>> today on c-span2, a discussion on health care and the u.s. economy, posted by the advanced medical technology association. live coverage starts at 10:30 eastern on c-span2. >> tonight, texas republican john culberson shows how politicians use technology to stay in touch with their

constituents. >> this week on "q&a," we do cafaro discussion on health care talking with doctors and staff at the virginia hospital center. we talked to doctor john garrett, chief of cardiac surgery. >> doctor john garrett, chairman of the board of directors of the virginia hospital center, can you remember the first moment you thought you might want be a doctor? >> i think so. my stepfather was a surgeon. and for lots of reasons, i

wanted to be like my stepfather. so from about age 7 when he came into my life, i kind of wanted to copy him. i think it got a little more serious than that when i was in high school i injured my hip, dislocated my hip in a skiing accident. i had to be a hospital for about seven weeks where they pinned my knee and contraction and had a lot of time to just play and observe people in the hospital. i think in my mind that i decided then that i was going to do it. >> where did you grow up? >> montgomery, alabama. >> where did you go to college? >> emory university in atlanta for undergraduate and then i went to medical school at the university of alabama in birmingham. >> where did the hard part get into your life? >> medical school in alabama had

a strong cardiac surgery program led by a man named john kirkland, one of the world's greatest? surgeons. -- one of the world's greatest cardiac surgeons. that is sort of where i got to see a heart surgery for the first time. when i began my surgery training, i did an internship, and one of the things i rotated through was cardiac surgery, and doctor kirkland was my mentor. it was a very brutal six weeks of very little sleep and hard work and -- but when you finished it, you felt like you had been through marine boot camp, you were part of what you did. i remember when i finished, doctor kirkland but his arm around my shoulder and in an uncharacteristic way said, "you ought to consider doing this."

from that point on, even though my stepfather was a general surgeon and had talked about me doing that, after that i was cardiac all the way. >> when was the first time you did an actual part operation when you opened the chest, and what was and where was it? you are on your own, you are the boss. >> you know, it takes a long time to be a surgeon. it takes even longer to be a heart surgeon. it is not like to make up one day and you just do a heart operation. you do parts of the with the mentor, or someone who is training you. so from the time i was at alabama as an intern, i actually did parts of card operations -- heart operations, where there are thousands of different steps in the operation, and in cardiac surgery, you do one part. over time, you would have done a whole operation, but never the

whole operation yourself. and so it was only when i went to houston, texas, to train in cardiac surgery with another very notable, a famous man, it was there after about half of the year that i was left alone to do a cardiac operation. and i remember -- by that time i was an experienced surgeon, i knew how operate, but it was still an unforgettable thrilled to be in charge of that patient. >> have you ever done a heart transplant? >> yes. >> what is that like? >> i think that most people think is more glamorous than it really is. for me, the duty of a heart transplant is seeing a desperately ill -- the beauty of a heart transplant is seeing a desperately ill patient who

looks sick, looks like he is dying, and you put the cart in him, and actual technical part of the transplant is not very difficult. there are big to stitches did you put, big suture lines. but literally, instantly, but the next morning, the patient has a different look. that is the most thrilling thing about that, is it just takes no time at all for the patient to look just magnitudes better. >> are you ever frightened in the middle of an operation? >> no, i don't think frightening is the right term. sometimes after an operation i will think what could have happened or why didn't something happen. that sort of after the fact, you

might get scared of the consequences could have been. sometimes during desperate sorts of operations where there really is life or death, you are just so focused and -- on what you were doing that you do not think about the consequences. >> what is the longest you have ever been on your feet in the operating room? >> probably a little over 24 hourururs. >> doing what? >> we were doing a patient who had torn their aorta, the big artery that comes out of a heart. i was working with one of my partners. it took -- the patient bled and we cannot stop the bleeding. i think that if there had been one of us there, not together, we might have stopped, but we

were there together. it was in our program here, and the nurses still talk about it, because the shifts change but we did not. the talk about us both sitting by our little stools right at the operating table dozing off, waiting for this patient -- he would not give up. the patient eventually stopped bleeding and walked out of a hospital and was well. >> i know you will not name the person or -- well, i would just ask the question -- the most difficult patient a situation you have had that you can think of. >> ok, i have it. >> go. >> it is a great story. it was years ago, but i was operating on a priest. i had just begun taking the game

out of the priest's leg -- vein out of the priest's lead in the operating room good one of the general surgeons came in the room and said, "i really need your help. i have a young lady that has had an appendectomy, appendix removed, but she has had a cardiac arrest. her heart stopped and we're not sure what is wrong with her." she was about 28 years old. i broke a scrap went over and looked. i thought that patient -- it was a young girl -- i thought she had a big a blood clot two were long. -- to her lung. i basically read to the possibilities of what i could do, a little bit because of the patient was, i made the decision to move the patient out of the operating room, which is not a standard thing to do, and move

her into the operating room. i open her chest and urgently, open the artery where i thought the blood clot was to save her life, and a blood clot wasn't there. there was no blood clot. there i was with a patient i had moved out, had his patient who had made the wrong call, and then i started feeling around her heart, and she had blockages i could feel in her coronaries. bliley, a very substandard, i did three bypasses into these blocked arteries. she came off the machine with a little difficulty. but the next day, or later that day, i woke the priest up and said, "we have good news and bad news for you.

the good news is that we have saved and the baby's life tonight. the bad news is that we did not do your -- we saved another lady's live tonight. the bad news is that we did not do your operation today." the girl lived, beautiful girl. she became friends with the priest. he felt very much involved with her situation. we ended up catching her later. >> what does that mean? >> cathing is when you stick a catheter into the heart arteries and you squirt dye and you see what blockages they have in their arteries. we did that after i'd by pastor, because when i did -- after i bypassed her, because when i did i did not really know what was going on. the graph i did were just the ones that she needed.

and so i think that she got just what she needed. but it was not the standard way that you get that. >> when patients come to you, what can you almost always predicted they are going to do when you start to talk about the condition? >> more than you think, at least in cardiac surgery, patients really have a high degree of trust for you. a lot of patients don't want to know a lot of detail. i think it is pretty different in cardiac surgery and in other specialties. although more and more, patients will have been on the internet reading and learning things. but so many patients just want

you to do what you do, they are grateful for it, they don't need to know a lot of the details, they are interested in when they can go back to work, they are interested in the likelihood of them dying. but a lot of other details they are not too interested in. it puts a burden on us to -- there are certain things you need to know. we tried to tell patients those things even if they are not too interested. >> you are in the operating room, let's say you are doing bypass surgery. how many people are with you and what do they all do? >> well, before i answer that, the key in a cord surgery is critical -- the team in heart surgery is critical. i am blessed with a team that has been together for 20 years

and there is little turnover. it is like family. there is an anesthesiologist who was a doctor that puts the patient to sleep and manages the drugs during the case. he has a helper. at the operating table, i have an assistant, and i operate with a nurse, and i have three of these people. i am more comfortable doing a case with one of my -- i have their total attention, and they know exactly what my routines are. there are nurses -- they are nurses, and they are extremely skilled nurses. next to me, the person who passes my instruments, called the scrub.

in cardiac surgery, we usually have one other person at the typical a second assistant, who was there to hold the heart back, to retract the heart so that i can see where i need to operate. in the room itself as a person called a circulator. the circulator is another nurse who is the person who gets you the things that you need. if you need another stitch or another instrument that is not there, that person gets that. so that is pretty much a standard open heart team. it is bigger than a typical scene and a typical operating room. >> you said you have done this for 20 years of the virginia hospital center. did you come here in 1989? >> i did. >> from where? >> i finished my cardiac trending in houston in 2006.

>> 2006? >> excuse me, 1986. in heart surgery, you cannot just go somewhere and start doing card operations. it takes all hospital that will -- takes a hospital that will give you their equipment and team you need. it takes a lot of resources. one of my friends, dear friends, and i started a program started a program in auburn, alabama, at east alabama medical center. we were there for two years and we brought nurses from birmingham, and i brought staff from houston, and we started a program there. and during that time there, a hospital here began plans to have open heart surgery here. and they went on a national effort to recruit surgeons.

and we were included in that. and we came up and looked at the facility and the city. i had always wanted to live in washington, but in 1986 there was no opportunity for me to come here. this gave us an opportunity, and we left on good terms in alabama and moved appear in 1989 and started a program. >> why did you want to live here? >> well, it was washington. there is a lot going on here. i'm all into food and not so much into culture, but my wife is into culture. we like living -- we were not too happy in alabama. we wanted to raise our family in this area. >> where did you beat your wife? -- did you meet your wife?

>> my wife was on medical surgery. we had a blind date. in those days, i drove beat-up car, and all the girls i would go out with would spend the first 15 minutes complaining about the car. mary got in the car and never even noticed that there were holes in the floor. that is the first thing i liked about corporaher. >> she does what today? >> she is a pediatrician. she is in the office next door with pediatrician's you're on campus. >> you all work together in the same building. there is a big difference between being a pediatrician and being a heart surgeon. >> there is a big difference, yes.

>> first i would suggest is the difference in what you make. >> pediatricians -- i think that they are not very well paid. it would astound you, i think, to know what a pediatrician makes. you know, if you consider the amount of training that they have to go through, and spencext they incurred to get to where they want to go. >> you have it chairman of trustees -- you call them trusties or board members -- this hospital, is a non-profit, and if so, why? >> we are a not-for-profit hospital. if i could take a minute and describe what that means, not for profit the hospital does not mean that we do not make money. we have to make money. but it means that we do not have

shareholders. we are not responsible to anybody but our community. we are a 501(c) (3) organization. we try to break even or had a small margin of profit. last year we had a 1.6% margin. what we do with that profit is reinvested back into equipment -- we invested back into equipment. we try to have the latest and greatest that medical science has to offer. two years ago, we purchased $7 million cyberknife, a specialized piece of radiation equipment. that is what we do with our

money. we do not given out to shareholders. it is not to say that we do not need to make in come. we employed a lot of people. this not charity. -- this is not charity. >> gross revenues for you here? >> $288 million. gues>> how many people work her? >> 2000. >> how many of those are doctors? >> 300 on active medical staff. only a handful of those doctors are employed by the hospital. most of the medical staff here is an independent medical staff. >> there is noise in the background now. do you know that is? >> some sort of alarm. i do not know what it is because

i do not work down here. >> this is where in the hospital? >> this is the emergency room. this is the fast track part of the e.r. you hear disaster stories are coming to wait three hours before you get scene in the er. this is the part of the er where we try to avoid that. we get you in here and out without having to wait so long. i do not know what that alarmist. >> i will tell you what we will debris will stop it is not annoying to us, it is annoying to the audience. there it is, it stopped. we can keep going. what did you take on the job of chairman of the board? how much time in your date you spend doing that job? -- how much time in your date do you spend to bring that job?

>> well, i took it on because it was something else that i could do. i sort of worked my way up to the leadership here in the hospital, and then i got on the the hospital board. i felt like i made some reasonable contributions, but i did not feel that i had any sort of special ability. the previous chairman, a man by the name of pat healy -- when he was going off, he encouraged me to run for the chairmanship, and i really did not think that i had a much tougher -- that i had much to offer. but i did, and i was elected. you know, i have grown into the

job over the years. i think that -- you know, i work here. my office is here. i am here a lot. so i do spend time every day with chairmen sorts of things, but i think that probably the one thing i have done is to provide vision for excellence in clinical care, in the programs that we have developed here. an example would be, since it is under research reprogram, mark cardiac surgery program -- since it is a neurosurgeon reprogram, might kreteks surgery program -- my cardiac surgery program. these are programs that we've had a vision to bring forward. in the hospital that we have

built, we offer all private rooms to patients, regardless of their ability to pay. >> why? >> because we could read it is the best thing for the patient. years ago, he could stay in hospital for five days with an ammonia -- you could stay in hospital with five days with pneumoniae. nowadays, if you are in a hospital, you are sick. otherwise, you are out, you are discharged. i think it is unacceptable to share a room, in this age, with another sick person. it is better for the patient should have a private room. that is the main reason we did it. that is the sort of the main thing that we have pushed, to try to do what is best for the patient. >> you have 320 rooms. >> i think -- ok, to hundred 50.

-- 350. >> a lot of employees here, a lot of government workers come here, a lot of members of congress and all that. as you sit and listen to the debate oover health care, what is the first thing you would like to tell somebody that they do not really know what they're talking about? >> oh. well, i guess everybody knows it is complicated. ok, for starters, the hospital -- about half of what we do here is medicare and medicaid. about half an hour and missions in this hospital, medicare and medicaid, we lose money on all medicare and medicaid patients.

medicare and medicaid covers at best about 80% of the cost, not the charges, but the cost. and so the thing that i guess i want to tell people is that so far, what we have seen is the government's -- the with the government controls cost, they just pay you less. we take that, we accept that. we would have to change but we do -- but we would have to change what we do if not for the private insurance carriers, to whom we aggressively negotiate with to get rates that are 140% of medicare. because we're able to do that, we are able to make it 1.5% margin, so that we can buy

cybernknife for $7 million. >> our company has full insurance. so what you are saying is that we are paying to make a difference between medicare and what it costs. >> yes, you do. >> through our insurance. >> if we did not get that extra money from your company, if all we got was what medicare paid, then do the math. we lose 20%. well, we are a business. we cannot lose money. we either go out of business or we offer lasess so that we can break even. offering less means that we cannot give you the latest in greatest, which is not as good. >> who sets that cost. let me ask you this -- you do a heart bypass.

what does that cost? >> well, there are two different -- let me tell you how it works -- doctors charge separately from the hospital. so if i do on medicare operation, the medicare coronary bypass surgery, i accept what medicare pays me. >> what is that? >> about $2,000. >> what do you do for $2,000? what is the total amount of your time spent doing? >> surgeons are paid globally. if i operate on you, i get one payment and you and i are married. for that month, or until i get you well, that is what i get paid. i can see you 10 times a day,

and if you have publications, come in at the middle of night, -- if you have complications, come in at the middle of the night, whatever it is, i get one payment for the hospital, they get what is called a drg payment, based on the diagnosis. for bypass surgery, i think it is about $18,000 the hospital would get for medicare to pay for whatever happens to the patient. >> total cost of $20,000 for a bypass, that medicare will pay. what does it really cost? >> well, it costs more than that. i'm not sure exactly how much more than that. we are way beyond what we charge. we charge and what we collect is totally different.

>> but if medicare is going to pay $20,000, who determines what the insurance company will buy? >> well, we negotiate with the insurance company. >> do they negotiate off the medicare price? >> absolutely. that is part of the rub. we feel like that is a bit of an unfair floor. medicare sets the rate, and everybody wants to go there. but we lose money with the floor rate that medicare sets. >> how does medicare set the right? >> i don't know. >> you don't know? >> know. -- no. it is law, but it is different now than what it used to be. >> what it used to be? >> there used to be. --

>> anesthesia and respiratory therapy -- >> we are in a hospital. >> even if you were deaf, you could hear that. there used to be more money in the system. >> why? >> i think that -- i mean, look, medical care gets better and better every year. new technology. it is expensive, but it is better and better. things used to be cheaper. you know, we are of the mind that there is nothing that is too expensive. we want the latest and greatest. we are willing to pay for it. and we have. but that occurs at the same time -- in parallel that we are getting paid less. the hospital is getting paid

less. >> every year? >> absolutely. >> why? >> that is part of what medicare has the ability to do, too low or what they pay you, and we have nothing to say about that. -- to lower what they pay you, and we have nothing to say about that. for the past several years,, right at the very end, they do not do it and we have a sigh of relief. >> but if in your position -- how much are you motivated -- this is a hard question to answer -- how much are you motivated by money? >> i'm not. >> code bleu, 7-b, room 178. >> that is a little more startling than the last announcement.

>> most doctors truly did not go into medicine to make a big income. physicians of my generation were attracted to medicine by what you could do for people. the idea that you could be independent, work for yourself, your own person. >> code blue, 7b, room 738. >> doctor, we were interrupted -- by the way, what does that mean? >> code blue is when a person has a cardiac arrest and a team descends upon that patient to resuscitate them. >> would you normally do that? >> no. anesthesia, and we have a medical staff residents here

from universities, and they lead the team. this is a daily occurrence in the hospital. you know, it brings up a point of this is what we do in a hospital. it is our fault, is to help -- it is our default, it is to help, to save people. in doing that, we do not think about the money. we don't. it is the last thing on a physician's mind, is much money we're spending -- is what money we are spending to bring someone back. i think that illustrates a very important point. it is not part of what a doctor does. >> we have been hearing -- i think in an earlier conversation we talked about this, where some of the younger people coming in the business have a different attitude about money and their time than, say, people your age. >> yes, it is clearly different.

i think the reasons are justified, but i think that young physicians see a different horizon than the guys and girls of my era. >> what is their horizon? >> i think they are much more protective of their private time. i think they are much more eager to be employed, do not have the responsibility to run their practice. i think part of that is because there -- it is hard -- the opportunity to hang out your own shingle now is very difficult, very expensive and. you cannot afford it. the young people do not want to take that risk. there is more of a shift mentality. in my group, we sort of never get away from it. even with nights off, you are

still a little bit on edge. it is part of your life. i think that with a newer generation of physicians, there is more of you work your shift and there are long hours, but at the end of things, you are really off and you have your life. it is what it is. >> back to my original question to you -- what do you want to say in this debate that you think is not being heard? what else. >> let me just make it a point about tort reform. >> explain what that is. >> well, you know, in everything we do as physicians and as hospital, we have a possibility of being sued by patients or family or whenever -- or whatever. and it is that's the thing that

is like in the front of your mind, -- it is not something that is like in the front of your mind, but it is almost ingrained in you. and it has the unintended consequences. i will give you every pertinent example that honestly just happened this week. i had an 86-year-old, chronically ill man, that is my patient he came into the emergency room and he had a ruptured aneurysm. a big ugly in his abdomen had popped. he will -- a big artery in his abdomen had popped. he recently had a nominal surgery and the padded opened before. -- and he had it open before. i had absolutely no problem saying that this patient is too sick to death emergency surgery -- too sick to have emergency

surgery. he is not going to survive. we have new technology, new expensive technology, called a stent craftgrafts, placed in the artery through the grind and up the artery and it prevents an aneurysm. we have that capability. because of that, i said this patient down to radiology. they quickly shoot some stududue they call me and say, "we can do this, we can save him, but if we save him, he will lose his kidneys, we are sure of that." now, if i did not have a family that i could talk to at that point, i would have said go ahead. that would have committed at 86- year-old to dialysis company probably would have died within a month -- committed to that 86-

year-old to dialysis, and he probably would have died within a month. but i would have been afraid to not proceed on the fear of what if the family really wanted to go ahead and say, you could have saved him, which we could have and we did not. fortunately, i had a family who understood everything and elected to stop. but my point is that if the family had not been available, we would have done what we do, which is to take the next step, which is a lot of times easier than saying, let's stop. that drives up the cost of health care. >> we are right in the middle of a fast-track room, emergency room. it is in that have a place for you where you have a lot of defensive medicine, based on the tort reform you are talking about and based on what to cover

yourself. can you explain that? >> wall, a lot of people that come into the emergency rooms to one of be there. they did not -- well, a lot of people that come into the emergency rooms to not want to be there. they did not plan to be there. emergency room, you come in and you do not want be there, you don't know anybody, and nobody knows you. if it is really a bad situation, there is lots of things going on. things can drop through the cracks without tight protocols. and so sometimes th, more things are done and it is just like a shotgun approach. it is easier to do everything so you do not leave anything out than to pick and choose. that drives up costs. >> go back to your mention of something called cyberknife.

i think the first one to have one was georgetown hospital. is this the first one in this area? >> it is. >> you have a $7 million machine and you have to put patients in front of it or you never get your money back. what does it do first? >> well, it delivers a focused beam of radiation to a target regardless of motion and all that is going on with our lungs going up and down any kind of body movements. it is a very precise way to deliver radiation. nes, we do -- we don't utilize the machine to pay for the machine, but we do pay for the machine by utilizing it, if that makes sense. >> did you have to buy this

machine on time, or did you pay cash for it? >> well, we usually pay cash. >> is that wwear your profit comes into the picture? >> exactly. we do a needs assessment, we looked at the technology, we compared it to other technology, and at the time, we were recording a couple of world class radiation oncologist that are here. they believe in that technology. we really thought as a board that this would put us in the forefront of patient care in that area of radiation oncology. that was the prime reason that we decided to do it.

we did have a business plan that predicted -- i cannot remember the details, but how many years it would take to pay for itself. we try not to do things that are going to lose money over the time. we lose enough money just doing our routine taking care of patients. >> how much of the money that you take in every year comes from patients and how much from donations to a community hospital? >> yeah, we -- we don't get a lot of -- we have a foundation board that is pretty new. we were out of the fund-raising business for about a decade. we are back in it now. last year raised about $1.5 million. not all lot. we are hopeful that that is going to grow, but in these

economic times, we have seen a real downturn in what people are able to do to support the hospital. >> how often is your hospital? -- how often is your hospital full? >> it is full a lot. we try not to go on reroute, but we have to do that several times a year. reroute is when hospital is full at the seams and we cannot get a patient in. they have to go to another hospital. >> from your experience, what motivates someone to have a not- for-profit hospital as opposed to one that is all profit, and which is better for the patient and better for the country? >> well, i think -- what motivates someone to have a for- profit is the profit. i think not-for-profit is the best of the country, because at it is cheaper -- because i think

it is cheaper. i think that if a not-for-profit hospitals can adopt some of the physical restraints that for- profit hospitals have, it would be a valuable thing to do. but keep at savings as opposed to that giving it out to shareholders. but this hospital did a joint venture for two years with columbia hca in the late 1990's t, and that was a valuable experience for us. we learned fiscal restraint that we still benefit from, because we save money in areas that we normally would not have. but in for-profit system, that savings goes to shareholders, and in our system, it goes back into hospital. >> patients have spent less and less time in hospitals than they

used to. you come in and have an operation anywhere in their two days, and in the old days, he would be there a week. what happened? what changed all that? >> a lot of what happened is insurance companies, at least with surgery -- they changed on paying things on what is called a drg basis. you have a diagnosis, like pneumoniae, and instead of paying you piecemeal, they pay you a lump-sum for pneumonia. when that happened, there began to be pressure on the physician to get the patients out of hospital sooner. the sooner the patient got out of a hospital, the less money would be spend. if the patient stay in the hospital an extra two days, any part of the profit that might be

present would be dissipated. >> is that good or bad, in your opinion? >> i think it is good. >> we really did not need to spend all that time in the hospital? >> a lot of times you do not know what you get away with until you are pushed to do so. in cardiac surgery, we used to keep patients in hospital for eight days. we still have things called seven-day steady speed we would do all these things on the seventh day and let them go home the eighth day. devastated the art. now we get -- get -- that was state of the art. now we get patients out in three to four days. a lot of that was pushed from limited reimbursement. if you want to have a successful project surgery program, you cannot spend all the money. you of that have enough money left over to buy the equipment that you need.

you need to be responsible. >> as you listen to this debate on health care, what is the worst thing you hear? on a day-to-day basis, you hear people in this town hall meetings or members of congress or wherever? >> i guess the thing that scares me the most is just the thought of having the government -- having a sort of a massive medicare or medicaid, and having all the inefficiencies that brings, and ending up with a system that is poor, a hospital system that is poor, and have no ability to offer really the best to our patients. that is what scares me the most. >> why would that happen in an all-medicare, single payer system? >> the only thing i can say is

that right now we'd use 20% on medicare admissions but if we lost 20% and everybody we came in, we would have to do something different. as administrator, the first thing i would do is limit our capital budget. the new stuff that we buy every year -- every year by 30 milly dollars worth of new equipment here -- every year we buy $30 million worth of new equipment here -- that would stop. we would have to lay off people. we would have to make that 20%. the easiest way to make it up is to not buy new stuff, and that is what we do in our personal life. but when you talk about health care, new technology is expensive. the people that are driving technology expect a return on their investment. if nobody is buying it, it will

just be a matter of time before nobody is making, nobody is thinking about it. that is a disaster for the health care. >> knowing what you know about hospitals and doctors and operations, what would you tell patients coming in the door? they are for it, coming in with a heart problem, whatever it is, what would you tell them what you know, to give themselves more peace of mind if possible? >> i am not sure what -- you know, i think everybody needs insurance. if you don't have insurance, you need to get insurance. >> what if you cannot afford it? >> well, i think -- i am not a politician, but there is something to be said about insurance reform and making insurance more competitive so

that even people that don't have a lot of money can have some insurance. what you don't want is to have someone -- everybody can get care, ok? you can get care. the problem is someone who does not make a lot of money and does not have insurance, they are responsible to pay for the bill that they got for the care. that is the problem. paying for it. the only person that ever asks me about how much something costs is someone who has money but no insurance. they want to know what is it going to cost, because they have to write a check for it. and somehow we all need to feel some of the pain of, other than writing a check for the insurance company, we need to feel the cost issue.

but i do think that there needs to be insurance reform, and i think that everybody needs insurance, but i would start with -- i would start with trying to make there be more competition between insurance carriers, so that there is affordable insurance. >> who is your biggest competition in the hospital business? >> you mean what other hospital? >> yes, do you feel competition? >> absolutely. inova is our biggest competitor. they are in the area that we serve our patience, and so they would be our biggest competitor. >> so when you go home at night, you hook up with your wife, mary, a pediatrician, what is the difference in your two

lives? when you talk about your day in medicine, what is the difference the two of yours perspectives? >> well, i'm speaking for myself -- i tend to feel more of a burden. i worry more. my wife has a lot of well patients, while babies but when she does have a sick child, she is totally worried that night. but that is not very typical. i think most pediatricians see well babies and routines of stuff -- routine sort of stuff. i forgot that patients who are pretty sick. -- i frequently have patients who are pretty sick. it is an inescapable burden that i do not run away from, it is just part of our life.

you know, sometimes patients don't survive, and that is a terrible struggle that, over the years, gets harder, because about the sense that your ability should be so much greater than it was, say, 20 years ago. but we are not always successful. >> 11 years as chairman of the board -- if you were to pass on this job that you have in addition to being in heart surgery, what would you tell the next chairman to worry about? >> i would tell the next chairman that, regardless of -- i would tell the next chairman to worry about the system getting dumbed down and having it affect patient care, and i would encourage them not to do

anything, anything, that affected patient care, that made it mediocre, to keep an edge of pressure on the administration, on the board, to never cut corners, to never let this thing that we have built, where we give our patients the absolute best -- don't let that change. that is my biggest fear, because at the end of the day, you have got to pay. >> last question -- if you were not cardiac doctor or heart surgeon, what would you be doing? >> i would be a chef. i would on a restaurant, and i would work in my restaurant, and that is my second love. >> and your favorite food? >> italian.

>> see you finally smile after this interview. we're out of time. john garrett, thank you very much. >> thank you, brian. >> for a dvd copy of this program, calle -- for free transcripts, or to comment about this program, visit q-and-a.org. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> doctor john garrett, featured on "q&a," will be a guest this

morning on "washington journal" ." over three days, the hospital's top medical and financial administrators will join us in the emergency room to take your phone calls and provide context to the health-care debate that is currently before congress. we will continue on the team of health care next weekend on "q&a" with our guest, t.r. reid, formerly of "the washington post," and the author of "the healing of america." up next, live, in your calls and comments on today's "washington journal." at 10:00 eastern, the secretary-

general of the afl-cio on the future of the labor movement. >> as the debate over health care continues, c-span's health care hub is a key resource. go online, follow the latest tweets and advertisements and links. share your thoughts on the issue with citizen video, including video from town halls to of gone to. there is more at c-span.org /healthcare. >> this morning, democrat congressman gerald connolly of the virginia talks about a town hall meetings and how the issue is playing out at those meetings. we will talk to james cole and doctor john garrett about the health care system, and provide a context to the health-care debate that is currently before congress. in a couple of hours, paul rainwater, executive director of