addressed. and remember as we say, every problem is a job. we need 30 million of them. let's get started for this thursday, january 26th, from miami. good afternoon to you. day two from south florida. nice to see you. day two, week two of the 30 million jobs tour. i am dylan ratigan. delighted to be seeing you again. easy to see. look around. millions of people choose to retire to florida. millions of ageing americans need increasingly more and more health care. and we, all of us, are working within a system that's more focused on cost than actual care. today, we're going to focus on one of the major causes for the

the cost overruns in our health care system. the fee for service model for medical practice. it's something we talk about extensively in our book "greedy bastards" in that we don't really have a health care system. we have a treatment sales system in this country. the more tests and treatment a doctor can sell, the more money he or she can make in fees. what an incentive to order that extra mri or perform a surgery that may or may not work. that, in turn, when married to an employer-based health insurance monopoly, drives up costs for all of us. instead of more and more medical interventions that we defer the cost into an insurance pool. shouldn't we be striving to be healthier so we receive fewer treatments and test? our current system creates a massive incentive for fraud. in fact, it's estimated that 3%

of our annual health care spending is lost to fraud. south florida is ground zero for that. it's estimated that medicare fraud business here in florida is now bigger than the still booming illegal drug trade. joining us now, former dnc chair howard dean, who right here on this show and we recorded him in the book, has called fee for service the single biggest barrier to controlling health care costs in america. also with us, and we're happy to welcome him back to the show, charlie cole, president of the committee for economic development. they represent a wide variety of major corporations in this country. charlie and the ced called fee for service a recipe for fiscal irresponsibility. and dr. dean, i'd like to start with you. how do we end up with a fee for service model in the first

place? >> it goes back to world war ii. employer-based health care became a way of getting around price controls in the end of the war and war period. and doctors have always been entrepreneurs. the problem with that is when you charge by the service, as you pointed out in the opening, you get more service. whether you need it or not. so what i believe is if you want to control health care costs, you have to go to a certain amount of money for the patient and that's all you get. whether you do 75 mris a year or whether the patient doesn't come in. that will give you a budget to live with and a predictable budget, and secondly, it now all the people paying the bills pay for wellness. if you're just getting a fixed amount, you want to take care of that 30-year-old so they don't end up on dialysis when they are 60. that makes sense from an investment purpose. in today's system, nothing makes

sense except to buy more machines and do more things to people. >> charlie, you represent a huge number of significant, massive american employers who bare a huge percentage of burden for american health care. why is it -- why is fee for service so expensive and such a problem for the major employers who are really dealing with the costs in this country? >> first of all, congratulations on the book. you got it absolutely right in "greedy bastards." you quote governor dean and the g governor has it right. the problem with fee for service, quite simply, is it rewards volume over value. and if you have a system that's set up that way with those sorts of incentives, then you get what we have today. "the new york times" had a very

interest chart that is relevant to people. take a couple examples. in the u.s., an mri scan is $1, 009. in britain i it's $100. you have to ask this question about the american system. which is drimpb by fee for service. why do we pay so much and have relatively little to show for it? we outspend the rest of the world, but france which spends half as much as we do, the people live longer. they have lower infant mortality rates and they don't have the obesity problems we have. >> dr. dean, you touched on this in your first answer and even when we do our jobs tour last winter, we visited the mayo clinic. they use a partnership model that is a version of what you described. what can we do? what's the alternative?

how can we in the media and the public advocate for reform in this? and how do you suggest we go about doing it? >> first thing we ought to do, the insurance companies are making doctor's lives miserable through medicare. we don't have the ability to reform insurance companies, but we can through medicare. that will reduce the cost of the united states government and make it predictable. it doesn't ration care anymore it's rationed today. we spend more than 70% above what the next country spends. the fact of the matter is, if we could cut out about 50% of what we spend and still have adequate health care for everybody. the first is to cause medicare to be on a different basis.

>> charlie, from an employer standpoint, whether it's dow chemical or honey well or any of the great and prosperous american companies, none of them are in the business of health care. is there anything they can do or we can do to help them to lever the burden they are paying to resist these forces? >> first of all, dylan, this system is not helping the american business community. it's extremely costly. it is affecting their international competitiveness. if you look at countries in germany and japan, they don't have this system. take one example of general motors. if this system were so good for large businesses, why did general motors go bankrupt? and one of the major reasons that company went bankrupt was the costs incured for their

employees health care coverage. the employer-sponsored system is an anam nism. they see it as a way to compete because they are large. they can put all the money in to pay for cadillac premiums, but it's a dinosaur. the result is going to be more and more examples like general moto motors. so i so i agree. we need to look for disruptive innovations and look for market-based approaches, which will move away from fee for service, which is inflationary. >> the interesting thing about this is i'm not a big of the obama bill, but the aco, were they to take risk, they could do this with the private sector. they could go on the exchange and sign up with them. that would start to bring the costs down. they are one of the institutions that does well.

that's because they know they can make money by saving money if they take care of 30-year-olds properly. including demanding they meet various targets in exercise and weight. that's reasonable if they are going to pay the bill. the other thing that's going to happen is under the aco, there will be a huge exit by the small business community out of the health insurance business and turn their employees over to the government. and i actually think that's a positive thing. then the bills will be paid by individuals who are having to make choices and will be subsidized. the small business community will get out of the health insurance business. i think almost all of of them within two years. that's a very good thing. i totally agree that competitiveness is hurt badly because of the employer-based system. >> the underlying premise of "greedy bastards" not just in health care but across the board is that if we e don't have

aligned interests, we won't solve our problems. the interest is to seek to provide had health and health care and the patients. give me a sense how it is that fee for service as a model so grossly misaligns the interests of the health industry and the patients that they treat. >> this is a great question. there's a division in the medical community. primary care people are getting totally screwed by what's going on today. they would love it it if insurance companies no longer managed health care. they don't know anything about health care. when you call to get prior authorization, you're talking to somebody who doesn't know anything about the patient. under this system, the allocations of expenses are made inside the health care system. so at least it's professionals

making the decision. now the resistance is going to come from the hospitals and the specialists making a ton of money off this system. but today one of the reasons that you see polls that show most primary care providers would prefer a sing of had payer system is because together they make liar lives miserable. they would like to bring the decision making in-house. you could make those decisions professionally because you're already in a budget that isn't going to expand and contract based on your decision. >> what i would add to that is we should change the system so the focus is on the patient and not on the provider. that's a key change for the american health care system. >> that is everything. it's the same e way we want our investment devoted to

entrepreneurship. it's the same way we want to have teaching aligned with learning. we want our doctors aligned with health care. i learned a tremendous amount from both of you. i really appreciate you joining us today. thank you very much. dr. dean and charlie cole, hold on a second. it's too far to jump 37 we continue the 30 million jobs tour this thursday. there are thousands of jobs up for grab right now here in florida. so why is no one applying? also ahead our thursday mega panel on the ground in miami. we're ramping up to tonight's republican debate and whether those who want americans top job have a plan to get you a job. plus one of the greatest lessons we learned while writing "greedy bastards." the idea of hot spotting. and how it could change the way we do things in this country. [ male announcer ] alka-seltzer plus presents: the cold truth.

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with the vote from the gop, just five days away in florida. the high-stakes primary. we're poised for a showdown at the corral tonight. just north of us here in jacksonville. in the final debate before the

primary, the big faceoff between mitt romney and newt gingrich. romney has a 52% chance of winning here in florida. some have romney at a lock at 81% as a bet he will be the gop's guy which means we should expect to see desperation politics in the next 48 hours. while it will make for great theater, are we solving any of this country's problems in getting the debate america deserves? i want to bring in our mega panel, karen finney, susan del percio and jimmy williams. you were joking we need the animal house food fight. >> that's what it's going to look like. i don't think we're going to hear anything never mind the important issues. >> the most important thing that struck me is i feel like we have

had an education in leveraged finance, thanks to mitt romney. and the revolving door, thanks to newt gingrich. is there a benefit broadly to that it because of the food they are throwing at each other with one guy saying the other is a vulture capitalist and the other saying he's a revolving door on the american government. is there a benefit to at least understanding what and how some of these function? >> as a democrat, i'll say it. they are teeing it up great for barack obama for the summer and going into the conventions in the fall for the elections. both men running for the gop nomination for president don't even worry about ron paul and rick santorum. let's just focus on those two. they are remarkably wealthy. one more than the other. but the point is, they are not like most americans. fine. >> barack obama is also very

wealthy. >> it's the mechanism by which these people accumulated the wealth. >> as mitt romney is well to point out, i made all of my money. really? by doing what? he's got nothing in common with my brother who works five days a week. he has nothing in common with the guy that lives in dubuque, iowa. >> when you look back, presidents don't have that connection. >> they are not president. they are running for president. >> but it's different than saying -- >> go ahead, karen. i don't think this is about we don't like people who are wealthy. god willing, we could all be wealthy. but the point is what romney and gingrich represent is a broken system. newt gingrich created his own sort of pay for play system. maybe it's historical and not

l lobbying, but that's what was going on. that's how he made the wealth. and similarly, mitt romney, i'm sorry. when you have accounts in switzerland and the caymans and complicated tax forms. the system he's protecting and standing up for is the very broken system that means that people like jimmy's brother could never even accumulate enough money to put in modest investments. that's what both of these guys are missing. >> the only thing i would sort of add to that because we're in the 30 million jobs tour. we were in the valley last week. we saw very wealthy people who have created a tremendous amount of value by solving problems and creating things, which is different than what we're talking about with this type of wealth. i think it's critical to make a distinction. this isn't about a class issue. this is about do you make your money by creating value for other people?

the indictment not against these people, but a lot of people in our political apparatus. it's not being made in that way. with with that said, i spend a lot of time criticizing the president for his failure to reform the policies that have benefitted people like mitt romney. so we look at mitt romney and say the tax code and this and that. where has the democratic leadership been since 2008? not just from the president, but the entire democratic party on affecting a meaningful revision. t campaign finance, it's easy to point to these, but where's the leadership from the power base that this is a referendum on. >> it's true you could have said that about the republicans four years before that. it is both parties. but right now, people are looking towards the president. he's the one up for reelection. they are going to hold him accountable. >> the one thing i like from the president to make your point. whether you agree or disagree

with the policy proposals, i like what he said to the business community, you're asking what you can do. i'm saying ask what you can do to create jobs in the country. it was a kennedy-esk moment. if you're wealthy and have ideas and can create jobs, invest in this country. the government should be there to help you. if that's what it takes to get that going. let's have more of a partnership instead of this combat. >> with that said, it is fe nomin nominally easy to say those things. it's phenomenal politics. if you look at the record of the president and the president before this president, all of the policies that go to getting wealthy people or entrepreneurs or educators or investors to invest in this country, our tax code, our trade policies, and

our banking policies, i'm sorry, but this president has not done the job. he only has the benefit of opponents that may not do it as well. it's easy to say it. but this president has talked the talk, but he has simply on the issue of the most significant tax, trade, and banking issues, not walked the walk. >> and he heads both houses. >> this president, the one before it, and the one before that all bought and sold by corporate america. i hate to break the news to everybody watching your show today. none of this means a thing unless you stop buying your politicians. >> i thinkhe's gone farther though in having this conversation. at least a lot of the things i've heard him talking about over the course of the last year. i feel like he's raised issues that i haven't heard before. i heard him talk about things the other night. it may not be the change you're talking about, but i think you

have to start somewhere and say, wait a second. milli millionaires can't be getting breaks when everybody else doesn't get those breaks. at least to have the conversation. >> but he had the opportunity to do that. when he had the house and senate. >> let's not rejud indicate that. >> hold on. there's a bigger issue. i consider it the targeting of millionaires is -- but proportionally to a banking system that's sucking out of our country that this president has helped a trade policy that is extracting money by the billions every month that this president continues to validate. great politics. that's fine. but at the end of the day, you have to wonder -- and this is why i picked up on mitt romney the other day saying, this is mitt romney. president obama has never said this. it is time for the banks to own up for the fact that what they

are carrying on their books is a fraud. it's an accounting fraud. it must be resolved. it struck me that it was mitt romney, who by the way has the most credibility to understand he works with the banks and knows it's a fraud because he's been financed by them throughout his career, do you think the mitt romney statement may apply some pressure to this it president to address the banking issue? >> no. >> i didn't think so. >> it was short, but i said no. mitt romney is flip-flopping. it makes john kerry looks like a junior in high school. i do not expect they will hold to what you said. so no. >> it's great to see you. karen, you look lovely in florida in our minds. >> thanks. >> we have an imaginary chair here for you. thank you for being with us. nice to see the two of you. as the 30 million jobs tour rolls on, up next, nursing america's job crisis.

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on the first leg of our 30 million jobs tour, as you may recall from last week in california, we identified cradles of innovation and investment and entrepreneurship. we saw the chinese steel on the bay bridge. as necessary to get iting ameri back on the right track with sustainable meaningful systems and environments that can can grow for us the 30 million jobs we need. the final component is actually solving our nation's problems. remember, every problem, and there are plenty of them, is a job. and no place is this more clear than in our nation' health industry. there's an overwhelming demand to care for our ageing population. 315,000 health care jobs added

last year. nursing is that industry's largest sector. what's more? the health resources and services administration predicts that the nursing shortage will grow to one million nurses by 2020. that's one million jobs to take this down to a 29 million jobs tour to keep up with the demand the institute of nursing is calling for an 80% increase in nursing staffs. what's causing the shortage? the boomers. it's happening in two ways. first, 10,000 baby boomers are turning 65 every day in this country. that means they are retiring and leaving jobs and positions like nursing unfilled. second, those same boomers are not only retiring but by 2030, the medicare roles are expected to jump 70%. no wonder nurses are in such high demand. >> we suspect that probably a third of the current nursing workforce will be vacated as soon as the boomers retire. but in the meantime, the need

has grown at the graduate level. >> the workload is stressful. you feel the need for more staff, more nurses. nursing was a career i kind of fell into and then fell in love with. >> my family wanted me to be a lawyer, but i said no. i wanted to be a nurse. nursing is a science. you have to be absolutely intent to do this. you have to use critical thinking. also it's an art where we have the compassion side. but the science of it, the assessment, the diagnosing, all those scientific things that we do is very important. >> it comes down to your self-fulfillment. the surgeon will go home and the nurse will be there 24/7 with the patient. i'm interesting in nursing faculty. they are the ones who teach the next generation of nurses. >> there are not enough

qualified nursing faulkty. >> they had to turn away qualified students because we didn't have enough faculty. >> nursing is a great career. you can start out as an undergraduate student and immediately have a job upon graduation. >> you can get work within a week. i have never had an issue finding a job. >> with nursing, you can do anything. nursing has one of the best salar salary-start marks of any profession at this point in time. >> a registered nurse making $60,000 plus. an executive can make over $200,000. you can make a lot of money in this profession. you have to be flexible and be open to learning. once you're open, then the sky is the limit. >> three things. problems that need to be solved, people who want to solve them, and money to pay for it. all are in place when it comes to nursing. good-paying jobs waiting to be

filled. that the recipe for job creation in america. when we come back, from health care to crime fighting to the way we teach one another and allocate our defense resources. the technique with a lesson for all of us in the 21st century about efficiency and getting far more for far less to get the job done. c'mon dad!

i'm here to unleash my inner cowboy. instead i got heartburn. hold up partner. prilosec can take days to work. try alka-seltzer. it kills heartburn fast. yeehaw! you may not know this, but 5% of us account for 50% of the health care money spent in this country. 5% of us. 50%. that is an incredible figure and not unexpected. health care is disproportionate. old and young spend more. one town in new jersey

identified this trend and used the very same hot spotting te technique defined by former police commissioner bill bratten to help direct health resources to those most in need and in the process collapsed the cost of health care. and here now with us, our hot spotting problem-solving dynamic duo, dr. jeffrey brener, and bill brten, former police commissioner in new york city and boston as well as l.a. police chief. he's ceo of integrity security consulting. it's a delight to welcome you back. dr. brener, tell us how you took the techniques applied by commissioner bratten in crime. how did you apply that to health care? >> dylan, thank you for the chance to be on. as i got to spend more time in

the city of camden, i was overwhelmed by the level of violence and crime in the city. i had an opportunity to make some of the people that worked with mr. bratten in new york. they tried to reform the police department. as i learned more about how they use data and built a management structure to support that data, i felt i could do that in health care. i threw my hands up on the police department and got deeply involved in trying to take those ideas and move them into health care. >> so give us a sense of exactly what you did and what the results were. >> we managed to get over the course of three years. it was a student project. patient level claims data from the three local hospitals, combine it into one data set, and began to map and chart that. we first learned that half the

population goes to an er hospital in one year and that 1% of the patients in camden are responsible for 30% of the costs. and that 20% are responsible for 90% of the cost. so it became very clear to me, both from my professional experience and the data, that we were essentially ignoring sick people in health care. >> commissioner, when you first really drove the application of this in crime fighting, and i thank you as new york city resident for the safe nature of our streets. did you think that technique would be applied to something like health care? >> well, actually some of the ideas for it came from health care. if you think of it, the policing system of come stat is the exactly the same as when you go to the doctor. the doctor does an examination. he's looking for hot spots. he's looking for irregularity in

your heartbeat. so the parallel between medicine and policing, it's like two rails on the same train track. >> and we know that the crime results were remarkable in a lot of major cities because of your complete reformation of that system. how much resistance, commissioner, did you face in resource allocation and decision making? >> well, i think because we had so many victory so early, the resistance that may have formed never had a chance to form. the turn around in new york city with overall crime going down 40% within 30-some odd months was a phenomenal change. people saw that change quickly because we weren't just attacking serious crime, we were attacking the minor crime that people saw every day on the

streets. those types of things were making the streets feel unsafe. i know you like numbers. let me give you another set of numbers. we call it the 10/50 solution. 10% of the criminal population commits 50% of the crime. and 10% of the locations in a city are responsible for almost 50% of the 911 calls in most cities. >> it's stunning. the thing is, before computers quite simply, this type of information simply wasn't available. you couldn't make decisions like this. dr. brener, complete your story for us. you identify 1% of the population is 30% of the cost. you go to a preventive strategy to work with that 1% to try to help them. what sort of results did you get in the overall reduction in health care costs and have you

seen an expansion in opportunity to scale what you're doing beyond camden, new jersey, to a broader application of this principle? the same we have seen in crime fighting in multiple cities. what are your results? >> we spent the last four years going out and meeting the sickest and challenging patients over the last four years. it's been a great adventure in health care. what i have learned is that if you can improve health care for homeless, mentally ill, patients like that, you can do it for anyone. the kind of teams you need to project in the community, the kind of data and accountability you need to achieve will be the same systems we need to build all over america with 10,000 people over 65 every day, we're going to have a cataclysmic problem of how to project care into the community and do a better job caring for sick people. we have expanded our model to trenton and newark.

they have similar teams in the field. the team in trenton found someone who went 450 times in one year. it's so far the leading high utilizer in the country that we have found. the whole community coming around that patient, they were able to go from 450 visits to just a couple visits in the last eight months. so we're seeing similar work pop up around the country. the fundamental theme is we have to do a better job taking care of sick people and stop ignoring them. one of the things the commissioner did in new york was he empowered beat cops to pay attention to crime. and we need to empower doctors to pay attention to sick people. >> yeah. the headline for you in terms of the cost savings was what? >> we have had pretty dramatic raw changes of 40% to 50%. the data is complicated to adjust. we're working to figure out what the long-term outcomes of all

this are. >> dr. brener, you are an inspiration and a teacher for all of us, as are you commissioner. i thank you for making yourselves available in public to discuss these things. i personally believe this is the critical solution. it's not about austerity. it's about problem solving. thank you, gentlemen. we talked a ton about hot spotting as the central new mechanism for problem solving in our book "greedy bastards." last night, we had a great event here in florida. thank you to everyone who came out. and of course, to the folks at books and books. just a beautiful place. what a wonderful place to be. check it out. next week, we take the show to the belly of the beast, washington, d.c. we'll be at the sixth and i historic synagogue. next wednesday. come pay us a visit.

details of where we'll be posted on our website. still ahead here today, silicon valley and south florida. the cradle of innovation is not just for north california. new businesses here in south florida as a launch pad for 30 million jobs. [ male announcer ] feeling like a shadow of your former self?

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small businesses. so let's pass an agenda that helps them succeed. tear down regulations that preve prevent aspiring entrepreneurs from getting the financing to grow. >> we talked an awful lot about the need to create cradles of innovation. investment, education, and a culture of experimentation that accepts and encourages failure in the quest to learn, solve problems, and succeed. of course, tuesday night the president acknowledging the critical role that new business formation has in job creation. according to a brand new report, startups creates three million jobs in each year. in south florida, a million and a half of them were created by new businesses between 2005 and 2009. it's not easy from going to zero to google, facebook, or groupon.

with us are two folks who understand the obstacles and the opportunities in getting americans back to work through a new business. executive director of the launch pad out of the university of miami and john duff y, one of the big entrepreneurs helping to drive the cradle of innovation here in south florida. it's a pleasure to see both of you. the culture of investment and repeated failure that leads to all the learning that leads to the successes is unique to them. is that fair? >> it is unique right now. because silicon valley has everything you could need. that doesn't mean it can't be done elsewhere. one of the things we've been working on is an idea of ecosystem. we're growing it 1% at a time. it's been successful so far. >> why, john, is the ecosystem the critical thing? >> well, you know, first of all, i'd like to say we have 112 people that think it can be done

spectacul spectacularly. the e ecosystem is important because we believe good people make a business successful. in order to develop good people, they need mentors and exposure to how things are done. that's what silicon valley does pretty good. what susan's program is starting to copy. >> the characteristic when you talk to folks in this world is how they relate. it's how people solve problems. it's the combination of investment with the educational system with the entrepreneurs. how are you cultivating that culture in south florida? >> it started with the launch pad. we started three years ago. we approached it different than normal. we wanted it to be about educating the individual. so in these three years, we have had over 50 companies launch 150,000 jobs locally. the blackstone charitable

foundation has replicated our model to ohio. and we have two schools in detroit. we're taking it national. so that model works because even in these areas where there isn't that startup ecosystem now, it's able to be created one student at a time who helps build and foster. >> that's who john is. >> no question. and people like john, he's the best example. they give their time. they want to help entrepreneurs. that's one of the keys to making it successful. >> you get the last word, john. >> i'm a mentor. our chairman and our investors, these are the people that have helped me be a better entrepreneur. i'm trying to give back through programs to help people learn how to build companies and create jobs. >> the bottom line for all of us, if we cultivate these ecosystem, we'll not only create jobs, a part of that will solve the country's problems.

a tremendous compliment to both of you for such engagement in that. >> and we're having a lot of fun. thanks for coming to florida. >> it's better when it's a party. "hardball" up next. but first, we're back with a look ahead to tomorrow's finale. the employee of the month is... spark card from capital one. spark cash gives me the most rewards of any small business credit card. it's hard for my crew to keep up with 2% cash back on every purchase, every day. 2% cash back. that's setting the bar pretty high. thanks to spark, owning my own business has never been more rewarding. [ male announcer ] introducing spark the small business credit cards from capital one.

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welcome back. as you surely know, we're here on a 30 million jobs tour. and our belief is that if we are able, as we assert in the book and every day on the show, to align our interests, we can start to get more things that create value for all of us through our combined investment and aligned interests and fewer things that exploit one another for the increasing benefit of an increasingly small number of people. we revolve today's conversation around trying to do that in health care and understanding how those techniques can be broadened. here's a look at the highlights of what we learned today. >> the problem with fee for service is it rewards volume over value. and if you have a system that's set up that way with those incentives, you get what we have today. >> today's system nothing makes

sense from an investment purpose except to buy more machines. >> nursing is a great career. you can start out as an undergraduate student and have a job upon graduation. >> one of the things the commissioner did in new york was empowered beat cops to pay attention to crime. we need to empower doctors to pay attention to sick people. >> i cannot think of a better example of how to deal with getting more with less than the hot spotting techniques being deployed by dr. brener in camden or across this country in crime fighting. we spend a lot of time in the current political discourse debating whether we should tax people more or create more austerity. both of them failed to recognize that the industrial era is behind us. and that our ability to actually know who needs exactly what by

virtue of those marvellous computers puts us in a situation to identify the 1% or 5% in crime fighting or health care or education and solve those problems in a way that gives us vastly more for significantly less. that is the road forward for this nation in conjunction with a culture of investment through tax, trade, and bank reform. investing in entrepreneurship like the launch pad here in miami, the pillars of industry like the port that you saw yesterday over our shoulder or the bridge in california, and then the work of actually doing what needs to be done with things like nursing, teaching, and direct engagement with one another in our communities. it's very frustrating to watch the presidential debates and feel the debate we all want is not happening. but it is empowering to know that we have the privilege of a free press in this country and an