think about security against financial risk is still built for that world. >> but how does a worker, you know, greater worker rights or whatever doesn't necessarily have to be a the labor union. >> i am not arguing against that, i think in terms of thinking about how to improve people's wages by entering into the management practices of large companies, i think it is a bad idea on substance. i think it also doesn't get you very far, and the first steps you want to take if you think of the role of government in better enabling mobility first of all there is the prerequisite, and that is economic growth and i think parties agree about that, republicans tend to stop there and that's a problem, but i do think that we need more growth oriented policies, which means tax reform, which means entitlement reform, which means thinking differently about the kinds of pressures that the government puts on the economy, but beyond growth, i think first of all, government has to think

about clearing up bottlenecks, especially bottlenecks created by public policy a bottle neck is a certain kind of impediment to mobility, the aznar rowing of options. and so one to think about is higher education, where higher education is and should be a path into the middle class, it is very also now a bottle neck in the way of success for people trying to improve their situation in life. >> and bottle neck in what way? >> it is a bottle they can because costs have grown and value is not increased because it is hard to inject competition in higher education so it is a system that is kind of stuck that is costing more and more but putting people into more and more debt but not providing them with more and more value. >> well cost is certainly an enormous problem, don't people think the system of higher education is a pretty darn good one? >> it is good for people in the top institutions there is no question that it is worth it going to college, but is it worth three times more than it was in 1980? that's what it costs. >> i am going to come back to that but one thing i want to talk about yuval one of the

center pieces of what you propose and the rubio lead proposal is a tremendously increased child tax credit, $2,500 per child, first of all, tell us why you think that is so important to relieve middle class stress, but also, has it been, is it that republicans have focused too much on marginal tax rates, corporate tax breaks, mitt romney's concern about the top one percent or whatever? is this the change of emphasis, at least? >> yes, i think it is a change of emphasis, those rates still matter a lot, marge maltax rates are very important for economic growth. i think right now they are most problematic on the business side and the same rubio proposal from rubio that you mentioned includes a very aggressive progress reform of the business tax code, but tax reform has got to include tax relief for working families, and today. >> and republicans haven't done enough of that in the past? >> i think republicans haven't

done enough of that in the past. >> when they have succeeded is when they did that. the bush tax cut included child increase tax cut, in the last few years republicans have not talk about that enough and i think an increase in the child credit is the right way to deliver tax relief, it allows some people relief from the payroll tax, the burden most families bear and most parents are over taxed in this system, the way the entitlement system interacts with the tax seasonal there is a kind of disincentive that raises child, it is counteracted some and a lot more room to do that, so it seems to me and i think to a growing number of people on the right that as a plausible, logical way to deliver a meaningful tax relief to a lot of people. >> neera pick up on any of that. >> i think we should have a child tax credit or a middle income tax credit -- >> that you endorse the rubio-lee proposal. >> not all of them, but the child tax credit, i do think that is one avenue in which the

government can help address the kind of wage stagnation, wage -- the way people feel, at least from the tax side, families will get some relief. the only thing i would say is, i do think that we have to look at how other countries that are pretty flexible are managing to have wage growth, middle income growth, and we are having challenges. in fact, we are more flexible than they are. and we are having some of these real problems, so i don't think -- i don't think the issue here is, we don't want to regulate the business. we want to ensure that businesses are as innovative as they have ever been, the question is, what is the kind of social contract we have between business and workers and others to say you know what? w we wat you to be as profitable as possible. but it is also important in an economy, there is hope for the middle class and other people working really hard that have delivered higher productivity over the last decade and are

seeing no gains from that private -- >> on income inequality, neera is it a trade-off, do rich have tto pay more and have the most f the economic gains got to the top one percent, do you have to redistribute more to the lower and the middle? >> this is where i would disagree with thomas pit di i think his analysis is right we have seen growing inequality around the world, but i think the challenge for us in the united states and in other countries is not to come up with redistributive answers but predistributive answers as a progressive, i would much prefer to have good jobs and have families have good jobs that pay decent wage, and an increasing wage, productivity in doing this, i would just say let's tax the rich to give to the middle and the bottom. i think that over the long-term is not going to be sustainable. from our perspective we need an economic growth strategy that shares prosperity and my concern

about particular -- particular answers that revolve around mobility, we might have broad disagreement on issues to the child tax credit and others we have to think about the social contract between business and workers and government can't, you know, specify the rules of the game, but other countries have been able to manage, other countries are as flexible as we are and have managed to create norms in cultures where companies are profitable but also feel more that they have to share those gains with workers. a larger role in the rules of the game? >> well, rules of the game are the rules of the game. i think that the micromanagement of the relationships between companies and workers at this point is not a major part of what government needs to do to improve mobility and to improve growth. i think that we don't have enough growth to enable mobility. it is not easy to say how you get there. i don't think anybody has an easy answer. you know, growth in the past 50

years was driven by growth of the labor force and growth of productivity. we are not going to have the kind of labor force growth we had in the second half of the 20th century. it is not possible. you had women coming into the workforce in huge numbers and the baby boomers, women are in the workforce in huge numbers but that rate is basically plateaued and the baby boomers are retiring now and not entering the workforce, a lot of the growth we are going to have, the vast majority, rather than just half is going to have to come from productivity improvements. and productivity improvements are a challenge. i would say the the issues thing we have to think about are the ways that our economy is not well geared to enabling productivity improvements. now, those prosms have got to be -- have got to happen in a way that helps workers and not just employers. i certainly agree with that. and you can imagine ways that would not be the case and we do have to think about that. but at this point i think there are enormous impediments to that kind of growth that are put in place by public policy, that have to be rethought. >> you continue think as near as other countries like canada and

australia provide modelings of sorts or are those the wrong model? >> look they are modelings and interesting but can a da, canada is in a different place than we are, they have a different economy on the whole than we do and not the second half of the 20th century than we did, they have much for in the way of low-lying fruit than we do, and australia is too, they are different from each other and ours, we have a lot to learn from them, it is not that the models are not important but it is not the case that they have a solution that we can simply adopt. >> i think one thing i would just want to focus on a little bit is, we can always have greater productivity that is for sure, we can always have greater economic growth that is for sure, we definitely want to encourage all of that, but we have had productivity gains over the last decade. we have had productivity gains over 30 if percent between 2000 and today and yet there, the productivity gains are not being shared equally, the wealth in the economy is really moving up, and so, you know, i don't want to harp on a lack of -- i would

like to have more worth, but the growth that we have had is moving almost exclusively to the top end and not the bottom end, and that is really not just the economic challenge we face, but i believe over the long-term a challenge of democracy, because i think we go from an economy that has 50 percent middle class voters, the voters to 40 percent middle class people. >> a shrinking middle class is dangerous. >> and it is going to hurt politics on both the left and right. >> if you really want to help the middle class, why not eliminate the payroll tax? i mean if you make seven at this grand a year, i don't care whether you have one child or four kids, you are paying $10,700 in payroll tax, if you may make 40,000 -- why wouldn't that be the most effective way? one of you authors in your room to grow suggest that. >> i agree, payroll tax relief is now the way to provide middle class tax relief, because the payroll tax is the greatest tax burden on the middle class. it is a very regressive tax and, you know, the resistance to it,

and it happens on both the left and right comes from the fact that we think of the payroll tax as funding medicare and social security, which in a way it does and in a way it doesn't. the fact is those programs are, in fact, funned by the treasury and taxes are taxes. we have per swayed powerselves that, you know, there are these accounts that are held for social security and medicare, it is not really quite true and we can rethink the way those are funded but if we do eliminate the payroll tax we would need to rethink the way those are funded. i think there is a lot of room for payroll tax relief. >> i agree. i think the payroll tax is regress stiff and political challenges around that, but if you look at it, if you were to start from scratch you would not be creating essentially any, a tax on unemployment, 0 so we would actually make it -- i mean from our point of view it would be more of an income based tax but there are arguments about the insurance nature of it, but in my view, i think we should be getting to greater -- we should be focusing everything on not only employment issues, because

in our economy, having a market has been the way we have gotten wages up but also should be thinking about how you can have broad wage growth. >> just a few political questions. you have as we mentioned earlier i don't know subtled with marco rubio, with paul ryan and met with jeb bush recently, is jeb bush on the same page on these issues as rubio and ryan? >> i think it is early to say, the people running for president are still formulating their policy positions and thinking about where they are. he certainly seems to be thinking about the question of mobility as everybody is. i think you are going to fine that everybody running for president in 26 teen in both parties is going to be talking about that issue. that is where our economic debate is going. and i think it is a very good thing, because the parties really have been talking past each other in the last couple of years market the last ten years at least, and when they have talked about the exhifa+ they have been talking about different things, and so coming to a debate that is about how to enable economic mobility is at

least the way to clarify the differences between the parties and to help them think about the same questions together. >> and neera tanden, will hillary clinton, if she runs in 2016, talk more about this and less about trying to revive clinton only micks of the nineties. >> i would agree that both sides are going to talk about these issues. in my view, when hillary ran in 2007, 2008, when i was policy director back then she was talking about issues of stagnant middle class and how ensure economic growth. those chance have only become more pronounced but i imagine this whole challenge of single class squeeze and mobility and yes rising inequality -- >> and how optimistic are you both that it really will be joined in 2016 which is likely to produce results afterwards? you know, oil work in policy and so i have to believe that policy will matter in this election, but i also think this is not an

election where the incumbent is the question. there is not an incumbent and inevitably going to be more policy driven than the last election. it almost couldn't be less policy driven than the last election so i do think these questions will be front and center and what the eventually winner says is going to matter when that person is president. >> neera? >> i would agree, i think that this election, like past elections where you again don't have an increment will be about answer to the struggles families are facing, and we live in cynical times, but both sides are going to have to breakthrough with real ideas to answer those -- >> what better place to end than an agreement between two of the most policy architects of this next pea chul campaign, yuval levin and neera tanden issues thanks for being with us and thanks for joining us, we will see you next time. >> for more about this program and early episodes visit us online at pbs.org and

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