rationing. host: from delaware on republicans line. caller: 5 like to know why the -- i have liked to know why the 1151 windows were singled out to not get? wrongful death in the health- care? guest: i'm not familiar with the issue. caller: thank you for c-span. i have a question regarding smokers in the country. what is the health cost incurred by smokers in death and all the illnesses versus the taxes at a race? i do not understand why smoking is still legal in this country. that is my question.

thank you very much. guest: as a physician, i have fairly strong feelings about smoking and how bad it is for you. we tried prohibition with alcohol and they did not work. the voters get to speak in this society. whether making smoking illegal would really ban it, who knows about that debate? i think what the state and local and federal governments have done is make smoking more expensive and try to take the revenue and put it to health care. that makes a lot of sense. most insurance companies charge you more if you smoke because they know you are more likely to die early. i would not have an objection to having health insurance charge more to people who smoke. smoking is actually a disease. it does not start as a disease. it stars as a stupid choice. usually when people are young

enough so they are making still good choices. i consider smoking to be an addiction and a disease. nicotine has the same addictive powers as heroin. it is one of the most addictive drugs. the tobacco companies know that. they get kids smoking early. that is a great thing for them because they have a customer of us hoped for life -- is hooked for life. it is a complex issue, but it is true that smokers contribute disproportionately to the healthcare in this country. i favor economic means rather than prohibition means. we're stuck with this drug, but we have to continue to make more expensive. host: soda and alcohol are ok with you?

guest: i have no problem with it. soda is not in the same league as alcohol, but those things to contribute to health care problems. the in something and having the money going to a fund that pays for a release health care makes sense. host: how should the problem of obesity be tackled? guest: this is an interesting and complicated issue. i'm not an expert in obesity, but i know some doctors were doing cutting edge work. it turns out that obesity may be a disease. i do not mean a symptom. i mean, it may be a chemical disorder. if it is, there will eventually be a way to cure it. maybe stress induced. it may be environmentally induced. it is hard for me to believe that the human genome has

changed all that much in the last 50 years or 60 years, but it is clear that obesity has become an epidemic around the world. as the standard of living rises, we've seen an increase in obesity. it is typical of emerging economies. obesity is not just a matter of telling you to secure live in just the carrot -- telling you to just zip your lip. obesity may be a modern disease that may be contributing to one of the factors of is changing so fast. if it is, i think we need to give people who suffer from obesity a break. people used to make fun of alcoholics until we found out that it was an addictive

disease. i do not think anybody thinks alcoholism is a good thing, but it is a disease. it may turn out that obesity is also a disease and there may be a medical model to use for its. that does not excuse people from reducing calories and eating healthy. of not trying to make excuses. in addition to that, we also need to look at the medical evidence. host: richmond, va. on democrats line. caller: thank you very much for your leadership, governor dean. the question that i wanted to ask -- i'm always hearing the people on the right saying that medicare is a cheap program, but the reason it is cheap is the cost is paid by the government. i'm wondering, when you come up

with those figures showing that medicare is less expensive than other plans, has the cost paid by the government been included? guest: absolutely, yes. who cares if the cost is paid by the government or the private sector? it is cheaper. is the argument of the republic is that we should allow it in the fishing industry to drive us into economic oblivion. we should not get around to having the government running health care because the private sector knows everything -- that is their argument. the private sector knows everything, how come our economy is not better? let's look at the best way to run health care. let's not be against the government or the private sector. the conservative or republican view is ideological. i do not care about the

ideology. i just want a choice. the president does not say the private sector is bad so we have to have a government plan, or that the public sector is that so we have to have a private plan to give the president is saying let the american people choose. why should politicians choose? you choose. if you go into the plan because it is cheaper and do discover all these things that dr. coburn is a part too bureaucratic, then you can leave and go to the private plan. that seems to be the right thing. but the american people make the choice. the republicans always seem to be against letting people choose for themselves. >host: houston, texas on republicans line. caller: unfortunately,

[unintelligible] controlled by the republican party and -- please inform obama to quit wasting time. i have to take my families overseas to iran for medical and medicine to this is the worst i have ever seen. thank you. guest: i do not know anything about the iranian medical system so i cannot comment on that. look, we need a system that works. we have been fully around with this for 60 years since harry truman suggested a universal health-care system. it is a very simple way to finally change things. we are not saying you should choose the system or choose the

system. you should decide. stop listening to the people of the right. stop listening to the people on the left. we will give you a system where you make the choice. i think that is the best way to go after 60 years. we cannot keep doing what we're doing today. host: an e-mailer talks about an experience that he had with his father. he said -- guest: that is a very important question. this is not something we have talked about. that is the talk of the end of life care. most seniors do not want to go through what your father went

through. he did not have much say because he had alzheimer's. one thing i like to see that nobody is suggesting in washington, if we are going to have a public health insurance option, there have to be some things that the american people are responsible for, not the government or the private sector. one of them is having a living will and power of attorney. either everyone should be required to have a living will and power of attorney. that means they will give directions to whoever is in charge if you cannot be about the general guidelines of your care. if your dad had been able to say 10 years ago before he develop alzheimer's, -- if i have the disease from which there is no hope of reasonable recovery, no extraordinary means to be taken, and these are the things that should not be done. they would not have taken him to

the hospital. if they did, they would have faced a lawsuit. that is the kind of stuff that individuals ought to have some recourse. we do not want rationing, unless we are doing it to ourselves. i have a living will. most people think the medical establishment -- something that may happen to me. the something that that may happen to you is you have 97,000 things done to you that you did not need and the government will be stuck with the bill. your example is so good and we do this so often and replaced so much money on situations -- and we waste so much money on tuitions where there's no benefit from the procedure. host: the e-mailer says -- gues.

this is a difficult position for me because i am a physician. i do not personally believe that i can participate in assisted suicide. on the other hand, i do not think it ought to be illegal. what jack kevorkian was doing it should be illegal. i think he was the immediate human life by making the holding a spectacle. i do think that the idea of death with dignity is something that has been going on in the medical system for years. it is usually a quiet, private decision that the family, the patient, and the doctor make. i would not prescribe somebody a town of tells of i knew they would kill themselves with it. -- i will not prescribe some of the a ton of pills. you can say that you do not want ivy treatment or tube feeding in a living will. you will get somebody who goes

through a horrible experience and knows they're not going to get any better. when they get a little bit better and they can go home for a short time, they said the next time i come in here, i do not want to to do anything. the guy did come back. i said, the last time you came in you said you did not want me to do anything. he said, help me. of course, we did help him. this is a very difficult situation. it always has to be done on an individual basis. there are some things that individual americans can do ahead of times. we're all going to die sometime. we do not know what the circumstances are going to be. we do know that we can write broad, general guidelines for those who love us to help them make decisions in a difficult time. host: arizona on independents line. caller: good morning.

congratulations, you just said something nobody does think about. i have a mother who is 63 who is going to alzheimer's. thank you very much for getting people's attention. ok, what do you think about the doctors -- the -- what is it about the doctors double dipping? what about president obama's plan on making sure you do not do the same test 10 times or 15 times because they do not talk to each other? >> that's a very smart thing, electronic medical records is a good idea. the only problem is that a lot of the systems do not work right . this software is not all that dr. friendly and these are the programs. they're very hospital friendly. it does not work so well in

doctors' offices. some companies are better than others. the ones that are good are the ones already in the doctors' offices for other reasons and have broad abilities to help doctors and medical personnel figure out a platform or technology that is friendly and usable. it is a good idea. it has a lot of thingkinks. i remember we did the tax department in new york. it always takes twice as much money, twice as long, and you have to do it twice to get it right. there are some places that have done a great job. a lot of places will do an awful job. we will have to see how that works out. it certainly does share information and make it efficient. it drives me crazy. i know of a hospital whose reaction to get the bad grades on pneumonia treatment was to vaccinate all their patients

without checking with a primary care physician to see if they had been vaccinated. that does not make any sense. it sounds great. it will be great, but there will be a lot of problems. we have to be prepared for that. host: lancaster, ohio on democrats line. caller: hello, dr. dean. it is an honor to talk to you. some other speakers have call ied in have hit my question is little bit. i want to get at these rural hospitals to yet this is just my idea. it seems to be that they're taking doctors who cannot climb a doctor in a big city. when you go to a rural hospital,

it is a good-sized hospital, but the treatment you get is zilch. take me for instance. i was in a town where i was taken to the emergency room. i thought i was going to die. he knew i was allergic to this. the committee hospital and gave it to me three hours later i. i went to medicare about this and the paragraph that came back from his emergency doctor said you are not allergic to this. i'm very allergic to codeine. when my husband was alive, 14 doctors treated him in southeast ohio that said that he had a

football injury in his shoulder, and there was eight infusion into his heart -- a infusion into his heart. in other words, you're going to hospital in a suburban area or a smaller town, and they will keep you for a week. they cannot find your problem. host: we have to leave it there. guest: it is hard to sort out whether you just have a hospital in your area that is a real problem or if this is a major national problem. it is a little bit of both, although, it sounds like this is more of a problem in your local area. rural healthcare is a difficult area because proportionately, many more americans continue to go from rural areas to suburban areas or urban areas.

it is hard to sustain an expensive medical operation if you do not have a population to support it. receive a downward pressure on rural hospitals. -- we have seen downward pressure. we have seen medical care that is not what we would call tertiary care. this solution is not to bring all the experts from boston and new york into a small town in southeastern ohio. that is not want to work. there will not be enough patience for them to see. the solution has to be that you have got to have medical personnel that know what they know and do not try to do more than they know. without talking about the specifics of the case that you brought up -- i'm obviously not in a situation to examine that situation right now. i would say, rural hospitals need some emergency stabilization capacity in a

slightly larger than tiny town, i think some obgyn, perhaps some uncomplicated general surgery, and then an ability and a relationship, hopefully a electronic relationship as long as a physical relationship, with a major medical center. in terms of your allergies, if the story was so, somebody did not look at the chart. there are some other remedies for that kind of stuff. in general, there is a boy to be a difference in terror that is immediately available to you -- there is going to be some difference in care that is immediately available to you. there's not a way to realistically change that. host: plano, texas on republicans line. caller: i have been on medicare

for some time. i came to a conclusion not too long ago that medicare would be a good public health care system since that is the way we are going. i want to know how it is going to change when the whole nation is on it. right now i pay $106 per month for medicare insurance, $38.40 for prescriptions, and $199 for supplemental insurance. that comes to $4,100 per year. what are you going to do with a family of four or five? are they going to pay the same amount? who is going to supplement that? is it going to be the government, or is it going to be be paid higher prices? guest: you're a smart cookie.

you have got this down. i agree. medicare is not perfect. but it does have the benefit of being pretty easy to understand for the most part. the payments are pretty easy. you do not lose the insurance if you get sick. i do not know if the whole nation is going to be on medicare. i do believe that a significant proportion will be, if we get the bill out of the house. i believe a significant amount of people will choose their private health insurance. i think that is their right. i do not think the whole nation is going to be on medicare could one thing i like about the president's plan, even if that were to happen, it would happen very gradually. you would not overwhelm the system. in terms of how the payments are going to work, the payment will be related to income. if somebody is making $100,000

per year and they want to be in the public system, then they will probably end up paying the full cost of the public system. of the $4,100, what you are paid is supplemented what you have already paid over your lifetime of work. so you have built up a credit in addition to the $4,100 per year that you are paying. there will initially have to be some taxpayer money involved. i talked about the carbon t ax earlier today will pay premiums out of their income and they will pay whatever the fee is to get into the program just as you half. a lot of those details have not been worked out yet. they have not even decided whether there will be a public

plan or not they i think that the bipartisan is right, but i do not think it is worth passing the lousy bill. if the bill does not have a public option, it is not worth doing. $1.5 trillion is a lot of money. it is worth spending and if we can't save our health-care system. it is not worth doing that if we will not do anything. -- it is worth spending it if we can save our health-care system. not everyone will choose it. it will not be exactly like medicare. although, i do not think it makes sense to have two different health-care bureaucracies. your rates may go up over the years because medical care is getting expensive, but they will not go up because somebody else is using care that they're not paying for. host: 5 minutes until the house

comes in. san diego, calif. on independents line. caller: one of the serious problems with the medical debate is that the press, which takes a lot of medical advertising, is simply not telling the public about the dangers that exist as far as surgery's daughter so expensive and so lucrative that doctors perform -- surgery's that doctors perform better so lucrative and so expensive. you are relying on the doctor to tell you to take two aspirin and go away. that is not likely. no matter how honest they are, doctors will tell you they do not want to $30,000 or $100,000 for the surgery. there's a tremendous danger to the health of the patient.

the dodgers have their own complications -- the doctors have their own complications. guest: fee-for-service turns out to be not a good way of paying for medicine. there's a terrific article in "of the yothe new yorker." . in it. in texas, they spend more money than anywhere else in the country. florida has the highest statewide spending for health care. their health care is among the worst in the nation in general. you are right. it encourages people to make decisions based on money and not based on health. that is not been addressed in the current health-care bill. hmo's were not so bad.

everybody hates them now because they became for-profit. i practiced under a practicedhmo when i was treating patients and i liked it. i got paid how much i needed to get paid on a monthly basis. i was free to practice the way i wanted to practice. i seethink you are right. fee-for-service medicine is a problem. british primary-care physicians make more than american primary care physicians. i do not know why american physicians are in love with fee- for-service. there are systems that were very well and pay doctors pretty well. the system does not encourage people to do things that are unnecessary. there's no question that one of the reasons health care is so expensive in this country is the enormous amount of unnecessary

things that are done. they're very expensive. host: cleveland, ohio on democrats line. two minutes until the house is expected to come in. caller: if it were not for medicare, i would not be able to get any medical help. i have a primary -- secondary entrance to medicare. medicare takes care of most of the medical needs that i have. when you go to these doctors and everything, if you do not have medicare insurance, you do not get the same amount of terror that the people who do have health insurance -- you did not give the same amount of care that the people who do have health insurance. if it were not for medicare, i would not be able to go to any doctors. i went into the emergency room a couple of weeks ago.

that was four thousand dollars for x-rays. i was not even there for a whole day. medicare took care of most of that. as far as the amount that i had to pay, it was no more than $90. can you imagine? the people who are against medicare, and the people who work for the government -- they get very good insurance and they do not pay the full price. guest: this is exactly the point . the truth is, the same people like dr. coburn who argue against the public health option, there republican conservative ancestors were against medicare. medicare has turned out great. it is not perfect, but there are millions of seniors all over the country who would not have health insurance if it were not for medicare. all we are asking is to