so we really need to think about how we can provide more value with the subsidies we are providing asopposed to simply increasing subsidies. and that allows to some extent enhancing flexibility and choice and thinking of ways that states might be able to come up with more attractive coverage packages or maybe novel subsidy schemes that can actually encourage the takeoff. and it seems to me that those goals should be somewhat compatible across the political spectrum. related that i think another thing that is important and we all know that if you have seen one state, you have seen another. the problems are really different. if you take iowa and most of you don't want to take iowa, you have a lot of independence, they are not in group plans and they are really hit hard by premium increases the market. it's not new jersey and of course all the state specific flexibility which is broadly consistent with the new guidance that has come out on waivers, without endorsing every thing it really makes sense, in my humble opinion, to think about what we can do to provide states flexibility. a few

encourage all groups to begin providing the input they would like to provide because we are committed to making changes to reduce burdens from american clinicians. the current system is leading to physician burnout and driving consolidation and it can't be allowed to continue. thank you to aei for convening these events today in such a knowledgeable groups of participants. the fee-for-service program is in many ways a program with improvements that are long overdue, in order to keep the promise that america has made to our seniors. every ideas on the table for this administration, we are not vetted to the current way of doing things just because it's been done that way for many years. together we can ensure that american clinicians are able to spend less time with the computer screen and more time with their patients and we can promote competition in the healthcare marketplace. thank you very much. [ applause ] very good. thank you very much. so, physician burnout. you've done something here to reduce, to some extent the paperwork requirements but, what else can you do, given that as

-based providers.by december of 2017, the previous six months before that, that almost doubled or at least increased by significant amount in about 650,000, almost 700,000 requests in the prior six months. what's interesting about this chart is the grant rates have covered more or less at about the same rate. at about 80%. they've been consistent over time in terms of the percentage of requests or demands that providers complied with, but that also means the absolute number of requests that are being turned down for the number of disclosure demands that are not being complied with is higher given that there's a bigger volume of actual requests. to some extent law enforcement is frustrated because they are sensing this bigger number of request denials, where his providers are saying we are pretty consistent and how we've been treating this overtime. the chart only shows whether qwest are made, not for the requests were not made because the law enforcement did nowhere to go over otherwise stymied in the

we voluntarily provide that help. we have hope and honor and respect for the god-given role as a parent. we volunteer to help as they volunteer to ask for help. we believe that becomes the power for change. this week, i met with a woman named uganda. at mcdonald'seet and play in the playground with the kids while we do paperwork. as i sat at mcdonald's, she said to me i have never done this before. i said what, she said i have never sat across the table with a mom at mcdonald's having a coke. i said what do you mean. she said i have a professional who comes in to make sure i take my medication. i have another professional who comes in to make my kids are getting to school. i have a mental health visit once a week with my therapist. i don't have a friend like this. that is where the community needs to make a difference. early intervention. child is prevention. believe in the power of relational support and the fundamental value of family preservation. children belong with their parents whenever possible. sometimes, tha

advocacy as it providers. we also know there are a substantial number of issues tat affect families that also indirectly affecir pregnancies and the health of their pregnancies. we address those isss as well with the family support services we provide. i want to say our workehat are -- we actually have a second part of our mission that trains women of col to provide these services to moms which is really important, because it llows us to have a workforce development program to continue these services in our community and empower women as they're providing tho services other women. >> providing the service to them and teaching them to provide it to someone else. >> exactly. >> passing it on. >> absolutely. >> how long have you been around? >>years now. >> how did it get started? wh i started >> avana dari and caset pringle, they were working as doulas in d.c. and they noticed the need for services for women in color. noticed it was a barrier for women to receive these services. they wanted to provide a platform

communication provider. in short to demand tech companies weaken the security features of their products. for example the australian government can now make the same request to apple the fbi made in the san bernardino shooter case as they build a new system to circumvent those features as apple explained in that case building a software tool would have made that technique widely available threading the cybersecurity of other users and as we know in the lawsuit here in the us the united states government argued under the obscure act that dates back to 1789 they were permitted to make this demand of apple but apple supported by other tech companies and privacy advocates said it was unconstitutional the justice department withdrew the demand before the court could resolve the legal question because the fbi could pay an outside vendor to hack into the phone now in a still you they can make these demands. another worrisome scenario is it could use its authority in the same way the united kingdom looks to use it j

it provides free nutritional. it provides educational programs. and across the street, you have our mental health services, which used to be a funeral parlor. for the last 20 years, it's been providing mental health services for spanish-speaking families. but folks in the mission had the great pride of, which is st. luke's. if you wanted someone to find out about what programs are available in the mission, you knew somebody at st. luke's. it's still that way. one of my sons was born at st. luke's. you say, wait, what's going on here? to me, instead of making it part of the new facility, st. luke's lamp is going smaller and smaller and smaller. i mean, you put -- we have -- your foundation is on valencia street, 20th almost. nice place. you always see people stop in there. people stop to read, to pick up coffee. couldn't you have diabetes classes there in spanish? i don't know. i've never been in there. isn't there some way creatively we can think about providing these f.t.e.s and have -- a lot of the foundations in the mission would even help out,

this is for persons with disabilities age 18-59 and we have seven providers who provide the congregate meals for adults with disabilities. with this, there's increase in service level for two contractors and that is centro latino and russian america. it will serve an additional 212 unduplicated consumers and another 12,632 meals. the third program is the home delivery program for seniors. and it is basically for seniors who are unable to go out to a congregate meal site because they have some disability or mental disability and unable to go out. the meals are delivered to them either hot, chilled or frozen, depending on their ability and the storage capacity to handle the meals. so, providers do the assessment to see what would be the appropriate meal. there is one time only money. a majority of it is to add three vehicles in order for the providers to expand and add new routes to serve new areas. and also we have increased the service levels, special -- especially to the areas with high needs like the ethnic meals like japanese and chinese meals. both those contractors have added capa

we provide a suite of services. we do consulting, we provide affordable kitchen space and we spent a lot of time navigating the ecosystem, specifically for food business entrepreneurship. we are working with wonderful partners and charting a course and doing a lot of advocacy with for-profit partners and businesses to create equitable opportunities for small micro businesses. we focus on low income people of colour, and today we have 30 businesses run by graduates around the san francisco bay area. and from that we learned a lot about the gaps that are still there for entrepreneurs that have the business competency, they have the proven revenues, they have employees, within the gap in really moving through the program into a place of full self-sufficiency. i'm happy to keep talking about that more margin questions. thank you. >> hello. my name is jenny from start small, think big. we are a nonprofit organization. we have an office here in san francisco and also in new york city. we provide three different services.

and stress and provide ongoing social support. practical help so families not left alone in a time of crisis and children can be safe until stability is established. we come alongside families in multitude of ways . we have crisis hosting of children. approved families are hosting children temporarily while parents have a safe option to clarify their issues. we offer respite care, sleep preplanned daytime overnight care. to alleviate the parental stress. we want to pursue healthy relational development. we all know that everybody needs an extra friend. and so we offer that once a week or one time per month. and also wraparound care for families. both families that are hosting children but also families that are in crisis. our best work is done in collaboration with the community at large. parents are empowered to ask for help. parents are empowered to not worry about whether they will lose their children to foster care. parents voluntarily ask for help and we voluntarily provide that help. we uphold and honor and respect for the g

and we really appreciate the help that they provided. i think this is -- it's a hard thing for agencies to come and tell you what they're expected performance is going to be after an earthquake. it's a hard thing to say what they think the goals should be after a major event. so we really appreciate the people are stepping forward and we really think this is going to be important to understanding how we work together. i should mention that in 2014, we did complete a lifeline dependency study that looked at how dependent the different providers are on each other. as we know, if you don't have electricity, it's hard to run your mta system and so forth. if you don't have water, it's hard for people to stay stay in their homes or at work. so those things are important. and the committee that we put together has been facing those things. actually, the study led to the defining of the sea wall, that the port of san francisco is managing and we're really proud that voters also recognize the importance of that with the passage of the bond in nov

that involves the provider. and then there's medicare advantage, and the chairman and i've always been interested in that. my state as the third highest percentage of seniors in ma in the country. we said let's start by putting some points on the board for each type of medicare. so for traditional medicare we were able, and the chronic care bill provides new benefit for telehealth for senior suffering from strokes and people with kidney disease who wanted to get the dialysis treatment at home. and we were able to expand primary care services for seniors at home through what is called independence at home. then moved to ma, which is a more recent effort of private plans to sell coordinated coverage to seniors. there we were able to expand supplement benefits that offer nontraditional benefits that a been shown to improve seniors health. the bpc has been very interested in this, looking to expand things like nutrition assistance and safety measures at home. then we were able onto in the front to cut red tape for t

we're providing options. if developer chooses to provide the child care unit, they could get a reduction in their developer's child care impact fees but they would also bring in an amenity to their building. thirdly, they would also be able to bring in hopefully rent in a space that might otherwise be vacant. the other thing i want to mention for you today is that after meeting with the developers to see whether or not they will opt in this program, they want to see more child care options. we do want to offer couple of amendments that we want to entertain. as states now, the unit need to be designated a child care unit for ten years. it would actually remain the bmr unit in perpetuity. that seems to be a difficult decision for developers or property owners because that's a unit they would like to have more flexibility. supervisor yee is offering the amendment to allow this unit after the designation period to go back to market rate. in ex-- in exchange we're extending from 10 years to 15 years. also in worki

no state was able to provide data on all five elements. the three primary themes by the courts the reason that they cannot provide the date it was that the authority and practices are highly localized, a lack of standard for data reporting, and outdated technology and case management systems. so why is data a concern? many courts may not be aware of which cases are open and should be monitored and which cases are closed or no longer need their attention. there are states who have taken on reviewing each case and updating records and accompanying data. texas, nevada, and new mexico are reviewing case files to determine if each case should remain open, what filings and accounting are missing and need follow-up. texas, pennsylvania, and others have established systems to help them track and monitor cases. determining the open or closed status of the case although very basic, it's an essential step for court reform and guardian conservatorship case management oversight. the texas process could be adopted as a model for court case review. court

really see some improvement is in the provided directory -- provider directory, for instance, being clearabout who is offering telehealth services and have it updated on a regular basis to let you know it's real time. >> sean cavanaugh taught -- do you want to move -- speak on this? >> i think we need to move from thinking of this as a benefit to telehealth as a mechanism for delivering other benefits and its origins reflect skepticism about it that we should've moved long past. we are missing all these other technologies and that's why cms has tried to keatts -- create schedule codes for emails and so forth -- when i get to 65, lord knows how i'll be communicating with my doctor, but it won't be through a tv screen but that's the big thing is that we need to move past that, i think.>> this is also an example of where innovation can really inform -- the situation. i agree with you. what is telehealth and telemedicine -- telemedicine -- we are picking this up more than secret service was. >> if you don't mind -- i will go to the audience. so we have microphones -- i ask that you quickly te

so thank you so much. >> teledock provides second opinions and provides information to consumers.ledoc works and how it can help a patient pick hcg or md anderson or dana farber. welcome. >> thank you. i'm the chief medical officer at teledoc. i'm my own journey into telemet sin, really began about 18 months ago. was the chief medical officer at a company well-known to reggie, best doctors, one of the k series at harvard business school that you taught for many years along with a founder, dr. jose halperin. started ted brigham and women's hospital by two professors, ken, who passed away this year, along with jose halperin and that was really a way to access top level medical opinions anywhere in the world. so we're a global company. and 18 months ago we were acquired by a very large telemedicine company call tela doc and the vision of the company is to -- with the acquisition of best doctors and the acquisition this year of a another expert medical opinion company that provides physician services globally, advanced medical, headquartered out of barcelona is to private a very compr

we must increase investment and provide subsidies for families and boosting stagnant wages of our providers. we must invest in creating new childcare centers in the city and especially in neighborhoods with a scarcity of slots. lastly, we must stabilize this work force, who are often at the fore front of sustained livability for our families. this would allow developers and property owners to build residential units on the ground floor if it's designated for family childcare. this is a voluntary program. i will let the planning department go into more details in a second, but before that, i really want to thank the planning staff, mayor's office of housing and office of early care and education and especially want to thank my chief of staff, jen lowe, who worked tirelessly with developers and different departments. want to thank my co-sponsors in the legislation, supervisors ronen and kim. chair tang, i would like to invite sheila nikolopolis from the planning department to present. >> hello. san francisco planning department. i have a presentation here. so the proposed legislation that we'

we will put young people, providers, and parents and family members on it. we ask together we build a community of community members to move san francisco to the forecast of juvenile -- forefront of juvenile justice reform. on behalf of the entire juvenile justice providers association, we thank you, and the community for your support. >> supervisor mandelman: questions? supervisor ronen? >> supervisor ronen: i wanted to make some comments because i have to leave. i just wanted to start off by thanking supervisor fewer for holding this hear. this is a long time coming. we've needed this public discussion about what's going on. i know that it impacts many, not only youth but community based organizations that serve residents of my district. so this is really important. in no specific order, i just wanted to give a few of my thoughts before i leave. one, i just want to say i've had a lot of time to -- when i was a legislative aide for supervisor campos to sit down and be in j.j.p. meetings to help create the road map to peace program that is an incredible comm

they provide resources to protect the environment. water we drinke in the air we breathe is safe for this generation of children, and for the next. these national security programs that enable the united states to thatglobal leader, a role is being increasingly challenged by china and russia. i have to ask, is the president going to hold the american people hostage over a wall that he, time and time again, promised mexico would pay for? is he going to force hundreds of thousands of federal employees, including the very agents he depends upon to carry out his immigration policies, to work without pay over the christmas holiday? is he really going to tell millions of americans, including his most ardent supporters, that he could care less whether they are cut off from government services in service of his own vanity? the president has decided that fighting a symbolic fight for a shiny object is more important than keeping our government funded for the american people. it is the height of irresponsibility. negotiations with chairman shel

the assistance that he provided the special counsel's office is extraordinary. when you think about it, he provided help with links in coordination between the russian government and individuals associated with the campaign. you know, we talked about this criminal investigation that he's providing information on. he's also providing information about links, about people connected to the campaign that may have been communicating with russians, all of that. this is certainly the heart of the special counsel's investigation. and it's quite clear when you read these documents that he was central and he came in early. he came in early to them. he was willing to cooperate from the beginning. he helped perhaps bring other people in to cooperate. >> mm-hmm. >> so what you see here is that without him, you're really starting to see how important michael flynn has been to the special counsel's office. >> yep. they said he provided firsthand information about interactions between the trump transition team and government officials and on and on. they said officials with the

australia now has the authority to compel providers to great encryption backdoors, and once providers are forced to build weaknesses into the products, other governments can exploit those weaknesses. i've only make an example of apple versus fbi. now if australia issued a technical capability notice to compel apple to build a new operating system to circumvent iphone security features, which is what the fbi demanded in the san bernardino case, then if apple complied and built that system it could no longer argue that it lacks the capacity to turn over data to use government in similar cases. similarly, if australia forced facebook to read your what's at encrypted chats to be accessible in response to australian legal finance, those chats would also be vulnerable to other governments demands. finally, there's the course also visit the us government could simply seek to expand its own direct authority by pointing to australia as the new model for quote responsible encryption legislation. so whether it's as a pathway or as a model, yes john law creates risks to cybersecurity and privacy

crop insurance and providing certainty to farmers. i'm particularly glad to see industrial hemp descheduled from the controlled substances list. mr. comber: this is a key provision i worked on to ensure key restrictions are lifted from this valuable commodity. i thank chairman conaway for his work on legalizing industrial hemp and all my colleagues to supported this issue and helped bring it to the table. i was proud to represent the interests of kentucky farmers in this process and look forward to a new year of growth and prosperity for farmers and producers across rural america. i yield back. the speaker pro tempore: the gentleman reserves. the gentleman from minnesota is recognized. mr. peterson: i'm pleased to yield two minutes to the gentleman from california, another of our subcommittee ranking members, mr. cost tafment the speaker pro tempore: the recognized for two recognized minutes. mr. costa: i thank my good friend mr. peterson for yielding the time. i thank him for his work along with chairman conaway. i want to thank the

in january, they will present an update to the service provider working group so they can provide insight and questions to the oversight and advisory committee. and then they will give an update to the oac in february. and with a draft of the plan going to the oac in march. so, we're moving along within the process. this month at the oac, at the follow up to the needs assessment, there thereby a presentation on the diaper dive that planning did into the equity analysis of communities of color and lgbtq population. i think that's it. if there are any questions, i didn't mean happy to answer. >> president serina: thank you very much. any questions? commissioner loo. >> vice president loo: you said that the state came and do the audits. do they also interview the consumers? >> deputy director kauffman: they will go on site during congregate meals. they will have an opportunity. i don't know if they will have opportunities to speak because that is part of what they're doing is they will go and take a look at the kitchen. they will look at the congregate meal site itself. there's an opportunit

the legislation also provides ey reforms to the imls and its programs. s. 3530 updates provisions of the law to reflect the evolving role of libraries and museums in our society. it recognizes libraries as community hubs, equipped to serve community needs and the legislation highlights the unique educational role that museums play. the bill increases the set-asides for services for native americans and codifies the museum professional development program in a way that mirrors the laura bush program for 21st century librarians. lastly, the legislation puts an emphasis on the needs of rural communities and funds activities that will serve geographically diverse areas. this is commonsense re-authorization legislation that affirms the important role that libraries and museums play in our communities. mr. speaker, i reserve the balance of my time. . the speaker pro tempore: the gentleman reserves. the chair recognizes the gentleman from arizona. mr. grijalva: i yield myself such time as i may consume. the speaker pro tempore: the gentleman is recognized for a

while they provide environmental impact reports they do not provide services compliant with ceqa. we scored the proposals based on the points in the slide. our planner and the former deputy city attorney and the port'port's operating officer b. on october 18th the proposal deadline we received theory responses four the r.f.p. they met the minimum qualifications. the final rankings are on the slide. each panelist scoreid it at each phase. environmental science won with a score of 94 out of 100. on august 17 we issued notice of intent to award a contract to the most qualified firm. no protests were received during the five-day protest period. the contract monitoring division sets l.b.e. subcontracting goal also based on the scope of work and number of small local businesses to perform the work. the l.b.e. goal is 18%. esa will subcontract 25% of the work to small businesses. l.b.e.s make up all subcontractor and five firms are women or minority owned firms. the low number available to provide the services. we asked all three how they plan to mentor and support smaller firm to build

because the goal is to provide outcomes for the veteran and those health care providers know which instrumentsre the best to use. lastly, the veterans' electronic record modernization act, which we already talked about here, this is key to providing seamless care from the veterans, beginning of their service, to the end of their service. this is overdue. and it needs to be monitored. it needs to be assessed so that we as the committee in a bipartisan way can make it happen. in closing, i'm extremely proud of the bipartisan work and i'm looking forward to the 116th congress and i yield back. the speaker pro tempore: the gentleman yields back the balance of his time. the gentleman from tennessee reserves. the gentleman from california. mr. takano: mr. speaker, i'd like to yield two minutes to my good friend, the gentlewoman from maine, ms. pingree. the speaker pro tempore: the gentlelady from maine is recognized for two minutes. ms. pingree: thank you, mr. speaker. and thank you to my good friend from california for yielding the time. i rise in support of the veterans benefit and transition act

a lot of service providers come to them or their office. we have a strong belief in having workers go out into the field meaning children and families where it is most convenient for them in their community. fourth is using highly intensive clinical protocol so most of the children in the system or at risk to experience some sort of trauma in their life that leads to that involvement and it is critical that those that are working with children and families be trained clinically to be used into one - - evidence-based intervention to have kids and families. and then delivering accountability and those who pay for services accountability is what we take very seriously one way for our service models to achieve accountability is one staff to say this person is working on schools this one is working on housing this is on clinical support we have one person that is trained to address the range of issues they are facing into be responsible for the sex - - success of that family we believe that organizational structure drives lasting change with muc

crop insurance and providing certainty to farmers. i'm particularly glad to see industrial hemp descheduled from the controlled substances list. mr. comber: this is a key provision i worked on to ensure key restrictions are lifted from this valuable commodity. i thank chairman conaway for his work on legalizing industrial hemp and all my colleagues to supported this issue and helped bring it to the table. i was proud to represent the interests of kentucky farmers in this process and look forward to a new year of growth and prosperity for farmers and producers across rural america. i yield back. the speaker pro tempore: the gentleman reserves. the gentleman from minnesota is recognized. mr. peterson: i'm pleased to yield two minutes to the gentleman from california, another of our subcommittee ranking members, mr. cost tafment the speaker pro tempore: the recognized for two recognized minutes. mr. costa: i thank my good friend mr. peterson for yielding the time. i thank him for his work along with chairman conaway. i want to thank the

these are the types of things they've asked us to provide them so they can provide us with the security we task them to give to the american people. the disaster relief is something i think probably both sides should be able to agree on. we know there's a genuine disaster. we've had fires, we've got hurricane relief. i have a detailed summary here of all the various items that would be taken care of, be more than happy to provide that to my friend. that's something we should do before we go home. that's something frankly americans have a right to count on. i remember and i was with my friends in this endeavor, during the sandy debate. and how desperately we needed aid at that point in time. and how severely the action was when congress went home and then -- without getting that done and came back in january. and i think the reaction was appropriate. so this disaster relief is extraordinarily important and i hope that we focus on that in our debate as well. with that, mr. speaker, i would like to yield, if i may, three minutes to my good friend, the distinguished gentleman from alabama,

to being primarily an in-home services provider is because with we found out when we provide the services, that data is better because they are more likely stable at home with families two years after we worked with them than if we provided residential and then that was it and then got reunited with a family without any sort of additional support. we also work with third party research organizations. for instance mdrc that will look at not just the data of how children are faring but how they are doing compared to a comparison group so what the family first act requires in terms of prevention services is that services that receive federal reimbursement have proven they are effective compared to what else that child might get. and typically that requires a third party research organization to be collecting that data because we have the data on the kids we serve, we don't have the data on the kids we don't serve, the public agency has that data. so one other thing that i think is important to take away related to family first act in general is that the public system, the child protective sy

a, to provide that access but be to provide lower-cost sites of care. optimized primary care, this venture will be an extension of primary care and to providers, it's not a replacement. there are other models that we are looking through, this is an extension. and the one statistic i use here just to demonstrate this point, we know patients with diabetes see their position roughly 4-5 times a year. they will see their pharmacist and talk to their pharmacist 18- 24 times a year. so how do we leverage the information that is in the medical records that is in the patient record, to drive to maximizing the the point of engagement? when the consumer when the patient wants to engage. it's not the phone call at night at dinner time. it's not the letter, it's that race to face contact with the care provider that is available. that is fundamental to what we are talking about here. in a complex disease management is the last area of care. and fundamental if you look at 10,000 folks each day, we know what that means budget wise as we go forward in terms of the cost

that you provide. i appreciate that. my question is this -- i wanted to focus on the new york times article about what they referred to as the mobile location industry. i understand the way the data is collected, when you talked on your website about searching google and getting directions for maps, watching videos. you could be collecting the services to make it work better. i understand that. that is also collected to use in advertising and according to the new york times story, it's a hot market to target advertising reaching an estimated $21 billion this year. it talked about your company and facebook dominating the mobile ad market and also the location-based advertising. it says google also receives precise information from apps that use the ad services. can you explain that to me? is the new york times saying that if there is an a company that uses your ad services, and given the dominant places you play in advertising, that would be -- i imagine -- most. if any company is using your advertising

to nonprofits versus not providing a second chance to the others? >> it boils down to economic means. food pan tries -- pantry operating at losses an come for funding and they said not only do we want to be pushed back the effective date and that was the effective date for affordable housing and nonprofits goes back to july 1, 2021 and we'll spend the next two years working with them and the flower mart and put in place these practices in advance of the legislation. but even then if that were the case we would not be able to overcome that, we'll give them two audits and give them one more thing that says if these entities can prove financial hardship, then the director has a discretion so only for those with lack of financial means. the other entities we referred to which this talks about which is 95% to 96% of the remainder are large entities with the financial means to make this happen. in most cases they understand -- let me rephrase, in all cases they know their diversion rate and discount rate. they've been made aware and the incentive are buil

and that definition of communication providers is overbroad including anyone who provides electronic service in australia. so anybody doing business in australia or providing services is subject to government demand with those tproducts and services. >> what is it mean for the united states? it to be a part of the coordinating effort if you are not familiar with the term it is the intelligence alliance comprised of australia and new zealand united kingdom and united states dating back to world war ii since 2013 these five nations also form a ministerial with strategy and information sharing and those avwith strategies and policies to weaken encryption and the five countries to release a statement on principles and that statement that if they continue to have those encrypted communications they may have legislative mandates. and with that exposure draft. so now australia's law can provide the united states and other governments with the back door to the encryption backdoor. australia has the authority to compel providers t and then to build weaknesses into their products i have alread

or a evaluation to provide the benefits. what will be the impact on the caregiver? not all of them will produce the types of savings or improvements in experience in care -- they will vary and i want to end with the note that a third of the medicare population. opportunity to see what could work or be experimented beyond this population. that, i turn things over to catherine hayes. >> thank you very much and please join me in thanking our panel and thank you for attending. great job. thank you. >> in washington today, a labor department released the latest employment numbers. the unemployment rate for november related -- remained at 3.7% for the -- straight month. were in healths care. jobs slowed in construction and the service sector. >> sunday, on q&a -- people,ked with four future presidents, jimmy carter, bill clinton, barack obama, and to my surprise, donald j. trump. >> publisher of many best-selling nonfiction books -- >> i also came to understand about donald trump and this is profoundly important for how things wor

providers look for ways to compete why providing the tallest -- highest quality care at the lowest cost. we want to improve the lives of our beneficiaries. this has been a particular focus for me. the currentys technology is changing the face of health care. guided by what is best, innovations could help assure in a new world of health care embraced by patients and providers that identify new avenues of care delivery and that proves the value of care by increasing its quality, while lowering its cost. this is particularly vital for our disabled -- elderly and disabled populations. a patient managing a chronic disease can connect frequently spend lessteam and time going to their doctor's office. health challenges and questioning, these are areas beingch telehealth is used to deliver value to their patients. a rural healtht issue. we can all benefit from its innovations. we can now offer access to such services, whether they live in rural areas or not. i want to call out to be benefits of flexibility. this particular change is a game changer for the program. flexibility is increased for m

medicare under pace providers right now compared to the competitive marketplace. if you force the market basically allow the medicare for all buy-in access to those lower medicare rates, you will crowd out and cause a complete and utter disruption of the employer-sponsored health insurance system in the united states. 174 million american insured either in voyeurs and if you create an option to basically give socialist price fix for the low for compensation access to compensation for doctors and hospitals through that, there's simply no way private-sector insurance could compete against fat and it would be completely distracted with hospitals, doctors and long-term access to medicine with systems like we see in other places of the world where the better hospitals opt out and say i'm not part of thie system i won't take it and seniors don't have access so there is a bit of a stream it seems appealing until you get to the mechanics of why does one want to do it and it brings the whole system crashing down and not in a good disruptive way. >> i want to thank you for

think we should provide the best healthcare. we should require to have mental health issues and therapy. that should be part of your job. you should be paid to have this kind of self-care session so you can do the most important work. i really hope that as revenue comes in, i'm hopeful about prop c that we really think about how to invest that on the services on the data share and the workers. i know this going to come up in the next hearing which is how we can incentivize folks that to this work. it can't just be salary. other people things people want to see is flexibility and benefits as well. we have to really think hard about how to get good people into this work. supervisor safai thank you so much for calling this hearing. >> supervisor safai: lot of what supervisor mandelman and supervisor kim summarized today, i want to really appreciate and thank the budget legislative also office. this was not a normal audit. i knew what i was asking for it was going to be a significant amount of work. it took well over a year. i want