those are committed serious crimes and completed their prison sentences. special lies this morning for those with felony convictions in your past. we want to hear your stories -- special lines. 202-748-8000. for those who work in correction, 202-748-8001. is your number. a line for law enforcement 202-748-8002. a line for all others, 202-748-8003. you can also catch up with us on social media, twitter @c-spanwj, on facebook, facebook.com/c-span. good tuesday morning to you. we are talking about prison reentry programs. we sit a visit. this comes in the wake of the white house announcing its effort to promote this week as national reentry week. president obama over the weekend laid out his plans for a national reentry with some of the efforts of his administration is pushing in his weekly address. here is what he had to say. [video clip] president obama: every year, 600,00 people are released from prison. we need to ensure they are prepared to become productive, contribute and members of their families and communities and maybe even role models. that's why we have been working to make our criminal justice system smarter, fairer, less expensive and more effective. this week, the department of justice will highlight how reentry programs can make community safer. my administration will adopt a new actions that will build on the progress we have made. detailsrelease more about how we are taking steps to ensure that applicants with a criminal history have a fair shot to compete for a federal job. we are issuing a new report that details the economic costs of our high rates of incarceration. and we are calling on businesses to commit to hiring returning citizens who have earned a second chance. that effort, of attorney general loretta lynch was in philadelphia yesterday. she said in that speech that too often americans who have paid their debt to society leave prison only to find they continue to be punished for past mistakes. this is the story from "the new york times." in that speech she laid out steps to address the problem including a new push for states to allow newly released -- " it would send a message they are welcome back in society, that they can now quite literally exchange their role identity as federal inmates for a fresh one." notes also promised a new federal focus on job training and mental health and substance abuse programs to better prepare inmates for the outside world. reporting from "the new york times." several newspapers talking about that effort, one of the first of what is being termed national reentry week. the inaugural national reentry week. the idea is to reduce recidivism. stats on recidivism from "the washington times." it's proving to be a difficult problem to tackle. tracks report that individuals after their release from state prisons in 2005 found that 68% were rearrested within three years of their release. after five years, the rate of recidivism increased to 76%. ear from our viewers in this verse 45 minutes of your thoughts on should the government be doing more to help former felons, those felons who have served their prison sentences and are out trying to reenter society? what do here you stores. a line for those felons who have been released. 202-7480-8000. for those are working correction, -- we will start with jay in maryland: on the line for felons who have been released from prison. good morning -- claling on -- calling on the line for felons. caller: i wanted to say i think they should be doing more. and specifically what i mean is once you're released a whatever your -- and takes care of that, there should be a time period in which certain rights are given back. yr maybe that felonly conviction can beu expunged. that is the biggest problem folks have. in my particular situation, i was only 20 years old at the time. i'm 36 now. that is 16 years ago, almost 17. and that will forever be there. so, what i mean is, say if if you had a weapons -- [choppy audio] never bet right should restored because you'd use that privilege in the wrong way. and my particular situation, that is what it would ask for. i'm ok with never having that right to bear arms. but the felony itself, that could be expunged. that would be something truly appreciated because what happens is there are certain areas that you can no longer move to. apartments, buildings or jobs, in particular jobs you can no longer get. and that is the thing, you know. tot: i want you collaborate. what are some of the other rights that have been taken away from you, for those who do not have experience. what are some of the other way should have seen this affect you past the time you have served to prison sentence? caller: like i said i was 20 years old at the time. so, because i have a felony, i can never again be a gun owner. which i'm ok with. but because i abuse that privilege. having the felony alone, if you are in the whereng industry, -- jobs there is anything concerning credit cards regardless of the fact that they did not have anything to do with any kind of fraud charge. there is a lot of jobs you can't get because of that. you cannot get a government job. you can't even get a contract or anything for the government. in certain instances, you cannot get -- that allows you to haul materials in and out of a rail yard. also, even if there is something ant once -- needs to get apartment. there are certain housing developments that you cannot get into. and regardless of how young you were at the time, any of those things, and regardless of the fact you had never been in trouble again. so, those of things -- like i said, at 70 years old and will be the same way. host: l.j. is also on that line for felons who have served their prison sentences and then released. good morning. . go ahead. caller: morning. certain little simple things as far as i'm just piggybacking what the last person said. certain simple things. i live in arizona. this is a right to carry gun state. so you can carry a gun at any given time. you do not even have to have a permit. once you have a felony, you get that right taken away. simple right is voting, things like that. after you paid your debt society. part is that this -- after i paid my debt to society, i'm going to get out and be allowed to produce a paid-in everything that has been going on in society once i was in. once you get out and you do not see that, you do not see the jobs. it took me about 12 years to even get the judge to consider to expunge anything off my record. this is something that happened when i was a child. i was only 22 years old. i'm 36 now. that is 14 years ago. course,m a child, of childish things happened. i don't have any problem with the guns. that is not the problem. the problem is the housing, jobs. as far what barack said as making sure that jobs are going to hire guys. but how is he going to do that? how do we get ensure that? regardless of what you do, and lets you are going to take a census poll of these jobs -- and make them sign some kind of agreement, they are not going to hire felons. many people do not even want you in their housing areas. host: you mentioned voting rights. you are in arizona. arizona, one of the states with the toughest provisions when it comes to voting rights for felons. takes awaytates that voting rights for felons after, even after serving prison sentence parole and probation. this according to the sentencing project which is looked at voting rights and americans who have been disenfranchised due to felony convictions, 5.8 5 million americans are prohibited from voting due to laws that disenfranchise citizens convicted of felony convictions. virginia, one of those states that is changing those laws. the story from last friday that many of our viewers may have seen. governor mcauliffe of virginia used his executive power to restore voting rights to 200,000 convicted felons, circumventing the legislature. action effectively overturns the thel war era provision in state's constitution aimed, he said, it disenfranchising african-american's. "the sweeping order and a swing state that could play a role in deciding the november presidential election will enable all felons who have their prison times and finished parole or probation to register to vote. most are african-americans ,a core constituency of democrats. that action has received some criticism, not just inside the statement on the national level. about bylked presidential candidate donald trump yesterday at a campaign stop in rhode island. [video clip] mr. trump: you know what they just did in the state of virginia? 200,000 people that were in prison for horrible crimes for horrible crimes are being given the right to vote. for the first time. oked politics because virginia is a very close stat e. win virginia. i have a tremendous amount of property in virginia. they are giving 200,000 people that have been convicted of heinous crimes the worst crimes, the right to vote because you know what? they know they are going to vote democrat and that could be the swing. that is how disgusting and dishonest our political system is, all right? host: the republican party of virginia also reacting to terry mcauliffe's action on friday. here is a tweet on friday after his order.' lanket restoration without regard to the nature of crimes committed does not speak of mercy. it speaks of political opportunism." we are talking about those actions on the state level, federal actions that the obama administration has laid out. one to hear your thoughts on what the government is doing for felons after they have been released from prison. go to our line for law enforcement. john in new hampshire. good morning. caller: good morning. great to talk about this topic. first started in law enforcement -- i was 21 years old. i've watched the laws change and become more aggressive in aggressive and aggressive or you have one felony arrest in a month to several week. and most of those crimes used to be misdemeanors at one point. drugs.ot had to do with and a lot had to do with the different variations of politics. -- have to carry out a political agenda. the sad thing is, i'm glad this is being discussed, i'm glad everybody is -- [indiscernible] e believe the callers we'v heard this morning hit the nail on the head. that when we look at crime as a whole, -- of america. have drastically increased. in200 some-odd percent suburbia which is naming white. -- mainly white. the sad thing i see today is people coming out of prison in need of -- it is because of the system we have. i think it is a great topic. that we're looking at options and opportunities. to try and turn this around, to give these people coming out of prison a shot. for lawhn on our line enforcement. we also have a line for felons released from prison and those who work in corrections. michael, greensboro, north carolina. what do you think this morning? caller: good morning. i think they should be able to have a life -- the right to come back and go into a job. there are certain jobs you may not want to put them in. i don't think you should penalize them for the rest of their lives. i was told you had to wait 15 years for expungement. that is too long for somebody that went in -- they should be able to come back and get a decent job and work. i'm going to keep my short because everybody said pretty much what i was thinking. thanks haand have a good day. host: several felons calling in. james is on that line in arizona. good morning. caller: good morning. how are you today? hey, i'm in a unique position. i am retired from the military. after i retired i got convicted of a felony due to circumstances actually, i was involved in it. and i am not going to deny that but it was, nevertheless i was convicted. and the thing is i have been fighting for a long time just to get my rights back. however, i am not in a lot of positions of a lot of people because i am retired from the military. i only get 30 days in jail but i still have a felony conviction. but i still have my military pension coming in. so, it is not like i got a worried about going out there looking for a job, that kind of thing. been fighting for almost nine years just to get my right ss back. it is not like i am trying to expunge my record because i am never going to deny what happened. i want the basic rights back . -- i just want the right to vote, honestly. arizona has some of the toughest laws in the world on expunging rights. we have some tough laws. you have got to go in front of judges. you have got to take fines, pay court costs. the felony conviction was in 2004. i'm still fighting this. and it's like, my god, what is it going to take? do i got to move to virginia to get my rights back? come on. this is unreal. tif a person has done their time and they owe nothing back to the state or the community, you actually aref they trying to get their life together then i have no problems with that person getting their rights restored. the voting rights issue, arizona, one of 12 states that has some of the toughest laws on the books when it comes to disenfranchising citizens convicted of felony. the other states included are alabama, delaware, florida, iowa, kentucky, mississippi, nebraska, nevada, tennessee, wyoming, virginia on that list -- although now being overturned after the executive action by the governor, something he said he is going to continue to do as more felons are released from prison. he is going to do it on a monthly basis. there are states that have no restrictions on voting rights for those convicted of felonies. maine and vermont. all other states falling in between in terms of when those restrictions are applied and when they are lifted. in. you to keep calling want to hear your thoughts on the actions on the state level and the federal level but also want to remind our viewers that today is a primary date in five states on the east coast. five mid-atlantic states and talk about primary day in those states. joined by adam wollner. good morning to you. adam: good morning. host: it seems like from the polling it is going to be a good day for front runners. is right. donald trump and hillary clinton are both entering as the favorites in their respective parties for the five states holding primaries today. all in the northeastern part of the country. the state will offer the most delegates today will be pennsylvania, but the roles are a little quirky on the republican side. even though donald trump, polls show him with a double-digit lead, it does not mean he can walk away with the lions share of the 71 delegates up for grabs because only 17 of those delegates will go to the overall statewide winner. are elected directly on the ballot. voters when they enter their polling stations today they will vote for someone for president and each district they will vote for three delegates to send to the national convention. they're going to be unbound. they will be able to vote for whoever they want on the first ballot. delegates could wind up playing a big role if we get to a national convention and donald trump does not enter with that 1237 number. host: for viewers who might have questions about those strange or you need delegate rules in pennsylvania, i would encourage them to stick around because we are going to spend 45 minutes talking about that with terry madonna. adam wollner, if there is an upset today in one of those five states, what is the state that you would put the money on? adam: boy, it is really tough to say because especially on the republican side, all five states are really not very favorable territory for ted cruz. especially as he emerged as the most viable trump alternative. he has relied pretty have agreed an evangelical base. on the democratic side, bernie sanders might be able to do a little bit better than others is rhode island's of the because independent voters will be able to cast ballots in rhode island. most of the other states voting closed primaries, meaning that only registered democrats can vote. and those are the contest where bernie sanders has especially struggled. rhode island is maybe a little closer -- but it is still. trump and clinton do enter all five states as pretty considerable favorites. host: back to the republican side for a minute, yesterday we saw a lot of reporting about this agreement between the cruz and kasich camps to look ahead to three upcoming primaries and duty them out. some -- divvy them up. some reporting today that that agreement seems shaky. adam: it is. less than 12 hours after that deal was announced. you have to wonder what the parameters are. john kasich yesterday said it does not necessarily mean that in indiana should vote for ted cruz, just that he is not going to be spending a lot of time or money there. ted cruz's super pac is still running an ad on kasich in indiana. so, clearly, neither one of them are going to be seeding these stat -- ceding these states. you thought that john kasich was going to stay out of indiana. and ted cruz would stay out of oregon. these are two candidates have not always gotten along. their supporters, there is not a lot of crossover there. be difficult, even if john kasich wanted to, to convince is more moderate meaning supporters in indiana to vote for a much more conservative candidate like ted cruz. even in the ultimate goal of stopping, chop. -- stopping trump. host: adam wollner covers it all for "the national journal." cover today's primaries and pennsylvania, maryland, in rhode island, connecticut, and delaware. thank you for joining us this morning. this question we are asking about whether the government should be doing more to help those felons who have been released from prison. we have lines for felons who have been released. for those who work in corrections, the number for you 202-748-8001. law enforcement, 202-748-8002. all others, it is 202-748-8003. doc is calling in from baton rouge. good morning. caller: good morning. thank you for taking my call. ares see, illegal aliens going to be allowed to vote, dead people have voted in the past, and now felons? where will the democratic party stop. are they going to let rats and termites vote before it is over with? they would do anything, absolutely anything, to keep opower and to win elections. host: doc in louisiana. on our facebook page, comments from robert. " seriously? should the government of laws help those who transgress the most serious of laws? do you have any clue how other countries treat their felons? believe me, released felons are getting more government assistance than military veterans who fought for this government. explain that." "felonsove that says lose the right to vote -- the basic right to choose how we are governed is taken away. this is not acceptable if somebody has been rehabilitating and is rejoining american society. so, yes, we should be doing more to help former felons. no doubt." send uscall in, comments on facebook or tweet as well @c-span wj. 's beenis a felon whoo' released from mississippi. good morning. caller: good morning. this is johnny thomas and thanks, c-span. was convicted. after being released, i was reelected to myaayor. what was disturbing to me when i was incarcerated on the state a felon.or and given i went to montgomery and at that system i was allowed to take all the training i want. i became a car salesman, a plumber, a paralegal. all of those things. a young man again, came to me with 12 years of a citizen.a felony, but he was released and somehow he had made it to employment with me in the town of glen dora. the town of glendora is the home of the murderers off -- and it is now 161 people. but i have been mayor since 1983. what is disturbing is that this young man was released and he does not know how to do anything. and i remember that i received four certificates leaving federal prison for those four months they gave me on the state misdemeanor. but they decided because of my progressiveness to give me federal time. knowyoung man -- he don't how to do anything. host: was it a cost reason? was he not offer these programs? was him deciding not to take the opportunity you took in prison? caller: the thing he tells me his last three years he was -- confined for 23 hours a day. host: it is the corrections process that you're concerned about as well? caller: well, i'm thinking that those areas out there, that there would be a push to do something to correct what has happened to ex-felons. i was released during the same time as nelson mandela. i consider myself a political prisoner. what needs to happen is where the rubber meets the road, -- the larger community. those places should be given the opportunity first to reform those peoples and to train them and to give them a way forward. host: do you think this is an area where people are open to moving tax dollars to or are there, are prisons and corrections not the place where people general hly are happy to increase budgets? caller: well, the budget here. we have a private prison here. i'm glad to hear the private prison being cut out, because it where people go and they are worse than the states. so, i think definitely funding they're spending on inmates incarceration should be forwarded for a period of time to get those peoples acclimated back to society, especially bese with i.q.'s too low to convicted in the first place and then come out, do not know how to chop grass, how to work a garden, can't drive a vehicle. that is critical to me. thank you. host: from mississippi this morning. on our line for those who work in corrections, john in connecticut. you are on "washington journal" . caller: i think if you entered a system and you pay your debt to society, yo we enter theu system you should have your rights as a citizen back. i don't think it should be continue to be punished for something you have done in the past. my experience with people in the system when they get out and continue, they can their behavior and they end up back in the system but without that opportunity to change, you're going to be limited for everything. host: deal included voting rights as far as rights being restored? caller: sure, you paid your debt and jail is not easy. host: thomas liston rights for american thinker and was talking about restoring the voting rights any puts forth his concerns about giving voting rights back to convicted felons. if your crime is serious enough, you will do a lot of time. get out, you would be limited on certain things. i would figure security jobs. maybe there is a little bit of a time limit like of you did something serious like murder or something real serious, yes, down the road, you want to make sure that you don't re-offend. you also have parole. host: there are states that restore voting rights after you have completed parole, states that restore voting rights after you've done probation. in some statesed but there are 12 states that even after prison, parole, probation, there is still restrictions on voting rights. caller: yeah, they should give them back. if you do your time and complete your parole and you show that you are doing well, you do your time and you finish, you should have your rights restored. that's the way i look at it. host: thank you for that call on the line for those who work in corrections. havee line for felon so been released, north carolina, good morning. caller: good morning, can you hear me? host: i can, go ahead. caller: i am glad that you put me on the air this morning. i want to say thanks god for you, thank god for c-span and thank god for america. felony back in 1986. there are two different types of felonies. there is one where you are convicted by a jury of your peers. then there is one where you plead guilty to a felony. i was listening to what donald trump says. that's the thing i have noticed about the republican party. in andman that called called people rats, god does not make no rats. he makes human beings. sometimes, human beings make stakes. call themselves evangelical christians and are so high and mighty in christianity but they would not bow -- bow to god and forgive their fellow man and woman. what i want to say is yes, the government should do more to help former felons. i think president obama -- i thank president obama for what he is done and the governor in virginia. young, they have the tendency to get around the wrong crowd of people and just get caught up in wrong. don't hold people for the rest of their lives for a mistake they have made. don't hold that against them and then get in the church and talk about you are christian. problem ie biggest see as an african-american man in america, it's coming from those republicans and that's why i will not vote for nary a one of them because god did not order man to think that way. thank you and have a blessed day. host: from twitter -- you can follow along with the @c-spanwj.n piedmont, south carolina, good morning. caller: good morning. up my part of the system in the mid-1990's in the state of florida. they automatically gave you back all your rights. i even have a right to have a gun back. two years ago, they changed the law and they removed my right to vote. you keep using the word conviction. i was never convicted. judge adjudicated me and said i was guilty. noevidence was given, witnesses, no jury, no nothing. i got a convention. -- a conviction. once it was over, my rights were restored and i got a paper from the federal government, not through the state of loretta. -- of florida. last year i got another paper from the state of florida since i was voting since the mid-1990's. it's that i can no longer vote. i was never convicted. your terminology needs a slight change. host: i appreciate that, thank you so much. line fork to that same felons who have been released from prison. caller: what people don't understand is there are different types of felonies. a felony if a cop says you are trying to flee before you get pulled over. they can give you a felony for a traffic ticket or you make a mistake on your taxes. there are so many laws that the government has got out right now. when you get into the system, most people get caught up in the system because it's a money racket for the government. by the time you pay all these fees and stuff, it's such a shame that you have no kind of rehabilitation. you could build furniture and toff but most people do that be able to buy extra food and stuff in prison. what they need to do and what the american people need to do let you go in and do your time. unless you are a murderer or rapist or something of this nature, all of your rights should be restored. people don't understand. you can come out of prison as a felon and you can carry a black powder gun or rifle. tells youl government that you can have a black powder gun or rifle and it's legal. it's legal in any state because federal laws supersede state laws. -- anderal law is that voting rights, most of the states right now, you come out and they never took you off the books. since you don't have to have an id to vote, you can pretty much go to any state you want and register to vote 50 times or 55 times. nobody ever checks on it. peopleave been dead registered and people who have felons against them who have never gotten taken off the books. felonies,t commit some of them are not bad felonies. they are not murderers or rapist, that might have just gotten a traffic ticket that turned into fleeing or they messed up on their taxes. they are little things that the people never dreamed. host: we got your point. from twitter loretta lynch yesterday in philadelphia talks about this. she said that too often, americans who have paid their debt to society leave prison punishedind they are for past mistakes. they might discover they are ineligible for student loans putting in education out of reach. that was loretto lynch yesterday after her speech in philadelphia taking off national reentry week. hasre talking about what worked for you and what hasn't worked for you from your perspective either inside or outside the system. on the line for those who work in corrections is jim in washington, good morning. caller: good morning, i used to work as a parole officer. i am retired now. host: where'd you find work? caller: i worked in the state of idaho and i worked in the state of washington. i've got a brother in prison in the state of california for murder. of rings ina lot the corrections system that has problems. -- a lot of things in the corrections system that has problems. they have too many gangs in prison so there is not much opportunity to rehabilitate. that's one of the key areas. they go ahead and put these inmates to work in may get $.11 per hour-$.95 per hour and i find this troubling. when these guys get out of comen, the families they from are usually extremely dysfunctional and they cannot rely on them. these people crawl out of the van and they have people like me who read them the riot act and tell them what they can and can't do on parole. they have absolutely no money for resources. after we read them the riot act and have them sign their paperwork, we drop them off at the local mission. for those who made it out and stayed out, what were the qualities of those folks? what help them the most to keep them from returning to prison? biggest ringso were communities support. we have different groups of faith raised organizations that help out. and positive family is important. as i said, somebody who comes from a dysfunctional family, that could weigh against the inmate. until we really look at what we are doing with these people long-term, there's going to be no long-term solutions. in the state of washington, we legalized marijuana because our department of corrections budget is higher than our state education budget and our state medicaid budget combined. all of these states are breaking themselves with this expanded because people are not willing to forgive and let people move on with their lives and help them as needed. host: also on the line for those who work in corrections is tom in michigan, good morning. caller: good morning. i am a retired librarian. i worked into prisons. back to prisons themselves. i live in a place in the country where there is a prison every 50 miles. is the biggest employer of people. it's the best job around, working for a prison. i thought you worked out a prison as a librarian to help people but the truth is, it's a way of making money and prison, there is a lot of programs but it's so difficult. iran probably the first advanced placement program for prisons in the united states. the pushback was tremendous. host: did you get the sense from the people you worked with -- how many of them felt the same way you did about wanting to make a difference and how many saw it as it just a job in a moneymaker adventure? caller: the first prison i worked in, a guard that had worked there for many years said 2/3 of these people could be left out. prisons are like a secret society. experiment classic called the stanford prison roger read a put people and created a prison in a psychology building at stanford university. people who work ordinary workers got aprison, once they prison security uniform on, pretty soon a were treating prisoners worsen worse. to try to help listeners, the attitude is you lock them up. i made a lot of money working in prisons but i'm retired now. it's not a good system. i don't know how it can be changed. i see a lot of the prisoners on facebook now. the ones i have helped have done very well. most of them have had to start their own businesses. host: we've got a few more former felons waiting. let's talk to heather waiting in pennsylvania, good morning. caller: good morning, i wanted to talk about florida where i lived for over 20 years. i have a drug felony from florida. with $20 of crack cocaine. that is a felony in florida. there was a republican congressman from fort myers they got caught with 2.5 grams of powdered cocaine in washington, d c it has been 20 years since i had voting rights and i have had difficulty finding jobs because people do background checks like for being a waiter. i hear these people talk. inbe you smoked a joint college. if you got caught, you would not be able to vote for the rest of your life either. urging youial beach on the line for felons who have been released. impacted by what governor terry mcauliffe did friday? caller: i think it's great. prisoneople get out of and they should not have to pay taxes because they are not part of society. else, when you release these people with no jobs, replace them with illegal aliens. get them out of here and put them in their own forms and stuff. that's it. host: what did you do that you went to prison for? i shot somebody's window with a bb gun. i was charged with a felony because i was the oldest one in the car. host: how old were you when that happened? caller: i was 20. host: how old are you now. caller: 62. host: do you still see the impact of that? voter: oh yes, you cannot it you have to pay your taxes, that's wrong. our last caller in this segment. we will talk with terry madonna next, the director of franklin and marshall college center for politics and public affairs. he will join us from pennsylvania's capital with a preview of today's primary in the keystone state. director the polling will join us to talk about his new poll on millennial voters in that group's potential impact on campaign 2016. that is coming up on the "washington journal." ♪ guest: >> >> independent media is the oxygen of a democracy. it's essential. holding those in power accountable. somee not there to serve kind of corporate agenda. warrantees that were brought you by the weapons manufacturer. >> journalist amy goodman talks about the book she has co-authored. it looks back of some of the stories and people the show has covered. >> the idea of democracy now starting 20 years ago, it has not changed, bringing out the voices of people at the grassroots in the united states and around the world and they very much represent the majority of people. i think people who are concerned deeply about war and peace, about growing inequality in this country, about climate change, the state of the planet are not a fringe minority, not even a silent majority but the silenced majority, silenced by the corporate media which is why we have to take it that. >> sunday night at 8:00 p.m. "> "washington journal continues. host: pennsylvania is the biggest rise of the five primary contest taking place today. for a deep dive into their politics, we're joined by harrisburg from -- by terry madonna. we have learned anything about this primary season, it's that each state has its own rules for who can vote and how the vote works. take us through the rules governing pennsylvania today. who can vote in today's primary? guest: you have to be of legal age, 18 and over. we have not part, had very much controversy in this state about it. there has been a lot of controversy over felons and once they pay their dues and get out of resin and get back into society, whether they can vote. we have not had a big issue here. one of the things that is fascinating is we have had a pretty substantial uptick in voter registration. 5.5% overicans are up last year and the democrats are up 2.5%. intereststrates this we have seen throughout the primary and caucus process. on the republican side of the aisle, largely because of the competition. at one point, 17 republican candidates and of course the energy level that donald trump is brought to the campaign. we are looking for a very substantial turnout today on the republican side. i'm not sure about the democrats. one of the other situations is trump on a side and hillary clinton on the democratic side have double-digit leads. as the voters turnout, the drama is not so much who wins but how close is the margin. on the republican side, the focus has been on these delegate rules that have been cited in innumerable times throughout the country in terms of how different they are for most other states. host: you talk about the turnout among democrats and republicans, independents cannot participate today? guest: yeah, i think we have one ballot question that matters. it has to do with the philadelphia traffic court. independents can turn out to vote for that particular question on the ballot but they cannot vote for the democratic and republican primary. another question on the ballot will not count. you go and vote and the vote will not count because the ballot question has been ruled impermissible by a judge. that has to do with whether we should raise the retirement age ,f state judges in pennsylvania mandatory age from 70-75. . i judge said it's not valid and we will push it off to the fall. -- people will put their eczema block but it will not matter. host: the delegate allocation matters. they are being closely watched him a number needed to win the democratic side is 2383. is 1237.publican side, take us through how the delegates will be allocated in pennsylvania? guest: the democrats are fairly easy to do. 210 delegates on the democratic side, 21 of the superdelegates. democratic officeholders and every democratic member of congress in pennsylvania. there are five of 18 members of the congressional delegates who are democrats. there are a number of other party people. from what we can tell, they are mostly committed to secretary clinton as we have found out nationally where she has a huge 516 of theem, about 712 overall. 189 are on the ballot area in pennsylvania, democrats pledged to a candidate so it would be mary jones pledged to bernie sanders. bob smith pledged to hillary clinton. the fascinating side which is being reported is how the republicans pick their delegates. there are 71 delegates. 17 go with the popular vote winner. whoever wins this date, you don't have to have a majority, a plurality does it -- 17 goes to the popular vote winner. then you get into the issue of the 54 other delegates that are unbound. without getting into the weeds on this, pennsylvania has 18 congressional districts. there are three delegates elected out of each congressional district, three times 18 is 54. so 54 total. when individuals go to vote today, they will get to pick three names from a choice of names that are on the ballot but no connection to a presidential candidate. no connection at all. of 162re a total delegate candidates who want to go to the republican convention in cleveland in the third week of july. three out of each congressional district. this is where gets interesting -- the campaign just started and has reached out trying to get the delegate candidates known and their choice. there will be slate cards handed out. the donald trump people are little behind but they are starting to catch up. vote for mary jones, if she goes to the convention, she will vote for donald trump. here is the rub -- no matter what they have said they will do, whatever candidate i have stated a preference for, they are unbound by the rules and they are free to vote for anyone, any candidate on any ballot. host: we like getting down into the weeds on this program. we are asking our callers to join in. we have a special line for pennsylvania voters. we can discuss the franklin and marshall poll that has been in the state for over two decades. you talked about donald trump with a big lead in this poll but a month a go, john kasich was much closer. what has changed in pennsylvania in the past month? basically, in march, john kasich one ohio a net gave him a big lift and marco rubio dropped out. since that time, it has been tough for john kasich. he has not won a single state since ohio. the delegate selection is relatively low. short ofr 1000 votes getting the magic 1737. mathematically, he is eliminated. he is basically around if there is a second or third ballot at the convention. i think he has lost a lot of momentum. what's going on in pennsylvania, every poll done the past two weeks shows donald trump somewhere between 40-50% with ted cruz and john kasich in the mid to high 20's so the polls are consistent. what has happened is that donald trump has picked up a good read of the important demographics in this state just as he did in new york. pennsylvania has the fourth oldest population in the state. who wins voters over 55? donald trump. who wins male voters? donald trump. earn 35-50,000 dollars of income or less? who wins voters with high school educations or less? donald trump area he wins the gun owners and the catholics. the you go through demographics of this and look at the regions of the state, donald reasonsetty well has and he competes with john kasich in the voter rich philadelphia suburbs, an area of the state where we would expect kasich to do well. voters are moderate, income is slightly higher, john kasich is leading in most polls, but trump does do very well among those voters in the philadelphia suburbs. host: if you want to go through the polling report, it is available online, you can found it -- find it at fa ndm.politics.com. lines were republicans, democrats and independents are usual. in pennsylvania, republican, you are up. caller: thank you for c-span. this deal about the delegates in pennsylvania, house and many of them are uncommitted -- how so many of them are uncommitted. i called all the ones running in the district and tried to find out who were they -- who they were supporting. most of them would not tell me who they are supporting, only that they would vote for whoever the district voted for, at least on the first ballot. some of them came out later and put a letter in the local paper that they were going to support ted cruz. polls today,o the it is like buying a paik -- a ig. you don't know who these people are going to vote for. are you seeing a lot of what jim was talking about in pennsylvania? guest: jim makes a great point. in the surveys that have been done by reporters, there are 162 delegates total. than any other category, they said whichever presidential candidate carries my congressional district is who i will vote for. more recently, we have learned 162 sayut 31 of the they will vote for donald trump, about 28 or so have said they will vote for ted cruz, meaning out of that 128 scattered, -- hundred 62 scattered throughout the congressional districts, it is hard to know. suspect todayi when people go to vote, if you really want to go to the convention and you think your district is going to go for whoever, you will only hand out what we call slate cards. hi mary jones voting for donald trump, when you go in and vote, but the x in the box for me. i think you will have a fair thent of that, particularly ted cruz campaign has been trying to get a delegate that say they are going to vote for crews -- ted cruz, get that information out. most voters are going to go and not know anything but a name. that creates some confusion. we are talking with the director of the center for politics and public tears at franklin and marshall college. taking your calls for the next half hour. janet in florida, a democrat. caller: good morning. nurse retired registered and i live in florida. my sister lives in pennsylvania. elections andhe we both decided that we would be fine with hillary or bernie. for the pennsylvania election, my sister changed her registration to vote in the republican primary, so she could trumpgainst donald because we think he is a danger to this country. she plans to vote today for kasich. i tried to go online and help delegates, but you cannot figure out who these people are for. it is a little disturbing that she went to all this trouble to vote against donald trump. none -- neither of us in the general election are going to vote for any republicans. go says she cannot wait to back to being a democrat and that she feels dirty being a republican, but that is her plan, devote her kasich. how much of that is going on, people changing their party registration to vote against somebody? guest: that is another aspect of the campaign that received a good bit of attention. 92,000 people, since the beginning of this calendar year went from democratic party's, third parties and independent to republican. went from republican, third party or independent to democrat. a very large number. let's talk about why people might have switched to the republican party. , andvoters who did that there have been interviews, there is nothing quantitative, but my sense is that they switched the vote for trump. these would be trump supporters. you find them in areas of the is likely to do well in. others switched to support john kasich or ted cruz and remember, early on, marco rubio was in the race. we don't know how many, but there are certainly more than a handful who went from democrat to republican to do what we call strategic voting. that is a political science term. it means i'm going to vote for donald trump because i think he is the easiest candidate for hillary clinton or bernie sanders to beat in the fall general election. host: is there any penalty for strategic voting? guest: no. i call it sabotage voting. you are trying to help one party out by getting the nomination for someone you think would be easier to beat. that was all the rage in our state for about two weeks. that dominated the attention because of a large number of people who switched the parties. a lot of it on a republican side, look, there were 17 people in the republican nomination battle. in january and february when in, people switching were switching primarily because of trump and the excitement of the republican race. host: republican, john is in pennsylvania. caller: good morning. i would like to say i am a trump supporter and my wife is, too. of what might happen if he does become president but i understand what -- where he is coming from. dirty systemg the of the political system in this country and if he does not get imination, i'm not sure who would vote for, but under no circumstances what i vote for any democrat. trump can beat hillary, i believe. the: as you are looking at returns coming in tonight, where would you expect the biggest trump support and if there is an upset where should viewers be should -- upset, where should viewers be looking? guest: the polls show up in the and thet and northwest upper portions of the state. if you look at the demographics, donald trump does well with a particular -- individuals who we would refer to as a reagan democrat. i'm not saying he was, but we are talking about voters to got upset with the party and left the party when it became too liberal. these are voters who tend to be conservative on social questions and believe that there is not enough patriotism and they want strong national security, who don't like some of the policies that our government has towards immigration. trumps the element of that we have seen in the primaries and caucuses to date. the area of the state i will down inclosely with the the suburban counties of philadelphia where the republican voters tend to be upscale inte and term of personal finances, probably have college education. if trump does well, given where -- where we know he will do well, that could help to give him a larger than expected victory. my sense is that he wins by somewhere between 15 and 20 points. the only question is, how many delegates does he get out of that? the caller is really on to something that the polls have tracked. donald trump has caught the support of a lot of voters who think that government and politics does not represent them, that the country is on the wrong track. -- tells it like it is. it, he sticks his proverbial finger in the eye of the establishment. regardless of what he says and how controversial it is and some of what he has said has been beyond prerogative, he has that hard-core one third support that he has maintained from the beginning of the candidacy. host: on the republican side of the aisle, 71 delegates up for grabs in pennsylvania. on the democratic side, 210. pennsylvania is the biggest prize of the day. we are talking pennsylvania politics with terry madonna for about the next 20 minutes or so. june in florida, republican. caller: good morning. go ahead with your comments. ok.er: i'm calling in to try and get our voters to think about the issues and the presidency of the united states. we don't want this tomfoolery of donald trump. it is ridiculous. that wantrious people to talk about the issues. how can we know what's going on get all that goofiness of his? him, isick of seeing turned him off as fast as i see him on the tv. host: who are you supporting? caller: ted cruz. and secondary, john kasich, but ted cruz from the very beginning, i have had a lot of interest in what he has a say and his seriousness, but it's not particularly because of crews, it's the issues that are fitting and could give me a nervous breakdown with this trump business. if i had to see him for four years as my president, i don't know how loyal i can be. host: june with her thoughts in florida. let's go to stanley, democrats in texas. caller: good morning. how are you? host: well, go ahead. like 63 people changing over to republican, the same thing, trump is the leading candidate for the president, but he's not very good at this. he's not covering his area very good and most people don't even know what to vote on at this time. they think that ted cruz to do the best as far as republicans, but on the democrat side, ellery ought to be the next thing to vote on. she seems to be the candidate that is doing best in the washington area, covering the presidency very good. she seems to be -- doing very good at her own personal self. i think being the president should be a good thing rate candidate that is running best in our country, taking her of our country. host: that was stanley in texas. when it comes to issues candidates are running on, what are the the issues that have impacted pennsylvania? trade was such a big issue in earlier primaries and a big issue in recent weeks. it has, particularly out in the southwest and milltown and mining areas, places that once dominated the pennsylvania economy. they fall into three categories, the economy, personal finance, ,he fact that many voters particularly those that support donald trump believe that they have not recovered from the recession. the wage gap, all of the aspects of creating jobs, good paying jobs that the candidates talk about. the other is foreign policy, the fear and concern about -- on the war of terror, policies in the middle east and the third and this polls actually higher than the other two is the disgruntlement with politics and government. the disenchantment that in exists andist and -- that is reaching a fever pitch in our government and that has to do with internal situations in the state of pennsylvania. the candidates have largely tailor their message to certain areas of the state. out intrump is pittsburgh, talking about bringing jobs to the region. bernie sanders spends a good bit of time on college campuses. he has been at temple university, penn state, pitt, he has been to gettysburg college and millersville university, focusing on the millennials. in addition, hillary goes to philadelphia and talks about her connections. she talks about local issues, she is localizing the election because of her personal roots more than any other candidate. her dad was born in scranton, her grandfather was born there. your dad played football for penn state -- her dad played football for penn state. she goes the churches in philadelphia and talks about gun control and gangs. what an idiot a candidate, she has localized the race if you get my drift, talking about voters wouldocal pay attention to. host: lancaster, pennsylvania, nancy, republican. bringing back jobs, abolishing the irs, i am at 10 true supporter and i want to make it known that i did find a way to find out who his delegates are. he made it clear to those of us who are is supporter -- are his supporters. he came to her she and he had paperwork and identified all of his delegates who were going to be voting for him, so i wrote them down. i could not take a picture of them, so i wrote them down and i have been disseminating them or a week or more, or whatever that was to all the people that i know that want ted cruz. to the this goes back ground game, someone who has been very well organized in the beginning. i know who i'm voting for. good morning to both of you, by the way. thank you for calling us before you vote in terms of the organizational efforts can you speak to that? guest: the ted cruz people seem much more organized, they have slate cards, trying to reach out. it is a mixed bag. if we have this huge turnout that we expect among republicans, there are still going to be a large number of voters who will go to the poll said they and not really be able to identify the delegates choices. that, you are liable to walk into a polling place and have to go through a gamut between people handing you slate cards for all sorts of things which you can take with you into the voting booth. there will be a certain amount of confusion, but there is no doubt, the caller is right. ted cruz's people have done a better job of this than the trunk people -- trump people. i have seen efforts by trump supporters to get out who his delegates are. be a fairthere will amount of confusion when people go to the polls. host: in pennsylvania, not only are the pennsylvania primaries happening, the congressional primaries are happening as well, one of two states holding its congressional primaries today. maryland is the other state holding a congressional primary. gary is in maryland, democrat. with bernieoncern sanders situation. i hope he does not become a danger because right now, it looks like predominately, hillary is going to win the bid. the thing that bothers me is ernie is pushing these viewpoints of his which will not work in the united states. i have friends that live abroad and would not want the government taking 65% out of my paycheck to give free this or free that, education, all the socialists ask that bernie is putting forward. if he loses today, i think he should submit, hillary has it, she is moving forward. he has pushed her and up to the left. he has done a great job of that, but i hope he does not\and become a danger by hanging in there too long in making our party look like the book -- republican party because they are totally confused with donald trump. i would say don't let them take america back, the republicans because what the heck is make america great again? i'll be going back to slavery or something, we are doing very well with president obama. he has been handed a bunch of craft on the republicans -- bunch of crap from the republicans. they really loaded him up with 800 thousands -- 800,000 in job losses. forget about this make america great again. host: terry madonna on the story tomorrow, if it is a hillary clinton sweep in all five states. guest: she needs about 440 delegates to cinch the nomination. as an analyst, i don't like to end elections, but how can you fact shehat given the is virtually there. she is expected to win all five ,tates that are up for grabs today, given rhode island with a possible exception. when you go back to the superdelegates, there are 712 of them and at this point, she has about 516 of them. in other words, she is likely to be the nominee. bernie sanders in an interview has said that he will go right to the convention. he actually talked about something that i suspect he will try to do and that is to influence the platform at the democratic convention in philadelphia. i think he is going to stay in, he wants to give this week at the convention and wants to do the platform and keep clinton on the road that she is on as she has moved to the left over the last several months. it is virtually impossible to believe that she does not win the nomination, given the lead that she has and what is likely to happen. pennsylvania, alex, public and -- republican. go ahead with your comment. i am a 20 something in york, pennsylvania, and i was -- really feeling kasich a lot. i like the way his campaign is more positive, but with in the last few days, this whole ted cruz, john kasich alliance rubbed me the wrong way and i just wanted to know from your point of view, is there any real parallels that can ultimately trumpnce trunk voters -- voters to sway over to ted cruz or kasich or, voters that were going to vote at all and are now coming out. i don't see what the ultimate theory was behind this alliance. i think that is a great question and i thought when they announced that sort of arrangement, that it was not the best idea. of backed off, indicating that he once is voters to still vote for him in indiana. the fact of the matter is, i think it plays to the trump theative that this is republican establishment, the rulers of the party trying to manipulate the process. he called it an act of desperation. i could not agree more, i don't know where it gets them. there is an argument about if trump had been matched up with either one of them for the longer time and they did not divide up the anti-trump vote, that that would help one of the other gain momentum and pick up more delegates. both of them are mathematically excluded from winning the nomination on the first ballot. thatact of the matter is this is just about denying donald trump 1237. it gives them a trump a great narrative to use throughout the course of the campaign, and i don't think it gets them very much. host: jacksonville, florida, democrat, josie. caller: good morning. i hear donald trump say that he is going to be the best job creator. products are made in mexico and china and honduras. those are the only ones i remember. i wonder when he will bring those jobs back to the usa. have you heard any campaign ads about that? host: i'm sure you have seen many campaign ads, your way. guest: i don't think i have seen one of them and the caller is talking about inconsistencies in campaigns. that is the rule, not the exception. some cases you get these inconsistencies. the point that i have tried to make is people look at donald trump, and say he is not andervative, is he liberal everybody trying to decide that he has positions that are both liberal and conservative. he angered both sides on the abortion question a few weeks ago, something i thought was impossible to do. the fact of the matter is, he is not a conservative, don't think of him as conservative or liberal, he is a populist and he is getting in touch with the anger and frustration that voters feel. he is a consummate showman who knows how to use that. there is no doubt his campaign lacks specifics. there is no doubt that it is unclear how he would work with congress should he be elected. there dealing in a campaign likes of which we may not have seen throughout the course of american history. host: a comment from john in north carolina as we've been talking about the delegates, unbound and down to delegate system. he writes if i vote for candidate x and faceless collector why, there was a good chance i may have cost candidate x two net delegates. good system. let's go to michael in illinois, independent. caller: i have a comment. have a militia group in illinois and we are all veterans and we find astounding that every newscast in our offices, all these people like you talk about is how they will take the election races and everybody casts a vote and make their own choice and our votes don't count. what you are doing is upsetting people. we are angry that we are not accounted for. everybody is worried about protecting their money and their election and all you pundits are only worried about keeping the money in the campaign financing going. the basic right of every american is the right to vote, yet all of our votes are not going to count, the selection and when this election is over, you will see rides in the streets, a rise of people worse than isis because we have had enough. host: michael in illinois on the concern about those not counting and concern about the frustration it could cause. guest: as you know, when the last time we were debating delegate selection in this country? we have gone through a couple of decades of election in which by mid-march, we know the nominees of the party, because they have wrapped up the nominations in one form or another with a sizable lead or the actual necessary majority. we have never had this debate. as we talk about local historians, you go back to 1976 was short at- ford the convention and what his campaign had to do to get the majority on the first ballot, which he succeeded. on now is, we are seeing this disconnect with the voters who cast votes for delegates and the operational theory that has been in existence since literally beginning of the republican delegatest it is the that take the nominee, not the voters. history, theye of have literally deferred that choice to the delegates of convention and because it has been basically wrapped up, there has been no need to get into this business. 90% of the republican delegates on the first ballot are bound, at least through the first ballot. that is where you get into this argument about, should the delegates at the nominee or should the party voters pick the nominee or whoever voted in the process depending on the state, this is the first time we have in -- i don'te river the debate taking place -- remember the debate taking place. the democrats had a series of rules changes after the democratic convention when fewer concrete won the nomination without entering a single primary. the party split apart, richard nixon got elected and the democratic party and through a series of rules changes which the republican party someone followed. that is the big disconnect the party was talking about and it is very important. host: a minute or two left with terry mcdonald. phoebe is waiting, democrat. caller: if you are voting for donald trump, you are voting against climate change, they are using this big old airplane and burning up all the gas and when in atlantic city declares bankruptcy, who got hurt, all of his voters -- workers, i'm voting for bernie sanders. host: i will give you the last minute on the storyline, tomorrow, you talked about the democratic side, what about the republican side? caller: that a trump is going to turnoutepending on the and which set of voters vote, we look forward to how close it will be, what we know about the delegates election, we expect him to end the day picking up about 90 to 100 delegates in total in the five states. the question will be, how many delegates does he win, does he have any momentum, have kasich and ted cruz been able to halt that momentum and is thus a many delegates -- not so much how many delegates in the pickup, but how many delegates they can deny donald trump. host: if you want to see -- terry madonna is the director of the england and marshall college, we appreciate you being here. coming up on washington journal, we are joined by the director of the harvard institute of politics. to talkbe joining us about a new poll on millennial voters in campaign 2016 and later we are joined by the president and ceo of the mayo clinic to talk about health care in america and the implementation of the a portable care act and -- of the affordable care act and containment of the zika virus. ♪ >> our c-span campaign 2016 coverage continues to travel across the country to honor winners from the student can contest. we recently traveled to wyoming to recognize winners. they were recognized by classmates, family and elected officials are honorable -- honorable mention winning video. to south dakota and visited with winners of the cities of rapid city and sioux falls. a final stop included a visit to minnesota with third prizewinners. a special thanks to our cable partners, comcast, charter to help coordinate these visits. every weekday this month on c-span, be sure to watch one of the top 21 winning entries at 6:00 eastern for washington journal -- before washington journal. >> that a secretary, we probably give 72 of our delegate votes to the next president of the united states. >> washington journal continues. host: the polling director of the harvard institute of politics joins us after releasing a new survey of millennials and their views on this year's election and politics in general. this survey might have some republicans concerned, not just when they look at the selection, but perhaps looking into the future. guest: i think so, and inks for having me, it is a pleasure to follow dr. madonna from frank the marshall college -- franklin marshall college. a year ago, i might've been on this program talking about my position that this could be a very good year for youth,cans regarding the but i felt that after two cycles of running against barack obama, somebody who really could have understood not only how to connect but communicate and empower young people, but the playing field might be a little more level in 2016 in just a few months before the general election, we see that the net advantage the democrats have generally has gone from plus 15 a year ago to plus 28. when we look at the most likely match of birth november, hillary clinton versus donald trump, we see secretary clinton with a one point share of the vote, compared to only 25 percent for the likely republican nominee. host: 40 you attributing the change to over the past year? is it the candidates themselves? guest: i think it is the campaign, generally. we conducted polls once a semester. it is a collaboration between me and 26 undergraduates from harvard. a year ago, it was. about a 15 point advantage for democrats. that was before the campaign actually kicked off. what we are seeing is, as the campaign, especially the very divisive republican campaign where it fits one segment of america against another segment, we see the republican brand suffer in the eyes of americans across the board. for example, the republican brand has suffered among young whites who prefer republicans to democrats a year ago, that is not the case anymore. also young, independent-minded americans who were a toss up a year ago and are now fairly solidly democrat. i think as the campaign has gone on, we have seen a divisive campaign on the republican side and the unfavorable number for donald trump is in the 70's and i think that is the main reason why it is such a significant advantage for democrats. there is a second reason as well. the sanders campaign deserves a lot of credit for inspiring a generation again americans -- of young americans to think about politics and issues in a different way than they might have even thought was possible. host: as you talk about this poll of millennials, we are splitting up the phone lines by age group. .8 to 29, (202) 748-8000 30 to 50 years old, (202) 748-8001. over 50, (202) 748-8002. i want to pick up on your comments about bernie sanders. why is the only candidate -- oldest candidate in the race attracting the most support on the youngest voters? guest: there is no relationship between a candidate's age and their position. young people pay attention to the position, they pay attention to the worldview and perspective. he is the only candidate among the five currently vying for their nominations where a majority of young americans you him favorably. -- view him favorably. it has to do with the positions he is holding as well as his overall persona. people generally get excited that he is so passionate in terms of what he believes in, and trying to create a movement. it is the idea of his campaign, less about winning a nomination and more about putting a variety of issues on the table and that has really galvanized a significant part of young america. i conducted some analysis of the exit poll data over the course of the first several months of his campaign and he has one close to 70% of all votes within the democratic primary and of alland about 40% votes cast between 18 and 29-year-olds across america. millennialsoes into views on politics, their understanding of the political situation which leads to this question from twitter, the people understand that we have $19.2 trillion in debt? that?ng people get guest: they get that america is essentially -- the politics is broken. in fact, we ask a question in terms of what direction emanate -- is the nation heading and we asked this back in 2000 when the ball started and 15% again americans believe the country or the nation is heading in the right direction. 85% disagree with that statement, about half say we are on the wrong tracks. and people are concerned about the future of america and debt is certainly near the top of that list. line for 30 tour 50-year-olds in arizona. caller: a quick comment. i just wanted to say, i think my generation is generation x. myself and a lot of friends are leaving towards trump because even we can see the system is kind of broken. corporate america. i'm leaning towards trump for no other reason than it is a -- he is not a caught in the machine and could set us on a different cog in theled the -- machine and could set us on a different path. host: how does that compare to the millennials you have talked to? guest: in some ways, it does the other way, as i've said, i don't think we have a lot of support among americans for donald trump. i think in people, millennials agree that in big picture, things are going in the wrong direction but they disagree on the solution. what we've seen in the last year is a significant shift in how young people are thinking about politics and issues. i would argue that when we look back at this campaign and the ,uture, that this campaign specifically the sanders campaign, will be responsible for shifting a significant part of this generation to the left. you have seen movement across four or five issues that we have been tracking for over 10 years to significant movement just in the last year, five points on issues like the government's responsibility to aid people who are impoverished or protect against climate change. these are issues that the sanders campaign to look at about, putting into the national dialogue, especially moving them closer aligned with his positions. host: we are seeing the same sort of things when ron paul was running and libertarian principles and the support that he was getting from young people. tillman on twitter says they change like the wind. ofst: a very small number young americans fawned over ron paul. he did very well in new hampshire. he probably received about half of the youth vote in new hampshire, that ron paul was not a factor in the campaign at this stage and going back to even 2008, the obama campaign really empowered young people and made them an integral part of that effort. i would argue that was less of an ideology and more of a optimism in the future and having a voice at the table. today's campaign from the sanders movement is really about ideology and it feels different both the obama campaign and there are elements of the paul campaign, perhaps but this is different. host: augusta, maine, 18 to 29-year-olds, tyler is waiting. caller: i wanted to comment on this guys -- young people shifting toward democrats. that may be true in the cities, but i'm thinking that in the country that more are shifting toward libertarianism or even the republican party. basically, what we are seeing is that a lot of people, especially like in my community, a lot of people are going more toward bernie, i find they tend to have drug problems or they tend to be more dependent on the state and local government and we see that a growth in any of these small communities, and massachusetts i know people down there are pretty crazy about trump right now. right here in maine, it is more in the southern areas, more left wing but you are seeing a lot of people are getting a little upset about the kind of slow growth in some of these rural areas. guest: i think tyler raises some good points. i think he is right about the concern about slaughter -- small growth. we asked a question inspired by a town meeting we discussed -- we conducted on campus about the american dream. we asked americans if they believed that the american dream is live -- is alive and about half of them said that for them, they believed the american dream was dead. that is the element of the electorate, a significant half of thoses folks believing the american dream is dead. pessimistice more about america are more likely to align with donald trump on the right and bernie sanders on the left. that there are large numbers of young people flocking to donald trump. we just do not see it in the numbers. mostderperforms among traditional republican constituents. looking at the 18 to 29-year-olds in our survey who voted for mitt romney, only 60% of those folks indicated they would vote for donald trump if he ran against hillary clinton. we have a minority, only 42% of kasich supporters say they would vote for trump. supporters -- ted cruz supporters said they would vote for trump. i thought the future was fairly bright that the republicans would when this constituency and have more of a fight. 29, -- 18 toeam to 29, (202) 748-8000. .0 to 50, (202) 748-8001 50 and older, (202) 748-8002. we are talking up his only came up yesterday about millennials and their views on the candidates this election cycle. 18 to 29-year-olds, nicholas in maryland. caller: good morning. i wanted to call in and comment about the support for donald trump. the caller a couple of minutes ago said that he wanted to vote for trunk because it would be throwing a cog in the political machine. as a millennial, i can understand that idea and a lot of my peers are voting for bernie sanders, but i think no-trump and the way he carries himself is disgraceful and i would urge people against voting for him that reason and looking for his character and politics, thank you. host: looking at character. guest: i think that is the first step. it is still relatively early in some respects in terms of the number of people paying attention to the general election campaign. we are still trying to figure of the convention process, what i believe with young people that they need to seek a connection with a candidate before they can think about particular issues. that is the kind of current challenge with donald trump. -- seekeeking candidate a candidate, we asked what attributes they are interested in, they tell us integrity and willingness to compromise, authenticity. that'll trump has some of those characteristics but others are turning off young people, especially the divisiveness around his comments about muslims and walls and those sorts of things. a majority of young people do not agree with those and i think it is hurting him. his unfavorable rating is over 70% and that should be a concern, and that is about character, to me. actually a is majority of republicans -- a majority of the young republicans hold a unfavorable view of him. a republican, you need to create a better relationship within the party first before we can think about expanding to independents and conservative democrats. host: george is above 50 years old in alabama. caller: good morning. i want to pass this thought along where i have heard several conversations and one that comes up is the delegates and the people. the people elected the delegates, did we put them in power and they turn around and say well this is what the people want. what isly that is not happening and there is not much of a debate when the people to get all the votes is not get elected. does not take a rocket scientist that the people are not putting our politicians in power, that the politicians are putting politicians in power. i am a democrat, but i am not voting democrat this year. host: let's stay on that line for those over 50, rich in west virginia. kimberly in houston, texas, 30 to 50. caller: good morning. havet wanted to say -- i three children that are millennials and all of them are backing donald trump. like the last caller said that it does not take a rocket scientist to figure out that the system is broken, that we are not actually doing anything and i feel like more thereans need to get out and be a citizen and vote. a lot of my friends don't even want to vote because they don't inc. their vote counts, and it takes the citizens to make a change in america. host: thank you for the call. voter participation, why do young people consistently fall below other age groups in going to the fold election day? i think a couple of reasons, in terms of that they don't think their vote matters, or the start of his budget in 2000, the questions, you have questions about the asian is reform patient, essentially because the answer we get back to me ask -- young people need to see -- it did feel like there is a tangible difference between one candidate and another. i think in this campaign, we will see that and we can encourage more people to participate but only if the candidates really take apart and -- take a part and empower the people. they dot to note that care deeply about the country and they volunteer in significant numbers. young people are participating in every way, but i do think and hope that the campaigns will also begin to encourage more participation among young people. asked all you we americans in our survey, 3100 interviews -- all young americans in our survey, 3100 interviews. -- the states in which obama targeted young people and increased, but it is a combination of everybody's responsibility to encourage and empower more youth participation. line california, on the for 30 to 50-year-olds is can. -- is ken. caller: i would like to ask the guy from harvard, do you think the fact that young people are over towards the back the percent of our college professors are either socialist marxist? caller: i am not familiar with that statistic. i too -- i think it has more to do with the sanders campaign right now and the principle of the democratic party during this campaign. i spent a lot of time on college campuses, not just harvard, but franklin and marshall, kansas, and young people are really excited to talk about politics in a new way and think about politics and have debates. i think we are not giving young people enough credit if we think that they are being somehow brainwashed by socialist or marxist professors. host: on the issue of socialism, one finding from the pole that we can show our viewers. a majority of 18 to 29-year-olds reject both socialism and capitalism. into the question when it was asked, which of the following do you support? for 18 to 34-year-olds when you asked socialism, 34% say they support it, 38% say they support capitalism. when it comes to those 65 and older, just 7% said they supported socialism, 60% said they supported capitalism. this is a collaboration i have with a couple dozen students of harvard and one student from oregon was really interested in trying to measure whether or not young people could associate with -- or call themselves a socialist or capitalist. what we found was a couple of things, young people really don't like any labels. very few people as we -- as you indicated, but comfortable calling themselves a socialist or capitalist. more telling is that a majority of young people today -- the first thing we did was, we expanded the polls for the first time ever as you noted and asked people over the age of 30 as well, we conducted a survey and found that the fleet of the over -- over the age of 50, there is not a lot of support for capitalism. once you get over 50, a majority of people in america tell us they do not support capitalism. i went back to a college campus and conducted a focus group of in y caster or so and franklin and marshall college and what i learned was capitalism that is practiced today is something that is unfavorable for students. they tell us that it provides opportunities not for anyone but for a chosen few that know how to manipulate the system and that those of the main reasons why capitalism is not supported by members of this generation. largest generation in the history of america. host: about 20 minutes left. paulina is waiting for that line over 50. virginia, good morning. caller: good morning. mentioned. note you thyselfnd neighbor as -- help thy neighbor as thyself. wasreason i was calling with respect to millennials and their predicament. first we had automation and software and that eradicated jobs. i read recently that i think it was 4000 banking jobs will be eliminated due to robotics. as we start incorporating robotics into the work lace and moving up the job chain into white-collar jobs, not to mention the fact that certain jobs that are white-collar get shifted overseas. imports development and where does it leave these young people looking for jobs that will allow them to start a life? guest: it is not even the question of just jobs. it is the question of jobs plus debt. don'tof young americans have a grand plan in terms of their definition of the american dream. it is the ability to do what they want, pursue their version of the american dream. i spoke to somebody last week on a college campus and their dream after attending college for four years was to college was serving the public but unfortunately, and there are a lot of other people, who would like to pursue that kind of career but they feel like they can't because of the load of student debt after college. so it is a combination of child shifting overseas and shifting from one sector to another. it is that incumbent nation with the cost of college and it has placed a significant burden on young americans. 30 having 50 years of age, suzanne, good morning. caller: how are you? 45 years orhould be old or older. that never really existed. and the same people who want to 45,re and are lower than waiting for their place in management and decision-making. host: how do you define the american dream? caller: i do find the american dream as opportunity. you know, there are people who think of back in the day, this is america. it is about progression. so if a syrian refugee who is a doctor of wants to come to america, bring them. they add to their productivity. you know? age group think about the global world. we think differently than the people who are 45 years old who somehow hang to the past. ,he jobs that have been lost these are not jobs that we want. we don't want to be stuck in a factory working from 9:00-10:00. we'd want to shift the service sector so we have to adapt. we need to bring back all of these old jobs and teach younger people how to become programmers. how to become doctors or whatever. they cannot. host: a couple of issues there. guest: he is right on in his definition to the american dream. we have done a lot of research into the common theme that ties everyone together in america and it is dead on when you talk about opportunity. i talk to people in thousands of cities and we talk about all of the other countries out there. the idea of opportunity still exists. for some, they think it is slipping away. from the young people i have spoken with recently, that is part one. host: a comment from karen on twitter who says most younger people i talk to like bernie sanders as they see him as more genuine than hillary clinton. we are talking about the harvard institute and the latest poll on millennials. is the pollinge director there. now, lynn from texas. good morning. caller: good morning. to say i couldin not disagree more with mr. john .ella volpe harvard is a liberal institution and he is affiliated with harvard and i am sure that if you asked him who he was going to vote for, it would be either hillary or bernie sanders. my comment is, -- host: let's let him talk about the ideology of harvard. give him a chance to respond. guest: thank you. i don't know where to start of cash start other than be conducted this for 16 years and we spent yesterday in washington, d.c. with two students, one was republican and one was democrat. i think frankly, it to have the cycle, some recycles feel about our data that i have been saying for quite a while that this race among the youth vote, take it vantage of the opportunity. we tracked it back to 2000, and in 2004, people were in the mix. republicans had taken a big step back. for some time now, i thought this could be much more competitive. it had nothing to do with the way in which i vote. it has everything to do with which pages 29-year-old answered questions in the survey we released. host: let's talk to another 18-29-year-old, and it is in baltimore. caller: good morning. you talked about how millennials rejected labels. i wonder how this relates to vibrant rumors -- to open primaries. host: hannah is asking about open primaries. do you want to expand? caller: yes, i know a lot of my peers will not register as democrat or republican and are then unable to vote. because of that rejection. guest: i think that is a key concern. people could participate in the cycle but in several states, you have to change your registration. we have seen a significant -- we that bernielysis sanders has 140% of all of the votes cast among young people in america. secretary clinton has received about 16%. 55% of all votes cast for democrat candidates and i think that number will actually increase in favor of the democrats if we had more open primaries but that hasn't been the case. host: let's go to armando in connecticut. 30-50-year-olds. thank you to c-span for the great programming. i have a quick comment and a question. hear thatfreshed to millennials are starting to reject labels. we need to take a more practical look at our problems. so if you think about what unites us, we talk about searching for things that unite us. withrobably are aligned him credit principles. republican. when i look at the country, i think that the things that are the things in our infrastructure. airports and roads. and you look at japan taiwan, that is how they compete. i wonder whether this is part of the question. whether people are starting to see our human resource, our people as part of the .nfrastructure it is leading people to all different messages, including bernie sanders. people starting to recognize that it is an important area to invest in? host: john della volpe. guest: i think that is the case. i will say just a couple of reasons why a think that is the case. one of them is that the young people always tell us when we have follow-up questions as far as what the top two or three issues are, education is typically in the top tier of issues. education defined as college education and trying to deal with student debt but we had a focus on k-12 education. when we asked the question in this survey, we talked about education and which deserved 65% ofctation, 2/3, young americans said investment in k-12 education. they understand that the quality of their education generally is very good and that is factory. believe they had a satisfactory education through the point in life. but we asked them what their advice was to further improve k-12 and another caller called up as mentioned earlier technology and stem training. including more stem-based curriculum in the grammar school. it was one factor and was the wast significant thing that followed by lower class sizes. 52% said there should be more emphasis on stem. smaller class sizes with 50%. increasing teacher present at 46% and free pre-k at 35% and increasing school choice at 33%. they said that would be most effective in improving the education system and 32% said standardizing the curriculum across the states. let's go to osler, kentucky where richie is waiting. he is on the line for those over 50. caller: i lived through the exchange that we went through in america where a man -- especially college people, i barely can go through technology today that years ago they could get out of college it be placess of a factory or but what we have done is take a whole group of people. people, il these drive a truck. [indiscernible] i have a house sitting on an acre of land and i don't how to read or write. but today, i went down to get a job as a school bus monitor and they told me that i have to go back to school and get a high school diploma to learn how to put a child under a school bus and i have been driving a tractor trailer truck for 36 years over the highway. and you people are putting a piece of paper and between a person with intelligence against a piece of paper. that is what is happening to our country. we ship these jobs overseas. american people wanted the cheap stuff. i hear people say that they don't want to work in a steel factory but the college kids today want to go into high-tech jobs and there is no other jobs left. host: john della volpe, your thoughts? the idea of the need for a college education these days? tost: first of all, i want appreciate the story in terms of the american dream. he used his talents to to make a great life which is the opportunity that should exist in the country. there is athat pathway to college. one of the barriers on we to young people in committee colleges, we ask them why they aren't pursuing a four-year degree. 90 percent of the folks say cost. there are people who want to pursue higher education and they are locked out of the workplace. so i do generally agree with a lot of the points of richie. carly,n austin, texas, welcome. you are on with john della volpe. caller: thank you. y ultimate focus here on the discussion is that our biggest problem with our limited understanding of the world through a narrow amount of information. we have this wonderful station here but i married into a christian family, i am third-generation submariner. my great-grandfather built a hydroelectric plant in buffalo it ise niagara falls and the epitome of the american people but before i left my environment and started traveling the world, i really had a very narrow understanding. i was always into the political standing of standing up for what i believed in but how do you feel? about the young today not actually having the chance to go out and experience the world? and having such a lyrical profound viewpoint, on the world itself. host: john della volpe? guest: i do think that when we talk about the american dream, the idea of opportunity is something that comes up a lot. young people who want to experience the world. and i do think that they are interested in learning about other cultures. and that is part of the reason that we see the overall level of capitalism because they are tuning in to help a seat other cultures and other economies and political structures around the world. now they are not necessarily seeing perfect models but i do now they are not necessarilynd seeing perfect models but i do think they read and travel and they do believe that their choice would be some sort of hybrid system. so young people to want the opportunity to experience the world but again, it is difficult when you graduate from college or even attend college with that. so i do think that young people today, they may consider themselves to be a global citizen and that is a good in. i think that the more opportunities for young people to explore, suffer be terrific for everybody. nk that the more opportunities for young people to explore, suffer be terrific for everybody. host: on the line for 18 have a 29-year-olds, glenn, can you make it quick? caller: yes, i'd wanted to point out that just because it a lot of millennials are going away from the republican party and the old conservative standards, it doesn't mean that they are flocking to the democratic party. a lot of the liberal ideals that are upholding there. because a lot of people, like me, i consider myself something of a progressive independent. because i do understand the need to be fiscally conservative derg of a progressive independent. because i do understand the need to be fiscally conservative and not give everything away. because i am a 27-year-old roofer, nonunion. i don't feel like the democratic party is necessarily the best one to help me. host: our last 30 seconds. guest: that is a good point. we typically see a plurality of young people call themselves independents. the survey was the first survey were receiving number of independents clip democrats. it is a reality today that there are two major candidates for office. likely to be hillary clinton and donald trump. we asked young america's choice a or twist be and we see 61% support hillary clinton and 25% are republicans. if there are other candidates, it could change. there is a strong independent streak that still exist and democrats, especially hillary clinton, really needs to work to convey the principles of her campaign in her vision of america to them if they secure the vote. host: check out the new poll from the harvard institute of politics. john della volpe is the polling director there. thank you for your time this morning. up next on washington journal, we are joined by dr. john noseworthy, president and ceo of the mayo clinic. we talk about the imitation of the affordable care act and containing the zika virus. ♪ >> independent media is the oxygen of a democracy. it is essential. holding those in power accountable. we are not there to serve some kind of corporate agenda. when we cover war and peace, we are not brought to you by the weapons manufacturer. >> sunday night on cue and day, the host of democracy now talks about the book that she has co-authored covering the movements changing america looking back on some of the stories and people the show has covered. >> the idea of democracy now starting 20 years ago has not changed. bringing up the voices of the people in the grassroots and around the world. and they very much represent the majority of people. concernedople who are deeply about war and peace, about the growing inequality in this country, climate change and the fate of the planet, they are not a fringe minority. not even a silent majority. but the silent majority. silent by corporate media, which is why we have to take it back. >> sunday night at 8:00 eastern on porate media, which is why we have to take it back. >> sunday night at 8:00 eastern on q and a. dr. john noseworthy joins us now. he's the president and ceo of mayo clinic. we want to ask you first about an issue that came up as we were talking about the sixth anniversary of the affordable care act implementation. we want to talk about how transparent hospital pricing is these days and has it gotten any better? can a patient go in for a broken leg and know how much it will cost by the time they are done with the procedure? guest: we are not where we need to be. in this journey to deliver complete transparency to our patients. it is a complex issue and a lot of folks are working on it but in general, the profession, the payers, the providers they all see the value in engaging patients with their health care decisions and then understanding the cost of care and the quality of care. they were our prices for everything, as you would expect. but that doesn't tell you all story. there are a few patients pay the list price for the procedure or the test because they are having insurance discounts and a big factor in this is the utilization. how often the test is done and where it is done and over what amount of time that episode of care is taking place. so it does become a bit more complex then the price of something. but that said, the mayo clinic is working very hard on this. to try to be much more transparent about the cost of care and the quality of the care. what is the outcome? we think those are terribly important. we are developing an estimator for our patients that they can work with so they say, if i have this condition and this procedure and this kind of insurer, over what amount of time will buy be able to asked to pay which percentage? it depends on insurance, if it's a high deductible plan, they will pay lot up front. we are getting there. and there is very little resistance. is nothing as complex as cost and price. host: was this something that the affordable care act did something about to change this? or was this a conversation that was started during discussions about affordable care and trying to deliver care better? the affordable care act was essentially an insurance legislation. it basically got more patients covered nationally. and that has been a good thing. mayo clinic supports that for patients. patients should have some form of interest to help them access health care. it really didn't go very terribly far in measuring paying for the value of the care. you have the proper diagnosis and you have a good outcome. there were some early steps in the bill. and that is the next step in the past on health care reform. paying for quality and better outcomes. we are moving away from a fee for service environment and that is a good thing but creating a pay for value outcome system is in progress at the moment. progress is being made but it is complex. host: we are talking with dr. john noseworthy of the mayo clinic about hospital management, he affordable care act and if you have comments, our fomite are split up regionally. (202) 748-8000 if you are in the eastern time zone, (202) 748-8001 in the mountain or pacific region and a special line for medical professionals if you want to call in and talk to dr. john noseworthy, it is (202) 748-8002. to get back to the six anniversary of the affordable care act, what has been the biggest change in the mayo clinic system that you have seen? guest: i think the biggest change we have seen is that pat biggest change in the mayo clinic system that you have seen? guest: i think the biggest change we have seen is that patients with insurance, the typical patient, a working american who has insurance, they are staying away from health care more than they used to because they are uncertain how much their total experience they will have to pay for. many americans have high deductible health care plans. ahich basically gives them crisis traffic coverage but depending on the terms of the insurance, they may be responsible for the first one thousand dollars-$5,000 or $12,000 in high care costs. so patients are staying away. up to 40% of patients in the middle-class are actually delaying and deferring going to the doctor or having procedures concernedse of their that they will pay more out of pocket than they used to. that is balanced by the growth in the medicare population, as you have talked about before. 10,000 americans each week turn 65. we are seeing more patients who did not have insurance before now accessing health care and many of those folks have delayed or not had experiences with health care coverage for some time. and as we have seen, they are sicker than the average patient in the population because they have not going to be. there. and now they have coverage to medicaid expansion and they have great health care needs. and that has been a huge change for the country. it is a good thing but it is one of the biggest changes we have seen. host: so both of these questions about transparency, jim asks on twitter why discounts are offered to insurance companies and not to the folks who pay out-of-pocket hospitals? well, a great question. essentially, americans have access to health care through the insurance companies. and in shivers negotiate with providers and payers based on the quality of outcomes what the rates are negotiated with the providers. that is the way it has been for quite some time. patients pay out-of-pocket if they don't have insurance and that is a great disadvantage to them. that is the way the system has evolved. host: terry is up first in bethesda, maryland. you are on with dr. john noseworthy. caller: good morning. that hospitals negotiate with insurers or providers to come up with the prices. and that is fine but the problem with the affordable care act or a guess with our system right now is that it seems to break down because of the lack of transparency. it seems to me that the relationship between the providers and the insurers might be a point of leverage here. why could you not, at the mayo ,linic, work by medical code the price you can negotiate with orferent insurance providers make that information available to consumers so that without regard to other issues such as what procedure will be used for whatever, they at least have a departure for people to make comparisons? right now, it is completely opaque. and that breaks the system down. host: dr. noseworthy? guest: that is the direction we are moving in, thank you for the question. what we have found is that patients want to know what it will cost them and there are literally hundreds of different insurance plans for folks to choose from. and the price and the discount matter less to them than the ultimate cost that they will be responsible for. so we try to work with individual patients to work with them and show the cost of the care. that is what patients have asked us for and that is what we are working towards. host: let's go to linnea in washington. caller: yes, i have a question about leveraging the health care ontload it to have less cost. i am a health care professional. i'm not a medical professional but i was diagnosed with borderline diabetes and i was given the medication but it turns out i have a vitamin b12 deficiency but my primary care physician did not pick it up. since vitamin b12 deficiency can lead to significant neuropathy i am wondering why that wasn't picked up by my primary care physician, which could possibly leverage my health in the future in a good way by reducing or eliminating neuropathy risk. host: did you get that? guest: i did. thank you. so, let's go back to basic principles. it is absolutely essential that patients get the appropriate diagnosis. that we find out what is wrong with that individual patient at that time as quickly as possible. so the appropriate diagnosis and the treatment plan can be put into place. we are pioneering at mayo a shared decision-making process where the physician and provider works with the patient to understand what are their goals in the health care journey and what is important to them in terms of making these decisions about what they are going to do next. and involving the patient in their health and decision making regard to their medications or seizures. at joint work together is terribly important. in this situation, as it is laid out, a vitamin b12 deficiency wasn't identified by the first provider. another diagnosis was made and then you begin that journey of fragmented care where a patient goes from provider to provider, trying different medications but essentially at the heart of it is an inaccurate diagnosis. that is where the quality piece sets into the initial thesis about cost and transparency. it is cost for what? transparency for what? did you get the diagnosis upfront russian mark in certain situations, more testing might be needed and it will cost a lot of money but in the situation, that would have presumably reached a more accurate or gnosis so the treatment plan is appropriate for the patient going forward. cost is a combination of that needs to be brought together. as mayo clinic we do a lot of research, discovery science research and how to improve the efficiency of the practice and how to redesign and reengineer the practice in order to get answers quickly but also accurately involving the patient at all times in that. that team-based care so you get the right answer at the right place at the first time. getting the diagnosis correct is the first step in any medical illness. host: the mayo clinic is a not-for-profit hospital system operating in six states, a question for you, picking up from usa today. "gulf coast is the frontline in the zika fight and the u.s. lacks the vaccine. what is the mayo clinic doing to prepare for the zika virus? guest: thank you. this is a concern to all of us. in the united states. the mayo clinic, as you would expect is deeply involved in researching to develop a new -- for seekeret virus. we are working with a lab in brazil that produces 90% of the vaccines used in brazil. we are working to create a vaccine but it takes time and funding and effort to move this forward. it takes cooperation with congress to get the funding appropriately. you needed allocated to the effect can do this. the vaccine is a major part of this and we are one of many who are working to develop one. it is much more than the vaccine. it is patient education. the vaccine to prevent mosquito bites? but since commitment to research that is driving our work to reduce the risk of the zika virus. host: let's head to minnesota where bruce is waiting period caller. caller: good morning. i am glad to hear somebody in the medical profession use the word "retail" because that is what it is all about. the retail cost. i went to the mayo clinic, i am a disability veteran who got all of my care at the v.a. but i got a diagnosis of the prostate cancer and the sophistication at the v.a. was not on par with the mayo clinic. came back and second time. i had to pay $10,000 down before i could even make an appointment. and it turned out that i paid the full retail price. and i didn't have private insurance at the time and i am wondering why people who need when theyre would pay don't have private health insurance would pay full retail price where if you are a member of an insurance program, you get the discount. i would appreciate your thoughts on that. host: dr. noseworthy? guest: thank you for your question and thank you for your service to our country. so, i'm sorry that you had to pay out of pocket for your care. without an insurance program, that is our policy. .e do a lot of charity care to doe to balance how work and how to fund the organization so we can go forward. we have a lot of charity care and we're happy to do that and it is out of the non-for profit status and we are committed to the situation. the policiesment, are in place at the retail price is applied to those without insurance. we do this on a case-by-case basis. based on medical need and the uniqueness of the care at mayo clinic. we decide which ones are written off as charity care. i'm sorry that it put you at a disadvantage. host: jerry is waiting, good morning. caller: how are you doing? i am a treatment specialist. treatmentsh a lot of for certain diseases and afflictions. so i wanted to ask the doctor, when you go to the emergency , they have a -- that scans everything that it does for you. aspirin, band-aid and every procedure. i went to the emergency room and probably 30 times. they scan everything. and you don't know what you are -- people with no illness go there and they get 20 or 30 different kinds of tests getting someup kind of prescription. host: is your question about unnecessary testing? what is your question? what's the question? caller: the question is, how much do you make a year and are you invested in any of the device makers and the drug company stocks in the company. dr. john noseworthy, do you want to answer? guest: i didn't hear the but mayo clinic has a very strict policy about our relationship with private industry. staff, as far our as through our trustees. we have a very strict policy about our researchers and it has been an issue that we have been strict about. we can do research with industry but we can't do both. this is one of the most transparent and clearest policies that is available in the industry. it sounded like jerry was concerned that unnecessary tests were done in hospitals but i think that would not be the standard that any of us would promote. host: a recent exchange on twitter between dan diamond, politico health care reporter tweeted out that the current pace of health care will become the biggest job sector in america within three years. he tweeted a chart showing that but there was a response from a yield cardiologist who asked, is this good news? are we making the current health care infrastructure to big to be disrupted? what do you think? krumholz well.r. i think he is asking, or be open to disrupting health care to so thatthe quality patients can get cutting-edge care of low-cost? his custom was a provocative one but a good one. on the simple one at the beginning, the health care industry has been a growth industry. it has been a great place for young people to train. they get solid reporting, mission driven employment in their life. and we would encourage young people to go into health care. it is growing. it is the fastest area and the economy and i think that is a good in. but are we on that path or can different way of doing things? and the workforce issue for tomorrow is critical. everything that is currently done by physicians, could it be done by advanced practice nurses? are their health care managers that can be trained differently to help patients make decisions to reduce the cost of care? is there management that can help people look at records and ask what they need to do next? i am looking forward to innovation in health care again to deliver on the goal that we have as americans which is to create the highest standards of health care in this country. it has to be affordable but it has to be a high standard. there is a lot of change in the system which needs to happen. that is what he is talking about. a great industry and a very rewarding feel. host: what are those changes where technology could help? is enough being done to support telly medicine? is that something you would support? guest: absolutely. thank you for the question. g forward quickly and the technology piece is there no. hospitals are rather small and would have 5-10 care unit beds but there are a shortage of intensive care physicians and nurses to staff all of those. at mayo clinic we have a cockpit which looks at 100 community-based care units and partners with them to help manage care being delivered in their critical care units around the northwest. and to intervene quickly with additional help including a rescue helicopter. hat something that is unique to the mayo clinic? guest: no. other groups are doing that as well. most of this is done within a single state because problems there aresure -- things being done at the state level to break down barriers. because some of the hub deliver helpld room more broadly over very diffused areas if we could get past the licensing issues. progress is being made. this will reduce the cost of care and improve the quality of care for patients and that is what it is all about. providing better care for patients. host: we have a special line for medical professionals. the number is (202) 748-8002. richard did: from reston, virginia. the morning. caller: i think this doctor is a pollyanna. some of the things he said is -- there is no reason why mayo can't post a single price because that is what they do for medicare. they have a medicare price and they could charge everybody that. it is going down the tubes. money has been taken out of every residency because of the rules so in my specialty, 4000 hours has been removed for training. rational's don't know much about anything and they are undertrained. host: what is your specialty? caller: ob/gyn. but that was every residency. people arrive unable to do regular surgery. nurse practitioners are a joke. if it is possible to practice good medicine with having a four-year college degree and two years of a master's degree as in his practitioner at the nobody needs to go to medical school. i see it every day in my office. gps and nurse practitioners come in. what the doctor says and they only see the nurse practitioner. our spending comes back to us to reinvest and research in education and technology and the community, that is our business model, it is not to become wealthy, it is to provide better care and support the mission, going forward. host: thank you so much, we appreciate you taking calls from our viewers this morning. guest: it has been a privilege. host: we have a few minutes left in our show to take your calls and comments about any foreign-policy issue as we do , also callers talking about the medical issues and their experience with the affordable care act. steve is waiting in south carolina, good morning. your thoughts on the sixth anniversary of the affordable care act. caller: disappointed and i wish the doctor was still on the phone. i knew people in the medical profession and i know a couple of doctors. i know running a private office is very expensive. you have your typical falls to -- calls to pay staff, insurance, medicare, nurses, your physicians assistants, cleaners, electrical, everything associated. it costs a lot, but having said that, my youngest son did not have insurance the longest time and in south carolina, he was always able to negotiate a prompt pay discount. he paid $50 to go to the doctors are -- to go to the doctor's office last year. health insurance and his co-pay is $88 and his duck double is $3000 and of course, the co-pay does not apply to the deductible. that is a big problem, he pays a lot for his insurance and when he did his tax returns, he had to pay a penalty because he only had insurance for half the year. let me say this about another problem. my mother was 93 when she was -- when she died. when she went in the hospital, the immediately assign you a caseworker. is to seeorker's job how fast they can get you out of that hospital and they will leave you on the curb with your head hanging over in the same condition. you talk to the caseworker and they say at into medicare, we have done all we can do, you have to go. it is a messed up system, primarily because of the cost and the health care you get and how quickly they boot you out of the hospital and how the government controls it instead of the doctors. that is a big problem. here, ify this, down you don't have a job, the university will negotiate a prompt pay cash discount for you and it does work. that is the good part about not having health insurance. the bad part is you are stuck with these high co-pays and deductibles and you are always subject to the medicare standards for what they have done. host: thank you for sharing your story and your situation in cap. south carolina. we have 8 -- down in south carolina. or weblic policy issue can continue talking about the sixth anniversary of the affordable care act just past last month. illinois.ley, tina, caller: i have a question for the doctor. host: the dr. is gone, but what is the situation you want to talk about? caller: i have severe gastroparesis and i wanted to know if the mayo clinic had any research going on for that because i have been suffering with it for the past three , nausea,th not eating and lots of weight drastically and energy -- no energy. we are attending northwestern in like i amd it seems not getting anywhere. host: is this a condition that your insurance covers? yes, but i have had diabetes for 20 some years and that i had a pancreas trance went, so i guess with the transplant, it kind of -- my stomach is not working at all. host: we appreciate you sharing your story with us. next, houston, texas. caller: thank you for taking my call. i had a question for the doctor but my comment was going to be, does he know all the different investigations going on about our medical fraud that all these places are doing? you go to a hospital and you get your bill and there is a bill for an aspirin that was $60. as a veteran, how come we are not allowed to go to these other hospitals like the mayo clinic if i had a severe disease that no one else could hear -- cure? that was my comment and maybe he heard it and will do some about it. host: he will be back on with us down the road. he does enjoy taking calls. thank you for calling in. we want to remind our viewers that today is primary day in five states. we will certainly be wrapping up what happened with the voting on tomorrow's washington journal. here is the providence journal, trump rivals are pathetic is the quote from donald trump on the front page. headlineecide is the to the front page of the news journal. voters views ahead of the primary. taking place in connecticut and rhode island and pennsylvania, delaware and maryland. the biggest being treasure trove of potential delegates for the candidates. we go to susan in north carolina, independent. are you with us? in northo to john miami beach, florida. caller: good morning and thank you for taking my call. i have a comment for all the politicians and donald trump in particular. he claims that he is going to make all of these great trade deals. reinsesn't he take the and lower prescription drug costs? europe doescause not pay for any research and development. the united states are hobbled by this. this is after we bailed europe out of two wars. we paid for a land lease before the war. we pay for reconstruction under the marshall plan and now we pay for nato. they build trains, we cannot afford it. contracts are going into dust and we hav p

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