all society. i was thinking about former questions about this and the united states doing enough for that and the answer is no again because we need the leadership of the united states on this issue. i know that there lot of troubles now, not only american, but a lot of people are thinking how to recover economy, recover income, improve the conditions for their own economy. even today may be converse of the united states are trying to move now and say there isn't climate change at all and we need to change that. we need to mobilize public opinion and strain again that first there is increased carbon emissions in the world, there is an increased global average temperature, there is a correlation between carbon emissions and global warming is provoking serious changes with climate and finally, that there are solutions related with reductions of omissions. but in order to do so, we mobilize a lot of resources and mainly we need to change our style of life, and in order to do so we are doing with the secretary general was saying. it is important the effort and leadership of the developed country and i mustn't say the effort and leadership of the most developed country in the world which is the united states. i'm sure that president obama has realized the problem and understand some that he's facing a new congress and political reality. however, it is not enough to a understand the problem. we need to mobilize that society and congress and of course try to find out what could be the solution. >> i want you to take this up. even with all the best innovation, dewey and can we read what your people in a way that they would want less? that's not all the necessary. reduction by saying to the yolly in india use one camel every two weeks or taking an attrition level but a typical in northern india and say yeah we have to cut back on mess. there is no doubt more food and more energy is only just as appropriate. sure, you can say that the u.s. could cut back by even three but it's a meaningless number compared to the justice of letting people live and type that -- have the type of communications and freedom that developed countries have. so fortunately that is in the there a solution or be, going to happen. we want people to live better lifestyles, and all of you have to do is make sure the energy that you are using isn't emitting co2 or causing other problems. let me get some more questions but go ahead quickly. >> we can improve with people but the point is we need to do that in a way to use energy. >> you cannot -- you have to make sure the energy you are using doesn't cause a problem. you do not have a just world by telling those people use less energy than the average european. >> it's not a question we are going to ask these people to use only one campbell. people need electricity but it is possible to use traditional lamps those houses in order to use energy lamps and that is a practical kind of measure we need to take. >> if we can get a few more questions before we have to close i can't see that far. anybody back there this is an awfully shy audience. peter are you out there? where is my friend, peter? [laughter] -. >> my question is for you as a technology still in a clean energy space is been a disappointing period where we've not had national comprehensive energy legislation was in the press on carbon or even most sort of basic steps are found providing the kind of technological framework jimmy looted to earlier we have a comical lack of consensus in congress. what is your view, and i heard you say 2013 of your earliest, what is your view on what it's congress to get serious in terms of implementing its technological framework that sends a signal to the market about what this clean energy future should look like in energy efficiency and generation. >> it is a good point. both mike and jim to take it up. i think it is going to be a signal from the market or mother nature. it's going to be a spike in oil prices that goes up to $200 a barrel or we get some from mother nature will call the perfect storm to find the end of the debate about climate change that's so big but not so big that it ends the world so that we can actually still do something about it, but i want to hear from mike and jim what would a more coherent longer-term framework around as you've been so missing mean? >> first of all, i would say that business shouldn't be sitting back waiting for government. business can be leading in this area, and this past year we set our own aggressive a greenhouse gas reduction of objectives, we may get a part of our dna as i said. we start investing in renewable energy and we can sit back and wait in the debate and wait for government leaders, but i think is responsible business leaders that's not productive. i think the government -- >> what response have you gotten from consumers? >> frankly it in up over time to the inappropriate response from consumers. i think in the short term in particular in the markets consumers are still wondering great deal of personal pressure to get jobs, economies and so i think right now they've got things under mind about their own family and their own livelihood so it's probably not one that isn't getting a great deal of feedback, but in the long term consumers are going to provide the benefits to take responsible action. i think in the future companies will buy from responsible companies and associates will work to companies that have a purpose, and i think that's how business moves in the future and if we sit back and wait for the government, we will not be taking our responsibility seriously. >> what is your take on this? >> you know, the nexus of these issues is unambiguous. it is a linear relationship between gdp per capita and the number of people in the energy consumption, and that's just -- any way you look at the map is going up four or five next 23 years and so you need a dramatic adjustment here and i just think this is the kind of stuff we are going to have to rethink economic and talk about food and the numbers quoted we make about eight times the food we need to feed the world so this is the market breakdown so somehow we are going to have to -- the time i spent on mass everything comes back to political pressure. you know, and devotee here says give me political pressure, give me political capital, that's what i need. and so, business is going to make money. businesses can make money either through an adopted frame three modified from work or through a crisis of a politician in a perfect set of scenarios. business is business. you know, the question is what role does this want to play? i just don't want false positivism because any way you the map it is we worse and the problem with innovation is innovation is about creating energy, and it's not about avoiding cartons because you're competing against 200 to $300 billion a year of subsidies to the use of carbon has its negative values and so until you rethink economics and factor the public goods, social capital which you brought up and the natural capital, there is no chance. i just think we have to be radically ambitiou and there is an enormous opportunity. business is always going to make money. that's what it's here for. i think this comes down to our intellectual capacities and what is the role of business in this forum in getting the political capital to the leaders to face and make the changes that everybody who's been a short period of time being briefed knows that the math is tough. >> is their anything you want -- >> just to underline your point that we are talking about dealing with climate change, the global warming, with the world is doing now is not enough. we have to double our efforts, accelerate the process, and i would agree that if a lot congress must take the lead but developing countries must do more as well. based on the principal of the common principal, a responsibility, and if we are talking about the planned change about avoiding the crisis this is important responding to the question of the lifestyle and innovation and technology and of course correct and sound policies practiced by the, that's my point. >> would you like to follow? >> i think the answer is public policy. you were saying we need to reduce and eliminate the substance and study the policies internationally which is very costly in political terms that we must do that. second is pricing carbon because i'm sure business is business, but if the governments are able to establish the right economic incentive you can make business according to those economic consensus you need to pay more because your technology, suppose you can switch your own technology to produce more efficient or you are going to use energy be you can use the energy coming from and that we can promote so there are measures in which we can win the necessary growth and the necessary consensus of energy in order to make it more competitive most environmental friendly if i can see that. so it is possible in terms of the public policies and international cooperation to do that. of course it is necessary the energy to grow and it is necessary to the conditions of the people you're going to use the more energy than now but also another way. >> as we draw to a close here i hope we can come back next year or the year after and secretary-general you will be presiding over a different kind of competition. during the cold war we have a space race who could be a first to put a man on the moon and only two countries could compete and only one could win and it's clear to me right now who can convince the most queen technology so that both men and women can stay here on earth, and i would love to see mexico competing against indonesia and indonesia against brazil and russia, china, everybody trying to win that race we would all be better off and hopefully we will come here and be able to say that actually molecule co2 was affected by what we say and do here. thank you very much. >> good afternoon. and welcome to the signature panel session, insuring the future, the financing of health care. ms. hill as an ally of the university of miami where i received my bachelor's degree in 1975 and my m.d. in 1979, i am particularly delighted to be here today. i am also proud to be here as the chief medical officer of diagnostically worldwide and honored, truly honored that quest is a sponsor of the global business forum. for those of you not familiar, we are and 8 billion-dollar company. we have 43,000 employees, we are connected to 150,000 physicians in the country's doing lab orders. we do 550,000 of laboratory tests every night. we touch 150 million people a year. so chances are, if we haven't stuck you, we have stuck one of your friends. [laughter] but me talk briefly about diagnostics. you see, for the positions in the room you know you do four things when you see a patient. you do history, a physical, you may order an x-ray and you do a diagnostic test. you see, the diagnostic test contributes to 70 to 80% of every single decision that a physician makes. so although we are responsible for only 3% of the cost to the cost of health care, we probably contribute to 80 if not 70% of all the cost of health care in the country. the question i used to get asked a lot is why is quest health care -- cost felker expense of which the panel will address. as i travel a presidential campaign in 04 and actually as a candidate for lieutenant governor traveling all through the 59 of the 62 counties the question was the same in 04 and 06. why does it cost so much and the same issue is why does it cost so much today. so just briefly before it to the other intro hundred 25% of the cost of health care is paperwork. one-quarter of 1% of all health care is responsible for 20% of the cost to 80% of the cost of health care is used in the last six months of life. prescription drugs have tripled in the last ten years, it costs $15 for every transaction in health care compared to less than 1 penny in banking. the reimbursement system is based on volume of quality. we have a third-party reimbursement system where the consumer is not responsible for the cost of a technology drives at least 50% of the cost. we have a malpractice system that just doesn't work. we have poor quality by many, many measures. and the obesity at the then it is contributing to a huge number of the cost across the country. so with that, it is my pleasure today to introduce pact, first vice president and chief operating officer of the federal reserve bank of ballan tuck read in this capacity, pat not only oversees the day-to-day operations and administrative matters of the atlanta fed, but he has a direct hand in the development of banking policies. he's also the retial payment product director for the federal reserve system nationwide. he's a fellow kaine who holds a bachelor's degree in management from the university of miami school of business administration. he's also a trustee of the university of miami and serves on the president's council and the university alumni association board. it's with great pleasure i welcome patrick baron hill the global business forum. [applause] >> thank you so much, john. youre such a key part of the hurricane family. we thank you for your involvement and contributions. certainly today, i would be remiss if i did not recognize you and quest diagnostics for your support of this signature panel and for all that you have been engaged in through this global business forum. i also want to take this opportunity because it is my only opportunity with the microphone to express my gratitude to deanne for everything she's done and express my best wishes to her and bob as the move on to the next sector of their life. i would say that the luncheon speaker made a reference to my generation and he drew the analogy of a pig and a python, and why why didn't particularly like the view from being that pagen i discovered one of my colleagues said there's three things about being in that generation. that is that during a crisis situation if you are taken as hostage you are generally the first to be released. [laughter] secondly, you can take up bad habits without worrying about them telling you. and finally, and finally and relative to this panel, you would begin to get more out of the health care system than he have to pay into. last year after many months of shall we say spirited debate, we come of this nation got a jury historic health care reform bill passed. as they say, the devil was in the details, and even this document was some 2,000 pages -- 2,700 pages to be exact has left several unanswered questions. but perhaps the primary unanswered question, one that john e. lewd it to is how can we contain health care costs while providing every american with access to high-quality health care? today's panel brings together the perspectives of physicians, hospitals, finance years and insurers to discuss the overarching issue but is so critical to the future of the nation. and so let me introduce our distinguished panel. let me start with richard clark. richard has served more than 14 years as president and ceo of healthcare financial management association a professional membership association with more than 35,000 members. he is the past chair of the commission on the accreditation of healthcare management education. among his numerous professional activities, dr. clark serves as a faculty member of the university of miami school of business administration. recently launched the m.b.a. program in the health sector management and policy. a very important program for us. his academic degrees include an m.b.a. and management and finance from the university of miami school of business administration. our second panelist is michael tuffin. he is an accomplished strategist with extensive experience in public policy, healthcare and national politics. as executive vice president of american health insurance plans whose members provide health care, long-term care and dental and disability benefits to more than 200 million americans, he leads a hip's public affairs strategy which includes communications, advertising, media relations, new media, and grassroots mobilization. he has worked on a wide range of political campaigns on the legislative staff and both the u.s. senate and the house of representatives. i would say that his focus has been on economic and fiscal issues, but more germane to my area in 1996 he was the deputy campaign manager for a successful referendum campaign that enable the miami heat to build the air lines arena and certainly we thank you for that. [applause] which umbenstock serves as president and chief exceed officer of the hospital association and is the past chair of the board of trustees. prior to assuming his current position, he was executive vice president of providence health and services, which provides an array of health and housing and educational services including 27 hospitals and more than 35 non-acute facilities in communities in the five western states. among the numerous activities that have drawn on his extensive expertise in health care administration, rich has consulted with voluntary hospital governing boards throughout the united states. and cecil wilson, an internist is practiced in central florida for more than 30 years and former navy flight surgeon. he became the 165th president of the american medical association in june of 2010. as the florida medical association and chair of the board of governors as well as its executive committee. dr. wilson is a member of the board, physician run organization that accredits more than a thousand physicians, office laboratories nationwide. our panel today is moderated by the university's distinguished president, donna shalala, and i think we would all agree she knows a few things about health care, so it's a nice warm welcome to the panelists and donna shalala. [applause] >> thank you very much. thank you. thank you very much, pat. we really appreciate your coming out to do this with us. let me thank john cohen and his loyalty to the university's legendary, and we are just delighted to have him and thank quest for their sponsorship. i would also like to introduce my senior vice president who is responsible for advancement which is fund raising communications and politics, the advancement is particularly important because it means i don't have to contain costs if he does it the right way. sergio gonzalez. [applause] and you have all met barbara. i'd like you to meet her successor at least temporarily. we still when someone from the private sector is a distinguished career in private banking and whittle's all -- was also one of or sophos lacasa who has joined us today. [applause] >> now every time i get on fox they say to me so, why did the president do anything about cost containment? the real criticism of the clinton and the obama health care plan is they really didn't do any thing about the cost containment. we are going to answer that question today but the simple answer is it's very hard to do. making up this panel are stakeholders. people who represent significant parts of the health care business. and it is hard to do. i believe that probably twice a week i get an e-mail from someone somewhere in the world who wants an hour with me because they have an idea that saves health care costs, that they want me to talk to the president about, not that i talk to the president every day or even whether he would be interested in a specific suggestion, but everybody has an idea about how to contain cost. but those who say we can't afford health care reform i say that we can't afford not to reform the health care system. and whether they like the specific parts of the bill or not, the gentleman that make up this panel also believe number one we need health care for everyone in the country, and number two, we need to make it affordable for eve