piven for better coordination and things we don't pay for now to help people stay healthier and get better care like medical homes where we don't have payments now for an answering e-mail's were using records to track of patient and filling prescriptions and providing those medical services. two actually pay for better performance in some dimensions the so-called pay for performance elements that have been demonstrated in the private sector to show impact. they pay more when it gets better compliance with diabetes medication or better results and other specific aspects. the challenge is there are some dimensions of important quality of care that even if you get improvements in some specific areas and can be hard to have an impact on overall cost and our overall health outcomes for a population so and many of these demonstrations when we have seen is an impact on specific aspect but may be less of an impact on overall cost because additional payments offset savings that might occur because you've got improved performance. more of an emphasis on trying to bring cost and reducing unnecessary

was, of course, the beauty, but i was thinking of the intellectual capacity because of and we think piven is a man as primitive as in his brain were not as good as our brain, that he wasn't as smart as we are and i was thinking approximately 40,000 years ago, right, then these people were doing these works of art to with the brilliant powers of creativity. there privily -- they're probably no different than any powers of creativity that we have today. >> guest: but perhaps they were women. >> host: of course. >> guest: and this is not a possibility open in any of the books about prehistoric art that i have read and i have read a lot of books. they are always thinking of these artists, they were artists, indeed, as men but perhaps they were women. >> host: i wanted to know that your book "mirrors" is probably one of the most, i will use the word feminist books i have ever read. the overwhelming number of portraits of women are favorable and admiring, adoring. men come in for much more criticism in your book. >> guest: yes perhaps but we are half of humanity, we are not all of humanity, jus

search leyna working on piven reform and need to repeat a lot of what you've heard of but i agree with the premise that has been put out here. if you pay for volume you get volume. and we have seen that largely across the united states. in minnesota we have a medical homes and what we call baskets of care that are actually part of public policy and are being piloted in a variety of places so these are certainly measures that we think are important in the system as a false but we also think that global payment is going to be a very important and significant feature of how health care gets funded in interstate. it will be important that as the private sector in combination with our health systems move towards more globally oriented payments that we move that way with medicare moving that way as well so i agree with the comments that have been made about medicare and medicare payment reform. is going to be important to have critical mass as we move to that. a variety of other instruments have been put into place to sort of get at the cost issue because there isn't one flagrant than suits

and i thank you had too many piven don is on the court at that time and i'm not sure anybody and i think that sort of a judgment of history is not clear that anybody could have brought the members of the court together. >> does he have a lasting legacy whether it be from his work on the court when different posts within government? >> i think is lasting legacy was in the area of civil rights and i think that he's never been given full credit for that. he wrote one other case in the area of civil rights shelley vs. kramer in which a rule that state courts could not uphold restrictive covenants where people would refuse to sell their houses to summon a particular race. so i think that the court was chipping away at all these practices of discrimination during that time and i don't think they could have gone to brown vs. board of education when they finally overturned the notion of separate but equal without laying the groundwork courts don't move that quickly. the move incrementally and i think they were unanimous decisions. i think that was very important. >> thank you so much. we have be

the blockade of american ports forced coastal shipping on to piven of land routes and one wagoner, of course, applies loaded in massachusetts a rise in charleston, south carolina to a half months later. nothing had changed dramatically in the decade since peace was restored until the erie canal opened on may 5 holiday in 1825. so that sets the stage for what the country was light until the erie canal got built. before trains, planes and automobiles, boats and horses were the only way to travel significant distances and in the days before groce deily to transport numbers of people or things was by water. the natural water route west and the hudson was overland from albany with, bypassing the falls and the mohawk river. and then a backbreaking labor 125 miles of the eastward flowing river and small boats, pulled over rapids, meandering shallows to the headwaters of the mohawk river. then a porridge of a mile or more depending on the season to the west were flying and aptly named wood crate filled with trees and down a series of floods and drought afflicted waterways to eastern lake onta

our new piven model is going to be one of those things as well but we have recently announced the cross blue shield of minnesota are going to be paying for online care. online care is honoring the physicians' time. a position talks to you on the phone, walks through a situation and they get paid nothing for that. they are paid in a show up at the office: we look at this we are going to be paying for that online interaction. we have a partnership with an american wow and it will be an ideal setting through the web can exchange with the position but we think this has a world of potential. if you think about situations like chronic mesa interaction inouye know how you are going to be treated and go twice a year every time it is the same thing. they bring into the office because that is where they get paid for syria. if they told you this they don't get paid. online caris says you have that interaction on-line with the physician. they order the prescription the never show up. they spend their time on something important and is been a time on something more important, your employer is happy

>> guest: it has got to show restraint, first of all, piven that is how we got to where we are right now. and, yes, we have to spend some money at this stage we're in an economically but we have to understand and again that this single issue that is unified conservatives to the years moderates republicans, conservative republicans and even liberal republicans most have believed in less government. again as i've heard you say in this book that is the essential relationship that buckweed understood between man and state, individual and state that has a stake expands the rights of the power of the state the rights of the individuals contract. >> host: blasted reagan republicanism, in an era in which almost all agree that americans have come to light in government. >> host: but that is just not true that is not true -- americans have not been given the alternative. i hear even the most conservatives say they want big government, we are all fdr's children now. and that is just not the case. iran in a district that had not elected republican since 1872 and i think the hon last republican t

the recent high-profile outbreaks demonstrate the huge challenges and opportunities for piven in the nation's food supply this ap infrastructure. laws and policies to be frank philosophies developed decades ago no longer suffice. two successfully meet the new demands. the legislation we're discussing is there for a critical step in reviving the food safety capacities of the fda. i work in a state health department as an epidemiologist responsible for investigating foodborne diseases and in effect cleaning up the mess left when things go awry in the food safety chain. i'm excited to see this proposed legislation addresses many of the problems i experience firsthand. in my role of investigating and helping prevent foodborne disease. improving the traceability of food called for in this legislation is fundamental to successfully achieving many of the other tasks described herein and traced back information have been more broadly available in shared pastor at the many other problems associated with the reason to made a jalapeno incidents could have been mitigated and likewise tracing pea