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tv   Key Capitol Hill Hearings  CSPAN  April 14, 2015 4:00am-6:01am EDT

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l in america who would say that. interesting. this guy has some interesting ideas. so let's bring out josh kushner. [ applause ] >> joe kiani is the founder and chairman of mossimo corporation. it was sort of a garage startup that now employees more than 3,000 people worldwide. and it's production and distribution of a market-leading measures through motion and low profusion pulse oximetry technology. it's another one of those non-invasive medical breakthroughs. but i know joe kiani through his commitment to build a coalition to eliminate preventible patient deaths entirely by the year 2020. and he just had his annual conference not very far from here in irvine. it's a fascinating struggle with
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so far very good results. and an amazing thing. it would be interesting to know why he thinks we can do that. so let's bring joe kiani out. [ applause ]'@ú zk our last panelist is jeffrey selberg, who heads the peterson center for health care which has just gotten kicked off. and this is really important because michael peterson who is here and his dad pete peterson are great friends of mine. and they have worked for years to get americans to focus on the long-term consequences of unsustainable debt. and how we can bring debt, especially the debt we run up every year consuming, down so we
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can invest in our future and secure it. and after years of beating their heads against the wall, they looked at the numbers for the federal budget at least and decided that actually all the real structural problems are in health care. combined with aging population. and they decided that they would try to be a part of the solution instead just sitting on the sidelines, complaining about it. so they are developing a growing program of initiatives aimed to improve the american health care system. so let's bring jeffrey selberg out and thank the peterson foundation for what they're doing. [ applause ] let's just begin with something elemental.
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why did you decide to do what you're doing in health care? let's ask all of our three reformers in the middle here. whatever possessed you while you were still a teenager to do this? >> i had the opportunity to spend a lot of time thinking about what i could do with my life to make a difference. and i've always believed that the purpose of building a business is to make an impact in the world and that we're all here for that reason. and to me, nothing matters more than the reality in our health care system today which is that when someone you love gets really, really sick, by the time we find out about it, it's often too late to do something about it. and in those moments, nothing matters more.
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and if i could spend my life trying to change that, we could make a difference in the world. and spending a lot of time thinking about that led to the realization that we live in a system in which people can only get a diagnostic test paid for by insurance once they're symptomatic for a condition. and so the ability to create a preventative care infrastructure where people have access to the information that can change outcomes by making it incredibly inexpensive, by making it less invasive could help to realize this change where people start getting access to actionable health information at the time it matters. and that's what our life's work is about.
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[ applause ] >> what does it mean to reinvent health insurance? we thought we were doing pretty good just to get 10 million more people health insurance last year. some people did. i think it's an interesting idea. explain what you mean when you say you're trying to reinvent health insurance. >> sure. i think this is on. yeah. well, the vision for oscar came about when i opened my health insurance bill about three years ago and realized that i had absolutely no idea what it meant. so overeducated and at the time was starting a business, and i realized i didn't know what my benefits were, what doctors or hospitals i had access to how to play a claim. the list goes on. and if you think about health insurance in reality, it's one of the most important
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relationships that we have from both the human perspective, but also cost perspective. the idea that we had when we set out was to kind of use technology and data to make the experience more simple and transparent and understandable and relatable. but, you know, what we've been able to accomplish is we've been able to take the data that we've gotten and actually not only provide a better consumer experience, but provide people better access to better care, primarily because we actually know a lot more about them. sos, you know there has not been a ton of innovation in the space. we're the first new health insurance company in new york in about 15 years. you know, we feel very grateful that we're going after the consumer market because to date, health insurance has primarily been sold from brokers to companies. and for the first time ever, the consumer actually matters. so our ambition is to create the
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best consumer product possible and do whatever we can to enable people to make educated decision about their health. >> so you're marketing to the -- in the individual market? which is about 9 or 10% of the total number of people -- who could buy health insurance in the country right? the rest of people are covered by bigger plans. >> to date. i mean we only started about 14 months ago. but we didn't start the company because we believed that there is a void to be filled in the individual market. we started the company because we felt like people deserved a consumer experience in health care where as to date you know what we say often is that health insurance companies traditionally have done everything they can to acquire customers. but shortly thereafter everything they can to avoid them. whereas we want to do everything we can to be proactive, to give
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people access to care, to give them things for free. i mean we're paying people to go to the doctor. we're paying people to get flu shots. we're giving away free generic medicine. we're giving away free physician visits. so being proactive is what we're hoping to accomplish. >> and what percentage of your potential market know you exist? >> the what potential of the market knows we exist. right now we're only in new york. >> even in new york. because new york insurance is generally higher than it in the rest of the country, as you know. and one of the things that really burned me up in this whole health care debate when everybody was saying the government lied about their policy because it went away, before the health care ever passed, 80% of the policies in the individual market lasted two years. or less.
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and so i'm going to be very interested to see. you know how you modify the policies hour, you continue to do outreach. talk a little about that. there is almost no understanding of who these people are and how they struggle to become insured. so talk about it a little bit. >> yeah, sure. so right now about 10% of all those that are eligible for insurance that is signed up this past year signed up for oscar. which is a decent market share for a new entrant. but the most interesting fact about us which we haven't ever disclosed is that 40% of our members signed up for us because they heard about us through existing members. so no pun intended we claim to be the first ever viral health insurance company. but you know, i think -- i mean the best way to acquire customers is by having a really
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good product. and that's what we've been spending all of our time and attention to accomplish. >> joe, talk a little bit about how you moved from your core business into this audacious effort to try to eliminate every preventible death in the health care system in america. why did you do it? how did you do it? what in the world ever made you think you could do it? >> well, thank you for asking. first of all, since the topic is innovation for helping people i want to congratulate you for your innovation. with this commitment-based approach of holding summits like you started your last count you have impacted over 430 million people around the globe. and i learned from that.
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you know i think in life while it's interesting to know why you do what you do, it's more important what you do and you do it. because how you do it teaches others maybe what to do in their own world. so i have been around the medical space for about 20 years. i remember when the institute of medicine first reported in 1999 to err is human and reported 100,000 people were dying from preventible causes in the u.s. hospitals every year. i was shocked. but a lot of great smart people jumped in. and i thought, okay, they're going to take care of it. and i went on doing what i did, making non-invasive monitors. and then a few years ago, the new data came out that showed over 200,000 people were getting killed in our hospitals from preventible causes. and that's when i realized maybe
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it's time i step up and try to do something about it. i've been fortunate enough to get to know a lot of companies in the medical technology space. a lot of great hospitals and clinicians. a lot of amazing people like you, president clinton. and i felt maybe if we brought everybody together on silo at the eco health care system, bring in the meditech companies bring in the hospitals, bring in government, bring in the patient advocates that provides powerful voice. because when you think about 200,000 people dying every year it's a number that runs through your head unfortunately. i think stalin said one death is a tragedy. a million is statistics. but when you think about that one life, how it impacts the family that was left behind, it really grabs you and wants you to do something. so we borrowed shamelessly, with your permission from the clinton global initiative, created this commitment-based approach that if you're going to come to our meetings you're going to make a
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commitment. and for my engineering background, we started unpealing the problem, seeing what are the things that are causing these preventible deaths. from hospital-acquired infection to medication errors to lack of monitoring when someone is giving opioids that reduce pain that also stops them from breathing. and we created solutions. we asked the meditech companies the hospitals to go implement them. we asked meditech companies to share their data to anyone. maybe to josh, to anyone who could use it. to come up with algorithms to predict it. and fortunately, it's worked. i think we reported at the summit that you were gracious enough to attend. and the last two years we have gone from saving 600 lives a year to over 6,000. and we hope maybe next year we can report 60,000 lives saved. >> let me ask something all three of our innovators before i
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come to jeffrey. is technology -- what role does it play in creating the health care system we want? and what, if any economic imperatives actually block it from creating the system we want? that is you have all disrupted marketed with non-invasive technology, with you know whoever heard of an insurance company giving you medicine. all this stuff. but how are we -- how is it all going to come out? how would you measure the success of what you're trying to do? and how much of it does it depend your definition of success depend on the whole system transforming itself? how much do you think about the
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health outcomes in america and how they're not as good as they are in other countries, but we spend more money? where is the end of this and what is the role of technology going to be? how do you think other people in your line of work should behave? where is this going? >> we've always seen technology as a tool. and it's a tool we believe, for empowering the individual. because we believe very strongly that the answer to our challenges and health care lie in empowerment of the consumer and in enabling people to take more control over their own health and therefore their own outcomes. so what's been very interesting to us about our model is we decided we were going to start building when we launched our
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commercial laboratory. initially at 50% off of medicare reimbursement rates. now increasingly at 90% off of medicare reimbursement rates. and that's lowering medicare and medicaid reimbursement rates over time by definition based on the way that we're billing. so technology can serve as a tool for facilitating change in policy and for empowering the individual to then get better access to in our case the diagnostic space, it's 80% of the decisions that are made in health care are driven by this laboratory data. so if you can facilitate that access in a preventative context, you can change outcomes. and we strongly believe that one of the things this country is so great at is innovation and creativity and applying it
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toward helping to solve policy issues. in this case, with our work, without having to raise taxes or cut programs to realize the same kind of savings. >> i want to come back to you. let me ask you. joe, you made your money and you did a lot of good with your medical device work. and one of the things that you said at your meeting or whatever this week is that some of the people in your line of work think that if they share information and we have truly comprehensive electronic medical records, which it will be necessary to do in order to save all these lives, as well as do it in a way that lower costs. so how do you get other people to join? what -- how come you think you can do this and still be successful and so many people don't? how do we break down that
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illusion that nontransparency is good economics? it's disastrous over the long run. >> well, first of all, with your help. you've been a huge, huge source of inspiration and people wanting to get involved in what we're doing by coming and helping start the patient safety movement. but we have to think about at the end, sooner rather than later, we're going to become either victims or recipients of a great health care system that not only has amazing technology amazing doctors and nurses but it provides us safety and quality care with dignity. so i tried to reach out to the ceos of the medical technology companies and say to them, look, 20 years from now, after you have retired, how would you have liked to have left this industry? because if we don't all share the data we can't get do this patient data superhighway where
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we can create these predictive algorithms that can tell us where we're going. for example, if we're in a hospital and we're just looking at the vital signs data, that's helpful. a doctor or nurse might see it, but not everyone is going to see it. if we get the data from x-ray from imaging from lab, all of the sudden smart algorithm and computers can predict it. and we have 50 companies who have made the pledge so far. companies like cerner, ge, phillips, zole, massimo. but we need the rest. if we don't get everyone to share the date that that their products are purchased for. we're not asking for the internal data, but what the products are purchased for, we won't be able to get it. i made the analogy we're like leonardo blind men trying to feel out an elephant. but if only three are feeling
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the tail and the side, we're not going to know what we're touching. so i hope that they will join. >> so josh, this insurance model you just briefly described to us just as some layperson listening like me from a naked business model point of view, it sounds like you're saying if i promote wellness i can insure people pour less money and still make money. is that right? is that essentially what you're trying to do right? >> absolutely. >> so what we want to do is to insure for wellness. now, since -- and presumably, the bigger programs including medicare and medicaid and the vets program and the federal insurers program and everything else would follow your lead if you could do this.
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that way you could be truly disruptive. what do you need to happen that is beyond your control for your business mod toll have a good chance to succeed? >> great question. so i think it's mostly about aligned incentives. i think there is a lot of things that we're doing that are very differentiated. and just to go back to the question you asked before how does technology impact our businesses, or the industry, i'm of the belief that if you're not a technology company in the next decade then you won't be a company. i think this is just an unprecedented change in the world where everyone either needs to adapt or just move on. but there is so much that we can
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do, for example amazon and google know when a woman's pregnant almost immediately based on what she is searching for. but a health insurance company doesn't know until the claim is paid three months after birth, right? so our ability -- [ laughter ] yeah. [ applause ] so our ability to understand what is happening in the system in realtime enables us to actually take something that is real. we can't prevent by giving away free medicine. if someone is sick, they're going to be sick. but we can understand what is happening and point them in the right direction. i think over time, our ambition is to work even more intimately with systems and we're starting to have conversations around that to say how can we actually work together? how can we enable you to interact with the customer in a way which we believe we're
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capable of doing, but actually work together to make sure we're providing the best consumer experience and the best overall experience. i think in many ways the insurance company and the hospitals are butting heads because incentives aren't aligned. and hopefully that will change over the next years. >> it's interesting that you gave that specific example, because that's another version of the point elizabeth made about early intervention through technology not being insurable because you don't know you're sick yet. and both elizabeth and joe have different non-invasive technologies. that's what they do for a living. that's their day job. so let me go -- jeffrey, how -- these people are really amazing right? and impressive. don't you feel better living in a country where people like this are doing this stuff? [ applause ]
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so how do you propose -- what are you going to do with what they know? in other words, how do we align the incentives and the health care system and government policy and all of that so that their ideas can bloom? and others too. the people that aren't on the stage. i mean we've got a system that has for a long time actually punished people who did what they were trying to do. and underimburst them and everything. now we're getting to the point where we're maybe almost into neutral, but we don't have our pedal to the metal. we're not creating a 21st century wellness system. >> well first of all, mr. president, i want to share joe's gratitude to you. thank you for inspiring all of this. it makes it easier for us, first thing. [ applause ]
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i'd say the second thing is that we believe going out and doing it is the best way. that if we find ourselves in policy inside the beltway, we're going to be there for a long time. i think it's one of the reasons why the institute of medicine says it takes 17 years for these kinds of innovations to be fully script. so our thinking is just what elizabeth is doing. she is out there doing it with walgreens as her distribution network amount. you go at it and you find the ways to scale. so right now all three of these innovations i would call exemplary innovations in that they're very small. they haven't scaled. our idea is to get the exemplars to the community, from the 5% to the 95%.
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one of the things we're doing is working with the clinical for excellence research at stanford. funded some research. they found that 5% of the primary care practices that they survived highest in terms of quality, lowest in terms of per capita cost by far. a factor of 50%. they visited these exemplary practices and found ten attributes, the essence of the high performance. and our idea is that we need to find that essence and find ways to spread and scale it. there is an old adage that you're limited to publishing. and that's what we found in philanthropy. it's kind of the spray and pray approach. publish and hope that it will sprinkle down on the field. our thinking is that we've got to get out there. we've got to mobilize. we've got to work with all the stakeholders, especially patients. to create the demand necessary to pull through this kind of high performance.
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and so as we do that as we collaborate, and i really hope that we do collaborate with all three of you, because you have wonderful things. and we find those barriers, those thresholds, after trying to scale it, then we'll circle back to the policy piece. policy piece is important. but the know-how transfer is more important. >> yeah just on that note, so what we noticed is that when we first launched oscar about 14 months ago, we did a lot of things that had never been done before. for example, one is we give away telemedicine for free, 24/7. so you can speak to a doctor within ten minutes and it costs you zero. the idea for us is if we could just actually understand what our customers need in realtime then we could pinpoint them to the right place and actuarily it would make sense and save them
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money and save us money. at the time everyone thought we were absolutely mad. but now a lot of insurance companies are starting to do it as well and copy us. and our approach from the get-go, i remember when we submitted our first business plan, which was almost three years ago to our first investor he said what if people copy you? and the we responded at the time which i think rings true, we hope people do. because finger they do because i think if they do it will make the system better. i think what is elizabeth is doing, a lot of people are starting to be inspired by working in health care. a lot of our peers or engineers always want to go work at the next social application, or whatever it is. and i think a lot of people are starting to realize now in addition to copying the idea of certain functionality, to start focusing on the space as well.
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>> how do you personally measure success? how do you keep score in what you do? >> for me it's completely about every single day how many people's lives are better because of what we do. when we -- i mean the first time that i was able to be in one of our wellness centers which is what we call our places where people go to give samples and see a woman who had taken a bus from about 100 miles away to come in to phoenix because she couldn't afford the ability to do a test anywhere else because even though she was insured, her deductibles were too high, and she was pregnant. and she needed to understand certain information about her body. and when we were able to take
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care of her watching that kind of emotion and watching what that means in the context of one person whose life is now better because of what we did, that's what everything that we do is about. >> that is pretty consistent with what they said. you don't mind if you get competitors doing what you're doing. that makes the system better. you'll have to get better. you actually believe you can get rid of every single avoidable death in the health system by 2020. and by the way, if you keep increasing performance year-over-year by tenfold, which has now happened twice in a row, i told him a couple of days ago you'll actually get there in september of 2017. but anyway so you basically said the same things. if you were dictator of health care in america and you could do
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two or three things, what do you think the most important things to do are? if you could change things based on your perspective what would you do? whether you would spend more money, change law, whatever, what would you personally do if you were in control of what everybody does in the health care for a month? and we'd all have to follow your lead? >> i would unequivocally make it clear that access to health information is a basic human right. and i talk often about the fact that in california today i can buy a gun and i can shoot myself, but i can't order a pregnancy test. it's illegal because somehow that information is too dangerous for me to be able to handle. and until we get to a point in which every person has a human right has the ability to get
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information about their own body we will not change our health care system. because individual accountability can only start with understanding. i had the chance to do a lot of work in louisiana with some very sick communities who were heavily obese. and you would listen to people talk about the fact that oh, their quote/unquote lazy. and that was not the case at all. they had no idea what to do to change their health. and if you can empower people with information if you can educate, you take the first step in being able to facilitate that change. today in our country, there are 26 states in which it's legal for a consumer to be able to order lab tests. and all the rest of them, it's not. and to say that by law an individual doesn't have access to that information i think is a symptom of the overall problem in our system.
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because at the end of the day, it is that individual accountability you were talking about, type 2 diabetes, 80 million americans are prediabetic. 90% of them don't know it. and all you need is a simple glucose test to be able to tell you. [ applause ] >> and all the conditions are reversible. >> completely. with individual accountability. yeah. >> okay. so what change would you make if you could do -- if you were dictator of health care? >> well, first i would start over completely. >> good answer. >> yeah. i think i would one, just enable people to understand their health. and understand everything that they have access to. i find it amusing at times that, you know a child in africa with
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a smartphone has more access than you did when you were president of the united states at the turn of the century and more access to information. i don't know how much this is going to cost me when i go into a doctor's office on park avenue, and i don't know why i'm going to that doctor. so i think enabling the consumer to understand what they have access to and why they should go to one place versus the next is a good place to start. i think there is a structural disadvantage to our system though. because the health care system in the u.s. was primarily built on a b-to-b business. and that doesn't necessarily put the consumer first. when you're selling to companies, you're not selling plans that are right for the consumer always. and i know that there is a lot of people here especially in the audience that are doing their best to change that. but, you know, i think there needs to be just a structural shift that is focusing on what
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the ultimate -- what the end consumer wants. >> i start off in innovation is best medicine. so what i would do like the general accounting office, i would create a general innovation office. and before the president or congress does anything i would ask how does that impact innovation. whether it's new patent laws, whether it's new health care laws, how does that impact innovation? because we don't want to impede innovation. secondly, i would look for getting rid of misaligned incentives, such as right now there is a perverse incentive to maker roars in hospitals. it's less now with the affordable care act. but if you're going to get your car a tune-up, and the next day you go to pick it up, and the car has caught on fire they don't ask you to pay for the tune-up. they usually give you a new car. not ask you for the tune-up. but if someone goes in for a hip
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implant or a tonsillectomy god forbid, one of the ten things that can cause preventible death happens to them then insurance preventative care whoever they still get billed for that initial thing they went in for. so what if in an instant, unless a hospital has created processes to avoid these preventible causes, we're not going to pay when somebody gets harmed. and imagine for a moment what ceos and cfos of hospitals would do. they would now make sure all the processes are in place there is only ten of them, to make sure people don't get hurt. and there is is more misaligned incentive incentives. like group purchasing organizations getting paid by vendors to negotiate for the best product at the lowest price. but they're getting a percentage of fees by the vendors. so what do they do all the time? they don't negotiate for the best prices and product. aligning misaligned incentives,
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and making sure we don't lose the innovation edge that our country edge, that the world relies upon. >> i'd empower the patient, and i'm empower communities. we have the technology now to bring information to people where they can activate and engage in their own health process. we have an expert culture that is not giving up very easily, however there is a sense and this isn't just health care. thing is kind of across the ages where there is this buildup, this vested interest of i have the expertise come to me, i'll take care of you when in fact now we have the technology to bring this expertise out on a decentralized basis. i don't think there is anything more effective in terms of care both from a quality outcome and from a cost outcome than an active engaged patient and surrounded by an active engaged family, surrounded by an active, engaged community.
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that's where i think we have to go. [ applause ] >> i don't want to end this on a downer, but thing -- i love this stuff. i could keep you here until tomorrow morning. but i think it would be a mistake for us to conclude this without recognizing that if all this were as easy as all of you highly intelligent deeply committed, incredibly creative people make it sound, we would have done it already. so talk to me about -- this will be very good for all the people that are here. talk to me about at least one frustration you've had in doing what you do. one failure, how you manage it and how do you in your business
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and how would you recommend us in working on health care what do we most likely to flub up, and how should we deal with it? joe? >> one of my frustrations is that you come up with a new smartphone. and within six months, everybody has it. you come up with technology that saves lives and reduces costs dramatically to our health care system. it takes 17 years before it gets adopted. there is a problem with that. and i think it stems from this third party mentality, you know. a third party taking care of you, a third party paying for that care. a third party negotiating for things that the hospital should use that they should know what they want. so the frustration is how do you get rid of this 17-year cycle that along the way kills and hurts people?
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you know today our technology the first one we invented measure through momentum pulse oximetry, over 100 million people are being monitored annually, at minimum three people are being impacted positively, from saving their eyesight to saving their lives. by the way, that translates to about a half billion savings and yuli to the u.s. another technology we invented non-invasive hemoglobin it could save $5 billion a year. two randomized control trials show it reduces blood transfusion dramatically. mass general just published a study. 90% reduction in blood transfusion. yet it will probably take ten more years before it gets adopted widely. >> so what should we do about that? that's -- i mean -- >> patient advocacy. i like that. >> you're like the little engine that could. you just keep pushing the rock up the hill. that's sort of been my strategy in life.
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less time you have to foot rocks up the hill, the more you would like a different way. so i'm thinking about that. how can we -- what legal or institutional changes do we need to avoid that? because it would be hard to get anybody in america to stand on this stage and say i'm for this 17-year time lag. it's the greatest thing since sliced bread. by all means let's wait another ten years and let people die in the meanwhile. i mean it's a hard case to make. but we have lots of systems like that in america. not just that lots of things that no one would ever defend up-front but we all every day shrug our shoulders and live with such things. so you want to go next? >> yeah i might get in trouble for saying this. >> you will. >> god, i hope so. we need somebody to get in trouble here. >> i feel very grateful that
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i've interacted with some extraordinary people in the health care space. but i think what has been frustrating, but also at the same time motivating and has enabled us to add and bring on some of the best engineers in the world that i've ever worked with is that there is a lot of people in this industry that are also just evil. and they don't actually care about the patients. so there has been some systems that we have interacted with that are so ecstatic about the idea of working with us and creating a better experience for the people that go to their hospitals or certain physician practices that realize that they can still make a tremendous amount of money, maybe even more, but provide a much better experience. and then there are some who just look us in the eye and say why would we ever change? because we're making really good money, and we don't really care. so, you know it's actually funny. we live in like this idealistic oscar is great world and actually get really excited when we have a meeting with one of these people, because it fires
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me up for a couple of months. but at the same time, it's just frustrating in a world in which you're providing a service to people where their health is the primary thing in their lives, that people just don't really care about them as individuals sometimes. so frustrating, but also motivating. >> i think it goes back to empowerment of the individual and the consumer as a way to not have to deal with sometimes the confusion that exists with some of the established entities around something simple like do you want to save money, right? and sometimes these conversations, we can come in we can save you $80 million a year $100 million a year.
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that should be a very simple conversation especially when you're not asking for anything in return. but the entrenchment is so great that trying to work through those systems trying to work through existing policies in our mind is harder than empowering the consumer and creating an infrastructure outside of that system, which by definition will make that change because of the way that you're empowering the individual to take ownership, and because of -- for example we started billing at the rates we bill, we published all our prices. so everybody knows how much a lab test is going to cost them before they get a test every single time. that's making a shift in the system by acting outside the system. and we really believe in that as a way to make a change. so we try to spend most of our time focusing on ways in which through individual engagement,
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we can facilitate that change as opposed to trying to convince the existing system to change. because that could take a really, really long time. >> my biggest frustration is data. health care is so opaque in terms of performance. and if i had the step that i'd like to see us take is make all data open source. all of it. [ applause ] >> and the idea that it has -- that it's proprietary, i think there are other ways to compete. i mean you go into a grocery store, there are no prices, you go to the cashier and they tell you the bill? i mean, that's how health care is. so what elizabeth is doing i think is groundbreaking. with data i think we can shine a light continually on best performance.
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and consumers can see what best performance, but so can providers. the primary care exemplars didn't know they were exemplars. they didn't know. so i think data is the biggest frustration. and that's where i would go. >> i want to tell you why i ask you all these questions. and i spent most of my life trying to change things. i was always making somebody mad. 40 years in there will be life. but i found that the resistance to change that was self-evidently good, like in just the examples you all have cited was often rooted in naked self-interest. that's what you talked about. but also the comfort of the way
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things are. people find -- a lot of people reach a point in life that they just don't want to think about doing things at a different way. it's the inertia that it builds into society is enormous. and the advantage it gives to the status quo is staggering. just the idea of changing people's, you know, the boxes within which we arrange reality. it's a real problem. and the third big problem that i found is if you want to make a change that will make things better but that has more moving parts than the way things are, that's really hard. the best example is with energy. you want to build a coal-fired power plant and accelerate climate change, you got to go to one contractor to build the plant, one contractor to supply the coal, one government agency at the state level to approve the building of the plant and the rates. and you're off to the races. somebody else does all the rest of the work. you want to create just as much energy in a much less expensive
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and more labor intensive way by having massive building retrofits, something try to do, a lot more moving parts. cost you less money. save the environment for our children. and create a heck of a lot more jobs. i worked, i spent decades -- a long time working in my foundation in the caribbean where they have the highest electric rates in the world. they all ought to be on solar and wind and biomass and geothermal. should it be a 100% clean energy region. but if they buy oil from one purchaser and somebody gets it and then the appropriate political people get their contributions and you have old-fashioned generators, there you go. you're contributing to climate change and you're bankrupting the country. and it would be a lot cheaper to be on totally clean energy. and what way to market a region. it's hard to do because of the
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moving parts. the reason i'm saying that is because we're coming to the end of this program. and no matter what the policy is whether we get rid of the 17-year time delay, that's why the world desperately needs people like you. that's why we will always need innovators because brains will always be more attuned to the comfort of the present than the adventure of the future. most people's brains. and yours are. because there will always be more money in the status quo. one reason i admire trevor fetter sitting there atop his little health care giant is that every day he gets up and he is still a little like i've known him for a long time. he is still a liberal reformer he was as a young, young person. and he tries to think of a way to push that thing down the road in the right direction. a lot of people don't do that.
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we will always need the disruptive innovators. we need you. and so that's sort of off topic, but it's true. and i want to thank you for what you have done with your lives and urge you to keep going. because for all those other reasons, no heart what you achieve, we will always need somebody to do disrupt whatever is going on. and i thank you for it. [ applause ] >> we have about ten more minutes. you've got people here who are involved in health care across this valley and across the country. a lot of them, like me wonder if they'll ever see the east coast again. and -- go figure.
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so i want to give -- i want to give you a chance to close out in a totally different way. i want you, the innovators, to ask them to do something. if you could get everybody who came here committed to developing a wellness model of health care, community by community, what would you ask them to do? go in any order you want. >> well, i -- i think wild data is critical and is king, i think action is king. and i think action that is inspired by love. so i think if we all start loving other people's children the way we love our own, all of the sudden these misaligned incentives and these issues just step out of the way. so i hate to sound like the
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beatles or whoever but please just give more love to the world. [ applause ] >> my wish would be that every person here takes just a minute to think about what it means for health to be a basic human right, and a right that every single one of us has, a right that every single person we love has in the context of ultimately being able to change what we know in this world today around having to say goodbye too soon. because if we start to see access to our own health insurance as our human right then we will start to engage with it, and we'll start to become more interested and look through a different lens at understanding it. and then using it to change our
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lives. we should not be living in a world in which we know more about our credit card data than we do about what the cell blood count on our lab report means. and that starts with recognizing that we have this right, the right to the health and well-being for those we love, for ourselves is perhaps the most fundamental human right. and when we know that, we'll begin to change our system. [ applause ]system. [ applause ] >> very much in line with what elizabeth just stated. i think what i would ask is as you're developing your businesses, you don't necessarily think about your business as much as the product that you would want for yourself, and i think a fundamental principle of what we've done is we wanted to create the health insurer that
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our family would use and get access of care that we would want for ourself, and i think that sets the bar at a much, much higher level so i think that's it. [ applause ] >> i had an old mentor when he heard my dreams he said, so, jeff, what are you going to do on tuesday? i ask you the same question. i think you all have a dream. you all have a vision. you have passion. it's time to execute. what are you going to do on tuesday with that vision? [ applause ] >> well, i'm going to do something off the books. would anyone here like to ask any of them a question?
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then i'll ask. do you have plans to go beyond the individual market, and how can you get traditional insurance companies to adopt some of your changes? can you -- when will you have enough data on this to prove that what you're doing works? there are insurance companies that are trying to promote wellness now and they really do recognize that they can keep rates down now that there's no cost shifting, that they have to eat and -- or there's less anyway, how do you think we can move from what is only 10% of the insurable americans in the individual markets to the other 90% with your model? what do you think -- when can that begin to happen in earnest? >> so first, we're expanding to additional states next year
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hopefully. california and texas and we'll also expand into the group market at some appointment. it's not the top priority at the moment, but we didn't start the company because we wanted to provide insurance individuals and we wanted a better type of insurance for everyone. that will happen at some point. in terms of data on what we're doing there's a tremendous amount of engagement. some of which we shared publicly, which is 835% of people have given us access to all their previous medical health records. 90% of people have filled out detailed health risk assessments. we have a large cohort of users speaking to us through telemedicine telemedicine, and mlrs for the
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health insurance nerds in the room pretty much went above the lowest in the state on the individual market, and i think we're, you know, one of the only insurers that asked to drop prices after the initial year so, you know, we're actively doing our best to kind of continue to introduce new products, see if they succeed or fail, and then hopefully drive our costs lower so we can reach as many people as possible. while we have had a tremendous amount of success to date, we'll introduce things over the next years that don't work. if we don't. we're not trying to innovate enough. in terms of working with other insurers and hospital systems, we're starting to have those conversations to get our products to as much people as possible. >> it is important to record
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what does and doesn't work. everyone will follow this. there's enough action in insurance business now that everyone will start looking at this. it is very interesting the -- joe's conference on preventable death, there was a lot of talk about how troubling it is when people don't have access to their own records on everything and how we could clearly store them securely and make them available to individuals and their designated providers people they approve it to. this is a huge issue. it's the next big thing you know it was kind of touching, almost, the government made an effort last year almost a year ago now to publish the first comparative data on you know
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medicare and medicaid and there's a lot that they didn't have. you know, in terms of what the results were in different health care providers, and pennsylvania is the only state that -- at least was the first state that started regularly reporting the impact of what did things cost and what were the results and hospitals throughout the commonwealth of pennsylvania, and they, every year found out that there's no connection between price and quality. the only connection with quality is how many times do you do it, whatever it is. but still, we're just -- we're almost in the stone age in real access to data. and empowerment. that's what i heard in different ways from all of you today. that i -- it's maybe a imagine we ought to send out there that it only hurts for a little while
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when you practice transparency and pretty soon you can't believe you didn't do it. you're stunned how long it took to get around to it. everywhere i work in the world where things are transparent, they are working well. where they are not, it's not so hot. i just went back to indonesia ten years after the tsunami, recognizable, the first global disaster that i believe was ever conducted with virtually 100% transparency. where did the money come from? where did it go? who got it? what did they did with it? you can get it all on the internet from start to finish everything should be done like that. but it's an upnrecognizable place now. that's the thing i wanted to -- that, you know i got that from all of you in different ways, but if you really want a patient
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citizen centered health system you got to be able to get the information. >> one of the first things that we did at the peterson center on health care was to go into a partnership with a kyser family foundation to create what we call the peterson-kiezer health system tracker. we track what's driving the spend, and the numerator is what's spend? mori it willty by condition compared to other higher countries, over time and we hope others join with us we want to find those whole system measures that are really meaningful, and our thinking is the old adage you don't manage what you don't measure. we need it not just a micro
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level but a macro level as well. >> if i may, president clinton imagine what the internet would be like if people did not share data or have interoperate interoperateability, but when it comes to our lives, we have disconnected products out there. there's a story of someone going to the doctor's office thinking they have the stomach flu, go to the emergency room thinking it's the flu, but the white blood cell counts were high, heart rate is high. the clinicians did not connect the dots. could you imagine if all these equipments that made the information would feed into somewhere where someone could create algorithms to see the pattern, you could save so many lives, and all of us could benefit, and whether some kid in pal palo alto comes up with the algorithm or ge does it that's not the point.
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it will save so many people's lives, and the rest of the industry will benefit from it. >> thank you. we have to wrap this session up. i do want to say the governor of kepz has come here. he's a great friend of mine. he and the governor of arkansas were the only two on election day in november with approval ratings of 70% or more and voters voted against everything they did. but they loved them for it because no one onces how health care works, health care economics, policies and you ought to get it if you talk about it a little bit, but it will encourage you to skrit what they suggest. the only way to get level of knowledge about the health care system on a general citizenry is to empower them first to do
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something they can understand, which is their health, the family's, the family's health, what they pay for it what they get, how they're going to do this, and i think you guys are great. we have an impact announcement and i'd like to ask you -- let's give the panelists a hand, and i'll have the announcement. join us tuesday when we're live with a hearing on immigration issues with the head of immigration and customs enforcement. testifying before the house judiciary committee starting at 10:00 a.m. eastern here on c-span3. the senate committee relations chairments congress to review any iranian nuclear deal and introduced a bill to make it reality. working on it with fellow committee members tomorrow live at 2:15 p.m. eastern. more foreign policy on wednesday when the u.s. ambassador to the united nations samantha power, testifies on the 2016
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state-foreign operations budgets wednesday, 2:00 eastern and we'll have that here on c-span3. this weekend the c-span cities tour partnered with comcast to learn of the history and literary life of st. augustine, florida. >> they may or may not have been searching for the fountain of eternal youth. people said he was out for additional property for the king of spain and colonization attempts and goals this is undecidedly true. we do know once ponce de leon came assure took on water and wood. this area presents one of the few fresh water springs in the area around 30 degrees 8 minutes, and it's also the location of the 1565 first settlement of st. augustine, 42 years before the settlement of
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jamestown was founded and 55 years before the pilgrims landed on plymouth rock. >> this was built by henry morrison flagler. little is known about him, but he was one of the wealthiest men in america. he essentially had been a cofounder of standard oil company with john d. rockefeller rockefeller. he was a man who always wanted to undertake a great enterprise, and as it turned out florida was it. he realized he needed to own the railroad to ensure that gusts could get to the hotel conveniently, and so clearly the dream was beginning to grow on flagler. he was a man with big dreams.
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he was a visionary. >> watch all events from st. augustine, saturday, noon eastern on c-span's booktv and c-span3 on sunday afternoon. the l.a. times reported in march that california would run out of water in one year. governor brown announced mandatory water restrictions for the first time in state history. next, remarks from a canadian author who was a key player five years ago when the u.n. declared water as a basic human right. food and water watch chair recently addressed the kpamp university in cincinnati on the global water crisis and how to solve it. this is an hour and 20 minutes. this is the water right's
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activist. in fact, if you google the phrase "water rights activist," these the first and only person specifically named in the results. she chairs the board or is a member of the council of canadians food and water watch, international forum on globalization and the world future council. she holds 12 honorary doctorates, and holds the earth care award highest international honor of the sierra club. she's highly published and latest is "blue future" protecting water for the future and planet forever. honored to have here here at xavier. please help me in welcoming her. [ applause ]
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>> wow. thank you very much. i'm absolutely delighted to be here. thank you, mark for your beautiful words. i'm quite embarrassed if that's true. that that's -- if i come up first, i am going to look. thank you so much to nancy and elizabeth for stainability community, and thank you, james buchanan and cynthia for the work you do, and i just a shoutout to edward the founder and i just want to say it is a true pleasure speaking at a university where your stated goals have to do with actually up front who you are. it's not that common, actually and so it's just really a treat to be here. i'm going to talk to you a little bit about the global water crisis and welcome, by the way, to the high school students, happy you guys came here. it's special that you are here. and then i'm going to talk about
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what we can do and are doing and i want to say to you that i hate it when people my age come to talk to younger people and say it's doom and gloom and you should, you know forget about it, nothing you can do. there is a lot we can do about the crisis i'll talk to you about, and i deeply believe hope is a moral imperative and if i share with you the bad news, it's also because i'm going to then share with you what i think we need to do about it. but i do think we need to face the actual dimension of the crisis. we've seen enormous increase in the amount of water we're using as a human species in the last couple decades. basically, a 50% increase in withdrawals in a very very short time. we are seeing what some of us call running dry, massive pollution of the surface water
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and even pollution of the ground water. in the united states, it's legal to dump toxic waste into the ground water sources and massive amounts are dumped out of sight out of mind i guess is the thought but i was sharing they found an audiocassette fer under mexico city, which is in real trouble and water-wise, and they took out all the water under the city but they found another, and when they pulled the first glass, cup of the new fresh water up, the engineer said and drank it and said it's delicious, and said, this is why you don't destroy ground water because you'll need it. we're damming rivers, pulling up ground water, ground water mining faster than these ground water sources can be replenished, and we're damming rivers so most of the major rivers in the world no longer reach the ocean and where fresh
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river meets salt water is an important spawning ground for aquatic life. the moster underdemand is for the global economy, and it's important to start off with knowledge of something called virtual water, the water that's embedded in things we eat or computers we news whatever. until not long ago, the united nations said each person on earth uses x amount of water, and now we understand that that's one-tenth of the water that we really use nine tenths of the water we use is not something we see or touch, but embedded in our dinners and so on. if you sit down as a family of four to a small steak each, you're consuming the equivalent of an olympic size swimming pool with that steak. this is -- we're beginning now
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to bring this into equation to understand what this means. what's happening is like a bathtub. it's like a bunch of us sitting around a great big tub with water in it and blindfolds and straws drinking up that water really fast, and we think it's fine because there's lots of water, and there's a lot of water for everybody, and then all the sudden, there's no water for anyone. that's exponential overuse of something. you can't see it coming. it's not like one and one makes two and two and two makes four. it's the exponential overuse of something that's finite. last month, there was the world economic forum held for leaders around the world held in switzerland, which always is, and always every year they do research ahead of time on what are major issues? they talked to 900 experts around the world, and to a person they said it's the coming water crisis. it's here in terms of impact. another meeting with u.n. of ban
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ki moon, secretary general, brought 500 scientists together and said what we're doing now is what they called planet to water, that's what they called planetary transformation, as great a change to the planet and world as the melting of the ice age. and they also, in a separate different study, the -- again, this done through the world bank the statistic that stunned the world at the time was two years ago was that by 2030 the demand in our world for water will outstrip supply by 40%. this is almost impossible to try to understand, and, of course, you stop and think about who is going to do without, it's going to be the poor. it's going to be the marginalized, the people around the edges. it's the people in slums. the massive slums of the global south or people in poor communities here in north america. it's also going to be the animals. it's going to be the species that can't survive easily
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without water. i just want to give you a few examples of what we're talking about the india is in terrible trouble. 630 -- 60% of all of their water for farming comes from irrigation, and so they are pulling up their ground water and damming rivers seriously. dpleting water in some places by five feet a year. in some states, running dry. china, 75% of the surface water is polluted. here's a stunning new report that since 1990, half of the rivers in china have disappeared. what do you mean, disappear? they are gone. they disappeared. that's partly from hydroelectric coal and mining for hydroelectric power and because they use water and air and soil to produce so much of the stuff they get sent around to the rest of the world. there were two things i want to tell you about, one is the
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aero c, so big a lake it was called a sea. the other was lake chad. once the fourth and sixth largest lakes in the world, and now almost nothing, down to a bear trickle. it was not climate change as we come to understand it. it was absolute over extraction. the story that most disturbs me now is brazil. brazil has been until recently considered the country with the most water. the most water rich country in the world. they never had droughts. tons of water, right? they have the aquifer, the rain forests that hold tremendous amounts of water. suddenly, the second biggest city in brazil with about 20 million people living there has gone dry. i mean, when i tell you in the last two years, there was no problem two year three years ago, it is going dry incredibly
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fast with massive draught over the last few years across brazil. turns out it's because they cut down the amazon. what we now know is when you cut down forests or rain forests or vegetation, that changes the pattern, and these rain forests give off massive amounts of humidity and vapors forming flying rivers. think of it as a river in the sky, and being held up by air, by air currents but it can travel thousands of miles and then it delivers rain to the cities and places. they are cutting down the amazon because they are growing massive amounts of sugar cane and soybeans for exports. not only cutting down trees but taking up massive amounts of water in the form of virtual water. and basically sending this water away. the great lakes are a big issue for those of us living, you guys
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live about as far away from the great lakes as i do. i live in ottawa, canada, we are about equal distant from the great lakes, not far. the great lakes are in serious trouble. we have invasive species massive pollution, but we also have over pumping, over exploitation of the water system itself. not to give too many studies but another study oun ground water taken said if the great lakes were pumped as mercilessly around the great lakes the great lakes could be bone dry in 80 years. if you stood on the bank of the big lakes, superior, and michigan, you can't imagine. that's why i told you about the sea. it is possible to take a massive amount of water and destroy it. we are dealing with the blue-green algae you read about it in toledo last summer and expecting it to come back this summer. this comes from industrial
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farming, the chemical based agriculture business where there's not proper regulations and these nutrients are running off into our water systems and there are 67000 square miles of business around the great lakes basin, and it is poisoning them. the patch that we thought we got rid of in lake erie is back, and it is a serious issue. you probably know that your own ohio river is named the most polluted body of water in the united states for seven years running, and i know there's a tremendous amount of work done in cincinnati and in the state on renewable energy and on this being a kind of a very exciting area of high-tech solutions to the water problems but we are not stopping the water pollution at its source, and we need to understand this. there's 23 million pounds of chemicals dumped into the ohio river last year. we have to find a way to stop this. martin luther king said many
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wonderful thing, but one, he said legislation may not change the heart but restrain the heartless. sometimes i see people doing wonderful things, but the government will not stop the people doing bad things from doing those bad things like, you can't catch up because you can't keep up with the destruction taking place, so we absolutely need to regulate and say nobody's allowed to do that to the lakes and recent concern that i have is that the great lakes are increasingly used as what i call a carbon corridor to move the dirtiest energy on earth by train, by pipeline, around and underthe great lakes and recently shipped on barges and ships on the great lakes. this is from the tar sands, alberta, and fighting hard in our country and it's an oil substance, and to get it
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through, they use chemical laced substances, and when they leak they create terrible pollution. now the coast guard and the united states gave the okay to ship on ships on american waterways waste water from fracking. that's amongst the most volatile substances that we can, and to my mind when we know what we know about the water system the water situation, the water crisis in our world how ke with do this is continues to be just stunning to me, and colorado the colorado basin, lake mead, the reservoir that was created when the hoover dam was built, all of these are down. there's a new nasa study saying they have taek p down enough water ground water out of the colorado basin to provide all the water that's needed for all american households for eight years. i mean, that's just -- we just put bore wells down, and we drink this stuff up. there's 200,000 bore wells in
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the ogallala aquifer that goes down the spine of the u.s. down to the texas panhandle. again, building massive industrial farms to grow corn for corn ethanol and pumping up that ground water with pumps that were not designed until the late 1950s, so before that, they had no ability to pull up that ground water. it's only in you know, 70 years or so that we have been able to greep the desert in that way but there's a terrible price. the terrible price is the department of agriculture here in the united states said two years ago that the aquifer will be gone in our lifetime, and you try to say that to people who farm there or who live there, and, you know it's going to be gone. and people say i don't know what you mean. yesterday, the los angeles times, if this is not a headline that gets you, i don't know what will but it was their major headline, major editorial said
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california has one year left of water. will are we ready to ration yet? look it up don't believe me, look it audiotape. how can we get up every morning and say it's business as usual. it's not business as usual. just go back to the people in brazil. i visited some communities, an they get their water now -- this is from water rich area two years ago, three years ago. they have water from five to six in the morning, just a trickle, and then it's turned off. they have water again from 10:00 to 11:00 at night. do whatever you need to do that needs water or collect it in those two hours because that's the water that you get. you don't have to go that far away. i've been working with the people in detroit, michigan who have had their water cut off, many thousands of them. we got a moratorium, the u.n. experts involved to look at what's happening. this is an area where a lot of money left the inner city, people left behind are poor
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mostly african-american, older people single mothers, very high unemployment. they don't have the funds and so the city near bankruptcy then, now in bankruptcy doubled the price of water. people cannot afford it. they are coming in. they literally go house to house and turn the water off. try raising kids or caring for the ill with no water. it's not just happening far away. it's happening in the so-called rich parts of our world in north america as well. these are real issues, and another nasa report that just came out last month reported unprecedented megadraught coming in the midwest in the united states and parts of canada the great plains and southwest over the next few decades, and they say it will last decades, that it will be unlike anything in living history or living memory. now, here's a prediction i have
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for you. you got a presidential election coming up. i predict this issue will not be on the table. i predict they will not speak about it. they will not write about it. they will not be asked about it in debates. now, why is this? well i just have four thoughts on why. the first is the myth abundance. we all learned back in grades six or whatever there's a finite amount of water. it can never be destroyed. it's the same not only the same amount of water, but the exact same water that was here at the beginning of the planet, and it goes around, and we all have a diagram in our heads, like a river around the earth, stick all the straws you want in it, and so we learned we could not run out. i think that in the gloenl north or west whatever you call us we tend to think there's a technology that will fix it, but that is -- that myth is deep and
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rooted and hard to get rid of. we see water as a resource, pleasure, and profit and convenient. we do not see it as element necessary for life. we don't respect water. we don't think about it. we don't care about it. it exists to serve us, period full time. one of the advisers to president hoover when building the hoover dam and the other big megadams said america will be great when she learns to conquer her rivers. this notion that water is here to be conquered for our economic model is really a powerful run. >> i also think that we have misdiagnosed the water crisis. if you talk to environmentalists involved in climate change they say water is a victim of climate change induced by greenhouse gas emissions. that's true. the healthing glaciers and ice packs is true. what's missing from the diagnose
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is that when we take water and move to where we want, as they move water all over the place to produce 85% of the almonds for the entire world right in a state running out of water so as they say, water runs uphill to money right? we have a situation where we are mis misdiagnosing what the situation is. our placement our abuse of water is the cause of climate change. it's really very much past time that we put this in the mix and start talking about water and undo what we've done as one of the answers to climate change. i say to you in terms of reasons, politicians not talking about it and artists don't either not suggesting it's just
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here in the united states. it's common other than in a few countries where they are just facing water shortage like the water is running out now, but it's the dominant model of economic development that says more growth unlimited growth keep going forever. more trade more stuff, more market economy. i want my strawberries in january. i don't care where they come from, who it costs. we have a notion to have all things at all times and we created a global economy that started, i argue, not just enormous wealth gaps between the rich and poor, and in the year 2000 there were 11 billionaires in the world, and now there's 2500 billionaires in the world. 15 years, what does that tell you for policies of the 1%, for the 1%, by the 1% right? i argue the way we grow food for
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a global market is like putting a pipeline in the water system and sucking water up and taking that away. remember when you grow food -- when you use water to grow food, you're consuming that water that water is not returned to the water shed. so what do we need? i call for a new water ethic p, and that says water is not just a resource. as i say, for our pleasure and profiting veengs inging convenience, but the element that gives us life to be respected, revered, and we need a new relationship with water. we also and if i were clear of the world and make every leader in the world do what i say and save the world's water all policy, and this has to happen at all levels, municipal, state federal, international. all policy asks the question
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what is the impact on water? our energy, using fossil fuels is not just bad for air. everybody knows that. it's terrible for water. fracking uses destroys abuses huge amounts of water. growing corn for ethanol it takes 1700 gallons of water to make one gallon of corn ethanol so, yes, okay, maybe that's a better use for the car but it's the water foot print is not worth it. i argue that ethanol is worse than fossil fuels, and we must not set up air versus water kind of reality. what does it look like about the impact on water of food production? well, i'll tell you. we have to stop using chemicals. we wouldn't have anymore toledo green water if we stop putting and stop having factory farms
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stop putting pesticides and narcotics in animal feed. if we go back to growing food, local, sustainable, family farms, or ganganic, and food for local consumption, that cuts the water consumption of the world in half. what would be the question is always what's the impact on water of the trade policies? what if we took into account, okay, all trade is not the same. there's a white shirt coming from this country, and a white shirt -- excuse me -- coming from this country, and they both took the exact amount of water to produce but the water -- but the water in this country is almost gone so that shirt is coming at the price of the local people's water rights and in this country, they still have water, so it's not quite the same, so we don't ask that question. we never ask the question in the
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doppler radar agreements, are we protecting our natural resources? are we protecting our people? we have to declare water to be a public trust, and public trust is an old concept in the united states, entrenched particularly in the north eastern states, less so in the southwestern states where nay have more of a first to come here, got the rights to water sort of thing. public trust says water is a commons. it belongs to us all, and governments must protect it in the name of the people for all and for future generations. that does not mean you can do whatever you want. it's not a commons that you can, you know say, well, i can abuse it. it does not belong to anybody. we fiercely have to protect the commons and say, what is the priorities for people having access to the water? you just can't have it for anything anybodiments it for.
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i give you an example of vermont. i worked on the legislation and vermont has beautiful water, a lot of ground water, and a few years ago, there was bottled water companies coming in, setting up a plant to drink the local water source until it was gone, and they were concerned. they brought in legislation that their ground water is a public trust, and they actually said to protect it, we're going to giver priority to water for people's daily needs water for protection of the ecosystem and water for local food production, not for agriculture business sending our water and food far away. there was a high artyerarchy of access and they were able to use their public trust doctrine because of the nuclear facility that was leaking into the local water source, and the local company, the nuclear power company, said, yes, it's our water, we have the
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rights. the stated said, no, the fact that we made it a public trust trumps your private right to dump this into the water. we're taking it back. it's a very exciting concept that we need to go back to and i have been working with the great lakes to get them declared a commons, protected buyer region so we stop seeing it your piece of this and that piece and we see it as a water shed. we need common laws and protections and common enforce. . you get enforcement totally different on different parts of the lakes, and we need together, to say no more shipping of this extreme energy. we cannot put the water up at this risk, and it's a new way of thinking, thinking in terms of water shed governance which they are doing in europe. since 2000 all of their water
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sheds must be governed by committees and legislatures from all of the countries that surround the water sources. it's not my water but i'll try to get this amount and it's our water collectively. at a global level, i'm calling what i name a martial plan and it was the major plan led by the united states to rebuild europe after the second world war and i mean, europe was in tatters. everything from rescuing orphan children to rebuilding schools and hospitals to putting in an economy back together, it was an absolutely incredible endeavor and we need a plan for water. we need our leaders to come together and say this is a crisis. when you read in the newspaper, when you read that california has one year left of water, i don't know what people in california think when they read that but i think a lot will move here, i guess, we might
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see, you know, american refugees moving from one part of the country to the other. what do we think of when we read that? we have to take this very very seriously. and the united nations needs to set up a separate process for water. water is linked into and comes under the end brel la of climate change. you go to the climate summits, i go to every one, they just talk about greenhouse gas emissions. those are important. i'm not negating that, but they do not talk about water but anything other than a victim. they do not hear the stories if you rebuild water retentive landscapes, if you created a desert, bring in the technologies and the techniques that we know, and if you put people to work rebuilding and refurbishing water sheds, rain comes back. it's mir rack cue lus. there's so many wonderful examples of where we have done this.
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we have to stop destroying our water systems. we have to repair those hurt. projects to replenish water, retentive landscapes, working with a wonderful scientist? who had land hurt by bad industrial practices, and dumping and so on, and he convinced many municipalities then the federal government, to allow a project to put thousands of people to work rebuilding, the kinds of small berms and dams, water retention, water collection, rain water clerksollection and greened an amazing amount of the lands. in india there's many projects where the rainmaker brought back water to a massive amount of
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land, a wonderful engineer in southern australia, and we'll gather the rain water, the sewage water put it through lagoons planted with the plants that eat bacteria, and the poison and greened the desert, the birds came back and animals came back. it's a miracle because we have to remember nature comes back if we stop hurting nature. nature wants to come back to us once again. we need food policies. we have to move away from the form of agriculture we have that we are now engaged in. all of our country,ers ported land three times in great britain, and africa, alone, where foreign interests and foreign investors have come in and bought up massive amounts of
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land and water, and they are fixing it to grow up crops to sell over the community, and they use all the bore well technology that's ruining the aquifers here. they use that there and pumping it there. we have to learn people who communities, and south america they know how to live with the fluxuations of rain and dry seasons, and they know how to conserve and how to farm properly. we're fighting the pipelines you know the keystone xl pipeline, which is still a hot issue, and it's going to remain contentious through the next election fighting other issues
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like tar sands in alberta to export markets, and fracking is a really dangerous form of energy in terms of water. we have to say we can do better. if we ask the question for energy, what's the impact on water, we get different solutions. i also call for, in my book the notion of using water as the source of peace, and rather than a source of conflict, and the demand for water 1 going straight up and the supply is going down. it does not take a genius to figure out maybe there's going to be conflict. maybe there already has been. the deep germ of many of the conflicts in the world have at least partially to do with water from syria to egypt to israel, palestine, many, many disputes in africa, disputes in asia are
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around water or water as a part of it, and water is being used now around the world as a weapon of war. the government in syria cut water sources off in alepo where the original revolution took place, just cut off the war. to make war on people, take away the water supply, and there's very little people can do in the absence of access to water. the question will be then well, if it's a source of conflict, can water be a source of peace? think about water as nature's gift to humanity to teach us how to live with each other and maybe, you know, my grandfather was taught to hate your grandfather and your father hate to hate my father and vice versa versa, and i have to hate you, other than we both live on the river, and it's dying. rather than the hating each other, let's come together and
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build something to save the river. we'll live in peace and come together to save the water source. there's a discipline in universities now around water and nature being forms of peacemaking, forms of negotiating peaceful settlements, coming around the concept of governance watershed govern governance and sharing. rather than it's my portion. whatever the demand, let's conform to it. let's make that happen. one of my favorite examples is the group called friends of the middle east, and they came together years ago with members from all the factions gaza, ill israel, syria, lebanon, all of them, and they came together to say we're not going to talk history. we won't agree. we're not going to talk religion
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or politics baa we do not agree. we are going to talk about how to save the water systems in our community. it's been so successful there's some parts of the wall taken down where people just got to know each other and realized how much more in common they have one one another than they might have thought. we have to promote human laws that reflect the law of nature. there's a movement i'm involved in a number of really thoughtful interesting people are creating called the right of nature. they have rights beyond the use to us. yes, there's the public trust. we all have common access, all have equal rights, but water has rights separately. even if water did not serve us, water serves other species. water serves itself. nature has rights. we have to stop thinking of ourselves at the top of this
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chain of command as if we're so important and how that would be well, we actually have examples around the world where local ordnances are declared and local wetland or forest has the status of the human being, right? it has rights. people are coming around the concept of protecting the right and somebody said, oh, you can't go fishing, you know, because fish have rights. i said no, of course you can fish, but you can't fish a species to extinction. that's the way the law works. how -- yes, you can take water from the water shed, but not so much from the water shed that you destroy it. you have to leave the integrity of the species or the integrity of the ecosystem in tact. and that's a sea change for us for we human and the were we give and the more powerful and the more we stick together the
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more we can really accomplish. i'm going to stop so we can take questions. we have to accept water as a human right. nancy talked about the struggle at the united nations. i was invited in 2008 and 2009 to be an adviser to the president of the u.n. general assembly. that's not ban ki moon, the secretary general. general assembly, which is all the countries together every year, elect a president, and that year was a man of the liberation theologian from nickthat was a wonderful man, and he called, would you come to new
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york to meet with me because i want to make water a human rightment i said do i have time to go to new york? yes, okay, maybe, like, now, can i get on a plane now? fabulous man. we worked with a lovely man who was the ambassador of that time in ÷'bolivia, a land locked country, which was locked into a water war and that water war where people were killed because the world bank said you have to take a private water company if you want to go from us and they brought in a company that tripled the price of water and they said, we own the rain much rain. we're going to charge for the water that you catch from the sky, and they said inspectors are around and these are the poorest people on earth. this is 85% indigital nous this is the water from the sky told they had to pay for it. so there was a revolution.
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army brought out, people were killed. it was a water war. when the new president came in, he assigned this to the u.n. and they worked together to build a small team there and he put the resolution to the u.n. general assembly in june of 2010. it was a very brave thing to do. it basically said that water and sanitation are fundamental human rights equivalent to all other human rights. water was not included in the 1948 declaration because nobody imagined water being a problem, but for the last number of years, it's been clear that not only is water a huge -- the lack of water a huge threat, but it's the greatest threat particularly to children. and when pablo got up in the general assembly had formidable enemies, your country was
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opposed at the time, since changed your mind, my country opposed, great britain, water companies opposed. we didn't think we'd win. he got up to present to the general assembly and said there's a new study that says in the global south every three flaf seconds a child dies of water-borne disease and went like this, held three fingers like this and half a finger. everyone realized a child just died, a child died. you could hear people breathing. it was absolutely amazing. voting started. at the u.n. when they vote they sit in the seats and just press an electronic you know button, and it comes up on a great big board at the front. and i was standing at the back in the bilkny holding hands with a couple of my staff saying we're going to lose but it's okay. we never thought we'd win so soon. back in five years, win then, and i was sure -- i was preparing them because i was sure we'd lose.
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they are in tears. they vote. i was wrong. 122 countries voted in favor. not one country including the u.s. and canada voted against even though they were opposed. they abstained. 41 countries abstained. and the price erupted in cheers. it was an absolutely fabulous moment and in my opinion in that moment, the human faechl took an evolutionary step forward, and we said it's not okay that your child that hashas to die a horrible death of water-born disease because you couldn't afford to buy expensive water. that's not okay. now, does that mean the day after this was adopted everything was fine? no. in fact, the crisis in detroit has happened since then. well, we have outlawed torture back in 1948 and torture exists in the world, but that does not mean we think it's okay and when we don't think something's okay, we collectively make that statement, and it was really important that as a human
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family, the united nations said we will strive so no one has to do without. the only way that no one does without is if we take care of our water better, and we share that more justly. this is our task now. it's a huge and very, very powerful one that lies before us. we've had tremendous success with this law, and a number of countries, mexico being the most recent. have adopted the human right to water in their constitutions or in separate laws, number of countries have plans to move forward, and we have a wonderful success with the group of first nations, indigenous people in botswana, north of south africa. they have the desert and bushmen, hunter-gatherers who lived way their ancestors did,
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and 15 years ago, the government of the time tried to get them out of the desert because they found diamonds in the deserts. they were beginning to frack in the desert and they wanted people gone. when the people would not go and kept coming back no matter what they came back they smashed the wells, and said no more water and said anyone bringing water to the bushmen would be put in jail. it was a terrible violation of their human rights, and they went to court with a group named survival international, and they won the right to go back to the desert, but they did not get their right to water. after the u.p. adopted the human right to water sanitation, we went back to the supreme court in botswana, and armed with a new right, the people, the first nations, indyigenous people won the right to have their water reopened and returned to the desert, and it's a really marvellous story of a kind of genocide and people fighting
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back and saying we know who we are, and we know what we stand for, and we'll take nothing less than these fundamental rights. we don't want the whole world. we don't want to be competitive. we don't want all your stuff. we want to live our lives the way our parents and grandmothers and their parents lived and we want and need water for this. and so it was, you know -- when i think about my own life, i think of a few highlights that i can tell you that being part of that struggle was a very deeply moving one for me and for everyone involved. so this vision i have a water shed govern nans saying what's the impact, water is a public trust, no one can appropriate it
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for private property, collect it sell it for profit when other people are dying because they don't have access to it. water is a human right not just for this generation, but generations to come which is why i called it forever. it's cheeky to write a book saying how to protect water for people on the planet. i put forever in and my husband, andrew, said, oh, that's strong. ied said well, what do you want me to say for a hundred years? like it's got to be forever, right? we have to think about it forever if we -- we better do what indigenous people do and think seven generations ahead. i want to end the formal part of this is two favorite quotes, and then we have time for discussions, i think. i'm going to just -- there's so many wonderful ones, but here's three quotes because i have the time. one is from a writer michael who talks about water sheds
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saying water sheds come in families, nested levels of intimacy. on the grandest scale the web is like all humanity, ser bs russians, amish, billion souls and people's republic of china broadly troubled, but it's hard to know how to help. as you work upstream towards home, you are closely related. the big river is like your nation. a little out of hand. the lake is your cousin the creek your sister the pond her child. and for better or for worse, in sickness and in health, you are married to your sink. then there's the late great carl, your wonderful scientist, environmentalist, anyone who used to watch him on television will remember he used to talk about billions and billions of stars. he would make nature and science come alive. he was a wonderful man.
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he said this. he said anything else you are interested in is not going to happen if you cannot breathe the air and drink the water. don't sit this one out. do something. you are alive in a critical moment in the history of our planet, and that would be my message to you guys, younger people in the room. it's not like me saying okay, we're handing over the problem to you. this is generation to generation. we do this together. but we are given a gift of a challenge here, and that's how i see it. i do not see it as a problem. i see it as a gift that we can come up with the answer, that is needed, and we can. and the last quote that i love the best, this is from "lord of the rings," this is gandolph sees himself as a water steward, and i share this with you because you are water stewards, or you would not be here but talking about what it means to
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be a steward of nature a steward of the earth. and this is the night that he is standing there, some of you remember, and the terrible army is coming. this is the deep, you know the one in the second movie, and where they are going to all living things all good things all things of nature could be possibly destroyed and i don't know about you but for me, the books are about the assault on nature and nature fighting bark, the trees fight back, and it's nature fighting back. i leave you the formal part of this thought. he says the rule of no realm is mine, but all worthy things that are in peril as the world now stands, those are my care. and for my part, i shall not holy fail in my task if anyone passes through this night that can still grow fair or bear fruit and flour again. in the days to come.
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for i, too am a sty ward. did you not know? thank you very much. [ applause ] so now we have time to chat. we have two wonderful people who are going to bring the mic around. don't be shy. questions, arguments, yes, right here. >> okay. thank you for your presentation. you outline a very comprehensive and interesting approach to things that need to be done. my question relates to setting priorities about where to start, and what i'm thinking is some of the -- many of the issues are broad, very deep comprehensive
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how would you go about looking at priorities or criteria to determine where you can get the political consensus what set of goals where you can get the political consensus and the financing to do it? i'll just give one example that everyone recognizes in this state and in most urban areas. and that has to do with storm water sewers and what's going on, and yet the proposed budget in our state that the governor came up with is basically $10 billion short. there's not any funding for infrastructure and in general everyone wants to shrink government and no one wants to pay taxes. so against that backdrop, any thoughts you have about how to
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identify the priority where consensus is low hanging fruit where you can actually make some progress? i'd appreciate thoughts on that. >> well it's a really really thoughtful and very tough question, as a matter of fact. i wish that there were not the apathy that there were -- that exists now. i'll start with the smaller local. i think that people can say what can -- well, first of all learn as much as you can. read, read read. get your heads around this. i'd send you here in the u.s. if you lived in canada send you to canadians canadians, but go to foodandwaterwatch doirgt that's good information on keeping water in public hands and leading the fight on fracking in the u.s., or one of the groups. but, so it was starting with getting as much knowledge as you can. for those students or those very involved in the institution high school, or university, you can start a discussion around
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bottled water on your campus. there are many, many campuses around the united states and canada that have actually stoppedstop ed providing bottled water. not that they banned it. if you want to bring bottle water on to campus, that's your business, but the campus is no longer going to provide it because we have great drinking you know -- the fresh water -- yes, thank you. it's been a long day. my brain's gone. and so that sometimes is a way to start that then leads to much greater sensitivity. i was in one university where students collected the small plastic bottles from just one week from the vepding machines, from the caves, from the cafeteria, from all sources that existed, and they put them end-to-end, and they went all


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