Available podcasts. Thank you for joining me today. I have to tell you, i thoroughly enjoyed your book. I had the opportunity to read it and its obviously a timely subject. Obviously very important subject. Very. As you made know, im a pharmacist currently the only phenomenon pharmacist in congress so health care is something that is extremely important to me. Also important to the american citizens. I think everyone would agree we. They thought it was interesting you start by start off the book with the premise the Health Care System is broken, and if we look at the polls i think the polls would indicate that. Almost 70 of the people in america say that the Health Care System is broken. Right, well, i really think that health care is going to be in the number one domestic policy issue in the president ial election. In a recent poll, just came out from gallup that said 35 of the American People polled weighed health care as extremely important as one of the issues and we have seen in the polling 53 of americans support a single pair. I. E. No private coverage but now 65 are supporting the public option which would be a Government Insurance plan to compete against private insurance and i call this stepping stone approach at two single payer or government run health care, medicare for all. Host the proof is in the pudding. If you look what hat happened the last election cycle, my party a year ago biparty Republican Party were ousts as the majority in the house another rev tings. Maybe people women make the arrange. The reason for that was the issue of health care; that many of us campaigned on repeal and replace and unfortunately we came close but we didnt get that done. And it was shown at the ballot box. Guest exactly. Unfortunately because i think donald trump won the presidency and you had the house and senate but by saying were going to repeal and replace disastrous obama care which is disastrous and turn the Health Care System upside down for few people. Im going to see health care be out there and be the issue, and we have got to present a Cohesive Strategy to the American People and educate them why it is important that we have a marketbeared Health Care System and not one controlled by government such at the federal government. Host lets talk about Obama Obamacare and the affordable caring a. Senator come co bern made the statement the Affordable Care act has failed. Five years after it wasnt into full effect individual market premiums have risen 75 . Many low and middle income people have been forced into plans with dedetective double digittibles a as high as 12,000. Give me your boundary on barack obama kaz. Guest it will turn ten on march 23rd. I thought it would have been overturned in Supreme Court in 2012 and then in 2015 but it wasnt. But senator coburn is absolutely right. The American People do not like obamacare because of high premiums hiker deductibles and even higher comping into this year 2020. Small networks of doctors and hops, people i have spoken to who bought the platinum or gold plans on the exchanges thought that they were going to be able could keep their doctor, the health care would be fantastic and unfortunately they call their Doctors Office and say were not taking any of the exchange plans. So, its really been an overturn in the Health Care System and hasnt done what we wanted and theres still 27 Million People in this country uninsured but most of them had options. They could have signed on to the exchange, eligible for medicaid and other for subsidies on the exchanged but didnt sign up. Were looking at 4 Million People some of whom are illegals who couldnt sign up for obamacare but we need a competition and choice in our health care, families and individual idaho be able to get the kind of health care that sued their nights and not one where the governments mandating Ten Essential Health benefits and the state man dates thatted make health care more expensive and limit the choices that people have. Host from my perspective, ive always thought that the greatest failing of obamacare, the Affordable Care act was it did take choice and question competition out of health care, and away from patients and from doctors, writ should be. Guest right. We want too sim that empowers doctors and patients, not the federal government, not state governments. And so that was really i mean i really thought that we would be able to repeal and replace obamacare when the democratics took the house back in 2018. I think the republicans made a mistake in not really explaining to the American People what would happen to those people with preexisting conditions, because the democrats say 120 million americans have preexist chronic conditions and will lose their maximum it and witness be a disaster. Mose of theme people have employer sponsored insurance and not going to lose their coverage. Only 6 million pipe who have christianic conditions who are in the individual market. Those are the people that we need to take care of and doctor tom price when he was in the house, he and i talked a loud about getting the federal government to give money to the states so that it it could set up or expand and make bet their high risk, pools so that those people could get ready good coverage they can afford and the younger people who really came out against obamacare, even with at the individual mandate and paid that penalty, rather than buying insurance because the cost for young person of 25, 28, 300 to 400 a mo wang to cover the people we plea existing conditions and said im going to pay the individual mandate fine rather than buy health coverage. So everyone else was supporting those people who are with preexisting conditions. Iwould have to agree with you. I love my party and support my party, i dont think messaging is our strong point and we need to do a better josh. If you look at the American Health care act that came within one senators vote of passing, you will see we did indeed cover precissen condition but never able to articulate that. Guest that is a problem. That its one of my jobs as a former canadian to educate the American People on why a full government takeover of our health care will lead to rationed care, long waiting lists for care, shortage of doctors and of course higher and new taxes, and people like senator sanders, senator warren say the canadian Health Care System is free. Its not three. Average canadian family plays 13,311 a year in hidden taxes for asystem that denies them care. Host right. So lets go into the premise of your book, medicare for all. Medicare for all as describe its this sheeny new toy that the democrats have grabbed ahold of and as we say in politics, perception is reality. And for a lot of people they perceive this to be the answer, until you get into the details. Guest right. Exactly. So, medicare for all, single payer has always been out there. Bernie sanders but really didnt dom into the for until 2016 when he was rung against Hillary Clinton for the democratic nomination for president. He really get out and stumped for medicare for all, and then of course in 2017 he had a single payer bill, 2019 cosponsor, 16, like cori booker and Elizabeth Warren and all the people kind of in that race or out of it but were in it and so he really told the American People, we need the government to run the Health Care System. At that time will lead to universal coverage and wont cost very much and everybody will have access to very best care. And we can talk but how much a single payer sim city system would cost. So he is senator sanders is just adamant for single pair and i fine it amazing and im sure you do too, he is 30 in the iowa caucus and at the top of the lister of the candidates in New Hampshire and just in a recent poll this week, he is the number one candidate in california, california is extremely liberal but i was amazed that in particular young people are really buying into what is better than the free health care. It sounds like a fantastic idea until you unravel the onion. Host thats right. Should being in, sidewalk tout a contrast, donald trump and Bernie Sanders. Thats a contrast. Guest thats a contrast. Host let me ask you but the numbers. When it was fir mentioned when bernie sans terse was running against Hillary Clinton, the support was high, and in 2000 and it continued to grow. In 2000 the support for was at 40 and 2019 had gone up to a 51 , 72 of democrats were in favor of it. However, when you Start Talking about those things you brought up, eliminates private Health Insurance, then all of a sudden you see a plummet. Guest we have 180 million americans have their employer sponsored coverage. So when you see in the polls that 59 , 53 support met compare for all, but then as you say you say, well, what do you think but met compare for all if you are going to lose your private insurance . Well, the numbers drop down to 37 . How do you feel about medicare for all if your taxes go up . Support guess down, also 037 . I think the problem is the American People dont really understand what medicare for all means and it sounds great and its free but you have to get under the weeds, unravel the onion and explain what it will mean for their health care and they wont be able to keep their employer sponsored coverage, which in the recent poll 71 of people who have esi like it. They rate as excellent or good. So when Liz Les Warren goes ive never met a person in life who likes their halve insurance, who has she talked. To 71 like. I like my insurance. These are sort of lies to the American People which people think, if no one likes it, why wouldnt we have the government take it over . Host thats one point that ive always noted, that people like medicare. People on medicare now, generally when you say medicare it has positive connotations and people like it. However, add everybody into it and what is going to happen . Guest right. If you look at medicare today, which came interest being in 1965, under president johnson and the great society, were spending about 700 billion, 800 billion a year on met compare and Medicare Trustees say part a could be bankrupt by 203. A lot of of people, i would say probably upward of 50 of people on medicare toy now have Medicare Advantage or medicare supplemental because one in three doctors is not taking new medicare patients because theyre reimbursed ate 40 below what they get paid for treating People Like Us with private coverage, and i think thats a very important statistic that the government took over the whole thing it would be far worse, think but medical doctors, going paid 40 below what they get paid today, theyre going to quilt and retire and i think the bigger point is that the best and brightest kids traditionally have bon into medicine that and theyre just get together go into it and then also they doctors would be employees of the government. Government would term what creped of medicine theying can practice how much theyll be paid. You may be the very best o. Yip surgeon and im the worst but wore pate the same and what in november is the budget is down we would have to good on vacation. Even if we couldnt fortunated. Host what about some of these other plans that are advertised as more moderate lying adding a public option or allowing more patients to buy in to medicare and medicaid . Guest 65 of people polled now support the public option. I think if you go back to remember when caminiti kamala harris, her candidate dropped but a of their waffling on met compare for all. One day she supported and next day she didnt. Senator warren until recently was a big supporter of the full government takeover of health care. Now she says, well, went the first 100 day wise introduce a public option. My third year id be bringing in met compare for all because of those people who have had the public option, which is a Government Insurance plan, that would compete in the exchanges against private coverage, they would all love their Government Insurance so therefore theyd want to be in medicare for all. So i just think that is a complete lie and we know that in talking to people. But senator warren, mayor buttigieg, joe biden, theyve all kind of switched to this, well go to this public option, the government plan first, and its a stepping stone approach and even mayor buttigieg said at that time while he supports the public option its after a couple of year its its not working and not everybody is in then he would go to medicare for all. Host when we talk about medicare for all, thats somewhat of a misnomer because its not somewhat. It is a misnomer because it is really should be called what it is and that is its a one size fits all government run Health Care System. Guest right. A couple years ago i was debating, a prince princeton economic professors who sadly passed away a year and a half ago i was doing an International Debate with him talking bet. The canadian wait times, remarked care, cant seat a specialist without getting a referral. And he said, solly, we have an example of a single payer system in this country and it is terrific and i said, what plan is that . He said the va. The Veterans Administration. And of course this is before all of the information came out about the fact our vets north getting top care, theyre on waiting lists, they dent have access as you well know to the latest drugs and biologics available for people who have private coverage. So we really have to educate people, and i think the American People understand now that the Veterans Administration is a disaster and so is that what we want . These politicians are pushing to because some people think skittish about medicare for all single payer. Lets good and have a public option to compete and my own oo ob gyn says i lose a lot of money on me medical patients. Californias med indicate. I barely brake even on medicare and i have to make my salary from people like you who have private coverage but you get i get really good care. Host so lets talk but two plans the sanders plan and jaypal plan. They would destroy health. I it would mean they would be into a new government run Health Care System. Right. Exactly. So, jaypal is really pushing to tell at the American People she is from Washington State. Im from vancouver so similar areas, both British Columbia and Washington State very liberal but senator sanders and say met inquire be and medicaid would be eye limit named. Get to the only two problem would be anyone Health Service chez dont think gives the best of care to our indian people, and the second would be the Veterans Administration, which is another example of the system talk about that hasnt gone and this jaypal admitted when asked, what would happen to all the people that worked in the Insurance Industry and things like that . A Million People in the Insurance Industry would lose their jobs and Elizabeth Warren when it was confront with that she said asked what will these people do she said they can work in the auto Insurance Industry or the Life Insurance industries. Theres no comparison working in the Health Insurance versus all to insurance and of course Bernie Sanders said one to two million will lose their jobs but im going to set up a federal Training Program to retrain all of those people so that within five years, they will have a new career. And you and i know that is just not going to work and it would be incredibly expensive. Host in your book you say, met compare for all give this governments a monopoly over. The provision of Health Insurance i forebits doctors who par tis mitt in the scheme from accepting private payment from any service the government coaches. You wend to ob gyn and she said i lose money on medicaid and then medicare i break even and then i make my salary on private. I if you take that away, what is that going to mean to salaries of health care workers, not only doctors but pharmacists . Guest Health Care People that work in hospitals. Its going to have a tremendous impact on your ability to keep your job and means that the federal government if its the federal government taking over, who is going to do all this work that once 2 Million People in the Insurance Industry and then another maybe 1 Million People in pharmacy. Who is going to be doing these jobs in the government it going to have to expand tremendously because doctors are going to have to be paid. A whole new bureaucracy to pay doctors and my cousins ophthalmologist in vancouver and he says i find it amazing the American People think it will be so wonderful if the government is paying their bills. He says do you know how long it takes the government to pay me and when my budget is done in november i have to good on vacation . And its going to be its really going to be a disaster for pharmacists, for people who work in hospitals, doctors, even for hospitals, its going to reduce the number of hospitals. A lot of rural hospitals will go out of business under a single payer government system. We need more rural hospitals because the people in the rural areas have to travel many, many miles in order to find doctors and hospitals and to get the latest treatments and things. So, exactly. Host now, youre from canada. You mentioned that a number of times. Being a canadian native, you have seen it first hand. You safe seen the government run health care. Guest i grew up under it. The federal government fully took over the canadian Health Care System in 1984. No private coverage is allowed for anything considering medically necessary. Most things are medically necessary in health care. A couple of thing thatnt are, cosmetic surgery. Lay six surgery for you eye, where the prices have gone down, not gone up because the government is not involved. In canada, in 84 the government took it over. I worked at the Fraser Institute where we started a project in 88, called waiting your turn, guide to hospital waiting lists and in 1993 the first year the average wait time from seeing a primary care doctor to getting treatment by a specialist, you dont call up your ob gyn you have to go to a general practitioner who refers you if he tickets necessary. In 1993, that wait was 9. 3 weeks just over two monthsful least year, 2019. The average wait time had increased to 20. 9 weeks. Thats over five months. Weeks. And 680,000 canadians cross the werder every year and pay out of pocket for getting mri,pet scansorthopedic surgery, hip re limit, heart valve replacements, things like that because they feel that their health is too important to have to wait so long. Canadians have an escape valve. If we where are be together no go . If if have to sit a liberty ship so doctors likes dr. Tom price will have to practice offshore so we can get continue to get the very best in medicine but the American People demand my america is very wealthy country and my mom used to say i hope youre not becoming one of those impatient americans which i am now. But canadians and brits when the doctor says im sorry, but youre not going to be able to get an appointment to get a colonoscopy for eight amongst to a year when you hockey have a problem. Canadians say, thats fine, that will be. A lot of people are just so polite and dont know anything different but a most people growing up have green up under single payer and started slowly and it finally was all in, in 1984. Host a number of propose sals. We have talked but the sanders some jaypal proposals. Its that what they have in canada or guest thats what they have in canada. Nothing no private coverage for anything considered medically necessary which is the majority of things. You can get private insurance for like if youre a canadian request want to come to the u. S. On vacation and youre afraid if you get sick, the canadaon government pays would not cover any of the cost here so people get private coverage for traveling, private coverage for having a private room in a hospital because thats not part of the system. An ambulance going to the hospital, things like that. But Bernie Sanders plan is even more comprehensive than the canadian plan. Over five weeks wait from seeing a primary doc to treatment by a specialist. The average wait in canada for neurosurgery is 33 weeks. We have for every one Million People, 16mri machines versus 44 in the u. S. By more interestingly 24 in lithuania. Its really ridiculous. But bernie wants to add free eye care, free dental care, free drugs, free longterm care. So when charles playhouse says 30 to 40 trillion for bernies plan, and he agreed that would be the price until he didnt, changed mind and si he said on cbs evening news, i just dont know how much my plans are going to cost. Back awaywood about knows its very expensive and as we just saw today, the increase in the federal deficit under bernies plan would go up 20 trillion over ten years at the high end. So if you add more of thieves canada tried bring in free drugs under a liberal prime minister, and he found out that it was so expensive that they just couldnt afford to do it. So, bernie wants to make it our system even more comprehensive and no referral to a specialist. You have to havegate keepers because the demand for health care will far exceed the supply of health care that can be given and thats why i think even that 30 to 40 trillion increase in federal spending is on the low side. Host the two most prominent examples of medicare for all system are in canada and uk. And there are other countries thats have it. Now in keyed and the United Kingdom you have an out of pocket expense, out of pocket responsibility, as well as in denmark, norway and finland, still some out of pocket expenses that you have responsibility for. Guest right. Exactly. So in canada is one of three country friday world that has a true single payer Health Care System. The other two are cuba and north korea. So think what kind of health care you get in those country. The United Kingdom has universal coverage system. The nhs started in 1971 and covers about 90 of brits. They allow private coverage to run parallel and 10 of brits rising have private coverage from companies in the uk are american companies, like the Blue Cross Companies and theres a british company. But they this is becoming more popular because just in december, there were over 4 million brits on a waiting list to get treatment, and the Cancer Treatment is not suppose told be delayed from seeing a general practitioner to getting treatment more than 62 days. They have not met in the uk that standard for over five years. And more important, under the World Health Organization study, brits are the bolt of the rung in most industrialized countries all form on cancer survival rates. That tells you something but Life Expectancy with cancer under a government controlled system. Host you mentioned just a few minutes ago, and its obviously a big concern, how much is this going to cost . Host ive seep figure, 32 trillion. Over ten years. Trillion. Guest trillion. Not million or billion. And and as i say charles coast evidence it and he said that would include if they had some reduced administrative costs and some reduced drug costs but the that would be in the increase in federal spending over ten years but if you what would be the tote cal cost of the plan, somewhere 50 to 60 trillion over ten years. And as you i wont be free. Taxes will have to good up. Sanders said there would have to be a now 4 income tax on anyone own e earning over 29,000 a year. Thats very little income the is in country and would hit a lot of people. A new 7. 5 payroll tax. Elizabeth warren said the payroll tax immigration not paid by middle class people because her plan wouldnt increase taxes on anyone in the middle class. But she dent realize that people that pay this employer tax their he employees and they are know most part middleclass. Then a new tax on the wealthy. There would be new taxes on large financial institutions. You if you double all the Corporate Income taxes and all the person income tax is it would it wouldnt be enough to cover this plan. So taxes would have to go up even further. And as i say it wont be free because you will be facing all these taxes and its not free because in terms when you are in pain and cant work, theres a cost to having your care rationed and not being able to get access to timely care. Host a cost 0 to the employer and physical. Host a domino effect. Let me ask you this. One thing we have been working on in congress has been Prescription Drug pricing. Obviously something is very interesting dish have other high interest in, and we have talked we havent but proposals by the other side, the other party, that call for price controls on Prescription Drugs. Our concern and my concern has been stifling innovation. I start practice farm any in 1980 when i was ten but guest exactly. Host but the point is that over that period of time ive seen nothing short of miracles through research and development, and that is phenomenal. Now i want to make legislator the pharmaceutical movers need to do a better job with pricing but other things we can do. With price controls, do you see that stifling innovation . Do you see companies not putting money into research and development . Guest absolutely. Totally stifle innovation and you have to think, where is most of the research and development into new drugs biologics, where is that innovation done . Its not done in switzerland or germany or england. All the company whether its novartis, all of those dies their r d in this country and theres a row. If you both countries, captained, england have price controls so you would just lose your shirt trying to develop new drugs and as youll know most new drugs dont make it through the system. Costs 3 billion from an idea to getting the drug through all the trials and getting it to market. So, countries wife price controls cant do this, so we are the innovator and incubator of all the great new innovations and think of the Cancer Therapy and things coming out for various muscular dystrophy, alzheimers, awful taking place in this country, and very few of the drugs go into trial make it and its very expensive, and so we want to keep the pipeline in this country open. Countries like canada with price controls, they do import drugs from the United States and or the manufacture them in canada but their american drugs and people say, oh, well, their drugs are cheaper. Theyve heave price controlled but what people dont realize is that the canadian patented met sins prices review board decided what drugs will be imported at what price if they decide the latest new drug to treat muscular dystrophy is too expensive it doesnt get ton to the form layer. If nancy pelosi and he cure at hr3 get that through and got through the senate this would be a disaster for all of us who depend on these great new innovations and for every one dollar spent on newer pharmaceutical wed save 7. 17 in hospital costs. Used to be if you had a gallbladder situation we had to have your gall bladder removed. Drug now have supplanted surgery and its some hospital costs are louvered as well. Host absolutely. I give the example all the time of help tight heap tis tuesday. Now we can cure it with a pill. Guest that people say that pill 85,000 but it does do the cure. If you have to have a live there were looking at 500,000 and a many times youre not able to get a live that is a match so its very inexpensive and you get rid of your hep c. Host you mentioned hr3 and the republican had an alternative, which was much better didnt have any price controls. Congressional budget office, cbo, scored he hr3 and with the price controls it was estimated that 8 to 15 drugs that would have come out on the market in the next two years would not, if we put those price controls into effect, and which drug is senate is that the cure for alzheimers in the cure for diabetes even if its just one, its one too many. Guest exactly. And ive even seen numbers at 100 fewer drugs would be developed in this done so many people with diseases like diabetes are just wait being hoping they can survive and when the next new drug comes out, that will allow them to be like people who have survived with hepatitis c because of the drug from gilead. Host one last thing on this up mentioned that not all the drugs that are available here in america are available in canada. Or in the unite kingdom. Guest exactly. You have to pay for drug inside canada. Only people at the low end of the income lad ever get free or reduced drugs. Most people pay at the pharmacy. But they in many cases the drugs that they are getting, because the latest drugs arent on the form form layer they dont know theres a newer job that it may cure tear leukemia cure their leukemia my undel died from nonhodgkins imfoam ma. When taj to my cows sit but uncle i said you should go to head of the Cancer Agency and say what would getting retuxin for your dad me and did and head of the Cancer Agency never havent oat it good. Government bang to my cousin and theyd that drug is not available here young. Take your dad down to seattle and good to Fred Hutchinson clinic there you he to good over the border. Its about big deal when youre older and sicker. A lot of these knew drugs are just not available and people dont even know about them but they think, the canadian Health Care System is almost like a religion, just like in the uk. You cant criticize it and yet everybody is complaining and the older you are the more likely you for complain. Host lets talk but the other costs and not necessarily monetary. Wait times. And the overcrowding that takes place, and in the hospitals and in the Health Care System in general. Guest so in canada, the average wait from seeing a primary care doctor to treatment by a specialist is 20. 9 weeks, over five months. Can you imagine americans if i went to the doctor and felt i had a problem but couldnt even go for my primary care doctor to getting treatment by a goods throw enterologist or whatever it would about dish would be very upset. Americans would not tolerate it. You have long wait times. Care is remarked. My mom was a senior, and who thought she had colon cancer. She went to the doctor, had an xray and i said, he said i dont see anything so i okayed you dont detect toll lon cancer with an compare. You need to get a colonoscopy. She said you call. Said, im in the out. You call so she did and the doctor told her, unfortunately youre a senior, we have too many younger people who are on the waiting list to get a colonoscopy who have symptoms that are serious. So, six months later, my mom had lost 30 points, she was hemorrhaging, one morning, we got her to hospital in an ambulance two days in emergency room two dies in transit lounge wait fog a bed in a ward. Got her colonoscopy, died two weeks later from cop lon cancer. This how government we intent 18 of gdp, canada spend 11. When queue limit what you spend there isnt enough to go around and people are going to have to wait and people are going to wait the most are seniors. Its the same in the uk. Just 4,000 people, just revealed, went blind with glaucoma because the weight time get an appointment with an ophthalmologist was just too long. By the time they get the apotential. A thousand hover them were had gone blind. Host the book fault premise, fall promise. And one thing enjoyed was the stories just like the one yo just shared ubut one story that talks about overcrowding, mary louis measure question was sweating and had trouble breathe when a friend brought her to abbottford Regional Hospital on the night n2017. She was quickly seen by a doctor told that 56yearold she was experiencing muscle spasms. She was given a shot of morphine and sent home. Murphy died two days later on february 1st. Her experiences unnorthern common and canaday overcrowd leaves hospital staff knuckle ball guest Emergency Rooms are piled high with patient. When the sars situation was in canada, several years ago, ambulances were having to leave one hospital and good to another to get room for somebody to get in to the er but they have bed blocking in canada which means people who are older in the hospital with something, chronic, they stay in those beds and so people that younger people who need to have surgery, they cant get into the get a bed in the hospital because theyre blocked by these people who really should be in a seniors home or in an assisted living facility. So it really is its just amazing how the canadian Health Care System, the government system, work. A good friend of mine is an Orthopedic Surgeon has a private surgery in vancouver, has been treats private patient which is it illegal under the Canada Health act in British Columbia. He has been in a lawsuit for ten years this case has been in the bc Supreme Court for the years. The government keeps putting more and more money into it to stall because they dont want to open up the system to a bit to some private alternative. And a lot of the people he takes care are people who are in the government who are opposed to helping out the system. So we choice and competition will solve so many of these problems, and theres no question that there are some things that need to be changed in american Health Care System but choice and competition will bring down the cost, like in every aspect of our lives, and it will lead too universal coverage. Host another thing that out of the monetary costs, doctor shortage. Now, one you mentioned fewer students going into young people going into the medical profession. One thing were struggling with in washington, dc right now is the high cost of education, and student loans. And certainly physicians and pharmacists and other Health Care Professionals come out with high student loans. Howwe going to deal with the doctor shortage. The American Association of medical colleges has come out just recently and said, by 2030, which isnt that far off, never might be 2020 so soon a shortage of 122,000 general primary doctors and general surgeons by 2030. So, that is not thats even before they consider whether the government takeover of the Health Care System. We have seen a lot of doctors in he country, 50, 55 retiring early abuse of obamacare. His husbands own primary care doctor sent him a letter and says all of the Electronic Health record i cant Practice Medicine so medicine so im agreeing tire and government gets involved you have to have Electronic Health records, you theres a relationship there that has development. So there will be a shortage and that shortage will be even greater. So, i think its incredibly worrying about our supply of doctors and under single payer in britain right now theres a shortage of 100,000 doctors, nurses, and people who work in hospitals. The British Government tried to bribe doctors who left england because of the national Health Service and how little they war paid and how long they worked ask tried to bribe them to come back and response was virtually nothing, just a few docs came back because doctors arent paid very well. In the uk versus the u. S. And in the u. S. Versus in canada as well. Our doctors are wellpaid and could have debts and it is expensive, but over time they make good money, they save peoples lives and i think we dont want to destroy that great incentive. Host earlier in our conversationout talked about the number of mri machines and the cutting edge treatment. Guest right. Host does that exist in canada and the uk like in america. Guest absolutely not. Because when the government the provincial governments control what is going to be sent spent on health. You see reports, stories from radiologists saying our equipment, our xray equipment is so old we dont even think we can rely on the results. But if you think the average wait in canada for an mri is 22 weeks, thats over five months, and the fact that canada has 16mri machines for every Million People and it as large country with only 37 Million People but one mr 16mri mens for a Million People. We have 44 machines for every one emergency people and countries in the eastern bloc have 20 to 24. Canada is highly industrialized country. Its shock you cant getting a cities and he number of tomography machines i a higher level, very few in canada, whereas here if you have cancer and theyve discovered something you get a pet scan. Host one of the darker parts of the book, you discuss the assisted suicide and the death panels. I found that to be very interesting and quite honestly a little depressing . Guest yes. Host tell me. Guest when sarah palin was running she talk but rationed care and death panels. They are death penals. Its remarked care because government is determining who is going to get care and how much care and so in canada in men cases people are told, well, youre not going to be able to get better. Youre older, you should have assisted suicide because it while be cheaper for everybody and of cures thats unless the american way. The relationship should be between the for, the family and the patient, and so once you start government getting involved, in the uk, for example, they have nice and its not a nice division when the m the National Instant constitute for health and clinical excellence. They have a division which figures out how different what is the value of your life and the cost of the treatment or the, quality quality adjusted life years, and so if the nice the governmentboard decides that you youre retired, youre worth 30,000. But you could be cured with help c with a drug that costs 80,000. But because youre not worth that, youre not going to be able to have access to it and is what i fear will happen in the u. S. , an organization in massachusetts is patterning itself on the program in the uk. This would also be a way under a single payer system the would have do come in because it would be an additional way of denying care to people by determining, letting if youre not worth that youre not going to get a drug or treatment that costs more than what we have determined your worth. Host one last question about the american system versus the other countries. You hear these statistics of how much the Life Expectancy in canada and the uk as compared to the United States. And that can be misleading. Guest definitely. The two things are Life Expectancy and infant mortality. Walls hear on infant mortality we have a very low high rate of infant mortality. Host the state of georgia has the highest. Embare ration. Guest but the thing that when youre comparing the United States infant mortality rate to that, say in france you have to compare apples to apples. We have very highly developed neonatal units and a child has a baby has access to latest treatments and ways to keep that baby alive, tiny, primo babies live inform france a baby has to be is considered a live birth it weighs a certain amount and is of a certain length. So many of these babies dont make it in france or in germany do make it here, and so youre not comparing apples and apple because the measuring infant mortality are different, and on life expect sanity you say leak expectancy is declining in the country, down to 79. 2 years. But you have to look at what makes up Life Expectancy. The issue is the United States has a the highest level of deaths from Car Accidents, obesity is a big thing0. An per cap catabasis, the per capita, the highest death from guns other countries dont have death through Car Accidents at the level we do they dont have deaths from guns, the United States is a very sear yours problem with obesity but you dont see that in many countries in europe or canada but many of this people who are very obese leads to many medical issues and in some cases a shorter life span. Sow you have to compare apples to an little and all of these things and i think if you look at the cancer survival rates five years out, whether its pancreatic, colon cancer, breast cancer, prostate cancer, we have the highest survival rates. The w. H. O. s stats from the commonwealth, we do we have the very best and want to build on that. Dont want to have to go down and become like a third world country. Host one last thing. You talk but this earlier. The onset of the programs, medicare for all. What does that look like . How does that work . The sanders reply, the jaypal plan if they were to implement medicare for all would it be suddenly or over a period of time or guest we dont know. Bernie sanders said recently, when he was in the huge debate he and Elizabeth Warren are at loggerheads right now youre a liar, youre a liar. Sanders said, because she said she would introduce the medicare for all in year three of her preponderances si. He said i would introduce medicare for install the first week of my presidency because you dont want to be stalling and taking time because then there would be complications. So he wants to just take over the whole Health Care System immediately, ban all private insure ares, people out of work who know how a doctor would get paid. How much would they have to expand their bureaucracy to get people to do to have people doing billing in the federal government. If you ask people do you like the post office . No, i use fedex or ups now. But people have a choice some people use the post office but people have a choice of the private system and theres a reason that fedex and ups and dhl are in business. People want to get rid of the dhl and have government be in charge, and makes me very nervous when guy to think about thank you dmv or post office the kinds 0 peeve making decisions about my health care, your maximum . About how doctors are going to be paid what they will be paid . And if theyre not paid, what theyre worth. Thats a problem. Host okay. We have established this premise. Now, about medicare for all. Obviously know the American People arent going to put up with this. This i not what they want. What will work . Conservatives take criticism that you dont have a plan. We do have a plan, but we have to communicate. Host tell me what works. How we fix this system that beginning in the book you said the maximum system is broken. Guest re wouldnt universal conk and that will come through competition and choice, empowering doctors and hops. During world war ii when wage and price controls were in we get into the, employers got the ability to write off the cost of health care and we at employees got our maximum tax free. If im fired or quit my job and go into he individual market i have to buy my health care with aftertax dollars which makes people decide they dont want to buy health coverage. I would say in the supreme we need to reform the tax code so that individuals other could get their Health Care Tax free in the same way that we get our health care. But of course we do make lower wages because when the employer is paying, they dont employers dont have money. Taxpayers do, so we make less money because we get ore Health Care Tax free. Id like to level that Playing Field and ultimately over time get rid of that tax exclusion. We dont get our car insurance, hero underrans, life three ance through our employer shouldnt bet getting our health care through the employer but the feds got abuse the mels so we need to make that change. We need to expand Health Savings accounts. 20 some Million People in the country have hsas, employers if offing the. Put doctors and patients in charge. People are more careful when theyre spending their own money. Freedman used to say health care the first dollar coverage, they have no idea what it costs. They think its three for thatlying copay and People Public its free and use more weapon wantoned and Health Savings account. H65, should be able to continue to put money into their hsas. I think miami be able to use their hsa money ohelp pay their primum. Put the doctor and patient in charge. We need do medical malpractice preform. Remember when president obama said this, this little pill, your doctors are giving people pills, doctors are doing unnecessary testing and its very expensive because they want to line their pocket width money. Doctors practice defensive medicine because theyre afraid of being sued and particularly neurosurgeons and obstetricians. Some drop out because they cant afford the premiums unless theyre in a large hospital practice operate water house cooper said that cost defensive medicine 210 busy billion 210 billion a year. Texas capped we have to do these punitive charges and noneconomic damages, put control in so that we stop all this frivolous lawsuits of an ambulance chasing lawyer going after people. I think we also need to block grant medicaid, allow people on medicaid to feel better, get hundred mmo. We need to trumps medicaid work part is a very important part. Why should people decline taking a promotion because they dont want to go off their medicaid . This people are willing and able to work and those who are should be not on medicaid. That should be working their way up the ladder. People should be able to buy their Health Insurance across state lined. We need Price Transparency and thats a big issue and thats people want to know what things cost and if they dont know, they cant compare. And American People like to compare. We need to get rid of this an issue in georgia right now the certificate of need laughs which keeps new hospitals off the market and helps those hospitals staying in business and make more money so we need to get rid of those like in florida. So those are a few of the things part of my plan to bring about keep america as the Diamond PlatinumHealth Care System in the world. People do come here from all over the world. Not just from canada but people from the middle east come here and get tremendous treatment they cant get in their own country. Host why is it that Americans Still dont trust the free market system . I dont get it. Guest we were talking about this is the morning. Hough is that socialism is expanding in this country and that young people, the Young Millenials are all thinking the government can do this better . Do they take a look . Good to the post office, the dmv, look at people in the va health system, people on Medicaid Program . Why i think its partly because in the Public Schools and even in private schools today, children are being taught by teachers and professors who continually say, the capitalism is bad, socialism is good, and its Milton Freedman would say we need more social jim so they were indoctrinated without hearing but free market ideas. I founded an organization in 2008. Its a comparable to the federal soave site for law students yesterdays to have debates on cam pulse us because if i debate doctors on campuses in medical schools, theyre all for government takeover of health care and their students never heard. The alternative and ill be talking and debating and theyll be snickering and laughing because they think that thats all they know and think it will be mow epatient and cheaper and everyone will be covered. They have no clue what it will men for their able to Practice Medicine so we real a huge problem is in country with identity politics, with government taking over everything, and how we have to take that back. We have and its no easy undertaking, just one last thing from personal experience if you will. Give the example because people ask me, how is competition going to bring drug prices down. We are i was practice taylor see we lad a company with this idea of generic a 30day supply of generic for 40. Couldnt buy generics that achievement i said im not going to do that. I cant even buy them that cheap. Guess what . A week later i was selling a 30 day supply of generic for 4. Called up my display and said you have to do something. You have to help me. I had people leaving. I cant let that happen. It drove down the price of generics. Guest generic, most people today in america take generic drugs and they are really reasonable because the original drug has come off patent and generic drugs in canada are even way more expensive than here but the fda needs to quicken up the approval of new drugs and new biologics and need to shorten the time it takes to generic to get through because generics are much more efficient and for many, many diseases people with regular sore throats and colds, high blood pressure, high cholesterol the generics are copies of the patents drugs and they do work and they are far cheaper and that brings down the cost of drugs. Host again, false premise, false promise. A great book. Thank you. Timely book. If you have the opportunity i encourage you to read this. Thank you. Guest it was a terrific and running a game and youre reelected and help the republicans take back the house so we can get Real Health Care reform in this country. Host thank you. Its ban privilege. This program i available on a podcast. Cspan, your unfiltered view of government. Created by cable in 1979, and brought to you today by your television provider. A as spend institute in washington, dc form easterly secretary of state Condoleezza Rice led a talk on u. S. And china relations. Heres a portion of the program. I think whenever you have the reemergence of great power rivalry let me call it that it it is a different kind of challenge than the challenge of terrorism, for instance, because great power rivalry brings with its whole array of tools on the side of the other side, whether its military power or economic so it looks different and i think actually after the chance of the soviet union we thought we were done with great power rivalry. There was a sense that everybody would integrate into the was consensus. Into something that at least looked like capitalism and maybe even democratic capital jim. The russians seemed to be very much on that path, and there were those who believed that by the integration of china into the International Economy we would begin to see the liberalization of chinese politic. You said she expectation had been cooperation with china. Actually the expectation was integration with china, and now you see frustration with that and of course the russian and chinese challenges are different, russia is really a power without the full array of assets. When is the last time you bought something that was made in moscow . That was not made of petroleum . And by the way, dont say vodka. You might buy that in france these days. If you look at china you have rising power but emergence of great power rivalry is defendant than what thought we would face and thats why i think they rightly noticed this to be probably the greatest National Security challenge we have. To watch the rest hoff if the discussion visit our website, use the becomes at the top of the page to search Condoleezza Rice or the title of the book the struggle for power