why did scotland choose to announce its biggest decision and not to this house? where is the accountability in that? during thursday's statement, mr. mccaskill said at least eight times that he was responsible for the decision, but at least eight times he sought to pass the blame on to others, from jack straw to a so-called higher power on the other. why did mr. mccaskill visit him in prison? what was said? will the notes be published, and was an appeal discussed at that meeting? above all, why make that visit when there was not one but two appeals in progress? what'd busted he take from the crown office on that matter? -- what advice did he take? we know that he did not need to visit him in prison. a written representation was all that was required, despite what he has said. prisoners can have a justice visit them in their

cell. and doesn't this conduct mean that no prisoner no matter the crime, will have a request turned down again? this has caused the split of scotland and next week colonel can breed this discussion. and the fine redeeming four-year term of government will be ruined by many for years to come. >> from this parliament and by the providing officer. and i say to you mr. scott, it's my decision and mine alone. i stand by it and i will live with the consequences.

no, i dontspeak to the proud, that would be inappropriate, and it would be wrong for me to approach them and therefore i didn't. and in terms of paper and process, we are looking to release as much as we can. and to make sure that those who have written and cooperated and those who have given evidence, have the courtesy to say if they want their names released. but we will seek to provide those papers. and can i say that i appreciate you as leader of the democrats, and can i say that i did look back at those who had given compassionate terms before, and under the release of a child

killer given a life sentence was released. clearly he committed one life, not 270, and he was provided the due process. and i believe of the people of scotland. and can i quote from another formal leader of liberal democrat, lord, said this morning, and it was not me as part of a deal or trade agreement. and i think that people should focus on that, and most people in scotland are in favor of releasing him on compassionate grounds. and you may take a different view, and as i said, this is my decision, i will stand by it and live with the consequences. >> order. when it comes to open questions, i have 30 members

wanting to ask questions, and i am keen that everyone who wants to ask a question do so. so i suggest that everyone be brief. >> the votes of scotland have criticized your legal system in application of justice in this case. and be aware that the report of releasing mr. megrahi on compassionate grounds go to many. and do you agree that if a cabinet be set down for compassionate release as mr. megrahi, and to deny that release is to criticize that decision. and can the justice confirm, that anyone who has made a request has been refused compassionate release? >> no, i can confirm those who riteria, no cabinet

secretary for justice has refused a release since 2000. and that's how the position is and the laws of scotland that i followed and those followed before me. >> when will the cabinet secretary publish on the advise to meet megrahi and it was not necessary to meet personally, and did not meet personally the american families. and given the decision, will there be a full leak inquiry into this? >> he's quite right, i did not meet with the american families, that was not possible. but we had a telecast link and we were able to exchange and i listened for over an hour. and of the papers that were

sent with as much information as possible, we have to be able that those who can, can provide their consent. and if not, we cannot publish that. and in subject of leak, and on sunday it was said that the decision was made and they knew about it four weeks ago. london said that i made a decision to refuse it. there was a wide range but i made my decision on wednesday, 19th august, 2009. i made it public on the 20th of august, 2009. and i stand before the chamber of the scottish parliament today to stand by my actions. >> so to remain as the cabinet secretary, to maintain wisdom,

integrity and justice and compassion. and these are the values of the parliament and government. and we expect much support from the families and our archbishop that you mentioned today. and there seems to be come confusion of what is meant by compassionate release. >> well, the guidance of my position as laid down of the guidance of the scottish prison, and this is followed by myself, and it wasn't simply the laws, but the guidance of scotland, but the values. and you spoke of archbishop, and i am glad there is talk on this, but the church of scotland said this decision has sent a message to the world, of

what it is to be scottish. we have decided to show mercy even those who hurt us didn't. and justice is not lost in acting in mercy. instead our deepest humanity is shown, and today our nation made that challenge. i made that choice, it was a tough decision. and i believe i followed due process and stood up for humanity that we pride ourselves as people. >> thank you, in the weeks following the horror of bombing of pan an 103, the people of lockerbie received compassion of those americans who died in the sky. and the relationship of trust

and friendship has remained over the years. how many families of the american victims did the justice consult as he made his decision to release mr. megrahi on compassionate grounds. and what stand did he take of their views, and what advice did he received on compassionate alternatives? did he explore those alternatives, and that the american families would know that he would remain and the trust would be honored. >> i think that the suggestion to send mr. megrahi to a hospice in scotland is ludicrous, and people go there to have tenderness with their

family, and not to be turned into a media circus, which is what would have happened. with the police, we discussed with the deputy constable, and as was said by many of different debates in this chamber, i do not direct the police on their operational matters. it's their advice, and that this security would be severe and a minimum of 40 officers. i decided on that advice, it would be inappropriate. and with americans that i interviewed, and those were contacted and we offered them every courtesy. have i done so and i am conscious. and the pain for them started on december 21, 1988, and caused by the actions

perpetrated by mr. megrahi. i feel their heart-felt pain and suffering, i can do nothing to take away that pain. but i had to make a decision not just on the basis to oppose the justice, but to stand up to the laws of scotland, which is to be able to show mercy. which i did. >> the cabinet secretary thought to aleve suspicions, and the contact of the libyan leader, and has met with megrahi's son, and none of these events and the release are unrelated. did the first minister or the

cabinet secretary feel at any stage that the cause of their negativity and that they were set up for a much bigger international gain? >> i did make it clear, and i thought it highly regrettable that the government of the united kingdom failed to exercise opportunity to meet representations that was made available to them, or to provide any information that would have counteracted information i received, both from the victims and american families, and from the government of the united states. that was i believe highly regrettable. i cannot comment or state what did or did not take place. whether lord madinson and tony blair, i made my decision

based on the basis and laws of scotland. it will be for others to decide if my actions were wrong and if the actions of others were appropriate. >> could i thank the cabinet secretary for his statement, and to comment of how much advice and support he received from the first minister of the release of mr. megrahi. any or none? and can i ask kenny macaskill confirm that his scottish compassion and bizarre reference of a higher power, whatever rule that may be. that every terminal prisoner, no matter how hainuous their

crime, and does kenny macaskill now offer to meet every convicted criminal seeking release on compassionate grounds if they command it? and does he feel that many in this chamber and all of scotland his concerns about his conduct and credibility as justice? >> sorry, cabinet secretary, there should be no applause from the gallery, that's against the rule. >> it will be for each one of us to decide what our compassion is. and i believe when you take the oath, and you may have some consideration, because it's those comments that i scribe to and believe that are supported by the charts of scotland, you

may disagree, and that's your right and entitlement. but i stand by my right of compassion and i believe it's supported by many. i am grateful to have the support of the first minister. but @@@@@)@@@ ,@ @ @ @ @ @ @ @ >> if we are to get through all the members who wish to ask questions, they must make them briefer and they have been today. one question per member, without too much preamble. >> the cabinet secretary has emphasized the process of consultation in relation to the prisoner transfer agreement. with regard to his meeting with the prisoner, can he confirm the position of jack straw when the pta was ratified?

the subject of the pta has a right to put the case as requested. first ever prisoner transfer application that could be made by a national government without the consent of the prisoner involved. the application that came before me was an application by the government of libya. it was my requirement to hear representations from the prisoner involved. mr. megrahi chose to make those representations himself. i practiced in the courts of scotland for 20 years, have i never come across the instance where someone was to represent themselves, unless for a sexual matter, and they would be refused that entitlement. natural justice dictated it. >> there are a number of

people, and megrahi received a hero's welcome when he returned to libya. and with the libya government, can they consider the possibility of a pre-condition attached to mr. megrahi's release that would prevent his engagement? >> as i was said, assurances were given to me by the libya government. and they were not upheld, as to whether the decision would go, to the u.k. nationals or others. i regret very much that those assurances were not adhered to. >> thank you, presiding officer, regardless of the current control and the strong

views, it remains the case that mr. megrahi is a dying man. and likely soon to be a fact of history, that he would die in libya and not in a scottish prison. does the cabinet agree that a decision with longer term consequences is a decision that must be taken not only by the scottish government but the u.k. government, to publish all information relevant. not only for mr. megrahi's release and all those of scott's, libyan's and the world will be able to finally answer the serious and troubling outstanding questions in this case. >> can i simply say once again, presiding officer, that i stand by the investigation and conviction and indeed the fact that that conviction was upheld on appeal. i recognize there are issues of concern to many. that's a matter to be proceeded

by others. if it's sought by this chamber or anyone else, if an inquiry in scotland, we can consider it. but clearly the laws of scotland are concealed and the matters that are upheld are matters beyond that of scottish government and the parliament, they may be matters to be investigated but by the proper authority. >> further to the question and the cabinet secretary of publishing the relevant material, may i ask him to clarify of that of the review commission, that there may be a misjustice, as an bomber, and

if they can approve the report, and that's not within his power, will he support my call for full publication? >> i stand by the position i stated on the 20th of august, i have great pride of that of the police and scottish courts. they did scotland a great service to bring mr. megrahi to justice and trial. i recognize the individuals that have cause for concern. it will be for them to decide and other matters to decide if any public inquiries. what i can say, the scottish government will fully cooperate in any way to answer the questions. but it's for us to decide of the jurisdiction of the lands and of the parliality. -- parliament. >> thank you, i am sure that

mr. secretary will be well aware that his decision of mr. megrahi is wide-spread criticism and could deteriorate by the scottish government. it's agreed that such a visit would not be appropriate, and such a visit should be ruled out to avoid further damage to scottish reputation. >> i have to say i am not away of any visit, and we will do not to damage scotland's reputation. and you may disagree with my decision, and with your former colleague, and that the justice minister has arrived at the right decision on compassionate grounds. >> will the cabinet secretary

say what he said to mr. megrahi in his prison cell? what he said back to the cabinet secretary, and will he say whether or not he's made any effort to discover from mr. megrahi's council why he would agree that he would enhance his chances of going to libya? >> i made no such references to mr. megrahi, his counsel or those with him throughout the meeting. no such suggestion was made, it would be entirely inappropriate. i said at the outset of this matter, it would be following due process and proper guidance. and i made clear that his appeal was by him and the courts, he made the decision without interference. >> thank you, people who are

dying of prostate cancer can vary from days to years, and can the cabinet secretary detail the advice he received on his prognosis and of the cancer? >> dr. key is better qualified in the medical matter, but the report is provided to the united states government and made widely available. it's clear from the evidence contained in there , not from the director of health, but the consultants and other experts that dealt with mr. megrahi's treatment and after that ?the's terminally ill. that's a matter and whether he would live longer or shorter. but the prognosis was terminal, and on that basis i made my

decision. >> thank you, does the cabinet secretary recognize ever those of white -- those of us that take a different view, and whether he made the wrong judgment? can i ask the cabinet secretary if he asked his officials of the details of scotland, what did the cabinet secretary ask in terms of those compassionate terms? what the results and will he publish those? >> we spoke to the deputy council, he's the man incharge of operational guidance, and it's his guidance that we have to accept. i will not interfere with the matters that are in the domain of the police. it may be that admiral and margaret believe that a hospice

should be made available in scotland. i believe that the hospices that we have in scotland are entitled to be treated with dignity and not placed on them the encumbrance of numerous police officers and the entourage that would follow, and that people have their own dignity to die in comfort. >> the cabinet was told that you sought in the transfer agreement to set that understanding of the compassionate release order, and will the cabinet and all communications between the scottish government and u.k. government be made public, and if there was no such communication? >> as i said, we will be happy to produce what we can, of the authorities to release them, whether victims or national

governments. i cannot comment what they will do so say, it will be for them to justify their actions. >> to the people of lockerbie have made it clear they want to move on from that, and i understand this is a matter for the cabinet and bureau, but the cabinet secretary, will he and the party submit a democratic release of this chamber to show the world what the true scottish view on the matter, than this minority view? >> these are matters for the bureau, i do not seek to impose upon them, if that's what is wished of the bureau, then we will fully cooperate with. >> presiding officer, i will

never forget that particular day, because the very next morning, i left with my family on a pan am flight. so this is firm in my own mind, can the cabinet and the house elaborate more on the advice from the police and if any costs were given to them? >> costs are not a factor that we take account into the justice system, and had it viewed as appropriate, but this was based on the consequences of severe problems and the safety of mr. megrahi and other people. the consequences of those who live in close proximity, and that was a matter that had to be considered by me on the suggestion of hospice care. i had to consider that decision, if i force mr. megrahi on a hospice in

scotland to look after people in their dying days. i made a decision on operational advice. >> it's for the belief that the criminal justice system was not made. and not on the release that mr. megrahi on his appeal, and can he offer an explanation, why he said, i faced a choice that the hope of dying in prison and that my name be cleared. can you confirm, cabinet secretary, was it competent for this appeal to continue? or was it an obstacle to his release? >> according to the laws of scotland, it would be competent for it to continue, whether he

deceased. that's a fact of the laws of scotland. and yesterday it was revealed that no pressure was brought on mr. megrahi, and those of london made it clear that mr. megrahi was clear in his own name. and no pressure brought by the government of scotland, he did so to return home to die. . he said we need someone to preside over the parliament with justice, wisdom, compassion, and integrity. each of us should embody these principles everyday in the carrying out a parliamentary duties. >> i do not seem to impose my

views and beliefs on anyone. i made this decision following the guide is laid down in the loss of scotland and what i believe it is my interpretation. many will disagree, as has been made clear. i have to say, i am heartened by the support i have received from many people in scotland, and in particular the archbishop and the rev.. >> in his statement last week and again today, the justice secretary stated he had ruled out a prisoner transfer request. . . >> no there's never been advice to me being incoverage tent.

it was quite clear. i felt it entirely inappropriate. it was quite clear to me that the americans had either received or had an ookspectation that they received clear information prior to trial that he would serve his sentence in scotland and to say it was on that basis that i made my decision. >> the responsibility which now falls upon the council to be responsible for the where wits all and where abouts of him. can the cabinet secretary confirm what conversations he had and whether during those he explained to them the arrangements he has put in place to recall him to custody should that prove to be necessary? >> as he is aware we do not

operate the criminal justice social work directly from the house. it was for that reason it was the social work department who became responsible. officials have been discussed because clearly it's appropriate there should be these discussions at official level and clearly the requirements required to be laid down for the terms and conditions for the license that he required to sign. and the fact of the matter is that the guidance and the laws prescription prescribe that it has to be the council. there is no alternative. that is what is laid down by the due process that i followed. and, as i say, we sought thereafter to ensure that appropriate conditions would be in place regarding place of residency, limitations on travel. other matters that would appropriate not only in scotland but also taking into account the peculiar and unique circumstances relating to this case.

>> presiding officer, as someone who is here as part of the team the day after pan am 103 was brought down, i saw the full effects the atrocity and it is something i'll never forget. the cabinet secretary says he didn't make his final decision until after august 14. yet, the bbc reported exactly two days beforehand, something they would not have done unless they were sure of their facts. on the morning of their decision -- >> come to a question, please. >> the herald also reported his decision hours before he made it. the cabinet secretary has been asked three times whether he would make an inquiry. will he do so? because someone has been leaking information. and. >> i will thank you mr. whitten of the time line. the application for compassionate release came in on the 24th of july.

the medical report i received from the director of health and social care in the scottish prison service was dated the 10th of august. the financial submissions i received from my officials were late on the 14th of august. i made my decision on the 19 ds of augs and i made a full statement on the 20th of august. and as i said in response to previous questions there has been a variety of speculation on this. some speculated that i was going to refuse, many speculated i was going to make compassionate release. and some made speculation they knew about this four weeks ago. i nare rated the time line. i took due process and i followed that. >> i'm really interested in the health grounds. i understand that the guidance is that death should take place

or seem to probably take place within three months. the medical reports which i have read indicate that in july the lower end of the previous expectations were to be look at. and that meends that he in july was expected to survive for eight months until april 2010. and all medical advise ers have said the prognosis is really difficult to determine. so the three-month rule is questionable in this case. i would ask therefore who he took advice from other than a consultant urologist and a -- and the prison medical officer. did he take any ide vice from a care expert who would have a greater understanding of the possibilities around this? because if he lives for much longer than the three months this will add to the insult to american families and others. >> presiding officer, i followed the three-month rule. that was the medical information given to me. the medical report that came

from the director of health and social care from the scottish prison service was date it had 10th of august. that was based upon an interview and examination on the 3rd of august when it was made quite clear that there had been a change for the worse in his circumstances. i do not have the benefit of dr. simpson's training in medicine or psychiatry, but o i do follow the rules and guidance that are laid down for cabinet secretaries for justice. i do recall that dr. simpson has also served as the minister for justice. i followed the same rules and regulations that he would have been required to do so had it become before him. >> we are getting very short of time. >> thank you very much. and there have been countless reports in the media and indeed comments from members of this parliament concerning the avingt of information on this case. can the cabinet secretary

therefore once again consider an order to bring an end to these baseless accusations when they have been made and other reports from the governor and social work on which his decisions was based, when these reports were received. >> as briefly as possible. >> in the case that i received the full and final submissions on the 14th of august late on and i made decision on the 19th. >> does the cabinet secretary discuss any of the potential economic impacts arising from his decision and prior to its arrangement either with cabinet colleagues or anyone with the scottish government? >> absolutely not. >> as he may be aware it falls on the local authority to monitor him under the terms of his release. it is also my understanding that the scottish government

have only insisted that he attend a video conference once a month. a video conference once a month may i ask the scottish government what action it will take if he fails to show up for his monthly appearance? >> on the basis of the medical evidence given to me, i have returned him to lybia to die. >> the cabinet secretary will be aware that a u.k.tori suggest idea that basing it on additional grounds was throwing away a bargaining chip. will he join with me in condemning these comments as utterly inappropriate. and would he ask all other politicians in this chamber to reject such ideas? >> well, the laws i followed are the laws laid out by previous administration. someone who thought under the border and some under liberal leave o within the scottish

parliament. i followed due process. i hope and believe that everybody who is given the privilege to serve in this position before or after will follow that and will do so without conversation on political, economic, or dip plo matic routes. >> can i regret the plitization of what is a quasi judicial matter and for my part commend the justice secretary for a courageous decision, which is entirely consistent with both the principles of scott's law and christian morality as evidenced by the widespread support of churches across scotland? does he share my revullings, however, when he returned to lybia but does he accept that there is nothing that anyone could have done to stop that and does he also agree that it is entirely irrelevant to the rights or wrongs of the original decision? >> cabinet secretary.

>> presiding officer, i'm very grateful and i'm glad we share the same beliefs and values and they transcend whatever political evaluations we have. he acted without compassion and showed no sensitivity but to say our values are deeper and different. >> cabinet secretary i'm sure you will not suggest that you have a monopoly on beliefs and values as a christian myself. i do not share your position. however, i think we're both entitled to that position. you have indicated today that cost is not a factor in the scottish justice system. can i therefore ask you again specifically which alternative compassionate release options you considered, what advice you received on them, what the cost of them would be? and if you're not prepared to give us those answers today if you will publish that as a matter of urgency. >> i can say as i said to

others, i was not prepared to foist the incumbrens of him on any hospice in scotland requiring to deal wh a terminally ill in their last moments. that would be unfair upon any of them. accordingly, i and i alone ruled that out. the other aspects relating to residence within house were based upon the advice that i had from the deputy chief constable. i am a great supporter of our police both with regard to what they did and what they do on a day and daily basis. >> and i thank all members for the forebearance and patience they have shown. this concludes today's business and i close this meeting of parliament.

[captions copyright national cable satellite corp. 2009] [captioning performed by national captioning institute] >> you never watched a debate on the pan am flight 103 lockerbie bombing. you can watch this in its entirety on our website, c- span.org. -- you have watched a debate. coming up next, a discussion of the canadian health care system. and then, an fcc workshop on the advancement of high-speed internet. following that, the government use of new technology in communications.

tomorrow, three doctors from va. hospital center in arlington, va., tell personal stories about treating patients and offer their views on legislation pertaining to health care currently before congress. >> the charge is anywhere from $1,800 to $2,000 b of the payment is usual a medicare reimbursement for mastectomy usually between $650.700 $50. >> also, issues surrounding patient care -- medicare reimbursement for mastectomy is usually between $650.700 $50. -- $650 and $750. >> they usually think they have some horrible disease, so if there is anything i can say, patients should be trying to not make their diagnoses on the

internet. >> join us tomorrow and watch all three doctors from the arlington hospital center in virginia share their stories about treating patients and their views on health-care legislation. that is at 8:00 p.m. eastern on c-span. a discussion now on the canadian health care system. from today's "washington journal," this is about one hour. 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 system that stand side-by-side with medicare and medicaid

and so, we have got to develop a uniquely american approach to this problem. this, by the way, is a problem that all countries are going to have to deal with at some level because if medical inflation continues at the pace that it is going, everybody's budgets are going to be put under severe strain, so what we are trying to do is make sure we at a sensible plan that provides coverage for everybody, that continues the role of the private marketplace, but that takes care of the people who fall through the cracks and gives them a realistic and meaningful option, and we've got to do it in a way that also changes our delivery system so we're not engaged in the kind of wasteful, inefficient medical spending that is so costly to us, so i suspect that we are going to have continued vigorous debate. i suspect that you canadians will continue to get dragged in by those who oppose reform, even

though i have not seen anything about canadian health-care reform. i do not find canadians particularly scary, but i think to some, they think it makes a good bogyman. i think that is a mistake, and i think that once we get into the fall, and people look at the actual legislation that is being proposed that more sensible and reasoned arguments will emerge, and we are going to get this passed. 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 need, 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 ranll, 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 have generic drugs, but also genuine drugs.

host: with your system coverage outside your country -- would it? guest: yes, but at the price paid here. if you go to the u.s. you need supplemental insurance because the costs are not the same. the insurance in canada will pay canadian-level costs, but most of the time it is not the same amount. we need supplemental insurance to go outside the country. host: you say part of the funding comes from taxes. can you break that down? guest: 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@@@@@@@@ and in his bid on the back of those people who worked for the country, and they have been underpaid -- this has been on the back of those people. now, the system in canada is not perfect. they are admitting that, and they are saying they are going to put a strong effort into trying to improve that, instead of dealing with what we have always dealt with, we should at least try to prove that we care about people. host: we will get a response. thank you. guest: i think it is very

important to get everybody covered, and even if people are not paying for that, in canada, we feel we have a collective social responsibility to give service to everyone, even if they do not have money, because they deserve it. it is very important for us canadians that health care is covered. health care is provided to anyone. if he has money or no money. money is not important. it is the social responsibility of a country that we have taken, and this is the way we think, and 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 theeart 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. . .

so this is why we're trying to offer that. whatever, if they have money or they don't, we want to offer them health care. this is the basic. >> what is the number one complaint you get from your patients about the canadian system? >> wait times. people are tired of waiting. and this is why we need to

transform our system, to change something in our system so that it must be much more efficient than it is right now because we are -- people are suffering for wait times. we have good quality in our system. they don't have to pay for that. but on the other side they have to wait. and this is why we're doing our study this year, the canadian medical association, because we think we can still have our system without significant wait time. we have improved but it's not enough. we need to do more of that. but we still have a good system. and people once they're in the system they're very, the satisfaction level is very high. it's to get in the system that is the problem. >> another tweet. are u.s. citizens sneaking over the border to receive canadian care? >> well, usually we don't ask that -- have that many americans coming to canada to

have care. we don't -- this is not a problem that is going on in canada. u.s. citizens are not coming to canada. they're probably going to other countries like india or thailand for medical tourism. >> one of the many ads ot issue of health care. americans for prosperity took a look at the canadian system. we'll watch it, come back, and 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 because they wanted to have faster service. we are receiving a good quality of service in canada, and i do not think that you could find people that are putting the amount of money that she put, i think, is $100,000 in their surgery. you do not think to do that in canada because it is available for free, free meaning that someone is paying. we are paying with their income tax, but for the patients, it is free, so this is not untypical story of what is happening in canada, and i do not think it is fair to say that people are dying industry in canada and that we do not receive high- quality services in canada. that is not true. we do receive high-quality. we have a problem with wait times.

we know that. but it is not true that people are dying in the streets. 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. this is a cultural thing. and we want to keep it like that. host: we welcome mark joining us on the phone from virginia. caller: good morning. you know, it's unfortunate that the debate is taking place around the canadian health care system because of those government managed plans, it's probably the one that unfortunately, and no auches to your guest, has worked the least well in terms of dollars spent. the japanese system, for instance, could do a cat scan at one tenth of the cost that we could do them here. patients who need major surgery have it done within the week. germany is pretty close. france is close as well, as is the scandanavian system. you know, having this debate around the u.s. versus the canadian system is exactly where the likely opponents of health care want it to be because the canadian system is the poorest choice of those

currently available national plans. no e offense to your guest, but as he's admitted it needs improvement. guest: i have to agree with you, because if we compare ourselves, canada to other european countries, we're not performing well. and i agree with that. and this is why we need to make some changes in canada. this is why our association wants to transform our system to become a system much more efficient like the system we have seen in the european countries. of course we have a problem because of a shortage of doctors to do that. they have more doctors than what we have. but we have seen systems where they have universal coverage. their system doesn't cost more than our system and they don't have wait times. so it's possible to do that. and this is where we're going with the canadian -- we want to go with the canadian system. we want to improve. we don't want to change everything but we surely want to improve it. and i agree with you that we're

not the best in the world, the u.s. is not the best in the world. there are some countries performing more than we are doing rights now and this is costing less money than even we're spending on our system. host: peter from wini peg. 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 and we have almost universal coverage in the state. the fact that people are not covered is probably that they do not know about the program. secondly, my dad got treatment, very adv