Transcripts For CSPAN2 Capitol Hill Hearings 20130829 : comp

then after he loses is willing to say he is my president. we will support him. we don't really have that around and that is very disturbing. to get back to your point, it was just as bad or worse back then. gives us hope that maybe something can be resurrected out of this thing we are going through. any more questions? yes? >> given lindbergh's fear of getting into the public and the press, what combination of factors drove him to be one of the leaders against the war? >> u.s. really good questions. that is a really good question. charles lindbergh, one of the things about charles lindbergh he was always, whenever he took a position he always thought he was right. there was never any doubt in charles lindbergh's mind about what he should be doing or thinking. .. when i think it was the busiesti -- loci middle of mistakes, butl it was certainly the biggest mistake during that time that he made. tha he just tarnished his reputation as a result of that. his he was never happy lesson was flying. what he could do really well waa fly. do he new aviation inside now.he and getting involved in know, smething he knew nothing about was a very big mistake and ise part. part. >> after the war started, can you tell us briefly about what charles lindbergh did? i mean, he had a lot of, i guess, intelligence based on his tour of germany and all that kind of stuff. was he, um, participating after the war broke out in any kind of way on a pro-u.s. side? >> that is one -- that's really one of the most interesting things about charles lindbergh's life, is what happened after the war. after the war, when pearl harbor happened, he disappeared from the isolationist movement. he was gone. he didn't criticize roosevelt publicly, he did not criticize the administration publicly. what he wanted to do was to be able to fight. he wanted to be able to go into the air force and fight. fdr said absolutely not. i'm not about to have you in the air force. i mean, he still -- fdr still believed that he was a threat to the administration even though he wasn't. so he was banned from taking part militarily. he became a civilian consultant to a number of airline companies, and what he did, he tested the new military planes and actually helps make them safer and improve their flying ability, etc. a couple of years after the war began some of his military friends came to him and said why don't you go to the pacific and be a civilian consultant there. and lindbergh said, well, roosevelt won't let me. and they said, well, why does roosevelt need to know? and so he went to the pacific as a civilian consultant wearing a military uniform without any insignia, and he flew. he flew on a number of missions, was almost shot down, shot down one japanese zero. and in the course of this time over there he also, again, improved a number of new airplanes. and from all accounts he was never happier. i mean, you know, this is where he really belonged. and his wife once said those five months that he spent in the pacific were the happiest, was the happiest time in his life. i don't know, i suspect that roosevelt did find out eventually that he was over there. but all of the military people that he flew with turned, looked the other way, you know? it was never, there were never stories about him flying. it was very hush hush. but he did have an impact on, a small impact on, certainly, on the flying in the pacific. i think we have time for one more question if anybody has a question or a comment. okay, george. [laughter] >> so talk, your book so balanced, and there was a lot of character assassination on both sides. but talk about what you found about anti-semitism in the isolationist movement and with respect to the big speech that lindbergh gave. what did that reveal about his own mindset and his views about the races? >> there was anti-semitism in the isolationist movement, not throughout. but anti-semites did join america first, for example. charles lindbergh did give this very infamous speech in des moines, iowa, in which he named the three groups he said were most responsible for trying to get us into the war, and that was the fdr administration, the british and american jews. and his comments were anti-semitic. but what i point out in the book is that he was not alone. i mean, basically, what he was doing was reflecting the attitudes of a good many americans at the time. there was a very strong, overt streak of anti-semitism in this country, in this period, during this period. and i don't write this in the book, but basically what i think is charles lindbergh's mistake was that he voiced -- i mean, it was a mistake to have those attitudes, obviously, but he voiced in a public speech, you know, what other people were saying privately. and this, again, shows his total tone deafness to, you know, politics, to whatever. but he didn't care. be but there's no question that there was this very big kind of climate of anti-semitism that extended, you know, from, you know, you know, the midwest into washington and the state department, the war department. i read diaries of important state department officials, and it's appalling. i mean, what charles lindbergh said in that speech was nothing compared to what they were writing privately in their diaries at the time. okay. thank you very, very much. >> out of the transpiration that they want with each step of the well-worn shoes, that's the debt that i and millions of americans go those maids, laborers, porter's, secretaries , folks it could have run a company if they ever had a chance, those white students to put themselves in harm's way even though it in after. those japanese-americans who were -- those jewish-american that survived the holocaust. people who could have given up and given in but kept on keeping on knowing that people may indoors for a night, but joy, as in the morning. [applause] of the battlefield of justice, men and women would liberate gasol. in ways that our children not take for granted as people of all colors and creeds live together and learn together and walk together, fight alongside one another and love one now of our character in this greatest nation of earth. to dismiss the magnitude of this , to suggest has some sometimes to that little has changed, that dishonors the courage and sacrifice of those who paid the price to march in those years. [applause] they did not die in vain. [applause] their victory was great. but we would dishonor to suggest the the work of this nation is and how complete. the universe may bend toward justice, but it does not bend on its own. to secure it big gains this country is made requires constant vigilance, not complacency, whether it by challenging those to erect new barriers are ensuring that the scales of justice work equally for all the, pipeline from underfunded schools to overcrowded jails, it requires vigilance. >> in a few moments to look at how spending cuts are affecting early childhood education programs like head start. and a little more than an hour and this conference on how large employers are planning to implement the new federal of carol. >> several life of its to tell you about. debating action against syria regarding allegations that the syrian government used chemical weapons against its own people. you will see that here on c-span2 at 9:30 a.m. eastern. unamerican pain in network, we're covering in the u.s. chamber of commerce's focusing on economic issues. >> 2006, were going to a takeover, looking pretty bad for republicans. vice president cheney's office : one to know of which could come over and have breakfast with them. i met him before thin. the band saw many of these districts as other republican leaders. but basically he the soda of asking us how bad. it's pretty bad, but that's kind of fun when you talk to various caucuses. >> tracking every congressional race from 1984. >> now i discussion of how spending cuts are affecting early childhood education programs. >> good morning, everybody, and welcome. i am the executive vice president for policy here at the center for american progress. we are delighted to be hosting this event today with the national head start association of the impact that budget cuts and having on our youngest and most vulnerable children. we're lucky to have several people here today who will know better than any of us with the impact of these cuts on their children and in their communities, and we're grateful to them for coming to share their stories with this. but doing this event today on the in the nursery of the march on washington because this really is a critical issue from the perspective of civil rights. too often children of color from low-income communities enter school behind their peers throughout their academic life. programs like head start help to level the playing field and prepared those children the center's school ready to learn. when programs like head start of his children of color are disproportionately impacted. the largest cut under sequestration and their enrollment in california and texas of over 70 percent of the children :. high quality in early childhood education programs on one of the best tools we have to ensure that children have been a close -- eight the shot at being free. recently one of our panelists today, recently put out some to nicole for reset in the debate $1 trillion in deficit reduction. because of lower cost, sequestration. we also pointed up, stifling economic growth. we challenged under to take these facts and evidence and to shift the debate from cuts into investments in a future. there's no better place for us to invest in our young children. in that paper we do call upon congress to make substantial investments in the religion of the education. the evidence for these investments we believe for an average charge of it is not receive a high-quality education is 25 percent more likely to drop out of school, 40 percent more likely to become a teen parent, 50 percent more likely be placed in special education, 60 percent more likely never to attend college, and 70 percent more likely to be arrested for violent crime. other countries are asking on this. china has pledged to increase preschooler moment by 50 percent by 2020. mexico and india have announced plans to reach 60 percent of the children of preschool education. these countries know that these investments will need to know more competitive work force for their countries, and if you want to continue to compete in the global economy money to do the same. now all of like to turn over the podium. the executive vice president and partner for this event. a long-term advocate for children and families. happy to have here today the talk about health sequester is affecting the headstart comedian the national level. >> thank you for that kind introduction. good morning, everyone. we have a small staff. and the executive director. we have no room for executive vice president yet. i really want to take a moment to thank the center for american press for the generosity and willingness to call attention to this really important issue. the fate of the nation's. i'm glad for a form that allows us to talk frankly. think you're one in the audience for being here. the lincoln memorial pier for us to be thinking about ensuring that all children have access. we have all been moved, the weekend of the 60th anniversary of the march on washington. today we actually reflect, on the important moment in the nation's history. we have come, how far we still have to go. to mention that there is a push for equality. our colleague mr. thompson become a history shows that 48 years ago the drive-by shooting of head start programs. some employees were threatening emmy's to announce in the children's head start. we have come some way, and we have ways to go. in 2012 had starred in their early headstart pronouns around the country broke parkin and scant eligible children. the waiting lists for lawn and over so years rising costs and rant, energy, health insurance, programs have already begun deferring their maintenance intriguing support staff and lowering salaries. so we have almost always operated at the margins because it seems inconceivable the -- inconceivable not to spend every available dollar on providing the best possible quality program for every possible child . so when the unthinkable happens, sequestration became the new reality amount we had little fat to cut. your recent ec -- youth likely seen the recent office of headstart reports that over 57,000 fewer children will be served in headstart and early headstart next year because of the sequestered. and this is not a small number. the creative number crunching thinkers figured out that 57,000 people would fill a football stadium at the university of louisville. 1900 school buses and create six and a half mile traffic jam. and what their arms outstretched for. analysts cheered that this number is lower than the original projection, a closer look at the details shows an even more troubling picture. head start programs across the country have the authority to be flexible in implementing these counts. that's an opportunity for which we're all grateful. this local flexibility, many much of in and families will be affected by the cats, and here is how. the data shows the program cuts over 1 million days from the school year. not only does this take away very critical days ever learning , let's also puts parents and families in the difficult situation of finding quality, affordable child care options in order to stay employed. from a survey that we conducted among more than a quarter of programs closed one a more of the locations where they offered services commemorating the parents lose a community resource and will have to transport their children to a new fighter away centers provided they still have a spot mckeon and to keep their spot. it's a tough act for them with gas prices already high and many families without guns. in addition, 15 percent of the programs reported cutting transportation, reducing access the the most iceland and vulnerable families. even before the sequester, only half the programs have been able to afford the offer transportation. the strategies for cutting and a sustainable. the program cuts will be available to cut next year. this insures that any additional cuts will have an even greater impact on access in 2014. the office of head start also reports the 25,000 staff and-seen a salaries cut or lost their jobs which means that a head start feel will lose the expertise and the investments : less six years. mom so if you ask me, are in the this year when i would like to be talking about in 2013, my answer would not been sequestration. have been lucky enough during my time in this field to witness this low building acceptance among policy makers and citizens alike of the critical importance of investing in high-quality early education. today the environment in which we advocates find ourselves could not be more positive. i speak for all this when i say am pleased that the health researchers have given us better and more concrete data on the effect of health the early child experience. i am thrilled to see that think tanks in washington pay more and more attention to this issue and to find new allies and supporters in congress of the week. i am surprised and delighted to be speaking in agreement with they m brass are not picking themselves to this issue . overjoyed to be working with the business community this issue and to be talking about a dozen issue of revenue for the future of our economic liability. has there been a moment in recent history when the national acceptance of are they learning was at such a high? sequestration's was a swift punch that took the wind out of the sales of the millions affiliated with the day said start. in the midst of this anxiety president obama announces plans to propose massive new investments in high quality of early learning. this is what we should be talking about the really have more data behind us now than ever before. more acceptance on the part of states and local communities behind as the never before. the stalemate over the budget princess from diverting our attention while it is still cutting show and from our prisons. the answers the same. investments mattered greatly. today we come together to talk about the impact of those of us having to them slowly of time as my financial advisers tell us to do as well as the inverse, the detrimental long-term impact of chipping away at our investments in the future to save a little money today. if i think about what i feel most common is the unintended consequences. you can't calculate the loss of hope. for but what is cats cannot be sustained. today's panel deeply understands the harm sequestration has caused a man the help that we find new ammunition to use in our fight to reverse the damage. our community is a passion of one. we disagree all the time, but we'll come back to the same table because we are united in our long standing common goal to expand access to high-quality early childhood experiences for our children. diane, as always, a privilege to work with each of you and grateful for your support as we conquered this hurdle today so that we may focus again on a brighter future. the national board, she is former chair of the parent policy council and drop parent child center here in washington, an exceptional advocate. just recently please join me in welcoming. back. >> good morning. to be here on such an historic turning. that she said, i am the proud mother of five. lucky enough to be starting again here in washington d.c. where the former chair of the parent policy council and currently sit on the national and start association board. we were able to avoid cutting children slides this year only because we've won a grant from the d.c. half of state superintendent of education. big grant funded in extra headstart classroom that we will have to cut them. but the loan that plan learned. just because we were able to not cut children this year the plea by the staff this is something that many people don't go to the center every day in the stand. incredible to me and to the apparent. suppositions of already been eliminated even the staff is still have their jobs health the grave fiscal degree they should only have to stress about keeping the children save, in case, and learning, not about their own lives the it. , but it is clear that the sequesters impact of staff and that unfortunately rubs off on the children of parents like chris and from kansas who has to travel over an hour each way to a drop-off and pick-up daughter after the town program closed and cut of transportation services to nearby programs over civil kelly in marin. she is unable to find or afford quality child care. i can tell you, i'm in this in place. it's not like they're of the programs if it wasn't for head start. and and just talking about those parents who were unlucky enough to get a head start fought to begin with. upper middle-class folks who probably don't qualify in many of the folks who probably do qualify. the see they are jealous of me because they know how effective it is and have seen it work. at the can't afford a program like kidney or they're just isn't enough room in their community. to wrap up, i have to say that i never wanted or thought that i would find myself in this position. for many parents like the finding a job, succeeding at the job, and raising a young one is stressful and challenging enough after losing my job and struggling to find another in this economy, the extra stress were overwhelming. head start has helped me to rattle. even though i have, i'm still not making enough to afford quality child care. have studies been the stability in my, that is quickly changed because of the sequester and the uncertainty it has promised. i am proud that what the center has done, but i know most of the folks across the country were not so lucky. it is clear that if the sequestered continues even move will have to cut and no one seems to care or want to talk about it. i understand cumbersome president obama have to make our decisions, but i don't understand why they should take it out on a chill. our children are futures, and leo it to them to provide every opportunity to succeed. we should be doing more to help our children, but until then i just want people to understand that the sequestered rates and it is a reality and that over 57,000 stories out there just like mining kelly's in%. thank you. >> you know, somebody did a study in of the health of people and child care. the administrators, the directors came out. have a chance now the here from the executive director of the hen stardom the cawnpore them in white plains, attended north carolina before beginning her career. a great friend of ours and also the president of the new york head start association. [applause] >> good morning. and so happy to be here. it think the national and start association and the center for progress for this opportunity. and like the start off by saying -- will repeat some of what is already been said. don't like to say that in new york state has been 3,847 children that was the response this year and none. this summer in new war unable to serve 300 children in. these were 4-year olds are ready for school, and we have prepared them through school readiness to be prepared. they're losing. we pass through the community we see young children sitting in london's watching the world go by not attending a program or having any kind of opportunity. so we know that these children are at risk have different family situations. they come from low-income families, substandard housing. we're cutting class from some program supplies. when you talk about the return on investments, we know in early childhood is better to invest $1 now today. your return is seven to $9 later these children are very vulnerable. early child has been proven some that it reduces the rate of crime. the children go on the college, less likely to be a social welfare programs. we really need to support headstart and all it does. right now is the 50th anniversary on the march on washington. we have to think what the war on poverty was all about. why headstart was started. when you think about it, it's so confusing that this time head start is being attacked and cutbacks. really need to think about what is going on. there are fears as to what is going to happen. very difficult. next year will have a job? cavalry operate the program? is very stressful. some ask everybody to please support head start. hopefully we can overcome this. thank you. [applause] we invite our panel of. we have some of the best experts on budget and a headstart program error of the state. good morning everyone. mustaf writer covering early education policy. this is a fascinating time to be covering early education in and children. a great panel here to discuss these important issues. at like to give the panel a moment to introduce themselves before we launch in the questions. if you could just introduce yourself. >> i have the honor of serving as the executive director. our office is located in jackson mississippi. i have been with a head start since 1988 and i am excited to be here today to share some of our concerns about sequestration . >> i'm the associate director for education income maintenance of labor, part of the executive office of the president. we oversee the budgets of a number of federal agencies including education and the administration for children family. >> and the director of policy and planning. i started my 20 years ago. i'm really happy to be it today. >> was president budgets, policy, and economic cover tentative. i worked for secretary sibila is set the department of health and human services. >> i'm the managing director for economic policy here at the center for american progress. deficits and debt. >> was wondering if we could start with you. we heard numbers mentioned in the introduction. i wonder he might drill down on the more. the office has some additional information. maybe even what we might be seeing if sequestration continues. >> let me start. our topline numbers of children now. that's about 6,000 infants and toddlers that otherwise would have been in her early headstart and 51,003 and for your roads. so about 60 percent of our children had to make these cuts in the enrollment. then there were other programs that made other choices. mentioned at the beginning, there was flexibility about how poor room or able to implement the cuts with the caveat that the standards we have for the quality and health and safety of our programs are not negotiable, something that you really quite -- can't minimize the quality or do anything that would not be a general standards. we have some flexibility. subprograms also make choices, not only to serve fewer children but children are also now receiving head start and early headstart for fewer days. so the top line number that we talk about is across the country is over 1 million days of head start going to children across the country. what that really means is programs, about 28 percentage our programs just assured the school year. 87,000 kids are receiving a shorter head start your. on average that's about 15 days shorter. even kids that are still lucky enough to be in instant having their school year reduced by close to a month, more than three weeks. the other big numbers that some programs to establish order day. about 11,000 kids are having a shorter day. on average progress the shoreham the day short by bob allen half. a child that was getting a six our program is now only going to be receiving a for a half-hour program. five hours is down the three and a half. a big impact, but we also know more about that they're getting less hours and days. >> that is a great kind of national perspective. no wonder what will see with the children who were rolled and with the adults who were employed. >> we are looking at about 1800 opportunities. so that's 1800 children who will have an opportunity. and a significant loss in jobs them. that adversely affects not only families who won't have access, there won't have jobs and in the kids and services that we purchased, fenders and the community will be available. >> a warrant to go back really quickly. i don't know whether we know what this point what further cuts might be coming down the line. is that something that is still to be determined? >> we don't know what programs will face. one thing we do know is that some of the changes the programs made an unsustainable. we may have had a one time cut. the use that money to keep more children and will. similarly, while in the first year we will able to say you can operate and a shorter school year, we're really know the kids need to have more exposure. those are not things that programs will have the option to do. in the future cuts will be compounded by the fact that some of these onetime fixes and not available in future. >> zero wanted to put this in larger context because as everyone knows, this budget concerns are gory. we have the ceiling flights coming in. continuing resolution from the government. tom wondering if you could talk a little bit about what the emma -- obama of ministers and is proposing. what they're watching to see and maybe how they're working to get congress to take of these issues . >> one thing, the cuts were very much not the administration's plan. very much trying to put ourselves on a path to reverse that. our plan for early education is one of investment, not only in making sure the programs can keep up with the cost of inflation, but also to build out partnerships of the soul of the best things can be brought to the broader chair of care system . early childhood for infants and toddlers. we propose a large investment in home visiting which is in place right now. we think it's a fantastic and should be continued and built upon. finally the large investment. we know that there is solid evidence to show these investments are small ones. then very much believe we can continue to reduce the deficit on making these investments. consent of the appropriations bill and fully funded administration's request. that is the path that we and many in congress would like to get on. it's hard to find someone in congress it will tell you that room in education is a bad investment. robbers the sibylla. >> the interesting thing they talk about is the investment and now is tied to economic policy in growth. wonder fee by the will to go with that because this is something that you just recently a report about. >> my role not so much a matter of which have the education. it's important. the notion that we need to be cutting anything has really missed the boat. three years ago the deficit projections were legitimately concerning to a lot of people. this is not a sustainable path. the stop the path orion. we have a lot of spending cuts. discretionary programs, the discretionary programs. infrastructure, research, lots of things have been cut. we raised a little bit of, and there are other trends happening in the wire, in bringing the deficit down. the deficit today is falling. the notion that we need to be cutting anything really is in the ocean from three years ago. more important there would say that even more importantly the spending cuts we have done on the last few years a big bash for the economy brought a speaking. we can see it in specific terms on this panel. when you cut teachers, those are jobs averred gone. think about the ripple effects. not only of those jobs not there, but they're not spending money in the community which creates jobs. even bigger than that. and this i start -- head start spots. they cannot work anymore because they don't have child care. that is economic up to the lost. very her to go back. imagine the scale of to hundreds of billions of dollars. you can get a sense of why the economy is turning a slowly and growing a slow his it has been. kind of mind-boggling that we're even talking about more spending cuts red and. rex actually, i have a question about the federal role in this the your living to. one of the interesting things i found when i was writing stories and utterly childish education is at the state level theory is not a debate. being seen expansion some friends of the, since some cases them wondering if you might -- maybe you can talk about this. the federal rule, why is important for the federal government to have fallen this? could this be something of relief to the states to back what is important? >> i'll start. the federal gorman has historically had a significant role. it actually dates back to the war on poverty which established the program. one of the early investments recognizing that it is a national priority, but children in every state and opportunity for someone education and the economic opportunity that comes with. it is served in the case that the federal government and state government is partners in education. by having a partnership several things happen. the phantom of government is able to make sure that opportunities exist even in states and communities and more disadvantaged than others. saw that. the fadel can help drive policy toward higher-quality. but the doe will veteran starters played in advance in quality, not just in head start programs, but the feel of release education a large is a really important piece of history of the development of early education. without the federal presence and the federal standards and the federal dollars but the media and a much lower level of development and early education. going forward there is no question that early education investments will have to be a partnership between the federal and state government, but i don't think either will be able to do it on its own. we will see a much bigger disparity between states and between communities where disadvantaged communities, those children would have even less opportunity if we did not have the federal embarrassment that allows us to equalize to some degree and opportunity around the kutcher. >> the other thing, new york has an interest in making sure that mississippi has a highly trained workforce. mississippi has an interest to make sure the california has the best workers in the world because we all want him to commit to the economy. it's very important -- we talked a little bit about how beneficial investments in their early childhood education in that. it's a national issue, not those of the mississippi economy is separate from alabama or tennessee. that is absolutely new federal laws to come in, we're all pieces of it. thus the perfect role. >> on wondering what you're hearing from lawmakers, with your going to talk to them about preschool and expanding. >> one of the things, a lot of interest and bipartisan interest. one of the things that state level policy with a balance, one of the purposes of the administration's plan, jump-start that involvement because no : of them actually were disinvestment. one of the things we can do, where will to be more dynamic. we'll have the same strict standards. rican jump-start. this will pay off. a substantial infusion of funds. make sure there are quality. i think the notion that the federal government will come in as a partner is intriguing. where we get stuck is on this question of financing. there is acknowledgment that resources would be beneficial. >> is there a concern? i have heard this from lawmakers and federal money might come with strings attached that they are not necessarily interested in. is this something you have dirt? >> that's always something we struggle with. no federal tax pair of what the dollars that we spend to be spent on something that is not generating that have returned. that is for high-quality preschool. they're is a much lower return on low quality. it's important that we spend the money wisely. we are not trying to mandate no one size fits all. the idea is to have certain standards and that lets states design a program of works. >> just jumping off that piece, the going to reprocess right now where it is going -- asking grantees to apply. i wonder how that process is going. is that affected at all? that i obviously is a bigger undertaking to improve the quality of the program. >> we're in a time when there has been unprecedented change. we'll only be redoing funding for programs that we can demonstrate our providing high-quality services in the running more and more competition to see who is the best of the best provider. the first big round of awarding new grants game wherein the same time. i think for programs that are really thinking they absolutely have to be provided the highest quality service is both because that is what they want to be doing for children but also because they are under new accountability standards that are higher than before. obviously in extremely difficult time to then also figure out how you're going to absorb and operate at reduced funding levels. logic and we have seen reductions remotely close to the history of this program at the same time they're being held to the highest standard and quality . it's important to have the standards. people there actually trying to run these programs, an incredibly difficult time. >> you gave us some information about how this is affecting mississippi. i wonder why you're hearing from lawmakers are policymakers? our people respond? are they listening? a state lawmakers kind of weighing in? what is the discussion? >> well we are hearing is what all of the other panelists and shared. high-quality early chair of that education is to give the idea. all children deserve it. where the rubber sort of means the road is that how we figure out how to pay for it. what we have been asking the federal and state government to do is while you're making these difficult decisions about where dollars a going to be spent, don't balance budgets on the back of poor children and poor families. it is incredibly important that the federal government set a standard the non-citizens of the unit is states have a basic right to certain sorts of access . families cannot flourish, they cannot move for video have a safe place for the children to go in to be trained and educated if they don't feel comfortable leaving their children in an environment where they think that they will grow. in mississippi it is interesting during this last legislative session for the first time the legislature appropriated money. we were all sharing about that and anticipate about 2,000 roman opportunities for children. then when these a 200. room looking ahead and did cain had 200 opportunities. it is heartbreaking. our office gets calls from families where parents to turn your back to school or sometimes working two jobs and still not making a very high salary. .. we are choosing not to invest the money which is a completely difference thing than saying we just don't have the money. that is not the case and if we thought about being a little bit smarter we would say when we invest in scientific research and when we invest in infrastructure or whatever it is these things are going to pay off in the future. we are going to all be better off down the line. we don't live in a rational world that if we did that is what we would be doing now. we wouldn't be talking about we can't afford it but we would he saying we can't afford not to. >> the this is definitely a reporter type question to ask and i can open up to the whole panel. what are the chances we will see some movement on this? it's being talked about by the administrative and i certainly see the secretary of education out there and talking about the importance here and you hear it reflected back. i think there aren't very many people who argue like oh jobs are not that important so what are we looking at in terms of movement and i guess to go along with that is if congress for whatever reason, are there things the administration can do on its own to perhaps promote some of these issues? i'm not sure what kind of leverage our action might be able to be taken up. >> i can jump in there. a couple of things. the president has put forward a conference of band to request -- replace sequestration to reduce spending and make reductions in our deficit. if that were to be enacted or something like it we would not be facing head start cuts. i think it's possible in the growing awareness across the country of how hard sequestration is to local communities and families of all income levels feeling the pinch and the question is can we build off of that platform? as i mentioned before we have the pending senate bill that has more than $2 billion and increase investment in early education within the caps by the budget. this is not wild-eyed spending. this is careful trying to does does -- choices. that is sitting in a pending bill. if we have the awareness that we have been going in the wrong direction and think about turning it in this direction this fall we could be a few months from now celebrating a significant infusion of resources into early education. what can the administration due? there are some things we can do and there are some things we are doing such as proposing reforms in the childcare program that will increase the quality of care that is provided when a family gets a federally funded childcare voucher but at the end of the day you need to be able to hire a teacher and you need to be able to have a classroom. you need to be able to support those children. there are dollars associated with that of me can't kid ourselves if there is anything that truly replaces that. the head start competition is incredibly important for raising the quality on head start services but again the dollars have to be behind this. >> i will jump in and say that i think all of washington and i don't know about the rest of the country but all of washington is watching with baited breath to see what happens when congress returns in the fall and i do think there is a growing awareness that sequestration cuts are ill-conceived, ill-advised harming the country harming the economy. this is an this is and just progressives that are saying it. the congressional budget office has weighed in about the economic drag on the economy and the frustration is producing and there is no question given as michael said they have improved budget outlook that getting to medium and long-term deficit reductions in stabilizing our debt to the share of the economy is eminently achievable. at the same time building investments with these kinds of things that have high payoffs and are absolutely central to economic opportunity in the american dream. today of all days as we think about what were people marching for 50 years ago? many things that part of it was for opportunity and it just isn't the case that there is no pathway from here to there. that i will say that i do think that there are people on both sides of the aisle that recognize the harm that the cuts are doing. so i do think there's a pathway for replacing sequestration with a more balanced package and for beginning down the road of investment and what we see in the senate labor hhs appropriations bill that does comply with caps set in the budget control act that actually have spending cuts relative to where we were in 2010 but even in that constrained environments we can make good priority choices and invest in our kids. so i think when people say there is no way to get there, the i don't think that's right and i think the more people engage in the conversation the more that people in the communities are sharing their stories i think there is a possibility of getting to a better place over the coming months. it won't be easy and it won't happen miraculously but i think that the more the conversation is engaged, the more likely it is that we get to a better outcome. >> i have a more pessimistic view. i think what's you said was right but it's important to note that while there is a growing awareness among some parts of policymakers that sequestration is that i think at the same time there is a sense among others that it wasn't as bad as we thought it was going to be and that they aren't hearing necessarily on their constituents on a daily basis this these cuts are affecting them in a very real way. that worries me quite a lot because i am very worried that members of congress will decide well the kind of lives through 2013. yeah it was bad but it wasn't as bad as we thought which is well and good for them to say but tell that to the 7000 families. so we will just live for it. now we are here and sequestration is here and it's a reality and we are just going to live with it. that really worries me but i think we have learned over the last few years that congress will take the path of least resistance and just doing the status quo is typically path of least resistance. we have to make sure that they understand the sequestration is not status quo. that was a disaster and we should not have done it and we should not do it again. so i do think it is very important over the next four weeks for families who have been impacted iva sequester to call their members to make their stories known. >> it's also important not only for people who are making decisions to have numbers and data. they really need to have faces so parents like chevon who can stand before you and you see a real-life reading person who says i am doing everything i can to try to make it to try to make the american dream real and every time the doors opened to other doors are closed. i think decision-makers need to see the pain of sequestration and actual families face. when there is a 17-year-old and we don't get into why a 17-year-old has a child. that is secondary. the child is there. a 17-year-old was trying to finish high school and we know if we don't have at least a high-risk old diploma what a bleak outlook employment is and you have to say we are sorry there's not an early head start enrollment opportunity. michael talked about taking his 3-year-old on a bus to school. there are places in mississippi where there is no public transportation. there is not a car so even if it's fair how do you get there? these are real people, real families, real struggles, real pain, real poverty and we need to look at it. when you think about it in terms of real people the numbers take on a whole different meaning. >> i can understand that something came out of the inertia that you are referring to. we can take some questions from the audience. i don't know if there are some. just wait for the microphone and introduce yourself. >> and the project manager for for -- broadcasting and we have been working with head start for the last two years. thank you for all that you have done with us. as a partner we are wondering what we can do at the local level the state level and the national level to help support you aside from writing checks for money that we don't have either and raising awareness which we are very happy to do. what can we do to help support you to ease the impact of these cuts while we wait for something to change at the federal level? >> i think one thing that is important to do which goes along with raising that awareness is actually dragging bodies to head start truax grahams. because there are a lot of people that know about head start and when they go into a head start program they are all struck at all of the things that are going on. the health and wellness and the engagement piece. head start is not just a child development or graham. it's a family development program and once you help to stabilize families there will be growth and movement in the communities. actually getting people your supervisors and commissioners and mayors and governors your local legislators to come in and actually see how the dollars are being spent and what a great investment it is. the other thing is trying to help us leverage what resources we have left after those cuts, pudding if there are teachers who can come out and help to improve the quality. if there are opportuniopportuni ties for parents to have access to more resources to either improve their employment skills or access to employment, just a whole community partnership investing in families and working together to improve outcomes for families. >> are there other questions? i think there is a gentleman. >> hi reef joel with communication funding and my question is for martha. when the administration release the specific date on the head start it's got a lot of press very concrete from a reliable source. do you see similar data coming out about the impact on other programs? i know that not every program works as same way and sometimes the data is harder to get at that would be very helpful because that would generate a lot of the press. >> you are right. one of the unique things about head start is a federal to local grantee and the office of head start did something that was extremely helpful to program management as well as public awareness raising which is a few months ago the grantees updated their plans to say exactly what they were doing so we could say how many children would be affected. that's somewhat unique. that being said we do know a lot about what's going on and venus tape i state the reduction in unemployment benefits. we know how many title i $ have been pulled out of the state and those are dollars that flow through the school district and as we have that information in a form that we feel is consistent enough and scrubbed enough that people will take it as seriously as they should and we are happy to make it available. i fault the media of little bit for playing gotcha and set up looking at what was their sub people say we predicted 70,000 head start kids and only 57,000 markup. first of all the prediction was done mechanically based on dollars. we didn't know how how many head start centers would choose to reduce the number of hours or days or what have you. flexibility is a dangerous word but there was that flexibility there and i think the more that we can get the media to understand that the story is not in the small delta between an early prediction and the on the ground reality. sometimes it goes the other way. they said it would be this and i was actually that. the more we get out of that game obviously the administration stands ready to make sure that story is told. >> you want to jump in on this issue on the cuts to other education programs. i think it's important to think about the compounding effects particularly in poor communities. poor communities have a larger share of their public education dollars coming from the federal government because the federal government directs more education funding to poorer school districts. that helps equalize. one educational funding is cut they can make a bigger impact in those less advantaged or more disadvantaged school districts so you have poor families in poor communities losing head start and then having dollars, out of their public education k-12 system. that is just to programs that i've talked about. some of those same communities are losing housing assistance for families that are stretched in a variety of ways that now less likely to get help paying rent. and childcare assistance dollars are also being sequestered so you can see how for low income families and communities there is a compounding effect that i do think it's important for everyone to recognize we were talking about head start this morning and thinking about cuts targeted on low income people. the cuts are not just about low-income families. they're also cuts in medical research that is a major driver of our economy and improving health over time there is the ability for the weather service to keep up its satellites and redid the weather accurately. the list goes on and on so for those lower income communities and families there is a compounding effect that it has. >> i almost wonder and this was something i was wondering when this sequestered was first put into place and we saw the air traffic controllers and how congress patch that hole. i was wondering whether head start or other programs could be patched in that way and whether that would need a short-term fix or whether it would be bad because there would be no incentive to address things in a broader perspective. i don't know whether there has been a conversation about doing something like going into support head start and let the rest of this sequestered go. i don't know whether that is something that any of you have have. >> is important for people to understand congress did not approve one time of additional resources to solve the faa problem. they allowed the department of transportation to shift cuts to a different part and so they basically shifted some immediate effects to cuts that would have immediate effect to cuts that would have a longer-term effects on our infrastructure. ultimately if we want to make sure we are investing in our economy and investing in our kids and investing in medical research that has led to breakthroughs that we all take for granted today, for and improve health every day for millions of people it's not about shifting the deck chairs. it's not about pulling money here and put a little that here and taking a cut over here. it's about recognizing that right now we are underfunding investment and we are not a poor country that doesn't have the money to make the investment. what we have to have is the will to have the right budget prior to and be willing to support those investments. so i think that over time whatever funding level at the top line is they would need to make the right party changes within those funding levels little tightly at the moment we simply are underfunding investment on the domestic side writ large and that is where we have got to fix that and then have a right prior to discussion at the second level. >> by 100% agreed with everything that sharon said. if we think about who we impact we about low income families and children and the faa. if you want to step out and say who are we affecting with this sequestered and all these cuts, who we are cutting the future. we are cutting investments in early childhood which affects our future and cutting health care research and all the smaller things in other places which are not maybe we wouldn't think of this investments a lot of the ways they are dealing with sequestered as they are differing maintenance or not making investments in their own infrastructure to make whatever job they are doing better in the future. it's incredibly short-sighted and it's mind-boggling. >> are there any other questions? >> my name is phil and i'm a local educator and you guys have spoken a lot about what a quality preschool education and how that is needed and why that is needed but i am curious what are the aspects of a quality preschool education that you would like to see in every single preschool in the country or head start program? >> first of all head start started making very significant changes as far back as the 80s and teachers, cayenne class-size , in staff to child ratios in curriculums and being able to track children's progress so all of those things are important but i think what has made head start sort of stand above is the approach to the whole child calm cannot just the academic and school readiness side which is very important but the health and wellness side. we all know if children aren't well they can't learn. if families are not healthy they can't help stabilize their families and move them forward so i think there has to be an inclusive program which looks at school readiness and academic preparedness for school but also those other things that shore up their mice that help them become productive citizens in moving their families forward. >> if those same characteristics of head start are very much the building blocks for the preschool for all initiative which would be for 4-year-olds. very much the same elements are important. one that i would add is to be constantly learning and looking at what models are effective where children are learning and where are they not to make sure we are not lightly investing but investing smartly in the future. >> i think that we are at the end of our time. i think the panel for taking the time to have this great conversation and thank you all so much for joining us. [applause] [inaudible conversations] thousands of people attended the 50th anniversary commemoration of the march on washington at the lincoln memorial. the highlight of the 1963 march was dr. martin luther king, jr.'s "i have a dream" speech. you can see the commemoration insincerity on line at c-span.org. here's some of what president obama said. >> the march on washington teaches us that we are not -- by the mistakes of history but we are masters of our fate. but it also teaches us that the promise of this nation what only be kept when we work together. we will have to reignite the embers of empathy and fellow feeling. the coalition of conscience that found expression in this place 50 years ago. i believe that spirit is is there. that truth force inside each of us. i see it when a white mother recognizes her own daughter and the face of the poor black child. i see it when the black youth who thinks of his own grandfather in in the dignified steps of an elderly white man. it's there when the native warren recognizing that striving spirit when an inter-racial couple connects the pain of a couple discriminated against and understands it as their own. that is where courage comes from when we turn not from each other or on each other but towards what another and we find that we do not walk alone. that is where courage comes from. >> building human rights would be one of the foundation stones in which we would tilled in the world and atmosphere in which peace could grow. >> i don't think this white house ever can completely belong to one person. it belongs to the people of america. the first lady should enhance it and leave something of herself there. now i look at how large employers are planning to implement the the new federal health care law and how their plans will affect workers in the cost of health care. leaders of the national business group on health spoke with reporters for a little less than an hour. >> good morning everyone. thank you so much for coming. i'm really glad to have you. this is a big way -- day in washington. with me is craig lykens who along with karen marlowe conducted this survey and i am helen darling and this is the national business group on health and nonprofit membership organization of mostly very large employers including 66 of the fortune 100. we are a nonprofit 501(c)(3). we did not lobby and we provide information education and research. our surveys especially important because it's the first look at what's going to happen in 2014. since we survey our large employer members at the time they have made all their final decisions for the subsequent year so we do this annually. which is in the june to july timeframe. this is a look forward and not a look backward based on responses of 108 large employer members. it reveals what employees will see in their opener moment packages. another difference in our survey is mostly very large employers and as you can see in the chart path that you have been given in the report we have 22% have employees up to 10,000 and the affordable care at their definition of the large employer is 150 employees. we are talking about in the thousands. 27% of 10,000 to 25,000 employees in our survey and 12% have more than 100,000 employees. so these are really big employers. we asked them what they budgeted for their medical claims costs and related administrative expenses. these are self-insured employers that they basically pay radical claims white affair on assets. they pay for administrative services and special services through health plans or insurance carriers but they are not insured and they do not pay premiums. they protected they would need 7% in 2014. the same amount that they projected for 2013. we won't know the final numbers in 2013 until the late spring of 2014 because you have to have what is called a run out so we don't know what they will actually end up needing but i can tell you they have some expenses this past year that they did not anticipate. i can go into that in more detail later the $63 for the reinsurance pool. as you will see when craig gives you more detail employees will not see big changes in their proportionate share of costs in 2013 or 2014. employees open in rome and they're likely to have cost increases in special circumstances such as tobacco surcharges spousal surcharges and financial penalties or rewards related to wellness program so they need to read the material very carefully. rising health care costs remain a serious concern of u.s. employers. especially in light of the slow growing economy for very low growth in wages and fears about forces that threaten to drive up costs even higher. there's a lot going on that is going to drive up costs. some of them are due to changes in the industry and some of them are due to specialty drugs and high-cost conditions a whole range of things. they're also deeply concerned about the looming threat of the cadillac tax in 2018. which is not so faraway. things of that as -- because it's going to be a whopping tax on anyone who does not control their costs significantly. this year in upcoming 2014 is a big year for the nation but for most large employers plan designs and health care strategies will not be affected that much other than cost and some of the things they have to do to control costs. even sallai the delay for one year the implementation of the employer mandate doesn't have a big effect on large employers. employers spent considerable time designing health plans that comply with the various provisionprovision s of the affordable care act that would have become effective next year. a decision to delay the employer mandate on out-of-pocket expenses have provided some respite for some of those requirements. the pressure consistently will continue on health care costs and that's for everybody. it's very easy especiallespeciall y in the debates we have around this town and in the nation to forget we have not really solve the problem of health care costs. no one has and we got to do that. employers expect that certain populations and so we ask about the public exchanges when they're up and operational, the public exchanges may be a viable option on an individual basis in 2014. they think that 41% of the employers believe that cobra plan participants might find exchanges to be the most cost-effective option. that is pretty clear. 26% felt that some retirees might opt to joins exchanges. it could be higher but that is what they were reporting while 20% believe that part-time employees will do the same. only 12% thought that current full-time employees might choose the public exchanges and you can imagine these are most likely to be in industries like retail and hospitality to have more seasonal employees, people who are in and out of the workforce and more part-time employees. private exchanges we are hearing more and more about aren't other option that some employers are considering for active employees sometime in the future so they are thinking more ahead as that might be enough gin and future. not the 2014 future. in fact only 17% plan to move retirees to private exchanges and 2014. very few employers are considering eliminating health care coverage entirely so 3% are considering and the key word is considering. we know that health benefits remain a key part of the total pay and total rewards package for employees to recruit and retain talent. if you want to be taken seriously as an employer especially in areas where the market is really tight, you would have to provide a good health benefit -- package. certainly this year, the next year and probably for many in the future. in fomenting a consumer dreck that health plan was considered the most effective attack take to control rising costs cited by more than a third of respondents , 36%. 72% of our large employer members opted one consumer health in. this number has remained relatively steady over the last couple of years but 22% are now offering only a consumer directed health plan. they don't have hmo's or provider organizations or point of service plans. they just have a consumer directed health plan. they may have a couple of options so there might be a high deductible and a higher deductible for which the employee would pay less but they have no other options. we asked employers about initiatives they used to manage the health of employees so at this point i'm going to ask craig lykens to come up and give you some more details on those options. thanks helen. i won't go overall the tactics they use the dash employers are utilizing but -- be on consumer directed health plans health improvement initiatives are listed as being one the most effective tactics for health care costs in 2014. 50% of employees indicated wellness initiatives would be one of the top three methods for controlling costs. these programs include things like tobacco cessation programs which are offered by 89% of respond and and telephonic or on-site health at 77%. more than half the respondents make on-site weight management programs available as well while nearly eight out of 10 also conduct health assessments and biometric screenings. many employers are also working to further integrate these initiatives into long-standing benefits and programs. for example 44% currently have an on-site health clinic in at least one of their locations. these clinics have traditionally provided services including occupational health acute care and primary care services but now nearly two-thirds of employers are offering health improvement services in all of their clinics and some are now offering chronic care management and on-site employee assistance programs as well. now most respondents indicated that for the health plan with the greatest participation still the ppo for a majority of respondents caught sharing would not increase in 2014 for employee only coverage. the average employee contribution to the premium will remain at 20% so an employer will continue to pay roughly 80% of the cost and the employee will be responsible for the remaining 20%. the average in network deductible for employee coverage will remain at $500. now employers did have a slight increase in car sharing for family coverage for an employee an employee contributions that came in increased 23% to 24% in the median network to testable would rise by an average of $200 up to $1200. this changes the increasing cost and because employers want to continue their mission and keep the cost affordable for employees. nearly two-thirds of employers 66% when not cover surgical interventions for the treatment of severe obesity in 2014. additionally with the release of the first fda approved weight loss limitations for the treatment of obesity in the last year to 6% of employers reported they will cover these medications and 2014. employers will continue to use a number of pharmaceutical management techniques like they do for all pharmaceuticals or include things like tire authorization knowledge ability restrictions and quantity limits to ensure these medications are used appropriately. some employers are also directly contracting with surgical centers of excellence patient-centered medical homes or other providers while other employees are incurred in utilization of centers of excellence in high-performance networks by reducing car sharing requirements for employees. lastly employers are continuing to offer innovative solutions to ensure timely convenient and cost-effective consultations with physicians by offering telemedicine options. with that i want to turn things back to helen who will take us through the rest of the survey. >> think you craig. we are happy to answer more detailed questions if you're interested. most employers will do everything they can and you can be assured that the cost of medical claims in 2014 would be even higher if they weren't doing these things. so they will be doing all they can to reduce medical trend. we are hearing more and more as i am sure you all are too about specific steps such as spousal carveouts or surcharges tobacco surcharges and so forth as ways to control costs and also to ballot some of the increased expenses due to the affordable care act. although most employers want increase incentives beyond 20% under prior law they are able under the current law to go up to 30% of planned costs and wellness incentives. most will not go beyond the 20%. all of this is going to be done in a world that much more transparency. we are going to see a very different world than the next couple of years just around what is happening with transparency about medical charges quality safety and the whole range of things. the process of selecting benefits of open enrollment for most americans has become much more complicated. the employee will pay even more if they don't read their materials very carefully and take advantage of the opportunities that they will have earned back wellness credits so what is really happening is most employers are putting in some increases that will be in a sense balancing out wellness practices. you have to do what you are supposed to do in order to earn those back and if you don't do these things by the fall you will probably end up paying even more. they also need to make more decisions about dependence. what we are seeing is a definite shift towards employers looking at the total pay package. what they give to people and cash wages other benefits and health benefits and they are trying to make that more balanced and more performance related. so for example they make change in the proportion that they pay for families because many employees don't have families or they have the family by pickup or gender different employer. what they're trying to do is move more towards a package of benefits that is more balance between individuals to win three parties and families. so you will see a lot more on that. so with that i will end and open it up for questions or comments from anyone. >> hi helen. i am jay from health care news. can you put this in terms of employers seeing the exchanges as viable for certain populations that they have traditionally covered. to what extent is that perception and what they're expressing here to what extent is that a result? it sounds like employers are saying they expect to see members of these populations seeking coverage in the exchanges. would you say that is correct? in fact i think that was the question. to what extent is that going on because employers are reducing their coverage and their benefits? it seems that there would be a cause and effect here that you didn't directly address. >> actually there isn't a cause and effect. for example first of all you use the word reducing their benefits. they are actually not. the dollars that they are putting in health care going to go up next year so they are not reducing their benefits. but they certainly are for example one of the reasons we needed the affordable care act and we needed a change in health benefits for certain populations because they didn't have access to a functioning private individual or family options or small employer options in the marketplace marketplace so you had people for example who are on cobra. you could be on cobra if you had a death in the family or someone was terminated and lost benefits , someone was disabled and lost benefits or divorced. in the old days before cobra there were people who want someone was no longer connected to the work as they had to go into the individual market which in many places didn't work at all and when it did it was very expensive. what we have is all those populations that have been partly taking care of. cobra gives you coverage for a while. 18 or 36 months depending on the circumstances but it's very expensive. as paying the full tab for whatever your employer provided before so you get 102% of the cost of what the coverage with the. all they are saying is in the future with the exchanges and the individual exchange these people who otherwise had nothing in the meantime that something that wasn't all that great they will actually have a functioning individual market so i think there is a completely understandable belief that if the exchanges work in the way they are supposed to work though should be good options for people even in a moderate income situation and if they are lowing, it's even better. right now if you are a cobra so you lose your job because of a divorce and you have to go to cobra and that was the only option you had because the state didn't have any option for you than if you were moderate or low income you have very expensive pockets that you had to buy back under the exchanges. that will change pretty dramatically. it's not related -- you used the word reduce to whatever they are investing. it's not related to what they invested in. >> even if you had 12% of your members thinking that seeing active full-time employees that is not necessarily -- there is this debate about whether it's leading to erosion of coverage among your members and you don't think that's evidence of that that the 12% are looking at having their full-time employees covered by the company being in the exchanges next year? >> first i would say yes. 12% said they could see and consider that as a possibility. that is probably very specialized to industry so you have business is like retail and hospitality hotels and things like that where between the relatively low wages and the relative cost of health care these are people that anything in the best of circumstances may not be taking the benefits they have got because they can't afford them. i think that is what we are seeing in the 12%. if you were sitting in almost any organization. let's say you ran a shoe store and you have a clerk. i was just in a shoe store so i have this conversation. she made $12 an hour the woman who was waiting on me. she could not afford health insurance and she is a good example of somebody who if she win the exchanges are open she could go to the exchange and hopefully get affordable health insurance and she would get a very substantial federal tax credit. thank you. >> hello. brian from employee and benefit health exchange news. he said they may consider in the future but you look at the private exchanges on cedars so why do you think your member companies are looking at it in the future and not now and a couple of years from now? >> first evolved their new exchanges. the private exchanges are brand-new and i don't know the exact number of that i read it every time i get it. the number of people who are in a private exchange now is quite modest because they are brand-new. i think if you are a large employer you certainly will be thinking about it for retirees. that is a very obvious one and i think you will see a lot of that in future but they have to be up and running and they have to be serving a lot of people and they have to get evidence if you will of a good solution. right now i think a number of employers feel there is a track record for retirees that is very a very comfortable step for retirees because they track. the future is 2015. right now all the decisions are made and everybody put to bed 2142 months ago. so, they are already beginning this december they will start doing all the planning for 2060 2060 -- 2015. in the benefits world the cycle becomes almost a full year ahead it has to because it takes so long. >> page winfield with politico. going quickly back to the 12% employers that said they think folks will want to go to the exchanges. was that just all employees or just full-time employees or part-time employees as well? presumably wouldn't they be penalized if full-time employees went to the exchanges? >> the way they reported yes. do you anticipate that your current active employees would go so yes it's currently active employees and i would guess although you didn't have to specifically that this is mainly they are looking at the finances you would imagine that someone would choose to go because they will get the tax credit even if it's not ideal from the point of view of the employer. if they can't afford the benefits and i mean if you look at some of the cost-sharing the family coverage i think the total number is over $3000. these are people literally living worse than paycheck to paycheck because they probably also have debt so they don't have money for cars and they don't have money for -- they certainly can't have a house. the idea that they could shell out $3000 a year just for their share of health insurance is just unrealistic. it's heartbreaking. we should do something about costs in this country for everybody. >> jerry with business insurance just looking at my notes. can you elaborate of the move of employers to either impose higher costs surcharges for family coverage or deny deny coverage if the spouse is eligible for coverage from his or her on employer? they think you used the word trying to reduce the difference between single coverage and family coverage. >> yeah two things. as you all papa prop up way now already another adult dependent is very expensive and then of course children are less expensive but nonetheless the more you have the more they cost too. so when an employer looks at the total cost for an employee in fact the numbers you calculate you take the total month claims cost and abided by the number of employees. in effect people who don't have large families are subsidizing those with large families. when we have to increase costs to our employees it's because of costs overall increasing and the employer has to do that too. the way to do that is say we want to make it fairer across the work lace. we want to move towards giving more in a pay package, wages and other benefits and less than health care that is skewed towards larger families as opposed to individuals. and if you are going to come up with ways to do that at this point because we have been at this for many years there only were only so many ways that you can control costs. historically the coinsurance has been one way to do it. higher deductible has been another way. surcharges combat tobacco surcharges a whole long list of things that can be done, to many of those a party been done so we are moving more towards the vision of total pay per employee and then for example if the employee is able to keep more in his or her wages then someone who has a larger family wants to cover lots of people would maybe pay more out-of-pocket. but they would have more out-of-pocket excess they would be getting more money. somebody who doesn't have a large family to cover would get more out-of-pocket that they would necessarily have to use the health coverage. they might able to fund their retirement or they might be able to have more money in their pocket so that is the broader total rewards thinking that is going on. it's a bit of the change in what they are trying to do is to do these things slowly and incrementally so it's not a big shock but that is the direction everybody is headed in trying to change the relationship with dependents. it just happened that when the affordable care act added the requirement that everyone would not have to be a dependent. a child and adopted or natural child had to be covered up to age 26. that increase the cost of family coverage in this country. and so somehow that has to be balanced. if you spend a lot more, i know of at least one employer the gained 8000 people. now even if they are not the most expensive 8000 people, that's a lot of people so we have to rethink if you will the way an employer has to rethink how they reward people were the work they do and to try to be as fair as possible. if costs go up everybody equally has to pay them unless you start doing things. this is why the tobacco surcharges become so important. smokers cost employers a lot more and they also cost other employees a lot more and that is part of what they are trying to do, to balance some of those effects. >> alicia alt with img medical media. we publish newsletters for doctors. you are talking about it looks like most of the emphasis is on what employees can do with employees. tobacco cessation, chris surcharges for certain behavior consumer directed health plans. it looks like employers are only very tentatively embracing aco's patient-centered medical and what they can do with physicians. is that never going to be a focused? is it always going to be on the employee? is there a reason why they are all my slowly adopting these new models? >> yes combat there are not very many out there that are functional and contracting in the private sector among private entities is much more complicated and harder. they can't elect the federal government and just say we are going to do this. this is what we are going to pay you, is this what we are going to do so health plans to administer and networks who administer the services for large employers, they would have to at least help with that and it's a lot harder than it sounds. but i can tell you that the numbers reflect modest, if you will, commitment. there is no modest commitment. if a patient is in a medical home and aco surround country are delivering the goods in terms of value, quality, safety and affordability than i can assure you our large employer members would be thrilled. the other thing you have if you are a large employer is you are in a lot of different locations so it's very hard to administer benefits differently in one location from another. so, for example if we have patients and medical homes and some of them are doing that we will report you if you are in a patient-centered medical home or in a primary care family practice and that kind of thing. but if two-thirds of the employees live in areas that don't have them than they don't have that at an edge so you have got to have a much more complicated plan design and administration to pull that off. since you are writing for physicianphysician s and others please let them know that we would be thrilled to have many more opportunities to have changes in the delivery system and the financing of the system. we support those things to encourage more patient-centered medical homes compact centers of excellence, we have a number of our members engaged in direct contracting walmart with six different centers of excellence so we are enthusiastic. do we have other questions? okay, thank you. >> sean forbes. i had a question about transparency and we are seeing more articles say in "the new york times" recently about how expensive a saline drip can be where one provider will charge 500 plus dollars and another charges only 100 plus. these are things that will be very difficult or consumers. the line item may not be broken out or they might not see it at all and as you mentioned consumers need to read through their packages but that's the package provided by the employee and not the provider. as you said this gets very complex and it's going to be very hard for an employee to control their costs. how are the employers going to help the employees without? >> yeah so most of the health plans now including united at the cigna anthem and number of health plans are are on the leading edge have applications that allow people to know a couple of things and also some third parties. this is a fast-moving field and what a consumer patient need to know are what's it going to cost them so even that data on charges we know nobody pays most of those so it's a question of what do i pay as a consumer if i buy something or go on a visit and what will my plan pay because even if i might have coinsurance at 20% that if i have my deductible and going to pay basically both so you want wanted and then we have more and our mobile apps which are in your smartphones which you can take with you and it they will tell you what will it cost your employer, to in some instances there are some alternatives like they will actually show you or tell you that you can go to a retail clinic for example and have the same thing for less. as you know we think they are very exciting because they keep the field much more competitive so those are easier to understand. in addition they include quality measures. you can frequently get reviews. i know some of them also allow you to make an appointment. they also allow -- they have gps capabilities so you click on that and you will get a map. it will show you from where you are standing so you literally know where you're standing and say this is how you get there in the stuff is very fascinating. the key is what would he paid for you as a patient and that is what is going to drive at least the individual consumer. that said we need transparency at the national level and the policy level and the corporate policy level and the health plan level to drive change in the delivery system so we don't have some of these problems where somebody is charged for something that they didn't get and it's a ridiculous amount of a have to spend four hours on the phone with people who are only open from 8:00 to 4:00 to get that removed. transparency will also allow consumers to know that when mistakes are made on their behalf that they can get them fixed and ideally they can send that off electronically and somebody will pay attention. >> moving back to the public exchanges again you said numbers for specific by history. 12% might move to the public exchange and the private is kind of see how it goes. do you think the 12% will stay pretty static? >> i think that is a great question because i don't think we know. first of all think of the timing it isn't until 2017 death the exchanges are even allowed to consider more than 100 employees. they go from 50 to 100 bistate choice. so the big question is when are they, if they are ever going to be ready for larger employees of larger employers than in the meantime the other moving target you have got that is going on is regulatory positions and legislative position so so it is unclear what could happen between now and then in terms of the people making decisions about what changes will be allowed to do and what penalties would be paid so for example if an employee's ideas i think these changes going gangbusters and i don't want to be necessarily in the business of health care and that is not my business. there are so many veritable siege of which have multiple fat years around those decisions. most of them are businesses that are very pragmatic. they have to live in the here and now and prepare as much as they can for the future but with so many factors in play it's virtually impossible to think it through. you have got at least four years minimum before you will have any sense of what is going to be possible in 2018. that said the big thing we know that is programmed for 2018 is the cadillac tax and as i said already that is the big, big factor. every employer since the law was signed said we are not going to pay the cadillac tax. so this has been one of the factors that has been driving the consideration of many ways to control costs. if they have no other reason to care and they have plenty of reason but if they had no other they would care a lot about that and they have said that repeatedly. >> i'm with kiplinger's. you talked about some of the wellness benefits and how people can almost buy back some of those premium increases. are a lot of employers offering a whole slew of benefits and can people pieced together a lot of things and add them to substantial decreases in cost and also how are they providing them? are they doing premium discounts are contributing to the hsa's or cash? >> i will let craig answer that because he has got the date in front of him. >> sure. their survey did not look at wellness symptoms. it did look at how employers are can and should bidding to hsa and art hra's and a number of employers are using incentives for completing benefit education courses and hsa and hra's as well as your standard participaparticipa tion in wallace programs are based on achieving health benefits. when you look at the hsa and hra the median employer contribution for an hsa that an employee could earn was $350 and for an h.r. 8 was slightly higher at 500. that is based on on the kind of bonus activity or achieving a health goal or something of that nature. other surveys have looked at how an employee could earn wellness goals. i know the survey we do directly with towers watson every year they came out in march i believe looked at that. march of 2013 and in 2014, 81% of employers use financial rewards for it employee that would participate in a health management program. >> the interesting thing is stored at it is that just within the last few years many of our employees -- employers have said along with incentive to read and programs these wellness programs are the most effective for controlling costs. that is the surprise. that is the big turnaround. no one thought that this would be the direction that people would go. you can look back and say why didn't they think that? they just didn't think of it. they were focusing on different things. they thought more like plan designed to increase co-pays were put in three or four tears and all this tinkering with benefits will change the results and what they realized is that if we don't have people who are committed and living healthy lifestyles and in this case living unhealthy lifestyles we will have high cost no matter what. and if we keep having smokers we are going to keep having high costs. realizing that they need to change the labor system and they need to change the demand side how and why people seek care and what they paid towards that care but fundamentally we have to have people doing everything they can in terms of their own health and health management themselves and their families and we will change the outcome if we do that well. that was a big change. >> eimer shauna with insight health policy. i have a quick question about dependent coverage. could you talk about whether do you see your members increasingly not offering stossel coverage that they continue to cover the children of the employee? >> i can't say that they wouldn't offer spousal coverage or family coverage or domestic partners actually. many cover domestic partners. what we do see is a change in how that is subsidized or not. in the case of spousal surcharge they are charging them more specificaspecifica lly. but you can still get it. if you have other coverage the one area we would see is to say that if you have, and there's a little bit is about light coverage so for example if you had and this may be a bad example because with the affordable care act these will go away but if you had a mini-med plan that was only paid $5000 if you are sick and out of be it and it didn't have patient care. it wasn't a good plan. that would not keep you from getting access to your spouse's plan. if you have it then there are a growing number of employers who will say you need to take their coverage. that they would still them if they are not. they don't have access and i don't see that changing at all. i don't want to say my lifetime. that just sounds too grand. in a time i could imagine. any other questions? yes, sir? >> i came in late but if you could go over at the survey results of the groups expecting to find public health exchanges as a viable option? >> the biggest one is cobra so these are people which i'm sure you know, they lose their employer coverage by either disability death termination divorce. one way or another they lose their coverage and then they can buy back coverage. it is 102% of whatever was paid and your and a plan which might have been far richer than you necessarily need or would choose if you were on your own. that has been a population that has suffered in the past because even if they took cobra it was expensive and if they didn't then many jurisdictions they had no choice and individual coverage was a high-risk pool. it was prohibitively expensive. the 365 retirees so these are obviously people who have left the work place for retirement but they are not eligible for medicare yet. that is a really obvious one as well. that's another expensive group for 365 retirees is probably going to be more like 55 to 60, 63 or something like that so they would be relatively expensive. but they don't have any other coverage if they don't have a public exchange so that is 26%. current part-time employees 20%. spouses that are dependent, 15 seasonable or temporary 15%. we have had extensive discussion about the current full-time employees and i don't know if you heard that we talked about that's more industries like hospitality so having access to the federal tax credit would be very beneficial. anybody else? if not a thank you all for being here and all those of you listening on the phone. we thank you for being with us as well. thank you. thousands of people attended the 50th anniversary commemoration of the march on washington today at the lincoln memorial. the highlight of the 1963 march was dr. martin luther king jr. as "i have a dream" speech here you can see the commemoration in its entirety on line at c-span.org. here is some of what president obama said. >> that is the transformation that they want. with each step of their well-worn shoes. that is the depth that i and millions of americans owed those laborers those porters those secretaries folks who could have run a company maybe if they ever had a chance. those white students who put themselves in harm's way even though they didn't have to. those japanese-americans who were called their own internment those jewish americans who had survived the holocaust. people who could have given up and given and that kept on keeping on knowing that joy cometh in the morning. [applause] on the battlefield of justice, kia men and women without rank or wealth or title or fame would liberate us all. in ways that are children now take for granted because people of all colors and creeds lived together and learn together and walk together and fight alongside one another and love one another. and judge one another by the content of our character as a greatest nation on earth. to dismiss the magnitude of this progress, to suggest as some sometimes do that little has changed, that dishonors the courage and the sacrifice of those who paid the price to march in those years. [applause] .. >> it requires vigilance. >> one of the most fun times i had was 2006 it look like democrats really would take back over the house and it was looking bad for republicans and vice president cheney's office called and wanted to know if i could come over and have breakfast with him. submit to the vice president residents and had breakfast with him. i had been there before but first of all, it is unbelievable, which he had new. he had been to so many districts of the republican leader of the house but basically asking us how bad is this? we were saying, they yes coming it is pretty bad. but when you talk to the caucuses on both sides you get a glimpse of the inside players. >> our first panel entitled pathology of race, and health. before i introduce our moderator i also want to thank you alrich for pulling the panels together to discuss and come up with the idea of what conversations will be presented to impact us or the community and we will discuss to see if we can find a way in or out. thank you so much. our moderator for our first panel is the professor, and the author of genetic justice, and civil liberties. a professor of humanities and social science say you have me there. you know, how the academics right? it is tough she diversity and then from brooklyn college please welcome professor sheldon. [applause] >> it is a real pleasure to moderate this distinguished panel and my job is to simply put forth a conversation to get started quickly. first of all, let me introduce the panel members of the black panther party and the fight against medical discrimination. [applause] to her right is samuel roberts who has written infectious be your, and the health effects of segregation. [applause] into his rights is jonathan who has written in the of a protest psychosis. [applause] and did to his right coming period washington whose book deadly monopoly, please give her a welcome. [applause] i will start the conversation by first asking what mythologies did we all learned that we would want to share with the audience today and discuss among ourselves? i will start with three myths that i learned from writing genetic justice that is really about forensic dna like when you watch these crime programs aren't tv, a dna rules so visa the three myths that i learned. first of all, the number one, that dna profiles are like fingerprints. not true. very different. myth number two, a dna evidence is infallible. not true it is not indelible for prosecutions or exoneration. number three, collecting dna profiles is a race neutral. that is also a great myth. so now let me turn and maybe you can tell us some of the myths that you discovered in your work. >> good afternoon, everyone. good afternoon, harlem. [laughter] thank you. thank you for the introduction mine are three truce's i begin my book with the sentence health his politics by other means that when we talk about the issues of health and science we could talk about test tubes him laboratory benches but we also talk about challenges and resources to health care access and scientific information and health education. number two that this civil-rights black freedom tradition was always a health activist in politics traditions of think back to marcus garvey which had the black cross nurses in think that when advocating for civil rights and sick and tired of being sick and tired giving us the poignant euphemism of four black women in the south that were sterilized against their knowledge. and also the black panther party was a healthy and social movement it is up for shaq test how we think of black politics of the last half of the 20th century but we don't appreciate they were deeply engaged of how effective as of, a healthy quality and access to medical care services in the united states. and engaged to give people information to services that we did not know enough's about that they were underutilized such as sickle cell anemia and those that provided basic health care services in a given her private book the black panther party protected black panther party's from overexposure of medical experimentation and i'm sure there are others but the black panther party participated in the '70s in california in the struggle to stop university from using or introducing medical protocol that would disproportionately affect black and brown men and boys so they provided services to respond have a black communities are underserved and protect them from the way we were over exposed to. >> samuel, what about your findings? >> good afternoon. i have found some truce as well i focus as a historian to the mid 20th century that in a lot of ways is the era of jim crow but also the birth of modern public housing and for many black communities that were urbanized there was one particular disease that claimed the most lives than one cause of death and that was tuberculosis that was a diseased contrary to the myth of predisposition of living conditions. so we find that the very birth of public health in the united states come with the mythology of black people are dying from tuberculosis -- tuberculosis because they were predisposed but it was a way to mask terrible conditions that black people were forced to live. by the way it was part of residential segregation and exclusion from many jobs. that was the first truce the first myth that i found was the race neutrality of the dna in genetics or forensics we tend to think it is a rational science that has the merged and that the very birth we find racial assumptions that work to the detriment of those they are to survey and the second truth i found as mentioned there has always been a black health activism. where do we look? if we always think about the white men and white coats and hospitals to be knowledge production we may not find african-americans there but we find clubs, the ymca, churches, all very much to engage in their communities and environmental health in particular. thank you. >> what about your findings? >> it is true honor to be here today. i were come on race a and mental health trained as a psychiatrist but look at the social trend in the diagnosis of mental illness. the research i did for the book continues to look at over diagnosis and starting about the 1960's there were a series of research findings of the blue all the sudden people discovered this bill this schizophrenia was being over diagnosed in rapes maybe seven times more than any of their group. to my surprise i found this was not always the case although there was of a long history going back to the slave times but schizophrenia was a large diagnosis through the 50s then in the '60s seemingly out of know where there was a disproportionate over diagnosis that has continued into the present day that african-american men are dramatically more likely to be diagnosed in this is something that is at odds the way we think of the biology of mental illness because according to genetics schizophrenia should not have any race or gender issues because it should happen supposal the beanies the level of race and should occur 1% of the world's population so my research was set the question why in the '60s did this start to happen? also perry specifically but it is for the criminally insane in michigan it is largely wait but now the '60s 1870's not just of african-american men that those who have participated in the nation of islam and other groups or participated in different riots. somehow made their way to the hospital and were diagnosed with mental illness. that is not a huge surprise if we think about the way politics has gone together. but the increased rate of schizophrenia was somehow the result having to do with biology your genetics people argue about that at the time that it was almost entire the social phenomenon linked to serious of changes there was a lot of the anxiety of people were thinking political protest at the time in ways that started to make sense and the diagnosis changed in 1968 and the official diagnosis all of a sudden said acre, hostility and projection, blaming other people so what made it easy for doctors to see black men who were protesting because of these criteria. myth number one is biology but the misdiagnoses happened because they were disproportionately racist and what i found some of the doctors were well intentioned and soviet was structure of the diagnosis. but our approach is to make it with grace -- racial the ethics but they are indebted to the structure of the health care system. i argue we need to teach the medical system to be confident rather than to be culturally sensitive. >> harry and i just want to say one word before you get your chance and that is in our constitution the one bright listed in it, not the bill of rights but the right to take out a patent. amazingly enough that was built in by thomas jefferson and your book deadly monopolies questions some of that so tell us what you found. >> hello. i am very happy to be here thomas jefferson was actually not a fan of patents he really did not want them to be issued but he bowed by pressure of others. but the patenting of entities that we typically don't think of especially seeing as like medication medication, it has always been hotly contested but those who have issues are not those in power but those who will profit. so producing there is always that tension, through the law as but to go against them a and through the conclave and it is expected. i think that's as we were discussing in the greenroom we have some recent good news that the patents on breast cancer genes have recently been struck down which is in the right direction but the methodology that i want to address is first of all, the myths that pharmaceutical companies act as a rationale van and then patenting see on wages and affordable price. the rationale is we invested a huge amount of money and time in the interest to develop the medication so we have a right in we have a need to charge you a lot of money to cover the cost without our investment you would have medications for hiv or tuberculosis or sickle cell anemia. you need to pay as this money so we can continue to provide them but the truth is it is not the corporations it is the federal government. where did they get that many? from you, you pay for the modification on dash medications twice with government money that outrageous from those who want to charge for what you need to stay alive or to stay healthy. another myth that i hear frequently sometimes you hear about a search being done and often nigeria, brazil, thailand often there is a complaint the ethics have not been adhered to properly and people are not being tested under informed and they have the bank given the death information to agree. so informed consent in one frequent response is you have to understand we test these drugs for leprosy in brazil and perhaps we catechu corners with there is a high rate in the need the drug. that is a myth there is a great need in the countries where they test the drug's but the company's do not benefit harvard did a study within a 24 year spee and of the 12,033 drugs invested invested, only 14 were for use in the developing world and then five of those were animals. in the end, for drugs and 20,233 were devised for people in the developing world by yet one-third of all clinical trials because it is cheaper. that is a very important myth. so the rationale to bypass the people he and condemning them to poor health is a myth. but i do want to back up a minute that i addressed in medical apartheid first of all, i take the entire book to address the myth that was used to change about medical research is a very prevalent myth that african-americans have been underrepresented in medical research. if i say this people quickly produce to show that i am wrong but many who have been used do not show up in the data. it has been done in a secret way and also has a detailed. >> the research has been conducted in this country without fully documented or acknowledged butted has been true leading to the conundrum. it is not an easy concept when you leave, we do need to be participants and research may be more they and other americans. but what leads me to my final myth is that of informed consent. most of us believe should reach used to me i don't mean but to ask your permission also entails but you have to give her consent and that is ongoing. if i knew for example, that red-haired people don't fare well you have to get constant information but informed consent is under assault and diminishing very quickly in my opinion and in a very shadowy way. not because it gets a lot of attention but the law was written twice 1990, 1966 of but for people but the medical culture in sometimes not ask their permission or give them the full benefit of informed consent. it is something that i think we should actively be seeking to redress and trying to eliminate the holes with informed consent. it is quite dangerous. it is philosophical but. >> does anybody on the panel want to joe ho. >> i just wanted to respond to say one of the places to look for how black communities but going back to the black freedom struggle which in some ways feels uncomfortable or not a place most typically but part of what is so important if we can get beyond the demonization of the black panther party the wavering gauged about medical research, protocols, and particularly interested in the ways but a wait to be more vigilant is to take agency of the set the table and understanding and finding information of research in your community. >> after it to a body of research, there is something that i bring but how will i enter i don't know know, epiphany, how you interact with the health care system, a medical system, or the scientific system, from your research. although it is familiar to his area but if i go to work and this position will offer me a drug, i will not take it right away. the first thing i will say is, is this been approved for this use by the fda? doctors have the power to give you a drug that is not approved i had moments of overlap with my own schizophrenia i try to keep a separate but there are moments where themes from my research have come into the medical practice and one when i was doing my first book, prozac on the couch talking about the stereotypes of white women and i spent two with three months ratings there resist her jack -- prozac campaign and there was a woman who had a wedding ring playing with her kids and happy and i said this is a stereotype so does this mean you have to be a white married woman? what is going on then a woman came into my office carrying this ad and said this is the. i want to be normal. at that moment would answer was malpractice that i would have said what you are suffering from is a socially constructed condition and we need to change society rather than change the individual. that would have been the wrong answer but i realized racial and gender stereotypes shaped her expectations of the drug that i would maybe prescribing and also the way i will listen to what she said. in retrospect the right your answer was not to say yes or no but instead, what does normal mean to you? and then raised gender in educe a better insight that pharmaceuticals of the establishment. >> i don't have a personal anecdote but what i have found in my research to talk about the politics of health is the importance of us speaking with each other at dinner tables and wherever you may be about health and health politics. i say that because quite often, no offense to my right we invest so much authority with but there are these debates we disagree sometimes the jury will go out and quite often things that are represented are plain wrong. it is important we talk and find information in think about not just on the individual terms that often we will do but to say in the case of mental health it could be an issue of your problematic self adjustment or it was genetic and there is a medicine i can't give you for a hefty price to fix that but we need to think how our personal health is a part of our community health and life as well. that is the stuff we don't talk about them in particular mental health. that is the bold new upcoming frontier. but because they are in part to that it should have been thought to be public health we have thousands suffering imprisons not getting clinical care. >> i will just echo what sam said part of what changed for me is the increased interest in the health clinics in the work of health care and interested in the work but it is a community issue to bring people in for holistic medicine and softer referrals prefer i think it is the tradition that very much thinking about health not only as the individual issue but thinking social health coverage to be healthy is to live and a healthy community and when you don't suffer micro aggression's every day or fear for your life going to. >> host: 11th of a feel safe in your community and in your home and at school is part of what it means to be truly healthy and community based health organization's help to make this possibility have they inc. violence through the public health? icahn asked city will, is that no part of public health? >> it is. there are schools here in the united states people whose e system for petty crime will find with because fete for public health some things and not appropriate i am very aware of the guy with a hammer that thinks everything is a veil i think everything is not a problem but we have much to contribute to. >> he is doing amazing working and i think addressing these questions of violence are best served when we have strong coalitions between historians in the medical community and with the stuff you are doing i am put the violence but then to have better the public health issue then there are these established industries that will come down on hugh. looked at the debate about guns it is jerry rationalized even calling it a public health conversation puts you at odds with many other tenants of public kelso the question of violence is very complicated. >> i want 2.0 there was a very serious problem in boston with adolescents by linz. and then writing a billion book on lake my sons and do you look in she found interesting things. he told me that chicago there are no middle-class black neighborhoods. that is fascinating. but in chicago it is either a or. all these things what could they be worth including the harvard school of public health and social work and a school in during the year that was active there was not one fatality. so that kind of synergy is important but it is important to note that i don't know what happened then left harvard and that and expected but talking about right violence really are addressing it that they're studying violent racism like in the south's he thought that should be a mental health diagnosis. how about white people killing five people? that is uppermost in my mind but surely someone it is a member of public health and but those assumptioassumptio ns that harry points that we have to be casual and we're talking about the e epidemiology of black budget to day but i think that has to be part of the question. is part of every answer. >> you seem to have some ideas about this? >> looking at gun violence and the numbers most deaths we have to 19,000 with the hope that we can actually do anything about it just reinforces the stereotypes. >> is there anyone in the audience that would like to ask a panelist? >> good afternoon. my question is to root piggyback off what she mentioned in reference until we eight knowledge in the attack on the african-american male, we will not be able to resolve it. when will we address it? anyone on the panel. . . great event. thank you. [applause] >> our first panel is titled methodology of race, science and health. before i introduce our moderator i want to acknowledge rich who worked with me tirelessly in pulling these panels together. .. >> and civil, civil liberties. he is a professor of humanities and social sciences. he says here at wfts university, so you have me there. >> tufts. >> oh, that's tufts. you know how these academics write. [laughter] okay, and visiting professor at brooklyn kenneling. please well -- college. please welcome professor sheldon sheldon -- [inaudible] [applause] >> it's a real pleasure to be moderating this panel, and my job is to simply put forth a question of conversation so we can get started quickly. first of all, let me introduce the panel members. to my immediate right is -- nelson, who has written the black panther party and the fight against medical discrimination to -- [applause] to her right is samuel k. roberts who has written "infectious fear: politics, disease and the health effects of segregation." [applause] to his right is jonathan metzell who has written "the protest psychosis: how schizophrenia became a black disease." [applause] and last but not least to his right, harriet washington whose book, "deadly monopolies: the shocking corporate takeover of life itself and the consequences for your health and our medical future." please give her a welcome. [applause] so i'm going to start the conversation among us by first asking what mythologies did we all learn from writing our books that we would want to share with the audience today and discuss amongst ourselves? i'm going to start with three myths that i learned from writing "genetic justice" which was really about forensic dna. you know, when you watch all these crime programs on tv, dna rules, it seems. so these are the three myths that i learned. first of all, myth number one, that dna profiles are like fingerprints. not true. very different. myth number two is that dna evidence is infallible. also not true. it's not infallible for prosecutions, and it's not infallible for exonerations. myth number three, clerking dna profiles is race neutral. that's also a great myth. so let me turn now to allandra, and maybe you can tell us what some of the myths were that you discovered in your work, "body and soul." >> good afternoon, everyone. good afternoon, harlem. thank you. thank you for the introduction, sheldon. so i guess mine are more three truths than three myths. i begin my book, "body and soul," with the sentence health is politics by other means which means to suggest that when we're talking about issues of health and science that we can be talking about test tubes and laboratory benches, and, you know, advanced scientific research, but we're also talking about contests over challenges to resources over health care access over access to scientific information, health education and the like. so that's one truism. the second is that the civil rights tradition, the black freedom tradition, the black protest tradition was always a health activist tradition and and a health politics tradition. so we can think back to marr cuts garvey's unia organization which had a cadre of nurses called the black crose can think back to the powerful and brave fannie lou hamer who talked on the stoop about being sick and tired of being sick and tired and gave us the poignant euphemism mississippi appendectomy to give votes to the experience of -- voice to the experience of poor black women that were sterilized against their knowledge, an issue that's been in the news the last couple weeks in california. and lastly, i want to offer for you that the black panther party was a health social movement, a kind of rorschach test for how we think about black politics in the last half of the 20th century in particular. but i think what we don't appreciate so much is that they were deeply engaged and involved in issues of health activism, health equality and access to medical care services in the united states. and particularly as i discuss in my book, they were engaged in giving people information to and access to services that were under mention that we didn't know enough about, that we didn't -- that the services were underutilized or not provided enough for such as sickle sell anemia, and they also had a network of health care clinics that provided health services. and notably with, and i think given harriet's prior book that many how i don't have probably -- many of you probably know, the black panthers were engaged in protecting black communities from overexpose z your to the bad forces of medical experimentation. i write about one incidence of this, and i hope other scholars will carry this forward, but they participated in the 1970s in california in a struggle to stop the university of california from using, from introducing medical protocols and medical research that would have disproportionately affected black and brown men and boys in southern california. so they provided services and ways for, to respond to how black communities were underserved and also protected black communities from the way in which we were disproportionately overexposed to the worst harms of medical research. >> thank you. samuel, what about your findings? >> thank you very much. good afternoon, everyone. i, similar to alandra, i found some truths as well as some myths in my work. i focus as a historian on the late 19th to the mid 20th century which in a lot of ways is the era of jim crow, but also the era of the birth of modern public health in the united states. and in doing so i found that for many black communities which were increasingly urbanized communities that there was one particular disease that claimed the most lives, one cause of death which above most others claimed black lives, and that was tuberculosis. and this is a disease contrary to the myth of racial predisposition was actually one of living conditions of poverty. so in many ways we find at the very birth of public health in the united states this mythology that, well, black people are dying from tuberculosis because they are racially predisposed when, in fact, this was a way of masking system of the quite often impoverished and just plain out terrible conditions in which black people were forced to live. this was largely a product, by the way -- and not incidentally -- of racial segregation and exclusion from many jobs. the truth that i found -- or that was the first truth. and the myth, first myth that i found is one of the kind of race neutrality of public health, the way you mentioned, sheldon, ant the myth of -- about the myth of forensic genetics, pardon me. we tend to think in the history of public health as it being this rational science that as emerged as a way of thinking about society and epidemiology, and at the very birth of it we find racial assumptions which worked quite often to the detriment of the people it was supposed to serve. and then finally the second truth i found is that much like alandra has mentioned in her study that there has always been a black health activism. and the question is where do we look for it. if we also -- if we always think about the men, usually white men in white coats in hospitals as being the locus of health knowledge production, then we may not find african-americans in the early 20th century there. but, in fact, we find clubs, ymca, ywca, churches, masonic orders all being very much engaged in their community and environmental health in particular. thank you. >> jonathan, what about your findings? >> okay. well, again, thank you so much. it's really a true honor for me to be here today. i work on race and mental health. i'm trained as a psychiatrist, and i look at kind of historical trends about racial disparities in the diagnosis of different kinds of mental illness. and the research that i did for the or book and that i continue to do looks particularly at race-based misdiagnosis or overdiagnosis or schizophrenia in black men. people might know this, but starting in about the 1960s there were a series of research findings that found kind of out of the blue that all of a sudden people discovered that this illness has schizophrenia was being overdiagnosed in black men at rates of anywhere from four, five, six, even seven times more than any other group. and to my surprise if researching the book -- in researching the book, i found this actually wasn't always the case even though there's a long history of the relationship between race and sanity going back to, you know, slave times when we had diagnoses about slaves who ran away must be crazy and, you know, dropping mania and other things. but schizophrenia, actually, was a largely white diagnosis in the united states through the 1950s. and all of a sudden in the 1960s kind of seemingly out of nowhere there was this disproportionate overdiagnosis that actually has continued into the present day in which african-american men are dramatically more likely to be diagnosed. and this is something that is actually at odds with genetic science. the way we think about the biology of mental illness. because according to biology or genetics as we know it, schizophrenia is an illness that shouldn't have any race or gender imbalance because it's something that should happen at the level supposedly beneath the levels of race. it's according to, you know, biologists it should occur in 1% of the world's population regardless of who they are, where they live or how they look. so my research looks at the question of why in the 1960s particularly did this start to happen, and i also look very specifically at a hospital called the ionia state hospital for the criminally insane in michigan where it was largely a white hospital through the 1960s. and all of a sudden in the '60s and '70s, increasing numbers not just of african-american men, but actually of african-american men who had participated in black power protests and been members of the nation of islam and other kinds of groups or had participated in some way in different riots like detroit riots somehow made their way to the hospital, and they were diagnosed with mental illness. and so, you know, that's not a huge surprise when we think about the ways that politics and the diagnosis of mental illness have gone together in this country. but i would say that the main myths that i look at, one i've already kind of suggested, is that this increased rate of schizophrenia was somehow the result of something to do with biology or genetics. of course, a lot of people were arguing that at the time. but what i found was that it was almost entirely a social phenomenon that was linked to a series of changes, and the two i'll just put forward, one was that people -- there was a lot of anxiety about the political moment, and people really were linking political protests at the time to insanity in ways that started to make sense to people. and the second was that the diagnosis of schizophrenia had changed in 1968, and the official diagnosis all of a sudden said anger, hostility and projection, blaming other people for your problem. so in a way it made it very easy for doctors to see black men who were protesting as mental illness because of these criteria. so myth number one is biology. myth number two is that misdiagnosis happened because these doctors were disproportionately racist. and i found through a lot of interviews that some of the doctors were pretty well intentioned, and some were not. and so really it was the structure that they were in, the structure of the diagnosis that in a way they were all using the diagnosis. and so it was a structural issue. and so the third myth is really how we deal with race-based misdiagnosis in sigh psychiatryr mental health. our approach in my profession is often to make the clinician more sensitive to racial or ethnic issues. of course that's very important. but what i show in my work is that, actually, racist assumptions are embedded in the structure of health care systems. and so i argue that we need to teach the medical system to be what i call structurally competent rather than teaching individuals to be culturally competent or culturally sensitive. >> thank you. harriet, i just wanted to say a word before you get your chance, and that is in our constitution the one right that's listed in it -- not the bill of rights, but in the constitution is the right to take out a patent. amazingly enough, that was built in by thomas jefferson. and your book, "deadly monopolies," questions some of that patenting. so tell us what you found. >> first of all -- >> use your mic. >> hello, harlem. very happy to be here. and excellent question. i want to point out that thomas jefferson was not actually a fan of patents. he didn't like them very much. he didn't really want patents to be issued. he bowed to pressure by james madison and others. and the patenting of entities that we typically don't think of as patentable, especially things like parts of our bodies, especially things like medications that we need to live has always been hotly contested, but the people who had issues with it tended not to be people in power. they tended not to be corporations who are going to profit from them. so although there was always that tension, gradually through the laws this friendliness towards patents by people who were going to profit from them triumphed. and now we have a medical system that viewed the patent as common place, as something that's expected. i'm not sure if i addressed your question fully, but i think that there is a tension there, and i also think that as we were discussing earlier in the green room, we have some recent good news in that the patents on breast cancer genes that were held by -- [inaudible] have recently been struck down. i think that's a move in the right direction. the mythology, though, associate with the that that i want to address is a mythology that -- well, there are two actually. first of all, there's the myth that pharmaceutical companies like to promulgate as a rationale for doing things like patenting genes, patenting medications which may then charge you and me an outrageous, unaffordable price for, the rationale is we've invested a huge amount of money and time and interest in developing these medications. so we have a right, in fact, we have a need to charge you a lot of money to coffer the costs -- cover the costs. without our investments, you wouldn't have medicines for hiv disease, for sickle cell anemia, for all the things that threaten our health. that's a myth. the truth is, the reality is it's not the corporations who are investing this money, it's the federal government. where does the federal government get that money? from you, your tax dollars. so you are paying for these medications. in fact, you're paying for them twice. you're paying for them to be developed and then to pharmaceutical companies who want to charge you thousands of dollars for medications that you need to stay alive, sane or healthy. so that's an important myth. another myth i want to promulgate is something i hear frequently. sometimes you hear about research being done, and often we hear about research being done in developing countries; nigeria, brazil, cuba, thailand. and often there is a complaint that the ethics have not been adhered to properly. people are not being treated, are not being tested under informed consent. they don't know exactly what's being done to them. they haven't been given enough information to agree. so informed consent, other abuses that surface. and one frequent response by the company is that, well, you have to understand we're testing these drugs for leprosy in brazil, and perhaps we cut a few be ethical corners, but there's a high rate of leprosy in brazil. they need these drugs. that's a myth. there is a great need for these drugs in developing countries where they're testing drugs, but these countries do not benefit. in fact, michael kramer at harvard did a study, and he found that within a 20 of year span, i think a 24-year span, that of the 12,033 drugs invented by pharmaceutical companies, only 18 were for use in the developing world -- 14. and five of those drugs were for animals, not people. in the end, four drugs, four drugs out of 12,033 were devised for the use of people in the developing world, and yet one-third of all clinical trials by pharmaceutical companies are now being conducted in the developing world because it's cheaper. so that's a myth, a very important myth. so the rationale for these very high prices, the rationale for bypassing the people in the developing world and condemning them to poor health doesn't hold water. it's a myth. and i want to back up for a minute and address another bit that i addressed in my earlier book, "medical apartheid." first of all, one might say the entire book is addressing the myth, and that is the myth that was used to change the law in this country about medical research. it's a very prevalent myth that african-americans have been underrepresented in medical research. and if i say that this is a myth, people will quickly produce data to show me that i'm wrong. the problem is many of the african-americans who have been used in medical research do not show up in the data. the research has been done sub rosa, it's been done without notations being done, it's been done without their knowledge, it's been done in a shadowy, secret way. and it's also not necessarily therapeutic. as i detailed in "medical apartheid," a great deal of nontherapy piewsic, harmful, stigmatizing research has been conducted without being fully documented or fully acknowledged so that this mitt that we are somehow under-- this myth that we are somehow underrepresented is only true if you're looking at therapeutic research. and that leafs for the conundrum. it's not really an easy set of concepts to keep in mind, but we do have to remember two things, in my opinion, and that is that we do need, we do need to be participants in research because we need to benefit from research perhaps more than other americans. but we have to do so with vigilance. we have to do so mindfully, we have to do so with all the protections which leads me to my final myth i'm going to address here today, and has the myth of informed consent. most of us quite rationally believe that should we choose to engage in medical research, be recruited, that we are guaranteed informed consent. and by informed consent i don't mean simply that the researcher asks your permission, that's part of it. but he asks your permission. informed consent also entails maintaining information about the study. so you have to be told everything that you need to know to make an informed decision about whether to join the study. you have to give your consent. but that consent is ongoing. when new information emerges, we find out, for example, that red-haired people don't farewell with the drug being tested, they have to tell you that. so you have to get this constant information. informed consent is under assault in this country. it is diminishing very quickly, in my opinion and, again, in a very occult, shadowy way. it's not something that gets a hot of attention, not much attention at all. but the law was rewritten twice in 1990 and '96 the federal code was rewritten for people to be committed to medical research without their consent. medical culture has become more and more friendly to the idea of conducting research without asking people's permission sometimes or without giving them the full benefit of informed consent. so it's a myth that we can afford complacency about that. it's something we have to be very vigilant about, and it's something that i think we should be actively seeking to redress. we should be trying to eliminate these holes in informed consent because they're quite dangerous. informed consent is more than a philosophical abstraction. for african-americans with our history of research vulnerability, informed consent is a necessity. thank you. >> thank you. is anybody on the panel wanting to raise a question for another panel member? any thoughts you have amongst yourselves? >> >> i just wanted to respond to harriet just by saying, you know, i think one of the places to look for how black communities can think about responding and being more active citizens and participants in clinical research studies is to think back to the legacy of the black freedom struggle, right? which is, i think, in some ways it feels like an uncomfortable or, you know, not a place that we look typically. but part of what is so important if we can get beyond the demonization of the black panther party is the way that they were centrally engaged in conversations about medical research. they were looking at protocols, they were going through protocols for a research center at ucla and particularly interested in the ways in which they might disproportionately harm black communities. so, you know, one of the responses i think to the insights that you raise many your book is certainly to be more vigilant, but a way to be more individual hasn't is actually to take agency -- vigilant is actually to take agency, you know, sit at the table and take agency and understanding and finding information about research studies taking place in your community including those here in harlem taking place via columbia university. >> after i do a body of research, there is something that i bring to my own personal life usually. you know, just a higher understanding of how i'm going to interact with the world. did any of you come to some personal, i don't know, epiphanies about how you're going to interact with the health care system, with the medical system or with any of those or the scientific system from your research? i'll give you one example, and this is from research i've done in the past on conflicts of interest in the drug industry which is probably familiar to harriet. but if i go to a physician and this physician is going to offer me a drug, i'm not going to take it right away. i'm going to -- the first thing i'm going to say is, is this been approved for this use by the food and drug administration, by the fda? doctors have the power to give you a drug that's not been approved for that use. they have that kind of power. and if that's one thing i've learned from my research, it's how to talk to a doctor about the drugs that they're planning to give me. did any of you reach any insights about your own personal lives? >> i'll give the flip side because i think i'm in the unique position that i'm also -- i'm practicing as a doctor -- >> yeah. >> and i have this funny life where half of my life i'm a practitioner, and the other half of my life i'm being a sociologist, historian, kind of cultural critic where i basically tear apart everything that i stand for on all the other days. [laughter] saying that it's imbued with all these problems. and it's funny because i've had some moments of kind of overlap where i kind of -- it's part of my own schizophrenia, i try to keep the two parts of my week separate. but there have been some moments where themes from my research have actually come into the clinical practice, and one is when i was doing my first book, "prozac on the couch," that was a book about white femininity ander the r stereotypes of white women in drug ads. and i was -- i probably spent two or three months writing this critique. there was this big prozac ad campaign, and it was sud playing with her -- sue is playing with her kids again. she was all happy and playing with her kids, and i was saying this is a total stereotype. does this mean you have to be like a white, married woman to be mentally hell healthy? and then a woman came into my office carrying this ad, and she said, hey, docker i'm sue, and i just want to be norm. i think at that moment would have been two practicalling answers. you're suffering from a socially constructive position, and what we need to do is change society rather than treat the individual or something hike that. [laughter] i think that would have been the wrong answer. instead what i realized was that racial and gender stereotypes shaped her expectations about the drug that i was maybe going to prescribe, maybe not. and they also shaped my, the way that i would, you know, listen to them and hear what she said. so i think in retrospect the right answer at that moment was not to say yes or no about prozac or some drug. it's instead to say what does normal mean to you? what are your expectations about this? is what do you think, how do you think it's going to change your life. and to think through my own lens of kind of, you know, race and gender and culture and class to say that if you study culture, it actually, i think, gives you better insight into the complex symbols, symbols of power that pharmaceuticals in the medical establishment become. >> in answer i might -- i don't have a personal anecdote per se, but what i've found in my research and kind of thinking about the politics of health is the importance of us speaking with each other amongst ourselves if communities, at dinner tables and wherever you may be about health and health politics. and i say that because quite often we invest -- and no offense to my, to the physician to my right -- we invest so much authority with medicine. and if you read medical studies or if you look at medical journals, you find out there are these debates that to the lay public may be represented as being instead of consensus. and, in fact, they disagree amongst each other. the science is, the jury is sometimes still out on these things. and quite often things that are represented to us are just plain wrong. it's really important that we talk to each other, that we find information and think about health not just on the individual terms that medicine often will have us do which is to say in the case of mental health the may be, you know, an issue of your own problematic self-adjustment, or you could end up being misdiagnosed. or in the sense that, oh, there's genetically something flawed with you and, by the way, here's a nice little medicine i can give to you for a hefty price to fix that. but we need to think how our personal health is a part of our communal health and our community life as well. and those are things we quite often don't discuss, particularly in mental health, i would say. that's probably one of the new or the upcoming frontiers for black health, how we think about mental health. because too many of our mentally ill are now part of the prison system. and for reasons that are, ought to be thought of as public health and medical reasons. and we have thousands of people suffering in the prisons who ought to be getting clinical care. .. or holistic medicine and also often for referrals to other forms of medicine. caring for it is a tradition that in public health the social medicine tradition but very much what sam was saying about thinking about health not only as an individual issue but thinking of the issues of what we might call social health. for that to be held the is to live in a healthy community, in a society where you don't suffer microaggression every day or fear for your life going to a 711, where you can feel safe in your community and your home and your school as part of what it means to be true be healthy and community health, community-based health organizations play a large role in making this a possibility. >> has the public health establishment inc. violence in the public health framework, is that now a part of public health? >> there are schools in the united states which look at violence as a problem, columbia university building public health and starting to look at that as well. i don't think it is yet part of the mainstream public health. that is for a number of reasons. we don't think of epidemiology of violence where we might -- i am not sure that is the way we have to, there are certain epidemiological things about violence, ways that social structures that would aid and abet violence. if it sounds like i am counting my answer is because i am, there are ways in which public health can intervene but there are ways in which it was not appropriate. and it is particularly urgent, demanding at this moment, the problem of mass incarceration in prisons. there we have a problem which is a solution which causes more problems than ever solved. many people who enter the system for petty crimes or quite often no crime at all will find themselves burdened with medical and public health issues that they had not had prior to entering the system and that goes to the community as well. for public health those are two of power more urgent issues. and the caveat that public health is not appropriate to everything. i am aware of the issue with the hammer thinks everything is the nail. public health should not always in everything is a public health problem but we have something to contribute. >> sam is doing amazing work. addressing these questions of violence and mass incarceration, when we have strong coalitions between historians and the medical community, it is fantastic the kind of stuff you are doing. i am writing personally about race and guns and gun control and this question of violence is unbelievably complicated, a statement of fact that will surprise no one but try going out in the world and saying gun violence is a republic health issue. there are huge established industries in whole states that come down on you. look at the debate about guns. it is of very racial conversation that even calling it a public health conversation puts you at odds with many other tenants of public health. the question of violence is complicated at the moment. >> i want to point out in boston, we had a very serious problem with analysts and violence. in 1992 and 1993, public health epidemiology and violence initiative going on, there was someone who wrote a brilliant book about violncesencend also of people like milton girl who had a problem in chicago in which he looked at the social dynamicsearl who had a problem in chicago in which he looked at the social dynamics and found some interesting things. in chicago there are no middle-class black neighborhoods. i found that fascinating. you can find white neighborhoods that are middle-class but in chicago it tends to be either/or. there are all these things that look as if they would be worth examination but the thing that worked best in boston was one of bunch of organizations including harvard school of public health, including a group of ministers, social worker organizations and schools formed the coalition and during the year the coalition was active there was not one fatality among adolescents in boston, not one. that kind of synergy is extremely important but also important to note that initiatives like harvard happen. i don't know what happened. i left harvard not long after that and wrote an article for the public health review, expected great things and didn't hear anything more. the sense is it has been seen as a public health initiative, and it is more wisely that way. the other thing is when we talk about violence i find it interesting we are only addressing half the issue. we are talking violence among black people. what about white on black violence? some time ago, violent racism such as encountered in the south by civil rights workers, that should be a mental health diagnosis. how about the mind-set of white people who kill black people? considering all the things that happened in the last week that is uppermost in my mind and also an important part of the equation. >> i want to add that that is part of my reservation as well about public health. with the best of intentions, certainly as someone who is a member of public health and has a certain investment in its mission i don't want to set myself up as a public health basher but those assumptions kerri points out that we have to be careful of that quite often the ndp it assumption is violence and epidemiology, and we don't ever, very rarely is it invoked except today on the stage. what is going on where there is really scary white aggression on black youth for example? that would have to be part of the question and part of the answer. >> you seem to have some ideas about this. >> looking at gun violence. the numbers bear out. we have 19,000 suicides for example. we rationalize this conversation away harriet and sam say are exactly right and reinforce stereotypes and texas farther away from the hope that we can do anything about it because it reinforces these cultural stereotypes. >> is there anyone in the audience who would like to ask one of the panelists a question? don't be shy. can we get a microphone? can you step up to the microphone? thank you. >> good afternoon. it is more of the piggybacking mentioned in reference to until we acknowledge the racism, until we acknowledge the attack on the african-american male, you won't be able to resolve it. when are we going to address it? anyone on the panel. >> anyone want to tackle that? >> i wish i knew. i agree with you. >> the collaboration you mentioned in boston where the church, board of education and everyone came together and mobilize that is the start because my question initially would be how to go back to my community in connecticut and implements something to make a difference to help our youth? known nothing else, vacation bible school this week for ninth grade to twelfth grade and the main theme was family reunion and we talk about what does family reunion in compass? with that, we went back to how people come that you haven't seen in a long time, share stories of the past and one thing i said to my students was one of the words you say now, my new gear --nigga you change it and take the sting out of the but the reality is still there. i asked how many of you remember 9/11 and most of them remembered and remember where they were. how many of you remember last saturday's verdict and where were you and it kind of hit them. do you remember is the steam? that is what the holocaust was for african-americans. wherever we were asked, whether -- it was the sting. now that you understand that maybe we will have more of a dialogue because realistically we stopped talking to young people, stopped having stories, we would be more free to them and hopefully open a dialogue open to take time and talk to the children and listen to them and like saying hello. so on up personal knows, a bag on this but it is an eye opener and something we need to try for children and the community because it starts with us. >> thank you very much for those comments. >> these organizations, they have to work together. and it may start the building. it does have to happen. >> if you give us some support that will be great. >> interesting for us because one common thread through our work is we looked to history to find instances of structural oppression and structural racism, places and responsive to it, and to see where the system seems incredibly slanted in a very violent way and stearns out we don't need to look to history. how open all of this stuff about stand your ground, it is their right now in the present moment. how to deal with this as it is happening so blatantly, not even hit in. >> one other way of saying it is to suggest these ideas about violence particularly as it pertains to black men and black people are foundational to american society. we want to talk about saying hello, the issues you're talking about in your specific community and if it is not only when individuals are doing, it certainly helps to say hi and treat each other better but there is a longer a trajectory of dehumanization and society moreover that manifest things like drone violence and manifest in long periods of social isolation for people who are incarcerated and we see in recent events last week. that is a longer problem, not only for black people or black men, it is a problem of american society written large. to think about the little things, things we can do in our communities and interpersonal relationships that can add to compassion and justice and society but also about understanding structural peace and working on both those terrain's at the same time. >> ultimately it is about the human race and we are all in this together. when a president can be disrespected in front of everybody and called a liar and nothing is done about it it starts from the top and goes down. all i am asking is we need to acknowledge it. once we acknowledge the problem we can start addressing it. >> next. >> i am very interested in continuing conversations about the mythology of race and what happens and colleges we as a community can interact and have better and better conversations about health care professionals. i was wondering if you all have websites, that the public can go to if their family has been diagnosed with something how do we have access to these clinical trial data bases? if you give us some names of databases as samuel roberts was saying, having conversation with family and friends as they come up and tell me they are family members or friends have been diagnosed with things, where do you go besides the internet? where can we as a public, where can we access this information to do our own research and the more proactive on health care? >> excellent question. there is a great deal of good reliable health information on the internet. the problem is there's a great deal of the other kind of information on the internet too. how do you separate the wheat from the chaff? i urge people research your diseases and things you are told you may have or that doctors are trying to rule out. get the information for yourself. it is critically important to talk to a physician as well. i know it is not easy. there are a lot of -- 15 minutes on average for insurers looking over their shoulders. the information is -- anything to do with your particular case. you simply cannot research your own condition on the internet. it just can't be done. if it could be done i would be very happy. but get the information, read it but please do not do that without discussing it with your envy. i recommend printing it out and taking it with you, this is what i found, tell me what is going on with me. otherwise you will never get accurate complete information. if you don't trust your doctor enough to do that you need a new doctor. >> i can just give you one for clinical trials. the government has a web site, a reputable website called www. clinicaltrials.gov. you can at least find a list of the ongoing war started clinical trials in a particular disease category and then you can take that to your doctor and say are any of these relevant to me? those are reputable list of ongoing clinical trials that are required to be posted if they are to be approved by the food and drug administration. www.clinicaltrials.gov. put in a disease category and they will list 15 or 20 that are ongoing and you can bring that to your physician. >> there are a number of support groups depending on the condition you talk about. one is the national association of mental illness, national advocates, there website is a robust one updated regularly and deal not just with dealing with mental issues but public policy advocacy as well. in terms of advocacy i want to really reemphasize the importance of any political mobilization. we often talk about the medical industrial complex like a huge behemoth that squashes everything in its path. we are all historians. you find out the power is very weak. at times if you mobilize in the right way and ask the right questions you can find where things for a around the edge and have an impact. that being said grassroots organizations, some of this can be very good, just a few bad leads, ask the right questions over and over again and get the right people to start asking questions is really important as well. >> i want to push back against the advice of a physician. you want to talk to a doctor but people should start book groups, research reading rooms in your community and information, expertise is diffuse. maybe you want to talk to a physician but i don't think it has to your personal commission. your neighbor next door will read the journal of the american medical association with you and other people. maybe there are physicians, assistants or nurses working in your community that you know. you probably know a nurse or two. and the studies are in conflict, increasingly we have to be savvy sorts of readers and consumers and patients, and all of us brings certain types of expertise. and there are 40 people and make these large claims how drugs operate based on 40 people. we want to have these coalitions and that includes people with medical expertise because of a particular kind of expertise. doesn't have to be your clinician, drive that -- grabbed the doctor at church and get together and read a medical journal together. it is a model from the black panther party for sure. >> a lot of local experts if you had to care for an elderly parent or someone with a specific condition you will find that person within two or three years is as knowledgeable as many doctors in a lot of ways. that person is a community resources. >> i think we have to distinguish between gaining health information, always a good thing to do, educating yourself about health which is why i agree with everything that has been said. in case that was mentioned was a case where you yourself have been told you have an illness, where you yourself are facing potential health crisis. in my opinion it is a different situation and in that case by liam portents to communicate with your clinician because only your condition is responsible for your health. this is the person you have chosen to be responsible for you. you have to share the information, have to trust that person. this is the only person who is -- sues responsibility it is to look at you in particular and see where exactly you fall on that spectrum and what should be done with you. you can't ask other people to do that, they won't be equipped to do that. >> the discourse is directed to mr. roberts on it. i want to know what is the defect of the food industry to the public health and also the fact of the fda and authorizing toxic things to their food. >> i have to say i am not a scholar of food and drug policy except that research on drugs addition treatment dealt with fda policy. there is a lot of critique of the fda--some of the cases before us. maybe two of our panelists talked about fda policy so i should just defer to them. >> the fda. the food and drug administration, often touted to be the best in the world's. other countries follow the rules very often and there are really good people who work there. as a matter-of-fact especially under democratic administrations, much better. the colleague who i wrote the book with, genetic justice, used to work for the aclu. you know that organization. and she went and was hired by the fda to be assistance to the director. she is a very good progress of the individual but efta like any other federal agency has political pressures on them, political pressures. that is the problem. we can't always sort out what those political pressures are, behind-the-scenes, some country might ban a chemical from exposure but the fda says no, we don't have enough information yet to ban it. you knows that being pressured from an industry group saying if you ban this chemical our profits are going to go down. it is a mixed bag. very good people work there, they can always decide things. it has to go up the chain of command and eventually somebody says no, we can't ban this or we can't restrict this and there are organizations out there that are constantly watching the fda, suing the fda when they feel it is necessary and these are good. these public interest organizations help us and everyone's in a wild they sued the fda and the courts say the fda hasn't done enough. that is the way the system seems to be. you have good people working for the agency but not all their decisions can be reached at the top levels and the fda makes mistakes. when they do they pull the drug off of the market. sometimes those mistakes are because lack of information, sometimes because drug companies don't reveal the information and they get sued so there are all kinds of reasons why sometimes drugs get on the market that they shouldn't be and sometimes food additives get into our food and they shouldn't be. the good question, have to be vigilant. >> is difficult to trust the fda. it has changed a great deal since the time when it protect americans, the fda did not allow the little mind --polydimide it prevented sick children -- there are many children born with a dramatic birth defects, didn't happen here. that was a long time ago. today, 40% of the money the fda receives to evaluate new drugs and new additives to food come from the manufacturers of the articles themselves. that is an unacceptable conflict of interest in my opinion. i am concerned about the economic pressures on the fda. they seem too industry friendly. they approve multiple drugs that over the objections of their own evaluate is doctors who work for the fda will refuse to approve a drug, it goes on the market for a few years, causes a terrible toll in illness and death and is cooled from the market often not by the fda but the manufacturer itself. why? because the manufacturing, the manufacturer can put it back on. the fda is too compromise in my opinion. >> i was going to make the same point. i think the relationship to industry right now is something people should be wary of because there is all this other nefarious practice, ghost writing research articles, squelching negative studies, things that a brief career as an expert witness testified against the drug industry, i found out i was very conflict of veraverse s a bad witness it was pretty terrifying, something to be wary of. i had to tell patients of mind to trust drugs with longer track records even though there's all this pressure to get the new drug or something but to trust drugs that have been on the market longer for this reason. >> i would urge everyone to read summer 2011, the american scholar. cover story is about exactly this issue. how difficult it is to trust the fruits of medical research, partly because the people who run clinical trials do a great job, they can't catch everything. they can't give you correct information if they have been lied to themselves and also partly about how the fda has been less than vigilant in keeping the drug off of the market. american scholars 2011 the title is lacking for big pharma. very objective title. >> thank you very much. more and then you expected. >> thank you very much. my question is in relation to informed consent. .. >> the patents -- >> oh. >> yes. >> um, i think the last question first is easier. patents should not be banned, but they should be much more strictly controlled. and, in fact, that's what most other countries do. they permit patents, but they do not permit as many patents as we do. they don't permit a 20-year patent life which a company can easily extend by various, you know, manipulations. we have too many patted edges covering too many things -- patents covering too many things, and we allow them to persist for too long. they need to be tightly reined-anyone and controlled. a company holds a patent on a medication but they are making the medication at too high a price, $20,000 a year, or if they are not making the medication but holding the patent so nobody else can make it, then there is a regulation that says the government can step in and say you're not using this patent correctly, we're going to pay you a fee and give it to another company so they can make the drug at an affordable price, or they can actually use it and make the medication. this is in the law, it can be done, and countries like brazil and thailand do this. we are reluctant to do this for medications. we'll do it for electronics and tv and things like that, but we don't do it for medication. we need to do that more. in terms of informed consent, what you're referring to as a sugar pill, doctors call it a placebo. one group gets the active ingredient, and the other group gets the placebo or sugar pill. those studies are not always appropriate, they should not always be done. be you have a life threatening illness or very serious illness and you're testing a medication for it and you're testing what you think is a better medication, you hope is a better medication, and another one already exists, you can't give the person the placebo. why? was that mines -- because that means they're not getting any treatment for this illness, and that's wrong. what you have to do is you can give one group the standard of care, the regular medication people are already using, and you give the other group the medicine you hope can be better. placebos can't be used as frequently as they used to be used in the past. informed concept, of course, is something altogether different. that's when you don't tell someone they're in a study, or you don't tell them all the information. youyou should tell them about te study. or you don't share all the risks of the study and other information. and that is a, like i said, the serious problem here because it's not that that many people are affected so far, but we're not talking about a small number of people. the study that tested artificial blood only involved 720 people in the u.s. and canada. 720 people is not a lot of people. but at the end what did they find? they found be what they were testing caused more heart attacks and deaths than the regular standard of care. so you had people dying in the study who never knew that they were part of medical research, who never knew that they were in the study. and even worse, the very year the study ended a new study was started. the research outcomes consortium study which involved 21,000 people in the u.s. and canada. 21,000 people enrolled in studies where no one tells them they're in research. what happens is they're trauma victims. so ambulances go to attend to them, sometimes take them to hospitals. instead of being given a standard of care, they're given experiment alamo call theties, a whole variety of them, including things that are patented. and why do i point this out? because the patented valve is going to make money for someone if it's approved. and yet these people again, no one asked their permission. in many cases they're not even important. according to the protocol of the study, you don't even have to tell them they're in the study, and this is a very, very dangerous precedent for a country that has a long history of abusing people through the use of studies that didn't use informed consent. it was bad enough when people did it and could be called rogues or renegades because there's nothing sanctioning it. now people are doing it, and they're protected under the law. the rationale is that trauma victims, you know, they've been in a car accident, they've had a gunshot wound to the heart, trauma's a very broad category, and the rationale is that we need to do the research. but these people are not in any shape to give consent. but that's not true. number one, no one has tested how many of these people are able to give consent. i talked to one of them. i found one and i'm not even a researcher, so i'm sure there have been other people that were able to give consent if someone had asked them. and the other problem is there's an assumption that the research is more important than the person's right. the fact is some medical research you just can't do. this may be a case where you say if we can only test it on people who are unconscious, then we can't test it right now. and you give that unconscious person something that you know is going to help them. you know? perhaps we are turning our back on modality. that'll be very helpful. but until we find a way to test it about violating people's rights, i see that as a big problem. so i hope i answered your question. >> jonathan, did you want to respond? >> i'll just say one thing really quickly because i know we're getting towards the end here, but it's interesting because like now a lot of times when people call medical clinics or if they call the psychiatries clinic i used to work at in michigan, they'll talk to somebody about research before they even see a doctor or something like that. the relationship between especially medical academic centers and research right now is very close. almost -- i mean, some people are seeing researchers and, you know, while they're in a time of crisis before they're even getting treatment and stuff. so i think these issues are going to be increasingly important as we move forward because it's how a lot of academic centers are getting funding now, different kinds of research. >> one of the things i've learned over the years is try to avoid drugs as much as you can. [laughter] try every other method that you can think of -- diet, whatever. [laughter] [applause] you know, there are times when you can't avoid it, you know? antibiotics. and if you can't avoid it, you can also ask questions like the questions harriet's -- first of all, you can ask how long has this drug been on the market, because if it just came on the market, we haven't tested it on enough people yet to know how safe it is. but there are always going to be side effects. almost every drug has side effects. and if you're the lucky one, you won't get it. but, you know, try to avoid it. doctors -- and they're all good intentioned -- will want to give you something even if it's not necessary. and you have to decide yourselves what's necessary, how low do you want your cholesterol to be. [laughter] you know? so anyway, there's another -- >> another question. >> all right, thank you very much. >> hello. my father recently died. he had crucial felt jacob disease, cjd, and my question -- i didn't think it was here in america, i thought it was a myth. i didn't see any african-americans with it. so now i know. he's passed away, and i was just wondering since you all are in the health field, is there any study, any research, any information out there of how many african-americans are dying with this disease? because we've been going to workshops, we've been going to conferences, and there's not that many african-americans there. and i haven't seen that many -- i haven't seen much literature on it pertaining to african-americans. so just wanting to know do you know anything, any books, any researchers, anything out there? because i want a different perspective than what i've been getting, and i just want to narrow it down to african-americans and how it's hitting that population. >> well, i think jonathan actually is -- one thing i do want to say, though, is i spoke with laura -- [inaudible] who's a researcher at yale who studies it, and she told me it's her opinion that many cases of alzheimer's, dementia in this country are misdiagnosed. and it seems as if it's hard to get a handle on precisely how many cases there are. >> right. >> it isn't something that's not looked for routinely, so that means it's really hard to get good data on how many people have it. >> okay. >> let's exchange e-mails after the panel -- if thank you. >> -- and i can find out for you. i do think there are related forms of enreceive lop think, i mean, i don't know the racial breakdown for cjd, but i do think there are other forms that have been studied more globally, and this might be data outside the united states. >> okay. >> is it a myth that mad cow disease doesn't exist in the united states? >> yes. [inaudible conversations] >> yes, i thought -- i didn't think it was here. of when they diagnosed my father with mad cow disease, i thought what in the world? i'm thinking, i'm like, mad -- are you serious? and i didn't think it was real. and then when i started looking up, no black people. okay? >> i ask a question about that, i'm very sorry for your loss. you know, my condolences. what are you looking for when you say you want information about black people? >> because -- [inaudible conversations] >> with regards to mad cow. >> because you, because it's already rare and you don't know anything, okay? >> uh-huh. >> and then you find out when you do look, when i do go on the web site, it's all white people. so i'm like, okay, is it hitting black people? do black people catch it? >> we all get -- >> i know. but this is the stuff that -- you asked me -- >> yeah, no, i'm just trying to -- >> what i want to know is how with cancer you may be able to find out how many people have cancer, you want to know about your population. does it hit african-americans differently than it hits caucasians or chinese. i just want to know how is it affecting us as black peoplement because it's so rare by itself, and then on top of that you don't see that many african -- when we've gone to these workshops, i can count on one hand how many of us are there. so i'm like, damn, why did my daddy have to get it? how did he get snit so i wanted to know is there information out there, how many black people do actually catch it, any other minorities get it. i just want to know. >> thank you. >> yeah. well, you know, without data it's hard to know, you know? >> uh-huh. >> but the fact that it's not very visible among black people as you already suspect, that means nothing, you know? it's recently the case that these will be written about at length. in fact, you often see language like, um, very prevalent in this group of people. >> uh-huh. >> which i may be but sometimes i've looked into it and found out it's more prevalent in african-americans. >> is it just not being documented? because you're right, the way to diagnose it is very -- my family pushed, and we kept pushing. we're even getting the death certificate changed. >> good for you. >> so we're different. i'm wondering how many families are being misdiagnosed and how many more african-americans do have it. >> right. >> that's what i was wonder, in the health field, are african-american doctors talking about it? is there even an interest? is there research out there? >> well, misdiagnosis is, you know, certainly likely a problem. it's also the case that african-americans particularly if they're poor are less likely to have access to health care. and so when you're talking about this kind of rare disease, it sounds like your family poured a lot of time and resources into keeping your father with you and lots of people don't have access. so that could be part of the reason why we don't have data that might yield some of the answers that would be, i think, both intellectually and emotionally important for you and your family. >> thank you very much for your question. i think we have time for one more question. questioner? >> yes, thank you. i got the last one. i've already been coached to keep it simple and quick. i'm going to do so. dr. meltzer, i was listening to your presentation, and you mentioned something about in the '50s it was primarily the schizophrenic diagnosis was primarily for a white population. then all of a sudden, and you used the term out of the blue, it became something that was popularized for african-americans. and i'm wondering, i wasn't quite clear whether you were saying that when you say out of the blue whether it was they genuinely ignorantly started to make this misdiagnosis, or were they more like being dumb like a fox? in other words, needing a population that they could study, evaluate and do some different kinds of treatment with modalities? and my last part to the question is, is it coincidental that there were certain types of controversial therapies like shock therapy and, you know, in that sense that seemed to occur at the same time, and is there any connection. thank you. >> i'll just say very quickly because i know we're short on time that part of the point -- thank you, it's a terrific question. part of what i think we're all studying, i don't want people to leave or here and think like, oh, man, there's no hope for any of us, you know? like whatever. so it's more when you spend a lot of time studying particularly issues about race and ethnicity in the medical system, on one hand i think -- and hopefully you've heard this from this panel today, there's a very genuine need for people to get information. doctors want to help people a lot of times, but a lot of times there are these moments where the racialization of the system, the bias, the racism of the system becomes more apparent than others. and what happens then is not so much all of a sudden there's this plague of insanity in the black male population. it's that the frames around illnesses, the way we define illnesses change in ways that have some things to do with biology but other things to do with politics. so what i argue in my book is the reason people started seeing black men as being crazy is because they were afraid of them. they were in the streets protesting and all this kind of stuff and this language and insanity became a way of quite literally incarcerating black men but not having to take seriously the threat that they were posing to the white political order. that in a way it was a very political -- but to get back to alandra's quote, it was health being politicized in the name of maintaining the status quo. and so part of what i think we're saying is that it's important to get treatment, to get help, to talk to your doctors. but also to be aware always of the politics of the health care system that can kind of shape those kinds of disparities. >> well, we're at the end of this wonderful conversation, and i really appreciate the audience participation in this because you helped raise the level of the conversation. let's give a hand to our panelists. [applause] [inaudible conversations] aheadr callins and we're pleased now to be joined on our sets at usc by the best-selling author, dennis prager. his most recent book: "still the best hope. why the world needs american vallates triumph. " is this about experting american values. >> guest: we first have to import them. but it's about exporting elm that's why the subtitle is about the world. people need guidance to be good people. we're not born good. this is one of the basic differences between left and right. left wing ideology tends to believe we're born basically good. conservatives understand we're not, and it's a huge source of the differences between left and right. so if you understand -- and my preoccupation is with understanding why there's so much evil in the world, since i was a child, that's always preoccupied me. i take no credit for it. but it has been. you need ideas to guide people's lives. you need, if you will, ideology, and there are three competing ideologies in the world today. islamism, or islam, i'll explain the difference in a moment -- leftism and americanism. those remember the three competing ideas. two of them are proselytizing. one is not. americanism. and i define americanism very simply, not simplistic include in the book -- that's why they're a coin on the cover. occurred to me in -- i don't know -- 25 yours ago, emptying my pockets at night, i looked at the coins and century enough it was amazing there they were, the american value system on eve coin. liberty and in god we trust. that is applicable to owl all societies in the world. what i call the american trinity, those three values is the greatest value system ever devised for liberty and goodness. >> host: how do you define leftism and. >> guest: leftism -- that's the thing. as i point out. that's the largest single part of the book, leftism has characteristics and it begins, for example, with the belief that the greatest vehicle to goodness is the state. that the state is the great, as i said, vehicle to goodness. that you rely on the state as much as possible for the welfare of people. it begins with the belief that economics explains human behavior, not values. so that the idea that poverty causes crime is a sort of dogma on the left. we who do not subscribe to leftism, but to judeo^- christian values to, i think, common sense, know that the basic cause of crime certainly in our society is a malfunctioning conscience. people don't rape because of poverty. people aren't killing because of poverty. they're killing because they stink. that's why -- and we can't say that. it's just unbelievable. you can say, madoff stinks. people can say everything terrible, and they should, about bernie madoff, white collar criminal but you can't say the average rapist and murderer is of that level. it's not really him. it's his parenting. it's poverty, and so on. so, the blaming of outside forces for human evil is a very deep part of leftism. the materialist view of life is part of secular leftism. in fact leftism is by and large opposed to a strong religiousity because marx said the obstacle to -- is religion. religion says try to be happy in the world that exists and leftey. says make utopia here. religion says utopia is in the next life. so those are part of the, whichics and they're all developed in the book. >> host: dennis prager is our gift. if you want to call him the numbers are on the screen. >> or go to our facebook page. you can post a comment on mr. prager's name. it's on the top of the page. no, mr. prager, in "till the best hope" in the chapter, why left succeeds, or part of the book why the left succeeds, favored groups are rarely to blame, you say, about certain issues. what do you mean? >> guest: well, if, for example, the most obvious being a racial minority. if they kill, it is because of racism and poverty. during the l.a. riots that took place in this very city. i was talk show host then as well. i said -- i'll never forget why i said it, a local nbc reporter said here i am at the corner of two streets where the riots were happening and i see a black gentleman throwing stones at drivers. and i thought, the man throwing stones is not a gentleman. the word i can't use on national television but the word that comes to mind is not gentleman. why did he say gentleman? he wouldn't say there's a white gentleman wearing a hood, burping a -- burning a cross. the left of center doesn't have the courage and doesn't have the ideology that permits it to blame evil on evil-doers. if the evil-doer is black, it's white's fault. if the evil doer is white, it's white's fault. and you name it. the palestinian israeli conflict is another example. don't blame the palestinians. what they're doing is understandable in light of how evil israel is. the -- by the way, that's a very significant example of the upside-down world of the left that israel is now increasingly the villain. in that conflict. in the history of the world, there has not been a war between a free society and an unfree society. never. it's either free and unfree or two unfree societies. this is the first time in world history that i know of that the free society is blamed for a conflict. that is thanks to the left. israel is the villain. not the palestinians, who -- half of whom vote for a genocidal ideology to prevail. the leftism is an upside-down moral world. i say this with sadness because a lot of people who subscribe it to are decent people, which, incidentally, is unique to us. we constantly understand there are good people with whom we differ. i have never heard a prominent leftist say conservatives are good people. people who believe that same-sex major is wrong and that we should continue to keep the male-female major. they're not doing this from hate. they have sincere beliefs in this regard. they can't say that. because if we're not demonized then the can't be fought. we're fought by demonized. that's what we are. and that is how they prevail. we're not basketballing ideas. we're battling bad people. we think they're wrong. they think we're bad. >> host: dennis prayinger in here you write about the left wing takeover of the universities, and you give, as an example, the university of california san diego. and you list some organizations that the university has, and -- >> guest: want to read it? >> host: i'm going to read it. >> guest: awesome. this is from heth very mcdonald at the manhattan -- >> the vice chancellor for descriersty, the chance're lazy diversity office. the associate chancellor for faculty equity. the say si stays vice childrenless for diversetive. faculty equity -- the staff diverse city lee anson, the undergraduate student relay own, the graduate student diversity lee asewn, the director of development for diversity initiatives, the office of academic diversity and equal opportunity. the committee on gender identity and sexual orientation issues. the committee on the status of women. the campus council on climate, culture, and conclusion, the lesbian gay buy sexual gay tax gender resource center and the women's center. a left-wing seminary, not a university. >> guest: that's right. >> host: should not these en. >> guest: they have nothing to do with teaching. it has to do with indoctrination and ideology. this is another tragedy. i was raised in the jewish tradition the teacher was honored bay pavement i'm serious. i was racessed a religious jew, i still am, to the not orthodox. i have written two book on judaism so i'm steeped in my religion. and we were taught to respect teachers exactly like parents. in fact the hebrew root for torah, teacher, and parent is the same. that how hoely -- holy the teaching role is in my extra collision. has sullied the word teacher. i never thought it would be possible. it's like the pure is word you have. what the teachers unions have done to teaching in the public schools and what the left has done to teaching in the universities, i do call them left wing seminary. the christian seminaries there to produce committed christians. the university there is to now produce committed leftists and they're succeeding. that's the biggest reason for election results and for the shift in american values. are you don't hear this ideas in an american campus. not here at usc and i'm not picking on usc. doesn't matter where we would be. there are fine teachers at every university, no question, but overwhelmingly it as an indoctrination. bill maher, man of the left, just had a guy from uc san bernardino. who -- said to him, i'm courteous, in light of the latest terror attacks. i'm just

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