shot was dangerous. the upshot was a lot of companies got into the business and not much was invested in making a technology better. we're stuck with it and the cdc is stuck with it. they have nothing to do with the process of making it, we are faced a crisis and paying the price for our slow investment in that technology. >> the final thoughts? >> stay tuned. we of clinical trials under way right now that will answer the number one question -- do you get one shot or two? if you need to, how you line up and get both? >> thank you to both of you for being on "newsmakers." >> monday morning on quality washington journal" we will be live from virginia medical center and virginia beginning

with the president. the chair of the board of directors and chief of cardiac surgery also. on tuesday, robin morgan, the senior vice president and chief financial officer and the chief information officer. on wednesday, the chief of emergency medicine and the head of the intensive care unit and respiratory department. >> a discussion on the canadian health-care system from today's "washington journal." this is about one hour. on senator mitch mcconnell. first, here are comments as president obama traveled to mexico for the summit meeting. he was asked questions about the canadian health-care system. here is part of what the president said earlier this

month. >> i have said that the canadian model works for canada. it would not work for the united states. simply because we have evolved differently, in part. we have an employer-based system and a private-based health-care system that stand side-by-side with medicare and medicaid and our veterans administration health care. so, we have to develop a uniquely american approach. this, by the way, is a problem all countries will have to deal with at some level because if medical inflation continues at this pace, everyone's budgets will be put under strain. we are trying to make sure we have a sensible plan that provides coverage for everyone, that continues the role of the private marketplace, but provides people without health insurance who are falling through cracks a realistic and

many got. option we have to do it in a way that also changes the delivery system so we're not engaged in the kind of wasteful, an inefficient spending. i suspect we will have continued vigorous debate. i suspect you canadians will continue to get dragged in by those who oppose reform even though i have said nothing about canadian health care reform. i do not find canadians particularly scary. but i guess some opponents of reform think they make a good bogyman. i think that is a mistake. once we get into the fall and people look at the actual legislation being proposed, that more sensible and reasoned journal" continues. host: joining us is the former

president of the canadian medical thank you very much for joining us here on c-span. guest: good morning. host: let me begin by asking how the canadian system works? guest: it is mostly publicly funded. the funding comes from income tax. everyone is covered. this is the main feature of our system. it is universal. everyone is covered. no one must pay anything to see a doctor or go to the hospital. it is a system that covers everyone, basically. host: how is it funded? guest: by the income tax. you pay the income tax. we have to understand that there are about 14 systems in canada because we have provinces, and other government structures.

it is not a premium of insurance that is paid. in some provinces there is a premium, but mostly it is an income tax. host: you delivered a speech as you left your position and alluded to a couple of points. first of all, in areas of how canada can do better you wrote, waiting 15 hours in an emergency room is unacceptable. within four hours in a doctor's office to renew a prescription is electable. within six months or more for his replacement is unacceptable. -- is unacceptable to wait so long and a doctor's office for a prescription. is that standard? guest: is not like that everywhere, but these examples exist. in quebec right now the average wait for an emergency ward is 15

hours. i give the example of four hours for the prescription in the doctor's office -- this was my cabdriver's expense. it may not be the rule, but it exists. the six month wait time for a hip replacement -- that is our target. if we compare it to other countries this target is very remote from what should be. host: so, how do you fix it? guest: the biggest problem in canada is the wait time. we are looking at what other countries have done. european countries where they have a universal system -- we want to keep it like that. their system does not cost more, but they don't have those we times. we need to improve. we need to avoid the weight tons. this is the biggest problem in canada -- we need to avoid those wait times. host: it is not a single system,

but varies by province. can you dig into some details to explain how would work if you live in montreal compared to toronto, or in the western part of the country? guest: basically, is the same system but would variation. it is based on five principles. what is included, universality, meaning that everyone is covered and no one pays for services, accessibility, public administration -- the system is publicly administrative, and these principles are the basis of our system. portability is the last one, meaning that you can go from one province to the other and are still covered. the difference in the services that can be provided from one province to another -- some include a few extra, and some exclude the same.

the biggest difference is about pharmaceutical care. in quebec it is a universal program. that is different in some other provinces. host: some background information on canada for our viewers here in the u.s. we'll also show you phone numbers. canada is come to over 31 million residents. the average life expectancy is 78 for men, 83 for women. that is comparable to ours here in the u.s. 8.6% unemployment, slightly less than here. with issue to prescription drugs or medical equipment you nee is that all covered under the canadian system? guest: well, for the equipment, the care, if you go to the hospital or to see a doctor

everything is covered from the first dollar. for pharmaceutical care is different. depending on the province there is a part you must pay. we pay about 30% out of pocket. 70% is covered by the state. this part of the money is for dental care, pharmaceutical care, or ambulance, or long term care. the rest comes from the government. host: so, is medical bankruptcy even an option in canada if you face high bills without insurance? guest: this is not something we see frequently compared to what you see in your country. the police usually do not get bankrupt in canada because we're cover. there could be expenses if you have too many drugs to take in

some provinces. -- the people usually do not give bankrupt in canada. we are covered. if you do not have the money to pay premiums, the government will pay it for you. so, there is no bankruptcy in canada because of health care. this is a very different system in the u.s. host: our guest joins us from montreal. we have a line for canadians listening. we want to share an excellent of an interview we did for an upcoming interview. the author has a book about health care. he outlines the evolution of the

canadian system. it began in the 1940's. >> you read my chapter about canada. what happened is one province, saskatchewan which is a lot like colorado, have planes and half mountains -- half plains -- elected a left-wing governor who decided everyone in the province should have health care. he's set up a state-run single- payer system in 1944. his name was tommy douglas. he called the medicare and it work. everyone in that province had medicare. many doctors came there because they knew that they would get paid. the other provinces saw it and gradually they copied it. they saw it was working. by 1961 it was so popular that the people of canada demanded that the federal government

established it coast to coast. it began in one state with tommy douglas. in 2004 the canadian broadcasting company did a poll -- millions of voters. the candidates included alexander randall, there'd jfk, -- the >> green, and others -- the >> and the one was tommy douglas. host: could you elaborate on that? guest: yes, it is important to know that the healthcare system is imported for canadians. you want to keep our system because it is important for everyone. we want to improve our system because we have wait times, but we still want to keep that universal access.

no one needs to be denied health care if he does not have money. this is the basic principle and we. want to. everyone in canada wants to keep that. host: the line for the worse in canada is on the screen. in this country, dr. ouelett, you quite often good to the emergency room if you do not have health care insurance. the causes of soar by those who are injured. what type of procedures are involved? -- the cost are suffered by those who are insured. guest: if you do to the emergency were you not pay anything. if you have any kind of surgery will not pay anything. even a heart transplant, or whatever procedure, you do not have to pay out of pocket.

this is covered. it is imported. you will bwill not be denied any future for not having money. it is important to us to give access to everyone. it is the wait times that are the factor not -- that is the factor not working well. host: pharmaceutical companies say here in this country they're able based on our system to spend money on research and development because of their profits. is there such a system in canada? guest: yes, we have pharmaceutical companies doing research. researchers also funded by our system and hospitals and universities. the government funds research. we also have companies working

in canada, pharmaceutical companies. we have generic drugs, but also do drugs. we have companies doing research in canada. they're making profits on drugs. -- we@@@@@@ guest: it is covered, but it is covered at the price one would pay in canada. when you go to the u.s. committed have supplemental insurance because the costs are not the same trade the insurance in canada will pay what they are paying here, but it is a sometime not the same amount. we need to have supplemental insurance if we go outside of the country. host: use say it comes from taxes. can you break down what the tax structure is in canada and what

percentage of your income goes to fund health care system? well, it is a gradual income-tax. some are not paying income tax at all. the maximum you have to pay is about 46% if we compare among provinces. there is a federal and provincial income tax. the maximum is 46%, but some do not pay income tax. even if not, they are covered by the system. it is not a premium you pay if you are working or not. if you do not have a job the government will give you. you merger will give you care. it is not related -- the government will give you care. it is not related to having a job or not. host: jacqueline is joining us from california.

caller: good morning, i would like to comment on the healthcare system. i personally feel the only people who are complaining are the middle to upper class whites were feeling the financial strain of what bush has done to them. now that their leaders are beginning to get another game plan and helping people have forgotten where this mess came from, they seem to be angry that some poor kid from a family less fortunate might receive something they say they have not earned. the white republicans and richer people have received things they have not earned all their lives. it has been on the backs and sweat of poor people who have worked hard for this country who have been underpaid and without benefits. then they were discarded like" paper.

can this system is not perfect. they are admitting that and saying there will put a strong effort into improving -- canada's system is not perfect, which they admit. we should at least try to improve the care for people instead of doing the same thing we always have. host: we will get a response. guest: it is very important to have everyone covered. even if people are not paying for income-tax, in canada we feel we have a collective, social responsibility to give service to everyone even if they do not have money. because they deserved it. it is important for us canadians that health care is covered and provided to anyone. if he has money or no money. money is not important. it is the social responsibility of the country that we have taken. this is the way we think. this is it.

host: our next call is sandy from new york city. caller: yes, i would like to ask a couple of questions. you mentioned earlier that you do not have to pay anything if you went into the emergency room and you would not have to pay anything if you had heart surgery or heart transplant. i wanted to ask you about the madison. do canadians have to buy insurance for the medicines after they have the heart surgery? that would be a lot of money. also, the police and firemen, public workers, and people serving in the armed forces in canada, are they covered under the universal health care? finally, the you think the system would work if you have a population of 340 million like the u.s.?

thank you, and i will listen to your reply. guest: the first question is, everyone is covered. the workers working for the government or armed forces have the same program for everyone because everyone has a universal system. everyone is covered whether or not he is working for the government. there is no relation between your work and the healthcare you receive. for pharmaceutical care, people pay for medication, but depending on the province the amount differs. i will give you the example of quebec for you pay about 20% of the cost because there a maximum, a deductible, and accost you share. you can have private insurance

or government insurance. it works. it is compulsory to be insured, but you pay about 20% of the cost. if you must pay more, it is covered. you do not pay more out of pocket. this is for the medications outside the hospital. inside the hospital everything is covered and paid 100%. what was the third question? host: could your system work here in the u.s.? guest: i think we cannot explore the system -- the base of yours is different from what we have here. you need to look at what you are doing now and try to improve it. we have a good system we need to improve, but i'm not sure that it will work in the u.s. now. the starting point you have is so different from ours.

i do not think you can import that. it is not about the number of people, but the way it is working. i do not think it could be imported in the u.s. many in canada will say we do not want to have the u.s. system. here in the u.s. you say we don't the canadian system. maybe both are right. you need to improve yours and we need to improve ours. host: dr ouelett joins us from montreal and is a graduate of university of montreal. guest: i'm a radiologist. host: we have a message from twitter. what types of care are not covered based on age? guest: no, there is no -- i have

seen those in the u.s.a. if you're 85 you will not receive it. that is not true. you receive the care you need. whenever your condition or age, if you need this procedure you will have it. you will not have to pay for that. this is the most important aspect of our systems. we do not select patients. we do not say no, you do not have money, so you do not have cared. you will get the care they need. this is very important. host: we're joined from australia. what time is it there? caller: it is 25 past nine on sunday evening. i am watching your program live. host: we are thrilled to have you. what kind of system do have in australia? caller: we have a combination of a private system and a public universal system.

there is universal coverage, but almost 40% also take out their own private health insurance. host: what do you do personally? caller: personally, i have a private, but for those who cannot afford it they can get free hospital care and up to 85% of the doctor's bill when they go to their general practitioner. host: are you satisfied with your coverage and insurance? caller: yes, i think as the former head of the canadian ama said, all systems need to improve it. there is no system that is absolutely right. as i speak to people in the u.s. you have the very best of medicine, but the lack of

universal coverage is the problem. also, the cost of the system there -- just a very simple statistics. the u.s. spends nearly 15% of its gdp on health. here are in australia spend nearly 10%. at the u.k. spends almost 8%. i think you can does not spend enough, but the u.s. is spending a lot of money for a wealthy country. much of it is going into administrative costs. i'm a medical practitioner myself and my colleagues in the u.s. will talk about how they are controlled by insurance companies, about what services they can provide. we do not have those same sorts of controls here. there is administrative waste in the complexity there.

the life expectancy in the west happens to be four years less than in australia, despite the greater cost. more money is spent but without a clear, improved outcome. many of the top academics in u.s. universities have been very clear looking around the world, at canada, european countries and looking at the strengths and weaknesses in each area and seeing how that might be applied to the u.s. there is a lot of academic work i am sure it is informing the plans in your country at the moment. host: thank you for the call, john. we will get a response from our guest. guest: yes, in canada we spend about 10.7% of gdp, and you spend 15%. this is a lot compared to other countries.

we went on a fact-finding mission of this year to european countries. we have seen countries not spending more in their system compared to ours. they have universal access which is the most important thing, nor significant weight time. it is possible to have a working system -- without a significant wait time. i agree with the person on the phone that you have one of the best systems, the best care if you were going to some hospital, but the cost is very high. it is not sustainable, probably. you are paying too much. maybe you are paying too much for defensive medicine. we do not have that kind of attitude here in canada.

this cost you a lot of money. . . we have 70,000 members out of about 85,000 doctors in canada. we have about 85% of doctors in our association. >> we have a tweet: that canada think health care is a right or a privilege? obama says it is a civil right. >> i think it is something that is fundamental. if you are not healthy, how can you work? how he got outside to enjoy life? we need to be healthy and this is a fundamental thing for us. this is the most important thing -- health care is very

important. it is something that you need. this is why we are trying to offer it to our citizens. whether they have money or if they don't have money, we want to offer them health care. it is a basic. host: what is the number-one complaint you get? guest: wait times. this is why we need to transform the system so that it must be must more -- much more efficient than it is now. people are suffering for wait times. we have good quality, people don't have to pay for that. but on the other side, they have to wait. this is why we are doing the study this year because we feel our system, we can have without the wait time. we have improved the wait time, but it's not enough. we need to do more, but we saw the good system.

once people are in the system, they're satisfied. the satisfaction level is very high. . border to receive@@@@@@@@dr we'll watch it, come back, get your reaction. >> i survived a brain tumor. but if i had relied on my government, i would be dead. i'm a canadian citizen. and as i got worse, my

government health care system told me i had to wait six months to see a specialist. in six months i would have died. >> some patients wait a year for vital surgeries. delays that can be deadly. >> many drugs and treatments are not available because government says patients aren't worth it. >> i'm here today because i was able to travel to the u.s. where i received world class treatment. government health care isn't the answer and it sure isn't free. >> now, washington wants to bring canadian style health care to the u.s. but government should never come between your family and your doctor. learn more at patients united now.com. >> my advice to americans, as patients it's your care. don't give up your rights. >> until earlier this month, u were the president of the canadian medical association. your reaction to part of the debate here in this country on health care.

>> well, about that video, we have seen that. it's unfortunate. it's a sad story for that person. but it's not typical of what's happening in canada. people don't -- people are not dying on the street in canada. people don't ask to go to the united states to have health care. some of them will do that but it's a very, very small portion of people that need to do that because they wanted to have faster service. but we're receiving good quality of service in canada. and i don't think that you could find people that are putting the amount of money she put i think it's $100,000 in her surgery. you don't need to do that in canada because it's available for free. >> free meaning that someone is paying. we're paying with our income tax. but for the patient it's free. so this is not a typical story of what's happening in canada.

and i think it's not fair to say that people are dying object street in canada and we don't receive high quality services in canada. it's not tru. we receive high quality. we have a problem with wait times. we know that. we want to fix that. but it's not true our system is so bad that you're dying on the street. >> this program is being sime you will cat on cpac in canada and cheryl is joining us. are you happy with your system? caller: very happy, steve. and good morning. i was just watching the canadian medical association meeting that they have every year and my biggest concern and i am scared to death about this as much as the americans are fighting to keep public system out of their private system, i don't want private system in my public system. i feel this is going to be a very slippery slope that final

thri public system will be so degraded. the problem with our wait times, and i'm 250 miles north of toronto, the problem with our wait times is we have a shortage of doctors. what we should be doing, and i think canada can do it, we should be paying the freight to educate our doctors. we pay the shot. let's pay for these doctors to go through so they won't get hung up with high, high debt when they get through their schooling. then they will come to smaller communities. and about the wait times, i had a hip replacement four years ago. i opted to go to toronto for it. i could have gone to the city next to mine but i opted to go to toronto. i hasn't seen this surgeon in 20 years. i saw him in 30 days and in the next 30 days i had my hip replacement. then i had home care, i had fizzyo therapy at home.

it was just fantastic. i had nurses come in and take care of me all at no expense to me. thank god for our system, sir. i hope we keep it and i hope we don't go down this private sector slippery slope. host: thank you for the call. guest: well, some people are receiving good care in canada. and when we're talking about wait times, some people don't have to wait that they're lucky to have that. fortunately it's not everyone -- unfortunately, it's not everyone who has the same kind of service that she has, but it's true that many people have that kind of service that she was talking about. so nothing -- it's not everything that is bad in canada about our health care system. and people are happy. and she was talking about privatization. we don't want to privatize our system. the only thing we have said in our general meeting is, if needed, we could ask the private sector to help.

but this will be paid by the public system. for giving private delivery of surgeon services. and this is not about going toward privatization of the system. it's just taking all the measures, all the possibility to give the better service to the patient. so it's one way to try to improve our system. but we're not going toward privatization of the canadian system. that's for sure. host: another tweet from a viewer. guest: it's not for everything. it depends. and you heard that lady, she had her hip replacement within 30 days. depending on where you live, canada is a wide country. we have remote areas, we have big cities. and there's variations for wait times for surgery and wait times for medical examination like x-rays or ct scans.

it's different depending on where you live. in some of the big cities you might have a better access than if you have -- if you are in a remote area. so it's not even in canada. it's depending on where you stay. host: if you just joined us, today we're taking a closer look at the canadian health care system. what we like to call as canada health care 101, dealing with some of the basics. as part of the overall debate on health care. and tomorrow, tuesday and wednesday we'll take a look at health care through the eyes of one hospital, and during the course of the programming over the next couple weeks we'll take a closer look at the health care system in great britain. caller: good morning. i've had a few of my questions partially answered but i'm wondering, can the doctor tell us, if the difference is 6%, where 6% higher here because of

our costs, it's just hard for me to believe that it's all because of defensive medicine here. how do you keep your costs down if there's no rationing? and isn't it try that there are businesses or associations up there just to help people get to the u.s. to have procedures that they either have to wait so long for or can't be taken care of there? guest: there are some associations that are doing that, but it's a very, very small portion of people that have access to health care in the u.s. there are about one or two offices that are doing that. but, believe me, it's a very, very small portion of people that are getting in those kind of associations. so it's not a widespread phenomenon. people are saying, because they will receive good care in canada. and i believe we have a good system in canned dafplt we need to improve it but it's a good

system. host: go ahead with your question. caller: good morning to everyone. good morning doctor, i'd like to know as far as the wait times are concerned, to what extent the rules that guide the doctors, the operation, the operation rooms basically. because i heard that to a certain extenlts that doctors are allowed to operate maybe four hours a week and they are kind of frustrate bid that. but there's some kind of rule. maybe you could elaborate on that. that's my first question. number two, we are are talking about like waiting up to 15 hours in the emergency rooms but if you get there with a broken leg or a gun shot or asthma attack, you're not going to wait 15 hours. so i'd like you to comment on really the 15 hours. is it because there's a shortage of doctors and instead of going no where they just go there for their cough or for

whatever reason? that's not really an energy? and my last question -- emergency. and my last question is maybe what was the ratio between the doctor and the population like back maybe 30 years ago and what is it today? thank you very much. guest: ok. first, for the doctors having one day of operating time a week, it's about the situation in canada. and we think that doctors and surgeons think that they could operate more than that. so this is why, if they were going in the private facility paid by the public system, they could operate, they could have operating time more than what they have right now. for the wait times, 15 hours, of course. if you come in the emergency with something very urgent you won't wait for 15 hours. the wait times is for those people that they don't want to

see their doctor or their doctor is not available they come to the emergency ward for something that is not that urgent. so the wait time for those patients could be 15 hours. but if you come with a cardiac arrest, don't worry, you won't wait for 15 hours. that's for sure. and the last question was about zoo the ratio between doctors and the canada population. guest: the ratio of doctors is 2.1 right now. it has been about 1:120 years ago. we're improving. we're training more doctors. but in the 90's there was a great cut in the training spots of doctors and we're still suffering from that. this was a decision of all the provinces and the federal government to stop the funding of training doctors because they thought at that time that

if we had less doctors the system will cost less. this was a big mistake and we're still suffering from that because it takes a long time to train a doctor. you could take ten years and we're improving. we're putting more spots, more training spots for doctors for residents and students but we're still have a big problem in canada of shortage of doctors. if we compare, we have 2.1 doctors compared 1,000 people. in some countries like belgium they have 4.2 so they have less of a problem of access in those countries than what we have here. host: tonight a conversation with dr. john gared, who is the chairman of the board. he is also the chief cardiologist at the virginia hospital center. and then next week, t.r. reed, the healing of america. and during the conversation comparing the canadian and the u.s. system and part of the interview includes a look at

the cultural differences between our two countries. here's an excerpt of next week's q and a. >> i'm pretty tough on canada because they keep you waiting so long. and i was talking to minister in canada and i said you keep people waiting. how can you call this good health care? you have to wait months to see a speshtist. and his answer was, look, canadians don't mind waiting so much as long as the rich canadian and the poor canadian have to wait about the same amount of time. and that is their national culture. and we don't have that ethic. it's a standard in america that rich people are going to get better health care than poor people. no other country lets that happen. host: your response to the comments of the author. guest: well, i think i have to agree that this is a different attitude that we have and that you don't have here in the

states. for us, it doesn't matter if you have money or you don't have money for health care, you will be offered the same kind of health care for everyone. and this is a matter of culture, of attitude, because we believe that health care is the number one priority in life that we need to provide to our citizens. citizens. this is a this is a cultural thing and we want to keep it like that. guestcaller: it is unfortunate t the debate is taking place around the canadian health-care system. it is probably the one, no offense, that has worked least well in terms of dollars spent. the japanese system can do a cat scan at one-tenth of the cost

that we can do here. patients in need surgery can have it done within a week. germany is pretty close. france is pretty good. the canadian system -- had been this debate are around the canadian system is where the pope -- the opponents of health care wanted to be. it is the poorest choice of those currently available national plans. no offense to his guests -- to the guest. guest: i have to agree with you. if we compare ourselves to other european countries, we are not performing well. and i agree about that. this is why we need to make some changes in canada. this is why we won a transform our system to be more efficient like the system we have seen in european countries. we have a problem because of

shortage of doctors to do that. they have more doctors than we have. but we have systems where they had seen universal coverage, their system does not cost as much. it is possible to do that and that is where we're going with the canadian system. we want to improve our canadian system. we do not want to change everything but we surely want to uproot -- improve it. i agree that we are not the best in the world. the u.s. is not the best and the world. the our country performing more than we're doing right now. -- there are countries supporting more than we are doing right now. you're next. caller: good morning. i'm a resident in minnesota and do lot of work in win nipeg. first, there's a lot of misconceptions. minnesota has a state subsidized insurance program. there's a number of states that actually have some of the

culture that he is talking about. they're not framed around civil rights, they're framed around the good of the economy for the state. and we have almost universal coverage in the state. in fact, the people who aren't covered probably don't know about the program. secondly, my dad's currently getting treatment at the mayo klinic for esophageal cancer. now, i don't believe the canadians are coming there because of a problem with their system as much as it's the fact that it's the mayo clinic and it's a global hospital. my question is that a lot of the advances in treatment and a lot of the advances in pharmaceuticals come from the u.s. paying so much money. and if the u.s. creates a new type of system, how is it that those type of extremely advanced global centers, pharmaceutical developments get paid for, how do the canadian citizens pay for it when they go to the mayo clinic?

so two points. i think the states might be better and share some of that culture. and second global centers the cutting edge of medicine, how will that get paid for? guest: i agree that you have institution in the united states that are top notch, that are top of the world, like mayo clinic and some of them. and you need to keep that because this is very important for research. and you're doing some procedures, some things that we're not doing in canada. but if a canadian citizen wants to go to the mayo clinic, he has to pay out of his pocket to do that because it's not covered, or at least the part that will be covered is very small compared to the real cost. so people are paying out of their pocket if they want to to have that. but these are for very specific things that could not be done in canada. but we're doing most of the things. but you still, i believe that you still need to keep those

great institutions that you have. they are world class and you need to keep that. host: larry is joining us from pittsburgh. and some more information on canada and its health care system. caller: really great program. i'm originally from pittsburgh. i've lived in germany for three years, and my wife's family comes from canada and i've seen all three systems. and i will tell you this, i do cancer research. and if you have cancer, you want to live in canada because they have 100% coverage. their women come for their pap smears, they have the lowest incidents of cervical cancer than any country in the world. they're the best at screening women for cervical cancer. and we have these statistics. american women do not come to the doctor as often as canadian women because they don't have insurance. if you want to talk about wait times, just go to any major city, where you have people

without insurance. and go to the emergency room. you'll see three, four hour wait times. i think the canadian system is much better than we have here in american's on the whole because we have too many people without coverage. and germany, you pay 7.5% of your income for excellent insurance. it's very expensive but you get great care in germany as well. letting these people with serious diseases like cancer in this country without screening for cancer is an abomb nation and something has to be done about it. host: thank you for the call. next, montreal. caller: hi, thank you for taking my call. doctor, thank you very much for being on. i'm from montreal and i'm living in connecticut right now taking care of my mother who has leukemia.

doctor, you're being very modest, and i know that you're very smart. but you're being like us good canadians who are always saying thank you even when you know we're right. i know that you do not want to be in a situation that the americans are in like the gentleman just said, the call before this call. the waiting list in canada, i have lived in three provinces, i have lived in new brunswick, ontario, and question beck. and i have never had more than a three hour wait, maybe a four hour wait in any er room. i have three children. we have four adopted children. we have never had any long waiting period in any hospitals. i have a large family. and i want to say to the american people that they do

want a system like the canadian system in comparison to what they have right now. i have complex region al pain syndrome. the canadian take care of us beautifully. that's pain 24/7. we do not have anything compared to what you're looking at without any type of medical system at all. host: doctor. guest: well, i think she's right. we have a good system. and this is what i've been saying. she was lucky enough not to wait but i can tell you that some people are waiting. we have to look at the situation like it is for some people. some of them are luckier than others but we still have a problem with wait times. if this patient could have all those services without wait times, thank god, that's fine. and i think that the most important thing is what she

said about having access to those treatment even if you don't have money, even if you don't have to pay for that it's provide bid the state, provided -- the care is provided by the state because we believe in that. host: shirley joining us from pennsylvania. go ahead caller: good morning. thank you very much. i wanted to know, with your health care system, is there a limit as to how many times that you would be allowed to go to the doctor, say you have something that is chronic and you're always -- say allergies, for instance. and from one time to another gets worse, gets better, gets worse and you need to make numerous calls to the doctor to try to get these problems solved. is there a limit as to how many times you're allowed to go? and if they see that you are making too many appointments,

maybe they're going to say no more? i'm concerned about that because it looks like maybe we're going to be getting the same thing here in the united states and i'm truly worried about it. at my age, we're on medicare. we have a supplement. and we're very happy with what we have. now, i understand there are a lot of people here in the united states who don't have any. host: how old are you if i may ask? caller: my husband and i are 70. and he has numerous problems. and he is back and forth all the time and has to have blood work done. and a lot of times, he couldn't wait sometimes say 15 hours or whatever, he could never wait like that. that would be absolutely terrible. host: thank you for the call. guest: well, i think that in

canada you don't have that problem. even if you have a chronic disease and you need to see your doctor each week, you won't be denied. as you need care, you will have care. so this is not a problem. and no one will say, oh, you're coming too often. no. if you need that care, it's, you can come and you will receive it for free because the system is like that. so it's available and it's there. and you won't be denied any procedure if you really need it. and you will have it. so people are not afraid about that. and so those people with chronic disease who come tuvene their doctor, they're not waiting 15 hours. we're talking about patients going to the emergency ward for something that is unexpected. but if you go to your doctor you won't wait 15 hours for that. if you have a chronic disease, you will be seen reg alreadyly by your doctor -- regularly by

your doctor. and you don't have to pay for a team of say social workers and nurses. this is included in our system, and you will have the care that you need. host: to our radio audience, our conversation is with dr. wolet, former head of the canadian association. caller: good morning. i would like to ask the doctor, he's being very tactful and i thank him for that. he said that the difference in attitudes between our two countries. but it seems to me that it's more of a difference in moral values. that is the fact here. i personally believe that every citizen should be entitled to adequate health care regardless of income or race or status in

life. that's just a basic right of human beings. and it seems to me that is what canada feels. guest: well, i think you're absolutely right. this is how we feel and this is what we think. i'm not saying that you're absolutely wrong. but i think a great country like yours should look at giving their citizens a full coverage on health care because this is fundamental. and this is what european countries have understood also, because they're giving full coverage to everyone, whether they have money or don't have money. and this is the principle that we have here in canada and we want to keep it like that. host: janet, former resident of toronto now living in indiana. go ahead. caller: it's not a question, it's more of a statement.

i love the states and i love canada and i've lived in both. i came to the states for graduate school and when i came here, i did not have insurance here. i'm a student, i'm paying a lot of money to be here in school so i ended up getting injured in my dorm apartment and it became a problem where for the first time in my life i had to be debating whether to go to the hospital to get care or whether to just stay there with it and try to figure it out on my own. that was the first time i was ever in such a predicament because it became about money and not about my health. and i remembered ending up going to a pharmacy to ask the pharmacist what ideas he had about what i could do to care for myself because i could not afford to go to the hospital. i also at the same time i have a 77-year-old mother in canada

right now. for the past 25 years she's had multiple medical problems. her medical history is very complex. i thank god for the canadian system. she has been cared for thoroughly with no expense to her. what's sad to me is when someone has to lose their life savings to get health care. and i think that shouldn't be the fabulous country with fabulous people. and i think that there's something that can be done about it. the money is there to make it happen and it shouldn't be about certain parties making money, such as h.m.o.s and so forth. so i find the canadian system fabulous. i thank goodness for it. that's what's keeping my mother going. in terms of wait time she has so many complex problems we have never had a wait time for surgery. she had to have back to back summerry last year and there was not anything about a significant wait time. significant wait time. she has to go to i wanted to give both

perspectives. host: this was at tweet. guest: in various specialized areas you can do that. in quebec, we have some clinics where you can pay out of your pocket and you would jump the queue. but this is a small segment. usually is not that. you do not have to pay anything usually. money is not the first concern. the lady that spoke and said -- i was not sure about what to go to the hospital because i had paid so i had to make a choice, we do not have to make that choice. you can go to a hospital because you know that you will not pay

anything. it is not a choice. it is something that people do not think about because it is available. host: dr. ouelett, a final question. what advice or observations would you give americans? guest: you really need to let the jury system and a look at those people who are uninsured, 46 million, and try to find a way -- it is your problem but find a way to get health care services to those people. i think it is a social debate but it is very important. collet are right, called a moral thing, -- call it a right, call it a moral thing, but find a way to get them health care. host: dr. robert ouelett, thank

you for your time this morning. >> money on "washington journal," a discussion on recent town hall meetings with representatives at gerald connolly. we will have more with james cole and dr. john garrett, and a discussion on recovery efforts in louisiana four years after katrina, with the head of the louisiana recovery a party. "washington journal," live at 7:00 a.m. eastern here on c- span. and now, commerce secretary gary locke speaking at a conference of minority-owned businesses. this is about 25 minutes. >> i was an adviser to president

barack obama during the last election. in all of my experiences this was raised by one of his daughters. looking out over a sea of thousands of onlookers, when suddenly his daughters, one of his daughters, tug at his coat tand asked a profound question. she asked, why are we here? why are we here?

and it is a profound question, one that i believe that we must ask each and every day of our lives. as individuals, as americans, as leaders, as businessmen and businesswomen, all across this country, why are we here? and i think that same question is even relevant today at this conference. why are you here? i imagine that many of you are here for varying reasons, some to network, some to gain new knowledge, some define ways to access capital, and for many varied reasons. i am here, a vice-president but biden -- vice-president biden participated in this congress, magic johnson was here. gary locke is here and we're

here to represent our president barack obama. we are here to affirm our commitment, a commitment that minority businesses are crucial, are vital to america's economy. we are here to confirm and reaffirm that we look forward to continuing to work with you, to help you grow and expand and innovate and create wealth and create jobs and change communities, because we understand. when minority companies prosper, all of america prosperous. our secretary gary locke is here for that reason. he is a key member of president obama's economic team and he has a distinctly american story. 100 years ago, his father chat

-- traveled from chinatown washington state, initially working as a servant. his father was a small business owner of a grocery store in seattle. the secretary also worked there as a youngster. his strong work ethic and a termination eventually took him to the highest office in the state, where he served two terms as governor. during the eight years of the l ocke administration, they gain 280,000 jobs. like his grandfather, he traveled as an advocate, working across the country and this globe, to help advance economic prosperity, to help restore the american dream to people all across our great land. it is my distinct pleasure to introduce our united states commerce secretary gary locke.

♪ [applause] >> thank you very much for the introduction. i wanna say one thing about him. he as a -- is doing a great job as the deputy chief of staff and an adviser for the department of commerce. he is also doing an incredible job advocating on behalf of minority businesses. he is a participant on the vice- president is task force on the recovery act. president obama has charged vice-president biden quit the actual monitoring and implementation of hundreds of millions of dollars throughout communities and states on recovery act. and vice-president biden made it very clear that we will not be successful in implementing the recovery act unless minority businesses are fully participating in had a great

share of the funds that are going out. rick has done a great job working with all the agencies to make sure that they are keeping in mind the vice-president's and the president's priorities. let me just say that i am very happy to be here. at the same time, i am saddened by yesterday's news of the passing of senator edward kennedy. perhaps the greatest tribute that one can pay to this man is that it is impossible to tell the story of america's progress without telling the story of senator edward kennedy. for half a century, he was on the front lines of the battles to expand civil rights, protect our liberties, and provide healthcare and educational opportunities to all. no modern day senator has done more to advance the prospects of minorities then senator kennedy.

and all of the successful leaders in this audience today, what you have done so much on your own, we have to be aware that the path for everyone here has been made easier thanks to the efforts and dedication of senator edward kennedy. [applause] we're going to miss him. it is an honor to be among so many talented business owners gathered here by the mbda, which has been working with minority businesses or over 30 years. i feel really at home here, because as rick wade indicated, my father was a small business owner. after serving in the army after world war ii, my father came home to open a small family- owned grocery store. i grew up in that place stocking shelves, providing free deliveries, working at the

camera, and making sure that our customers had everything that they needed. my father put everything he had into that grocery store. it was his little piece of the american dream. and now is under, that dream was there for millions of -- and when i was younger, that dream was there for millions of americans. america saw the greatest ever expansion of the middle class. but today that dream is slipping away for far too many. it has become uncomfortably normal to turn on the news and hear about massive layoffs at this automaker or that financial firm, or just that company down the street. but hit hardest of all has been america's small and medium-sized businesses, many of which are minority owners. through the third quarter of 2008, half of all private sector job losses have occurred in companies with fewer than 20

employees. far too many americans -- are too many american businesses, but bills have kept coming while the payments for products delivered or services rendered have not. there is no doubt that this has been a rough year, but now it is time for america to get back to basics and empower the doers, the builders, and entreprenuers to start growing and innovating again. if i am talking about the people in this room. already we're seeing signs of economic recovery, but we want more minority businesses to be part of that recovery and that growth. going forward, america must end its dependence on economic bubbles for growth. what we need are new inventions and innovative ways to deliver products and services, and increasingly we need these advances to come from minority businesses.

many of you are anchors in your community, and america needs you to succeed to ensure that opportunities for prosperity are shared by all americans. we had a chance to meet with some of the award winners yesterday afternoon. i have to tell you that in reading the descriptions of the award winners, nonprofit organizations, business advocacy, to the entreprenuers themselves, so many of the entreprenuers that we honor are those that have established a policy of working almost exclusively with other minority firms. we urge you all to continue that, just as you have realized how much it has been a struggle for you to succeed, and as the vice-president said, reach back. get back and support other minority firms. -- give back and support other

minority firms. i wanna talk about how we plan to enable minority business owners and all business owners to start growing again. and the day that he took office, president obama has made exceptional efforts to provide immediate help to small and medium businesses that are accountable for the significant number of jobs here in america. it all began with the recovery act, which is really in itself divided into three parts. one-third of the recovery act money, some $800 billion, is going directly to tax relief for families and for small businesses. another one-third of the money has been allocated for emergency relief, like additional medicaid and unemployment funding for those who have borne the brunt of this recession. and the last one third of the recovery act is for investments, to put people back to work and to lay a new foundation for long

term prosperity. this includes vital infrastructure improvements like roads and bridge repair, renovating our schools and our hospitals, as well as investments in things like broadband and renewable energy. thanks to recovery act, some $100 billion in funding and loan guarantees were set aside to said it -- to encourage manufacturing in america, much of which will assist smaller enterprises. this is allowed the small business administration to increase loan guarantees from 75% to 90% on their biggest loan program and to weigh the -- waive all closed up fees. $24 billion has been made available to fund some 7400 shovel ready transportation and other construction projects in states and communities all across america.

more than 4000 of those projects are already under way. in these difficult times for employers and workers alike, the recovery act has helped to expand the social safety net. within 12 million laid-off workers are collecting an extra $25 a week in unemployment benefits, but also many more americans have had more time to sign up for the 33 extra weeks of benefits. families that have lost their jobs are able to required -- to rely on corporate health insurance and paid 65% less for that health care coverage. more than 7 million low and middle-income students are receiving a 50% interest -- increase in their scholarship programs to help for college. and we know how important it is for our children, children of color, to succeed in college so

that they can have a leg up as this economy recover so that they will be in a position to get as good paying jobs with a sound college education. [applause] and as the president promised during his campaign, he has provided tax relief for 95% of american families and workers. with unemployment continuing to rise, i share the frustration that the economy is not getting better quicker. isn't getting better faster. let's remember for a moment what the economy looked like at the beginning of 2009 when the president took office. every day seemed to bring news that was worse than last. we were on the process of a great recession turning into something much worse. a great depression like the one that my father lived through. the recovery act, along with

other economic initiatives, has worked to stabilize economic conditions and help those harmed most by the economic crisis. but a true mystery -- the true measure of the recovery act will not be determined in just a few months. to put our economy on a sustainable path, we've got to make fundamental changes like we have not seen in america for decades. for too long, american businesses, particularly small and medium-sized businesses, have been fighting against systemic imbalances that make it tough for them to create and -- compete and create new jobs. and president obama aims to fix them. number one, we have an education system that is not preparing our kids or retraining workers for the jobs of the 21st century. the president's recovery act as set aside some $44 billion to improve our schools and much of

the funding is contingent on states putting together tough new academic standards. we need to make sure that states stay true to these tough new academic standards, because we know that it is not good enough have our kids graduate if they have not mastered the basics. it makes us feel good that our kids are bred to wedding from high school, but if they do not have the basics, how can they compete and get good paying jobs in the global 21st high-tech world economy? we want our kids to succeed, and that is why the president is so focused on high academic standards and reinvention of our school system. no. 2, we have had decades of mismanaged energy policy that puts our environment in peril and leaves american businesses, especially manufacturers, bulbul

to price swings in the oil market. -- vulnerable to price swings in the oil market. the president wants to develop and national smart grid and putting an emphasis on energy efficiency. he is putting us on a path to environmental and economic sustainability, but he is also helping to grow a domestic renewable energy industry that is already taking hopeful steps to put laid-off industrial workers back to work building wind turbines and solar panels. this will be the next great growth industry of the 21st century, and the president wants to make sure that america leads it. and minority companies should look to this sector and sees the incredible opportunities, because all the players in this sector are virtually new comers, competing at an early stage.

no monopolies and no barriers to entry like in many other fields where companies and institutions have long played in that particular field, making it very difficult for new people. and finally, we have the most challenging domestic issue of all, a health-care system that leaves almost -- leaves 50 million americans without health care, millions more with too little care, and a system riddled with inefficiencies that pile backbreaking costs on government, on businesses, and on individuals. there's plenty of room for honest debate on this issue, but let us be clear about one thing, but those who advocate continued in action -- inaction, are not only guaranteeing that people will remain uninsured or underinsured, but they are also consigning american businesses

to a less competitive future because of unsustainable health care costs. insurance premiums have gone up by nearly 10% annually in the last 10 years, and they are likely to do the same -- excuse me -- in the next 10. the impact on small businesses is even bigger. small businesses pay up to 18% more per worker for health care insurance than large companies to for the very same coverage. a disparity that is hitting minority businesses especially hard. because of the rising cost of health care coverage every single year, small businesses more and more are stopping providing health-care coverage to their employees. less than 50% of firms with 3-9 workers now offered any type of health insurance to their employees in 2008, compared to

99% of firms with over 200 workers. there has been so much misinformation out there about what healthcare reform will mean for small businesses, and i just want to briefly set the record straight. president obama has articulated three very broad criteria for any healthcare reform. reduce cost, number one. no. 2, per pat -- protect americans choice of doctors and insurance plans, and number three, assure a quality -- quality and affordable health care for any american that was it. the current drafts and the congress do exactly that. i know many of you have endured difficulties finding insurance or seen your employees struggle to get good care. that is why you need to know that health insurance reform will undoubtedly help small- business owners and your employees.

small businesses will not be required to offer health insurance to their employees, but if they do, they will get a tax break -- tax incentives for doing so. proposals working their way through congress include the creation of an insurance exchange, where both small businesses and individuals can purchase coverage. these exchanges would basically act as a large pool to help spread the administrative costs over large numbers of employers, companies, and people, getting small businesses some of the same advantages that large businesses have been trying to purchase health insurance. this exchange will make available high quality plans at much more affordable rates. and low-wage workers will be provided subsidies to help cover the costs of purchasing health care on their own. crucially, the reforms supported by president obama will end once

and for all the practice of insurance companies denying coverage to people with pre- existing conditions. or limiting or terminating coverage once people get sick. or stopping those insurance companies from astronomically raising the cost of the premiums that company is paying in some or if you of your employees get seriously ill. at the end of the day, any bill the president signs will allow businesses to buy quality and affordable health care for their employees, and will allow individuals to buy health care on their own at affordable rates. [applause] this is the biggest issue affecting american companies. especially small and medium- sized companies. the cost of health care

insurance has risen in the last 30 years from 1% of payroll to almost 10% of payroll. the cost of health care to businesses has doubled in the last 10 years, and is expected to double in the next 10 years. as i indicated before, annual premiums are rising at an average of 10% figure. your revenues are not growing by 10% a year. as a result, so many companies, to afford the rising cost of health care, have actually cut back on wages or scale back on the coverage you provide your employees. wages for american workers over the last 10 years has been flat because of the rising cost of health care. and the need for companies to take whatever additional revenue that they have to put into their rising cost of health care coverage for their employees as opposed to wages. this is an issue that must be

solved if our companies, american companies, are to be competitive, to be successful here in america and abroad. there is still much work to be done to make health insurance reform a reality and senator kennedy's voice will be sorely missed. but it is my hope that members of congress will be encouraged by his memory to come around the idea of progress, that will drive down unsustainable costs, improve choice, and cover the millions who lack health insurance. it is my hope that the senators enduring example will help deliver access to quality affordable health care to all americans. the thing that people need to understand about healthcare reform is that this is a competitiveness issue for our companies in america. the longer we wait to do something, the worse off we all will be. for all the different things

that the commerce department does come up from protecting america's oceans and intellectual property, to improving companies' efficiency and opening up markets, what we're really about is improving the competitiveness of american businesses at home and abroad. helping companies succeed and does provide a good family wage jobs. we have tools of the department of commerce to help businesses at every point in the cycle, from the birth of an idea to starting a business with that idea to help them find markets once that idea has been transformed into a product or service. and if you are a small business, we want you to become a medium- sized business. if you are medium-size, we want you to become a large business. week that the resources to help you do that. we are in the midst of restructuring our programs to make our services and our offerings and our expertise more relevant and more readily accessible to you.

the commerce department is working hard to help minority businesses and all american businesses reach their full potential. somewhere in this audience is the next magic johnson, bob johnson, or jerry yang. they are simply the best of what they do. ultimately you will succeed or fail on the strength of your own ideas and your own persistence. the private sector has always been and always will be a source of american prosperity. but the commerce department and president obama want to help make your businesses a little bit more efficient, a little bit more innovative, and to help you access newmarket's. we want to help you succeed because again, america is not successful unless minority businesses are successful.

america has always been a land of freedom, hope, and opportunity, and we need to make sure that minority businesses are part of the american dream. we're so proud of what you do day in and day out. we're so proud of what you do for your community. we're so proud of what you do to provide good paying jobs for people in your communities. we in the department of commerce stand ready to help you. we're proud of you and want to work together to help you succeed. thank you very much. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] dollars this is c-span, public affairs programming courtesy of america's cable companies. next on ""q&a" dr. john garrett on how the government and nongovernment p