they are going to share -- bruce chernof, dr. bruce chernof, the president and ceo of the scan foundation. doctor chernoff serves as the chairman of the long-term care commission. doctor mark warshawsky, we're going to hear from dr. warshawsky, adjunct scholar at the american enterprise institute. he is the commission's vice chairman. and then doctor judy feder, one of the commissioners of the long-term care commission. dr. feder is a professor at georgetown with policy institute and they fell as the urban institute. and also served at the commission staff director under my former colleague, of which i was the president of the claude pepper fan club, and she served for claude pepper. and by the way, i mean, there was an example. for those of you who were not here in washington in that era, claude pepper and ronald reagan would go to it. but at the end of the day they were personal friends where they then could work it out together. and one of the great examples of that, also with the leadership of the speaker, tip o'neill, was whe

dr. chernof also to respond? dr. chernof. >> thank you. yes, i think we have public policy -- i said this before i will save incredible view. public policy that is perfectly built for 1972. the reality is, medicaid is the program and its inception was predominant focus on women of childbearing age and their children. that was its kind of constitutional core way back when. the average life expectancy in 1965 was 69. as a physician if i was in practice then you would have just seen the first icus and ccus. the likelihood of surviving girlie man morbid or morbid event like a six stroke or heart attack, a very different time and place. people are living much longer and will live with it -- with more serious chronic illness and limitations. the reality is our public policy has not kept up with it. the reality is -- i agree anne's description of the role of medicaid. i would just offer to all of you that the hypothesis if we do nothing is incredibly expensive and that medicaid will bear the burden of that. and it will -- we will all bear the bur

dr. chernof. if you have any way to quantify what the cause is of that, that will help our discussion in terms of trying to work with cbo and other people to figure out, if we're going to pay for this to a degree anyway and there is a smarter way to do it i would like to have that conversation bearing in mind what the experts say we are going to pay for this anyway. >> senator whitehouse, cms at one point did a present value calculation, sort of a mini trustee's report for that number. i don't know if they continue to do it. >> that's why i made it a question for the record. anybody who has info could get back i appreciate it. i yield back to the chairman. thank him and our wonderful ranking member for all their leadership on these issues. >> well, it's not clear to me where we go. we've had two different opinions expressed. dr. feder argue that is a public benefit is the answer. dr. war thousand ski, why don't you give us an financial and political difficulties. why wouldn't a public benefit help

dr. bruce chernof, president and ceo of the skin foundation. dr. hernof served as the chairman of the long-term-care commission. dr. mark warshawsky. we are going to year from dr. warshawsky, adjunct scholar at american enterprise institute he is the commission space chairman. i meant, dr. judy feder. doctors feder is a professor at georgetown public policy institute and fellow at the urban institute and also served at the pepper commission staff director under my former colleague of which i was the president of the claude pepper fan club. she served. either way, there was an example for those of you who were not here in washington in that era. claude pepper and ronald reagan would go to it. but at the end of the day, they were personal friends were than they could work it out together. one of the great examples of battles with leadership of the speaker, tip o'neill was when social security was within six months of becoming a graft in 1983. they said we are going to take off the table so that you can't hit your opponent over the head with it. it app

dr. chernof to respond? >> we have public policy -- i have said this before.public policy that is perfectly for 1972. the reality is that medicaid is a program that was predominately focused on women of childbearing age and their children. was kind of its constitutional core, way back when. the average life expectancy was 69. as a physician in practice then, you would have just seen the first icu. the likelihood of surviving a fairly morbid event like a serious stroke or heart attack -- a different time and place. people are living much longer and will live with more serious functionalness and limitations. the problem is, public policy has not kept up with that. i agree with anne's description the role of medicaid. i would offer that they know hypothesis, if we do nothing, is incredibly expensive -- that the null hypothesis, if we do nothing, is incredibly expensive. medicaid. i would offer that they know hypothesis, if we do nothing, is incredibly expensive -- that the null hypothesis, if we do nothing, is incredibly expensive. we will all bear the burden --

bruce chernof, dr. bruce chernof, the president and ceo of the scan foundation. dr. chernof served as the chairman of the long-term care commission. dr. mark warshawsky, we're going to hear from dr. warshawsky, adjunct scholar at american enterprise institute. he is the commission's vice chairman. and then dr. judy feder, one of the commissioners of the long-term care commission. dr. feder is a professor at georgetown public policy institute and a fellow at the urban institute. and also served at the pepper commission's staff director under my former colleague of which i was the president of the claude pepper fan club -- [laughter] and she served for claude pepper. and by the way, i mean, there was an example. for those of you that were not here in washington in that era -- [laughter] claude pepper and ronald reagan would go to it. ..

dr. chernof, i can't help but smile thinking about how you could get people to buy this insurance well ahead of time. you could have an individual mandate, and if that sounds familiar, we just had a quite a -- a debate about that. and it was declared constitutional by the supreme court. but it is not easy. let me ask you on a completely different kind of subject. and we've really had problems in florida with assisted living facilities, basically taking advantage of seniors. nursing homes. do you have any suggestions? i mean, we've got people that are starting these things up that are unlicensed. obviously, they are breaking the law, and we are talking about the care and nurturing of our seniors. did your commission suggest anything that we ought to be doing? >> you raise a really important question, senator nelson. and actually, as a commission, this is not an area that we had a lot of focus on directly. i think indirectly we had a real concern that we don't really understand how to think about or measure quality in this space. this is a space that has a lot of resources that are paid for pr

dr. chernof also to respond? dr. chernof. >> yes, i agree. i think we have public policy -- i've said this before and i'll say it in front of all the. public policy that is properly built for 1972. the reality is that, you know, medicaid is a program in its conception, which predominate focus on women of childbearing age and their children. that was really it's kind of constitutional core way back when. the average life expectancy in 1965 was 69. as a physician if i was in practice then you have just seen the first icus and cc use. the likelihood of surviving fairly morbid or moral event like serious stroke or heart attack, we live in a very different time and place. people are living much longer and will live with parsers chronic illness and functional limitations. the reality is our public policy has not kept up with it. i agree with anne's sort of description of the role of medicaid. i would just offer to all of you, if we do nothing is incredibly -- medicaid will bet the burden of that. we will all bear the burden to families with their t