{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://iastate.aviaryplatform.com/iiif/4f1mg7g98t/manifest","type":"Manifest","label":{"en":["Roy, William R., The Future of Public Programs in Health Care"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/004/original/ISULogo.png?1601681107","metadata":[{"label":{"en":["Preferred Citation"]},"value":{"en":["Rostrum. Iowa State University Lecture Series (RS 8/6/53). Special Collections and University Archives, Iowa State University Library, Ames, Iowa."]}},{"label":{"en":["Publisher"]},"value":{"en":["Iowa State University. Special Collections and University Archives"]}},{"label":{"en":["Rights Statement"]},"value":{"en":["There are no restrictions on access. (access)","This item is protected by copyright and/or related rights. You are free to use this item in any way that is permitted by the copyright and related rights legislation that applies to your use. 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sessions","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=22.23,23.9"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/7","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"of the Congress in Washington, DC","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=23.9,26.23"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/8","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"the 92nd and the 93rd,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=26.23,28.49"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/9","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"a person who, while coming from Illinois","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=28.49,31.44"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/10","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"now situated in Kansas and studied medicine","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=31.44,35.18"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/11","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"at Northwestern university law at Washburn","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=35.18,38.09"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/12","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and has been a participant in the formation","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=38.09,40.15"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/13","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"of a number of pieces of important legislation","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=40.15,42.2"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/14","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"associated with health and tended to related 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medicine.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=69.6,70.63"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/24","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I've never claimed to be a lawyer.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=70.63,72.61"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/25","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"My wife and I, for some 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1970","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=77.55,80.91"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/28","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"at Washburn at Topeka.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=80.91,82.08"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/29","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"It happened to be very, very handy.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=82.08,84.33"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/30","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And in 1970, I graduated from law school","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=84.33,86.77"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/31","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and then shortly 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happened.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=101.42,104.05"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/38","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So I called her and I said, \"Mother,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=104.05,105.67"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/39","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I'm going to run for 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Florida.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=137.71,139.71"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/54","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And then later appeared on a panel","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=139.71,141.32"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/55","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"with a good friend of mine, Dr. Ernest Seward.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=141.32,143.29"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/56","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And we were talking about that particular proposed law.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=143.29,147.37"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/57","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And Dr. Seward said, \"Bill, the thing wrong","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=147.37,150.29"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/58","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"with that law is you're going to love it to death.\"","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=150.29,152.86"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/59","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And what he meant by that was we were going to","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=152.86,154.42"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/60","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"set such high standards for health maintenance organizations","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=154.42,157.4"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/61","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"that nobody would be able to qualify.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=157.4,159.85"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/62","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Well, in a sense, I'm going to","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=159.85,160.96"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/63","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"love you to death this evening.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=160.96,162.28"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/64","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And I'm going to extend to you","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=162.28,163.23"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/65","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"from the beginning of my sympathy","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=163.23,165.28"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/66","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"because I'm going to read a talk to you","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=165.28,167.097"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/67","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and a talk shouldn't be read.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=167.097,169.26"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/68","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"If I was an academician","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=169.26,171.32"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/69","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and could qualify this as a paper","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=171.32,172.94"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/70","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"perhaps I would have an excuse for reading it.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=172.94,175.08"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/71","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And there are two things wrong with me reading to you.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=175.08,177.12"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/72","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"One is I don't read very well.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=177.12,178.733"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/73","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And the other is that unless I'm very, very careful","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=179.78,182.706"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/74","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I'm tempted to comment on my speech as I go along.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=182.706,186.72"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/75","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And that sometimes can stretch out","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=186.72,188.931"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/76","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"the words that are on the paper.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=188.931,190.683"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/77","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"As you folks here know nearly-","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=191.81,195.31"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/78","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"the people of nearly every industrialized nation have acted","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=195.31,198.2"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/79","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"to guarantee basic medical care","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=198.2,200.16"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/80","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"for every individual and their societies","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=200.16,202.77"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/81","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"by establishing a national health service","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=202.77,205.49"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/82","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"or a national health insurance program.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=205.49,207.853"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/83","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"They have acted and we will act","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=209.0,211.54"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/84","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"because of the principles of fairness and equity.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=211.54,214.463"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/85","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"We accept that no one should die or suffer","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=216.03,218.52"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/86","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"because he or she cannot pay for medical care","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=218.52,221.65"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/87","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"or because medical care is inaccessible to him or her.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=221.65,225.813"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/88","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"But if we are to act wisely","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=227.04,228.41"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/89","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"as we move to national health insurance,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=228.41,231.55"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/90","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"we need to know no all we can","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=231.55,233.43"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/91","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"about our current health system","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=233.43,235.54"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/92","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and the trade-offs that will be facing us","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=235.54,238.07"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/93","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and will necessarily be considered","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=238.07,240.2"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/94","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"in any future health system.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=240.2,241.683"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/95","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"In addition, we must be as clear and realistic","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=242.61,245.55"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/96","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"as possible about our goals and our expectations.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=245.55,250.29"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/97","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Comment, I would underline expectations","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=250.29,252.94"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/98","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"because I know many times our promises have exceeded-","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=252.94,257.03"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/99","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Our promises and expectations have exceeded","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=257.03,259.17"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/100","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"that which we've been able to deliver.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=259.17,261.46"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/101","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And for these reasons","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=261.46,262.57"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/102","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I am very pleased to participate in this program.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=262.57,265.43"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/103","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I congratulate you for calling it for attending it.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=265.43,269.65"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/104","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And I also congratulate you","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=269.65,271.09"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/105","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"upon your further plans to disseminate","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=271.09,273.69"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/106","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and consider further the information that you're","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=273.69,276.96"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/107","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"gathering here these three days.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=276.96,278.973"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/108","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"While we can learn a great deal","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=280.82,282.01"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/109","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"from the experience of other nations,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=282.01,284.25"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/110","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"the most important things I'm sure","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=284.25,286.042"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/111","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"we're going to have to learn for ourselves.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=286.042,288.83"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/112","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Because we're approaching national health insurance","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=288.83,291.17"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/113","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"not only at a different time chronologically,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=291.17,293.95"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/114","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"but at a greatly different time measured","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=293.95,296.05"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/115","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"in terms of medical knowledge and technology.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=296.05,299.6"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/116","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Our health system is presently highly advanced","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=299.6,302.61"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/117","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and has well established patterns of financing and care.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=302.61,306.41"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/118","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"In addition, of course, we have a unique economic system","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=306.41,309.95"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/119","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and we also have deeply held convictions","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=309.95,312.97"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/120","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"about the role of government","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=312.97,314.9"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/121","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and the responsibilities of individual citizens,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=314.9,317.68"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/122","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"which differ at least in degree from those of other nations","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=317.68,320.88"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/123","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"in which also differ from other periods of history","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=320.88,324.11"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/124","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"in our own nation.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=324.11,325.143"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/125","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"While it's difficult to deal with changes","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=326.46,328.28"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/126","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"which come about at a never accelerating rate","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=328.28,331.26"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/127","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"there are three medical facts of life","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=331.26,333.73"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/128","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"which are virtually undisputed today","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=333.73,336.88"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/129","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"in which I hold will be true in the foreseeable future.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=336.88,341.113"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/130","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I also believe that these","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=342.39,344.43"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/131","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"facts must be used as guideposts as we make our plans","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=344.43,347.84"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/132","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and in the future, as we measure our achievements","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=347.84,351.02"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/133","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"First,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=351.02,352.59"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/134","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"it is imperative that we realize that we cannot provide all","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=352.59,355.7"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/135","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"of the medical care that is scientifically","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=355.7,358.42"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/136","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and technologically possible for everyone everywhere.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=358.42,361.103"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/137","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Secondly, as a result of this limitation","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=362.61,365.64"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/138","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"we must decide what we're going to do for whom, where.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=365.64,368.733"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/139","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And thirdly, we must always keep before us the","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=369.74,372.71"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/140","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"fact that personal medical care,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=372.71,375.48"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/141","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"personal health care medical care,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=375.48,377.58"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/142","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"is only one of the determinates of health and longevity.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=377.58,381.253"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/143","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So I'll take a few minutes If I may","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=382.09,383.61"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/144","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and review these three points with you.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=383.61,385.73"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/145","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And then after reviewing these three points","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=385.73,387.72"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/146","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I will discuss some of the implications","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=387.72,390.14"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/147","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"which I believe flow from these limitations.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=390.14,392.993"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/148","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"We cannot do everything that's scientifically","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=394.07,395.77"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/149","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"possible for everyone everywhere.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=395.77,397.95"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/150","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"We, as a society have long accepted this economic reality","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=397.95,402.19"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/151","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"about nearly every service and product except healthcare.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=402.19,406.033"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/152","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Victor Fuchs, an economist has put the","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=407.13,408.88"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/153","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"basic economic laws simply and succinctly","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=408.88,412.39"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/154","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"quote, the first is that resources are scarce","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=412.39,415.57"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/155","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"relative to human wants.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=415.57,417.53"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/156","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Second, is that resources have alternative uses.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=417.53,421.6"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/157","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And third, that people have different wants","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=421.6,424.96"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/158","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"to which they attach varying degrees of importance.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=424.96,428.83"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/159","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I think this third one is particularly important","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=428.83,431.6"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/160","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"in our economic system, in our society.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=431.6,433.633"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/161","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"While we 6% of the world's people","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=434.79,437.5"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/162","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"continue to consume approximately 30%","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=437.5,439.93"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/163","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"of the world's resources each year,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=439.93,442.69"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/164","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"even we in wealthy America are beginning to realize","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=442.69,446.19"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/165","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"the finiteness of energy sources and other raw materials.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=446.19,449.77"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/166","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And to appreciate that nearly everything consumed","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=449.77,452.38"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/167","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"must first be produced","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=452.38,454.2"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/168","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"by combining capital, raw materials, and labor.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=454.2,457.53"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/169","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"The economic romanticism of the sixties is yielding","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=457.53,460.39"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/170","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"to the realities of the seventies","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=460.39,462.72"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/171","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"political leaders of every persuasion.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=462.72,465.47"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/172","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Look at us seriously and repeat profoundly,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=465.47,467.717"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/173","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"\"There is no free lunch.\"","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=467.717,469.84"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/174","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Yet by choice or by happenstance.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=469.84,472.6"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/175","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"We are greatly increasing the percentage of our wealth","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=472.6,475.52"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/176","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and productivity that is consumed for medical 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mark.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1194.63,1196.36"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/428","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So this is equally balanced, I guess between this","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1196.36,1200.23"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/429","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"somewhat long explanation and the balance of the talk.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1200.23,1204.673"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/430","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I believe these alternative mechanisms","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1205.63,1208.31"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/431","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"should be measured by at least four criteria.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1209.7,1212.253"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/432","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Back again. I'm going to talk about four mechanisms","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1214.84,1216.98"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/433","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"for containing costs of health care.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1216.98,1220.0"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/434","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And these four mechanisms 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idealistic,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1237.874,1240.27"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/441","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"but certainly that is compatible","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1240.27,1242.8"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/442","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I think with very many basic 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nation,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1255.64,1257.96"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/447","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"commensurate with the state","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1257.96,1259.46"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/448","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"of the art and science of medical care.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1259.46,1261.653"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/449","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And if Louis Thomas had been with us","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1263.34,1264.83"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/450","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"he would have a great deal to say about 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values","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1278.613,1281.38"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/457","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and national values and needs.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1282.49,1285.693"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/458","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"The harmony of these two often conflicting values","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1287.1,1289.83"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/459","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"is ultimately reconciled by government.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1289.83,1292.5"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/460","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Essentially. There's no other way.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1292.5,1294.4"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/461","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Which determines the combination of market forces","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1294.4,1297.52"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/462","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and regulation in the healthcare industry at any given 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efficiency","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1306.21,1309.17"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/465","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"of the healthcare system.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1310.06,1311.89"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/466","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And time and time again, as we talk about these many 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degree","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1322.63,1324.43"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/471","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"that it increases longevity","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1324.43,1326.63"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/472","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and decreases suffering and disability.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1326.63,1328.49"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/473","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Or to put it another way,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1328.49,1329.98"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/474","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"the medical care system is effective,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1329.98,1332.27"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/475","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"or other health initiatives,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1332.27,1333.83"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/476","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"are effective to the degree that they lengthen","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1333.83,1336.79"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/477","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"the number of years of useful life.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1336.79,1339.473"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/478","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"A more efficient system","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1340.86,1343.15"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/479","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"provides an identical service or product at a lesser cost.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1343.15,1347.223"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/480","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"A fourth criterion is whether or not","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1349.18,1351.99"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/481","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"the cost containment mechanism is compatible","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1351.99,1354.63"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/482","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"with the degree of equity and fairness","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1354.63,1357.26"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/483","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"which are the first goals of national health insurance.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1357.26,1361.653"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/484","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I will discuss four cost containment mechanisms.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1362.71,1365.34"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/485","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Number one,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1365.34,1366.65"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/486","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"arbitrary expenditure limitations imposed by government.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1366.65,1370.093"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/487","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Number two, process regulation.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1371.5,1374.163"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/488","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Number three, input 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government,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1478.57,1480.68"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/523","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"excuse me, on a state budgets.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1480.68,1483.023"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/524","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Federal government officials repeatedly","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1484.58,1486.55"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/525","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"proposed caps on Medicare expenditures","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1486.55,1488.77"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/526","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and incidentally that's bipartisan,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1490.01,1492.15"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/527","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"president Ford proposed such a cap,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1492.15,1494.41"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/528","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"the congressional budget committees proposed such a cap","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1494.41,1497.89"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/529","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"as the 1978 fiscal year budget was under consideration.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1497.89,1502.623"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/530","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And we all 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misnomer.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1508.6,1510.483"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/533","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"that's currently being considered by the Congress.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1511.76,1514.62"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/534","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"This bill proposes federal government 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patients","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1519.18,1520.86"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/537","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"including private patients who are not entitled","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1520.86,1523.038"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/538","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"to any government payment for their hospital bills.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1523.038,1525.663"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/539","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Expenditure limitations for Medicaid","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1526.84,1528.64"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/540","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"are widening our dual system,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1528.64,1530.393"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/541","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and we have a dual system","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1531.67,1532.9"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/542","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and it's getting worse and worse and worse","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1532.9,1534.64"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/543","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"at one level of health care for the indigent","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1534.64,1537.88"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/544","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and another level of healthcare for all others.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1537.88,1540.86"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/545","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And while we haven't quite done that","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1540.86,1542.15"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/546","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"where it's threatening to do that with Medicare.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1542.15,1544.83"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/547","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So then we can say the indigent the elderly and the disabled","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1544.83,1548.23"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/548","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and another level of care for all 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poor.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1552.94,1554.89"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/551","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Almost anyone who could afford to","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1556.51,1558.2"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/552","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"seems to be withdrawing services from the poor","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1558.2,1560.54"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/553","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"because sometimes they get 60% of their usual charge","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1561.62,1564.79"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/554","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"sometimes they get 50%","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1564.79,1567.04"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/555","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and therefore","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1567.04,1569.66"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/556","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"somewhere along the line,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1569.66,1570.91"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/557","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I guess because they thought they were promised payment","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1570.91,1572.97"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/558","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"for taking care of the poor","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1572.97,1575.15"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/559","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"or for some other reason, they withdraw their services.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1575.15,1578.61"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/560","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Institutions are shifting costs to others.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1578.61,1580.893"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/561","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Government caps are much more likely","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1582.21,1584.51"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/562","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"to reflect the average Americans abhorrence of taxes.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1586.08,1589.023"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/563","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Other words, if you can't tax and get more money","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1590.28,1592.14"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/564","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"in the government, you have greater expenses.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1592.14,1594.38"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/565","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"You're going to have to cap expenses, or I guess","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1594.38,1596.51"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/566","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"continue to write deficits.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1596.51,1598.48"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/567","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"What are we talking about this year?","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1598.48,1600.09"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/568","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"We're still in the 60 to $70 billion range, I 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reflecting","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1606.24,1608.46"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/571","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"the public's abhorrence of taxes","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1608.46,1611.92"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/572","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and the relative relation","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1611.92,1614.14"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/573","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"of health to other government priorities.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1614.14,1617.363"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/574","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Rather than the real importance","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1618.98,1620.423"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/575","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"that the people of this nation place on health.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1620.423,1622.793"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/576","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"If government arbitrarily 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correlated","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1628.32,1631.14"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/579","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"in any way with the state of the art and science","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1632.4,1634.56"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/580","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"of medical care and the true needs of the American people.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1634.56,1637.46"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/581","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Caps may or may not increase the effectiveness","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1638.82,1641.9"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/582","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and efficiency of the healthcare delivery system.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1641.9,1644.94"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/583","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And please don't get the wrong picture in this sense.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1644.94,1647.73"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/584","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"There's certainly a great deal to be done in this 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programs.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1679.61,1681.51"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/595","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"In a sense, when the Carter administration","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1681.51,1683.16"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/596","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"talks about 9% across the 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fraud.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1723.16,1725.67"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/609","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Retrospectively it's not surprising that government programs","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1725.67,1729.81"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/610","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"have gone up,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1729.81,1731.0"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/611","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"the cost of government programs have gone up","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1731.0,1732.99"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/612","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"at an even more rapid rate","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1732.99,1734.83"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/613","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"than total national health expenditures.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1734.83,1737.493"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/614","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Government's not dumb in it's collective sense.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1738.74,1741.78"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/615","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So it's not surprising that government became quickly aware,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1741.78,1745.72"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/616","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I think they were aware before they 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costs,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1750.14,1752.92"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/619","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"government should not pay for unnecessary services.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1752.92,1755.803"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/620","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Government should not pay for services","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1756.68,1758.22"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/621","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"of less than standard quality.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1758.22,1759.913"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/622","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And government should not pay for services provided in","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1760.96,1763.52"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/623","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"costly but inappropriate settings.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1763.52,1766.65"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/624","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I try to avoid the term inappropriate","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1766.65,1768.41"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/625","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"because I don't know any term","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1768.41,1771.23"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/626","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"that is less appropriate than inappropriate,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1772.67,1775.66"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/627","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"but we do sneak it in once in a while.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1775.66,1777.56"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/628","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"In order to review services and 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insurance.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1894.49,1897.14"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/665","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And the best bet is that it will be in all probability.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1897.14,1900.46"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/666","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"This is what our national health insurance law,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1900.46,1902.79"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/667","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"if and when we have one will look like.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1902.79,1904.82"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/668","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Literally billions of services will have to be reviewed","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1904.82,1908.29"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/669","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"either on a sampling or on a service by service basis.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=1908.29,1911.893"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/670","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Third way of containing 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size","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2147.31,2149.62"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/747","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"of the healthcare system by government control of inputs.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2149.62,2153.363"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/748","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"If we can not do everything for everyone everywhere","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2155.29,2158.26"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/749","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and we can not, the least unacceptable alternative","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2158.26,2162.05"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/750","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"you ever hear politicians talking","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2163.73,2164.57"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/751","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"about least unacceptable alternatives.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2164.57,2166.33"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/752","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"We were talking about politics at dinner tonight","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2166.33,2169.14"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/753","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and I'm two and a half or three years away from it.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2169.14,2172.09"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/754","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And I said that I, I can forget about it","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2172.09,2173.75"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/755","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"as long as people don't talk about it.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2173.75,2175.46"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/756","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And then I get a little bit excited again.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2175.46,2177.57"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/757","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So maybe that the reason I mentioned politics again","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2177.57,2180.46"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/758","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and politicians again, but 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want","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2193.61,2196.77"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/763","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and what personal health services we're willing to pay for.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2196.77,2199.34"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/764","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And there are three different things.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2199.34,2200.79"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/765","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"There isn't enough money in the country","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2200.79,2202.1"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/766","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"to provide all the services we want.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2202.1,2204.61"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/767","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"There's a real question, whether there's enough","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2204.61,2207.02"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/768","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"enough money in governmental budgets","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2207.02,2208.52"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/769","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"to provide all the health services we need.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2208.52,2210.67"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/770","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And there's a great question","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2211.93,2213.62"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/771","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"as to how many health services we're going to pay for.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2213.62,2216.54"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/772","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"But anyway, the least unacceptable alternative","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2216.54,2219.095"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/773","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"is to make these decisions.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2219.095,2221.39"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/774","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And then to make certain that the facilities","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2221.39,2222.878"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/775","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and skilled people are available to provide these services","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2222.878,2226.45"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/776","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"on an equitable basis to all citizens of our nation.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2226.45,2230.053"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/777","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Now I said at least once, and maybe more than once","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2231.29,2234.94"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/778","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"in the absence of a marketplace","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2234.94,2236.92"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/779","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and nearly all national health insurance proposals assume","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2238.12,2241.91"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/780","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"that there's no way to re-establish","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2241.91,2243.031"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/781","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"a marketplace for health services.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2243.031,2245.383"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/782","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"The greatest hang up being I'm sure,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2246.87,2248.5"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/783","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"how in the world can a marketplace be equitable.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2248.5,2251.003"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/784","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And until recently I have made this same assumption,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2252.29,2255.79"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/785","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"but over the past year, I've become less certain","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2255.79,2260.03"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/786","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"as to whether or not we can at least","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2261.18,2263.66"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/787","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"in part establish a marketplace.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2263.66,2265.94"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/788","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"So the fourth way of determining cost containment","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2265.94,2269.75"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/789","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and total expenditures for health in this country","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2269.75,2272.64"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/790","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"might be a return to market forces","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2273.74,2276.22"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/791","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"or at least to some degree a returned to market forces.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2276.22,2278.97"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/792","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Now to show you how I felt a year ago","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2280.17,2282.2"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/793","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I wrote a little article and it said this quote","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2282.2,2284.26"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/794","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"total national expenditures for 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annually.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2289.63,2291.53"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/797","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And based on the laws of supply and demand","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2293.13,2295.36"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/798","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and the specific 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another,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2355.496,2358.25"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/823","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"applying law could be won","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2358.25,2360.09"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/824","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"as far as access to the market of 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further","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2365.43,2366.79"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/827","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"a return turned to a free market is exceedingly unlikely","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2366.79,2370.07"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/828","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"because of the obvious value","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2370.07,2371.52"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/829","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"that the American people place on health,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2371.52,2374.14"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/830","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"the size of present day house bills,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2374.14,2376.513"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/831","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"the present reliance on health insurance,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2377.43,2380.07"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/832","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and the demand for equity in healthcare.\"","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2380.07,2382.958"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/833","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"End of quote.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2382.958,2384.13"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/834","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Since I returned to the private sector in January of 1975","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2384.13,2387.303"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/835","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I've become increasingly interested","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2387.303,2389.75"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/836","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"in whether or not it's 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mechanisms","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2411.54,2413.85"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/845","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and which will fail","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2413.85,2415.83"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/846","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"totally or dismally","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2417.09,2418.4"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/847","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"to reorganize the healthcare delivery system.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2418.4,2421.42"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/848","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"In addition, I've continued to 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that","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2426.0,2427.53"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/851","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"is heavily government regulated.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2427.53,2430.2"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/852","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And we're hearing this from the so-called liberals","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2430.2,2431.99"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/853","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and the so-called conservatives and everything in between.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2431.99,2435.09"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/854","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"As far as the air transport industry.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2435.09,2437.9"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/855","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"We've seen it as far as the railroads","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2437.9,2440.2"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/856","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Were having increasing 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Schultze,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2471.44,2473.563"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/867","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"not known as a Neanderthal man,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2474.67,2477.2"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/868","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"in the May 1977 Harper's","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2477.2,2480.21"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/869","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and taken from three lectures he gave at Harvard","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2480.21,2482.3"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/870","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"called the Godkin lectures","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2482.3,2484.52"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/871","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and entitled \"The public use of the private interest\"","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2484.52,2488.18"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/872","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"deals with market failure","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2488.18,2489.7"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/873","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and the federal government's efforts to substitute,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2489.7,2492.54"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/874","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"quote, a command and control 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panels","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2513.69,2515.92"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/881","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and by the courts","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2515.92,2517.04"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/882","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"often all three in 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imposing","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2523.85,2526.09"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/885","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"command and control solutions","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2526.09,2528.56"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/886","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"over an ever-widening sphere","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2528.56,2530.24"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/887","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"of social and economic activity.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2530.24,2532.013"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/888","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And what I've indicated to you thus 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efficiency,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2654.72,2657.5"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/931","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"but the test would be","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2657.5,2658.93"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/932","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"whether or not they are more 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competition","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2668.12,2670.63"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/935","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"in the healthcare delivery system.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2670.63,2672.8"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/936","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"It is my intention to interest you","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2672.8,2674.67"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/937","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"in inquiring into the possibility","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2675.91,2678.15"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/938","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"of restoring competition and marketplace considerations","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2678.15,2681.35"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/939","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"to the provision of healthcare services","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2681.35,2683.47"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/940","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"as a part of a national health insurance program.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2683.47,2686.36"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/941","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"At the very least I urge you","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2686.36,2687.69"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/942","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"to examine carefully the incentives","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2687.69,2689.59"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/943","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and disincentives that exist in our system","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2689.59,2693.13"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/944","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and to determine whether or not","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2693.13,2694.9"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/945","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"they may be modified in such a way","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2694.9,2697.5"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/946","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"that government regulation could be lessened","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2697.5,2699.98"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/947","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"rather than increased and made more severe","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2699.98,2702.94"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/948","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"or I might 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up-","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2707.87,2711.31"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/951","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and my, where did the time go?","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2711.31,2712.883"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/952","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"May have been a long time for you,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2715.15,2716.32"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/953","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"it was a short time for me.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2716.32,2717.67"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/954","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I realized that my talk may leave you","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2719.32,2721.24"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/955","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"with a sense of frustration.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2721.24,2722.893"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/956","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And I share that frustration","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2724.35,2726.4"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/957","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"as a physician I would like for every physician","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2726.4,2730.14"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/958","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"to be able to do everything that's scientifically","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2730.14,2733.02"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/959","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and technologically possible for each patient,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2733.02,2735.533"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/960","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"my wants are the same as everybody else's wants.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2736.84,2740.08"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/961","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Everybody wants a Mayo clinic every 400 yards","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2740.08,2743.71"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/962","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"plus a bunch of family physicians to go with it.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2743.71,2746.123"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/963","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"As a family man I would like for each member of my family","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2747.47,2750.3"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/964","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"to have accessible at all times,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2750.3,2752.35"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/965","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"not just quote, basic medical services","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2752.35,2755.07"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/966","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"but every medical service","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2755.07,2756.17"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/967","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"that might be of marginal benefit to them.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2756.17,2758.27"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/968","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"And I'd like to have the same thing for myself.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2759.42,2761.77"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/969","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"People if asked, automatically answer that they think","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2763.32,2766.96"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/970","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"everybody should have better than average medical care.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2766.96,2769.72"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/971","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I don't know of anybody in this room","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2769.72,2770.95"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/972","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"that probably wants average medical care,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2770.95,2773.58"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/973","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"but people answer this question","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2773.58,2774.94"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/974","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and make this statement of course,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2774.94,2776.0"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/975","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"without realizing the impossibility of such a goal,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2776.0,2778.563"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/976","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"but the fact remains that is no more 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possible","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2786.58,2789.81"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/979","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"to obtain individual immortality.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2789.81,2792.043"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/980","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Our only choice is to act consistent","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2794.1,2796.54"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/981","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"with our individual value systems","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2796.54,2799.54"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/982","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and our sense of fairness, equity, and justice,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2799.54,2802.71"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/983","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and our concern for our fellow man","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2802.71,2804.58"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/984","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"and to work to make certain that our government is,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2805.49,2807.84"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/985","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"to repeat a recent successful theme,","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2807.84,2810.78"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/986","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"as good and decent as the American people.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2810.78,2812.84"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/987","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Thank you very, very much.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2812.84,2814.757"},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/988","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"(applause)","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=2814.757,2817.007"}]},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108","type":"AnnotationPage","label":{"en":["English [Transcript]"]},"items":[{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30108/annotation/989","type":"Annotation","motivation":"subtitling","body":{"type":"TextualBody","value":"https://d9jk7wjtjpu5g.cloudfront.net/file_transcripts/associated_files/000/030/108/original/AV167963_Rostrum_a.vtt?1624899268","format":"text/vtt","language":"en"},"target":"https://d9jk7wjtjpu5g.cloudfront.net/file_transcripts/associated_files/000/030/108/original/AV167963_Rostrum_a.vtt?1624899268"}]},{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30109","type":"AnnotationPage","label":{"en":["AV167963_Rostrum_a.txt [Transcript]"]},"items":[{"id":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627/transcript/30109/annotation/990","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"- This evening, we have a very interesting and I think from my perspective, at least and I'm sure you'll find from yours an exciting member of the medical profession, a person who has experience in the area of law, a person who served in two sessions of the Congress in Washington, DC the 92nd and the 93rd, a person who, while coming from Illinois now situated in Kansas and studied medicine at Northwestern university law at Washburn and has been a participant in the formation of a number of pieces of important legislation associated with health and tended to related matters. Dr. William R. Roy is our speaker this evening and he will deliver to us a lecture entitled \"The Future of Public Programs in Healthcare.\" Dr. Roy.\r\n\r\n- Thank you very much. If you listened closely to the introduction, you notice that I have a degree in law and a degree in medicine. I've never claimed to be a lawyer. My wife and I, for some reason which we haven't figured out to this day went to law school between 1964 and 1970 at Washburn at Topeka. It happened to be very, very handy. And in 1970, I graduated from law school and then shortly thereafter determined that I would at least run for Congress with the prospect that I would leave my practice of 15 years if I won. The prospect incidentally wasn't very, very good. But I thought I should call my mother back in Illinois and tell her what had happened. So I called her and I said, \"Mother, I'm going to run for Congress.\" And there was a long silence on the other end of the line. I said, \"Mother, are you there?\" She says, \"Yes son, I'm here.\" I said, \"Did you hear what I said? I'm going to run for Congress.\" She says, \"Yes.\" She says, \"I heard you. I knew if you get mixed up with a bunch of lawyers, something horrible would happened to you.\" I am delighted to be here. I recall one other incident that I will pass on to you. I was speaking to a medical audience, which was very much against the health maintenance organization concept down in Fort Lauderdale, Florida. And then later appeared on a panel with a good friend of mine, Dr. Ernest Seward. And we were talking about that particular proposed law. And Dr. Seward said, \"Bill, the thing wrong with that law is you're going to love it to death.\" And what he meant by that was we were going to set such high standards for health maintenance organizations that nobody would be able to qualify. Well, in a sense, I'm going to love you to death this evening. And I'm going to extend to you from the beginning of my sympathy because I'm going to read a talk to you and a talk shouldn't be read. If I was an academician and could qualify this as a paper perhaps I would have an excuse for reading it. And there are two things wrong with me reading to you. One is I don't read very well. And the other is that unless I'm very, very careful I'm tempted to comment on my speech as I go along. And that sometimes can stretch out the words that are on the paper. As you folks here know nearly- the people of nearly every industrialized nation have acted to guarantee basic medical care for every individual and their societies by establishing a national health service or a national health insurance program. They have acted and we will act because of the principles of fairness and equity. We accept that no one should die or suffer because he or she cannot pay for medical care or because medical care is inaccessible to him or her. But if we are to act wisely as we move to national health insurance, we need to know no all we can about our current health system and the trade-offs that will be facing us and will necessarily be considered in any future health system. In addition, we must be as clear and realistic as possible about our goals and our expectations. Comment, I would underline expectations because I know many times our promises have exceeded- Our promises and expectations have exceeded that which we've been able to deliver. And for these reasons I am very pleased to participate in this program. I congratulate you for calling it for attending it. And I also congratulate you upon your further plans to disseminate and consider further the information that you're gathering here these three days. While we can learn a great deal from the experience of other nations, the most important things I'm sure we're going to have to learn for ourselves. Because we're approaching national health insurance not only at a different time chronologically, but at a greatly different time measured in terms of medical knowledge and technology. Our health system is presently highly advanced and has well established patterns of financing and care. In addition, of course, we have a unique economic system and we also have deeply held convictions about the role of government and the responsibilities of individual citizens, which differ at least in degree from those of other nations in which also differ from other periods of history in our own nation. While it's difficult to deal with changes which come about at a never accelerating rate there are three medical facts of life which are virtually undisputed today in which I hold will be true in the foreseeable future. I also believe that these facts must be used as guideposts as we make our plans and in the future, as we measure our achievements First, it is imperative that we realize that we cannot provide all of the medical care that is scientifically and technologically possible for everyone everywhere. Secondly, as a result of this limitation we must decide what we're going to do for whom, where. And thirdly, we must always keep before us the fact that personal medical care, personal health care medical care, is only one of the determinates of health and longevity. So I'll take a few minutes If I may and review these three points with you. And then after reviewing these three points I will discuss some of the implications which I believe flow from these limitations. We cannot do everything that's scientifically possible for everyone everywhere. We, as a society have long accepted this economic reality about nearly every service and product except healthcare. Victor Fuchs, an economist has put the basic economic laws simply and succinctly quote, the first is that resources are scarce relative to human wants. Second, is that resources have alternative uses. And third, that people have different wants to which they attach varying degrees of importance. I think this third one is particularly important in our economic system, in our society. While we 6% of the world's people continue to consume approximately 30% of the world's resources each year, even we in wealthy America are beginning to realize the finiteness of energy sources and other raw materials. And to appreciate that nearly everything consumed must first be produced by combining capital, raw materials, and labor. The economic romanticism of the sixties is yielding to the realities of the seventies political leaders of every persuasion. Look at us seriously and repeat profoundly, \"There is no free lunch.\" Yet by choice or by happenstance. We are greatly increasing the percentage of our wealth and productivity that is consumed for medical care. Expenditures, and you've heard these over and over I suspect Expenditures for health care have increased 500% since 1960. And the portion of the gross national product devoted to medical care has increased nearly 50%. The portion of the gross national product has increased nearly 50% between 1965 and 1976. The slice of the pie has increased by 50%. And as we know, our gross- When I was a partisan politician I used to say, \"In spite of eight years of Republican administration our Gross National product has grown over the last 12 years.\" Today the average American is working one out of every 12 months to pay for medical care. Four prominent forces have caused the medical system to be characterized as a vacuum cleaner that will suck up all dollars made to it. There are one, the expectations of patients i.e. the value we pay place on medical care. This is perhaps best illustrated by the recitation of the belief that medical care is a basic human right. Two, the scientific and technologic revolution. Three, the open-ended third-party payment programs which we have for most of our citizens and four a physician ethic whereby each physician tries to provide all health care to do everything that's scientifically and technologically possible for each patient. People undeniably value health very highly and their expectations about the scope and efficacy of personal health services have increased year by year. Illich has spoken of this phenomenon as the medicalization of society. However, the single greatest force responsible for increased health expenditures is that we live in a time of scientific and technologic revolution. Medical knowledge, it is sad, and I think they said it, I don't know who they are, has a half-life of four to seven years. Expensive products of medical technology have a similarly short half-life and therefore are constantly being modified or replaced by newer and more expensive instruments, private health insurance for many people and government payment for services for some people have removed payment at the point of service as a marketplace regulator of the use of medical services. First dollar national health insurance would remove all barriers of cost. If this happens, it is predictable that nearly all people will seek any and all medical services of any possible marginal benefit excepting those that are inconvenient, painful, or dangerous Combining with third-party payment is the force of provider determination of services. We've heard about this again and again. Once one goes to a physician or other health professional that health professional pretty well determines what tests will be run, what services will be provided what surgery might be done and so forth. And as I stated, we physicians are trained to use every available resource possible that may benefit our individual patients, regardless of cost. We do not want to be 95% certain of an additional test or procedure and the associated additional expenditure will make us 97% certain. Furthermore, our patients expect nothing less to my knowledge just has always been so. And it's my expectation that in the one-to-one doctor patient relationship this will always be so. Two other descriptions of our present healthcare system are helpful. One is Hiatt's description of the medical commons. He analogizes the finite resources available in our economy for health services, with a limited commons available to herdsman for grazing their cattle. He points out that a commons is not a marketplace because all of the members of a society are entitled to use the commons. Excuse me. Overutilization and ruin of the commons is inevitable because each individual rushes to use the commons in his or her own self-interest. Each herdsman adds one more animal until the grazing land is destroyed. We've adopted a health service commons for most Americans by the adoption of private health insurance for many people and the aforementioned government payment for services for some people. Many people contend that the passage of universal first dollar payment national health insurance would assure the destruction of the commons. The second helpful perspective is an economist description of our present system. Today, most health institutions are paid on a fee for procedure basis, and most health providers non-institutional providers are paid on a fee for service basis. Dentists, physicians, podiatrist, pharmacists, and so forth. Most consumers are required to pay little or nothing out of pocket in order to obtain hospital services. And nearly 70% of physicians bills are also paid by third parties Fee for service and fee for procedure payment result in what the economists call a positive marginal financial impact each time a service is rendered. That is the more services that are provider renders the more income the provider realizes. First dollar insurance results in a zero marginal financial impact on the consumer. That is each time a service is rendered, there's no financial loss or gain to the consumer. There are rare occasions when there's a positive marginal financial impact on the consumer if he or she can collect on two insurance policies but that doesn't exist very often. This combination results in the maximum utilization of services, the provider gets more money and the consumer gets more services. and the third party, government or insurer gets more bills to pay. There is subsequently a 15% annual increase in expenditures per house. As a result of these four factors and this description costs go up and up at such a rate that few or none within our society will contend that it's mathematically or politically possible to continue indefinitely present trends in increased expenditures for health or that it is possible even in wealthy modern America to do everything which is medically and scientifically possible for everyone everywhere. We must decide what we're going to do for whom. This conclusion is a corollary of the recognition of limited resources for health. In any society whenever there's not enough of something to go around, there are ways formal or informal organized or unorganized less fair and equitable or more fair and equitable of determining who gets what. Many people point out accusingly that any national health insurance law will be a method of rationing healthcare. This is so, but it's also true that today we're rationing healthcare by several mechanisms including the barrier of cost for some people. And incidentally, while that may not be true for 185 million people it may be true for as many as 30 million people. The inaccessibility of services for others, and for others the inability to find a point of entry into a complex health care delivery system. For even others it is a matter of chance whether or not they are beneficiaries of already limited resources. For example, who receives the single kidney available for transplant or which victim of aplastic anemia gets into the one remaining sterile cocoon. All nations with national health insurance or some might call their system socialized medicine which indeed some are, are faced with the same problems of limited resources and the rationing of services. While they address the problems in a variety of ways, the most common resolution is for the government to determine total expenditures for health. Where there is reasonable equality of access to existing services, there has been until this time, little social or political strife, and nearly without exception the citizens of these nations strongly support and endorse their respective systems of national health insurance or national health services. In sum, it is a matter of first magnitude of importance that we recognize and articulate that the most we can expect of any future national health insurance program in this country is equal access to limited basic medical services rather than all medical services. Third point I want to make is one that I suspect has been made several times in the previous presentations but I'll take a little shot at it too. And that is that personal health care is only one determinant of health. There's a great deal of evidence that personal health services alone can provide only marginal improvements in health. One of the most persuasive arguments that I know for the need for health expenditures other than traditional medical services is the documentation in the Lalonde report, \"A new perspective on the health of Canadians\" Of the causes of loss of years of life between ages one and 70, Canadians suffer early death as a result of five main causes. And these five main causes incidentally result in the loss of almost 60% of the years of life that are lost prior to age 70. 1. Motor vehicle accidents. 2. Ischemic heart disease 3. All other accidents 4. Respiratory diseases and lung cancer and 5, suicide. The report points out that most of these causes of premature death cannot be prevented or cured by the medical care system. Accidents and suicides obviously often result in death before any contact is made with the medical care delivery system. We also recognize that diet, lack of exercise, smoking, and environmental factors have a great deal to do with the incidents of the diseases of the heart and the incidents of cancer and other diseases of the lung. Very importantly, a great part of the money available for public health immunizations, health education, environmental control, and similar purposes, comes from public sources rather than private sources. However, the increasing costs of medical care to government the $5 billion plus annual increase in federal expenditures for Medicare and Medicaid have resulted in less adequate public expenditures, i.e. governmental expenditures, for other health initiatives In view of this experience, I believe we must measure each national health insurance program by whether or not it will so greatly increase expenditures for sickness care, medical care, personal health services, that we will spend less and less for other traditionally publicly financed health initiatives. The balance of this presentation, and this is the first time I've seen it typed. I hope my secretary didn't say, \"You're on your own after page 12\", will deal with four mechanisms for containing costs and thereby determining national expenditures for health. We're celebrating the halfway mark. So this is equally balanced, I guess between this somewhat long explanation and the balance of the talk. I believe these alternative mechanisms should be measured by at least four criteria. Back again. I'm going to talk about four mechanisms for containing costs of health care. And these four mechanisms thereby determine total national expenditures for health. Now, what are these criteria? First, the nation's total expenditures for health should reflect the importance that the people of this nation place on health. That may sound vague and idealistic, but certainly that is compatible I think with very many basic beliefs. Second, total expenditure should assure adequate resources. This may be the physician in me speaking. Total expenditures should assure adequate resources to provide for a healthy nation, commensurate with the state of the art and science of medical care. And if Louis Thomas had been with us he would have a great deal to say about this and also commensurate with our abilities to modify other health determinants. The first criterion preserves our respect for individual values and needs. The second criterion indicates a recognition of societal values and national values and needs. The harmony of these two often conflicting values is ultimately reconciled by government. Essentially. There's no other way. Which determines the combination of market forces and regulation in the healthcare industry at any given time. A third criterion is how the cost containment mechanism affects the effectiveness and efficiency of the healthcare system. And time and time again, as we talk about these many things at least as we talk in the narrower term of medical care we should be saying, \"Are we effective?\" and \"Are we efficient?\" The system is effective to the degree that it increases longevity and decreases suffering and disability. Or to put it another way, the medical care system is effective, or other health initiatives, are effective to the degree that they lengthen the number of years of useful life. A more efficient system provides an identical service or product at a lesser cost. A fourth criterion is whether or not the cost containment mechanism is compatible with the degree of equity and fairness which are the first goals of national health insurance. I will discuss four cost containment mechanisms. Number one, arbitrary expenditure limitations imposed by government. Number two, process regulation. Number three, input regulation. And number four a return to some market forces. While these mechanisms are not mutually exclusive. And there isn't much of a social logical nature that is. They do represent distinct approaches to cost containment which are either now partially implemented or which are current proposals, arbitrary expenditure limitations. This is the cost containment mechanism and current vogue the popularity of so-called payment caps reflects the fact that nothing else is working at this time and that the legislative and executive branches of government state and federal view with alarm current rates of increased expenditures for health primarily increased expenditures for medical care. So they're desperate and in their desperation they're seizing upon arbitrary caps as a mechanism which can be implemented rapidly. States are placing arbitrary limitations on expenditures for Medicaid and they're also cutting back benefits for Medicaid. It's interesting how they figure their fee structures or their payment for fee for procedure for hospitals. Oftentimes they figure out how much money can be allotted within the state government, the number of services that they can anticipate divide services into the amount of money and thereby come up with a figure. Which is the number of dollars paid for a service which may or may not have any relativity at all to the cost to providing the service. But this is the way we have moved in recent years because of the tremendous impact of Medicaid on federal government, excuse me, on a state budgets. Federal government officials repeatedly proposed caps on Medicare expenditures and incidentally that's bipartisan, president Ford proposed such a cap, the congressional budget committees proposed such a cap as the 1978 fiscal year budget was under consideration. And we all know that there's a hospital cost containment bill, which really is a misnomer. that's currently being considered by the Congress. This bill proposes federal government limitations on the increase of hospital expenditures for caring for all patients including private patients who are not entitled to any government payment for their hospital bills. Expenditure limitations for Medicaid are widening our dual system, and we have a dual system and it's getting worse and worse and worse at one level of health care for the indigent and another level of healthcare for all others. And while we haven't quite done that where it's threatening to do that with Medicare. So then we can say the indigent the elderly and the disabled and another level of care for all others. Physicians and other health professionals are withdrawing services from the poor. Almost anyone who could afford to seems to be withdrawing services from the poor because sometimes they get 60% of their usual charge sometimes they get 50% and therefore somewhere along the line, I guess because they thought they were promised payment for taking care of the poor or for some other reason, they withdraw their services. Institutions are shifting costs to others. Government caps are much more likely to reflect the average Americans abhorrence of taxes. Other words, if you can't tax and get more money in the government, you have greater expenses. You're going to have to cap expenses, or I guess continue to write deficits. What are we talking about this year? We're still in the 60 to $70 billion range, I think. But anyway, if the government arbitrarily does this they're more likely to be reflecting the public's abhorrence of taxes and the relative relation of health to other government priorities. Rather than the real importance that the people of this nation place on health. If government arbitrarily determines total expenditures for health such expenditures are not likely to be correlated in any way with the state of the art and science of medical care and the true needs of the American people. Caps may or may not increase the effectiveness and efficiency of the healthcare delivery system. And please don't get the wrong picture in this sense. There's certainly a great deal to be done in this area. But this will depend upon how providers are paid and whether or not we see considerably different organization in health care delivery system than we have at the present time. The fourth criterion, the degree of equity and fairness under arbitrary government limitations of expenditures depend upon whether or not government caps total expenditures for health or only places arbitrary limitation on government funded programs. In a sense, when the Carter administration talks about 9% across the board, as far as equity and fairness, that's a great leap forward. When we talk about capping only Medicare and Medicaid it's obviously a great leap in the other direction. Process regulation, a form of government regulation, government, local state and federal pays 40% of the nation's healthcare bills. Providers are paid on cost reimbursement or fee for procedure and fee for service basis. Providers thus have financial incentives to provide more and more services. In addition, government programs as we know have been beset by fraud. Retrospectively it's not surprising that government programs have gone up, the cost of government programs have gone up at an even more rapid rate than total national health expenditures. Government's not dumb in it's collective sense. So it's not surprising that government became quickly aware, I think they were aware before they passed Medicare and Medicaid, that in order to contain costs, government should not pay for unnecessary services. Government should not pay for services of less than standard quality. And government should not pay for services provided in costly but inappropriate settings. I try to avoid the term inappropriate because I don't know any term that is less appropriate than inappropriate, but we do sneak it in once in a while. In order to review services and bills for necessity, quality and appropriateness, federal standards, review organizations and utilization review committees have been established by law and are government expensed. To date these day by day case by case and service by service reviews, as far as we can tell, have done little to contain costs. This is because I believe patients, physicians, and institutions frequently do not perceive utilization and PSRO activities to be in their best interest. For example, it's not perceived by the patient to be in his or her best interest to be removed from an institution where his care is paid for by insurance to a site where his care is not paid for by insurance, the home or some other facility. It is often not perceived by the physician to be in his or her best interest to take the time necessary for the efforts of utilization or quality review or to try to supersede his judgment or colleague's judgment. Particularly when you're talking about days of discharge these are something that are not subject to computers and absolute answers. It is not perceived by a hospital, which is paid on a fee for procedure basis in which has empty beds to be in its best interest, to send patients out of the hospital at the earliest possible moment. And because even government can not expect individuals or institutions or individuals who represent institutions to do the things that they believe are not in their best interests. These regulatory efforts, even with modification have a doubtful future as effective cost containment mechanisms. Furthermore, if this cost containment mechanism the one I just spoke of is process regulation is adopted for national health insurance. And the best bet is that it will be in all probability. This is what our national health insurance law, if and when we have one will look like. Literally billions of services will have to be reviewed either on a sampling or on a service by service basis. Third way of containing costs and determining total expenditures is input regulation. During the short time that I served in Congress I began to recognize the myriad of problems associated with the two methods of federal regulation that I've just reviewed. Arbitrary total expenditure limitations do not seem likely to assure adequate resources to provide for healthcare for this nation commensurate with what we can otherwise do. And case by case regulation seems to be both expensive and ineffective. The major component of input regulation is the planning of the healthcare system instead of leaving its size and its function just to happen as a result of reimbursement and other forces. Other components of input regulation are the development of approved plans and sanctions to prohibit unplanned development, one major group of inputs for providing personal health services is facilities, hospitals, skilled nursing homes, and to a lesser extent physician's offices. Specific inputs such as the equipment necessary to establish a cardiac surgical unit, renal dialysis services, and radiation therapy departments further refine the nature and functions of the hospital. Each physical improvement requires the expenditure of capital, costs money. The health planning and resources development act which requires each state to issue a certificate of need for each hospital capital improvement It is a capital expenditure regulation law. It's an input regulation law. The other major input for house services is manpower, the educated, trained skilled people who provide services by using the facilities and special equipment that are made available to them. Recent federal manpower legislation which mandates more residencies in primary care is a crude manpower input regulation bill. While this law will eventually determine the kinds of physicians we have available to provide care it does not, I feel, deal effectively with determining the numbers and kinds of health professionals who can provide services efficiently but rather the law perpetuates the thinking that the more physicians we have the healthier the American people will become. I don't necessarily think confessions all that good for the soul, but I went to Congress in 1971 in January. And one of the first things I read was the Carnegie report where distinguished educators and others made the determination that we need lots and lots and lots more physicians. And we set underway programs which now had resulted in our medical schools having twice as many freshmen medical students as they had 12 years ago. So that input is more and more and more into the present time. And I accept partial responsibility. It is apparent that at any one time the facilities and manpower available determine total health services available. Obviously there's some expandability in this but generally this is true and all or nearly all services available are likely to be used to capacity. If the services are paid for particularly on a first dollar basis by private insurance or by the government. In sum, in the absence of a marketplace there are only two feasible alternatives that I know of for effectively limiting total health services expenditures. One is an arbitrary government cap on payment which to be maximally effective requires government payment for all or nearly all services. The other is limitation of the size of the healthcare system by government control of inputs. If we can not do everything for everyone everywhere and we can not, the least unacceptable alternative you ever hear politicians talking about least unacceptable alternatives. We were talking about politics at dinner tonight and I'm two and a half or three years away from it. And I said that I, I can forget about it as long as people don't talk about it. And then I get a little bit excited again. So maybe that the reason I mentioned politics again and politicians again, but anyway the least unacceptable alternative is for us to decide what personal health services we need inexact as that determination may be what personal health services we want and what personal health services we're willing to pay for. And there are three different things. There isn't enough money in the country to provide all the services we want. There's a real question, whether there's enough enough money in governmental budgets to provide all the health services we need. And there's a great question as to how many health services we're going to pay for. But anyway, the least unacceptable alternative is to make these decisions. And then to make certain that the facilities and skilled people are available to provide these services on an equitable basis to all citizens of our nation. Now I said at least once, and maybe more than once in the absence of a marketplace and nearly all national health insurance proposals assume that there's no way to re-establish a marketplace for health services. The greatest hang up being I'm sure, how in the world can a marketplace be equitable. And until recently I have made this same assumption, but over the past year, I've become less certain as to whether or not we can at least in part establish a marketplace. So the fourth way of determining cost containment and total expenditures for health in this country might be a return to market forces or at least to some degree a returned to market forces. Now to show you how I felt a year ago I wrote a little article and it said this quote total national expenditures for health would then equal the sum of hundreds of millions of individual decisions made annually. And based on the laws of supply and demand and the specific importance that the individual places on health services this very effective means of allocating resources would require a law prohibiting first dollar private health insurance because your market effect is just the same whether the money comes from government or whether it comes from private insurers that isn't in there. return to the statement. A returned to market forces would also require either some kind of guaranteed income for each citizen so that each citizen could realistically make his or her choice to spend or not to spend for health or a continuation of government payment for health services for the poor. A return to market forces would also require modifications on the supply side including antitrust actions and provisions for increased freedom of access to providers of services to the market. I'm not much of an economist, but I think to have a market one knows one has to have both providers and consumers. And if you have a cartel or limitation of one kind or another, applying law could be won as far as access to the market of providers you certainly could not have a reasonable market. I wrote further a return turned to a free market is exceedingly unlikely because of the obvious value that the American people place on health, the size of present day house bills, the present reliance on health insurance, and the demand for equity in healthcare.\" End of quote. Since I returned to the private sector in January of 1975 I've become increasingly interested in whether or not it's possible to restore marketplace considerations to the medical care system. I've also become increasingly convinced that we have no marketplace today. I've become increasingly concerned as I've already indicated that we're likely to pass a national health insurance law which will continue the adverse incentives of the present provider payment mechanisms and which will fail totally or dismally to reorganize the healthcare delivery system. In addition, I've continued to observe the inefficiencies and ineffectiveness of most private industry that is heavily government regulated. And we're hearing this from the so-called liberals and the so-called conservatives and everything in between. As far as the air transport industry. We've seen it as far as the railroads Were having increasing difficulties with our regulated utilities. And yes, we're even having difficulties with that symbol of private enterprise, the banks. I've been as patiently impressed with the difficulty government has mandating one action when financial incentives dictate another action. We have great areas of market failure in our economy but perhaps even more distressing is how government reacts to market failure. An article by Charles L Schultze, not known as a Neanderthal man, in the May 1977 Harper's and taken from three lectures he gave at Harvard called the Godkin lectures and entitled \"The public use of the private interest\" deals with market failure and the federal government's efforts to substitute, quote, a command and control approach to deal with the specific market failure. End of quote, Dr. Schultze finds that decisions begin, quote and surely this might sound familiar to everyone in the room to be made on a case by case basis by this specific decision of regulators by administrative hearing panels and by the courts often all three in sequence. Close quote, he concludes quote that we cannot afford to go on imposing command and control solutions over an ever-widening sphere of social and economic activity. And what I've indicated to you thus far the process regulation that I see in healthcare is a command and control solution that ain't working as are many other so-called command and control solutions. It is my observation that nearly all federal regulation of health fits in the command and control and case-by-case description and to date, it appears to be unsatisfactory. So a second look at a possible market and the probable results of competition and the provision of healthcare, seems to me at least, to be worthwhile. The most troublesome area in considering a restored marketplace is equity, but equity can be assured if government provides poor and low-income people with adequate purchasing power specifically for health in an amount equal to that possessed by other Americans. True competition, maybe I should read that one again. Equity can be assured if government provides poor and low-income people with adequate purchasing power not necessarily all purchasing power, specifically for health in an amount equal to that possessed by other Americans or reasonably equal to that possessed by other Americans. True competition can perhaps be established only between organized health delivery systems or insurers who are required to be both competitive and at risk. Most insurance companies aren't at risk as we well know what they lose this year, they make up next year. It may be necessary to adopt perspective, excuse me, it may be necessary to adopt prospective capitation payment for defined medical services for a given period of time in order to establish competition and also to retain consumer choice. Just such a system would not rule out fee for procedure and fee for service. If these two payment mechanisms or any other payment mechanism results in greater provider efficiency, but the test would be whether or not they are more efficient. It is not the purpose of this presentation to deal in detail with a plan for structured competition in the healthcare delivery system. It is my intention to interest you in inquiring into the possibility of restoring competition and marketplace considerations to the provision of healthcare services as a part of a national health insurance program. At the very least I urge you to examine carefully the incentives and disincentives that exist in our system and to determine whether or not they may be modified in such a way that government regulation could be lessened rather than increased and made more severe or I might say in such a way that government regulation can be effective. I realize finishing this up- and my, where did the time go? May have been a long time for you, it was a short time for me. I realized that my talk may leave you with a sense of frustration. And I share that frustration as a physician I would like for every physician to be able to do everything that's scientifically and technologically possible for each patient, my wants are the same as everybody else's wants. Everybody wants a Mayo clinic every 400 yards plus a bunch of family physicians to go with it. As a family man I would like for each member of my family to have accessible at all times, not just quote, basic medical services but every medical service that might be of marginal benefit to them. And I'd like to have the same thing for myself. People if asked, automatically answer that they think everybody should have better than average medical care. I don't know of anybody in this room that probably wants average medical care, but people answer this question and make this statement of course, without realizing the impossibility of such a goal, but the fact remains that is no more possible to make immediately available and accessible to all people all medical services than it is possible to obtain individual immortality. Our only choice is to act consistent with our individual value systems and our sense of fairness, equity, and justice, and our concern for our fellow man and to work to make certain that our government is, to repeat a recent successful theme, as good and decent as the American people. Thank you very, very much.","format":"text/plain"},"target":"https://iastate.aviaryplatform.com/collections/1150/collection_resources/45607/file/118627#t=0.0,2841.24"}]}]}]}