Show: Larry King Show
Host: Larry King
Date: August 18, 2009
Larry King: Three more doctors join us, including Texas Congressman Ron Paul, Republican of Texas, medical doctor. By the way he was a flight surgeon in the US Air Force and an OBGYN in private practice. Here in LA we have Dr. Paul Song, Radiation Oncologist. He supports the President’s healthcare initiative and believes there must be a public option. And in Atlanta our own Dr. Sanjay Gupta, CNN’s chief medical correspondent and practicing neurosurgeon. How will this debate about public access and the like affect you? Will public option affect you, Sanjay?
Sanjay Gupta: Well, probably not. In fact the President has come out and said that people who have private insurance right now, who have access to private insurance and whose premiums are not above a certain percentage overall of their income, aren’t going to be eligible for the public options. So, there are a lot of people who it won’t affect and I think that’s really important, Larry, because there is all this talk about people flooding the public option. Not everyone is going to qualify, myself included. You as well, Larry.
Larry King: Yeah. Dr. Song, you favor it, do you not?
Paul Song: Yes, and I think the big reason is that Milton Friedman, who’s an economist a lot of conservatives like to quote, in 2001 had an essay that basically said that the third payer system that we have right now was the most cost-ineffective system that was available. But since that time the insurance companies have continued to grow, their overall profits have increased by over 400%, and the premiums have raised by greater than 80% during that time. And I think the big concern is that if we don’t have a public option, all you’re doing is putting more money into this system that will basically go to the insurance companies without any regulations for patients.
Larry King: Congressman Paul, if you agree something is wrong and you don’t like the public option, what do you like?
Ron Paul: I’d like to see a little bit more freedom. Most of the time people do say there are problems and nobody is denying that. But, you know, the problem is that we’ve had managed care, we’ve had government manipulation of medical care for 40 years now. So, we can hardly say it’s the private sector that has caused the trouble. So I would like to see a renewal of the spirit of freedom in this country where we can trust the market, but not trust the government because the government doesn’t deliver.
They’ve had Medicare, it’s broke. They have veteran’s care, it’s a lousy system, nobody likes that. People aren’t getting taken care of. But what do we do? We have rejected the notion, of say, the church hospital; we wiped them out of business. We have Shriner hospitals, 22 of them, that give free care to all children, and they are having trouble because of the inflation, because of the cost. So, I think our biggest failure in this debate is that we have not analyzed where the problems came from, rather than just saying “let’s go on with more government.”
Larry King: Before I get back to Dr. Gupta, do you want to respond, Dr. Song?
Paul Song: Yes, I have a lot of respect for Dr. Paul. But one of the things that I think he’s saying is incorrect. The idea that the VA system and also Medicare being failures or not being popular are absolutely false. The RAND Corporation, which is actually a conservative think-tank, recently published a study that showed excellent satisfaction with the VA system, and the Kaiser Family Foundation actually showed that Medicare is actually run more efficiently with much more dollars going for actual patient care than the private sector.
And the only thing I want to touch on is this idea of freedom. We have less freedom when you are told by an insurance company where to go, where to get your treatment, what hospital you need to get seen at. Some patients need to drive extra distances because their insurance companies won’t let them go to the hospital that’s in their neighborhood. If you had some type of single payer system, patients would be free to go wherever they wanted. And I would also add that if you’re really concerned about freedom then if you’re an employee who’s stuck in a job that you don’t like but you’re there strictly because of the health benefits, if you had some sort of universal system you could go to take a job anywhere you wanted.
Larry King: Dr. Paul, before we get to Sanjay, what do you think of the co-op idea?
Ron Paul: Well, if it’s private it’s okay, but the government mandated co-op won’t work. But the doctor misinterpreted what I said, because he didn’t accept the fact that we’ve had managed government care. So if he says it’s not doing well, then you have to blame managed care, the tax code, tort law, how well people can sell insurance across the borders, and the inflationary problem. And I didn’t say that Medicare didn’t work, I said it was broke. And you got to admit that. And here we’re putting another program on the government system, the government’s broke, we have 2 trillion dollars worth of debt this year, and you think you’re going to add this new program and the country is broke, it is bankrupt.
Larry King: Sanjay, where are you in this?
Sanjay Gupta: Well, you know, no one is going to control cost here, that is one irrefutable fact; whether it is the private sector or the public sector, you can’t hold up any of these sectors and say, “Look, this is a good example of how to do this right.” And by the way, it’s not just the United States; it’s around the world where health care costs have outstripped and outpaced inflation in just about every country in the world. So this is something that we’re dealing with as a global society, Larry. Whether it’s people using technology more, using more prescription drugs, whether it’s chronic disease, we spent almost a 150 million dollars on obesity related diseases in this country alone. So you know, healthcare is expensive, and I think that’s why at the heart of a lot of this is how exactly are we going to pay for it, who’s going to pay for it exactly and I think that’s where this debate is really centered.
Larry King: Sanjay, can you briefly explain the co-op idea?
Sanjay Gupta: Co-op is not government run, although it may have some government seed money. It is a non-profit organization that typically is made up of people who are often members insured. Meaning they’re people that want to get healthcare insured from a co-op, but they’re also members of the board of the co-op, so they can help and determine premiums. They can help determine what kind of services are covered. The way that a co-op is successful, typically, is that it is based on scale. If you have hundreds of thousands of people involved in a co-op actually buying into it, you can negotiate prices well and be competitive with the private insurance industry. So for example, a house mom in Tennessee watching right now if she’s uninsured and she’s trying to get herself and her kids insured, she might join a co-op and it could be cheaper than private insurance if they have lots of people involved. But if they don’t it’s very hard to compete.
Larry King: Dr. Son, does that appeal to you?
Paul Song: I think the problem with that, in my study of this, is that unless you have at least 500,000 people that will form a network that it’s going to be hard to do, particularly in rural areas. And what you’re seeing more and more in the past 7 years is monopolies that have been formed by insurance companies that make it real hard for any type of negotiating power and premiums have gone up. So if you can’t 500,000 people together to really put together a good economy of scale, I’m not sure how this is going to work in large parts of our society.
Larry King: Congressman Paul, you are there in the House. Where do you think it’s going? What are we going to get?
Ron Paul: Oh, a little incrementalism. I don’t think Obama is going to get what he wants, but we’ll have more government and the cost will continue to go up and the quality of medical care will go down. They put 50 billion dollars in the bill just for surveillance of every single medical transaction and they have the legislation to control that in Washington, so there will be no medical transaction that isn’t controlled electronically and known by the government for so-called monitoring. So it’s going to cost 50 billion dollars to try to find out where the waste and the fraud is. But the system is wasteful and fraudulent.
Larry King: Sanjay, you look puzzled.
Sanjay Gupta: I guess I was a little bit confused as to what specifically Congressman Paul was talking about there. I am not sure if he was talking about the Health IT or what. Or if he is saying that’s a bad idea to try. My understanding was that that was to try and streamline a lot of the unbelievable paperwork, and yet primary care doctors who are seeing over 5,000 patients in their clinic, each one of those patients comes with insurance forms and all sorts of other forms. To try and streamline that in some way has been one sort of tactic to try to increase the number of primary care doctors. So I was just a little bit confused about what you were talking about there.
Ron Paul: Okay, let me tell you; the stimulus package gave the authority to the executive branch to set up the computer system to record every medical transaction in the country. Now they put 50 billion dollars in seed money in there for somebody to monitor everything a hospital does, everything a lab does, everything the doctor does, everything a pharmacy does. Now, that is not going to be efficient, that’s going to cost a lot of money, very confusing, and it’s going to distort the whole concept. When the government is in charge and they want this one-payer system; this is socialized medicine. It doesn’t work, it fails all the time. Some people may get care for a while, but eventually everybody is going to get equal care. But equality is going to go down, that’s what it’s all about.
Larry King: But we don’t have the best care now, do we Dr. Song?
Paul Song No, I would argue that we could all agree that the current systems is absolutely broken. And as far as a track record of how government programs work, I think Medicare has been in business for 45 years, my own father who was diagnosed with cancer is able to get access to care in a much more timely fashion than my own patients who come in to me who have private insurance.
Larry King: Right, tell you what guys, we’re going to have you all back maybe tomorrow because this needs a lot more attention than it’s getting. And it’s getting a lot. By the way if you don’t have insurance and need medical attention, a man helping to provide that care will join us next.
Our panel will return momentarily. Many Americans have been shocked and dismayed during the past week at the sight of thousands of their fellow citizens waiting for hours, even overnight, for medical services from a free clinic set up at the Los Angeles forum. The event is the work of Remote Area Medical, a non-profit foundation which is generally focused on bringing healthcare to rural America. Joining us from the site is Stan Brock, the founder of Remote Area Medical, it is a non-profit, volunteer, air-borne relief core. Known to millions he is as the co-host and the associate producer of Wild Kingdom.
Stan, how did this come about, what do you do?
Stan Brock: Well, the whole idea was born when I lived down in the Amazon, Larry. And I had a very bad accident with a wild horse and when they were pulling me out from underneath the horse they said, “The nearest doctor from here is 26 days on foot.” It was about that time that I got the inspiration for trying to bring those doctors just a little bit closer.
Larry King: And that lead to this. So how does this work? What’s behind you?
Stan Brock: Well, you know, I formed this organization to provide care around the world, but shortly after we stared it, I started getting requests to bring care to some of the areas in rural America. And that was many years ago and it’s just sort of grown from there and now 64% of all the work we do is here in the United States and so we’re sort of backing off from some of the places where we really need to be like in Haiti and Zimbabwe because of the pressure here from all the millions of patients that need the care we give free of charge.
Larry King: What can Congress learn from this?
Stan: Well, I think one of the things they need to learn from it is that that the greatest impediment to what we do, Larry, is that for some extraordinary reason that I’ve never been able to understand, a fully qualified and licensed doctor, dentist, nurse, veterinarian in one state is not allowed to cross state lines to provide free care in another state, except in the state of Tennessee where the law was changed in 1995 to allow it. So in Tennessee we get doctors coming from all over the country to help out. Then we came to California, one of the other 49 states that does not allow it, and although we’ve seen many thousands of patients here, we could have seen twice the number had we brought in forces from outside the state to help.
Larry King: Stan, we salute you. It’s not our “Hero Of The Week” time, but you are our hero for the week. Thanks for joining us. What do you make of this idea, Dr. Song?
Paul Song Well, I think it is a sad statement of our society that we need to set up these free clinics in major cities like Los Angeles and have lines out the door and people waiting for many, many hours. If we talk about a waiting line, there is a prime example of that. But I do think that there needs to be a partnership within the private sector and public volunteers to offer this. I don’t think it can just be shared just by one aspect of our society.
Larry King: What do you think, Dr. Paul, Congressman Paul?
Ron Paul: Well, I disagree. I think this shows the greatness of American. If we had a free society and a prosperous society with no inflation, no wasteful wars that we spend trillions of dollars on, there would be so much wealth in this country that there would be thousands of clinics like this. And like I said before, there’d be these church hospitals, there would be more Shriner hospitals, they wouldn’t be closing down because of all this government interference and inflation. Yes, we do have inflation. Just because the CPI isn’t going up, the money because of government policies channels the money into medical care. That pushes prices up. That doesn’t give you more quality care.
Larry King: Dr. Gupta, what do you think of this?
Sanjay Gupta: I’ve been to several of these places around the world, including Haiti where Remote Area Medical works, and it is amazing to see some of those same practices now here in the United States. I am not sure I completely agree with Congressman Paul on one point though and that is that if you leave it to sort of what the better the goodness of man trying to take care of these problems. I don’t know whether it has been taken care. You know, our private health care industry has created a situation where you have things like this sort of needed necessary. So I don’t know. You know, it’s somewhat hard to imagine same thing I saw happening in Haiti happening right there…
Larry King: I said it earlier, I’m going to bring you all back, because we’ve just scratched the surface. Ron Paul, Paul Song, and Sanjay Gupta, doctors all.