Chapter 11 first 18, dodd said he would destroy anybody who destroys the earth. Do you hear christians talking about that . Host one more phone call on this. Independent from indiana. Caller good mine. There is really no choice deal here. We have a budget problem. A deficit problem. We have severe spending problems. Less and less and less taxes coming in. Consequently, we are going to be facing the sorts of issues on all sorts of these projects. Such as the epa, family planning, all of these things. These things are going to start coming at us and we are not going to have the money to pay for them is what is going on. We can kick and scream about the right and wrong, but the reality is these things may not get totally defund it, but i bet you they all get cut back. Lawmakers dont have much choice. Host that is dan in things montana. An independent color. We will leave it there. Up next, switching topics. Medicare. Last month marked the 50th anniversary. We will talk about two leaders who oversaw the per program about the success and future of it. Later, we will turn our attention to alzheimers and Research Dollars for. We will be right back. Question on the communicators Cyber Security issues and how to combat recent data issues. We have seen attack after attack. The most recent attack on the office of personnel management. Also in private industry. Target, home depot, so many other private corporations have had customer information stolen. What we have realized is we can try very hard to keep ahead of the hackers. But we need to think to what we need to do is think about how we minimize the need for customers to put their private information on two websites. Right now, there are a legal observations from the government sharing classified information with the private sector. There are legal prohibitions of the private sector sharing private information back to the government termed as acting as agents of the government. It is not allowed. What we want to do is allow those barriers to be removed so that you could share information on threat signatures narrowly defined. You are talking about ones and zeros, technical information. Of the various hacks that have taken place other. For example. If we could broadly share that information, when one hack occurs at Network Speed we can widely share that vulnerability and more broadly protect everyone. Tonight at 8 00 eastern on the communicators on cspan2. The republican president ial candidates are in manchester New Hampshire for the first president ial forum today at 7 00 p. M. Eastern. Cspan is providing love live coverage of the forum on cspan radio and cspan. Org. Following the live forum, you can provide your input by joining our callin program or adding your comments on facebook and twitter. Road to the white house 2016 on cspan, cspan radio, and cspan. Org. Washington journal continues. Host in july, medicare marked its 50th anniversary. Here to discuss that, the former administrator of the center of medicare and Medicaid Services served from 1990 to 1992. And the acting administrator serving from 2002 2001. 20002001. I want to share with the viewers about what Lyndon Johnson is had to say. More than 18 million americans over the age of 65, most of them have low income. Most of them are threatened by medical expenses. Through this new law, every citizen will be able to have insurance against the ravages of old age. This entrance will help pay for caring and hospitals and nursing homes. Under a separate plan, it will help meet the fees of the doctors. Here is how the plan will affect you. During your working years, you will contribute to the Social Security program a small amount each payday to Hospital Insurance protection. The average worker in 1966 will contribute 1. 50 per month. The employer will contribute a similar amount. This will provide funds to pay 90 days of hospital care diagnostic care. And 100 Health Visits after you are 65. Beginning in 1967, you will be covered for up to 100 days of care in a nursing home. Under a separate plan, when you are 65, you may be covered for medical and surgical fees whether you are in or out of the hospital. You will pay three dollars a month after you are 65 and the government will contribute an equal amount. It will be as varied and broad as marvelous modern medicine itself. Host Lyndon Johnson on july 30, 1965 signing into law medicare. Here to discuss is to former administrators of the program. His medicare working is medicare working like explained their . Guest in general, yes. Medicare was designed to meet an important need for the older population of america. To make sure they have access to Insurance Coverage for hospitals and physicians. Something that was a challenge to most seniors, even those who were not low income had a great travel getting insurance. It has changed enough. Coverage has broadened. 55 Million People on medicare now, almost 10 million of whom are disabled and under 65. Broadened that way. Preventative services are now covered. Health patient Prescription Drug coverage was expanded in 2003 through legislation. The financing has changed significantly. The need that medicare was designed to respond to, making sure that seniors would have access to care, has indeed been met. Host your thoughts . Guest i agree, and i would assess a couple other items. One is that Health Care Delivery has changed radically since he gave that speech. In those days, most people got their care and hospitals by physicians. Over the years, there has been a great need for a bunch of new sources of care, new kinds of providers, Skilled Nursing facilities hospices, all of that has been added to medicare. It creates a challenge to reorient the program. I think the program has met those challenges over the last 30 years with new payment models, new delivery. The current focus is to address quality. Quality has not been as good as it should be in u. S. Health care generally and in medicare specifically. The program was taking some steps to try to address that. Host we want our viewers to weigh in on the situation. This is how we have divided the lines very if you are a medicare beneficiary, 2027488000 doctors dial in at 2027488001 all others 2027488002. That me ask both of you this. How would you fix it . Guest you asked the first question of did it meet the directive that the president johnson laid out . Yes. In terms of providing ready access. As health care is evolving significantly, not just the focus on quality but on value as well, the Delivery System has changed a lot. Medicare has been slow in that area. It is somewhat joining the movement in terms of trying to promote value and better quality. Physicians are expressing frustration, although less than they had been, because the dactics was passed in april. It was not perfect, but its all day frustrating problem for many physicians which was not knowing what happened to their fees every january with threats of reductions as high as 31 , although they never happened. Even more dysfunctional in the sense that it did not reward those clinicians who were providing higherquality, better value care. They can movement in general to give patients more knowledge and let them be more active participants in their own health care. Medicare solves the racial problem it was designed to solve. There is so much more that we need to do to make sure that the program improves. Most important is a run for our children and grandchildren and those beyond them. That will be another discussion. Host what changes would you make . Guest caller we need to establish that something is happening that is producing better results. We are not sure what that is. In the last five years, per capita medicare spending has been flat are going up at the rate of the gdp. It is unprecedented. In the history of medicare, it has been said that the actuaries are wrong. We spend more than is pretty. Now we are spending less than is predicted. We will probably end up talking this morning about whether this is sustainable or not. Something good has been going on. There have been recent studies demonstrating a decreased mortality of Medicare Beneficiaries, decreased hospitalization rates. There have actually been progress is. My point would be there are reforms. We are not at the point where we need to take a dramatic departure for restructuring. We can continue to of all. The final point i would make here is that we now how options for Medicare Beneficiaries which include getting medicare from private insurance companies. 30 of Medicare Beneficiaries currently take that option. We have more choice in this program than we used to. That is a very positive impact and it gives everybody on their toes because we are moving to a Competitive Health system. Host lets take one of your points. Decrease in mortality rates efficiency of the success of the Medicare Program. Is that because the government negotiates that rate . Is a because of the way medicare is set up . Guest in some specific places you can point to medicare as the leader of change and certain payment methods. How we pay hospitals something called diagnosis related groups. Instead of paying for each individual item, they pay the case rate for the whole hospitalization. In some other areas hospice and others, medicare has been. The general point is the Delivery System is changing. Medicare in some cases has led and in some cases has followed. We are increasingly understanding that medicare and other actors in the Health Care System have to be host do you have some thoughts. Guest you asked specifically is it happening because the government negotiates or administers prices. The answer is no. I can say that with some certainty because it was happening in the private sector even earlier and happens in the private sector as well where the government is not doing the negotiation. I agree with a number of things that bob just said, which is there is some areas where medicare traditionally has led and other areas where the private sector has led and both have roles in which they can take the lead. But we need to understand that what has been going on in medicare has been going on in the private sector and started even earlier. It started around 2006 or 2007, the slowdown. I think that bob anticipated one point i want to make, which is we dont know why weve seen this dramatic slowdown. Theres no question some of it has to do with the very heavy recession that we are just starting to come out of. 2015 is the first year anybody might say we are seeing something that feels like a real recovery. People saw the doctor less because they didnt have as much money . Guest it is part of that. It is part they had less money that they were uncertain. They had a big hit in their wealth. The insurance for seniors of course is more stable because of medicare. But their wealth was hit because the places that took the biggest hits were husbandousing values and 401ks and that is is under 65 and over 65 and something us economists call permanent income, not just the annual income that you receive. That has an impact on how you spend. Theres a lot of change that is being tried right now again actively in the private sector in the under 65 and public and Accountable Care organizations have been going on the private sector sense 2007 and 2008. Just started in medicare officially in 2011. The question of whether the changes that we are seeing will be sustained and what happens when were in a real robust economy and Economic Growth which thank goodness we appear to be going into is something we dont know. We are seeing already some indication this year of a bump up in spending in healthcare. Host we have calls waiting for always. Anne in dallas, texas, medicare beneficiary. Go ahead anne. Caller good morning. Im 74 and it has been a Wonderful Program for me. I have multiple sclerosis and im low income. And i have the q. M. B. Which the federal government and state of texas pay my part b and then the wraparound and it has been a Wonderful Program. It upset me when i heard jeb bush said he wanted to do away with it. For people like me i have had to go to the hospital twice in the last say, nine years since i had the program and i have a great doctor and living on 900 a month, even my part d might pay like 2 per prescription for my prescriptions and i dont know what i would do without it. It has blessed me. Host let me jump it. Dr. Berenson, what do you make of what you heard from anne . She said it is successful and likes her doctors, paying 2 for Prescription Drugs. Guest that is a good story. I think it does bring up the issue of whether or not the program is broken and needs to be fundamentally restructured or working pretty well and needs to be tweaked at the margins. I believe candidate bush has been one of the republicans saying it is broken and needs to be overhauled and im with the caller who thinks that it is working pretty well. Host i will give eric the second call to you. A doctor in tillson, new york. You are on the air. Caller good morning. Im a primary care doctor in upstate new york. I know pedestrian care has done medicare has done many good things. However, what is going on now under the auspices of quality is really a disaster. It is called meaningful use. Anyone who does it knows it is neither meaningful or useful t. Is computers and checking boxes and driving us crazy. It is killing us. Can you please comment on this. Anyone involved with the program is not paying attention it the fact that it is a disaster. Host ok, eric. Guest the meaningful use provisions had to do with legislation passed in 2009 meant to encourage physicians to adopt the use of Electronic Medical records, which is a very important part of trying to make sure that information is readily available on people when they change where they receive care, if they are in emergencies elsewhere, to avoid having repetition of tests or information lost in terms of transmission. Now, has in worked as well as it should have . Sounds like for this physician not. I dont know what kind of system he bought. There was a lot of opportunities to choose the kind of system that would work well for individual physicians. My main concern about the promotion of the use of Electronic Medical records is different from this physicians and that is we dont do anything to really assure inter interoperability between the kind of Electronic Medical systems he might use versus what is in use at the Community Hospital where he lives or if the patient goes to manhattan or is spending the winter in florida to make sure that the physician physicians that his patients might see might be able to pull up the records electronically. Im concerned about the specifics. But we need to move off the paper charts that were being used. It has a lot of down sides including not being able to transmit information. He hope he is sharing with his medical society what exactly it is about meaningful use that is making his life more difficult as primary care physician. Thats not what we want to see. Guest im with the doctor. I have written about the offense we have this term called value based purchasing, the idea we can pick a few quantitative measures and reward or penalize doctors that the doctor is going to move based on incentives doctors moved into better behavior. It is misconceived and is back firing because doctors are reacting the way this physician did. It is not just meaningful use. There is something called the value based payment modifier and physician quality reporting system. These are quality measures that purport to be able to assess the quality or value actually of a physician. The behavioral economists tell us that it is probably a mistake to go in this direction. For professionals who have complicated jobs who ro doing lots who are doing lots of Different Things that are all valuable to pick a handful of measures and reward and penalize may get better performance on those particular measures but their overall intrinsic motivation is compromised. There is no evidence this approach works for teachers or other segments of the economy, about you in healthcare both parties there is bicameral bipartisan endorsement. It just passed the congress in the recent legislation that we are going to move in a big way toward value based payments to doctors based on a handful of quality measures is wrong and should be reconsidered. Host sally from olympicaolympia, washington on medicare. Caller i was a recent medicare patient and im of that age and i had excellent care. I recovered from something that my doctor was even surprised about. But one thing i would like to pass along to people is the alternative practitioners. We have to Pay Attention to them them too. It is up to us to heal our bodies through proper food, proper exercise knowing that we are in charge of our own healing. It is not up to anybody else. I dont want to spend those extra dollars. I would rather spend my money on something else. Host we will take alternative medicine. Gail, is that allowed under medicare . Guest some of it it. It depends on the system you choose. Bob mentioned earlier almost a third of people on medicare choose to receive it through private plans rather than traditional medicare. Many of those include alternative providers as part of the plan. But of course you can and i do interpret the commenters comments in a broader sense which is that we need to be responsible for our own health. We know we need to exercise and eat properly and drink alcohol in moderation if at all. And that we are also responsible for our bodies. This is not something we just can farm out to the physicians and hospitals or nurses and think that will resolve all of our medical issues. Host next call for dr. Berenson from newark, california. On medicare as well. Caller my question actually has two parts because first of all traditional medicare in m