1 00:00:06,320 --> 00:00:12,719 Speaker 1: Yeah, Welcome to the Bloomberg Surveillance Podcast. I'm Tom Keene 2 00:00:12,800 --> 00:00:16,239 Speaker 1: with David Gura. Daily we bring you insight from the 3 00:00:16,239 --> 00:00:21,640 Speaker 1: best of economics, finance, investment, and international relations. Find Bloomberg 4 00:00:21,720 --> 00:00:27,000 Speaker 1: Surveillance on Apple Podcasts, SoundCloud, Bloomberg dot Com, and of course, 5 00:00:27,320 --> 00:00:34,320 Speaker 1: on the Bloomberg. Our first guess Russ Castrick, who joins 6 00:00:34,360 --> 00:00:36,320 Speaker 1: us set now from our studios in New Yorker Bloomberg 7 00:00:36,360 --> 00:00:38,880 Speaker 1: and living three at studios. He is at portfolio manager 8 00:00:38,880 --> 00:00:41,560 Speaker 1: for black Rocks Global Allocation. Russ, great to speak with 9 00:00:41,560 --> 00:00:43,360 Speaker 1: you once again. Sorry I couldn't be there in person. 10 00:00:43,479 --> 00:00:45,120 Speaker 1: Let me ask you first of all, just what you're 11 00:00:45,120 --> 00:00:47,639 Speaker 1: gonna be listening for tomorrow? As I mentioned the FED 12 00:00:47,720 --> 00:00:51,159 Speaker 1: kicking off this two day meeting today, I expect we'll 13 00:00:51,200 --> 00:00:53,280 Speaker 1: get some commentary on on the balance sheet. What are 14 00:00:53,320 --> 00:00:55,480 Speaker 1: you gonna be listening for? When FED chere? Jannyellen takes 15 00:00:55,520 --> 00:00:58,080 Speaker 1: to the podium after that meeting, concludes tomorrow, Well, good morning. 16 00:00:58,080 --> 00:00:59,600 Speaker 1: I think there are a couple of things. Obviously, the 17 00:00:59,640 --> 00:01:01,800 Speaker 1: balance she's gonna be front and center. I think the 18 00:01:01,880 --> 00:01:05,839 Speaker 1: other is we had up until August a string of 19 00:01:05,920 --> 00:01:09,720 Speaker 1: consistently weak inflation reports that started to shift in August 20 00:01:10,280 --> 00:01:13,800 Speaker 1: thanks to some some hike in gasoline and energy prices. 21 00:01:14,560 --> 00:01:16,720 Speaker 1: What is the Fed's view of inflation. Are they still 22 00:01:16,720 --> 00:01:19,640 Speaker 1: concerned about the disappointments earlier in the year, or do 23 00:01:19,680 --> 00:01:22,600 Speaker 1: they believe those are transitory and therefore a December hike 24 00:01:22,720 --> 00:01:26,560 Speaker 1: is more likely if we see indications that that that 25 00:01:26,680 --> 00:01:29,720 Speaker 1: inflation area had wins. Our transitory confirmed something that Janet 26 00:01:29,800 --> 00:01:31,720 Speaker 1: Yellen said now many months ago, she walked it back 27 00:01:31,760 --> 00:01:34,080 Speaker 1: a little bit when she was speaking and testifying on 28 00:01:34,080 --> 00:01:36,800 Speaker 1: on Capitol Hill. Has her initial assessment of that been 29 00:01:36,800 --> 00:01:38,560 Speaker 1: confirmed by the data that we've seen here over these 30 00:01:38,640 --> 00:01:41,280 Speaker 1: last few months. Well, certainly the August print was stronger 31 00:01:41,280 --> 00:01:43,400 Speaker 1: than we've seen. But I think there is a legitimate 32 00:01:43,480 --> 00:01:46,959 Speaker 1: question here because many times we talk about the transitory 33 00:01:47,040 --> 00:01:50,120 Speaker 1: nature of the data. We cite particular instances, whether it's 34 00:01:50,440 --> 00:01:55,000 Speaker 1: hotel accommodations or data charges going down, and the fact is, well, 35 00:01:55,000 --> 00:01:58,080 Speaker 1: those might be one off events. You could also view 36 00:01:58,120 --> 00:02:02,960 Speaker 1: those through the prism a secular downward UH price pressure 37 00:02:02,960 --> 00:02:07,000 Speaker 1: in many industries and telecom in hotels, and that's something 38 00:02:07,000 --> 00:02:10,040 Speaker 1: that that may continue, and perhaps the inflation numbers are 39 00:02:10,040 --> 00:02:13,919 Speaker 1: not quite as transitory as we think we're focusing here 40 00:02:13,919 --> 00:02:16,080 Speaker 1: on inflation. I think it's safe to say that, uh, 41 00:02:16,360 --> 00:02:18,639 Speaker 1: since since these last few meetings, we've been speaking less 42 00:02:18,639 --> 00:02:20,560 Speaker 1: about the labor market. When you when you look at 43 00:02:20,560 --> 00:02:22,800 Speaker 1: the US labor market today, the health of it, how 44 00:02:22,880 --> 00:02:24,400 Speaker 1: much of a concern isn't Do you think that we've 45 00:02:24,400 --> 00:02:26,320 Speaker 1: been a bit neglectful here not talking more about the 46 00:02:26,480 --> 00:02:29,160 Speaker 1: state of the labor economy, focusing so much on inflation. Well, 47 00:02:29,200 --> 00:02:30,800 Speaker 1: you know, the funny thing is, the labor market has 48 00:02:30,840 --> 00:02:33,520 Speaker 1: been so steady, uh in some ways, you know that 49 00:02:33,600 --> 00:02:35,919 Speaker 1: the CPI print has become what the non farm payroll 50 00:02:36,000 --> 00:02:38,840 Speaker 1: number used to be. I think what's remarkab about the 51 00:02:38,919 --> 00:02:42,440 Speaker 1: labor market is not the consistency the job gains. It's 52 00:02:42,480 --> 00:02:46,080 Speaker 1: the fact that we're creating jobs at a faster pace 53 00:02:46,240 --> 00:02:49,920 Speaker 1: than than to to keep a neutral unemployment rate, and 54 00:02:50,000 --> 00:02:52,680 Speaker 1: yet wages remain stuck at around two and a half percent. 55 00:02:53,160 --> 00:02:54,920 Speaker 1: And that, to me is the big conundrum. And it 56 00:02:54,960 --> 00:02:57,600 Speaker 1: ties back to this inflation argument. When are we going 57 00:02:57,639 --> 00:02:59,720 Speaker 1: to start to see will we start to see that 58 00:02:59,760 --> 00:03:03,760 Speaker 1: for aditional relationship the so called Phillips curve between the 59 00:03:03,840 --> 00:03:08,160 Speaker 1: labor market and inflation. So far, it just hasn't manifested 60 00:03:08,440 --> 00:03:11,919 Speaker 1: the way economic textbooks say it should. So that's the question, 61 00:03:11,960 --> 00:03:13,560 Speaker 1: as you've been chewing this over, are you Are you 62 00:03:13,600 --> 00:03:15,880 Speaker 1: any closer to, if not an answer a theory on 63 00:03:15,919 --> 00:03:18,320 Speaker 1: why that's the case. Well, I think the theory is 64 00:03:18,360 --> 00:03:20,360 Speaker 1: that there has been some things that have changed, and 65 00:03:20,400 --> 00:03:22,320 Speaker 1: it's not as if the laws of economics have been 66 00:03:22,320 --> 00:03:24,840 Speaker 1: repealed at some point. I think if the labor market 67 00:03:24,880 --> 00:03:28,440 Speaker 1: remains tied enough, you will nudge wages higher. But clearly 68 00:03:28,480 --> 00:03:31,320 Speaker 1: some of the mechanisms have changed, and I would cite, 69 00:03:31,720 --> 00:03:35,200 Speaker 1: uh the role of globalization, I would say technology. I'd 70 00:03:35,200 --> 00:03:38,880 Speaker 1: also probably cite the decline in private sector union membership 71 00:03:39,120 --> 00:03:42,280 Speaker 1: as severing one of the links between cost pressures and 72 00:03:42,280 --> 00:03:46,440 Speaker 1: wages that existed up more clearly thirty or forty years ago. 73 00:03:46,600 --> 00:03:49,440 Speaker 1: Broadcaster with a set from Blackpark, Tom Keane wandering you 74 00:03:49,480 --> 00:03:51,520 Speaker 1: walk to work today? Tom? How did you get in 75 00:03:51,560 --> 00:03:55,080 Speaker 1: with the the traffic? I walked to work, of course, Key. 76 00:03:55,120 --> 00:03:57,839 Speaker 1: It was so busy and the security was so There's 77 00:03:57,880 --> 00:04:00,320 Speaker 1: a little knoll on Central Park where the risk you 78 00:04:00,360 --> 00:04:02,720 Speaker 1: can get down to pick me up. They usually do 79 00:04:02,840 --> 00:04:06,280 Speaker 1: that at three SHO couldn't even do it today even 80 00:04:06,280 --> 00:04:08,280 Speaker 1: know It's like where Nathan Hale was before he got 81 00:04:08,280 --> 00:04:10,880 Speaker 1: over the third Avenue. It was tragically killed and it 82 00:04:10,920 --> 00:04:13,840 Speaker 1: was like a revolution kind of thank good morning, David. 83 00:04:13,840 --> 00:04:17,080 Speaker 1: Gr Lots lots going on here in New York. Terrific 84 00:04:17,120 --> 00:04:19,719 Speaker 1: news flow. We'll get to that through the hour. Good 85 00:04:19,720 --> 00:04:23,200 Speaker 1: morning everyone, coast to coast and worldwide as well. Russ 86 00:04:23,240 --> 00:04:27,200 Speaker 1: consters with us and just brilliant ideas for us over 87 00:04:27,240 --> 00:04:29,839 Speaker 1: the last hour and a half with you. Let me 88 00:04:29,920 --> 00:04:33,000 Speaker 1: tie in your work with one Jeffrey Rosenberg, he of 89 00:04:33,080 --> 00:04:35,840 Speaker 1: Carnegie mel and Mr Rosenberger black Rock will join us 90 00:04:36,120 --> 00:04:40,520 Speaker 1: on our FED show this tomorrow. Are you strategizing in 91 00:04:40,760 --> 00:04:46,680 Speaker 1: a one unit one economy Gaussian probability world, a Bell 92 00:04:46,800 --> 00:04:51,479 Speaker 1: curve of one America? Or are we so split in 93 00:04:51,560 --> 00:04:55,039 Speaker 1: our wealth, in our inequality, in the amount of equity? 94 00:04:55,520 --> 00:04:59,160 Speaker 1: Were we so split that it's not only two America's politically, 95 00:04:59,520 --> 00:05:04,120 Speaker 1: but it's who America's financially. For black Rock, well, certainly 96 00:05:04,120 --> 00:05:06,120 Speaker 1: the economy looks different, and I think you're asking a 97 00:05:06,200 --> 00:05:09,000 Speaker 1: very legitimate question. You We spoke back on on the 98 00:05:09,040 --> 00:05:12,279 Speaker 1: air a few minutes ago about the wealth effect. Now 99 00:05:12,360 --> 00:05:15,320 Speaker 1: the wealth effect goes exactly to your question. We've seen 100 00:05:15,320 --> 00:05:19,720 Speaker 1: this enormous surgeon wealth household wealth up fifty in about 101 00:05:19,760 --> 00:05:23,000 Speaker 1: six years. That is very significant for one part of 102 00:05:23,000 --> 00:05:26,800 Speaker 1: the country. It's almost irrelevant for another part, particularly to 103 00:05:26,839 --> 00:05:30,440 Speaker 1: the extent that much of those wealth games came through 104 00:05:30,480 --> 00:05:33,480 Speaker 1: the stock market, whereas you will know, many Americans simply 105 00:05:33,520 --> 00:05:35,839 Speaker 1: don't participate. And I want to really emphasize, folks, this 106 00:05:35,920 --> 00:05:38,320 Speaker 1: is something David and I've talked about, which is it's 107 00:05:38,360 --> 00:05:41,960 Speaker 1: not East coast, West coast anymore, or you know Nashville 108 00:05:42,040 --> 00:05:45,480 Speaker 1: saying they're the third coast. It's about in every region. 109 00:05:45,800 --> 00:05:48,600 Speaker 1: David helped me with the Carolinas here. I mean in 110 00:05:48,640 --> 00:05:52,719 Speaker 1: every region, there's a city here, a city there that's booming. 111 00:05:52,880 --> 00:05:56,080 Speaker 1: Is that right, David Caroline, you mentioned North Carolina where 112 00:05:56,080 --> 00:05:57,640 Speaker 1: I'm from. Of course, a lot of that seems to 113 00:05:57,680 --> 00:06:01,040 Speaker 1: center around places where you have us tuitions of higher education. 114 00:06:01,040 --> 00:06:03,159 Speaker 1: You've got universities and colleges, and that seems to to 115 00:06:03,200 --> 00:06:05,640 Speaker 1: make a difference. And you see a lot of effort, 116 00:06:05,680 --> 00:06:08,279 Speaker 1: particularly in western North Carolina, central and western North Carolina, 117 00:06:08,320 --> 00:06:11,040 Speaker 1: to to kick start communities that had relied on furniture 118 00:06:11,080 --> 00:06:12,800 Speaker 1: other forms of manufacturing. And then do we have a 119 00:06:12,880 --> 00:06:15,920 Speaker 1: fed dealing with that Russ and then that lead us 120 00:06:15,960 --> 00:06:19,320 Speaker 1: to bubbles. You know, Steve roach X Morgan Stanley now 121 00:06:19,360 --> 00:06:23,839 Speaker 1: at Yale University. Uh lad the charge on bubble analysis? 122 00:06:24,360 --> 00:06:28,080 Speaker 1: Are we bubbly? Are we bubblicious? Well? I think there's 123 00:06:28,040 --> 00:06:29,479 Speaker 1: a couple of things. I mean, first of all, on 124 00:06:29,520 --> 00:06:31,600 Speaker 1: the FED. In fairness to the FED, people have leveled 125 00:06:31,600 --> 00:06:34,640 Speaker 1: a lot of criticism at them. The FED really doesn't 126 00:06:34,680 --> 00:06:37,760 Speaker 1: have the tool set to adequately deal with some of 127 00:06:37,760 --> 00:06:40,200 Speaker 1: the issues we're talking about. You know, rates are very 128 00:06:40,200 --> 00:06:43,200 Speaker 1: blunt instrument, and I'm not sure that the ideal mechanism 129 00:06:43,520 --> 00:06:46,920 Speaker 1: to tackle inequality. Uh. In terms of bubbles, you know, 130 00:06:47,920 --> 00:06:50,400 Speaker 1: I don't think we're necessarily an equity bubble. What I 131 00:06:50,440 --> 00:06:53,279 Speaker 1: do believe is that we're in this unusual set of 132 00:06:53,320 --> 00:06:57,119 Speaker 1: circumstances where stocks and bonds are expensive at the same time. 133 00:06:57,560 --> 00:07:00,320 Speaker 1: We haven't seen that, at least to this extent, in 134 00:07:00,360 --> 00:07:04,280 Speaker 1: many decades. Let me ask you just about the prospect 135 00:07:04,279 --> 00:07:06,560 Speaker 1: of change at the fedizer If we've talked about this 136 00:07:06,720 --> 00:07:09,679 Speaker 1: a little bit this week and the week before, of course, 137 00:07:09,760 --> 00:07:12,200 Speaker 1: fights chairs stand Fisher announcing his resignation effective in a 138 00:07:12,200 --> 00:07:14,320 Speaker 1: couple of weeks at time. Who knows what's going to 139 00:07:14,360 --> 00:07:16,440 Speaker 1: happen to the FED chair. There are other vacancies on 140 00:07:16,480 --> 00:07:19,800 Speaker 1: the FED as well. How what transformative is this moment 141 00:07:19,840 --> 00:07:23,760 Speaker 1: for the FED? You know, it's it's a great question 142 00:07:23,800 --> 00:07:25,560 Speaker 1: because we talked about the FED, we talked about the 143 00:07:25,600 --> 00:07:29,080 Speaker 1: fans reaction function. But obviously the FED is an organic 144 00:07:29,120 --> 00:07:32,640 Speaker 1: institution and it will change as its members change, Which 145 00:07:32,720 --> 00:07:34,680 Speaker 1: raises the question, what is the FED gonna look like 146 00:07:34,680 --> 00:07:37,240 Speaker 1: in a year? Uh? You know, my my own view 147 00:07:37,320 --> 00:07:39,840 Speaker 1: is I don't believe we're going to see a significant 148 00:07:39,880 --> 00:07:42,960 Speaker 1: shift in policy, uh, given some of the comments from 149 00:07:42,960 --> 00:07:45,960 Speaker 1: the administration, given some of the views they've expressed on 150 00:07:46,000 --> 00:07:49,600 Speaker 1: the dollar, I would personally be surprised if we saw 151 00:07:49,720 --> 00:07:53,920 Speaker 1: many of the open positions filled by UH economists or 152 00:07:54,040 --> 00:07:58,960 Speaker 1: or or others that have a reputation as being fairly hawkish. 153 00:07:59,120 --> 00:08:01,080 Speaker 1: Do you think we're to see more business people? In 154 00:08:01,080 --> 00:08:03,560 Speaker 1: other words, is the day of the FED stacked with 155 00:08:03,560 --> 00:08:06,400 Speaker 1: with PhD economists coming to an end? Well, I don't 156 00:08:06,400 --> 00:08:08,600 Speaker 1: think it's coming to an end, but I certainly think 157 00:08:08,640 --> 00:08:11,720 Speaker 1: you will see more business people. There's been that Tennessee 158 00:08:11,720 --> 00:08:15,160 Speaker 1: already with the administration up and again that's not necessarily 159 00:08:15,160 --> 00:08:18,120 Speaker 1: a bad thing. I mean certainly the economy is changing 160 00:08:18,160 --> 00:08:21,320 Speaker 1: in ways that are not fully captured by textbooks and 161 00:08:21,320 --> 00:08:25,280 Speaker 1: getting some of that granular, more tactile experience. I don't 162 00:08:25,280 --> 00:08:27,920 Speaker 1: think that would be bad. And Browing Russ Costers, thank 163 00:08:27,960 --> 00:08:30,640 Speaker 1: you so much for a perspective with black Rock with 164 00:08:30,760 --> 00:08:46,760 Speaker 1: their strategy and sset allocation as well. David Burrick here 165 00:08:46,800 --> 00:08:48,880 Speaker 1: in Washington, d C. And the Ronald Reagan Building for 166 00:08:48,880 --> 00:08:51,760 Speaker 1: a Bloomberg Live event on the future of healthcare, Unlocking 167 00:08:51,800 --> 00:08:54,480 Speaker 1: and supporting value. Tom Keane in New York and our 168 00:08:54,480 --> 00:08:56,600 Speaker 1: Bloombergo eleven three oh studios, and I'm joined by Dr 169 00:08:56,640 --> 00:08:58,959 Speaker 1: Toby Constate with the CEO of the Cleveland Clinic. I'll 170 00:08:58,960 --> 00:09:00,520 Speaker 1: be speaking with him a little bit late or on 171 00:09:00,559 --> 00:09:02,840 Speaker 1: a panel with three other CEOs, the head of American 172 00:09:02,880 --> 00:09:05,400 Speaker 1: Cancer Society, the head of Visor, and the head of 173 00:09:05,440 --> 00:09:07,960 Speaker 1: Walgreen's Boots Alliance as well, and we're gonna be talking 174 00:09:08,000 --> 00:09:11,200 Speaker 1: about value based healthcare. I told you, what is it, 175 00:09:11,400 --> 00:09:13,319 Speaker 1: uh exactly? Help me do my homework here head to 176 00:09:13,440 --> 00:09:16,080 Speaker 1: the panel. This is the new watchword. We're hearing this 177 00:09:16,160 --> 00:09:18,920 Speaker 1: a lot across the healthcare spectrum. What is it exactly? Well, 178 00:09:19,280 --> 00:09:21,880 Speaker 1: currently and most places are being paid on the basis 179 00:09:21,920 --> 00:09:27,360 Speaker 1: of uh, an individual procedure or treatment. And what we're 180 00:09:27,360 --> 00:09:29,719 Speaker 1: really looking at is beginning to treat people on the 181 00:09:29,760 --> 00:09:33,040 Speaker 1: basis of the outcomes and that and the idea is 182 00:09:33,080 --> 00:09:35,000 Speaker 1: to keep people from getting sick, keep them out of 183 00:09:35,040 --> 00:09:38,480 Speaker 1: the hospital, and we'll be paid on the basis of 184 00:09:39,120 --> 00:09:42,240 Speaker 1: maintaining their health. And so the healthy you are, the 185 00:09:42,280 --> 00:09:44,480 Speaker 1: better off it will be for us. And uh so 186 00:09:44,559 --> 00:09:48,040 Speaker 1: the objectives aligned with the patients. You say we uh, 187 00:09:48,040 --> 00:09:50,079 Speaker 1: and I wonder what we means in this context. I'll 188 00:09:50,080 --> 00:09:52,000 Speaker 1: be talking with you you run a big, big hospital, 189 00:09:52,200 --> 00:09:53,679 Speaker 1: big medical center, and be talking to the head of 190 00:09:53,679 --> 00:09:57,160 Speaker 1: the pharmaceutical company Walgreens Boots Alliance in the American Cancer scize. Well, 191 00:09:57,200 --> 00:09:59,320 Speaker 1: are all the parties together working on this. Who's who's 192 00:09:59,360 --> 00:10:01,480 Speaker 1: taking the league when it comes to this transition. Well, 193 00:10:01,520 --> 00:10:03,959 Speaker 1: the risk are really going to be on the providers. Uh. 194 00:10:04,000 --> 00:10:07,120 Speaker 1: You know, we will be paid a certain amount per months, 195 00:10:07,160 --> 00:10:10,800 Speaker 1: remember per months to look after patients. Uh, and we 196 00:10:10,840 --> 00:10:14,360 Speaker 1: will be responsible for all of their care. Uh. And 197 00:10:14,440 --> 00:10:17,120 Speaker 1: so the really the providers, I want to take the 198 00:10:17,240 --> 00:10:21,040 Speaker 1: risk and the WIE as the providers, what's the risk exactly? 199 00:10:21,120 --> 00:10:22,920 Speaker 1: It sounds at face like this makes a lot of 200 00:10:22,960 --> 00:10:25,160 Speaker 1: sense that that you should be paying for something that works, 201 00:10:25,640 --> 00:10:27,320 Speaker 1: you should be paying for things that are bundled, paid 202 00:10:27,320 --> 00:10:29,280 Speaker 1: for the whole the whole day. What's what's the risk 203 00:10:29,320 --> 00:10:31,240 Speaker 1: that you're taking on with this transition. Well, the risk 204 00:10:31,360 --> 00:10:35,360 Speaker 1: is UH twofold. First of all, Currently there's an upside risk. 205 00:10:35,440 --> 00:10:38,520 Speaker 1: If we do better, we get to share in the 206 00:10:39,040 --> 00:10:42,920 Speaker 1: UH in the difference if we then eventually it will 207 00:10:42,960 --> 00:10:45,360 Speaker 1: be downside risk too. And if we don't do is 208 00:10:45,400 --> 00:10:48,160 Speaker 1: well and cost less for taking care of patients, we're 209 00:10:48,160 --> 00:10:50,319 Speaker 1: going to be responsible for that and we will lose 210 00:10:50,360 --> 00:10:53,680 Speaker 1: money on it. So there's incentives both up and down. 211 00:10:54,120 --> 00:10:56,160 Speaker 1: Where did this this idea come from? Does it date 212 00:10:56,200 --> 00:10:58,120 Speaker 1: back to Michael Porter at Harvard Business School who had 213 00:10:58,160 --> 00:11:00,520 Speaker 1: this revolutionary idea? Why are we doing it at this 214 00:11:00,559 --> 00:11:02,680 Speaker 1: point in time? Is it's something catalyzed by the Affordable 215 00:11:02,679 --> 00:11:05,280 Speaker 1: Care Act? Well, it actually dates way back before that. 216 00:11:05,640 --> 00:11:09,200 Speaker 1: Romney really I brought this in in Massachusetts, uh and 217 00:11:09,520 --> 00:11:11,640 Speaker 1: with the idea and we've really been looking at a 218 00:11:11,679 --> 00:11:14,640 Speaker 1: new way over the last decade or so on how 219 00:11:14,640 --> 00:11:17,320 Speaker 1: we get paid in healthcare and what the objectives of 220 00:11:17,679 --> 00:11:20,640 Speaker 1: the reimbursements are. Ducher cosgrew wonderful to speak to you 221 00:11:20,679 --> 00:11:23,959 Speaker 1: again after Davos this year, when when you look at 222 00:11:24,120 --> 00:11:26,839 Speaker 1: the four or seven or eight, I can't keep count 223 00:11:26,920 --> 00:11:32,200 Speaker 1: iterations of Republican proposed legislation in Congress, in Senate at 224 00:11:32,240 --> 00:11:38,040 Speaker 1: six Pennsylvania Avenue. What's the best proposal for doctors and nurses? Well, 225 00:11:38,040 --> 00:11:40,360 Speaker 1: I'm concerned about all of them. To be honest with you, 226 00:11:40,880 --> 00:11:43,280 Speaker 1: I think the concern is that there's going to leave 227 00:11:43,320 --> 00:11:46,480 Speaker 1: a lot of people uncovered. Uh. And I frankly don't 228 00:11:46,520 --> 00:11:49,959 Speaker 1: think that the bills, the repeal bills, deal with the base, 229 00:11:50,520 --> 00:11:52,480 Speaker 1: the root cause of the problems. The root cause the 230 00:11:52,520 --> 00:11:55,880 Speaker 1: problem is, I see, it is the rising cost of healthcare. 231 00:11:56,240 --> 00:11:58,839 Speaker 1: And that happens really for two reasons. First of all, 232 00:11:58,880 --> 00:12:02,400 Speaker 1: you've got an older population. Uh. And secondly, there's more 233 00:12:02,440 --> 00:12:04,960 Speaker 1: things that we can do as healthcare providers to to 234 00:12:05,160 --> 00:12:07,760 Speaker 1: take care of them. So you're seeing across the world 235 00:12:07,960 --> 00:12:12,840 Speaker 1: increasing costs of healthcare. Uh and uh, none of these 236 00:12:13,000 --> 00:12:15,600 Speaker 1: bills really begin to deal with that. Are we going 237 00:12:15,640 --> 00:12:18,360 Speaker 1: to go across Lake Erie and do a Canadian plan? 238 00:12:18,679 --> 00:12:21,720 Speaker 1: Are we heading for some form of Canadian or United 239 00:12:21,800 --> 00:12:24,800 Speaker 1: Kingdom plan? Well, I don't think that's a political reality 240 00:12:24,800 --> 00:12:27,280 Speaker 1: at this point in the United States, I think that 241 00:12:27,559 --> 00:12:30,120 Speaker 1: what I would like to see is that none of 242 00:12:30,160 --> 00:12:34,760 Speaker 1: these repeals really take effect. If you look at the 243 00:12:34,800 --> 00:12:37,120 Speaker 1: bill and you go back and what it really started 244 00:12:37,160 --> 00:12:39,720 Speaker 1: out to do. It really wanted to increase coverage, which 245 00:12:39,720 --> 00:12:43,160 Speaker 1: it did. It needed to improve the quality of healthcare. 246 00:12:43,240 --> 00:12:45,360 Speaker 1: And if you see across the country over the last 247 00:12:45,400 --> 00:12:49,200 Speaker 1: eight years, gradually you've seen an improvement in quality of 248 00:12:49,200 --> 00:12:53,000 Speaker 1: healthcare for hospitals. UH. And then UH, the thing that 249 00:12:53,040 --> 00:12:56,760 Speaker 1: it has not done well is control the cost of healthcare. UH. 250 00:12:56,800 --> 00:13:00,120 Speaker 1: And so UH and I would hope that what we 251 00:13:00,200 --> 00:13:05,080 Speaker 1: would see is UH coming together and a bipartisan fashion 252 00:13:05,240 --> 00:13:07,840 Speaker 1: to begin to look at the cost of healthcare, both 253 00:13:07,880 --> 00:13:11,760 Speaker 1: the efficiency of how we deal with patients who are sick, 254 00:13:11,800 --> 00:13:14,480 Speaker 1: and also how we begin to keep people well and 255 00:13:14,559 --> 00:13:17,120 Speaker 1: deal with the three epidemics which are really plaguing in 256 00:13:17,160 --> 00:13:21,800 Speaker 1: the United States right now, which is smoking, obesity, and UH, 257 00:13:21,960 --> 00:13:24,680 Speaker 1: the opiate condiction. David Gern, I want to get to 258 00:13:24,679 --> 00:13:27,120 Speaker 1: the opioid issue here at a moment. Thank you Allen 259 00:13:27,160 --> 00:13:32,000 Speaker 1: Krueger of Princeton for important comments yesterday. Dr Cosgrove, David Gerrn, 260 00:13:32,040 --> 00:13:34,480 Speaker 1: I have to rip up the script and we do 261 00:13:34,600 --> 00:13:38,000 Speaker 1: that with Toby Cosgrove, who wandered out a medical school 262 00:13:38,640 --> 00:13:41,959 Speaker 1: in three cups of coffee. Later was in Denaying running 263 00:13:42,000 --> 00:13:46,120 Speaker 1: twenty two casualties, staging flight, trying to get people on 264 00:13:46,200 --> 00:13:49,400 Speaker 1: airplanes so that they could live coming out of wounds 265 00:13:49,440 --> 00:13:52,240 Speaker 1: in Vietnam. We do this with a backdrop of ken 266 00:13:52,240 --> 00:13:56,080 Speaker 1: Burns the Vietnam War. Yes, Mr Burns will join us. UM. 267 00:13:56,160 --> 00:13:58,200 Speaker 1: We've been really trying to work with his schedule, and 268 00:13:58,200 --> 00:14:03,120 Speaker 1: we'll have ken Burns on October. Dr Cosgrove George Will 269 00:14:03,200 --> 00:14:07,040 Speaker 1: calls ken Burn's effort a masterpiece. What did you see 270 00:14:07,120 --> 00:14:10,680 Speaker 1: in Vietnam that you need ken Burns to tell in 271 00:14:10,760 --> 00:14:16,720 Speaker 1: his documentary? I think ken Burns will tell a story 272 00:14:17,200 --> 00:14:21,400 Speaker 1: UM that is clearly the horror of war. UM. And 273 00:14:21,440 --> 00:14:24,080 Speaker 1: there are no good, good guys or people who wear 274 00:14:24,120 --> 00:14:27,400 Speaker 1: a high how white hat and a war UM. And 275 00:14:28,160 --> 00:14:31,480 Speaker 1: I think until you have participated in war and you 276 00:14:31,560 --> 00:14:34,880 Speaker 1: really don't recognize the magnitude of the destruction it is 277 00:14:34,960 --> 00:14:39,640 Speaker 1: in both human lives and property within that is the 278 00:14:39,720 --> 00:14:43,720 Speaker 1: medicine that you learned. We've gone to a medicine that 279 00:14:43,840 --> 00:14:46,040 Speaker 1: is so removed most of us barely know who the 280 00:14:46,080 --> 00:14:50,160 Speaker 1: pediatrician is. Or maybe the surgeon wandering by and three 281 00:14:50,240 --> 00:14:51,760 Speaker 1: levels you may be not even sure who's going to 282 00:14:51,840 --> 00:14:54,760 Speaker 1: operate on a given day. What can we learn about 283 00:14:54,800 --> 00:14:58,920 Speaker 1: the medicine of another time and place around Vietnam, around 284 00:14:58,960 --> 00:15:02,040 Speaker 1: the general care we knew that we can bring forward 285 00:15:02,040 --> 00:15:05,560 Speaker 1: and rekindle today. Well, first of all, I think that 286 00:15:05,640 --> 00:15:09,400 Speaker 1: you clearly recognize that the quality of care across the 287 00:15:09,440 --> 00:15:13,720 Speaker 1: country has improved and dramatically over time, and uh, even 288 00:15:13,760 --> 00:15:17,000 Speaker 1: since the time of the Vietnam War. Just uh, let 289 00:15:17,000 --> 00:15:19,240 Speaker 1: me put it in perspective for you for a second. 290 00:15:19,560 --> 00:15:23,640 Speaker 1: During the Civil War, of everybody who was injured died 291 00:15:23,960 --> 00:15:27,560 Speaker 1: an he started injury in Vietnam, ninety five percent of 292 00:15:27,600 --> 00:15:31,000 Speaker 1: the people who are injured survived. Now it is closer 293 00:15:31,040 --> 00:15:36,440 Speaker 1: to so the quality of the care, both for civilians 294 00:15:36,440 --> 00:15:40,520 Speaker 1: and the military has improved enormously. I think what is 295 00:15:41,080 --> 00:15:46,040 Speaker 1: being lost and in fact, what we're trying to improve is, uh, 296 00:15:46,280 --> 00:15:51,280 Speaker 1: the fact that we need to to concentrate on patients 297 00:15:52,080 --> 00:15:56,240 Speaker 1: um and all of the things that surrounded patients, particularly 298 00:15:56,680 --> 00:16:00,160 Speaker 1: the emotional aspects and the empathy that are require are 299 00:16:00,240 --> 00:16:03,400 Speaker 1: to drive that. And at the Cleveland Clinic, one of 300 00:16:03,440 --> 00:16:05,960 Speaker 1: the things that we did is we UH said that 301 00:16:06,040 --> 00:16:08,600 Speaker 1: our matra is going to be petting patients first and 302 00:16:08,680 --> 00:16:11,600 Speaker 1: everything that that involves, and everybody in the hospital, whether 303 00:16:11,680 --> 00:16:14,880 Speaker 1: you are a neurosurgeon or you're driving the bus, UH 304 00:16:15,680 --> 00:16:18,840 Speaker 1: is uh. The reason that they're there is for patients. 305 00:16:19,360 --> 00:16:22,120 Speaker 1: And I think once you're centered around that, it begins 306 00:16:22,160 --> 00:16:26,400 Speaker 1: to change of the attitude that people have in the 307 00:16:26,560 --> 00:16:30,160 Speaker 1: empathy which they exhibit. My one of my first summer 308 00:16:30,240 --> 00:16:33,280 Speaker 1: jobs was at UNC Hospitals in Chapel Hill, working with 309 00:16:33,320 --> 00:16:35,840 Speaker 1: the department that looked into quality. It was clear that 310 00:16:36,040 --> 00:16:38,600 Speaker 1: was becoming the rage in healthcare policy, doing better at 311 00:16:38,640 --> 00:16:41,400 Speaker 1: measuring the quality of care, looking at how patients were 312 00:16:41,400 --> 00:16:43,960 Speaker 1: fearing and how they felt. Where do things stand now 313 00:16:43,960 --> 00:16:46,120 Speaker 1: when you begin to assess the efficacy of treatment? Are 314 00:16:46,160 --> 00:16:49,080 Speaker 1: we are we doing a better job of ensuring that 315 00:16:49,080 --> 00:16:51,800 Speaker 1: the treatment is a quality treatment and that patients are 316 00:16:51,840 --> 00:16:53,880 Speaker 1: doing better as a result. Yeah. We want people to 317 00:16:53,960 --> 00:16:57,680 Speaker 1: come in the hospital to be safe, uh, free from 318 00:16:57,840 --> 00:17:00,720 Speaker 1: errors and mistakes, and I think we're question that we 319 00:17:00,800 --> 00:17:04,840 Speaker 1: are having a much more high reliability UH for our organization. 320 00:17:05,200 --> 00:17:08,479 Speaker 1: The quality has improved, UH, and it is improved with 321 00:17:08,600 --> 00:17:11,040 Speaker 1: measurement UH. And one of the things that I think 322 00:17:11,119 --> 00:17:16,680 Speaker 1: is so important is the transparency that goes with measuring quality. 323 00:17:17,119 --> 00:17:21,040 Speaker 1: The transparency has to be both internal, uh two members 324 00:17:21,080 --> 00:17:23,680 Speaker 1: of the healthcare team, and it has to be external 325 00:17:23,720 --> 00:17:27,640 Speaker 1: to the community. And we've attempted to do that over time. 326 00:17:27,720 --> 00:17:30,000 Speaker 1: But if you look at quality, quality really falls into 327 00:17:30,080 --> 00:17:35,200 Speaker 1: three categories. Uh. It's the clinical quality, which we are 328 00:17:35,240 --> 00:17:39,040 Speaker 1: measuring like crazy. But until recently, we did not consider 329 00:17:39,080 --> 00:17:43,440 Speaker 1: the physical nor the emotional quality that went with the hospitalization. 330 00:17:43,880 --> 00:17:46,960 Speaker 1: And now we're much better at that um and measure it, 331 00:17:47,680 --> 00:17:52,080 Speaker 1: report it, share it both internally and externally, and right 332 00:17:52,119 --> 00:17:54,560 Speaker 1: down to individually. David, this is what you and I 333 00:17:54,600 --> 00:17:56,359 Speaker 1: love to do, and this is what our team puts 334 00:17:56,400 --> 00:18:01,000 Speaker 1: together every day. Alan Krueger yesterday a prince and I 335 00:18:01,040 --> 00:18:03,880 Speaker 1: believe you have Dr Cosgrow with you in Washington from 336 00:18:03,880 --> 00:18:06,040 Speaker 1: the Cleveland Clinic, a Dr Toby Cosco, the CEO of 337 00:18:06,080 --> 00:18:08,080 Speaker 1: the Cleveland Clinic. And I'm still thinking about many of 338 00:18:08,080 --> 00:18:11,080 Speaker 1: the statistics that Dr Krueger brought up yesterday on the show, 339 00:18:11,119 --> 00:18:13,800 Speaker 1: among them that nearly half of prime age men, men 340 00:18:13,840 --> 00:18:16,480 Speaker 1: between the ages of twenty five and fifty four who 341 00:18:16,480 --> 00:18:18,920 Speaker 1: aren't in the labor force, take pain medication on a 342 00:18:19,000 --> 00:18:21,080 Speaker 1: daily basis. Two thirds of those men are about two 343 00:18:21,119 --> 00:18:24,440 Speaker 1: million of them take prescription pain medication on a daily basis, 344 00:18:24,440 --> 00:18:26,879 Speaker 1: and brings some economics to what is a crisis in 345 00:18:26,920 --> 00:18:29,359 Speaker 1: this country, the opioid crisis. Dr Toby Cosco has been 346 00:18:29,359 --> 00:18:32,280 Speaker 1: thinking about and speaking out about this as well. Give 347 00:18:32,359 --> 00:18:33,920 Speaker 1: us the lay of the land that we talk about 348 00:18:33,920 --> 00:18:36,800 Speaker 1: it as a crisis. What constitutes that particular crisis? How 349 00:18:36,800 --> 00:18:38,840 Speaker 1: bad are things as you see them? Well, I think 350 00:18:39,040 --> 00:18:41,600 Speaker 1: if you look at it just in terms of deaths UH, 351 00:18:41,640 --> 00:18:44,359 Speaker 1: this year there will be sixty two thousand deaths UH 352 00:18:44,720 --> 00:18:49,240 Speaker 1: from overdoses. UH. That compares of what went on in 353 00:18:49,359 --> 00:18:51,720 Speaker 1: Vietnam and then the total Vietnam War there are fifty 354 00:18:51,760 --> 00:18:54,760 Speaker 1: eight thousand deaths UH. They expected to go to ninety 355 00:18:54,800 --> 00:18:58,760 Speaker 1: thousand deaths over the next three years, which is UH 356 00:18:59,280 --> 00:19:02,840 Speaker 1: doesn't begin to talk about the number of overdoses that 357 00:19:02,880 --> 00:19:05,480 Speaker 1: there are. Just in Caihua County, we saw over seven 358 00:19:05,520 --> 00:19:12,000 Speaker 1: thousand overdoses come into hospitals uh uh in the last year. UH. 359 00:19:12,040 --> 00:19:16,760 Speaker 1: And that doesn't count the financial uh cost of maintaining this, 360 00:19:16,960 --> 00:19:22,159 Speaker 1: nor the social or emotional costs of looking after these patients. 361 00:19:22,200 --> 00:19:25,879 Speaker 1: It's really ah escalating at a very fast pace. How 362 00:19:25,920 --> 00:19:27,280 Speaker 1: did we get here? And we don't need to to 363 00:19:27,359 --> 00:19:29,400 Speaker 1: assign culpability if if you don't want to do that, 364 00:19:29,480 --> 00:19:31,440 Speaker 1: but this is certainly something that has, as you say, 365 00:19:31,480 --> 00:19:33,480 Speaker 1: taken off. How do we get to this point where 366 00:19:33,520 --> 00:19:35,280 Speaker 1: so many people in the US are taking these kinds 367 00:19:35,320 --> 00:19:37,960 Speaker 1: of drugs. Well, first of all, you know, we have 368 00:19:38,200 --> 00:19:42,399 Speaker 1: had a try to maintain people without pain. Uh. And 369 00:19:42,560 --> 00:19:45,679 Speaker 1: I think that you have to say that inadvertently the 370 00:19:45,960 --> 00:19:49,680 Speaker 1: medical profession was responsible for a lot of this. We 371 00:19:49,760 --> 00:19:54,400 Speaker 1: had gave out pain medication, and people did not realize 372 00:19:54,400 --> 00:19:57,600 Speaker 1: the addictive nature of a lot of the new pain medications. 373 00:19:57,600 --> 00:20:01,600 Speaker 1: Octic coding, for example, is UH was touted as not 374 00:20:01,680 --> 00:20:06,920 Speaker 1: being as addictive as UH codeine was UH, and so 375 00:20:07,440 --> 00:20:10,360 Speaker 1: it was prescribed widely. And then on top of that, 376 00:20:10,880 --> 00:20:14,879 Speaker 1: pain became one of the new vital signs, and people 377 00:20:15,040 --> 00:20:20,359 Speaker 1: trying to contain people's pain by medicating them uh. And 378 00:20:20,400 --> 00:20:23,400 Speaker 1: then the government began to reimburse us on the basis 379 00:20:23,400 --> 00:20:27,320 Speaker 1: of how well we looked after people's pain. All these 380 00:20:27,359 --> 00:20:32,439 Speaker 1: things began to suggest that physicians should give more and 381 00:20:32,520 --> 00:20:36,840 Speaker 1: more pain medications, which they did. Um. And Uh. It 382 00:20:36,920 --> 00:20:40,520 Speaker 1: turns out right now that of heroin attics started with 383 00:20:40,600 --> 00:20:44,040 Speaker 1: some sort of perscrission drug. Uh. And then on top 384 00:20:44,080 --> 00:20:48,240 Speaker 1: of that, Uh, we have seen uh an influx of 385 00:20:48,440 --> 00:20:55,639 Speaker 1: new medications um. Uh they have seen um coming in 386 00:20:55,680 --> 00:21:00,720 Speaker 1: from China. Now, Uh, what you have have begin to 387 00:21:00,840 --> 00:21:03,760 Speaker 1: drugs that begin to be a hundred times more potent 388 00:21:04,560 --> 00:21:09,320 Speaker 1: than morphine. Uh, and they're now being laced into the drugs, 389 00:21:09,560 --> 00:21:12,320 Speaker 1: and so you may get a drug that has been 390 00:21:12,400 --> 00:21:15,920 Speaker 1: laced uh and invertly way overdose from that. It goes 391 00:21:15,960 --> 00:21:18,240 Speaker 1: back to the conversation we're having before the breaking part. 392 00:21:18,640 --> 00:21:21,000 Speaker 1: We're talking about measuring quality. There's certainly been efforts to 393 00:21:21,000 --> 00:21:23,840 Speaker 1: measure pain as well. Is is the measuring of pain 394 00:21:23,840 --> 00:21:26,240 Speaker 1: is subjective thing. I know we've counted on patients to 395 00:21:26,320 --> 00:21:29,840 Speaker 1: rate with the smiley face to the wincing cartoon face, 396 00:21:29,920 --> 00:21:32,760 Speaker 1: how they're they're feeling at this point, Uh, is that 397 00:21:32,800 --> 00:21:34,840 Speaker 1: still a problem measuring how much pain the patient is 398 00:21:34,840 --> 00:21:36,760 Speaker 1: in and when the patient needs to take the kind 399 00:21:36,760 --> 00:21:38,960 Speaker 1: of medications that we're talking about, No question about it. 400 00:21:38,960 --> 00:21:42,480 Speaker 1: It is a subjective measurement and various. If I remember 401 00:21:42,480 --> 00:21:46,919 Speaker 1: one time I had a kidney stone and I was 402 00:21:46,960 --> 00:21:50,680 Speaker 1: well medicated, and uh, in in fact, that hurt a 403 00:21:50,760 --> 00:21:54,560 Speaker 1: lot and so I just wanted more something. Yeah, please 404 00:21:55,119 --> 00:21:57,879 Speaker 1: get rid of the pain. Um. But you know, we 405 00:21:57,960 --> 00:22:00,560 Speaker 1: have to understand that about of people in the United 406 00:22:00,560 --> 00:22:02,359 Speaker 1: States at some time in their life have back pain. 407 00:22:03,200 --> 00:22:05,280 Speaker 1: And if we give all of those some sort of 408 00:22:05,720 --> 00:22:09,040 Speaker 1: opioid medication, we're going to put a lot of that 409 00:22:09,080 --> 00:22:13,360 Speaker 1: medication out into the into the environment. And so we 410 00:22:13,440 --> 00:22:15,520 Speaker 1: have begun to look at new ways we can begin 411 00:22:15,560 --> 00:22:17,919 Speaker 1: to treat people with back pain. Not everybody needs to 412 00:22:18,000 --> 00:22:22,000 Speaker 1: have some sort of medication. Uh. And so we've treated 413 00:22:22,040 --> 00:22:28,120 Speaker 1: with psychological support, with physiotherapy, et cetera. You're a Williams guy, 414 00:22:28,359 --> 00:22:30,200 Speaker 1: I believe you know there's a small school up in 415 00:22:30,240 --> 00:22:32,880 Speaker 1: New Hampshire called Dartmouth. Not that you'd pay attention to that, 416 00:22:33,640 --> 00:22:35,840 Speaker 1: but when you when you in the Dartmouth grad Center, 417 00:22:35,840 --> 00:22:40,720 Speaker 1: Apportman of Ohio get together and talk about opioid. Portman's 418 00:22:40,720 --> 00:22:43,679 Speaker 1: had the courage to lead on this. How do we 419 00:22:43,760 --> 00:22:48,760 Speaker 1: get from Portman's leadership to Ohio solution or the beginning 420 00:22:48,800 --> 00:22:54,280 Speaker 1: of solution on this this heroin opioid epidemic. Well, I 421 00:22:54,280 --> 00:22:56,280 Speaker 1: think the first thing we have to do is recognize 422 00:22:56,320 --> 00:22:59,040 Speaker 1: the magnitude of the problem. Uh. And I think that 423 00:22:59,320 --> 00:23:03,159 Speaker 1: generally not recognize what a serious problem that is. And 424 00:23:03,160 --> 00:23:05,840 Speaker 1: I don't think it was generally recognized until fairly recently 425 00:23:05,880 --> 00:23:09,560 Speaker 1: even amongst the medical profession. Um, and certainly it is 426 00:23:09,600 --> 00:23:13,600 Speaker 1: not recognized amongst the general population. And until such time 427 00:23:13,680 --> 00:23:16,520 Speaker 1: as people understand the magnitude of the problem, we're not 428 00:23:16,560 --> 00:23:19,040 Speaker 1: going to get a solution to it. Because the solution 429 00:23:19,200 --> 00:23:22,880 Speaker 1: is not just uh located in the medical profession. It's 430 00:23:22,920 --> 00:23:26,480 Speaker 1: not just located uh in the public. It's frankly, it's 431 00:23:26,480 --> 00:23:29,679 Speaker 1: gonna end and require education in the schools. It's going 432 00:23:29,720 --> 00:23:33,520 Speaker 1: to require the physicians, it's going to require the law enforcement. 433 00:23:33,600 --> 00:23:36,880 Speaker 1: It's going to require uh, the appreciation of this by 434 00:23:37,000 --> 00:23:40,800 Speaker 1: legis legislators. Uh. So all of society has to begin 435 00:23:40,880 --> 00:23:44,199 Speaker 1: to understand what it is, how serious it is, and 436 00:23:44,200 --> 00:23:47,359 Speaker 1: and um the METI factorial approach to fixing it. Do 437 00:23:47,400 --> 00:23:50,600 Speaker 1: you blame doctors? I mean, we we all perceive I know, Dr. Costco, 438 00:23:50,600 --> 00:23:52,879 Speaker 1: if you're gonna be nice on this, But the fact is, 439 00:23:52,960 --> 00:23:56,600 Speaker 1: David and I and everyone we know perceives quality or 440 00:23:56,760 --> 00:23:59,960 Speaker 1: levels of doctors. Is there a part of the doctor 441 00:24:00,119 --> 00:24:03,800 Speaker 1: during industry that's really been wrong on opioids? Well, I 442 00:24:03,800 --> 00:24:06,919 Speaker 1: think all of us frankly, did not appreciate the magnitude 443 00:24:06,920 --> 00:24:10,640 Speaker 1: of the problem. We didn't understand how addictive the drugs were. 444 00:24:10,720 --> 00:24:14,720 Speaker 1: We didn't understand, uh the propensity that some people have 445 00:24:14,920 --> 00:24:18,080 Speaker 1: to get easily addicted to some of these and uh 446 00:24:18,240 --> 00:24:22,320 Speaker 1: so it's a process of education, educating us as a profession, 447 00:24:22,760 --> 00:24:27,000 Speaker 1: and uh so we certainly are culpable or part of 448 00:24:26,800 --> 00:24:30,159 Speaker 1: the issue we uh We talked to Dr Krueger yesterday 449 00:24:30,200 --> 00:24:31,639 Speaker 1: is as we've mentioned, and one of the things he 450 00:24:31,640 --> 00:24:33,800 Speaker 1: said is Washington's very good at convening meetings. You can 451 00:24:33,800 --> 00:24:36,240 Speaker 1: get stakeholders to the table. We can talk about these issues, 452 00:24:36,680 --> 00:24:38,399 Speaker 1: we can outline how big a problem it is. But 453 00:24:38,480 --> 00:24:41,439 Speaker 1: solutions are another thing entirely. Imagine you've thought about what 454 00:24:41,480 --> 00:24:44,200 Speaker 1: could be done differently or should be done going forward. 455 00:24:44,520 --> 00:24:46,479 Speaker 1: Is it going to be something that emanates from this 456 00:24:46,560 --> 00:24:48,199 Speaker 1: the nation's capital. Is it going to be done at 457 00:24:48,200 --> 00:24:51,520 Speaker 1: the state, local level? What could make a market change here? 458 00:24:51,520 --> 00:24:53,879 Speaker 1: And what we're seeing, Well, first of all, you know, 459 00:24:54,000 --> 00:24:56,359 Speaker 1: I think it has to be all of these. Uh 460 00:24:56,480 --> 00:24:58,280 Speaker 1: you know, let me tell you what we've done locally. 461 00:24:58,400 --> 00:25:03,119 Speaker 1: We've begun to enter into reducing the amount of uh 462 00:25:03,160 --> 00:25:06,520 Speaker 1: pain medications that we give to our patients. The state 463 00:25:06,640 --> 00:25:09,840 Speaker 1: has now said that you get a seven day for 464 00:25:09,920 --> 00:25:14,920 Speaker 1: adults uh in five days of prescription for children. UH. 465 00:25:15,000 --> 00:25:19,320 Speaker 1: We have made it easier to understand about how people 466 00:25:19,560 --> 00:25:25,520 Speaker 1: have had a successive prescriptions and so we uh so 467 00:25:25,600 --> 00:25:28,239 Speaker 1: we can get that from the electronic medical record. We 468 00:25:28,320 --> 00:25:32,080 Speaker 1: have begun to have education both for the community and 469 00:25:32,680 --> 00:25:37,240 Speaker 1: uh for our physicians. We've begun to look at uh narcan, 470 00:25:37,480 --> 00:25:40,600 Speaker 1: which is the antidote for overdose, and make that so 471 00:25:40,640 --> 00:25:43,680 Speaker 1: you can get it without a prescription, UM and all. 472 00:25:43,800 --> 00:25:48,960 Speaker 1: And we've begin to expand our treatments UH locations and 473 00:25:49,640 --> 00:25:54,000 Speaker 1: capabilities to deal with people who are addicted. So that's 474 00:25:54,119 --> 00:25:57,359 Speaker 1: sort of what's going on and the local ground level. 475 00:25:57,480 --> 00:26:01,400 Speaker 1: Obviously Washington can help a lot with dancing and by 476 00:26:02,600 --> 00:26:07,760 Speaker 1: being um a voice about the magnitude of the problem, 477 00:26:08,200 --> 00:26:12,440 Speaker 1: particularly coming from the president. UM. But uh so it's 478 00:26:12,440 --> 00:26:14,560 Speaker 1: going to I think there's lots of things that can 479 00:26:14,600 --> 00:26:17,000 Speaker 1: come together. It can begin to help. I've got about 480 00:26:17,000 --> 00:26:19,679 Speaker 1: thirty seconds left here. When somebody becomes addicted to these 481 00:26:19,720 --> 00:26:21,520 Speaker 1: kinds of drugs, what is it like to get off of? 482 00:26:21,680 --> 00:26:23,120 Speaker 1: How do you? How do you how do you begin 483 00:26:23,200 --> 00:26:25,159 Speaker 1: to do it? Well? First, of all, I think you 484 00:26:25,240 --> 00:26:27,639 Speaker 1: have to understand the problem and have to enter into 485 00:26:27,800 --> 00:26:32,359 Speaker 1: a treatment. Uh. And treatment really is, depending on the 486 00:26:32,400 --> 00:26:36,560 Speaker 1: magnitude of the problem, can be drug assisted UM and 487 00:26:36,640 --> 00:26:40,159 Speaker 1: that's has been increasingly successful for people who have done that. 488 00:26:40,840 --> 00:26:42,800 Speaker 1: Talk to Tubacatro, thank you very much for the time 489 00:26:42,800 --> 00:26:56,800 Speaker 1: today joining us. Who knows the shock of the deficits. 490 00:26:57,560 --> 00:26:59,560 Speaker 1: Douglas Holtz, he can he joins us on her phone 491 00:26:59,560 --> 00:27:02,120 Speaker 1: lines or olds he can anything to talk about here. 492 00:27:02,160 --> 00:27:04,280 Speaker 1: But I guess we go to the deficit. You have 493 00:27:04,359 --> 00:27:08,960 Speaker 1: a vector of deficit to GDP growth that borders on frightening. 494 00:27:09,320 --> 00:27:12,399 Speaker 1: Is anyone in Washington where of where our deficit to 495 00:27:12,520 --> 00:27:16,760 Speaker 1: GDP is heading? I'd say people are aware of. The 496 00:27:16,760 --> 00:27:19,959 Speaker 1: Congressional Budget Office has issued numerous reports, including the Long 497 00:27:20,040 --> 00:27:22,919 Speaker 1: Term Budget Outlook, that paying a pretty dire picture, but 498 00:27:23,400 --> 00:27:26,480 Speaker 1: it hasn't risen to the level of action so far. 499 00:27:26,600 --> 00:27:29,840 Speaker 1: And the fundamental action that is needed is something which 500 00:27:29,880 --> 00:27:33,199 Speaker 1: puts so Security, Medicare, Medicaid, the Affordable Care Act at 501 00:27:33,200 --> 00:27:37,440 Speaker 1: the large federal health and retirement programs on a sustainable trajectory. 502 00:27:37,600 --> 00:27:41,000 Speaker 1: Right now, so Security scheduled to have to cut benefits 503 00:27:41,680 --> 00:27:44,159 Speaker 1: across the board under two decades. That's a bad way 504 00:27:44,200 --> 00:27:47,040 Speaker 1: to run a retirement program, and it's a disservice to 505 00:27:47,080 --> 00:27:50,560 Speaker 1: the overall economy to have a big deficit. The Wall 506 00:27:50,600 --> 00:27:53,920 Speaker 1: Street Journal reports this morning the stuff of Douglas holes 507 00:27:53,920 --> 00:27:57,840 Speaker 1: Heekins nightmares. One and a half trillion dollar tax cut. 508 00:27:58,640 --> 00:28:04,200 Speaker 1: Uh that isn't paid for? Uh is what happened to 509 00:28:04,200 --> 00:28:06,200 Speaker 1: the Republican Party. Didn't you used to be a Republican 510 00:28:06,240 --> 00:28:11,800 Speaker 1: I mean, the Republican party with the deficit party at all? 511 00:28:12,040 --> 00:28:16,000 Speaker 1: Where did those people go? I think they're still out there, 512 00:28:16,040 --> 00:28:19,439 Speaker 1: But there is a division, uh, certainly in the folks 513 00:28:19,520 --> 00:28:21,440 Speaker 1: who are running the House, sent in the White House 514 00:28:21,520 --> 00:28:25,000 Speaker 1: right now. There's no evidence from his campaign that the 515 00:28:25,000 --> 00:28:27,800 Speaker 1: president is concerned at all about budget deficits. When he 516 00:28:27,800 --> 00:28:31,800 Speaker 1: announced his candidacy, I remember distinctly him saying, I'm not 517 00:28:31,840 --> 00:28:33,679 Speaker 1: going to touch so security, I'm not gonna touch Medicare. 518 00:28:33,680 --> 00:28:36,359 Speaker 1: I'm just gonna go get the money. I don't know 519 00:28:36,440 --> 00:28:40,840 Speaker 1: what that means, but certainly, any reasonable assessment of the 520 00:28:40,880 --> 00:28:42,880 Speaker 1: fisc Closs says that you're going to have to make 521 00:28:42,920 --> 00:28:46,800 Speaker 1: sensible modifications of those programs. It's an imperative. So you know, 522 00:28:47,000 --> 00:28:50,240 Speaker 1: the president sets the tone in any administration and in 523 00:28:50,360 --> 00:28:54,120 Speaker 1: any UM Washington, and that's an important issue right now. 524 00:28:54,240 --> 00:28:58,360 Speaker 1: Douglas seekin with this, the American Action Forum president, obviously 525 00:28:58,400 --> 00:29:00,640 Speaker 1: former director of the CBO. But we all knew that 526 00:29:00,800 --> 00:29:03,080 Speaker 1: Mike Rickie Alice Rivlin will join us on our FETE 527 00:29:03,080 --> 00:29:06,040 Speaker 1: show tomorrow. Excellent. Well, and she invented it and the 528 00:29:06,080 --> 00:29:08,320 Speaker 1: whole silly you can kick the thing forward. I'm not 529 00:29:08,400 --> 00:29:12,600 Speaker 1: sure that she would disagree with doug on the budget deficits. Uh, 530 00:29:13,320 --> 00:29:18,840 Speaker 1: there is an argument monetary modern monetary theory. They're having 531 00:29:18,840 --> 00:29:23,880 Speaker 1: a big convention UM next week, next month UM out 532 00:29:23,920 --> 00:29:26,200 Speaker 1: in Kansas City. The people the adherence to this that 533 00:29:26,320 --> 00:29:29,239 Speaker 1: suggests that because we have a printing press and we 534 00:29:29,320 --> 00:29:35,200 Speaker 1: have a fiat currency, we can live with these deficits. 535 00:29:35,720 --> 00:29:41,040 Speaker 1: It's not really a problem. And Uh, in essence, you 536 00:29:41,080 --> 00:29:44,480 Speaker 1: can if you want to consider it monetization. The only 537 00:29:44,480 --> 00:29:47,200 Speaker 1: thing you have to be careful of his inflation. So, 538 00:29:47,640 --> 00:29:49,960 Speaker 1: given the experience of the Obama administration and the big 539 00:29:49,960 --> 00:29:52,440 Speaker 1: deficits that were run up in trying to get out 540 00:29:52,440 --> 00:29:56,840 Speaker 1: of the the Great Recession, why just for the sake 541 00:29:56,840 --> 00:29:59,680 Speaker 1: of argument, couldn't we have a tax cut like they're 542 00:29:59,720 --> 00:30:02,760 Speaker 1: talking about and a deficit like they're talking about and 543 00:30:02,800 --> 00:30:07,200 Speaker 1: still survive it. So I think in the end, you 544 00:30:07,240 --> 00:30:12,320 Speaker 1: can't decide now whether you like or dislike the rumors 545 00:30:12,320 --> 00:30:14,520 Speaker 1: of a trillion and a half dollar additional deficit over 546 00:30:14,520 --> 00:30:17,000 Speaker 1: the next ten years. That does depend on the quality 547 00:30:17,040 --> 00:30:20,280 Speaker 1: of the tax policy. UH. There's no question that the 548 00:30:20,400 --> 00:30:24,360 Speaker 1: US is growing poorly. It's transford activity growth is too low. UH, 549 00:30:24,440 --> 00:30:27,840 Speaker 1: standard of living is rising too slowly. UH. Some combination 550 00:30:27,920 --> 00:30:32,560 Speaker 1: of regulatory reforms, tax reforms, UH, and infrastructure and education 551 00:30:32,680 --> 00:30:36,680 Speaker 1: are probably the best recipe. So we'll see what gets 552 00:30:36,720 --> 00:30:39,920 Speaker 1: proposed there and I'll reserve judgment on that. But I 553 00:30:39,960 --> 00:30:43,320 Speaker 1: think you have to always think about the death at 554 00:30:43,400 --> 00:30:45,400 Speaker 1: very differently. At this point in the cycle, we are 555 00:30:45,720 --> 00:30:48,720 Speaker 1: essentially at full employment by any measure, versus when you 556 00:30:48,800 --> 00:30:52,000 Speaker 1: had ten percent unemployment. Those are very different animals. These 557 00:30:52,000 --> 00:30:53,800 Speaker 1: deficits are far more difficult to get rid of, and 558 00:30:53,800 --> 00:30:56,479 Speaker 1: they're more important to get rid of. Michael mckaway US, 559 00:30:56,520 --> 00:30:59,520 Speaker 1: you only agree because the Denver Broncos are doing better 560 00:30:59,560 --> 00:31:01,800 Speaker 1: than good and Mike, it's always a good time to 561 00:31:01,800 --> 00:31:05,680 Speaker 1: speak to Dr whole Skin. Douglas hold Skin the American 562 00:31:05,720 --> 00:31:08,640 Speaker 1: action for him, we talked about a vector for the 563 00:31:08,640 --> 00:31:12,720 Speaker 1: deficit to GDP. Uh, Doug, is it a different vector? 564 00:31:12,880 --> 00:31:16,720 Speaker 1: Is the makeup of our growing deficit to GDP different 565 00:31:17,040 --> 00:31:21,160 Speaker 1: than the last time we did this ballet. Each time 566 00:31:21,720 --> 00:31:23,800 Speaker 1: we do this, it becomes more and more a story 567 00:31:23,840 --> 00:31:26,080 Speaker 1: that's just about the entitlement programs. I mean, if you 568 00:31:26,200 --> 00:31:28,800 Speaker 1: go back to success in balancing the budget in the 569 00:31:28,880 --> 00:31:32,920 Speaker 1: late nineties, that was largely accomplished by a the dot 570 00:31:32,960 --> 00:31:34,920 Speaker 1: com bubble. I don't think we want to have a 571 00:31:34,960 --> 00:31:39,040 Speaker 1: big bubble again. Be caps on discretionary spending, the annual 572 00:31:39,040 --> 00:31:42,280 Speaker 1: decisions by Congress. And we're in a very different world now. 573 00:31:42,400 --> 00:31:44,640 Speaker 1: We're we're in a world where two thirds of the 574 00:31:44,640 --> 00:31:48,840 Speaker 1: budget is so security, Medicare and Medicaid, federal health programs. Uh, 575 00:31:48,920 --> 00:31:52,600 Speaker 1: those programs are growing faster at rates like six and seven. 576 00:31:53,280 --> 00:31:55,680 Speaker 1: Then you could plausibly have revenue grow, which is about 577 00:31:55,680 --> 00:32:00,280 Speaker 1: four percent nominal. And in the end, those pro grams 578 00:32:00,280 --> 00:32:02,480 Speaker 1: are growing so rapidly that they're really pushing out of 579 00:32:02,480 --> 00:32:07,440 Speaker 1: the budget national defense, basic research, infrastructure, education, all the 580 00:32:07,480 --> 00:32:09,680 Speaker 1: things our founders saw as the role of government. So 581 00:32:09,880 --> 00:32:12,200 Speaker 1: we have a real problem both on the top line 582 00:32:12,240 --> 00:32:14,880 Speaker 1: this nash Treen revenue and spending and in the composition 583 00:32:14,920 --> 00:32:18,760 Speaker 1: of the budget when you look at those entitlement programs, 584 00:32:18,760 --> 00:32:22,960 Speaker 1: do you have it? I suppose this is a naive question. 585 00:32:23,000 --> 00:32:26,640 Speaker 1: Stan Collender would say, there you go, thinking logically again, Um, 586 00:32:27,400 --> 00:32:30,600 Speaker 1: that's illegal in Washington, didn't do that. Do you have 587 00:32:30,640 --> 00:32:34,520 Speaker 1: any hope that as uh, maybe misquoting WC. Fields are 588 00:32:34,560 --> 00:32:38,840 Speaker 1: missing attributing this, but the the nearness of a hanging 589 00:32:38,880 --> 00:32:42,200 Speaker 1: may concentrate the mind. Do you think that we will 590 00:32:42,240 --> 00:32:45,120 Speaker 1: see any action over the next few years in terms 591 00:32:45,160 --> 00:32:50,160 Speaker 1: of the the the entitlement programs? Well, I mean really 592 00:32:50,160 --> 00:32:52,320 Speaker 1: two thoughts in that. The first is how important it 593 00:32:52,360 --> 00:32:54,440 Speaker 1: is to move quickly, because it takes a long time 594 00:32:54,800 --> 00:32:57,480 Speaker 1: to change those programs, and and changes have to be 595 00:32:57,520 --> 00:32:59,000 Speaker 1: faced and people have to know what the deal is 596 00:32:59,040 --> 00:33:01,600 Speaker 1: on their retirement for examp of Well, so there is 597 00:33:02,000 --> 00:33:04,600 Speaker 1: some you know, urgency in my mind that's making some 598 00:33:04,640 --> 00:33:08,320 Speaker 1: steps forward. And if you don't, the only thing you'll 599 00:33:08,320 --> 00:33:10,080 Speaker 1: be able to do to close the deficit in the 600 00:33:10,120 --> 00:33:14,280 Speaker 1: crisis jack of taxes. And generally you're in a crisis 601 00:33:14,560 --> 00:33:16,400 Speaker 1: because the economy is not performing well, and that's gonna 602 00:33:16,400 --> 00:33:17,760 Speaker 1: be the wrong time to be doing that. So you 603 00:33:17,800 --> 00:33:20,840 Speaker 1: want to avoid that that sort of constellation of problems 604 00:33:20,840 --> 00:33:23,800 Speaker 1: by getting going. Now, the one thing we did see 605 00:33:23,840 --> 00:33:26,719 Speaker 1: this year was the House and the Senate take up 606 00:33:26,760 --> 00:33:30,120 Speaker 1: healthcare bills, and if you look inside those bills, those 607 00:33:30,160 --> 00:33:33,720 Speaker 1: were major reforms of two entitled programs, Medicaid and the 608 00:33:33,720 --> 00:33:37,080 Speaker 1: Affordable Care Act. Whether you like those reforms or not, 609 00:33:37,160 --> 00:33:39,680 Speaker 1: and that's a different debate. The fact that they took 610 00:33:39,760 --> 00:33:43,520 Speaker 1: up entitle reform I think was really a tremendously important thing. 611 00:33:43,960 --> 00:33:46,600 Speaker 1: It looks like the sentence trying to revive that effort. 612 00:33:46,960 --> 00:33:48,160 Speaker 1: I don't know if there's any real reason to be be 613 00:33:48,200 --> 00:33:51,920 Speaker 1: optimistically getting done, but we do need to take on 614 00:33:52,360 --> 00:33:54,280 Speaker 1: these rising spending programs and do it in a way 615 00:33:54,320 --> 00:33:58,680 Speaker 1: that's sensible for the beneficiaries. Well, speaking of the entitlement 616 00:33:58,680 --> 00:34:03,320 Speaker 1: programs in healthcare, you just mentioned, it looks like the 617 00:34:03,320 --> 00:34:08,640 Speaker 1: the dead have arisen in Washington. Graham Cassidy, Uh, It's 618 00:34:08,640 --> 00:34:12,000 Speaker 1: sort of two questions about this. But first, um, what 619 00:34:12,040 --> 00:34:14,600 Speaker 1: do you think the odds are that the Senate would 620 00:34:15,160 --> 00:34:19,399 Speaker 1: actually pass this? Oh? I think they're they're well less 621 00:34:19,400 --> 00:34:22,520 Speaker 1: than fifty as we speak. But there has been a 622 00:34:22,560 --> 00:34:28,279 Speaker 1: remarkable change in sentiments on the ground in the past week. 623 00:34:28,719 --> 00:34:32,760 Speaker 1: I think even last Friday, there was no real reason 624 00:34:32,800 --> 00:34:35,279 Speaker 1: to believe that Graham Cassidy was other than an exercise 625 00:34:35,640 --> 00:34:39,560 Speaker 1: by its authors. But Republicans in the Senate have heard 626 00:34:39,600 --> 00:34:41,920 Speaker 1: repeatedly from the people back home that they're unhappy with 627 00:34:41,960 --> 00:34:44,480 Speaker 1: their failure. They're hearing from the donors that they're unhappy 628 00:34:44,480 --> 00:34:48,200 Speaker 1: with their failure, and they are now serious about taking 629 00:34:48,200 --> 00:34:49,840 Speaker 1: this back up. And that that's a sea change for 630 00:34:49,920 --> 00:34:51,960 Speaker 1: me even a week ago. And I'm quite surprised by that. 631 00:34:52,120 --> 00:34:54,600 Speaker 1: So we'll see how it evolves. I still don't see 632 00:34:54,640 --> 00:34:56,920 Speaker 1: how it gets over the finish line, but um, the 633 00:34:56,960 --> 00:34:59,480 Speaker 1: fact that they're even taking it up, I think is important. U. 634 00:35:00,120 --> 00:35:02,319 Speaker 1: Let me follow that up with this question here and 635 00:35:02,360 --> 00:35:06,000 Speaker 1: talking about the tax reform and the healthcare programs. Senator 636 00:35:06,400 --> 00:35:10,000 Speaker 1: John Kennedy, this is not the old John, obviously, Senator 637 00:35:10,040 --> 00:35:12,759 Speaker 1: from Louisiana. Yes, he said, he's quoted in the Wall 638 00:35:12,760 --> 00:35:15,720 Speaker 1: Street Journalist Morning quote. For every economist, there's an equal 639 00:35:15,760 --> 00:35:19,600 Speaker 1: and opposite economist, and they're usually wrong. Do you think 640 00:35:19,760 --> 00:35:26,560 Speaker 1: the financial crisis did such damage to the reputation of 641 00:35:26,600 --> 00:35:32,920 Speaker 1: economists that politicians feel completely free now to ignore whatever 642 00:35:32,960 --> 00:35:37,080 Speaker 1: recommendations and economists may come up with if if it 643 00:35:37,120 --> 00:35:41,080 Speaker 1: doesn't fit their preconceived idea. I don't know if it 644 00:35:41,200 --> 00:35:44,040 Speaker 1: was just the financial crisis, but I do think you know, 645 00:35:44,160 --> 00:35:46,799 Speaker 1: during the course of my career, I've been concerned that 646 00:35:46,840 --> 00:35:52,560 Speaker 1: economists have oversold their capacity to forecast the economy, forecast 647 00:35:52,640 --> 00:35:55,480 Speaker 1: the impact of policy changes, and basically fine tuned business 648 00:35:55,520 --> 00:35:59,440 Speaker 1: cycles from Washington that that's never been a big success, 649 00:35:59,480 --> 00:36:01,920 Speaker 1: and they're a long track record of of failure in 650 00:36:01,920 --> 00:36:04,799 Speaker 1: that front. The financial crisis. Don't saw that comming out. 651 00:36:04,800 --> 00:36:07,879 Speaker 1: I don't think that's helped um, but you know, it's 652 00:36:07,920 --> 00:36:10,480 Speaker 1: it's not just economists. You you could also appeal to 653 00:36:10,520 --> 00:36:13,319 Speaker 1: your common sense and uh, some of the things that 654 00:36:13,360 --> 00:36:17,280 Speaker 1: are that are going on. For example, having a projection 655 00:36:17,320 --> 00:36:21,000 Speaker 1: in the in the budget where interest on public borrowing 656 00:36:21,239 --> 00:36:23,680 Speaker 1: will be the third largest program in the federal budget 657 00:36:24,400 --> 00:36:27,520 Speaker 1: in ten years. I mean, that doesn't take it consteralize. Jeez, 658 00:36:27,520 --> 00:36:29,360 Speaker 1: you're tying up all the money on just paying interest. 659 00:36:29,520 --> 00:36:31,840 Speaker 1: This is an important insight, Mike, thank you to bring 660 00:36:31,840 --> 00:36:34,680 Speaker 1: this up, and we consider Sender Kennedy to be of 661 00:36:34,719 --> 00:36:37,680 Speaker 1: great value when he speaks with Bloomberg Surveillance, Doug, I'm 662 00:36:37,680 --> 00:36:41,160 Speaker 1: going to disagree with the polarity of economists. There's one 663 00:36:41,160 --> 00:36:44,000 Speaker 1: guy over there, there's another woman over there. They don't agree, 664 00:36:44,040 --> 00:36:46,719 Speaker 1: and it makes for great TV or radio. The fact is, 665 00:36:46,840 --> 00:36:51,040 Speaker 1: is a common central tendency to economists on a Venn diagram. 666 00:36:51,360 --> 00:36:54,840 Speaker 1: There's a lot of commonality between John Taylor Stanford and 667 00:36:54,880 --> 00:36:59,880 Speaker 1: Paul Krugman of Princeton. And the issue is within the 668 00:37:00,239 --> 00:37:05,000 Speaker 1: crisis that central tendency was so far off I would 669 00:37:05,040 --> 00:37:07,920 Speaker 1: go to the center rather than the polarities at Senator 670 00:37:08,000 --> 00:37:11,200 Speaker 1: Kennedy brings up, I think that's a fair comment. I 671 00:37:11,239 --> 00:37:14,720 Speaker 1: really do. I mean mccamas builds do agree, and um, 672 00:37:14,760 --> 00:37:16,840 Speaker 1: the places where they don't agree get the most attention. 673 00:37:17,200 --> 00:37:21,000 Speaker 1: And quite frankly, the notion that somehow e commists are 674 00:37:21,080 --> 00:37:23,920 Speaker 1: uniquely equipped to to do forecasting, I think it's misplaced. 675 00:37:23,960 --> 00:37:30,120 Speaker 1: I mean forecasting the teacher isn't hard like this is 676 00:37:30,160 --> 00:37:33,279 Speaker 1: critically important? Is not? A Rabenia stated what everybody got 677 00:37:33,280 --> 00:37:36,440 Speaker 1: wrong was the amplitudes. A lot of people predicted it, 678 00:37:36,520 --> 00:37:41,279 Speaker 1: but we completely missed the sign functions, the amplitudes of 679 00:37:41,360 --> 00:37:45,480 Speaker 1: these shocks and the crisis. Question From a listener here, 680 00:37:45,520 --> 00:37:50,480 Speaker 1: Tom uh for doug as Congress considers fiscal policy and 681 00:37:50,480 --> 00:37:55,160 Speaker 1: they're looking at gigantic tax cuts as as it um. 682 00:37:55,960 --> 00:37:59,440 Speaker 1: They want to know which stimulus works best. I mean 683 00:37:59,480 --> 00:38:03,200 Speaker 1: the government can buy things, can increase transfer payments we're 684 00:38:03,200 --> 00:38:08,640 Speaker 1: talking about that, can cut taxes. Uh, can use corporate 685 00:38:08,640 --> 00:38:12,080 Speaker 1: tax provisions. Um. What would be the best thing, the 686 00:38:12,120 --> 00:38:16,759 Speaker 1: most effective thing to boost growth? So, Uh, this is 687 00:38:16,800 --> 00:38:20,719 Speaker 1: not a stimulus um moment. We are essentially at full employment. 688 00:38:21,120 --> 00:38:24,480 Speaker 1: There are very few opportunities for low hanging fruit where 689 00:38:24,480 --> 00:38:27,880 Speaker 1: you put people back to work and do Keynesian style stimulus. 690 00:38:27,920 --> 00:38:31,279 Speaker 1: This has to be genuinely focused on the supply side 691 00:38:31,280 --> 00:38:34,440 Speaker 1: of the economy and raising the trend rate of growth 692 00:38:34,480 --> 00:38:37,680 Speaker 1: and and doing that by raising productivity growth. So what 693 00:38:37,840 --> 00:38:40,320 Speaker 1: is interesting about this set of discussions about tax formers. 694 00:38:40,360 --> 00:38:44,800 Speaker 1: They are very much focused on the business tax issues 695 00:38:44,920 --> 00:38:48,520 Speaker 1: and on the capacity of businesses to invest, innovate, do 696 00:38:48,640 --> 00:38:51,400 Speaker 1: it in the United States and and higher workers and 697 00:38:51,520 --> 00:38:54,919 Speaker 1: agin them raises. Uh. That's the key, and that's that's 698 00:38:54,960 --> 00:38:58,200 Speaker 1: the test by which you should judge the tax proposals. 699 00:38:58,400 --> 00:39:01,640 Speaker 1: If it's provide cash individuals to go out and spend, 700 00:39:01,840 --> 00:39:03,359 Speaker 1: there's not gonna be much out of that. That has 701 00:39:03,400 --> 00:39:06,319 Speaker 1: no no lasting impact on the economy. Thank you so much, 702 00:39:06,320 --> 00:39:08,200 Speaker 1: Douglas huls A good generous of you to be with 703 00:39:08,280 --> 00:39:24,280 Speaker 1: us this morning with the American action for him. Michael 704 00:39:24,360 --> 00:39:26,839 Speaker 1: McKee is at the exit stage right, and it's good 705 00:39:26,840 --> 00:39:28,680 Speaker 1: to have Mrs Lund Chris with us joining us now 706 00:39:28,760 --> 00:39:33,360 Speaker 1: Scarlet Food of of fame and fortune. Tomorrow we have 707 00:39:33,360 --> 00:39:35,839 Speaker 1: our fed day Scarlet Food leading our coverage with Bill 708 00:39:35,840 --> 00:39:40,480 Speaker 1: Gross every two PM as well. But now is a 709 00:39:40,719 --> 00:39:44,120 Speaker 1: lovely annual visit. We treasure this visit with a guy 710 00:39:44,239 --> 00:39:50,400 Speaker 1: fourteen years in of building hockey from a comedy of 711 00:39:50,480 --> 00:39:53,120 Speaker 1: four hundred some whatever the small amount of money was 712 00:39:53,560 --> 00:39:56,480 Speaker 1: into a billion dollar business. I want to ask one question. 713 00:39:56,520 --> 00:39:59,200 Speaker 1: I know Scarlett really wants to drive forward the present 714 00:39:59,239 --> 00:40:03,240 Speaker 1: business converse station where you are now, what's the next 715 00:40:03,280 --> 00:40:07,399 Speaker 1: stage for NHL. You had your huge Canadian TV deal, 716 00:40:07,480 --> 00:40:11,759 Speaker 1: you this success of NBC up sports hockey. What's the 717 00:40:11,840 --> 00:40:16,400 Speaker 1: next big commissioner like transaction for you. Well, first of all, 718 00:40:16,440 --> 00:40:18,480 Speaker 1: it's good to be with you for our annual visit. 719 00:40:18,680 --> 00:40:21,440 Speaker 1: And I know time flies when you're having fun, but 720 00:40:21,480 --> 00:40:25,560 Speaker 1: it's actually been twenty four plus years through a decade. 721 00:40:25,880 --> 00:40:28,000 Speaker 1: He's okay, you know, it's you get to be our 722 00:40:28,080 --> 00:40:31,920 Speaker 1: age every year matters. Uh, We're very excited about the 723 00:40:31,960 --> 00:40:36,799 Speaker 1: start of the season. UH. For us, the opportunities presented 724 00:40:36,880 --> 00:40:41,120 Speaker 1: by digital platforms and the social media really gives us 725 00:40:41,120 --> 00:40:44,439 Speaker 1: a way to connect with our fans. Our fans tend 726 00:40:44,480 --> 00:40:48,239 Speaker 1: to be very tech savvy, very avid, and since historically, 727 00:40:49,000 --> 00:40:52,280 Speaker 1: and I'm now talking thirty years ago, we were underserved 728 00:40:52,320 --> 00:40:55,719 Speaker 1: by traditional media, the current landscape gives us a lot 729 00:40:55,760 --> 00:40:59,840 Speaker 1: of great opportunities. Secondly, we currently have two teams in 730 00:41:00,080 --> 00:41:04,640 Speaker 1: China and the opportunity to grow the game worldwide. There 731 00:41:04,640 --> 00:41:07,160 Speaker 1: are a lot of places throughout the world where hockey 732 00:41:07,239 --> 00:41:11,600 Speaker 1: is already strong. Roughly of our players come from outside 733 00:41:11,600 --> 00:41:16,719 Speaker 1: and Mr would suggest that would be as Sweden actually 734 00:41:17,000 --> 00:41:20,799 Speaker 1: is the largest exporter of NHL players. And I'm out 735 00:41:20,800 --> 00:41:23,600 Speaker 1: of touch. Is Yager in a uniform this year? Not yet? 736 00:41:24,080 --> 00:41:26,080 Speaker 1: Are you working on that? I don't work on that 737 00:41:28,120 --> 00:41:29,879 Speaker 1: is saying that it's a good there's a good chance 738 00:41:29,880 --> 00:41:32,520 Speaker 1: we'll see No, No, I don't know. I don't know. 739 00:41:32,680 --> 00:41:36,640 Speaker 1: He doesn't have a contract. And he's a great ambassador 740 00:41:36,680 --> 00:41:38,480 Speaker 1: for the game. He's one of the great players of 741 00:41:38,480 --> 00:41:41,319 Speaker 1: the game. And we'll see if he hooks onto those 742 00:41:41,360 --> 00:41:44,520 Speaker 1: of you globally. Not a hockey. Yeremi Hugger is two. 743 00:41:44,920 --> 00:41:48,600 Speaker 1: You can still quite that Charlett. He works harder than 744 00:41:48,640 --> 00:41:52,480 Speaker 1: any other twenty year old player. You talked about digital platforms. 745 00:41:52,480 --> 00:41:55,240 Speaker 1: The NHL streamed a handful of games on Twitter last season. 746 00:41:55,640 --> 00:41:57,880 Speaker 1: What did you learn from that experience, what worked, what 747 00:41:57,960 --> 00:42:00,680 Speaker 1: needs to be tweaked refined? Well, the the issue I 748 00:42:00,719 --> 00:42:04,560 Speaker 1: think ultimately is going to be not just taking broad 749 00:42:04,960 --> 00:42:08,360 Speaker 1: cast content and stream it. It's whether or not, Uh, 750 00:42:08,520 --> 00:42:13,560 Speaker 1: some of the social media or other digital companies decide 751 00:42:13,840 --> 00:42:18,400 Speaker 1: that they're gonna produce games differently. That may be directed 752 00:42:18,920 --> 00:42:24,200 Speaker 1: more to the way that excuse me, perhaps that's a 753 00:42:24,239 --> 00:42:29,640 Speaker 1: surveillance sneeze that perhaps millennials and Gen z s will 754 00:42:29,680 --> 00:42:32,319 Speaker 1: want to consume the games differently. We don't know that 755 00:42:32,320 --> 00:42:35,960 Speaker 1: that's the case, because frankly, Rogers in Canada and NBC 756 00:42:36,000 --> 00:42:38,960 Speaker 1: in the United States do incredible jobs covering our games. 757 00:42:39,440 --> 00:42:42,920 Speaker 1: But as more and more young people are either cord 758 00:42:43,000 --> 00:42:45,719 Speaker 1: nevers or there are cord cutters, we have to make 759 00:42:45,760 --> 00:42:50,160 Speaker 1: sure that however we're presenting the game is relevant to 760 00:42:50,200 --> 00:42:53,200 Speaker 1: particularly young people. How do E sports fit into that? Then? 761 00:42:53,760 --> 00:42:56,600 Speaker 1: I view E sports as an opportunity for us to 762 00:42:56,680 --> 00:43:00,799 Speaker 1: teach people the game and to use this hockey to them, 763 00:43:01,040 --> 00:43:04,640 Speaker 1: introduce hockey to them, and to create a better sense 764 00:43:04,640 --> 00:43:08,040 Speaker 1: of community. Ultimately, what we're gonna work on is a 765 00:43:08,120 --> 00:43:12,160 Speaker 1: series of competitions where fans of teams will compete against 766 00:43:12,160 --> 00:43:15,200 Speaker 1: each other and have some you know, North American tournament 767 00:43:15,320 --> 00:43:18,719 Speaker 1: that's called engagement. Tom very good, Okay, I didn't. I 768 00:43:18,719 --> 00:43:21,040 Speaker 1: didn't miss that, Gary. You know that I've been a 769 00:43:21,120 --> 00:43:24,000 Speaker 1: critic of the changes in the games. I sometimes want 770 00:43:24,000 --> 00:43:26,880 Speaker 1: to get upset called the National Deflection League, which is 771 00:43:26,920 --> 00:43:31,080 Speaker 1: the only way you can get the party doesn't. What 772 00:43:31,120 --> 00:43:33,480 Speaker 1: are you gonna do to open up the game? You've 773 00:43:33,520 --> 00:43:35,880 Speaker 1: got some guys on NBC that used to play the 774 00:43:35,880 --> 00:43:38,439 Speaker 1: game differently than it's played. Now, what are you gonna 775 00:43:38,440 --> 00:43:40,760 Speaker 1: do to open up the game? And let me start 776 00:43:40,760 --> 00:43:43,359 Speaker 1: with block shots? You got two guys in the ice 777 00:43:43,640 --> 00:43:48,760 Speaker 1: gifted defenseman essentially being second and third goalies. Well, in effect, 778 00:43:49,040 --> 00:43:54,920 Speaker 1: our game has what you called deflections because our players 779 00:43:54,920 --> 00:43:59,040 Speaker 1: have never been more skilled. Coches have never been better 780 00:43:59,160 --> 00:44:01,680 Speaker 1: on their system. Having said that, the game has never 781 00:44:01,719 --> 00:44:06,520 Speaker 1: been faster, never in terms of lead changes in the 782 00:44:06,560 --> 00:44:10,600 Speaker 1: game and ability to have the unpredictability we have in 783 00:44:10,640 --> 00:44:13,319 Speaker 1: our season would would we like to see it a 784 00:44:13,320 --> 00:44:18,120 Speaker 1: little more open, perhaps if goaltenders were a little smaller. 785 00:44:18,160 --> 00:44:20,680 Speaker 1: And I don't mean physically, I'm talking about equipment, which 786 00:44:20,680 --> 00:44:22,920 Speaker 1: is something that we're working on that will open up 787 00:44:22,960 --> 00:44:26,920 Speaker 1: more space. Saw well, we we it's a work in 788 00:44:26,960 --> 00:44:29,920 Speaker 1: progress and it's something we do with the Players Association 789 00:44:30,360 --> 00:44:35,000 Speaker 1: and the Unofficial Goaltenders Union, and there's some resistance to 790 00:44:35,080 --> 00:44:37,480 Speaker 1: some of the changes, which we understand because this is 791 00:44:37,520 --> 00:44:40,920 Speaker 1: their livelihood. We we'd like to shrink the equipment, but 792 00:44:41,040 --> 00:44:44,000 Speaker 1: not cause any risk of injury. I know, Scarlett, you've 793 00:44:44,000 --> 00:44:46,279 Speaker 1: got I'm gonna ask one more question on this. I 794 00:44:46,320 --> 00:44:48,640 Speaker 1: don't want you to go back to Gump Worsley. I 795 00:44:48,680 --> 00:44:50,600 Speaker 1: don't want you to go back to me watching Don 796 00:44:50,719 --> 00:44:54,439 Speaker 1: Cherry and l Arbor block shots years ago. I want 797 00:44:54,480 --> 00:44:56,439 Speaker 1: you to get back to what Rennick did the guy 798 00:44:56,480 --> 00:45:00,400 Speaker 1: on NBC ron excuse me, Jeremy Ronick A Thay, and 799 00:45:00,440 --> 00:45:02,520 Speaker 1: what he does on NBC, what he did for the 800 00:45:02,560 --> 00:45:05,160 Speaker 1: black Hawks, which is a thirty or forty shot that 801 00:45:05,239 --> 00:45:08,919 Speaker 1: goes by the guy. I would respectfully suggest that's missing. Well. 802 00:45:08,960 --> 00:45:12,959 Speaker 1: You you would be an advocate of bigger nets, which 803 00:45:12,960 --> 00:45:16,120 Speaker 1: would open up more angles, but I'll take a shrunken 804 00:45:16,160 --> 00:45:20,319 Speaker 1: goalie equipment. But also physically, the goalies are bigger in 805 00:45:20,400 --> 00:45:23,640 Speaker 1: terms of height and weight than they've ever been. But 806 00:45:24,160 --> 00:45:26,919 Speaker 1: it's not a problem, but it's a trend that we're 807 00:45:26,920 --> 00:45:29,360 Speaker 1: watching and we'll make adjustments. One of the things we're 808 00:45:29,400 --> 00:45:31,840 Speaker 1: doing as well is we're going to heighten the standard 809 00:45:31,880 --> 00:45:35,720 Speaker 1: on slashing this year. Please. In the preseason game yesterday 810 00:45:35,719 --> 00:45:38,760 Speaker 1: with the Rangers, we don't we don't want broken hands 811 00:45:38,760 --> 00:45:42,720 Speaker 1: and fingers, particularly for the skilled players. So a slash 812 00:45:42,840 --> 00:45:45,320 Speaker 1: adder around the hands, we're going to call him more tightly. 813 00:45:45,400 --> 00:45:47,400 Speaker 1: Love it, love it. We're breaking news this morning on 814 00:45:47,440 --> 00:45:51,680 Speaker 1: this Okay, that's not breaking, that's okay. Well, I understand 815 00:45:51,840 --> 00:45:55,239 Speaker 1: you talk about bigger goalies. The players are smaller, they're 816 00:45:55,280 --> 00:45:57,560 Speaker 1: more skilled. I'm thinking of Tyler Wong, who was an 817 00:45:57,640 --> 00:46:00,640 Speaker 1: undrafted rookie still on a minor league contract, played in 818 00:46:00,880 --> 00:46:04,720 Speaker 1: the Golden Knights first preseason game How to Hat trick Um, 819 00:46:04,800 --> 00:46:07,799 Speaker 1: but his size five nine highlights how much the league 820 00:46:07,800 --> 00:46:10,400 Speaker 1: has changed during your tenure from what was once just 821 00:46:10,440 --> 00:46:13,560 Speaker 1: about size and braun it's speed and skill. The game 822 00:46:13,600 --> 00:46:15,920 Speaker 1: we opened up the game. We we there are two 823 00:46:16,000 --> 00:46:19,680 Speaker 1: things that play. One is because of the system we have, 824 00:46:20,000 --> 00:46:22,480 Speaker 1: all of our teams can afford to be competitive. We 825 00:46:22,560 --> 00:46:25,840 Speaker 1: have extraordinary competitive balance, the best in all of sports. 826 00:46:26,120 --> 00:46:29,320 Speaker 1: And if you look at it, last season, seven teams 827 00:46:29,800 --> 00:46:32,640 Speaker 1: made the playoffs that didn't make them the year before. 828 00:46:33,440 --> 00:46:35,520 Speaker 1: And and I like competitive balance. I think it's a 829 00:46:35,520 --> 00:46:39,640 Speaker 1: little more elegant. But but also um, we the four 830 00:46:39,880 --> 00:46:42,720 Speaker 1: of the five worst teams from the year before actually 831 00:46:42,760 --> 00:46:45,000 Speaker 1: made the playoffs as well. So no matter who you 832 00:46:45,080 --> 00:46:47,439 Speaker 1: root for, you have hoped that your team can make 833 00:46:47,480 --> 00:46:51,080 Speaker 1: the playoffs. We opened up the game, um in terms 834 00:46:51,080 --> 00:46:53,200 Speaker 1: of how it's called. There's less what they used to 835 00:46:53,239 --> 00:46:56,480 Speaker 1: call obstruction, hooking and holding and clutching and grabbing, and 836 00:46:56,560 --> 00:46:58,800 Speaker 1: so if you've got speed and you can got skill, 837 00:46:59,160 --> 00:47:01,239 Speaker 1: you can play this game. Let me ask you a 838 00:47:01,239 --> 00:47:04,280 Speaker 1: final question here on the Vegas Golden Nights, Bill Fully, 839 00:47:04,320 --> 00:47:06,240 Speaker 1: the owner of the team, has said that his team 840 00:47:06,560 --> 00:47:09,040 Speaker 1: won't be available to bet on it some casinos on 841 00:47:09,120 --> 00:47:11,640 Speaker 1: game day. Is there any plan for the league to 842 00:47:12,040 --> 00:47:15,279 Speaker 1: ask bookies not to take better The answer is, we're 843 00:47:15,320 --> 00:47:18,440 Speaker 1: not concerned about the betting on the game per se. 844 00:47:18,480 --> 00:47:20,479 Speaker 1: There's a lot of betting going on, some of it legal, 845 00:47:20,560 --> 00:47:23,080 Speaker 1: some of it's illegal. What we want to do is 846 00:47:23,200 --> 00:47:27,320 Speaker 1: make sure that the environment in the arena is typical 847 00:47:27,400 --> 00:47:30,759 Speaker 1: of what you see at an NHL arena, which is 848 00:47:30,840 --> 00:47:34,120 Speaker 1: fan friendly, kid friendly, and like, we don't want it. 849 00:47:34,160 --> 00:47:35,959 Speaker 1: Not that there's anything wrong with it, but we don't 850 00:47:35,960 --> 00:47:39,000 Speaker 1: want it, like, for example, at a race track where 851 00:47:39,040 --> 00:47:41,439 Speaker 1: you can go get a ticket and go sit down 852 00:47:41,560 --> 00:47:43,960 Speaker 1: and watch the event. We're looking you know, people are 853 00:47:43,960 --> 00:47:46,440 Speaker 1: gonna bet we don't want to make it part of 854 00:47:46,480 --> 00:47:50,040 Speaker 1: the same experience you mentioned last year in your ute 855 00:47:50,200 --> 00:47:53,760 Speaker 1: and wisdom. The resurgence of the Toronto A believes arguably 856 00:47:53,760 --> 00:47:56,960 Speaker 1: the most valuable sports entity in the world. Some would 857 00:47:57,040 --> 00:47:59,120 Speaker 1: argue that, but I don't. I'm with them on it. 858 00:48:00,000 --> 00:48:02,480 Speaker 1: What's your insight this year on this season? Who are 859 00:48:02,480 --> 00:48:07,759 Speaker 1: you watching? Um, it's it's well, well, what's gonna be 860 00:48:07,800 --> 00:48:11,600 Speaker 1: interesting is the fact that we provided the Golden Knights 861 00:48:11,680 --> 00:48:14,600 Speaker 1: with the deepest expansion dract you've ever had, so they 862 00:48:14,640 --> 00:48:16,919 Speaker 1: will they should be more competitive, be fun to watch. 863 00:48:17,200 --> 00:48:19,600 Speaker 1: What when you look at our game, the number of 864 00:48:19,719 --> 00:48:23,840 Speaker 1: young players across the league, whether whether it's Keel and 865 00:48:23,960 --> 00:48:28,839 Speaker 1: Buffalo or a line a uh in Winnipeg or McDavid 866 00:48:28,920 --> 00:48:33,239 Speaker 1: and Edmonton or Austin Matthews in Toronto and two or 867 00:48:33,280 --> 00:48:36,719 Speaker 1: three other young players on each of those teams. Uh, 868 00:48:37,280 --> 00:48:39,400 Speaker 1: this is a young man's game, Gary Batman, thank you, 869 00:48:39,520 --> 00:48:52,560 Speaker 1: congratulations on another NHL season. Thanks for listening to the 870 00:48:52,600 --> 00:48:59,440 Speaker 1: Bloomberg Surveillance podcast. Subscribe and listen to interviews on Apple Podcasts, SoundCloud, 871 00:48:59,760 --> 00:49:03,640 Speaker 1: or whichever podcast platform you prefer. I'm on Twitter at 872 00:49:03,680 --> 00:49:08,360 Speaker 1: Tom Keene. David Gura is at David Gura. Before the podcast, 873 00:49:08,640 --> 00:49:12,040 Speaker 1: you can always catch us worldwide. I'm Bloomberg Radio