These organizations move to pay people for quality instead of quantity. The Obama Administration will give a hospital a set amount of money for caring for the patients. Then the doctor has to strategize so they dont have to go into the red. They are hoping the model will drive down costs and get rid of the incentive or just that were at the start of that program. Host brian from massachusetts with sarah kliff. Caller a caller talked about marriage practitioners and there is a lot of them. They pretty much have a lot of schools are graduating many Nurse Practitioners and physicians assistants. There is a cap on the amount of doctors they can create. Nurse practitioners have two years of crammed education. I think they are good providers. We cannot assume that a Nurse Practitioner or physicians assistant are going to be as good as medical doctors. Guest that is a criticism that a lot of people raise. Are these people going to be as good as doctors . In certain spaces, they provide justice highquality of care as doctors. A lot of people expect that Nurse Practitioners provide basic functions of madison, things that been done in a standardized way. Doctors have more training. Host this goes into the overall debate in terms of the doc fix. The National Debt was in excess of 16. 3 trillion. Guest health care is a huge part of it. It is pretty much our Health Care Programs and i think that is why we are debating that in washington and that those programs are a huge part of the conversation. Host democrats are saying it is off the table. Guest there are other changes they might be ok with. Means testing in medicare which results in those who earn more pay more for their medicare premium. That is one proposal that democrats have begun more comfortable with. There are other changes they might be more comfortable with. Host ron has this suggestion from our twitter page. Guest that is a term we heard. When the cut health care, someone will be bearing the cut. T of that kin that is similar to the concept of those care organizations. They also include Quality Metrics as part of the contract, where they look at peoples outcomes. One way to prevent against the u. S. Skimping on care. Host this from sasha guest that is one proposal that gets floated by democrats. Medicare part d bargains for drugs. I do not know i do not think it would be a cure all, the one proposal that would fix everything. Democrats think it would reduce the cost of medicare. Host is there a plan b . Guest we have seen them as the january 1 deadline before and get 30day extensions. At some point they were working without an extension. Medicare told doctors to hold off on submitting your claims for a little bit. That is a situation we have ended up in before. If were talking months, were talking about big pay cuts for medicare doctors. That would be uncharted territory. Host joe from arizona on the republican line. Caller good morning. If we look at it logically, sarah is on the right track. We have become a society with honesty as a technicality. You can get more money but you break the law. Our society you need to stop your people on the show, politicians and say, i asked you a question and you didnt answer it. This is why the doctors in medicare can get away with it. Grover norquist was on the other day. This guy is affecting the whole country. Lets be logical and real. Youre cheating the system. Honestly with a technicality has to stop the way Walter Cronkite used to do woit. I asked you a question and that wasnt the answer. Stand up to people. Were the first line of defense. I applied all of you for as much as you try. You have to hold their feet to the fire. Im so sick of the split amongst this country. Hold them to the fire. Host thank you for the call. We try to do that. Keep calling in and sending those tweets and emails and keep us on our toes. Guest why isnt anyone doing anything . Health and Human Services runt Fraud Prevention and fraud detection. That has been ramped up by the Affordable Care act to target those people. The government estimates they have recovered about 4 per 1 billion in Medicare Fraud 4. 1 billion. Host this is from one of our viewers. Guest that is the hope from the Obama Administration. Reimbursements cannot keep going up and up and up. Health care is about a fifth of the entire economy. If you give people a budget to work in, they will change the way they work. They have to figure out a new way to do business. Host cedric from texas, good morning. Welcome to the program. Caller im a physician and i follow your journalism. The fewably one of physicians that agrees with eliminating i want to eliminate all government plans. I would be willing to take nothing. I believe the only way to fix this is by setting up a free market. Prices meet demand. None of these things meet the demands of the people. With regards to seniors, they talk about how much Insurance Companies are taking. When they convert from a plan to medicare and how there are hoops. Their lifestyle decisions they are lifestyle decisions. President obama is trying to give bundled payments for health care results. A large portion of the population knows they are supposed to eat well and not to smoke. They need their hips replaced the day they turn 65. They know what they need to do. It is not something simple like putting through a scanner and getting the answer right away. They are not interested. You end up living a long, healthy life. You can still get everything at the expense and burden of the younger generations. Ive been a physician for 10 years. I just turned 40. Im not the primary care physician. m an anesthesiologist host we will get a response. Guest that is an important point. Lifestyle decisions are driving spending. The healthcare law allows employers to vary their premiums. By taking a Smoking Cessation class or going to a primarycare doctor like you should be . There is only so much that a health plan can do to affect the lifestyle choices that its members are making. You do see some investment in the health care law. Host janet on the republican line. Caller good morning. I am in massachusetts which is probably the future of where we are going as a nation. The healthcare part has grown to over half of the budget. I took a look at my personal situation. My Health Insurance costs were taking up 25 of my income. I read to the policies. Poor and lowincome people are being required to pay a premium. When it elected its services they get when you look at the services they get, what they are required to pay for is air. There is no benefit there. These programs are taking money t. Om the poor and keeping i called around to the practices in my county. I found that if you were on any of the subsidized programs, you were told that the primary care physicians books from booking initial intake annual physicals were all booked up for the next year and thats the next three months of appointment books would open up and call back then. Guest these are interesting points you raised about massachusetts. Massachusetts was the model for National Health care law. They have the top medical institutions in the country, places like harvard and massachusetts general. They have the highest insurance premiums in the nation. Increasing insurance coverage, and they have done that. 90 of the residents are insured 98 of the residence are insured. Host will this be resolved before january 1 . Guest i think a lot of people want to get solved by january 1st but were still a few weeks away. Host sarah kliff covers health care for the washington post. Thank you for joining us. We take a look at america by the numbers and what america looks like by the year 2016. Jennifer ortman and william frey here to talk about america by the numbers. We are back in a moment. [video clip] punch me, straggle mae, take things from me. Were starting to see people coming out and talk about their experiences of this phenomenon that some have experienced and had no words for other than growing up. People were starting to stand back and say, this is not a no part of growing up. There was a moment where there is a possibility for change. We decided to start the film out of that feeling that voices were bubbling up to the surface it to say, this is not something we can accept in our culture. She has gathered essays and stories together in bully. Like us on facebook. The white house was very controversial, as most things in america were. Lenfant designed washington city. There was a competition and he submitted the design for a palace. Americans were not having a palace. It was not particularly awe inspiring. In fact, in 1821, a european diplomat told the congress that as neither large nor awe inspiring. But the answer the congressman gave said the building served its purpose. If it were larger and more elegant, perhaps some president would be inclined to become its permanent resident. Former New York Times photo critic Vicki Goldberg has gathered a few of her favorite white house photos in the white house, the president s home in photographs in history. Watch sunday evening at 7 30 eastern and pacific on c span3s American History tv. Washington journal continues. Were glad to have back william frey from the Brookings Institution. And do Jennifer Ortman. Population will be in excess of 400 Million People in the u. S. What is going to change . Guest the nation is projected to grow at a slower pace over the next 38 years. The population will continue to age. That the nation is projected to become more diverse in growth, minority population, and decrease in population. Host look at these numbers. 420 million how do face the demand of that growing population . Education, health care . Guest that is a Perfect Question for bill. Guest it really is a Slower Growth than we have been used to for a long time. About a 34 growth rate over those 48 years. We have been going on about 10 a decade. Well get used to Slower Growth with a new minority population filling in at the bottom of the slowgrowing part of the age distribution. And older population that is growing rapidly. We have to deal more with minority integration and social inequality and issues with the new americans. Host so aging growing slowly and more diverse. We have divided our phone lines by region. Host you can also join us honor twitter page. I want to go back to this graph. Under the age of 18, you can see a drop. Then an increase of those 65 and older. Can you touch on these numbers . Guest fertility rates, mortality rates, and the international migration. What were seeing when it will look at the population and will look to these broad age groups, and then the population 65 years and older, those retirees, were projecting lower rates of fertility overtime. Thats one reason the group under 18 years old is not growing. The population 65 years and older, we project some improvement in terms of mortality, Life Expectancy going up. People to live to older ages. Were seeing the baby boom ohorts moving into the 65 years and older population. Host white, black, and hispanic of any race. Guest were comparing what our projections show the distribution of the population to be in 2012 compared to the projections for 2060. The white population has the majority and the largest in terms of share of the majority. 69 in 2060. If we focus on the nonhis panic population, that population is projected to decrease its share of the overall population as well down to around 43 , becoming a minority in these projections. Guest i think what is happening here is the fastgrowing part of the population an artist more than double their population size over this 40year period. The white population after 2024 starts to decline. We see this shift with the lower white share because of the growth of the minority population, which will continue from fertility and immigration. The white population will have a natural decrease, more deaths than births. It is growing younger and minorities and declining older whites as we get to the last part of this decade. Host that puts this in perspective. By 2043, the minority population projected to be the majority. Guest that is correct. They are projected to reach the the 50 and cross the mark in 2043. Guest we are at a pivot point. Guest by 2018, the child population will turn it into a minority white because it is the younger part of the age distribution. We will become majority minority for different age groups, the under 18 population and the 18 to 29 population and keep on going. The older population stays majority white for the entire span of the projection period. I think it makes an important difference for lots of then use of our society. The child population is leading the way. We see that in the schools and into the Housing Market and middle ages. We concede the ages coming and people should Pay Attention to that. Host once agreement is reached on the fiscal cliff, the next item will be immigration reform. How do these numbers went into the debate weigh into the debate . Guest they made good assumptions about what the projections are. That is the biggest question mark in terms of what will happen with the growth of the population. If we have increases or decreases in immigration overtime and what the countries of origin will be. In the last five years, immigration has really tanked. There has been some emigration back to mexico. I did not expect that to continue over time. The real issue the kind of longterm Economic Growth for the United States will be very much shaped by the immigration policy and the nature of the kinds of preferences we give to different immigrants that are coming in. I think well have a large discussion about this once we get over these political hurdles. Host did you want to weigh in . Guest potential future of migrants coming into the United States. Our projections are based on past trends. We make some projections about how many believe thing. It is lower in this theory. We have projected a much higher level of international migration. Led to less rise in that assumption to have that much lower level overall. Host explain this graph and how you get to these numbers by the year 2060. Guest this answers the question of how we make the projections. They are made based on assumptions of future rates of tality. Ty, mor we start with the starting population. We are using the 2010 census. We start by aging the population forward. Each year the population is when youre older. Then we had in the number of projected burst and immigrants projected births and immigrants. We subtract the number of deaths. Host Jennifer Ortman from the u. S. Census bureau and william frey from the Brookings Institution. What will this country look like . John is on the phone from florida. Good morning. Caller i would like to make a couple comments. Slavery, this is chasing cheap labor. This world trade nonsense. This is chasing cheap labor business chasing cheap labor. Guest he goes back to the era of slavery. I think that is part of the past. It is important that we treat immigrants fairly, even if they are not yet citizens. In terms of their general overall quality of life here. That has gotten better over the years. Host kelvin from portland, oregon. Caller good morning. Thank you for hosting this show. Looking at the census for the future hello . Host we can hear you. Caller i am a fan that enjoys the various topics that you show. I agree with the folks debtor showing Demographic Data that are showing Demographic Data. My question to the guests this morning has to do with the impact of a Single Member district verses running at large and the correlation to how that will impact the voting patterns for the future. Thats my question. Guest i have to punt on that specific question. We saw that in the president ial election. Never saw a so much attention given to demographics. That had a lot to do with the outcome. It may have some impact and it is part of the Voting Rights act. That is being relooked at again. Host to find a baby boomer define a baby boomer. Those baby boomers at are beyond the age of retirement. How many are moving into retirement age in the next five or 10 years . Guest i dont have that number with me. Host but it is growing. Guest it is growing. This is the projected age structure of the population. Each park or descends the population at a given age each bar describes the population at a given age. I have highlighted the baby boomers in red. They have been driving the trends we see over time. We project they will continue to be an important driver. As to look from 2012 to 2035, we see the baby boomers moving into the oldest ages of the population. By 2035 there will be between the ages of 71 and 81. In 2060, 2. 4 million baby boomers left. Caller good morning. How are you . I wanted to thank cspan. I like the topics you show on the air. At 2043, youking are going into the second generation. We all come from immigrants. Im a Third Generation american. My family came from italy. Just because im white, we do not look at those numbers the way. The immigrants here today or 20 or 30 years ago, their children in 30 years will have children. You are looking at a Third Generation americans. I dont understand the numbers of what you are looking at at 2043. Guest that is an important question as to how we classify people. We have a ready rate of enter ethnic an interracial marriage in the United States. It is fairly high for asians and for hispanics. My prediction is that 20 years or so outcome these kinds of categories