having the highest labor cost in the state of california. in addition, unfunded government mandate. the most strict staffing ratios in the nation, seismic compliance in california cost hospitals $110 billion in increased cost exclusive of financing costs. >> one of the things i think when i talk to professor malnic or ask a break down of the cost, perhaps it would be great to do work together to say what the cost are. i don't think he was claiming it was 100 competitive or lack of competition base. he said we can get that break down for you. whatever the line items are, let's work on that. >> happy to do that. >> data is data and we should focus on the reality so i look forward to that conversation. >> i will reach out and make sure that we do that. >> great. >> as we talk about costs, i would be doing a disservice if i failed to mention the chronic and acute funding of government programs. medical in california fails to cover $5.2 billion a year in the cost of care provided to this low income population. those are costs, real costs. medicar

moving to page 16 on the cost per month. the overall total cost per month per month have increased annually and decreased lightly since 20 11 for an average decrease of 2.25 percent. of that pharmacy is about $112. moving on to page 18. first what we want to do is pull out each of the portions of the pie for the early retiree. what you will notice the facility cost per month has increased by 8.9 percent since the last time i was here. however the portion of the pie that the inpatient facility represents has increased 5 percent going up now to 39 percent. again, we see that the inpatient cost continues to rise as the cost per day and over all the outpatient and professional cost have decreased leading to an over all decrease in the total premium or total cost. looking at the admits per thousand what you will see is they have decreased to 109 per thousand or 13.5 percent. if you remember the actives are at 414. and remember the higher age and the city plan is about 36.3 percent higher than blue shield and 37 percent higher than

what happened, and who should pay the cost of cleaning up the environment? what happened when the environmental protection agency ordered s angeles clean u, no matter what the cost? should we spend billio to mitigate climate change or wait and see what really haens? since the late 196 erhas been a consens among americans that the air we breathe and the water we drink should meet certain standards of cleanliness. but, like most things of value, those standards come with a price tag attached. pollution -- how much is a clean environment worth? economic analyst richard gill and i willxaminehat question on this edition of "economics usa." i'm david schoumacher. the united states has always been blessed with vast natural resources, including some things we used to take for granted, like fresh water and clean, healthy air. but not any longer. in the past few decades, we've learned that industrial activity carries with it a substantial environmental price tag. if we want fresher water and healthier air, somebody is going to have to pay for it, as we found in the ti

provide protection for communities within the fire area. manage costs effectively for the values at risk. >> for us - and for this film - this is the last fire of the season and we wanted to get as close to the frontline as we could. >> as we go along the sky is getting darker and darker and it feels like we're actually geting close to the heart of the fire. >> here, the forest hasn't burned in decades. the flames are moving quickly into the crowns of the trees. >> you can hear the sound of the helicopters flying over head doing water drops the sound of the sap popping, and the branches falling in the forest. this is really, very close to the heart of this fire. >> i appreciate if you guys get your shots real quick and lets get out of here because we're going to be in harms way if we don't. >> ok, well, we've been told we have to move out of here right now. these flames are incredibly high - this is one of the biggest fires that we've seen so far this season. we've never seen anything like this, there's a really loud roaring sound of these trees going u

in the middle blue bar, you can see the impact to the cost of someone who chose to go to the highest quality, most cost efficient providers around the country. we saw about a 20 to 30% reduction in costs. when you include travel, so we plaid for travel and a companion to travel. similar to what health purse is doing. again, about a 30 perts decrease in cost and from a quality perspective, no adverse side effects. potentially avoidable complications, there were none, by someone maybe not going to a facility in their hometown. where they had to travel for that knee replacement. we had people traveling around the country for those surgeries and had great feedback and experiences and as you can see, great quality and low cost for our members or associates and overall, i would say our associates are very pleased with the programs. one of the things we thought we would hear is a lot of pushback. you're just shifting the cost to me. instead, we're hearing thank you. thank you for letting me know there's such a big difference in cost in my community and if i know i can go some place else and

are you and me we're paying the cost of the cost of the cleanup from katrina we're paying the cost in the cause of over half of all counties in the united states declaring a weather emergency last year we are paying the costs tom why do you defend the oil companies and continue to want to stick it to the i don't actually the oil companies a lot of them would rather have this kind of a tax because then they can go ahead and pay and pass those costs on to the consumer tom big corporations run these regulatory agencies because the big corporations as soon as they are done working at those corporations they go and work for the government they write this write legislation so that it benefits the big corporations who are you calling to export oil energy business is absolutely not i'm standing up against global warming so how are you going to get over the costs of carbon it would have to be done through susan or a the cost of carbon the people who pollute other people's private property should have to pay for it but what they shouldn't have to do is be able to allow to get away with the poin

to give you an example of the variation in cost, in ohio, where a ct scan of the abdomen, the cost ranges from about $260, to about $2600 depending on where you go. so that education alone both to the provider entity associate our associate is critical. right now it's all telephonic-based comments are getting them to really have that conversation with her provider is difficult but we are making progress, as you can see in her numbers and getting people educated. early and 14 we will be implement in an online tool so that people can access, cost, and quality transparency, cost information online so they can start to make even better decisions. so what we actually saw with the unit cost, when the blue rose here, the 2012 results for the 10 states where we have had target pricing in 2012, and as you can see were actually able to reduce the unit cost through target pricing by redirecting people to a cost efficient provider. and by about 12% on both ct scans and mris. compared to all other states in 2012 where we didn't have target pricing implemented, costs actually increased for both ct scan

the cost drivers on the technical side, no surprise to you, personnel and operations and maintenance are relatively flat. they are now a small proportion of our budget but what is driving our need is capital. it's showing your 10-year financial plan and projections and you can see the portion of the budget of people is really shrinking and the portion investment in capital in the stewardship you charged us with grading the capital you can see here is coming online mainly in the form of cash funded as well as mortgage funded or debt capital improvement. that's the large department. in fact about 75 percent of the rate increase that is needed is to pay for capital investment. only about 20-25 percent is for general inflation for personnel cost and for operations and maintenance. the areas that we need your help is considerations in slide ten. the last time we did this was a 5-year rate package which was to get us through the we sip construction. we need more years to get us through. rate design as how you want average rates to look. we have already given some indication that we want no

well, this is what the experts say. rising costs, prices not rising utilization is the primary driver in the recent spending growth. hospitals and markets are able to charge higher prices to commercial insurers. providers growing market power to negotiate higher rates is the elephant in the room that is rarely mentioned. this is a broken marketplace and we're all responsible for that. all of us have to recognize it's a broken marketplace. the number one reason why we're paying more is because organizations are charging more because they can. the number two reason why we're paying more is that there's any -- there is a big amount of waste. access administrative cost and prices that are too high, fraud, missed opportunities. so the number two reason for paying more than anyone else and getting less health care is the waste and the way to solve this and the way to solve the first cause is transparency and accountability in health care. juft to drive this point home a little further, this is the cost for angie owe mras tea which is open

the cost in american college. the fifty thousand us dollars per year the median annual income for entire american family. you probably will have to contend many paying tax which university can be greatly appreciated. don't go away because of the cloak and the look of study abroad student teaching. welcome back to china price watch. in today's money matters were caught in the study abroad student of chinese cover for overseas students. whenever anyone think of overseas students with less than five years working experience about twenty six thousand us dollars. the new incumbent hundred and forty three thousand dollars it gave more than five years work experience. cover most overseas students still have work experience at all when they get back to china teaching the language difficulties and huge financial pressure. it's harder for them to look for job or brought home. a survey showed that the annual income at the first job for sticking stamps of overseas students with lauren and i got the eight hundred dollars to get

are you and me we're paying the cost of the cost of the cleanup from katrina we're paying the cost of the cause of over half of all counties in the united states declaring a weather emergency last year we are paying the costs tom why do you defend the oil companies and continue to want to stick it to the i don't actually the oil companies a lot of them would rather have this kind of a tax because then they can go ahead and pay and pass those costs on to the consumer tom big corporations run these regulatory agencies because the big corporations as soon as they are done working at those corporations they go and work for the government they write this write legislation so that it benefits the big corporations or you calling to export oil energy business is absolutely not i'm standing up against global warming so how are you going to get over the costs of carbon it would have to be done through susan or a the cost of carbon the people who pollute other people's private property should have to pay for it but what they shouldn't have to do is be able to allow to get away with going to play

people objected to the costs and on the other hand, the cost of the drugs went into the hundreds of millionollars that's a difficult problem and the city of san francisco has been paying for this drug if this drug didn't exist there's many people who wouldn't be alive. we need the money for the groups that do the research. many drugs fail that are successful. just two days ago our pharmaceuticals opened $14.04 the next day it was down. $11 declined in one day 66 percent. it's a pear cancer drugs. that's typical are what happens. i site overlooking another one there was a suddenly drop back in agriculture those repeatedly happen. i have to compensate our research companies otherwise they're not going to be in the field and costs lives. this is the position of the house and a senate 33 they have to encourage the companies in order to save lives. ms. kelly while this sound like a great change many people are reluctant to building they'll see a difference >> i really want to talk about would the opponent of this just said. i don't have the money to buy drugs myself. i also don't have the money

fund they mate not use the fund to pay for the costs until january 20, 0200. preparing will allow the bodies to make payments from the fund only as the cities account balances to fully funded it has to be large enough to pay for the costs as they're due and thus, the cities total payroll costs can't go over 10 percent. they must allow the payment and they're limited to no more than 10 percent of the cities account or the governor and the trust board passed it. they would allow only if the agrees fund account or two-thirds of the agencies funding board and the trust board productive. a yes vote means you want to change the charter from the health care trust funneled only under specified circumstances a no vote i don't want to make those changes. i'm here with supervisor marking feral and he proponent of preparing >> thanks. having me. i'd like to start with supervisor farrell why do you believe this prop a is important >> i started working on this when our city controller said we have a 4.4 blindfolds liability. number one we have retirees who worked long and a

. >> the cost of the poll versus the cost of the salaries for the employees might be far less. >> good point. >>> any other comments, commissioners. we won't be calling for a vote. but i will call for public comment on this item. any public comments? >> seeing none. item closed. no. 10. >> approve amendment no. cs 113 b. >> i will move the item. >> it's been moved and seconded. >> any public comment? seeing none, it's closed. commissioners, would you like for me to call for a vote or hear more on the item. >> a vote. >> all in favor say, "aye". >> aye. >> motion carries. >> it's been moved and seconded. any public comment on these items? this item is closed. >> are these trails that we passed years ago? >> no these are trails by san mateo county. >> division management and this was for easement. they manage the trail and pedestrian bicycle and people and dogs. >> any other questions, commissioners? i move the record show that it been moved and seconded. is that okay? >> all in favor say, "aye". >> aye. >> the motion carries. madam secretary. next item. 13. >> approve the terms and cond

so this looks at the cost per day in the hospital in california for 2011. and what medicare pays and what commercial payers pay and this is adjusted by cost of the living. medicare pays more. for whatever reason, cost per day is higher in san francisco under the medicare program. if you look at commercial payers, they pay much more in san francisco than los angeles. well, one the main reasons is los angeles is a much more competitive market. within 30 miles of usc, there's 70 different hospitals and there's not so much systems so the plans can negotiate to keep prices down. they can pick this hospital and that hospital. they're not forced to take and some markets they are , and that's why prices have gone up. at the bottom you can see this kind of summary measure is in san francisco, commercial plans pay 240 percent of medicare and in los angeles it's close to 200 percent. and that points to the differences in regional competitive structure. can what be done? policies to provide a market. some of these were talked about your earlier speaker. we need to go th

the cost is not in the material. the cost is not in the paint. the cost is not in the hardware. the cost is in the time, the prep, the installation and all that work. so, i always say, buy the best equipment, buy the best paint can. the paint is cheap compared with the cost of the painting job. don't you think? >> don't buy the cheap caulking, bite expensive one. >> another common problem which homeowners can deal with, this is a little flour bed that goes right up to the -- flower bed that goes right up to the siding of the building. as they water it, unless there is a very clear water protective membrane between that little flower box and the siding, every time they watt tier they're going to water the inside of their wall. the building code specifically requires that, to have a water protective membrane or be physically separated from the building. >> could you explain again how you would probably flash the -- [inaudible] with the stucco wall? >> if you're rebuilding the stair, if you're starting from scratch and going to put the stairs in, you want to put the stairs in first

it's the cost. it's almost back to bill clinton, the economy is stupid. it's the cost. we hear you. our whole company hears you. our new ceo made public statements that health -- health care insurance is unaffordable. and we have physicians that are doing things everyday to drive down the cost of health insurance and health care while improving quality. we're also encouraged that there's a number of studies out there and you know them already. there's accounting and consulting firm that says kaiser is the most sufficient health care in california. that's not good enough. it doesn't mean we're affordable but it says we're more efficient than the others. we're deeply committed and i was with lisa today for over an hour, so i want to reemphasize that we're committed to the city and county and your employees and your union to give you the best value for your health care dollar and we intend to lead the way to make things better regarding both the cost and the transparency. so it's a little strange. we talked about transparency. i go throughout the state and talk to customers and transpa

people objected to the costs and on the other hand, the cost of the drugs went into the hundreds of milliont problem and the city of san francisco has been paying for this drug if this drug didn't exist there's many people who wouldn't be alive. we need the money for the groups that do the research. many drugs fail that are successful. just two days ago our pharmaceuticals opened $14.04 the next day it was down. $11 declined in one day 66 percent. it's a pear cancer drugs. that's typical are what happens. i site overlooking another one there was a suddenly drop back in agriculture those

the rising cost of the retail market have also been significant. many chinese shopping mall have increased the rent. some clothing companies involved have been higher than the opinion year's turnover to maintain revenue the table level shopping mall to bring the turnover of every clothing store the look with the chorus he picked out a shopping mall it became the position from us. therefore to keep the doors open. the price you could need to go up. some even double or triple their closing price. i kinda finance report. if they keep their prices down to make smaller profit will have trouble competing with foreign companies. they choose increase prices the chinese consumers would rather buy corn bran. to much with too broad. chinese people might get to see chinese made products with low quality and cheaper. if their prices begin to increase. the were rabbit ears i care for brett. when goods are more valued in china than domestic product the comics have better pricing power. therefore for brent came to their image in the country that cares for my dad.

or at the reasonable cost that it should be. but we have begun the conversation to engage with them. thank you. >> thank you. >> and next speaker. >> hi, supervisors, thank you. my name is crystal and i work for meals on wheels. i have the tough job of doing the intake and eligibility for meals on wheels and i just wanted to share, a quick story. and an example of one client. i took a phone call about two months ago of a client who first of all one question that we always ask is how are you now providing for yourself? how are you getting your food now? and when i asked this question, one lady answered that in the days before she called, she had gotten herself to the grocery store on muni how she gets everywhere, and after doing light shopping, was not able to carry, the two small bags of groceries on to the bus and so we literally and in order to get herself home. so, she saw meals on wheels bus on the bus and gave us a call. and that is one of the hundreds of phone calls that i have had in the last year and a half that i have be

that's where the costs will go up. democrats like to brag that the growth health care spending has slowed. to the lowest level in half a century. but we're still, nevertheless -- it's something that started happening ten years ago. you're seeing a record cost for health care. almost $3 trillion this year. that, again, the increases will continue to skyrocket. in part because of this law. >> by the way, that was a very good way to put it. that was more the weak economy than anything else. >> right. >> we can argue the particulars. one of the things i noticed here is companies are setting us up for the next wallop. >> right. could you imagine if president obama ran on the truth of this stuff? just say he tried to sell it? listen, you're going to get thrown off your plan. you're going to pay more, you know, it's going to be, you know, this is -- >> we're going to subsidize 400% -- >> i mean, this is a big lie and it's coming apart. i tell you, part of me says just let it roll and let the worse happen. the other part of me

the cost, it's not just the deficit, direct taxpayer money. it's just obama care's lying like a lead blanket over innovation, as well as doctors -- >> i've been for tort reform for a long time. trial lawyers put a lot of money into the campaign -- >> the highest medical costs in the united states of america -- >> that one i don't understand. >> actually, you would like this. insurance companies aren't really paying. people think that's a big myth that you sue a doctor and insurance companies just pony up the money. they don't. tort reform is actually not the answer. next, how to raise your children right. right as in conservative. or else they could turn out to be punk kids like these kids. >> coming up on "the five." >>> welcome back to "the five." being a parent is not easy. i've got a son at home. we're trying to raise him to be a good citizen. who cares about the country. unlike these punks who harassed general petraeus a couple weeks ago. >> you have blood all over you. i can smell you. >> you scumbag. >> what do you have to say? huh? eve

of ownership when comparing this to the cost of the lease. we're under a projected cost per skeet. we can remain flexible and enjoy a slightly lower tenant risk. every one of those is case by case property. happy to have that discussion. the budget analyst has an ice toward termination or other opportunities and the desire is part of the capital plan in about a year. my team b will work closely that the staff and we look forward to this discussion. there's a recommendation to clarify the lease term. i'm happy to answer any questions >> colleagues, any questions. >> i know from the being the r budget analyst report it's almost doubling the cost of the leasing and are we going to see that happen to other private property leased areas. >> a question about what the future looks like. the good news is we have purposefully worked on extending a number of leases over the last couple of years were we do a 5 year forecast and into 2015 and 16 we have fewer renewals or xieksz. i'm pleased we're not going to keep the market apace for the next 24 months w

the first one looked at cost drivers for cal pers. it turned out that osteoarthritis is one of the drivers and about a third of those costs come from hip or knee replacements. in addition, a deeper dive showed that from 2005, to 2008, there was a 40% increase in that cost for hip or knee replacements. one of the other studies we looked at, included looking at regional variations in cost. but we also saw not only those regional cost variation, but a lot of variation within region. i'll have some charts to show you that kind of variation towards the end. in addition, you know, we -- as andrea alluded to, a lot of the literature in the from house study suggested that the hospital cost had little to do with the quality of hip or knee wre placements. so as you go through the four requirements for revs based pricing you have variation of costs, cost driver that volume might increase quality and then the last one is that the procedures could be scheduled. so in january 1st, 2011, cal pers and blue cross implemented the reference price program

we are finally bending the cost cutters here. and we have seen this year costs for health care going up by the least amount in 50 years. i know as a small business owner, i get my plan dropped all the time. three times out of the last five years when i have go to re-up my plan, it's not been available. i've had to change it and unfortunately to a plan with lower benefits and higher premiums. this is finally going to change this. >> john, is it going to make it better as bernard says? >> no. it's not going to make it better. this fallacy -- and it is another fallacy. have you to understand these guys have spun this magnificent tale. we have been sold a bill of goods. they talk about premiums coming down. they started coming down in '09, before obama care ever kicked in. it has to do with the recession. studies have shown that over 80% of it has to do with the recession, not with anything to do with obama care. but yet they tout these numbers, as politicians do. they have said that no one will have to lose their policy. that's not t