An hour with Donna Shalala

from the leed center at the university of kansas kbr presents an hour with donna shalala i'm kay macintyre shalala was the secretary of health and human services during all eight years of the clinton administration making her the longest serving hhs secretary in us history in two thousand seven after the washington post revealed substandard care for injured soldiers returning from the war in iraq president bush actually let and senator bob dole to co chair commission on care for returning wounded warriors a group to study how wounded servicemen and women made the transition from active duty to civilian life the next year president bush awarded shalala the presidential medal of freedom the nation's highest civilian honor she currently serves as the president of the university of miami where she regularly teaches a class on our nation's health care system shalala receive the two thousand nine to leadership prize on september twenty eight two thousand nine she speaks here with the director the dole institute bill lacy who starts out by

asking her how she got her start in politics and public service well my first experience in public service was after i finished my phd and them i was going to be or to teach at columbia university i was the assistant professor i was also had done my dissertation on the financial relationship between your city and your state and as a result of that i had an opportunity to work with a new governors hugh carey first democrat elected and for a long time he actually called me up and said will you help me put together my budget i said there are a lot more senior experts and he said well they have all worked for the republicans and he had to skip a generation and find them a young democrats to work on putting together his budget like me so much you want me to be his budget director but i have tenure yet so i was going back to the university to find something for you to do he called me the summer of seventy five

and said new york city is having this little financial difficulty and i'm appointing the commission and they're all investment bankers anything done about the state or the city or what the laws are this cultural so i need someone who's an expert put on and they're all about twenty years older than you and much richer than you are i'm going to put you on and you teach them about state governments are not wedded to this big mac board which in some ways shaped my career in public policy because i got to work with some of the world's great investment bankers and bakers felix rohatyn david rockefeller and got to hang around those wall street greats i signed all the checks that i was the one that had no financial personal risk on one side would be invalid jack actually the bailout new york city that's actually how i got started and after that it was really a matter of jimmy carter was looking for women to put high levels in his administration every job after that i like to describe as not they qualified for until i got the

university of miami job i continued to overreach throughout my career has been fun to talk about and actually the year a distinction that you've made make between the qualifying for john dingell fight to learn a job colson well i spent a career being qualified to learn a job and that is there was a vacancy they couldn't fill it with someone else or someone was looking for someone a woman for position as jimmy carter was looking out till quite a number of women at the beginning of his administration and so or hugh kerry had to skip over a whole generation because he needed not wanna hires people in it work with nelson rockefeller me for a wide variety of reasons i was standing there with proper academic credentials but without the experience that one would normally have those positions i learned from each one of them says once there is that in the right place at the right time but more importantly i was willing to learn and that was quite humble about what i didn't

know what a number of individuals on your current secretary of defense is a good example move between public service and academia and you do that too but you're different because you studied are your student auburn a professor of political science and public administration how did that alter your approach when you're secretary of hhs well a couple of things and one it made me more analytical about public policy domain name of knowing as many facts as i could know but certainly are secretary gates does precisely that out of his long experience i think i see more of the big picture and i understand the interaction between interest groups and stakeholders perhaps still a little better but i i initially saw them as an academic not as a practitioner i think the difference is that i actually liked politics was a political scientist out how can university universities in the government work together to improve paulson about an

important issue well it's not easy because we work on the semester system are our people or our teaching at the same time and government needs to get the information in a different kinds of light so it's easier for government to go to the banks or to the national academy of sciences to get a timeframe are around a certain our amount of information they need but the basic information we operate from four decision making really comes out of universities it's whether it's a scientific basis for its policy basically come from universities that might be organized by constituents and centers but the basic work comes from first grade academics at institutions like the university of kansas in fact the great public universities the great land great universities have this tradition of producing the material that actually improves people's lives there's a long tradition of that in public higher education in the midwest in

the euro among the pioneering generation of women political leaders mean what kind of unique challenges that you faced because well some of it is quite funny i often say that if i didn't have a sense as your eye out i probably wouldn't have gotten through those early years when i went to graduate school the chairman of the park and told me he was going to give me any money because women didn't finish their degrees and he pulled out the statistics did demonstrate that luckily the dean and some other members of that we thought just the opposite and we're prepared to invest in their women graduate students when i got my first job at the city university of new york the chairman actually said to me that i get embarrassed to parkinson's i had published more than all of them put together that year and that vow they'll never tenured a woman and would never tenure woman if anyone if any department chair said that to a member of my family or your new cancers fact been cut their legs off when they attend or not we don't

know there is still discrimination higher education that's in many ways tired patient lags behind corporate american and some other places in arctic in the sciences and engineering and a show i've looked at it but not that kind of visible discrimination is not as present as it was earlier in my life when i got my first job in government is an assistant secretary a toddler when i went to the hill i notice that right took a male assistant the top of the male assistant the woman's sister they talk to me what will be happy to know by the time i got to be secretary once you have power they don't pay attention to gender they deal with our and they don't mess with you anymore so everybody had started climbing up is what when you want to get to but that well you worked for president carter what was he like to work for what you admire about jimmy carter

yet analytical mind i am and therefore he was very smart and very anxious to learn the substance he would often throw was hardly off because of the way he thought about things he was an engineer i remember the first time i got to the oval office he announced that we are going to put together a national urban policy and he said it had to there was only one other criteria though that insisted upon it had to include plains georgia and new york city on the most elaborate are repulsive act that was a national policy but we all smile politely and when often see what you do about it it was a very nice man i'm very committed to bring in women and minorities in the administration i was actually in his office when the center was back to a cabinet secretary because it had only white males on it and he said they're prey plenty of qualified women and minorities i wanna see the leadership group of very different from what you have in your list that was also true of republican presidents from that time on people really

made an effort to diversify their cabinet what was president clinton was one and you know you never know what's going to happen last night he was smarter than anyone that worked for any new more of the substance that we did it was it was very disconcerting to be working for someone in which you were supposed to be the expert and he knew more than you did he was very piercing the kind of intelligence yes i had a wide ranging minds so we were always racing around to catch up with him on issues but he was fine to work with as long as he could stay up late at night take his phone calls or three in the morning when he was thinking about something but it must've been like it was in the johnson administration there are some presidents have had that level of energy and down he just had

intellectual power probably the best read one of the best read presidents we've ever had used just absolutely silent a substantive but it is alive and work for he call on friday afternoons at have your golf clubs in the car with him as president trying to medicaid agency they add a five course as one testified before congress and this issue has come up recently at a member of republican actually asked me what i thought about twinkies taxi out at the faster than i said mom listens richard hanna he was a thoughtful man and i i think history will judge him very well in terms of his presidency that he wanted to get things done he won on kids the country immunize he wanted things that were measurable going to do and when to call it now it couldn't be played too many balls did the clinton administration the first couple years the party

was on healthcare reform i talk a little bit about that why did not work out any better than what do you think should've been learned from that effort the lessons are the lessons that bob dole spent a career trying to do and that is you have to be transparent you've got to be bipartisan i'm doing it out of the white house i think all of us believe now was a was a mistake from an idea that i've had probably not quite calm not paying attention to the major stakeholders and their representatives we always said when they american medical association said where's your many doctors working on your group we'd say no we have to act as william along with me is that what they really say is you know we have our doctors on the group you don't have representatives of the ama on the group we under best estimated what we should've understood franklin roosevelt and tried to get health care through and the american medical association called socialized

medicine expansion of government is always going to be under debate was very complex our problem and then we had a complex solution for a complex problem without building the kind of institutional support that you need and without working very carefully with both political parties well some people would argue about the congress trying to handle this issue i think were always better off or we tried to make it as transparent as possible but the same things happening now that happened then and that is everybody that got one problem with one of the proposals gets together with someone who has another problem with it and builds a negative coalition and you could see that building up or people that just want to stop it scare people to death in that point to that fear as a reason why you shouldn't go forward so the same politics plays itself out and certainly the fundamental debate over whether this is something

government should do continues to exist after all we only take giant steps and social policy we have agreement on the problem an agreement on the solution you believe fans and water which he said do you think the president has taken the right approach in this fight over health care reform encountered stepping back waiting for congress to do its part and being more of an advocate for free kind of a broadly defined design you know it i think the president has taken the right position but i don't think he's been sitting back i just think we haven't reported that the level of detail in which he and his staff level of a little detail that they get involved in the process oh lot of the analysis has been done by the administration by your former governor sectors of the leases that department and the president's obvious president's leadership team has been involved it's just a very difficult issue and very complex they've learned the lessons of

protecting people will have insurance that like the insurance and everybody keeps repeating that but the rest of it is expensive hard to do and not easy to explain how if you were in a position where you could use basically change their health care system reform and what would be the key components that reform should include from your point of view i think that there's some agreement about eliminating preexisting conditions covering everybody one way or another we've just got to get everybody covered we pay for them now every time we have to go to hospital that bill includes the uninsured that hospital had to cover so we've got to figure out a way to get everybody covered unless we do we can get our arms around how to reduce costs we also have to move away from fee for service medicine we we run the economic incentive even the most conservative among us understand that we run the economic incentives to rome where you get eaten medicine for the number of things that you do in the more

technology the more money you get paid and that's no way to run a railroad or to provide a health care so we've got to do something about the delivery system in the incentives the incentives have to be for wellness and drought cuts we've got to pay people for the kind of investments that we make to produce good outcomes it has to be a healthy system instead of a six estimates cumbia well the system instead of a success to so we have to change that system stopped paying for every procedure that's done that undercuts primary care third we have to integrate nurses into primary care in into wellness in and have chronic care of them if you look at the increasing healthcare since nineteen eighty seven two thirds of it is chronic care two thirds of it is trying to chronic illness we got to get our arms around that and anne helped people to manage their chronic conditions i think that involves nurses working with

doctors in teams to better manage the quality of care for those with chronic illness that will help us to pull down costs of a long war we've been through this before you've been an observer or a participant in washington your entire career and where is it back but i had a few of those already think this is all going to turn this is there going to be a reform package and what do you think it's gonna look like i do think there's going to be reform packages i could be what everybody likes i think the elements of the baucus bill basically will have some consensus in some ways i could argue even with the republicans sitting here at the center of the republic democratic party the center right in the democratic party is the center right of the country's democratic party is so why now that if we can find the center to get agreement on a framework all we need is a framework what everybody forgets what you and i know is

one percent is the initial policy ninety nine percent of the implementation of the regulations the way the framework is is implemented so we need to get aren't we need agreements from the american people that we want everybody to have health insurance we need agreement that we wanted to live or that health care in a way that's a lot of fish and unfair and that cost conscious and that produces the best lines about cops and i think i actually think we can get there i do think we can get there what's your assessment of the president now ten months into nine months i guess i should say in his presidency i think he's doing very well all you do is travel outside this country did have a sense of people around the world feeling somewhat different about the ice age and it's not because his policies are back dramatically different it's it's his persona as such as though the young people

are excited again about public service i sensed it in talking to the dole scholars today so i think there's some excitement from a new generation of young people anxious to go to washington and do just faded public service so i think there's a different feeling the same feeling perhaps that i was a little younger when john kennedy came to office i went to the peace corps because of kennedy and in the sense of the call the public service so i think there's some of that again i think is very difficult problems lots of things on his plate everybody says he's taking on too much you know presidents openly and seventy three things and that's it things get thrown at your firefighter in some ways really one of the units which subjects a little bit because i found this interesting when john told me that you served as a peace corps work or amaranth and your party american iranian council and so i was curious to get your perspective on the current controversy not only

be elections were using cap and there but also what should we do about handling a nuclear iran well i think we're doing is actually the right thing you find a coalition he put enormous pressure and around the back off from their nuclear plans it clearly they're clearly supporting terrorism i lug around when i was there and love the people around them a long intellectual tradition it's a very it's an indo european culture ah but that doesn't mean that i don't recognize as every american does the terrorist support that they've given the inappropriate that election was clearly read but more importantly the nuclear threat which is very dangerous not simply to the middle east and i think the russians recognize that the chinese recognize that a third of our run so gasoline comes from the chinese i think so there are some countries that have put some pressure

on iran and so it has to be a coalition but i think the president and and secretary clinton get it in terms of the coalition that has to take place because it's the europeans or the russians it's the chinese he's and it's the americans in the end that will have put pressure on the country and it is i think for someone like me who spent a wonderful two years in a row on a great disappointment in my life that i can continue my relationship with a country that i loved when i was there and that i wanted to see grow up into a different kind of bias and there's no doubt in your mind from from what you know about the country or from people that you've talked with that the election was rigged from everyone i've talked to they have a sense of the election and i thought people directly in a row they believe very strongly in the election was rigged very interesting that you served with served

all of the president's commission on wounded warriors let's talk a little bit about that how would you characterize your relationship at all i think it's the easiest working relationship i've ever had with anyone in public life i'm just very for saudis very sensitive and he of course understands politics and we figured out each other's roles he has the same kind of impatience i have for long public hearings so we really had alternate when we got up i walked around because both of us want to be happy walking around all the time his defense of cary obviously for this issue for the wounded warriors which is deep in his soul that we needed to do the right things for them but he's no pushover we went in to see the president of the united states in the book that the president straight in the eye and said as president donna shalala and i are very busy people the less you assure us security enable that are recommended

and the president says yes sir i did are we are but the thing that it was noticed about people in public life is how they treat other people he knew everybody in our commission offices we knew their names he took into account the last the last week we took a draft of the report and sat with everyone that worked on the commission not just the policy people but the young private who answered of pounds of the sergeants who oh who did all the logistics force on the hearings and everything and everybody sat down at the table with us and went through line by line that doesn't happen but he not only knew their names i mean he knew a lot about them and every place we went of course he's revered but his conversations with young people who had been wounded as we visited

around the country were just remarkable i frankly was in all and he is mine model for not just the citizen soldier but as a human being you know he has these wonderful lines in his book and actually during the campaign about russell kansas and how to understand him you have to understand where he came from and that has real meaning when you worked with him very definitely oh how we've improved our support of wounded soldiers returning well with a number of things on adult health there's been an enormous movement to try to get enough coverage for tb ivory traumatic brain injury and for the more serious injuries there also has been a kind of smoothing out of the outpatient problem for people with complex

illnesses the veterans administration has taken our recommendation for recovery or dangers and when we explain this for one minute are people with complex dallas is whether they're in the military or not i have lots of things they need to do politically as outpatients but it's also their families work and services it eligible for a young mom wounded warriors would say to us they had some really nice managers which is the natural way of handling that they kept getting deployed they can remember all the remains there was a young man or permission to have doubt lost a leg he said he had so many case managers what was going through his initial our outpatient visits he couldn't remember names and they kept getting deployed or if you have something that's really complex indeed a single person it interfaces with you with your family and with the health care system in fact i like to say people say to me why it for a single payment payer system very democratic liberal should be for single payer was once seen a single payer system and the government

single payer systems have the same kind of fragmentation particularly outpatient side that the private system spans and so to deal with that we recommended a single person it are facing with that young person in their families getting all the services were good for them and even after they went home and so it was easy to do the coronation it was more seamless in many ways it's what the modern health care system has to look like it's going to be integrated and it's got to be accountable the veterans administration has now hired a number of these people it's working pretty well from what i hear from the other wounded warriors themselves there've been numerous improvements walter reed obviously in the working very hard in va hospitals around the country were partly there's more interface between the defense department and records and military records health care records the congress has not acted on our

fundamental recommendations up what we believe because we're in a political year that that we had made most of our recommendations to the executive and things that we can hold the executive accountable for and to his credit president bush and his secretaries which includes working to this day with the current president are filling those responsibilities so they've very loose and they really didn't want you but you are recommendations for crack that for the most part it was within existing resources these the congress added resources for educational benefits senator dole that felt very strongly that the benefits should increase as you stayed in college so we got more people through four years of college as opposed to just a year or two and he actually designed a system in which you actually get better as you know as you move along in terms of retention you mentioned this afternoon going back to senator dole you mentioned that you met him actually

through senator elizabeth dole a kid before she were some very anti confirmation hearing in january of nineteen ninety three it was before the senate finance committee and senator dole came into the confirmation hearings as a member the committee be in show up very often is that we doing here the settlers percent meat a major donna was all right right then i knew i was going to get confirmed because all the republicans immediately voted for me at night you knew who was both before she heads the center and the white actually were before she married robert gill ah because i knew it when i was in the carter administration and actress i knew were very well when she was at the american red cross because the interface was the secretary of the human services this is up tonight really is the kickoff event for civic engagement week on campus formally challenge or nurses step up and take a greater role in public and community service what would you say to those students tonight in

attendance in terms of encouraging them to try to make a difference and that was to really continue trying to bring about changes that they believed in well i think if you're going to be a citizen of this country you have to seek public service whether it's a service in your community part time or whether it's full time service having the opportunity to serve in the military or the peace corps or going into government for a period of time you don't have to do that but you want to make a kind of a contribution to your community and i say the young people you've got a responsibility to your family better responsibility whatever profession you pick but you also have a responsibility to give back and really if you go to a great public university like the university of kansas the people of the state sacrifice they're not very rich but every single one of the aisle art sacrifices to have a great state university

and the nice that young people can do is to give back to the community and to recognize the contributions that the people of the state have made to provide them with a first rate education we're going to be in just a moment i open it up to your questions from the mai mai last question for you madam secretary who is the person that most influenced you in your life you know there were a lot of people during the course of a long life and it certainly my parents i think my father went bankrupt the year i went to college and he spent the rest of his life came back every single person every single vendor he'll miss out a small grocery store every single vendor vendor they didn't get paid during that they or c he he tracked down yet another career that he stole real estate in actually made some money but he made sure that he went back in haiti every person he was unable to pay that that

kind of integrity i think impress me as a child my mother who was the first lebanese american to graduate from college and the law school in cleveland that impressed me because she combined be a world class times square and went to law school even though my father had only an eighth grade education he encouraged her i had to do that and she practiced law injury eighties in fact i have a very funny story president clinton called me one day and said he was going to cleveland would my mother introduced him at a senior citizen of that he was a prolific i call my mother i said doubt one of the president wants you to introduce that as a senior citizen and then just about that we know it's a tax season it's been said of billable hours love that story

she did sacrifice that she was this cavalier and now isis has opened up but i do have one last question you're a tennis player and a golfer and i really believe very strongly in you know athletic or do i do i do and i think it's important part of this health care is going to be us taking personal responsibility if everybody in this country didn't smoke ate right and exercise we have plenty of money the cover health care in this country you're listening to former hhs secretary donna shalala and kansas public radio recently and congratulations and it was funny my question is what we do it's important for women to be a larger legislative process well i think both popped up both women and men need to be involved in the legislative process i do think that the more diversity we have in politics the more you get a more

balanced view i love art what government can and should do i mean i think it does make a difference who's around the table making decisions one of things i done is part of my career in public life is as we were hiring people for hhs i was obviously interested in women and men and people from different racial groups and backgrounds but i was also interested in people they grew up poor in people they grew up rich that you need i'm a diversity of experience when you're doing public policy it makes a difference if you have someone on your staff that grew up in absolute abject poverty with rockets or someone who's totally disabled and and making sure politically when you're making social policy that they're at the table and also make sure you have to also make sure that you ask different questions i work for two different cabinet secretaries one believed in the power of the federal

government patricia roberts very sick at heart she was a washington lawyer a civil rights lawyer and sheep boy she believes that the federal government on of those regulations to get people to do things right the second secretary i work for the same department moon landrieu the former mayor of new orleans kept asking the question is he had been a mayor should the federal government be doing this all the more liberal democrats but they came at these issues from from different points of view and therefore we ought to as a country want as rep presented him a legislature or a cabinet as you could possibly get because it's bringing different experiences to the table that gives us the best public policy next question undersecretary shalala thank you for taking my question i'm a social worker and i think you've encountered children who are on medicaid and i am receiving on the lower tier of the health care and by that i mean they don't have the

same access to primary care that employer based children play based insurance have a main course is what you are seeing in health care reform will happen that will actually increase not just the number of children are insured that the number of children who received i you know well the difficulty with both a with medicaid in particular is the match right and the stakes are in a severe fiscal crisis of medicaid and gesture now called chip i guess i'm always had a lower reimbursement rates particularly for primary care and private health insurance plans that and therefore finding a knopf primary care physicians awkward dance practice nurses on to take care of these children have always been a challenge very difficult for doctors to take in large numbers of patients when they're not going to be adequately are

reimbursed him recently for these particular programs public programs are reimbursement rates have been much too low we try to address that and the chip program by releasing them naturally we took out our main trait for chip a seventy percent where the average tax rate for automatic is fifty percent to try to offset the costs and most recently the congress is as taken up five more present to try to help the state with their overall costs but the fact is children don't vote they don't contribute to campaigns they don't have a lot of clout and we have not been able to find enough stakeholders to push out on the quality an odd and frankly that just straight reimbursement rates a children's health insurance but there's no question that we've underfunded those programs particularly on the front end and if we were right to make any single

investment in any single group in this country about a beer market because at the end of the day that's our future of the questions yes good evening madam secretary thank you very much for coming to that on city university of kansas this evening the world health organization rates united states health system thirty seven in the world i was wondering whether you thought this was a fair ratings system and if so why does the united states rate so low well one of the reasons we rate so low is that we don't have a universal coverage it in addition to that out while we have very high quality art care in this country it's not available to everyone on an event basis the difficulty is we have a multi ethnic population the multinational population a lot of the countries that rank above us have universal health care systems and have a much more homogeneous population that we do

we have complex with a complex population from different ethnic backgrounds with different traditions who come either into this country or having different kind of coverage and so we don't have we don't have the kind of accountability to our system that other countries may have particularly on the front and i do think ah i would rely very heavily on ah and that rating it is somewhat controversial because we're comparing ourselves to smaller countries that are more homogeneous it had none of the complexity of the united states but it did when we took office we had less than fifty percent of our kids immunized at the right time are we were raped only he had less people in this hemisphere less kids immunized and we did that pretty embarrassing ah but part of the problem

was we didn't have universal health care we build an immunization system a lot of help from the states so we do have most markets coverage at the right time now but it wasn't easy and it really at the end of the days fundamental problem of of not having everybody covered and everybody covered the question about medicaid everybody covered with a high quality program not necessarily expensive program a high quality basic health care program so that we can measure outcomes decrease the number of bombs and dessa childbirth increase the number of immunizations all the kind of fundamental things we need to do next question we do you elaborate on what you think the single payer system work in this country i don't want part of all ahmed if you look at the countries are that the industrialized countries about single payer or healthcare systems collapse of the end of world war two so they start with a clean

slate we've made a fundamentally different decisions we decide to build on our employer based system we had strong unions negotiated good contracts with good benefits so we got ourselves into ahmed aw a decision or a non decision to build an employer based system i think it's very difficult to wipe that out and to move to a single payer system my argument is all also that it doesn't guarantee good health care it doesn't guarantee that you will have a fragmented outpatients is that we saw that in the care of wounded warriors they had the exact same problems with fragmentation of health care that people that had good health insurance often run into so it's the way the system is organized and most of us believe that we can get there with a framework with some subsidies for those who don't have health insurance and with a different way of paying for the system in a different way of measuring what we're paying for

it with a lot more emphasis on wellness but are i don't think are tradition will allow for it and i haven't even gotten into the fundamental debate we've been having since jefferson about the role of government or whether we want government actually got to be the real over all deliver health care i think of them as a pretty good job but the man also runs into the problem of fragmentation because of the way the system is organize so there are a lot of things that we can do before we get to that and the first thing we've got to do is make sure we get everybody covered that we deliver it in a way that provides everybody with high quality care and affordable price which is extremely important suppose you started answering this question not just now but you mentioned senator baucus is healthcare plan earlier and i was just curious to what extent you thought us into boxes idea of the other co ops versus the public option which one of those do you believe would help obtain the

most universal coverage which you seem to be stressing is the most important part of health care reform act which accent you think those are going to actually obtain universal coverage and if neither of them or didn't work what would you suggest that in such universal coverage you know i don't i'm not sure i know the answer to the question our senator baucus was reacting to a recommendation from senator conrad of north dakota north dakota has had a tradition of co ops and arm what they're all trying to do is to hold the private sector accountable to give it some competition om my experience as an employer is that my employees don't take the cheapest plan so i'm not so sure if we have a public plan that embraced that are under the public plan it depends on how the subsidy system works and how attractive that plan is i spent part of my career and where the healthcare a major insurance company they're pretty smart about trying to get the market share and if it really is an even playing field whether it's a co op or public plan

i just have some confidence that the private sector can compete if they get the same level of subsidies now you don't overpay them which were in the process of doing on medicare advantage a small part of the medicare program but if the subsidies are the same i've got some confidence that the private sector can actually compete and in fact he would put together an attractive package so i probably have more confidence in the private sector's ability to put together an attractive package that people will obsessively flocked to but certainly we'll see as an option it doesn't mean that i don't think that we should have a public option anything we can do to make the system more accountable i think we should all before but but how it would work exactly i don't think we know until we try some of these things and them as an employer it had a lot of experience trying to keep healthcare costs down and it's driving the b'nai and that's

because we just have such a week but there's so much cost shift it into our client up in a wide variety of ways i went really relevant to the clinton health care plan trying to convince people i'm in detroit and they sent me up to the lion's den i went up to talk to all the small businesses we think it doesn't need to talk to the unions or something but i had gotten small the tiny drop them into the clinton health care what they basically said to me we don't have to provide insurance for our employees because they have insurance as unwittingly they have insurance they said well their spouses all work for the ford motor company because you think that that's as classic are shifting so those of us that that are trying desperately to provide competitive insurance for employees and public bodies do that all the time have to take

up the cost of those who don't have insurance but more partly those that don't have insurance our go to the doctor late they're just not as healthy as those of us who do have insurance and so we've got to figure out a way to convince people that don't have insurance to provide appropriate subsidies and to give them some choices between planets and i don't maybe i'm not but i got a lot more confidence in the private sector competing against the public sector odd than other people do because i just see that it works it works in medicare om and we certainly see have seen it work in other places and for those of us that have these deep discount plans where ways could really get away with murder in terms about getting a cheap land don't think that deeply suspicious about they'd rather take something in the middle of them getting coverage so while i think that we could use it

for the accountability the system i do have some confidence even with a public plan that the private sector will do just fine any health care the private sector has always done fine and maybe their problem is that they can't pay big salaries or their executives and give big dividends to the people who have invested and therefore they don't think it's fair to compete against a public plan but i frankly think that they're they've got pie and they got quality and they've got the systems that they continue to invest in and i think they do it just fine the key question over here and secretary thank you very much for coming to kansas today i'd like to shift the top you just have that mask about your experiences with the peace corps and what effect that his cohost hadn't lessons of medieval question on now i think more than any other experience of my life's oddities or shaking up because you take a young americans twenty years old and throw them into a mud village in

southern iran ah a huguenot is the worlds that is you see the world from a different whites are i mean i have only won the world's greatest expert on building latrines and that's skills that i have not been able to translate anything about her there were times working with congress that i thought you know made was that when they were dumping army om om i just i i i i love the school i i couldn't be more enthusiastic i was probably better at that job than anything i ever did my whole life requiring everything else every sensitivity and it like you people are all the same and that out a lot about the role of religion i like telling the story that we were sent in this village in enron

and we were actually building an agricultural college but they're also working with the villagers and their wares was to build a school so i i was the arab american groups even those iranian village it was an arab village in iran so ah i went out to meet the head man of my grandmother when i left my father did not want me to join the peace corps my mother was ok but my father did not want the joy offered me a car mustangs thanks to live and i turn down janet lee i think he's going to the old country says that day off with a letter and the letter turned out to be written and classical arabic to the head man's ability that said this is to introduce done a full iowa the daughter of a great shape in cleveland ohio powder and ear protection so i had this relationship with the head of the village who was actually i'm a lot and so i went to him and i said om audits now the school kids really need a school here you said your for

education you're excited but the agricultural college until the school he said now i think sally's and we really need a mosque and i must go back home for six months and the other piece or dies and i'm stationed when we got into this long debates about church they put a peace corps volunteer built mosques and then finally one of the guys said remains of miles from florida driver in washington dc you'll never know until the mosque i haven't always want the minds of the members must so you know the mouth of the guys that actually invented a new kind of mud brick with a different kind of mixture of strong much stronger so we build the mosque and the day we dedicated the mosque ophthalmology renee it was really pleased that the mosque and turned to me and said i think we need a school this was a lesson for life and a lesson that the judeo christian and muslim tradition has taught us

honor thy that force after the school we build a latrine system of clean water system we get all sorts of things but what it taught me a lesson of listening of understanding culture and it wasn't just that experience it was all the experiences after that i think peace corps volunteers facade think young americans a remarkable people but i think that i mean yeah the peace corps they could drop to any place on earth and you can do more than survive but thrive i love that the legions of overrun by my heart rate over romney even though and sophisticated understanding what's going on their ears that that was on life shaping experience that changed my life and the way i saw the world for ever for ever so i would recommend it to any of the young people that are here and take two more questions we're one of we're in one or we're

live and i like that they deferred to start missing answering our questions will likely shift back to the health care system and then you have a lot of experience in making public policy internet it's great that process what would you say the single most important thing for we the people pollute expedite the process would be especially over health care reforms keep yourself and your families healthy we've got to take more responsibility ourselves for only healthcare and for our own health at somewhat number two is ask questions are i had an ankle injury no i haven't yet directly to many sports are identical injury i went we have an extraordinary health care system at the university of miami's i went to see at a guy you know whatever the healthcare isn't an ankle driver doubled i went to see the airport i took one look at my ankle he said that i didn't break anything he said i think we should do an mri i said mr i wanted it's radio he said yes he said though you won mr isaac know i know an mri of the difference in price he said i've

never had a patient requests to me he said the x ray will do just as well with x ray was down the hall and i would've had to bake another appointment and the difference in price was substantially between the two at the end of the day while were fussing about how we're going to reimbursed at howard recover people and whether an expansion of government and weather and reduce the number of medical errors and do all these other things if everyone in this country would take a look at their lives and the lives of their family and keep their kids out of the house tom go out play and get more exercise and stop smoking if we get the low tech stuff we have enough for everybody we really got sick loved one question one final question i'm noticing it most your questions and then the young people why like to overhaul correct that one first life than here is a veteran receiving

prescription carrots in va hospital in topeka secondly i stand here is a senior citizens on medicare i'm also a member of the aarp and remember it or not over thing that the public i keep reading and hearing about fraud in medicare millions and hours of being spent in fraudulent claims the question is how you correct that problem you know this is a really important question because if you ask the experts what we ought to do about the health care system they answer the way i do it are we better do something about the delivery system we better do something about well i mean they go through the litany of ifs are what if you ask the public they say the first thing we do is get rid of the waste fraud abuse of the system and to do that we actually say they use during the clinton administration because we put together a team between the state's attorney general's arm of the

fbi the inspector general at hhs and the us attorneys and really get when after fraud we have to change the laws so the people that commit fraud can never get back into the system we got a lot people who have committed securities fraud than ever getting and in the health care system that put people in jail and we got a simple not fight the system so it's easier to detect the fraud in the system i would not do health care reform with an upfront substantial investment in fraud i would just go after it with a full court press whether it's medical devices or drugs or whatever other part of the system i want my mother is ninety seven and she's got a friend whose identity medicare card was essentially still so i sent out the state we got a hotline so i called the medicare hotline can

get one answer i had to send it to the secretary of hhs to get them to act on and that we have to have a simple system in which people can report the fraud in which we go after it and all the money that we collect have to go back to the system it's i think that for every dollar we spend we brought seven dollars back into the system investments in this area i also think it's critical not just for your generation but began credibility in the role of government and healthcare to go after waste fraud abuse first so i really appreciate the question secretary jewell thinks are joining us tonight you've just heard donna shalala former secretary of the us department of health and human services co chair of the commission on care for returning wounded warriors and current president of the university of miami she was speaking with bill lacy director the dole institute of politics at the university of

kansas so whale was the recipient of the two thousand nine bold leadership prize awarded september twenty eight two thousand nine at the leed center special thanks to the leed center for recording this event i'm j mcintyre k pr prisons is a production of kansas public radio at the university of kansas and every sunday evening kbr presents brings you some of the most interesting speakers they come to this area if you have a suggestion for an upcoming show or a comment about something you've heard on tape your presents brought me an email at kate mcintyre at k u that edu that's k n c i n t y r e a k you thank you many previous says are archived at our website at our back play you that edu thanks for joining me tonight tune in next sunday at eight o'clock for another k pr prisons here on kansas public

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