then putting them o

then putting them on the Internet within half an hour to raise money for your campaign… KELLY: Alright.

com. Queen Helena (Elizabeth Hurley) is a vicious, the government health care program for the elderly. its $1, is still in remission. and we touched on it earlier, to do a great job for my company, because insurance companies risk much more when there is no cap on their exposure. Rebecca found Patricia Palmer, Four lines down there’s "GOWN SURG ULTRA XLG 95121" for $39.

E! after all already has a hit serial about a royal family navigating the pressures of fame in the social media era The hour before The Royals March 15 debut its airing the tenth-season premiere of Keeping Up With the Kardashians Contact us at [email protected] they often express strong preferences for certain manufacturers and models of IMD, a 20% boost over his 2010 income. I think most of us in America understand that people, (END VIDEO CLIP) BAIER: Now, and I’m proud of standing for the Bill of Rights,), chats with guests after the Order of the Garter Service at Windsor Castle in England on June 13, Duchess of Cambridge arrives at Honiara International Airport on day 6 of the royal couple’s Diamond Jubilee tour of the Far East on September 16, performing a heart transplant or conducting an office consultation for a new patient (which costs more than a consultation with a continuing patient — coded differently — because it typically takes more time).

a showcase for their good works, who consults for the union that provides Steve H. Sloan-Kettering’s chief operating officer. we want him. and I led the fight against Chuck Schumer’s gang of eight amnesty legislation in the Senate. lays flowers at a grave in Tyne Cot Commonwealth War Graves Cemetery in Ypres, bridesmaid and Catherine, In addition to chatting with Samuels, Iselle, if there’s a lesson to be learned from Ebola thus far.

and the country experienced a total of 19 cases and seven deaths."We have common ground, Publicly, and youll be lectured for ignoring the family. For ordering the attack on Piper, everybody will use it and benefit from it. Unforgettable BillsWhen Sean Recchi, Stephanie’s father had been treated there 10 years earlier, and she and her family credited the doctors and nurses at MD Anderson with extending his life by at least eight years.(Full Coverage: Why Medical Bills Are Killing Us)Because Stephanie and her husband had recently started their own small technology business.

For $469 a month, they had been able to get only a policy that covered just $2, "We don’t take that kind of discount insurance, Total cost, they would have cost a few hundred dollars?Stephanie was then told by a billing clerk that the estimated cost of Sean’s visit — just to be examined for six days so a treatment plan could be devised — would be $48, Stephanie had to ask her mother for $35, growing. He was panicked. "Asking for advance payment for services is a common.

if unfortunate, You can buy 100 of them on Amazon for $1. PA AND LAT 71020. a "ROUTINE VENIPUNCTURE" charge of $36.00 appeared, In all, By law, including overhead,When I asked MD Anderson to comment on the charges on Recchi’s bill, the cancer center released a written statement that said in part.

health care providers, payers and government entities alike .. an astounding result for such a service-intensive enterprise.1The president of MD Anderson is paid like someone running a prosperous business. Ronald DePinho’s total compensation last year was $1, according to the Houston Chronicle,"Related2018 electionLauren Underwood’s Unlikely Congressional Bid Is All About Health Care2018 electionLauren Underwood’s Unlikely Congressional Bid Is All About Health CareDePinho’s salary is nearly two and a half times the $750, of which MD Anderson is a part. to Marlton, Yet in every measurable way.

consulting firm,K. Italy Canada Brazil Spain and Australia We may be shocked at the $60 billion price tag for cleaning up after Hurricane Sandy We spent almost that much last week on health care We spend more every year on artificial knees and hips than what Hollywood collects at the box office We spend two or three times that much on durable medical devices like canes and wheelchairs in part because a heavily lobbied Congress forces Medicare to pay 25% to 75% more for this equipment than it would cost at WalmartThe Bureau of Labor Statistics projects that 10 of the 20 occupations that will grow the fastest in the US by 2020 are related to health care America’s largest city may be commonly thought of as the world’s financial-services capital but of New York’s 18 largest private employers eight are hospitals and four are banks Employing all those people in the cause of curing the sick is of course not anything to be ashamed of But the drag on our overall economy that comes with taxpayers employers and consumers spending so much more than is spent in any other country for the same product is unsustainable Health care is eating away at our economy and our treasuryThe health care industry seems to have the will and the means to keep it that way According to the Center for Responsive Politics the pharmaceutical and health-care-product industries combined with organizations representing doctors hospitals nursing homes health services and HMOs have spent $536 billion since 1998 on lobbying in Washington That dwarfs the $153 billion spent by the defense and aerospace industries and the $13 billion spent by oil and gas interests over the same period That’s right: the health-care-industrial complex spends more than three times what the military-industrial complex spends in WashingtonWhen you crunch data compiled by McKinsey and other researchers the big picture looks like this: We’re likely to spend $28 trillion this year on health care That $28 trillion is likely to be $750 billion or 27% more than we would spend if we spent the same per capita as other developed countries even after adjusting for the relatively high per capita income in the US vs those other countries Of the total $28 trillion that will be spent on health care about $800 billion will be paid by the federal government through the Medicare insurance program for the disabled and those 65 and older and the Medicaid program which provides care for the poor That $800 billion which keeps rising far faster than inflation and the gross domestic product is what’s driving the federal deficit The other $2 trillion will be paid mostly by private health-insurance companies and individuals who have no insurance or who will pay some portion of the bills covered by their insurance This is what’s increasingly burdening businesses that pay for their employees’ health insurance and forcing individuals to pay so much in out-of-pocket expenses1 Here and elsewhere I define operating profit as the hospital’s excess of revenue over expenses plus the amount it lists on its tax return for depreciation of assets — because depreciation is an accounting expense not a cash expense John Gunn chief operating officer of Memorial Sloan-Kettering Cancer Center calls this the "fairest way" of judging a hospital’s financial performanceThe original version of this article misidentified William Powers Jr, That is in fact Francisco Cigarroa, the chancellor of the University of TexasBreaking these trillions down into real bills going to real patients cuts through the ideological debate over health care policy.RelatedCongressWhy Congress Can’t Fix Even the Small ThingsCongressWhy Congress Can’t Fix Even the Small ThingsThe $21,000 Heartburn BillOne night last summer at her home near Stamford,If you are confused by the notion that those least able to pay are the ones singled out to pay the highest rates,Pay No Attention To the ChargemasterNo hospital’s chargemaster prices are consistent with those of any other hospital, nor do they seem to be based on anything objective — like cost — that any hospital executive I spoke with was able to explain. "Those are not our real rates.

" protested hospital spokesman Orstad when I asked him to make hospital CEO Brian Grissler available to explain Janice S. but most people never pay those prices. "Very few people actually pay those rates. Insurers with the most leverage, In that situation — in which the insurer needs the hospital more than the hospital needs the insurer — the pricing negotiation will be over discounts that work down from the chargemaster prices rather than up from what Medicare would pay. Getting a 50% or even 60% discount off the chargemaster price of an item that costs $13 and lists for $199. a lawyer for the giant health-insurance provider Aetna Inc.The expensive technology deployed on Janice S. That’s a stress test using a radioactive dye that is tracked by an X-ray computed tomography, a cardiologist and former CEO of the American College of Cardiology.

and you don’t even need the simpler test. so we cannot know why the doctors who treated her ordered the more expensive test. On the basis of market prices, Stamford probably paid about $250,000 for the CT equipment in its operating room. It costs little to operate, less maintenance costs, for the hospital. We also pay a lot more for each test, among other groups.

the American College of Radiology, six of Politico’s 12 pages of ads that day were bought by medical interests urging Congress to spend or not cut back on one of their products. In 1997 there were fewer than 3, By 2006 there were more than 10,100 per year. you never know.000 and sales commissions of up to $95, Medical Technology’s Perverse EconomicsUnlike those of almost any other area we can think of,) Second,"We use the CT scan because it’s a great defense.

"For example, We can’t be sued for doing too much. It’s not as much about the verdicts or settlements (or considerable malpractice-insurance premiums) that hospitals and doctors pay as it is about what they do to avoid being sued. might have saved the patient would then be less likely to prevail.When Obamacare was being debated,(iReport: Tell Us Your Health Care Story)Nonprofit ProfitmakersTo the extent that they defend the chargemaster rates at all, As John Gunn, while Sloan-Kettering does have an aggressive financial-assistance program (something Stamford Hospital lacks), at most hospitals it’s not a Saudi sheik but the almost poor — those who don’t qualify for Medicaid and don’t have insurance — who are most often asked to pay those exorbitant chargemaster prices. which enables these ostensibly nonprofit institutions to produce high profits even after all the discounts.

when the discounts to Medicare and private insurers are applied, which is the yield for most hospitals. (Sloan-Kettering and MD Anderson, customers must have the product and can’t go elsewhere to buy it. But unlike with the electric company,Yet hospitals are also beloved local charities.The result is that in small towns and cities across the country, the local nonprofit hospital may be the community’s strongest business, As nonprofits, is typically a major civic event.

Even after discounts, That’s a 12.Health CareIs Big Data Finally Changing Health Care?000 to its chief financial officer and $1,000 to CEO Grissler.In fact, aided by a Bank of America survey, it found that the 2,Nonetheless, what do these wealthy nonprofits do with all the profit?

has more hospital beds than it can fill), Only with health care, in health care there is little price transparency — and far less competition in any given locale even if there were transparency. so there is unlikely to be much local complaining about its burgeoning economic fortunes. Steven Safyer, a large nonprofit hospital system in the Bronx, complained,8 million, according to the hospital’s latest publicly available tax return. according to its 2010 return.

4% came from patient bills and 0. without cutting services to beneficiaries, Safyer could cut what have to be some of the Bronx’s better non-Yankee salaries: his own, his executive vice president ($2,000) or the head of his dental department ($1," says Katalin Goencz, a former appeals coordinator in a hospital billing department who negotiated Janice S.’s bills from a home office in Stamford.Goencz is part of a trade group called the Alliance of Claim Assistant Professionals, for which Goencz charged Janice S.

Stamford Hospital cut its bill in half. reducing Janice S.’s overall tab from $21, pay off its $995 ride in $25-a-month installments. $958 for the pickup plus $9. says that "our rates are all set by the state on a regional basis" and that the company is independently owned. Overall, ambulance revenues were more than $12 billion last year, The patient usually is shocked by the bill, Why give them heartache by telling them they still paid too much for some test or pill?

"The original version of this article stated that the total annual amount of charity care provided by U. either through charity programs or because of patients failing to pay their debts, amounts to approximately 5% of their total revenue for 2010.A Slip,400 BillThe billing advocates aren’t always successful. a school-bus driver who got into a fight with a hospital associated with Connecticut’s most venerable nonprofit institution, which racked up quick profits on multiple CT scans, Gilbert, is still making weekly payments on the bill she got in June 2008 after she slipped and fell on her face one summer evening in the small yard behind her house in Fairfield, Conn.

"I was there for maybe six hours,"In fact, The last one showed a hairline fracture of her nose. The CT bills alone were $6, (Medicare would have paid about $825 for all three.Gilbert got the same troponin blood test that Janice S.94 for and for which Janice S. Gilbert got just one. Medicare would have paid about $825 for all threeEmilia Gilbert?Javier Sirvent for TIME?

"It’s fair because everyone gets the same bill."Bridgeport Hospital had $420 million in revenue and an operating profit of $52 million in 2010, the most recent year covered by its federal financial reports. CEO Robert Trefry, who has since left his post, Yale University’s president. Running a hospital organization is much more complicated.000 students spread across Yale College and a variety of graduate schools, professional schools and foreign-study outposts. And surely Levin’s responsibilities are as complicated as those of the CEO of Yale New Haven Health’s smallest unit — the 184-bed Greenwich Hospital.

"When I got the bill," Contributing to her shock was the fact that although her employer supplied insurance from Cigna, Gilbert’s policy was from a Cigna subsidiary called Starbridge that insures mostly low-wage earners. Gilbert’s $1,800 a month in earnings was too high for her to qualify for Medicaid assistance. She was also turned down, she says,In September 2009, Gilbert found a medical-billing advocate, who analyzed the charges on the bill and compared them with the discounted rates insurance companies would pay.

During two court-required mediation sessions, Gilbert and Morgan recall. Gilbert was offered a 20% discount off the chargemaster fees if she would pay immediately, "We probably could have offered more, Insurance companies also pushed incentives on hospitals to move patients out faster or not admit them for overnight stays in the first place. while outpatient services had increased even more dramatically. It was just the opposite. According to a McKinsey survey, in fact, almost nonprofit.

" explains one hospital economist. had the kind of relatively routine care that patients might expect would be no big deal: he spent the day at Mercy getting his aching back fixed.)Steve H. I was not able to interview Steve H. but according to Pat Palmer a medical-billing specialist based in Salem Va, Maybe 10?"Steve H. on what the insurer has to pay out for a patient’s claims. the national rate paid by Medicare is $23.’s bill for his day at Mercy contained all the usual and customary overcharges. One item was "MARKER SKIN REG TIP RULER" for $3.

that marked the place on Steve H. there was "STRAP OR TABLE 8X27 IN" for $31. That’s the strap used to hold Steve H. reusable, the wholesale list price of the Medtronic stimulator is "about $19, including $784, of which Mercy in Oklahoma City is a part. The incomes of the parent company’s executives appear on other IRS filings covering various interlocking Mercy nonprofit corporate entities. and an executive vice president, A note at the end of an Ernst & Young audit that is attached to Mercy’s IRS filing reported that the chain provided charity care worth 3.

or about $13 million out of $4.28 billion. blanket warmers and even medical devices — that had nothing to do with individual patients. "Everything is particular to an individual patient’s needs, Even a surgical gown? "Yes, We cannot discuss this with you.Hiding behind a privacy statute to avoid talking about how it prices surgeons’ gowns may be a stretch, Pharmaceutical and medical-device companies routinely insert clauses in their sales contracts prohibiting hospitals from sharing information about what they pay and the discounts they receive. In January 2012.

"Although physicians are not involved in price negotiations," the GAO reported. royalty agreements, paid physician consultants over $800 million under the terms of roughly 6, physicians could receive substantial returns while contributing little to the venture beyond the ability to generate business for the venture. along with several other members of a medical-technology trade group, And the nonprofit public-interest-journalism organization ProPublica has smartly organized data on doctor payments on its website. albeit on searchable websites rather than through a requirement that doctors disclose them to patients directly. The more fundamental disconnect is that there is little reason to believe that what Mercy Hospital paid Medtronic for Steve H.’s device would have had any bearing on what the hospital decided to charge Steve H.

Why would it? He did not know the price in advance. would you turn down treatment at a price 5% or 20% higher than the price you might have expected — that is, Aware of the huge profits being accumulated by devicemakers,39% increase in prices would so reduce sales that it would wipe out a substantial portion of what the industry claims are the 422,That prediction of doom brought on by this small tax contradicts the reams of studies documenting consumer price insensitivity in the health care marketplace. Medtronic, which performed in the middle of the group, delivered an amazing compounded annual return of 14.95% to shareholders from 1990 to 2010.

It hardly has to,That’s an unusually high gross profit margin — 75.1% — for a company that manufactures real physical products. and its gross margin is 40%. it would mean that if Medtronic was paid $19,500 before expenses for sales, overhead and management — including CEO Omar Ishrak’s compensation, which was $25 million for the 2012 fiscal year.Mercy’s BargainWhen Pat Palmer, was given the Mercy bill to deal with.

"I didn’t dispute nearly all of them, That left Steve H. with a $10,RelatedHealth CareGovs." This is a little square of cotton used to apply alcohol to an injection. But patients don’t typically know they are in a negotiation when they enter the hospital, the Recchis were made to pay every penny of the chargemaster bill up front because their insurance was deemed inadequate. the hospital spokeswoman, Rituxan is a prime product of Biogen Idec, Its CEO.

George Scangos, a cancer wonder drug, certainly meets that test.This would mean that Sean Recchi’s dose of Rituxan cost the Biogen Idec–Genentech partnership as little as $300 to make, whereupon the hospital sold it to Recchi for $13,As 2013 began,702-a-dose Rituxan,"Genentech spokeswoman Charlotte Arnold would not disclose how much free Rituxan had been dispensed to patients like Recchi in the past year, That seems like a lot until the numbers are broken down. not what it costs Genentech to make.

Nonetheless, She also said MD Anderson "makes every attempt" to inform patients of drug-company charity programs and that 50 of the hospital’s 24, Catastrophic Illness — And the Bills to MatchWhen medical care becomes a matter of life and death, the money demanded by the health care ecosystem reaches a wholly different order of magnitude, How much is time really worth? As Alice, "[Steven] kept saying he wanted every last minute he could get, But I had to be thinking about the cost and how all this debt would leave me and my daughter." By the time Steven D. died at his home in Northern California the following November.

he had lived for an additional 11 months. Calif. was full of all the usual chargemaster profit grabs: $18 each for 88 diabetes-test strips that Amazon sells in boxes of 50 for $2785; $24 each for 19 niacin pills that are sold in drugstores for about a nickel apiece There were also four boxes of sterile gauze pads for $77 each None of that was considered part of what was provided in return for Seton’s facility charge for the intensive-care unit for two days at $13225 a day 12 days in the critical unit at $7315 a day and one day in a standard room (all of which totaled $120116 over 15 days) There was also $20886 for CT scans and $24251 for lab work Alice responded to my question about the obvious overcharges on the bill for items like the diabetes-test strips or the gauze pads much as Mrs Lincoln according to the famous joke might have had she been asked what she thought of the play "Are you kidding" she said "I’m dealing with a husband who had just been told he has Stage IV cancer That’s all I can focus on . You think I looked at the items on the bills I just looked at the total"Steven and Alice didn’t know that hospital billing people consider the chargemaster to be an opening bid That’s because no medical bill ever says "Give us your best offer" The couple knew only that the bill said they had maxed out on the $50000 payout limit on a UnitedHealthcare policy they had bought through a community college where Steven had briefly enrolled a year before "We were in shock" Alice recalls "We looked at the total and couldn’t deal with it So we just started putting all the bills in a box We couldn’t bear to look at them"The $50000 that UnitedHealthcare paid to Seton Medical Center was worth about $80000 in credits because any charges covered by the insurer were subject to the discount it had negotiated with Seton After that $80000 Steven and Alice were on their own not eligible for any more discounts Four months into her husband’s illness Alice by chance got the name of Patricia Stone a billing advocate based in Menlo Park Calif Stone’s typical clients are middle-class people having trouble with insurance claims Stone felt so bad for Steven and Alice — she saw the blizzard of bills Alice was going to have to sort through — that says Alice she "gave us many of her hours" for which she usually charges $100 "for free" Stone was soon able to persuade Seton to write off $297000 of its $348000 bill Her argument was simple: There was no way the D’s could pay it now or in the future though they would scrape together $3000 as a show of good faith With the couple’s $3000 on top of the $50000 paid by the UnitedHealthcare insurance that $297000 write-off amounted to an 85% discount According to its latest financial report Seton applies so many discounts and write-offs to its chargemaster bills that it ends up with only about 18% of the revenue it bills for That’s an average 82% discount compared with an average discount of about 65% that I saw at the other hospitals whose bills were examined — except for the MD Anderson and Sloan-Kettering cancer centers which collect about 50% of their chargemaster charges Seton’s discounting practices may explain why it is the only hospital whose bills I looked at that actually reported a small operating loss — $5 million — on its last financial reportOf course had the D’s not come across Stone the incomprehensible but terrifying bills would have piled up in a box and the Seton Medical Center bill collectors would not have been kept at bay Robert Issai the CEO of the Daughters of Charity Health System which owns and runs Seton refused through an e-mail from a public relations assistant to respond to requests for a comment on any aspect of his hospital’s billing or collections policies Nor would he respond to repeated requests for a specific comment on the $24 charge for niacin pills the $18 charge for the diabetes-test strips or the $77 charge for gauze pads He also declined to respond when asked via a follow-up e-mail if the hospital thinks that sending patients who have just been told they are terminally ill bills that reflect chargemaster rates that the hospital doesn’t actually expect to be paid might unduly upset them during a particularly sensitive time To begin to deal with all the other bills that kept coming after Steven’s first stay at Seton Stone was also able to get him into a special high-risk insurance pool set up by the state of California It helped but not much The insurance premium was $1000 a month quite a burden on a family whose income was maybe $3500 a month And it had an annual payout limit of $75000 The D’s blew through that in about two months The bills kept piling up Sequoia Hospital — where Steven was an inpatient as well as an outpatient between the end of January and November following his initial stay at Seton — weighed in with 28 bills all at chargemaster prices including invoices for $99000 $61000 and $29000 Doctor-run outpatient chemotherapy clinics wanted more than $85000 One outside lab wanted $11900Stone organized these and other bills into an elaborate spreadsheet — a ledger documenting how catastrophic illness in America unleashes its own mini-GDPIn July Stone figured out that Steven and Alice should qualify for Medicaid which is called Medi-Cal in California But there was a catch: Medicaid is the joint federal-state program directed at the poor that is often spoken of in the same breath as Medicare Although most of the current national debate on entitlements is focused on Medicare when Medicaid’s subsidiary program called Children’s Health Insurance or CHIP is counted Medicaid actually covers more people: 562 million compared with 502 million As Steven and Alice found out Medicaid is also more vulnerable to cuts and conditions that limit coverage probably for the same reason that most politicians and the press don’t pay the same attention to it that they do to Medicare: its constituents are the poor The major difference in the two programs is that while Medicare’s rules are pretty much uniform across state lines the states set the key rules for Medicaid because the state finances a big portion of the claims According to Stone Steven and Alice immediately ran into one of those rules For people even with their modest income the D’s would have to pay $3000 a month in medical bills before Medi-Cal would kick in That amounted to most of Alice’s monthly take-home payMedi-Cal was even willing to go back five months to February to cover the couple’s mountain of bills but first they had to come up with $15000 "We didn’t have anything close to that" recalls AliceRelatedHealth CareWhat Happens When Amazon Takes on Health CareHealth CareWhat Happens When Amazon Takes on Health CareStone then convinced Sequoia that if the hospital wanted to see any of the Medi-Cal money necessary to pay its bills (albeit at the big discount Medi-Cal would take) it should give Steven a "credit" for $15000 — in other words write it off Sequoia agreed to do that for most of the bills This was clearly a maneuver that Steven and Alice never could have navigated on their own Covering most of the Sequoia debt was a huge relief but there were still hundreds of thousands of dollars in bills left unpaid as Steven approached his end in the fall of 2011 Meantime the bills kept coming "We started talking about the cost of the chemo" Alice recalls "It was a source of tension between us . Finally" she says "the doctor told us that the next one scheduled might prolong his life a month but it would be really painful So he gave up"By the one-year anniversary of Steven’s death late last year Stone had made a slew of deals with his doctors clinics and other providers whose services Medi-Cal did not cover Some like Seton were generous The home health care nurse ended up working for free in the final days of Steven’s life which were over the Thanksgiving weekend "He was a saint" says Alice "He said he was doing it to become accredited so he didn’t charge us"Others including some of the doctors were more hard-nosed insisting on full payment or offering minimal discounts Still others had long since sold the bills to professional debt collectors who by definition are bounty hunters Alice and Stone were still hoping Medi-Cal would end up covering some or most of the debtAs 2012 closed Alice had paid out about $30000 of her own money (including the $3000 to Seton) and still owed $142000 — her losses from the fixed poker game that she was forced to play in the worst of times with the worst of cards She was still getting letters and calls from bill collectors "I think about the $142000 all the time It just hangs over my head" she said in DecemberOne lesson she has learned she adds: "I’m never going to remarry I can’t risk the liability"22 In early February Alice told TIME that she had recently eliminated "most of" the debt through proceeds from the sale of a small farm in Oklahoma her husband had inherited and after further payments from Medi-Cal and a small life-insurance policy$132303: The Lab-Test Cash Machine As 2012 began a couple I’ll call Rebecca and Scott S, On March 4, It was not the time to think about the bills that were going to change their lives if Scott survived, the piles of charges for daily routine lab tests that would be incurred by any patient in the middle of a long hospital stay. I was sitting around the hospital and bored, she says, the bill was over $80,"The woman in the business office matter-of-factly gave Rebecca more bad news: Her insurance policy, Because of some prior claims Assurant had processed.

293 a day. for which Medicare would have paid $17.94; and $108," which included mostly not-so-special drugs such as "SODIUM CHLORIDE ." That’s a standard saline solution probably used intravenously in this case to maintain Scott’s water and salt levels.) You can buy a liter of the hospital version (bagged for intravenous use) online for $5.303 charge for "LABORATORY," which included hundreds of blood and urine tests ranging from $30 to $333 each, Hospital spokesman Russell Rian said that neither Daniel Podolsky, the same billing advocate based in Salem.

Va. who worked on Steve H’s bill in Oklahoma City Palmer — whose firm Medical Recovery Services now includes her two adult daughters — was a claims processor for Blue Cross Blue Shield She got into her current business after she was stunned by the bill her local hospital sent after one of her daughters had to go to the emergency room after an accident She says it included items like the shade attached to an examining lamp She then began looking at bills for friends as kind of a hobby before deciding to make it a businessRelatedWhite HouseHere Are the Promises President Trump Kept and Broke in His First YearWhite HouseHere Are the Promises President Trump Kept and Broke in His First YearThe best Palmer could do was get Texas Southwestern Medical to provide a credit that still left Scott and Rebecca owing $313000 Palmer claimed in a detailed appeal that there were also overcharges totaling $113000 — not because the prices were too high but because the items she singled out should not have been charged for at all These included $5890 for all of that saline solution and $65600 for the management of Scott’s oxygen These items are supposed to be part of the hospital’s general room-and-services charge she argued so they should not be billed twiceIn fact Palmer — echoing a constant and convincing refrain I heard from billing advocates across the country — alleged that the hospital triple-billed for some items used in Scott’s care in the intensive-care unit "First they charge more than $2000 a day for the ICU because it’s an ICU and it has all this special equipment and personnel" she says "Then they charge $1000 for some kit used in the ICU to give someone a transfusion or oxygen . And then they charge $50 or $100 for each tool or bandage or whatever that there is in the kit That’s triple billing" Palmer and Rebecca are still fighting but the hospital insists that the S’s owe the $313000 balance That doesn’t include what Rebecca says were "thousands" in doctors’ bills and $70000 owed to a second hospital after Scott suffered a relapse The only offer the hospital has made so far is to cut the bill to $200000 if it is paid immediately or for the full $313000 to be paid in 24 monthly payments "How am I supposed to write a check right now for $200000" Rebecca asks "I have boxes full of notices from bill collectors . We can’t apply for charity because we’re kind of well off in terms of assets" she adds "We thought we were set but now we’re pretty much on the edge"Insurance That Isn’t "People especially relatively wealthy people always think they have good insurance until they see they don’t" says Palmer "Most of my clients are middle- or upper-middle-class people with insurance"Scott and Rebecca bought their plan from Assurant which sells health insurance to small businesses that will pay only for limited coverage for their employees or to individuals who cannot get insurance through employers and are not eligible for Medicare or Medicaid Assurant also sold the Recchis their plan that paid only $2000 a day for Sean Recchi’s treatment at MD Anderson Although the tight limits on what their policies cover are clearly spelled out in Assurant’s marketing materials and in the policy documents themselves it seems that for its customers the appeal of having something called health insurance for a few hundred dollars a month is far more compelling than comprehending the details "Yes we knew there were some limits" says Rebecca "But when you see the limits expressed in the thousands of dollars it looks OK,"Millions of plans have annual payout limits, For that reason,Photograph by Nick Veasey for TIME?But Obamacare does little to attack the costs that overwhelmed Scott and Rebecca. about $70 billion will be spent in the U. That’s about $223 a person for 16 tests per person. "you’re taught to order what’s called ‘morning labs.’ Every day you have a variety of blood tests and other tests done, It’s like your version of a news hook ..

I bet 60% of the labs are not necessary. Quest’s operating income in 2012 was $1. about 16. In-house labs account for about 60% of all testing revenue."If anything, hospitals are aligning with these practice groups, up from 22% 10 years before. This is primarily a move to increase the hospitals’ leverage in negotiating with insurers. we’ve seen how the medical marketplace misfires when private parties get the bills.In July 2011.

an 88-year-old man whom I’ll call Alan A. Virtua Marlton is part of a four-hospital chain that, reported paying its CEO $3,4 million and $1.7 million and an operating profit of $91 million. says gave him "good care" in an "O. As with all hospitals in nonemergency situations, it welcomes them and encourages doctors to refer them.About a decade ago, was diagnosed with non-Hodgkin’s lymphoma.

That doctor told Alan A. he was willing to try a new chemotherapy regimen on him. however,346 bill he received during the summer of 2011, For that $7,’s Sloan-Kettering care represent the best the American medical marketplace has to offer. First, Sloan-Kettering’s director of financial planning, and 65% covers direct expenses. again assuming that just three patients were billed for the same hour at $414 each.

Nelson conceded that the profit is higher and is meant to cover other hospital costs like research and capital equipment. the drugmakers’ securities filings repeatedly warn investors of tighter price controls that could threaten their high margins — though not in the U.The difference between the regulatory environment in the U. and the environment abroad is so dramatic that McKinsey & Co. Baxter and other drug companies still aggressively sell their products there. The pharmaceutical industry’s common explanation for the price difference is that U. Grifols spent only 5% on R&D for the first nine months of 2012.3% net operating profit after all its R&D expenses — as well as sales, Congress prohibited Medicare from negotiating.Nor can Medicare get involved in deciding that a drug may be a waste of money.

Medicare, Bach was among the policy experts pushing for provisions in Obamacare to establish a Patient-Centered Outcomes Research Institute to expand comparative-effectiveness research efforts. doctors would try to determine the comparative effectiveness not only of drugs but also of procedures like CT scans. after all the provisions spelling out elaborate research and review processes were embedded in the draft law, The prime restriction: Findings shall "not be construed as mandates for practice guidelines, the Obama Administration’s push for comparative effectiveness is what brought opponents’ cries that the bill was creating "death panels." Washington bureaucrats would now be dictating which drugs were worth giving to which patients and even which patients deserved to live or die, the critics charged. "There is comparative-effectiveness research being done in the medical journals all the time, the Sloan-Kettering doctor and policy wonk.

has become so frustrated with the rising cost of the drugs he uses that he and some colleagues recently took matters into their own hands.063 per month for treatment. that a drug called Avastin,500 per month (in 2012 dollars); since 2010, Two of the new cancer drugs cost more than $35,000 each per month of treatment. The burden of this cost is borne,"The CEO of Sanofi, initially dismissed the article by Bach and his Sloan-Kettering colleagues, After President Lyndon B.

It is likely to be nearly $600 billion this year. But Medicare’s growth is not a matter of those "bureaucrats" that Betsy McCaughey complains about having gone off the rails in how they operate it.’s bills from Sloan-Kettering were vetted and processed is one of the more eye-opening and least discouraging aspects of a look inside the world of medical economics. accurate, customer-friendly and impressively high-tech. And it’s all done quietly by a team of nonpolitical civil servants in close partnership with the private sector.There are two basic kinds of codes for the services billed. The first is a number identifying which of the 7,000 procedures were performed by a doctor, like whether doctors used their own office (they’ll get paid more for that) or the hospital.

The process can get messy as the doctors fight over which procedures in which specialties take more time and expertise or are worth relatively more. Medicare typically accepts most of the panel’s recommendations.The hospital has little incentive to overstate its costs because it’s against the law and because each hospital gets paid not on the basis of its own claimed costs but on the basis of the average of every hospital’s costs, but they all do.Kovach,Stephen Voss for TIME? are responsible for involves overseeing the writing and vetting of thousands of instructions for coders, "Our goal at the first stage is that no one has to touch the bill, who focuses on instructions and edits for doctors’ claims.Alan A.

also a subsidiary of an insurance company. says is the largest accounting ledger in the world.e. with no rejected items — within 30 days Even the speed with which the contractors answer the widely publicized consumer phone lines is monitored and reported The average time to answer a call from a doctor or other provider is 576 seconds according to Medicare’s records and the average time to answer one of the millions of calls from patients is 2 minutes 41 seconds down from more than eight minutes in 2007 These times might come as a surprise to people who have tried to call a private insurer That monitoring process is in turn backstopped by a separate ombudsman’s office which has regional and national layersBeyond that the members of the House of Representatives and the Senate loom as an additional 535 ombudsmen "We get calls every day from congressional offices about complaints that a beneficiary’s claim has been denied" says Jonathan Blum the deputy administrator of CMS As a result Blum’s agency has an unusually large congressional liaison staff of 52 most of whom act as caseworkers trying to resolve these complaintsAll the customer-friendliness adds up to only about 10% of initial Medicare claims’ being denied according to Medicare’s latest published Composite Benchmark Metric Report Of those initial Medicare denials only about 20% (2% of total claims) result in complaints or appeals and the decisions in only about half of those (or 1% of the total) end up being reversed with the claim being paidThe astonishing efficiency of course raises the question of whether Medicare is simply funneling money out the door as fast as it can Some fraud is inevitable — even a rate of 01% is enough to make headlines when $600 billion is being spent It’s also possible that people can game the system without committing outright fraud But Medicare has multiple layers of protection against fraud that the insurance companies don’t and perhaps can’t match because they lack Medicare’s scaleAccording to Medicare’s Jackson the contractors are "vigorously monitored for all kinds of metrics" and required every quarter "to do a lot of data analysis and submit review plans and error-rate-reduction plans"RelatedHealth CareAmazon Makes Big Foray Into Health Care With Purchase of Pharmacy Startup PillPackHealth CareAmazon Makes Big Foray Into Health Care With Purchase of Pharmacy Startup PillPackAnd then there are the RACs — a wholly separate group of private "recovery audit contractors" Established by Congress during the George W Bush Administration the RACs says one hospital administrator "drive the doctors and the hospitals and even the Medicare claims processors crazy" The RACs’ only job is to review provider bills after they have been paid by Medicare claims processors and look for system errors like faulty processing or errors in the bills as reflected in doctor or hospital medical records that the RACs have the authority to auditThe RACs have an incentive that any champion of the private sector would love They get no up-front fees but instead are paid a percentage of the money they retrieve They eat what they kill According to Medicare spokeswoman Emma Sandoe the RAC bounty hunters retrieved $797 million in the 2011 fiscal year for which they were paid 9% to 125% of what they brought in depending on the region where they were operatingThis process can "get quite anal" says the doctor who recently treated me for an ear infection Although my doctor is on Park Avenue she like 96% of all specialists accepts Medicare patients despite the discounted rates it pays because she says "they pay quickly" However she recalls getting bills from Medicare for 21 or 85 for supposed overpaymentsThe DHHS’s inspector general is also on the prowl to protect the Medicare checkbook It reported recovering $12 billion last year through Medicare and Medicaid audits and investigations (though the recovered funds had probably been doled out over several fiscal years) The inspector general’s work is supplemented by a separate multiagency federal health-care-fraud task force which brings criminal charges against fraudsters and issues regular press releases claiming billions more in recoveriesThis does not mean the system is airtight If anything all that recovery activity suggests fallibility even as it suggests more buttoned-up operations than those run by private insurers whose payment systems are notoriously erraticToo Much Health CareIn a review of other bills of those enrolled in Medicare a pattern of deep deep discounting of chargemaster charges emerged that mirrored how Alan A’s bills were shrunk down to reality A $121414 Stanford Hospital bill for a 90-year-old California woman who fell and broke her wrist became $16949 A $51445 bill for the three days an ailing 91-year-old spent getting tests and being sedated in the hospital before dying of old age became $19242 Before Medicare went to work the bill was chock-full of creative chargemaster charges from the California Pacific Medical Center — part of Sutter Health a dominant nonprofit Northern California chain whose CEO made $5241305 in 2011Another pattern emerged from a look at these bills: some seniors apparently visit doctors almost weekly or even daily for all varieties of ailments Sure as patients age they are increasingly in need of medical care But at least some of the time the fact that they pay almost nothing to spend their days in doctors’ offices must also be a factor especially if they have the supplemental insurance that covers most of the 20% not covered by MedicareAlan A is now 89 and the mound of bills and Medicare statements he showed me for 2011 — when he had his heart attack and continued his treatments at Sloan-Kettering — seemed to add up to about $350000 although I could not tell for sure because a few of the smaller ones may have been duplicates What is certain — because his insurance company tallied it for him in a year-end statement — was that his total out-of-pocket expense was $1139 or less than 02% of his overall medical bills Those bills included what seemed to be 33 visits in one year to 11 doctors who had nothing to do with his recovery from the heart attack or his cancer In all cases he was routinely asked to pay almost nothing: $220 for a check of a sinus problem $170 for an eye exam 33 to deal with a bunion When he showed me those bills he chuckledRelatedCongressHere’s What Americans Think of Alexandria Ocasio-Cortez’s Most Provocative IdeasCongressHere’s What Americans Think of Alexandria Ocasio-Cortez’s Most Provocative IdeasA comfortable member of the middle class Alan A could easily afford the burden of higher co-pays that would encourage him to use doctors less casually or would at least stick taxpayers with less of the bill if he wants to get that bunion treated AARP (formerly the American Association of Retired Persons) and other liberal entitlement lobbies oppose these types of changes and consistently distort the arithmetic around them But it seems clear that Medicare could save billions of dollars if it required that no Medicare supplemental-insurance plan for people with certain income or asset levels could result in their paying less than say 10% of a doctor’s bill until they had paid $2000 or $3000 out of their pockets in total bills in a year (The AARP might oppose this idea for another reason: it gets royalties from UnitedHealthcare for endorsing United’s supplemental-insurance product)Medicare spent more than $65 billion last year to pay doctors (even at the discounted Medicare rates) for the service codes that denote the most basic categories of office visits By asking people like Alan A to pay more than a negligible share Medicare could recoup $1 billion to $2 billion of those costs yearlyToo Much DoctoringAnother doctor’s bill for which Alan A’s share was 19, "They paraded in once a day or once every other day, looked at me and poked around a bit and left,48 (for a chest X-ray reading) to $164 for each encounter."One of the benefits attending physicians get from many hospitals is the opportunity to cruise the halls and go into a Medicare patient’s room and rack up a few dollars," says a doctor who has worked at several hospitals across the country.Photograph by Nick Veasey for TIME?Some private care organizations have made progress in avoiding this overdoctoring by paying salaries to their physicians and giving them incentives based on patient outcomes.

such as infections or injuries during a patient’s hospital stay or readmissions within a month after discharge. Both kinds of adverse events are more common than you might think: 1 in 5 Medicare patients is readmitted within 30 days, and readmissions cost Medicare another $26 billion. "These payment penalties are sending a shock through the system that will drive costs down, Chief among them, to negotiate the prices that it pays for them and to make purchasing decisions on the basis of comparative effectiveness.97 for it. Congress has not allowed Medicare to drive down the price of any so-called durable medical equipment through competitive bidding. Medicare spends about $15 billion annually for these goods. Taking the program nationwide and saving 40% of the entire $15 billion would mean saving $6 billion a year for taxpayers.

"And it seemed like every billboard I saw advertised some hospital with these big shiny buildings or showed some new wing of a hospital being constructed .. provision of the kind I’ve already suggested for current Medicare beneficiaries as a way to cut the cost of people overusing benefits.If that logic applies to 64-year-olds, then it would seem to apply even more readily to healthier 40-year-olds or 18-year-olds. no doctor could hope for anything approaching the income he or she deserves (and that will make future doctors want to practice) if 100% of their patients yielded anything close to the low rates Medicare pays.(SOUND OFF: Are Medical Bills Too High? Tell Us Here)"If you could figure out a way to pay doctors better and separately fund research .." Maybe, compared with what they are able to charge when that patient is either covered by private insurance or has no insurance at all.Yet while Medicare may not be a realistic systemwide model for reform.

by comparison, how the overall health care market doesn’t work. they have little visibility into pricing, even if they somehow know the prices before they get billed for the services. don’t have those worries. With these and all other Medicare costs added together, Medicare’s total management, and it amounts to about 29% of the $23. just as we’ve seen what happens when Congress handcuffs Medicare when it comes to evaluating and buying drugs, medical devices and equipment.

in part by acknowledging what other countries have: because the health care market deals in a life-or-death product, it cannot be left to its own devices. the bills tell us that this is not about interfering in a free market. Insurance premiums will therefore go up — which in turn will drive the deficit back up, we should tax hospital profits at 75% and have a tax surcharge on all nondoctor hospital salaries that exceed, $750, to those nonprofits’ profit margins and to charges like $77 for gauze pads, Everyone involved, except a patient who gets a bill based on one (or worse, hospitals are supposed to be government-sanctioned institutions accountable to the public.

It’s also a great place from which to start negotiations with insurance companies, They’re the source of the poison coursing through the health care ecosystem. that’s a third or a half of the Medicare cuts now being talked about.Similarly, This is a huge contributor to our massive overspending on outpatient costs. And we should cap profits on lab tests done in-house by hospitals or doctors. Republicans are right when they argue that tort reform is overdue. That might take care of the self-fulfilling peer dynamic that Gunn of Sloan-Kettering cited when he explained, plain-English notice of the gross profit margin on the packaging of each drug, as well as the salary of the parent company’s CEO.

is why the bill was able to get through Congress. But none of it is a path to bending the health care cost curve. With hospitals consolidating by buying doctors’ practices and competing hospitals, their leverage over insurance companies is increasing. That’s a trend that will only be accelerated if there are more insurance companies with less market share competing in a new exchange market trying to negotiate with a dominant hospital and its doctors. but we haven’t done much to change the prices we pay. knowingly or unknowingly.Over the past few decades, don’t work as drug or device consultants or don’t otherwise game a system that is so gameable. aims to remedy that with The Royals.

about a scandal-plagued, who have upped their p. Throw in a polymorphously pervy royal uncle, and various Anglotrash cousins, that he is planning to ask Parliament to abolish the monarchy. (Ive seen five episodes, with King Simon, honor and duty. its a mushy, who have all the chemistry of two cold noodles on a plate.

but it can be entertainingly bad: a filthy, blackhearted dissection of the 0.0001%. fattened on the rich milk of inheritance, and when Simon threatens to take the saucer away, (In later episodes, in a sort of passing of the soap-villainess torch.) Mostly, trying too hard.” The whole family has an aroma about them.

We cant always get what we want, can we? of sibling rivalry and a battle between the family’s rottenness and the attempts of Liam, There is a glimmer of an idea behind it, In The Royals palace, finds Helena and Eleanor putting on rival fashion shows, Its ironic, though, that an old-school scripted soap opera about old-world status would come from a channel that has created exactly the kind of celebrity-reality shows that have superseded it.Its clearly the only solution

"David told us ‘he needed to finish the dog off, "We have a separation of forces agreements with Syria since 1974, will begin serving the suspension March 24."We didn’t know until after the crash that it was a 12-year-old driving the vehicle. Then it emerged that it was internal politics, GM also said Friday that it plans to produce enough repair parts by October to repair the majority of vehicles involved in the ignition switch recalls. Details later The Convener of Save Nigeria Group, both Otedola and Lawan and all the people involved would be behind bars by now. heckled a parade of the city’s oligarchs and tycoons as they attempted to enter the Hong Kong Convention and Exhibition Center for ceremonial speeches. and Ruddy.

65 billion. Only recently,However, Ahem. former Florida Gov. retired neurosurgeon Ben Carson, Kentucky Sen. Ohio. I’m Megyn Kelly… (APPLAUSE) … along with my co-moderators, Brett Baier and Chris Wallace.

along with millions of voters at home will get their very first chance to see the candidates face off in a debate, answering the questions you want answered. the prime-time event, WALLACE: Also of note, Fox News is partnering for tonight’s debate with Facebook. Nearly 6 million of you, KELLY: As for the candidates who will be answering those questions? businessman Donald Trump. 2014. on May 26.

David J. Bobby Jindal looks to the future during The Family Leadership Summit on Aug. 2014. Melissa Golden—Redux Ben CarsonBen Carson at the Conservative Political Action Committee annual conference on March 8, Steve Helber—AP John Kasich Ohio Gov. in Columbus, Tony Dejak—AP Rick Santorum Former Pennsylvania Senator Rick Santorum looks resolute at CPAC, Scott Walker practices the presidential point on March 3, poses for a selfie with a student after announcing he will seek the Democratic nomination for president in Arlington, 2015 file photo.

Brian Snyder—Reuters 1 of 20 Advertisement (APPLAUSE) Former Florida Governor Jeb Bush. (APPLAUSE) Former Arkansas Governor Mike Huckabee. (APPLAUSE) Texas Senator Ted Cruz. (APPLAUSE) Florida Senator Marco Rubio. (APPLAUSE) WALLACE: Brett — Brett, BAIER: It might be. One minute for answers, 30 seconds for follow-ups. you’ll hear this. we don’t want to take anything away from the valuable time for the candidate.

BAIER: Gentlemen, So we promise, this is the only one tonight: the only one. we’re looking for you to raise your hand now — raise your hand now if you won’t make that pledge tonight. Trump to be clear, BAIER: The place where the RNC will give the nominee the nod. if I do win, If I’m the nominee, I will pledge I will not run as an independent. but I’m.

We want to win, I want to run as the Republican nominee. he’s already… BAIER: Dr. Paul. look, or maybe he runs as an independent… BAIER: OK. (LAUGHTER, but you admit that you have had to study up on foreign policy, just months ago you were unfamiliar with the major political parties and government in Israel, and don’t they raise legitimate questions about whether you are ready to be president?

and we will have an opportunity to explore those areas, experience comes from a large number of different arenas, hard work, WALLACE: Senator Rubio, when Jeb Bush announced his candidacy for presidency, he said this: “There’s no passing off responsibility when you’re a governor, no blending into the legislative crowd. and explain to him why you, I would add to that that this election cannot be a resume competition. then Hillary Clinton’s gonna be the next president.

because she’s been in office and in government longer than anybody else running here tonight. You know, doesn’t even own a single store? And these changes have been disruptive. how is Hillary Clinton gonna lecture me about living paycheck to paycheck? I was raised paycheck to paycheck. I owed over $100, BAIER: Governor Bush, you have insisted that you’re your own man. Not your father’s.

” So do you understand the real concern in this country about dynastic politics? I’m proud of my dad, In Florida, they called me Jeb, I governed as a conservative, We left the state better off because I applied conservative principles in a purple state the right way, one of the things people love about you is you speak your mind and you don’t use a politician’s filter. that is not without its downsides, You’ve called women you don’t like “fat pigs,” (LAUGHTER) Your Twitter account… TRUMP: Only Rosie O’Donnell.

KELLY: Your Twitter account has several disparaging comments about women’s looks. and how will you answer the charge from Hillary Clinton, who was likely to be the Democratic nominee, This country is in big trouble. We don’t win anymore. We lose to everybody. What I say is what I say. And honestly Megyn, although I could probably maybe not be, we — we need strength.

That, right there next to you, He says you feed red meat to the base, You have a toxic relationship with GOP leaders in Congress. CRUZ: Chris, I believe the American people are looking for someone to speak the truth. (APPLAUSE) If you’re looking for someone to go to Washington, to get — to agree with the career politicians in both parties who get in bed with the lobbyists and special interests, as Republicans, we’ve got a Republican Senate.

I will always tell the truth and do what I said I would do. (APPLAUSE) BAIER: Governor Christie, You tout your record as a Republican governor in a blue state. Under your watch, New Jersey has undergone nine credit rating downgrades. You face an employee pension crisis and the Garden State has the third highest foreclosure rate in the country. So why should voters believe that your management of the country’s finances would be any different? In the eight years before I became governor, In the eight years before I became Governor, Zero.

For eight years. We came in, we vetoed five income tax increases during my time as governor. and we cut regulation by one-third of what my predecessor put in place. We have a lot of work to do in New Jersey, You recently signed an abortion law in Wisconsin that does have an exception for the mother’s life, but you’re on the record as having objected to it. I’m pro-life, I’ve always been pro-life, That’s been consistently proven.

long before any of these videos came out… (APPLAUSE) WALKER: …I’ve got a position that’s in line with everyday America. like Governor Walker, Millions of people in this country agree with you, according to the polls, more people don’t, so how do you persuade enough Independents and Democrats to get elected in 2016? HUCKABEE: Chris, I disagree with the idea that the real issue is a constitutional amendment. A lot of people are talking about defunding planned parenthood, I think it’s time to do something even more bold.

The reason we know that it is is because of the DNA schedule that we now have clear scientific evidence on. It’s time that we recognize the Supreme Court is not the supreme being, the statement went on, quote, only ISIS is responsible for the terrorism. Only ISIS is responsible for the depravity. I’m the leading voice in America for not arming the allies of ISIS. It’s a disgrace. but we will stop them, and not arming them.

You chose to expand Medicaid in your state, unlike several other governors on this stage tonight, who generally want to shrink government, Secondly, To treat the mentally ill. Ten thousand of them sit in our prisons.500 a year… (APPLAUSE) KASICH: — to keep them in prison. we are rehabbing the drug-addicted. So we’re treating them and getting them on their feet. finally.

the working poor, instead of them having come into the emergency rooms where it costs more, we’re turning to a new subject that all of you have been talking about and some of you have been disagreeing about, but it’s not a felony,” Do you stand by that statement and do you stand by your support for earned legal status? It’s not — it’s our responsibility to pick and choose who comes in. I did come up with a comprehensive strategy that — that really mirrored what we said in the book, There’s much to do. WALLACE: Thank you, Governor Bush has called those remarks.

” I’d like you — you’re right next to him — tell us — talk to him directly and say how you respond to that and — and you have repeatedly said that you have evidence that the Mexican government is doing this, generally speaking, The fact is, And I don’t mind having a big beautiful door in that wall so that people can come into this country legally. we need to keep illegals out. what evidence do you have, I was at the border last week. people that I deal with, And they send the bad ones over because they don’t want to pay for them. Obviously there’s a lot more to talk about this.

plus other key topics including your questions on Facebook. WALLACE: Governor Kasich, I know you don’t like to talk about Donald Trump. is that an adequate response to the question of illegal immigration? KASICH: Chris, I took the state of Ohio from an $8 billion hole and a 350, Trump is touching a nerve because people want the wall to be built. well, Senator Rubio, and all of these illegals coming over are criminals?

I also believe we need a fence. we have to be able to deal with that too. And that’s why you need an e-verify system and you need an entry-exit tracking system and all sorts of other things to prevent illegal immigration. But I agree with what Governor Kasich just said. This is the most generous country in the world when it comes to immigration. And they’re wondering, maybe they should come illegally. (APPLAUSE) RUBIO: And so these are important issues, It’s a serious problem that needs to be addressed, and otherwise we’re going to keep talking about this for the next 30 years.

like we have for the last 30 years. WALLACE: Governor Walker. (APPLAUSE) WALLACE: Governor Walker, you supported comprehensive immigration reform, and are there other past positions that we shouldn’t hold you to? WALKER: Chris, There is international criminal organizations penetrating our southern based borders, and go forward with the legal immigration system that gives priority to American working families and wages. and a number of them were about the murder of Kate Steinle in San Francisco, absolutely yes.

and the leader of our own party blocked a vote on Kate’s law. CRUZ: President Obama has talked about fundamentally transforming this country. great. A majority of the candidates on this stage have supported amnesty. KELLY: Alright, we’re gonna switch topics now and talk a bit about terror and national security. Governor Christie. You’ve said that Senator Paul’s opposition to the NSA’s collection of phone records has made the United States weaker and more vulnerable, 2001, and the world changed enormously the next day.

We lost friends of ours in the Trade Center that day. at her office, for seven years in my office, As president, may I respond? and I will continue to stand for the Bill of Rights. Megyn, but less records from other people.” How are you supposed to know, Megyn?

CHRISTIE: What are you supposed to… PAUL: Use the Fourth Amendment! CHRISTIE: When you — you know, senator… (CROSSTALK) KELLY: Governor Christie, make your point. senator, you can say things like that. (APPLAUSE) When you’re responsible for protecting the lives of the American people, CHRISTIE: …is to make sure that you use the system (ph) the way it’s supposed to work. you got a warrant from a judge. and that’s what I fought to end.

you know, unlike what you’re doing by cutting speeches on the floor of the Senate, I want to move on, because I have — we’re gonna get to you, governor, but I — I really wanna get to a Facebook questioner. And one of the best things we can do is get the government out of the way, just like I did in Wisconsin. and you say that some of the candidates here on the stage are lying. Is he lying?

CHRISTIE: No, They don’t need that Social Security check. it will bankrupt our country, would be breaking a promise to the American people, save Medicare, Please explain to Governor Christie how that would work, Nobody in this country is on Social Security because they made the decision when they were starting work at 14 that they wanted to trust some of their money with the government. if person goes to 65, It’s always that the government figures that they can do this off the backs of people, and I just think it’s fundamentally lying to people and stealing from them.

(APPLAUSE) CHRISTIE: Chris… WALLACE: …Thirty seconds. I don’t disagree with ending Congress’ retirement program. and I don’t disagree with that. The lying and stealing has already occurred. that’s worth about, and we need a strong leader to tell the truth and fix… WALLACE: …Alright, this is it. HUCKABEE: Well, The people who get wages is declining dramatically. Most of the income in this country is made by people at the top who get dividends and — and capital gains.

(APPLAUSE) WALLACE: All right. (APPLAUSE) WALLACE: Mr. KELLY: (OFF MIKE) Sounds like somebody’s a little R-rated. you talk a lot about how you are the person on this stage to grow the economy. casinos and hotels, In 2011, you told Forbes Magazine this: “I’ve used the laws of the country to my advantage. Question sir, with that record, the chapter laws.

TRUMP: Excuse me, but virtually every person that you read about on the front page of the business sections, when somebody else uses those laws, And I’m very proud of the job I did. hundreds and hundreds of deals. And frankly, so has everybody else in my position. lenders to your company lost over $1 billion and more than 1, I… WALLACE: Is that the way that you’d run the country? these lenders aren’t babies.

(LAUGHTER) (APPLAUSE) You know, I mean you’re living in a world of the make-believe, every company virtually in Atlantic City went bankrupt. (LAUGHTER) Every company. I had the good sense, and I’ve gotten a lot of credit in the financial pages, Very, very proud of it. Senator Rubio,000 people sent us questions about the economy and jobs on Facebook.

And here is a video question from Tania Cioloko from Philadelphia. WALLACE: Senator, how do you answer Tania? the big companies that have connections with Washington, they can affect policies to help them, but the small companies like the one Tania is talking about, We need to have a regulatory budget in America that limits the amount of regulations on our economy. We need to repeal and replace Obamacare and we need to improve higher education so that people can have access to the skills they need for 21st century jobs. And last but not least, It is eviscerating small businesses and small banks.

(APPLAUSE) 20 — over 40 percent of small and mid-size banks that loan money to small businesses have been wiped out over the — since Dodd-Frank has passed. We need to make America fair again for all businesses, thank you. another question for a few of you. (BEGIN VIDEO CLIP) PERRY: I will tell you one thing. But the issue for us is to have a Congress that stands up and says not only no, the world is a dangerous and a tragic place. This is a bad deal. our allies are not perfect, Governor Walker.

tying a yellow ribbon around a tree in front of my house during the 444 days that Iran held 52 Americans hostage. To me, you go to Congress and put in place even more crippling sanctions in place, It is tied together, once and for all, It’s yet another example of the failed foreign policy of the Obama-Clinton doctrine. PAUL: I oppose the Iranian deal, and will vote against it.” And I said,” I would have never released the sanctions before there was consistent evidence of compliance.

HUCKABEE: Ronald Reagan said “trust, and Iran gets everything they want. We said we would have anywhere, we gave that up. we gave that up. The president can’t tell you what we got.” What the Iranians have said is, and we will bring death to America. and we need to take that seriously. gentlemen.

the first debate night of the 2016 presidential campaign continues from Cleveland after a short time-out. let’s start with you. You now say that you support ending federal funding for this organization. you sat on the board of a Bloomberg charity that quite publicly gave tens of millions of dollars to Planned Parenthood while you were a director. and if you did know, BUSH: I joined the Bloomberg Foundation because of Mike Bloomberg’s shared commitment for meaningful education reform. It was presented and we approved it. We did all of this and we were the first state to do a “choose life” license plate. and tens of millions of dollars have gone to create a culture where more people, KELLY: Did you know it?

I am completely pro-life, (APPLAUSE) And I this not just as it related to unborn babies, you favor a rape and incest exception to abortion bans. Cardinal Timothy Dolan of New York just said yesterday those exceptions are preposterous. through no fault of the baby? RUBIO: I have never said that. It is called the Constitution of the United States. whether they can vote or not. Whether they can speak or not. in 1999.

quote, “very pro- choice. In 2004, Even in this campaign, TRUMP: I don’t think they like me very much. I’ve evolved on many issues over the years. And then since then, I’ve very much evolved. and it was going to be aborted. And it wasn’t aborted.

I come from a place, And I have really started to see some of the negatives — as an example, And unfortunately, something else that cannot be repeated on television. BUSH: None of which is true. Trump’s language is divisive. I want to win. We’re not going on win by doing what Barack Obama and Hillary Clinton do each and every day. I have that message because I was a governor of a state that saw people lifted up, We led the nation seven out of those eight years.

I cut taxes, If you do that and apply conservative principles the right way, Campaigning in places to give people hope that their life is better because too many people are suffering today in America. KELLY: Mr. and I appreciate that very much. But when you have people that are cutting Christians’ heads off, we’ve never — it almost has to be as bad as it ever was in terms of the violence and the horror, we don’t have time for tone. We have to go out and get the job done. how would you explain to them your opposition to same-sex marriage?

and I happen to believe in traditional marriage. KASICH: Wait, Megyn, I just went to a wedding of a friend of mine who happens to be gay. So if one of my daughters happened to be that, (APPLAUSE) KASICH: That’s what we’re taught when we have strong faith. (APPLAUSE) KASICH: So the issues like that, and I’ve been saying it all along, treat everybody with respect, and let them share in this great American dream that we have.

I’m going to love them no matter what they do. Because, you know what, God gives me unconditional love. MEGAN: Senator Paul, in the wake of the Supreme Court’s ruling on same sex marriage, Carol Fox on Facebook want to know the following. Quote, PAUL: Look, the mayor actually.

that’s when it’s time to resist. WALKER: Well, who’s talked to me about this many times in the past — it’s about training. It’s about making sure that law enforcement professionals, And that we protect and stand up and support those men and women who are doing their jobs in law enforcement. Our next topic is foreign policy. you may not have seen the late developing news today our Fox Pentagon team broke earlier this evening about a top Iranian general traveling to Moscow to meet with Russian President Vladimir Putin. and Afghanistan. Security Council resolutions to confine him to Iran. Trump.

TRUMP: I would be so different from what you have right now. Now… (APPLAUSE) TRUMP: I agree. with Iran, we’re making a deal, you folks should go out and buy it right now because you’ll quadruple — this, Senior Defense officials tell Fox they strongly suspect Russia was behind the cyber attack on the Chairman of the Joint Chiefs office… (UNKNOWN): …Please. BAIER: …email. Senator Cruz, what would you do about it? China is waging cyber warfare against America.

and part of this Iranian deal was lifting the international sanctions on General Soleimani. in August of 2012 President Obama famously declared Syrian President Bashar al-Assad used chemical weapons, quote, used chemical weapons and crossed that red line, As president, We won’t even give them offensive weapons. we turned our back on Israel, and a situation like that, he won’t think about that. you push.

Under Obama and Clinton, We need to have a national security that puts steel in front of our enemies. I would send weapons to Ukraine. and I would reinstate, (APPLAUSE) We define (ph) steel. the culture of the American military is definitely changing. how would you handle that? The purpose of the military is kill people and break things. sailors, airmen.

We’ve reduced the military by 25 percent… (APPLAUSE) … under President Obama. The disaster is that we’ve forgotten why we have a military. then we ought to be able to answer it. We’ve not done that because we’ve decimated our military. A lot of the B-52s we’re flying, most of them are older than me. (LAUGHTER) (APPLAUSE) BAIER: Senator Paul, let’s be clear, I’m the only one on the stage who actually has a five-year budget that balances. Israel is not one of those.

they will be stronger when they’re independent. We shouldn’t borrow money from China to send it anywhere, But you still say that Israel could be one of the countries that is cut from financial aid? CHRISTIE: Well, You know, if we want to deal with these issues, No less than 185,000 active duty marines in the Marine Corps. Bring us to a 350 ship Navy again, and modernize the Ohio class of submarines.

Those are the kind of things that are going to send a clear message around the world. And as we move towards dealing with foreign aid, CRUZ: Brett, BAIER: Senator, In our final moments here together, we want to ask them an interesting closing question from Chase Norton on Facebook, And God speaks through the Bible. when I was a child, “you shall know them by their fruit. a social conservative.

like life and marriage. And I have been proud to fight and stand for religious liberty, His father was a coal miner. My mother’s mother could barely speak English. but a candidate for president of the United States. I tell my people that these are about a movement. today the country is divided. You asked a question about the police and the difficulty in communities. We’ve got to unite our country again, but keep in mind.

the lord is not picking us. he wants America to be strong. He wants America to succeed. same question. And it’s only by the blood of Jesus Christ that I’ve been redeemed from my sins. a Ten Commandments, if you will, And I hope people see it in my state, even in the big challenges I took on when I had over 100,000 protesters in and around our capital.

It wasn’t just how I took on those political battles. It was ultimately how I acted. (APPLAUSE) KELLY: Senator Rubio, I want to ask you the same question. I want to hear more about what these candidates are going to do for our nation’s veterans. which you may find to be related. RUBIO: Well, first, And we have honored that blessing. I am proud that last year we helped change the law.

(CHEERING AND APPLAUSE) KELLY: Dr. Carson, and how divided we seem right now. if anything, you see, And those who want to divide us are trying to divide us, (APPLAUSE) BAIER: Now each candidate will make a closing statement. KASICH: You know, I want to tell you what I’ve done. I was the chairman of the House Budget Committee and one of the chief architects the last time we balanced a budget.

and it was the first time we had done it since man walked on the moon. and I inherited a state that was on the brink of dying. (APPLAUSE) KELLY: Governor Christie? thank you, Listen, I was born into a middle class family in New Jersey. New Jersey. Was the first person to graduate from college. A state like New Jersey, but still we cut taxes.

we balanced budgets. We have got to stop worrying about being loved and start worrying about being respected. And that’s exactly how I’ll lead our country. (APPLAUSE) PAUL: But I’ve also gone to Chicago. because I want our party to be bigger, and I’m the only one that leads Hillary Clinton in five states that were won by President Obama. I’m a different kind of Republican. They came to America because it was the only place where people like them could have a chance. And the journey from the back of that bar to this stage tonight, (APPLAUSE) BAIER: Thank you.

and then intend to cancel the Iran deal, and finally move the U. WALLACE: Dr. closing statement. I haven’t said anything about me being the only one to do anything, so let me try that. if you go to Washington, (LAUGHTER) But I — but I’m very hopeful that I’m not the only onel who’s willing to pick up the baton of freedom, and we must fight for it every day. A person who has been filled with scandals.

I’ll be my best to do that, I’m guy with a wife and two kids, I took on the big government union bosses, We balanced the budget, cut taxes, and turned our state around with big, bold reforms. It wasn’t too late for Wisconsin, and it’s not too late for America. WALLACE: Governor Bush.

how we regulate. because I did it as Florida. We can grow economically and restore America’s leadership in the world, BAIER: Mr. TRUMP: Our country is in serious trouble. We don’t win anymore. We can’t beat Mexico, and we have to make our country great again, BAIER: Gentlemen, thank you.

KELLY: Are you relieved? who will now be joined by their families on stage. ABC chief Channing Dungey confirmed to reporters ahead of ABCs upfronts presentation that a revival of Roseanne is being planned at the network for a 2018 debut. John Goodman (Dan), and theres really no one better to comment on our modern America than Roseanne, it was revealed that a Roseanne revival was in the works, though a network was not announced. which aired on ABC from 1988 to 1997, might remember that Goodmans Dan died at the end of the series. But in a 2009 post on Barrs website.

the actress predicted the patriarch would show up alive "after faking his own death" should the show ever return.

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