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It's very challenging because suffer developers are in demand around here and they can command pretty high salaries in this area and we wanted software developers to be our teachers we want to people who had been on the development floors of major companies actually doing this to be the ones teaching so we really it's a struggle we have to find people who are passionate about our mission who are passionate about giving this opportunity to other people to be able to get into this lucrative career instead of people who are just chasing a paycheck and they really have to be mission driven they have to be very passionate people and very empathetic to new learners I know you mentioned trying to fill a void that's needed this specially in the field of coding and now data engineering a little bit later that will be coming down the road but once you found your staff How tough was it to try to find those people interested in trying to get into coding it's not as challenging as you might think once people started seeing the success of our school applications started coming in and it's not just a success but it's saying we have an amazing staff at the school everybody there from the office managers and marketing managers and structures everybody there just lives and breathes what we're doing there and they're all resources for our students so far our next cohort which starts in October we had $444.00 applications for $35.00 spots so there is a lot of demand and it's exciting it's a great place to be and to have so many talented qualified people interested how do you tried to at least get those candidates in early and then for the remaining 400 or so waiting for their chance again how do you just try to make sure those people who applied continue to get him while being on a little bit of a waiting list we do have resources that we share with peoples that they can keep working on their coding skills and and there are a lot of other great area programs that we refer people to as well we work with year up and they have. Great job a program that we referred several people to there's a lot of options and the area which is great zip code is going to be the right opportunity for everyone and luckily in this community there are a lot of options so there are programs for people who need to work during the day you can't work full time while you attend zipcode and for some people it's better to have a different program and they can go to even classes so there's a lot of different things that we can refer people to when it comes to the growth of the program what were some of the growing pains that you had to maybe undertake as things started in 2015 in the beginning we really were trying to figure it all out it was very much a start up environment and we always joke our very 1st cohort were very brave individuals because they applied without having seen any success and put their all into it and were so lucky they were who they were because they did an excellent job and set up a great reputation for zip code so I think from Mer it was really just figuring out what was going to make us unique there are other boot camps around the country there's a number of them and we had to stand out and we had to figure out how to stand out as a nonprofit and our team has done an amazing job of figuring out how to differentiate what we're doing here and I think a large part of that is because they've done such a great job training these students we have great buy in from our corporate partners in return they realize that they can find great talent from our organization and so they've stayed really close and that's helped us differentiate ourselves from other boot camps where they don't necessarily have those close ties with the employers looking at the curriculum looks like there's a lot of things that are discussed the basics of computational thinking tools in the toolbox the real world languages and frameworks How did you build a curriculum and really what are some of the examples of what people learn during their curriculum. So we built our curriculum our national curriculum with our corporate partners we really involved the lead technologists from our partner companies looking at what their job descriptions were and building a curriculum around that our former director of education to recoat was instrumental in building that all out he is now leading our youth program animation and outreach but he was really the one that built that curriculum out with our corporate partners to make sure it was what they needed at that time and so students really are learning object oriented programming we focus on Java because that's what the majority of our partners use here but we work with plenty of companies that use other technologies to what we're really trying to do is teach students how to use their resources so they should be able to pick up other technologies really quickly on their own they know what resources to use they understand the terminology so we have partners that you see sharpened dot net who have hired our graduates right after graduating our program and they've been very successful there is there a ballpark number of how many people have been success stories who instantly were able to get picked up and find a job in a career field involving job and computer coding and programming sure 92 percent of our graduates have been placed within 6 months of graduating so a loan has been pretty amazing and a number of them get picked up within days of graduating which is really exciting I mean I can give one example of a success story that was really exciting for us to see we had a student who came to zip code 10 from Puerto Rico she had been working at a big box store in Puerto Rico to support her family who had lost their jobs after the hurricanes she heard about zip code Wilmington because she had a relative who lived in Delaware she moved up here to attend zip code she came on scholarship she took advantage of an amazing stipend program that we have thanks to our partners at Blackrock that allow us to get stipends to individuals who are living below 200 percent of the poverty line. And she worked her tail off while she was as a codomain 10 she worked really hard for everything that she got and shortly after graduating I think it was maybe less than a week she accepted a great developer job so you know are seeing people like that her truly able to change their lives it's amazing and our last outcomes report we do audit outcomes reports every year and our last one which covers students from April 2017 April 28th seen as show that their average salaries increase from before as a coach $30000.00 per year and are placed graduates after zip code earning an average of $74000.00 a year so that's a real transformational change for people and I know that you mentioned the program that was recently created what led to that decision to create that youth program and is it easier to see quicker development especially young younger kids because kids tend to pick up things a little bit easier than adults or is it I guess fairly even when it comes to the development and be able to pick things up and concepts so our youth program began because this is to 6 show if individuals are not exposed to coding in their younger years they're significantly less likely to pursue careers and software development you can't just reach out to people when they're in college that is too late and especially when you want to get diverse groups people who are under-represented in technology so we really wanted to work with the school system to introduce younger people to software development earlier on and we're working with the pathways program thanks to a grant that we received from Bloomberg philanthropies to work with their computer science pathway program to get more diversity in the program and to help people succeed on their way out of the program as well how long is the program been in place so we had one full year this is our 2nd school year doing it you mention expanding to data engineering and things like that and what are some of the other things long term that you think zipcode. I'm going to and will look to add to its curriculum and program we will continue to grow whatever the hiring needs are we are very much in the technology field and we've heard lots of things from our partners everything from cyber security to different technologies that they'd like people to learn so when those jobs become in great demand we will be teaching things in those areas so really just a matter of talking to our partners and figuring out where that demand is and just looking at partners you have a lot of partners people can go to zipcode Warmington dot com to find out more information but seeing the Bank of America Capital One Comcast n.b.c. Universal Barclays m. And t. Bank among the many to have such a solid group of partners who are looking to help build on a future involving a lot more technology what do you feel that means to the strength of the program and to the program in general. I think it's a huge part of our success as an organization is having those companies supporting us along the way and in fact a number of candidates who applied to zip code come from afar also from our partner companies which is always an incredible testament to what we're doing and we're very excited about that those companies are supporting us in so many ways I think they see the value in helping people with nontraditional backgrounds pursue this career and they want to give back to their community Deller is such an amazing place to be especially having come from Washington d.c. I really realize how special and well me 10 everybody really rallies together to help bring this community up and it's been it's just been amazing to see that the partners are willing to volunteer their time to give tech talks we have tech talks 2 mornings a week where our partners come in and just talk to our students about what kind of projects they're working on completely voluntary in their time to come in and do that we do site visits where we get to go onsite and have our students meet their tech teams and really see what it's like in those work environments and this is just something that I think has been really unique to being in this area how open they are to giving back in those ways and I know course you being from Washington d.c. Northern Virginia is a really huge tech Corps door does the Wilmington or the Delaware area have the potential to be something similar to that especially for the Philadelphia market or even the surrounding areas being so close to Baltimore New York and of course Philadelphia as we mentioned a little bit earlier the you feel like Delaware could be the next tech boom Absolutely I think it's very competitive in that area and the trying to do its part to help with the tech talent to help sustain that growth I think with the cost of living here being so reasonable and as you mentioned the proximity to New York and d.c. And Philadelphia makes it a great place for companies to have their tech hubs here and it's definitely much more affordable to hire talent here than in Silicon Valley or and. Arlington Virginia so we certainly talk to companies all the time about the benefit of hiring teams here with the name being zip code Willing to the ball is probably is more centralized than focus on Northern Delaware are there plans of extending down to the southern part of the state so right now we haven't heard about enough demand job wise in the southern part of the state to sustain an entirely separate school down there if there were demand that would certainly be something that might come up down the road but for right now we have been working with companies there out of Delaware and we're working with students from throughout Delaware we have relationships with the College of Art and Design and legacy of suites that provide really reasonable housing for students who want to come to zip code will maintain and get really reasonable housing for 3 months and then potentially go back down to the southern part of the state to work with some of the companies that we partner with down there so right now that's something that we've been working on but as demand changes who knows what might happen in the future and you mentioned of course trying to interact with younger kids earlier because college can sometimes be too late for them to get an understanding and coding and technology and those types of things how have you tried partnering with maybe some of the universities at the moment as well University of Delaware Wesley Dels they are willing to so we've done programming with dollar State University we did a mobile application program one summer with a few other programs with them as well we also have a partnership with Wilmington University whereby students who graduate zip code will maintain a full semester's worth of college credit and university for no additional charge which is pretty exciting so we're always open to exploring new relationships with the universities and colleges in the area what would be the biggest misconception about going into coding him things like that I'm not sure really what kinds of misnomer. Or is there are people can they know if you're going into coding is this this and this I think there are a lot of stereotypes about coders you envision you know the guy with the hoodies sitting in his basement just typing alone and I think there is so much more out there that people don't realize and they don't realize that they could be a software developer because that image in their mind may not look like them you don't have to be a math wizard in order to be a software developer you can be very social and be a great software developer much of what's happening in software development today requires teamwork it's no longer people working in a basement in a silo it really is involving those great communication skills that a lot of people from nontraditional backgrounds may be bringing to the table so you know we have people from incredibly diverse backgrounds we've had truck drivers come to the Co well maintained we've had scientists engineers bartenders waitstaff customer service representatives we had a mailman our last class it's a really diverse backgrounds because it isn't just one type of background that will make you a great software developer It really is if you like logical thinking do enjoy logic problems and puzzles do you like breaking things down into smaller problems and solving them is that satisfying for you are you passionate about technology even if you don't know much about it doesn't excite you when you get to learn something new about it that's what you really need to ask yourself to see if this might be the career for you because I think people have a lot of misconceptions about was a software developer looks like what is I guess the tuition for being in a program like this that is of code warming to him and what all goes into we have a very unique financial model what we do is the total tuitions cost for students is $12000.00 However students pay only $3000.00 and up front to ition and we offer unlimited scholarships for individuals who are living below 200 percent of the poverty line for that $3000.00 we also have scholarships available for eligible military members and their families to the Liberty u.s.o. And we all. So have a relationship now with the v.a. Where eligible students can use the g.i. Bill to cover their tuition as well so students pay that $3000.00 in tuition up front and upon graduating if they take a job with one of our corporate partners and stay there for at least 6 months that corporate partner pays back the remainder of their tuition costs so that's what's really exciting about our corporate partners as they really are putting their money where their mouth is if they need the talent they're willing to pay to train people to get these great jobs and especially to have such partnerships there I mean there's the interest in partnerships keep growing as well have there been any new partnerships added that in the past year or so absolutely when we 1st started I think we had 5 partners now we have over 20 which is very exciting we're always getting new partners a new companies that are interested well maintained trust I think has been with us for about a year now in m. And t. Bank technologies as a company that's recently started hiring from we have a lot of new companies and what's great is that we've got companies that run the gamut we've got large companies and smaller companies a few startups and we are getting interest from companies outside the region who are very excited about hiring our students as well when do you feel possibly that tech boom and elsewhere could occur I know it's ongoing now across the nation but when you feel like. Wilmington in general in Northern Delaware it could just honestly blow up the way it did in Northern Virginia and Silicon Valley and I think it's really starting to happen here and I think it's more companies come here and see the benefits of having tech teams working out of dollar is going to continue to grow so many companies financial companies now are tech companies has changed significantly from when banks 1st started out so many of their customers are expecting to be able to use their apps and use their phones to interact with their banks so I think the tech boom is happening now is there a company that no one really expects to use a lot of technology in coding now that Ok this is something that we didn't expect to use it now but it is going to be he you mentioned banks said over time they've had to do that more and more with apps and with online banking and things like that but is there one particular industry where you see technology in coding will be needed as the years ago along I think some of the developments in healthcare attack have been really exciting to see there certainly r.t. And it but I think it's going to continue to grow and they're able to do such amazing things you know care is an amazing example they have some really neat projects underway to help patients going through serious treatments using virtual reality and other ways to minimize stress of patients who are about to undergo serious procedures I think health care is going to be another exciting area to keep an eye on something else that I think makes our program unique is that I versity of our students over 30 percent of our students are women over 50 percent identify as nonwhite and over 30 percent identify as African-American or Latino so races that are really under represented in technology and that's been really amazing to see because the folks that are coming into our program don't make it in our program because of their gender because of their color or the. Making it because they have earned their spot and that cohort and because of the way that our admissions process runs we're just finding the best and the brightest and the best the brightest are a very diverse group and that's been exciting to see the feel like there's been not as big of a jump of women in the field technology and coding in general certainly women are still very under-represented in technology and the numbers are greater than in the industry as a whole the reasons for that I think are many. But I think it's not just women I think it's you know people of color too that are under represented I think it's a bigger problem than just women currently plans on growth and you mentioned the 2 programs how do you try to maintain especially a program like this like you said sessions that come in every 12 weeks how do you just try to keep things going on a constant basis so we ran 3 cohorts a year we have classes that start in February. And October I think I've gotten that correct. All the Agora dates are on our website and during those 12 weeks it is really intense and our focus is making sure that students that come through our program are getting the best possible experience that they can and the fact that we're able to maintain that really is a testament to our team our team is just they're incredible people who really believe in the mission of our organization and who really believe in our students our students are fantastic examples of people willing to put their all into transforming their lives and I just saying about really looking at coding him I had initially had gotten into computer science and I knew that when I did it in college it was just the more to take the scholarship than anything else and I thought well he had it in math is not my strong suit and I knew it wasn't for me and you mentioned before that you don't have to be a Maginnis to know about it you just have to be willing to. Work as a team and be able to pick it up for someone to think Ok that's no longer an excuse math I don't have to worry about math being a hindrance What does that mean to someone who wants to aspire to get into coding I mean really what's necessary is high school level algebra you don't have to be going into more and danced areas of math I mean had a lot of people that have come to our program and been surprised that they've been able to succeed because they don't think they work great at math certainly if you're getting into other areas like data engineering math may be more of a necessity but for getting us off a development you need to have some of the basics but you don't have to be a math was or so did you graduate with a degree in computer science I actually change after the 1st year and then went into English in communication then that's where I pretty much found my niche in their wrists and yeah and I owe a myth to me at the time was a very challenging thing and aside from a little bit of coding when working on things such as blogs and things like that I still think it's a very daunting challenge and just even learning a little thing that I feel like is still a tough thing can be a task is tough how do you really been exposed to suffer development before college have you dabbled in it all beforehand I maybe took one computer class in high school we learned some really minor stuff I think it might have been c. Plus plus by that it's been so long it's been a nice a good 20 years since I took any type of computer class and and even then I feel like I finished in math and trigonometry but I didn't really see math as a very big focus of what I was going to do in a future career sure I understand that and I think. Part of what makes the code and special in that regard as the cohort feel you are surrounded by if you're in a class of 35 you've got 34 other people surrounding you working through this problem it's not competitive in our program it's very important to us that everybody see each other as a team member and we lift everybody up there so between your classmates who are there to support you and our staff members are instructors who are there to help you get through the tough program it is daunting and it is challenging but you have so much support going through it and you have other people say next you struggling through those 80 to 100 hour work weeks with you it becomes bearable and when you make it through you're so proud of your accomplishments and it's pretty amazing and you mention the they want an hour workweeks What time do the classes start and how well do they run daily so classes are Monday through Friday from 9 am to 5 pm and we do have tech talks 2 mornings a week started am but our students are putting out a lot of time outside of those hours finishing labs and projects and other assignments so we have a 247 facility our students take advantage of that and they're there for early in the morning until late at night their their weekends it becomes a 2nd home to them during the 12 weeks and it is because no matter what time of day you're there you're going to have on your classmates sitting next to you there to support you so it's a great place to go instead of just standing alone in your bedroom or might get lonely and overwhelming you've got that support system if you're in the program and you're sitting there in a class next to somebody and I feel like sometimes even with that background of having that situation where you have their teammates there and they're not being a very competitive one words something like a cup they're a nature maybe you might have a piece to the problem and the other person might have the other piece of a problem that neither one of you can figure out by yourselves but working together will actually help solve that and make that problem a little was difficult and challenging that's absolute. Trail and we definitely tell people to look at it that way because everyone's going to understand something differently and you may understand one thing quicker than the person next to you and that person is going to understand something else and you're going to rely on them to get you up to speed on the thing that you're struggling with Melanie Augustine the executive director of Zip Code Wilmington thank you for coming on Delaware spotlight and discussing some of the programs offered by zip code Wilmington and I look forward to having you back again in the future thank you so much I appreciate this is great I'd like to bring my guest melody Augustine the executive director of Zip Code Wilmington for the full podcast go to high hard dot com backslash podcast and search for Delaware spotlight until next time this is our all Holland saying thanks for listening and have a great week. Thank you for joining us this week for Delaware spotlight on $4050.00 w. If you have a topic you'd like us to cover or if you are going to say she would like to be part of the conversation e-mail and I heard Media dot com or go to w dot com and click on Connect. The latest views but what do you think about it is up to you Go Go to write your views repeal. W.y.l. Am it's a busy world out there if you're driving look for cross walks on a bike know your signals and use them and if you're walking you have rules to let's start looking out for each other again go see flee California brought you by the California Office of traffic safety. Technology credit union our mobile app is specifically made to keep up with the modern family. I lost my credit card that would be a good thing. To work for. The call health just went for cell can we afford it. Maybe enroll in. Promotion to $1000.00 go to Texas. Save more. See. The week. End one down. And maybe the grand prize which includes an accountant dollar everything you need to make w. . Goodlatte indeed used by over 3000000 businesses where business owners and h.r. Professionals can post job openings with screener questions review and communicate with. The festival told only. To find Ramsi from team Obama must week the. Drug costs through the wholesale import of Canadian drugs. Are Made in America. Experts fix the United States health care system there's really no. Where we purchase decisions with no visibility into what it costs it's really absurd. This week health journal. 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Surveys show that Americans are upset about the high cost of prescription medications it can be especially frustrating if you look at other countries whose residents pay a total cost that's afterward 3rd what we pay for some drugs it's even worse the cost of a $10.00 day supply of insulin in the United States maybe $300.00 while for the same thing Canadians pay just Tam That's because around the world other governments set prices for drugs significant Lee it has to do with the Canadian government agency that regulates the maximum price of a prescription drug that's John Adams Board chairman of the best medicines Coalition a group of $28.00 patient advocacy organizations in Canada we have a mixed market for the pricing of prescription drugs we have government programs and we have private insurance and then we have people who cashed out of pocket and the government drug programs in addition to having a price ceiling a price controls maximum they are also now negotiating together to do their own version of ball purchasing from drug manufacturers and so they have using their power as a monopoly of government buyers they have been driving down the price well below the legal backs of we could do something like that in the United States but we don't just in Mendoza is state partnerships manager for the consumer health advocacy group Families USA The larger problem here comes down to Congress is an ability to act over a number of decades at this point 15 years ago the u.s. Signed Medicare part d. And created a prescription drug benefit and even in that provision decided that Medicare and the u.s. Government could not negotiate description tag prices within the program despite the fact that that program is the largest pages here prescription to. In the entire world that policy hasn't changed yet finding a way to drive down prescription drug prices was a presidential campaign promise in 2016 so in late July the administration announced a plan that Mendoza says could help it would allow importation of cheaper drugs from Canada on a massive scale the proposal importation is based on a 2003 law that was passed to really take on prescription drug importation in terms of shortages and other extenuating circumstances and the proposal is set up to allow licensed wholesalers and prescription drugs to purchase safe and regulated prescription drugs from pharmaceutical distributors and wholesalers in Canada bring them into the u.s. And then put them into the u.s. Supply chain now the proposal which is really a proposal to make a proposal make it clear that they have to be compliant with the statute so f.d.a. Safety and quality standards and also it specifies only those who are licensed whole félix can actually use the pathway drug importation from Canada has been possible on an individual basis for the last 15 years and millions of Americans have gone across the border to get cheaper medications for themselves but the importation plan envisioned now by the White House is much different and much bigger our latest estimates actually show that around 4000000 Americans imported drugs from Canada in the past year when their prescription costs are too high here but that all being said this proposal actually use the entirely different mechanism outlined in the same law based on the same law but in this mechanism it would actually be all about purchasing those drugs and bulk on behalf of a state or another large entity wholesaler and then infusing them into the current system so people would still get their prescription drugs from the same folks who they get them from now they'd be prescribed by the same doctors that were. Just be potentially lower cost it's important to distinguish between personal imports which have been both ways from Canada to the United States and from United States to Canada for decades distinguished personal imports from bulk imports and that's the new thing from the White House above the idea of bulk imports where the state of Florida for example or a large pharmacy chain Walgreens or a middleman company distributor company will come out to Canada and buy drugs involved and ship them across the border the personal import one of the limiting factors is that you need a prescription to buy a drug in Canada you need a prescription from the Canadian physician another limiting factor the u.s. Has always claimed that Canadian drugs might not be safe enough for mass import even though the governments look the other way at individuals bringing drugs over the border every White House and every secretary of Health and Human Services has said we cannot guarantee that those drugs will be safe and for or against that Secretary as are the secretary of Health and Human Services change that it is a one aide I believe one direction from the White House and said we're prepared to contemplate and actually proposed a new rule 2 different pathways for states or corporations businesses could wholesalers or pharmacies could bring in drugs from Canada in bulk and that's a game changer and it could upset the friendly relationship Americans and Canadians have when it comes to individual imports of medications Adams says it works both ways not only do Americans go to Canada to get cheaper drugs Canadians come here for scarce ones I have done that I have a son with a rare genetic condition and there was a new drug that was available in the United States that was not available in Canada my son actually was in a clinical trial in Chicago that worked really really well for him so for 2. Years I went around Chicago every 90 days to bring back a 90 day supply for him 20 percent but drugs that are available in United States are not available in Canada so maintaining that personal import provision in good shape is really important for the health and well being of Americans and of Canadians Families USA likes the importation idea it's pretty clear that little is likely to change in terms of American drug pricing so Mendoza says it's a good workaround this proposal is something that we approach with support for the broad concept we like the idea of giving Americans relief from high drug prices and this is one possible way to do so in the short term however importation isn't the long term solution importation doesn't address the underlying pricing mechanisms or the patents or the monopolies of the government grants to pharmaceutical companies that allow them the price their drugs to hide to begin with It doesn't address annual price increases and it doesn't really address even just passing on savings to consumers necessarily so this doesn't take on the issue from every angle that's needed to truly reform the system but it does allow states the opportunity through this pathway to create some leverage over pharmaceutical companies to be able to say hey if you're going to continue breaking the bank when we buy a prescription drugs here in the u.s. We'll just import them from Canada but it's not like imports can happen just like that under the best of circumstances Mendoza says it'll take time this importation piece overall it's going to take at minimum well over a year from the point where we see a final rule to actually be implemented and put out and put together so we wouldn't actually be seeing any importation program starting in this country at the state level until at least 2021 in terms of how likely we are to get there a lot of factors could change that. One of those factors perhaps the most important one is whether Canada is willing to let us have their drugs but Adams says the prevailing sentiment north of the border is not so fast keep your hands off of prescription drugs thank you very much we already have a significant shortage of drugs in Canada a matter fact every time a pharmacist calls a supplier the reorder drug one time out of the supplier says I haven't got any. Pharmacist they can spend 20 percent of their time doing work around existing drugs sorry please do not work you've got some issues in the United States one of those issues is the high price of some drugs we uncandid didn't cause a problem we can't fix it for you it's a made in America problem in the Made in America solution and let's be practical here Canada could give all of its prescription drugs to America and because our population is less than one percent of the Us population it would not do anything for 90 percent of the American people and Canadians would have no that isn't. So this is not a good idea when that's not how you treat a good neighbor some Canadian experts say the administration plan is presumptuous at best Others say that America is trying to steal Canadian drugs however Adams says the shortage in Canada is real even before Americans reach across the border in large numbers the newest shortages appear to be in for some chance or drugs but it's also involved epilepsy it has involved people with high blood pressure I'm one of those people the frontline therapy but 1st medication on is no longer available in Canada so we've had to go to a 2nd line therapy for that and there are 5000000 people in Canada who are being treated for high blood pressure hypertension Canada can easily shut down the. For Taishan idea if it wants to it doesn't even take parliamentary action though that's one way a ban could be implemented the quickest route would be for Prime Minister Justin Trudeau as government to put prescription drugs on what's called the Export Control List nothing that's on that list can be export it without permission and Adams says when he was in on a meeting of major stakeholders and the Minister of Health last month nobody objected there is significant support this was brought up by actually that had the chief executive officer of the industry association that represents the brand name proud of so tickles to specifically brought this up and all the patient reps and the pharmacy industry reps and the Canadian Medical Association and pharmacists Association everybody was there nobody had a problem and we all unanimously we didn't say the civically what action the government of Canada should take where we said Canadians need and deserve the federal government to stand up and be clear and specific and in public and say This shall not happen Canada could also slap tear of sun prescription drugs to the u.s. Eliminating the price advantage but Adams says they don't want to encourage a trade war which these days seems all too easy to trigger so while mass importation of Canadian drugs may seem like an easy solution to America's high prescription drug prices it's not something Canada sounds like they want and without their participation it's a proposal that's essentially dead on arrival. Coming up the power of primary and preventive care one radio health journal in 10 years. It may not be stomach issues for me it's intense gas or pain or diarrhea sometimes all at once over and over I spent years with the symptoms but could never figure it out no matter what I did they never went away so I decided to break it down for my doctor and get really specific about my symptoms we discovered that excerpt from pancreatic insufficiency or e.p.i. May be the reason for my stomach issues e.p.i. Is caused by my pancreas it leads to diarrhea gas bloating stomach pain unexplained weight loss in oily stools the symptoms just don't go away but a.p.i. Can show up with even one symptom the good news if manageable but to get to the right diagnosis you have to break it down for your doctor and get specific about the severity of your some tips visit identify e.p.i. Dot com to learn more and use the symptom checker to help change the conversation with your doctor brought to you by at the. The United States spends far more on health care than other developed nations but for a lot of people the quality of care still lags behind recent political debates have focused on issues of health care access and cost with politicians offering many different proposals for health care reform many of us don't agree on a solution but most do agree that the current health care system is broken and needs to be fixed half the bill and health care today is footed by the government through the for Medicare and Medicaid and the other half is through commercial insurance and I think where we should focus our energies is on things that allow people to get more access to primary care and do it through things like virtual engagement which will on clattered waiting rooms of doctors things like that that's bred Jorgensen chairman and c.e.o. Of Am d.v. IP a concierge medical provider he believes that increasing access to primary care and encouraging consumers to engage more with their health care would be a huge step in upgrading the system Jorgensen says offering more primary care would help with physician burnout which is a major problem with the current system the burnouts really a reflection for the most part of physicians having greater and greater numbers of patients and less and less time to deal with those patients and having a greater need to treat patients over to either specialists or for procedures and things like that and I think for a lot of the doctors obviously that love to spend more time with patients spend more quality time diagnostically in trying to help people get ahead of their health right now doctors especially primary care physicians can't spend the time and energy they want with patients the effects are frustrating not only for doctors but also for patients but the consequences usually often more expensive time. Smore triage to specialise early in the sort of diagnostic process and really less of an ability to have the kind of impact that they want to have on their patients it can be difficult to find the time and money even to have a primary physician and when you do go the doctor may be spread too thin to do much this is why a lot of Americans end up in the emergency room for preventable conditions emergency room can't turn somebody away who's having an emergency right a so a lot of times people show up pretty late in their health care cycles and it ends up costing the system a lot of money 7 studies that have shown half the spending on chronic diseases is stuff that could have been avoided had leaked gotten involved earlier Jorgensen says another part of the problem * is that many consumers don't feel the pinch of paying for medical expenses we've had a system for decades now where not only has the health insurance been covered by either the government or the employer so you have a consumer who's not involved in the purchase of their own health costs their health insurance and while they consume the health insurance in terms of medical procedures and all of that stuff they have no visibility on wanted anything costs there is just not enough visibility around price information and transparency and clinical information for consumers there's really no other area of our life where we make purchase decisions of products or services with almost no visibility into what it costs it's really absurd and I think that's one of the fundamental things that has to change the lack of Americans understanding of health care costs highlights how on involved they are in their health Jorgensen suggest that to increase involvement and pricing transparency consumers should pay more out of pocket for primary care it's like maintenance on your car right you want coverage to make sure that if you have an accident or you lose the draw on something and get some cancer or some other illness you know you want coverage that is. Good coverage for those more catastrophic or significant events but a lot of them more routine maintenance kinds of things it's kind of like the maintenance on your car you know feeling change or while doing things like that those are things that are just done out of pocket and aren't solved by your car insurance right I think that same sort of approach really does work in health care if you focus primary care things more in the hands of the consumer and just make sure that they're covered for major medical events however if we expect consumers to pay more Jorgensen says we need to expand primary care or maintenance beyond the doctor's visits we currently think of there are a whole bunch of consumer friendly tools that are emerging there are a wearable devices monitoring devices there are telemedicine solutions that give people more access in other kinds of markets that maybe don't have enough either physicians or caregivers there are lots of retail clinic kind of solutions that are cost effective again all aimed at trying to get people access to health care so they don't show up in something like an emergency room if they don't need to where it's quite expensive these solutions could allow people to have access to primary and preventive care at a lower cost and help alleviate pressure on primary care offices Jorgensen thinks that virtual medicine in particular could solve a lot of the problems that consumers and physicians experience but 1st they would have to be a change in how doctors are compensated there's a reason why a primary care doctor for example does not have their cell phone or their e-mail on their business card when you walk into a doctor's office any doctor for that matter not just primary care and that's because they don't get paid typically for virtual engagement probably half of the visits in primary care today could be handled by an e-mail a text a quick phone call or some other virtual way to engage so instead of having 100 dollars visit that clutters the waiting room of these doctors if you. Find ways to give people access to these virtual tools which are wage cheaper and have the ability to at least get them in gauged their health in a more proactive way you could effectively unclutter the doctor's office and actually expand on a relative basis of supply of doctors just by that one thing virtual medicine is a simple cost friendly solution to get people more involved in their health before illness lands them in an emergency room but virtual care is not the only solution there are a number of other things going on as well for example a big focus on what people call physician extenders where their nurse practitioners are physician assistants and other caregivers who can take some of the less severe cases of in terms of the visits right so that everybody is kind of operating at the top of their license at a medical doctor doesn't need to deal with everything they deal with some of the things and somebody else maybe a nurse or somebody else deals with it so I think those are the things that can allow us to give better access to everybody spreading out the responsibilities of primary and preventive medicine to other providers creates more opportunities for consumers to be proactive and involved in their health Jorgensen believes consumers are already becoming more interested in their health care they're very interested in the political debate going on they're very interested in their personal health today but I do think it is one of the things that is going to promote health the most it's not just a payer question it's not a structural question out there it's people actively getting engaged in their health early enough to have an impact on the trajectory of their health care and the health care spend Jorgensen says Americans need to get more involved in every aspect of their health care they must be more aware of their bodies health and the cost of their care and he says these changes will help push us towards a solution to fix a broken system you can find out more about all our guests on our website radio health Journal dot org Our writer producer this week is Morgan Cali our studio producer is Jason Dickey I'm Nancy Benson. Radio health journal returns in just a moment. Glaucoma is an eye it is ease that affects more than $3000000.00 Americans it can cause permanent vision loss and there is currently no cure coma Research Foundation recently commissioned a survey to learn more about patients' experiences with the disease 64 percent of those surveyed said glaucoma impacts their lives daily 76 percent said they are very concerned about losing their vision and fewer than half are very satisfied with the eyedrops they currently use to manage clock Homa Dr Andrew comer Research Foundation board chair the information services and treatments available to all coma patients have increased significantly in recent years but we know that patients still struggle to manage the disease this survey helped us understand patients current experiences so that we can identify in new ways to support them the national glaucoma impact survey was supported by ary pharmaceuticals for more information visit koma dot org That's glaucoma dot org What are you going to do with your old car you can try selling it you could junk it or you can donate it to heritage for the blind your car will be towed away for free in your donation is tax deductible just call 180-835-1478 heritage for the blind excepts cars vans trucks and boats it doesn't matter if your vehicle runs or not it will be towed away for free and you'll be supporting those that need help heritage for the blind is a nonprofit organization that helps the visually impaired live fuller lives call right now to donate your car and as a special thank you you'll receive a free 3 day vacation voucher to over 50 locations call heritage for the blind right now call 180-835-1478 donating is easy and your vehicle is total way for free plus you'll get a free vacation voucher for donating call now 180-835-1478 that's 180-835-1478. This week. During the day may be an early warning. Disease a study in The Journal. Shows that. Damaged. Of the brain. And examination of patients. As many. Of their. Medications the way they're supposed to the u.s. Preventive Services Task Force is recommending a doctor. But it doesn't specify how doctors are supposed to carry it out they could simply ask patients about drug use. And hope that they get an honest reply. Really could be just the ticket. In the brain that ramps up stress as plentiful in the skin and. Researchers suggest could be an effective alternative to drugs for patients with depression and anxiety disorders and that's medical notes this week in a moment.

Patrick who's 21 is said to have posted a document online calling the attack a response to the Hispanic invasion of the state Mexico has condemned it as an act of terrorism against Mexicans in the U.S. President has blamed what he called a mental illness problem for the El Paso killings and the shooting in Dejan Ohio that left 9 people dead. Hong Kong's chief executive Carrie Lamb has said her administration will stand firm in maintaining law and order as pro-democracy activists try to enforce a general strike more than $200.00 international flights have been cancelled and commuter trains have been disrupted demonstrators have been clashing with the authorities for 9 weeks initially over plans to allow extradition to mainland China Muslims at the protests were a source of high anxiety and could destroy Hong Kong. The cost of rural crime in Scotland spiked last year jumping by more than 60 percent the rate of increase was faster than across the U.K. As a whole the total cost $1600000.00 pounds up 600000 pounds on $27.00 team and it's been largely driven by gangs stealing expensive farm machinery inspector Allan drawn is the National Rural crime coordinator with the Scottish partnership against rural crime on the face of a percentage rise of variants that are welcome to think on this occasion the high street if we put into context for something we are actually interested created and expected the percentage goes up into one point. He actually will be an issue which you have stated the number of claims who actually mean much the same as the previous year but just to follow you over these claims indicate that the equipment the plant. Stored is of greater value the number of companies in Scotland declared insolvent has risen by 46 percent in 6 months K P M G said economic volatility is behind the trend with bricks and creating uncertainty for businesses the professional services firm is advising businesses to plan for worst case scenarios and to be fiscally cautious. Police the prison service and a music based social enterprise have joined forces to turn and out of service bus into a roving community center in the 1st collaboration of its kind inmates at Edinburgh prison have spent the past 6 months refitting the vehicle and installing high tech sound recording equipment soon the heavy sound bus will head to deprive parts of the capital offering advice support and a range of activities Alister Moore is from Police Scotland's violence reduction unit I think this is a prototype for the fish tanks probably going into communities where some of the people in the communities find it really difficult to do anything for sale it's. A little bit of just violence we're also just going to call to it's giving helping hand to people who need it and so. If this works which I have every reason to believe it will then let's look at crosscut let's look at different parts of Scotland where the need it's sport now here's Thomas Duncan thank you Sara good morning come on a Gun Police Scotland are investigating after the roof of a shelter covering disabled supporters collapsed as Rangers fans celebrated a stoppage time when our drug Park yesterday Goldens 91st minute header got Rangers Premiership campaign off to winning start but sparked an invasion of the pitch Celtic Rangers and Aberdeen find out their potential playoff opponents in European competition which are this morning the draw for the Champions League in general police took place in New York from 11 o'clock the Manchester City manager Pep Guardiola says the club could afford to sign 80000000 pound defender County Maguire who's on the verge of joining rivals Manchester United and having been set a victory target of 300 $98.00 runs and once cricketers will resume their 2nd innings on 13 without loss on the final day of the 1st Ashes Test against Australia at Edge Boston that's a sport. GAVIN OTTWAY has a travel update thank you Thomas facing traffic in the road in the M 900 pound for Junction 8 Glen fog to junction 9 it bridges and it's affecting traffic heading towards Perth the 82 is restricted to one lane north of 10 drum due to my agency road works where Jesus are advised to laugh along the journey times and to embroil and Donington Broughton road is closed following carriageway subsidence as a green light an East climate street that's affecting both directions and on the trains expect delays and some cancellations on Scott Leo services between Glasgow Queen St and Perth and between Edinburgh Waveland F.S.U. To clean problems at Perth B.B.C. Radio Scotland travel and Scotland's weather a cloudy start for most with outbreaks of rain moving from the northeast eventually becoming confined to the Northern Isles this afternoon it will brighten up with sunny spells but also a number of afternoon showers breaking out mainly across the north with some heavy thunder a downpours light winds today and temperatures generally between 1000 to 21 Celsius but slightly cooler in Shetland and Orkney. B.B.C. Radio Scott the news thanks and after all these years I think I've finally managed to impress you have no doubt there is a beautiful dog just very casually chilled out laying on its side here in the hallways my dog isn't for me. Well yes it is work like a dog day to day so we thought we would bring the dog and but as you can see she's not working very hard who's that very good advice for me you've taught her well she's gorgeous by the way thank you thank you Sarah. Good morning I hope you have a lovely weekend it is Monday the 1st of August and this is K. Adams and be with you until 12 o'clock on B.B.C. Radio Scotland 30 minute open you could delay the men opposed and prolong your fertility for up to 20 years it is no a reality would you do it away to 859295 double as a number to call Also coming up from. National Walk like a dog day and we want to know what you could learn from your pet when it comes to work will speak to the Scotts dad who has made sure that his children will not inherit the deadly genetic condition which runs through his family and. Years golden slumbers on our tech talk today Kathy has been trying out a high tech sleep pillow so did she get the sleep of her dreams 1st up on the phone and would you take the chance to delay your men a pause for up to 15 to 20 years or wait and wait 502295 double of your calls your story mornings with key items on B.B.C. Radio Scotland. Where the story has attracted a lot of attention over the weekend a fertility expert in Birmingham is offering a procedure which will the layman oppose along fertility by removing a part of the woman's ovary Prima Nepal's. Preferably I think in their twenty's freezing it and then returning it when they hit men a pause there by tricking the body into thinking that it is younger that it actually is the younger the procedure is carried out the more effective it is so which you do it a way to wait 580 to 95 W. Is the number to call Professor Simon Fishel is the man behind us and we hope to speak to him I think he's popped up out there so we speak in the very shortly the benefits being quoted are more useful forty's and fifty's without all the debilitating symptoms of menopause hot flashes night sweats loss of concentration errors ability insomnia and then the added bonus or prolonging fertility so you can sort out the career and then have the babies so does that sound like a good idea you can text as on $8.00 to $95.00 you can email K. At B.B.C. Dot co dot U.K. . Really busy on the messages on this one on Facebook Melanie says it has proven to be safe and will prolong a quality of life at this age I would jump at it Linda says life is so much better no it's over get it over and done with she feels Gail says it might be better at a later age as you might know may there not be juggling children and job on top of all the symptoms and they says just because you can doesn't mean you should and Christine Dallas in the style of when Halle had a set and met Sally has come in with yes yes yes slim Haitian MARK Well do tell us what you think so far only a handful of women have had this procedure could you see it becoming more common and in the meantime how are you coping with the miniport is are you getting the help that you need to deal with any symptoms that you experience and give us a call 859295 double is the number would you jump at the chance of delaying the minute pause and we do have Professor Simon Fisher with the who is the co-founder of true. F.E.M. I'm not entirely. I have a pretty good morning to Simon is a profound morning just profound talent like profoundly but it stands for protecting fertility and my nipples OK All right thank you thank you for that kind words I've given the very brief history of descriptions there but let's hear it from the man himself OK Well well 2 things 1st of all it works by. Taking a small portion of one ovary So for example a 3rd of the outer layer of one of the ovaries and then we divided up into tiny little strips I'm talking around 4 by 8 millimeters something like that and that's very very carefully prepared and then that tissue is transferred to computerize freezing mechanism that takes it down to minus $150.00 degrees Centigrade were it is then stored and frozen for as long as needs be and the whole process once we've got the tissue to stop the pairing it is about 4 hours on the actual procedure to remove the tissues about 30 minutes so this is a surgical procedure clearly. Are there any risks attached well it's keyhole surgery it's microsurgery There's always risks and when anybody does anything you go to the dentist you have an injection this risks the risks are very very low I would say the people having keyhole surgery all the time but it's any risk associated with keyhole surgery the way the micro surgery is is done is done in a new way that really does everything possible and does protect the remaining ovarian tissue we see no damages to that time and again I suppose the only risk might be down the line maybe one or 2 of the grafts don't work but. The other thing I should say is this is on the back this is very important of 20 years of work with cancer patients who where we in emergency situations have been using this technology to try to preserve to Lety and the fact that we know it does that and it does that well it has been over 5000. Tissue repairing movements on cancer patients over the years we've just simply join the dots we said well if it's if it seems to work to preserve the tendency by preserving fertility those hormones have to be working normally so why not use it for the other side of the human female life and that is to provide either a postponement of the many cause or not short totally natural way of delivering H.R.T. Who is what we does it delete them in a post. Well if you don't go into it yeah and you lay on happily so it seems so what women try to do they try to ameliorate the Simpsons by taking H.R.T. And what H.R. 2 years doing in many ways is kind of. Giving you a pre-menopausal hormonal environment but if we are doing that with your own tissue the likelihood is that because it's going to be Sun that true and that's the way you're tissue to live is your hormones then you're going to be just pop delaying the matter portion and that could be for many years but it's still going to hit you at some point well you never know you might you know you might out live the time that you're going to get the mail of course and so for example and I think this is another important point which we might come on to but I'll mention it now is the earlier you do this the longer you're you're likely to get with the benefit so say for example you know if you do get 10 to 20 years you you you may actually be on the benefit of this and allow live before you hit menopause or you may go into medicals later in life yes yeah well hoping not to put more clothes and the mid sixty's there but there you go. As far as it is that Professor Simon special here if you've got any questions or want to be happy to take the minimum to have a look because you know that very very many messages coming through on Facebook and on text and if you want to join in the Facebook conversation just search the cabins forgot of course the takes number as ever is 8 to 95 pick up the phone and tell us what you think if you had the opportunity and this opportunity would no seem to be there not on the N.H.S. Of course and I think less than 10 women have actually had this procedure thus far in the U.K. But it is not on the table as it were is it something that you would consider $59295.00 the blue to delay the men a pause and all the. Cendant symptoms that may or may not come with of course women have different experiences with the men opposed and tell us what your experience is with the men oppose do you feel that you are getting the support that you need the moment Debbie on Facebook says Would it not be more productive to have something to make it symptomless rather than delay it I'm sure we would all jump for joy at that Katherine says let's just let nature do what it's supposed to do not interest says unless you're going to see is the element opposed and why delay is a natural part of getting older I went through it at 45 I'm no 54 you're still going to go through it you may as well just get on with it give us a call tell us what you think oh wait wait 59295 W. And if you'd like to put a question to Professor Simon official who is pioneering this procedure in the U.K. Then please do I'm sure you'd be happy to to respond let's speak to Jane Hallam who is the founder of this team no paws who offers a range of policemen opposable clothing Good morning. Good morning Kerry Good morning to sound attractive option. Yes I am I think. About what the symptoms are that men of course would be in my twenty's I don't think I would have gone ahead I don't think I'd go ahead with a. In my twenty's I any so the medical was not well. And the period. Going 3 Manapul I know the man opposes a lot a lot more than that. And a lot to develop a concern says Wow I think I'd rather have those militating symptoms now late forty's early fifty's rather than in my late sixty's early seventy's so what will kind of symptoms have you experienced and Jim because you know it's a very individual thing. Mine of being debilitating sick a so quite narcoleptic type experts who have just falling asleep on the spot. Anxiety depression. Anxiety was driving on the motorway which was. Severe acne all way from my back and my had. Also not flat hopelessness. And what was sort of help and treatments have you had in dealing with those I'm very fortunate in my cheap a will they say recommend things. Slightest thing she will say she will send you off. A clinic has met no more bleeding the last November straight to the county club to cook local got a college cook clinic. And was diagnosed with the kind of actress say which I have no idea I was experiencing. You know make sure yet this is a pool so your hormones are all over the play. She's just absolutely fantastic for your nature to be. Stretching cream. OK And has that been your choice. That was. Given and given that it. Just I am quite happy about quite happy about you things get. I also you. In between disciplines. Well I mean given this is interesting as I bring you inside me again on the one hand Simon I have to say when Jane came straight up and said look all of these very debilitating symptoms I would rather deal with them when I'm in my my fifty's. And feeling kind of robust in other ways that and potentially my late sixty's so yeah that makes sense but then Jane when you lest the symptoms that you have had and the difficulties you have had with dealing with them if somebody can say OK a procedure that you you undergo relatively simple in your late twenty's and then you could sort of ignore those symptoms until much later in life is it not tempting . Thanks Erica. I think it might have been tempting my kind. I think I know how debilitating they can because it's not fair. I don't think in my early 2nd favorite of to have to cope with Simon let me be a Simon because it's a very good point isn't it Simon because you know you said OK potentially you might lead those symptoms but I mean ideally you don't want to because you'd rather have a longer life presumably so and you know it does mean that you're going to hit those symptoms and Jane overseas had a very difficult time and had a later stage in life and absolutely I think there's a whole range of complexity here and one glove isn't going to see it all there's a very interesting paper in the iconic journal Nature and chronology that actually said that opposing symptoms accelerates aging I think there's no doubt we women the whole point about this is women are living longer. Than they ever have done before and they're likely to be living as long or maybe even longer in the post by the forces phase as the premenopausal failings and that's one of the reasons why why we're doing this so I think there's a couple of points I think I'd make I think yes one of the real challenges is that the younger you do this the more greater benefit you'll get down the line but young people feel immortal and they don't feel that the things that are happening to all the people are really going to happen to them so all they really going to want to invest in something that is if you're like a potential insurance because young people don't do that well I think that's right and I think I think I think the challenge that but the other thing is very important is that what Jane is describing is. Has a lot of the symptoms that people get but they get worse symptoms too when you get them encroaching on osteoporosis for example let's just take osteoporosis that that can be extraordinary debilitating when used. To get to so in your sixty's and you are frightened because anything you do could create spinal fractures these are these are serious conditions that get worse and you have to watch them because if you delay the onset of that that surely is beneficial and there's the potential costs are sort of the potential cost element to society to here we don't know the full cost of of them by the post to the National Health Service but we know it's fast if you take for example in Canada in 1903 The Chinese still only seem to be talking about delaying it and I mean if you delaying this is the sentence of osteoporosis then you just putting off the problem until a later stage but if you're living with it for 10 years rather than 25 or 30 you know a little risk of your risk going to minutes I've I agree I could talk because the other problem is the H.R.T. And Jane was talking to a taxi man I don't miss misunderstand you Jane but I think you are saying that you are revisiting your talk to millions of women to revisit clinics they tried different types of H.R.T. They tried different modulations of pharmacological trucks so there again they're trying to do their own type of delay they're trying to do their own type of resolution of the symptoms but it's never quite right and it's never quite working so I say it's a very empathetic to those who wouldn't want to go through this I mean that's that's fine it's exactly the same in many aspects of medicine not one glove fits all but the option to do it naturally if you're going to do it by a child seeing the option to have it for your your helmet's longer is an option Yeah I mean I suppose the only thing is I mean we're just talking about this I mean this is landed on our plate over the weekend you know something that really new but he had to consider that we're speaking about the man opposed to much more now than we did previously so we're just kind of talking around the Simon. But you do know in your twenty's. What you made a pause is going to be an I suppose the thing is if you wait until 8 Chartier wait till it happens and then examine or look at all the options that are open to you given the kind of menopause that you're having then you're dealing in real time whereas you could go through this procedure and invest the money that's required in your early twenty's or whatever and then it comes from an opposing as a has as it happens you have a perfectly you know reasonable symptomless and then opposing it was all unnecessary and soon the one you mentioned osteoporosis I think that's a concern of suit I'd also like to speak to Dr image and show who's a G.P. Specializing in women's health and then approaches to get her thoughts on it but let's have your thoughts a way to wait 590 to 95 a double or if you had the option to delay the men a pause for up to 5015 to 20 years and all the attendant symptoms would you do it and the other side of this of course also is that it prolongs your fertility so perhaps that would be an attraction for you that you may have another 10 or 15 years of sash tile rep life that you could perhaps a Ranger life differently give us a call or wait wait 592952 pull. The world revolves again our understanding of I was on the job is I think if I was trying to get. My. Consent. To search from the 1st was on you we were again struck yourselves up to the last. Couple of the legal action this season on sports team sports team results and sports the new league season continues this weekend on the B.B.C. Scotland channel B.B.C. One Scotland and on B.B.C. Radio Scotland. It is $924.00 you're listening to B.B.C. Radio Scotland with me K. Adams cat Harvey will be here a bit later on with our regular vacay allowing you to escape your Monday blues and picture yourself on a sunny place with marble street. That's where she's been and look of in many clues as morning I but you'll find out after 10 will also be asking you what can you learn from your pet when it comes to work my own pet is with me in the studio here she is currently flat on the studio and snoring rather gently and to be honest I think she's she's got a right call now or wait a week by 9295 double 0 warnings with. B.B.C. Radio. Asking this morning if you would take the opportunity to delay the men a polls we've got Professor Simon official with the who is the co-founder of proof and he has pioneered this process original take its origins from. Dealing with women who had cancer and who want to try and maintain their fertility so and if I can describe this in very layman's terms this is a relatively short procedure and 30 minutes or so which takes place through keyhole surgery where slivers of all one of the ovaries are removed and then they are frozen at a very very low temperature and preserved until the date somewhere in the future when men oppose approaches that they are then replaced and delay the symptoms tricking the body essentially. And resetting the biological clock delaying the symptoms of menopause for potentially up to 15 to 20 years and also prolonging the fertility window as well no I want to know if that sounds appealing to you or not well good speak to soon just a 2nd but we've got Dr image and show with us the newer time is short she specializes in menopause Good morning imagine morning good morning you've had the opportunity to listen to Simon here giving as a bit of background as to the thinking behind this and just think it's an appealing prospect. But we don't need YOU development we need to. Be cautious about. Risks and benefits. And ensure. Properly. Research of the people research but we still don't have a lot of experience. It is only if you will just have this procedure so also we we we don't know. The risk benefit analysis it will take many. Ot. Have a. Very few We can't plan to just yet Well absolutely and absolutely right to flag that I mean we'll speak to Simon shortly about that because clearly this is very new work in terms of this current incarnation but I'm saying Eliot that in terms of working with with cancer fertility challenges then it has got a longer kind of back story to it but the principle of it you know I mean let's just sort of take this as a concept at the moment let's let's assume that all other factors are relatively safe and we can assume that but let's do it just for the purposes of this conversation do you think this would be a good idea. I think. I thought that was saying that we on this NG many is someone that I think many up to 40 in a postman a police state which is a relatively new thing a recent development because the part of life expectancy was much shorter but having made it is when. It was thinning because of the state and all the other attendant problems. Didn't. Have anything that can preserve the quality of life and today potential delay quality of the youth. Is potentially a good idea but is that no one to suppose to do yet and. That at the point that we already have a child T. Which is a medical. And also a very replacement we were placing the same hormones. It's a fraction of the cost all of. You don't have the attendant potential risks of surgery. And can be detected those could be just date. I think that having adverse effects they can then stop it or change to a different formulation you don't have 1st Attila to see it but you are getting Yeah actual stitching back I mean you're obviously dealing with women at the moment and I say this is a very very kind of recent development so you know yours is a more normal experience if you like or dealing with women with a more normal experience the question that pops up for me and I would love to get people to get in touch on this one is whether we are managing men a pause right know as effectively as we potentially could whether women are getting the support and the hoot that you know they could potentially get in order to give them an easier time or are we letting women who are going through the menopause and having a difficult time don't a lot of the time. Yes I think we are not providing enough. But will in. This stage of their lives I think we need to have more education in medical school and more education for G.P. Trainees so that G.P.'s are well versed in the problems of the manifolds and therefore better able to help their patients. Terry. We improve the low region or. There's about 120 medical or they were close call it a lot or a that yes that we hear about yeah. Image and they very much Dr image in the show I know your time is tight the line on Fortune got a bit scratchy there and we are going for travel but 59295 double 0 is the number to call and I want to know whether you're interested in the prospect of delaying your men to polls but also if you are going through the menopause have gone to the men opposer is imminent do you feel you are getting the support that you need to manage as well as you possibly can what kind of responses do you get if you do approach medical services and ask for a little better help get in touch you can text as NATO tonight live or you can email K B B C dot co to U.K. And Simon Fishel Professor Simon official who has pioneered this surgical procedure to delay the menopause is with us for a while longer if you'd like to ask him a question then please to wait a week 59295 double the time for travel. And Sharon Oakley has the latest thank you busy and the radio X. On the M $100.00 band from Junction a to claim fog to junction 9 bridge event that's affecting travel heading towards Perth the $82.00 is restricted to one lane north of 10 Jamieson one morning due to emergency roadworks road users are advised to and often on the journey times staying with Sterling a 9 Bannockburn road closed for gas main works between Boston Crescent and Mayfield street as a diversion in operation at the moment in Edinburgh is close following carriageway subsidence that's between local Green Road and east Clement Street defecting both directions heavy traffic on switchback road and southbound between counties bento and his land cross this morning establish early a 77 C'mon across southbound is closed for right LAX from the battlefield and a change of Health had to Monckton and dead. Dumfries and Galloway a 7 o 9 in both directions is closer to access between coastal Hellgate and the high rate and finally on the trains expect delays and some cancellations between guards and Queen Street and path and between Edinburgh Waverley in Perth and that's due to signalling problems and yet B.B.C. Radio Scotland travel thank you very much indeed and it is 933 this is Kadam associates all 12 on B.B.C. Radio Scotland still to come. On national work like a dog day we need to know do you want to be more like your dog when it comes to work going to have my own dog with me here today and she's working very very hard right no she leapt up she stretched and she lay down on her other side so she's being fed a very active this morning well done 57 a scratch and cat is back for her V K This week she's been ruling a beautiful place with great history with marble streets and gothic palaces we didn't manage to get your duties so I'm just telling you about it but if you know what it is you can always send and we get a toe 2000005. Right let's go to the polls we're talking about the menopause and whether or not you would take the opportunity to to lead them in a polls and through the surgical procedure that we're learning about over this weekend at moderates and a lot of them must be dissidents who feel good morning my. Good morning to the sound appealing to you know what clearly I don't know what if I. Started to demand a pause a few years ago fest in a nutshell and prior to that many pause in years I had met each of which is the mother of all T.V. And problems right Kate really extreme extreme pity cotton you name it. Luckily willed my life out of a 10 years because I couldn't go any vs that of a toilet I couldn't go any P.S. If I thought I was going to stop or you know it was just. They made a point kept some did try to talk all right and I just enjoyed life for the better oh god GA I mean that's all I've always had to patient and I so to be quite honest I didn't notice any difference. 3 years ago I had to. I'd actually when I was chucked off a horse and the consultant said that I didn't need to because the bone density is excellent right to do one thing with what your saying of osteoporosis touch wood. And so far I've not had the one. So completely Johnnies on. But only the last week that snow had my blanket on so we must accept either the bus not. So I feel quite the best thing ever but for me personally. So far I've no I don't RINGBACK think of going to run the gauntlet of all the horrible things a lawyer went in court to do yeah well I mean I think that is a key saying that the men oppose hits different women a differently and you're not going to be able to predict that an earlier stage and also the site you read productive system to give you a different set of problems. You know with I think it's a strange thing we speak about them in a post so much war over the last maybe 5 years I think it's a discussion that we're having was previously we wouldn't and you know of course that is a good thing but I also wonder if there is a danger or demonizing them in a pause to a certain extent and making it this big scary thing and that's not to diminish some of the terrible sentence that some women have but for you it wasn't it wasn't and the thing is a lot of people say oh well I did you hated mom and I have to save I don't know because my mom died at 48. Full I have no yet thank you notes possibly help because I don't have a preconceived idea if that makes sense yet. Yes And so maybe maybe the fight that I was going to with absolutely no kind of a patient was of and these P.D.'s all Stolpe. I would. Expect In this to nail sort. But hopefully you know it but thankfully no this is your repertoire system seems to be giving you a bit of a break. How to dance up you know. Notice before you go before you go what level of support did you get then getting through all of that well. I'm kind of a still have a notable P.D. And I finally plucked up the courage to talk to because I do know and I think it's quite cool to be a. I finally plucked up the courage to go and speak to the doctor I said it to me I was not a spirit. And it was a female doctor and how doctors should was oh well we've we don't want to go shouldn't things I mean you know you might want to have children and I was like I'm 55 I'd never want to catch up to Elaine what makes you think I'm going to help in the press and you know so I'm 55 she was discussing your fertility with you yet I'm going. To have to have been tried on a big price section paid to tell by all the Don't talk. And none of them want to can a good period and has had a solution worked all just get you pregnant and also. I think my case yeah yeah OK I get the answer to that question and thank you so much to do thank you Susan spittle feel good morning Sue Hi good morning good morning what was your experience. Well I sound like the previous caller I also didn't have a yardstick because my mom also died at around 40 and I expected to live and be healthy and I my sister hadn't had any symptoms of manifolds. We were told not to take a short T. Because we had a high cancer risk in our family and learned to hold they came to us to Paris's. If I could've avoided by. Then I definitely would take the chance to have the procedure a 5 none too how does how do to prove the 1st manifested and how does it affect you. That's a difficult question to answer because which sometimes also menopause and which sometimes are from the last year but I literally have felt my aged 10 years in about a yeah right when I got diagnosed I was just. Back ache and I get a sudden pains which. The doctors will not commit to whether that is us to persist but. The last time really healthy so when you see you feel you D. 10 years of the way the. Mercy. Pen pain in my pain in my back just a little black my body was old a plastic rod and sickle too. And let me bring in Simon again can I just mind you for your general medical knowledge. In terms of osteoporosis what exactly is I mean it's just a serious peaking I realize there I've clearly got the wrong end of the state when I think of those people who says I think of low bone density and that you're going to be more fragile and more liable to break bones that was my Perhaps muddled thinking about what exactly is goes to prove Well I'm not a Last year person specialist but I'm going to be better than me well it's basically about your physiological metabolism and how you're mobilizing the either build up or the breakdown of bone tissue and clearly. A very important point here is it is what is the backdrop to causing this Maloney's to Janick States is known to have a an effect moderate to severe effect on the disintegration the not the buildup of what is required to in the bone cells to to keep the bone strong and stop them being brittle and you know I think see this is one of the reasons why I think we are very busy in tissue approach for us as it is possibly possibly I think it's a wonderful conversation we're having of benefit to women. Later in life and will be answered her not now but in years later that it's so much more physiological and there is an exquisite relationship between all the hormones in our body that are being released in a rhetorical impulse a child fashion in a way that no pharmacological drug can do even if it's a good it's a good drug and even it's very similar to a not. For one it's how it's delivered is important about the condition like osteoporosis can be purely related to to the lowest region levels which effects on the Togolese some of. The cells that are responsible for keeping the bones in good shape or there may be another underlying clinical condition and this is always the great difficulty in many physicians job is to find out what is the cause of the position of the condition and or the great problems if you already said it was all we're hearing it from from many of your your your public is that you know not what you know that is not one glove fits all the you know not one situation is is the same for everybody under 4 it's a very hard job for doctors to be able to prescribe something that is satisfies one person which may become politer wrong one for another but I guess that's what my give me concern about the procedure that you're suggesting Simon in that you are committing to a procedure ideally in your twenty's. To preempt a condition or delay a condition from coming to not see a condition a very natural process and you don't know what it is going to be like for you well you know from the can see this is this is why I. Was image and I think it was made a point that we mustn't forget the work that has been done for 20 years on cancer patients who were in a man opposing state what we did and we met I mean friends I mean I haven't had particularly any issues with with my my Manapul as you know it hasn't been something that has been a major impact on my life I have friends who have been really really debilitated by it now when we were in our twenty's we didn't know that you know that I know that I fully accept that and I said to the beginning of the program that is that is the challenge. It's in a sense it's almost like banking with some insurance you know hopefully never need it and you never know what your outcome is going to be the reason why I think this is of the. Henschel benefits to young people is not just that a pause of course young people are being advised to freeze eggs and it's a completely different story I know but it's an issue that being told because of the poor society is at the moment the difficulties of women getting pregnant they are also banking at the same time hundreds if not thousands of eggs in the same process so it's both fertility and potentially men a pause issues that could be helped by doing the procedure when you're young but yes I accept doing it when you're young is a challenge I mean you know because I am an old man oppose a woman's time and I am a little bit cynical and I have to say having read this over the weekend I did kind of wonder if this is essentially a story about prolonging your fertility and we all know that that is a very lucrative industry and that's really what is underlying this and then the kind of men applause line has been kind of spun over the top of it I mean for the come last point K.K.K. I have to tell you that's not not the case because. There are there are little own just thousands of side to be got with there are journals that are dedicated to the problems of the men are ports and we know that there are 13000000 women going through in the Med a pause in the U.K. 60 percent of them require continual medical support so that means a 5000000 a fund so you always find people quite rightly so that will go through them in a pause and really have no issues but then there are certain 1000000 people who have moderate to severe conditions well we're not absolutely and I mean goodness knows I'm not in any way trying to ignore that fact I mean but what I would question and I'm saying that from from the perspective of the woman in that age group is whether or not even with the knowledge and the treatments that we have commonly available neither whether or not women are getting. The support that they could potentially get to make it a better experience than it is I mean you know your procedure is not necessarily related to that I mean you know it could have been absolutely individual benefit although that soon but right now where we are we're talking about the men oppose a lot but are we actually supporting women as well as we possibly could with the means that we have read it live a little just now and I mean it was interesting listening to a earlier on who had had men and. Actually the men oppose for her was it was a blessing it's not just about the men it was isn't it is about the rich productive cycle and rip reproductive systems as to whether or no women are given the help that they could be given Well and that's why it's so complex I mean I was just listening to a very eminent American who's in his eighty's he's been he's been course specialist for years and he's saying now the best advice he can get to women who are having been a postal issues is to walk just keep walking and so therefore you know you've got people who are saying lifestyle will help but you know you can go from one end of the scale lifestyle may benefit some people because it's been direct or it's been in direct help and you go to the other end of the scale we're all the help in the world women visiting clinic every month to try to get some support change the medication etc is not helping. You with it with the complexity of human beings metabolism which is what be very hormones are all about with a complex city of can we get it right for all women all the time though well and so I mean just to take my cynical off for a 2nd I'm very grateful to be spending the time with us this morning and you know being open to the discussion and open to questions are very grateful for that Professor Simon Fishel who has pioneered this. This procedure the surgical procedure which could potentially delete human opponents for 15 to 20 years if you do have any questions for him I think we can hold on to him for just a little bit longer wait a week 59295 double Howland's in Cumbernauld Good morning haven't morning came over here I'm very well indeed but how are you going to the point oh I can't wait to get him and of course we were rushed into court with families gorge by which I was before the home the main course my 70 behavior. The prospect of delaying is one 0 god is the worst thing in my life I mean I will tell you what I was surprised I was deceived. To die of heart of all type reverse the things of a thief in my haste. Then Mother says Night me is a manifold. You know if it's not past and it's not there we have pretty much based my mother's last post difficulties in my twenty's my need to tell it to treatment right so why did I want to just go with my ovaries to see that. You know this gets me all this post because of the spot I was made of course so I came by and of Connie's blog there's a some pasta in the post but I'm going to the well all the old devices are those and can tell you what Mani has the main. Behave the top of the front on the front all know. What. I mean to do with the customer and have and have a. Good good I don't know I don't want the customers I want Helen to be happy with our life but that is so much more important and good on you I say and I'm actually you know I think it's like speaking to him that way you fantastic publicist it go to great well you have to lose haven't gone. SIMON I need some advice and the other question is the same thing for tell us to. Hear no as well in 5 days same thing fertility compare me to fish you know just for the women themselves in the older women having babies. You know then use the fellas to your lips and not. The beauty of color think of the out of it because they are going to have multiple pregnancies as I've told myself before but it cost more to learn it said you must not call them well I write a check older woman in the baby was supposed to be between. 40 or so with the but I think it's going to be I think we agree on that and I don't want to discuss the fertility issue here because because that's that's exactly what these programs in the budget numbers but it's very fair comment we wouldn't want that we would want women to be having their children in their early thirty's preferably maybe late thirty's a problem in society at the moment every single economic advance assigned to declining birthrate it does not have a population replacement level it's a huge problem for society and one of the big issues surrounding that is primary infertility is on the increase secondary infertility is on the interest because women are not starting to have their children to later in life you know we mean we need to go but it's it's just to clip to say women should have babies young blood to society doesn't have the climate to allow that to happen at the moment so preserving fertility and till you know let's put but face it over you the the the old the old sixty's is is a woman of $44050.00 or whatever it is so yes they can have they can have children into the mid forty's but only if you are younger rakes time you know was the last 5 you know that although we have been die of women of my generation and it stays the same when our mothers was so we have here. Have ever been with parents. Well because of the things that I wasn't going to. So you know born here. So I feel well weapon and some concept of the thing he's come. From a long term. Perspective of bonuses. But this man of course of course is on them you know and you know I said I look at dollars and I accept the kernel of that yeah all of all of that is very important the other thing we should just Of course I think you mentioned you had P.C.O.S. Well here again having certain situations medical situations. Ironically does make it a lot easier for women going through the multiples Rimmon can for example produce a lot of peripherally sturgeon from for example the fat cells while there's been a very intense shoot then then they will have a better restriction of compartment so again it's you know it's a complex issue and I mean I'm it's not it's not something. We can take an example from from a single case and then apply to the population and you have a good kind of just as having clearly you don't think this is something that you would have been interested in for a whole host of reasons but do you think it is an option that it would be worthwhile to have their on the table. I could go off to 2220. 7 conducted over these list of really have to and not just one of these is my piece to you. Because one is left to create play puts a cloak of. A layer. And you know I buy that I want my government to the housing for the least of those we don't have to. Do that leap. No choir you know I. Know this is a not so evolutionary thought you know I love everyone was. So many members one of the oh well being. The last of all. You know so. When you say that you the natural evolutionary process is totally that of Eclipse range because if you're talking about that is only about 150 years ago women wouldn't be alive about 10 years after childbirth so you know it's not a natural process it's a modern medical process the women being able to live for 30 or 40 years in the men opposing state. Interesting conversation between you I mean I've just been listening and what we're trying to speak to soon are the just before the news Helen thanks very much. To have enough to this. Every orchestrates brought to our capital cities Kabul streets to take in the festivals Incredibly the number of tickets sued rivals to only the World Cup But the Olympic Games to bomb this August as you know able to make it and I'm proud that we are bringing Edinburgh to you because you took it to the biggest Don't spend still in the world right here and different Bestival is with B.B.C. Scotland on T.V. Radio and online what you do is you write some good stuff but for me I just stand up and say I'm going to get the best rate in. Congress because a reader would be asked initially we need jobs for site today continues on B.B.C. Radio Scotland getting its own B.B.C. Radio Scotland you can call our free phone number on 4 wait wait 59295 you can text 80295 network charges apply this is B.B.C. Radio Scott. Right we've got shown on THE LEAD Good morning show in a Yes good morning to good morning is this something that sounds interesting to you . Well it's way past my time for being interested and will not be able to do anything about it not OK. Interesting I don't know it's a very complex and complicated issue I think not the main thing that the foreman has shown us and I mean I have nothing positive to say about it and then applause I'm told if I could have escaped I definitely would come crashing years if you could have delayed it or yes absolutely but then it would I would never have thought of that on my 20 Celsius course of weakness and it's such an individual but you have no idea what it's going to be like for you. How has it been for you not good not good K. . I get can sometimes get the feeling these days that people think it's something you go into and things change and then you can at the other end the a fine well in my case and I think for a lot of women I felt this morning you know sign I've come out on the Able to a contact lenses and then all because of the China that's associated with and then opposed I've got osteoporosis. So you know. Nothing positive to say about it i don't feel that my quality of life you know is definitely not improved the man opponents are saluted and aunt. And still produces again. People may think well it's just something you take some medication for well yes there's lots of medication there for her and my particular case some medications I didn't tolerate Well there's been quite a few changes of medication of how to go through and some that didn't agree with me some of the have very adverse effects so it's not it's not straightforward So if you want to delay maybe having all stew a process until. I was much older Yes I definitely have done not and then I'd have to live with uncalled for so much less time than I come out yeah definitely and in terms of support through all of these different challenges Suna do did you have adequate support did you feel. Much the same as the other women who have been on the program is very had unless I mean I was on H.R.T. For 10 years that helped a little bit but then frankly I found that one doctor took me off H.R.T. Because she said I couldn't go on that longer the centers just came back again. She did ter day but I think so much more research needs to be done in this field but as I have this morning it is such a complicated complex issue. And I can wholeheartedly see why some of the latest simple arms money I'm been very glad to see in a minute or the other side of I want to make a point you have to let play. A Listen thank you very much you hear from the music they were running short of time as you say a complex issue but we're grateful to Professor Simon Fishel this morning for coming on a spending time with and explaining this procedure and what he sees as the potential benefits though is very open to the discussion and people get in touch with your messages will try and get through some of those after the news just coming. In Wayne. Chrebet. The Scottish conservatives are calling on the spending watchdog Audit Scotland to current a full investigation into its construction of the new Hospital for Sick Children in Edinburgh It comes after senior tradin official Tom Waterson suggested part of the building may have to be pulled on due to drainage problem he says he's warned the matter potentially pose a greater safety risk than the ventilation issues that hold the hospital. Opening the health journalist Penny Taylor says there's a raft of issues with the building it seems that offense elation in the critical cat areas of the children's hospital which are meant to clean the air about 10 times an hour they are allegedly not powerful enough that been questions about the water supply issues raised about drainage there are plenty of concerns about the new hospital Donald Trump says Hit has no place to being criticized for going to mush shootings in America over the weekend critics say the U.S. President is part of the problem because of his opposition to gun control and an immigrant language the suspect in the attack in El Paso Texas is thought to have posted online calling it a response to the Hispanic invasion of the state Professor Rafael colon Almagor to study his speech online I've been following United States politics for the past 30 years I cannot recall a president who speaks like Mr Trump I mean it's unprecedented so he should be very very careful about the words that he use because these words are powerful and gives it a scam equal to what Cosby extruded poll hold the U.K. Government says Scotland will receive an extra $100000000.00 pints after yesterday's health spending and once meant the funding is worked out using the usual Barnett formula after the prime minister pledged one point it 1000000000 points for better equipment on technology in English hospitals Scotland's health secretary Jean Freeman said that while extra money is welcome to recent U.K. Government decisions have short Chin's to Scottish out of just as a culture's old from extra spending on health in England it will be ring fenced for .

Welcome brought a journalist in Sydney to the listing to news do we have the news up next. You might think that because the kids on from the top are so amazing at their music that they're just slaves to the practice room with no life beyond that well I think and damn one of my hobbies is raising chickens and one nationals for dance about 3 years ago we really hope someday we can actually qualify for the Olympics I have a small part in the movie Wall Street Money Never Sleeps join me Christopher O'Reilly for our weekly celebration of great American kids and great music it's N.P.R.'s from the top. Sunday night at 10. This is w. When p.r. Connecticut's public media source for news and ideas w when p.r. And w. When p.r. 81 merit in at 90.5 w p Katie and w h t one Norwich at 89 point one. F.m. Stamford at 88.5 w.r.i. Southampton at 91.3 and w. When p.r. Dot org. B.b.c. World Service this is all in been adjourned with news hour extra one hour of discussion on a single topic every week and this week out topic is health care how does it work in different countries which ones have the best systems and we're discussing this at a time when president trumps promise to repeal and replace of Bhaumik is running into trouble the Republican leadership had hoped to hold a vote in the Senate but too many senators said they didn't want Trumka that's being postponed but then as Mr Trump himself conceded health care is not as simple a topic as he once told now have to tell you since the leave of Lee complex subject nobody knew that health care could be so complicated but the u.s. Debates is just part of the program this week will also be going around the world to see which systems work which ones cost a lot and which ones deliver results is it a case of the more you pay the better you get health care after the news. You know as with the b.b.c. News the American secretary the American stage of how are you has a federal judge to clarify the legality of the Trump administration's guidelines on a controversial travel ban parts of it have now come into effect on Monday as Supreme Court ruling upheld or the temporary ban which covers visitors from 6 mainly Muslim countries and all refugees travelers without close family or business relationships in the u.s. Could be barred from entry I wise attorney general has argued that the definition of close family is too narrow but the u.s. State Department spokeswoman have ignored said the ban was necessary for national security this is been one of the president's top issues he has talked consistently about how he believes the United States needs to do more to and Hance our screening procedures and to take a better look at people who will be coming into the United States because the safety and security of Americans comes 1st American Media reports say that trumpet ministration plans to arrest parents and other relatives who the authorities believe have smuggled their children into the u.s. The reports say Customs and Border Protection staff have begun sharing information with immigration agents the move is aimed at disrupting people smuggling gangs the German parliament is about to vote on a bill to legalize same sex marriage the measure is likely to be approved after the German chancellor Angela Merkel changed her mind to allow a free vote from Berlin and here's Jenny I'm going to change of hearts took Germany by surprise and to political rivals jumped at the chance to bring a bill to parliament before the summer recess the chancellor has long opposed same sex marriage citing concerns over the welfare of children but in an interview this week she said she'd recently met a lesbian couple had fostered 8 youngsters and changed her mind today's bill which would also grant gay couples the right to adopt children is backed by most of Germany's political parties and it's expected to pass. Documents obtained by the b.b.c. Show that the cladding originally due to be installed as part of the refurbishment of Granville tower in west London was changed to a less fire resistant cheaper version at least 80 people were killed in the fire at the time block 2 weeks ago more now from Tom Simons the 10000000 pound refurbishment of Grenfell tower included new cladding to insulate the aging building and improve its appearance residents were told it would be made of zinc but the documents from 2014 setting out a list of savings requested in various aspects of the project show the zinc cladding was replaced with aluminum panels instead these were a different color but the b.b.c. Has been told another key reason was to save money world news from the baby Siri President Trump has host of the South Korean leader and after dinner in Washington before formal talks on how to handle North Korea Mr Moon Santy hope that they could find common ground to tackle the crisis over the North's nuclear weapons program he takes a more conciliatory position than Mr Trump. The Chinese president Xi Jinping has praised his in Hong Kong for calving the territories independence movement is to show he made his remarks to senior Hong Kong officials during a visit to the 20th anniversary of the city's handover from the u.k. To China 26 protesters detained by police ahead of the Chinese president's arrival have now been released on bail our correspondent Julian a new says there's been a mixed reaction to the president's visit there seems to be very divergent mainstream views in Hong Kong and China about this visit here in Hong Kong obviously the city is very divided there are people who support the president who support the visit but on the whole the coverage has been critical about what they perceive as increasing meddling by the Chinese government. Questions about the relative decline in. Tents to China South Africa's governing African National Congress is due to start a 6 day conference today in Johannesburg as deep divisions persist over the future of President Jacob Zuma his position is likely to overshadow policy discussions on land reform health and education some n.z. Veterans are boycotting the conference calling from his desire to resign over corruption allegations against his government the New South Wales Government in Australia is to begin deploying drones fitted with sirens to alert swimmers and surfers to the presence of shots in the water shocks mounting drones and helicopters have been used to monitor the creatures on a stranger's east coast but this is the 1st time sirens have been fitted. Hello and welcome to News Hour extra with Owen Bennett James and we're talking health systems this week and the figures same clear enough the u.k. Spends $4003.00 per head on health care call it 4 $1000.00 and it has an average life expectancy of $81.00 at the u.s. Spends over twice as much $1451.00 for head as an average life expectancy not of 81.4 but 78.8 so much more money spent for worse results but then those Japan it's got the highest life expectancy 83.6 but spends only slightly more than the u.k. 4001 $150.00 And again that's less than half the u.s. Spending but maybe that's all the fish and Japan let's look at the maternal mortality rates of female deaths per one 100000 live births very striking figures again Japan 5 u.k. 12 us 21 deaths so today a bomb a cat from care the British National Health Service they admired ties system and everything in between what sort of system works best and we've got an excellent panel to guide us on this from the u.s. We have Joe Antos who's with the American Enterprise Institute he's in Washington we've got Adam Gaffney who's a medical doctor and instructor at the Harvard Medical School Ruth Olby assistant director of policy at the Health Foundation and Professor Carr a Hanson from the London School of Hygiene and Tropical Medicine So just to sort of locate you all on this issue I'm going to ask you all to describe which you think is the best system in the world which country has the best system I don't you start us off Adam Gaffney who's got the best system I think the best system is probably an amalgam of a couple different systems but I think the big picture a fully public system with either national health insurance like Canada or a national health service like the u.k. Serves the population best achieves the best results and does so at the best. Cost So I would think a fully public universal system without a role for private insurers is the optimal system show and tell us in Washington you're allowed to die because he did tell you what's the best system everybody assumes that one can instantaneously go to some best system I think the the problem the United States has is that we're bound by our culture and our history our recent history in particular so we're working on it I'd say the best system is the system that suits the circumstances of the people in that country in a reasonable way which I would argue is not the case in the United States but I wouldn't point to any particular system and say that's the one we really need because we're just beginning on our journey to to make changes I don't see in the u.s. Has to have I'm just saying what system your money is how far out which is the best that's rather simplistic these mortality rates for example never adjust for differences in demographics the lack of uniformity culturally and so on in the United States makes a big big difference it is true that we have major major problems there are other things that we should be doing other than arguing about financing which is what Washington is doing and we should be really focusing on developing a more efficient way to deliver health care and a better way of getting patients involved in a more active way that they do in this country Ok We're going to some of those issues over the next out Ruth will be you going to be a bit more specific about what you think is a good system in the world today as the world is more I'm going to slightly duck actually because I think I mean there are lots of good examples in Europe I won't wide of good systems but they've got things that went well and they've got things that don't want so well I guess it really you know doesn't mean it has to fate the values of society I mean universal coverage seems to me to be an obvious thing that health systems need they also need to be able to prevent ill health which. For them I'm not very good at so you know lots of examples we can point to in Europe where there are some bits that are working and not working so well we could kind of mash one up and come up with one we could probably do quite a professor I've got to George's top Dr. Can you going to give me a clear out of snow in 2000 the World Health Organization undertook an exercise of ranking health systems and they looked not just at the amount of health they produce health outcomes but also the extent to which they provide financial protection and that I mean preventing people from becoming poor as a consequence of using health services and also responsive to being responsive to their users so the system that came out number one then was friends and interestingly they have some of the principles we've talked about already the idea of a substantial share of public financing which is essential but also a fairly mixed economy on the provision side and that I would say my own views about you a good system would be one where the bulk of the expenditure is from public sources but I'm pretty agnostic about the provisions odd and how important it is to have a soul the public system or whether a mix of public and private providers you know you might you made the point there are lots of things to measure in deciding whether it's a good or a bad system Ok what we're going to start with the us I promise you we're not only going to talk about the us in the program we will be going on to the National Health Service and services like that and also some of the developing world what they're doing it systems there is a global coverage but we are going to start with this thing that's going on in the us the moment there's such a row about trying carrot Obamacare and all the rest of that so just to give the big picture in the us most people would agree and we should say despite having the best medical technology in the world the Americans do spend an awful lot of money on getting some pretty poor outcomes and the gaps in the Us system are very well known which is going to start with a bit of tape we have some tape through the program and this is Brooke he's dedicated his life to providing medical services to people who need it but when he started on that my. If mission he imagines he'd be working in the developing world it's not been like that he's been kept busy in the United States and he told me about his work from an operation that started in the Amazon in 1953 we've been bogged down here in America since well 32 years now providing free health care for the under-served of which we've done something like 864 expeditions as we call them expeditions in the United States all in the United States yes although we do still go to places like Haiti and Africa or we were in South Sudan recently but 99 percent of the work we do now is here in the United States the need is so great and what work are you doing we have the capability to set up 138 dental chairs and 20 or more lanes of I examine equipment and make eyeglasses on the spot and of course do all of the general medical work as well for diabetes and heart disease and all the other ailments that people suffer from because dental work is not covered I think by Medicaid and these other programs in the United States presumably most ailments are you know the Affordable Care Act and now the House bill put together another one that's being debated in the Senate none of those address the desperate need for dental care and vision care in our glasses amongst adults this is a terrible situation and not only results in other diseases from infected teeth like diabetes and heart disease but in this country death how many people are you saying are not getting tensile and vision cover it runs into tens of millions the difficulty with the American system is it leaves all these people you're seeing uncovered but it also produces the greatest medical technology in the world Yeah it certainly does but how come then the United States is sitting down a number 37 in the world ranking. By the World Health Organization there's something wrong here and nobody seems to know how to fix it so could you describe one of these events that you do for us a typical event patients start to line up certainly 24 hours before the event unfortunately opens but sometimes as much as 72 hours and we start issuing numbers so they enter the facility in an orderly fashion about 10 hours before the event opens and at exactly 6 am we open the doors and we just keep going day after day as long as the dentists and the our doctors and the other physicians and nurses are able to hold up it's a very very tough and lengthy process for these volunteers of which we've had over 101000 volunteers in the field and that was broke with a pretty remarkable occurrence of what he does in the United States let's just try and work out why America has these problems I'm Gaffney Can you just kick us off with how on earth can this be well it is the inevitable consequence of the structure of our health care system when you have a system that is composed of this complicated mix of private insurance public insurance you're going to have people fall through the cracks and there's going to be tens of millions of people falling to the cracks I mean before we even get to the issue of Trump care and what that would do it's important to recognize how many people are being untreated and uncared for even in America today 28600000 people remaining uninsured we have a epidemic of what some people refer to as under insurance meaning people have insurance and it doesn't actually cover the cost of their illness thousands of dollars deductibles this is the amount you have to pay out of pocket before insurance kicks in those sorts of out of pocket payments deter people from seeking care or if they do attain care they may go broke in the process. Yes we have an epidemic of medical bankruptcies one study shows that actually a majority of people who go bankrupt actually have a medical reason for that bankruptcy and there's also the issue that insurance doesn't cover the full spectrum of medical care as we heard dental care is far too often left uncovered there are large percentages of the population that go without basic dental services adults but also children too so we are seeing the inevitable consequences of having a system that does not provide universal coverage to everybody as a matter of right and just to understand the system just talk us through quickly if you can this will highlight some of those Medicare insurance. Medicaid correct so many Americans get their private insurance through their employer Americans over the age of 65 have access to Medicare which is a public program signed into law by Lyndon Johnson in 165 and then there is Medicaid which is for low income folks and that program was expanded substantially by Barack Obama those are sort of the program 4 years ago to Joann's us does that mean that everybody. Gets comfort and some Why it may not be this the luxury treatment you get in a private insurance system but if you'll pull on your you know you will get treatment almost no not necessarily there's a law that prevents emergency rooms from turning you away and you know if you die in the streets if you show up but you know there's as I said 28600000 people remaining uninsured so you'll get emergency treatment if you show up but you may not be able to go to a doctor you may not be able to get other health care needs fail to know we have persistent levels of high on insurance in this country even under the Affordable Care Act So Joe I'm sort of Gaffney's very unimpressed I guess you also you know I'm unimpressed by all these arguments Stan Brock is providing a wonderful service he's not the only one the thing that you're focusing on is financing but in fact what Stan is also doing is he's actually providing the services and that's one of the big challenges of this country it's an enormous land mass there are a lot of rural areas where you couldn't find a doctor or a dentist to literally save your life so that's a challenge that goes beyond financing which is what the current debate is and what Adam is talking about now when it comes to government programs let's pick the biggest one in this in this country the most important one which is the Medicare program for people over the age 65 and disabled persons as well in the last election some politicians who are gay for Medicare for all but Medicare for all doesn't cover dental care doesn't cover I glasses doesn't cover hearing aids you know I mean the point is everyone around us the world thinks one of the most I mean a very rich country well becoming those in the middle No I don't think is it doesn't take things the fact is that doesn't that's the point you know if you're saying that you want to leave decisions about what should be covered to politicians in this country you are definitely treading on thin ground it seems to me and the. The feeling that somehow the federal government is going to solve all these problems is the Chinese the I think is is grossly mistaken Adam I think you'll be surprised to hear me say that the Affordable Care Act I don't call it Obamacare the Affordable Care Act or the a.c.l.u. Made a big stride in the direction of getting more people eligible for health insurance in this country the debate is over how much federal control how much decision making has to be made from Washington let's bring in. Contributors to sort of adjudicate on this I think this is really the issue is who gets cover when not it's not really the politics it's just a really good cover that they need in a rich country is not the main issue yes I'm thinking about the United States system and I think it has to recognize that there are a lot of people in the us who are very uncomfortable with the idea that the government is involved in the health care of the question is how can you know what is the role of government behind the scenes there are other examples in Europe where the government takes more of a back seat but it plays a really important role in sort of redistributing an evening out. That might otherwise occur so there is a question of matching value in society so I understand that there's a 100 francs and what you just heard from American contributors I do think it's interesting that so much of the debate has focused on on the financing side and much less on the provision side of the service delivery side and the other thing that's notable in the u.s. Is that so much of the effort to control costs you mentioned earlier they're very high levels expenditure they spend 18 percent of g.d.p. On health compared to about 10 percent or so here that all of the control in costs comes through users it's about charging deductibles and charging co-payments and I think in Europe and actually in the rest of the world we're much more inclined to use supply side controls to try to shape the way that services are delivered to make sure that they're delivered as well I'm going up at the same question to Joe Antos Can you explain if you just compare the u.s. . And you kind of talk about the whole service here in a minute it's such an enormous difference 18 percent of g.d.p. To 10 percent of g.d.p. Where does that extra 8 percent of them Gaffney go want to get spent on well for one thing we have and uniquely inefficient system when it comes to health care administration and this is sort of a boring point but it's an important one as a result of having a fragmented public private system like we have in United States we spend enormously more on health care ministration billing coding and this is something I see even in my practice as a physician and that's the result of having to build all these different shores of having to have hospitals come up with enormously complex bills for each individual patient tabulating every line item of what they charge what they use one estimate puts the potential savings in moving towards a Canadian like system about $500000000000.00 a year could potentially be saved through a transition to a Medicare for all system according to one estimate so that's a major factor there are other factors as well I'm not sure that we should reduce spending all the way to you count u.k. Levels in the United States I actually don't think that's possible and maybe the u.k. Could spend a little more in health care I'm not sure one of the things I've heard is that the n.h.s. May be underfunded right now but the point is that there's huge savings that can be unlocked through moving towards a more administrative leave simple public program note that the evidence bears that out John says Do you agree with this massive spend basing percentage of g.d.p. That was something going wrong in the way it's being spent I agree with Adam that the United States has considerable inefficiency when it comes to administering health insurance it's not solely because there's a multitude of private health insurance and public programs it's also just the complexity of everything we do but we have several major problems one is Adam Adam is a physician in the United States I'm sure his income is respectable position incomes are much higher in the United States than in most other developed countries hospital administrator incomes are much higher in the United States than in other developed countries are also. Operate at a much higher pricing level and it's not just because of all the intermediaries if you eliminated a lot of this administrative waste you'd still be paying doctors and hospitals a much more on a per procedure basis than anywhere else in the country another problem of course is that we have very limited primary care use this is a great place if you're if you're deathly ill and you need high tech specialty care great place to be but in terms of ordinary medicine ordinary problems as Stan Brock points out this is not say it's such a great country to begin Ok well let's just hear about an individual case now which illustrates the sort of difference Trump could make compared to a bomb a cat this is Chandra He's 2 years old maybe 3 born with a red condition called a hetero taxi syndrome apparently that can lead to really serious problems organs mild forms misplaced multiply the missing I'm treating it as extremely expensive and just one of the many operations Ethan has had cost a quarter of a $1000000.00 but under a bomb a cat his parents paid just 500 dollars I spoke to his mother Allison Chandra there are several concerning things with this new legislation and one of them is the fact that states would potentially be allowed to reintroduce lifetime caps lifetime benefits caps are an arbitrary dollar amount placed on human life is what it boils down to the insurance company can say we paid out enough money and that's it your kids too expensive That's it for the rest of his life every single penny would be our responsibility out of our pocket so instead of $500.00 at the bottom of that bill we would see $231000.00 so you can have the operation I honestly I don't even know what that would look like I don't know if we would be able there's one surgeon in the world who knows what you can start looks like and. Really know is how it set up right now I don't know if he would accept us if we didn't have insurance let me put the other side of the argument to you which is that people should take their own responsibility for their own health care and the health care of their family and that it's inappropriate for the government to be getting as involved as it is in subsidizing people in your situation. Right well I would ask them how should my 8 week old you know being more personally responsible with his organs when he was forming it's absolutely ludicrous That's a great talking point to just show personal responsibility but when you bring it down to a human level to real people stories like ours you realize it's not about that when did we stop caring about each other Ok So that was honest and Chandran and it's a very specific point she's making about one aspect of from the compromise health spending from people who are covered under the system that would really affect her but let me just ask you Joe I'm sauce you know there are lots of groups who will be in the similar situations and does that mean Trumka will actually never happen because it's just politically impossible because you have the anger in her voice almost desperation in a voice there will be too many people like that to get this through. Well I actually don't think that there that's going to be what's going to kill it but she I mean it certainly is said situation and a fair number of people could be faced with something of a similar magnitude and the same and certainly similar heartbreak don't take any of my comments to imply that I'm unsympathetic I think it's a serious serious issue just make a point though the a c. a If your state only did protect people in terms of maximum out of pocket book cost there's a limit on how much you had to take out of your own pocket is it Baba you know yes that's right and we could call that catastrophic coverage except for one program the Medicare program the Medicare program does not have a limit on how much a senior citizen might have to pay so you know it's quite interesting that our job and its government program doesn't have that feature now I might also add that when you scrape some of the politics aside Republicans and Democrats are both. It would beings and I don't think you would find Republicans acting as human beings saying that they think it's really a wonderful idea to impose enormous costs that people can't possibly afford to save their baby's life I don't think that's the issue if you personalize it then you can of course find all sorts of terrible examples but you can find them today under Obamacare just because you have health insurance in this country doesn't mean you're getting good care last word for you in this off the program from you I've been governor. I think that Joe is right the status quo is inadequate There are sad stories happening now but in every respect from care would make that worse 22000000 more people being uninsured under Tom can according to the estimates over 10 years one last thing it is true that Medicare has deficiencies right now this is the public program and many of us think that Medicare for all single payer program will be the way to go we need to fix those out of those inadequacies and also expand it to everyone so we need a universal program we need to be better and more complete than Medicare but there's no question that the status quo is unjust and is inadequate for the needs of the country will take a short break mantras to remind you please do let us know what you think of the program do that by e-mailing us at News out extra b.b.c. Don't go don't you k. You can tweet at b.b.c. h Extra and if you want to get the program every week one hour discussion on a single topic every week then just go to polkas the b.b.c. News Extra polkas to be dilated chill device once a week. Distribution of the b.b.c. World Service in the us is made possible by American Public Media producer and distributor of award winning public radio contact a.p.m. American Public Media with support from Deloitte private delivering audit tax consulting and advisory services tailored to the needs of growing probably helped companies the Lloyds dot com slash u.s. Slash private. Coming up on news hour extra over the next half hour we'll move beyond the u.s. And the u.k. To look around the world how does China handle health care it's got a very high percentage is insured but is that enough how does largely privatized Switzerland perform Why is the toy system considered a good one how come Japan has got such good outcomes apart from spending money what else can you do to get good health systems that's coming up after this news summary . A.b.c. News with new owners so the u.s. State of Hawaii has asked a federal judge to clarify the legality of the Trump administration's guidelines on a controversial travel ban parts of wage have now come into effect on Monday a Supreme Court ruling upheld that the temporary ban which covers visitors from 6 mainly Muslim countries I mean one American Media reports say the Trump administration plans to rest parents and other relatives who the author is believe have smuggled their children into the u.s. Their reports say Customs and Border Protection stuff have begun sharing information with immigration agents about u.s. Relatives of occupied children unaccompanied children the German parliament is about to vote on a bill to legalize same sex marriage the measure is likely to be approved after the chair German Chancellor Angela Merkel change their minds to allow a free vote she has long opposed same sex marriage documents obtained by the b.b.c. Show that the cladding originally due to be installed as part of the refurbishment of Grenfell tower in west London was changed to a cheaper version which was less fire resistant at least 80 people were killed in the far 2 weeks ago the enemy of planting his thoughts to have contributed to the rapid spread of the blaze China has warned that American arms sales to Taiwan will undermine bilateral relations they were warning came after the Trump administration confirmed that it plans to sell arms to Taiwan with about $1400000000.00 as Lebanese officials say that 5 suicide bombers have blown themselves up during an attack on 2 refugee camps near the border with Syria at least 7 soldiers were wounded and South Africa's governing African National Congress is due to start a 6 day conference today in Johannesburg as deep divisions persist over the future of President Zuma is position is likely to overshadow policy discussions baby Xenu's. You're listening to music director from the b.b.c. World Service with him but it churns and we're looking at how the caste systems around the world and in the 2nd half of the program will broaden this site away from the u.s. To systems out where and we're joined by Joanne self from the American Enterprise Institute Adam Gaffney from the Harvard Medical School Ruth Olby of the Health Foundation and Kyra Hanson from the London School of Hygiene and Tropical Medicine we're going to move on to the u.k. System now the National Health Service you can have private insurance in the u.k. And about 10 percent do but the vast majority rely on the National Health Service and I discovered today is the 1st largest employer in the world do we know who did largest employer in the world as well not the Indian Railways. Is Number 3 I'm taking other offers for the top full u.s. Government well Department of Defense and then the People's Liberation Army Walmart McDonald's chief because our franchisees and then the National Health Service 1700000 people no fewer than that and we just thought it would help to hear an American in London talking very briefly about his experience of the National Health Service to get back contrast here's Jeff hi my name is Jeff I grew up in Oregon but I moved to London in 1988 at the age of 23 and the National Health Service has been providing my medical care ever since then I think when I 1st came here I was overwhelmed at the simplicity of the way the n.h.s. Worked I went and registered I filled out one form of my doctor's surgery I was registered and that was it everything else was free my national insurance deductions out of my paycheck it seemed like incredible value for money everything was taken care of that was really appealing to me so when I 1st moved here it was really easy to get an appointment to see my doctor within a couple of days they've built 6000 apartments in my area in the past 20 years but they haven't opened up any more doctors surgeries so I've been with the same doctor for. 18 years but 15 years ago it was a relaxed visit to the doctor and we could chat and have time now it's a strict sort of 8 minute appointment and the poor guy seems like he's rushed off his feet I would say the n.h.s. Is really good about Critical Care So for instance I have something called Barrett's esophagus which is a precursor to a soft field cancer and I need to have an endoscopy every 18 months just to check on it and like clockwork every 18 months I go to the hospital and I have my endoscopy on the whole I feel like the n.h.s. Has been providing excellent quality of care but I do feel like the system is underfunded and every year it's struggling more and more to meet the needs of the people in the u.k. So that's Geoff and he ends up making a point that is overstretched and Ruth o.b.e. You would probably know I mean most people in the u.k. Would agree with you yes I think it is I was fresh in the moment I think it did come been ation of not enough funding going in and perhaps. An unwillingness to plan well enough food just work out how quickly demand was rising and so you know where in a situation where where it is feeling very very tight and it's not because the system is faulty in that it just depends on politicians coming up with the money and over various reasons I mean old well that is the drawback of tax funded systems is that you know the Parliament generally has to decide and it's a debate that goes on between different government departments about how much needs to go into health versus other sectors and in this period after the recession when we've been trying to cut back public spending health has been protected. Compared to the other government departments but the demand and cost pressures on the health service have risen faster and so I gap as a pin drop in that gap is now being felt by lots of people Professor Hansen How do you reflect on the strengths and weaknesses of this system in the u.k. Where basically it's free you. You've got comes out of taxation and whoever you are you can wander into a hospital and foot she would move paperwork you know I mean I've experienced as much I could believe it is going to you know to fill in a form you get treated I think that's absolute the case on it so in terms of equity of access that it's universality it doesn't excellent job and I think I'd agree with Ruth that there are definitely strains in terms of the velvety of resources and our ability to meet those needs would you with your expertise think that the systems in Europe whether it's more insurance but based on the generating revenue in a different way superior in some ways whether you raise your money through insurance or through taxes to me that's not really the decisive point I suppose the advantage of a health insurance based system is a compulsory social health insurance system is that it puts the debates about the budget ever so slightly outside of the political realm but I think that's a marginal I'm not sure that there's a really big difference in terms of revenue mobilization capacity between tax funded and insurance funded systems we heard out of Gaffney praise the British and Canadian systems at the beginning of the program Joe I'm told when you when you hear that American in London saying you know it's a bit of a stretch but basically it works what you think I'm not at all surprised but you know a lot depends on what your expectations are I think one of our big challenges of the United States is that most people believe that even for things that you know 50 years ago we used to handle without going to the doctor we go to the doctor an awful lot for things that are really quite minor and we tend to go to specialists rather than primary care doctors it's a real problem there it really has to do again with Americans view of what they think is right and Merican is a lack of understanding that we're talking about real money here and it's their money but you know I guess what I'm asking is if you strip the politics out of it you know sort of said you know we're not going to worry about. I do logical bands of the American people versus the British we broke just in terms of rationality is this an h.s.a. System superior to these the more messy insurance systems make systems you know it's hard for me to say because the again you're asking me to say do I think if we work in the United States maybe but I'm not sure in my lifetime because of Green Death habits and beliefs that we seem to have here certainly the emphasis that I think Britain does have primary care is an important attribute that we should be late but you know shifting away from a system of private insurance and makes to government programs that's not something that we can do very easily Professor Hobson So Joe is raising a really important issue there which is the sorts of things that you can do on the supply side we talked about the focus on primary care and a really important element of what we have in the system here but also in a lot of European systems is the idea of a gate keeper you can't go straight to a specialist you have to go through a primary care physician so here in here in the u.k. You can't go straight to a dermatologist you can't go straight to a cardiac position you have to go through your g.p. I'm going to G.P.'s my family doctor my family doctor general practitioner and they can manage an awful lot of those conditions quite efficiently at the primary care level there are other things at the on the supply side that we do more of in Europe as well one is applying economic analysis to what sorts of treatments what sorts of drugs should be available through public financing and not really does not happen it will be can you just very gives a very sort of brief appearance of nice is the system they have and in the u.k. For determining whether a drug should be available through the National Health Service and they have this amazing process of working out whether it provides value for money with the terrible consequences some people need drugs can't get them so how does that work yes so they it's called Health Technology Assessment and actually that function does exist now in quite. A lot of other countries as well and it's a process whereby you take into account all the effectiveness evidence that does this drug work and then the cost evidence as well and you look at both the long side there is some patients involvement in this that need lots of clinical involvement and then there's a currency that you think in terms of quality adjusted life years and generally speaking if it cost more than about 30000 pounds but quality adjusted life years so that's the extra large a $45000.00 as a victory was going to cost more than $45000.00 will be is unlikely to be funded by the n.h.s. You know just before we wrap up in Britain Madame Gaffney that it's seen as a strength and a weakness of the British system so I know that comes under a lot of criticism in the United States but people have to get rational you can't have limitless spending so you've got to draw a large somewhere you might as well dirt on the basis of some deliberate thought I think the most important thing is that you're actually negotiating with pharmaceutical companies are through your national system to bring down job prices that's probably the biggest benefit from a system perspective we spend twice as much per capita on drugs in the u.s. Than in o.e.c.d. So I think that's critical I just want one other quick point in America we actually don't go to the doctor more frequently than other countries on average the reason why health care costs isn't because we're going to the doctor too much the reason why is because of the system itself and it's fragmentation and I would just say it is an amazing aspect of the your system that people are always covered that everyone is covered and that care is free at point of use Americans have to duck to balls in the thousands of dollars when they go to the doctor and they have to pay out of pocket so that is a really special attribute and in the u.s. We believe in skin in the game you have to be exposed to health care cost to be applied in health care consumer that's not necessary and it's not what I think we need and I think that your system works better in that respect we're going to move on merit to other parts of the world thinking about China just sort of be interesting to see what they're doing next they're obviously getting so much more money into their system at the moment but how are they managing their health care system with those new resources professor to raise. Scott is a specialist on the Chinese health system based at University College London So how does the Chinese system work China has a very well developed health care system now throughout most of the country and course in such a huge country there's big diversity in the way the health care is delivered in recent years as there China's undergone a vet major health system reform program which has meant that now the vast majority of people have health insurance one of the problems of the health insurance is that the premiums have extremely low and affordable which the good thing on the bad side people have to pay sometimes by large co-payments for any kind of treatment that they receive so there would be premiums 1st of all what happens if you can't afford your insurance premium extremely few people can't afford it we're talking 5 pounds per year in terms of health insurance or everyone can afford it but it's not compulsory in fact people don't pad course the people who could afford it generally speaking as I got there and private arrangements exactly what percentage do take it over 95 percent in some places up to we're talking 1009 percent in some of the wealthier provinces verdant So on the other side you go in with let's say a simple one a broken leg what's covered if you go to a tertiary hospital paternal also Pete except that you may end up paying 80 percent out of pocket for that treatment if you go to a low level hospital you make it up to maybe around 50 percent you'd have to pay that they do try to discourage people from going to the levels of hospital which is not appropriate for the condition there's a huge you go to a box not available it's free if you go to a very low level hospital it be very cheap right and you still get like fixed and you still get your leg fixed it would you say they're doing it right they're doing quite a lot of things right the major problem in China is that the Chinese people in general . We'll seek the highest level of care that they can research to be done ourselves in fact shows that very often people actually don't know ahead of time how much they're going to have to pay to pocket there are people who think that they will get their cat virtually free even to high level hospital people do not and not told exactly what things will cost right but you are saying that given the state of its economic development you know where it's got to China the Chinese economy is delivering health care to fairly sensible way I think that's probably fair to say however if your poor still and you go even to a lower level hospital you have to pay 50 percent that's an affordable and there are many people who for example the classic example things that catch that surgery read to be simple very important for quality of life there are people who can't afford to get their cataracts done old people for example even though there are showed even that I'm sure because 50 percent is still a lot for them so that would be really a Baratz true true barrin there are many people in that sort of situation in China Professor to raise has scared that so I prefer sir some I know you have thoughts on Thailand which I'd like to hear about and you think that's worked very well there so what are your reflections on what they do in China tell us about Thailand so China is fascinating because they have about 1300000000 people covered by health insurance the scale is absolutely normal and they've achieved this since about 2005 so it's you know it really is an incredible achievement I think that raises point illustrates really nicely the tradeoff between the breadth of kept coverage and the depth of coverage and so you know there's a lot of people covered but not all of their services are covered and that's choices that poor countries need to make because they can't actually afford with the resources that are available to cover everybody for everything so some countries are choosing to cover everybody for a more shallow benefit package and to gradually expand that as the resources become available how do they do it in Thailand Thailand. A really interesting case I would say from about the through the 1980 s. Anyway they built up through community based health insurance some degree of insurance coverage at a fairly low levels at the same time they've had a separate health insurance scheme for those who are employed in the private sector and yet another one for civil servants in 2001 that is added to the launch what was called the universal coverage scheme which basically covers everyone who's not formally employed or a civil servant that's about 75 percent of the population it's funded that's a scheme it's funded through taxation and they've gone back and forth a bit to whether there's a co-payments or not but when there is a co-payments about of the order of a dollar a visit before they launch that big expansion on the demand side there was even a decade or so of building up their district based health system so there is strong primary care services primary care units are links to hospitals in contracting units as I guess there's 2 point there one is that the process has been gradual and also it's been accompanied by the development of a good strong primary care system so it just shows you when you hear these developing countries working out is rangelands how complicated this hybrid is a really difficult policy issue they are very difficult policy issues and you know they're If you're starting to build something not quite from scratch but you know you've got more capacity to plan things then there are lots of different leavers that you can use then to try and need an incentive age that the doctors often think of as the patients to go to they have less expensive places and you know these are all positives that a kind of bewildering to work your way through I think the really important thing that's right about the ties system is that not to repeat the mistakes that some of the developed European countries have which is have you know hospital heavy systems you need to have money in primary care you need to have money in prevention actually outside primary care because health a lot of health is determined by things way way outside the health care system and that's the challenge and we. We still you know in this country was still quite obsessed with hospitals we must t.v. Programmes about the need of hospital care is exciting g.p. Care isn't. As good germs as when I didn't care for you coming off to him on the importance of the health care system versus culture so if I think I guess example of Japan everyone says they have a brilliant. Privacy and I do of course I do have these amazing good statistics so you know is it really nothing to do with it's not much to do with the health system a lot to do with does well or behavior in general regularly I think I really think that that is an issue you know it's a little hard to say but clearly the health system is critical to maintaining the population's health status but we've put it really emphasize that too strongly in this country in many cases among poor people they would benefit more from good social services you know we have a homeless population they end up in the emergency room because they're homeless and if we could get them into a reasonable housing that would reduce the incidence of their need for medical services so it's a much more complicated issue I think for all countries but it's excruciating really clear that were medical heavy and were like these other kinds of services you're out of government how do you see if I could just to put a culture of 1st is how systems Well we know that many factors affect health behavioral environmental inequality itself is bad for health and it also does conclude with this isn't an either or issue I think sometimes especially in the high income nations so those people pose that as we have to make a choice between providing for people's health care as opposed to providing for the other basic needs and we know that we can do both and we know that many countries to do both and so it's important not to be sort of led down the garden path that there is a trade off that has to be made. I don't think it has to be resolved I agree with that but everyone on the n.h.s. It does feel like there is a bit of a sort of tradeoff heading our way in terms of you know if we are trying to redesign cath or that there is more preventive care and yet that means taking money out of hospitals right now which is deeply unpopular and people are frightened that you know if you can't get to the local emergency department then you know having an extra distinctness isn't going to make a difference to you so these debates are really very lives here at the moment and yet I think everyone recognises that we do need more primary care more preventive care because of the numbers of people who are getting these speculators diseases cancers many of which can be better managed to even prevented through good quality health care Professor Thompson and the emerging economies are seeing this there's a wave of chronic conditions just beginning now it's going to be a few years before it peaks and tsunami like proportions but that's I think where this balance between care and prevention and behavior is going to be really important because these systems are are not well poised to manage the long term condition so what you're saying developing countries there are lots of new medical conditions becoming very prevalent because of lifestyle change absolutely so actually more than 50 percent of the world's burden of chronic conditions is already in the middle income countries and that's culture I would say behavior rather than cutthroat but certainly behavior Ok so what I'm hoping you can do now if I transport you to Mars or some of the humans are just about to colonize Mars I'd like you to design a health system for us it's going to work properly so it was like from scratch so it is not going to do with whether or work in the States which is what is the most rational system why don't I start here in London Professor Hansen you muscles over there still professorial hat I mean if you if you were you know a dictator for a day. With a clean clean slate what would you do Ok so I'm going to start by spending the right amount and raising money in a way that's fair so we know that it takes about a minimum of 5 percent of g.d.p. To be able to provide a basic package of of comprehensive primary care. So I spend enough on a raise that money through taxes the 5 percent is nothing I mean Britain's 10 percent America's 18 percent I suppose I'm thinking more of a lot of countries in the poorer parts of the world which spend much less than 5 percent and so you got to get to a certain threshold and then beyond that actually how you spend the money is going to be at least as important as how much you spend you can't spend your way to recently but how would you design the system you do it through taxation sort of sure as I would do it through tax because I think I'm tax is a fair way of raising money with you have a progressive income tax and I'm going to pull in a single payer to control those administrative costs and I'm going to have probably a mixed provision sector public and private sector and how are you going to ensure that politicians don't decide that spending money on beer and football is more important I'm going to keep the middle classes in my system to make sure that they're the ones with that really powerful voice that's going to object to any efforts to cut the budget to try to for a dictator for a day well I think I'm going to agree with you that I think that you know tax is probably the best way of raising the money progressive tax so those who can pay contribute more can pay more I think I'd also want to build in social care into the system a bit earlier on because that's the big weakness of our meat. Meaning a long time cast if you need to help getting out while being washed or anything like that you have to if you have to be spectacularly poor now to get it in this country paid for by the state and that's leading to all sorts of problems it's leading to you know provide a sector that's about to fall either because nothing comes running out of money said Bill that I want to debate so you know I would have a system that's probably a bit more heavily weighted towards g P's in prevention and get hospitals to work more closely with their generalist colleagues so that we don't have a sort of runaway hospital system but yeah it would look so very different probably what we have now but I don't go out and graphic seems to be these these systems that we're hearing about don't really care for the fact that spending on health is potentially limitless because you're always very. Extend life by another month with that extra enormous toll of exposure of the end of it so it does require very difficult decisions and it's not always clear is that the politicians are the best ones to take those decisions at the end of the day sure there's going to be have to be some decisions that are made but health care is different than many other goods because most people don't actually want care they don't need there is some mount of intrinsic limitation people aren't going to get chemotherapy that they don't actually need simply because it's available free so I agree of course that needs to be choices and I think I agree with the overall picture of how about optimal health system that has been discussed but I think financing is critical people pay into the system on the basis of their economic means and they get from the system or they need on the basis of their health needs and if you do that I think you can actually cover everybody for at least right now what is medically necessary services I don't think there's anything that needs to really be left out I would agree that we should switch more towards primary care and less towards some of the tertiary care but I don't agree with what's happening now in the n.h.s. Where hospitals are being squeezed it seems like you need a new government that's going to actually properly fund the system instead of having to make these hard choices and pitting one health care part of the health care sector against another of us going to hard politics but. You know you're saying the British system doesn't have enough and that's 10 percent of g.d.p. Just not from presidents and she was recommending 5 percent of g.d.p. This is working I go in for. A minimum of a minimum of a floor of 5 percent and that's in those countries not spending that's there's a rather to reveal the problem of how well I don't govern if we're going to germs let me ask you what would you think is an appropriate g.d.p. Percentage I think it depends upon the resources of the country I mean I can't speak of the United States in the same way we speak of Thailand we just have a normal citizen as a percentage of g.d.p. So when you're asking for what they can afford what percentage of what they produce should go to health I still think it makes a difference depending. On the income level of the country even though we're speaking in terms of percentage of g.d.p. I think in the United States we should spend about what we spend now rather than try to reduce that I think we should use the money more efficiently to cover everybody with care free in point of use and I think that as countries gain more in terms of economics and income the percentage of probably rise to what it is in the range of Western Europe and other high income nations I think that you can achieve universal coverage at you know the 10 to 20 percent of g.d.p. Gravel that we're seeing in most countries between 10 and 20 church are true I'm tossed to tell you different. Well certainly a big issue has to do with whether a government system in this country I can't speak about other countries but if we really had a government system in this country would there be sufficient flexibility for the health system to adapt to changing circumstances to vent your new approaches to learn from their mistakes not have we locked into their mistakes if you don't have the flexibility to try new things that could potentially really pay off but not be locked into a bad idea then you could potentially see over time real value coming from our dollars whether it's 18 percent or 10 percent it's a very interesting sort of comment because you're saying that the production of good medical technology should be but that is a an important metric it's not just it's not just medical technology it's also has to do with you could call a patient management practice and so yeah exactly expands the really the entire spectrum of what we would think of as how health system broadly defined Ok Well thank you all very much as it is a highly complicated subject and hopes understand it so I thank you Joe from the American Enterprise Institute I've been governing from the Harvard Medical School rule full body from the Health Foundation here in London and a professor Hanson from the London School of Hygiene. And tropical medicine if you just showed it and thought well that's actually fascinating I need to hear the rest of that then the solution is to get the polka's that's the b.b.c. News Extra post-concert you can get one edition of the program every week one hour of discussion on a single topic dilated to your device and you can let us know what you think of the program news out extra at b.b.c. Don't kowtow.