Previous generations were the 20s and 30s, largely because of Mental Health issues. Theaid that in remarks at Detroit Economic Club about the future of health care, Prescription Drug costs, and medical innovation. Thank you, steve. Good afternoon, everybody, and welcome to our d. C. Members and our guests. It is wonderful to be here at club, anit Economic Organization that has long attracted some of the nations most distinguished thinkers and innovators. To introducer todays participants, who will engage us in a captivating discussion about the future of health care. I begin by introducing our guest speaker, someone i have known for many years and consider him a mentor and a friend. President ta is the and ceo of the Blue Cross Blue Shield association, a National Federation that supports 36 independent communitybased and locally operated Blue Cross Blue Shield companies, including Blue Cross Blue Shield michigan. The Blue Cross Blue Shield system, through its federation of insurers, covers one out of every three americans. I think this is a very important statistic, nobody else does this, frankly, is that it serves every zip code in the united needing every zip code in america, someone has a blue cross card. He is overseeing one of the most healthd brands in care and driving Public Policy and conversations on health care and Health Care Reform so everyone has access to quality Affordable Health care. Devotedtly, scott has his career to improving the health of all americans through innovations like the bcbsa health index and the health of america reports, which identify Health Issues and challenges and provide insights to improve the quality of care across america. Scott was named president and after serving quarter years as a Senior ExecutiveVice President , including two years as chief operating officer. Prior to that as an executive Vice President for system development, he was in charge of new Business Strategy and bcbsa Technology Evaluation centers, which is renowned for evaluating safety and effectiveness of emerging medical treatments. During his tenure, the Blue Card Program was introduced through whichational program, allows blue plan members to receive Health Benefits while traveling or living in another part, another blue service area. The nationwide membership in the system has increased from 65 members in then beginning to 110 million members today. Got the vision to use available data to develop insights about what is happening across america and driving solutions on Health Care Trends like millennial. Ealth before joining bcbsa, scott of president ial health plan, and also has ties health, inc. , a missouribased pho. He has a strong commitment to Corporate Responsibility and is awfully driven to be cynically active, both professionally and personally. In addition to serving on numerous blue cross boards, he is a Founding Member of the National Business group, a board member of the Brain Research foundation, and an advisory paragonmber of biosciences. He also serves on the leadership council, the health care Financial Management association, the American College of health care executives, the deans newership council at per university, and the Washington University school of Medicine National council. The whiteo advised house and congress on policies, programs, and services affecting ar older citizens and was charter of the American Health information community, a commission to advance Health Information technology. Ceolso serves on the Advisory Board for building a healthier chicago. Degreearned a bachelors from purdue university, where he is a proud boilermaker, and holds a masters in Health Administration planning from the Washington University school of medicine. He also holds an honorary doctorate of science degree from purdue. I would also like to introduce our moderator today, dr. Deanna awardwinning Health Reporter at wwj news radio 950. Previously, she was the Major Medical reporter for tv news stations in miami, chicago, and boston. She has received multiple awards for reporting. Two American Heart Association awards. A bachelor of science degree in nutrition from Michigan State university and of podiatricor medicine in chicago. She completed her surgical residency at the Phoenix Community hospital, so it is my pleasure to introduce both scott irota and d analyze, se, and we areli looking forward to their conversation. Hi, good afternoon. I am thrilled to be here with the Detroit Economic Club. Thank you for having me and scott. I want to officially welcome you. Thank you. Deanna so we are going to be talking about the vision for the future of health care. A lot of people i talked to over the past few weeks found out that i was going to be meeting with you today. They all had questions that i should ask you. But but one question kept showing up over and over and over. So lets start with this. Im sure it is something you have never heard. They want to know why is health care so expensive for consumers and business as in our country . Scott thats an easy question. [laughter] will get to the question. But i did not get a lot of applause when you said im a proud boilermaker. [laughter] scott so i have to go on record. My daughter did not see the light and she is a proud spartan. [applause] scott you got to do something to get the audience on your side. Ok, why is health care so expensive . Health care is unique in that the consumer of services is typically not the person paying for the service. So you have a strange dynamic in that environment. You have organizations, whether it is the government or insurers like the blues, who are paying for the service, but the manufacturing plant who are the physicians and hospitals delivering the service. So you have lots of disconnects. And lots of missing checks and balances, and that would be point one. The second point is, we built the Health Care System on a piecework basis. That is, the more you do, the more you get paid, so we have created incentives for delivering excessive care, so long as that care is not going to do harm. So we have a scenario where providers are in scented to deliver more care. Patients have no buffer not to accept that care because theyre typically not paying for it. And payers are afterthefact trying to manage the care in a remote basis. So that drives the price up. Second, what is more important than health . Nothing. So we invest as a society, i believe appropriate lake, lots of dollars in innovation, in finding new breakthroughs and ways to drive better value in the system. And those innovations and breakthroughs have a price attached. We have also increased life expectancy, improved health outcomes, we have eradicated diseases. So we have done a lot of good things with those dollars. The logical question is what can we do to make it more affordable . The evolution there is to move our Health Care System to one that is less focused on inputs and more focused on values and begin to construct relationships between payers and providers that are focused on the outcomes of the care received, rather than the inputs. In fact, Blue Cross Blue Shield of michigan is one of the leaders of that movement, about 5000 physicians operate here on a patient centered medical home, an environment where the primary care physician begins to manage or take ownership of the full spectrum of care of the people who are part of his or her practice. We try to do that across the country. In fact, in our system alone, 70 million americans get their care through some form of a valuebased care arrangement. The goal there is to focus our reimbursement on approving the outcomes that our patients receive. And it is showing results. We have had diminished remissions to the hospital, diminished emergency room utilization, increased compliance with chronic disease treatments and protocols. We have a whole host of activities beginning to show positive results. Long answer to a short question. Deanna will a lot of Companies OfferWellness Programs and incentives so if you quit smoking or lose weight. I just wondered, how effective are these . Are they worth businesses investing in . Scott i believe any investment you make in your employee or Workforce Health is a benefit. I think the lifestyle things, losing weight, reducing smoking, all have positive outcomes. The jury is still out if the investment in those programs is still paying out in a real dollar benefit. But i think if you factor in the noneconomic or nonhard economic factors like reduced sick days and parter to be measures, i productivity measures, i clearly think it is an investment we should all be making. Deanna about a year from now, we will be having a big election and health care is always a big issue. If you were running or advising a candidate scott the former will never happen. [laughter] deanna lets say you were advising somebody. What are some things that would make a Good Health Plan and what are some things as voters we should be looking for . Scott im a big believer in building on what works and not just tearing things up for the sake of tearing things up. Or i advising candidates, i were advising any of the candidates, i would say we spent, as a nation, a long time working on, debating and implementing the Affordable Care act. I would build on its successes and look at the fact that as of this moment in excess of 90 of americans have Health Insurance today. So i would look at ways to close that gap and get the last 10 . I think the number i saw this morning was 7. 5 , but how do we close that gap without disrupting the care that the rest are receiving . There are a number of Public Policy initiatives we could do that would improve lower costs and improve our ability to access care. I would encourage candidates to look at the issue of pharmaceutical costs and promote the idea not just in pharmacy, but in the entire Health Care System, of transparency, allowing patients, employers, insurers to have a real line of sight and understanding of what the components of health care really cost. And therefore identify where the opportunities are for improvement, so how are pharma drugs priced . Lets get some transparency. What are the real developmental costs . Real costs. How are the Research Costs . Are those prices develop so we can have a better Public Policy discussion on how much we as a society can afford to spend in that regard. We have to develop Public Policy initiatives on high cost drugs. We now have our first drug that exceeds 2 million for treatment. We have to, as a country, figure out how to deal with those particular issues. We have to improve access and in lots of communities. We have to ensure our rural hospitals survive. There is no shortage of agenda. The answer to your question in this regard. As a priority, i was a focus on building on what is working today, as opposed to disrupting what is working today just for the sake of disruption. Deanna ok. There have been some major Health Issues in the news lately and i kind of wanted to get your take on them because we are talking about the future of health care. And also how does the blues combat these things . For example, the vaping, ecigarettes . Here, we have five people that died. Over 450 people have been hospitalized with respiratory illness. What do we do with something that is newer, or something you dont have a lot of data on . Scott the issue of how to deal with vaping, i put in the broader category of how do you deal with lifestyle issues. How do we as a society, or we as the blues, because as dan said earlier, we are in every community. What makes us unique, the unique qualifications of our programs are People Living in the communities in which they operate. So when we make decisions or policies to decide priority issues, it is impacting our neighbors and our friends, our families and communities. So we are very committed to a to community activities. And i put all of these things, be it smoking, vaping, nutritional issues, all of those things into a category of social determinants of health. We as a blues system feels very resources,o take the the insides, the information that we have and try to work with local communities to solve those problems. Thatnt to be certain peoples genetic code is more important than their zip code as we look at how we attack health care issues. Again, we tried to take the data and information we have to work with policymakers in washington and in state capitals, so they can understand the depth of the problem. So they can understand the communities that are impacted with the problem. And then we try to work with those communities to actually take our resources and staff to invest in those communities and solve those problems. It is vaping today, opioids yesterday and opiates for a long time. Deanna the measles outbreak, vaccination rates. Thet vaccination rates best way to deal with it is with facts, data, and information that we bring to bear and put in the communities. We are blessed with a data resource, because of 107 million members in every zip code and age cohort group and every demographic. We are blessed with the data that provides us great insight, so the trick is to take that for that insight and provided back to the people who can really make a difference. When we think of health care, a lot of times people think the elderly as the ones who are the sickest, but i saw a report that say the millennials are not the healthiest group. Can you talk a little about that . Scott sure. We have a program we call the health of america, and we have done 27 different kinds of reports on various Health Conditions, given that we are in this beautiful stadium, i would say one of the ones that hit the headlines earlier on was a concussion report. But the latest one that we did was on Millennial Health and we were very surprised that we found the millennial generation, which will be 50 of the workforce in 2020, is at this stage of life the sickest generation of any other cohort group. 6, 7 of thees top 10 conditions are Mental Health or Emotional Health generallyonditions, stemming from detachment issues. Lots of virtual contact but not enough human contact. We are seeing chronic conditions arise, things like high cholesterol and high Blood Pressure in that generation that we would fully expect to see in people 20 or 25 years older. It is an issue of vital importance to us. We at the blues have taken that to try mission of ours to address this issue. We have had listening sessions. Because the data only tells you so much. So we went out and spoke to in a live in communities across the u. S. , spoke to the millennials and asked them what they were looking for. Interestingly, people of my generation, seniors, are very concerned about privacy and data. Not an issue for millennials. Not an issue. What they want is a compassionate medical professional who is willing to treat them as a whole person, and look at their conditions in a comprehensive in the context of their life as opposed to treating each disease condition independently, which is kind of like the patient centered medical homes that you are doing here in michigan. They are very free to share information. They will seek sources anywhere so try to Seek Solutions to their problems. But they really are craving human contact and they are craving that ability to interact and communicate with people. So 11 cities. In november we are having a national culmination event in philadelphia, where we are bringing leading experts in Millennial Health together where we can begin to embark on a campaign to try to address these issues. Im counting on millennials to support the Health Care System in the future to take care of me. So we need to be sure that that generation is as healthy as they can be and should be given their physical age. Deanna do most of them even have a primary care physician . Scott no, i would say that the number of millennials with a primary care physician is markedly lower than the seniors, but they crave that and they are looking for that connection. So i think that maybe one of our sort term shortterm solutions, to try to make that connection. But they are much more comfortable with virtual care than we would be. They are much more comfortable with telehealth than other generations, so we have to find that sweet spot where we can get connected to the Health Care System. Deanna what about Artificial Intelligence and the future of health care . Scott you know, Artificial Intelligence and Machine Learning have a wonderful opportunity to do a number of things. First, in underserved countries around the world, Artificial Intelligence can serve as an extension and do screening that may not get done because of the lack of access to medical professionals. I was at a conference recently, where executives from google were talking about working with Artificial Intelligence to do retinal scanning in india, which is underserved from an ophthalmologist standpoint. And found that the scanning and screening they did compared to human screening was actually better in the plumbing preliminary screening. If you multiply those kinds of out,ities in various areas you can envision a time when we can get trained radiologists, pathologists and others out of the basement and to the bedside, and have a lot of the screening work done by machines. And have the medical, Trained Medical professionals over read and actually get more involved with the more complex matters and leaving the routine matters to machines. So i think theres a wonderful opportunity for us to be more efficient and effective in the delivery of care and to free up our medical professionals to deal with more complex problems. So i think it has an incredibly bright future. Deanna how about as we are moving, we have more electronic records. Patient portals. We are using wearable devices for medical testing. What about our security with our Health Information . Scott a couple of comments on that. First, one of the greatest challenges in my professional life has been, or frustrations i should say, has been the lack of interoperability for health care data. The inability for us to share data between physicians and hospitals, between our devices and our physicians. Take your pick. We have had very little success despite enormous investments. You heard dan mention i was part of the very first Health Information community. It is not one of the stellar successes of my life. We were charged by the Bush Administration to try to create a national, interoperable standard. Still working on it. People point to banking and say we have created those kinds of standards. We are not there in health care, and we need to be. Interoperability is a challenge for the next administration. And unfortunately probably will be for that generation after that and after that. We have to create these data superhighways that we can move information seamlessly amongst and between people, so we can have a better understanding of people have,ions building off of an individual record. From a privacy and security standpoint, there is a lot of concern and fear about concentrating that health data in any location. People, at least our generation, not necessarily the millennials, they are very protective of that data. Identity theft is clearly easier if you have access to all of this kind of information. Unfortunately, the bad guys are usually a step ahead of the good guys in that fight, but we invest in the blue system enormous amounts of money trying to ensure protection. Of health data. We have established National Standards. We have adopted National Standards established by others. To protect that kind of Health Information. I know that others do the same. It is just a never ending battle that we have, the fight to ensure that that data is protected as much as it can be. Deanna what about Precision Medicine and the future of health care . Scott Precision Medicine affords us, for those of you not familiar with the term, it is really developing interventions that are focused on your own personal genetic code. So it is understanding your genome, understanding your genetic makeup and then targeting treatments to use specifically. Obviously, extremely expensive. But it has the potential to be curative. I think we are just beginning to see the potential of that which means nows the time to establish National Policies about how to deal with that and protect precious data that is necessary to develop those targets and how to pay for it because it is going to be astronomically expensive, but again, if it is curative, and if it is substitutional for other treatments, it may not have to be additive to the total cost of health care. But we have to have the National Debate now. I wish i had a solution. I dont, but it is something that we as a society need to wrestle with now before it becomes so ubiquitous that it is treating all kinds of conditions. We well how do we get have all of this information. How do we get patients to take some responsibility for their health care . Because we have obesity epidemics, even Childhood Obesity is on the rise. Scott if i had the answer to that question. But personal accountability is a cornerstone of any Successful Health policy. Some would argue you need to have skin in the game. You need to be paying some of the premium. You need to understand the economic implications of the decisions you make. Some others would argue that the implications do not always need to be economic, the Health Implications themselves should be a sufficient deterrent. But we have watched generation after generation continue to smoke and continue to eat unhealthily and not exercise and do all those things, so obviously the Health Implications are insufficient motivators, so i think we have to create a Health Care System which has accountability and consequences. The difficulty is how do you really create those consequences and how do you make the relevant if the Health Conditions themselves are not consequential enough, what can you do to create that consequence . I think it starts with education. I think it starts with education at the preschool level. You begin to educate the children, the families, the communities about the importance of health, but you do it in a fashion that not only educates them about what they need to be doing, but facilitates them doing it. That, again, gets back to the social determinants of health, ensuring that all communities have access to the things they need. In our world, in the Blue Cross Blue Shield world, we take this very seriously. We have created an institute whose focus is on social determinants of health. The first area that we started with was transportation because we found that a number of people were not compliant with medications or appointments because they just cannot get there. So we partnered with lyft and uber so when physicians make appointment, they can also ask if they have a ride. If not, we can arrange for transportation to and from and we can arrange for cars to take them to the pharmacy to get the medications. Recognize many communities dont we also have access to healthy food, so we have created a program which will deliver healthy meals at very low cost to communities that have deficiencies in access to fresh fruits and vegetables. Because we have patients in every zip code, we are trying to design programs that are portable and repeatable and we can do on that scale. Will also look at food deserts to design programs thatinsufficient and begin to invest whether it is building playgrounds or doing other programs to advertise and begin to invest in that, whether it is building playgrounds are doing other things, because it is one thing to tell people they need to do it. It is another thing to show them a pathway. We want to be able to do both. Deanna ok, so we only have a few seconds left, what is your vision for the future of health care . Is it positive . Scott im extremely bullish on the future of health care and on the future of our industry. Earlier,all, as i said what could be more important than healthy ipo i know we wring our hands about what percent of the gdp is going to health and all those other things, but it is hard for me to think of something that is more important than that. Investing in health, i think, is appropriate, so long as you are getting outcomes, so long as you are getting outcomes for that investment. So i am very bullish on that. As a huge employer in the marketplace. Most Health Care Providers are very committed to their communities. Im also bullish that there are opportunities to make dramatic savings in the cost of health care today, just the financing of health care, by building on the successes of the Affordable Care act and by investing at the National Level perhaps in catastrophic insurance where our sickest people would be covered by a catastrophic policy that the government would be responsible for and the rest of us would operate underneath that. We could produce premiums by a third. By a third in a program like that and improve outcomes. So there are wonderful opportunities for us to make great improvements, both in the delivery and financing of health care. It is a great time to be health care professional. Deanna thank you so much, scott. Scott thank you, deanna. [applause] dan thanks to deanna and scott. Now it is my pleasure to ask some questions from the audience. Will start off, scott daca, the aca, how would you rate it and what is coming . Scott when it started off i would give it a c. I think it had kind of a rocky road. Systems did not work, etc. I think over time we have all committed to improving it. Health care professionals, government alike. I think it is approaching a b, b plus and i think it has an upward trajectory. I think if Congress Acts in a responsible fashion, and build on the successes, some of the things i talked about with regard to shoring up the idea of a reinsurance program, and investing in making sure that the subsidies are properly administered for a relatively modest investment we can have a dramatically positive impact. Remember, the statistic i sent earlier. Somewhere between 7. 5 and 10 of the people are uninsured. That means that 90 to 93 are currently covered. And the Affordable Care act has played a role in making that happen. Dan we have a student question here. How do you think Blue Cross Blue Shield and the Healthcare Industry as a whole will advance and change over the next five to 10 years . Scott first, i will be retired. [laughter] so it will be some elses vision somebody elses vision you will be discussing. I think that from the blues perspective, i think you will see us investing much more in technology, much more in our ability to use data to predict and assist providers in intervening early, the treatment and care. Youll see Greater Movement toward valuebased contracting. We have 70 million of our members connected through a valuesbased contract today. I assume it will be all of our members within the next five or so years, virtually every relationship we develop what providers will be focused on with providers will be focused on outcomes and successes, as opposed to inputs. It is a vital way to go. I think that the Health Care Industry will be much more rapid to adapt technology. We will eventually, within that timeframe, solve the interoperability problem. So we can share and communicate information. Information will be much more transparent. We will have a much deeper understanding of pricing structures and outcomes. So patients will be able to shop for Health Care Like that shop like they shop for television and cars and other things. Or you will be able to comparison shopping. We will be directing people for the bestperforming institutions which will raise all boats. So i think it will be an exciting time for the industry. Dan to piggyback on that, as technology continues to accelerate. A question we are replacing the old with the new. But the problem is unlocking innovation is hard. What are your thoughts about that innovation and of all of this, and how we can make breakthroughs easier than we have . Scott the issue in health care today is not necessarily the breakthroughs, it is the adoption of the breakthroughs in rapid fashion and its scalability. One of the benefits of being as large a piece of the economy as we are today, health care, is it attracts a lot of money and a lot of entrepreneurs. So theres a lot of very smart people trying to solve some welly complex problems, and have seen some incredible breakthroughs, we have seen some promises on behalf promises unfulfilled as well, as a result of that. But i think that Health Care Innovation will be sparked by patient demand and buy a and by a Movement Toward a much more patient focused, patient centered delivery system. And as we look at our Health Care System from the patient out instead of historically we have looked at from the professionals in, as we start to look at it from the patient out, we are going to find that there are incredible opportunities for us to improve communication, improve education, improve the information flow, and unlock the power of entrepreneurship into the Health Care System. Once we do that, i think we will find wider spread adoption. Dan in the current medicare for all act and similar bills in congress, and if they were to pass, what impact would that have on the blue cross organization, and what role could or would Medicare Advantage play in all of this . Scott well, medicare for all takes many shapes and means many things to many people. Imagine, i think that the disruption that would because by a medicare for all makes it unfeasible to implement and not in the best interest of our nation. I think the American People are used to choice. I think it is important that the Health Care System of the future is a publicprivate partnership. Each play a very Important Role in sparking innovation, sparking creativity, managing costs. I think a Tighter Partnership between the government and the private sector is necessary. Better communication and sharing of information and data, building on the success of your of the Affordable Care act. I think they all are critical pieces. Some defined medicare for all as literally medicare for all. Every american is automatically enrolled in the medicare program. In that environment, and some in that environment, and some have said, and eliminate private insurers. If you take that extreme measure, obviously Medicare Advantage goes away. You become a fee for service r for everybody. In the more traditional, if there is such a thing, in the less progressive implementation. Would be a medicarelike program, a singlepayer type program, in which case there would be robust competition amongst the Fastest Growing program today in medicare, Medicare Advantage. Medicare advantage is a program by which the government reimburses private insurers and we compete for patients by creating, by establishing and creating Innovative New mechanisms, new benefits, and we are evaluated on our performance on a star system. And we get reimbursed based on our successes and how well we treat patients and how will they how well they evaluate us. A brief unpaid commercial, the michigan plan is one of the nations leaders in Medicare Advantage. They do a spectacular job and job in doing that and embracing that particular program. But it will be a vital piece of a medicare for all. It would allow the private sector to continue to compete for patients in that environment. They would the advantage programs would be reimbursed by the government. The government would pay the Medicare Advantage programs, who in turn would contract and pay and incentivize the providers. So it could be a cornerstone link just as it is today in the existing medicare programs. Dan scott, before we get to the lightning round, how about pharmaceutical costs . Is there an answer . It is almost on a daily basis that you see stories in the politics of washington around pharma. Where is this going and is there a solution . Scott there must be a solution because we cannot afford the current trajectory of the pharmacy benefit. I think that the answer lies in a couple of things transparency, it lies in the pricingg formulas, and it lies in injecting some new competitors into the marketplace. And i think all of those are coming, and i would say stay tuned for exciting announcements in that space with regard to injecting new competitors into the marketplace. Dan great. We are going to move now to the lightning round, which is a quick question, quick answer to get to know you. Scott i dont do quick answers really well, but i will will try. [laughter] dan what is something on your bucket list . Scott a hole in one. [laughter] dan what is your Favorite Team growing up . Scott it was and is the chicago bears. Dan so if i asked due on october 27, bears or liens, you have answered the question. Scott yes. Dan last book you read . Scott the last book i read was i am blanking on the name of it, but it is one of these spy novels. I do not have a lot of time to read, so when i do, i tried to read something that catches my attention. I think it is called red zone. It is one of the cia type spy novels. I have been carrying it in my briefcase, business adventures. It is an old book, like 12 old new yorker articles about successes and failures in the Business Community that ive been meaning to read. I kind of read one story every now and then i think gates and buffett had it high on their list of the best but if you get brownie points for carrying it, i have had it in my briefcase for about six months. [laughter] dan Favorite Movie . Scott the godfather. Dan favorite vacation spot . Scott jackson hole, wyoming. Dan what advice would you give yourself . As a 25yearold . Scott lighten up. [laughter] scott i took life way too seriously when i was growing up. Dan best sport when you were growing up . Scott football. Dan what person, other than a family member, would you like to have lunch with . Scott that is a good question. Unfortunately, he is not here anymore, but i would say ronald reagan. Dan ok. Lets see what else do we have here . Final question. You have been here many times. Describe detroit in a word or two . Scott you know im not pandering here, but amazing and resurgent. I mean, the downtown, ive told the story before. 10 years ago, 12 years ago or probably more than that now since you have been there 14 years. It is probably 18 years ago when i came here, i stayed at the dac 18 years ago and i wanted to get food and they said we will bring it to you, do not leave. Today, you go to the dac, you can walk around, go to restaurants. Is a remarkable, resurgent it is truly an american success story. You should be proud of your community. It is amazing. [applause] dan again, thank you. Im going to turn it back to steve. Steve . Steve thank you. One quick announcement before we say thank you and adjourned. If you like todays program and wants to hear it again, you can download the audio podcast tomorrow about this time. In fact, we were just recently named as one of the top podcasts in metro detroit. We hope you can punch it up in your phone and listen again. So how about another round of applause for scott, deanna, and dan . [applause] steve you all did an amazing job. Thanks for being with us. Scott, particularly you. Thank you for traveling and for giving us your thought leadership. Youes and gentlemen, thank for coming today. On time, every time, this meeting is now adjourned. Thank you. [applause] a look at our primetime schedule on the cspan networks. 8 00 p. M. Eastern on cspan, live coverage of President Trump holding a Campaign Rally in lake charles,. Ouisiana on cspan2, it is book tv, with authors who have appeared on our indepth series. On cspan3, its American History tv, looking at the history of the american automobile industry. Tomorrow, more from President Trump as he speaks at the 14th annual values voter summit here in washington. At saturday, 6 15 p. M. Eastern on cspan. This columbus day weekend on American History tv, saturday at 10 00 p. M. Eastern on reel america, the film the whole world is watching, about the antivietnam war demonstration in the largest mass arrest in u. S. History. Thousands swarmed onto washington circle. Over 1000 more hit georgetown. Eastern, at 2 00 p. M. As artists shares his vision for the Upcoming National native American Veterans memorial on the national mall. A 12 footmiddle is stainless steel circle, and at the base of that is a fire. You can use that fire to light your sweet grass, sage and things that you use, you can fire,the water, use the and we call that the draw. Monday, columbus day, at noon, Supreme Court justices Ruth Bader Ginsburg and sonya judicial discuss the impact of the first woman on the Supreme Court, sandra day oconnor. Sandra, if you read between the lines, what she is saying is, if you want to improve the status of the women in the nursing profession, the best way to do it is to get men to want to do the job, because the pay is inevitably going to go up. [laughter] explore our nations passed on American History tv, all weekend, every weekend on cspan3. Sunday night on q a, a historian discusses his book the vagabonds about the summer road trips taken by henry ford and tomas edison between 1914 1925. The idea was they wanted to go out and have fun, demonstrate that hey, you can go get in your car and do these things too. But they would not have to try to light their own campfires, eat cold beans out of cans, or put a blanket on the ground. They had all of these different amenities. Poweredrefrigerated car i edison batteries so they could have fresh dairy. They would have chefs that prepared or main meals at night. Dress morning, they would in freshly ironed clothes. But they were so famous and america was so grateful to them that it did not matter. The point was hey, we are out in cars traveling and seeing these things. You can do it too. Sunday night at 8 00 p. M. Eastern on cspans q a. Thinking about participating in cspans studentcam 2020 competition, but youve never made a documentary film before . No problem. We have resources on our website to help you get started. Getting started and downloads pages on studentcam. Org for producing information and video links to footage in the cspan library. Teachers will also find resources on the teacher materials page to help introduce studentcam to your students. My message to anyone who wants to compete this year, find a topic that you are truly passionate about and pursue it as much as you can. This year, we are asking middle and High School Students to create a Short Documentary on the issues you would like president ial candidates to address in the 2020 campaign. Award 100,000 in total cash prizes, as well as grand prize. Grab a camera and produce the best video you can possibly produce. Visit studentcam. Org for more information today. New america high most of a discussion on ranked choice voting, also called instant runoff voting. It takes second and third choices into account if no candidate receives a majority. This is one hour, 20 minutes