today. [ applause ] >> thank you. >> c-span, where history unfolds daily.

in 1979 c-span was created as a public service by america's cable television companies. and today we continue to bring you unfiltered coverage of congress, the white house, the supreme court, and public policy events in washington, d.c. and around the country. stash stish c-span is brought to you by your cable or satellite provider. 50 years ago apollo 8 became the first manned spacecraft to successfully orbit the moon and this weekend american history tv marks the milestone with special features starting sunday at 9:00 a.m. eastern, we're live from chicago's museum of science and industry, home of the apollo eight capsule with author robert curse intaking your phone calls. at 10:00 on oral history, the 1999 interview with apollo eight commander frank boreman and at 4:30 p.m. eastern an oral history interview with apollo 8

command pilot. watch the 50th anniversary of apollo 8 this weekend on american history tv on c-span 3. senate health education and labor and pensions committee chair lamar alexander will be leading efforts by the senate to reform health care. this week he talked about how the 116th congress beginning in january could reduce health care costs. this axios interview lasts about 15 minutes. please welcome axios executive editor michael allen. >> good morning, early birds. welcome to axios. thank you very much for joining us for a conversation about health care, kicking off 2019. we're going go get a head start since we're covering 2020 in the news letter, i figure we should cover 2019 here on the axios stage. i would like to thank delta

dental for making this conversation possible. we appreciate their support of this conversation about access to health care. axios makes you smarter, faster about the topics that matter. the topics that are changing our world. business tech, media politics, science and health care is such an important part of that. even before axios launched, two weeks before the start of axios, we had vitals. our health care news letter and david nader and i were doing news letters before there even was an axios.com. so we appreciate having you here to continue that conversation. we hope you'll tweet along at #axios360 and i want to thank the event team for their miracle overnight and otherwise a very grateful for them. the amazing and knowledgeable axios health care team under the leadership of david nader and sam baker who helped prep me for today and we're going to hear

from caitlyn owens shortly. and bob herman who joins them on the business of health care. so we love their coverage and i would like to thank also the teams of our speakers today. so thank you for a great conversation. our first speaker is a seven seventh -- generation tennesseean and a governor of tennessee twice and he's been mr. president, president of the university of tennessee, he's been mr. secretary, secretary of education under president george h.w. bush and now senator and mr. chairman, chairman of the senate health, education, labor and pension committee and the health committee, chairman marl alexander, welcome to axios. >> thank you. >> you just spent a nice stretch of the nation's time remembering a great man, president george h. westchest

w. bush. what was his biggest contribution to health care? >> i worked with him on education. the biggest contribution to health care was the american for disabilities act. that -- that helped millions of americans and american families. >> senator alexander, yesterday you gave a floor speech where you said up to half of health care spending is unnecessary, that is a bold stat. how do you defend that? >> well i defend it because we've had five hearings on reducing health care costs and dr. brett james, who is a member of the american academy of medicine said that. he said 30% to 50% of what we spend on health care is unnecessary. so i was so startled by that that i asked the other witnesses, and they agreed with him. and i asked the next panel and they agreed with him too. that means of the huge amount we spend on health care, that we waste an amount of money and -- in the proseiss -- precisely

spend money for every country. and so my focus over the next two years if i'm chairman of the health committee is to see if we could do one or two big things to reduce health care costs and maybe ten or 12 little things and try to move the whole debate from health insurance where we've been stuck for eight years, arguing about 6% of the health insurance market, that is obamacare, to health care costs. you'll never get lower cost health insurance until you have lower cost health care. >> now, as part and conjunction with that floor speech, you sent a letter asking experts to identify ways to cut costs and you're including in your conversation economists, doctors, nurses, patients, hospital administrators, state regulators. as you did these hearings around the country, what was the best, most practical idea you heard

for cutting health care costs that could be accomplished. >> well, here is one. dr. gross in florida runs a direct primary care center. you pay him $60 a month, $25 for a child, $10 for a second child and so for $1,000, $1,200, you get basically all of your primary care. which is 80% or 90% of your health care. there are thousands such entities in the country. and so you know what you are paying for. that is not insurance. you just pay that. and then if you have to go to a more serious problem, why then your insurance might kick in. that is an example. the general example i hear, it looks to me like that the single most important thing we may be able to do is to find ways to make the health care system function with a discipline and the cost saving benefits of a real market. and to get rid of the barriers

that are innovation -- barriers to innovation that keeps costs from going down. and also to find ways to make it possible for consumers to know the price of the health care service they are buying. and if we could make the health care system a true market, that might do more than anything else to bring -- >> and you said that one of the biggest problems is people don't know the true cost. >> that is it. that is the second thing. the first is get rid of the barriers in the way of innovators, but nobody knows -- secretary acer will be here and he has a great story about how he went for a procedure and found out it cost several thousand dollars and he got on the website and checked around and found out he could get it for $500 in the doctor's office. so the way our system is set up, you don't know the price and if no one knows the price, prices aren't going to come down. >> now, you talked about over the next two years and we're going to -- in january we'll

have divided government. we have a little preview -- sneak peek of it yesterday. our divided government. you were hoping to do two or three big things, that is a lot. so maybe pick one of them. what is one big thing that you believe you could accomplish next year as chair. >> well i'll have to sit down with senator murray and figure that out. whenever we agree on something, we can usually get it done. it just takes a while to agree on it it. >> what is on the short list. >> i've talked with her and on my short list is reducing health care costs. i've sent these letters to aei and brookings and say give us something specific to do. i think the thing i'm going to focus on is making the system more of a market, getting rid of barriers and if i could find away or ways to make it possible for those of us who buy health care services every day to know the price of what we're paying for, that would be the single most important thing i could focus on for two years.

we should do that. members of congress should not sit around with the facts in front of us that we are spending $1.1 to $1.8 trillion unnecessarily on health care and not do anything about it. >> the question i have about these letters, though, mr. chairman, is the people in this room are very knowledgeable about it, they will agree the problem in health care is not ideas, there is no shortage of ideas. >> no. i don't agree with that. most ideas fail around washington for lack of the idea. and i'll give you an example. i wasn't to the national academy of sciences in 2005 after particularly dreary budget meeting and said i believe if you give he is ten specific ideas in priority order about how to improve american competitiveness, congress will do it. they formed a commission and ron augustine headed it and they gave us 20 specific proposals in priority order and congress did 14 or 15 of them in the american

competes akts. one for example is we created agency in the department of energy called arpa-e after darpa which is in the defense department. that is a very specific idea. so what i'm hoping is that someone at aei or brooking or someone here today will say i hear you. if you want to do something to make the health care system more of a true market, here are five specific things you can do in priority order. >> carl holston introducing you on his new york times podcast said the republican effort to overturn the affordable care act is in shambles an the insurance program is in serious trouble leaving mr. alexander to try to pick up the pieces. no pressure. >> well, the truth is most health insurance -- what he's talking about is the individual market. most people have health insurance, 60% of us have it on the job. we don't hear many complaints

about that. most of the rest are medicare and medicaid. and 5% or 6%, 7% have individual market. half of those have subsidies so you don't hear about that. so we're talking about 3% of the people, the contractor makes $60,000 a year and spending $20 for his health insurance. we had a planner to fix that. senator schumer said it was good enough for every single democrat to vote for. and we can pass that any time the democrats want to vote for the hyde amendment again. to so it was reinsurance, cost sharing subsidies and giving the states more flexibility without changing the essential health benefits or pre-existing condition. it was very good policy and the various groups that said it might reduce the cost of insurance up to 40% a year. but i don't want to get stuck in the next two years on health insurance. the democrats have really elevated it to the 67th book of

the bible and they won't change it even if they disagree with it. so let's move over to health care. >> and well that is clever because health insurance is a loser issue for republicans. >> well, maybe -- it was a loser issue for democrats when they passed it. we got a republican congress based on obamacare. >> well senator we have a different view of that. but my colleagues -- >> well look at 2010 and 2014. >> my colleagues caitlyn owens and sam baker are colluding over here. they're going to jump in as my phone a friend for question in just a second. but before i turn to caitlyn and sam. senator, you have a very rare working relationship with the republican leader and is mitch mcconnell, has that been strained a little bit and how do you think that eco-system will change as we move into divided

government next year. >> not very much in the senate. in the senate because we respect minority views, i have to get senator murray and the democrats on my committee to approve something, if we are going to get it we have to work in a bipartisan way anyway. the best opportunity for success sometimes is with divided government. i tell people sometimes, look at washington as a split screen television between october 6th and november 6th, that is the kavanaugh hearing and all of this stuff over here. but over here you had 72 senators, murray and i and a lot of others creating a landmark opioids bill. we passed record by medical research funding for the fourth consecutive year. we passed the biggest change in copywrite law that helped song writers in 15 years and faa bill and dam and infrastructure bill and banned cell phone calls from airplanes. senator feinstein and i have

been working on that for five years. he did have to sit next to somebody revealing their inner most thoughts for four hours as you fly to california. all of that happened between october 6th and november 6th. so if you look at washington as a split california. so if you look at it as a split screen television, this year or the next two years, i think you'll see a lot accomplished, but it will have to be bipartisan. which is why i'm glad i have a good relationship with senator schumer as well as senator mcconnell. >> caitlyn, a question for you? >> i want to thank you for your work on the cell phone ban bill. it sounds like a lot of other people do. just kind of cleaning up a little bit, two specific areas that you didn't get into where health care costs become a very political issue is prescription drug prices and now, increasingly so, surprise medical bills. >> what bills? >> surprise medical bills. >> oh, yeah. >> what, if anything, do you plan to do in these two specific