>> from our studios in new york city, this is charlie rose. >> anthony bourdain is here. he is a chef, author, television personality, known for his

candid approach. eric ripert has told him the indiana jones of the world. unknown," takes him all over the world. i am pleased to have anthony bourdain at the table. you seem awfully mellow today. is there a particular reason for that? >> i am coming right from jujitsu. it is a humbling experience getting squashed by younger, more fit experienced people. >> why jujitsu? things like something you would know for a long time. >> i started at 58. it is the last thing in the world i could have ever imagined running to do or enjoying. i have never hung out in a gym. -- describede this

to learn a new skill at my age is satisfying. on thehe person lowest totem pole in the kitchen, knowing nothing, the incremental, tiny satisfactions of being a little less awful at something every day, that is jujitsu for me. i am learning an entirely new skill. a difficult one. a physically demanding one. one that i think about what the rest of the day. they call it is a gold chest -- physical chess. >> what else in your life has had a trajectory? >> i am a guy who likes making things. when i was a chef, i like multitasking. i like making things, whether it

is a tv show, a story, a plate of food. i do not really even need to have it afterwards. the process, i think being a you toooking conditions the satisfactions of properly executing a single plate. when theprivate moment plate sits there momentarily in the window before it goes out into the dining room to be ruined. where you look at it and you know that you did this particular thing well. it is a very private moment. i think that has been useful in learning to like something so temporary. so fleeting. useful inat has been being happy in television and writing. you know, i like the process. the editing process.

the preproduction process. the nuts and bolts. the technical satisfaction of putting these elements together in conjunction with other people. and having one tiny golden moment where you say, that looks pretty good. >> you seem to have a value structure as well. personal value structure, so there are things you do not want to do. you never wanted to march into product endorsement. you knew what you are capable of doing in terms of value structure and not capable of doing. it seems like the things you are not capable of doing, you could not do them. and you walk away. >> it is not a matter of integrity. there is the quality of life issue. will i be able to it with whatever decision i make today? will i be able to live with her tomorrow, a year from now?

mistakes inso many my life was ultimately helpful. i think achieving any kind of 44 also wasge helpful. i have learned how to say no to things that might hurt me or make me unhappy. >> might make you unhappy or do damage to you. most of my creative and business decisions around a simple principle. who will i have to speak to on the phone for a regular basis? if the phone rings and i pick it is someone i would not ordinarily want to have a conversation with go to dinner with, i certainly do not want to be in business with them. i do not want that in my life. it will lead to bad stuff. and i want to keep them away. >> you mentioned people have

been enormously important, your wife and kid. changed you in a way. you were noten really looking for wife. >> we met on a blind date arranged by eric ripert. were, she is crazy. have fun. do not get serious area --. >> and then you got serious. age was a guy who, until 50, though i might have your for what a normal life might be like, i think i recognize i was not up for the job. at some point after meeting my wife, i had that thought again. wouldn't it be cool to have a child? with it this time came the knowledge that i am ready.

i am actually old enough. i would be good at this. i'm not only want to, but i can. is it necessary to be good at it? >> it is necessary in my view. you owerything -- everything. i have disappointed people in my life, and this is something i wanted to get right. tois such a wonderful thing find you were no longer the star of your own movie. it is such a great thing to realize it is not about me anymore. it is about this little girl. that is an enormous pleasure and privilege. i feel relieved of the burden, actually. >> you said holding her in your arms, you realize this brings

you more satisfaction than you could imagine. >> yeah. -- especially to be the father of a little girl. it is a particular delight. >> that the way of it is what other fathers, the sun and moon? >> i do not know how it is with other fathers. >> also, heroin and crack ,ocaine -- to not know you then you say he is too smart for that. >> there are plenty of smart people on drugs. back, i was delivered only doing stupid things. with malice of forethought. whatever you do, do not do that. there is the smart option and the release of the suicidal one. i would absolutely with

determination had with the stupid one. >> why? >> i don't know. happy, i guess, with something. not satisfied with the world the way i saw it. the right decisions for most of my life when i had exhausted every other option. >> to look at your show, i think i understand why it is so good. why do you think it is so good, without being in modest? -- immodest? >> i worked with the same people for years. we are a type of people love film, who enjoy their work. who experienced an extraordinary amount of reading creative. doing what we are doing. we insist on having fun doing what we are doing. >> demand.

outfit,e a handcrafted embarking on an adventure together, doing our best to keep it interesting for ourselves. to find new ways to tell often similar stories. >> you find new ways to tell stories. it is not about finding new stories to tell as much as it is finding out how to tell the same story. this person's culture, this person's culture. >> we are asking simple questions. it is often a similar story arc. i go someplace, i eat a bunch of stuff. i come to conclusion or i don't. >> and over food, you talk about who they are, what makes them happy. >> that is actually a pretty complex story. if you go to the congo or iran or libya, you are going to get

some very surprising, very nuanced, very complicated answers. >> provincetown. i was just looking to do a completely different story. that story was about heroin. it was not about a place. i went back to provincetown tracking my own progress, sort -- descentinto drugs into drugs, as was emerging as a major drug epidemic in new england and other small towns. >> heroine, not crack cocaine. n. it is heroi when i first started reading about it, the small, predominantly white, norman

rockwell towns all over america that have moved from legally prescribed oxycontin to epidemics of heroin use. probably the worst urban street drug there is. i find that interesting. likely, thehe most best argument for depicting heroine as a problem. it is going to be the easiest sell. what precise moment did it become a criminal problem? who is a junkie and who is someone who has been overprescribed? ofse questions become sort tricky to answer. >> where are you going, in a sense?

you are at cnn and do the other thing too. but cnn talked about you as representative of the future. that what you have done is representative of the future of where one cable network wants to go. where are you going? >> i am not looking that far in the future. nothing about me sees you as a guide with has planned his life out. [laughter] going?e am i i see what we do as an adjunct to the news. we are telling stories about people's everyday lives. more often than not. that i think are useful. you know, when you are reading about iran right now, who are we talking about? whether or notg they hate america but who they are.

>> we do not see that side. it is uncomfortable sometimes. it is confusing, complicated. things generally television of hors.-- ab world.is a big i will keep doing what i am doing as long as it is fun. as long as we find creative ways to tell those stories. what is the idea of what's for dinner? one makes you happy if you are away or let tom -- left home. i often ask what is the dish that you crave? the first experience of food or

drink you want to have when you get back. and, you know, there is a lot of information in the answer. do with who is eating, who is not eating, what your social economic situation was growing up. ethnically, where this food might have come from. i find that fascinating. the other stuff intrudes. we never intended to become a political show. as i also said, there is nothing more clinical than food. >> this is a scene from provincetown. we will see another one from where you first worked as a cook. >> many of the old places are gone. but the lobster pot is still going strong, all these years later. it still has what i want and need, the essentials.

my friends worked in the kitchen, starting a tradition that cooking work was noble toil. >> i was getting to that. >> this is homemade portuguese soup. made on the premises. a version of soup caldo verde. chorizo, kidney beans, potatoes. that is what i love about the food here. the portuguese thing. with sausagened and breadcrumbs three some sherry and sauce. >> i was a deadbeat for a while. and then my friend comes home from work and says, our

dishwasher did not show up today and you are our new dishwasher. i put on the apron and did not take it off for 30 years. i would hang out on the beach until 3:00. >> it was fun. work, drink all night, getting high. you had all the liquor you wanted. all the sex you wanted. and it was still an essential part of the economy. >> believe me, i remember. >> tell me who he is. stillt is john ingling, owns and operates a pizzeria thirty eight in provincetown. he was a central figure in my life and now a respected elder statesman in provincetown. >> can you see progress year-by-year? in terms of how you present the

material that you see? >> somebody asked me, what other documentarians are influential to you? and the answer is none. we spend a lot of time looking at dramatic films, foreign films, classic films. particular eye towards storytelling, timeline, editing. we use those as reference points and inspiration. -- snstance, stephen sadr oderbergh's "the limey." it keeps falling back on itself. we are always looking to use a device like that. >> so you watch that and say, you have to see this. it is really interesting. or does images watch that and take a listen -- less and

incorporated? kari will be watching wong wai, and i meet with my crew, and say i want that look. the lush camera angles, the movements. we are all film nerds. it gets us excited. they go out and watch wong kar wai films, and we talk about how we are going to do that for less. >> emagin of career as a filmmaker? >> i produce independent films. i am working on two now. >> like what? .> a documentary for cnn all full-length feature on a famous chef. and another project.

>> i hear you. this is research about you that really fascinated me. we talk about a mission statement. whether it is soldiers or athletes or anything else. this is it. -- bourain says it is a quality-of-life issue. are we probably what we are doing? do we have anything to regret tomorrow? those things are huge to me. that is what we want to create. that is what i was talking about as values. >> i want to look in a mirror and be happy with what i did yesterday. i have been fortunate to avoid that feeling. it is important to me to feel good about what i did yesterday. >> take a look at this.

going into this, give me a sense of where your head was as you got on the plane. >> i had been wanting and trying, unsuccessfully, to get to iran with a crew for five years. >> are you intrigued by the place beyond the politics? >> i had heard from a few people who had been that i would be surprised. , the way i would be treated on the street by iranians, was very much at all iran we knowthe from the news. i heard the food was fantastic. i knew that very few people had had the opportunity to do the kind of show i was interested in doing. just hanging out with people. showing people doing their thing. have beenmething i

trying to do for a long time. the window open. were allowed. others were not, but we were allowed. >> and you said yes? >> finally. and we did our best. we knew that this was an incredible opportunity. try very hard to do the best work we could. >> did it change your impression of iran? >> it is so confusing. i have seriously said that very few places i have ever been have been as overtly friendly to us just by virtue of being american. this incredible sense of, where are you from? america. fantastic. come to my house.

this with the "down with america" mural on the wall. very friendly. from how we are sort of conditioned, knowingly or not, to expect iran to be and look. barcelonaind of like tehransuburbs of rome in . said, everything is fine until it is not. as we found out with someone we spoke to in the show, suddenly, it was not good at all. we had a lovely person with us on the show. they behaved impeccably. shortly after the show, he was

arrested and basically disappeared into the prison system. and has not been heard from since. >> take a look. parts unknown, iran. does not look, does not feel, the way i expected. neither east nor west. but always somewhere in the middle. ♪ >> well, it looks spectacular. >> it is time-consuming, expensive. so persian cuisine has to be experienced in somebody's home. this is slow cooked lamb and yogurt? >> gilbert, saffron, and any of.

art gallery owner insisted i come over for lunch with friends and family. >> here we have sour cherry rice with chicken. >> sour cherry. more than any other nation, we use our cherry. >> nahim has been the family cook for generations. ace and saffron baked into crispy dough. rice is not a side dish. it can be the main event. you put more on the table than anyone could conceivably. eight -- eat. >> if you do not like your guest, you do not put anything. >> ground beef, onions," rice. apricots, and tomato. >> we are a very interesting

nation. >> the contradictions are enormous. take you to our house, our hearts, all of that. that is really extreme in so many ways. you see this tortured iran for manyn years. how do you think americans will react? [laughter] >> what was the answer to the? >> i said or to the absence of evil? >> he said, we are never evil, like everybody else. the women in particular, very assertive. very opinionated. of the religious police. we hear what is set by the government, the clergy.

but how people talk and hold themselves, it is very surprising. that, ifdy speculated you go to some countries, the more the regime loves us, americans, the more the people hate us. and the more the regime hates us, the more the people love us. and they use iran as the best example of that. >> don't know. -- the shahtainly loved us. a country, very old empire with a deep traditional love of poetry and music. >> filmmaking today. >> things that are very much at odds with the official attitude towards these deeply persian characteristics. very conflicted.

and you can really see it kind of playing out in an unspoken way. desire to figure out what is permissible, who we want to be. where are we going? there is a real simmering of something. -- ieling like something got the feeling sometimes in tehran that if someone pulled off and started playing dance music in a car, like a broadway musical, everyone was dancing. >> thank you for coming. >> a joy always. >> anthony bourdain. back in a moment. ♪

>> john noseworthy is here. he is the president and ceo of the mayo clinic in rochester. named the best hospital in the nation's here. it is celebrating its 100 80th anniversary. it is undergoing major changes, including a 20 year, $6 billion plan to make rochester a destination medical center. i'm pleased to have you up his table. >> is up privileged to be here.

>> i think everyone has an appreciation that mayo clinic is a first rate institution. --t replication proceeds you reputation precedes you. what is it in your judgment? >> we were the first and now the largest integrated multidisciplinary group practice of medicine. we are rooted in research and education. essentially, the guiding purpose of the clinic is the needs of the patient come first, and we do our work with teamwork. that is essentially what we have done for 150 years. we have a staff completely dedicated to patients. and we move forward to predict the future needs of where health care needs to go. we have some unusual features, as i am sure you know. our physicians are salary.

the institution's physician led, every position is paired with an administrator to make sure the business works well. we have a committed staff. we are not for profit. humanitarian organization. we branched out from rochester to arizona. we built a national network of affiliated hospitals and health care groups with which we share information so they can provide better care to folks around the nation and mexico and puerto rico. it is a service to work there. >> my impression of mayo clinic is that one has at his or her service a whole variety of experts. and there is a look at that well-being coming from many directions? >> one of the innovations was a single medical record. that started in the early 1900s.

a patient came to mayo clinic. the record was shared with other health care providers. wherever the patient went, the record went with them. prior to that, doctors kept their ledgers private. at mayo, you have a position that sees you first. if we need to bring in a host of folks, they work together to meet the needs of that patients. either face-to-face or electronically. and then everything is summed together. it has worked very well. >> it is a teaching institution? >> it is one of the largest teaching institutions in the country. we trained 1500 specialists a year. we have one of the largest graduate medical programs. the allied health school is very large. their goal is to train the workforce of tomorrow. currently, we are looking at

what the health care workforce will look like 10 or 15 years down the road, especially with technology involved. you are trying to be a step ahead of we can. >> how does it look 10 years from now? >> i think different from it looks today. i think it can be better. there is a movement in developed countries to share what we know more broadly across physicians. i think patients are expecting that. andthey are expecting deserve patient-centered care. it has not happened broadly, but i think it it will. i think patients will take a greater role in making decisions in their life. healthy decisions about tobacco, alcohol, meditation and exercise. i see them moving forward. are going to want an emphasis on digital

technologies. so they have what they need 24/7 to make good decisions. the united states does not have a good, sustainable health care system. it is fragmented, quality is uneven. >> why is that? >> i think it has grown up organically over many years. trained, still are trained, to work in isolation as opposed to in teams. we need to change that, and i think we will going forward. but mayo is trying to make a sustainable future for itself and sharing it with anyone wants to learn from us. >> technology has had an amazing impact on medicine. more cutting edge than ever before. technology isthat developing machines that give us more power to look inside the human body. we are getting tons of

information we never had before. so you can see disease and a broader spectrum as well as it broader perspective. >> that will accelerate. no doubt about it. with the human genome work that is becoming all portable, we can now do whole human genome testing for under $1000. patients in the future will have their genome done, and they will keep that in place. as new advances come forward, they will have it updated. we now know about diseases that you may be predisposed to. know aboutt we patients, we will be able to say, for you, that is the right therapy. do not bother with that one. one example would be breast cancer. cancer, webreast know from genome work that some cancers behave like lung

cancers. so by doing the genomics on the tumor itself that came from the breast, if we used breast treatment, we know it will not respond. and that will make a big difference. it will reduce costs, suffering for patients. there are exciting things happening. >> what did the affordable care act college and what did it not? >> the president refers to the affordable care act as health insurance reform. i thought that was an interesting twist of words because that is essentially what it did. got about 8 million to 10 million insured. more signed up for medicaid. >> it spoke to access? >> it spoke to at least having insurance. physicians seem to be taking those patients into their practice. what it did not do very much of, and one needs to happen next is health care reform.

we need to modernize the payment system. that is a government activity. for medicare particularly. we and the health profession need to modernize the delivery system so we provide more integrated, more efficient care. and ultimately, what we think the work that needs to be done now in the government is to recognize there is a spectrum of complexity. there is a spectrum in outcomes. not all care is the same. complex care to be recognized as complex care. and safer care ought to be rewarded at some point. places like the mayo clinic and other large, academic medical organization. and we have patients that are very complex. operation orip someone who has a hip infection as well. or they are morbidly obese.

bayway 400 pounds and no one will operate on them. that is a complex puzzle. in the moment, there is nothing in the system to recognize you got the diagnosis right and you did the surgery you should do. that is one step in health care reform. i think you have already alluded technologyntial for to it and how we practice medicine. using mobile technology, we can use robots and digital cameras to put a neurologist in a rural hospital. within a minute, they can identify whether the patient needs treatment for stroke. a footballrobots in stadium and on meteorologist can determine whether a person had a concussion. there is no reimbursement for that. as much as it is nice to be reimbursed, if we are going to advance and bring technology in,

we need to reward excellence and innovation. that is where america has always end, the cutting edge. of struggling with the government defunding the nih. we have to modernize the payment system. we need to take on sustaining medicare. it is important that the country has a strong medicare program. it is a leading driver of the federal deficit. it is a political issue. >> it is a political issue. and has to do with years of dialogue and debate about it. and it had to do with treatment and economics. but if you were designing a system, would you make what medicare delivers the better way to go? >> medicare is a payment system for folks over 65. >> would you make it for people over 21 or from birth? >> candidly, medicare does not

reimburse for the care that is given. and for those of us in the nonprofit sector who deal with care, it deals with roughly 60% of total costs. it is hard for those of us in the academic medical world to manage medicare rates of payment . we can do a lot with efficiency, we can drive out waste, but unfortunately, it does not really cover the cost. it does not recognize the spectrum between getting it right and not getting it right. forre often penalized getting the diagnosis right and not doing additional tests as opposed to the fee for service environment, which is still how medicare is paid. >> and that should be changed. >> that should be changed. >> what is the cutting edge of research telling you? we were at a conference with a talked aboute, who the remarkable discovery that you could take adult stem cells and you could create embryonic

stem cells. from blood, i guess the sample he got. >> we can take a piece of your skin and grow heart muscle, pancreas, loan, or brain tissue right out of your skin and give that back to you. we are personalizing the use of stem cells. and that is an area that is really going to develop going forward. >> on a scale of zero to 100, probably of five? what do you give it? >> i do not know what the scale means, but i think there are now studies in patients with heart disease using their own stem cells. >> so we are fixing heart tissue with stem cells. >> we are healing wounds with stem cells. we are looking at muscular dystrophy. we are looking at parkinson's disease and multiple sclerosis. >> does that mean that his five or 10 years off?

we have human trials coming out in those areas to see whether stem cells will prevent degeneration.euro >> multiple sclerosis, what is the promise there? >> the brain is complex. we have a thousand rock that all connect with other cells. it is rough. it as humans figured out how to program the tissue to do that work, we would fail. there is something in the genome that tells the cells what to do. we are investing heavily in stem cells, heavily at mayo, in the work we do with individualized medicine. we talked about the human genome as a more mundane level, perhaps, using engineering to deliver health care more

efficiently. >> and engineering principle. >> essentially managing workflow and allowing surgeons to do more efficient surgeries with fewer operating rooms treat get patients home earlier. those are big steps we can take to reduce health care costs. >> my impression is that since you have been there, you have change the economics of a ovonic. and you have gone from an institution that was i'm not i'm not great financial plays and given it more viability. primarilyone that through cost efficiencies or something else? >> about 10 years ago, we could see what was coming with the health care system in the country. we knew there would be less revenue for the work we did, and we knew consumers would be

getting more engaged with health care. >> and there would be more of them. >> and research is going to be underfunded. so we try to grow our revenues. we still are. management a expense and revenue growth. as i said, reengineering how we work so we are more efficient than we have been. there is a limit to how far we can go. >> mayo clinic is famous because of the doctors that run the institution. why is that? >> a decision was made early on -- >> the cleveland clinic as well. >> they followed our model, and it worked well there. but it seems to work best if physicians are involved with that, in that of making business decision. it works well having physicians advise other physicians how it should work. it is managing change, charlie. undergone this

extent of change as we have in the last five years. most of that comes from market shifts, the affordable care act, other things that are putting huge pressures on the medical profession. it is hard to change patterns when you have been in practice or 30 years. >> there was an article in the wall street journal that suggested doctors are increasingly unhappy with their practice of medicine. >> yes. there is a phenomenon called "burnout." it is a big deal. 43% of physicians report of feeling of depersonalization and detachment, a loss of interest in their work. mayo is not immune from that. we have burnout at the mayo clinic. the pressures are such that folks are losing the flexibility that is so important in their work.

there have been recent reports that 90% of decision would tell their kids, do not go into medicine. you have huge debt, it takes you forever to get there. >> how would you fix the problem? >> there are a number of things that need to happen. >> other than the structure and sustainability. >> it is a great time to be in medicine and science because the future is ahead of us. we need to embrace change and have the courage to make those changes. >> and the government needs to fund the research aspect of it? >> the u.s. has always been number one in innovation. but they are losing interest in the long term investment. they need to make those investments. >> the government is losing because of its own politics in washington over funding and taxing and budgets? >> the private sector is burgeoning. so we at mayo and others are

turning to the private sector, to our benefactors, to invest in research. >> would medicine be better off if there were more mayo clinics around the country? >> that is for others to judge. we think it works well. it is not easy to duplicate the culture, the patient-centered culture. as we look ahead at all the things that are happening in the market, bigger hospitals getting bigger, the not for profits coming together with insurance thatnies, mayo clinic says does not sound like a patient-centered answer. how will the patient's benefit if the hospitals get bigger and bigger? it provides them with purchasing power to be financially successful. knowing weide to do, could not scale our culture like that across the country, we basically digitize our knowledge of how we work as a group

practice. and we have made that into tools that others can subscribe to to carethem provide better locally. in kentucky, california, mexico city, puerto rico. we are a finding with the affiliate model that they are able to keep 80% to 85% of their patients at home and never send them to a mayo clinic. the 10% or 15% that you need to come come for specific reasons. so it reduced care cost. but that is a different model. >> number one, the idea that this is a place that people with limited resources come because they know they get the best health care, especially for certain kinds of specialties. kings and royals come to the united states. are you saying we will lose that if we do not pay attention to what we have to do to understand

what produced that and make sure we continue to produce that? recognize people excellence, and they will go where there is excellence. over 50% of the patients we see our medical patients. we see kings. but they are way less than 1%. but we need to fund excellence. >> people can go anywhere in the world, and they choose to come here most of the time. >> we like it when they do come here. we have patience from 135 countries. >> you should do it because you want excellence, as you say. but i'm just trying to put my finger on the sense of what is at risk unless we have a deeper appreciation of the challenge of medicine in the future. , in in terms of research terms of organization culture. >> i think excellence is at risk

in science and medicine in this country if we do not invest in the innovations that we talked about. it will be a race to the bottom. that is our message from -- to government, our message to the private sector. we will get this right. >> is not debated in political campaigns. not, but americans deserve, and i believe they will demand, a sustainable health care system. what they do not recognize is they will be paying more out-of-pocket with the system we have. they will not be happy with that. they will presumably say, how do we get a better system? that is health care reform 2.0. >> when will we start? >> i'm not sure we will start before the next major election. there's a sense that health care is done. has affordable care done better than expected or about

what you expected or not as well? >> the commonwealth fund's survey just came out, and they suggested that things that can be measured with a short time, the people who are uninsured that are now insured, and folks plans,up medical advance they are getting passing grades. in terms of what he will do to the total cost, the jury is out on that. there is not very much in there about how we modernize the system to sustain excellence going forward. that is the next issue that needs to happen. >> partnership with octomom, what is that? optimum, what is that? >> are trying produce better outcomes are lower cost. the cost issue has been a problem. years ago, we paired

up with unitedhealth group and said, let's create an open innovation lab, where you can put your 150 million patient claims data over 20 years. what people really spend in health care. we will put in our data on outcomes on how things work and use big data tools to determine what determines better outcomes. what is working? we now open bell loud, have 20 groups that join us, other academic medical centers, centers,a, policy saying how do you get a better outcome with parkinson's disease or breast cancer or heart disease? we would like to create a database where patients can look and say this is the best place to get this. i want to get a diagnosis

accurately. i want to have all the care i need and no more than that. that will create a competitive marketplace. >> thank you for coming. thank you for joining us. see you next time. ♪

>> i'm john heilemann. >> and i am mark halperin. we are all about the stirred and not the shaken. ♪ on this show tonight, the right puts its foot down and the president assures ceos they won't foot the bill and obama and mcconnell play some footsie. but we get with breaking news. just like in ferguson, missouri, there will be no indictment for a sheriff who killed a black man in new york city. he was put in a chokehold and was captured on a cell phone camera. the video is seen around the world. moments ago, president obama spoke about the implications of another grand jury decision not