Overall, the United States has lagged behind other developed countries in providing accessible health care to its citizens. Explain why the United States is behind in this arena and h

[INTERPOSING VOICES]

[APPLAUSE]

I am John Donvan, your host and moderator for Intelligence Squared US. I am with ABC News Nightline. But tonight, it is a pleasure to be introducing and moderating these debates, Intelligence Squared US, Oxford style debating on America's shores.

The motion for tonight's debate, as you know, universal health coverage should be the federal government's responsibility. You are going to be hearing from six panelists throughout the program, three who are for this motion and three of whom are against. We're going to have a three part debate.

The first part, the most substantial part in a certain way, will be opening statements. Each of the speakers in turn will be given seven minutes to make the case. I want to clue you in.

There is a sound that you will hear at the six minute mark. It's a warning sound telling them that they're running out of time. And it sounds like this.

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Very gentle sound. And it can become more insistent. And it will. At the seven minute mark, it will become rather relentless, like this.

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All righty. All righty. We're going to poll you both before and after the debate. Because the point here is to win the room.

These debaters are trying to persuade you to their point of view. Everyone comes in here with a point of view or the absence of a point of view, known as undecided. We're going to poll you to find out what our baseline is coming in.

But this is, in a sense, a contest. It's not quite a reality show. But it is a contest.

It's a contest of wits and facts and information and persuasion. And all of you are the umpires. You are the referees. You are the judges in this.

We will also, later in the program after the opening statements, will be coming to you for questions. And then the evening concludes with each of the debaters taking two minutes to sum up and reach a summary position. At that point, we will vote again to find out how they did, who were the winners of the evening.

So once again, the topic, to reiterate, universal health coverage should be the federal government's responsibility. If you go to the keypads attached to your seats at this point, number one means that you are for the motion. Number two, you are against the motion. Number three, you at this point are undecided. Please vote.

So in a short time, we'll have the results to share with you. But we want to begin now with the opening statements. Once again, our topic universal health coverage should be the federal government's responsibility.

And arguing first for the motion, Paul Krugman, a well-known Op-Ed columnist for The New York Times. And I want to point out that in an era when many of us were beginning to refer to our potatoes as freedom fries, Paul Krugman stood up and talked about the French when it comes to health care, in some ways, doing it better than the United States, and the Germans, and the Koreans. Paul Krugman, the podium is yours.

So I'm an economist, which means I'm supposed to talk about efficiency. But I actually want to start by talking about morality. And in fact, I don't want to start by talking about health care.

Let me talk about something that's going on right now. As we sit here, there are several million people in the Houston metropolitan area who are without electricity or running water and hit by disaster. They didn't do anything wrong.

They stayed in their houses, because that was what they were advised by the Governor of Texas to do. It was the right thing to do given the impossibility of evacuating a city that size. And now, a lot of them in trouble. Some of them can manage.

Some of then can now go and stay with relatives. Some are in good health. Others are not. They're in a lot of trouble.

Now, do we think that the people who are in trouble, who are elderly, who are in poor health, who just don't have the financial resources, whatever, to get themselves out of that situation, do we believe that– look, you know, it's not a government responsibility to help them, they should be left on their own? Of course, we don't. I mean, I imagine there are some people who do believe that, but not many.

They certainly don't show their heads in American politics. We do believe that if our fellow citizens suffer misfortune that is no fault of their own and we can help them, that we should. Now, imagine some American who is in poor health and can't afford medical care, some American who is elderly and in need of trouble, or maybe not elderly, something's gone wrong, someone who is trying to work, but can't get a job that has health insurance, someone who is in difficulty.

Do we believe that that's their problem, that we should not be taking care of them? And by the way, we're not just talking about the 45 million people without health insurance. We're also talking about the roughly 75 million people who have inadequate health insurance, health insurance that basically crumbles whenever it's put to need.

We're talking about a large part of this country that does not have adequate health care coverage. Well, I would submit to you that actually as a nation, we don't believe that it's appropriate to leave these people on their own, that we actually believe that the right thing to do is to help people. We don't think that people should be protected from all of the risks of life.

But when there is something you can do, we believe that we should do it. And in fact, by and large, if you ask people should people have health coverage in this country, should people be guaranteed health care, most polls I've seen say that a heavy majority of the public thinks that they should. So then the question would be, well, how is it we don't actually have that?

How is it that we haven't actually taken care of our citizens, in the way that overwhelmingly as a nation, we believe is the morally right thing to do, that as a matter of values, we think we ought to do. And the answer is, of course, that we're told– well, actually, we're told two things. We're told, first of all, that we already do it, that we already take care of everybody.

And we're also told that it's impossible to take care of everybody. Now, you might think that it was impossible to believe both those things at the same time. But that's why these guys are paid the big bucks.

So we're told that, well, look– and I can quote the President there. I mean, people have got access to health care in America. After all, you just go to an emergency room.

And of course, I think we probably have a fair number of doctors here. Right? It ain't the same thing. First of all, going into emergency is no substitute for continuing care. And secondly, if you go to an emergency room, they will bill you.

Now, if you're indigent, you will get the care all the same. But you will get the bill. And if your indigent, maybe that doesn't matter.

But for working Americans who don't have good incomes, they're terrified of emergency room coverage. And there's something sick about our debate that anybody can even claim that the emergency room is a substitute for universal health care. But the other argument is that it's impossible.

If you tried to have some form of universal health care, it'll be terrible. It'll be lousy quality. It'll be wildly expensive.

And so people are told that a government insurance system can't possibly work. It will be lousy insurance. It will be awful care.

Now, we're going to hear a little bit, I think, later on about some of the international evidence. We're going to hear about other countries. But there's a secret.

I don't know if people know about it. But you know, there's this program called Medicare, covers every American 65 and older. It is horrors.

It's a single payer health insurance system run by the federal government. When it was being proposed people said it would be terrible. You may have heard of something called Operation Coffee Clutch.

Or you may not have heard of it. Doctors wives were urged to hold coffee clutches in which they would try to convince the doctor's patients what a terrible idea this proposal called Medicare was. And they would play a recording by a fellow named Ronald Reagan explaining what a terrible idea Medicare was and how it would lead not only to destruction of health care, but actually the destruction of freedom.

It's quite something. You can listen to it online. And at the end, basically Medicare as is the route to a totalitarian state.

Well, it's become as American as apple pie. A famous quote in the health care field is the constituent who accosted Senator John Barrow, saying "senator, don't let the government get its hands on Medicare." The fact of the matter is, we have universal health coverage for our elderly already.

The other thing that people say is that it would be impossibly expensive. Now, the truth is a little known other big secret. You really have to go in deep research and actually look at a couple of official statistics that are easily available to find this out.

In this country, the government already pays more health care bills than private insurers do. Medicare and Medicaid together are already a bigger program then private insurance, all–

[BELL]

–private health insurance. The reason is that we already cover the expensive of cases. We already have the expensive cases. The elderly, the very sick who end up being bankrupted, and therefore end up poor enough to get Medicaid are covered by public programs.

What's left are generally lower income working adults. And we pay an enormous amount to not cover them. The fact of the matter is that our health care system is wildly inefficient, largely because we have an insurance industry that devotes enormous resources to try to identify who really needs health insurance, so as not to give it to them.

And we have health care providers devoting enormous resources fighting with the insurance companies to actually get paid. And the result is a wildly inefficient system. It would be cheaper, by far, to just cover everybody. We pay this huge price, because we've managed to convince ourselves, or be convinced, that somehow something that–

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–every other advanced country does–

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–and that

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–we do ourselves-

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–for the elderly–

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–is impossible.

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Thank you.

Paul Krugman, thank you very much.

[APPLAUSE]

Pretty well-timed actually. Speaking against the motion, John Stossel, my colleague from ABC News. But we did not discuss this ahead of time. In fact, though both of us have worked a quarter of a century at ABC News, we've never met until tonight, bizarrely enough.

Separate orbits, I suppose. I kept my feet on the ground. John Stossel's hard-nose take on many a liberal policy assumption is summed up in his catch phrase, "give me a break."

Tonight, in a sense, we're discussing what if you break your arm or your neck. Should the federal government be there to provide your insurance safety net? John Stossel here to argue against that idea and the motion tonight.

It is intuitive to think that it should, that we have the very poor and helpless people, and it's the job of government to help them. And actually, we have that. We have Medicaid.

If you are poor, you are covered in America. It's not a good system. It's tempting to think that's a wise government could step in.

Paul Krugman has just said, look at Medicare. People like Medicare. And that's true.

But of course they like it. Because it gives you stuff free. People like that.

But it's unsustainable. It's $35 trillion in the hole. That's the unfunded liability of Medicare.

They made promises to cover us when we're 75, when the panel is 75. There's no way they can possibly do that. Right now, it's working.

Because there are lots of young people and relatively few older people. But there's just no way it can be sustained. If a private company tried to run its pension system that way, I bet they'd throw the owners in jail. It's a Ponzi scheme.

Now, some people will talk tonight about the widely publicized data that America spends the most on health care. And we do. And studies have found that we have the worst result.

But those studies are deceitful. They compare us by how long we live. But Americans are different.

We drive cars more. We kill each other more often. Our accident rate, deaths on the highway, triple that of the United Kingdom.

We murder each other 10 times as often as the United Kingdom. When you take that out, we live longer than those other countries. And that doesn't even include diet issues.

Because we eat more. And that kills people. A lot of these studies are skewed to make America look bad.

Now, many people say that the perfect system is in Europe, where you have universal health care. It's true. Most other countries do have systems like that.

And it gets rid of the horrible anxiety that some people have in America. Will I be covered? And that is horrible. And that does make people sick.

But it's better to be anxious than to be in horrible pain or to be dead. And these universal coverage systems, they don't guarantee universal access to actual care. In Canada, more than a million families can't get a doctor.

We taped in one town in Ontario where they have a lottery. They have a little box. Everybody puts the family name in. And the town clerk pulls out a name. Oh, you get to see a doctor this week.

There aren't enough doctors to go around. In Britain, one in eight patients waits more than a year for treatment in a hospital. The Journal Clinical Oncology says 20% of potentially curable lung cancer patients become incurable on the waiting list.

Now, why does this happen? Well, because when everything is free, when the government pays for it, everybody wants everything. But the government doesn't have infinite money.

So the government then must ration it. And they do it by not giving you the latest, most expensive stuff. Or they make you wait in line.

In one town in England, they opened a new office where you could get dental treatment. People lined up for blocks. Now, most of them didn't get in. So people pull their own teeth with dental tools or pliers and vodka.

So it's not a good way to live. Still, despite the fact they spend less, European care is not remarkably inferior. It's pretty good for most people.

But that's true only because they free load off of us. Because most of the innovation comes from America, from the greedy, profit driven companies that want to take as much money from you as they possibly can. They're the ones who gave us so much good stuff, the MRIs, the CT scans, ACE inhibitors to lower blood pressure, vastatins like Lipitor to reduce cholesterol, coronary bypass surgery, hip replacement, knee replacement.

What will the world be like if we have universal care and we don't have America to invent those things? Yes, the private market is awful in many ways and wasteful. Health insurance companies waste all this money on advertising, paperwork, duplication, claims officers trying to make sure you're not cheating them.

It is intuitive to think a single payer would be more efficient. And Michael Rachlis, who will speak shortly, has written that a public bureaucracy is cheaper. And I used to believe that when I attended Paul Krugman's university.

I was taught that, that the wise elites in Washington and state capital can plan these things better than these competing companies. But then I became a consumer reporter. And I watched the market work.

I watched government and private, greedy companies trying to deliver services to people. And now, I say that's nonsense. Government can't do anything even close to the efficient way that private companies do it. When government pays for things, people don't change.

They don't innovate. They keep doing the same thing they did to get paid. So as an example, look at the inefficiency of the private car companies.

They waste millions on advertising and my program. I'm glad they do. And they run these gross ads. They sell cars not based on their engineering, perfection, or safety.

They sell sex and muscle cars. They have these competing dealerships and pushy salesman, selling things like rust proofing that we don't need. Despite all of that, what's the worst you get when you buy a car in New York?

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The worst you can get is better than this. This is what the planned economies universal coverage gives us. And I apologize to those of you on the radio.

You can see. I'm holding up a picture of the Trabant, that East German car. This was the best those brilliant East German engineers could produce. It was an awful car.

You had to put the oil and gas in separately and shake the car to mix them together. As soon as the Berlin Wall went down, this disappeared. Because it couldn't compete with the mediocre products that were produced by our competing companies.

I don't want to have this kind of health care. And that's what we'll get if government runs it. At the beginning, government can do things well.

You get the Peace Corps, New York's public schools. But after a while, it deteriorates.

Because they don't change. They don't improve. Maybe once every 12 years, they change a little. If we have–

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–universal health care–

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–this is what we'll get.

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Thank you, John Stossel. We have a Canadian in the house tonight, Michael Rachlis, a physician who–

[APPLAUSE]

Maybe we have a lot of Canadians in the house tonight. Michael Rachlis is a physician, who has lived on the other side of the US, Canada border. He trained in Canada.

He practices medicine there. He is a health policy expert there. And given that Canada so often is the example cited for why universal coverage is the solution or why universal coverage is the problem, we are pleased to have Michael Rachlis standing at our podium to argue for the motion, universal health coverage should be the federal government's responsibility. Michael.

Thank you very much, John. And I'd like to thank the Rosenkranz Foundation and Intelligence Squared very much for inviting me to New York. I've had a wonderful time while I've been here.

I also have a strong personal connection to the United States. My wife is an American. And I visit her family on a regular basis and see the great health care that the United States has and the terrible health care that this country has.

And one is given to her father and one is given to her uncle. And the difference is insurance coverage. I've also slept overnight– I don't want to give the impression I sleep around. But I've slept overnight in 23 US states.

And I have a pretty good idea of the health care system in this country, as even my daughter has used it when she had a catfish spine through her palm in Florida. Now, as Paul said, this is very much a question of values. And it's actually a case where you can have your cake and eat it too.

In fact, you can only eat your cake if you have it. In other words, you can only get cost control if you have equity. And as Paul as said, as we've heard others say, the US system cost most in the world. It denies care to tens of millions of Americans. And I have seen that personally.

And the international performance and quality is just so-so. Does this really reflect American values? Is this really what you want out of your health care system?

In Canada, our values for health care go back to Tommy Douglas, the Premier of Saskatchewan between 1944 and 1961. And when Tommy was a boy in my hometown of Winnipeg, Manitoba, he developed Osteomyelitis, an infection in his leg. There were no antibiotics at the time.

The recommendation of the doctors were that his leg should be amputated. Fortunately, Dr. Robert Smith, a noted surgeon, saw Douglas, told him that because he was an interesting case he would treat them for free if he allowed teaching students to– he allowed Dr. Smith to teach with him. Douglas was left with the impression all his life if he hadn't been fortunate enough to run into Dr. Smith and the interesting, he would have lost his leg.

Then a few years later, after Douglas' government in Saskatchewan had implemented universal hospital insurance and universal medical insurance, despite the fact in the 1940s being the poorest province in Canada, Justice Emmett Hall, a Supreme Court Justice in Canada and if anything a conservative, was asked by our then Prime Minister John George Diefenbaker to review our health care system. His conclusion was that we should move ahead with medical insurance. Because we already had hospital insurance. The main reason he gave was efficiency.

He said that it would be a lot cheaper to have a single payer system than to have multiple private payers. And so his vote was for efficiency. And those are the values in which our system are based, equity and efficiency.

What are the results? 50 years ago, we had the same health system as your country. We had the same health status.

We paid the same amount for health care. 50 years later, all Canadians are covered for hospitals and physician services. In the United States, millions have no coverage and tens of millions have inadequate insurance.

We actually get more of most services than Americans do. We have more visits to doctors every year, more days in hospital, more days in nursing homes. We take more prescription drugs than you do.

I mean, not all of these things are good. Too much health care can kill you. But even though there are some services we don't get as much of– like nobody in the world does as much cardiac interventions as you do.

The Belgians are close, but nobody really else is close. We actually do more bone marrow transplants. We do more lung transplant surgery.

Toronto is an international center for lung transplants. And far from lacking innovation, we're the country that brought you insulin. We developed bone marrow transplantation.

When Paul Tsongas was telling the electorate years ago that he wouldn't have got his service in Canada, it greatly expanded the two doctors in Toronto who had developed the procedure. And all of this cost way less, 10% of our GDP compared to 16% in your country. How does that happen?

Well, half of the extra expense is administration, because of the extra expense of this multiple payer system. The other half is due to higher prices. Because you don't have effective cost control. Because you don't have a single payer.

Now, this must cost us a fortune. We must be basket cases. The Canadian federal government has run surpluses equal to 1% to 2% of our GDP for 11 years in a row. There's no problem affording health care when you do it because you're concerned about other people. Then you can make it affordable. And our health status, of course, is not a true reflection.

But from what you'll hear perhaps from there panelists and others, you'd imagine Canadians are dying in the street waiting for medical care. In fact, we now live three years longer on average than you do. This if over a 50 year period.

We've now got a three year longer life expectancy. Our infant mortality rates are 20% to 30% lower than yours. And finally, it's a great boon to business in our country.

The province of Ontario in the last couple of years has been assembling more motor vehicles and any US state including Michigan. The cost manufactures are 9% of payroll for health care costs in this country, 1.5% in Canada. Our manufacturing sector is under pressure. But it would be gone without our health care system.

So Canada has done well. But Canada is not the outlier. Canada is the outlier in North America. Around the world, wealthy countries, all wealthy countries that Americans would think of when they would think of other countries they could live in with the comparable standard of living, all other countries have a mainly public system.

And Canada does have problems in its system just as every country has problems. Our problems are second order problems. We've dealt with coverage. And we've mainly dealt with affordability.

So we have waits and delays in Canada.

[BELL]

They're improving. But we do have them.

But France and Germany have much shorter waits for care than you do in this country. So despite the individual anecdotes that you're going to hear, health care in Canada or Germany or France are remarkably similar to the US. A recent letter to the editor by Lou Holman from Rochester, New York reported on his heart attack in Toronto while he was visiting. And he was having his surgery within one hour of calling the ambulance.

So let's get serious that health care is pretty standard in most developed countries. We have similar problems in delivery. You are the only ones that really have problems with coverage and affordability.

So it comes back to values. If you focus on equity, you get a bonus. You get cost control.

If you focus on cost control, you don't get equity or cost control. And I strongly encourage you folks to vote for our side. Thank you.

[APPLAUSE]

Thank you, Michael Rachlis. I am John Donvan. And this is Intelligence Squared US, Oxford style debating.

We have six panelists for and against the motion. The motion in this debate is universal health coverage should be the federal government's responsibility. We are halfway through the opening statements at this point, halfway to our Q & A section.

But I'd now like to introduce arguing against the motion, Sally Pipes, author of The Top 10 Myths of American Health Care, A Citizen's Guide. She is President and Chief Executive Officer of the Pacific Research Institute, a think tank based in California. She also comes from Canada. But not only does she argue against this notion, two years ago she completed a personal journey and became a citizen of the United States. Sally Pipes.

I'm against the proposition that universal coverage should be the responsibility of the federal government. I do think that everyone here would agree that the key goal for America is affordable, accessible, quality health care. The question is how do we achieve that goal?

There are two competing visions for health care reform in this country today and also for achieving universal coverage. One focuses on government, mandates, and taxes. While the other focuses on free markets, innovation, and empowering consumers.

Today, that government vision is on the rise. The long-term goal of most liberals is a Canadian style, single payer, Medicare for all health care system. These liberals tell us that socialized systems like those in Canada and Europe are better and cheaper and can provide universal coverage for all of us.

They also cite, as Michael did, life expectancy and infant mortality as evidence of the superiority of these systems. Well, let's look at life expectancy. People who make this claim usually note that life expectancy is higher in Canada and Europe.

The World Health Organization ranking does not measure, though, the quality of a health care system. The World Health Organization ranks systems that treat people equally higher than those that treat people well. Now, let's look at infant mortality.

The US does have a higher infant mortality rate than Canada. Hence, their government system is rated better. The reality is that the United States, with its superior neonatal care facilities, has allowed more high risk babies to live.

But this also pushes the infant mortality rate higher, because of a greater number of at risk births babies being born. And in other countries, many of those at risk babies do not live and are not counted in infant mortality statistics. Earlier this year, a woman in Calgary was expecting quadruplets.

There wasn't a single neonatal unit for that woman to deliver her babies. She was airlifted to Great Falls, Montana, a city of 55,000, where she successfully delivered her quads. I'm from Vancouver, Canada.

I was home three years ago visiting my mom. And the front page story in The Vancouver Sun was pregnant mother with twins airlifted to Edmonton, Alberta. When they came back, the husband in the interview on the front page of The Sun said the Canadian health care system is that of a third

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