cheng believes that the most important thing in treating a terminally ill patient is the trust with the patient's and their families. [ speaking foreign language ] [ speaking foreign language ] >> the next day, the patient pass away without suffering. [ speaking foreign language ] >> cheng's continuing work gradually became famous through various media reports. this, in turn, helped raise awareness and understanding of palliative treatment. [ speaking foreign language ] [ speaking foreign language ] >> in 2012, shanghai became the first chinese city to implement a policy spreading terminal care among medical institutions within the city. currently, terminal care is provided at 76 medical facilitiesny shanghai, the highest number in all of china. this hospital is one of them. this facility accepts patients suffering not only from cancer, but also from strokes or dementia. under 24-hour care, many patients have chose tone spend their last moments here. every saturday young members of an ngo come visit the hospital. they call themselves hand in hand. their members volunteer at six end of l

and the medical services that are provided. it is patient-clinical care delivery highway of remote services. it can be critical, emergency care, and it can include technical and diagnoses remotely and often for critical conditions. between the doctor and the position and the patient or a consulting team. telemedicine provides access long-distance and remotely to expertise and experts with experience in specialists that would not be available in remote areas of the world or to remote provinces. the american telemedicine association likes to give an example of telemedicine, and that is the medical peer that was provided in the monitoring of the astronauts in the early graham, and that continues today. militaryed in remote deployments to keep the troops say. it provides three areas of patient care, focused on instrumented, interconnected, and intelligence solutions. medical data and transmission and access -- radiology, imaging -- and this gives us insight that is needed to drive the information for the patient from the details of the data. als

technology and how it can better manage the patients on medicare. members of the finance committee are working on lek leg slaits slags aimed at improving care for chronic sufferers in the is an hour and 45 minutes. >>> the meeting will come to order. ietd like to welcome everybodier everyone to this morning's hearing on bipartisan medicare policies to improve care for patients with chronic conditions. it was almost exactly two years ago today we reformed a bipartisan working group cochaired by senators isakson and waern to work on legislation to address these issues. that work group spent many months listening to stakeholders in the healthcare community both in person and through more than 850 formally submitted comments. in december of 2015, the working group released a comprehensive document. in october of last year we issued a legislative discussion draft. soon after that we finalized four of our policy proposals in its 2017 medicare physician fee schedule rule, and twon provisions from our discussion draft where included in the 21st century cures

the patient has reason to be proud. e pediatric ward. the new nurse may be assigned to almost any ward depending on the immediate need of the hospital . although she may be assigned here and may become something of a specialist in working with children, she is required to be first and foremost an expert bedside nurse, capable of providing efficient basic care for all types of patients, old or young. ♪ narrator: over at the nursery for the newcomer, and incubated baby doing very nicely. also doing nicely is an army father maintaining a steady vigil, grateful that this woman, one, although tiny, was all there, perfect in every detail. human life and the struggle to maintain health, this is the great drama of a hospital. to be part of this drama is exciting and rewarding. ♪ narrator: the skill with which simple bedside care is performed, this can be as much a matter of pride as that specialized experience. from her first days as a nurse, the army urges her to learn and practice the bedside skills which are the true sign of

routines such as taking the patients' blood pressure. a major responsibility in the life of an army nurse, especially overseas, where knowledge of modern methods of medical care is at a premium. an interpreter, one instructs a two group of korean nurses in some of the techniques and procedures used in our hospitals. the newly arrived nurse takes a few days to get adjusted to being on her feet all day. so in her off-duty hours, she is often off her feet. but those who are pretty well accustomed to the hard physical routine are ready and looking for active recreation when the work day is over. we nurses enjoy physical exercise and take pride in keeping fit and alert. we must take care of sick people. and so we ourselves try to maintain our resistance against illness through regular exercise. a lot of being overseas is fun. fun in sightseeing and exploring. each country has its wonders. and since our troops are now scattered just about everywhere, an army nurse has a chance to see a good bit of the world. in seoul, korea at the chain duck p

, but unfortunately aye mong medicare patients the national average tpa treatment rate is only about 2.5%. there's several reasons why tpa rates have remained low, including a shortage of stroke experts, as well as patients arriving at the hospital too late. the good news, however, is that telestroke has been proven to increase the percentage of stroke patients who get tpa and get it faster. one recent study of four urban hospitals in illinois with low treatment rates found that their use of tpa increased two to six fold after telestroke was implemented. rapid and accurate diagnosis of stroke is a critical first step to ensure that patients get the best care. even in urban settings they may experience delays in streemt. when a patient presents as a hospital that does not have a stroke expert, they can use the telestroke to get instant access to stroke expertise. despite the proven benefits, medicare's coverage of it is outdated. the current policy restricts coverage for telehealth services only to originating sites in very rural areas

one is when the patient comes into the emergency room with a stroke, so many times they're an older patient, 65%, 70% of all of the strokes that we see are in medicare beneficiaries, on multiple medications, haven't been taking their medicines, didn't have the money or didn't understand the prescription or something got changed, they didn't make it to their last doctor's visit. so often we see a failure of prevention. 25% of strokes happen to people who have already had a stroke. the issue is not knowledge and the issue is not a desire to improve their health. the real issue is the challenges of navigating this incredibly complex system. and i think from the perspective of then what it's like to be someone in this community, the average length of stay in the hospital now after a stroke in the united states is four days. so in four days you come into the hospital, you have a new disability, you can't speak well or you can't move your arm or you can't walk. you get given 100 pieces of paper. 55 things get explained to you. you're discharged from the hospital and unfortunately for most of our

and then the nurse for the patient ratio? so heidi and manage those benchmarks we are collaborating with the bedside team we're not replacing bad soviet additive in the responsibility of those ratios that are typically a bedside ratios and then complementary to the bedside staffing that they choose to employ a. >> [inaudible] >> if you could not hear have you seen any characteristics for bread telemedicine providers? so what we have come to understand a doctor to make the technology go way. we can trade the doctor and what it takes to train a patient in person but most of those differences are very treatable but if we start with the sea negative student that is a much easier challenge that translates well into telemedicine space that is a good start with the employment ratio and also our physicians have two alternates from time to time from being the al flood end a situation or a consultant. and from your point in question battling to hire good doctors also those who understand to toggle between those two was very different ro

especially in most importantly, the patient. drotherapy, a whirlpool bath, to give passive exercise to muscles of the leg. many of the experts who wear the white uniform of a nurse are actually members of the women's medical specialist corps, a branch of the army medical service. these women are experts in the fields of dietetics, and physical and occupational therapy. they are in relatively new professions, which the army has recognized as an important part of medical practice. since the army assumes the responsibility of providing medical care for the servicemen's family, those children are fortunate you are cared for in the tokyo hospital. for here, the pediatric surface is the finest. those nurses who were assigned to it find their task of continuous interest and pleasure. there are moments, however, when the patient sees no pleasure in anything. traditionally, it is been a woman's role to tend the sick. but it is her natural and instinctive role to care for the young. with young children, the army nurses very much at home. i

when it was just the position in his or her office, what does this mean for patients. when the business people start coming in sometimes it is as direct as consultants being hired by hospitals and the consultants come in a. they are not medical people. they don't know what is the best treatment for your liver failure or pneumonia they just think hell do we make it more efficient and the answer they come up with over and over we give kind of the easy answer you just do the exact same thing you've been doing all along that you can charge a lot more because it feels like no one is paying so it was $200 maybe $2,000 then you see these administrators coming. when you and i were in hospitals, many were former chief physicians. they were medical people. they didn't have much business training. they could have used a little dose of efficiency. the business people became primary and the medicine became secondary and what you see at that point this is where it moves to the physicians question, and understandably so they think they almost sound marxist. here's all this work. i'm l

throughout the course of the of the 100 zero patients were admitted to the hospital. think about that. no emergency room visits for any of these previously chronically ill patients. this is an excellent care that can improve patients' lives. in fact, telehealth can save money also. the mississippi department of medicaid found that if this remote monitoring program were extended to just 20% of mississippi's diabetic medicaid population, the state would save $189 million per year. medicaid, like medicaid programs in virtually every state, is expanding access to an coverage for telehealth and remote patient monitoring. however, medicare is behind the curve, limiting access for millions of seniors. imagine the incredible act this technology could have if medicare would allow its most vulnerable beneficiaries to use something like remote patient monitoring. i'm confident that the success we have seen in mississippi can be replicated for patients across the united states upon enactment of the chronic care act and, ultimately, enactment of connect for health. we are still loo

. >> ramon, patients who go to the loudoun free clinic are uninsured patients or patients who are caught in the cracks there? >> both of them. so, there are patients who are 18 to 64 who are 200% or below federal poverty rates. so, we're able to provide primary care, mental health, as well as medications, imaging and also laboratory results for those patients at little to no charge. >> is your clinic full these days? >> it is, and, so, we've had to find a way to provide more walk-in visits now because the patients that we have that are existing patients who take up a lot of the appointment times, and so we've shifted around some of our staff. we're adding some new providers, both volunteer and staff and so we're able to take care of that volume today. before we'd have wait lists for hundreds of patients that were there, now we're just back to about a thousand patients roughly. and, so, we're opening more slots, though, for walk-in because of demand. >> does anybody get turned away? >> we don't turn folks away unless they don't fit into the 200% of federal poverty or over 64 years of age.

is too often the finances are on the front burner and the patient evidence is on the back burner that is the shift of a bike to see. >> he is said about this book to organize this in a thoughtful way starting by talking about describing the problem that is taking a history and then you go on to offer therapy nsa organize the patients with their problems. so maybe you could start by describing what is the american sickness?. >> said the chief complaint is the high prices and it is unaffordable health care. i don't think anybody would disagree with and that. >> how did we get to those high prices?. >> this is where the history has to figure itself out of what i realized that this is a classic case the road to hell paved with good intentions. to see a new idea but then somehow is perverted how do we make money from this? people say the middle of the last century a lot of people got health-insurance that is not to say it is it that they we need that because health care was getting more expensive and historical reasons but a lot of people were on employer based or medicare. and those who w

it seems the real damage is not so much patient data but the fa ct not so much patient data but the facta precaution, turn off their it systems to prevent the infection spreading. so they are resorting to pen and paper, asking patients not to turn up to accident and emergency wards. so the knock—on effects seem to be serious. you said there will be some pretty frantic people trying to get to grips with this, what will be the priority for the computer experts who have been drafted to ta ke experts who have been drafted to take a look at what is happening? priority number one will be to stop the malware spreading, which is why organisations have turned their computer systems. number two, will be to try to remove the malware. there are anti—virus companies that can actually obtain the encrypted signatures for this malware, well—known antivirus companies that offer a service to do that. so they will be bringing in the experts to try and remove this malicious softwa re try and remove this malicious software from their computer systems. some organisations might actually be tempted to pay the r

centered, evidence-based and life-sustaining and empowering the patient to be a partner in their care, not a passive recipient of care. it also needs to be accessible to those who need it. for patient centered care, it begins with shared decision-making. the patient is the expert on his or her life and hopefully, clinicians are experts on the entire menu of treatment options and we provide that information in a way that's easy to understand. my colleagues in the va and our academic detailing service created some education materials that make it easy to convey the rationale for our medication treatment. opioid therapy is a particular kind that includes both. [inaudible] it has been shown through science to reduce hiv risk behavior, clinical behavior and opioid use. as she also showed earlier, there are two kinds, methadone is a. [inaudible] they have a unique method of action that makes it safer to prescribe in any settling methadone because it has properties and is only available to special certified opioid treatment programs. there is a full antagonist.

we can talk about the ages of the patients. n't know who they were. we couldn't identify them. it was remarkably hard, somehow more so than doing the medicine, not having a clue of the name of the person you're looking after and not knowing where their parents were being able to share with them what was going on. inaudible question. a number of bars before we could identify everybody. inaudible question. i would have to say that what has come through our daughter is not something exceptional in terms of things we might have seen as one or two patients presenting after a car accident or something like that, it was the volume that was extraordinary. certainly the separation from family was really ha rd separation from family was really hard i think for everyone on every level, the families and the staff. what do you do if you don't know who the patients are? treat them. that is easy. the human thing is you can'tjust say, is easy. the human thing is you can't just say, peter, is easy. the human thing is you can'tjust say, peter, i

history is too often the finances are on the front burner and the patient centered and evidence are on the become burner and that is the shift i would like to see. >> host: sure. so, you said about this book, organizing it in a doctorally way. you started talking about describing the problem and what we call taking a history of the present element and office and diagnose and then offer therapy and those are the way doctors go about organizing their interaction with patients and their problems. i would like to take a viewer through those three segments if you will. maybe you could start by describing the problem. what is the american sickness that presents itself to you? >> i was an er doctor so the chief complaint is high prices. it is high unfordable prices and unfordable health care. i don't think anyone, republican, democrat, libertarian, independent, would disagree with that. >> host: how did we get to those high prices? what is the diagnose, if you will? >> guest: this is where the history of present illness has to fool itself out. i think what i reali

we have just got a statement in from the patients' association. 's attack may be the biggest, but it isn't the first and probably won't be the last, and really saying that we should look now for more spending on the cost to defend the national health service in terms of it technology, to defend against cyber attacks like this and the patients' association is saying now is not the time to be squeamish about the cost of keeping our nhs secure. would you agree with those sentiments, that it does maybe require some more spending on it defence in the nhs? yes, sir. i have a lot of it background, i use a lot of computers despite being a doctor —— beside being a doctor and i can tell you the it system here is brilliant, the people working behind it are very intelligent. the problem is, we need more sophisticated systems, more secure. to be honest, i don't want to get into a proper conversation and have people get upset with me if i recommend different systems for our nhs system, but i think maybe abroad they are more secure. the a nswer to abroad they are

the program. imagine a system that works better for patients. medicaid deals with disabled, elderly, healthy moms and kids. and yet the federal government has said to the states up to this point you have to treat every sink gel one of those individuals exactly the same. that doesn't make sense to anybody. so what we're fashioning is a system that would allow the states to tailor that medicaid program to those specific individuals saving money but also a higher level of care than they currently do. sounds like it makes a lot of sense. >> my dad is a pediatrician and he takes medicaid dollars. and one of the reasons why so many of his colleagues do not is because the medicaid reimbursement level for doctors is so little. as opposed to for medicare which is for seniors. which why will cutting $880 billion over ten years from the program encourage doctors to keep taking it? it sounds to me that it will actually discourage doctors, less money, lower reimbursement rates. >> remember what the 8d $80 billion is off of, it's off a baseline which is what t

guards-- the promise myself, but every single patient talk today, so i eliminated the difficult patients and my data however informal would be flawed. i guarded myself for battle and asked how can i help you today and turn on the stopwatch. every single thing hurts she says from my toes to my head with shooting paid-- pain and her scott, her scalp was sensitive, neck pain down her spine. her mother had insomnia and was up all hours of the night. each time she paused i said anything else in there always was. she said i'm only 45 and i feel like i'm 85. my head feels like it's swollen. it's like i'm walking through manas-- molasses. i scribbled notes on paper as she talked and maintained eye contact. list everything on the table, every last symptom and we will figure out where to go from there. i let her keep talking until she fully had come to the end of all she had to say and in the silence i reached over to click off the stopwatch and estimated eight minutes, 10 minutes transpired, but in fact it was four minutes and seven seconds. i suppressed the urge to jump up and say wow instead i

it should be life sustaining and empowering the patient to be a partner in their care. and it also needs to be accessible to those who need i had. >> so for patients centered care, it begins with shared decision making. the patient is the expert on his or her life. hopefully we clinicians are experts on the entire menu of treatment options and we provide that information in a way that's easy to understand. and my colleagues in the va and our academic detailing service have created some education materials that make it easy to convey the rational for medical assisted treatment. opioid therapy is a particular kind that includes both bupronorphrine and it reduces hiv risky behave yoshgs criminal behavior, cravings and withdrawal and importantly opioid use. and as they also showed, there are two kinds, methadone is a full ago onnist and then bupronorphine makes it safer to prescribe in any setting. methadone becausest full agonist is only limitedly available. so i'm able to provide this information. buprenorphine is more readily available. you don't have to pick it up every

peoplesnocent -- incets to take your basic rehab patient and avoiding the more economy patients. the religious he we made would be on patient need and bring great balance and improve the value for the beneficiary, a greater balance in how that payment works. you mentioned quickly the not-for-profit and for-profit. that isn't it-b making the payment system peculiar to for-profit and not-for-profit that just happens because the way the payments shift based on the patients that those two different types of providers pay. the other two quick comments on value, and i'll get out of your way, we do talk about the notion of tying patients -- payments to different outcomes. avoiding returning to the hospital. avoiding going to the emergency room. and then we have other conversations about re-organizing the entire payment system, having a unified payment system, but also ultimately moving towards more episode of care in which inside the clinicians would have the flexibility to engage in practices and delivery practices that they would hopefully bring lower costs and higher quality. we have

history is that too often the finances are on the front burner and the patients center and evidence base is on the back burner average that's the shift i'd like to say. >> host: you organized this book in a very doctorly way and started by talking about the problem, describing the problem, what we in medicine call taking a history, the history of the present illness and then went on to offer some diagnoses and then went on to offer therapies and those are the way doctors organize their interaction with patients and their problems. i'd like to take our viewers through the three segments. and maybe you can start by describing the problem. what is the american sickness that is presenting itself to you. >> guest: i think i was a new york doctor so the chief complaint, as we said, was it's high prices. it's high prices and unaffordable health care. don't think anybody, republican, democrat, independent, libertarian, would disif a free with that. -- disagree with that. >> host: how did we get to these high prices? what's the diagnosis? >> guest: well, this is where the

patient. the recommendations we've made would be based on patient need and bring a greater balance, we think, and improve the value for the beneficiary, a greater balance in how that payment works. and you mentioned quickly the not for profit and for profit. that isn't about making it superior to for preseofit, or n for profit, that just exists because of the way those providers take payments. we do talk about the notion of tying payments to different outcomes, avoiding returning to the hospital, avoiding going to the emergency room, and then we have other conversations about re-organizing the entire payment system, having a unified payment system, but also ultimately moving towards more episode of care in which inside the clinicians would have the flexibility to engage in practices and delivery practices that they would hopefully bring lower costs and higher quality. so we have a few threads in this area. >> just to follow-up on that, reform payment system proposed by the american health care ass

as long as the underlying patient payment to patient need is not lost in the process of doing that, it is consistent with the direction we have been talking about going. >> we appreciate your being here. medpac over the years has helped deconstruct the hopelessly complex system congress routinely makes more complex and helping us dive into the details that otherwise we wouldn't have. we can explore some of this but otherwise we wouldn't. i'm hopeful that once we can move past the current controversies we can do a better job diving into what some of these elements are to understand them better, look for areas of being able to rebalance the complexities, coach more value and incense more appropriate behaviors. and obamacare, we still pay twice as much as anybody else in the world and too many americans get mediocre to poor care. people in canada and france and great britain and japan live longer than we do, we get well faster, don't get sick as often and they pay far less. you are helping us understand some of the elements that are part of that, how we can use some of these large healthc

but getting them out to the patients that need them is the next challenge. they are also exciting and even better medications that i talked to us about. education, right now, physicians have to take an eight hour training course. nurse practitioners and physician's assistants have to take 24 hours of training. what about having that 24 hours of training in that basic .urriculum we will learn from those and apply the lessons learned to continuously improve our process. opioid use disorder is preventable. it is treatable. effective treatment is patient centered and evidence-based. and we do need more help for newer and better treatment as well as how to implement the ones we have. thank you. [applause] deborah: dan and nora, would you come up? we will take questions from the audience. but you need to line up. there are microphones in the two isles. -- two aisles. when i call on you, give your name, affiliation, status. question.o ask a let me start with karen. is there a difference between the veteran population and the non-veteran population? men and women of

payment system would be made so that we pay more on the basis of patient need, and that will result in greater equity across different types of providers. we believe that if the congress were to follow this recommendation, something like $30 billion in the next ten years could be avoided. the commission has recommended moving away from the silo and towards a unified payment system for post acute care providers, and on the basis of patient need, rather than site of care. and also it would increase the potential to measure quality of care more accurately. part c and d, managed care and medicare has continued to show strong growth, currently accounting for 31% of enrollment, multiple plans available in every town of the u.s. they're bidding below fee for service which is a significant improvement since 2010. the dollar value of extra benefits that they provide has been increasing and the commission has made a few recommendations in this area. most notably to recapture payments from excess coding that targets plans that are most aggressively engaged in that co

patient operation. we have ideas that we have been talking through where you could restructure the in patient subsidies and support freestanding emergency rooms in isolated rural areas. it's not that free standing emergency rooms have no role anywhere, we have concerns about their growth in certain areas of the country, and then we think we'll probably not got quite the right incentives out in the rural areas. chairman tiberi: one follow-up. if you have the diane black main hospital, the main hospital with the main emergency department and then 10 miles away you have the freestanding black fire -- excuse me, emergency department. oes medicare get data on the visits to that 10 mile away facility? 9 maint art of hospital? mr. miller: it's all mashed together. chairman tiberi: you can't discern if i go to the freestanding one or the main one? mr. miller: we cannot. and we're concerned about that. that was the recommendation we made here in this report to say that c.m.s. should begin to develop a modifier so that when the claim flows come in we know it's occurring on or off tamm cam pus. chairman tiberi: th

macarthur's order made no pension-- mention of the navy patients, only the army patients barton and his fellow navy patients were left behind and i was later captured stray from their hospital caught. lead on new year's eve, 1941 or could they were captured along with a small naval medical staff that had accompanied them and cared for them. by all accounts the patients in japanese were equally surprised. these were the only americans left in manila. all others had evacuated the capital and taken up defensive petition-- positions elsewhere. so surprised where the japanese at the patients and medical staff were suspected to be spies left behind intentionally together intelligence. they were interrogated by the japanese brutal secret police. veni, the oldest of the three brothers was the anti- aircraft and gunnery officer on the uss enterprise, one of the few ships unscathed by the sneak attack on their home port, pearl harbor. enterprise and her crew returned to the dark and harbor the night of december 8, 1941, lit only by flaming oil slick waters. with few operational ships, not to ment

it's really worrying for us and for the patients. it's friday evening now. sorted out over the weekend so that come monday morning, you can try to get back to normal. we've got contingency in place for monday morning so that if the system is not up and running, then we will be able to do something about that, so if people are phoning us about that, so if people are phoning us to ask for appointments, they will be able to come and sit in the surgery and it will be first—come, first—served. the it service locally is very much an issue and they are going to be sending somebody out over the weekend to try to get our system over the weekend to try to get our syste m u p over the weekend to try to get our system up and running. what we don't know is how many other practices might become involved. we know there are at least three others in dundee and another one in perth, but whether there are more now, we don't know. we don't know what will happen with the out of hours service, either, as we don't know if they are affected. you have pre-empted me there, because i

local health officials say the patient visited d.c. and prince george's county and even used public transportation. anna-lysa gayle is live at prince georges hospital center with the latest developments. what have you found out tonight? anna-lysa: kimberly, health officials are asking people to check their immunization records if they believe they had a director with this person who was infected. doctors at children's hospital and doing well. >> concerned, that's for sure. diagnosed a patient with measles visited several locations in the area between may 8 and may 15. they are releasing details about the activities before him. >> the patient was admitted to children's hospital on the 13th and almost immediately put into isolation for concern of measles. prior to the visit to children's national medical center, the person also visited the following locations. may 8, the department of social services building in hyattsville. and then the social security building insulin. may 9 through the 13th, he or she visited the prince george's center

but i think the focus is how you support what patients and consumers really want. and both of these populations have some very similar needs and supports. the zakt community has been very much a part of the conversations about certainly the kind of support system needed. >> got time for one more. yes. yes, sir. >> don taylor from -- sorry, don taylor from duke university. i was worrieding if you could reflect on the class provisions. how do we get back to that kind of conversation? >> another one of our favorites. so the class act was an initiative, really, that senator edward kennedy had worked on for years. and it was a notion that individuals should be able to set aside funding out of a paycheck or out of their own support system and then pay for a variety of services needed in the home. and it was particularly driven by, i would say, the disability community recognizing that often their choices are very restricted based on what they can pay for and support. i think it's fair to say that teddy kennedy helped to write it as a new entitlement. he believed strongly

generating an immediate outcry from the patient community. that's when ptc therapeutics stepped in paying $140 million to marathon to acquire it. >> ptc at that point came in, acquired the asset, and had sort of, for lack of a better word, resunk the approach to the drug. >> the new price tag is still drawing criticism. >> it's the drug business back in trouble again over pricing. they don't seem to learn their lesson. >> insurers may pose barriers. many will require patients to try a cheaper steroid first before they'll pay for this drug. many patients argue it has a better safety profile. so this is a headache christine mcsherry says the community doesn't need. >> the worry is with the patients and families. we have to write the appeals and appeal to our payers to get the drug covered. >> in a changing environment for health care in the u.s., they worry about paying for something else. for "nightly business report," i'm meg turel. >> shares of ptc therapeutics had a rough day. they fell nearly 12%. >>> the price of prescription drugs is one

that gives the patient the power. >> all right. it always seems to me -- i haven't looked at a hospital bill in quite sometime, but a tylenol, $10 for a tylenol. there is some extraordinary amount when i can buy a whole bottle for $2. are we really talking about price transparency. are you speaking to that issue as well? >> for example, there is a friend of mine, his wife, she's a physician, went to get a mammogram. she wanted to pay cash, they talked her out of it. they talked her out of it. she later learned if she paid cash her mammogram would have cost her $90. but because they billed the insurance company, the insurance company was charged $500 and her d deductible was $100. if she paid cash she would have made out better both sides of the equation. she did not know the price. i can give example after example where you go one place and pay 1/10 the cost of something else. patients do not know that now. they need to know that. >> that assumes that you have some money. there are a lot of people in this country who don't have mon

what about the issue of patient confidence in the nhs?u're not sure whether they can get treated at the turn up at a hospital. we do not believe that any patient records have been pondered oi’ patient records have been pondered or accessed. as you have said, this isa or accessed. as you have said, this is a random attack across the world. i think what this is, is data being held hostage for financial gain, i think what this is, is data being held hostage forfinancial gain, not that patient details are being shared with somebody they shouldn't be. there are many trust which don't appear to have been affected, but what are they going to do as a precaution to make sure that they don't get sucked into it? there is a bit of a ripple effect coming through the country. the trusts not affected a re through the country. the trusts not affected are shutting down their systems as a precaution. they are in effect being affected by the virus even though they have not been attacked by the brand somewhere themselves. it is rippling through themselves. i

|j was the spirits of patients and staff?” ed in the queen's visit, i was in a conference call, but i am sure a visit like that lifts people, it makes them feel valued, appreciated, and it is a good experience for staff to having these challenging situations. the queen also meant patients and their families as well. in your career can you recall situations with so many children and young people in such a condition? i am a surgeon by background and then the 90s you may recall we had quite a lot of gunshot wounds and knife injuries through that decade. i have seen injuries not entirely like this but similar. but the scale? not since the last bomb. how unusual is that so many children come in at the same time dealing with those, injuries? very unusual. what challenges does that bring? the challenges are the same whether it is adults or children, the staff who are used to dealing with those patients rise to the challenge and the clinical situation. the motion support required is perhaps more intense but it is very much part of the

>> these are the backbone of the treatment being provided to patients up and down the country. thout those digital patient files, they are unable to access medical records, doctors are unable to see what allergies people have said they cannot treat ongoing conditions while they are lockout of those systems. obviously emergency care is still there. for anything requiring deep knowledge of either the condition or the patient medical history, at the moment, they are in the dark. christopher: this is extremely worrying for patients across the country. >> it is. they are expressing their concerns. the prime minister has spoken on television here in the u k to assure them there is no evidence of their medical records have been accessed. but considering this is coming from the same id experts that were supposed to create a system incapable of being brought to its knees so easily, it is too soon for people to relax. these systems were not supposed to be hacked by malware. there is no telling how deep this goes. christopher: i realize this is already on -- early on in this story but do w

let's put the patient, not the bureaucrats, at the center of the system.oes all of those things. this bill delivers on the promises that we have made to the american people. you know, a lot of us have been waiting seven years to cast this vote. many of us are here because we pledged to cast this very vote, to repeal and replace obamacare, to rescue people from this collapsing law. are we going to meet this test? are we going to be men and women of our word? are we going to keep the promises that we made? or are we going to falter? no. after all of this, after all of this, after seeing what is happening in iowa and around the country, after seeing this law collapsing while we witness it across the country, knowing all this turmoil that is coming, we will not falter. we will replace. and today is the day that we're going to do this. today this house has the opportunity to do more than just fulfill a promise. we have the opportunity to raise our gaze and set a bold course for our country. we have the opportunity to show that we've got the resolve, to tackle t

up to serve the patient. and by the way, just a rule of thumb, if you ever go to a hospital that delivers babies and you walk in, it is clear who has the power. the walls are painted mauve or powder blue or pink. there is a concierge to park your car because women don't like to walk in parking lots at night. and if you're pregnant, you really don't want to walk at all, so someone parks your car for you. there is a coffee shop as you walk in and a floral shop. it's all a therapeutic experience that addresses not just the physical need but the emotional and psychological need, and that is because that system is lining up to serve her, that patient. the patient freedom act incorporates that. now, by the way, we also have a third option. if a state doesn't want anything to do with this, the state can say take a hike, we don't want you, but generally states have three options, and that recognizes a conservative principle that states should have the right to do what they want to do and which works best for the state

susan collins and four other co-sponsors came up with the patient freedom act. we take care of people with pre-existing conditions. we do it by expanding the risk pool so that those who are sicker, if you will, are in a pool of those who are younger and healthier. it works. we have a plan on how to address that. i personally will be working on that plan. >> let's go down that road. you have a proposed a bill along with susan collins. i went to her website of some of the promises that are made. she said it keeps essential protections, prohibition of pre-existing conditions, exclusions. again, just so we understand where we're headed in your mind, do you think allowing states to get waivers from the community rating, does that achieve your promise of protecting people with pre-existing conditions? >> if you have a big pool, think about exxon mobile which probably has about 50,000 em moi yees and they are all in this plan with their families and spouse and children. if 20 people get liver transplants or other expensive illnesses it doesn't matter. within that big 50

perhaps he likes the adoration of the patient. tell someone they are going to die of breast cancer but if you let me operate on you, you're not, and then tell them afterwards that the pathology shows that yes, if i hadn't operated, you were going to get breast cancer, even though it's untrue, that patient is grateful and likes you, and indeed all the patients, before they found out that he had actually misled them, thought he was a wonderful doctor. a high court action for damages against nhs trust and private hospitals where he worked, and paterson himself, is set to begin in the autumn. our correspondent phil mackie is outside nottingham crown court. listening to some of those patients outside the court earlier, they said ian paterson seemed to show little remorse in court. what do they make of the links of the sentence he has been given? i spoke to quite a number of them immediately after the sentence was given earlier on. i think it was at the lower end of their expectations, i think any lower and they would have been angry. 1

the government says it does not believe that any patient data has been compromised. has insisted that the cyber attack had not compromised nhs patient records. the prime minister has also said it was right for the home secretary to chair the cobra emergency meeting as she "has responsibility for these issues". the national cyber security centre is working with all organisations in the uk, and that is very important. i would like to thank nhs staff for working overnight to ensure, as we know, that there is no compromise to patient records. the labour leader, jeremy corbyn, said he had nothing but contempt for those behind the cyber attack. what we've now got is a bunch of 21st century highway robbers that have hacked into our nhs and are basically offering protection money to get the information back in order to treat cancer patients or anybody else. it's unbelievably disgusting, and i've got nothing but contempt for the people who have done it. jeremy corbyn has insisted he and his deputy tom watson, are "are working flat out" for a labour victory at the general elect

let's put the patients, not the bureaucrats, at the center of the system. this bill does all those things. this bill delivers on the promises that we have made to the american people. you know, a lot of us have been waiting seven years to cast this vote. many of us are here because we pledged to cast this very vote. to repeal and replace obamacare. to rescue people from this collapsing law. are we going to meet this test? are we going to be men and women of our word? are we going to keep the promises we made? or are we going to falter. o. after all of this, after all of this, after seeing what is happening in iowa and around the country, after seeing this law collapsing while we witness it across the country, knowing all this turmoil that's coming, we will not falter, we will replace, and today is the day that we're going to do this. today this house has the opportunity to do more than just fulfill a promise. we have the opportunity to raise our gaze and set a bold course for our country. we have the opportunity to show that we've got the resolve to tack th

vulnerable, and it shifts power from washington back to the states and most importantly back to you, the patient. like i said, we got a lot of work to do, but one thing is now clear. republicans are committed to keeping our promise to lift the burden of obamacare from the american people and put in place a better, more patient-centered system. it is my pleasure at this time to thank and to welcome to the stage someone who helped make this so possible, our very talented majority leader, kevin mccarthy.