role and i shared my story about needing a surgery for a hernia and that's the kind of shoppable health care that applies to. i do think we need to be thinking about it in comprehensive inclusion with care for the kind of health care that a lot of folks -- payment for the kind of health care that contract messak takes care of and is not shoppable and has to be done at the edge of real risk and is definitely part of the solution and can be included in a broader package of asking how to provide support and care for all the needs people have. sen. hiken blooper: dr. sen. hickenlooper: appropriate competition has to be tied in with the level of transparency and i think that that kind of competition can push health care providers to continually innovate, which i think if you connect that to the increased transparency, the patients could be a catalyst to finally lowering prices. what can we do at the federal level not only to prioritize the policies and promote competition in the marketplace but making sure that those savings -- well, make sure those savings ultimately reach patients? dr. bai: num

and the high health care costs. why does health care costs go high in the u.s.?rimarily because our government policies have continuously the playing field in favor of further and further away from the health care dollars. congress designed the 340 b program as a by low program. hospitals to buy drugs and sell them to low income patients at a low price. now these hospitals ended big -- ended up buying low and selling high. recent studies found 340-b hospitals would set a commercial price can be as high three to eight times. their markups are higher than the markups of non-30 be and health care prices. so basically congress to the state 3340-b program and advised them because they do not enjoy 340-b benefits. congress bans physicians from establishing hospitals and pays them much less than what hospitals get. that is why we don't have many independent physician practices. basically health system give , markets power. that is why we end up with medical debt. should we cancel medical debt? imagine grocery stores allow consumers to take on debt and congress cancels i

and the high health care costs. why does health care costs go high in the u.s.?ause our government policies have continuously the playing field in favor of large players and patients further away from their health care dollars. let's take congress the 340-b program -- [indiscernible] >> nonprofit hospitals and sell them to low-income patients at low price. now these hospitals ended big low and selling high. recent studies found 340-b hospitals would set a commercial price can be as high three to eight times. and their markup are higher. [indiscernible] so basically congress to the state 3340-b program and advised them because they do not enjoy the 340-b benefits. congress bans physicians from establishing hospitals and pays them much less than what hospitals get. that's why we do not have -- [indiscernible] basically health system give markets power. that's with meed will debt. now imagine grocery stores allow consumers to take on debt. we will see more and more grocery debt. and then we'll see the quantity and the variety drop. why? because the government pays o

lowering costs but not decreasing benefits and improving the quality of overall health care, including relations healthcare. so that was sort of the magic north star. and with the affordable care act there was a real effort to bring down overall costs of medicare and to approve some of the qy outcomes. and this became an early space to do that. where it was identified that if you were paying differentially for care and the quality didn't improve, all you were doing was layering additional costs on beneficiaries, increasing the overall cost of the program without improving quality for anybody. so it became one of the targets in the overall medicare savings, how you really improve lives of beneficiaries without decreasing the benefits that they are eligible for. and so i would sit in the early budget discussions, unfortunately was not included -- would say -- not included in the budget till 2015 when it finally became part of the balanced budget act of 2015 but it was always one of the targets that was put on the table, talked about, put forward along with a host of other programs and ma

health care. and they know that their doctor is not hiding information from them and protect them, and in fact, even have to travel somewhere, i feel safe going into the emergency room and the clinic, we all know that health care is so important to women everywhere and we know making sure your privacy is protected is critically important at this moment. so thank you to you, of course, secretary becerra, and it's important and i appreciate the opportunity. i think we have a little bit of time. and ask you all-- do you have any particular-- (inaudible) ## >> why are we here? we're here because of the former president. the former president who ran on a platform that one, women should be punished that came out of his mouth, and that he talked about nominating supreme court justices that would overturn roe v. wade. and that is exactly what he wanted and that's exactly what he got. so let's be honest here. this is on the former president, the guy who aims to run for president again on a platform of taki

abortion is health care. and in some cases a patient's life may depend on whether they can get that care or not. that is that is why we need to make sure every provider can get the comprehensive reproductive training they need by supporting medical training programs that are doing this important work. it is incredibly frustrating to me that so far republicans have blocked these proposals from moving forward. seems when it comes to an abortion, there is no bill too simple for republicans to oppose. there's no right to basic -- too basic for republicans to attack. and no problem too important for republicans to ignore. republicans haven't just voted down our efforts to restore abortion rights in every state. they have voted against the right to birth control. they have voted against the right to ivf and now they have opposed letting patients leave their state for care, letting doctors provide legal care to anyone who comes to them, and helping health care providers get the training they need to save a life. but

that, health care results. there are ways to solve that problem. the accountable care organizations which flourished in rhode island, did fabulously well in the wake of the affordable care act, were never criticized on either side. what bill and i are working on right now, we have a primary care provider enhancement bill that will move to the next level to just give you a moments background. the accountable care organizations followed the traditional fee-for-service but they also report how well they are doing relative to their own metric and then share savings if they drive costs down. you have to make money beyond just fee-for-service. they still have to monitor the fee-for-service aspect of it which is boring, complicated, expensive, tedious, and we are trying to develop these hybrid systems so you can take the leap to a pure value-based payment system which frees doctors not to just follow the treadmill but to provide care as indicated. i will close with my favorite rhode island story. a guy came in and said

who should get to make personal health care decisions? for women -- the women themselves, doctor, family, consultation or politician but she's never going meet they're not looking out for her. the anxious is clear as our country enters its third year without roe v. wade i continue to stand with my colleagues in the fight for reproductive freedom we stand on the side of the american people that have come together time and time again in kentucky -- where they've voted for a governor who is standing up for reproductive health care. in kansas, in the middle of the prairie where no one expected it the first real test of this where democrats and republicans voted on the side of freedom in ohio -- and a referendum whereby 11 points the people of ohio stood up for freedom. or in legislative races in virginia -- or in a congressional race in long island. or in the wisconsin supreme court race, the message is clear where the american people are. this is not about red states. or blue states -- think of this states that i just listed -- this is about

topics include negotiating drug rises, innovative health care treatment, maternal and long-term care, and expanded access to health care services. >> i hope everyone is having a great time. i am alice park and it is my pleasure to introduce the administrator chiquita brooks- lasure. to give you a sense of the scope of her job, cms oversees medicare, medicaid, children's health care and the affordable care act marketplace. 88 million people covered, half of whom are children, 65 million under medicare and that is 100,000 more people than the previous year, 20% of the u.s. population. we are living longer and estimates are by 2050 the population over 65 will double, so a lot more people. i am excited to have this discussion because it has been a busy year and you have responsibility for half the population. and you meeting the -- leading the agency through historic first. tell us what got you into public health policy. >> pleasure to be here to talk about the work our agency is doing. i started in public policy in washington dc and you get to work with people who are policymakers. profe

health care in this country, there are more than 87 million people who are without health care or whore underinsured. health care should not be connected to your job. it should be connected to your humanity. what we know is that in every state that is led by republicans, or extremist, i don't like to say republicans because my grandfather was a lincoln republican, an eisenhower republican, but everyone is led by extremists who call themselves republican. they're anti-raising minimum wage. anti-health care. anti-fully funding public education. and they are anti-labor rights. the very things that have been proven that lift people out of poverty. it's not a handout, it's making the playing field more level so that people can rise up. i've been in appalachia, in kentucky, east kentucky, and met people like from sturgil who died from black lung disease, he was a coal miner. he talked about how politicians allowed the coal mines to be taken over by multinational countries and then steal their labor rights, they didn't grandfather their labor right, they messed over their pensions. he died i

put emphasis on primary care health. we try to do that in medicare although some levers are limited . if we pay one person it has to be budget neutral so we have to balance, but we look in our models and accountable care organizations. some are run in medicare and some through innovation, emphasizing lifestyle changes in places medicare cannot reimburse thinking about how we can do that through other vehicles. >> i would love your perspective on care. the population over 65 will double and our current system places a burden on the families to find and pay for care. how are you thinking knowing this is coming of three envisioning the ways we provide care? reimbursing providers is one step. also more people need long-term care. how are you looking at that coming problem or issue and thinking about ways to rethink the current way we provide services? chiquita: maybe i will start on a like note -- light note. as we think about the aging population and growing, as a gen-xer, i have full confidence the baby boomers will lectur

do you support a woman's freedom to make her own health care decisions? the vast majority of americans, the answer is yes, without question. we know that because the american people have been speaking out loudly and repeatedly, and at every opportunity, to oppose republicans extreme abortion bands. the record here is remarkable and unmistakable. since trump and republicans succeeded at overturning roe versus wade and ripping away a constitutional right from our daughters and granddaughters, every single time, abortion rights have been on the ballot, abortion rights have won, every time. the american people have not just been speaking with their own votes, they have been using their voices and sharing their own personal stories of the nightmares that republican abortion bands have put them through. ..or a miscarriage because of abortion bans, women turned away from hospitals because their doctors' hands were tied until they lost over half of their blood, until their husband found them unconscious on the floor, until unconscious on the floor, until >> until

[applause] >> next, professionals talk about the challenges of medicare reform, rural health care, and medicare proposals at an event hosted by the paragon health institute in washington, d.c. [inaudible conversations] >> all right, everybody. thanks so much for sticking around to discuss more of the kind of policy details and background about the site-neutral payments. so again please if you're in a room use qr code up in the banner. he joined as great or you can text them to (703)527-2734. we will be taking those throughout the panel as well. so we have at this thing was panel. with the today that is truly about partisan group of experts that can work on this issue for a long time. i'm not going to go through all of the details of your bios. you hear this fit. you probably have seen of the details of what they were caught in the past. but for now i will just do a quick rundown of the titles and whether coming from. to my left with ben ippolito, senior fellow and economic policy studies at the american enterprise institute. we have loren adler who is a fellow and associate director at

there's not enough mental health care anyplace in in the country. how could we restrict, why would the v.a. restrict access to mental health in the sdmunts -- in the community? these veterans are among our most vulnerable and high-risk veterans in v.a. patient populations. since those recommendations were issued in the spring, veterans have been reaching out to me, as i've indicated on the floor before, many of the things i know about what's going on in veterans' lives come by conversations i have with veterans or my staff has with veterans or phone calls, e-mails, the suggestion that something is not right in the way the v.a. is caring for a veteran. it often ends up in casework and we try to solve the individual problem for the individual veteran. we also ought to solve the system problems, and this is one that is now systematic. it's not the circumstance that an individual veteran is uniquely being denied care in the community. it's become a systemwide effort to reduce the opportunities veterans have to access care in the community. i'm sure my co

yes, we emphatically believe that women should be free to make their own health care choices. all year long senate republicans have shown everyone out of touch they are too mainstream. senate republicans have shown that for all the attempts to send moderate on reproductive care, when it comes times to vote, they will choose bag extremism over the republican people. when senate republicans locked federal protections for contraceptives they chose mag extremism over the american people. this is no surprise. this is no mistake. n they did the same thing when the block federal protections for ivf they chosesm mag extremism over the american people. and when donald trump announced he would nominate hard right justices to the supreme court for thehe explicit purpose of overturning roe the same senate republicans enthusiastically voted to confirm them. not once, not twice, three times. so make no mistake, the maga our rights attacks on women are not done. first was abortion and contraception than idea. what's next? if they get the chance they will push for the ultimate goal of a nation

joe biden lowered the cost of prescription drugs and health care premiums. and in north carolina, he helped us finally expand medicaid. now we have more than half a million north carolinians enrolled in health insurance. but you know what? donald trump would snatch those health insurance cards right out of people's hands. we cannot let that happen. joe biden and kamala harris are doing everything they can to protect and restore abortion rights, because we ought to leave medicine to the doctors and decisions to the women. but donald trump, he's not going to stop with overturning roe v. wade. he's already promised to do more if he gets the chance and if you don't believe it, just look up project 2025. my fellow north carolinians, can we defeat donald trump at the ballot box? can we defeat donald trump right here in north carolina, and deny him the presidency? of course we can! and we must. so, here's your assignment, we're in a school. for the next 110 days, we have to be on the doors, on the phone, on social media, on top of our game to stop donald trump 's d

spending and you can see that in the chairman's chart in the beginning, the healthier spending is -- health-care care spending is rising significant way. there is some distortions, as you said, it is hard to get at them but there is so many dollars that even if you make modest progress in percentage terms. >> thanks for the latitude on time. thanks for your answers. in summary, we've got to spend less then we take in. history shows that revenue is stubborn. history also shows that we used to have health care as a percentage of our gdp closer to 10% not too many decades ago. and the rest of the world has figured out how to do that at better value. we need to start doing a few things that most americans believe should be done. don't spend more than you take in, and if something is out of line in terms of cost, reform it. >> thank you very much, senator braun. i believe we are awaiting one more colleague. i will take an additional moment while we give him a chance to walk from his other hearing to this one. and point out that at least, in our view, the net effect of the 2008 mortgage meltdown and t

agencies all coming together to change the way the federal government treats nutrition within the health care system. you heard about the white house conference on health, nutrition, and hunger that was an inflection point in this whole effort, a national strategy that emanated from that conference and how, as i said, across agencies a whole-of-government approaches transforming what the government is doing. they highlighted a few efforts and i asked gina afterwards, can you quantify all the effective changes across government, and she said they counted over 250 different changes they made. in the last month alone they changed some of the guidelines around the school meals program -- less sodium, less sugar. huge, effective changes. you also heard about incredible commitment from the states, and the presentation by oregon and massachusetts about how they are implementing the 1115 waivers. if you weren't moved listening to the way that they created programs with kindness, with concern, with, as they said, putting the patient or consumer center and understanding their needs, and their needs mig

and with the affordable high quality health care. and with that same title and asset we are trying to do. and then to leverage them. also going on boo called approach talk about the band of highly skilled operatives so they tried to settle the score with corporate evildoers and with and leveraging with the medicare financial disaster but what could they do differently about medicare? and talk about the financial insecurity of the lack of healthcare coverage this is the building blocks but at the core of what is being proposed today this is a concept going back decades ago in economics with the inflationary environment but you are the customer to have more leverage and control cash transactions and more transparent and also the quality produced and with the educated consumer. that is a stripped-down version but nevertheless that had value at the time. and then ultimately they have to close up shop in with the other retail sectors. so to think of with the welfare program that is pretty much with the healthcare system but this puts it i

but finding that 80% of the cost in the health care system is linked to chronic care.nd we have a portfolio products that are really addressing some of the chronic diseases of our day and age. diabetes, obesity, and the comorbidities that follow that. we know that there are projections that say, by 2035 the world obesity organization predicts that the cost burden to society will be $4 trillion of the people living with obesity. and that cost is going to, to a large degree, turn out to be taken up by health care systems who are already struggling today by aging populations and a shortage of labor. a lot of workers left the health care systems during the pandemic, or after the pandemic. so really articulating what is the actual value of the medicine we have? and if you invest in that, yes, there is a cost upfront. maybe we can discuss how we deal with that. but there is actually tremendous value in terms of preventing cost and keeping people out of hospital. francine: but this is a crucial moment, because your price will probably go down as you have more competitors comi

if you would about how this program distorts the rest of health care system. this removes a major distortion and not only does it not cut benefits for seniors but it actually lowers their out-of-pocket costs because of the way that those are tackling in the program. again to echo what the secretaries said and said before, , it is a win-win-win ad it is something that is a huge net benefit to health care system overall. >> thanks thanks, everybod. i know we talk a lot about the savings are medicare, like the big picture idea but i do want to talk about the potential impact for patient for a moment. my understanding there's a potential some patients could be lower out-of-pocket cost dipping what the plan looks like. what he would to comment on how this could save patients may. >> was i happy to did that. if you think about medicare beneficiary, right, so somebody made who's in traditional medicare but doesn't have supplemental policy, there unhook for 20% of services when they go to see, when you go for any outpatient service. so it you are in in a situatn where

profiteers and make health care affordable for every family. but. you must do your part. preventive care, prenatal care, childhood immunization. saving lives. saving money. saving families from heartbreak. that's what the new covenant is all about. on america, in which middle class incomes, not middle class taxes, are going up on america. yes. in which the wealthiest few, those making over $200,000 a year, are asked to pay their fair share. an america in which the rich are not soaked. but the middle class is not drowned either. responsibility starts at the top. that's what the new covenant is all about. an america, where we end welfare as we know it. we will say to those on welfare, you will have and you deserve the opportun ity through training and education, through childcare and medical coverage to liberate yourself. but then when you can, you must work. because welfare should be a check. a second chance. not a way of life. that's what the new covenant is all about. an america with the world's strongest defense ready and willing to use force

profiteers and make health care affordable for every family. but. you must do your part. preventive care, prenatal care, childhood immunization. saving lives. saving money. saving families from heartbreak. that's what the new covenant is all about. on america, in which middle class incomes, not middle class taxes, are going up on america. yes. in which the wealthiest few, those making over $200,000 a year, are asked to pay their fair share. an america in which the rich are not soaked. but the middle class is not drowned either. responsibility starts at the top. that's what the new covenant is all about. an america, where we end welfare as we know it. we will say to those on welfare, you will have and you deserve the opportun ity through training and education, through childcare and medical coverage to liberate yourself. but then when you can, you must work. because welfare should be a check. a second chance. not a way of life. that's what the new covenant is all about. an america with the world's strongest defense ready and willing to use force

to having a very close, intimate relationship with their health care provider, and now they're callingxact phone number, and the call is being picked up by someone who might not have all of the details about their chart and health condition, obviously it has been frustrating. lisa: can you help us with some specific examples of what happened to the patients when they called this call center? caroline: what was happening what we found, through the , documents that that i was able to obtain and see is that patients were calling in with what are called red flag symptoms internally. there's 17 of them, you know, things that would suggest, okay, maybe something urgent is going on in about a dozen cases, from what we saw, at least, rather than, coecting those people to a virtual health provider who could answer their questions right away, someone who was medically trained, the call center employees, they were scheduling appointments for these people same day or the next day, or in some cases a couple days into the future, rather than connecting them by phone withomeone who could help them. t

, _ has been developing ai for health care, scientific research and consumer— care, scientific researchnd consumer use long before it was fashionable. what does he think the labour government should do to make the best of— government should do to make the best of artificial intelligence? | best of artificial intelligence? [ think best of artificial intelligence? think it's best of artificial intelligence? i think it's an opportunity to embrace the economic epic opportunities that are going to come with aland scientific possibilities. helping with health care, drug design, but also climate. the with health care, drug design, but also climate-— also climate. the new labour government _ also climate. the new labour government has _ also climate. the new labour government has said - also climate. the new labour government has said that - also climate. the new labour government has said that it l also climate. the new labour - government has said that it wants to be a green superpower. we know at the moment that this technology, at a potential intelligence is very power hungry. how's that go

health care. where is this cost saving. it it true people are going to thinking that mou it is because you are short changing a service or care? help us understands where is this cost saving coming from. >> yea i appreciate the question and to give it context. we have visits the decision less than 12 time in the last 4 years to discuss the cost medicare. at a federal level the rising cost of medicare is a huge concern special ira addressed the ways that medicare is operating. so we have been following all of this and sprngs the on going increases in the service the contract we have with united health care for our medicare product. it has been at this open discussion every year. we looked at other ways of purchasing medicare. and the end of the day we determined a competitive bid is the best tool available to you to push that question all the way. we fully expected to get competitive bids that was the purpose. and we d. and i will say, the delta between the to was startling. first is this our partner united health care did no

there are experts in health care, in law, in all kinds of fields. there are referees who count ballots, and they count those not with an agenda, but they are honest referees. i think we have lost that basic trust. host: in other words, we have lost some gatekeepers. guest: right. gatekeepers sounds negative, and in many respects, it is negative. but in many respects, it is positive. i think we want someone to be a gatekeeper when people decide they would like to practice medicine, for example. if i go to a doctor, i would like for some gatekeeper to have decided this dr. pastor medical boards and went to a medical school and knows what she is talking about and does not just have an opinion about the best cure for cancer. and yet, if you go online, and this is what the book is about, the most popular websites and associated social media platforms dealing with cancer, for example, will tell you april cockpits will cure cancer and that your oncologist is just trying to rip you off. host: how do you determine credibility and trustworthiness, especially

what's been left of mental health care. and one of the things that i try to help people kind of make sense of in that period is that there's all these very messy and concurrent trends going on in the late 20th century. one of them is that, broadly speaking, people are becoming more and more sympathetic toward patients because medication arrives. politicians like jfk and others are pushing for community mental health care. get them back home, get them into vocational training, get them jobs, get them out. and they want to shutter these asylums. and so, you know, there's all this media and film that is dealing with mental illness and trying to destigmatize it in some ways for the first time. and so we're seeing patients come out and people feel more sympathy. but there's also the civil rights movement going on. black people are protesting and visibly angry in public in ways that many american institutions and thinkers weren't quite ready for in the moment. and there's this immediate and very harsh backlash and carceral respon

and we have health care systems around the world who are designed for acute care, but finding that 80% the cost of the health care system is linked to chronic care, and we have portfolio products that are really addressing some of the chronic diseases of our day and age. diabetes, obesity and the comorbidities that follow. we know there are predictions that say by 2035, the world obesity federation predicts that the cost burden to society would be $4 trillion. and that cost is going to a large degree be taken up by health care systems already starting today by aging populations. a shortage of labor. a lot of workers left the health care systems during the pandemic or after the pandemic so what is the value of the medicine we have and if you invest in that, yes, there is a cost upfront. maybe we can discuss how we deal with that, but there is tremendous value in terms of preventing cost and keeping people out of the hospital. francine: but this is a crucial moment because price will probably go down as you have more competitors coming in. we know eli lilly can be a competitor so this is

there are experts in health care, in law, in all kinds of fields. there are referees who count ballots, and they count those not with an agenda, but they are honest referees. i think we have lost that basic trust. host: in other words, we have lost some gatekeepers. guest: right. gatekeepers sounds negative, and in many respects, it is negative. but in many respects, it is positive. i think we want someone to be a gatekeeper when people decide they would like to practice medicine, for example. if i go to a doctor, i would like for some gatekeeper to have decided this dr. pastor medical boards and went to a medical school and knows what she is talking about and does not just have an opinion about the best cure for cancer. and yet, if you go online, and this is what the book is about, the most popular websites and associated social media platforms dealing with cancer, for example, will tell you april cockpits will cure cancer and that your oncologist is just trying to rip you off. host: how do you determine credibility and trustworthiness, especially

reforming how we pay for health care and increasing participation in accountable care organizations can save money without cutting benefits. actual and projected spending was $6.3 trillion. lower than predicted, which i attribute to moving to value-based care. i am working with ranking member grassley and other republicans on proposals to do more of that. democrats pledged to protect social security and medicare. republicans sought to cut both grams and now they say they do not. if so, that is wonderful news. if we all agree we are not cutting social security and medicare and trust funds become insolvent in 10 years there is only one solution, raise revenue to fund social security and medicare. we can do this so that big corporations do not pay less than nurses and firefighters. my fair share act will protect social security and medicare or wrapper or at least as far as science can see. imagine if american families could erase from their worries what if medicare will not be there for me? what a blessing that would be. for 18 months we've heard republicans expressing alarm and calling th

health care system can be made better, and more efficient, made more patient centric. i hope that's reassuring to people who live in the world where so much conflict out there to see that and our world of health care policy there are a lot of commonalities we can actually make progress on and limiting. thank you for hosting a. >> thank you. we look forward to next op-ed and able to another event. everyone please join me in thanking secretary sebelius and secretary azar. [applause] [inaudible conversations] [inaudible conversations] >> all right, everybody. thanks so much for sticking around to discuss more of the kind of policy details and background about the site-neutral payments. so again please if you're in a room use qr code up in the banner. he joined as great or you can text them to (703)527-2734. we will be taking those throughout the panel as well. so we have at this thing was panel. with the today that is truly about partisan group of experts that can work on this issue for a long time. i'm not going to go through all of the details of your bios. you hear thi

about how the antiabortion movement's playbook is so visible in their attacks on trans health care. there was a whistleblower, quote-unquote, in the clinic in missouri whose claims later did not hold up to scrutiny about what was happening at a gender affirming care clinic. for those of us who covered and lived through the attacks on planned parenthood with secret videos. and later saw how those claims fell apart, were distorted, or false. skepticism was warranted from the beginning in evaluating what claims were being made about what doctors were doing, what parents were or were not allowing. it is helpful to realize. it is the same people, adf and all their medical and legal partners, to also learn some lessons. because i had a colleague who fell for it. that's why i had to write my column even though i was like i am in the middle of something else. [laughter] i don't work for the new york times so i can call my colleagues by name. just the level of credulity. anybody who has been marinated in what the antiabortion movement has done to evidence and facts. the quote political gueril