Transcripts For CSPAN2 Key Capitol Hill Hearings 20131230

Courage, Kay Bailey Hutchison on the women who helped shape texas. Thats at 8 45. And on cspan3s American History tv, daughters of civil rights leaders and a segregationist share their memories of the Civil Rights Era at 8 30. Youre watching cspan2 with politics and public affairs. Weekdays featuring live coverage of the u. S. Senate. On weeknights watch key Public Policy events and every weekend the latest nonfiction authors and books on booktv. You can see past programs and get our schedules at our web site, and you can join in the conversation on social media sites. Ibis with sanchezserrano is author of a recent book analyzing the Worlds Health care problems. He claims Global Health care problems are based on a lack of access to safe and Affordable Medicines and not due to lack of good Health Insurance. He spoke to an audience at the New York Public Library in late august about the causes and solutions for the World Health Care crisis. As well as his thoughts on u. S. Health care reform. This is an hour and a half. [applause] good evening, everybody. I would like to thank you very much for taking the time out of your busy schedules to come and listen to this lecture, and i would like to give a special thanks to mrs. Deborah harris for her kind invitation to be here. It has been a very crazy schedule for me because i have been traveling in different parts of the world presenting my book and my ideas. I actually do have a scientific background in genetics as well as Business Management and Public Policy, so this has been advantageous in actually understanding Better Health care, but also the scientific part of it. I would also like to thank very much mr. Daniel moran from switzerland who was the person who sponsored this research, six years of my life. And it was funny because when i was working on this in the beginning i was working on biotechnology, about finding ways to develop better drugs. And health care was not the priority at that point. But then as i continued to travel and to speak with many experts all over in the United States, in latin america and and in europe, i found out that health care is something so complex that it depends on medicines even though the generallyassumed idea is that the issue is Health Care Insurance. So it was a six years project of my life in which i dedicated completely to this project, and i am very glad that i have the opportunity to share this knowledge not only with scientists and physicians, but also with the general population, and in that way i think that is what a book should be about. It should be about informing the general population and sharing with them the findings, because those are the ones who are generally affected by the problems of health care. And with that, i would like to start my lecture. Patients were in a veryies docile position. And i think that the internet has done a lot of positive things in that because we have a very informed and more educated patient population. So this is a wonderful opportunity for all of us right now. What im going to be talking about would be, first of all, i will be talking about the Health Care Crisis, Global Health care crisis. Because this is a problem that is not only exclusive to the United States, it is worldwide. I will be talking about what are the costs of this Health Care Crisis and also once i have covered the causes, i will delve a little bit into the pharmaceutical industry. I will try to make all the effort to explain everything in detail, so whenever you guys have questions, please, do not be afraid, because i will try to be very clear and very basic about this. I will be speaking about the Different Solutions on what is required for health care to be resolved and finally, some conclusions. Something that i wanted to mention from the very beginning is that i will be focused mostly on the Global Health care crisis, and as part of that Health Care Crisis comes the United States. So first of all, we need to define when we read the newspapers, when we listen to the news and as we get older, we are always concerned about our health. And this has been a big issue in the United States not only through the president obama administration, but also before that. So people talk about a Health Care Crisis, people talk about having access to health care and medicine, but what is it really . A Health Care Crisis is basically a financial crisis. And by financial i mean that there is not enough money, there are not enough resources to provide a 21st century person access to two important aspects. One of them is health Care Services, and the other one is pharmaceuticals. And this is an issue that gets complicated because as we have made many conquests in terms of technology and medicine, people live now longer, but also we have a demographic explosion. So what that means is that now these resources are very, very limited worldwide. So it gets more and more difficult, more competitive to have access not only to health care, but to other issues as well. And when it come toss the political level comes to the political level, health care has to fight with other important issues such as the pension plans, and that is an issue which is going on globally. So not only in the United States, it is worldwide. So what are the levels of the manifestation of the Health Care Crisis . First of all, the economic aspect and why economic . Because as time passes by, governments and people are spending more and more money on health care. That is an issue which has created a lot of tension in the United States. It is creating a lot of tension in latin america, in europe and also in the rest of the world. From a clinical perspective, and also there are other problems because nowadays it is very difficult for doctors to develop drugs which are safer. I mean, there is not a single drug, there is not a single medicine which is 100 safe to people. So we are finding an increase in resistance not only to antis that have been antibiotics that have been developed in the last 50 years, but also chronic ailments are showing resistance, and this is happening all over the world. There is another element here which is a pharmaceutical element, and it has become more and more difficult for the pharmaceutical industry to come up with new drugs. And so the drugs that are currently available have reached a point which they are very good, and they are very hard to improve, so it costs more and more all the time to come up with better and more efficient drugs. We have, also, the political dimension in which it becomes more and more difficult for politicians to come up with policies to address these issues. So what this creates is a problem in the sense that many of these politicians take rush measures, rush oils in order to policies in order to appease people and keep them quiet rather than thinking in the long term on how to solve the problems which are happening all over the world. And sociological has a great importance because from the social point of view we, for the first time, have a population which is getting more sick and are sicker. And then that is an issue because from the Economic Perspective it is very, very difficult to have a sick population or a population which is unhappy about what is happening in terms of their health and their health care. So what parts of the world are affected by this health care . In general, we think of the United States because this country has had Health Care Problems for decades. And also in terms of that, we also think of the developing world. But, actually, the reality is that there is not a single country in the world that at present does not have Health Care Issue of one sort or another. So it is affecting the United States, canada, latin america, europe, asia, africa. So this is a global issue, and it is very important to go over each one of these systems. There are benefits and also there are problems, in order to understand what are the causes of this Health Care Crisis and also how we could solve them. Let us discuss about, first of all, north america because, obviously, i am in the United States right now, and we are in new york, so well start with the United States. And it is very funny because in general, people think that everything in the United States is perfect, that everybody here is rich, that life is wonderful. And the reality is that the United States has a lot of problems right now, and they are affecting everybody. So i think that people outside should start learning more and visit more the United States to learn that people really sometimes have to struggle here too. So in general, the United States is a Health Care System which is the most privatized in the entire world, yet half of the Health Care Spending is financed by the government through medicaid and medicare. So what is happening is that despite the fact that the United States is spending more than 17 of its gdp on Health Care Spending right now compared to 5. 2 in the 1960s tells a lot about this difficulty. So the Health Care Costs have soared here for many decades. And then even though it is spending more in terms of money spent, it has the highest infant mortality rate, it is the country in which people have the lowest life expectancy, and in the next graph, next table i will show that. And also the amount of healthy americans at the age of 55 is low or than in other countries. Lower than in other countries. So one of the characteristics of the United States is that here we, the United States does not have price control for drugs, so this creates a lot of problems. And the fact that people because of the baby boom generation and also the increasing longevity, it is also atexting the Health Care System. Affecting the Health Care System. So before obama signed the health care act, there was about 46 , 46 million americans without Health Insurance. So that has created a lot of pressures in order to cover those people, and so the point of the obamacare would be to reduce those amounts. But this is very complex, and i will get a little bit into that. So one of the other issues that the United States has as a limitation is that there are many unhealthy habits here in terms of food, lack of exercise, and all of those things have an impact. Even stress, too, have an imact in the quality of impact in the quality of the life of people. What happens is when it comes to 65, many people have to suffer a lo hot of chronic ailments because of those issues. So in this table where as we could see here in terms of the infant mortality rate, we compared the United States with other industrialized nations. This has one of the, has the highest infant mortality rate. In terms of the amount per capita spent on health care, the United States is the highest. This terms of the amount of in terms of the amount that is spent by the government or subsidized by the government, it is also the highest. And also in terms of quality of life in general. So this is a big issue when a countrys spending so much money, but then the results are not seen. And that is quite preoccupying. So at present in the United States what is happening with the Patient Protection and and Affordable Care act of 2010 or obamacare, one of the things that have come out of that is that there will be a coverage, extension of coverage to about 30 million americans, and then the strategy of that comes to make available for them Health Insurance through, basically, a market. And one of the preoccupying things about this strategy is that it is worried about containing costs. So does this really represent a way forward for health care . And i will get back to that question later on as we examine other countries and also as we talk about the different causes for this problem. So as i mentioned earlier, the United States has no price controls, and that is a big issue because for many, many years this has been a debate here. And the issue is that because the United States is the leading country in terms of science and technology and also in pharmaceutical development, then that issue has great repercussions all over the world as well. Because if something is very expensive here, then chances are it is going to be expensive elsewhere, and people will not be able to afford that. And another characteristic of the United States system is that after all these conversations and all the implementation of all these reforms started, what has been happening then is that the deductibles and also the out of pockets have increased at least three times in the last five years. And then there have been other increases in health care that actually are straining the system. And this situation is only going to change, because regardless of whether people are going to be insure what is coming in the future is whos going to pay for the medicines that all of these people are going to need especially for diseases like cancer. And i will get back to that point. We see in the United States there is always a debate, okay, adopting a canadian system, a universal health care land. And if plan. And in many ways, this is something that one should always take very seriously because everybody should have of access to at least basic health care coverage. Everybody should have access to medicines. Everybody should have the best health care possible. Now, there is an issue here in terms of the cultures too. I mean, the United States has a culture and a history which is different from canada and from the rest of the world, and the mentality here is such that people want the best options for them. People fight for their rights. That mentality doesnt easily exist in other countries. So what is happening now is that when we talk about the universal Health Care System, canada has it, but then despite the fact that there are a lot of people covered by a universal health care because it is a one single payer by the government, then we run into high efficiencies. We have a lot of problems in terms of people waiting to be attended, that there are waiting lists of six, eight months, and during that time one hears a lot of people having their ailments complicated or dying. There is a lot of dissatisfaction in terms of getting access to the best medicines. So even the canadian Health Care System which have been proposed to be imitated here in the United States has a lot of problems, and it would be in many ways, i think, naive to think to implement that system in the United States because the histories are very different, and the mentalities too. People here want the best that they can. And that mentality not like that in other countries in which people basically take what they are given. So there we find an issue. So there are a lot of problems in the canadian system. So if we go back to europe, we find a similar situation in which people are always saying that the grass is greener on the other side. And what is happening in europe many people say, oh, i went to france, and i was attended there, and it was free, or i didnt pay for this in this country and everything. But if we look into this, nothing is really free. What happens is that people are paying this Health Care System from their own money, with tax, the taxes that they pay. So nothing is really free. So while they could see free could be something quite complicated because economically then all these countries are spending more and more money. So they have a limited budget, and that limited budget, the Health Care Part is consuming more so that if the health care is consuming more, then they have less police, less teacher, i mean, they have to sacrifice then the quality of other areas within the economy. And that is really not good. So what is happening in europe is that for many decades the europeans Health Care System have tried to create a safety net for people so that everybody is in one way or another protected and have some health care. But the issue now is that this has become a great difficulty for the european cups, even for the richest European Countries because health care has become unaffordable. I mean, many of these countries are Financing Health care with debt as is the case of france and some others. They do not have access to the technology that are common here in the United States. So in most of the European Countries, they have implemented a series of strategies like price control, differential pricing in which one drug, for instance, is priced in one way in one country, and then it is priced differently in another one. There is a copay. It amounts to privatization, in spain right now it is a big problem. So even the european systems which have been corrected and that a lot of people admire here in the United States is coming to a point in which it is very difficult and almost unsustainable. And that is the case, for instance, in countries hike the u. K. , greece like the u. K. , greece, spain right now, italy. They are having a lot of problems, so they are cutting a lot in terms of the percentage of drugs, etc. And in countries like the u. K. , they are suffering from an questions of rationing in the sense that an excess of rationing this the sense that, for instance, if one patient has cancer, that patient is not going to receive the same treatment that a patient in the United States would receive. Because its just too expensive. So what would happen then would be that those people who decide to cover that treatment on their own, they say, fine, you can do that, but then Everything Else you have to pay for it. To they basically get kicked out of the system. So the u. K. Waits two, three year, four years, fife years and waits until there is a lot of pressure from the public in order to be able to provide the medicines that are available in the United States like has been the case of [inaudible] for colorectal cancer. This is preoccupying all the European Countries, and recently i was talking with someone at the hague in hold land, the minister of justice. The president of the Supreme Court was telling me that holland which was, which has been the envy switzerland, of the Health Care System, is having a lot of problems right now because they see the increment in health care. So that is affecting the population. And then sweden has made [inaudible] and switzerland is privatized, and it it counts with some subsidy from the government. Even so, all these countries are having problems right now because health care has become unaffordable. So the other industrialized countries, japan and australia, these people have universal health care, but then they are having limitations in terms of access to medicine. So as we have seen now, we see the problem of health care not only in the United States, it is also serious problem in this country, and this is especially emphasized because of the low fertility rates in europe and also the increase in longevity. So in the japanese case, half of the suicides have to do with Health Care Issue. So this is actually continued to preoccupy especially the governments and the population a lot. So let us go then to the poor, developing and emerging countries. And then the situation there is very sad because these people have to suffer there a lot. They have to suffer not only all the issues that one finds in the United States and in the rich countries in which as people live longer, now they are suffering diabetes, hypertension. They dont die of infections, but they tie of cancer. And there are a lot of problems in terms of infrastructure, in terms of access to medicine, in terms of drinkable water, electricity, everything. So in the best scenarios, these people suffer the same issues that people in canada and japan suffer. In the worst scenario, in some countries like sierra leone, there are no hospitals, not even morphine. So it becomes a very, very complex issue. And being from panama myself and knowing how it is in latin america, even though we have a universal Health Care System, this universal Health Care System is on the verge of collapse because people cannot afford drugs, people cannot afford antibiotics. So you go to the doctor, it could cost you 2, 5, you could go to a specialist for 10, 20, but medicine is unaffordable because they are very, very expensive. Plus there are other regulatory issues and, unfortunately, we have had the case of massive poisoning and killing of people recently with newborns too because of take and problem medicines. Fake and problem medicines. So this is an issue which is affecting all over the world. And be then on top of that we get also the Infectious Diseases because most of these Infectious Diseases are endemic to the poor, the tropical and subtropical regions, so we get the case of a Chagas Disease can which is the kissing bug and then also by the sand fly. So on top of all these problems that people have to suffer cancer, diabetes, you name it they have to suffer from this, lack of electricity, drinkable water, transportation, everything. And this is having a big effect especially when we [inaudible] because they affectfect the chirp affect the children. And affecting the children what you find are children who cannot learn and who do not develop their full capacity at school. So all of this is creating a tremendous negative impact in society and also in development in which poverty is feeding poverty. So now we have made a description of the different Health Care System, we find that this issue regardless of whether it is private or public, whether it is universal or not, all countries have this problem. So what are the causes . What are the Common Elements . If we think about it, there are multiple causes for this. I mean, globally. And i have divided them into three different categories, and the first category that i have found have been structural causes. There are socioeconomic causes, and there are scientific and financial causes. And then in terms of the structural causes what happens is that most of the current Health Care System that we have today, they were created after world war ii, and then at that time, first of all, medicines didnt cost much. But also the population and the welfare of people was very different as it is to now. So what happens in many of these countries, especially in the u. K. , in the United States, in france, they had a wrong start. They really began with deficits to start with. So there were many more people, sick people, than they expected. And then a demographic explosion. What happens is that then it got complicated after a while because they never expected that the World Population was going to be this large. So this actually one of the issues that now we have been caring for, for about 60 years and is affecting us. When you come to the socioeconomic issues, after the Second World War there was a lot of increment in societal benefits in the west. And that had a very good impact in terms of prolonging peoples life. I mean, the antibiotics had been already created, and they were discovered. And then people started having a good life. But that had also complication in the sense that people became lazier, too, and more sedentary. And be they started becoming less conscientious about their own health care, and also they had to they moved to the urban areas, and people started having cars, etc. So all of that well being be welfare had a negative impact b in terms of people taking care of their own health. So they prolong their living, but the quality of living has been in many ways compromised because of all of those things. And then we have the issue of poverty in the developing world and in the poor countries as well. So, and then we have also a scientific cause in which disease have become an extremely profitable business. So we see in the next slide what i mean by this because, indeed, it has become one of the most lucrative business in the world right now. So this is a very negative impact, and i think that with these three categories, we would summarize the fact that as we have been living longer, we are fighting for resources in this world. For national resources, were fighting for money, were fighting for space, were fighting for the quality of air, for water, for everything. And we are fighting also for our own health. So when i talk about the pharmaceutical industry, this is a very funny thing because, actually, i went to school to make money out of pharmaceuticals. That was my training, to use all the scientific knowledge and then use my business knowledge to make money out of medicine. And it is very interesting when one listens in many of the debates that the claim in general when the pharmaceutical industry gets fired by this crisis, they say, well with, we have only 13 of the u. S. Spending is due to drugs. Actually, that is true but not quite because the issue is that every single intervention that every visit that one goes to the doctor represents a prescription of medicine. So even if one focus on prevention which i think is an important thing, i mean, we have to work on prevention all the time, we also need to realize that there are things which are not preventable and that even though we want to avoid to develop a certain disease, things just happen. So even prevention which is extremely important, it has its limitation. And as i will develop a little bit on this, why pharmaceuticals . Well, because most likely any visit to the doctor will represent a prescription of a drug. So that mentality even though i think that is right, we have to pay for it. So if we want better medicine and we want safer medicine, we also have to invest and there are people who will be there to make money out of this. Science and the whole pharmaceutical, medical sectors have become a base. I think people should look into that. They are part of the economy. So all of these issues about having better technology, better diagnosis, they represent cause. In order to have access to something that we have to invest. We have to put money. To recover that money and to win, we have to increase the prices. Having a very, very negative impact, economically to the country. Finally, when we talk about people say we should you exercise, we should just prevent. Fine, this is correct. We should stop smoking. We should take care of our own health. But even within prevention we need medicine. The reason why older was eradicated, is because there have been vaccines for them. So even within prevention plan, we need medicines. That is our reality. If one gets sick, even the one hypertension, something comes up. At that point the human nature is not going to prevent it. It needs to be solved. It needs a medical intervention. That medical intervention is a good diagnosis and good treatment. What happens is the pharmaceutical industry does know this. This has continued over the years, its that the price of medicines are increasing all the time. So at twice the level, twice as much as the increase of inflation. As many of these reforms have been implemented in the United States, then the strategy has been to increased pricing. So even though the industry has contributed with some money to the Health Care Reform, that money is going to be recovered very quickly because of the price increases in the United States. So what does that imply . That implies that the world isnt paying for all of these issues. If we look into these, if we look at the United States and we compare it, this is the dark green, this is the general government expenditures, the light green is other expenditures. The light is out of pocket. The United States is less than other countries. When i go to india, china and go to the developing world like india or like low income country, they depend on International Aid but also a lot of the coverage comes from their own pocket. That means what the government gives them in terms of health care, even though universal, what happens is its offset by expenditures have to do out of their own pocket. So that is a big problem right now. I would like to develop delves into what is the pharmaceutical industry. How this relates to health care and put in perspective, we have right now, this is big one of the most powerful industries. The current market right now are the pharmaceutical industry is about almost 1 trillion a year. So by 2016 people become 1. 2 trillion. The pharmaceutical industry alone will spend 35 of all what is com, of all the marketplace within the Health Care System. 75 is a lot when we think about it. When it comes to the games, in terms of equity, how much they make is way higher than in the other sectors. General equity of 23 and then the percentage of profit in terms of revenue is 20 . So this has been an industry that is gone through a lot of changes and is going in transition. To put this in perspective, these are the top 10 Largest Pharmaceutical Companies in the world. The big one is a pfizer. Pfizer is a giant of a 7 billion in sales a year. I would tell you one thing. In panama the current budget, 4 Million People in the country right now, the budget is about 10 million right now. The panama canal produces only 1 billion a year. The company produces 67 more than the panama canal, just to see how big this is. We see the market shares. They are increasing. In u. S. Market share has been about 38 . In europe 31 . So what it means is that the United States has become the most effective market. Here because of no price control of what is happening with medicare. And medicaid. So that is happening a big, big impact. Pretty much the numbers remain the same. What we see as an increased. If we look at the prior, it was 31. 5 in 2000. They have dropped to 17 . They cannot afford it. This has become a big issue. The industry right now is going through, going through a very big transition period in which it has become very difficult to come up with new drugs. By 1950 most of the drugs hypertension, diabetes, cancer in many ways. It has been very difficult to improve on them but they were very, very good. So coming up with a drug which is better, which is more effective, more affordable has become extremely difficult. What happens is that these things over the years, especially since 2003, the amount of money that is invested in all of this research has escalated to 60 billion or more, and what is happening is that now they not have new molecular entities, the that of new drugs have been declining dramatically over the last 10 years. Last year was also good because they did approve of 39 more that that was when you. Does that mean this is a trend . No. That has to do with some avenues the industry has been as mergers and acquisitions. So this is a trend in which you would say its an issue. A lot of money is being spent. So somehow this company which is 60 billion a year, somehow they have to make money. Who is going to pay for that . We as patients have to pay for that and that is clear. Not only in the United States but also in the entire world where us and unisys as a said before people can afford because of the private Health Insurance. What happens is as the drugs become more expensive in the premiums are higher. And what happens is not on the premiums are high but also the Insurance Companies create different tiers. So the more sophistication, the more difficult to treat, the more deadly the disease, more and more expensive. That is creating a huge problem in terms of the issue. Over the last year the pharmaceutical industry does have a lot of problem because of the expiration of drugs. What does that mean . Here in the United States, intellectual property law is covered by 20 years from the date of filing. So a patent last for 20 years but after 20 years what happens is the drugs become generic. Any company could produce a copy of it. So that create a little bit of a problem because over the last few years the pharmaceutical industry has lost a very profitable drug with no patent. In 2012, the price was about was 9. 8 billion. The amount of sales for lipitor will continue to increase because it has become generic. So the next one is going to be here it is about 6 billion of sales. These are very, very profitable drugs. In 2016 we are going to see a lot of drugs in terms of revenue. Excusing have lots of revenue because of expiration of the patent of about 127 billion. These are some of the experiences were going to get. These are infecting the industry and affecting implementing so they can survive. These parts are becoming half of all the new drugs because we have moved into that level. So what happens is that right now we look at the market. The oncology sector has become number one. It has become one of the very, very profitable. The price for this drug is only around 100,000. Now, if we relate that to the obamacare, to obamacare plan, what is going to happen . We have now is change. We have to ask the question going to pay for those drugs . Is it going to be sustainable or go bankrupt . Because as of now we are having problems with the system as it is. Even for people who have to question private Health Insurance. So the premiums are going higher and higher and higher. Different plans with different tiers. You will pay for these drugs . A special with an aging population which is becoming even in some countries is becoming the number one cause in some countries. What happens is even if we live longer and longer, we would all by cancer because this is a way in which the organism is progress. The business knows this and this is the reason why now with the obamacare, what happens is the ones that is going to profit the most is going to be the pharmaceutical industry. What is happening is there will be more people into your and more people needing this drug. The issue is to is this Health Reform really Health Care Reform . Is a going to be sustainable . Thats the big question. On i dont think it is. Because eventually these are only the top 10, Mental Health with alzheimers, problems with parkinsons disease which all of these, diabetes is becoming right now one of the largest causes of morbidity in the world. Because of obesity and because of other issues are having a lot of problems with diabetes. These are very common and very popular, yet theyre also extremely profitable and eventually they will have really a very strong impact in the health care. We think about genetics, but there is an issue with genetics. So many of these drugs after 20 years, what happens then is they become generics. Currently develop drugs. So even generics are not innovative so this going to come up with these individuals because we change, with climate change, with different resources. That is an issue and the economy says that 85 of all prescriptions are given in the United States our generics. But with this problem were going to find mutation after were there. They develop a process, and logistic quickly this gets technical but it is a very complex process in which we had to do discovery come in which we have to do a lot of investment in 12215 us to develop a drug and it takes about 1 billion in order to come up with a new drug, on average. Not all drugs take 1 billion to develop. If that was the case, Small Companies would go out of business. The cardiovascular sector are extremely difficult to develop because of the clinical trials. We have a face of discovery and development into have to go through the fda in order to approve that in order to get the drug. The process takes a lot of time. So in many ways these companies do need the problem is surprising of the problem is marketing. Because it is, the amount of marketing that the Companies Make is twice as much as what they been in research and development. We pay for that marketing. We pay for all of those things and theyre having an impact in their own pockets. So to make this long story short what i wanted to get at is, the pharmaceutical industry has had a lot of strategies in order to go over this development crisis. And then they have adopted pricing increase which affect our health care, price increase. They change something in the molecule so they can extend their patent, and then they look for other indications like something works for cancer, it can work for alzheimers, for instance. So to keep the revenues coming in, and theyre looking into niche markets. They are cutting a lot of operating costs and research and development. And theyre doing a lot of mergers and acquisitions. Those new molecules last year were a result of mergers and acquisitions. Some of these technologies are becoming convergence and theyre being integrated. One knowledge that belonged to one company now belongs to another company. But at the same time it could be as efficient, too. This is a shortterm trend that this will not be sustainable for a long run either. And as we can see these are some of the development of these drugs have an impact also because in the area of biotechnology we find theres about 31,000 a month, some these drugs even cost 400 housing dollars. So this is a problem that is affecting because many people, the people who would be covered for this, they will have to special insurance. The other issue is that okay, fine, if have private insurance in the United States, they could afford that may be. But what will happen to people in argentina . What happens to people in brazil . What will happen to people in france . Will they be able to afford this . Especially, or in the uk with so many restrictions. That is a big, big issue. In the United States, people say i want that because i am dying and i need this, i have the right to have it. In other countries its not that mentality to other countries, if i dont have a, i die. So we need to come up with solutions to these problems. It all boils down for ways to treat and prevent and deter it. So what is going on is that this is having a lot of problems not only in the United States, this is having problems in the developing world in which the are a lot of imbalances in terms of money, in terms of infrastructure, in terms of access to all of these things and also this issue, for the elderly used to make trips to canada because they found it cheaper in canada, thats a problem because many people are dying. Guess what . Over 90 of those medicines which are bought online or fake. This is a problem because now at least 10 of the drugs which are in the market right now are fake, counterfeited drug. What happens is people sometimes they dont know, people are desperate and they cannot afford medicine would have to split it with her spouse, and what happens is people instead of looking for fine actor, this complicates them. I was just in a forum in the hague and we need to do is treat International Treaty to fight counterfeit and take a drug. What happens is its very easy for this mafia, these criminal organizations to sell drugs to people. In developing work usually to have connection with the local government and the local people. And they are allowing this is the reason why in panama in 2006, thousands of people, thousands of people who were really killed. The National Laboratory developed a syrup that had an ingredient, and these people were killed. Recently because of a fake, probably because of the fake drug now, about eight or nine newborns were killed. So this is very sad, and its happening in other places. This is because these countries do not have a stringent regulatory system but if they had a registry system especially this mafia that introduced counterfeit drugs as generics, and the reason why they introduced the messiness because generics, once the brand name expires, the generic does not have to do they have to show that they have demonstrated the compound would have the same action in the body. We need to do something about it and we need to fight, especially because 9095 of the Worlds Health problems could be solved by generics, at least now. So they is a priority medicine list. Something we need to look into because this issue is that now the interest of many of the countries are especially in the pharmaceutical industry and not in terms of government are focused on drugs by cancer, hypertension and rightly so. What happens now is the world has changed. The vitamin has changed. The biggest threat in the world right now is resistance to malaria and other countries. Many people in general they believed okay, the problem in third world countries, well, those are problems of poor people. The issue is given the facility for transportation and communication right now, what happens is that this comes to the developing world as what happened to the hiv aids crisis. What happened with the pandemic influenza crisis. These things are spread so quickly and were not prepared. What is happening is that we are not prepared for whats coming next to i believe that i think unfortunately the world is going to succumb soon, sooner than later, to a plate and do Something Like what happened in the middle ages in which a large percentage of the population were basically killed. And that is the situation because we dont have enough antibiotics right now. The ones that we have, unfortunately, the bacteria have shown resistance to them. So this is an issue that the developed world should contribute to in order to help other countries. There are issues of neglect of medicine, neglected there are different, there are different areas that are not medicines at all. So what happens is now that regardless of whether one has universal insurance, regardless of whether people are covered, then issue, the population is always be more and more affected by one sort of another disease. People are not prepared because we changed our lifestyle. People used to run to be very active, and that is not the case and there is a food crisis. So that is an important issue. When it comes to food, a person who is not wellnourished and a person who suffers from malnutrition, then is more vulnerable to disease and their immune system is not prepared to fight whatever is creating their ailments. Its global. People should always be thinking that we live in a global community. We need to think about the development of these drugs that could help other countries that could help people in the United States, in europe as well. Sometimes the Drug Companies did have progress about providing social responsibility. But truly it is not enough. There is much more they could do, and thats a long way, especially in helping. And providing means of diagnostics because that is an issue. The early diagnosis of the diseases. So the issue in the developed world in health care has become and it is becoming unaffordable and they cannot continue that way. Even though now in the United States, we are starting a Health Care Reform, that is just a patch. It is not going to solve the problem, the issue of pharmaceuticals, development is not addressed. So this is the situation right now in which we are reforming. We have the whole Health Care Infrastructure to all of the reforms have been done in this sector. So basically to work on Health Insurance, but none of this area is being reformed right now in terms of whats happening for the developing pharmaceuticals. But what about pricing reform . Marketing reform . These issues which would not seem so obvious when we deal with the Health Care Crisis. Very powerful, the wait is tremendous because at the end of the day if one person that person needs to be treated or needs to be cheered. You do that through medication. And that is a very, very concerning issue. So when we talk about solutions to these problems, we talk about what we could do about this, first of all, we need to think about this issue. We need to find global solutions. There is no point in just fine solution for the United States or for france or for switzerland. We need to think about this globally. Even though we do these structure changes when you do think about all the development of medicine. We need to create a system in which we develop better medicine, safer medicine and make the more affordable, too. How do we do that . Simple economics. You have to find a way to lower the prices. To cut the time to develop drugs. You have to cut the pricing, marketing and all that expenditure. You need to work on a developing drug faster and also understand this is better. We need to work on prevention and education. Whenever possible. So that is something that has to do, there must be every country in the world, start in kindergarten about health care education. So that children learn about what he is what they are basically. And then have have a health care, the stress is killing people. So depression is another problem is having a big impact in the world. We need to work on prevention. We need to create a Global Campaign or so about International Economic development. We need to fight poverty. We need to fight corruption. We need to fight injustice. We need to fight inequality. It is not that diseases of happening right now but its just that people do not see the relationship between each one of them to bring all of these things together. So the people who are working injustice, they need to work in justice and health care also. Theyre fighting about human rights. Womens rights, whatever rights. They have to fight for rights for medicines, too. Site think that it is very, very important that when we think about this Health Care Crisis and we think in terms of the problem in the world because all that economies are interrelated and, therefore, health care is interrelated. And also what we need to do is create we create a better sense of humanity in the sense of the medicines, should go back to its roots. Not so much about being a way to make money. It is something that really affects the life of people. So there must be a change in mentality of going to the doctor but also to have someone who is compassionate, really compassionate, and to actually wants to really work towards the betterment of the health education. That requires a lot of thinking and reform. What we need to do is to work on a Health Care System. It will depend on country to country. In the United States because the United States is leading in terms of health care, Health Care Reform, in terms of pharmaceutical development come in terms of investment that we provide in science and technology. There are many ways in which would contribute. More collaboration in terms of the economy and also the industry. Many people sometimes have a negative attitude towards having an industry relationship but at the end of the day what we wanted it is we need to have all these ideas in laboratories into medicine. Something is useful. As i said earlier on, all of these feet on our development of people self. We need to work on pharmaceutical industries, and also they need to become they have to make money at the same time it cannot be as it has been so far in which the idea is to develop blockbuster drugs which constructs the cost, that drugs that sell for 100 billion or more a year. We need to get a different system in terms of intellectual properties in which the drugs will be developed, that should be accessible. I think we need to find a way to improve on that because eventually as i said earlier, 9095 of the developing world Health Problems could be solved with genetics. So we need to make sure that the drugs are reached t do those people get in helping them we help ourselves. And then i think the key issue is working with International Economic develop and. Truly, giving donations to people to invest money in after if that money will be wasted. If we dont work, if we dont worwork in education especiallyf we dont teach people that such and such sector is because of this disease. Or at least, it is a very difficult to work with some of these people. It has been an expense of myself. Because when i talk to people in africa all the think is one wants to profit from them somehow and one wants to take advantage of them. We need to work on the Economic Development but all of these things have to work hand in hand. If we have to work of access to water went to work in access to food. For pregnancy, for visits to the doctor. That is something that is required, but also medication so they dont hemorrhage. So all of these things need to be sort of a health care plan. And also especially to fight corruption. Because that is one of the main problems in the building world, and that is something that has a lot of problem beside access to medicine. So when it comes to the United States event, this Health Reform in this country should be about, more than only Health Insurance reform, which is not going to work, should be prevention reform, pharmaceutical industry forum, intellectual property reform, tort reform, medical education reform. At me, the cost of education here in the United States for doctors is so high. Students have to get high loans Energy Finance their studies but then they have to recover that money when they become doctors. So its a money driven system that unfortunately is not healthy whatsoever. And we need to work on toward reform about all these new suits. There must be a limit for that situation because all of that actually is part of the Health Care System. All of these issues, special that comes is the easiest way to come up with a better system to develop drugs and to lower these costs. We need to integrate knowledge. We need to collaborate more and have a lot of cross more efficient. And the issue is to work on all of them together. So there is no point in doing one thing. We have to work on all of them in order for them to work. If we dont work on these we are going to see an increase in longevity. Were going to continue fighting for survival, basically because were too many people on the planet already. So all of those things represent, unfortunately, a consumption of resources and we have to see of each one can provide assistance. I know that i focus more on the pharmaceutical problem i think this is the real essence. About Health Insurance is easier. Even in the United States we go to other countries the Health Insurance issue having access to the doctor, going to university to get medical dream is not expensive at all. Anyone can be a doctor but anyone could be a lawyer. The issue comes from how do we find a better treatment for the system . I think this is a big issue and, indeed, ive already developed a system which was probably in nature review discovery on how to do that and based on collaboration and it is a core model and i developed the way you have a sample of anticancer drugs developing for the treatment of multiple myeloma. How they did this efficiently and with little money. So if we adopted a system similar to that, if government were able to government something of this sort, they were and they create policies which are going to be extremely South Entrance of research and develop and working on this area. I think that were going to see a huge difference in educating people in prevention as well as in the betterment of Health Care System. I would like to finish this talk with two things. One of them is that this beautiful quote that i found from a painter. This is resizing the greatest thing. There are too many intelligent people all over the world who only talk about problems but who did not act. That should be true for medicine right now. It is about reviving the layperson access to a more noble concept of humankind. And with that, i finished. Thank you very much. [applause] thank you. If you have any questions ill be happy to answer them. Yes, sir. [inaudible] when a person in a third world wants to come, say, to the u. S. , does the u. S. Require them to have the kind of examination to get a visa that we could be sure company, some disease that may take weeks to find out for sure that they dont have the disease . In general, no. To apply for a green card i think hiv was required and to think now president obama has banned that. I would say that would be part of any other countries of quarantines. But in general for instance, when one applies for visa to the United States, it is not required. What is required is basically the amount of money that the person has in the bank. [inaudible] spent any idea about how to prevent the diseases from coming into the u. S. If they dont make sure they dont not only from the developing world to the United States, also member some people go from the United States and visit of the country. Sometimes they get exposed in the brain them back. Other questions . On one of your sludgy pointed out generics are lacking in many parts of the developing world. I dont know if youre aware of this, but theres a global shortage of generic drugs, including the United States. Absolutely. There are over 300 drugs on a drug shortage list thats administered by the American Society of Health System pharmacists, including cancer drugs, drugs for ovarian cancer, risk into, leukemia, and aesthetics, anesthesiologist and the United States cannot get propofol because its manufactured by a single supplier near chicago. And this whole system was created by an anticompetitive system of hospital purchasing in the United States. They are called Hospital Group purchasing organizations. They control the entire supply chain of drugs that are used in hospitals, clinics, Outpatient Facilities and so forth. And there was a statute that was enacted in 1987 that someone rammed through congress in the dead of night called the medicare antikickback safe harbor, that exempted these gpos from criminal prosecution from taking kickbacks from vendors. So basically a system of savings, a system of, like a harvard coop type of arrangement that had been in place about 1910 was the whole Business Model was the first to the point where we have the beginnings of pay to play system, in which the vendors, including the generic Drug Companies pay huge fees to get exclusive contracts to sell the product to 5000 american hospitals. So the number of suppliers are many of these drugs and this is an issue right now. There is a lawsuit against pharmaceutical companies. Said a google alert for drug shortages and youll get english language from all over the world spent in panama we are having that problem right now. Spent were talking about drugs that have been around for half a century that event effective and still are effective for hodgkins disease, for ovarian cancer. Your presentation focused more on the innovative branded drugs, but as you of the slide points out, 9095 of the Worlds Health care problems can be solved with generics. And which are not able at all. I want to add to what youre saying because right now there is a problem, some pharmaceutical companies are being sued because they get a deal behind with the generic drugs. They say, listen, dont become generic. Generic. That is a big issue which is affecting and which is accentuated the point youre making right now, absolutely. [inaudible] everywhere everywhere. [inaudible] generic drugs floating around the world to places that will pay the highest prices. Spent someone had a question over there. I want to address several points you made. Eight, not everyone who is professional comes off so quickly as a professional like engaging in the paper chase. These doctors and these professionals and hospitals are overworked. They cannot continue dealing with populations who feel that they are equal or superior to the doctors understanding. So they just write off and say next nation. This is logical because these men and Women Deserve to children and families of their own and continuing lives of their own. Number two, 50 of the drugs that you mentioned, 13 for hypertension, 23 for mental illness, et cetera, et cetera, are all engaged in addressing people who have cultural problems in this culture. The ada, attention deficit disorder, for example, has doubled in this country in English Speaking countries in 10 years. Women expect used to be in balance with males, have not increased due to a canadian study. Many of these problems, for example, the book about Substance Abuse, points out that the american right at the agency involved with Substance Abuse dictates how the canadians can have the australians, how the british deal with those populations and those problems. Even those populations have been proven to be more effective. I just have two questions. Does your agency deal with the problem of water such as they are doing in ecuador about the water coming down the stream so people get clearwater . And is your agency deal with those anxieties that refrigerator populations have acquired through cultural activities by taking certain types of food that may have worked 100 years ago that dont work today in this Culture Climate . Okay, so the question would be, if i the colombians and try to get some sort of coronation effort on your part equal to the environmental agencies a natural conservatory, et cetera, et cetera, to deal with water problems in these countries who are a special to international organizations, some ngos that are really focused on this. But, unfortunately, at that point what is failing is the population of the public. So the ngos and the systems are there to work. But then it does not become a priority. Therefore, it does not become as effective because there is very, very little education in terms of people, okay, getting involved in that. And when it comes to Natural Resource i would tell about panama to panama is a country that is one of the largest variety of plants and animals. What we have seen in the last few years, actually i thought about the last five procedures has been a destruction of our resources. And now with construction of this electricity plant which are enforcement based on water so there is no water, special in the indigenous population because of this issue. So even government is not helping much, and again, the answer to question is that our local and regional agreements and international provisions. But then the problem is when it comes to the mathematician because some governments do not do their fair share. They dont have like a Central American clearinghouse spinning in terms of pharmaceuticals there are some areas that work together. And latimer, Central America or south america. But in some others there is not. But again, each country lets its own role because of their sovereignty and because of they know their issues better. [inaudible] another question. Hello . Thank you. I appreciated the presentation and appreciated the perspective. One of my questions deals with the fact that i believe that many of us dont think systemically, are not aware of all the factors, so not aware of all the interrelationships. And im just wondering, it requires to be able to work with those. It requires expensive, which apparently some of these examples show there is some conspiracy but it requires feedback. It requires time anything about factors are affecting each other. You know, and like you said, this cultural issue. How do you see the viability of polling the course a little bit so that there is some loosening . Absolutely spent and more global systemic thinking. A ghost education. At that level, two different levels. One is the ngos and the others are the regional governments. The government get intimate health care education. As a course, in some countries they teach sports or mathematics or biology, whatever. The same thing could be done. That is what im trying to do. I have to spend a lot of my time in the last six months in panama. I do a lot of volunteer work and philanthropic work, especially working with the indigenous population. Educating them about the same time of lecture i gave today about the importance of science, the relationship so that they know. Special because i believe the way to do this is through education. When it comes to the ngos i think that is a very powerful way to do it. But then again the people who work, they should also be trained. That is an issue that sometimes people are not well trained and they cannot do this relationship. It has to work on the governmental level, and ngo. And also i think that science, pharmaceutical companies should give more about this. I have told them this. I said you need to clean up your image. The image is tainted because of this issue. I think there needs to be more work on this issue. Thank you. [inaudible] could you comment on the role of the Insurance Companies . I just and the Biggest Companies in this country. Obviously in general people claim to Insurance Companies for this crisis and for this issue. At least from my perspective i will tell you my perspective what my perspective is but its like they are not as evil as people portrayed in because theyre like the middleman. So it is a very opportunistic system in which they will try to get away with as many claims as possible. So they will try not to that is their role. It isnt economic, statistical system. So they play the best and thats it. They are there to make money and to game the system. It is mathematics. I dont want to say, oh, you know. But i dont feel that that should be the other conditions as we see the pharmaceutical him, the prevention element is deeper, working deeper. They are basically profiting out of the situation which is already bad. So that is my take on it. Do you have a statistic for the children who died . What kind of diseases do children die of most in panama, children under five. The major issue in panama with children would be i think malnutrition would be one of the major problems in panama. Malnutrition. There is a lot of malnutrition in panama and that has a lot of problems. I think in such as diseases i would say would be the exact numbers i would have to look it up and then i will give them to you if youre interested but i think it would be in that line of Infectious Diseases and malnutrition have an impact because they would not be able to assist someone with an infection. My other malaria and panama, is not as big. We do have malaria. We still have malaria in panama but we also the lot of genetic disorders and nothing is being done for the people. Right now im creating a foundation for the diagnosis and treatment whenever possible of genetic disorders because there are no resources there and the government is not interested in investing at all. It is so sad. But if you like to get more, the numbers, i would be very happy to get back to you with those numbers. Can you give us specifics, a specific solution providing corruption in developing countries speak with this. Last month i was in the heyday. I was at a forum, and when it comes to corruption it is a cultural despotism Companies Culture seems to become the first major. The system cannot work without corruption. Unfortunately, the case of my own country i can, france, one of the most corrupt action in the world, very sad. And so we need to work, especially ngos, like the world just as project can ngo which is a notforprofit that is interested, especially in the rule of law, and habitation of the law. Then we need to work with them and we need passionate ngos should work generally. After that the government should be able to incorporate then come and people, especially people should create the pressure after this proposals are employed. That is their role as citizens, to. From my perspective, that is the way to do it, to educate the people through the ngos so that they create pressure so they eventually are implemented. A few years ago i needed some foot cream and a body here in a pharmacy. Is a very wellknown product. I paid over 80 for it, and about a year later i bought it in a pharmacy in germany for 14. Yes. So who is making this huge profit . Who is in the United States you mean . Yes, it is the pharmaceutical industry because the prices go high prices first towards the first, for the first distributors, but for the wholesalers. They have increase prices to wholesalers so that the wholesalers failed it higher but in the beginning for our expensive. Yes, and that is that is the way in which the system is here, unfortunately. Stomach how is a really a cultural problem . The people on top are not the ones messing themselves a. For instance, you have one of the politicians trying to keep a hospital open,. [inaudible] five hospitals have been closed. They served the poor. That they are close. So people dont have access to the kid. The homeless and more homeless coming. They dont have access to anything. I once lived in france where you had one of the best medical system for everything, but they teach you how to eat. Thats education. They have people make fun of the food but they teach be blood appreciate food, canno how not t so much, how to eat well. Thats education. Has nothing to do with the culture. People who need it or not the ones giving themselves nine medicine, not the ones who are they will not read without the. They will not put on the level they can read your how can you educate them . Not so much culture but the people on the top, give no weight to fight them. They wont do anything for you. The budget in hospital for a little while, operate on you and let you go. You see it all the time. I agree. Is difficult but its intent of the culture, i think the overall culture, whenever you go, instead of drifting clean water you take data rate. It is the system and also the fast food. It gets they have become very complicated. This is a very complex issue that would have to explore, this historic issue of not only the United States also the west and how with the Industrial Revolution, and all that kind of stuff. Its a problem that has very difficult, but i agree with you. And the last question . Could you comment on socalled medical tourism . And to what degree that they contribute to a lowering of the cost as a percentage of gdp of advanced procedures in the west when they are performed in low labor cost economists . It is happening actually right now. In panama, i use the example of panama not only because it is my coach but because its an american economy. What happens is if one can afford it, one would have access to health and medicine which is spectacular. Its like the best. What happens is many of these it is affiliated to johns hopkins. What happens is many of these patients, special ones with latin roots or who know the system will have visited the country before, they go to and they get treated and they get the operation and they did an excellent bargain. I mean, truly. Because whatever they will get here, there they get because they have excellent doctors. Again, that is known to very few people and eventually one cannot think of it as a general thing, and it is unsustainable because, i mean, it is happening. Why should i wait when i could try to develop it in my own country. And this is an interesting case because cuba, for instance, p recently came up with a drug that actually helps avoid amputation of limbs of diabetic patients. So now pharmaceutical companies, and i think it is glaxosmithkline, if i am correct, are interested in selling that drug in the world. So it is, it is happening. So why not work on that . Im from panama, and true, i am from panama, but i was trained in the United States and in europe, and there are smart people and people who are willing to make a difference in the world with their work coming from developing and emerging economies as well. So why not government use their own resources . Why not they train their own physicians, their own people, and then instead of misusing the funds, why not to create a whole culture of research and development and activate the pharmaceutical industry which would be extremely important because that becomes an asset for the economy. So if i develop drugs, even genetic drugs, i create something for the economy, and i also create something for my country and for the other countries as well. So i think that that could be even more profitable and more influential from the Economic Growth perspective in the developing world. Yes. [inaudible] the whole world is falling into the ocean. Usually in these its like a tip, and what you get is reaction now. And what i see, im very conscious of all these trends like education whether the newspaper or tv, but people are taking grassroots movements and taking it on their own. It doesnt have to do with the government. And theyre very conscious of produce now, theyre eating better. You see at lunchtime everybodys eating salads, i dont know. But i see positive news that kind of tips it yeah, absolutely. People are fighting. It is happening. Yes. You know . Yes. It is happening. That was the purpose of the first quote in which people are becoming more informed, so they are fighting for their rights x that is the way to do. [inaudible] im sorry . It sounds like youre interested in, like, a oneworld medical system. Like you said, if somebody in cuba or panama developed something, they should share it with the world. I think so. I agree with it because in the end, i mean, we are fighting for the same resources, and we live on the same planet. So it could not be that only some people could have access to and others just whatever, you know what i mean . That is your problem, just deal with it. I dont see but we live in a world thats kind of resistant to that. I mean, when clinton or obama or anybody says, i mean, like you were pointing out like in canada or france or something, they have a Health Care System for everybody but all of the negatives and they pay higher taxes. I pay 35 in taxes, and i dont think i get anything in return. I wouldnt mind paying 35 of whatever in taxes if it included health care or Something Like that, but i get nothing for my high taxes and Everything Else that im screwed out of in this country. And i havent had medical coverage for years, and and any type of if i go to the emergency room or any doctor, i cant afford it. And im somebody thats worked hard all of my life. And i just, i get nothing in return. And that is the situation of millions of americans, indeed, many people who actually do work and they cannot afford Health Care Insurance or health care. So its a big issue. But what i think is eventually, i mean, the situation right now is unsustainable. In five years from now the government would have to work on giving People Better tools to take care of their own health too, you know . That is a big challenge. And, but, yes, theres a lot of work to do. I will someone had a question and then after that, i come back to you. Okay, sir . I just wanted to say in your country instead of using the water to feed the people, they should use the ocean water to run the plants. Its just a suggestion to you. Thank you very much for the suggestion. I am not so sure whether the president will be happy, but thank you very much. Thank you. Yes, and you have my question is i dont know if its in your research, come across or considered or reviewed the interrelationship between dental work and health . Oh, that is very important. And, indeed, its interesting because a few years ago i was working i was talking to a colleague of mine whos a geneticist as well, and then he was at bu, boston university, and then for whatever reason he didnt know where i was from, and he say where are you from . I say, panama. Panama, that is very interesting because i actually am working in on a project in panama about these people who have gum disease, but its genetically inherited. So i said, really. And there is a big relationship, and ive seen that, some countries do not pay enough attention to the dentist. If one doesnt take care of ones teeth, one could have problems, bacterial problems and Kidney Disease and some other type of complications. Well, the structural setup [inaudible] over there. Yeah, exactly. Absolutely. It should be yes, it should be integrated. Unfortunately, when one gives a talk like this, one should just try to get to the core of the problem because its so complex on so many issues. But in the holistic Health System that would provide also for people going to the doctor and feeling well about it. And i dont see that many people have that attitude comparatively to other world. So it should be mental, psychological, it should be spiritual, too, because many of these diseases cause loneliness, of not having a reason to live, of feeling sad. And when ones Mental Health is not good, then the rest is not food either. Not good either. Medicine should also provide people with a sense of spirituality, of faith and of mutual love. And with that, i think that i close. Thank you. [applause] [inaudible conversations] [inaudible conversations] taking a look at some of the prime time programming across the cspan networks. Join us at 8 30 be p. M. Eastern for booktv. Our focus will be on law and the courts. First up, author marcia coyle and her book, the Roberts Court the struggle for the constitution. At 9 30 its thomas healy and the great dissent how Oliver Wendell holmes changed his mind and changed the history of free speech in america. And at 10 30, jess braven talks about his book, the terror courts. Again, our booktv prime programming gets under way at 8 30 this evening here on cspan2. Meanwhile, tonight on cspan3 its more from American History tv. Tonights topic will be George Washington. At 8 p. M. , George Washington as an intellectual. From our lectures and history series, the speaker is denver brounsman of George Washington university who talks about the first president s lifelong interest in learning and commitment to education. At 9 15 p. M. , its washingtons presidency. Also from lectures in history, George Fox University professor carrie irish exam examines the presidency of George Washington who was inaugurated in 1789. And at 1025 p. M. , washingtons defeat in brandywine. Author bruce modet talks about a lesser known battle which p ended in a british victory over general George Washington at chazz ford, pennsylvania. In what was the largest land battle of the conflict. American history tvs look at George Washington begins at 8 p. M. Eastern on our companion network, cspan3. The world is on fire, and things are moving extremely fast. Computer science, my education expires after five to ten years, five to ten years everything is new. The cloud is new, facebook is new, twitter is new. A lot of new things. Historically, weve sliced human life into basically four slices, one is a play phase, then a learn phase the next 20 years, a work phase and a kind of resting phase afterwards and eventually dying. What i think we should be doing is we should have them all at the same time. We should play, we should learn, we should work and rest at the same time because the world moves so fast be today, we cant really afford having a single silo of education, we really have to stay uptodate. New years day on cspan just before 1 p. M. Eastern and throughout the afternoon, ceos of udacity, twitter and others on the future of higher education, robotics and data as the new Industrial Revolution on cspan2s booktv, unflinching courage, Kay Bailey Hutchisonon the women who helped shape texas. And on cspan3s American History tv, daughters of civil rights leaders and a segregationist share their memories of the Civil Rights Era at 8 30. Next, remarks from the chairman and vice chairman of the Bipartisan Federal Commission on longterm care. They recently outlined the groups report on reforming the nations longterm care financing and delivery systems. They testified before the Senate Special committee about the importance of getting more people to buy such insurance policies. Senator bill nelson chairs the committee while senator Susan Collins serves as the Ranking Member. This is just under two hours. [inaudible conversations] [inaudible conversations] good afternoon. Longterm care is an issue that comes up repeatedly. Its an issue that many of us not only have a legislative interest in, but a personal stake as well. Many of us have spoken in prior hearings about caring for our parents as well as planning for our own futures to alleviate some of the decisions for our children. Currently, about 12 million americans have longterm care needs, and that number is rising rapidly. Across the country middle class families are going through the same tough ever tough choices on how best to care for elderly parents. Medicare and most traditional Health Insurance plans dont cover longterm care expenses. And while private longterm Care Insurance is available, most people dont have it because they see longterm care as something that theyll never need. Well, additionally whos going to deliver longterm Care Services . Do we have the right work force with nursing home costs rising . Some families are turning to assisted living facilities or trying to provide care at home. All of these situations raise additional questions and potential challenges. All of us have heard from constituents about the trade tradeoffs that they have to make to provide care for their loved ones. Give you an example. Karen from englewood shared that she is a fulltime caregiver for her 79yearold mother who is paralyzed after a stroke. She wrote that every cent i have goes into helping my mother at home. Her mother cannot cook, clean or even wash herself. So im sure that many of our colleagues here would share similar stories because theyre obviously quite common. More than half of the longterm care in this nation is delivered through family caregivers. Cbo estimates the value of such care is roughly 234 billion annually. And despite these enormous costs, most americans have done little or nothing to prepare for their future longterm care needs, according to a recent study from the scand foundation. So our Current System of providing longterm care is unsustainable for both the government and for families. Cbo predicts that expenditures for longterm care are likely to increase from 1. 3 of gdp to as much as 3. 3 of gdp by 2050. But as we continue to struggle to find ways to address it, lets dont be naive to believe that we are going to find a solution in just one hearing. But we need to start. The panel that we have assembled will give us a wide array of ideas for us to debate as we strive to find a bipartisan solution. And so i want to thank our witnesses. I want to thank our bipartisan coleader, senator collins. And, senator collins, if you would share with us. Thank you very much, mr. Chairman. As youve indicated, more than 12 million americans rely on longterm Care Services and support to perform the routine activities of daily living and to maintain their quality of life and their independence if possible. I appreciate your calling this hearing to explore the options for improving our current longterm care financing and delivery system. As the senate cochair of the Bipartisan Congressional Task force on alzheimers disease, i am particularly concerned and sensitive to the complex care needs of alzheimers patients and their caregivers. I, therefore, particularly look forward to discussing ways to provide more support to the 62 million family caregivers who, in 2009, provided an estimated 450 billion in uncompensated longterm care, more than double the value of all paid longterm care. Longterm care is the major Catastrophic Health expense faced by Older Americans today. And these cuts will only increase as our nation ages. It is not just that there will soon be a greater number of Older Americans, it is also that Older Americans are living longer. Americans 85 and older, our socalled oldest old, are the Fastest Growing segment of our population. And this is the very population that is most at risk of the multiple Health Problems that can lead to disability and a need for longterm care. At the same time, declining birthrates mean that there will be fewer family members and paid caregivers to care for our nations growing aging population. Today there are approximately seven potential caregivers for each person over 80 as this chart indicates. By the year 2030, there will be only four. And by 2050 the number drops to fewer than one in three. Fewer than three. As a consequence, more people will have to rely on fewer caregivers. What does that mean, what are the implications for the quality of care that will be given . It is clear that we have to do more to support family caregivers and to recruit and retain a robust and competent longterm care work force. While there is a need for both public and private financing of Longterm Services and supports, i do believe that we must do more to encourage americans to provide for their own longterm care needs. Many mistakenly believe that medicare or their private medical insurance policies will cover the cost of longterm care should they develop a chronic illness or Cognitive Impairment like alzheimers. Unfortunately, far too many do not discover that they simply dont have coverage until theyre confronted with the difficult decision of placing a frail parent or loved one in a longterm care facility and face the shocking realization that they will have to bear the costs themselves. Americans should consider their future longterm care needs just as they plan for their retirement or purchase Life Insurance to protect their families. Private planning for longterm care will not only provide families with greater financial security, but also will ease the growing financial burden on the Medicaid Program and strengthen the ability of that program to serve as a longterm care safety net for those americans most in need. Again, mr. Chairman, thank you for calling this hearing, and i look forward to hearing from our witnesses. Out of a spirit of beenough sense and felicity, i would in the spirit of the season extend to our two most distinguished Committee Members the opportunity to say a word or two before we turn to our witnesses. Well, let me just say that, first of all, i appreciate, mr. Chairman, you holding this committee, and the Ranking Member collins, because its such an important issue. I come to you, come before you as a son, a grandson and a former governor that dealt with these matters very personally. And i can tell you theres not a greater thing we can do to add dignity and respect to a persons life as they grow older than to try to have them live an inget lifestyle independent lifestyle. My grandfather was 85 years of age, and one time i stopped and she was very, very lethargic, and i said, grandma, she said, oh, everythings okay, honey. And i could tell something was wrong so i said, mom, you ought to go up and see grandma again because my mother always wanted her to live with us, and she always wanted to be independent. This one time she said, okay, honey, ill come down and visit the kids. She stayed 15 more years, lived to 100 years of age. [laughter] and the thing about it, she was lonely. She was poor nutrition. She was trying to feed herself, and she wasnt cooking properly. All these things. Its right before your eyes, and you dont see it. And when you do, you see the difference of the life it makes. I took that with me, and i became governor, and the main thing i wanted to do was create programs that drew attention to how people could live independently. We started some programs in west virginia, im not sure if other states had ever started them before, but i used my lottery funds and table games licensing fees, and 100 went into longterm care for independent living. And we called it fair. And what the fair program basically all it said was whatever you could pay, you paid. We helped you. We sent people in to let you live independently. A lot of people didnt have family support. Theres so much we can do, and government doesnt have to do it all. But we have to be the best partner theyve ever had. We had a Lighthouse Program that allowed longterm care needs to remain in the home, and the families with alzheimers at homeless pit, you just respite, you just need a break every now and then. There are some compassionate things we can do, and it doesnt break the bank to do it. Im so thankful to you dedicating your lives to helping those. My mothers 91 right now and if it wasnt for my sisters and my nieces who take care of my mother, wed never put her in a nursing home. Thats where she wants to be, and most people dont. If they dont have the sport support, we have to give them that support that they can live independently. Youll help us do that, and we look forward to your testimony. Thank you. Senator scott. Thank you, mr. Chairman. I can tell that its a Holiday Season has begun, were sitting democrat, republican, democrat, republican. This is an odd thing for us in the senate im feeling lonely over here. [laughter] i just didnt want to get to your left, sir. Youre welcome anywhere anytime, senator scott. Thank you very much. Okay, well work it out in the second half. I will tell you that, for me, as senator manchin has talked about, the issue of longterm care is certainly an issue that i take seriously and have had to experience personally. My grandfather at 77 when she passed on april 29th, 2001, she had both parkinsons and alzheimers. My family, thank god for my grandfather, my mother and my aunt who spent an inodd nate amount of time taking care of her at their home. Fortunately, we had the resources to do so. Unfortunately, there are a lot of folks of color specifically when you look at the demographic background, unfortunately, minorities pa pay a heavy price for not having a resources and the adequate time to care for their loved ones. And so we had a unique experience in a very special way. I think its a wonderful opportunity to care for those who took care of you. Theres a old saying that youre twice a child and, unfortunately, weve experienced that, and its a very powerful picture of those of us who have had the opportunity to care for our loved ones. Thats why i think this issue is incredibly important for our cup. My second experience has been a guy in the Insurance Industry for the last 23, 24 years where i sold longterm care policies and understand the adls and the activities of daily living and how many people have not been properly educated on the opportunities to make a decision when youre young enough to make that decision so that the pay off is you dont exhaust all your resources trying to get down to that 2 or 3,000 level where medicaid kicks in. In South Carolina that expense has been a 1. 2 billion medicaid has put out trying to help folks who have exhausted all their resources. So to have a conversation about where were going as a nation and how this government can play a role, an important role, i think, is a very important decision. Thank god for a chairman and the Ranking Member who have the foresight to put us in this position, and i look forward to having a robust discussion about the future opportunities and creativity in the marketplace that will provide the type of resources and future planning that gives us real hope that more americans will retire and live for the rest of their time in retirement with dignity to include the life, the last years of their life. Thank you. Thank you. We are going to start with ms. Anne tomlinson. She is the Senior Vice President at avalere health. She will set the landscape on what its currently like. And then were going to hear from members of the longterm care commission. Theyre going to share. Bruce chernof, dr. Bruce chernof, the president and ceo of the scan foundation. Dr. Chernof served as the chairman of the longterm care commission. Dr. Mark warshawsky, were going to hear from dr. Warshawsky, adjunct scholar at American Enterprise institute. He is the commissions vice chairman. And then dr. Judy feder, one of the commissioners of the longterm care commission. Dr. Feder is a professor at georgetown Public Policy institute and a fellow at the urban institute. And also served at the pepper commissions staff director under my former colleague of which i was the president of the Claude Pepper fan club [laughter] and she served for Claude Pepper. And by the way, i mean, there was an example. For those of you that were not here in washington in that era [laughter] Claude Pepper and Ronald Reagan would go to it