Our chair chairman nunes for your leadership on this matter. Today i rise in support of h. R. 1560, protecting cybernetworks act, a bill im proud to be an original cosponsor, a bill that was unanimously voted out of our Intelligence Committee. Again, i want to commend both the chairman and the Ranking Member for their leadership. It is an honor to serve on that committee where we try on a daily basis to be bipartisan in our efforts to protect the homeland and to secure our National Security. This critical bill is both bipartisan legislation, which encourages the private sector to share cyber delet information which will cyber threat information. We are hearing about another company being hit by attacks. This costs our economy billions of dollars and threatens our National Security and jeopardizes every american personal, financial information. This bill takes a very important step towards addressing this emerging National Security threat without compromising the privacy of american citizens. Fostering an envirlte where companies can voluntarily share information with each other helps american businesses defend themselves against cyberattacks and helps them protect Consumer Information and privacy. Additionally, twoway information sharing with the federal government helps improve the federal governments ability to protect all americans against cyberdelets by disseminating information. I know is some continue to criticize this bill and all cyber bills as violating our privacy. I must assure you that this bill is a vast improvement over the sister bill that was entered and passed this house last term. This bill includes many more privacy protections that werent in the original bill. The most important of which is the requirement for two scrubs of private information, one by the private sector before sharing that information, and one by the government before sharing it further. There is also now a civilian portal. No direct sharing with n. S. A. A very narrow set of government use provisions, and a clear and legislative prohibition against such surveillance. Let me repeat, no provision of this bill provides any surveillance authority. Im encouraged by the strong showing of bipartisanship and as we Work Together to address the emerging threats to our National Security, i urge my colleagues to join those of us who are members of the Intelligence Committee as well as this administration has said that it also encourages a vote in support of this bill. I urge my colleagues to support the efforts and vote yes on h. R. 1560. The chair the gentlewomans time has expired. The gentleman from california, mr. Nunes, is recognized. Mr. Nunes at this time i would like to yield two minutes to the gentleman from michigan, mr. Trott. Mr. Trott i rise to speak about the need for a stronger cybersecurity efforts in our country. Personal data flows through the internet with great speed and data about people is gathered in an instant. The use of social media has opened up our lives and this is the same world where hackers steal millions of personal records from people in our distributes. Most members of congress have been affected by hackers. Internet criminals pose a dire threat to our government on the local state and federal level. The federal government has the resources but our local municipalities do not. Five southeast michigan counties, living ton monroe oakland, washington, wayne in the state of michigan came together to build the cybersecurity assessment for everyone. It provides a strong point for governments to begin assessing their cybersecurity needs and taking steps to respond. The assessment is an excel download. I commend these local michigan governments for committing the resources to develop such a tool and encourage my colleagues to Work Together to find the right solutions to fight cybercrime bypassing h. R. 1560. I yield back. The chair the gentleman yields back the balance of his time. The gentleman from california mr. Schiff, is recognized. Mr. Schiff i yield two minutes to the gentleman from rhode island, mr. Langevin, one of the congress leading experts on cybermatters. The chair the gentleman from rhode island is recognized for two minutes. Mr. Langevin i thank the gentleman for yielding and madam chair, this has been a long time in coming. When i served on the Intelligence Committee in the past two congresses, i worked closely with chairman rogers and Ranking Member rureptcomberger and their legacy is evident in this fine bill. I would like to commend chairman nunes for rising to the challenge as the new leaders of the House Permanent Select Committee on intelligence and producing an even better product, particularly with regard to privacy protections. It also provides statutory authorization for the center the president has created to provide comprehensive assessments of cyberdelets. While the protections are narrow could be important to understand that information sharing is not a silver bullet. It will be important work to be done to improve our nations cyberdefenses. Passing an informationsharing bill will get us significantly closer to being much more secure in cyber space than where we are right now. Particularly when it comes to protecting critical infrastructure. After careful study for better part of a decade, i can firmly say that this bill marks a meaningful step forward. Let me congratulate the chairman and Ranking Member of continuing with this bipartisan spirit that has shown the cyber the house returns for legislative business tuesday. They will consider a series of bills. On wednesday, the chamber hears from japanese Prime Minister shinzo abe in a joint meeting of congress. It is also possible this week that members will consider the 2016 budget resolution reached between house and senate negotiators. The senate meets tomorrow to continue debate on a bill that would give Congress Oversight of an iran nuclear deal. Later in the week, the chamber holds a vote on president obamas veto of the resolution of the National Labor relations board. As always, you can follow the house live on cspan and the senate live on cspan2. Earlier this month both chambers passed the socalled doc fix. More on that now from washington journal. I do not think you can blame her for taking the position her boss did. Washington journal continues. Host on your screen is dr. John noseworthy, president and ceo of the mayo clinic. He is in rochester, minnesota. Dr. Noseworthy, the socalled fix doc fix law was signed into bill. Sign into law. How does that affect you . Guest it takes the uncertainty out of yeartoyear payments of medicare payments to Health Care Organizations and puts us on a path to moving to pay for value Better Outcomes for our patients rather than pay for the volume of services we do. We think this is a step forward in the right direction. This is a path we have been advocating to the government for some time. Host how much of your funding, dismissed, deals directly with federal payments and the federal government . Guest approximately half our patients are receiving government payment for their medicare services. That is across our campuses in the upper midwest, florida, and arizona. A little more than half of the services we provide our for patients over age 65, he could as generally have Greater Health care needs. Host howell has the Affordable Care act, now that it has been in place a couple of years affected the mayo clinic . Lets put the numbers on the screen so we can get viewers involved. Guest of the Affordable Care act has done one thing rather well. That is to get more americans insured. That has been something we have been advocating for and supported. We think patients should have access to health care. The Affordable Care act on its own and the changes in the Health Care Marketplace has affected the mayo clinic quite a bit. It has placed downward pressure on reimbursement for health care, not just from the government pay, but in the private sector. It has driven Many Health Care groups to consolidate with others and form large Health Care Groups around the country. We have taken a different path from that. In a sense, it has been a good thing. Driving us all to create a sustainable, highquality Health Care System. Health care reform is not done yet. We saw this coming for about five to seven years before the health of the Affordable Care act was passed. We put together a strategy so we could be successful for our patients, regardless what happened in the external environment. That allowed us to make important, strategic investments, which are paying off for our patients. Host such as what . Guest we saw that there would be a drive to increasing the scrutiny of outcomes for patients. How well was health care being deliberate, where we bringing Cutting Edge Services to our patients, where we providing more efficient care more quickly getting accurate diagnoses and getting people out of the hospital more quickly. About 10 or 12 years ago, we ramped up engineering efforts to drive up more quality and value and more efficiency into our already efficient systems. The other thing we did, quite different from what others have done is said that mayo likes to share what we have with others. It has been part of our heritage last 150 years. We took advantage of the digital age and digitized our knowledge into tools that physicians and providers could use. We created an Affiliate Network with 32 sensors, who subscribe to mayo clinic knowledge so they can provide better care locally. That was our answer to the merger and Acquisition Strategy we knew others would go forward with. We thought that would provide better patientcentered care. We were not sure that a large consolidation would do that. It has proved effective. Nearly 90 of the patients that receive mayo knowledge from their positions across the country can stay home and not be transferred to a large center like mayo clinic. The 10 or 12 that need to, we know a lot about them. Host if you could, give us a snapshot of the mayo clinic. One of the revenues, number of employees, can anyone go . Guest we just celebrated our 150th year. We started in rochester, minnesota, our home for the last 150 years. We branched out to phoenix and jacksonville, florida. Those are now large sites as well. In rochester, there are approximately 39 thousand employees. 4000 physicians. 400 physicians in the jacksonville campus. 60,000 employees we are the largest employer in the state of minnesota. About 9. 5 billion in revenue each year. Patients can come to the mayo clinic without a referral. They simply need to contact us. That is how things are working at the moment. Host are you a forprofit or nonprofit . Guest we are a notforprofit humanitarian organization. We have a Strong Research and education component that has supported the practice the last century. Research is a big part of what we do. Our Research Programs support the needs of the patients. We bring in approximately 225 million a year in nih funding. Out of its income, the mayo clinic invests about 275 million a year in research. We have one of the largest Training Programs in the country for graduate, special its best specialists, and primary care physicians. Also postdoctoral scientists. We are a large, Academic Research driven, educationally supported organization. Host if you could make a change to the way medicine is delivered in the u. S. Or the Way Insurance is, what would that be . Guest number one, it would be wonderful if we could make sure our citizens get more engaged in their health care and life decisions. So much of health is determined by what people do. Staying active. Eating properly. Avoid excess alcohol. Not smoking. Understanding the risks in their Family History and dealing with those early. If one can predict what a patient may become ill with, one can often prevent that. In terms of providing optimal care, what we would love to see is that teams of physicians and nurses and other Health Care ProfessionalsWork Together with one focus the needs of the patient and their families. That has been our core value. We would like to see, as we move forward with reforming medicare and perhaps the next largest up award under the doc fix bill, is to put in place Performance Measures that recognize and reward Better Outcomes of lower costs. It is important for primary care and peter and its services and Preventive Services and those with complex Health Care Needs. How do you identify the complexity of a Health Care Issue and reward that are outcomes at lower costs . That is a complex series of questions. With that, the country will move in a more sustainable direction for Better Outcomes at lower cost. Physicians want to do the right ring and will start to Work Together more and work with Community Services and so want to produce a healthier population. Host this tweet from how does this value or outcome based Health Care Measure . Who makes up these rules and measurements . Guest those are made by the regulators working with health and human services. Many of us in health care are providing advice to those rule makers, if you will. That is the hard work that will about that will begin. Ultimately it comes to health and human services. Lots of us will provide input from health care as well as the private sector. In forming what is it we want to drive to in terms of debtor outcomes. This is complex work but it can be done. Host another tweet from myland. They want to know how much the doc fix will cost america in increased taxes and debt . Guest i am not a political expert or pundit. I am a physician. We understand that the doc fix did not entirely get paid for by the legislation and there was something in the order of 140 billion that was unaccounted for the next decade. That is for congress to sort out. One of the reasons the doc fix was passed this year was that there has been reduced health care spending, compared to a historic averages over the last number of years. The cost to the government was substantially less now than it would have been a few years ago. That motivated this incredible union of forces between democrats and republicans to come together and get this done with an overwhelming majority. It was striking. Host as president and ceo of the mayo clinic, how is your time divided . How much time do you spend paying attention to washington and internally at the hospital, etc. . Guest that is an important question and a balance. It is a balancing act. My first 2. 5 years in this job i was still seeing patients, but that had to go by the wayside. I had to focus on bushs more than the other. We have plenty good urologist to do the other work. 70 of my time is focused on the mayo clinic and its 60,000 employees, and the 1. 3 million patients we see every year, and the 60 million patients we touch electronically every year. 30 is an federal and State Government work. Host 60 million electronically every year . How is that . Guest we have a gold city developed a meaningful relationship with 200 Million People per year by 2020. We have created a number of Digital Tools that allow patients to interact with the mayo clinic. We have another a number of products and Services Patients can access or employers can purchase for Subscription Services and so on. In this digital age, folks want to know more about their health and more about what they can do to stay healthy. This has been an area we have been developing to deliver our knowledge, no only facetoface but to anyone who wants to have a relationship with mayo clinic. Host dr. John noseworthy is head of the mayo clinic. Numbers on the screen. Our first call is from indianapolis. Caller i wanted to ask the doctor if he could speak to the delivery of health care and nursing staff . I have to nurses and my family. One is a dialysis nurse, another a nurse aide trying to become a nurse. The dialysis nurse, it is not uncommon for her to work come in at 7 00, leave at 10 00. 13 to 14 hour days. That is going to impact her ability to do a quality job. The one in my family that is trying to become a nurse has been on the waiting list, looking at the costs. It really seems like the process is working against her becoming a nurse because the schools sees this as lucrative because of the demand. I do not see a big picture view host any comment for the caller . Guest yes. You must be proud of your daughters. It is something to have nurses in your family. We are proud of them. The future for nursing is outstanding. We are going to see physicians and nurses work more closely together. It is important that nurses and other Health Care Professionals are able to help work at the peak of their licensure to make sure they can Keep Health Care affordable. It is very stressful to be in health care. I am sure your daughters feel that. It is an emotionally draining profession that is very rewarding. It sounds like give your daughters has significant stresses at the workplace as far as Work Life Balance and the length of time they are there. Those are local issues that they need to deal with with their supervisors in order that they can continue to feel great about their work and do a great job. It is not ideal, but the future for nursing and other Health Care Professionals has never been better. Host christina in michigan. Caller good morning. Thank you for cspan. Dr. Noseworthy, i cannot tell you how impressed i am with the velocity of the mayo clinic. My background, i am 59 now, my background was when i was 25, had four children, a divorce, i got my are and because of my rn which helped provide for my children. Got a wonderful future for my kids and myself. It was due to the government. I worked in surgery for 30 some years, mainly at nonprofit organizations, they called themselves. They seemed years ago you are doctor who is ceo of the mayo they did not understand anything about health care when people took over the hospitals. It all turn into big business. I retired about 10 years ago. I am seeing such changes. I worked for a Major Corporation in detroit, the biggest one. What goes on is amazing to me. My husband has been a patient had a lot of surgical spine problems and stuff. The amazement i go through with what gets paid for with back braces and stuff, nobody cares. I am so impressed with your velocity, the teamwork of everybody taking care of host i think we got the point. Lets hear from dr. Noseworthy. Guest thank you so much. What a great story. The mayo clinic is a physician Led Organization and always has been. Our physicians are salaried. That is an important part of how we work. It works well at the mayo clinic. Theres lots of work to be done. Our physicians and nurses believe that when physicians are leading the organization, they understand the Health Care Needs and of the professionals delivering the health care. It works well for us. I appreciate your positive comments. Host how do you figure out the salaries of your physicians . Guest our Salary Structure is based on market data for similar organizations. We have a range of salaries given. A graduates after the first six years on staff, after yet proved yourself and are a full consultant. Then it is tied to the marketplace. Host williams calling in from rochester, minnesota. Hello. Caller hello, how are you doing. I want to say you do a great job at the mayo. I am a patient out of there. The service is top notch. The doctors are first class. They care. A dr. Call for me and wished me happy birthday. Their service, outstanding. Host are you out at the mayo now or do you live in rochester . Caller i live in rochester and emma a patient at the mayo now. And am a patient at the mayo now. He said something about a disease, it is you will not get will from the disease and it will eventually take your life it should not be counted against the doctor or hospital or wherever. We will all pass away. There is host guest i am glad you are getting good care. Host maverick tweets into you with the good doctor comment on our Current Health care system fee for Service Model versus singlepayer. Guest thank you. We have had a fee for Service Model and still do in this country. Medicare has been a fee for Service Model. This doc fix is taking us down a path away from that. As we talk about more paid for Better Outcomes, and so on. The other point i should have made is that this doc fix, as we move more terror pay for defined outcomes, safer health care and so on, will help that medicare on a sustainable path. Many of us feel it is unsustainable now. This is a social contract the country needs. We need a strong Sustainable Health care program, because it is good for our country. The singlepayer system, which we do not have in the u. S. , is in place in different countries. It has been debated heavily in the United States. It is a political issue. I am not sure where things will end up 10 years down the road. In the countries where there is a singlepayer system, almost every one of them have evolved to have a second system, which is a competitive insurancebased, marketbased plan for those who wish to pay up and have more choice in their Health Care Insurance and where they go for care and so on. Because they do not feel that the singlepayer system in those countries is working. I am not aware of a country that has a singlepayer system only, because there are others in the population who want to have more choice then generally comes from such a system. Host what is your policy when it comes to medicate tatians medicaid patients . Guest we see medicaid patients who are the montecito and adjacent states. We provide the best care that we can. All of our patients get the same level of care. It is biggest on medical need. Host what is your top line the will of the medicaid system as currently it currently constructed . Guest i am not a Health Care Policy person or elected official. It is an important safety net for those this advantage to in our country. There is politics whether it should be government at the federal or state level. There are strikingly different opinions about that. We are seeing that play out now especially with the Supreme Court case coming out. It will bring some of that to lie it. From our standpoint at the mayo clinic, the needs of the patient comes first. If a patient lives in our state or and adjacent state and they have medicaid or medicare, we are honored to see them. Host next caller, david. You are on with dr. John noseworthy. Caller good morning. My concern is having commercial insurance at the table. In helping decide how valuebased health care will proceed. When you look at relative values and how medical services are paid for now, at least two independent, freestanding doctors offices, they are very they are pretty much taken advantage of. You have a relative value medicare set, and the average commercial insurance has kind of muscled these doctors into accepting lowball contracts for their services. What is your sentiment on having commercial insurance involved in this process . Guest thank you. The payers, whether it is government or the private sector , the private companies are at the table because they are paying the bills. The mayo clinic has and continues to work with the government, advising the government about what is best for it the patients. Same with the Insurance Company. The wreck with dozens, though there are a few dominant ones. We work with dozens, though there are a few dominant ones. We are seeing evolution in terms of Large Insurance Companies that they recognize that what is needed is to identify what works in health care and pay for that and less so for things that do not work as well in health care. This bill and the movement of the field forward will be driven by data, not completely, but by data. Many of these insurance groups are putting together a large to best understand what is working and health care and see if we can push more and that direction. The mayo clinic is the Founding Partner of something called often labs. There are countries in big farmer and others, and we have partnered with a subsidiary of the unitedhealth group. We can together and said we understand outcomes and health care, quality, survival, good service and so on. Insurance companies have access to claims data, what people actually spend on health care. In this partnership, we are trying to find a better answer for the american people. Being of the table with them is part of this learning curve for the United States. I see them staying at the table. I do not think we can keep them out, no more than you can keep out the providers or the government. I am seeing Good Progress and that guard in that regard. These are complex issues, but i think we can get better every year as we move forward. Host 9. 5 billion dollars in revenue for the mayo clinic last year. About 60,000 employees at all its branches. Caller good morning, doctor. I was curious. What is your opinion of the Health System the v. A. Health system . I have a daughter in law who is a nurse at mayo and they would rather have i have some upcoming surgery and they would have me go to mail rather than ba then the v. A. Guest i havent worked in the v. A. Health care system and a lot has been made, recently, of the troubles they are having there. The new leader is moving as quickly as possible to improve the services to our men and women in uniform and our veterans. I think with your family, you need to make a combined choice of where you want to get your health care. I am sure you could get Outstanding Health care in the v. A. I promise you would get great care at the mayo clinic but that has to be a personal decision for you. I think the v. A. Has opportunities to improve as we all do. Host you have a treat into you dr. John noseworthy about Electronic Medical records and how private are your clients medical records and how extensive do you use that system . Guest thank you for that question. We are a completely pardon me everything we have is Electronic Health records. That has what mail has done for a large number of years. That is what mayo has done for a large number of years. Patient privacy is our number one concern. Previously, that has been a problem in the business sectors and others with the risk of tampering with or entering the systems for bad purposes. We have seen that with banks retail and so on. We have a group of folks to ward off cyber security, manage it, and keep our patient records completely private. It is an important concern for us and we focus on it every day. Host larry, rapid city, south dakota. Hi, larry. Caller good morning. One of my concerns is you i have had so many friends that live across the street, older guy, broke his leg falling down the stairs in his basement. Emt showed up, took him to the hospital and i talked to him and he said he would be all right. Two weeks later he is dead from staph infections. Rapid City Regional hospital probably has one of the worst records around. What bugs me is they have bought out every hospital in the whole black hills. Every Little Clinic is now a Regional Hospital and they start putting urgent cares up. And then they push out Insurance Companies because they say if you work with his Insurance Company, we are not going to work with you. To me, it is one big monopoly to monopoly conglomerate that looks at the bottom line and not the main line. Host that is larry in rapid city, south dakota. Any, dr. John noseworthy. Guest earlier we mentioned that could be a move in the marketplace to merge with acquisitions and these bigger systems. One of the drivers for that is to drive up the purchasing power from a smaller organization to a larger organization. For them to be successful, they must put the needs of the patient first. Mayo clinic decided to take a different path and to share our knowledge but not to become a much larger, owned organization, as you are saying. It feels like a monopoly. I guess what i would say larry is that in the move in america to more transparency of outcomes , hospital acquired infections like your friend unfortunately suffered from, and falls in the hospital and mistakes that can be made, those are being rooted out by this competitive transparency environment that we are living in. That is a good thing. Good doctors and good hospitals will hopefully recognize who will hopefully be recognized and rewarded. And those who need more help in terms of Higher Quality will be motivated to do so. Otherwise, they will be paid less money. I hate to say that way. Host barbara in miami. Caller i am a patient of mail for the past 26 years and i wanted to say how grateful i am for the mayo clinic and it is worth the trip if you want to travel to rochester diagnosis. The diagnosis i had in miami was not accurate and when i went to rochester, it was discovered even of the same tests were performed. Also perhaps dr. John noseworthy can mention the history of the mayo clinic and the mayo others. Mayo brothers. Guest thank you. I am pleased we have been able to help you. You describe the situation and the country where the quality varies quite a bit. You mention miami i wont say anything about miamis health care but they are multiple small care groups and so on. There is quite a bit of variability around the health care around the country. There is also a difference where patients go from one doctor to another and they dont talk to each other, tests are repeated. That is what drives up health care costs. Mayo clinic began 150 years ago with the father, dr. William mayo, who was employed by Abraham Lincoln to provide medical services to the union army. He was a surgeon, he had two sons, will and charlie, and a tornado ripped through minnesota in 1880s there rochester, destroyed the town. The sisters of st. Francis came together with the mayo brothers and said they needed to build a hospital to serve our patients. They raised the money, that happened. The mayo brothers applied Scientific Method to their surgeries and they provided a great deal of learning and it became a mecca in this small city in southeastern minnesota. It is their story. Host all right, here is your chance. Wild and wonderful tweets one of these days, a Health Segment will explain the infamous 25 hospital aspirin. Why do we get charged so much . Guest peter, i missed i was waiting until the will explain what . Host the infamous 25 hospital aspirin. Why when we get a bill does it sometimes cap seemingly normal products charged at higher rate . Guest yes, well, this is a complex area. The billing and pricing and transparency of hospital costs is a complex web that is beyond any single Hospital System to rectify. We all recognize we are committed to more transparency and more predictability upfront as to what the hospitalization or the medical evaluation will cost. The way the pricing is done and the costing is done is things have to be allocated across the hospital. And you see some of these unusual bills that are printed that says, suture costs 1000 or 25 aspirin the system is broken. We recognize that. It is a National Problem and we are working with those who can exit to fix it, but there is not a quick fix for that unfortunately. It is very troublesome to patients and it should be. Host can the patient get a line item of their bill . Guest yes, they can. Some patients request that. The way the billing is done, of course, you have to pay for the building, the depreciation of the building, the work that is done by the doctors, nurses, and technicians. Everything has to be accounted for, the gauze, the cleaning staff, so one. That leads to a very strange though that people strange bill that looks and people say, why was my aspirin 25 when that is the relative allocation of a process of a complex process. Host next call for dr. John noseworthy head of the mayo clinic ron who is close to rochester. Caller good morning, cspan. Thank you for taking my call. Dr. John noseworthy, i had surgery at st. Marys hospital and three years ago in august. I had not been to a doctor in 44 years, so it was a great experience for me. I just want to say that mayo has a great organization, absolutely outstanding. And the people that i worked with and i still work with the hospital, and you people do a great job and i want to thank you. Guest thank you very much. I am glad we were able to help you. What you better look after yourself. Youve got to see the doctor more often than every 44 years. Host dr. John noseworthy, he referenced st. Marys. What is st. Marys . Guest st. Marys hospital is the original mayo clinic hospital, if you will. It is the largest hospital in rochester, minnesota. We have two, the Methodist Hospital and the st. Marys campus. We have about 1000 beds, a large hospital, very busy. The largest Surgical Services hospital in the country. That is where he went for surgery. Host here in the washington area, i think i saw in the paper and add that led mayo clinic is now associated with the Virginia Hospital Center in arlington virginia. What is that association . Guest we built this nonowned Affiliate Network around the country that i mentioned earlier and we have 32 sites in the u. S. Mexico city, and puerto rico. These are very high quality Hospital Systems that have wanted to affiliate with mayo clinic. They join us as part of the Mayo Clinic Care Network and the doctors and nurses that are seen their have access to mayo clinic information, Digital Information the doctor Digital Tools the doctors and nurses can use every day. If they need additional assistance, they can call us. We can have telephone consultations or electronic video consultations. If that does not work perhaps 10 or 15 of the patients need additional face to face care and we are happy to see those patients. As you mentioned, there is an affiliate in the washington, d. C. Area. Host dana, a few minutes left with our guest. Caller thank you for taking my call. I have a question, when i called to get my son into the mayo clinic and he has medicare and medical, i was actually told that i would have to pay for the first consultation only with his medicare. An additional 640 something dollars and when the doctors talking about taking medicare, i wanted to know if there is any foundations or anything because he is very sick and i basically didnt get an answer that i need. I need a letter from his position and i cant get that because of the situation where he was after he had surgery. I really did want to bring him there, but with the additional cost because of medicare so i was wondering about his statement earlier regarding taking medicare and the additional costs were not mentioned. Host go ahead, dr. John noseworthy. Guest im sorry about your sons illness, it must be very tough for you and for him. Obviously, i dont know the specifics of this unfortunate case and that there are some complexities in many of these cases, particularly from afar with complex illnesses. We have a staff that tries to sort that out to try and help our patients understand what the expected cost would be. We dont charge over the medicare rate. That is not permitted and we would never do that, so i guess i am uncertain what that 600 was before. It may be something medicare does not cover and there may have been something with the insurance. Im sorry, i dont understand. It is unfortunate that your sons position physician wont write a letter and share with you and with us what needs to be done. It sounds like you may have a retained foreign object from surgery or something of that nature. Perhaps, offline you could be in touch with us and we can see we can help you. Host gail in oxford, florida. You are on with dr. John noseworthy, head of the mayo clinic. Caller yes, thank you for taking my call. My husband you up in rochester and he was born at the mayo clinic. We have a question. We are now in florida and we do come back to the mayo clinic. We went back last summer. When we try and go to jacksonville, they will not take our insurance. We have across and blue shield medicare advantage, but when we come rochester, they do. So my question is, why do the different locations take insurance differently . Host thank you, maam. Guest that is exactly right. There are differences across the regions and it is confusing to patients. We are going to fix that, gail. There are reasons for that our business reasons and relates to a number of if you will accounting concerns that we have found over the years. It creates confusion for the patients and it just doesnt pass the face of test and we are addressing that up. Host ron in florida. Caller good morning, dr. John noseworthy. Ive got to give props to dr. Schaeffer 2002. He fixed my heart, a myopathy. That was up in rochester when i moved up in minnesota. That was where i was born and raised, moved to florida and developed i disease. I went over to jacksonville and they strained up my eyes and saved my eyesight. The real reason i called is that i want you to explain all the research that is the followup. I get forms from the mayo clinic to follow up on my diseases and i think that is the big key that happens. Once again, they saved my life. I am very grateful and i do the v. A. Now and ive got to tell you, they do the same kind of services and i wish you guys could get tied together a little more because that would really help out the serviceman. Once again, t1. Once again, thank you. Guest thank you, ron. I appreciate your comments and what you address is so important. That we get engaged in our health care and we follow up on things to make sure we are doing all he can to keep ourselves and our families healthy. Thank you for your nice comments. Host comment in richmond virginia. These, go ahead. It helps if i pushed the button. Commet, you are on the line. Caller yes i have United Health care and work at a hospital in richmond, virginia. When i was in an accident, i had to pay it United Health care about 1000 something dollars out of my money because they told me that i had to pay back the money that they paid from for the services that i received at another hospital, which i went to after the accident. So i dropped United Health care and i went with hca because i am paying all this money out of my pocket for this Insurance Company to have the needs for Something Like what happened. Anytime i had to take money from a lawsuit and pay them back money that they paid at the hospital, i thought that was insane. Host any comment for the caller . Guest i think that is another great example of how confusing the system is right now for our patients that are citizens. It is virtually certain as we go forward and build a sustainable Health Care System that all of us citizens will be pay more out of pocket for our health care. It is terribly important that we build a system the nation build a system that provides transparency and helps educate the public about the decisions they are making when they invest in their health care. Buying an insurance product is a complex business transaction. What Many Americans are moving toward are the high deductible and lowcost Health Care Plans that they can afford. But they realize they can afford the insurance but they cant afford the copay or the deductible that comes with it. It is an awfully important life decision in terms of investing in your future. Most of us want to get her a sweet deal in each year, but ultimately, we all get ill and one needs to know what is covered, whats not cover, what if something catastrophic happens, where can i go for help here where can i go for health care . Right now, that system is in turmoil, as our caller articulated. Host dr. John noseworthy do you see much impact for medical savings accounts . Guest i cant say that i see much impact on that, but if one is buying into a medical savings accounts, they have to actually put money into the medical savings account. As they say, im going to buy lowcost, High Deductible Health care plan but i will save up in case i get really ill. It requires the discipline to do that. Host nancy in raleigh, north carolina. You are the last call. Caller good morning, dr. John noseworthy. I have Great Respect for the mayo clinic and i come from the medical family a medical family. I wanted to address the question from the caller earlier about the 25 aspirin. My husband had major surgery, a Knee Replacement at a facility in 2008. I wondered if the same conditions would apply. I took all of his medication with me and the pharmacist could not give him what he needed. I asked the nurse, may i administer all medications to my husband . And she said i certainly made. That saved us over 800 because we did have charges that i took for line by line item and i took responsibility for calling the hospital and assuring them that they never gave husband any medication at all. They accepted this and i just wondered, with with this same condition apply at the mayo clinic or for any other person who was trying to save on a medical bills . Guest thank you for asking that question. We do not encourage our patients families to give the medications to our patients in the hospital because of the concern of dosing and accuracy of the pills and so on to protect the patients safety. To be completely honest, there may be a better answer to that and i am not aware of it. I appreciate your concerns and your questions and your solution, but i dont really have a strong answer for that. Im sorry. Host does the mayo clinic operate Emergency Rooms . How much do you have to write off on reimbursed medical bills . Guest thank you. Yes, we have Emergency Services and Helicopter Services and so on and our hospitals are in cash at our hospitals. That debt and charity care and unfunded cost from Insurance Companies and government pay is about 1. 3 billion a year, total. Host out of revenues of 9. 5 billion or is that subtracted from the 9. 5 billion . Guest no, that is out of that. Host dr. John noseworthy president and ceo of the mayo clinic. We appreciate you co on the next washington journal, a look at the transpacific trade deal. Then, the role of government with whistleblowers. Then another discussion on the vietnam war and leaking documents to the New York Times that became known as the pentagon papers. And we talk about oil and gas pipeline in the United States and how the United States enacts them. That is live he here on cspan. The White House Correspondents Association hosted its annual dinner on saturday night in washington, d c. We will bring you our full coverage of the event tomorrow, beginning with the red carpet arrivals all the way up to remarks from president obama and this years entertainment comedian, cecily strong. Coming up next on cspan, q and day with former New York Times reporter judith miller. Followed by a preview of an upcoming Supreme Court case on samesex marriage. Later, opposition to the samesex marriage act and how it could affect religious freedom. Announcer this week on q a, our guest is judith miller, former New York Times reporter and author of the book the story a reporters journey, which chronicles her account of her reporting leading up to the American Invasion in iraq in 2003. Brian judy miller, author of the story a reporter