Or private sector alternative Medicare Advantage. Yes, the woman is correct you give up some choice to get more benefits. But it is a much better economic deal if you are feeling pinched and that is why many of the people who have chosen medicine cache advantage are Medicare Advantage are low low income not qualified to get medicaid but not able to buy their own medigap. They get to make it every year. So that they dont need to make the decision once and feel like they are locked in as bob said, the question about how other countries do it is a big topic and either at the end of this session or in another session you can explore it. Host we will go to anita in n. On medicare in florida on medicare. Caller im 74 years old and i have lived in florida since 2011. I had never heard of Medicare Advantage advantage, couldnt believe it when i first heard about it. But i selected it. And my question to you is i might as well tell you up front im an old retired nurse so therefore we have a tendency to look at things a little differently. But as i go to doctors here in that. Here in florida, which is not very often because i take care of my own health i see Senior Citizens wanting their bodies to become a bionic body being healed by a doctor who is making money off of things that i think is unrealistic at 90 years of age. Therefore, it concerns me whether or not we are addressing properly taking care of and what is our real goal. What is quality . What is our real goal. Host dr. Berenson. Guest i think the caller has put her finger on one of the issues and is the reason we are having a conversation about value based payment. We have payment systems. In fact most countries do. They are called fee for service for physicians which rewards them for doing more. And it doesnt reward for for keeping people healthy. So, we are trying in a whole bunch of demonstrations that were set up in the Affordable Care act to develop new payment models and new delivery approaches that would reward physicians and hospitals and others who were going to leave it, you can find it cspan. Org. Take you live to the white house where president obama will be unveiling new e. P. A. Regulations. It should be a place where communities are Getting Better at living with natural disasters, not bracing for worse and worse events every year. It should be a place where every generation is better off than the one before it. This is what america should be. This is what america must be be but it only be this for us and our children if we Work Together to protect the planet on whose basis our health depends. Today marks the beginning of a new era, in era in which doctors and nurses, scientists and citizens president s and the pope are all coming together to say that our planet and our health cannot wait. We are coming together to say that the time for action is now and that we will be the ones to act. I thank all of you for your commitment to addressing Climate Change and to improving the health of our nation and the world. With your steadfast dedication and your hard work, we can create a future that is bright and healthy, a future that our children deserve. Thank you very much. [applause] ladies and gentlemen, please remain seated as the program will continue momentarily, thank you. Were waiting for president obama. Hell be unveiling new carbon emission rules and power plant ules that have been established by the e. P. A. The Obama Administration had released a video yesterday talking about whats entitled including us Power Generators being required to cut their Carbon Dioxide output by 35 , in some of the first limits on Carbon Dioxide. Mitch mcconnell will make a priority of fighting this new rule and multiple states planning on filing lawsuits. And here at the east room in the white house. President obama about to unveil in e. P. A. Rules on emissions. Just waiting for the president s marks. Remind you tonight that starting at 6 00 p. M. Eastern right here on spn, you can join us for the republican president ial forum a number of candidates weighing on the event cohosted by the courier from New Hampshire. The administrator for the e. P. A. And president obamas remarks shortly. [applause] that is so cool to be able to do that. [laughter] i am the appetizer, the dinner awaits, but, hi, everybody, this is really such an incredibly wicked cool moment. Standing here right now, the word proud doesnt even come close to describing how i feel. It means a lot to have a chance to thank all of you, everyone who has worked so hard and waiting so long for this very day to come. [applause] looking around this room, i know many of you have been fighting this fight for a long time and since the beginning and we have been there together. We may be too old by now to remember just how long that is, but it hasnt dampered our enthusiasm or our passion. So we have talked for years about what needs to be done, what we could do. We have gotten a good understanding of how it can get done and, well today, were actually doing it. [applause] you know, the road has been long but we have come awfully far and look at how many new faces have joined in this fight. As many obama will no doubt tell you Climate Change is one of the most important issues we face as a country and as kitts of this world citizens of this world and it affects everyone we know and even we love, our kids, our communities, our ability to obtain a decent living, it impacts our health, our safety and our livelyhoods. One thing is Crystal Clear acting on climate has become what it is a moral responsibility. And thankfully no leader anywhere has understand that better or articulated that more forcefully than our president , no one has led on this issue as fearlessly as he has. From day one he saw Climate Change for what it was, a threat to our core American Values families, communities and safeguarding those who are most vulnerable. He did not back down from the challenge because of his Leonardo Dicaprio and his trust in the great people at the e. P. A. To get the job done right and they got the job done right. [applause] we now have a real shot at protecting this beautiful planet of ours. So this is a historic moment. We are forging ahead to do whats right for our kids and there is no turning back. And i am confident that the huge step forward were taking today will show the world just whats possible and it will encourage countries across the globe to join in this fight because Climate Change is a challenge we conquer together. Thank you. [applause] i just couldnt be happier that we have the right person leading this charge for us. So with that, i am honored, i am humbled and i am proud to introduce our president barack obama. [applause] president obama thank you thank you, everybody thank you thank you so much, thank you. Thank you. Thank you. Thank you, everybody thank you. Thank you. Well, good afternoon, everybody. Gina, i want to thank you, not just for the introduction but for the incredible work that you and your team have been doing, not just on this issue but on generally making sure that weve got clean air, clean water, a great future for our kids. I want to thank all of the members of congress who are here as well who have been fighting this issue and sometimes, you know, at great odds with others, but are willing to take on what is going to be one of the key challenges of our lifetimes and future generations. You want to thank our Surgeon General who has been doing outstanding work and helping to make the connection between this critical issue and the health of our families. You know, other the past 6 1 2 years we take on some of the toughest challenges of our time from rebuilding our economy after a devastating recession to ending our wars in iraq and afghanistan and bringing almost all of our troops home, to strengthening our security through tough and principals diplomacy. But i am convinced that no challenge posed a greater threat to our future and future generations than a change in climate and thats what brings us here today. Not everyone here is a scientist. [laughter] president obama about some of you are the best scientists in the world. And what you and your colleagues have been showing us for years now is that human activities are changing the climate in dangerous ways. Levels of Carbon Dioxide which heats up our atmosphere are higher than they have been in 800,000 years. 2014 was the planets warmest year on record and weve been setting a lot of records in terms of warmest years over the last decade. The one year doesnt maybe a trend, about 14 of the 15 warmest years on record have fallen within the first 15 years of this century. Climate change is no longer just about the future that were predicting for our children or our grandchildren, its about the reality were living with every day, right now. The pentagon says the Climate Change poses immediate risks to our national security. While we cant say any single weather event is entirely caused by Climate Change, we have seen stronger storms, deeper droughts, longer wildfire seasons. Charleston and miami now flood at high tide. Shrinking ice caps force National Geographic make the biggest change in its atlas since the soviet union broke apart. Over the past three decades nationwide asthma rates have more than doubled and Climate Change puts those americans at greater risk of landing in the hospital. As one of americas governors has said, were the first generation to feel the impact of Climate Change and the last generation that can do something about it. And thats why i committed the United States to leading the world on this challenge because i believe there is such a thing as being too late. Most of the issues that i deal with and i deal with some tough issues that cross my desk. By definition, i dont deal with issues if theyre easy to solve because somebody else has already solved them. And some of the them are grim. Some of them are heartbreaking. Some of them are hard. Some of them are frustrating. But most of the time the issues we deal with are ones that are temporally bound and we can anticipate things Getting Better if we just kind of plug away at it even incrementally. But this is one of those rare issues because of its magnitude because of its scope that if we dont get it right, we may not be able to reverse. And we may not be able to adapt sufficiently. There is such a thing as being too late when it comes to Climate Change. [applause] president obama and that shouldnt make us hopeless, its not as if there is nothing we can do about it. We can take action. Over the past several years, america has been working to use less dirty energy, more clean energy waste less energy throughout our economy. We set new fuel economy standards that mean our cars will go twice as far on a gallon of gas by the middle of the next decade. Combined with more gas prices, these standards are on pace to save drivers on average of 700 at the pump this year. We doubled that on our investment in Renewable Energy. Were generating three times as much wind power 20 times as much solar power as we did in 2008. These steps are making a difference. Over the past decade even as our economy has continued to grow, the United States has cut our total Carbon Pollution more than any other nation on earth. Thats the good news. [applause] president obama but i am here to say that if we want to protect our economy and our security and our childrens health, were going to have to do more. The science tells us we have to do more. It has been our focus these past six years and its particularly going to be our focus this month. In nevada later in august ill talk about the extraordinary progress we have made in Generating Clean Energy and the jobs that come with it and how we can boost that even further. Ill also be the First American president to visit the Alaskan Arctic where our fellow americans have seen their communities devastated by melting ice and rising oceans, the impact on marine life. Were going to talk about what the world needs to do together to prevent the worst impacts of Climate Change before its too late. And today were here to announce americas Clean Power Plan, a plan two years in the making and the single most important step america has ever taken in the fight against global Climate Change. [applause] president obama right now our power plants are the source of about a third of americas Carbon Pollution. That is more than our cars, our airplanes and our homes generate combined. That pollution contributes to Climate Change which degrades the air our kids breathe. But there have never been federal limits on the amount of carbon that power plants can dump into the air. Think about that. We limit the amount of toxic chemicals like mercury and sulfur and arsenic in our air an water and were better off for it. But existing power plants can still dump unlimited amounts of harmful Carbon Pollution into the air. For the sake of our kids and the health and safety of all americans, that has to change. For the sake of the planet, that has to change. So two years ago i directed gina and the the Environmental Protection agency to take on this challenge. After working with states and cities and Power Companies, the bench e. P. A. Is felting the firstever standards of elimination of dumping pluge from power plants. [applause] president obama here is how it works. Over the next few years, each state will have the chance to put together its own plan for reducing emissions because ever state has a Different Energy mix. Somesome generate more of their power from renewables, some from natural gas or nuclear or coal. This plan reflects the fact that not everybody is starting in the same place. So were giving states the time and the flexibility they need to cut pollution in a way that works for them. And real reward the states that take action sooner instead of later because time is not on our side here. As states work to meet their targets, they can build on the progress that our communities and businesses are already making. A lot of Power Companies have already begun modernizing their plants reducing their emissions and by the way creating new jobs in the process. Nearly a dozen of states have set up their own marketbased programs to reduce Carbon Pollution. About half of our states have set Energy Efficiency targets. More than 35 have set Renewable Energy targets. Over 1,000 mayors have signed an agreement to cut Carbon Pollution in their cities. Last week, 13 of our Biggest Companies including u. P. S. And walmart and g. M. Made bold new commitments to cut their emissions and deploy more clean energy. So the idea of setting standards and cutting Carbon Pollution is not new. Its not radical. What is new is that starting today, washington is starting to catch up with the vision of the rest of the country and by setting these standards, we can actually speed up our transition to a clean safer future. With this Clean Power Plan by 2030, Carbon Pollution from our power plants will be 32 lower than it was a decade ago and the nerdier way to say that is well be keeping 870 million tons of Carbon Dioxide pollution out of our atmosphere. [applause] president obama the simpler laymens way of saying that, its like cutting every ounce of emission due to electricity from 108 million american homes, the equivalent of taking 166 million cars off the road. By 2030, we will reduce premature deaths by power plant emissions by nearly 90 and thanks to this plan, there will be 90,000 fewer asthma attacks among our children each year. [applause] president obama and by combining this with greater investment in our booming Clean Energy Sector and smarter investments in Energy Efficiency and by working with the world to achieve a climate agreement by the end of this year, we can do more to slow and maybe eventually stop the cash quon pollution that is do Carbon Pollution that is doing so much harm to our climate. This is the rye thing to do. I want to thank again gina and her time for doing it the right way. Over the longest Engagement Process in e. P. A. History they fielded more than 4 million public comments. They worked with states. They worked with Power Companies and environmental groups and faith groups and people across our country to make sure that what we were doing was realisic and achievable but still ambitious. Some of those people are here with us today. So tanya brown wave, go ahead, there is tanya. [applause] president obama tanya brown has joined up with moms acr