given that could take up the entire interview. what works really is in essence of what a lot of what the book is about the actual medical care both the availability or access as well as implementation or introduction of diagnostic and therapeutic treatment of diseases. in fact, a lot of the impetus was declared by the background information that people don't really have despite what it has been said about the health care system. the bottom line it is both superb access and quality of care. . .

>> if you're talking about the basic affordability care act, now called obamacare, if you look at the numbers -- the protections are not actually the for the costs come down. it was put forth as one of the reasons why reform is so essential. yet when you look at the government's own estimates, and all the other agencies. none of them really project a decrease in health care expenditures compared to pre-obamacare.

the costs don't generally go down historically because it is not necessarily things to make them go down. whether things are minimally invasive or safer treatment, this really has to do with the quality of medical care. so there is a driver of cost that we really don't want to scale back on. and that is actually that things

cost money. there are ways to increase, and i will use the word control. as a believer in free market control. that is to let people decide what value medical care has for them, get rid of the barriers for competition. and by virtue of those kinds of things, every other service or good in the united states, the price does come down and you have to ask what is the fair price. i get asked this by my own children. if your price is the price that people are willing to pay. that is the fair price. not some arbitrary priced system or setting by some central authority. >> are you a practicing doctor right now? >> i have been up until a year ago. when i moved from being the head of radiology where i was for

about 13 or 14 years at stanford and then the previous 15 years, practicing clinical medicine and one year ago i moved over to who would work on health care policy. >> when you were a practicing physician, did you accept medicare payments for patients? >> yes, i did. i have always worked in an academic medical center. yes, we did. >> did the government reimburse the family? >> that is a difficult question. in a implies active term. did they reimburse at a set rate? well, yes, the wait was arbitrarily determined. it was significantly less than the private insurance. one way to assess would be to

judge how doctors in general, not my own self, how doctors in general react to this. when you look at how this reacts to the rate, the rate of reimbursement, it there is a decreasing number of doctors that are accepting medicare and medicaid patients, specifically because of the reimbursement rates. and as we all know, you cannot make up for that in volume, losing money for a patient. >> speaking about some of the barriers to what we call the fair market rate for health care. what are some of those barriers that you would like to see removed? >> one of the biggest barriers is the third-party payer. that is the barrier with the lack of information. people use this better service of medical care.

so obviously, there is no possibility of making a value-based decision on that. essentially all of the medical care, it is covered by the insurance itself create a way to help insurance have evolved, it has changed from the way insurance was intended, which is a way to reduce risk of exposure to unanticipated large expensive. almost everything aside from a relatively small deductible for most people. so you don't really care what it costs because someone else is paying. so the biggest barrier is there

is no incentive to even look at the cost. when something is free, someone says, let's consume as much of it as we want because i am not paying for it. so that is the number one barrier. a second there, i would say, it is the government created health insurance coverage is themselves, and that is, as we know, there are two sub segments to that question. one is that you're not allowed to buy insurance outside of the state of which you live. this, of course, is nonsensical and does not really is this what other goods and services. and there is a paternalistic way to view things, that you don't know what you're doing, if you live in new jersey, i don't know why those people couldn't shop

in pennsylvania. because that is one problem. it seems like a barrier to competition with insurance. the second issue is that there are over 2000 mandates that are required for all health insurance policies in the state to cover things that many people rather obviously would never want to pay for it. massage therapy, acupuncture, chiropractors, in vitro fertilization. when i give a lecture to people and the average age is 50, i would say that most of the people here are not going to use in vitro fertilization. yet it is included in a requirement in that coverage. many mandates are estimated -- by as much as 50%. it is not the opportunity for people to buy the insurance

coverage that they actually want, which would be cheaper. so there is a whole host of these kinds of things that the government has an opportunity, a big one that i failed to mention. it is not just about price, but there is no transparency is. you don't know if you are getting elective surgery where they actually do a lot of these procedures where they have good outcomes. there is a huge amount of information that is necessary if people are expected to make value-based decisions. and the question comes from our people able to make these medical care decisions, how could you make a decision like

that. my answer to that is there is no russian the you can make decisions like that as a nation. in concert with doctors. we do it all the time with things we don't understand. i'm not sure that many people can explain how a computer really works. in concert with doctors, particularly in the age of information, people are asking very good questions and they are good at talking to some of the patients about what the medical care and tails. if given the opportunity and incentive. if given the incentive, there are a variety of ways to do it. >> doctor scott atlas, one of the major factors in the affordable care act is the marketplace that is going to be created where people can shop

for insurance and there will be some more competition. is that a step in the right direction? in a okay, you're talking about the health insurance exchanges, which have turned the markets around on the government website. in general i would say that the idea and concept of the exchange is very good. but the problem is the implementation, the execution of that idea -- when you look at the health insurance exchange that is set up under the affordability care act, there are some major problems that are so bad that they cannot possibly function well. i will go through the three basic problems. the first problem is that there is this minimum essential benefit coverage. okay, so it sounds exceedingly attractive. but the problem is when you look at those, there is such an

enormous comprehensive list of medical benefit, the price and the policy to cover all those things -- it is unnecessarily high, and it eliminates those buying insurance policies tailored to what they want. so the prices are jacked up because all this coverage is required of all the policy. secondly, she has a minimum loss ratio. and when you look at the minimum loss ratio, you have sometimes limited or excluded cheaper coverage under the so-called high deductible health care plan. it is not only cheaper, but they

are more desired, the most popular toys over the past five years. the increase in that choice of employer-sponsored health insurance. why is this? because they are cheaper, you get to take money that is against the high deductible, put it into a deductible and it really is associated with a wellness program and other screenings and test that people actually want and encouraged for healthy living. so these things are limited by these minimal lawsuits. the most important thing that will make these exchanges not function, it is the idea that health insurers, no matter what proves the condition that you have, you will not be able to get the insurance. and if we eliminate the waiting

time, the waiting period, you would have to -- you would be able to buy insurance if you just waited with no problem. it makes people say, okay, that would be the rational way to think through this. there would be no risk factors except for cigarette smoking. so this is engaging and there are no real delays in buying insurance. these things are going to make insurance companies -- it's kind of a no-win situation. it's not possible to exist under that kind of scenario. >> the arguments that use that

for the, especially with the facts, is it too late to implement them since we are already on the road to hcs? >> this is a very good question. i don't have the real answer to that. although we can say that i think it is clear that unless something dramatic happens in the election obamacare, the aca is pretty much a lock. and i think realistically, i don't think it needs to be completely abolished. maybe people disagree with me. i am sure that there are some. there are things that can be modified. to get rid of some of the

negatives. for instance, the tax on the medical device companies so these are things that a lot of people in the congress and senate and members can agree upon. because it affects their own constituents. and then people can go through their ideas about how to change these requirements with the health insurance policy exchanges. so we modify and dramatically change parts of the aca. so we had a feeling that it is on the list at to say that the entire law will he repealed. >> you talked about americans having good access to health care. if some of that access to emergency rooms? >> if you look at the data --

>> too much access? >> there are two parts of your question. to clarify there is a huge difference to health care. access to medication, access computers, far better than any of the other countries held up as models for health care reform. and we can both much of the day the of the data that is in the book. secondly, the question is do people understand this. well, sometimes they do. no one is saying that it is just as good to have no insurance as it is to have insurance. generally, a lot of people go through a lot of hoops to get to that care. even the uninsured, i think them

in the book. but the misconception that people without insurance don't get access to care. so there is some of the issues that are true. on the other hand, i think it is markedly distorted. >> from "in excellent health: setting the record straight on america's health care", government officials themselves will circumvent restrictions on their own personal cares at stake. the national health service and great britain spent more than 1.5 million pounds to pay for thousands of staff members to leapfrog. some choose to have their heart surgery in at the cleveland clinic.

and when president obama was asked pointedly to promise that he would not seek out a plan if his wife and daughter became sick, he said if it was my family member or my wife or children, my grandmother, i always want them to get the very best care. >> that is right. and i think that people ought to know that single-payer health care -- when they pay for themselves -- for themselves, they need to do everything they can to manipulate the system and access their own right, which is choice. how i know this? because i have been one of the doctors sought out by several people, including many who are not on the record, so i will not say. but one of them who is on the with senator ted kennedy bridge was up on a single-payer health care and i feel good because it

was in the public record. i read the mri scan of him and it is not that he was my patient. even though in the political world he was pushed as a single-payer health care for the rest of us. when you look at these other countries, the single-payer system, whether it is canada, england, or all the others in western europe, they not only seek out ways to access their own country, but they have put into law that these countries will pay for medical care, either in private payers concepts or outside their own country. they could not handle the access

problem in their own country. so i'll be in the u.s., while we somehow have been moving toward a nationalized system, the countries that have the experience of nationalized system have made significant movements towards privatization. >> scott atlas, there are people that will watch this interview and say to themselves, he is a doctor. he makes this amount of money. he needs to make left of a salary. he is making too much. >> well, you know, i think that that is not exactly a surprise. unfortunately, i do not make up much money, but that is beside the point. we have to look at the point that this is a tricky part of health care. this is the kind of ethical moral dilemma that is detrimental to the discussion. which is the people that say health care is different from

everything. because health care is a right. in the ideal world, everyone would have everything for free and if they couldn't pay somebody, somebody else would. this could be the ideal world in people's mind. but we don't have that attitude about having a home. everyone should have clothing and the government should pay for, everyone should have food, everyone should have this or not, it doesn't work that way. the reality of life is that things cost money. someone has to pay for it. do doctors make too much money? i don't think there is anyone that should say someone makes too much money. the united states to me, i want to go down this path, the point is that this is the land of opportunity.

no one guarantees equal outcome. so i personally -- i do not buy into the argument saying that you don't make that kind of money. so you get what you pay for and if you want to have a medical system, where everyone is working with limits on what they earn and it is dictated by government, you better be prepared to have some medical care function like the u.s. post office or some of the other things. there is a reason why doctors flock from all over the world, to be taught by the doctors in the united states. i have been engaged for many years and continuing medical education courses. both here and abroad. by far, the leaders in innovation, the educators of the world are american doctors. you don't go to other countries to learn new medical care.

they all come here. this is genuinely overwhelming. but if you want to make doctors forced into this region of public employees, you're going to get what you paid for it. and in essence we are a party scene a little bit of that. when we look at doctors, their future plans, many doctors are getting out of the field and if you want the so-called best and brightest, which i'm not arrogant enough to say that the best and brightest are in medicine, but there are very good people in the medical field in the united states. if you want to clamp down on things and start telling them what they are going to earn and administrative costs, and all these other things, including a delayed return on investment, because you don't start making money until you are in your mid-dirties, you know, you're

going to get what you pay for. >> would you say to people who say that doctors order to make test and that is how they are making extra money and everyone has to pay for that? >> i think that there is certainly medical waste and redundancy in the system. there is no question about that. i think that there has been a little bit of distortion in terms of doctors gaming the system without saying that it never happens. people think that oh, these radiologists, these people order mris, and dt scans, no, that's illegal in the united states. it is actually not true. no one can order a test like a diagnostic test. so in other countries, that occurs, but not in the united states. there are certainly attempts going on now with electronic

medical records and other things that are streamlined in the system, to get rid of that waste and redundancy and excess costs in the system. but i would say that that is not the biggest problem at all in terms of the way national health expenditures go. >> why is it that the world health organization often reached the u.s. health care system lower than what you are saying it is? >> well, you have to look at the actual study of themselves, which i did in this book. you just kind of take the bottom line. i wrote it after a dinner party, discussing a michael moore movie. and the u.s. health care system in the world health organization reports to 191 nations and it is ranked 37th in the world.

countries like croatia, cuba, places that are not pure diamond with health care by any common sense assessment. so i thought, okay, let me look at the studies in specific detail. this has been done now in the academic literature of public health. we know that things were seriously flawed. almost two thirds were comprised of scores based upon the quality. so in essence, that was warning the country that has medical care where everyone was able to be deemed better in that country got an a and the other one got another great. there are many other things and that may report of the year 2000, such as when there was no

data available. they literally filled it in. it was so bad that in 2009, the organization of economically advanced countries, the who report is one of those things that they wish would just go away. it was so poorly done, but when they listen to their own government leader, what i have tried to do in the book, i think you realize the truth. >> what you think of where

doctors are speaking about this? >> i think they work well for what it is. it is a unique thing amongst all of the medical centers in the united states with health care delivery in general. that is the referral center, it has a certain kind of reputation where there is a gorilla in the room in terms of perceived quality, and so they do think it works well for what it is. i'm not sure that it is reproducible. you know, they had all kinds of things going on. so there are a lot of economic challenges involved. >> we have been talking with scott atlas, m.d. here at the hoover institution.

setting the record straight on america's health care. it is the name of the book. thank you for being on booktv. >> happy to be here. >> visit booktv.org to watch any any of the programs epc here are mine. type the author or book title on the upper left side of the page and click on search. you can also share on anything these see on booktv.org by clicking share on the upper left side of the page and clicking on format. it streams live online for 48 hours every weekend with top nonfiction books and authors. booktv.org. >> this is a lot of what we have going on. you know, i went over it. and it is not like i have any

personal friendship. but i am just saying that i didn't. i read what he did. it was just, it was interesting. especially regarding information >> i don't know why someone put this mentality into the legal case. but it was a very fascinating deal. abramoff was involved in this.

>> [inaudible] >> to what end? i mean, this is wonderful. >> you know, he was part of this as well. the amounts of money, i'm going through the door to the lottery. [inaudible] the other thing is secondary.

what up with. [laughter] and we wish the administration did pride themselves more on things. and nobody knew about this. so this goes back to what we talked about earlier. up we want 24% and nobody knew how it would turn out. nobody knew about that. >> i had some friends i decided to write. i found a it very fascinating when i looked at the facts especially when it comes to what on earth happened. you know, when i was at the

morgantown federal prison at that time, i did something that i swore i wouldn't do and i was listening to ellen ratner tommy to do more on the radio. she said now that you have some experiences and knowledge is and working history of the politicians and governments. the first show that we did was with thom hartmann. i have a lot of respect for him. and it doesn't matter if your two letter to the right. and he knows journalism and he is an accomplished author and we have interest to see some of his book. and we continued to do this.

i have a longtime friend, and he and i liked doing the daily show. so i have continued to do talk radio, and i have ventured over to india. what you do when you want to recharge her batteries? you go to india. i have a chapter in this book, which i was really delighted to write about. when i go there, it was about a five to seven minute walk with the indians and the tibetans and it provided me the opportunity to write this book because i was able to go over there for couple of months and then go back. watching my granddaughter in the program, providing assistance,

it was absolutely amazing. i never thought that i would do a book. but my cousin wrote about this. and he coined the phrase about this. and ronald reagan talked about this successful movie. but my cousin always holding, he said the need to write a book. i just never thought i would write this one or write it this way. i didn't do the book at first, i didn't want to do it. and you and i agreed to do 50 minutes together and we said that we would have me, then we will have you. and neil and i talked.

and it showed more of an honesty factor. so in my opinion, having the two of us side by side was a better way to do that. but i watched jack abramoff on 60 minutes. and i could feel some empathy as he was having been in prison. beyond that i just wondered where he was going in his version of history. and i said, okay, i got the short end of that.

but i sat there and i said, i want to tell my end of the, including speaker boehner and i want to make it more than that. i live in ohio, i'm in the district and i get asked, what have you. and it tells a very complicated story including here i go. i had my parts and there were other parts to it as well. it was sort of way that i put together the outcome of swords. also in the book, very important to me, and i want to mention us.

i sent that deal to the white house and they chose to ignore it. they recently made it legitimate. and i want to talk about how it's important for us. the other part is how i was a lawmaker and i became a law breaker. and then it was a very challenging situation. i met in the financing committee, and they said remove handcuffs from the man. and he did. and he came out and testified on the whole whitewater deal. that is how i met him the first

time. the second time ,-com,-com ma i just wanted to go to prison and it was like reporting for the firing squad. i sat here and he walked me through how we survived from day one. this included chief justice of the arkansas court, he was very empathetic to the plight of a lot of people in prison. i walked out of there with a lot of people and i'm new to tell this because things were going on and i didn't expect anyone to have sympathy for me. and i have the ability to have a

network. the ability to be on television, to have writers here, a lot of people don't have a voice inside of those laws. this government, under the current administration as well, they are big drug dealers and we put them away. there is a lot of addicts and the drug dealer was putting things away. part of this is my own personal struggle at dealing with addiction. and i have a message in this book and you don't have to abuse substances to make your life go down.

you can ingest substances into your body, you couldn't lose your focus, you can go down the path and i give credit to some members of congress in this book. there are few things that will shock some people they kind of on things and i came to the conclusion in the book. is it still correct? jack and i, jack eber abramoff anaya, it was the biggest gamble of its time and etc.

it has been codified into a legal situation today. once we have a fundraiser, i can take you hunting, i can take you to vegas, and they had a fundraiser last year. citizens united, i can tell you how was back then the other day with citizens united ruling, we have a situation today where a super pac comes along and we can take on karl rove or george bush. and so the average member, in order to counter that ,-com,-com ma needs to spend $10,000 a day.

they take their staffers, they go across the street and this includes the nrc see and many political parties. many members of congress would like us to change course. many members of congress do not find it delightful to be in elections. jack eber mine i jack abramoff and i helped people to feel more comfortable but it did not change anything. to paraphrase this, i had a substance addiction. today, there is another

addiction. and they need an intervention. i am not a better person. i spent time with my granddaughter today, i get to do radio and a lot of great people to the right or the left or the middle, they get their voice out there and they tell people a story of their government. so i am very happy. i am not a person that is unhappy or angry and i want to get everybody. as my grandmother always had, sometimes it just takes a while.