areas of pakistan proper would be one of the real game changers. not only in the u.s./pakistan relationship, but also in -- it would have ripple effects to pakistan's macroeconomic environment and the stability of it democratic system such as it is. and that's one of the, one of the large things which could change the, could change the scenario pretty significantly. >> well, thank you very much. i said in the beginning i was really excited about this going in because of the book and the speakers, and -- oh, and i've been, i was vindicated this feeling that way. thank you very much, anatol, josh, mohsin. it was really fascinating and quite illuminating. not that we have too many solutions, but i think we had a very rich discussion. thanks to all of you also. [applause]

>> you're watching 48 hours of nonfiction authors and books on c-span2's booktv. >> author sally pipes attended the 2011 los angeles times 'festival of books where she discussed her book, "the truth about obamacare," and took viewer tv phone calls. thisto is about 30 minutes. >> host: and our impromptu set here on the campus. this is sally pipes, and she has written her third book about health care in this country. this one is called "the trutht about obamacare." ho hw long have you been interen inside health care as aprof professional interest? >> guest: um, probably, susan, for about 25 years. i grew up in canada. i worked at the frazier institute, and in the late ph '80s we started looking at the growing waiting lists in canada. then in '91 i came to the u.s. to head up pacific research and got the opportunity to get involved in hillarycare and then, of course, following what's been going on in

particular with president obama and obama care, just totallyjust involved in it. >> host: in the book you acknowledge that the american health care system was in need of reform. in 2009 when this really began to take up -- what do you see a. the major problem with the american health care system? >> guest: well, you know,w, e everyone wants affordable,cess accessible, quality health care. . the president, of course,mented universal coverage and bend the cost curve down. we spent about 17% of our gross domestic product on health care. i would like to see the health care system reformed. my vision though is not increasing the role of government in health care. we have about 50% of health care is in the hands of government today, and i would like to see that reduced and to empower doctors and patients. get away from increasing government, and of course, under the affordable care act, this legislation is really growing the role of government in our health care system.

it's not going to achieve universal coverage or bend the cost curve down as the president said he wanted to do. >> we're here to interagent with you about health care and her book, and other books included miracle cure and the myths of the american health care published in 2008. you can send us your questions by e-mail, and that is at booktv@c-span.org. you can also phone us. phone numbers are on the screen and you can tweet us, it's at booktv. loathes of ways to get -- lots of ways to get involved and look forward to your questions on this. one of the things i learned is some of the interesting cross roads for the development of american health care, and just as a way of teaching people about how our system changed over time, i want to go through a couple with you and you talk about them. >> sure. >> one was as you point out october 26, 1943irs ruling, and

can you talk about how that reenforced the current health care system? >> well, you know, during world war ii when raging price controls were in, employers had a hard time attracting new employees because they couldn't give them wage increases and the government decided they would give employers a benefit if they offered health care, and employees, of course, would get their health care with pretax dollars, so the government got us into this mess in the first place, and now they are getting more and more into it, and i would like to see that changed. you know, we don't get our long term care insurance, and we should -- 64% of americans get their health care through their employer, and we need to change that to build a market-based health care system because if you lose your job, your health insurance, you go into the individual market, and you buy were health insurance with after tax dollars. we don't have a level playing field. >> people who support the single

payer system look at that same fact that it's employer-based saying that leaves us out of it if we lose our jobs or are unemployed for other reasons. you see the same circumstances from a sircht per -- circumstance from a different perspective? >> i would like to move away from employer-based insurance, but if the government wants to do something it's to change the tax code to individuals get their health care are pretax dollars as well. we need a competitive market in health care, and i think the president, himself, really wants a single payer medicare for all health care systems which is the system i grew up in in canada under, and, of course, you know, when the government controls it, you have government saying we'll spend 10% of gross domestic product on health care, and there's long waiting lists. few people in america realize today that in canada the average wait for seeing a primary care doctor and treatment is 18.2

weeks. that's over four months. that is going to happen if care is rationed. the older you are, the more your care is rationed. our seniors are rationed under obamacare because the president, of course,ments to cut $575 million. >> use his tore -- another historical point you talk about is the legislation signed by harry truman in 1946, the hospital construction act. how did they change the health care system? >> well i think, you know, it changed the health care system a lot. in california, for example, doctors cannot be employed by hospitals. we built community hospitalses, private hospitals, but under obamacare today, private hospitals can no longer be built, and doctors are not able to deduct if they don't take medicare paicialghts. there's a lot going on in the

whole system and that was harry truman, you know, was one of the people who got us into this mess, and now we're in it in a much greater extent. >> we have calls for you, let's get to the public and involve them with this. a viewer watching from new york. you're on with sally pipes. go ahead, please. >> caller: yes, i just wanted to ask the question that you posed to her when she sat down initially which was what does she think is actually wrong with health care, what can she do to come up with that answer, not so much about the health care reform act is saying. >> well, as i said, we want affordable, accessible quality care and how do we get there? instead of increasing the role of government through subsidies, taxes, controls on insurance companies, we need to change the tax code that we talked about empowering doctors and patients. we need to get states to do

medical malpractice reforms. the cost of defensive medicine in this country today is about $210 billion according to price waterhouse cooper. the president said, you know, doctors are, you know, doing all these tests because they want to line their pockets with money. of course, that is not the case. they are afraid of being sued. we need states to do medical malpractice forms and demand mandates, and all of these things that add 20%-50% to the cost of insurance. you know, i think health savings account where they do empower doctors and patients. we need to remove the regulations and controls on those, and, of course, under obamacare what's happening is more regulations on sha and can't reduce the over-it-counter meds and others are reduced from

$5-$2500. that's what i would like to see. >> the diagnosis of what's wrong, if you think the bill should be affordable and successful that our health care costs too much and not enough people can access it. are those some of the problems you see right now? >> right. 64% of the americans get health care through their employer. 50% of people are on medicare, medicaid, s-chip, and the va system, and then the census bureau says there's 57 million americans unensured, but there's 9 million americans chronically ill without health insurance for two years or more. those are the people we need to help, and one of the things in the 50.7 million that's very important is about 14 million of those people are already eligible for medicaid and s-chip and have not signed up. the president wants to add 18

million more people to medicaid, and the people that are already on medicaid find they can't get a doctor because docks won't take them. that's going to be an increasing problem under this system, and we know the congressional budget office has shown that about 23 million people will still be uninsured in 2019 when, you know, the obamacare really becomes effective in 2014. that's when the big cost driver comes in expanding medicaid and state-based changes come into being. >> next question from texas. you're on the air. >> caller: hello, you talked about the one thing utah going to talk about with cutting back half a trillion dollars and forcing rationing. was the intention of the obamacare program was to eventually so staid l the insurance companies they can no

longer to make a profit and forced into single payer? also, if we are forced into rationing, is it something like the british program, the nice prm -- program where they determine how much care you get based on your age and ability to contribute to society. thank you. >> those are two very, very good questionsment i think base of the controls put on insurance companies already such as children being able to stay on their parent's plans until age 26, the beginning of the end of the annual limits. there's a lifetime cap, free preventive care, all of these things are adding already to the cost of insurance. i think, you know, kathleen, the secretary of hhs, has said she's going to keep a list if she thinks any insurer increases premiums by more than 10%, they may not be allowed to be a part of the exchanges. there's not a government

insurance program in the affordable care act but what happens is private ensurers are crowded out of the insurance market and then it's the goal of getting a public insurance plan and leaving us all in a medicare for all or a single payer system where it's like canada with waiting lists and a lack of care and resources on technology. also research patterned off nice in u.k., the national institute for health and clinical excellence, of course that program that don, the administrator by recessed appointment, he loves nice, he calls it a national treasure to pattern. what it does is the government determines what health procedures and treems are cost -- treatments are cost effective compared to medically effective. i think this 15 member group of bureaucrats to be part of the effectiveness board, they are

also going to determine what is cost effective as opposed to medically effective which ends up in rationed care. government decision makers decide what kind of health care we get, not the private sector. >> we have a tweet for sally pipes. this viewer tweets texas has regulated medical malpractice awards and seen the same increase in physician premiums in states that have not done so. >> well, i disagree with that. in texas in 2003, the state capped noneconomic damages and punitive damages at $500 and $250,000. we have seen in texas because of the change, 16,000 new doctors going into the state of texas. premiums have fallen in the state, and it is the way to go. california has the law, and we also have lower premiums. doctor, neurosurgeons and

ob/gyns around the country like virginia, pennsylvania, nevada, they have got out of the practice of medicine, and who does that hurt? the patient who needs the surgeon and ob/gyn. capping damages is the way to go. >> next phone call from las vegas on with sally pipes. go ahead, please. >> caller: hi, i'm calling because it's easy to sit this, but i was permanently disabled from the earthquake. i lived in california for 40 years. i was in three earthquakes. the last one permanently disabled me. if it wasn't that i was with motion picture and had a mention, i'd be out in the cold, and what do you suggest we do about people? i have two questions. the first question is i think

government should be more involved in health care because i see what these doctors can and will try to get away with, anded second question i have is what do you propose? you're talking about after -- you're talking about prior to medical trauma or something happening with taxes and medical taxes and things like that, insurance, but what do you do if a person is in the midst of his life like i was at 44 years old, and all of the sudden, i was struck down permanently. >> caller, let me jump in because we understand your question. >> you know, everybody in this country is entitled to health care under a federal law called empower, so nobody is denied access to an emergencyroom, community hospital, or community clinic, but going back to your point, i mean, if insurance were not tied to an employer, but it

was your insurance, you would be covered, you know, over the course of illnesses, and as we get older certain things happen and we need health care, but in the meantime i think if the federal government wanted to do something, one of the things they could have done was to beef up the state-run high risk pools from $25-$50 billion so people who are not employed like yourself, you can get insurance in a state high risk pool. today, most of the pools are closed, and it's very difficultment i understand that, you know, certain people are having troubles, you know, getting health insurance, but this way we would be able to get insurance through one of these high risk pools, and, of course, insurance of your own it goes through life like switzerland. >> health care is rationed now in the u.s. by how much we can afford. how is that a good system? >> well, health care is

rationed. the question is do you want your health care to be rationed by the private sector, by the market or want it to be rationed by government so in a country like canada when the government took over the health care system in the 70s, they determined what percentage would be spent on health care. it's 10.4% and the demand for health care in a country like canada is greater or even in britain, so people -- because that's all that's spent. the budget that's afforded so people go on a waiting list and government determines how long your wait will be whether you can get access to care. i think america is a country based on entrepreneurship. we want the private sector to be determining how we get health care, what level of health care we get, and if government gets involved in it, it's less waiting list rationed care and lack of access to the new equipment, the new demography, all the new treatment and

medical devices that are developed in america, not canada or europe. you have to have a market. we want research and development to happen. you have to be able to have a profit motive. >> 15 minutes left in our half hour with sally pipes. our viewers there's all kinds of sights and sounds and planes over head and carts rolling by, and now there's a group of muslims in noon day prayer, so if you hear sounds, that's all part of the techture of the festival of books so welcome to the experience with us here. next a call from colorado. you are on the air. >> caller: yes, ma'am. a couple of things. i deal with this all the time, dealt with them for years. i have not found that canadian who would trade their system for our system. i think ms. pipes is a hack for

the tea party organization. >> caller, let me just say, you can criticize, but you don't need to be up culting to people, so not found a canadian yet to trade in their system. >> there's two things. one, when you polka canadians in general, they like their health care system. when you polka canadians who get treated by a specialist, the numbers are bad. 17% of canadians are waiting to get a primary care doctor. when the president says we need more doctors in primary care to lower cost, canada, you know, has a huge waiting list for getting primary care doctors. a lot of canadians come to the united states, pay out of october for treatments because they're on a waiting list too long in canada. look at the chap in ontario who had terrible headaches, went to the doctor, told it would take, you know, 8-10 weeks, four months even.

he went to the states, paid out of pocket, had a brain tumor, went back to canada and was told it's another four months to get another appointment. came back to the states to buffalo, new york, paid out of pocket for that treatment, and is suing the canadian government. he said i'm alive today because there was an escape valve in the united states. the woman who was expecting quadruplets, there was not a single unit in calvary. she was flown to montana, a city of 55,000. her babies were successfully delivered and she said thank heavens for the united states and my quads were delivered. when he needed heart surgery, he couldn't get it in newfoundland. he then came to the united states to florida, to miami, to the hospital, paid out of pocket. he then found that when he came

out and the med ya was against him. he said it's my heart, my health, and my choice. americans want a choins in how -- choice in how they get their health care and don't want to wait as people do in canada. >> this is from someone called citizen of the world who writes sally pipes loses the argument. medicare advantage is the private insurance, and it's a failure. >> well, i disagree with that. there's a quarter seen seniors on medicare advantage. they like it. the results from people on medicare advantage have been very high. the president has said he wants to eliminate ultimately medicare advantage starting off with $2 o 2 -- $202 billion in cuts. it's a private program where seniors get their insurance through the private sector. very, very popular.

i disagree. seniors are concerned about the fact that as i said earlier, $575 billion is cut out of medicare in ten years. the care will be rationed first by our seniors, and, of course, in canada, that's how they cut costs. my mother passed away in canada because of her age as a senior, she could not get a an appointment. when she was employer-based hajing in november 2005, she went to the hospital in an balance, spent two days in the emergencyroom, two days in the lounge waiting for a bed in a ward. got her tests, but she passed away two weeks later. it's cheaper to deny care in a country where government controls the dollars. we do not want that in america. it's not the american way. >> this is sally pipes' book. you with critical of the democratic party calling expansion of health care a democratic obsession, but what is your view of the republican's

increase of the drug program? >> of course, right now, paul ryan has a budget plan, the republican plan, and president obama spoke a couple wednesday's ago on how to cut the costs and expand the vise reinvention board and control what drays and hospitals are paid. he wanted to really bring in price controls on pharmaceuticals to reduce the cost under medicare part d, the pharmaceutical plan. i think seniors need access to drugs and i think the private market is the way to go, and by putting price controls, it's going to a, reduce the ability of drug companies to research and develop and produce new drugs. it costs $1.3 billion when you have an idea until a drug or bilogic makes it through the process. very, v. expensive, but it's done in america, and i think we

don't want more and more government control over what kind of drugs our seniors can get. medicare part d is working, less costly than predicted, and, you know, it was brought in by president george w. bush in 2004. >> stanford, connecticut. on for sally pipes, good afternoon. >> caller: good afternoon. a quick comment and a question. i think -- [inaudible] what made this country great is the consumer -- [inaudible] it seems obvious to me through employers who pay for service on the government we deprive ourselves of the feed back. when i look at the future, my question is where's the natural advocacy for consumer driven health care? who are the constituents you see sign the fabricating for that. thank you. >> right, well, consumer driven health care, there's about 11 million americans with health

savings accounts. put money away each month in an account, it accumulates tax free, use it when you need to for your health care, and it has to be combined with the high deductible insurance plan. it's more popular among young people. more and more companies with the health of insurance going up offer consumer directed plans, i myself have a health savings account. we need to educate people on, you know, health care is srb it should not be first dollar coveragement people with employer based coverage have no idea what the cost of health care really is. if you pay part of the premium, if you pay a co-pay of $20-$30, that's not what health care costs. when people think it's independencive or free, they use more of it. when you put consumers and doctors in charge, they then are much more careful about how they

spend their money. doctors or a lot of doctors are in favor of consumer driven plans. the tea party movement which has been terrific in america, these are average american people who do not wants government making decisions about their health care. they don't want the post office being the way they get their health care. >> another tweet. this is from carolyn m.. people pay out of pocket even with a nationalized system, there's still a private market layer. >> that's not true in a country like canada with a true single payer system. the provinces that run the health care system, they are the only providers of health care. it's illegal in canada for a doctor to charge a patient. now, there's a number of private clinics in canada that rose, they are legal, but the use of them by patients is being very good because when people are on long waiting lists for care as i mentioned, 18.2 weeks is the

wait, these people are getting mri's paying out of pocket for them. it is illegal, and it's interesting in the province of quebec, the supreme court ruled in june 2005 that the ban on private health insurance and private health care in the province of quebec only was illegal because canadians are entitled to life, liberty, and the security of the person as madam chief justice said. access to a waiting list is not access to health care. you can hold up your care card in canada, but if you can't get a doctor, what good is that care card? >> couple minutes left, and this might be the left call from california. you're on, caller. >> caller: hi, -- >> hi. >> hi. >> caller: i can't believe what i heard. it's my sincere wish that you have someone on with a book that opposes this woman's views. i worked in and retired from

mental health -- community mental health and from the health insurance industry. this woman has not answered even the first man's question about what she would recommend be done. the only thing she has said is a tax exemption. it is criminal that you would have this woman on to promote her book, and i would like full disclosure of who's she is being paid by have this woman on without an opposing view is criminal. she has not answered the first question. >> thank you, and i'm sorry that you don't like me or my views. you know, the polls show between 54%-62% want this health care legislation replaced. the elections last november were against this government

incursion in the health care system. i grew up under a single payer system where government controls the dollars spent and who gets treatment, so i think that it's true that the american people do not want this. there was not a single republican who voted for the affordable care act which was passed and signed into law on march 20. i talked to doctors into changing the tax code, reducing state mandates, there's 2100 across the country doing medical malpractice reform at the state level and expanding the -- removing regulations on health savingsing thes, so i have given a lot of thought and a lot of solutions to how we do achieve affordable, accessible quality care in the country without empowering government and reducing us to a system like canada with a national health service in britain where there's tremendous wait and people denied care.