video ads, and leaves. watch the latest events including town hall meetings and share your thoughts with your own citizens video, including video from any town hall you have gone too. and there is more c-span.org. /healthcare. dollars this week on "q&a," our guest is t.r. reid, author of the new book "the healing of america." >> tom reid, when was the first time you thought about the issue of health care? >> when you move, your kids say, you're wrecking our life.

we moved to london, the kids said, you're wrecking our life. we will make the transition as easy as possible. our 13-year-old goes to camden town, finds a guy selling brass earrings. of course, you have to have your ears pierce, so the guy says, no problem, here, pierces her ears. they got infected. we've been in the country four days, didn't know where the doctor was or anything. what do you do? we went to the cab, the cab driver says, no problem, mate, he took us to st. mary's hospital next to paddington station. you walk in that hospital, there's a gold plaque that says, on october 28, 1928, sir alexander fleming discovered penicillin in this hospital.

which i'm sure is true. and it looked like it hadn't been painted since 1928. british hospitals, they're grody, they have buckets catching leaking rain, not reassuring. we got to the casualty ward, the e.r. a woman in a starched white uniform corm, the matron, she spots which of us has a problem, takes my daughter into a room, maybe 10 minutes later a doctor comes along, after while, she comes out, they've drained the pus, cleaned it, gave her a stern lecture on hygiene and she was cured. i felt great. i walked over to matron, pulled out my checkbook and matron says with great pride, oh, no, no, you may put away your checks we do it differently here, no bill, no paperwork, nothing they just give you health care. i turned to my wife and said, you know, there are different ways to deliver health care.

they've got it figured out. that's when i started thinking and you know, we had lived in japan, that's a good health care system. i think maybe i originally the idea was planted for me, i covered ted kennedy's race for president in 1980. everywhere he went he said all the other rich countries manage to cover everybody, why can't we? i got intrigued by that question, how come they can all cover everybody with high quality care, spend half as much as we do and why can't we? that's where the book came from. >> in your book, there's something called a bad shoulder. which one is it? >> it's my right shoulder, i washed it in the u.s. navy many years ago. >> how? >> the stairway in a navy ship, called a ladder, there are certain time whence only a ladder would be climbing a lad for the a submarine and i did.

so i just dislocated my shoulder many times and i was in the u.s. navy and they took me to bethesda naval hospital and screwed my shoulder together. there's a stainless steel screw in here. worked fine. over time, you know, we're getting old, brian, and now my shoulder only goes this high. so i set off to see how other countries provide high quality health care. i figured, while i'm going to doctors, i'm see about my shoulders. >> what year did you have this? >> 1970. >> and how many different doctors in the world have diagnosed what to do about it? >> 10, 12 countries, and many of these country, you have to go to the g.p. first, then she refers you to the orthopedic surgeons, i've got at least 20, 25 docs have palpated, examined, x-rayed my shoulder. >> let's start with the american doctor after you got out of the navy that you went to and said, what can you do about

this? where was that? >> a doctor in denver he fixed this shoulder after i busted it skiing, i went to don, i said -- i trust this doctor, he's an orthopedic surgeon, very confident, aggressive people. look, that's all i can do i can't swing the golf club anymore. he is an orthopedic shoulder, they'll fix that. he comes back with a little red box he opens it up and says, here's your new shoulder. he's going to cut out the shoulder god gave me and put in something made out of titanium to replace it. that's the american, high-tech, aggressive way. how much will it cost? he doesn't know. turns out to be about a $47,000 procedure in america. i said to him, what can go wrong? he said it's major surgery,

there are always some risks. like what? disease, paralysis, death. and i thought, maybe i ought to get a second opinion and actually i got about 20 other opinions. soy took my shoulder around the world, i was trying to get a cure for this, but i was also looking for a cure for our health care system. >> back to dr. frohlich at the time, you're not working there "the washington post" anymore. >> no. >> are you on medicare? >> at that time, i was working for "the washington post," we had good insurance, would have covered most of it. it would have cost me out of pocket about $1,650. >> are you on medicare yet? >> yeah. >> now what would happen? >> first you'd have to go to a second doctor to agree it was necessary. i think i'd get the operation, i don't know what it would cost. i don't know -- you can't tell in america. you know. >> give us another example of a doctor you visited about the shoulder. what about japan?

>> that was the widest choice of care. i went to a famous orthopedic clinic at a university hospital there, very prestigious clinic, called up, said can i get an appointment, my shoulder hurts. they said can you come in this afternoon? they don't have waiting lines. that afternoon, i was in the office of a famous orthopedic surgeon he did something no other doctor in the world did he called up my condition on his computer and read about it while he was treating me, which was reassuring to me. he's an expert but just wanted to check. in japan, their insurance would pay for the broadest range of treatment. he would have given me the operation, would have given me months or years of physical therapy, he suggested monthly cortisone shots, which would have been free in japan. but in japan, they'll do traditional chinese medicine they gave me acupuncture, they'll give you her ball remedy, all that is covered by

japanese insurance. in japan that operation would cost $10,000 but my co-pay would have been about $65. >> explain that, what insurance would have covered that in japan? your "washington post" insurance? >> yeah, or my -- if i'd lived in japan, it would have been my corporate insurance or you can also get insurance municipally. in japan, they have private plans and then they have what's called the public option, you can get it from the municipal government. >> what does it cost a year on the public option? >> the premiums are not cheap, they're cheaper than in america, i think for a working person like you and me, for family of four, it's about $400 a month. the employer pays as well. >> you have an indian doctor that treated you. >> i did a film for pbs

"frontline" about traditional indian medicine called ayurveda. so we took my shoulder to southern india to the mayo clinic of ayurveda. >> it's not a mayo, though? >> no, it's the most famous ayurveda clinic in the world. they don't cut. your body is going to heal yourself in this. it's an ancient her ball and laying on of hands kind of medicine. so -- what you do is lie on this dark wood table and six guys massage you with warm oil. it was sweet. i did it every day for five weeks. it was just -- >> you were in india for five weeks? >> i was making a movie for pbs "frontline" and at this clinic, they gave me a suite, i had my own massage chamber in my hospital suite, all my meals, $42 a day, including all the treatment.

basically they take the oils and put herbs and medications you, it's like being a rotisserie chicken, they're rubbing oil on your skin. they did it for five weeks. at the end, i didn't believe any of this. they made me, every day they made me go to the hindu temple and walk three times around the statue of the god of healing, i didn't buy any of it. it worked. i got more movement and less pain. they told me if i'd stay five more weeks, i'd do even better. >> what year was this? >> that was 2007. we made a movie. most of this movie, i'm lying there being massaged by these guys. now i walk down the street in america, this is one of those films they show at 2:30 in the morning, every insomniac in america has seen it. >> i tell my kids what a tough job it is to be a foreign correspondent, they don't believe.

>> i walk down the street and people say one of two things, how's your shoulder, or i saw you make. there's a lot of nude scenes of me in that film. i was being massaged. >> completely nude. >> they fuzzed, they pixilated. but i didn't realize i was get -- what i was getting into when i was doing this. but it was sweet. i didn't buy the religious background, i didn't buy any of this stuff. but it worked. there's no question. i got improvement. >> if you lived in india, what would it have cost you? >> probably the same $42 a day. though that's a significant amount of money for most people in india. >> how do indians get their health care? >> india is basically a developing nation, a third world country, can we say, and in those countries, there basically isn't a health care system. the system in those countries is the out of pocket system. which means if you have the

money to pay the doctor, you get greeted, if you don't have any money, you stay sick or you die. that's the system in all third world countries. it's brutal, it's simple, that's the facts. >> what's the program you had the falling out with, they didn't use you and you walked away from it? >> i made two movies for "frontline," one was this one in india, then the other was "sick around the world" where i go to five countries. >> some people say it's politically impossible to fix the health care system they have last time we tried it in 1994, the result was disastrous failure. but that same year, here in switzerland a country famous for huge insurance companies and drug companies, they did take on health care reform and changed the system. today they have universal coverage with high quality. we've come to switzerland to see why they made the change and how it's working. >> those were pretty successful

films. then we made sick around america and looked at american health care and worked months on it. worked months on it. i'm the on-air guy, they call you the talent. i'm the talent. i don't have any. so i did my bit, which was going around, interviewing everybody, we spent months on it. the producers go to boston where "frontline" is and make a documentary film. after six or seven weeks of editing, they sent me the movie and it was wrong. i thought it was wrong. they suggested that the solution to our health care problem was to mandate everybody into private, for-profit american health insurance. and no other country would do that. no other country would allow the thing ours insurance companies do. so i said to them, that's wrong. that contradict ours film that contradicts my book, i don't agree with it. but they didn't want to change it, they were happy, i didn't want to be in their movie.

we had an amicable parting of the way, i dropped out. >> you're through dealing with them after this? >> not only am i through dealing with them, i think i'm persona non grata now at "frontline." >> did that surprise me? >> it stunned me. i think it's perfectly reasonable for people to disagree on health care. >> are you going to do more tv? >> yeah, it turns out if you have a big argument with "frontline," other people come asking for you. it's fun doing this, you have a producer to do a lot of work for you a lot of stuff a reporter would do himself if i worked for "the washington post." but i will place a bet, it won't appear on pbs "frontline." >> let's get a t.r. reid update.

we've talked over the years a lot of times, most of the time you've been with "the washington post." where do you live now? >> denver, near where you teach at the university of denver. >> how many years did you work for the "washington post"? >> about 30. my last -- we worked around the world, but as you remember, i married peggy a denver native, she always said let's go home and the "post" very kindly twice made me the rocky mountain bureau chief. now newspapers don't have bureaus in denver. they shut down their bureau, i was getting into making films and write manager books, so i'm -- i've left "the washington post." >> i picked up something on a blog out there or an online magazine, 5280, i think it's called, where they said a couple of things, one that you're a democrat, and two that you were interested in being appointed to the legislature in

colorado. one the democrat is right -- >> now. yeah, i registered as a democrat. >> and two, did you get the seat? >> no. the -- my state rep from our district in denver buzz the leader in the colorado legislature on health care policy. she quit the job and took something else and a bunch of people came to me because i'm doing health policy and said, why don't you try for that? i tried for it, didn't get it, the guy they picked is great, better than i would have been. >> do they appoint legislators? >> they don't have special elections for legislators in mid term. lots of people in many state legislatures get the job that way. once you're incumbent you tend to win. >> will you run for office?

>> i might do that. i think the goal for american health policy is universal coverage at reasonable cost. that's where we have to get. that's where all the other rich countries are. i'm not sure our national government is going to get there. i mean, this summer is not promising. i think it might happen on a state by state basis. you read my chapter about canada. what happened in canada is one province in canada, saskatchewan, which is a lot like colorado, half plain, half mountains, there are no rivers out there, the borders are straight lines, it's colorado. they elected a very lefty governor, it's called the premier in canada, he said everybody in our province should have health care. everybody should have health care. he set up a state-run, single- payer system in 1944. tommy douglas is this man's name. he called it medicare. it worked. all of a sudden everybody in

saskatchewan had medical care. lots of doctors came there because they knew they'd get paid. and the other provinces saw it and gradually, one by one, two by two, they copied it. they saw it was working. and by 1961, it was so popular that the people of canada demanded that the federal government establish it coast to coast. but it started in one state. tommy douglas did this. in 2004, the canadian broadcasting company did a poll to pick the greatest canadian in history, millions of voters, and the canada -- candidates included wayne gretzky, alexander graham bell, pierre trudeau, who was their j.f.k. loren green, ann murray. and the winner was tommy douglas. i have talked about this topic to several state legislatures. i always say, if you would institute a health care system in your state that worked, you'd

be elected the best american in history because that's what happened in canada. now i think what's going to happen is we will get to universal coverage on a state by state experimentation. some state will get it right and the others will copy. one reason that can happen is, in whatever bill comes out of congress this year, there's going to be a state waiver clause. i think that's going to be in there. it gives them waivers against national laws like erisa, leaves more room for experimentation. i bet you next january, 25 states at least, will have bills in the state college legislature to try to get to universal coverage on a state level. some state makes it work, everybody's happy -- everybody copies it. >> what's erisa. >> it's the national insurance regulating law. it forces -- it requires that employers treat all employees the same for health care, can't charge betty more than george kind of thing.

that makes it hard. it's national, that that's what makes it hard for states to change the rules of health care. so they're going to give waivers on that law. that's probably going to pass congress. >> kaiser family foundation, how does that play into, you mentioned that in here, did they underwrite you for this? >> they did. it's a wonderful organization. they fund and finance and do a lot of health policy research. i went to them and said, hey, i got this very expensive project. this is before i was making the movie. they not only gave me money but gave me the cachet you need to go overseas and talk to the health minister. the best thing that happened was, when pbs, "frontline" signed me up to make this movie, here's the deal. in all these european countries and most asian country the

public broadcasting service is the big broadcaster. nhk, bbc, if you go to, say, switzerland and say i'm from american pbs, they think you're important, bigger than nbc or something. they're just private. so i went to switzerland and said to them, i'm from american pbs and i'd like to interview your health minister and they said, pbs? talk to our president. which i did. i talked to two presidents of switzerland, last time and the current one. so that helped a lot. but to see doctors, to see health care economists, it was quite useful to say, i'm here under the imprimatur of the kaiser family foundation. people know it and it helped me. >> there's names involved with the foundation, i want you to tell us how much they got involved in this. on the board, bill frist? >> i know him but he didn't have anything to do with it. >> cokie roberts? >> nothing. >> donna shillelagh. >> no.

drew altman, who is the boss of kaiser, was very helpful to me. >> but there is another name you mentioned several time, i'm not sure i'm pronouncing it right, uva reinhart. >> he's marvelous. here's what happened. i signed up to do this book. i started in 2006. pretty nice idea, i'd go to other rich countries and see how they do health care. signed a contract, got a decent advance, and then i realized how big it was. it's a huge, huge, it's so complicated. in the fall of 2006, i taught a course at princeton. i was leafing through the catalog the day i got there, here's a course through the woodrow wilson school, it's a graduate seminar, the title is the political economy of health care systems. that's my book. i walked over and it was a pretty formidable topic,

difficult chart, economics, you know, i walked in and within two minutes i knew it was going to be a great course, because he's a marvelous teacher and knows everything. he became my guru. i can say to uva, how do they keep costs down for major surgery in germany, he'll say, well, they had the commission four years ago. he knows everything, he's really good. and then he knows the health care economists in every country. i'm going to take a look at the british system, oh, you need to talk to dr. allen maynard at the university of birmingham he knows them. if you're a journalist, you need that. i'll tell you something, you'll really like this. i could have kissed reinhart, at one point, i said to him, you really -- why don't we write this book together? he said, no, no, no i'm an economist, nobody can understand us. you journalists, you can explain it to people. i could have kissed him.

that's what we all think. academics are deep and smart but we can say things in english in a way we can understand. >> he was born in germany? >> born in germany, grew up in canada. he knows those systems and as i say in my book at one point, he's been advocated for universal coverage in america for a long time. at one point he wrote a letter to the journal of the american medical association, their journal, and said, i want to pose a simple question, in america, if the child of a rich family and the child of a poor family both contract the same disease, should they both have access to the same care to treat it? his answer would be yes. in every other country, rich country in the world, yes. rich people and poor people said yes. the doctors said, tell him to take his socialist views elsewhere. doctors wrote in and said the answer is no.

you we shouldn't do that. you wouldn't get that answer in any other country. all the other countries have made what i think is a moral decision, ethical decision, everybody who needs health care should have access to care. >> back to that, but i want to take your shoulder to germany. what happened there? >> germany is good, high-tech medicine, she, the doctor in germany, you have to go to the g.p. first. >> if i call your office and say, oh, my shoulder kind of hurt, i'm not sure what's wrong, how long would it take me to see you? >> two weeks. serious, same day. >> if i come in here and you look at my shoulder and say, i think maybe an orthopedic specialist should look at it, then how long would i have to wait? >> perhaps another week or two. >> what if the orthopedic specialist said, we have to operate on your shoulder, do you know how long i would have to wait for that? >> not too long.

three weeks. >> three weeks before i could get in. >> she would send me to the orthopedic surgeon. he, you know, palpated, examined, all that. and he could have done the operations recommended in america he didn't think it was my need my big problem was limited movement. the operation is better for people with a lot of pain. so in germany, they proposed a regular regime of physical they are pi, which of course would be free in germany. >> why free? >> in germany, health care is paid for, you have to pay an insurance premium, but it's paid for by health insurance and traditionally in germany nobody paid a co-pay. there wasn't any you paid your insurance but in germany you don't get a bill. in 2006, all countries are having problems with the cost of health care. like we are. so germany came up with this shocking change, that is, once a quarter, every three months,

you have to pay a co-pay to go to the doctor. 10 euro, 14 bucks. once you pay that in january, all health care is covered for three months. if you have to come back on april 2, they make you pay another 10 ewe roes. this doctor in -- euros. this doctor in germany, he said there was an american ex-pat living in her town he came in with a hangnail in early january, she said, i'm so sorry, you now have to pay 10 euros. then he came back in late february, with some other problem, she said, he tried to pay me again. he'd already paid for that quarter. she said to me, do americans pay every time they go to the doctor? is that what happens? so in germany, i would have paid the 10 euro co-pay and everything else would have been free. >> in germany, if i worked in germany and i didn't have insurance, didn't pay for insurance, what would happen to

me? >> well, it's taken out of your pay. you don't have the choice not to have it. >> if i didn't have a job? >> the government takes the role of your employer and the government plays the -- pays the employer's part of the premium. if you don't have enough to pay your half of the premium, the government does that too. most people in germany get health insurance through the employer, they split the cost between the employee and employer. this is called the bismarck model, invented by the first chancellor of germany. 150 americans are on that plan. the big difference is, if you lose your job, you keep your insurance. the government takes over and pays your employer's part of the premium. in people in europe, they're mystified by our health care system. they can't figure it out. why would a rich country leave so many people uninsured? but as i say in the book, the health minister of sweden said

to me once, i was pretty friendly with her, i spent a lot of time with her. she said, mr. reid, there's something i don't understand about your country. she said, in sweden, we feel when you lose your job, that's when you need health insurance. but in your country, when you lose your job, they take away your health insurance. have you got an answer for you? that's arguably the cruelest of all the cruel twists of the american health care policy. when you need insurance most is when you lose it. that can't happen in any other country. >> your shoulder is now in france. >> in france, so the doctor puts my x-ray up on the light machine, you know, the orthopedic surgeon and as i said they put a stainless steel screw in my shoulder at bethesda naval hospital. he sees that, big smile on his base face. that's a french procedure. the french invented the operation.

here come this is american shoulder with a french screw in it. he was so pleased. like seeing an old friend on the street, you know. and he, too, told me, he said, you could have this procedure done in france, it would cost 5,000 euros, about 6,000 dollars, of which i would have paid about 60 bucks out of pocket, that's all. he also said, i don't think it's indicated for you. he suggested physical therapy or maybe pain pills or something if it were hurting. he would have done it, he said, you can definitely find an orthopod in france that will do it, he'll get 5,000 euros to do it. >> who says france is the number one medical health care system in the world? >> the world health organization did a four-year study of all the health systems in the world, 191 countries, they hired a harvard professor, dr. christopher murray, to do this. he was afraid this was going to

be just one more four-year study that nobody ever reads it. how could he get attention for his study. they came up with a scheme, we'll rate each health care system in the world on grounds of quality and fairness. they rated them from one through 191. and france came in first. so they rated as number one. if it's best in the world -- i don't know. i think it's a very good health care system. their results are great. they live longer and healthier than americans do and spend maybe 60% of what we do on health care per capita. >> let me offer some kickback on some of the things you're saying, just to see what your reaction. is the world health organization is basically the u.n.? >> yes. >> most organizations who belong to the u.n. would be this universal health care, they would not be disposed to like anything america does? >> that's wrong. in the first place, there are 191 countries in the world health organization, only about

40 of the world's richest countries have any health care system at all. all the others are thon out of pocket system we describe, where if you can pay the doctor, you get treated system of most of them would be developing countries. and yeah, i've heard this before. it's in geneva, it's a bunch of swiss, french people they don't like america. no, they hired chris murray at harvard and julio frank, the health minister of mexico did this study for them, not europeans. >> conservatives will say, harvard, a bunch of liberals, they want universal health care. >> you could make that argument. you know america is notoriously rated 32nd in that ranking and it's because of fairness. some americans get absolutely world class care, as good as anybody, better than the french. the problem is we leave tens of millions of people outside the door, they don't get treated.

according to the national academy of sciences, about 20,000 americans die every year of treatable diseases because they can't afford a doctor. we meet one on the first page of my book. do you know how many people in france die of treatable diseases? zero. germany, zero. britain, zero. no other country lets it happen. >> according to the harvard school of public health, 7,000 americans go bankrupt for medical bills. medical bankruptcies around the world, japan zero, canada, zero, other countries don't let that happen. in terms of the fairness of our system, that's where we get rated down. >> g.m. a general practitioner, family doctor, makes, i don't know, $140,000 a year on average. >> a little higher than that on average in america. >> what does a g.p. make in france? >> about 60,000. >> japan? >> probably makes 80,000 a year. >> germany?

>> he makes closer to $100,000, maybe $90,000 a year. >> you point out often their education is paid for by the government. >> most of them in most country, medical school is free or if there's a tuition your local government pays. there are malpractice premiums. i asked a doctor the doctored i spent time with in japan, has a clinic with nine beds in it, he's running a hospital. i said what's your malpractice premium? any doctor in america knows that off the -- what is my malpractice? i have no idea. he calls the office manager she says, that's included in the dues for the japan medical association, $30 a month. that's his malpractice premium. he'll never be sued system of they make less, but you know, their cost burden, they don't have a big loan to pay off when they start. i think the fundamental difference is, their expectations are lower. doctors in france and germany and japan don't expect to make $500,000 a year and drive a lexus to the country club.

they want to help people. they're people who like biology and science. you know all doctors everywhere i've met in our country and others, complain they're not paid enough. everybody says that. but there's comfortable, middle class people and they're comfortable with that, and they're helping people, curing illness. that feels good. >> if you set out to write a book that would show the american medical system in the best of light, what would you do? wow howe would you tell that story? what you've done is say, we're -- our numbers stink in every poll you show here. >> that's true. certainly coverage we're bad at. cost we're net worst in the world. even on quality and results, we rate lower than most of the other rich countries. that kind of surprised me. >> even on life's longevity, you show us 50-something -- >> we're at 77, the other rich countries are at 79 or 82, something like that.

neonatal deaths, deaths in the first year of life, we're two or three times worse than all the other rich countries. that seems outrageous to me. a rich country can't keep its babies alive? i can't stomach that one. but i could tell you a million great things. we should have the best health care system in the world. we have the best medical schools, nursing schools, pharmaceutical schools. we have certainly world class and maybe world-leading medical research. i'm absolutely convinced that our hospitals are the best in the world. they're the finest facilities, they care for you. they have all sorts of people treating you. all that stuff, facilities, training, skills, nobody can match us. the problem is, the system, people have to work and the payment system, it's just really badly screwed up. it's extremely unfair. and we just haven't allocated these resources equally.

all the other countries started by saying, we want everyone in our country who needs a doctor to have access. and for some reason, as you know, i struggle with this question in the book, we never have. the richest country in the world has never made that commitment. i talked to, you know, i'm pretty tough on canada because they keep you waiting so long. a long waiting line. and i was talking to minister in canada and i said, you know, you keep people waiting. how can you call this good health care, you have to wait months to see a doctor or a specialist. 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. that is their national culture, they're very egalitarian. we don't have that. 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. >> if you talk to people that run mayo or run cleveland clinic and all these places, they'll tell you the big 737s fly in from saudi arabia and around the world to get their people treated there. you talk about the canadians all the time, if you're listening to conservatives, they say the canadians are coming over the border to get treated. what did you find there? >> there are good studies on the canadian snow birds, there aren't many of them, there are a few of them. the canadians claim more americans go across the border to there to get treated. it's true that arab oil sheikhs fly to johns hopkins for treatment, because at the top, nobody can match america. we just haven't made it available to all americans. and that's the fundamental difference between our country and all the others.

>> you did france and japan and canada and britain. >> germany. >> did you do italy? >> italy and spain rate high. those are both british style systems, which i think americans would call socialized medicine. in that it's called the beverage model. in the british model, health care is the government's job. the government owns the hospitals, employs most of the doctors and pays all the bills. you don't get a bill. >> but you pay in taxes. >> they definitely pay for health care. they pay less than we do, because their per capita rate is about half of what we pay. but they pay for health care. but you don't get a bill. that's the is -- i call that socialized medicine, don't you? but the striking thing, many other countries, germany, france, belgium, japan, they're more private, less socialized

than america. in germany, the doctors are private, the drug companies are private, the insurance plans are private. and everybody stays with private insurance cradle to grave. they don't have medicare for old people. that's less socialized than the u.s. >> how much of all this in this kuhn country is the profit. whether to it's the drug companies or -- kaiser is nonprofit. >> yeah. >> but hospital corporation of america, the biggest of all. >> it's for-profit. >> you know, here's the -- when you're talking about the cost and profits, in my book, i divide health care into the providers, docs, hospitals, drug companies, and the payers, the insurance system. most countries have decided that it's ok for the providers to be for-profit. there's some competition there. but all the other countries decided that the payment system, whether it's government or private, has to be nonprofit.

that's a fundamental distinction with the united states. how much does that contribute? the american health insurance companies are the least efficient payers in the world. they have administrative costs they report this to the s.e.c. every quarter, administrative costs 18% to 20% of premium dollars. they add 20% to every doctor bill they pay. in france, which is private, basically private insurance. their administrative costs are 4%. germany, 5%. japan about 5% to 5.5%. canada's payment system, as i said is government it's lazy, overfed, government bureaucrats. their administrative costs 5.5%. one quarter of what our -- >> medicare is 3%? >> yeah, that's right. there's no marketing in medicare. no marketing costs. they don't deny claims and they don't make a period of time. -- a profit. that keeps costs down.

>> what about doctor? shouldn't they be allowed -- some of them make a lot of money, some make a lot of money in this system compared to others but few make the several millions a year. >> not many do. but doctors do very well in america. they're the best paid doctors in the world no doubt about it. >> are they the best doctors? >> they're certainly the best- educated. but our results, as i say, let's see, in terms of recovery rates for major disease, kind of mediocre. neonatal death, we're the worst of all the rich countries. we have very good doctors, have well-trained doctors, a lot of high-tech medicine. but we're about equal to the other countries. i don't think we're remarkably better. >> how much of this is the 11 million illegals that come to the country and don't pay anything and they're not

registered and they're given -- and they're given health care and figured in the average. >> the reason the averages are low is all the people who can't get care. take recovery from lupus, a chronic disease that strikes young women, and it's a serious disease. modern medicine knows how to manage it. if you get the right care, you'll live to be 75, if you have lupus. in other rich countries, where everybody gets care, they do. but in america, somebody without insurance who gets lupus is in very serious trouble. and they die young. much younger in america. same with asthmatics. die much younger in america than in other countries, the rich ones do fine they get care. but a lot of poor people get asthma who can't get the medical care they need and they die much younger in our country. >> talk about this book, when did you complete your research? >> it took me, gosh, three --

more than three years to do this book. it was much harder than i thought. i missed the deadline by 18 months. my editor beat up on me for a year, let's go, let's go, where is this book. my claim now is, well, i always knew that in the summer of 2009 our country would be obsessed with health policy and would want to know how other countries do it. so it's not true. it's sheer luck that i brought out the book at the right time. but i'm claiming that i saw this coming, that's my story and i'm sticking with it. >> how many different days were you on the road? >> months, months. >> take your wife with you? >> a couple of trips. >> how old are the kids now? >> i try t.d. get my kids to go, they didn't go, but they lived with us in japan and britain, they were guinea pigs for this book, i took them to n.h.s. hospitals. >> how old are they? >> 34, 27, 25. one of my kids, she's a runner, she was running in a female

runner has to get a blood test to test her mercury level. iron level, i'm sorry. >> where do they have to do that? >> anywhere. female runners need to do this. so my daughter was a competitive run for the britain. and she finishes high school and comes to college in america. calls me up and she's on the team, and the team, coach said, everybody go to princeton hospital and get a blood test, right. she calls me from the princeton hospital in america, i'm in london, she says, dad, dad, they want $120 bucks for this blood test. i don't know what a blood test costs. i said to her, well that sounds ok. what do you pay in britain? she said, dad, i go to the royal free hospital, i never paid a penny. that was her idea of what medical care should be like. that's kind of addictive, if you think about it. free health care. when you -- then you come home and they give you a bill.

>> when you did the research, did you have camera crews with uh you all the time? >> when we did the "frontline" show, but by then, i had met, i had been to all these countries at least once, i'd met most of the doctors and had to kind of convince these docs, i'd spent a week with each of them, i had to convince them to go on camera, some said, yeah, i'm ready, some didn't want to do it, but in the end, they all did. we got uva reinhart to help out and this marvelous guy, professor bill show at harvard, he designed 25 countries' health care systems he did egypt, cameroon, taiwan, he's designing a new health care system for china. fantastic resource for a guy like me who wants to know how other countries do health care he went to taiwan with us. >> in the late 1980's, tie what

these health care was worse than america's is today. about half the population had no coverage at all. he was one of the officials charged with designing a new health care system from scratch. >> taiwan is a small island. we always look abroad, internationally, for ideas. chinese saying, we say the track of the other cart is the teacher of the new cart. >> so follow those tracks. >> yes, if they have trouble, find a new track. >> they consulted experts from around the world and asked william shao, a chinese 46 born harvard economist to head a blue ribbon panel. >> we had a wonderful moment there he designed a taiwan these health care system that -- a twy these health care system that covers everybody, basically the canadian model. we went to a hospital on the

coast, there was a woman in the lobby taking people's blood pressure, i said to her, do you work here? she said, i do this as a volunteer. trying to help out. why do you volunteer? here's why. in 1980, this is before taiwan had a health care system, her mother got breast cancer and died. there was no hospital in the town. nobody to treat her. she died at the age of about 46. in 2005, mrs. lee, the daughter gets breast cancer but by now, there's a health care system that covers everybody and there's a hospital in her town and she went in there and of course they treated her cancer and saved her life for free. and i said to her, right over there is professor bill shao from harvard, he designed the system that saved your life. he put this hospital in your town. tie what these woman she walks over -- taiwanese woman, she walks over to him she has to say that to the this man, thank

you for saving my life. she's chinese, she walks over to him, and just gives him the most imperceptible bow. one-inch bow, and walks away. i thought, that was a perfect way in asia to say thank you for saving my life. a great moment. >> as you watch, and we've had many, many hers on this network in the last few weeks, of these town hall meetings, you see very sincere people standing up, saying, you know, all the things they say about -- don't mess with my health care. >> yeah, yeah. >> what do you say to them? do you think that members of congress understand that? >> yeah. i think they got health care. yeah. >> do you think they understand all the ins and outs? >> the guys who are saying it's all socialized nanny states overseas, they don't get it. it's not. a lot of countries, as i say,

are less socialized than we are. here's what i see as the difference between, you know, i set out to figure out how other countries manage to cover everybody at half the cost. i i think i got that in the book. but i figured out along the way, there was a more important question. why do other countries cover everybody? what makes a country make the moral commitment to cover everybody? i worked hard on that one too. if you think about that for a while, it leads to this question. why doesn't the world's richest country commit to cover everybody? why have we never done this? as you saw, i struggled with that in the book. i spent a lot of time worrying about that. why is it? i think -- to me, we're going at it from a different direction. all the other countries i went to first decided the moral issue, everybody in our society who needs health care can have it. we'll find a mechanism to get there. my sense is, our argument is all

about the mechanism. we've lost -- we've lost sight of the basic moral goal. i think if we could focus on that goal, then rather than saying, my insurance is ok, so to heck with you, we might say, yes, i want to find a way for my neighbors to get health care when they need it. >> if you sit back and look at these debates going on, it appears to some people that you have one side that is for universal health care saying, this is the greatest way in the world to get votes. i'm going to promise we're going to have universal health care, it's not going to cost you a thing. when it's all said and done, it's not going to cost you a thing. you have the other side say, i worked hard all my life, i paid my health insurance, now i'm going to enjoy good health care. what do you say to them about the cynicism of them. >> it's not going to cost you anything, that's baloney. it's going to cost. in all the other countries, i think a woman in france said

this to me, it's true in all the other countries, the formula is simple. health care for everybody, paid for by everybody. that's the system. we're all going to have to pay to make sure that all our neighbors have health care. it's not going to be free. i think the argument could be that the people, the organizations that have been the big winners in our current unfair system, big hospital corporations, insurance corporations and many specialist docs, should perhaps pay more. because they're sitting on more of our health care money than perhaps they should get. but the crucial point is, we want everyone in our country to have health care. if we believe that, we could get there. i know we could. all the other rich countries have done it. >> we've been focusing on the virginia hospital center. they have something called the cyberknife. it's a $6 million radiation machine. best of the best. >> yeah.

>> did you see cyberknives around the world? >> oh, yeah. the notion that other countries are backward is not right. there's a lot of good -- there's fantastic medical innovation in america, no doubt about it. >> does it start here? >> a lot of it start here's a lot of it comes out of universities and government, some comes from industry, but other countries with much lower cost structures have good innovation. anybody out there who has an artificial hip or artificial knee or artificial shoulder, that's french technology. they invented that. this deep brain stimulation, which is the first thing they've come up with to deal with alzheimer's, that's canadian. insulin is canadian. x-rays are german. >> what about drugs? >> a lot of drugs we see advertised on american tv come from swiss labs, british labs, including viva viagra, that's a british invention. >> why is it drugs sold here can be bought for so much less money in canada and europe and

africa? >> market power. in britain, the national health service buys every pill. then you get your prescription through that. and they negotiate a very good price because the drug company can't charge twice as much as anybody else, they're the only buyer. they do that in germany and in france. therefore those countries have negotiated low prices, as i say in my book, the same pill made in the same factory costs 20 cents in britain and $1.20 a pill in america. same thing. the reason is, they have negotiated a price in america -- they have negotiated a price. in america we have so many different buyers we don't have that kind of economic clout. in medicare part d, the government agreed not to negotiate for a good price. they won't use their economic clout. you get pretty good drug prices in the v.a.

the v.a. gets good prices because they do use their bargaining power to get lower prices. if we did that, here's what the drug companies say. if you cut prices in america, we couldn't do innovation. i'm not sure i buy that. they spend three times as much on marketing as research. maybe they could cut that. why, brian, you know people in japan have a higher per capita income than americans do. why subsidize them to get cheaper pills because i'm paying more. that doesn't seem right. let's let the drug companies charge everybody a fair price and ours would go down. >> go back to looking ate it from the outside, you see politicians say, i'm going to take care of you. you have the other side saying, no you're not. you're going to end up costing me more money. i like my health care system now. how do you get past that? it seems to me that we're 50 years late in trying to sell the idea that you're talking about because you're not going to get away from this idea that one side is going to say, you're uniting my vote. >> i think it's fundamentally a moral issue.

that's where the argument has to be. does a rich country have an obligation to see to it that everybody can have health care. >> and the answer? >> in every other developed country, the answer is yes. we have an obligation and we'll do it. the united states has never made that commitment. you know, as i say in the book, democratic candidate for president in the election, the guy who won the campaign, said that -- he said that providing health care for all our men and women is not some illusionary wish. it's a moral demand on our country. and the democratic president who said that was woodrow wilson in 1912. we've never gotten there. but -- and i argue in the book it's because we always lose the moral argument in the kind of noise about nanny state and socialist government and insurance companies will lose or the hospital companies won't make as much. the other countries first made the moral commitment, we'll cover everybody, and then found

a way to do it. >> the book is done and selling, high on the charts and all that already. >> reviews are good for once. >> you get sick today. >> yeah. >> or that shoulder is still bothering you. >> yeah. >> where in the world are you going to go? >> well i happen to be on the board of the university of colorado medical school, so i'm going to c.u. hospital, i think, and get treated. you mean of the whole world? i have access to the great care in america. so i can get it. if i didn't, i wouldn't have any trouble going to the doctor in britain. they treated my family great when we were in the n.h.s. >> britain's national health service is dedicated to the proposition you should never have to pay a medical bill. in the n.h.s., there's no insurance premium no co-pay, no fee at all. the system covers everybody. you know, when we lived here my family got really good care from the n.h.s., though we often had to wait to see a doctor. and yet the newspapers here are

full of n.h.s. horror stories, rationing, waiting lists, terrible mistakes. so i've come to london to see this n.h.s. is it an answer for the u.s. or some horrible, socialist nanny state. >> japanese care is excellent. >> french? >> french care is terrific. >> any place you went that you're a little skittish about, you'd put them lower on the list than the others? >> none of the rich countries, i think they're all fine. india, i don't think i'd want to be treated in india if i could avoid it. there's nothing wrong with it, but i'm not sure their sanitary standards are as high, i don't want to demean india, i got good care in india myself. i'm american, i'd go to an american doctor. i'd get great care. and i have decent insurance that would pay for it. the problem is tens of millions of our fellow citizens don't have that kind of access. >> are you buying insurance other than medicare now? >> i am.

you know what i'm doing, ladies and gentlemen of america, you're subsidizing me. i bought one of these medicare advantage plans. you know the history of medicare advantage, it was set up to prove private insurance companies could provide the same coverage as medicare more efficiently. as it turns out, they haven't been able to, they get a subsidy from congress, they get about $1,400 per person per year that's paid to subsidize them to provide me insurance. and it turns out it's very cheap insurance because i'm getting subsidized by the taxpayers. president obama and the democrats in congress have said they're going to end that. so i'm probably going to lose my sweet deal. but at the moment, i don't think it's right, but i have a very good policy that's subsidized by the taxpayers. >> we're out of time. one year from now, will there be a health care bill that has been passed he