tv Politics Public Policy Today CSPAN July 5, 2013 2:00pm-8:01pm EDT
communities, not all of our shore communities had the army corps of engineers designing systems. there is a lot of debate about this in new jersey. sandy settled the score as to whether they were worth it. in the towns that townsdune systems, the ones that didn't, the damage was completes of there is no longer a debate in new jersey about whether we should now there is no longer a debate in new jersey about whether we should have them as a safety precaution. that is number one. i pitched to president obama that that is one of the things that had to be included in the aid package, the ability to complete the dune system along the entire 130-mile-long atlantic coast of new jersey. congress agreed. we have the money to do that. that is what we are working on now to do that. [applause]
second, you had to deal with the ordinances and towns regarding the building code and work with the state to now deal with using better materials and more resilient types of standards. what we saw in new jersey was in an older town, a lot of big, beautiful homes on the ocean that were built in the 1950's or 1960's -- they look beautiful -- but they could not stand up to the storm. they had no dunes and very old homes under old codes. we have to bring those codes up in every town to deal with the new realities. our homes have to be much more hardened if they are going to be in these areas. you need to do that third. you have to work with fema on the flood maps and see how much
you have to raze existing houses. i think what you're going to see in the jersey shore, when you come back in another couple of years, most homes within a four- or five-block area of the ocean will be now on stilts, pillars to permit the water that comes underneath to not create structural damage. all of those conversations had to be had at the local level in our state because new jerseyans have a tradition of being imposed from the state downward, and will fight brutally to prevent it. my job was to go to these towns and convince them that this is something that needed to do. so far, with some exceptions, i have been successful. that is part of what we had to do to deal with the homeowner side of things, let people know that this is a new world in a different world, and if you want
to live here, and if you do not want to sell out, this is what you've got to do to make the next time a storm comes, avoid the risk to human life and damage to property. >> how many people took the option to take the buyout? >> very few comparatively speaking. although in certain towns -- i'm finding that in some of our more middle-class towns -- those folks have had it. jon bon jovi's birthplace, we are buying out probably 375 homes. those people are willingly doing it. we will probably get the first half of those bought out by this september. pretty quickly after the storm, within one year, those people will be out, and have the money in their hands to go to another community. my approach has been, i want to buy whole neighborhoods. buying houses piecemeal will not
do anything. you will still have to deal with destruction in those neighborhoods in the aftermath of it. what we have been encouraging is for folks to get together as neighborhoods and to say, all of us need to go together. and sayerville, and another, we will buy about 500 homes. in phase two of the federal funding we are getting which will come in october, that will go down the coast and start offering the same kind of deals to others. >> once you buy the homes and you are in the position with the land and whatever remains, what are you going to do? what are you going to do with the land? >> passive use and try to set it up so we know it floods there -- let's use the lands and work the terrain to try to protect other parts of town. to use natural approaches that will allow us to slow water down
as it goes through. not walls, but natural types of structures, but nothing on the land for any human use. what we want to do is to use it as a buffer against neighborhoods that are closer. >> is there federal money to help to do that, to restore the land to its natural condition? >> yes. in the hazard mitigation funds we are getting in the aid package, it helps us to mitigate against future hazards. >> if you do this and complete this project in a given community, will it have any effect on the availability and cost of flood insurance for the people that remain behind? >> no question. the fact is if we are able to do it effectively, for them, it will probably get them out of -- without getting too deep in the weeds -- out of the high- velocity zones of water into either a regular flood zone or
even out of a flood zone completely. the ripple effect for it will be significant. >> i do not want to get in the weeds, but i think this is important. the thing i love about the beachfront for new york and new jersey is it is one of the last remaining big stretches were middle-class people have real homes, real neighborhoods, real communities, real routes. i'm shocked by the number of people who have come up to me personally -- chelsea organized a day where our foundation took a thousand people to the rockaways -- they had little publicity -- a lot of people here at cgi worked there, and i had so many people come up to me to say they grew up here. all of their parents had standard middle-class jobs. i was afraid that when this property was vacated it would become the stuff of land
speculation and all of these people would be thrown off the land. both you and our governor cuomo in new york have tried to keep the character of the place. in doing that, the insurers are really important. the availability of insurance and the affordability of insurance -- that is why i asked you about it. i think all of them should know that because there are similar decisions that have to be made in tornado alley. that is where i was governor. most of the years i was governor, we had the highest tornado destruction rate in the country. now it has moved little bit a tad north. you see southern oklahoma city and joplin. how much have you or your government had to work with the insurance industry since this happened? >> flood insurance now is being completely governmentally
controlled, by fema. if you want to buy flood insurance, which have to new jersey if you are in a flood area and you have a mortgage, the banks will require it. the only place you can buy is the national flood insurance plan. that is now completely controlled by the government. they will have private brokers who will help them to sell it, but the insurer is the national flood insurance plan within fema. the way we've got to work with insurance companies, it has been the business insurances and homeowners, and homeowners pay very little on this because every homeowners plan that i know, there is a flood exclusion. it predominately fell on the national flood insurance plan. that is why the real sandy relief package is about $50 billion, because $10 billion of the $60 billion went to the national flood insurance plan,
because it had been underfunded by congress and the administration. we have worked with nfip. it is challenging. sometimes it seems they are more concerned about an oig audit than the people that are buying insurance from them. we have worked with the administration to help keep pressure on them. they are the only game in town. >> i think it is really interesting -- the coastal lands presented different rating challenges to them because most of these people were set up to deal with rivers overflowing their banks, so we had a 500- year flood in the lower mississippi. i think it was 1993 or 1994. we relocated whole towns that were built on a floodplain because we did not have enough information to know that those areas were going to flood more
often than every 100 years. we know something generally like that about the oceans, but i think a lot of these guys are shellshocked because they are not sure that all of the prediction models are out of the window. >> it's true. for a place like new jersey, there is a real romantic attraction to the jersey shore. for folks who live there, whether it is their primary residence or they go to vacation there and they rent those homes, they are close or on the ocean, new jerseyans do not want to give that away, even in the face of these obvious challenges that these storms have brought. there is an emotional connection by the people. we just reopened 22 of the 23 boardwalks on the jersey shore by memorial day.
i was going to a number of boardwalks, and i cannot tell you how many people came up to me, grabbing at me saying, thank you for giving us the shore back. there is an emotional connection. as a leader, you have to recognize that part of it, it is not just going to be a calculation -- it is an emotional connection and you have to do things to try to give people the ability to still have that emotional connection to the place they grew up, where they took their children. now those children are taking their children there. that is part of the challenge from a leadership perspective. >> let's talk about what we should do next. what should we do, what ve mayors of these coastal towns that have not been hit yet? what can they do to improve resilience, to improve
resistance, to reduce damage from a storm as severe as sandy now? i got to thinking about this, because obviously, we could just watch what you guys have been through in new york and new jersey, to a lesser extent in connecticut, and say, well, we should do as much of this as possible, and we ought to be able to do it at lower cost if we start now all up and down the atlantic coast and into the gulf area, but it looks to me like the funds do not flow until something bad happens. if you were designing this, what would you recommend to the governors and the mayors of these communities, and what would you recommend to the national government in terms of redesigning our response? >> you are right that we had a number of these dune systems that have been authorized by
congress, and some of them were authorized by congress for 20 years but never funded. you have to have a cost-benefit analysis of whether or not you need to do this upfront because what happens now is, as you said, the funds do not flow until there is a disaster. then you are dealing with it in a hyperelevated state in terms of cost and demand. we have companies coming from all over the country to help redo this rather than doing it in an orderly way because we are back in the middle of hurricane season again. what i would say to other governors is you need to look at your own funds that you use, and every state along the coast has this. there is beach replenishment funds that they put to either a dedicated fee or tax from
general funds moneys, and start to look at, instead of doing these replenishments to make the beach broader and prettier, but to take some of that money and saying, let's build doing systems. to me, the only way besides the ordinance exchanges in making the homes are resilient, the only way to do this on the coast, it is a type of natural system that will protect you against this type of storm surge. whether it is a wall or a dune system, either one, those are the things you will have to do. i think states have always looked at it along the coast and the moneys for beach replenishment, it is a tourism investment. i want to make the beach broader, more blankets, more chairs. now you have to start thinking, i've got to protect the property inland, and the only way to do that is through dunes. they can push congress, although in the current climate, whether or not congress will appropriate that money is questionable. states have already spent along the coast significant amounts of this money in other ways.
maybe they need to redirect it. that is what we are doing now not only with the federal money but with the state money, i am now redirecting it towards paying for our share of the dune building because there is a cost share with the federal government. >> what about -- is there some way to use the insurance system to require that any new housing built conform to new standards? >> absolutely. we are doing it. we are giving people a choice essentially. if your house is 50% destroyed or greater, you have no choice. you must build to the new fema standards. if you are at 51% destruction of your home or greater, it is required that you rebuild to new federal standards, but what we are saying to folks who are not to at all or less than that, we are offering to them the
opportunity to raise their houses now. the benefit is going to be, they are going to cut their flood insurance costs by 2/3 if they do it. the upfront investment of about the $2000, which is the average $50,000, which is about the average, you are going to save that amount of money within three years of the investment, maybe two years. we are trying to give people a mix of the regulatory requirement, and those for who are less than the 51%, we try to give you a powerful economic incentive that if you elevate now that that investment will pay for itself within two or three years. >> the reason i am talking to
all of about it -- you may live in nebraska and think this is crazy, but the truth is if you live in nebraska, you've got probably the same kind of considerations about either a local river flooding or tornadoes. we do not talk enough about this generally and publicly. the only country that has ever really done this right is the netherlands because it is so small, and they were totally flooded. at the beginning of this year, i took my first trip to africa to see some of the work we were doing in northwest africa. in lagos, nigeria, which we associate with oil systems that do not work, brownouts, religious and political conflicts, a developer is
building a 9 1/2 kilometer wall with interlocking concrete parts to let w in, designed by a dutch firm, based on their experience, and they have already recovered 10 million square meters of land to protect the point of lagos, which is an island. it is a first time in a developing country i have seen the kind of preparation to avoid disaster that i think we should be doing all over the world. if you have a population map of america, and you look at the percentage of our people that live from maine all the way down to florida and around in the gulf coast and up the pacific coast, this is something we need
to think about. we need to redefine leadership beyond just how you respond in an emergency to how you keep the emergencies from happening. >> no question. [applause] >> he's done a good job. i wanted you to hear this. the enduring image most americans have of you is standing there in your jacket, grieving with your people, working with them, and working with the president, and you got both praise and damnation for ignoring the political differences that you had then and still have with the president and all of us in the other party, to do something that was really important, and i wanted them to hear what you are doing now because i think this should be as unifying as that. we've got to stop waiting for something horrible to happen and then spend 10 times as much as we would have to spend to keep it from happening. >> the people in nebraska should care about it because they are paying for it. right? [applause] even if you have no interest in
this subject, you are paying to rebuild the jersey shore right now, in nebraska, iowa, kansas, south dakota, north dakota, you are paying it. arkansas, of course, mr. president. [laughter] it is an issue because of the number of people who live there and the expense associated with rebuilding in that area. one of the things i was trying to explain to president obama was, when he took the first tour were there two days after the storm, i said, mr. president, in a state like new jersey, to rebuild 365,000 homes in some of the most, if not the most expensive real estate in america in new jersey and new york, this is incredibly costly and one we have to try to avoid doing another time after this. that is part of the argument i made to him about the investment of billions of dollars that is going to cost the federal government and state government
to build that dune system, but to do it is going to avoid -- the loss to new jersey in the storm of property was $39 billion, so to invest $3 billion or $4 billion to try to prevent another $39 billion and losses seems to be whether you are republican or democrat a pretty smart investment to make for the country. [applause] >> just close the circle on this, if you were, if you could make federal policy by fiat -- >> how great would that be? >> looks better to me all the time. [laughter] how would you redesign this?
would you put this prevention and resilience function, would you put it in fema or lodge it somewhere else, or would you set up the funds for which states could apply if they had a approved plan -- how would you structure this so that we americans could minimize future losses and maximize future security? >> i would tell you that i would take it out of fema. i think fema's mission is getting too broad for it to be good at all of it. i think fema should be what it says, which is when you need to manage an emergency and natural disaster, they come in and help you manage through the emergency, the immediate crisis. i think within the homeland security department, taking this out of fema, and whether or not you put it in noaa, or you put
it in a function like that to say, these are people who will have long-term planning responsibilities for dealing with resilience, and i think matching funds or the state has to pony up as well for long-term planning makes sense, that the federal government should not have to absorb all of these costs themselves. you work and what the cost share would be. everybody would have skin in the game. if the feds are paying for everything, you might want to do things in one way, but if you have to justify to your home taxpayer the investment, you might do it another. i think it is time to get the national flood insurance plan out as a sole source of flood insurance. i think it was a bad idea. i think you need to get the private sector involved in this as well. that kind of responsibility inside the government exclusively -- any type of monopoly is not good. i think the government had a monopoly on providing a
particular type of insurance, and it creates a bureaucracy that is self-defeating because now they are more worried about oig investigations and audits than they are about paying claims. oig gives them more of a headache than any common citizen could. they react as bureaucracies due to that. to do with this over the long term, to make the flood insurance both affordable and responsive to the customer, they should take it out of the federal government and allow that to be handled by the private insurers and homeowners. >> for all of you listening, maybe most of you know what noaa is, but it is the national oceanic survey, and it is a great agency because they monitor the movement of the oceans. their ability to predict the likelihood of things like this happening is extraordinary. to imagine the effects of
greater ice melts up north and other kinds of external factors on the ocean and the likelihood of more storms and where up and down the continental united states, that is quite high. i never thought about using them before, but at least they could be a resource in trying to make good judgments about what the insurance rates could be. >> i think they could help prioritize the resiliency money. where do we have the greatest risks for this to happen again? focus federal resources on the place where there is the greatest risk the most quickly. it is going to be a long-term project for our country to deal with the coastline of the continental country and to deal with these types of problems. it seems to me that if they are in the business of predicting where we are at the greatest risks, they could be the agency better than fema who could be making the decisions on how to prioritize funds in a time when we have limited resources in the
country on all types of infrastructure demands that we have. this is another infrastructure demand, this protection of our coastline, and i think that is one idea -- none of them are perfect -- it is one idea that could work. >> do you think there is enough awareness between what you have been through and joplin and oklahoma and all of these things we have been through in the country -- now we are dealing with these unusually severe wildfires out west -- that we might be able to get a huge bipartisan majority of governors to ask for this kind of reform? >> i think so. so many more of us are now getting affected directly by it. i think it is very difficult to understand this until you have been through it. i think the overwhelming nature of a significant natural disaster -- to give you some
perspective, there are 8.8 million people in new jersey. when i woke up a morning of tuesday, october 30, 7 million people in new jersey were without power. the state was closed. i went on google earth that night and looked. as you went up the east coast, he saw the lights in the evening. if you get to new jersey, it was dark. until you go through something like that, all of this is conceptualizing. i think governors are practical folks most of the time. they are trying to deal with the problem in front of them. i think you're getting -- i have spoken with governor fallon and oklahoma who now has an even greater understanding of what it is like to see this kind of destruction and how to deal with the human cost and economic
cost. i think we are building towards that. the one thing i will tell you, there are no partisan lines on this one when it happens. you're reaching out to everybody you can print i was reaching out to every governor i could to say, can you urge your utility companies to send us crews? can you send some national guard troops up? i think this type of crisis breaks down a lot of the barriers between us. [applause] >> one reason i ask is -- i ran five times the governor, and not one time did anybody ask me on the street, in a press interview, or during a debate what i would do about any of this. i lived in a state which then had the highest incidence of tornado damage rates in the country repeatedly. i followed your governor's race closely. nobody ever asked you about it. we were all arguing about the
education policy, and to this one or that one get hired or not. you remember the whole thing. >> yes, i do. [laughter] >> this is really important. we have got to start to become a resilient society. we know we are resilient internally, but if you plan to resist the worst destruction, if you plan for a quick spring back, you can do this and minimize these damages. i wanted all of you to know how much work he has done on this. i think it is really important. we see these disasters. they have these indelible impressions in our mind. we form conclusions about what people did or did not do. what matters equally as much is what happens the day after everybody else is gone, and you are left with trying to put people's lives back together. >> the other thing that contributes to this -- you are right, we never do get asked
about it in the context of campaigns unless you just got through something like this -- uniquely, when this kind of thing happens, republicans, independents, democrats, you turn to government. no one in my state was arguing to me that on tuesday, october 30, governor, you should privatize the response to this storm from here on out. [applause] this is one of those things that i think regardless of where you fall on the ideological spectrum, you would agree that this is government's responsibility. if it is, and demonstrably so, when you look at joplin, moore, sandy in new york and new jersey, then governors need to be thinking about these things much more than we do before.
to be focusing on how we prevent this kind of severe damage in the future. one thing i can tell you for sure is you never want to go through it again. you do not. i can tell you that the other thing that contributes to this that makes people skeptical and not want to plan is the way the media covers this. any kind of storm, there is nothing that the networks love more than an oncoming storm. everybody is like get in front of a television set, the storm is coming to me. i want to make it sound as bad as possible. if you make it sound really bad, people will stay in front of their tv and say, tell me more. when it is not bad, when it is just ok, people start to say, to hell with it. we had hurricane irene the year before. all the national weather service and other people are telling me, governor, this is going to be
catastrophic. ok, so i will prepare for that. i evacuated the entire new jersey shore. i said, get the hell off the beach. my wife said to me, did you really tell people to get the hell off the beach on television? i said, this is new jersey, i felt like they did not understand. [laughter] it wasn't so bad on the shore. we had inland flooding. now when we had sandy and i told people, this is going to be bad, there were people on the shore. i went to the shore the days before and had to tell people personally -- they would say, you said that last year -- part of the problem for planning is that people become cynical about whether we can really predict these things. if we predict them wrong, then why should we invest the money to do it? that contributes to the thesis of your question.
there is a growing bipartisan consensus on this because so many of us have now gone through it. once you go through it in my state, people are going to get the hell off the beach really quick because they saw what happened. >> i am looking at a sign that says, governor must depart for airport. [laughter] neither one of us control the chicago airport yet. let's give governor christie a big hand. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2013]
>> omx, part of this year's c able show. jennifer lopez on her new network which targets latino americans. robertsarks from john regarding his life on the high court, and how much americans and foreign business or's spent on travel and terrorism and how these industries contribute to the u.s. economy. tonight, computer hacking and information activism. online hear about surveillance, and why the government could be using a law from 1984 to prosecute whistleblowers. here is a portion. >> what we are seeing in trends is there is increasing government surveillance of us
people, and increasing corporate surveillance of us, and at the same time people who are exposing this are being more heavily prosecuted. underscoredannot be enough. i wanted to talk about that. and how people are being prosecuted is that the government is using this law , unbelievably written in 1984, which is ironic for all the reasons you would imagine, and if you think about it, it was written at a time before there were computers. the law is incredibly broad. it is frightening, really. that touches a computer could be prosecuted under this law. whenever you come to a new website, a facebook page, and you click a terms of service
agreement which you did not read and you do not obey those exact terms, that you have no idea what they are, you are in violation of the computer fraud and abuse act and face five years in prison. share a netflix password, if you look at your friend's account, you are violating the computer fraud and abuse act and are facing five years for every time you have done that. anyone of us would be prosecuted under this act, and we are not. who is prosecuted? we are seeing more and more that the government is using the to prosecute leakers and hackers, being used as a political weapon against information activists. >> a portion of the discussion that happened during the annual rum conference.
american history tv continues wisight with barry le exploring american history through famous landmarks in new york city. at 8:00, pennsylvania station. central terminal. and later, times square and coney island. american history tv in prime time tonight on c-span three -- c-span3. >> the black okies thought they would leave behind the racism. i remember them telling me that it was a more cruel kind of
racism, a smile on the face, but a dagger behind the fact is how they describe california. they were not allowed to live in any of the cities, not even the small towns. they were locked out. the only land available was patches of our collide land, and literally when you write up on the land, it is so salty it snowed if it has there. this is available to them, and they built their shacks there, no water. they had to go into town to fetch the water. no city sewers. they had outhouses. no police roamed this area. it was a no man's land. >> more from mark arax on black okies, as we explore the history life ofrary bakersfield, california, this weekend.
year's cable this show held at washington, d.c. we will hear from artie duncan as well as remarks from jennifer cable discussing her new network, which targets latino americans. this is just over an hour. ♪ >> thank you. good morning, everybody. thank you for being up early on this last day of the show. i'm glad you have joined me. you have come this morning thinking you are going to lean back and relax during a sleepy final show session, well, you are at the wrong convention. we have an incredible lineup in store for you today.
where else can you find the secretary of education and j. lo sharing the same stage? [cheers and applause] i agree. she wouldn't leave me in the green room, i tell you. in my dream. [laughter] not to mention some of our nations finest education leaders. it will be a powerhouse session that will keep you on the edge of your seat. i want you to know how excited i am with this show. it has been wonderful. great highlights. we have hosted visits from members of congress and fcc commissioners and the public policy commissioners. an amazing the world of technology. that is pretty cool. yesterday we got to meet many men and women who have served in the armed forces and might soon
call cable their home. we have got a glimpse into the views of cable contributions in our observatory. along the way, we had some fun on the show floor. it is hard to ask any more of the cable shows that what we have experienced the last two and a half days. it is time to mark your calendar for next year. april 29 through may 1 in beautiful los angeles. a few weeks earlier than this year. thank you for participating in this year's cable show. and thank you for all you do to help us generate huge success and bringing so much joy to our customers.
let's get down to business and kick off this morning's impressive session. please welcome to the stage the west coast editor of "entertainment weekly." [applause] >> hello. i know that you are all excited to check out the secretary of education. last month in new york it was announced that jennifer lopez did not have enough time in her life and decided to be that chief operating officer of nuvo. here is a little bit more on that.♪ >> this is where i belong. right here. i'm involved in everything creative about the network. i'm committed to supporting diversity both in front of and
>> ladies and gentlemen, jennifer lopez. [cheers and applause] ♪ >> a couple of little notes. i want to repeat the quote that you just said. you said latinos are a force in this country and it is time that tv reflects who the modern latino is now. how is tv falling short? >> it has always been about a lot of stereotypes. though things have changed, you see more latinos on tv, but it is not a reflection of who the modern latino is. this is an english-speaking [feedback]
is that for us? >> yeah. [laughter] >> this is an english speaking for the modern latino. it is a different thing. it requires different programming and they targeted agenda. >> why this and why now? you have so much else going on. >> yes. when nuvo first came to me, they wanted me to be the face of the network. we started talking and he realized i had a lot of ideas about the network and what it could be an programming for latinos. my point of view came from my upbringing. i grew up watching marcia brady, but i did not really see myself. when i think about growing up in the bronx and watching tv, once a year "west side story" would come on. this movie inspired me so much to do everything i have done.
when i thought about nuvo and the network, i thought this was a great way to communicate with the community. if i could be inspired by one movie once a year at thanksgiving, then if you had a cable network that ran 24 hours a day with programming that was relatable, imagine how many people can be inspired and how many things can be done. it is an opportunity to empower. >> how is your role going to work? will you be there day in and day out? >> i can't be there day in and day out, but i'm the chief creative officer. the whole look and feel of the network, i'm involved in it creatively. marketing and how it looks and how the network looks itself.
the programming and the development of the programming. being and distribution meetings and that kind of stuff. it is a big job, but it is really important. it represents something bigger than just television. it represents doing something for this community that has been underserved for so long. >> talk about the distribution beginnings. what were they like? >> eke. they are very educational. distribution was a different thing. what i've learned from them was that everyone is trying to target this community. they're trying to figure it out and crack that nut. it is not an easy thing. >> how do you think your celebrity will help launch the network? >> being a celebrity, it brings awareness.
also i have had 20 years in front of and behind the camera. one of the things i bring is relationships. we have attracted different talents and agencies are willing to work with us in a different way. directors and writers and all of that kind of stuff, it makes a huge difference. we are able to boost the programming and the quality of the programming in a way that hasn't been done before. >> when you were in distribution meetings, were their ideas about what would work for tv that had a lineup of tele-novellas? >> you are dealing with a bunch of smart people. when you grow up as a mother, i understand it. i know how it affected me and
did not affect me. i'm able to bring that knowledge and my whole family and all of my friends. i'm able to bring that knowledge to it. i want to see this and i don't want to see that. great art, great television, because it is so cutting-edge, it is about making quality and doing quality stories and making great television. that is what i feel we have to concentrate on. this should be a network for latinos and anybody. i often think of the movie "the joy luck club." i remember when i was young and knowing nothing about asian culture in any shape or form this movie touched me. i was young at the time. i knew the movie very well. it was a great story. it didn't matter that it was about asians.
it did not matter it was about that culture. you saw yourself in it. some story in every movie touched people. that is what great art does. that is what we want to accomplish. you want to accomplish great art, great programming that is targeted toward the modern latino, but it is for anyone. that is the goal. >> do know what the perfect nuvo tv show is? >> the perfect one? there will be many facets. that is trying to put us into a box again. i think we are very diverse. there are many different things that interest us. one of my wishes is to infuse more music.
when you think about bet, they drew them in with music first and then the network grew. >> and you? >> there are some things i'm involved with. using the network with energy. it takes years to get it right. we are on such a fast track. we have a new head of marketing. we are on the right track already. it is the pace of where we are
going. we want to go into scripted. that is a big thing for us. one show can launch a network. one amazing show. we are constantly on the lookout for that. >> you're not exclusive. [laughter] there are some things that were announced last month, a special involving you is one of them. >> yes. one of the things that was important to me is to have some education. education in an interesting way. you cannot get important figures of their history. it can be politics or comedians or actors or writers or directors or political figures,
historical figures, people who change things and had turning point in their lives that led them down a path that wound up being inspiring or aspirational. one of the shows we are doing is i will be in the first episode. >> is there a chance you might trade on some relationships? >> absolutely. we are going to everyone. i have worked with a lot of great agencies. there is a wealth of writers and directors and actors. all of my relationships i'm calling on for this. i feel like it is an important initiative. i do not know what the word is. it is bigger than just a channel. >> of all your accomplishments, where will this rank in terms of
your legacy? >> my legacy. i don't want to. i want to have fun creating the show. i do not know. i wanted to be remembered as a place where we gave a home to artists that did not have a home before. latino artists have a place to tell their stories, our stories. and literally change the face of television. >> are there any shows on tv now that you think speak to the modern latino? >> i will have to get back to you on that. "the fosters." >> how will you balance this
with going back to "american idol"? >> what? that is just a rumor. i do not have any announcements to make on that right now. i'm concentrating on building this network. i'm working on my 10th album. >> wow. ladies and gentlemen, jennifer lopez. [applause] >> thank you. ♪ >> good morning. and now it is my great pleasure to introduce a very special guest, a man who shares our belief that all americans should
enjoy the benefit of broadband, that all children through the power of our technology can be ennobled to be good digital citizens. cable and broadband technology can transform our schools, their classrooms, and our children. over the past four years, arne duncan has forged a reputation as one of our nation's most distinguished secretaries of education. building on his success in his hometown of chicago, he has instilled new energy into our nation's educational system through innovative programs such as race to the top and through his personal commitment to america's educators and their students. he has lifted the u.s. educational system into global
competitiveness, in ensuring that critical broadband technology is accessible to american schools. by the way, did i mention that he has got a hell of a good jump shot? ladies and gentlemen, please welcome the u.s. secretary of education, mr. arne duncan. [applause] ♪ >> thank you for that kind introduction. i always love following jennifer lopez. i will talk about some sexy topics like academic learning standards, but i promise you it will be more exciting than it sounds. i will talk to you about the intersection of technology and education. i will take you into the future. last month i visited a school in
the heart of detroit. one of the lowest performing schools in the state, in a tough neighborhood. they are working hard to turn the school around and create opportunities for the children there. you wouldn't know any of the challenges without visiting the classrooms. if you did, you see young children working independently in small groups. you'd see them discussing the solar system and building 3-d models. you would see others and learning games and apps on their laptops. you would see the teacher not at the front of the classroom lecturing, but simply working quietly with a few students who need help. all of her students are on individual learning plans. they are working at their own pace. if that sounds like great teaching, it is.
that sounds like a wonderful way to learn. it is an example of what technology makes possible through the flexibility it gives teachers and the opportunity it gives to students. teachers are expected to know how each a student is motivated and match that to the right content and instructional approach. that is powerful and often hard to do. technology helps turn those goals and aspirations into reality. it also allows fantastic teachers to give her students experiences that you and i can never dream about having in school. she can send them on virtual trips to other countries. she can let them apply physics by designing a bridge using tools that real engineers used. she can connect them with real tutors and experts in real time or take a class on linear
oculus. to help her continue to learn and grow as a professional, she can share her ideas and lesson plans with others anywhere in the country. that reality, that sense of empowerment that is strong is sadly not the norm today. the simple problem is that most teachers cannot do any of that is most schools have about as much internet bandwidth as your house. probably less than many of your homes. let's talk megabits for a second. it takes about 1.5 or one student to do what he or she needs to do with broadband. a classroom would require maybe 45. for a whole school, about 120. schoolmmend that the should have about 100 with a clear path to get to a thousand that fiber optics provides. the typical school is nowhere
near that. our competitors are far ahead of us. in south korea, 100% of schools have access to high-speed internet. here it is only about 20%. we are denying our teachers and students the tools they need to be successful. that is educationally unsound and morally unacceptable. it is a problem because as a country we are not keeping up. in a coldly competitive economy, that is a job killer. forstatus quo is bad children and bad for families and communities and bad for our nation's economy. what will be due about it? it?e do about we need to innovate and invest.
at the federal level, we are pushing for fundamental change in the education system from cradle all the way to career. make it available to every family, as obama has outlined a plan to do that. it is expensive and paid for. it needs to happen. investing in high-quality early childhood education is the best investment we can make. k-12 level, we are supporting raising academic standards. this is a game changer. we need to set a high meaningful bar for students. it opens the doors to innovations that can work and almost any state. we are investing billions of dollars that is creating online assessments tied to higher and
more rigorous standards. those assessments will replace traditional fill in the bubbles standardized tests. everyone knows -- to give assessments, most schools require bandwidth that they do not have right now. at the college level, pushing new ideas to make all its more affordable because students and families cannot keep up with the costs. at every stage along the educational continuum, we need new ideas. we have created a competitive phones and to spur innovation. we want learning tailored to each student needs. we need funding for school districts. we have to get better faster even during a tough economy. technology is critical to raise the bar for all students in what i call the opportunity gap.
much of this depends on access to the internet. broadband internet has become the interface highway system for communication and ideas. today is simply does not reach most schools. it is time we built some on ramps. that is why president obama and i traveled to north carolina last week to announce -- a program that challenges the fcc to wire every school in the country withfiber optic connections over the next five years. training teachers for the tech revolution. it challenges the private sector to make it affordable for our nation's children. we have to move from print to digital as fast as we can. in that same spirit, i ask for your help and all of you to come together with us. there may have never been such a powerful culmination of content as exist in this room
this morning. it is amazing. it offers us a huge responsibility. first, we need you to get behind president obama's goal of connecting our nation's schools. we think we can do that with a fee that amounts to the price of a postage stamp on your monthly bill. you can help us connect schools and also cost effective manner. you are the experts. done,ld on what you have bringing the internet to lower income homes and families, we need you to help make sure our children when they leave school will not be living in a different century than more affluent children. i believe history will look back on this moment that the cable industry did the right thing for our nation's children and helped close the digital
divide. thank you to you and your colleagues at comcast for your vision and leadership and commitment and the hard work you have done. second, we need your content. one of the most significant opportunities is to bring the engagement you generate through your programming to classrooms across the nation. it needs to be easier for teachers to find it and match it to the children's individual needs. we have created a platform called the learning registry to help teachers find great digital learning content. please be part of that effort. thelly, a personal plea to leadership on behalf of our children's safety. both online and in their streets and neighborhoods. online, children need to be safe from predators and inappropriate contact and from the risk of making mistakes that could cost them the rest of their lives.
teach them and their parents and teachers that it is also about the control that you can provide. finally, we need your leadership on the culture of gun violence. when i lead these chicago public schools,we buried at least one child due to gun violence on average every two weeks. staggering loss of life. that is not unique to chicago. parents should not bury their children. what kids see on tv and in video games matters. the decisions you make have consequences. please help be part of the solution. thank you. thank you for the opportunity. [applause] ♪
>> ladies and gentlemen, lease welcome the moderator for today's education and technology panel, cnn chief political analyst. [applause] ♪ >> and now for the panel, u.s. secretary of education, arne duncan. next is executive vice president of comcast corporation's david cohen. the co-founder and ceo of zeal. and fifth grade teacher, valencia.
[applause] >> thank you all for having us here today. thank you, secretary duncan, for following j. lo. we needed to have an exciting panel. let me ask you, you have heard the challenges that the secretary laid out for cable. contact done a lot of and making broadband but are we succeeding? >> first, thank you are moderating. we appreciate it. mr. secretary, thank you for an articulate vision for what this country needs. there is no more passionate advocate in the u.s. than the
secretary of education. president. thank you. [applause] what i took out of this are two critical things. what we heard in that presentation was something i believe is essential, which is solving the problems of education are not one offs. it requires innovative solutions. from the beginning of the top's -- child's education and after the school days, providing support for them and their parents, graduate from college and into college, beyond college policies that the the secretary articulated our policies that all of us in the education space share. i think he's in the right room.
the cable industry has a new unique role to play. those are all challenges in wh aree currently gs, t we can be doing more. i, for one, look forward to parsing apart those challenges and see what we at comcast and what all of us in the cable industry can do to advance that agenda. >> you have spoken a lot about parents, parents involvement in this. how do you integrate the parents with all of the new tools you all are talking about? ify can't help their kids they do not have access or don't understand. importanty the most thing about getting families connect did is that you unlock the potential of parents to help their children. ofecially in the world rocket ships, most parents are very low income. they have never been on the
internet. there is no way for them to engage in anyways with their teacher. connectivity is the first step and then information about what they're doing with the teacher and school. it's a huge change. >> where do you get the money to do that? >> that we were having this conversation five years ago, i would say i don't know. so many things have happened over the last several years that have blown those barriers down. the work that comcast and the cable industry has done to have very affordable programs for, activity, huge. the smartphone revolution we have not talked about as much year, but it's happening. a huge impact on very, very low income families. the devices and connectivity are getting in the homes, so now it's about the software and the tools. i think we can make that
affordable. >> valencia, you are on the front lines. how do you do what all of these people are saying you need to do? what do you worry about? students bring their smart phones in to class and they are involved in connecting to the internet that still need to connect to the teachers. >> our roles are changing. we are no longer teachers but facilitators for learning. it is whetting the appetite of students and learning has become quite atypical. as i'm teaching or instructing, they are teaching me and we're finding out information where they're going home and teaching their parents and it's a community working together and moving forward. that's what's happening within the community. >> mr. secretary, you have talked about digital textbooks and how that's going to be the next thing. can you explain to all of us what it means for our students, our schools, and how cable would be involved.
>> it's fascinating that we are still spending $9 million per year. on textbooks. be on the spend, it's interesting. we have states that are on seven-year adoption cycles. every seven years, they buy a new science, then english, etc. we're spending so much money on something that is so outdated makes no sense to me whatsoever. >> why are are we doing it? >> it's the way we have always do things. we change way too slowly. we are challenging state and education leaders to take the textbook money and put it into this conversion. the school district revisited we visited in north
carolina they are 100 out of 115 in terms of per person funding. they are second or third highest performing, much better than the resources that they have. seven or eight years ago, they have the vision to put all of their money into technology, teacher training, engaging families. much higher graduation rates, test scores going up very quickly. we need to take those kinds of examples and make them the norm rather than the exception. we have 15,000 school district in this country and we are not at scale. >> if i can? i think the secretary would agree that digital textbooks does not necessarily mean it's take the old textbook and put it in electronic form as a pdf. you electronic textbooks, can make the lessons more vibrant and understandable. take a lifetime network and what they do in the education
feeds, which stays with the vibrant educational content. i've seen some amazing learning modules into which actual video clips of the news has been in bedded. it's just saving money. it is dramatically improving the quality and making them more engaging for the students, more interesting, and improving educational quality. it is a place where we can all be partners and where we has a cable industry can participate in this revolution in a fairly seamless way to really advance the needle on quality of education and learning in america. >> it you are nodding. >> the secretary move the entire system. the other thing that's going on that i think is really helpful is that teachers are taking it on themselves to figure out how to adapt to this new world. as they do that, what i saw in
rocket ship is teachers coming up with ideas on how to use the tools but no administrator, no secretary of administration would ever think of it because they are with the kids every day and can come up with better ideas. there is also a grassroots part of this thing where this may ultimately be a bigger change than anything we can do from the top down. let's see how that goes. >> you have said the model for selling the technology to schools is totally broken. >> completely. >> can you talk about that? >> the secretary may disagree with me, but schools are possibly the worst single buyer of any industry group there is. extremely low funded, extremely long sales cycles. any company in the space that survives shifts all of this
money from r&d to sales and marketing. 70% goes toward sales and marketing and the products are terrible. our industry has gotten what it has gotten, but the line on the rise and is that we are beginning to have a consumer business and learning. 2 billion kids come online over the net over the next 10 years, before it only made sense to sell products to schools, maybe there is a consumer market. that will be a much more rational -- >> i agree. i don't disagree. thefurther disability in dysfunctional marketplace is every state had different standards, different goalposts. it was hard to take to scale what was working. now a lot of courage at the state level. 46 states and d.c. have raised standards. having a high bar for everyone
and a common high bar creates a level playing field where people can compete and innovators can get out there. it's a huge opportunity going forward that literally has never existed in the history of education. >> our children are going to use the technology that's in there. let's be proactive and make it educational. i'm doing standards in the classroom as well as my colleagues across the country. i very what i do based on the needs of the student, but the standards are still there. we're all getting very successful at what we're doing. >> can you talk about the evidence that this is actually working in the classroom? it sounds fabulous, kids using their smart phones to learn, but how do we know that it's working? >> we are not at scale and we need to continue to improve and not rest on our laurels, but just to give you a few examples, this is a district that is significantly
state.orming the never exclusively in part due to access to technology. theyave many schools where are doing some really creative things. a school i talked about in detroit, one of the worst, which tells you something historically, we are seeing students being engaged in their own learning in very different ways. we have a lot of hard work ahead of us, but there are enough early indicators saying this is transforming how they learn, how they teach. it's connecting parents and very powerful ways and i'm very convinced we need to get there faster than we have been. >> knowing more about a student really helps you teach them better. one of the things that technology gets, you are collecting data on what are they doing well, what are they not doing well, so it helps you to
figure out later on in the classroom, ok, this child is really struggling in this area, let me help them with that instead of something they are doing well. business you run your based on data, but education has been run in the classroom without data for the last 100 years. that's a huge change that we are now able to collect and use data for instruction proactively. >> i think you almost go back to your first question. we have not made enough progress at scale in the technology space, and the classroom, at home to be able to have reliable data. like john said and he, anecdotally, as i have traveled the country with the internet essentials program and have met with hundreds of teachers, i will tell you that teachers are constrained by the inability of their students to access
technology at home. teachers have said to me, we even have technology in the schools and i'm always torn whether to assign homework that requires the work to be done at home because out the kids in class can do it and half cannot. the are so grateful about existence of a program that at least provides more ubiquitous coverage and increases their flexibility about what they can teach in the classroom to use that is not even adequate technology tools being provided to the fullest of their intent. anecdotally, there is just no doubt in my mind that it makes a difference. >> i will give our front-line person the last word here about what you are seeing in the classroom and your crystal ball priorities for the next few years. >> come to school.
they are able to take ownership of what they are learning and how they are learning. also, we are giving them the parameters. they own it. a few years from now, i see students coming ready for teachers in the door. that now. i have students saying,are you here yet? what time are you going to school? just to get in and work on something. not a game, but something academic. we are broadening the world of our children. we are taking it out of the neighborhood and we're actually beginning to own the world and that is what technology is going to do. >> thank you all very much. thank you. [applause] ♪ >> these welcome the moderator -- please welcome the moderator for today's content creation
panel, once again, west coast news editor for "entertainment weekly," lynette rice. the creator andexecutive producer for "desperate housewives," mark cherry. the executive producer of "breaking bad," mark johnson. and the creator, executive producer, and show runner of "the americans." ♪ >> i am privileged to moderate the first-ever show runner panel at this convention. let's hope there will be more. i need to go right to the juicy
stuff. you just collapsed a show with -- left a show with four very complicated minute. -- women. why are you jumping into a douche oh with four complicated women? >> what a good question. i love writing women. it's not really more complicated than that. i find women on television really work. i got my start being dixie carter's personal assistant when she was on "designing women." my first show was "the golden girls." i'md desperate and now doing this one. i love getting gals together them talk. it's something i understand. i find them to be endlessly entertaining. i don't mind the complications, as you said. >> i should probably give you time to explain what your new show is about. >> it is called "devious maids." it is about their lives working
for devious people in hollywood. it is about how that workplace is different than any other kind of workplace because it was the people in those homes and you just get exposed to different things and you become part of the family in a weird way. their trials and tribulations become yours. the format was brought to me from mexico. when i saw it, i thought i had a unique perspective on that because i was the help that one time. and now, many years later, i have people working for me. i have a lot to say about that world and i thought it would be fun. the show has turned out really well. it premieres a week from this sunday and i'm looking forward to people getting to take a look at it. >> this is a question for both marks. you started your career with
television, creating content for broadcast. what were your early perceptions about content on cable and creating for cable? future --come from a feature world. i have been producing movies since the 1980's. barry levinson did 11 movies with me. that was my perspective. the first tv i did was actually on cbs, a show called "l.a. doctors" and then "the guardian." i did not know about cable. was of the future people i working with had no idea what the possibilities wherein cable. . today, of course everybody am working with, writers, directors, there is not a person in the future world who does not desperately want to get involved, primarily cable. >> how about you? >> i got started 24 years ago when there were only four networks.
fox had come into being. didknow, that was what i for the last 23 years and this past july, i started doing devious for lifetime and that is my first experience with cable. what cable means now is something completely different than what it meant a few decades ago. even the most casual viewer in television, you can see the most exciting work is being done on cable. that is where the buzzworthy shows come from. every once in a while the network puts on something that gets attention. they are so hungry for viewers and they are taking risk. the safest thing you can do is take risks and that's what's going on there. it's a really fun world.
i am glad i have joined the parade. >> the safest thing you can do is take risks. a good quote. you started with "damages," right? >> i believe been in television did i have only been working in television for five or six years. i cannot honestly say i got involved because it was more interesting. it was more lifestyle. i talked to my agent about what would be a better place to work in and he talked about what it was like to try to do 23 episodes on a broadcast network. we spoke about this backstage, the grind. i don't think i could survive not really having any kind of a break, working long hours year- round. doing it for eight years, i don't think i had it in me. then he started describing cable. you could do 13 episodes, have a couple of months all off. it started sounded like being back in school and having a vacation. right now i'm on hiatus from my show and that's why i'm finally
in a good mood. if you had to see me two months ago, i was a different person, scowling all the time, exhausted. that was it for me. >> i asked how many episodes yet done of "breaking bad," and you said about close to 60. we did 180 on desperate housewives and i was much thinner and had much more hair when we started. it's incredible, the amount of time and effort because you get two weeks off in may and that's it. you start plotting the next season. it may be different if you are doing a procedural, but the intense plotting that goes into doing a soap opera, the workload is just overwhelming. for people who really watch my show, you can feel it around episode 14 where stuff starts
to not make sense? i have run out of story at that point. [laughter] then i usually try to get it all together, like episode 21, before the finale, all right, i know how to end this thing. that's one reason why i'm so impressed about what people can do on cable. literally, you look at some of these shows -- and by soap i mean a continuing drama -- you get to do deeper, more sophisticated, complicated work on cable because you have more ime. some people can really pull it off on the network. a show like "desperate," you think it might be compelling and then you go, ok, i was wrong. then maybe next season it will be better. with cable, when we started "devious," i had every episode planned out and i'd never had that with "desperate."
that's one of the reasons why i'm a fan of the cable universe. they really allow the creators to have a vision from beginning to end and i think the potential is there for the work being better. the potential is there. >> let's talk about the difference between the two because the perception of cable is that there is so much freedom, standards and practices be damned, you can do whatever you want, how real is that perception? >> every episode is submitted to people at the network to tell us what is ok and what's not. you can literally say -- there are specific rules. >> you can't really say that here either. [laughter] ust so you know. >> have you found this? >> different standards, certainly with "breaking bad" and "rectify." there are some rules we have to
adhere by. we are constantly in a battle. the rules are more lax, but at the same time, there are certain things we cannot do. there are different versions of all of our episodes, i think, that are slightly better than the ones who air. >> i know there is a certain amount of bartering. if i take out this butt shot, can i add the shower scene? is that what is happening on cable as well? have you found yourself bartering, marc? >> i'm still in a network mode of broadcast standards that my experience is that they have not given me a correction yet. i'm pretty well aware of what i'm allowed to do. you get pretty good after a lifetime on the networks. you can do provocative ideas, like we have a scene where a woman is undressing and so you
kind of see a touch more cleavage than you would on the network, but we did not go so far that it would be a problem for cable. you're always finding that line. i tend to be a little conservative in how i approach ome of it. we handed the pilot to hbo and i heard back from one of the executives was that it was not gritty enough. there was no nudity. the language was tame. it was racy for abc, but not for cable. it kind of depends on who you are as the creator and what you are doing. i would imagine "breaking bad," which is dealing with drugs is an issue. the very idea there is potentially more dangerous than some of the stuff i do, which is more personality and character based things. do they stop you from a lot of drug ideas? >> thematically, we have total liberty. it comes down to language, udity, and to a certain degree
violence, although we have certainly done things on "breaking bad" you could never do on a network. >> the only violence on "desperate housewives" was really behind the scenes. [laughter] with all of this liberty, there is a certain risk. you get an dramatic trouble. because you can do almost whatever you want, you start to think, the audience will love if we have this much sex or violence. you start to cross that line. no one else is watching you really. >> let's talk about budget. there is the perception that an cable maybe you don't have as much money. if you wanted to stage a tornado or crash a plane, could you do it? >> i watch television completely differently than before i was making. how did they do that? ho is paying for that?
"game of thrones," it just outrages me. i saw the end of "downton abbey," and i know the car crashes, and i thought -- oh. it's too expensive to pay for the car crash. i did not know that before. you could do anything, you decide to find ways to do it that are less expensive. i do not think that we don't ever have to not do them, but we have to find ways ways that do not cost as much. >> they give you a set amount of money. so if you're going to do that which costs of this, you have to find the cost for it. i'm times you decide you're going to put money into this episode, a tornado or whatever natural disaster and then then these stories are going to take place in the same room for a ew episodes.
[laughter] you wonder why they are always in the bedroom? that's why. and that is part of the job of the show runner-creator-writer. it is just finding what creative ways to spend the money, the best way to do it. and it's easier to do, again, going back to if you have time. if you have time, you can do some really great spotting and planning, so it's all possible, but like i said, it's a little bit easier on cable. >> and you do have the time if you're only doing 13 episodes a season. it is so much harder when you are doing network television. once the train starts, it does not stop. you cannot take the time and look at how you overcome a problem. mark is absolutely right. you have the time. do we have money battles? of course we do. but then we have the right amount of money to make our
show and that is what we write to. what may come up with an obstacle, something we have not been able to do, we either do as mark says and do a bottle episode or we find some imaginative way to cover it. >> as a viewer, it is such a giddy time because there is so much creative, gritty, edgy content on cable. do you have a fear now that there will be so much in the market is so saturated that they will just look like there's another diving competition show somewhere. is it too much of a good thing? >> i don't think we have to worry about people leaving us for a diving show. [laughter] at the end of the day -- i was very lucky with "desperate," but the interesting thing is it was always about something, the frustrations of the modern woman who has chosen to be a wife or a mother. the idea was always the strong part of it. whether you saw marcia cross
wearing a teddy, that could be provocative, but it was the idea that people came for, that's what gave the characters their resonance. there will always be shows that maybe try to spice it up with language, violence, nudity. at the end of the day, what did the show creator, the writers have to say that is the major selling point? as long as someone is doing a show hopefully with a rocket of ideas, there will always be room for people to say provocative things they have observed about society. i do not think we run the risk of running out of those. nudity, swearing, violence are great but they are so biquitous. i still think the idea is king. that is what will really determine who will come to your show, enough people relating what you want to talk about. >> i have to ask you about "the walking dead." a cable show can get pretty huge ratings.
is that putting some undue pressure on you with your shows? >> no, no. not at all. yeah, i think it is. even in relation to her last question about how to get an audience when there are so many good shows out there, popular shows, i worry about it a lot. i watch the twitter feed when the americans" are on. and they say tonight i'm watching this, this, and this. how many people can watch television all night long every night? there seem to be a fair number, but there are just too many good shows and i do not know how you get enough of an audience, high enough ratings for enough good shows. i worry about it a lot. >> numbers are always in the back of your mind. the truth of the matter is that the beauty of cable is that you
don't need those huge numbers to be a success. come from the feature world here opening weekend means everything. the beauty of what we do now, as long as you have interesting characters and good, compromising situations and you label it way lot of irony, you will have an audience. you will have an audience that will justify your being. >> are you sure? >> positive, trust me. >> marc cherry, mark johnson, joe weisberg, thank you for joining us. [applause] ♪ ♪ >> ladies and gentlemen, as we head out, we are heading near the end of the show. this is the last general session. i wanted to come out and say i
hope you agree that this has been an extraordinary few days. [applause] on monday, we made a promise. we told we would give you a glimpse of the future, and i think we have. the future of ultrahigh-speed broadband. you have seen new cable platforms connecting to the cloud that will provide delightful new experiences for consumers coming to a home near you. you heard a challenge for the secretary of education, with whom we hope to work to meet his needs, and we are beginning to pay a debt by helping our veterans find new career opportunities as they hang up their uniforms and join us in the civilian world. we have impacted the lives of many young people who have come as millennials to be a part of the show. i'm very proud of what we have achieved. on behalf of the staff of the national cable and telecom association, the best in washington, the board of directors of our wonderful association, i want to thank you. it's been an honor and a pleasure to put the show on for
you and i look forward to seeing you next year. thank you, and travel safely. >> coming up, remarks from chief justice john roberts on his life and career on the high court. after that, a discussion on how much americans and foreign visitors to the u.s. spend in travel and tourism and how these industries contribute to the u.s. economy. and a little bit later, two journalists talk about the future of medicare and whether it's a solution for inflated medical industry prices. tonight a discussion on computer hacking and information activism. we'll hear about online surveillance by the government and corporations and why the government could be using a law in 1984 to prosecute whistleblowerers. t's at 8:00 eastern on espn. >> sunday on newsmakers, the new president of the american
medical association talks about implementing the health care act and the role of doctors working with the obama administration. here is a quick look. >> we have been in communication with many, many individuals in the administration about our role as physicians in this and what we can help them do and what we can do to help our patients get the kind of information that they need. we will continue to work with the administration and do whatever we can in our power to make this happen. >> what do you see as the role of doctors in the affordable care act? obviously it's a pretty polarizing law i imagine, you have membership that doesn't necessary support it. what do you see as the role of physicians as far as doing outreach and enrollment for the administration or in partnership with the administration? >> clearly as we moved forward, our responsibility as physicians will be to our patients. my job as a doctor will communicate with our patients and their families going forward as what they can expect
from the exchanges or any of the other pieces in the affordable care act. physicians come together on many things. the american medical association has brought doctors together through our house of delegates. we set policy there. out of that body has come good work about outreach, good work about transparency and good work about how we can help our patients access the kind of care that they deserve and need. >> is your advice to physicians, to follow up on sarah's point, physicians that don't like the affordable care act, basically this is the law of the land they should do what they needed to to get people coverage? >> that's a very good point. i think, again, there was decision-making on both sides. some support it, some did not support it. at the end of the day, the american medical association and its policy body, the house of delegates came together in the support of the affordable care act. it is the law now. as i mentioned earlier, there
are things in play now which are helping the american public. our job as physicians will continue to be to get our patients the type of care that they need at the right time, at the right place by the right provider. >> a portion of our newsmakers program looking at the implementation of the nation's health care law. you can see the entire event sunday at 10:00 a.m. and again at 6:00 p.m. eastern right here on espn. -- c-span. >> no man needs a strong partner, an honest partner more than the american president sheltered an cocooned in what harry truman called the great white prison. that's what i concluded after five years and hundreds of interviews that those presidents with brave spouses willing to speak sometimes hard truths that others are unkilling to speak to the big guy, those presidents have a distinct advantage. let me give you an example. had pat nixon been able to cut
through her husband's paranoia, watergate might have been avoided. pat had long since given up on her husband by the time they reached the white house. they were leading virtually separate lives as you'll see in my pore trailer of this saddest of all presidential couples. i don't give my husband advice, pat was quoted as saying, because he didn't need it. is there a man or woman alive who doesn't need advice from the person who knows him or hers best. >> as we continue our conversation on first ladies, about ati marton talks presidential marriages and how the first ladies helped shape presidential history. up next, remarks from chief justice john roberts on his life and career on the high court. he also discussed the supreme court's 2012 term and what cases to look for in the fall. this is about 40 minutes.
[applause] >> always keep the audience waiting, yes, yes. [applause] >> great to see you. good to see you. thank you. >> thank you very much, you need not panic. i am not going to give a speech. i just wanted to have a few comments before i sat down with judge wilkinson for our conversation. i think these conferences are very valuable because they give the members of the bench and the members of the bar a chance to get together and understand the differing perspectives they have a little better. they weren't as necessary in earlier days where the judges and the lawyers interacted on a more regular basis and could gain some insight through that normal interaction, like the time when a barrister was
arguing before a judge in england and he said, my lord, i have three arguments today, one of which is a complete dead cinch winner for my side, one of which is kind of so-so, 50/50, could go either way and one of which is utterly frivolous. and the judge said well, by all means, counsel, begin with the strong argument. and the lawyer looked up and said, oh, my lord, i have no intention of telling you which is which. [laughter] of course, i cannot talk about the cases that we just decided, the opinions speak for themselves, which always makes me wonder why all of you are here. i will share just a few things about the court in the past year beginning with some statistics. we heard 77 cases out of the 8,000 or so petitions that were presented to us and we disposed of those cases in 73 signed
opinions. this circuit gave us some interesting work. we had five cases from the fourth circuit. we affirmed two of them and reversed three. that's a reversal rate of 60% which is actually quite a bit better than the average of 72%. we look a little deeper, it's better than that. one of the cases that was reversed was only reversed expressly, over my dissent, overruled one of our existing precedents so the decision was correct when it was decided by this circuit. so it's a success rate of 60%, which is really quite good these days. we have 45 cases already set for argument in the next term of the court beginning the first monday in october. that's more than usual. as a result, i will be able to schedule a few extra cases in the fall, we'll hear three a day instead of the average two a day several times which might allow us to ease up on the april arguments so that we'll
be able to get our work done without a mad rush at the end. what a fantasy that is. [laughter] >> none of the new cases is from the fourth circuit, so keep up the good work. we did have some exciting change at the court this year. we historically on mondays have announced our new orders for the week and had oral argument both at 10:00. the press corporation asked us to move up the release of the orders until 9:30 so they would have a chance to consider those without having to miss any argument time. i tried very, very hard to come up with a reason to say no, but i could not and so we made that change. so the reporters now have the option of writing about the orders that they see at 9:30 or pending arguments promptly at 10:00 or taking the day off. now, last time i reported on
our construction at the court. i indicated we were close to completion. once again, we're close to completion. the project turns out to be an example of the paradox which i understand is the idea that an arrow that gets halfway toward the target every second continually progresses but will never quite reach the target. apparently that is how our construction project is going. this year just when we thought things were wrapping up, we discovered that we had very extensive damage to the exterior of the building caused by weathering, acid rain, birds, and we discovered this pretty much the way newton discovered gravity, things started falling off the building nearly landing on some people like newton's apple. so we have to work on that. it will take about another year before that is finished. we had to put scaffolding up in front of the court, which, of course, we don't like to do.
this time we put a really delightful scrim over the front that is remarkable. you look at it in certain light and you can't even tell that it's not the real building. so at least the visitors touring the capital get a sense of what the building should look like without the scaffolding. the landscaping is an ongoing project. things are so dug up in the area, you think we were looking for jimmy hoffia or -- hoffa or something. i did want before sitting down for the conversation to echo something that chief judge transactionler said last -- traxler and that is a tribute to judge hogan for his work of the administrative office. as was mentioned, i had prevailed on him to spend one year in the job. my plan was to entice him with the many sources of entertainment that the job provides into staying longer.
it worked for almost a full year for which i am very grateful. tom leaves the post in the able hands of judge john bates from the district court of the district of columbia. john begins his job officially on monday, inquiries or complaints of the sort should be directed to john. tom also wanted me to announce john's personal cell number so there is no confusion about that, but i don't think i will do that. tom's service, the service that john is undertaking, is simply emblematic of the service that so many here in this room provide to the judiciary in the case of judges above and beyond their obligations. that is epitomizes here by chief judge traxler who serves as the chairman of the executive committee of the judicial conference, an enormously important position for which i am very, very
grateful. now i think i'll sit down with jay and have a little talk. thank you. [applause] >> jay. >> thank you. >> welcome. i first want to thank my fine colleague, judge gregory for his leadership in this wonderful informative and educational conference that we have just had. this was virginia's year to hold the conference and i know that the commonwealth joints judge gregory's, joins in appreciation for judge gregory's distinguished service on our court and shares the appreciation that his colleagues have. thank you for all you have done to put this conference on. i also want to say a word about chief judge traxler and the
magnificent leadership that he has provided the fourth circuit. he has held in the greatest respect by all of the members of the court and we are lucky to have a chief judge of his caliber. and, chief, thanks for being here. you have been through a ueling term and i'm sure you would love nothing better than to leave immediately and spend some quiet time with your family and the fact that you have come to join a throng of lawyers and judges, we're ever so appreciative. as i told many people, i just cannot begin to express the respect and affection with which you're held throughout the federal judiciary for the edicated service that you have given us.
it's a very hard job and we appreciate the warmth and dedication and sterling character of your leadership and it's a pleasure to be part of a federal court system with you as its head. >> i like this conversation pretty good so far. [laughter] >> don't screw it up! [laughter] >> you can interrupt anytime you want. chief justice rehnquist came here for many, many years. you clerked for him. he was your immediate predecessor. when we did the supreme court review session, it always amazed me the music and the poetry that chief justice rehnquist knew. he would begin each session with a little quotation from
ir thomas gray's "elegy in a courtyard." the line went the pure gem, the dark unfathomed caves of ocean bare, for many a flower is born to blush unseen and waste its sweetness in the desert air. the blushing flowers that were blushing unseen were some of the supreme court cases over the past term that maybe didn't merit the headlines or the broad public discussion with -- at some of the marquee cases did. they were nonetheless, extremely important in the laws of ordinary americans. i wonder if there are any -- if there were any blushing flowers out there in the desert from this past term that went
unnoticed? >> there always are. i think if you look at the there e have, out of 77, are a half dozen that people are going to be talking about at the panel discussions and things like that. some of the others, the littler ones can be very fascinating. my favorite from the past term was a case called loesman, it was a jurisdiction over what counts as a vessel. the law has a broad definition over what a vesselle is. the way that cases develop in the law, you have something that seems to fit, not comfortably into either category. depending on what side you were on, it was either a floating home or a houseboat. it was a residence that was attached to this shore more or less permanently, but which could be disengaged and would float and could be towed issue was whether it was a vessel or not.
it is one of those things where a picture is worth 1000 words. it looks like a house that got swept into the ocean rather than a boat. the court did hold it was not a vessel. we had a lot of fun looking at the different characteristics and posing interesting hypothetical at the argument. we had a bankruptcy case that was surprising. i am sure practitioners -- it may not have been as much of a surprise to them. there was a term in the bankruptcy law and had been for 150 years that applied when you were not entitled to discharge a debt in bankruptcy, when you are guilty of defalcation. i had not heard the word before. in jurisprudence, we often quote dictionaries to get a better
sense of the meaning of a word. i was looking up in the dictionary to find what the word had to do with. defalcation. it was a surprise to all of us that the term had been around for so long. there was a complete lack of coherent understanding about what it meant. i do not know if that counts as a blushing flower or not. >> it is sometimes a relief to have these sorts of cases where you can get into them and be traditional lawyers and deal with the raw materials of law without the volatile component that comes with some of the more controversial topics. i know that is true on the court of appeals. they matter intensely to the parties involved. they sometimes have an impact that is in inverse correlation to the publicity they receive. as much as i have enjoyed
talking about the high points of law, at some point we will need to talk about money. i know the sequester has hit a great many government programs hard. it has hit many public agencies and institutions hard. it has had a severe impact upon the federal courts. why should a man or woman in the street care about the budgetary impact the sequester is having upon the federal judiciary? why is this an issue for somebody who is not a lawyer?
this budgetary impact of increasing cuts are having on the federal courts. >> people who are not lawyers have a vital interest. the impact of sequester cuts are going to the heart of the process. whether you are talking about courthouses, keeping them open, in terms of funding not just judiciary, but the justice department. if they are not working, they are bringing cases. those cases get held up. the pace of justice which is already too slow in most cases is held up even more. everybody makes a special pleading in a time of this sort. you should not cut our budget because of this, cut everybody else but not us. the judiciary does have a special case to make.
we're less than 1% of the federal budget. you get a whole branch of government under the constitution for relative pennies. the idea we have to be swept along because it is good public policy to cut everybody -- i am not commenting on that policy, but the notion we should be swept along with it is unfounded. the cuts hit us particularly hard because we are made up of people. it is not likely are the pentagon where you can slow a procurement program or the other agencies. when we sustain cuts, people have to be furloughed or worse. that has a more direct impact on the services we can provide. in general, it is going to be a cold winter of austerity. we're going to have to bundle up. >> do you see any hope? will it get worse?
>> i tend to be optimistic on these things. i hope we're able to make an effective case for why we need more flexibility than others. the administrative office, led by tom hogan and after that by john bates are working hard with our appropriators to get them to go to bat for us. i want to say publicly i think the appropriators in congress are the best legislators since henry clay and daniel webster. you can quote me on that if you like. [laughter] >> chief, we may have touched on this before. there is of the recurrent subject of the hot bench. the hot bench is one asks a lot of questions. as someone who follows the court
with the greatest interest, the supreme court bench seemed to get hotter and hotter. there are more and more questions coming from the justices. i wonder if the lawyers are able to get in a word edgewise or whether the adversarial process has become more one of dialogue between the justices as opposed to the clash of views between the lawyers. i have the same concern at the court of appeals. the lawyers have spent weeks and months preparing their case. the oral argument means everything to them. they sometimes come to court and leave and feel like we have not
gotten it out because we have been bombarded by questions from the bench. i know if a bench is too passive, they wonder if the justices have prepared the case. this seems an exceptionally hot bench in historical terms on the supreme court. as a former advocate yourself, is this a good development? >> first of all, there are excuses for it. i am not sure everyone understands this. we do not talk about cases before the argument. when we get on the bench, it is the first time we start to get clues about what our colleagues think. we are using questions as a way to bring out points we think our colleagues ought to know about. we do tend to debate each other
through counsel. that is an explanation. it is not meant as an excuse. i think you are right. we do overdo it. i do think the bench has gotten more aggressive. recent appointees have tended to be more active in questioning than the justices they replaced. there's nothing bad about either of them. it is just a fact. i have had to act as an umpire in terms of the competition among my colleagues to get questions out. they are not being rude, but you do not always pick up in the acoustics the fact that one of your colleagues is already asking a question. i do think we have gone too far. we have talked about it a little bit. we try to make sure we do not prevent a lawyer from reserving argument time for rebuttal by asking questions when he is trying to sit down. it is too much.
i do think we need to address a little bit. i do think the lawyers feel cheated sometimes. it is nice for us to get a good feel about where everyone else is. it also would be nice for them to have the chance to present their argument. i am sure i am as guilty as most from time to time. i remember one time i told my colleagues let's not interrupt the lawyers when the white light is on signaling they have five minutes left. i found myself asking questions when the white light was on. you get wrapped up in the dynamics and forget to ease up a bit. >> this is sort of a personal question. for years before you went on the bench, you were one of the most
distinguished appellate advocates in the nation before the court of appeals and a large number of cases, you were arguing before the supreme court. do you miss your former life occasionally? do you have the impulse to be an attorney again? do you miss the satisfaction of that? you were so good at it for so many years. you had to leave it all behind. >> if it were the day that the client was paying their bill, i would jump over the side of the bench. my reputiation took a leap when i became chief justice, i found out i had no idea i was as good as people tell me i was at the time. i think the judges would say the same thing. you miss it. i miss the competitive edge. on the court, we do not win or lose.
when you have a particular position you think is the correct understanding of the constitution, one of your colleagues may have a different view. you debate internally and through memoranda. the court goes one way or the other. i never felt i lost a case or that i had won a case. we were both working to the same end. we ended up where we ended up. as a practicing lawyer, you do win or lose. you have to make the call to the client because it does not want to hear that we helped the court reached a resolution. they want to know whether they win or lose. it does give an edge to your work. it is a wonderful bar at the court these days. it was when i was practicing as well. you tended to be on the same side as your fellow appellate practitioners in some cases and on the opposite side in others. you were able to work together well. i enjoyed it.
i have no great desire to go back. >> sometimes i feel like writing a letter to losing lawyer to say i know you lost the case, but you gave the better argument. too bad it is not moot court. that would be of small comfort because you cannot take a letter to the client. >> it is a funny business because we are not picking the best lawyer. you are right. i know the best argument i ever thought i gave was for a losing cause and vice versa. the worst i ever gave happened to be on the right side of the court. >> i would like to ask about the membership and composition of the court.
when one looks historically at the court and their past experiences, you get chief justice william howard taft. he was a former president of the united states. you get chief justice charles hughes who was a former presidential candidate. at one time, i think the supreme court had three former united states senators with hugo black and harold burton. then justice lewis powell was a former president of the bar association. thurgood marshall was the chief litigator for the naacp. before coming on the court, they were giants of public life. now we have a situation where
the immediate past experience of the court's membership with the exception of justice kagan, they all come with sometimes extensive experience on the court of appeals. do not get me wrong. i love court of appeals judges. i wonder when the supreme court draws from this narrow band of immediate prior experience whether we're missing something in terms of the court's ability to relate to some of the larger aspects of american life. whether if you get a former
appeals court judges, the court becomes more technocratic as opposed to those in times past. is this a danger? >> you were very delicate the way you phrased this. you have william howard taft who was a president. earl warren was a governor. then you. [laughter] i liked the beginning of the conversation better. it has to be enormously significant what you are saying. you have courts that were made up of governors, senators, people like felix frankfurter, different backgrounds. it might be accurate to say more prominent statesmen. it was an historical anomaly
before justice kagan you had a bench entirely people who had been on federal appeals courts before. that has to have an impact on the work. i do not know yet if it is a positive one or not. if you think the job of the supreme court is trying to apply law to particular cases, maybe it makes sense to have a court of judges. if you view it more in terms of playing a political role as part of the political process, maybe the way a constitutional court in european countries does, maybe it makes sense to have people who have been active in the political realms. it has to be saying something
about the role of the court in terms of what the makeup this. you see in the arguments as well. we have a very good bar. they present legal arguments. if you go back and look at briefs filed in the warren era, they paint with a broader brush in terms of social policy and concerns. it reflected the audience they were in front of. people can and should debate whether that is a good development or not. i think one consequence is it is probably a good development if you have a sense of what type of issues should be presented to the supreme court. a different sense of whether it is good or bad if you think different type of issues should be before the supreme court. it is all interrelated, the background of the justicies and
the issues presented. it is an interesting development people need to think about. >> having a broad experience in elective life or high public office is no guarantee one will be a successful justice. someone like hugo black was one of the great justices. there were two other senators with whom he served that i do not think anyone would say were great justices. it is hard to draw a correlation. >> if you have been a president or governor or senator, you have a particular way of looking at issues, matters of public policy. if you have been a judge on the court of appeals, you have a different way of looking at it. you have to decide what type of questions you think the court should be deciding and if they call for people who have one way
of looking at public policy as opposed to technocrats. i do not think that is the right word. but a more focused way of zeroing in on the law. you may think there is a mismatch between the type of questions the court is being asked to decide and the personnel that have to decide it. you can resolve the tension one way or another. it is not a coincidence or happenstance you have a court that looks so different from what it looked like in the past. >> one of my favorite parts of our conversations is to ask you i think it is one of the most fun parts for the membership. before we head off into the summer. we're all interested in getting relaxation and reading some good books and seeing some good movies. we're always interested in what
books you have been reading and what movies you might recommend. people are interested as to what we should put in our suitcase to take to the beach. what are you reading these days? >> i mentioned a little while ago we already have 45 cases set for the fall. [laughter] i do not want to be seen as endorsing any book. i picked one up the other day i have not begun to read. it had a very good review in "the wall street journal." of course i can not remember the author or the title. it is about the 20 most significant battles in world history. the author began with the romans carrying all the way through iraq. it looks nice.
it gives you 20 pages about the particular battle but an overview of the history in general of that time. that is what i will be reading on the plane. >> very good. are there questions from the audience? we're running short of time. we would be happy to take a question or two from the audience if you have one for the chief justice. >> good morning. my name is dana moore. i graduated from law school at a time when the women were scarce but the bourbon was plentiful. i have a suggestion that you read a book written by professor larry gibson from baltimore. he will give you a sense of what the path to greatness looks like and what makes for a great justice. >> thank you very much.
"young thurgood." i saw the one-person play and cannot remember the actor who did it. it was just called "thurgood." it was a spectacular performance. it was a one-person show that went through his life from youth until the end. it was changes a tone or posture that convey the notion of ongoing time. it was a wonderful, gripping performance. they were talking about turning it into an hbo-type show. and i hope that they do. >> do we have a final question for the chief justice?
>> you talked about a hot bench. what are the best ways for the lawyer at the podium to handle the bench effectively and be able to make his or her case? what would be the tips you would give that practitioner? >> it is difficult. you do have to try to keep track of the questions. i remember one case i was arguing. somebody would ask the question and somebody else would jump in before you could answer. a third one before you could answer. justice stevens asked me a question. before i could answer, one of his colleagues jumped in with another question. before i could answer that, another question. i have been told you should try to go back and catch up. i did. i answered the best i could the third one. then the second one. i was feeling very proud of myself and turned to justice
stevens and said i do not think i had an opportunity to answer your question. he had a very warm smile on his face. i was smiling back at him and realized i had forgotten completely what his question was. i mumbled something about the case and his smile faded. [laughter] the one thing you cannot do is show any type of impatience. i have found sometimes the most effective thing is to stop talking for a while instead of trying to get something in while everyone else is talking. if you stand there, the justices will realize there is somebody here who is supposed to be speaking who is waiting for us to get finished. if you are the lawyer and the
justices are bouncing questions off of you, if you do not play along, it is hard for them to keep it up. next term, there will be nothing but lawyers standing there saying nothing. [laughter] it is a challenge. it is worth trying different things. it is almost quietly scolding the bench for not giving the lawyer the time he or she deserves. it might be effective. >> may i ask that you remain seated while we adjourn the conference. may we also express our appreciation for the wonderful visit of the chief justice to the fourth circuit court of appeals. i cannot tell you what a pleasure and honor it is to have you with us. >> thank you. appreciate that. [applause] thank you. well done. thank you very much.
>> next a discussion about how much americans and foreign visitors spend on tour resumed. later, journalists talk about the future of medicare. and then a look at gun violence and mental illness and what current gun laws are like around the nation. tonight it discussion on computer hacking and information activism. we will hear about online surveillance by the government and why the government could be using a law from 1984 to prosecute whistleblowers. seeing in trends there is increasing government surveillance of us people, and
increasing corporate surveillance of us, and at the time, people who are exposing this are being were heavily prosecuted. i wanted to talk about that. and how people are being prosecuted is that the government is using this law faa, the computer fraud and abuse act, written in 1984, ironic for all the reasons you can imagine. written at a time before there are computers. broad. is incredibly it is frightening, really. almost anyone that touches a computer could be prosecuted under this law. it ever you come to a, a you click a, and terms of service agreement that you did not read and you do not
obey those exact terms, you probably have no idea what they are, you are in violation of the possibly facing five years in prison. if you share a netflix password, if you look at your friend's account, you face five years for every time you have done that. any of us could probably be prosecuted under this act, and we are not. who is prosecuted under the cfaa? we are seeing more and more that the government is using this act hackers, leaders, activists, and it is being used as a political weapon against information activists. >> a portion of a discussion that happened during the annual conference.
book tv in prime time continues tonight as we interview authors at 8:00. germanower discusses women in the nazi killing fields. then remarks from rick atkinson books onitten world war ii. next a discussion on how much americans and foreign visitors spend on travel and termism. this is about 40 minutes. host: last week the united states bureau of economic analysis released new statistics on travel and tourism spending in the first quarter of 2013.
in today's "america by the numbers" segment, we will take you through that report that was released last week with the euro of travel and tourism branch chief paul kern and david heuther of the u.s. travel association. mr. kern, let's start with you. in the first quarter 2013, how did the travel and tourism industry fare compared to the of the economy? guest: sure, thanks. travel and tourism grew 6.8% in the first quarter of 2013 from 2.1% in the fourth. just to compare the growth rate of the overall economy, it was 1.8% in the first quarter. in the fourth quarter, 0.4. it was robust growth. it was concentrated in one particular industry, air transportation. and that is a little bit of a surprise, because generally the first quarter for air transportation is quite mild. so, we are in the heat of the travel season now, but we're talking about estimates for january, february, and march.
not necessarily great travel time, yet the airlines were able to manage very robust growth. host: let's put it in terms of dollars, if you could. here is a chart that the bureau of economic analysis put out showing in the first quarter of 2013 $718.7 billion -- is that correct? guest: that is. a large amount of money. this is showing what we call the direct spending on travel and tourism. that is you purchasing your airline tickets to fly to visit friends or relatives. there is also secondary spending on travel and tourism, which would bring the figure up quite a bit. another level of the estimates. so, in other words, in order for
that plane to fly, we need to put fuel in the plane, so that fuel purchase by the airline is also a travel and tourism expenditure, but in this particular chart, we are not showing that. host: david heuther, why this uptick? guest: i think there are two reasons. one is that the inflation rate and the travel sector has been relatively modest recently. travel prices are only up about 1.1% over the past year. as a result, we estimate right now that americans are going to take over 2 billion trips this year, which is a record high. so, the fact that the inflation rate is low, travel is affordable, people are taking a lot of trips. that is one factor. but the more important factor is international visitations to the united states -- a lot of people do not think of travel as necessarily an export. but when you have overseas visitors coming to the united states, spending money in the united states, that is an export.
just as if someone selling a boeing airplane to lufthansa is an export. through may of this year -- because the travel data form a tame out a couple of days ago -- travel exports are up close to 8% this year compared to the first five months of last year. it accounted for about 30% of the overall u.s. export growth in the past year. visitation to the united states is very strong. that is helping support the travel industry. host: in this segment we are taking your calls and thoughts and comments and questions about panels of experts here on u.s. travel and tourism. but we also want to hear how your tourism plans have changed in the current economy. give us a ring. we split up our phone lines regionally, eastern and central time zones --
host: we have a separate line for folks who work in the travel industry, wanted to see are seeing on the ground -- mr. kern, as we go through the numbers, give us some definitions. how do you define tourism for your purposes? guest: we are talking about travel and tourism. the reason why we use both of the terms is that business travel is an important component of travel and tourism. so, if we just say tourism, we tend to want to exclude the business traveler. if we actually go to slide 8, that way we can continue david's point and we can look at international visitors coming into the u.s. host: go for it.
guest: we hit a record this year of 67 million. that is 4 million more than in 2012. and we have very good data on where they are coming from. not a surprise that canada is our largest source of inbound tourism. mexico is second. however, there are a few countries that might be a little bit of surprise. brazil coming in at number six. china, seven. south korea, ninth. host: david heuther, what surprised you about the numbers? is this what the travel industry has been experiencing recently? guest: yes, we have seen the numbers jump up pretty significantly the last few years. it may be a surprise to some viewers who are not in the travel industry that you see brazil or china or south korea. but the visitations from those three countries as well as the developing economies in general as their middle class is
becoming stronger and stronger and growing have really been a source of significant growth for the travel industry. when these visitors come to the united states, they spend a lot of money. when the brazilians come here, on average they spend $5,000 in the united states on the trip. when you look at a chinese traveler in the united states, they spend more than $6,000. one of the reasons for that is that a lot of the costs of consumer goods are actually lower in the united states than they are for a lot of our trading partners. so a lot of international visitors come here, spend money, go to the national parks, go shopping, and they inject a lot of money into the u.s. economy. host: some spend less in terms of their representation, number of visitors. mexico, 14.5 million visitors in 2012 into the united states but it ranks fourth behind the united kingdom and japan in terms of dollars spent.
we can show you that chart as well, who is spending how much during their visits. guest: one of the reasons is you have canadian and mexican travelers who are daytrippers, not spending multiple days. so, on average their spending is going to be a little less than if you are traveling from australia or from china, where if you come here -- your first trip to united states, maybe ever possibly, you will spend several weeks here. you are spending a lot more more time here and spending more money. guest: slight counterintuitive. visits from european countries have declined recently, and that is quite logical given the economic situation that europeans have been facing. so, their outbound travel to the united states has dropped off a little. but these other countries have certainly made up.
host: canadians spending the most by far, followed by the japanese at over $15 billion. then folks from the united kingdom, over $10 billion, and in mexico right at $10 billion and then on down the line. if folks want to follow along with these numbers, are these charts posted on the website? guest: these charts -- this particular chart would not be on the bea website but on the ita website, international trade administration, which is part of the department of commerce. host: where can folks get them if they want to see your recent report? guest: bea.gov. host: we want to see how your travel plans have changed and tourism with the economy. chip from juneau, alaska. you are on with paul kern from the bureau of economic analysis and david heuther from the u.s. travel association. caller: thank you so much. i am calling from alaska.
the cruise ship industry has completely replaced the timber industry as far as the viable industry here in alaska. unfortunately, the timber industry never paid any taxes and the cruise industry does not, either, u.s. taxes. i am wondering why the cruise industry industry is able to avoid u.s. taxes. thank you. host: mr. heuther, is that for you? guest: some of that is because the activity takes place outside of the united states, sometimes the taxes are generated in the united states. but in general, the travel industry generates a lot of taxes. not just federal government but also, equally important, for state and local employers. if you have a traveler coming from more than 50 miles away -- could be from out of state -- and they are coming in and spending money spending money at
your local restaurants, hotels, etc., they are paying taxes and the taxes can be used by the state and local governments to support services. in fact, if you look last year at the amount of state and local taxes that travelers generated, it was enough to cover all of the police officers and all of the firefighters nationally. the travel industry generates a lot of taxes for state and local municipalities. guest: one point to improve upon that answer, the cruise ship industry, as they add a foreign itinerary to their cruise, they go to three places and one outside the united states, i believe the tax burden is reduced dramatically. those taxes can be used by the state and local governments host: we are taking
your calls. give us a ring. we want to hear how your trips have changed in the current economy. david from florida. . thanks for the topic. i live in central florida. i was impacted by tourism coming into our area. one of the questions i have is the foreigners that come here and they spend a lot of money buying merchandise and things
here and taking them back, do you have any concerns over the impact that nsa tracking will have on visitors coming in? in the past, they kind of looked to the united states freely to make the purchases freely without being tracked. now that information is obviously being tracked. do you think people will be more concerned about being so free in the united states? guest: i am not an expert right now. what i would say is that one of the things the united states has going for it in terms of international travel is we are recognized internationally as a top destination with world-class attractions, shopping
activities, national parks, etc. at the same time, the value of the dollar right now is very competitive. it is about 12% or so below its long-term average. international buyers have a lot of spending power. that is why you are seeing international travel in the united states to be growing at a very robust rate while other has moderated a bit. travel exports have the last three years roaming in double- digit rates which is what happened in more than three decades. we are in a really good place right now. i think because we have a very robust infrastructure in the united states, it allows international travelers to move to different states. that is an advantage that we have. it will continue to make travel
a very strong destination. host: take us through how the value of the u.s. dollar affects us. guest: this shows is the value of the u.s. dollar. the blue line. it is representative of the average. the gold line is the growth in travel and tourism. in particular, where we have these lines, what we're pointing you to is a timeframe when the dollar was declining and the travel and tourism was actually spiking, and the u.s. economy was actually quite flat during this time. what we see, we peel back and look at the numbers of inbound tourists which we show on a prior chart, you can see the spike in the number of individuals coming to the united states basically saying for themselves looking at the world and saying my currency will do very well when i go to the united states. i will be able to stay in nicer hotels. eat at a nice restaurant. they came in large numbers. host: we have seen spiking since
about mid 2012 even as the value of the dollar has gone down and then gone back up? guest: correct. it has continued into the recent timeframe. if we look at the prior slide, we can show you what travel and tourism does does to our deficit. everyone talks about the trade deficit and that it is large and negative. what may not be well-known or as one that is the travel and tourism does a very good job of reducing that total deficit. currently is about $46 billion that travel and tourism generates in surplus. host: the gold line is showing
guest: that is us spending our dollars. the blue line is coming here and spending their currencies. the difference between the two is the travel and tourism trade surplus. host: how many billions? guest: $46 billion in 2012. host: we are taking your calls and want to hear how your travel plans have changed. louisiana, good morning. caller: good morning. [indiscernible] i could not help but see there were no african countries or africa as a group. are african countries spending in the united states not tracked? i will take my answer off-line.
guest: it is tracked, it is not showing up on this chart, literally for space reasons. host: the top 10? guest: correct. guest: i think the top international spender in the united states from africa i believe is south africa. i think that is the highest. the other thing i want to highlight about the inbound tourism versus outbound tourism, it is not that americans aren't going overseas and traveling. in fact, last year, more americans actually went overseas than international people came to the united states. the difference is, when the international people are coming to the united states, they are spending a lot more money in the united states than when americans go and travel overseas. if you look at how much
americans go to china, it is around $1200. when the chinese come here, they spend $6,000. one of the reasons for that is a mentioned earlier, in general the price of consumer goods are much lower here in the united states than our competitors. host: a question for you, david heuther. which states get the most tourists? guest: you can look at it two ways. you could look at it in terms of how many workers in different states are employed by travel and tourism. as you expect, the top states are florida, texas, new york, nevada certainly. illinois is also the top area. host: california, not canada? guest: california.
what share of the private-sector workforce is employed with the travel industry? the number one state is hawaii. more than a third are employed by travel and tourism. nevada, wyoming, alaska, mississippi where more than 10% of workers, private sector in the state, are employed because of travelers going there. you are looking at california and texas, new york, etc. a lot of mountain states depend on tourism significantly as well. host: bob is waiting from lake worth, florida. good morning to you. you are on with paul kern and david heuther. caller: i had a few questions to try to weed out statistics.
i noticed that canada was spending $25 a day per capita of expenses, whereas mexico was only spending $10 a day. they were down to number four. i was wondering since we are those statistics compiled for the traffic for goods for trade from either mexico or from canada coming into the united states as far as trucks? the second thing was, i was wondering if you were adding on a per capita basis for expenditures, whether that was what we consider immigration for workers that are over here with visas or college students that are going to college. i was wondering if that was factored into it as well?
host: stay on the line and let mr. kern answer. guest: if someone is coming to the united states and they will be compensated at the location, they are excluded to the greatest extent possible from the statistics that you see here. your other question, we are not including trade other than tourism trade. i think you mentioned a truck coming in with logs. that is certainly foreign trade but it is not tourism foreign trade. that again would also be excluded. a trucker coming up from mexico, certainly, if he spends money, that expenditure would not be in these statistics. host: how would your tourism travel plans change with the economy in recent years?
caller: i think what happened was, after that 9/11, we had a real drop-off with grounded planes. the biggest thing was to get confidence to get back in the air. it was a little dicey. there were some old men over in newark airport in new jersey. the thing that was happening is they were making everybody take their shoes off. people that have some weight on them or were a little older, it was hard to bend over and put your shoes on. we advocated putting in shoe horns. we still have the lines, but what i am seeing in the last four or five years is your price point right now. i think the people are shopping a little harder as far as the
fares goes. they are still traveling, but they are buying their tickets two and three months ahead of time so they can get the biggest bang for their buck. passenger travel and some of the challenges that industry has faced? guest: post-9/11, there was an impact on the travel industry. we saw it the mystically and internationally were the share of inbound travel felt significantly for a number of years. it bottomed out around 2010 or so going from 17% of global long-haul travel down to around 12% or so. the last couple of years we have seen it come back a bit. in terms of issues to air travel, one of the things we have seen is in you look at wait
times that have been in place when you have international visitors coming to the united states, sometimes they can be overwhelmed and wait times can be quite long. one of the things we will advocate is to have increased funding for those agencies to increase personnel to reduce wait times and get international people into the united states. there can be sometimes negative effects if you have really long wait times. that word can get back to international potential travelers and they may decide not to come to the united states. they may decide wait times will long am able i will go to a competitor. it is an issue i think that we have been working with the government to resolve.
host: you are at the u.s. travel association. how many people are a part of it? guest: about 60 or 70 people. we have around 3000 or 4000 members. we represent all assets of the travel industry. we have hotels, attractions, state tourism directors. we have convention and business bureaus. the whole span of the travel industry makes up our membership. host: paul kern is with the bureau of economic analysis. he helped put together this report. he is a branch chief for the travel and tourism branch. we are talking about passenger air travel. if you can take us through some of the recent numbers. guest: sure. if we look at this chart on the screen, in the first quarter of 2013, we see the gold bar that is very tall, 19%. host: that is air travel? guest: that is air travel. the red is hotels or travel accommodations.
host: what is the blue bar? guest: all tourism goods and services. host: it jumped up by 7%? guest: right. the primary conservator to the growth was the 19% jump in air transportation. host: coming off a time when it was following just at the end we of 2012? guest: correct. the prior quarters you had negative growth in air transportation. as i mentioned earlier, the first quarter points that we are looking at is not generally the best time to generate a lot of revenue and a lot of income for their employees. it did happen. we look at the individual airlines as they talk about the quarter, and some detail within they saw an acceleration in january and february. they saw a slight soft patch in march. we were expecting to see a bit more of a slowdown because of
the sequester. average airline government travel makes up 3%, 4%, or 5%, which is not huge but certainly significant if we look at a quarter where things are generally quiet. but we saw a large growth rate. what we saw international routes to london, they were seeing significant increase in travelers. host: we are taking your calls and we want to hear about your tourism and travel plans and how they have changed in recent years. phone lines, we are doing regionally. host: tim is from florida.
good morning to you. caller: good morning. can you tell me to the extent that pricing and airline tickets are factored into growth in the industry when, for example, i bought a ticket to europe recently and it said it was about $800 and the taxes fees, which i believe they were $690. that came in after 9/11 and this is is not your area. this is a result of us antagonizing people around the world and standing in line would buy an airline ticket. my question is, to what extent was the growth in the industry you are discussing include the taxes and fees which are about the same price as the airline ticket at least with respect to international tickets? host: mr. kern? guest: my assumption is the $700
primarily was a fuel surcharge. on trips to europe, you will see the ticket price be one item and then the fuel surcharge can be significant if the price of fuel has risen. it is actually gone down slightly recently. that should be helpful for people buying tickets in the near future. of course, as the world is seeing changes, the price of jet fuel -- it is difficult to say what is going to happen. i am certainly not going to say what would happen. my guess is, if the caller looks of some of the fine print on that ticket, it will tell you that it was a fuel surcharge primarily as well as taxes. when a plane lands at an airport when a plane lands at an airport in europe, that airport has to charge a fee in order to support the airport. that fee is generally passed on to passengers. host: david heuther if you can answer this question from
twitter on world events and how the impact the tourism industry. how much european tourism might have gone to egypt cultural sites instead of national parks in the wake of ongoing issues that egypt is having? guest: you have seen for several countries, such as the uk, visitation to egypt in the last couple of years has increased rather significantly. i think in general, if you're looking at the uk and european countries and where they will travel internationally, i think one of the things you have is that the united states has an advantage of is that we are a fairly safe and stable place to visit. that is the one of the reasons why we have had fairly significant increase going forward. we're a modern economy with modern amenities in a world class travel infrastructure.
host: florida tourism depends on not having a storm, correct? guest: that is correct. sometimes there are natural events that have a temporary negative effect. one of the amazing things that happened after the gulf oil spill is that visitation back to the gulf states in terms of tourism rebounded very significantly very quickly. u see that tourism, while it can be negative affected due to a anatural disaster is one of the areas that also can come back the quickest. if you go nationally and you look at employment levels in travel and tourism, what we have seen is that after declining during the recession, the travel industry has generated jobs at about 15% faster clip than the rest of the economy to date through may of this year.
i don't -- i know the employment numbers came out early this morning. the travel industry has made up close to 90% of the jobs lost in the great recession. i feel fairly strongly that by the end of this year, maybe early part of next year, the travel and tourism employment will reach an all-time high. guest: i did a little research this morning in egypt travel and tourism. it is making up about 11% of their gdp. that gets to the point of the caller. it is very important that egypt continue that ability to bring in international visitors to see some of those historic sites. that makes up a very large portion of the gdp. in the united states, our economy is quite diverse and travel and tourism makes up just under 3%.
that is still a large amount of money. host: david heuther brought up the labor statistics numbers that were just released. the nonfarm payroll increased by 195,000 in june. unemployment was unchanged at 7.6% specifically in the leisure and hospitalality sector. this is according to a report that is out today. 75,000 jobs were added in june. monthly growth has averaged 55,000, almost twice the average in 2012. within leisure and hospitalality and food services, and drinks places continued to expand in june. employment and gambling also continued to trend up in june at 19,000 more. jane is waiting from new york. good morning. aller: good morning and they -- thank you for taking my
call. first of all, i would like to make comment. the comment is, it is nice that other people from other countries can come visit us and spend their money. we need their money. ok. now, what i need to say is, as far as i am concerned, the only way i can travel is by car. all right, i own a timeshare down in orlando, florida. i have not been able to use that timeshare since 2008. i cannot afford the gas to go down. just a little bit before that, i was able to get down to florida, but i could not spend money in the stores and somewhat. you know, as far as the tourism part thing goes and can be people employed. i did not have enough money because gas was going up. i don't know if you guys are telling our government this information, but they need to know. we, the people of the united
states, are not able to travel - at least not the ones that have decent amount of money to spend on travel. host: david heuther is with the u.s. travel association. guest: she is not alone when she says she travels by car. about 77% of trips taken are taken by alto. -- auto. half the trips are taken within their own state. another half are taken to states within the region or in other regions. a lot of travel is relatively close to where people are traveling from. i think that if you look at the impact of gasoline prices, there is a positive and negative story. the positive side is that gas prices have been fairly modest recently.
i think that has been a boom to the travel industry. when you have higher gas prices and people are going to go on trips, then if they only have so much money to spend, they're going to spend -- shorten their trip or spend less on amenities r shopping, etc. we look at what the tipping point is in terms of when gas prices get too high and when do they affect travel. right now, our estimates are in excess of $5 a gallon. right now, i think that we are in good shape to grow this year because the price of gasoline is fairly modest compared to some of the prices we have seen in recent years. guest: correct. our statistics show that it did decline 8% in the first quarter given what we have seen in the news recently, it is unknown what would happen to that price moving forward but in this first quarter, there was an 8% decline. host: we have a special line set up for folks who work in
the travel and tourism industry. good morning, norman. caller: good morning and thank you for taking my call. i am excited because i just oined the travel industry. i am working closely together with the gentleman, david siegel, here in orlando. tourism is very big here, the house of minnie mouse, mickey mouse and shamu. we are excited and noticing that resorts are offering hotel room rates at hotel prices. my question is, is that a smart way to go? is this the right time to do that? thank you for taking my all. guest: i think you were talking about a package deal with the
hotel and the resort. that is a fairly common business practice. i know it has been growing recently where you enter into this package deal that even sometimes includes your airfare. that has generally been a positive thing for the travel industry, from what i understand. host: are these deals leading to the growth we are seeing? guest: one of the things you're saying, a lot of times, the travel industry, it's a people industry. they thrive when there are more visitors coming to destinations. one of the things you see -- when you see spikes in gasoline prices, what you see is the industry will try to offset that by trying to bundle goods and services to make things less expensive to encourage visitors to come. the travel industry is a very innovative in that way. host: newark delaware.
good morning, nina. caller: actually, i am calling in from west chester, pennsylvania. have two questions. tourists who are applying from overseas to come to the united states -- this has created a huge hindrance and preventing trem from coming to the u.s. asia rists from seize countries would like to come to disney world, for example. what the government is doing is having them fill out an application which is like rning over your entire property and mortgages. we're asking for a very unrelated questions. not only that, when these families are finally given the
visa after a very long application process, they give the father and one child a visa and the wife and two of the children are refused the visa. host: if you want to take this quickly in the less than a minute we have left. guest: that is an interesting question. if you went back three or four years ago, the length of time it took to get a visa from china, india, brazil, was weeks and months long. we have been working with the state department to encourage them to increase personnel, et cetera. the wait times and some of these high-volume countries have fallen dramatically and due to increased staffing in these particular areas. more needs to be done. i think we need to have more offices to encourage more people to come here. it is a stimulus plan that does not cost any money. we're getting international people here and they're jobs. ing american
host: breach you both coming on today. >> thank you. >> we'll hear about online surveillance by the government and corporations and why the government could be using a law from 1984 to prosecute whistle blowers. it is hosted by the group left forum. you can see it tonight at 8:00 eastern here on espn. -- c-span. >> one of the points we make in this book is a perennial question, did it make any difference to have unpopular elections? we come down on the side, yes, it did make a difference. senators started to act like housemembers which is not something any senator wants to hear. it means they were out scavenging for votes. they had to actually go out and deal with the people as opposed to if you got a state
legislature and 26 members of your state senate, all you need is 14 votes and you can easily pay off and they did indeed in some cases pay off 14 senators, paying off their mortgages in a couple of know tore i don't see cases to buy their election. >> more with historian emeritus of the u.s. senate, richard baker, sunday night at 8:00 on c-span's q & a. congress is away on its fourth of july break this week. when the house returns next week, immigration legs will be talked about. in the senate, lawmakers are expected to take up the issue of student loan rates which doubled on july 1 from 3.4 to 6.8%. for the rest of the month, the house and senate will likely devote time to the annual spending bills that fund the federal government. the agriculture spending bill is ready for house floor action
and the senate appropriations committee has completed work on four of the 12 bills. both chambers return for legislative work on monday at 2:00 p.m. eastern. >> a discussion between two journalists who consider the future of medicare and whether it's a future for inflated medical prices. they spoke at the manhattan institute for just over an our. >> good evening. please take your seats. my name is paul howard and i'm a senior fellow and director of the manhattan institute center of medical progress. i'll be moderating our discussion this evening. prices are the most transparent and most important part of any
well functioning market and then there is health care. prices and health care are opaque, by incident teen and only -- byzinti nerve and visible to the people using the system, the patients. prices vary widely from one provider to another, for similar patients with spectacular conditions, not just in the same state or city, but across the street from each other. this even we brought together two of america's leading health care policy writers and analysts to explain why hospital pricing and by extension all health care pricing is so dysfunctional and what we can do about it. steven brill, to my right, kicked off this debate in a recent and very widely read article for "time magazine" where he deviled deeply into the absurd charge mast e-with a system as incomprehensible,
absurd, charged the highest prices to people the least able to pay them, the uninsured. steven pointed out from his point of view, the only force with pricing was medicare. it gares wide access, low cost and seemingly high quality care for medicare beneficiaries. let medicare do more what it already does well, he thinks, and we can bring more sanity to the system and save patients a lot of headache and empens. a rebuttal published by the war post-, david goldhill says he has it backward. our system is dysfunctional because medicare distorts prices in ways that produce perverse outcomes for patients and payers alike. let me introduce both of our speakers before i begin. steven brill is the founder of journalist online, for journalism to flourish on line. he is a writer. he founded the yale journalism
initiative which recruits and trains journalists. he is the author of most recently class warfare, inside the fight to fix america's schools, after how america confronted the september 12 era and the teamsters. he is a graduate of yale, a journalism school and yale law school. david goldhill is the president and chief executive officer of the game show network which operates a u.s. cable television network seen in more than 75 million homes. it is one of the world's largest digital games company. he is a member of the board of directors of the leapfrog group, an employer sponsor organization dedicated to hospital safety and transparency. he is the author of catastrophic care, how american health care killed my father and how we can fix it. he graduated from harvard university with a b.a. in history and he also holds a masters in history from new york university. to start off our discussion this evening, i'm going to ask both of our speakers, beginning with david and then going to
steven based on a coin flip, to state in four to five minutes for those in the audience who may not have been following the discussion very closely, you're not familiar with their works, what the central arguments are for why health care is so dysfunctional and whether or not medicare is the solution for those dysfunctions. let's start with steven. >> i start with me. >> start with you. >> first of all, i think that coin flip should be two out of three, but i'll start away. paul, thank you and thanks -- >> the game show. >> it would be more drama, i think. thanks to manhattan institute for hosting us tonight and steven. it's great fun to have this conversation with you and thanks for joining. as many people in the audience know, in 1965, medicare and medicaid were enacted. coincidently in that year, a debt company introduced the first nonmainframe company. it was the p.c.p. 8. it cost a mere $19,000 which
was a tremendous amount of money in 1965. in fact, to give you some idea of you how tremendous it was, the average american spent just about $200 on health care that year. let's fast forward a bit. the let's fast forward to today. everybody in this room is carrying a box much smaller, much more powerful than that p.c.p. 8. there is a billion and a half smart phones oneth at an average cost of $235. they are 1/40 of the amount americans will spend on health care today. why does that matter? well, in 1965, you would have thought that computers were the most complex, opaque impossible product to ever imagine ever person on earth carrying and picking on the basis of color and how good the camera was. in 1965, you would have seen health care as the most personal service oneth and in some ways, the most important.
it would have been inconceivable that the average person would carry something 1/40 the cost of health care without all of us having gotten computer science p.h.d.s. so what happened? well, one of the things that happened i think was pointed out truly brilliantly by my counterpart tonight in his article in "time magazine." we have a nonfunctioning price system in health care. it's very important, i think, to understand to me what is the most interesting thing about steve's article, it makes the point these are prices, not costs. they're not based on a major cal thing. they're what people charge for services. they often make no sense. i'm going to argue tonight that health care seems to bring out the inner part of all of us. it gets us too close. we look at one aspect of health care and see it as so incredibly broken, because everything in health care is so incredibly broken that we attribute too much to that particular thing. i'm going to argue that when you step back and compare what has happened in health care over the last 50 years to what
has happened in everything else, what you're going to see is that the reason health care has gotten unbelievably empensive while at the same time having inadequate or erratic access, erratic quality, terrible service, an enormous amount of slop nest and true complexity so the average person can't understand the system at all and the most complex product on earth was cheap and easily accessible, they were following the incentives that underlie their businesses. in computers like in every other business, you make more money by making it cheaper, better, easier to use, more accessible, more consumer friendly. in health care, you make more money by making it more expensive, by not controlling quality or quantity and by underinvesting in service. i'm going to argue that medicare is central to that. that, yes, medicare has lower prices than private insurance,
but the flip side of it, it encourages excess care leading to medical harm, a completely undisciplined health care system that has medicalized senior citizens and very much undermined the health care economy. i'm going to argue this is not just a matter of money, which is often the way we talk about it. the quality of care, the type of care and the reliability of care. unlike in computers, i'm going to argue in health care we failed to take advantage of the fundamental changes in care, in technology, in communication of information to make health care better, cheaper, and ubiquitous, which was the real opportunity of the last five decades. >> thanks. actually, i'm not going to argue anything, i don't think. i will just viscerally dispute the notion that a smartphone or a game device that you carry on your hip is more complex than medical care. let's save that for another time. i also will argue that if you
look at the various players and compare them, there is one, there are all kinds of easy comparisons. it costs the typical health insurance company, private health insurance company $28 to process a claim. it costs medicare 84 cents to process a claim. by every measure medicare is much more efficient, but let's come back to that. i guess the place i like to start is how i got into this in the first place. contrary to your flattering introduction, i am hardly the foremost analyst about health care policy. my experience extends to this article. i approached it with no preconceptions, certainly no preconceptions of the kind that i came out with. i guess i should confess in the
manhattan institute setting, if i had any preconceptions, they were sort of like the conclusion i reached when i wrote a book about the education reform movement. and the parallel there is that the public education in the united states costs much more than it does anywhere else and the results are no better and, in fact, a lot worse. the same thing with health care. so i was thinking when i went into this, maybe it's the unions which is the culprit in public education and maybe i could wry an article that the manhattan institute would cheer about the way they did when i wrote about the rubber room and about education reform, but i have failed. [laughter] >> and the reason i failed is that the way i decided to approach this was not from any kind of political perspective, but just by following the money. during the debate about the president's health care reforms and all of the debates about health care, what i was frustrated by was the debate
was all about who is going to pay the exorbitant cost of health care in the united states? how do we had shift the risk? what kind of insurance and who is going to pay the very high cost? the parallel is the debates we see about, oh, my god, you have a terminal patient and the last six months of life is going to cost $1 million. is it worth the $1 million to keep that patient alive for six months? i hear those debates and i say, well, how come it's $1 million? if that was a $50,000 debate, it would be a different kind of debate. so how do i approach it? i decided to follow the money and just take a bunch of bills and see why things cost so much. now, again, my suspicion was not where i came out. where i came out was that, i mean, this is where i'll happily agree with david, where i came out is there is no
market. the mission i think of the institute's health care policy is to connect the marketplace to health care. guess what, that just hasn't happened, not going to happen. the reason it can't happen is unlike everything else, accept in certain instances, maybe plastic surgery, maybe lasik care, nobody really volunteers to be a customer. and when they become a customer, nobody has the information, as david points out, and nobody has the leverage. you don't wake up one morning and say, gee, i think i'll wander down to the emergency room and see what they have on sale today and sort of check out the doctors and see what they're going to charge me for and how much my hurens -- that does not happen. it is not a voluntary marketplace and a marketplace that is not voluntary, is not a marketplace by anybody's definition of the term. let's take the first bill that
i found. here is a man who was diagnosed with nonhodgkins's lymphoma. and his wife decided that he needed to get to the m.d. anderson center in houston. her father had been there and had been treated very well there, prolonged his life. it's a fabulous place with fabulous care. so when they arrive, he is told that the insurance he has, he had insurance, he had started a small business, he had insurance. he had, by david's measure, a lot of skin in the game, however, because his insurance, it turns out limited him to coverage of $2,000 per day at the hospital. now, they won't even weigh you at m.d. anderson for $2,000. so m.d. anderson said we don't take that insurance, you got to pay us in advance. just to decided what your treatment regimen is going to be is going to cost you $45,000
and they have to write a check for $45,000. then your first dose of your treatment, the first transfusion is an additional $39,000. they had to hit their credit card for $39,000. when the credit card didn't go through, he was kept downstairs sweating and nervous and upset. he had a tumor growing in his chest. everybody knew this. they told them you need this urgently and he had to wait for the check to clear. $84,000, if i remember my math. now in that bill was a $13,700 charge for the transfusion, and when i followed the money, i found out that m.d. anderson pays approximately $3,500 for that. the drug company that makes that drug, it cost them maybe $300. now, there was some other things.
there was a $77 charge for a box of gauze pads. when you follow that money and as i did this with all of the patients, there was a patient who had some chest pains and she thought she was having a hard attack in stanford, connecticut, two hours and $21,000 later, she left the emergency room, her health insurance had lapsed. it turns out when you follow the money in stamford, connecticut, as many other places around the country, in fact most places, the local hospital is the biggest employer, the most prosperous business. in stanford, it's the biggest business than the city itself. it takes in more revenue than the city of stanford takes in in all of their taxes. what i found in this alter mat universe, except for the doctors and nurses, making all kinds of money. the exception happened to be
medicare where the problem wasn't that they were overpaying, the problem was, if anything, and i'll agree with david on this, a lot of medicare patients are underpaying because they have very little cost if they have a supplemental program and, therefore, they just keep going to doctors even if they don't really, really need to. so i had one patient who had $350,000 worth of bills one year. a lot of it was for serious stuff. he had cancer. he had a heart attack. a lot of it was to get a bunion removed or to go an eye exam, i think two or three times that year. the bunion cost him 19 cents. it cost medicare even with their discounts over $60. that's the kind of thing we have to correct with means testing. so i don't look at this as a right issue or a left issue. you really have to look at it down the middle. there should be means testing for medicare.
god knows there should be medical malpractice reform, which, if anything, will take away from hospitals the excuse of overtesting people with cat scans and everything else with exorbitant rates. but medicare works. medicare pays the right prices and anyone that thinks that hospitals lose money on medicare needs to just drive on any highway in florida and look at the billboards for all of the ads for all of the hospitals that are advertising how they have expanded. they have new services. who are they advertising for in florida? they're advertising for medicare patients. they make money on medicare. medicare is efficient. it works. and by the way, this actually, you'll like this, most of medicare is the private sector. medicare has 8,000 private sector employees who are contracted out and maybe 700 of
their people who supervise it actually work for the government. so i will stop there. >> i'm just going to do a couple of follow-up questions before we open it up to the floor. i think the big point of contention here is exactly how efficient is medicare, what role does it play in the system that you see it play since steve wrapped up, david, let me let you respond. >> let me stick with that. a couple of things i would love to talk about. i'm sure we'll have time. steve's last point, medicare, in fact, does rely on private contractors to process its claims. it relies on several private insurance companies. doesn't it seem strange that it would cost medicare so much less to contract out, to have a claim filled than the contractor would pay for their own claims? why is that? >> you want me to tell you? >> let me actually -- >> i have been a contractor, right. i run a business.
when you contract out something like ad sales, the guy who is contracting to you always gets the worst deal, right. you give yourself a better deal with your own ad sales. why is it that a blue cross would charge medicare so much less for processing a claim than it costs itself? well, the difference is and what we need to understand about the health care economy is that medicare, medicaid, private insurance are fundamentally different payments that encourage different business models. steve and i are in complete agreement that hospitals make money on medicare patients. you know who disagrees with that is medicare. medicare has reported that hospitals lose money on patients, inpatient and outpatient for eight years in a row. let's go back to why the difference in processing costs are so different. what private insurers do -- no ne wants to hear me. what private insurers do, they do very careful analysis in claims they engage in high price, low volume.
medicare is a public and political body that is supposed to show low prices. what does it do? it pays for everything in an undiscriminating way at what seems like very low prices. if you're a hospital, a medicare patient means excess diagnosis, diagnosis creep, excess treatment. and low prices. mcdonald's makes tons of money under that model. so do hospitals. medicare just looks better because the prices it pays look less, but the amount of treatment it pays for is so excessive. from the point of view of a private institution, it's a great business. >> well, first of all, just for the record, the head of medicare who i quote in the article is the one who says that hospitals make money on medicare. let me tell you a story about the efficiency of insurance companies. i probably in some ways don't need to tell any of you about the efficiency of insurance
companies if you have tried to call one in terms of customer service. let's take another example. one of the patients i left out, if you can believe it, this ok.cle is actually cut, ne of the examples that i took out was the example of a dr. waba in new jersey, in passaic, new jersey. dr. waba sometime in 2010 decided he wanted to go out of aetna's network and work on his own. he changed his rates that day from $350 for a half hour of treatment -- he was working in the emergency room at the passaic hospital. he changed his rates from $350 to $10,000 for a half hour of treatment. you know, inflation, everything, rates go up. so a patient, an aetna patient shows up in the emergency room
with a horrible respiratory illness, pneumonia, the patient ultimately dies and dr. waba bills aetna for that patient, i'm forgetting the numbers, something like $410,000 over a six-week period and in fact dr. waba bills aetna something like $3 million over a 10-year period. aetna pays the bills. this is your efficient insurance company. they pay the bill. i'm on the phone with aetna's lawyer and their spokesman and they're explaining this to me. now they're in court, which is how i know about this and suing to get dr. waba's money back. i say, listen, i just have one question, something is bothering me about this. if i submit a claim to aetna for $58, they send it back for $42 and then i can't get someone on the phone, how did you pay dr. waba $3 million for 10 patients in six months? how did that work? well, we can't look at every
claim. yeah, i guess that's true. couldn't you do something in your computer system so that like a bell goes off in the office if it's more than $1,000 for a half hour of a doctor's time and then you would have seen dr. waba? well, we haven't been able to do that yet. now medicare -- let me finish. medicare has -- i spent a lot of time at medicare, maybe one of the few reporters who is interested enough in digging into the bowels of a much maligned bureaucracy and they have terrific computer systems all designed and run by the private sector that aetna and the other insurance companies don't have and they are really good at it. i'm sorry, i know that sounds wrong. this is the yale club, so i won't get kicked out. if it was your building, i would get kicked out. they really do it well. i actually did the reporting, you didn't.
>> you misunderstand my point. medicare is $54 billion a year in proper payments. i can make a bank look really efficient by firing all of the security guards. i really need to put in the cost of robberies. medicare is being robbed blind. so the fact that it can process a piece of paper quickly is irrelevant. i am not claiming private insurance -- >> where are you get $54 billion number? >> it's c.m.s.'s number. >> no, it's not. >> well -- in fairness it's medicare and medicaid, it's c.m.s. total. >> oh, total. >> it adds 9% to their cost. >> medicare and medicaid, it's or $7. of every $6 i'm not saying that medicare is inefficient compared to private insurance. your point is they're more efficient than private insurance. my point is these are different businesses. medicare is in the business of saying yes to everything. that's what the politicians want, there are no real limits
on care. medicare says we will pay for all health care people need. that has caused a massive inflation in need. a lot of that need is medically harmful. the idea that they efficiently pay for excess care, to me is inefficient on its face. private insurance, you're absolutely right. customer service is terrible. their control of prices is terrible. again, the private business isn't the insurance business. it marks up the price of care and sells it to private companies. >> here is where we can agree. i agree with you that there ought to be a federal reg that says for supplementing -- supplemental insurance for medicare, you can't sell insurance so that people who are above the poverty level don't have at least x percent of skin in the game so that they will care about that and they'll worry about their excess care. second, you could argue that
there are all kinds of abuse of payments, but let's put this in perspective. medicare has a zillion different strike forces, task forces, inspectors general that catch this stuff. if you talk to doctors and talk o hospitals, honest hospitals, honest doctors, they will say that medicare can be a real big pain when they do an audit. when you're spending that much money, yes, you're going to get all kinds of abuse, but the solution that i thought i heard you say when we were on a television show recently was that people should just have total skin in the game, that if i had to pay for everything myself, i would be much more efficient about it, that doesn't work because i don't know what i'm paying for. i have no idea and i have no leverage in the marketplace. getting rid of medicare is not going to solve that problem. >> one point, i hear you both agreeing that for instance,
hospitals are making tremendous amounts of money onare, fair enough? >> no, not tremendous amounts. absolutely not tremendous amounts. >> they are making money. >> they are making their costs and a little bit more. >> the whole industry is, device manufacturers make a lot of money, drug companies make a lot of money on medicare. >> drug companies make money on medicare, congress has not allowed medicare to negotiate the price of medical devices or drugs. so go back to the leaders in congress, republicans and democrats and ask them why that is. >> let's get to one of the issues with the program, it's a political football, right? i mean it's extraordinarily hard for congress either to keep its hands off or to let the right forces operate and isn't that one of the perennial problems with the program? >> what kind of football would you prefer? >> well, i can answer that. i can answer that, which is the more we're going to have our health care system determined centrally, the more the incentives are going to be
perverse. they're going to produce way too much care. they're going to create, look, we're going to freeze -- i had dinner with a group of health care economists, if we didn't have medicare would we have general hospitals. general hospitals do a lot of care very badly. we encourage it on a greater and greater scale. the basic point i think is that if we assume that there is such a thing that health care is so different from everything else that it can't be subject to some of the discipline in everything else, some of the incentives in everything else that driven higher quality, lower prices, better use of information technology, more transparency, i have to agree with you. >> i agree with you on opposite things we were saying. >> you can put those incentives in, yes, you can and they should be put in, but i still can't figure out what you're
suggesting is, a, the alternative to medicare, but, b, since you and i agree that you should get rid of the private insurance companies is what you're suggesting again -- >> we can talk about that. >> we're all out on our own. let me give you an example. let me read you an email that i got from someone -- this is not about medicare. this is about how our system works. i'm getting a dozen of these today. your article in "time magazine" appeared during the pregnancy of my wife. even though we had insurance through my wife's employer, when we read your article, we had a fear that we would have the same billing problems with medical bills when my wife gave birth. we thus made extra sure before we had the baby that the hospital we were using accepted our insurance. despite our best efforts to avoid a billing mess, such a problem has now developed. when my wife was in labor, she had an epidural. the doctor who administered the epidural seems like every other doctor and nurse at the hospital and it did not occur to us that he was not a
resident or we would be liable for any of the out of pocket expenses for his services. naturally we had no idea what the bill for the epidural would be. since my wife was in intense pain and i was made to leave the room, we could not have asked a question about his insurance participation even if we had wanted to. you can imagine our shock when we found out that this doctor did not participate in our health insurance and the bill for the epidural would be $3,400. now, you want to leave people on their own to deal with -- >> the ones that you raise in your book, david, is there a customer -- who is the customer? >> that's the symptom, not the cause. every business would like to be so horrific. my son just had an appendectomy. i got a bill from an independent contractor for the service of discharge from the hospital. the hospital swears it has nothing to do with the bill. i have to pay this independent contractor. everyone in the hotel business would love to do that, right,
but we can't. no one can do things like that except in health care. >> why can't we? you volunteered to go to a hotel, i can go to a different hotel. >> on my television network which i'm sure most people have watched today, you would have seen ads for cancer centers. now getting cancer is not a voluntary act. what has changed in health care, although we never talk about it in political debates is that most health care is now a result of a deliberate choice by a patient. >> they chose cancer? >> it would hurt our business if they did, but we actually view it as a cure. and three out of four studies confirm it. [laughter] >> you know why, the reality is we talk about all health care the way we talk about a tire blowout on a highway. there is nothing you can do. it's urgent and your examples are often that and we know people who have been through that. that that is not the fat part.
where most of the money is being spent and all of the growth is chronic condition management, long-term treatment of things such as cancer, and the various replacements we all have. it involves a decision that a customer makes. food is not voluntary either. we have managed to build it -- for hundreds of years it had to be centrally controlled or else everyone would starve to death. health care has changed. it wasn't like 50 years ago when it was rare and urgent and catastrophic. this is the biggest industry in the company and in the developed world. it is something we use all the time. the idea that because you might have a blowout on a highway, we should govern the entire auto repair business to take care of that, the urgency is absurd and particularly since if any of you have had a tire blowout on the highway, the guy doesn't say let me seat your net worth statement before they change a tire.
they do it in health care because they can get away with it, not because it's so inherently different than anything else. >> let's talk about the cancer treatment centers of america. the ads, they're intriguing. they spotlight as you say, a high profit, a high profit disease because the drugs cost so much money, everybody is on that gravy train except maybe the doctors. i think those ads are great. i think the fact that they present information, indeed, if you go to their website, they talk about survival rates and it's caused hospitals like sloane kettering to list their survival rates, that's all good. but i think it's a bit naive to think that someone who has just been told they have cancer is going to make the same kind of decision that they would make, that you're going to make in a half hour about what restaurant you're going to eat it. >> you're absolutely right. >> they can't make that informed decision.
i'm not against those kind of choices. >> that's the problem is that you're right. yet they have to make that choice. there is no one else to make that choice. the idea of the health care system, medicare, private insurance is somebody who calls you up and saying concerned about that spot over your eye like to have you checked out is absurd. we are on our own. they're just the payer. my point is not -- and steve is right. it's just human. it's why we created the system in the first place. none of us are best positioned to make those decisions when we have a tough diagnosis. the problem is no one else is making that decision. someone else is just paying for it. and what that's meant, not just this enormous amount of money taken from us to fund that system and as my book shows, it's $1 million to $2 million per person starting out in the workforce today, not just that flood out from us, it's the lack of a health care system that treats us as opposed to these large bureaucracies who are its customers. i had the same fear you do. we don't make great decisions.
then again, we make terrible decisions about everything, including the restaurant we'll go to tonight. the way the economy functions is that people get paid for making it easy for us except in health care. nobody makes a living that way. >> but medicare is -- nor is your insurance company assuming cancer treatment centers of america are in the network. they're not getting in the way of that decision. they're just providing people with the economic security at a certain age that they can make those decisions and, in fact, not to have to make them based on cost because they pay the same thing at cancer treatment centers at america as they do at sloane kettering as it turns out. the deceptive things about the ads is if you are on medicare or if you're protected by a certain insurance company, you may not know that it's going to cost you the same at sloane kettering as it does the philadelphia place which is
where cancer treatment center of america is. >> economic security is one of the other great i will luges of our health care system. >> let me inject one question. neither of you have mentioned yet is the tax system. the tax treatment of our not for profit hospitals, how is that -- >> i bet we agree on that. >> i bet we do. >> it's fundamentally ridiculous to say that this hospital which had an operating profit of $197 million up in the bronx and pays people laries just shy of a utility infielder in the bronx is a nonprofit center. they had this debate with emmanuel and they pay the head of the hospital $5 million, the head of the dental department, $2 million. ezekiel says they do all of
these wonderful things for the clinics and this and that. that's absolutely right. when they get finished doing that, they still have $197 million. they should be taxed or their prices should be controlled. something needs to interfere there. >> we probably say it differently, but complete agreement. i think it's very important. when i talk about the fundamental incentives in our health care system they're faced whether you're for profit or not for profit. steven and i have talked the results are the same. they're not just the same in terms of money. they're the same in terms of any quality or safety of service you can measure. >> the-month profits make a little more profit. >> year to year. they pay their c.e.o.s more. that's one you're not going to get -- >> that's a way in which, the tax code pays a lot of money on our behalf, but doesn't give us the possibility to discipline. let me open the floor for the audience. wait for the microphone to come
to you. then state your name and affiliation, thank you. in the back there. >> is this on? >> yep. can you please stand up, too. >> sure. my name is ezra mager and i'm a member of this group. i don't understand something. when did being a doctor stop being a profession and start being a business? people went into being doctors, not because they wanted to make a lot of money, but because they wanted to have a presumably steady income. and now we have doctors who own portions of a hospital, the radiology lab, the this, the that. they are in business. it seems to me that that, too, is part of the -- >> that's a part of the problem. >> to say that doctors don't,
you know, they're not the ones getting rich here i think is completely wrong. >> it's actually completely right. it's actually completely right. there are a small minority of doctors -- >> can i finish my question? in small areas in country situations, it's a problem if there is anybody, a country doctor not making much money. in urban centers, i don't think that's true. >> i'm just counting on my fingers the numbers of doctors that i think my family has been to in the last year or so. it is probably a dozen. none of them owns a clinic. none of them is a consultant for a drug company. the vast majority of doctors, as i point out in the article, and certainly the nurses, they are the only ones who don't live in this alternate universe of being on the gravy train that the rest of the country has not enjoyed for the last decade. it's just a fact. on my list of priorities, i
would care more that the regional sales manager for a cat scan maker is making a half a million dollars a year than i would that a doctor is making a half million dollars a year, even $1 million a year. >> isn't it also a part of the pricing system? >> yeah, and i think that is crucial. i talked before how medicare's choices affect the practice of medicine, not just the cost of medicine. one of the most important things medicare has done and it's a surprise, is by underpricing the services of general practitioners relative to procedures, it's caused over of enerations, the number general practitioners to disappear. there are 6,000 left in the country. you thought medicare spending going from zero to $550 billion, that would be a gravy train for somebody whose practice was serving seniors and their needs. that's not what medicare funds.
one of the reasons that medicare prefers procedures, tests and major operations is because it's easier to justify spending money on them than on somebody's time. so every time medicare cuts, it often cuts time and increases procedures. so what do we have among seniors now? less than 1/3 of appointments that they have of any team, 2/3 are now for specialists prescribing specific procedures. i want to be careful about excess care as a matter of money. there was a great study published a year ago looking at every medicare patient in the year of their death. what they discovered and it was shocking to almost anybody in this field is that one out of every three medicare patients, medicare beneficiaries had surgery in the year of their death. one out of every five
90-year-olds had surgery in the year of their death even though most doctors will tell you there is no reason for a 90-year-old ever to have surgery. when i talk about the problems in medicare, to me it's not really about money, it's about the type of care being driven for our seniors, which is test rich, diagnosis rich, procedure rich including major procedure. we can talk about it as a matter of wasted money, what really matters is we're suggesting our seniors to an enormous amount of care that doesn't apply. >> i agree completely that the incentives for general practitioners and doctors like that are just completely reversed. i will add that in the debate er the obama care reforms, in e was an effort to add the comparative effectiveness section as it was called, various measures that would
allow medicare to opine on whether someone who is terminally ill with cancer on d have hip replacement the month before they're going to die and that became part of the betsy mccoy death panel debate and everyone just ran for the hills rather than try to pursue that kind of reform. >> isn't that the point? isn't it relying on medicare to discipline the practice of care? >> when you're talking about old people and you don't like it, but old people depend and will depend and should depend on medicare and they like that program, everybody in the country likes that program. you're not going to get rid of it realistically. if aetna tried to do that, they would go after aetna, too. >> making a different point in terms of how the politics gets into this, it's almost impossible to extricate
politics. >> not quite. to take an example, there are state laws that mimic medicare. medicare says if a drug is f.d.a. approved, congress says that if a drug is f.d.a. approved, they got to pay for it. congress says they can't negotiate the prices for it either. various state laws mimic that, especially when it comes to cancer drugs, that even if one drug cost eight times as much as another drug and they have the same effectiveness, to be licensed to sell insurance, private insurance in that state, you have to pay for both drugs. so i don't think you get rid of the politics of this if you get rid of medicare. >> you say we can't get rid of medicare. i say we can't get rid of congress. [laughter] >> same thing. >> that's right. that's the crucial part. remember, what i'm proposing is not that we get rid of government support. in fact national catastrophic
health insurance. by creating more of a market in routine services, we create other incentives for -- to balance it. the reality is everything you're saying is absolutely right. medicare is very much a political construct which will be governed politically. my point is, we have one disease, end stage kidney disease for which medicare pays essentially 100% of everybody's cost, right. dialysis is regarded as the most corrupt, poorest quality, highest cost, most complex and ultimately most dangerous part of our health care system. it's 100% medicare flexible, 99%, but roughly that. the c.e.o. of a big dialysis company is one of the five owners in all of health care. we my point is let's turn the safety net into a safety net. what we have now governs the medical economy in such a way
that creates per exercise incentives for all of this stuff and people are suffering. we can look at low prices and say, that's all about low prices, but not if you are getting too much care and not if care is genuinely dangerous and not if people are taking too much drugs. by the way, not if they're doing it in an environment -- i saw what happened to my father, ich is the type of slop -- sloppyness i would not expect anywhere else in the economy. since i have joined the board of leapfrog, it's they don't have the right discipline. they don't have the right accountability. i would like to see us balance that by getting us more involved. i don't think it's an eitheror. we're not as far apart as we are to entertain the crowd tonight. we're entertainers at the end of the day. >> keep entertaining the crowd. any other questions? sir, in front. >> the guy with the google glasses? are you sure you can interrupt yourself and talk to us? >> could you pass those up for
us? >> do you know anything that has happened in the last hour? [laughter] >> i'm andrew redick and one of the things i found in my work is that one of the largest costs both in terms of money and in terms of doctor's time is dealing with insurance companies, dealing with medicare. this results in the best doctors i find try to cut that out of their practice entirely, just ask their patients, they pay for it directly. does this not cause us to end up having giant hospitals, the hospitals doing a lot of medicare i am trying to get this in the right spot. are doing well because other hospitals do well because they can handle the insurance system well.
doctors can handle the insurance. >> hospitals do well because they do especially well in places like connecticut where they are the only game in own. then they tell the insurance ompany what they will pay. >> there are still economies of scale in healthcare. one is leveraging in insurance. with medicare it has a single diagnosis. 65% percent of hospitals have an exemption to it -- an exception to it. another 25% are completely. >> they are really not material. >> they are material enough to lobby heavily. the second economy scale is very important. which is administrative. if you look at i.t. and healthcare, that is the worst of any consumer facing industry.
they invested very heavily in illing technology. the major economy scale and administration in a hospital is dealing with regulation, insurers, and payment. general hospital's long ago stopped being the best way to reat people. yet, their political power and enormous advantages in the administration have prevented small, specialized institutions from competing effectively. the average doctor spends 20% of his time in paperwork. you're taking the most expensive and value part of the system and turn them into insurance clerks. >> they are happy to sell their practices to hospitals so ospitals take that over. >> thank you for putting out doctors are not the one making money on drugs. i am an oncologist. >> you get a little bit of a market.
>> you are actually losing money. people in private practice is a much more because hospitals are getting massive discounts and that is why they are able to buy up practices. it is much more expensive than the hospitals. people who think doctors make so much money, residents age 31 and 32 coming out with $200,000 in debt and getting about 130 or 140. i would worry about who is taking care of us in the future. hat is my big worry now. >> question, explain to me why the choir got the salary he got when he required -- retired. -- why maguire got the salary got when he retired.e half
dollars. that is one of the reasons we have art of our healthcare cost. everyone tangential -- >> there is no competitive healthcare market in this country right now. there is not likely to be. you will see above market alaries. hospitals are good at things they do a lot of. depending where you are, if your hospital does a lot of specific procedures, it's success is greater. when you look at the world hospitals protected by congress, you may have seen this study in health affairs two months ago. for most conditions, they do so few procedures in a hospital, you are better off flying to a
city. it is cheaper. general hospitals do not exist because they are good at everything. they exist because they are general. they are like big department stores. they not so good at things they do not do a lot of. we would be much better off having the type of competitive advertising leaves see in other things. we do not have it in hospitals. it is unfortunate because the presumption because it is big and does everything, it is the right place to have my hip replacement or my bypass or what have you is not a presumption that is met by the evidence. most consumers do not know that, just like they do not know there are massive differences between he safety records. >> sure. the political thing for me, it is something we agree on, the political influences major in these things. part of my argument for moving more dollars through individuals is to move some of it away from political decision-making.
if you look at something like dialysis, you see the influence of political contribution and how medicare pays for ialysis. >> i would add if you have much more transparency, it is probably the only way you will fight the fact the healthcare industry spends something like 3.5 times what the much bear military complex lobbies in washington, which is why nothing we are talking about a peer will change. unless you get people really angry and the way to get them angry is to give them information, to tell them there is a $77 charge. this hospital is doing a lousy job, this hospital advertises,
those are the kinds of things to get people aware of this so they can counteract maybe what the orces are in washington. >> we know in new york -- one last short question. he young lady in the back? >> two really short questions. i just want to make sure i understand what the solution is. are we talking single-payer, all payer employers driving the change to high deductible plans and abandoning -- demanding more transparency? is there any country in the world that has the model -- >> don't say --there is something wrong about that. singapore -- he will say singapore.
they point to finland to change the american education system. anyway, i purposely did not expound on a master olution. i do think what you need to restore or create israel leverage in the market place. part of that is the market has to intervene. you can have all the transparency you want. when you tell that cancer patient, who is waiting and sweating, to say, the transfusion costs over $13,000 and only costs the hospital less than one fourth of that and it costs the drug company a couple hundred dollars. you can have all the transparency in the world, but
he needs the drug. this government, this country, some way or another, has to intervene in that part of the marketplace the way every other country in the world does. there are all kinds of possible solutions, but they all involve the same thing, which is a lot of transparency, and some kind of intervention because you have to ignore its the fact this is not a free market -- to acknowledge the fact this is not a free-market. >> i am glad we are greeing. we need to take advantage of what healthcare can do in this country. our healthcare will get far more personalized, far more responsive, far more integrated. the amount of care spent on the urgent cases declines every year. healthcare will be our major consumer industry.
the question is how do we organized. right now, we are organizing it the way we first thought of it in the late 19th century. your house burning down. right now, under the guise of home ownership, home insurance, we are paying for, what happens if your house burns down, all of the utility bills, and your furniture going out of style. the problem is not, that makes us that consumers. it makes the industry that providers. consumers do not drive any consumer driven industry. providers do. the providers come out with a new phone, a new car, a new this every month and try to convince you to buy it. we found a discount m.r.i. in my family by calling around and asking. in every other industry, they find you. that is why we are in the media business. so they can find you. healthcare will look more and more like most industries in terms of what it can do but we continue to structure it in a
way that is old-fashioned. y echo one of the reasons is that we look at the rest of the world and say, look what they are doing. how come the europeans can get similar, better mortality data on less spending? one of the ways to get less spending is by spending less. we are never going to do that in this country. congress has never been able to do it. everything is subsidized one way r another. nother reality of america is healthcare spending has nothing to do with mortality at this point. mortality drivers are diet, drug use, smoking, alcohol, income, and education. >> and playing too many video games. >> which my kids argue will increase their lifespan but it s a shortening mine.
we say, they are doing so much better than that. they are not. no country is confident on their ability to handle the growth of health-care spending that comes out of the statement of, we will pay for everything you need, cause the industry response to the net -- to the statement, the amount of healthcare we need will get bigger and bigger as we get healthier and healthier. guess what. there is no way to fund or discipline that. i like symbol for -- singapore. i like it for one reason. they did a lot of things that would be hard here. it is the only country on earth that does one thing very differently. it separates out the role of under and payer. we have forgotten they are separate. an insurer can write you a check and you can be the payer. in singapore, you are the consumer even if the government is paying 95% of the bill. you always make the purchase decisions. they found the affect to be extraordinary. they have healthcare just like
everyone else in the world. perfectly good. a lot less demand and lower prices. >> you left out the fact they have price controls. >> i did not. there are tons of things singapore does we would have a hard time doing here. we will never have control with ongress. it is not an option. it will never happen. what can happen here? this is a country where we are leaving things to consumers constantly. i am not going to -- for 100% of the market. let's take 1 million and one half dollars and put half of it in a catastrophic care system that is national, universal, cradle-to-grave, and that the other half go back to healthcare. we will see in industry where the providers have different motivations. steve mentioned cosmetic surgery. anything not touched by health insurance, including carefree documented.
basic, primary, documented, operates on a competitive cash market. it has nothing to do with the type of care. it has to do with the type of payer. what i am calling for his understanding. treating healthcare as one thing. recognize some of it as catastrophic. where we need intervention and insurance. if we build a whole system based on the worst cases, we will have more of what we have now. incentives doing the wrong thing at high prices. >> i disagree to a little bit on the definition of catastrophic. women in stamford who had chest pains. they thought it was a heart attack and did not have one. you want to put her on her own. another patient who fell down on her backyard and broke her nose
and had cuts on her face, you ant to put her on her own. i think, again, even if it is collective knee surgery, there has to be controls because you do not have the free markets you have for lasix surgery. >> we have it in undocumented are. >> you ask the people who provide the healthcar, they will be the first to tell you those people are underserved. they are driven deeper into poverty and are not getting the equivalent healthcare other people would get. >> i do not want to put people on their own. the average working person in this country who has a family and is fortunate enough to have
health insurance, is putting about 25 to $30,000 a year into our health care system directly through taxes and their premiums. if a catastrophic care system costs $3000 a person, that means that prison is on the rhône on $10,000 a year. we have got to get some idea of the scope of money. the $2.7 trillion we will spend on healthcare this year did not all come from somewhere else. 350 million people are not all being paid for by somebody else. we are all paying for it. we will pay billions of dollars subsidizing medicare. you could give 100 million people $8,500 a year for their care. that is $34,000 for a family of four. when you build a system inefficient on price and administration and you are all paying for it. >> you left out the fact the people who are the beneficiaries
of medicare have medical needs because of their age, that puts them five or six times above the average. you are comparing apples to oranges. >> i am happy to tell -- talk about that. >> let's table the discussion. we cannot give you both the last word. [applause] >> tonight a discussion on computer hacking. we'll hear about online surveillance by the government and corporations and why the government could be using a law from 1984 to prosecutor whistle blowers. you can see it at 8:00 eastern on c-span. american history in prim time
continues ime time tonight. 8:00 eastern, a visit to penn station in man had tan. after that, mr. lewis discusses how time squares and coney island became tourist destinations. that is american history on prime time tonight on c-span3. >> if it were a state it would be in the top five oil producers in the nation. to put this in a little more context, 75% of all of oil production in california is done in this county and over 50% of the natural gas that is produced in california is right here. so we're really looking at, when you're in this county, oil along
with agriculture, they are the two largest industries that we have and it really turns the economy. > explore the history of bakersfield, california this weekend on book tv and american history tv on c-span3. a look at gun violence and mental illness and what current gun laws are like around the nation. it's about an hour and 40 minutes. >> good afternoon. i am a forensic sychiatrist. joe and i were trying to plan his year back in december.
we decided it was difficult to without including -- one of the deadliest campus shooting. >> there has been a tragic shooting incident today at fort hood in texas. >> several people have been shot at a grocery store in tucson, arizona. >> at least 14 dead, 50 injured after a lone gunman opened fire in a theater outside of denver, colorado. >> back to our coverage of a shooting in a temple early this morning. a frightening scene unfolding there. >> at least 27 people have been killed at an elementary school shooting in connecticut.
>> at least 27 people killed, most of them children. it was an elementary school at a small town in connecticut. > senseless slaughter, the latest has opened the subject of gun control and the second amendment. >> there is no doubt the debate over gun control will heat up in he coming days and months. >> i believe that my role will be more to raise questions for our speakers than to try to nswer any of them. thinking about where gun related iolence comes from, looking at the media, the issue of mental illness.
in 2010, about 16,000 children and teenagers were injured with irearms. when we think about violence and we think about how people die, it is clear to see handguns probably the leading cause of hat. there is some data to suggest that the availability of guns go down, the incidence of homicide would go down with it. if we take another industrialized country like japan, where all guns are banned, compared to the united states, where we have a right to bear arms, you can see there are dramatic differences in gun related homicides between the two countries. those are statistics that are difficult to argue with. homicide is not the only part of he equation.
two thirds of those victims are going to die from homicides. on the average, there are 49 gun suicides every day. the majority of the children who are dying are dying from using guns they obtain from family or friends. there is a question about whether more restrictive laws could do something about this. i want to draw the attention that we have laws. the question is whether they can be enforced and whether they are enforced in a sustainable way. it has been said that mental illness is probably one of the causes of the violence. there are many instances on tv where people have directly said that only crazy people kill. if you look at the actual numbers, rental illness only increases by a bare minimum.
less than five percent of american crimes involve people with mental illness. those numbers are difficult to sustain. i have questions for our speakers. i am sure they will address it at some point. the question is how we will define mental illness. there are questions of label anyone violence mentally ill. if we do that, it is easier to say that only mentally ill people commit these crimes. the final question, how do we differentiate pure malice from mental illness?
those are the questions for our speakers. i would like to introduce our first speaker. a currently senior fellow at the center for the american and a former special advisor to mayor bloomberg and director of mayors gainst illegal guns. he received his bachelor degree from harvard college and a law degree from harvard law school. he is a native new yorker who lives in washington, d.c., with his family and he tells a compelling story. you should be looking at last week's new yorker. [applause] >> thank you. i will also start with some numbers.
32 -- that is the number of people who were killed in the largest mass shooting in american history at virginia ech. the shooter in that case was someone who had been adjudicated mentally ill by a court, but the state of virginia had failed to provide that record into the background check system and that failure meant he was able to go into a gun store and buy the gun. 33 -- the average number of americans who are killed with guns every single day. 323 -- that is the number of people who have been killed in mass shootings over the last our years.
44,337 -- the amount of people who have been killed in all shootings. that number is the number of americans who died in gun suicides and gun accidents in that four-year period. the vast majority of those were uicides. if we think about the aggregate toll over many years, if we take the year 1968, which was the year that bobby kennedy and martin luther king were assassinated, more americans have been murdered with guns or
killed themselves with guns or died in accidents in that period than have died in all of the wars in our history since 776. with those numbers in mind, i want to talk about for things today. what i would define as scoping challenges, how do we think about guns and mental illnesses? the first question is, should we think of people who are mentally ill as perpetrators of gun violence, as victims, or otentially a scape goat? the next question i want to get people thinking about, what is the problem that we are trying to solve? mass shootings, everyday shootings, or suicides? or mental illness for that matter? the third thing i will talk
about is background checks, that has been the focus of the debate in congress. what might some other solutions be to this intersection of mental illness and gun iolence? the first question, are mentally ill people significant perpetrators of gun crime? this is one measure of it. this is a graphic that describes people who are rejected from purchasing guns when they go to gun stores and what portion of the people rejected are in the various categories of people who are prohibited? the biggest category are people who have been convicted of felonies. those are most of the people ejected. a very small portion of the people who go into a gun store and are denied the ability to purchase a gun are in this
category of people who are entally ill. part of that relates to the fact that many mental illness records are missing from the background check database. your chance of being killed by a schizophrenic person is about one in 14 million. that is one type of serious ental illness. you are more likely to be struck at lightning than that. another way to think about mental illness and gun violence, this is a category of people who are victims of gun crime rather than perpetrators. mental illness is very widespread and it is a problem that affects many americans. i would focus on the last umber, which shows that people
who are mentally ill are more likely to be the victims of crime than everybody else. i think there is a third way that mental illness has come into the gun debate, particularly in the period since newtown. this is a quote from the nra. on december 23 of last year, nine days after newtown, we have a completely cracked mentally ill system that has these monsters walking the streets. we have to deal with the underlying causes. the question is, is this the problem that we need to solve? is mental illness the cause of un violence? that brings us to the second scoping challenge.
what is it we are looking at? mass shootings, everyday shootings, or suicides? when we think about mass shootings, there is probably a compelling compelling case you can make that mental illness is quite involved in mass shootings. a mother jones magazine analysis of 62 mass shootings looking at the record, some of the court documents, most mass shootings involve some degree of mental illness. if we think about some of the most prominent recent mass shootings, there was a significant record of mental illness and a number of those shootings. when we think about everyday
shootings, everyday gun crimes, e see that people who have serious mental illness tend to commit crimes at a lower rate than the overall population. they are responsible for a lower ortion of crime. likewise, when you look at crimes with weapons, which most times will mean guns, again, crimes committed by people who are mentally ill is nderrepresented. it is worth pausing for a moment to think about how does the u.s. fit into this picture of everyday shootings? we may not have a gun crime problem where the mental illness
component is exceptional, but the gun crime problem is exceptional. we are not a uniquely criminal society. we are not a uniquely violent society. but we are a uniquely deadly society. the level of homicide in the u.s. is unusual when you compare it to similar countries. we have a level of homicide that is seven times higher than omparable countries. firearm homicide is way igher. we do have an exceptional gun crime problem. when we think about these everyday shootings, until illness does not seem to be deeply involved in it. that leaves us with suicide, which is the majority of sudden deaths every year in the u.s. we know that suicide attempts
that involve guns are far more likely to be successful. people who use guns to commit suicide are the people who are really seriously wanting to succeed. it also may be that impulse suicide, people who are in a particularly low moment, this is the mechanism that is much more effective and when people have this mechanism available, it is more likely to have a deadly result. there is this question that mental illness and suicide are related. before i talk about background checks, the bottom line is that mass shootings, guns, and mental illness, there is a nexus.
suicide, guns, and mental illness, there is a nexus. the gun crime and mental illness is, for the most part, there is not a nexus. when you think about some of the mass shootings and background check systems, that has been the subject of the debate in congress, a number of some of the most prominent mass shootings have involved gaps in the background check system. in virginia tech, it was a shooter who had been adjudicated, but the records had not been put in the system. columbine, it was going around the background check system by buying guns from a private eller at a gun show.
that was also the case in the hooting in brookfield, wisconsin, in october, where the perpetrator got guns online from a private seller, no questions asked. tucson, he had a history of ental illness. he had a history of drug abuse, which had prevented him from entering the u.s. military. that record was not provided by the military to the background check system. that could have been a isqualifier. why is fixing background checks important? it is probably especially important not in its nexus to
mass shootings and mentally ill, but to its nexus to everyday gun crimes. there have been prisoner surveys that suggest that the vast majority of people who commit gun crimes get guns from transfers, purchases, or getting it from a friend that do not involve background checks. i put a question mark under it because it is just one data ource. it is very hard to know much about this secondary market for uns. it is the guns sold after the gun stores have sold them. sometimes from somebody who says they are just a collector, but might be selling 100 guns at a gun show. sometimes that of the garage, sometimes online. the best statistic we have,
which is almost 20 years old, suggests that maybe it is around 40% of gun transfers every year. the solution is to require these private sellers who go to a gun store and do a background check to provide a little context. in our country, we have 58,000 gun dealers, almost as many gun dealers as we have post offices, mcdonald's, and starbucks combined. this is something that would not e a great inconvenience. there is a good study mapping all of the gun stores. 97% of americans live within 10 iles of the gun store. another issue was this issue of
records not getting into the background check database. there have been a significant amount of improvements in virginia tech. it was just under 300,000 records before virginia tech. now there are over 2 million. 18 states, six years after virginia tech, have continued not to supply records into the system. one of the things the legislation in congress would have done had it passed was oughen the sticks. do background checks matter? it is a hard question to nswer. crime overall and gun crime has gone down a lot in the u.s. in the last 20 years. but it is very hard, people do
not agree what causes the drop in crime. it is very hard to think about outcomes and what causes an outcome, but there is a fair amount of studies of particular laws and an enormous amount of circumstantial evidence to suggest that gun laws do have a substantial impact. different states have different laws. here in california, very tight gun laws. other states, very weak gun laws. if you look at states that have universal background checks, you ee the murders of women is basically very similar in non-firearm homicides. if you look at gun homicides, it is lower.
the portion of the legally trafficked guns in states that have universal background checks re much lower. in this study we did at the center for american progress, we looked at the 10 states in aggregate that have the trongest gun laws and the 10 states who have the weakest gun laws. we looked at 10 outcomes of gun violence, 10 measures of gun violence. you probably will not be able to read the text, but you can see the pattern. on each of these measures, the states that have stronger gun laws have substantially lower rates of gun violence. in the aggregate, it is half the level of gun violence. this is the correlation, when
you see correlation over and over again, it suggests pattern. my final thought is, as we think about gun violence, gun laws, mental illness, we should think about, what is the problem we are trying to solve? the options vary, but there are things we can do beyond background checks and things that could be quite effective. one thing, for example, what happens when somebody fails a background check? they are rarely prosecuted for that. that has something that has been talked about quite a bit since newtown. the federal government does not have a process to tell state and local law enforcement when
seriously mentally ill people are rejected from a background check. what would've happened at virginia tech had the shooter failed the background check? he might've gone to a gun show hat weekend. were the campus police and virginia tech or the state mental health authorities been alerted that a seriously mentally ill person in virginia attempted to buy a gun. alerting law enforcement and mental health authorities when people are rejected for background checks would be one good thing. another thing that would make a difference is effort to recover guns once people become prohibited persons.
when you have been convicted of a felony or when you have been adjudicated mentally ill, you no longer have a right to buy a gun. what about the guns that you may already have? some states, some cities have undertaken efforts to make sure that when people become prohibited, law enforcement it's to those people and get back their guns. california just passed a law that will provide funding to do this for 30,000 people in the state of california who are prohibited, but there have not been the resources to go to their homes. there are cities and counties in california who was had very effective programs in recovering those guns. even red states like indiana have laws in place to do temporary actions to recover
guns from people who are entally ill. there are a number of things we can do, but as we think about what to do, we should go back to the first set of questions. what are the problems we are trying to solve? are we trying to have a better system for taking care of people who are mentally ill? there's a lot we can do. are we trying to reduce gun crimes? there is an enormous amount we an do there. in the end, it might be somewhat of a less important problem to solve. what happened in newtown was a terrible tragedy, but if you lose a six-year-old in a single
victim shooting, if you are the parent, it is just as bad. nobody is going to pay any attention. maybe a short local news story, but it will disappear. when you take those single victim shootings in aggregate, you are talking about a newtown, virginia tech scaled massacre every single day in our country. thank you. [applause] >> we are going to leave all the questions to the end. we would like to introduce jeff swanson. he is a professor of psychiatry and behavioral science at duke niversity. his expertise is mental health services effectiveness esearch.
he has received numerous awards for his outstanding contributions to mental health research and has written numerous papers. 175 comes to mind. perhaps the country's leading authority on the link between violence and severe mental illness. [applause] >> good evening, everyone. it is an honor for me to be apart of this conversation. i want to thank you for coming. i would like to speak with you for a few minutes tonight on the link between violence and severe mental illness, gun violence and
mental illness. in the on text -- my slides are aumentically advancing. sorry about that. in the context of the other causes, the other important causes in our society. an undering might imply for the project of developing better laws and policies that will be oth more effective and fair in terms of reducing gun violence but also avoiding, reinforcing the stigma that goes with the unfortunate understanding or belief in the public mind that people with all mental illness are dangerous. how do we think about balancing
these important concerns of public safety on the one hand and civil rights on the other hand? i, too, would like to begin by putting this problem in a big picture perspective. i think all of you -- first of all, let me quickly acknowledge some of the sponsors of the research that i will present to you this evening. the national institute of mental he'll, the sociology program, the robert e. johnson foundation. forink it is very important grant makers to courageously sponsor research in this area. i think all of you have been to our national mall and you have seen what a sobering sight it is to contemplate 58,000 names
carved inalajara a -- a granite wall. i would like to ask you, what if we build a monument to comment rate all of the americans who have died in the last 10 years as a result of the gunshot. if we built one it would be five times larger than the vietnam memorial. i bring that up to take it a part a little bit. those out that 39% of are homicides, 59% are suicides, and 4% are other situation, such as law enforcement action or accidents. i've done some calculations and ade some assumptions about the
attributable risk of homicide and suicide that is associated with mental illness. i calculate roughly, if we reduce all the risk associated with mental illness we might be able to reduce that number by 100,000. we might be able to bring it down. but 95% of that would be from reducing suicides. why is that? well, if you think about the relationship as someone who studies the problem of violence in population, not just individuals, what you can learn is there are three ways to look at this sort of risk. one is about absolute risk. that is people with mental illnesses, bipolar disorder, depression, someone who might
engage in violent behavior. that means 93% would not. if you think about it from the relative risk, people with serious mental illness are three times more likely to engage in violent behavior than those who don't have mental risk. attributable risk takes into account how many people are with the risk factor. what that does is if we lower the risk on violence with people with mental illness how much would violence go down? the answer is about 4%. so there is a link between mental illness, a modest risk but it is a small contribution to the overall problem. it is not the place you would start if you say let's try to address the problem. now, with respect to suicide, it's a different story as you heard from the previous
speakers. there -- here you can see, this is a summary of studies. 14 studies of attributable risk associated with mental illness. the contribution of mood disorders such as depression and bipolar disorder that the evidence there is about 26% on average. 7%-45% in males and females it is 47%. so that's a stronger vector. it is also a treatable illness and if it was treated and there were interventions it could have big impact on the suicide -related firearms problems. what about the link between violence and mental illness? people ask me is violence and mental illness related?
it depends on what you mean by violence. ens and this shows how many people engage in violence behavior. u can see on the left, outpatients in treatment, stable outpatients about 8% would engage in small acts of iolence. there it's about 10%. if we look at discharged inpatients, people have been in the hospital because they have issue with violence or threatening other people, 13%. people who presented in emergency departments with mental illness, 23%. the next criteria is higher and look over on the right.
patients who come for the first time to a hospital or treatment facility, 37% of those people have had some issues with violence or threatening to harm others before they are seen. what is interesting there, if you had a strategy that is supposed to identify people at risk by searching for records that would gun disqualifying condition, these are people who have not been touched by the system. the problem too, if you have a policy based on one of these findings, they could be the same people at different moments, different stages of their illness, treatment career. so the people in the hospital might be the stable outpatients. there are people who are prohibited from guns who have zero risk of violence now. there are also people who are at risk and not captured by our
policies. how do we reduce gun violence with people with mental illness? it would be nice to broadly limit legal access to guns. having a gun for your own protection is too dangerous. we don't need 300 million guns. we can't do that. we might have a gun violence program. we can't limit access to guns because of the second amendment to the constitution as the supreme court interpreted where they struck down the handgun bans in chicago. they said our constitution is right but it is not an unlimited right. the long-standing prohibitions of firearms were felons and people with mental illness. we need to think about how we keep guns out of the hands of dangerous people. that is complicated to do because people are complicated
and violence is complicated. so i think there are two different approaches i would like to mention. they are not exclusive. one is the clinical approach, let's see how to predict violence, identify people at risk and prevent them from ccessing firearms. using involuntary commitment to detain people and prohibiting people from firearms. that is where background checks come in. that's one approach. another would say is let's try to prevent the unpredicted and it turns out that psychiatrists who will at predicting be violent. let's try to address the social
economic deterrence of violence. trying to have healthy communities and reducing youth violence and factors like child exposure to trauma. then let's provide effect of treatment. we may not know we were preventing violence, but we would not care because we are preventing the unpredicted. two different approaches. one is a long-term project and the other is maybe more short term. with respect to the federal law, which is basically embedded in what states do and they are all over the place, the law categorically exclude some people with mental illness from accessing firearms and we have this term, when people are
committed the idea is if they are ill enough to require involuntary commitment that they should not have a firearm. they have been afforded the legal protections of a civil commitment. that is also part of it. adjudicated, legally it means that has been in authority who determined that someone, as a result of mental illness is incompetent to manage their own affairs. they have been acquitted by reason of insanity. can these laws keep guns out of the hands of people like this, jared bochner, and these other perpetrators of mass shootings? this is why we are talking about this tonight, looking at it through this prism of these
terrible tragedies. can they keep guns out of the hands of people like this? the people with mental illness actually look like the people in this room and they have a whole range of risk factors for violence that range from your harmless grandmother to your neighbors not so harmless intoxicated boyfriend and everything in between. how do we think about that? do background checks work? there are a lot of reasons why they might not. one has to do with access. they cannot predict violence very well. states may not commit people and other states do. it could be that they do not have to submit to a background check.
lots of reasons why they think they might not work very well, but there is very little research that's been done to actually evaluate that and i will show you some of that right now. we have a study just completed in connecticut and this is sort of the punchline for the study. we have done 23,000 of people who had a serious medical illness, all of whom had been hospitalized, and we brought the records from the criminal justice system and we looked at the risk every month over and eight-year time as a function of whether they were disqualified from purchasing a gun and lots of other predictors. these two lines you see here, i call them involuntary's versus the voluntary's. involuntary are those who have had a gun disqualifier on the health record and you would expect them to have a higher risk of violent crime because of the commitment.
they do not have a gun disqualification of mental health record and as you can see, from 2002 until 2006 or so, the rate of violent crime is coming down and after 2007, something happens. the state of connecticut began to report records to the criminal background system. people try to buy a gun and they don't disclose it, it will be known. you can see there that are are they are where the lines come together. let me just try to put this in perspective. it turns out that 60% of the sample were not disqualified. they did not have any kind of disqualifying record. 35% had a disqualifying criminal record. only 7% had a record in the mental health arena, in mental health adjudication record that would prohibit them from purchasing a gun. there is a little overlap there of 2%.
the analysis i had shown is just looking at the people who were susceptible to that mental health policy. it turns out that 90% of violent crime in the group was committed by people who did not have a disqualifying mental health record. you put this in perspective and what the effect is it prevented an estimated 14 violent crimes per year in this 1100 people. but because it is a small group of people, the overall impact on violent crime was pretty small, less than 0.5% reduction. you could say it works in a 53% decline in those who were disqualified and only 34% in the comparison group. but, you know, it's on the
margin, but is not the whole answer certainly. i kind of like to end with this. it really is about the guns. here is a scatter plot that shows the relationship between state gun laws restrictiveness as measured by the brady score. you can see there is a correlation. states with more restrict the gun laws have lower fatality rates, but there is also a relationship between household gun ownership rates, so states with lots of families living in a house with a gun, those states also have higher firearm fatality rates.
it turns out there's a relationship between those variables. if you look at the relationship between the law and the fatalities, you see a strong relationship in states that do not have much of a saturation, less than 35% of the households with guns. more restrictive the gun laws are in terms of gun safety in the cell one, unless the fatality rate. as you move up to states that just have a lot of guns around, those laws tend to have less of an effect and you can sort of see why. i think we need to think about
this comprehensively, not just one solution, but we need to think about a lot of different things. partially about the guns, really to sing the legality -- reducing the legality. strengthening background checks. part of it really is better mental health care. there are a lot of solutions being contemplated and enacted at the state level, but quickly i would just mention these and a close. what about the idea of having mental health professionals being mandated to report people that they see in the community and private psychotherapy who they are concerned about. should the report them to the police?
report has -- new york has a law along those lines. what about mandated outpatient treatment? should we force people into community mental health care? that is controversial from the point of view of civil rights. should we just expanded background check definition? should we make this boundary boundary of who was disqualified much broader? what about the idea of seizing guns from people considered to be dangerous irrespective of a mental illness or if they have him committed. >> our last speaker, joe bankman. co-director of psychiatry and the law. [applause] >> thank you everyone. this is part of a course we decided to open up, so i will continue to play professor here and i will assume all of you are just sitting in. you know law professors call on people, so stay awake. the problem of mental illness and crime -- excuse me, mental
illness and violence and guns is really part of suicide more than homicide and it's really quite right. i noticed that the suicide is dramatically understudied. jeff is doing some exciting studies in academia on the effect of gun control and suicide and you had a slide that mentioned something on that. maybe later we can ask you to look at that? here's a question. if most violence is not a function of mental illness, if that is not suicide, does a mental health scholarship have anything to say about that? only about 4% of homicides have anything to do with mental
illness, is it a scholarship issue? it's true that violence is not causing serious mental illness and now we are thinking things like schizophrenia. jeff did a good job of showing us that there might be a relationship with the agencies that are so low to be significant. criminal offenders have a high degree of mental disorders as so defined and their much more anxious and depressed and psychotic. we do not think there is a causal relationship there. there are social behaviors and cognitions around them.
those of you in the audience who have else with offenders with that population would probably be nodding your head. i think it's a commonplace observation. it is one frequently made. first of all, if we think we can prevent homicides, stopping access to firearms, we are not going to give people a question to see if they're going to be the impulsive type. these are just bad people with bad traits and maybe we need to wait for them to age out of the violence. that is a caricature, and exaggeration of where the analysis could lead.
does mental health scholarship give us any alternative? i'm going to go with the answer just going to be no. i think there should be something in evidence-based therapy. maybe testing than the same way drug therapies are tested with random control trials. they seem to address these traits and they go by a lot of names. we will just call them anger management to take one of the more prominent therapies used in these settings. doesn't work?
and the answer -- absolutely somewhat. therapy is short-term. group therapy is relatively popular in part because these traits lead to lots of dysfunctional behavior, so dysfunctional that people who have the behavior exhibited. also, it's really unpleasant to be angry. think of the last time you were really pissed off. how did that feel? may be good for a while, but after a while, you wish you were not. these people are angry all the time and they would love to get that monkey off their back. they don't have problem in person admitting -- in prison
admitting you have an anger problem. group there be in prison is often oversubscribed, so lots of people jump into the therapy. and then there are hundreds of randomized files laying out there and a broad summary. yes, it does work somewhat. you get a sense of the standard deviation. if you take a control group, people who go through maybe half of the standard deviation, less angry by some measures, but doesn't work on recidivism? if you look at the analysis, yes. if you look at others, yes, but less. many talk about these therapies, you often think of risen and that is really where it started. if you are looking at this from the prison perspective, you would say that people who become
offenders are identified in school and they get in constant fights. school counselors know who they are and the same therapies that work in prison work about as well or maybe even a little better in school. i know as i look out in the audience that some of you out there has a daughter or a son that has some of these traits. this could be a great, loving person who can do awful things and you wonder where they are headed. most of your looking for controlling violence and gun control in part of the talk is to say that we don't actually have to give up on the 3 million prisoners or the at risk youth. part of it is saying that if we are looking for solutions to gun violence, we are going to have
to look at partial solutions instead of one solution and while i understand the import of distinguishing violence from mental illness because we're are worried about stigmatizing one group of americans as seriously mentally ill, the schizophrenic are the best example, and those were voluntarily committed, it's an overlapping group. another way to look at this is a little bit different and challenging, but look at people who have these traits which are very dysfunctional and have a lot of the characteristics of mental illness. if you have these traits, you're are halfway to some personality disorder, so look at them as a kind of mental illness and ask yourself if you want to invest the resources and treating that
and improving treatment modality. you don't get a chance, but i will not give you the chance right now, to clap at that little commentary, but what i would like to do instead is invite all of the speakers at this time up on the platform and i wanted to give our two principal speakers a chance to respond to each other and after that, we will come to audience participation. we have some experts in the audience and that we will take questions. i think we all have microphones. you can only hear us all. >> it's an excellent presentation and points out some of the challenges here. that's light on connecticut where you see that remarkable
dip in crime among the population right when they go in the database but then the limited impact because so few people are covered in the category of people deemed mentally defect is one of the problems. joe, as you were saying, gun violence is a very complicated problem. pardon the pun, there is no silver bullet to solve it. i think you rightly point out that there are many solutions that are not gun law solutions but in the range of solutions that are gun law solutions, there are many, many things that could be and there is good
evidence they are effect it. background checks themselves are part of one element of a system you would want to have worked. there is enormous debate around background checks in the commentaries are very pointed out. background checks on this group of people talking about these federally prohibited people who are in the two categories of mental illness, fugitives. there are a lot of people it doesn't include who are quite dangerous and a lot of people it does not include who are probably not dangerous. if you are convicted of a financial fraud felony 37 years ago, you may be less dangerous than most felons, but if you
have been convicted of multiple violent misdemeanors, you're probably more dangerous than most 37-year ago federal fraudsters and most states have taken action on exactly those questions. in california, for example, if you have been convicted of a violent misdemeanor, you lose your rights to guns for 10 years and there are studies to say exactly that approach has been very helpful. even if you have a set of laws to try to keep the gun access away from people who you have good reason to believe are dangerous, you have to have smart policing, innovative enforcement and, again, that is only the gun law and enforcement side of a very complicated
multi-factored gun violence situation. >> i appreciated your presentation a great deal. to me, it showed the complement of advocacy and research. i think you effectively used a lot of numbers to show both the scope and magnitude of the problems but also its complexity. there are some kinds of competing conversations here. there is a conversation from the point of view as an epidemiologist looking at the public health-public safety issue. from that point of view, we would like to figure out how we get people to stop behaving violently and how we live at
their violence with legal means. then there is a discussion about mental health and the definition of mental health is wide variable -- it is quite variable. we could look at violent behavior has symptomatic. then there is another conversation that is important to not only framing the right research questions but framing the potential advocacy solutions and look at the role in advocating people's lives and how active they should be in their policies and do we care more about limiting people's rights or do we care more about preventing themselves from injury? we are looking at this whole
problem with needle in the haystack events but they have a far disproportionate affect that translates into political will to do something. on the one hand they are important. the people who engage in mass shootings are very atypical of people in psychopathology. you want to use this moment to try to focus on what can be done. i think this is a hard thing to do and i appreciate everyone coming out here to help think about this. we need to look at critical details for policy and advocacy together and i hope we can do
that. >> we have just a few minutes. we have some people in the audience who have written on this or who have a perspective and i wanted to give them an opportunity to say something and ask questions. maybe i will ask john donohue who has written extensively on the thesis that guns could actually reduce crime by keeping bad guys in their place. but we are going to follow the gun debate. >> a great presentation by all of the speakers, so thanks for that. i just want to inject into the
discussion something that did not come up, the comparative evidence of u.s. versus the rest of the world. one interesting thing you will hear the nra-type talk about is the need for guns for protection and in a society who would take away the guns would be overrun by criminals, it is counter to what we see in modern industrialized nations in europe, for example, or japan, as was mentioned. interestingly, for most countries, the pattern is rarely established that the wealthier you become, the less murder you have in a society. the one great outlier of that relationship, which is a very
robust relationship, is the united states. we are a uniquely homicidal country. as the nra advocates have argued, we do have more guns than any other society. beyond that we spend so much to suppress crime in ways that other countries never need to express. in the united states, we incarcerate at about seven times the rate of europe, which does suppress crime in a very costly manner, but we would look even worse if we incarcerated in the same ways that these other countries did. i would imagine the relative rates of schizophrenia, of course, are rather common across
major industrialized nations, but perhaps you could speak to that as well. >> i will take a crack at that. what a striking to me is if you look at patterns of crime and countries over the past 50 years, what you see is the crime rate in the united states is about in the middle. it's not that much higher, lower, sort of right in the middle. but then when you look at homicide, as you suggest, we are seven times higher.
we are way up there. to me, it just makes a lot of sense to deal with the issue of firearms. if you do not have people behaving in criminal ways, you would not have gun violence. other countries don't have nearly as many guns, they still have crimes and people still try to harm each other. they are not as lethal. you have to look at the lethality of a gun. your chance of being successful in a suicide attempt by gun is about 80%-90%. to me, it is a no-brainer. it changes our landscaper policy solutions.
we have tried it. we look at reports of a study done in the sea -- done in d.c., it affected d.c. and not neighboring jurisdictions. they said it was not constitutional. >> we don't have an unusual crime problem. we have an unusual murder problem. we don't have unusual rates of mental illness or tastes in cultural products. first person shooters are very popular in other comparable countries. in our movies, what's different is we have a lot of guns and weak gun laws.
the question is if this is only a problem that can be solved by getting rid of guns. it is politically impossible, or is it a problem that we can solve by accepting that we have a gun culture in our country and we are going to have a gun culture where we make it much more difficult for dangerous people to acquire guns, misuse them, hold people accountable for illegally possessing them before they shoot someone. can that work? in the comparative space, there is some evidence that it could.
some have not as high rates of gun ownership than the united states but significant rates of gun ownership. germany has about one third the rate of gun ownership, but that's way higher than others. switzerland has a high rate. they also have a somewhat higher than comparable country rates of gun deaths, but they are way, way lower than the u.s. because they also have very significant laws. we have a car culture. people love their cars. we have found a way to make our car culture much safer. in the last 50 years for every one mile traveled, the death rate has gone down by 80%.
it was not one thing, drunk driving laws alone. it was not air bags, seat else, better signage, but all of those things. we managed to do that without making cars exorbitantly expensive. we managed to do it. you still have the car of your choice and we made this car culture much safer and i think there is a opportunity to do that with guns. the politics are a bit tougher. >> great. why don't we just take questions. i think the way this works is they have a procedure down where someone comes by with a microphone when i point you. there is your mic. >> good evening. i want to thank all of you for your comments tonight and i am particularly grateful we have gotten to the conversation
around the scape goat that goes on with people who have severe mental illness. we did have a bit of a natural fixation on trying to label and blame these particular individuals. the question that i do have and, forgive me, because i had to write this down is the issue of violence as a larger psychological turmoil, if you will. we got into this a little when we talked about youth violence and violence in communities. when we look at last year, the mass shootings that occurred and it took a strong interest in those situations, chicago had a ken issues to this problem all summer. black and brown boys killing each other and it was not really talked about in the media. surely they are contributing to
psychological malfitness. can we talk about policies and how they could properly intervene on that and help to deal with these issues of violence? >> i would like to start by agreeing with you that violent behavior has a lot of causes and many of them really have to do with social disadvantage, poverty, people's exposure over the life course too bad environments. the people with mental illness are subject to the same risk factors. stuff we did not show you from the study in connecticut is that the strongest determinant of
violent behavior in these people a serious mental illness are age, gender, sex abuse, and minority racial status which is a proxy for all kinds of social this advantages which we were not able to manage to measure. the demographics to the social determinants and interventions that could improve that are very important. as a political solution, that is something that is a long-term project and it is a lot longer than the elected term of a representative who is under pressure to do something right
now. it is a lot easier to do something to change background checks than it is to look at all of the causes of violence and these criminogenic fact is in society. it is not either or. it is both. even with people who have a mental illness, it is seldom in the case that the psychopathology is the master explanation for the violence. people who engage in violent behavior often meet criteria for other symptoms of mental illness besides schizophrenia and bipolar disorder. there are other types of things that joe mentioned.
in addition to thinking about improving our communities and having less social inequality and all of these types of things. thank you. >> what makes these mass shootings so different than gun violence, the perpetrators and the ends in the mass shootings that we focus on -- and the victims are white. they are often in wealthier communities. newton was one of them. they also tend to be months long planned attacks. most gun murders are not planned attacks. there is, of course, every disproportionate share of
perpetrators and victims of gun violence who are not white. what you see, i think, is the gun is an ingredient that makes the situation that is challenging, difficult, life ruining for both parties. 18-29 is the core demographic and the person who pulled the trigger is probably in that demographic, too. that's a life where lerner. -- that is a life ruiner. do we need to address all of these underlying circumstances? absolutely. it makes those things that are bad and undesirable from crimes like that and illegal drug trafficking, selling. one thing we can try to do is make all of it less fatal. >> i am pointing to the person in green.
>> looking at what was presented and the tones through which the facts are being reiterated in the panel discussion, i'm searching for a ray of hope and i'm not getting anything. i'm getting the sense that the facts are what they are. the right to have guns, making more fatal violent crimes. as specialists, what should we be hopeful about? there's nothing here that i'm hearing that's going to change the landscape of what you have the pick it as statistics which,
frankly, are just statistics and numbers but ey really reflected very sorry state. >> you are in a political arena, so maybe if we can just give that one to you? >> or there is a fair amount of data to suggest that laws make a difference. there is an enormous amount of research when you put it together that strongly suggests that gun laws can matter in legislation has stalled in congress. not just in new york and connecticut but states like colorado, which passed a comprehensive set of gun laws a few months ago, and nevada is
one of the houses of state legislature who just passed universal background checks. there is some movement and there is evidence that there is some movement and it matters. lives will be saved in states around the country and i think this will put the pressure on to do more of this at a federal level. >> there is a lot of variability in the rate of firearm deaths. what is it about the states that have not as serious problems? that may be the key to optimism. it is not that it is bad everywhere. there are areas where the problem is far less. >> i would like to throw in the fact that if we expand this to
include suicide, which is a majority of death, my guess is that the research is going to show that, not surprisingly, if we have background checks for people who fall into a certain category of mental illness that we will get more of an effect there. we just have not found it yet. i think that is a cause for optimism. >> there was a study done here in california showing that people who tried to jump off the golden gate bridge, only 5% were stopped and eventually committed suicide. there is no reversal of
believing that. >> thank you again for having this forum as part of the class. as somebody who works with those who have mental illness, can you comment a little bit on the stigma? for example, those with mental illness, there are studies done in the american journal of psychiatry and also the stigma for those who might seek treatment and how policies and even this discussion, how it might affect those people? >> there is research literature on public opinion of people with mental illness. there are a few things there.
about 60% of adults in this country believe that people with schizophrenia are likely to be dangerous which is a huge exaggeration of the actual evidence for it. it's a little lower. it's about 40% if you think about anyone with a mental illness. that's what people believe. second, that attitude is actually tied to the desire of social distance from people with mental illness, tied to support for coercive policies.
there is a nexus of attitudes that are related to the stigma and they are damaging the people with amount of illness -- with a mental illness and they have an effect that is the opposite of what you would like which is keeping people from disclosing that they have a mental illness. i think it's very important to think about that when we consider policies. there is a policy in connecticut that will expand the category of prohibited persons to those who have been voluntarily admitted. there's reasons for concern about that.
it might have a chilling effect and drive people away from services or keep them from wanting to disclose their wanting to harm themselves. really it results in reinforcing that everyone with a mental illness is a concern. finally, there is evidence that mediate the trails actually increases -- there is evidence about sensational mass killings that are more likely to think that people, everyone with mental illness, is dangerous and have this negative attitude. there is this phenomenon of a self stigma. this is an important part of the
problem that we certainly need to think about. >> you were talking about the issue of mandatory disclosure of providers. as you think about that, two potentially negative things would come about that. one is a patient would not tell the therapist that they were having any eventually dangerous thought because then the police would come over and sees them or their guns. the other one for mental health professionals, they would be liable if they suspect did that something may be happening. on those two parts of the spectrum, it could be very difficult. >> yes? >> good evening. my name is nancy stern. i'm retired but i had a 20-year career as a psychotherapist working in mental hospitals so i have a lot of experience with mentally ill people. i have several comments to make, not questions really. one of the problems why we have such a stigma against mental
illness is, number one, insurance companies don't cover it as they would other illnesses. right there it's being differentiated from having diabetes, heart trouble, or whatever. i think the government needs to do something to make sure that mental illness is covered by insurance companies. we are talking about a lot of people not really understanding what mental illness is. i think this is something that can be taught to children in school, how to recognize when someone is having a mental problem. i can give you a specific example. my former daughter-in-law is mentally ill and she became psychotic. i happened to be with my granddaughter who was 3 at the time when this happened.
she kept saying i'm sorry as if she had done something. i was able to talk with her. your mom has a sickness in her head and she has to go to the hospital. that is why she is going to the hospital to see a doctor. my granddaughter who is now eight refers to that time as one mommy was sick in her head. disparate people move out of the area. a lot of people still live with their parents. they have people who care about them, there is a whole different nurturing community. i think a lot can be done. i have friends to say this person is schizophrenic. i say to them do you understand
what schizophrenia's? people, mental illness is such an enigma to most people. i think a lot could be done to educate people so there would not be so much of the stigma and it could happen to anybody. >> keep it short and we can get everyone in. >> there is hope that the brain institute is being established. we supplied taxes so we can do the research. we know that all behavior is due to brain activity and adolescent animals throughout the world. the impulse control is a neurological problem, it seems to be. the connections are not right
and we need to study aggressive animals which are different. aggressive dogs are different than quiet dogs and a guide dogs. we need to study people in the same way we can visualize their patterns, we can see what is going on. we should spend a lot of money and trying to study these people. mental illness, teenagers, people who commit suicide, brain trauma.
to see why the connections are there or what why there hormel stresses. -- there are hormonal stresses. guns need to be restricted. that is publicized more. >> when you have described capture jury well and the emphasis and priority that the national institute of mental health places on research. it sounds 3 much like-it sounds very much like let's solve this problem and then let's have better treatment. i think that is important. i agree with you to an extent i
would say this. even if we understood that and we had the magic molecule now to vastly improve our treatment. we still have we still have many people who suffer from serious, disabling mental health conditions and cannot receive the trigger we know works now. there are evicted or they're homeless or they're in prison or they do not believe they are mentally ill and they do not want treatment. until the great hereafter we need to focus on research and policy. and have a system that is not so fragmented and ineffective. >> i'm going to let some other people talk.
>> the problem you're describing here i would describe the political problem as a complete distinction between the discussions around that problem. every person counts as one whether there is a suicide or their kids in the inner city. whether there were killed in a single murder or mass murder. the objective is to prevent bad things from happening. not to wait till the happen and respond to them. this is in such utter tension with the normal policy responses that people have in this country. there's nothing bad if i do not see it.
there's nothing bad it has not happened yet. an area -- the policy area is killing us. the question is whether you think there is a way focusing on the gun issue, a way to bring public discussion and public awareness closer to a public health perspective on this issue. or if we are stuck with taking the worst priming event in terms of what really matters. these mass killings and trying to squeeze something at that event. >> there is an enormous amount of what you're saying that is right.
if you look at the post-newtown policies, two of which related directly to what happened in newtown. the two that related there an assault rifle ban and a high sapacity ban. some of those proposals have moved to the state level. this would not have been covered under any version of the universal background check legislation because he got the gun from his mom and took it without her permission. was that a sensible from a public health perspective policy priority, i think it was.
there are a lot more deaths that you can prevent with universal background checks that you are likely to prevent with assault rifle bans or high-capacity magazine bands. it would prevent some with both those measures. but did speak to some of the advocates, some of the people, some of the policy-makers who thought this is the one that makes the most sense. if you look at assault rifle high-capacity magazines -- it is in the high 50's and low 60's. including mass of support from gun owners were to do not say. and some ways the focus of the
discussion has been around a policy priority that does -- is in place where politics and public health meet. is it a sufficient junction, no, but it is the best we can hope for in contemporary washington. we can stick around a little bit longer. we get kicked out and the lights go off. before that happens, i would like to thank our panelists that came in to talk to us. and thank the students and thank all of you who were students for a day in our class. the good days, i am an easy grader. thank you. [applause] [captions copyright national cable satellite corp. 2013] [captioning performed by national captioning institute]
>> tonight, a discussion about activist computer hacking. then an interview with david cody. and then, 30 years living in china. no man needs a strong partner more than the imagine -- american president. that is what i concluded after five years and interviews, those presidents with brave spouses willing to speak sometimes hard truths that others are will -- unwilling to speak, those presidents have a