if you can't come up with a receipt for specific service or a medical product for the hsa, your hsa can't pay for it. what clint is talking about is the ability to contract for a suite of potential services, but not on a fee-for-service basis. that is a huge distinction. once again, we have locked ourselves into this archaic weight of thinking. and -- archaic way of thinking and archaic way of acting. >> a number of employers over the past 10 years have been experimenting with creating private exchanges. like obama care exchange was specifically for groups of employers. we have had next results. not our company, but employees are given a defined amount of money to spend per year and they purchase a health plan through this exchange instead of being told here are your exact benefits. the jury is still out in terms of is this driving better behavior, are they creating dynamics where they are shifting demands, are they saving money? it is to be determined. it has been a slow adoption by employers. >> in the end, the age-old question is what can the government do to prevent disruption or get

so the hsa puts that back in place. with 99% of the time, the government doesn't understand the profit motive of the people and politically, we don't understand the profit motive of the bureaucrats implementing it and that is one of the bigger issues. >> from your book if you could expand on this, elon musk is one of the capitalists who knows that he is in a war and has built a company prepared to fight each and every crony battle to get his business is really advantage as possible. >> elon musk is an interesting character. i work with inventors and elon is that weird piece. there's two inventors that are well known. everybody knows, you have edison and tesla. people like to think of elon musk has tesla and this kind of wild haired inventor going out doing crazy things. the fact is, he's edited. -- edison. i personally am a tesla fan, but edison built a business. he was inventive himself, but he was ruthless in growing the business, and in fact, he attacked tesla for many years. elon musk does much of the same. he's inn

an hsa is a healthcare device it's a savings account you put your own money in. it's tax-deferred.hen you can use that money and use it in conjunction with a high deductible health plan. what you are given now is the incentive to shop. the doctors are given the incentive to treat you like the client. when you go into a doctor's office normally yes you are a patient. yes you might be sick but the fact is you're not really paying the doctor. you might be paying 10% of what the doctor gets paid. but the real payers are the insurance companies or the hospitals or the government. so the hsa put that back into place but i think 99 percent of the time government doesn't understand the profit motive of the people and then politically we don't understand the profit motive of the bureaucrats that are implementing it. i think that's one of the maybe bigger issues. >> from your book, if you could expand on this, elon musk is one of the capitalists who knows that he's in a war and built the company prepared to fight each and every crony battle to get his businesses every advantage possible. >>

employer said you guy the health insurance for you and i'll match funds and i'll put money into your hsa account and that way it's now a market system. life insurance, car insurance, home insurance, you understand and you understand there are some rules of the road that if you drive too fast and get a ticket your car insurance is going to go up. >> right. >> if you get a dui you will get penalized, and i think we have the sense that health care is an absolute right, but it's not an entitlement to not live up to the rules to the game and have no consequences. we have some of the most efficient systems and we pay double. we rank 25th or 26th in the last world health organization. >> do you want a single-payer system? >> no, i don't think single payer. >> wouldn't that simplify things? >> it simplifies it. it doesn't necessarily make it better. >> would it make it cheaper? >> i think you could argue that, yes, it could make it cheaper and not have better results. i would rather see a market-driven system that -- that individuals that we do what we do best in this country where we demand the

, you buy the health insurance for you, your families' needs, i'll match funds, put money into your hsa account and that way, it's now a market system. life insurance, car insurance, home insurance. you understand and you understand there's some rules of the road that if you drive too fast and get a ticket, your car insurance is going to go up. if you get a dui, you're going to get penalized, and i think that we have this sense, health care is an absolute right, but it's not an entitlement to live by no rules of the game and have no consequences. and i think that we're struggling as a society to how do you -- we have one of the most inefficient health care systems in the world. yet we pay double of anybody else in the world. we rank, i think, 25th or 26th in the last world health organization -- >> do you want a single payer system? >> no, i don't think single payer. i think that -- >> wouldn't that simplify things? >> it simplifies it, doesn't necessarily make it better. >> would it make it cheaper? >> i think you could argue that, yes, it could make it cheaper and not have better resu

in fairness if i have a good nest egg of hsa sitting over here, but i don't really have an ability toshop wisely and use the same dollars wisely. what are we doing. this conversation here is so very, very important when we talk about trends parent day. my hometown in anchorage, the largest city in the day, last year we passed an ordinance that requires in our facilities to provide cost estimates and they have to post a. they have to provide information within a certain number of days. granted this is still this point in time it doesn't appear that it appear that it had much of an impact. some of that is due to those issues would've far greater the difficulty of predicting services, benefits structures from multiple providers, and the like. i live in a state. we don't have a lot of competition. you've got one in the same is true in just about every community outside of anchorage, alaska. i looked with great interest at the chart that senator cassidy showed in terms of the cost of the facility cost and how does weigh in. the question that i wanted to ask you this morning as we are movin

his father hsa the m for the shooter. >> i hope they knowhey've ken away the life of somebody who would have been there to help >> reporter: d.c. police are continuing to investigate this . ca they urge anyone with information to come forward. if you were here, if you heard the three sh is, anyormation you can provide, is greatly appreciated. information,ny give them a call. a $25,000 reward for information that leads to an arrest and a nv tion. live in northeast,news4. >>> such a generous and outstanding youngman. >>> the outbreak of violence in the district is thidence. e has been a 44% spike in the murder rate compad to last year. marmet is the 135th person to bs killed t year. the death toll for all of 2017 was 116. ss than two weeks until election day and a loophole finds the congresswoman barbara comstock may be in trouble. the pollhows jennifer. weton with a 13-point lead.ic democr voters appear motivated to vote against comstock. more are motivated to vote for. be sureheo nbchave 4 app handy on election day. >> we've seen the attack ads from both sides nonstop. >>> a day after t

tweaks to what we have done to make the individual tax rate accountable they expire in 2025 but also the hsa accounts those are things that our voters would like to see but right now i stand or we are with the high rates and we have the right business frame. but the rest of the world or the corporate rates and we did not. paying 35 percent marginal and each country paying double or triple so to put our businesses at a disadvantage i want them to win. >> we know that tax bill is not working for all of us. we know it was i hand out to the millionaires and very large corporations who don't really need the tax break. the fact that the president now says we need middle-class tax cuts shows it did not cut taxes for the middle class. congressman bacon and talks that was only a half truth. we need to bring the corporate tax rate backup. i would support around 39 percent because that effective tax rate right now it is 14 percent that's not enough to make up the deficit in this country it isn't because of excess spending. he's not talking about his spending that will impact all of us but what did happ

however, fortunately, with the help of mod, the human rights commission and hsa, they finally agreed to accommodation for me to get groceries. and i want to thank mod staff for their role in that and making that possible. it would never have happened without their help. so i want to express my gratitude for that. i also want to talk about two of the issues that some of the most pressing issues for people with disabilities right now in the city. that is housing and transportation. right now, more than 60% of the homeless population is disabled in san francisco. of course, that includes many veterans that have served our country, yet the mayor's office has come out against prop c, which is a very modest propositi proposition. anyone who is too disabled to work, the maximum amount of money they can get is slightly over $900 a month. and i would love it if anyone here could point me to any place that would provide a place of rental on that income. to my knowledge, there is no place like that in san francisco. that's a huge problem for people with disabilities. about transportation, i wou

what we're seeing especially with high deductible hsas they don't want to burn through in a year allof their deductible and co-pays on one hernia that would cost $3,000 bundled where it might cost 15 to $20,000 in the hospital. >> do you have any guess about what percent of the people that pay cash also have insurance that they don't use? >> i think it would be very low. i don't have the exact statistics but the individuals paying cash usually do not have insurance but they have the means to do so or they have high deductible plans. >> let me move to this question. generally speaking, most americans are insured. more than 90% have insurance. >> correct. >> 55 or 60% of those that do have insurance, have employer insurance. they get it on the job. maybe 35 or 40 get it from medicare and medicaid. so am i correct, we have mandates from washington about transparency on costing quality for medicare and medicaid but not for employer sponsored insuran insurance, correct? >> i have two questions. can they figure anything out or do they need to be rewritten or made more meaningful or two sho

chancellor angela merkel's coalition has taken a hit with the cdu and spd down on the previous results of hsa. andre a nalos has described the state of the government as unacceptable giving merkel until next year time to deliver policy results. we have the latest on the story. i just noticed as we had to pull back on something across in europe, german bonds have marched higher suggesting there's an elevated risk out there, a nnetta. the outcome of the election which is a regional state where frankfurt is also located are not boding well for the current government a, it's a blow to angela merkel. her cdu has lost some. even worse the spd fell to a record low also that prompts discussion inside the party whether the grand coalition is something the spd should do or whether this will kill them altogether. the spd had to vote, the member base had to vote on whether they wanted to do a grand coalition i guess the noises will be getting louder and louder given all of these poor results in the regional election. it's the second barrier. so the spd is the big event risk in berlin. if they are pulling

but in fairness, if i have a good nest egg of an hsa sitting over here but i don't really have an ability to shop wisely and use those saved dollars wisely, what are we doing? so this conversation here this morning is so very, very important when we talk about transparency. in my hometown in anchorage, the largest city in the state, last year we passed an ordinance that requires our health care professionals and our facilities to provide cost estimates to patients who request the information. they have to post it. they have to provide information within a certain number of days. granted, it is still very early, but at this point in time it doesn't appear that it's had much of an impact. some of that is due to those issues that we've already heard, the difficulty of predicting services during an episode of care, varying insurance benefit structures, bills from multiple providers, the like. but to senator warren's comment there, i live in a state and a place, anchorage is, again, our biggest population center but we just don't have a lot of competition. so if you're looking to go to the hos

about everybody other month and we consist of representatives from city departments, from daas, from hsa, public health, emergency management and we have a number of community based organizations and non-profits that are contributing in part of this work as well. so, the california legislation very specifically defines access and functional needs and it covers a lot of individuals. we are talking about individuals who have developmental, physical or sensory disabilities. disabilities, limited english proficiency, those pregnant, living in institutions, homeless or transportation disadvantaged. we are talking about a large part of our community. so, last year i want to highlight a few things the group worked on. we talked about implementing the final cms rule which is a national legislation that makes sure that medicare and medicaid have emergency procedures as part of their operations. we looked at san francisco's paratransit operations and that's something we are continuing to look at this year as we're thinking about safe evacuation and how to best use paratransit services in those sce

[applause] >> the mohcd director, kay hartley, the hsa director barbara smith. so thank you all for being here. today is really a beautiful day in san francisco, and thank you for joining the celebration. [applause] >> all right. i'm going to thank mayor lee, especially since she thanked half the people that i was supposed to. anyone i didn't mention, i want to thank, as well. we -- we do a lot of these ribbon cuttings, which is great. we like to do them as often as we possibly can. part of what makes it possible is to have an understanding of what it takes to get this done. so in the obscure world of housing, you heard about the tax credit, which i'm sure you talk about over dinner. at least if you're in the affordable housing world, you talk about it all the time. you can't escape it. natalie was an expert in this. she helped shape the way our industry works with these programs, and she -- i think in addition to shaping those of us that work on this side, she shaped or banking and investment partners. no, natalie was tough, not as tough as then commissioner br

when you look at research from mortgage backers, hsa's in particular.he average san diego needs to make about $131,000 in the county to afford a home here. but what would you do about this? one of the things we need to understand in san diego is that we have federal government land and tribal land. a lot of it. there are scarce resources to build. where practically built out. so, i don't think people notice that when they drive up and on the freeway. they see a lot of open space, but it is not open space. it is not buildable. so i think whatever we can do to make things more affordable and understand and to increase transportation options for people to put in the rows and the freeways and the things that we need so people can live further away and still get to work. san diego has some of the worst traffic i've ever seen. it seems to be almost continual now. people are in their cars but they're having to commute long ways because that's where the housing is good you can move them downtown. i think we need to improve transportation, to cut down on some of

mkichael >> como saben s e sigue aproxi n aproximando a lfa florida y la zona ya tiene vientos de hsasa ty y 50ma eln la costa esta actividad ir aumentando eln la jornada en ea trarde ( musica ) >> vean como el ojo testa alejao de la zona costera que se intern a a otros lugares ahora en gh general es lluvia pero mads adelante sera mas intensa. ( musica ) >> por eso tenemos el aviso de t tormenta en especifico esto s significa que el nivel del mar e estaria subiendo en comparacion con la marea >> exaxctamente la fuerza del i viento seguira empujando mas a u agua y podria llegar hasta 13 pies de la zona que le mostraba el viento llegaba a 45 mpjillas por hora y en pocas horas estara llegando al centro del cicloclon tendremos un hacer enhuracan ta carsarolina sur. se alejaria de la zona impacata altuira de la ola actualmente d toda esta masa de agua se va a d desplazar por eso el aviso de a marejadas >> aqui estan los efectos ene e area >> (informacion en pantalla( >> claro que si los tdornados l ailados tambien tenemos que ag agregarlos mas adelante regresÁ el momento ahora vamos a pasar