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tv   Washington Ideas Forum Al Gore  CSPAN  January 1, 2016 10:33pm-11:02pm EST

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campaign headquarters of obama that he had in northern virginia. goal was not necessarily to simply celebrate president obama, but to talk about what this means as we entered into the early 21st century. that's what we're trying to do. the goal of this museum is, on the one hand, this would be the first green museum on them all. that's great. i'm -- on the mall. that's great. i'm proud of that. the goal of the museum is to help people realize that history is as much about today and tomorrow as it is about yesterday and that, ultimately, the job of the national museum of the smithsonian is to make america better. -- aret: many you don't get the up-to-date. ?hat surprised you what are you including that you would not have thought of before? what are you most proud of? lonnie: i really think that i'm
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proudest of the things that average people have shared with us. one day a woman came to my office and said her grandfather had been a black soldier in world war i and she had stuff. and she dumped this back on the table. and as i looked at this stuff, it turned out her grandfather was a black soldier in world war hell fought for the harlem fighters, a famous unit, but the u.s. government did not know how to use them, so they gave them to the french. they fought in french uniforms. --y were given french metals medals. margaret: so, some people found you. lonnie: people realized they had been waiting for this. it is both the trust of the smithsonian, but the recognition that the story of the african-american had been left out of so much. reach into their basements, share the stories of their families makes it very special and in some ways very humbling. margaret: do you ever cry?
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lonnie: all the time. margaret: you're making me cry a little bit. lonnie: with monotonous regularity. margaret: you and john boehner. you could be speaker of the house. [laughter] [applause] i will stick to being a museum director. margaret: you arrived here in 2005. you have done what many people thought was not going to happen in a decade. and you opened when -- open when? lonnie: the end of september a year from now. lonnie:i have never done anything for 10 years other than stay married. nch iset: mrs. bu thrilled, i'm sure. lonnie: she will be thrilled when we cut the ribbon. margaret: your child is born. do you stay another 10 years? lonnie: you stay long enough to candidly,ngs, one,
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take a victory lap, write the book. also, no matter what we do, people are going to be critical. you talked to much, not enough about religion -- you talked too much, not enough about religion. i'm hope -- i hope i'm there long enough to fight the fight. margaret: thank you very much. lonnie: thank you. [applause] now athena health ceo jonathan bush. >> hi there. >> lovely. and'm felix, from "fusion," this is jonathan bush, the ceo of athena health. -- you very outspoken
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want a revolution in health care , or so you say. you've got amazing software as a service company, which we will talk about in a little bit. i want to know about this health care resolution -- revolution that you want. going to be against the wall when the revolution comes. -- comes? going to start my answer by saying revolutions are supposed to be in very quietly. and i'm saying that in a microphone in front of thousands of people on record. i think the revolution, or the i aspire tot is -- is to coax the fragile little demand curve from out of the sofa and to come out and play again. there is no demand curve in health care. as a result, there is no
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innovation. innovation needs to come out and have freedom to move about. there are few examples of that. the definition of health care is mandated. this is what health insurance means. you can have bronze, silver, and gold, and something like that. they are different amounts of coinsurance, but they are exactly the same. do you remember that wendy's commercial? ♪ we are trying to wake that up. we think the way to do it is to connect all the players in the food chain and to present the doctor in the moment of care with all the different options available. felix: and with prices attached? jonathan: prices, quality, turnaround time. at this point, there is so little demand curve that any decision will be a shockwave to the system. just shopping for availability, shopping for the frequency with actuallyiven choice
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follow through and does the testing, gives you the results. shopping by cost. we can also do fully loaded downstream costs. some cardiologists are very cheap, but they never met a guy who didn't need a stent. we can do all the math. at this stage of the revolution, it is just getting the disconnect, breaking down some areas, some almost "monty python" disconnect in various areas of the health supply chain. felix: you want a shopping revolution -- jonathan: or just like a shopping day. felix: you want educated consumers. are these mainly primary care physicians? jonathan: i think you have to start with the doctor. i would love for it to be the consumer. all of this is white noise. doctors barely understand it. we have 70,000 doctors on our own network.
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bigger than your network. five kaisers, i saw the other day, which i thought was pretty cool. just getting those guys to be able to understand, where are the mammograms? i usually send mammograms to place x. turns out there are four other places. there is an 80% variation in cost among those four places and that is new information. the possibility they could keep some of the savings by choosing that cheapest place and convincing you to go there -- that's really exciting. those things are just beginning now as sort of nationstates. and the people who end up on the wall, as you said, are the people who don't get chosen anymore, because they are too expensive and too hard to access. felix: this thing that you don't like -- there are so many things you don't like. one of the things you don't like is called the "triple aim." jonathan: it is "we are going to
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do everything for everyone so it is all better and no one is going to do anything hard." we are going to do everything with a very narrow focus of being good for -- high service for patients and high-quality according to some temple that defines quality different every year but can't measure it and cost, and you can't measure that. you have three almost totally unmeasurable goals in equal amounts. i cannot run anything with that many goals that are that hard to measure. and that, to me, exemplifies the lack of real mission, the lack of actual dedication to make an impact that you run into in health care. it's not that anybody doesn't care. the superego ratio amongst health care people is very high. we get great value. they work late, they care. but the willingness to take out a villager to save the village is very low. the triple aim is a quaint --
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quintessential icon of that. felix: you have a single team, which is? jonathan: make doctors more shey by getting rid of their it work that they hate and suck at. it's really that simple. we have earned the right to chat about it because we have this extraordinary sized network. all we are doing, the job of athena health is find piles of paper that make doctors known say, inumb and ill and will do that for you. 55% of what doctors order, they don't know what happens. they don't actually get anything back 55% of the time. it's like a bad, sort of george orwell comedy sketch. felix: and what if you don't get anything back? jonathan: we can consolidate it and put the people who are
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disappear-niks up on the wall. fax the results back. let us connect to the server. who faxes in 2015? the average number of faxes in 1154 faxes a month. a month! they get their emr from obama. have fax servers which receive faxes and put them in pdfs in giant files. that was it. birdk my son to see "big on ice." he is like, he is not so big. it is that incredible letdown. we are focusing on creating a business model. it is really humble, just getting this stuff to go away. you talk about quality. the basic nonfeasance and this
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appearance of -- and disappearance of work, starting with that. felix: talk about demand curve and villains. the new billing was martin shkreli and his $700 bills for toxoplasmosis. is responding in an incredibly rational way. -- he is responding in an incredibly rational way. is he not such a villain? jonathan: you get these hilarious examples that take it so far. but on the other end of the spectrum, we all can trade stocks. there are a series of kickbacks, commissions, between our iphone, the fidelity fund, and the various people among them. generate about
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ent of one cent to one c commission. as the competition for trades automation and supply chain integration improved and the price went away. in health care, if the hospital pays a doctor five dollars for enrolling that patient in the hospital system so that they don't have to show up again to get a clipboard, they both go to jail. that is a jail time sentence. you go to jail. five dollars to do a supply chain, which probably at this stage is worth $10 to $15 to actually connect -- because of that, we sit with islands of isolated information. that's an example on the other end of the spectrum. you get these hilarious examples. .e do need the demand curve
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if we have to suck it up with a few thousand dollars bills, i think it is worth it. felix: can't we get competition by enforcing the same build as europe? jonathan: that is not exactly demand curve either. felix: what is the biggest barrier to achieving this lovely utopia that you paint of everyone being able to have all the information they need at their fingertips? jonathan: this is not a health care conference, which is why it is fun and cool. if you go to a health care conference, you find it is always about the barriers. there are a lot of barriers. so what? there are also patterns - paths through the barriers. when doctors get risk contracts, they have an incentive to see where patients go and can make money to follow them, said they -- so they are willing to invest. when urgent care is getting venture backed, hospital care
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goes from wanting to blocking access to their data to eagerly wanting them to connect, because guess where all these people are showing up? there are these little tech timeshift -- little tectonic shifts that are happening. it creates this opportunity where a doctor who shops for the right input when replacing it -- a hip can do better than the doctor that does not shop. thisool thing is that internet thing is going to be big and it is finally making its way into health care. felix: you know what else is going to be big? $3 trillion a year of the health care economy. and when the economy is that big, there are lots of infringed interests. when you come in with your revolutionary fervor, there is
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going to be pushed back. who is pushing back the most? jonathan: a fair point. that's why i like the quiet revolution. you start with the isolated villagers. machiavelli didn't say "take down the castle walls, my prints." -- prince." you go feed the villagers and give them a printing press and that is the way that we think all real innovation should start. start at the outside, the low end. steve jobs didn't get better than microsoft by making -- he found these subterranean creatures called teenagers. he took computing out of the laptop and put it in the walkman and it was able to grow from there. we are doing the same thing. and those are the big places. those movements are the ones that will work. felix: primary care physicians are the teenagers of the health care industry? jonathan: isolated, nearly going out of business, literally choosing between death and the dishonor, doctors are the teenagers of the health care revolution. felix: i need to ask you quickly
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about us poor individual consumers. i personally would love to give up any semblance of privacy if i thought about what would make me healthier. i feel this is -- i kind of want to make that choice. jonathan: yes. felix: if you are taking that choice away it is not up to me. in your utopia is going to be forced to give up that privacy whether they like it or not. jonathan: you are mostly right. in truth, every patient who shows up on athena net, they do have a choice, but it is defaulted after yes, yes, yes. but you have to dig in there and say, no, i want it to be no. you have to pay in full, because we cannot look at the claim win -- when your insurance denies it. you can pay in full. and we have some professionals athletes that say that they are
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checking and we do it that way. nobody can see it. it is less than 0.5%. less than that. it is true. like a lot of things, we will get swept up and we will lose some personal power the but we will gain so much on the other side. it's going to be worth it. felix: ok. with that, jonathan bush thank , you very much. jonathan: thank you guys. i hope that was useful. ♪ >> virginia senator mark warren is up next. ♪ >> good afternoon. the senator and i are here to talk about uber and airbnb and the future of the on-demand economy which is made possible almost exclusively because of the invention of the smartphone and mobile technology. the senator has a prop of the mobile technology that he helped
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to develop as a tech ceo before became senator. sen. warner: as a cofounder of nextel, i am the only speaker today who can say leave the cell phones on. it does not bother me at all. i did have a prop, thinking who would've thought that this would have turned into this? and the fact of the matter is, as we think about the on-demand economy, without this and gps there be no on-demand economy. so, where technology leads us as innovation comes about, we do not know. it raises a host of policy issues, which we are going to get to. let's have at it. >> the california labor commission had a ruling this summer. it said the people who work for uber are not contractors, they are employees. this is helped to kickoff a pretty feisty political debate
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between republicans and democrats about how we should classify these people working for a new breed of company. help us frame that question. sen. warner: i think anybody who thinks about this in the 20th century construct is behind the times. the idea that, as we change the notion of work, as people might 10 to 15 hours a month for uber or lyft, or rent out their apartment, or do work making stuff and selling for etsy, are they a classic employee in any of those constructs? no, but the notion that they are simply all a 1099-er does not really fit as well. -- 20th century definitions of work. because of that decision, many platforms that were potentially reluctant to get engaged in the policy debate are now actually -- absolutely anxious to be involved.
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what i found was they actually got regulatory constraints on trying out different models of social insurance. one thing that i hope to bring to the table is the idea, could we get a regulatory timeout so that those companies who want to think about social insurance, unemployment, workmen's comp., disability, and other attributes could try them without trying to fall back into 20th century classification debates? at the end of the day, i think we will end up with a third classification. other countries have already done that. i do not think that policymakers are ready to define what that will look like. derek: some benefits that are inherent to a 20th century style employee, health care, unemployment insurance, pension, 401(k), how is this public policy or do technological platforms replace the things that seem to be going away on
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their own in parts of the economy? sen. warner: this is not something that happened overnight. my dad is it 90 this weekend, he was a world war ii veteran. he worked 40 years in a company, and never made a lot of money, but he had a pension and benefits. if we move from this generation, we move to 3-4 jobs, we still had some benefits. the millennials, although many of people in the on-demand economy are not millennials, they are people who got dislocated and have not come back into the established workforce, they are operating on this high wire, maybe doing well but with nothing to catch them because none of these social insurance programs have actually moved into the 21st century. what my premise is is we do not -- are not going to replicate the 20th century model, it may not be government driven. it may be independent third parties, that could offer these. the idea that you could go from here down to which it hit the -- -- to where stuff hits the fan, that is a free rider program on
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all taxpayers. and i think we can frame this debate in a conservative way that says we have to try some kind of joint contribution models in between. what does it look like? could it be an exchange model? by the way most of this , on-demand economy would not happen if there had not been as -- been the aca, because the severance of health insurance and employment has allowed a lot of people to take this plunge into the on-demand economy. i should quickly add that simply being a w-2 employee does not guarantee success anymore, because without the rhythmic -- with algorithmic modeling there , are a lot of people who give back 28 hours and never get the full benefits of being an employee, because of the advent of technology. but could there be an exchange model where you shop for benefits? could we look at an hour bank the old model where you
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were a carpenter. you would work for different firms. each time you worked for a different firm, there would be a contribution. it was not run by the government. it was run by unions. could it be a trusted third-party? one of the things that we talked about last week in san francisco was, could you have a consumer driven model? when you are hosted by somebody at airbnb or you do some work as in a lyftit or ride car, could you give a gratuity that would be matched by the platform that would go into a social insurance fund? i do not think that we know yet, but what court decision drove in california was the threat that this innovation could be squashed by a top-down regulatory ruling that made all of these entities willing to try out new policy ideas. that is good. we have to find a regulatory
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timeout to allow some of these platforms try these models before we end up with a one-size-fits-all legislative solution. derek: i want to talk about part-time work. there was a study done of uber drivers, done by an economist and uber and it found that people who are driving for the company, 80% of them had a full-time job before they joined. and working for uber, only 31% had a full-time job. that suggests to me there are a lot of people who are willingly trading full-time work for the flexibility of piecing together gigs, part-time work a little , bit of freelance. what do you see -- do you think this could be a future model for work? sen. warner: i think it very much could be a model. but we do not have good data. the last time the bureau of labor statistics looked at these in a major way was in that is as 2005.
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much value as if it had been in 1985, because the world has so dramatically changed. we need to get all of these platforms under sequestration, the notion that we are going to get the government to figure this all out, we need these platforms to share data so we can do this. we know that this workforce is growing rapidly. at a lowt is that a -- mckinseyion or, as million, we need to figure it out. second, there are a number of folks who are cobbling together a variety of different revenue streams to create a workforce and what i found and i have been a series of these roundtables -- and this is not just millennials. i think about a session i had in roanoke where folks were my age, rather than millennial. to a person, they would not go back to a traditional 9:00 to 5:00 with the same revenue
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stream. i would ask of them. it took 35-40% increase in pay for somebody to be willing to trade back in to a normal job. and as policymakers, we have never been able to put a value from a policy perspective on flexibility. we all complain about the hurried nature of today's world, but a lot of people are trading in for this flexibility. what we want to do, what i want to do, is allow innovation to take place and allow this flexibility to take place in the but not create such a free rider problem that people are doing well again, if they hit a bump in that back upon government benefits only, because we created no social insurance jointly contributing in the interim. derek: let's talk about the relationship between obamacare and the on-demand economy. on the one hand you have accusations that say, you are socializing medicine and health care. this is obviously bad for capitalism.
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and yet there are a couple of studies that seem to suggest that universal health care actually encourages entrepreneurs to start off on their own. because when health care is not tied into work, then if you do something and you lose your job or it doesn't work out, you are not losing health care. you still have that because it is provided by the government no matter what. do you make that case? sen. warner: i know there are a lot of folks in my day job who are trying to re-litigate this [laughter] sen. warner: this issue is yesterday's news. we've got to fix it. we should not have cliffs. we should actually have a cheaper plan. we had what we called, what was it, a copper plan that would be cheaper than bronze in terms of a lower value. lower actuarial value. but this ability to detach benefits from employment, which started post-world war ii, has allowed enormous growth of entrepreneurship. now we need to think about the next set of benefits and how they fit in.
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the other issue -- your piece on work where it is headed -- one of the challenges, and i sit here as a proud capitalist -- we have to recognize that modern american capitalism is focused on short-termism and i would argue is destroying capitalism, distorting the ability to create long-term value and in many ways is not working for a whole slew of low and moderate income americans. 60% of americans if they got hit with a $500 bill would go into debt or declare bankruptcy. we have to read -- rethink this social contract idealistically, . i hope we can find a way for capitalism to help with this problem so we do not end up simply with a government redistribution model or that -- the old adam smith unfettered capitalism will fix it all. both of these issues, if we do them right, do not have to fit into the left versus right, republican versus democrat de


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