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tv   Public Affairs Events  CSPAN  December 30, 2016 2:00pm-4:01pm EST

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and because of the problems that he has -- i just don't know if he is going to even have it after trump gets into office. guest: thank you so much for calling in. i think your concerns are right along where my concerns are. we know there are improvements guest: thank you so much for calling in. i think your concerns are right along where my concerns are. we know there are improvements to be made to the affordable care act and the health care system overall so while we want to work on where we are now, we want to make sure that provider networks are improved, we want to make sure out-of-pocket costs are improved so they are more affordable. we want to build on what we have now but we don't want to knock down that we have so that we are right back where he started where people can't even get insurance in the first place. e't insurance in the first place. if you are at a house and your windows weren't in the right conditions so instead of fixing them you
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decided you had to knock down your house. it seems like the most illogical path forward. i thank you for your call and we are working to try to get a path forward. host: barry in houston, texas, independent. go ahead. caller: thank you for taking my call. i admire the decision to fix the medicare system but i am a student of history and one of the reasons why i think there is going to be an instrumental task is just like before the stock market crash in 1929, our country had just recovered from a recession. we had elected warren harding, a very rich man and a republican. the republicans also controlled both houses of congress and not long after that, the market crashed. to happen when republicans control houses of congress. i think, because republicans did such a great job of making
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medicare look like something that is a handout and not something that you actually paid into that they managed to vilify get something the houseshrough all of congress, especially considering the party that we have. not necessarily the party but the actors that we have. they want to expend their type of money in their elite, rich class. host: what is your perspective on that? caller: the one thing republicans have to keep in mind is that now that they are in power anything they do, they own so they do have to answer to the voters. if they break it they buy it. they do know that the onus is on them to keep people healthy and secure so they do have that in mind as they take action this january. host: the wall street journal editorial agreeing this morning that the gop's obamacare moment
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-- this is from wednesday -- they say that that won't relieve the gop of the obligation to pass a replacement that provides more certainty as quickly as possible. political capital each day beyond january 20, gop leaders will have to maintain the resolve against the status quo. the rank and file may have to vote for some form of subsidy to avoid the spectacle of millions losing their insurance. if republicans blow this they will set up the next democratic government for single-payer. now is the chance to show they can reform the entitlement solutions that have improved the daily lives of americans. what do you make of that? guest: that is exactly right. it was a lot easier to be in opposition to approving health care and to vote to repeal the affordable care act many times symbolic and it wasn't actually affecting millions of people's lives. i think that they are going to
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have to decide if they can really act on something that is actually benefiting people or whether they will have to change course. i hope for the health of millions americans that they do slow down and change course. host: in utah, a democrat. caller: good morning. say iof all, i want to would like to compliment you on the great job that you do but , isone question i have is health care a right or a privilege? that is the one question that has not been answered, if it is or get ridep the act of it and bring in single-payer. but if not, sorry, you're out of luck. guest: that is a good question
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that our society in the united states has not answered yet. and i think that the applications of that question have a lot of financial fallout for our country. they have public health fallout and that is something you have capital asut in our we struggle to determine the fate of the affordable care act and the fate of medicare and medicaid. certainly, we know that american values -- americans value the coverage they have, and that outpaced that has enrollment last year so i think it might not be something we can out right answer so much as what the republicans do next will sort of tell us the answer. if they take this step forward and lose the next election, that will tell us what the answer is. host: the wall street journal writes that the first entitlement in u.s. history has
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failed. the number of plans on the exchanges are already low end plunged 16% for 2017. why? what happened? what mistakes were made that this is now happening? guest: i really take issue with this comment that the affordable care act has failed. let's keep in mind that it was fully implemented two years ago so our health care system, this massive entity, trillions of dollars, trying to reform it in two years and we want to give up on this policy. this was an ambitious policy to reform the biggest sector of our economy and we gave it two years and we want to turn our back on it? if we want to do this again it is going to take 50-100 years. that would be the biggest mistake. it just baffles me that people expect it -- we want to judge two years and we
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already heard from s&p that premiums are settling and we want to say we give up on it because two years. host: what do you think could be a fix for what the wall street journal says, that in 30% of counties blue cross and blue shield alone are the sole insurer. how can we fix this situation where companies are saying this is not what we told -- what we were told would happen. we are not seeing healthier people in these exchanges. and that is why we have to raise premiums. guest: we are talking about the individual market. the vast majority of americans get their coverage from their employers. which is still a very important market. we care deeply about employers providing coverage on their own. seeing market, we are that premiums are settling for the future. i would go back to the same statement, that we need to
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stabilize that market for future years. majority ofast consumers in that market do have a choice of multiple issuers. the markets that tend to struggle our rural markets that are challenging to build because there is not a lot of providers on contract with. we do have signs that it is getting better. to back away from this and go to where we started where we heard say they werelers scared they don't have coverage that just baffles me. host: in a rural, -- in aurora colorado, independent. the morning. aller: i think we are on delayed broadcast. host: why do you say that? and therewas talking was also talking the same time. i thought there was a difference in time here -- there is, isn't there? host: joe, you've just have to
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listen through your phone and talk through your phone so you're not confused by the television. rates really jumped on obamacare. my children, who are 40 now, they can't afford it anywhere since it went in. let me ask one thing. vote for?u would you mind telling me? and what do you think of the health care repeal? we acknowledge there are concerns with premium increases and there have always been concerns of premium increases. it has been a long-standing problem with health care for many years. i want to see premiums increase and that is something we have been working on pre-election and
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it is something we want to work on postelection but if we see the affordable care act fall, we won't have increases to work on for many people because they won't have health insurance. primary focus will turn again to getting them a source of care, worrying about getting them into a free clinic which is a world i don't want to go back to. i can't disclose who i vote for because i work for a nonpartisan nonprofit organization and i don't have the kind of expertise cuba health care in because i am focused on the american health care system. host: matthew, republican. caller: good morning. -- you have made comments about not being able to have any coverage. to don't we simply go back the same way the health care system ran prior to the law
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being passed? one thing this is not is affordable. .y rates have almost tripled my friends rates have tripled. everybody's rates have tripled. all we are doing, right now, all this is is taking money from one group of people and giving it to another group of people. host: let's have claire respond to that. formal care act passed, we have had an increase in coverage for many, many people. we have now 22 more people who have insurance than we did before. that is a huge jump. if the affordable care act is repealed, by 2019, 30 million people will lose coverage.
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i understand that folks are concerned about their affordability of coverage and that concerns me as well. i also, having worked in this field for over 10 years have taken calls about the affordability of coverage every day, even before the law passed. the afford ability of coverage is something i want to be working on for a long time and i think i did get these calls before the law passed. that does not negate the concerned about affordability, however i think worrying about that for an additional 30 million people would be very concerning. that is why we don't want to go back to where we were where people couldn't get coverage because of their pre-existing people hador when lifetime paths on their coverage, even if they had covered through their jobs. ensures could say "we artie spent a million dollars we don't have to pay any more." john in beaverton, oregon, democrat. what is your question or
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comment? caller: i am willing to say, i have experienced a lot of the issues with health care in terms for a federally qualified health center, medicaid. a risk pool,n which i understand is part of plan -- creating this risk pool that is very expensive. i also spent a year and a half rattling blue cross, blue shield. where is a republican plan going re,be fitting in the because medicaid serves the poor and the high deductibles quote access,s, and universal how can you afford it?
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guest: thank you so much for that. i think you hit the nail on the head that a lot of the same issues republicans are attacking the act for, they are perpetuating through their own plans. high risk pools are a venue to into all the sick people one insurance plan, which naturally would cause very high rates because when you ar -- when you ensure only sick people it gets very expensive. medicaid is an essential lifeline to the most vulnerable of our citizens. it is one of the first items up for repeal if history repeats itself in terms of the reconciliation bill that republicans passed in 2015. we are likely to see not any solution out of these plans the -- butations continuations of the problems and a loss of what we had gained. host: on medicaid, this is the washington times. it says "mr. trump initially
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said he would not cut medicaid but later expressed the idea pushed by years that push for years my republican congress, sending fixed amounts to the state in the form of block grants." critics say these cuts would follow guest:. that is absolutely right in terms of the cut. there are different ideas being tossed about about medicaid. flexibility is a fancy word for cut. you have a situation where the federal government pays a percentage for the medicaid program. what is being proposed by various republicans are options where states will get a flat amount in terms of a block grant or a flat amount per person for the medicaid program. what that equals is a cut to states and ultimately a cut to a cut to eligibility in the medicaid program.
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it is not sustainable for consumers. host: mark is next in california, an independent. , and i yes, good morning hope this will lead us towards a good future for the coming year. the biggest problem with our health care system is a lack of integrity by the folks in congress. both parties have betrayed us and i am a veteran. you can't get quite the health care you were supposed to. upset, i am a threat somehow. really, the lack of integrity by the democrats and republicans and their need for money so they can stay there, there are a lot of smart people back there but i don't want the smartest people. i want the people with the most integrity and they are not
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democrats and republicans anymore and all you people who have college degrees think you're so smart. -- weren't smart to vote in host: we lost mark. claire, let's compare what mr. trump said he would like to do with health care versus the better way that we showed viewers earlier. mr. trump health care plan includes repealing the afford will care act, modifying an existing law that inhibits insurance across state lines, allows individuals to fully ,educt across tax returns allowing individuals to use health savings accounts, requiring price transparency, block grant medicaid to states we talked about and remove barriers to the free market for drug providers. what do you like from this list and what do you make of the difference? are there differences between what mr. trump would like to do and what republicans in congress would like to do? we did here him talking about reining in drug prices.
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guest: you heard him earlier in the campaign, more interest in preserving parts of the health care law. i would stress that it is really hard to save little pieces because the health care law fits together as a package. you have different legs of it holding it together. you heard a willingness to explore and then you had appointments like representative hhsprice to secretary of and it became clear that it was solidifying a position of opposition to the affordable care act. but i would hope that there would be a willingness to listen a little bit to how the afford will care act is benefiting constituents across the country and it is not just some of these big issues that we talked about but there are also aspects that don't come up. it is these benefits in medicaid that helps us deal with the opioid academic -- opioid epidemic ravaging states from
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ohio to alaska. it is the benefits that the whole country gets. before the afford will care act towas hard for coal workers receive black lung benefits because there were not adequate protections for those workers and in west virginia that has been very beneficial. thinking about all the aspects of this law, i hope the president-elect will think about that. instead of taking a wrecking ball to it, he should take a scalpel. before we were set on this course of looking for repeal we were actively at work looking at how plans can be designed to be deductible? we well on our way to that and we were at a remarkable place because we couldn't look at cost payment because for years our nation had been so focused on just getting coverage. we finally have the opportunity to work on the next step in health care. now we are back to square one, just focusing on the basics
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because of where congress is sending us. host: pete is in warren, massachusetts, republican. are you with us? caller: yes. was -- i have a friend whose company pays to have insurance. he was unable to use it along with several friends in the same situation. if anybody has any questions about the afford will care act, obviously keep your own doctor and this and that, but what is just one of the many lectures that he had given -- this is the same -- this lady is a democrat because she just sits there nine her head, yeah, yeah, it is wonderful, but i'm just wondering out of the 20 million people who have insurance that
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wouldn't have had it, are any of these people legals host:? host:claire can you answer that? guest: the afford will care act requires that you have to be in the country legally in order to get coverage to the law. you can't even use your own money to buy coverage on the affordable care act if you are not in the country privately, which for many of us is actually concerning. no one is in the country illegally if they have coverage through the afford will care act. of how stories every day this law is helping people throughout the country. there are people calling us right now saying that they have received this coverage and it is something that is a matter of life and death. without this coverage, they will lose this health care, they will potentially lose their life and i have received calls from
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people worried about losing their life and that they will die and leave their family in debt. it is a very scary situation. this is not about politics, but about what people have gained and i really don't want to see people put out in this situation. host: steve is next. an independent caller. about, i have a question talking earlier, about the -- ncing nutritional discussion is being put forward into this as a basis for health care? host: are you following, claire mcandrew? guest: can you say that one more time? caller: the question was, based on the finance, the affordable care act, where it is going with
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that and clarifying that with science -- my question is how much do you put forward with the and imposingfforts those into the health care system? host: imposing them? implementing them so they are more discussed. host: what sort of nutritional -- caller: nutritional guidelines on an individual basis for a doctor to stick to for each patient as they come in the door with each doctor and patient in the care system. guest: the affordable care act did include different models to improve the way care is delivered but it didn't get too specific in terms of the doctor-patient relationship and how care is delivered. is about how a doctor would deliver
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recommendations around nutrition but it did include different pilot programs for how we improve the way care is delivered, different funding mechanisms to improve care delivery and improve quality so we wouldn't want to see those things lost either for innovation which has really helped improve the way we deliver pay for care qualities. i would go back to the point that the law really has a diverse way of improving our health care system. these parts are discussed over and over again but there is a broad array of improvements in that law and it is a great ifmple of what would happen we rushed through a repeal with no replacement plan to cover as many people with as high quality coverage. host: in melrose massachusetts, a democrat. caller: i just wanted to bring up something that has always bothered me of the health care system.
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than anymore money other country on insurance. it seems like we take a lot of insurance we never get to use and cover the differences between europe and canada. if iton't have to worry happens on the job or in the home or in the car. the insurance companies spend a lot of money trying to not take claims -- workmen's compensation is incredibly expensive to business. not one politician has ever mentioned it limited workmen's comp.. that is a lot of money that can going to the health care system. we pay $8,400 per capita in our country. we has $6,400 per capita for health care. guest: i think we are on such a tod road to continuing
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reform our health care system and that is exactly why we wanted to keep this movement in motion, that we were working on reforms, working on getting costs under control, set up to move on to the next iraq of cost containment but if we go back to where we started, we are back at square one, really headed backwards to where we were 10 years ago. host: james in texas, a republican. caller: ask ms. claire if she has the affordable care act? host: do you have it? guest: we all have the affordable care act because there are many benefits to employer sponsored coverage. there are many that we are going to lose. act is not ae care thing. it is rules that apply to
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insurance. rules that we are all going to lose if this law is repealed. if you get coverage from your job there are protections i am scared of losing. before, your insurance company could say "i am only going to pay out a million dollars." there were people with hemophilia and leukemia who had a million-dollar lifetime limit. at no cost,rvices whether it is cancer screenings are contraception's, those would be gone. the requirement that your insurance company has to spend a set amount on your coverage and no more than the next set amount on profits and salaries, all of , for yourfits dependents, these things all apply to employer-sponsored coverage and will be gone with
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the repeal of the act. caller: in 1998, i broke my leg. i had insurance through my employer. . had quit a job i had for operations on my leg and i did not go broke because i was unemployed for almost two years. i made a mortgage payment. i paid my utility bills, i've paid for a car, so the affordable care act was sold on false premises that everybody would go broke if they had a health problem. i didn't go broke. host: claire mcandrew? guest: i didn't follow. because you had insurance or because you didn't have insurance? host: we will move on to ernest in chicago, a democrat. >> good morning. i think the whole discussion has to be centered around the idea
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of economy, physical economy and the fact that we are not producing, as a nation. people are unemployed and underemployed and unpaid. the solution to this ties into the solution to the health care theation, the solution to physical economy is tied to reinstatement of a law called glass-steagall, which i wish c-span would do more discussion on. but the question i have for what i want to talk about is that , before richard nixon was sold on this hmo, we had a standard and the standard was ill burden. ill burden was something and lamented in 1946, something that franklin delano roosevelt
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supported. what ill burden did was allow federal, state, county, municipal and private sales care -- health care providers to just pick a guy off the street and taken to the hospital and fix him and then work out how you pay. is richard nixon sold on the idea that there is a lot of money to be made in health care. how we got we have to get back to, like donald said, what made america great. thank you. >> let's hear from kurt, in new york. caller: hello, claire. i am a white lower middle-class person. i am paying $12,000 a year now. i used to pay 5000 that my employer pays also.
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last year we had a startup two years ago. lost health insurance through the if ford will care act because no doctor would take them. guest: we understand that there are many ways that the affordable care act needs to be improved and there is always many ways that health care needs to be improved. however, we are very concerned about going to a place where there is not just no doctor willing to take the insurance but no insurance at all. that means that if you go to the hospital, you have no coverage in an emergency. you have no in network coverage or out-of-network coverage. you are fully on the hook for a bill that is tens of thousands of dollars and we are very concerned right now that we are in a place where we don't have anything to improve upon. have, rushing forward,
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a repeal of medicaid subsidies that people can use to afford coverage. this is on the table right now. with it, we have no responsible plans that will tell us what is going in place of the medicaid expansion and the subsidies. this is rushing forward, potentially through congress in january. you have people all over the country. i know it is not working perfectly for everyone that for up to 30 million people to lose their insurance, this is a very devastating time. we want to see a replacement plan on the table sooner rather than later. definitely before the repeal vote goes forward. >> what will you do to stop the repeal? caller: we, and many of our partners throughout the country and partners in the coalition are working together right now. we have been talking to members of congress, hearing from people all over the country at the
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national level, to let them know what people have gained from this law. we are hearing from people who are scared they are going to die because they are going to lose their health coverage. if you look in papers around the country from pittsburgh to the daily news in maine and west virginia and charleston, there have been rallies going on with people writing to their local papers, because they are very scared about this rushed, irresponsible plan to repeal this law. are going to continue and people are raising their voices because they do not want to lose something that has already had value. host: you can learn more about them was >> c-span, where history unfolds daily. in 1979 commits c-span was created as a public service by america's cable television companies and is brought to you today by your cable or satellite
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provider. host: we are back. antos at our table. what is the consensus for about if they repeal the affordable care act, what they would replace it with? >> this is a problem for republicans. there is a schism between the people who are more on the extreme right and those who are more moderate. the extreme right people are basically saying they want to repeal obama care and they don't want to replace it. i think that is really unrealistic and obviously i am more of a moderate i think i am more realistic as a politician. republicans run in the off year election or run in the next presidential election with the tag "they took 25 million people off of health insurance" is not a winning political argument.
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host: what do they need to do? the editorial we read says republicans may have to vote for some form of tax credit subsidy to avoid the spectacle of millions of people losing their insurance. >> that is exactly right. the fact is that if you are going to have what the guaranteed call issue, which means no matter what your condition is you can get insurance if you want, in order to have that work it is going to cost money. there are no two ways around it. low income people don't have the money to buy insurance that could cost $115,000. so if you are not going to provide support, the offer of guaranteed issue is pretty hollow and you lose millions of people her coverage and generally people who need help. host: how would this work? caller: the most likely scenario immediate, at the end of
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february early march, repeal of many of the financial aspect of the affordable care act. not everything, but many of them and in particular, they are thatng about using a bill was vetoed by the president earlier this year, which foraled the tax credits people to buy insurance, repealed bunch of other things that had to do with the budget. however, they knew that president obama was going to repeal that. now that they have a republican or will have a republican in the white house, they will have to come to grips with the fact that they will need to finance a subsidy, a subsidy that will but effect in several years in between time, in the transitions, they will have to maintain some sort of subsidy,
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some sort of help for low income people to continue to buy coverage for two reasons. one is humanitarian but the other is you need a stable insurance market going into 2018. if you don't do that that won't happen. host: what if they don't do that? caller: we have already seen many large insurance companies dropped out of many of the health insurance exchange markets where they were losing the most money for this year, the 2017 plan year. counties 15 or 20% of in this country know who only have one insurer. possibility. the consequence of simply saying we will repeal and think about in maybe it sometime not 2017 but 2018 or 2019, that is a recipe for disaster because
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it means the big insurers will continue to drop out. the other insurers that have done well will find -- if we are going to get all the sick people -- they believe they have to substantially raise their premiums. host: i want to get your reaction to john yarmuth of kentucky, the incoming budget committee ranking member. here's what he had to say about repealing the affordable care act. >> repealing the afford will care act is not going to be nearly as easy as they think it is. a number ofto people recently, when we put the affordable care act together in 2009 or 2010 there were 7500 lobbyists in washington trying to affect that bill in some way. those lobbyists have not disappeared. they still exist. when you talk about taking revenue streams away from
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hospitals and insurance companies and medical equipment manufacturers and hospice and it, health care, you name you are going to get a lot of resistance from a lot of quarters. earlier this week the american hospital association chimed in saying "this may have adverse consequences for us." same with the insurance lobby. there is a lot of pressure on them to at least not repeal it without telling people -- for them to have a say in what is coming afterwards. guest: he is right. if you receive a subsidy you don't want to lose it. people don't like change, especially if there is money involved. on the other hand change is necessary. it is clear that the affordable care act hasn't worked. the exchanges were not made unstable by republicans. they remain unstable by the affordable care act. republicans were not in charge
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when major insurers dropped out for 2017. the republicans problem is that they can't afford politically or any other way to make them more -- host: ideally, what do you want to see from republicans? guest: it seems to me that the sensible thing is to go ahead and repeal major aspects of the aca that you can repeal through this so-called reconciliation process. it means you would repeal some of the financial aspects of the aca. however, it shouldn't take effect immediately. there should be a transition period. i would say three years. during that. -- during that it doesn't mean that republicans should take three years to decide what they will do. they need to come up with a solid plan very quickly.
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beenly, they haven't working on this as hard as the democrats were working on it eight years ago. to come upy need with a plan and they need a plan this spring. at least one that is credible so that insurers can say they are seeing some prospect that this could be a viable market. so we will put in our bids for premiums, which we have had to do by april or may in order to go into the 2018 market. it doesn't mean they will stay because they can drop out in september, 2017. that puts pressure on republicans, i think, to come up with a plausible plan in negotiation with people and also put up with solvent language and set up the political infrastructure necessary to get it to pass in the senate. i think they need to do all of this in 2017.
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host: let's hear from joseph in florida, a democrat, you are up first. caller: good morning. i would like to mention i am a veteran. my three brothers are veterans. we served in three different war periods. one thing that caused me great shame is this health care system that we have. we defeated italy and we defeated germany and we defeated japan. we did not cross them. we helped them. we helped them rewrite their constitutions. those constitutions pretty much guarantee health care. why in the world couldn't we do something for our own people? is a document, a bill they introduced in congress years before we began all this debate about obamacare and everything. it is a 30 page bill. "medicare for all."
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please comment on that. guest: first of all, nobody guarantees health care. what you could guarantee and what european countries often .uarantee is insurance there is a big difference between financial coverage and actual treatment. you still need access to services. you still need access to doctors and hospitals. so one of the things that i think is often overlooked in all of this debate is that the delivery system in the united states needs an overhaul. we are incredibly inefficient. we spend more money per patient in this country than any other country in the world. partly, it is because we are ising people the best there at the standard american line. the other part is we are incredibly inefficient. we have a lot of excess testing, we have people whose first recourse is not to look within
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i do to keephat myself healthy, but rather "now i am sick so somebody should heal me." nature, of course, but nobody is talking about guaranteeing access to appropriate services and appropriate times. now, medicare for all -- they're , if they can afford it, sure but it medicare is an incredible program. it is a program that assumes that the government can call the shots. a is true that there is advantage to choose a private plan instead of a traditional program. the people who support medicare for all would abolish all plan choices. should goverybody through medicare and everything
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would be ok because the taxpayers will pay for it. well, the taxpayers happen to be your children and grandchildren and they will have trouble paying for education and roads and bridges. they are going to have trouble. host: steven in jensen beach, florida, republican, you are next. caller: my background is that i am a physician. iran many health plans -- i ran many health plans. the company would bring patients and doctors together to improve decision-making because the cost of health care is not specifically related to how much you spend for a particular procedure or a particular .peration it is the sum over time of what determines the cost of care. health insurance is not the issue here. we have many people with coverage but not getting health care.
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there is no measure of what is being provided. we have to look at this whole issue. it is the quality of medical care. host: you're breaking up a little bit but i hear your point. guest: he is singing my song. he is singing the song of most serious policy analysts. until we get the health delivery system to work better and until we get people -- don't think of them as patients -- until we get people to behave in their own self-interest to get a more efficient way, and until we get a system where doctors actually talk to patients, we are not going to solve this problem. host: how do you do it? guest: you can't do it from washington. if you think about the great health systems that many people talk about in the united states, the geisinger health plan in central pennsylvania
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medical professionals in the private sector on their own. the government didn't tell them what to do and the other aspect do they are learning how to it everyday and it changes as because not only does the science change, the nature of the patients change, profile also changes. unfortunately for us. ut also, our understanding of how to do a better job and what really constitutes getting changing and is improving, but that doesn't happen universally. f you are talking about medicare for all, fee for service medicare is then tithe organized health plan. we have to have organized health plan. you advocating for block grants to the states for
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medicaid? , the problemdicaid or medicaid, we guarantee a percentage runs from 50% minimum 80% or so, around maybe 78% right now for the state. income we guarantee a federal subsidy of is that percentage whatever bill the state says for patients. now that might sound equitable to some people, the problem, it things es states to do very efficient. one example of that is that with the expansion of medicaid under aca, i think 31 states expanded medicaid, so a lot more eople in the states are covered, that is great, however, the average cost per medicaid went ub substantially and the reason is, being paid
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cost and so, the cost, i'll put in quotation that wasn't the cost before, the cost went up. why? easier when it doesn't cost you anything to say, sure, we'll pay more. is a problem. we need to put, have states incentive, same incentive we as individuals have to watch so way we spend our money that we're spending efficiently and not spending too much. trs that say, i'll get reimbursed 100%, here is the cost? think the hospitals, hospitals tend to be organized. obviously medicaid patients, their doctor is the emergency room. arguing the t hospitals shouldn't get paid the medicaid program, 100%what i'm saying is that payment not only made it
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possible financially, but it politically for states to say, sure, go ahead tis not costing anything. reaction to that and the states that did that ecause it is going to be their money on the line down the road. host: go to alana, in scottsdale, arizona, independent. i've been watching the earlier lady on here and and ning to this gentleman they both throw figures around 30 million, would lose health insurance. my been doing research on own and i'm a working person, 've retired, i've always had medical, good medical and i've always paid to have medical, some people can afford to pay for medical, but they choose not to and i just -- what is the figure of people that would
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medicare -- not medicare, but their insurance if repealed? y understanding is 14,000 people on obamacare are or 14 sorry, are medicaid welfare recipients, is that true? well, on me number -- medicaid, it is a little hard to they receive ther assistance of cash assistance ayments, but probably some number like 14 million. host: we can show the census numbers for 2015, u.s. health insurance employer based 156 million. direct purchase 52 million. medicaid, about 63 million. 52 million ut americans about 29 million uninsured people. is 2015 numbers, according to the census bureau.
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guest: oh, well, but the numbers useful.ery what this lady was really saying was what is the impact of repealing the aca. medicare number includes probably 10 million -- i mean 50 illion people eligible for medicaid and have been on medicaid or about that number on -- caid well before the host: okay. guest: and the same thing is true, the numbers don't tell you what the differential is. this lady wants to know what the real number is. of course we don't know for sure, it depends n what the other actions are, it depends on what republicans to do abouts decide whatever happens in the next two months. we don't know that yet. but i'm fairly confident that survival, not l talking about goodwill here.
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'm talking about political survival and democrats will be running for office, especially 10 or 12 d be i think unning for the senate and they want to get their seats back. somewhat optimistic that everyone will see their own self doing something that could be in the nation's self interest. michigan, , kathy in democrat, welcome to the conversation, go ahead. morning, greta and joseph. i have a friend who is on and medicaid and her -- she's a very intelligent, woman, her deep concern able to not going to be receive medical services because stipend is -- i don't, have to be a big stipend to cover the cost of her medications alone, then you have your office
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visits. away the medicaid for people in northern michigan, is rural, what you do, you burden the hospital with a debt that they have to treat peep when he will they come to the emergency room, it doesn't matter what they are reating for, they have to absorb the cost of that and it is called charity. has helped in keeping y hospitals viable in this part of the state. the government needs to watch its moneys better. i don't want to be charged for that i didn't receive. i don't want to be overcharged. the overnment should adopt same attitude. his ripping off of gouging of medication prices reimbursements for whatever services that monitored, should be standard pricess.
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those comments. guest: this is about a million questions, really. we've been debating this and thinking about this in decades.on for certainly on the point about rural hospitals and medicaid, is probably their most important payer, no doubt about that. owever, the reality is that hospitals do not in quotes costs. hospitals, the popular term is shift costs, i'm not sure that term, but the reality is that private payers medicaid, medicare more than medicaid, basically the statistics are that roughly speaking medicare 60% ospital services pays what the average private plan ays and medicaid on average of what the %
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avera average -- pays. there are variations medicaid patients may be sicker than a little hard to say. know, rsus 100%, you chances are there is what people call cost shifting and what it means is that middle class are picking up the cost of through taxes and picking up the cost of medicaid hrough their health insurance premiums and through copay. a moral statement about that, it is a fact, that is the way this system happens work. are we concerned that should we be concerned that hospitals will of business? in very rural areas that, is an issue. ost parts of the country, hospitals will not go out of business, but nobody will get a that, has year probably been true for some time. m rural areas, huge problem, hospitals are where they shouldn't be. we would be far more cost
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and probably more p ther put cally, if people who are severely ill were airlifted out of rural areas to where the facilities are and wecialists really are and if ordinaryedicine to get things dealt with in the community, this has been tried works, it has been ried on some native american facilities because they are extremely rural areas, it really people of the community can learn how to do it with assistance and with telemedicine, it is quite feasible. you can identify who is really do, and then what do you that is really critically important. keith watching there, republican. caller: good morning, i hope everybody has a happy and safe new year. host: same to you, keith.
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caller: funny thing real quick, 1967, my sixth birthday, had german measles, last time i comes to my ctor house. i believe it is starting to come ack, doctors going to the house. you almost said it, the biggest medical thing that will happen, medicare is ty and actually -- in the next eneration with smaller, so healthcare costs are going to explode here in the next 10 to 10,000 retiring in a day. i question is, as much as believe in states rights and things, i do not understand why individual state has these insurance committees that set up plans for what is required in the health insurance state.for their i don't understand why there is not one federal guideline on states can't sell in between states over state thes like they brought down
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car insurance in homeowners nsurance when they started selling across state lines. host: keith, we'll take your points. aca did create benefit package that is i think pretty generous minimum package that must be sold by all nsurance companies, except medicare , the program. medicare for all. part of it is that there is a what is called catastrophic cap, out of pocket cost a patient can ay in a year, that doesn't apply to the medicare program. there is some iron neall of this. he insurance commissioners, keith is right, there is one in every state. hey have been around probably for the last 70, 80 years, maybe -- life cause they insurance existed before health
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insurance, probably more like years ago. you could argue that it is an isifact of history, which it in a sense. however, there is another which is that under the aca, insurance commissioners premium requests in the individual market, aca the and the reason for that, the the closernd that is you are to the market, the more you recognize what the financial conditions are and we saw this as i think r 2017, many people know, many of the dropped out sort of by april or rocess so of this year. some, in may in some cases. ome of the plans actually failed. the so-called co-op plans failed
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during this year. so, those people who would have been customers of those plans be reallocated and tended to be sicker patients. states, the insurance commissioners raised the rates because otherwise they lost more insurers. so you do need some local some local knowledge of what is going on in the market. this is rguing extremely efficient system, but i'm arguing if you don't pay market, n to the local you will get it wrong most of the time. host: questions on twitter. aca gone, cost will be shifted to private insurance, premiums for those with skyrocket like before the aca. aca 2017ell, so for the plan, on average, went up 25%, that seems pretty steep to me, you are a if low-income person. yes, the administration says, if
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receiving the maximum subsidy, you didn't actually pay nything more, that is true because taxpayers paid it. 25% is 25%. the concern about rising healthcare cost and the concern rising premiums is a real issue. this is a challenge republicans essence, democrats had t easy, the theme was not affordable, but insurance, insurance coverage. so, the outgoing administration promoting time people signing up for coverage. that is a very social goal. affordability took a back seat and it obviously showed up this with premium because it wasn't affordable. to now find the key to affordability, not something you wake up in the say, here it is, this is going to be tough.
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host: don. false, i haveue or insurance from my employer, i for the um and i pay subsidy for the aca again as a taxpayer. true.: how much does he pay is always the question, on his income. absolutely. live in the system pay percentage of our adjusted gross income, so if he's relatively high income person, he's paying higher taxes. i think one could argue that is equitable. host: steve on twit wer this countries ration are, is that how we will get cost down? guest: all care is rationed. somebody makes a decision about hether you should get a treatment or a test. rationing goes on in every doctor's office everyday.
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ideally, they know something about your insurance before medicare had a drug benefit, for example, we know for sure, that senior citizens were being prescribed drugs, being prescribed generics primarily aware of s were very the cost. medicare part d came along, actually the rate of generic thenribing went up because there were organized drug plans in a more this aggressive way and actually made patient lear to the that this made sense to them personally because their opayment was very low or oftentimes zero. so in fact, we've, you know, go sort of thing host: what was impact of medicare part d on the taxpayer? everything medicare costs taxpayer money. is that part d is beneficiaries b, ay premium roughly 25% of the cost. and there's a little fuzz in there about other money that
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floats around, but, you know, somewhere around 75% of the cost picked up by the taxpayer. think you could argue that people who are elderly and limited nd who have incomes should not be expected pay exorbitant amount of money. came in, so did related premiums for part b. so senior citizens who are high earners or have high incomes are paying very, very high premiums up to 75% of the cost of the program. host: clarksburg, west virginia, frank, independent. you r: yes, greta, how are today? host: morning, frank. caller: happy new year. know, you're talking about lobbyists, they're not lobbying people who are making on medicaid, i mean, that is not
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happening. companies, or the middle man, okay, literally enied coverage to people who have catastrophic conditions who inevitably file bankruptcy. medicaid person on medicaid had paying y, they would be for insurance and that is a fact. the united at in states healthcare is a privilege for the rich and a right for the poor? i mean, what is happening here? your response?, guest: that is a little extreme statement, i would say. went a ue that the aca long way toward resolving problems of this gentleman raises. certainly the guaranteed issue of it, the idea of having refused re or be because you either have an active health conditions or had
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one sometime in the last 10 years, i think most people would say that was unjust and unreasonable and have to find to make that still work as a business proposition. that operates ry on market principles and that system.s the health so in fact, his statement that medicaid bies for beneficiaries is not true at all. he hospitals are very well organized and they're constantly ushing for better reimbursements for low income people because those are the are the bad debts they are having to deal with. they would rather not be cost drifters, much rather not be the bad guy in all this, who wants to be. same thing for physicians, they are not as well organized a lot of ey are still physicians who are independent not ices and the ama is quite the organization that the
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american hospital association is that he fact medicaid has active lobbies, the association ctors is very concerned about this alance of state costs, federal costs, providing services. host: okay, baltimore, michigan, patric patricia, democratic caller. good morning. caller: good morning. to say that the affordable healthcare act, first of all, did help to save my life. i to pay a premium, i think one work is because everyone did not join f. had one had joined like it been intended to to, it would have worked. are not hy people joining, the young people are not joining. the thing that bothers me, healthcare should not be something that we should be discussing on who can afford it who can't. i'm sure this gentleman here has olden parachute health insurance for him and his whole family and probably for the rest of his life, but if we can
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to have two wars and we can always find that money to go fight, we should also be ble to afford for everyone to have health insurance. host: patricia, mr. santos, her comments, she talks about this was supposed to work because more people -- what why didn't people join? guest: that is a fair criticism. the aca.the design in hat insurance companies would like is a balanced risk pool, in share ords, you get your of sicker people who need active of the t, you get sort average middle-age person ideally who isn't too sick, but for routine octor things. what you would like is to get people, e of young especially think about young guys, as a young guy myself, we never fwing to get sick or be in an accident and if e are, it will be a sports
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injury and somehow that will be taken care of. those exactly are the people who up.'t sign they didn't sign up for a couple of reasons. is aps the biggest reason that if you're under 26, under parent's tay with your plan. now that was a stop to middle class parents, but a dumb thing and people who put that in knew it was stupid. taking the bulk of the saying, people and don't bother. don't join with the risk pool more s going to be problematic risk pool. indeed they did exactly that. the ermore, these are people who, i had teenagers, or 20-year-old guys actually in my family and they didn't buy insurance right out college. i bought it. i was protecting myself. they weren't going to waste that, they had other bills to pay.
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those are people who would have they reat customers and were off by the aca. that is a problem. the other problem is that if to have a mandate, you better mean it and this weakest as one of the the ocean. the contrast is switzerland, where if you move somewhere, the first question that the local government asks you, they ask you is, show me your insurance coverage. you have to be covered. n switzerland, you have to be covered, it is more market-oriented system, you in switzerland without insurance and the local overnment checks on you every year. okay. have here? with the aca, there was a penalty, a very limited penalty and in 2014, nobody knew there penalty because how do you know anything in this country? you ask your neighbor. a neighbor who was penalized.
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the fact is, nobody knew there was a penalty. following year, there could have been a penalty, but 14 ways exempt, including the best way, which is any other way we didn't think of. the i.r.s. didn't didn't it and they 15, first en in 20 year they vehicled enforced it, i believe they didn't collect year, either there is regulatory process that goes through, you can appeal the result, we haven't seen penalty tis a very weak penalty. really not was designed to bring, draw into the people who would be fwd customers. host: republicans get rid of the mandate, what do they replace it with? guest: good question. of the uldn't get rid individual mandate, at least not right away. political practical, reason, if they get rid of the ndividual mandate, then the
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problems that will inevitably occur for 2018, there will be problems, no avoiding them. reduced or made worse by whatever republicans do. there will be problems f. they rid of the mandate, everybody will say, they got rid is why it ate, that failed. that is not why it failed. it failed because the epublicans are working off a design that just didn't work in the first place and they are building maybe for years down the road to something i hope will be a more workable more sensible plan that will actually bring people to coverage. florida, in tampa, republican. hi, mark. kwaukt morning.ood my question at the end of the day, how much profit is there at insurance with the companies and big pharma? other statement, i work with telemedici retired, ne, i'm ow-paid nurse, and excellent
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way to access patients and patients re to those who are either unable to come to the doctor's office or are too away. guest: absolutely right on the telemedicine point. seniornology goes and as citizens have their children teach them about how to do these things, they'll be able to get preliminary home visits, in a sense, telephonically, that will really help, especially for seniors who have a tough time know that is o we going to work. as far as profit in the insurance industry, i think that is sort of his question, it a very profitability industry, it.question about i'm not sure what he means by he high end, but it is certainly true that ceo's make a
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lot of money in the insurance they have tremendous responsibility, and they have to and they can't be fired and have been fired. ost: mark is next, in tampa, florida, a republican. caller: yeah, again, the a stion, the v.a. system is socialist system and works well, i don't understand why we don't have medicare for everyone. i think we talked to mark. rich in north carolina, hi, rich. caller: hi. of them mments and one anyone talk about sorry, how it would help company fist they went to single payer system, they wouldn't have o pay all this money out to cover their employees and would just be simple tax, less than
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paying out now with the way premiums are done going up.y they keep also, my girlfriend, she's been on edicaid and medicare and disability and we ain't never had a problem getting her the needs for her she situations and she was just in days, just for 12 bed stay was $30,000, something to be done about reign nothing cost. you can call one physician, they this, another physician charges double that. here is a lot of different aspects to this whole system that needs to be reigned in and controlled. okay. okay, rich, mr. santos. guest: right. of ink the critical aspect this, how is care delivered, how are medical decisions made? involved actively with their physicians in a way sensible for their health and sensible for their
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pocketbooks? you don't know you are paying anything and don't care about though y aspect, even paying, if ou are your doctor is too pressed for time, then you'll have trouble. i'm impressed that he reports a good experience with the medicaid program. i've talked to physicians in private practice and specialist necessary particular, whose to medicaid is yeah, we'll see medicaid patients, but with paying, if your doctor is too the immediat emergency and then we will refer to someone who specializes in the medicaid clinic, that may be a may be a hospital, that may be independent provider and may ll be fine providers, but the to is that it is difficult get specialist treatments and if
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ou have a good doctor, good primary care doctor, you know, they will call around to make of that you get the kind treatment you need, but if you don't have somebody helping you medicaid program is just financing program, does not guarantee care at all. if you want to learn more from joseph antos go to aei's eb, announcer: tonight on c-span, a look back at some of the public figures who died this year, including the former israeli prime minister, shimon peres. here is a look back at some of bill clinton's remarks at his funeral. president clinton: his critics often claimed he was a naive, overly optimistic dreamer.
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they were only wrong about the naive part. he knew exactly what he was doing and being overly optimistic. -- in being overly optimistic. he knew exactly what he was doing with his streams. dreams. he never gave up on anybody. i mean anybody. he wrote to the prime minister to talk about their beautiful friendship. it followed a very brutal campaign. but shimon always get the door open. announcer: more from the funeral of shimon peres tonight at 8:00 on c-span. we will also look at the lives of john glenn, mohamed ali, lav so, janet reno, and -- ellie we
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ie wiesel, janet reno and fidel castro. >> while people were starving, he was having the fancy parties in the white house. here was this rich man in washington sneering at the poor people. harrison had thousands of acres of the state, so he was actually a very wealthy man, that -- but he was portrayed as a champion of the poor. women came to the parade and waved handkerchiefs. some gave speeches. wrote pamphlets. it was shocking. some said they should be home. night at 8:00 eastern on c-span's q&a.
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>> the soho forum is a monthly debate in new york looking at issues from a libertarian perspective. this month, a debate on when the country should go to war. lawill hear from an nyu professor and a foreign-policy adviser with the cato institute. >> thank you. again, the resolution, the united states should he prepared to use force in defense of friendly nations, even when not subject to the direct threat of force. please vote on your cell phone or your smartphone, undecided, yes or no. you will vote this time and after the debate is over. as part of our tradition, we are going to be closing the vote before the debate begins, but you have a little time to think about it while we have our next
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event. we will begin with a warm-up act from a great live or terry and comic. last month, we had dave's -- libertarian comic. to daveth, we had smith. this month, we have andrew heaton. andrew needs no introduction, except to say that he is the author of a terrific book called, "laughter is better than communism." defend that highly contentious claim, and her heaton. andrew: thank you. thank whoever it was who preemptively clapped for me before the rest of you. you are my favorite. are you all excited about foreign-policy debate? yeah! i think this is particularly fun for libertarians because we on't have to study as hard
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foreign-policy because we don't need to know as much geography. you don't have to know about countries you don't plan to invade. here is america. don't bomb this part. don't bomb the free trade zone. here is arite about leper. man, we had to learn that, about here isight aleppo. man, we had to learn that, didn't we? hillary clinton had to know because shepo is planned to bomb it. --anybody think donald trump does anybody think donald trump those where aleppo is? who needs to know,
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aleppo is a city in syria. we can go from that. it seems like the neocons are on the dissent. know, thewho don't basic idea is, they want to go nationbuilding by bombing the ,ations they want to build which many of us would argue is counterintuitive. the flipside is that democrats are the most stalwart opponents of war there ever were, until given the opportunity to vote for war. afghanistan, world war ii, world war i, narnia, west rose. -- westeros, they want to go to war with all of them. i have a masters degree in
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european politics. did you get that, c-span? impressive, because i am from a place in the country where there are more cows than past orts. -- passports. i am from oklahoma, which is the canada of texas. [laughter] thank you, to the loan oki back there. 1966, and we are good. that's pre-much all you need to know. -- pretty much all you need to know. i grew up there but i got educated on global affairs by going to scotland. where i got my masters degree. if you are not a worldly cosmopolitan east coast elite like yourself, it can be confusing. in scotland, they have different words for things.
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high? high? it's pronounced i. issed, which is, where for angry.the word in scotland, it means drunk. i would hang out with my buddies and they would say, "last night, pisuld get so -- i got so sed, i blacked out. and i would think, i have never been so angry in my whole life. anre i am from, there is inappropriate, pejorative epithet for a gay person. in scotland, that means cigarette.
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wouldould say it, and i go ok, i am going to just sit here and be quietly heterosexual. feel compelled to announce my preferences, but good luck to you. anybody here been to ireland? they are super friendly there. scotland, which i love, is sort of a violent friendly. sort of a foreboding friendly. hello, welcome to scotland, we would like to buy you a pint, like something bad might happen. but a friend of mine from college is of irish descent, and they buy pints for everybody. the mayor of the town came out. welcome home. let's bring you a parade of young maidens you can marry. liket to england, which is for can with wool hats, and did not get a hero's reception. i went to a town where i thought
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my family was from and they said, you probably left because of debt. 30 seconds left. the important thing i wanted to communicate to you -- i got a little off-topic. i apologize. aleppo is a town in syria. you needn for office, to know that. thank you so much. dean: ok, now that we are warmed up, -- ok, now that we are warmed up, the main event. the resolution is the united states should be prepared to use when not subject to the direct threat of force. you can read about chris on our website, but here i do want to say that chris is the author of the powerlled, "
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problem: how american military dominance makes us less safe, less prosperous, and less free." chris is apparently such a fierce debater that bret stephens of "the wall street journal" declined my invitation to debate him on foreign-policy. but richard epstein was happy to accept, and in fact, when you set up a resolution between two debaters by email, it sometimes goes on for days. case, richard crafted the resolution. it was written by him word for word. accepted it.tely it was over in a minute. richard has been called a rebel without a pause and a force of nature. in fact, i am the one who has
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called him both of those things. those phrases have stuck. he is probably willing to debate anyone in a public forum on the many subjects he feels strongly -- the list go on is incredibly long -- provided to refraint agrees from physical violence. chris and richard have both generously contributed reviews to my book richard, you have 15 minutes to defend the proposition. the voting is all closed. that is your timekeeper, watch him. he will hit you over the head if you go over time. >> i will not be the second of three debaters on this issue sandwiched between two people who have taken the negative.
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let me see if i can describe why i am not quite a neocon but would classify myself as probably somebody who is more or less in terms not particularly appetizing to many people, a modest dubious cautious libertarian hawk. the question is how does one start to get to this decision. my own view generally speaking is to say the same -- take the same attitude we heard earlier on about how is it you try to very strong categorical rules to dictate the way in which governments ought to behave. some years ago called "simple rules for a complex world," which set out six basic rules which if understood what effect a sane and civilized society to get rid of most of the ailments that have befallen modern america. the question you have to ask yourself is, why do i take that kind of a categorical position on these issues that i don't take it with respect to foreign affairs?
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i think it's the right question to ask. let me see if i can give a couple of cause of the right answer. the first thing to understand is that simple rules for a complex inld deals with the way which the government tries to regulate an economy. with these particular circumstances, it's not that a discretion and confusion in the way in which various things ought to be done, but the basic intuition is if you have a relatively fixed set of legal rules, the discretion will be lost in private parties and they will try to figure out how it is they are going to be best able to deal with various kinds of uncertainty. if you look at the private organizations that have to make these kinds of choices, they do have a fairly complicated governance structure, but one of the features apart from separation of powers, is there is something known as the business judgment rule. what that means, when you are faced with uncertainty and two kinds of errors and you're not conflicted out of the situation,
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no matter which particular you will beake, insulated from liability with respect to your shareholders or other constituents. the reason this particular role has such incredibly powerful roots is you can imagine if you try to do it the other way around. if you got it right, heads you you will beou lose, exposed to some kinds of serious sanctions, including financial ones. at the front and expected value of positions of power will be negative, and so the organization shut down because they will not be able to get anybody in order to operate. rule,he business judgment it is designed to say we don't look at these things one tick at a time, we look at a market basket of ideas straight you get the right people in the right is that you choose overtime to do better in a rule of outlines than you are going to do and a world in which it turns out, you have it. why don't you apply this with respect to foreign affairs? the answer is unfortunately the definition of the state is that
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it has some monopoly of power within the jurisdiction in question and there are no private parties to which you can delegate the question of what kinds of judgments you want to make when you start to deal with foreign affairs. and so, as is particular point, the question of when and how you use force as to be a public function. if it has to be a public function, the same kinds of rules have to give you discretion on which particular way you are going to go, whether you will stay in or out. then people are going to start to say, why do you really need and letd of discretion, ansee if i can give explanation. if you start talking about most situations, essentially the world is a relatively simple place if everybody starts to play by the rules. if you don't cross the middle of the road to hit somebody else, they don't have to run and hiden explanation. if you start talking about most situations, to get out of the way. but anybody who spends any time worrying about the rules associated with self sense an individual and private cases will quickly realize it is that shrouds with a kind of
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irreducible uncertainty that no amount of clever analysis can reduce. if somebody comes that you, one of the things you can do is sit there and take it and after you are dead, bring a cause of action, which is nuts. now you are entitled to use force, but the question is how much force are you entitled to use. now we have elaborate rules force.xcessive and it turns out that the moment somebody deviates from the rules, you have to give a degree of discretion from -- to everybody else. one of the other great problems in the area in which you are is as follows. what are we supposed to do with respect to the use of force in those circumstances where we see b, and we as an individual have to decide whether or not we are going to intervene. one of the things you can say is, it's not my business if they want us to kill b. b better defend themselves, but i not going to risk anything.
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most people say a categorical rule would not only be hardhearted, but positively dangerous, if you thought the repetition of those kinds of events would continue to take place. what happens is now we say, you are allowed but not required to intervene. how do you decide the way in which the particular intervention is going to take place? easyhis is not a particularly question to answer. you certainly don't want to say you always have to go in. it may be there is a serious conflict that exists. you start to go into the situation, not only dose b get slaughtered -- does b get slaughtered, but you get messed up as well. whether or not there is time to get other -- before you start to intervene. the kindsght back to of serious problems about the use of judgment and the way in which you have to handle these cases. the question comes, how does this particular work when you translated from the individual
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cases into the cases having to deal with public affairs? it's interesting, those who study the classic sources, when you read only in translation, we will in effect discovered that they always try to figure out how you dealt with the international relations question by figuring out the way in which as itte the question arose in ordinary disputes between private individuals, recognizing the stakes would be vastly higher when you're talking about nations, but understanding it is more difficult to figure out exactly what the right answer is. what you have to do is approach the front of them with the appropriate sense of humility, knowing that both kinds of errors you have and he's kinds of issues are going to be extraordinarily hard. there will be some cases in which you don't intervene and you will regret it to your last day, and there are other days in which you will start to intervene and think it was premature, foolish, and unwise.
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it cannot be done on either side of this debate to simply announce this, that, or the other successive failure. one of the reasons why this debate is so difficult to undertake and how it is supposed to work is that it turns out that you have to look at a huge number of cases before you can decide whether a rule was some kind of muddy, uncertain position of the short i'm defending, is in fact the appropriate way in which to look at it. i think when you start to do that, the strength of the middle position starts to become a little bit more clear than it would otherwise be. let's start to figure out what it is that we mean when we start to talk about this particular resolution and the way in which it's going to start to work with respect to the use of force trade the operative word we use is prepared. how do you prepare? but suppose we have decided as an abstract matter that we are
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not going to intervene unless there is a direct threat against the united states. can we enter into any treaties or alliances with otherresolutih nationsng to start to and commit us to use force in exchange of a commitment by them to use force to defend us? this is not a simple abstract proposition, if one were to try to explain what the success of nato was in the postwar years. this was a great success because before the treaty was entered into, there was a genuine question as to whether or not the russians would continue to march westward and impose their free society upon helpless nations, and once it was clear the united states put themselves into the game in this particular fashion, that is a very
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effective counterweight to the way in which things went. it was also clear it was not just an idle treaty arrangement. you have to put troops in harm's in order to be able to stall the situation. about the same time we had another difficulty, and here is a we are going to do. there was a famous resolution which put south korea outside the protective zone of american interests, and one of the short-term consequences of that was the korean wall, which turned out to be bloody and rather difficult to deal with. if we had taken a firmer line going into that, it seems to me we would have had very much greater resolve. if you want other kinds of situations which are generally ofiguous, one has to think 1973, when there is the snake israelis, and the question is whether or not if you are prepared to go to war,
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are you prepared to rearm your friends if it turns out they are munitions, which was the case of israel for about a week or 10 days into the particular operation. the israelis managed to survive, the munitions, which was the case of israel for about a week or 10 soviets were drivef the middle east. if you then look at the situations later with the famous red line in aleppo, the unwillingness of the american position to enforce anything with respect to that is resulted in hundreds of thousands of people died, millions of people displaced, immigration pressures moving you into europe, the breakup of the british situation of being attributed to the migration question, you have paid a very high price under the situations. people can start to say, there is some notable fiascos. you can look at vietnam and argue that was one. and there could be a huge dispute about what is going to happen in a place like iraq. it seems to me the lessons you
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want to learn from this is not that you always stay out, but the lesson is quite different. if you are going to get in, you do not get in with just enough force to make it a fair fight. you think about this in the same way you think about predator and prey when you are talking about a state of nature. if you're going to be aligned, you're willing to take on a hyena. that is the only fight you enter into, those you can win with overwhelming force and given the position of the united states we can productive mind, bring about the circumstances. part of the problem you have with respect to vietnam is we have all sorts of constraints on what we were prepared to bomb and how we were prepared to behave. if you go in half way, you get yourself chomped to bits. the mistake wasn't the war, it was a dance. when they get to iraq, there's going to be mayhem and so forth.
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it turned out saddam and nothing left and it was a victory party marching there. if you win the war, you have to win the peace. you put somebody like petraeus in charge, and he was not just a military man. he understood the social commitments it requires to maintain a difficult kind of occupation, under circumstances where you hope the steady amelioration by not only having deals withmaking people you don't like and defending against force by people you do like. situation in iraq as of the end of 2008 and beginning of 2009 was one of uneasy stability. by the time the president comes in, he doesn't want to commit ground troops, which is a version of the stay out. the day after we pull out, the prime minister decides to arrest the deputy prime minister and
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the whole place false to pieces. understand when you're dealing with these military type situations is if you take half measures, you can be worse off than if you stay in. so now, the last question i want to mention, how do we know what is or is not a direct force. sometimes it directs, sometimes they are slow. we don't want to limit our defense to direct force is only because sometimes if you wait a little bit for an indirect force to manifest itself in a more serious fashion, the situation has gone out of control and you will be in a much worse position than you were than if you decided to intervene early on. you could've asked the israelis -- that saved everything enormously. understand there are two kinds.
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understand further that using forces always a difficult question, the judgment becomes an essential portion of the way in which we have to start to deal with these things, if you stall with the frame and make it very funny. when you don't use force, that is when the real calamities will happen. thank you. [applause] minutes to speak for the negative. >> is it ok for me to sit? >> absolutely. >> i have notes. this man is a force of nature. not only does he have no notes, i was searching for him taking a breath. i'm not sure he's in that. it's a great honor to be here. . thank jean, don and julie i think richard epstein, who i've known by reputation for many years.
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three years earlier than that, richard had co-authored scalia versus epstein. this is how i knew, richard, and we agree on many. we will also agree on one big thing, and that is when should the united dates don't want. there is this long-standing liberal versions of the use of , explainhn stuart mill there is no difference of opinion among honest people on commencing an aggressive war for any interests of our own, except when necessary to avert from ourselves and pending wrong. matter, theal nonaggression principle is a presumption against the use of force, not a prohibition against the use of force. i'm not a pacifist. i served in the united states navy. nor is richard and advocate for
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the use of force in any and all cases. we are trying to clarify this elusive middle ground between the two extremes of never and always. that is a useful discussion. are several different legitimate justifications or rationales for the use of force. this debate is not concerned about self-defense and i merrily about self-defense. the resolution if of -- focuses on those instances when the united states is not directly a threat. i imagine in the q&a and back and forth we might parse that .irect threat we could say that this is focuseddebate exclusively on the altruistic use of force on behalf of friendly nations, not in the expectation that they will reciprocate that efforts. it turns in large measure on the word friendly. i was in new york today, i love
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new york. i see people on the streets, not all of them glare at me, they are friendly. not what we that's are really talking about. we are talking about an actual friend, so when you have reason to believe wishes you well, and may even help you in your time of need through thick and thin, is that are merely of convenience. i have not memorized washington's farewell address, so that's why i have notes. founders were concerned about the issue of unnatural attachments to foreign nations, friendship as a guiding principle of u.s. foreign policy from the farewell address. the nation which indulges towards another in habitual hatred or fun this is in some degrees a slave to its animosity or affection. either of which is sufficient to lead astray from its duty and interest. history and experience prove that foreign influence is one of of most baneful foes
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republican government. this was an idea that the founders thought about long and hard, whether or not this country should be guided by interest or bonds of friendship. was washington right? maybe he was right back in 1791. maybe it's not true any longer. when i googled this, i said, america's friends -- who are america's friends? the first people that pops of is canada. canadians are our friends. you have to recognize that we don't agree all the time, our interest do not always align. another example which we have seen play out recently is the canadians did not agree with us on our policy towards cuba, for example. in another case, the united kingdom went to war against argentina over the falkland islands. ronald reagan, 1982, refused to
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help our great friend, the u.k., much to the chagrin of maggie thatcher. what other kinds of friends? richard mentioned the korean war. for many years the united states continue to help and assist south korea, even when it wasn't a democracy. does that matter? about turkey? which did fight with us in ally, but is a nato does the character of that country affect character changes? i submit perhaps the character of the government in turkey is changing before our eyes. other cases, saudi arabia, they helped us fight the soviet union in afghanistan, and right now we are helping the saudi's in yemen. another case that is interesting is, what about friendly nations that are threatened from within? egypt at theof
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time of the arab spring. the united states had good relations with hosni mubarak and the egyptian government, which was not a democracy in any sense of the term. i've been reading or rereading john stuart mill's essay on nonintervention. i commend it to all of you. here is what mills said on this question of helping a friendly government threatened from within. a government which needs foreign support to enforce obedience from its own citizens is one which ought not to exist, and the assistance given to it by foreigners is hardly ever any but the sympathy of one despotism with another. fair enough. mill arguing the united states should have intervened more decisively on behalf of the protesters against mubarak? no, he doesn't. this is what mill says about that, would it be right for a government to intervene, to help people overthrow a despoted
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government? as a general, mills -- general rule, mills said no. are willing to brave labor and danger for their liberation. if they have not sufficient level of liberty be able to arrest it from merely domestic oppressors, the liberty which is bestowed on them by other hansd than their own -- hands other than their own will have nothing real, nothing permanent. for people that does not value freedom sufficiently -- is only how few years or months people will be enslaved. i think mill was onto something. then the question how few yearsr months people will be enslaved. i becomes, at what cost? referred to this a little bit. i think especially in the case of taiwan, which has been in the news lately, is the united states obliged, under what
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circumstances is the united states obliged to come to taiwan? what should the american people be asked to pay? broadan apply across a range of contingency. what is the limiting factor to the from it to's position -- affirmative's position? he implied in the case of iraq that we should have been prepared to stay there longer with much greater numbers of force. then the question is, what role, if anything, are the american people paying for these wars, what role should they have? is it sufficient if merely a majority of americans are supportive of it, or should we concern ourselves only with the elites and what they think? if they are concerned the wisdom we are following, should we simply trusting their judgment? if the eilte's friends -- elite's friends appeal to them for help, should they be allowed to come to this whole nation for war? polls taken earlier this year
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found that 57% of americans agreed with the statement that the united states should not think so much in international terms that concentrate more on our own problems. another question earlier asked a very poniteinted question. would they be willing to use military force in the hypothetical case of a russian attack on one of its neighbors? this poll was taken in march 2014. 40% of adult americans would favor using force to defend poland. 29% would favor using force to defend turkey, and 21% would use force to defend latvia. these are all nato allies. that might strike you as audrey the same poll found a mere 56% of americans would favor using horse to the end britain.
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if you can barely get a majority of americans to support a defense of written, it's clear the american people want no more wars of choice. -- britain, it's clear the american people want no more wars of choice. even, to protect the american people or secure vital u.s. national interest, including our rights and liberty. we are debating whether the united states should be willing to use force more often that it has been, and use whatever it takes on behalf of others. so, i ask you, is the central flaw of u.s. foreign policy over the last 1/4 century that we have waged war too often, or not often enough? the affirmative position believes the latter, we should be seeking more opportunities to wage war. i think is a dangerous proposition, one that ignores this nation's founding principles and ignores the wishes of the american people.
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1/2 minutes left. more comments? >> you're welcome. [applause] of myield the balance time. can't -- the war of aggression. easure of time. don't let that affect the voting, that chris gave up on 4 1/2 minutes of time. you have 5 minutes to rebut what chris has said. >> five minutes, and -- never mind. >> i will not engage in aggressive activity against a friendly nation, even if i might engage in aggressive activity in order to help a friendly nation. let me see if i can unpack what i think are some of the difficulties. first of all, i think everybody agrees with the proposition that ordinarily, it is simply under
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the circumstances inappropriate to use aggression against other individuals. but there are some kinds of exceptions. and on the question is just how broad to the exceptions start to run? i think everybody agrees if there is an attack upon you, you are entitled to use self-defense. if themes rather tricky self-defense you used to defend yourself against an actual aggressor has collateral effects against some kind of third-party or the kinds of complications we always have to fix. it also says to me that in fact, if you're going to say there are comingceptions, may be to the assistance of friendly nations, by which i mean more than cocktail friends, people who have been with you through thick and thin, different degrees of friendship, the proposition i'm not making is that we do it all the time, and it's the only debate you have is whether we have done it too much or too little, then you have accepted the proposition that you ought to do it sometimes and agreeing onust this
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whether or not you have done this too much. for this proposition to be defeated, you would have to say there were no circumstances under which this particular activity would be undertaken, and that would be the mistake. if you start looking at this, you have to be careful about relying on early authorities to understand the application of the modern debates. there was a very famous washington farewell speech. this was the guy who i been very active in the french and indian wars, but that was maybe a war of self-defense, may one of aggression, who is not sure. he didn't have any immediate enemy sitting around his border, and it would take weeks and days to get involved, and the thought that somehow or other the united states could influence things going on in europe under those circumstances, it would have been the folly. but that was maybe a war of self-defense, may one of aggression, who is not sure. what happened is the world's gotten a lot smaller, the connections have gotten a lot deeper. you are always worried about the
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act that the attack you see upon one of your allies may give your enemies sufficient willingness to engage in an attack upon you. you start looking at the use of awnings that we see most recently in afghanistan, in treat these asan trial runs against the united states. it's hard to know whether or not these things are in direct or direct threats, but it seems to me to be appropriate to say that if we can have some intervention which would start to stop this stuff from taking place, that is something we really ought to do. what we have done is we talked about john stuart mill. john stuart mill was something of a -- he was a great idealist but not a particularly good realist in the way in which he ran his behavior. i certainly agree with him that there will be corrupt nations who you cannot root out from the outside. the key mistake in the argument he made was he used the word people as if this was a homogenous whole, when in fact
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many times the threats you have in deali with other kinds of nations is that a tiny fraction is willing to take over, staging the worldthe rest of is disorganized and helpless unless somebody from the outside comes in. to say these people could not move quickly enough to deal with that sort of >> it is an extraordinarily harsh and misguided judgment. if someone could of topped the 1933,hat took place in that would have been wonderful. if taylor had occupied the lerneland and the -- if hit had occupied the rhineland and he had been countered. if the lusitania had not been sunk, thousands of lives would have been saved. the


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