Can this be done in 15 hours 02wk9dis1

[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.

[BELL]

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

[BELL]

[BELL]

[BELL]

[BELL]

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–

[BELL]

–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.

[BELL]

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?

[BELL]

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–

[BELL]

–universal health care–

[BELL]

–this is what we'll get.

[BELL]

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 world country.

Now, let's look at adult cancer survival rates. A study published in the August issue of the British journal Lancet Oncology said that America is much better at treating cancer than Europe or Canada. Researchers found that Americans have a better survival rate for 13 of the 16 most prominent cancers.

For example, breast cancer survival rate among American women is 83.5%, whereas in Britain, 70%. American men and women are 35% more likely to survive colon cancer than their British counterparts. Now, I have discussed the data.

But let's look at the reality of universal coverage systems in Canada and Europe. Michael Moore in his movie Sicko, where I have a cameo appearance, points to the wonderful health care systems in Canada, France, England, and Cuba. And he says they're all free.

The US does spend, as has been pointed out, 16% of its gross domestic product on health care, while Canada spends in the range of 10% to 11%. The reason that Canada spends 10% to 11% is because the government sets a global budget and says that's what we're spending. And what is the result?

Long waiting lists for care, rationed care, and a lack of access to the latest technological equipment. Today in Canada, there are 827,000 Canadians waiting on a waiting list for procedures.

There are 3.2 million, or 10% of our population, waiting to get a primary care doctor. The average wait in 2007 from seeing a primary care doctor to getting treatment by a specialist was 18.3 weeks. That's over four months.

Canada ranks 13th of 24 OECD countries in memorize MRIs and 18th out of 24 in CT scans. When I turned 50– I know it's hard to believe that I've turned 50– but when I did, my doctor in San Francisco said you have to have a colonoscopy. And I said, well, there's nothing wrong with me.

I don't need a colonoscopy. Well, anyway, I had one. But my mother in Vancouver, Canada, three years ago, July, started feeling ill and was convinced she had colon cancer.

But her doctor kept saying you're old. There's nothing wrong with you. Go to bed, sleep more.

Finally in December, my mom started hemorrhaging from her colon. Her doctor said, you have to go to the hospital in an ambulance to get service in the emergency room. I could not take her. After being in the emergency room for a number of hours, she was then transferred to the transit lounge, where she waited for two days to get a bed in a room.

But she was not counted as waiting in an emergency room, because she was in the transit lounge. The issue is that she was too old, it was decided by the health care system, to have a colonoscopy when she was convinced that she was ill. And what about people with government coverage wait and wait in socialized systems–

[BELL]

–except the politicians.

Belinda Stronach, former Canadian MP, opposed any privatization of Canadian health care. And yet, when she was diagnosed with breast cancer in June, 2007, on the advice of her doctor, she flew to UCLA, and had her breast surgery, and paid for it herself. As my friend in Vancouver Dr. Brian Day, orthopedic surgeon and head of the CMA, Canadian Medical Association, told The New York Times, Canada is the country in which your dog can get a hip replacement in under a week, and in which humans wait two to three years.

Is this the kind of government run health care system Americans desire? Think about the post office. Think about the DMV and the handling of Katrina. A majority of Americans rate the quality of our system as excellent or good. In Canada, according to [INAUDIBLE] only 33% rate the system as a grade A or B. And 22% say it's failing.

[BELL]

Canadians intuitively know that long ways are the outcomes of government run systems. While we could no longer deny there are problems in American health care, markets, consumer choice, and innovation will solve them rather than putting the government in charge.

Thank you, Sally Pipes.

[APPLAUSE]

You owe me eight seconds. Striding to that lectern now is Art Kellerman, who is a surgeon at the ER at Grady Memorial Hospital, Atlanta's public hospital. He's also Professor of Emergency Medicine at Emory. And given that, as we know so often, the solution that the uninsured come to when they need medical care is to go to an emergency room, it is extremely valuable to us to have on the panel somebody who is at the receiving end of that process. I give you Art Kellerman.

Thank you. Actually, I'm not a surgeon. I am just an ER doc. And I don't have the distinguished background of my fellow panelists. But I have treated thousands of patients, insured and uninsured.

And I've also broken bad news to hundreds of families. I want to tell you about one of them that I'll never forget. It took them two hours to reach Atlanta from the North Georgia mountains.

I faced them across the outstretched body of their son. The ventilator hissed rhythmically, 10 breaths per minute. I spoke first.

Your son was in a terrible crash, I said. The ambulance crew could tell he was severely injured and called a helicopter. He reached us about three hours ago.

He has several injuries, a collapsed lung, internal bleeding. But these aren't his most serious problem. His brain injury worries us the most.

That's when his mother interrupted me. She said, doctor I don't know how to ask you this. But I must.

My husband lost his job six weeks ago. I work, but my employer doesn't offer health insurance. Is my son– is my son gonna get the care he needs? Momentarily taken aback, I replied.

Ma'am, you're at Grady Hospital, one of the finest trauma centers in the South. I swear to you we will do everything in our power to save your son. I meant what I said that night.

But I didn't tell her the whole truth. I didn't tell her that our best probably wouldn't be good enough and that if her son survived, he'd probably be disabled for the rest of his life. I didn't tell her that she and her husband would be billed for the helicopter flight and the days or weeks to come in the intensive care unit and that the total would probably reach $100,000, maybe a whole lot more.

I didn't tell her that she and her husband would empty their savings and mortgage their home in an effort to pay the bill. And it wouldn't be enough. And that the coins put in the coffee can at the local diner wouldn't come close to covering the difference.

I didn't tell her that the unpaid balance of her son's bill will push Grady Hospital closer to insolvency, closer to its own crash. And if Grady closes, North Georgia, a region of more than 5 million people, will lose its only level one trauma center, it's only burn unit, it's only poison control center, it's only emergency psychiatric unit, and 750 inpatient beds.

And that's not all. If Grady closes, metro Atlanta's private hospitals, already overburdened by population growth, will topple like dominoes one after another. Ladies and gentlemen, for me, this debate is not an idle and intellectual exercise. It's about lives, 300 million American lives.

I support this resolution for three reasons. First, because our failure to cover every American is a national disgrace. Second, because we'll never achieve universal coverage if we don't make health care in this country more affordable.

And third, because the only way we could make health more affordable and cover everyone is through a well-regulated health care marketplace. And to do that, the federal government must be involved. Now, let me be clear.

The majority of Americans do not want a government only health care system. But they absolutely want the government involved as a referee, as a cop, to make sure that everybody plays by the rules. The other side of this debate will try to convince you that rising health care costs are due to government interference.

Well, they've got it backwards. The problem is not government interference with the health care industry. The problem today is health care industry interference with government.

That's why the business of medicine is booming, record profits, huge executive salaries, bonuses, health care costs spiraling out of control year after year after year. But the caring side of medicine is failing. On the front lines, doctors, nurses, and other health care professionals are nearly as frustrated as you are.

The nationwide crisis in emergency care is a case in point. Every major challenge we face, ERs packed with patients, dangerously long waits to be seen, a half million ambulances a year turned away to more distant hospitals, and fewer specialists than ever willing to take ER call, all of them are due to the fact that the economics of health care encourage hospitals to favor elective cases over emergency patients. Good for business. Bad for patients.

And it's terribly expensive. Country music star Dolly Parton one quipped, "you have no idea how much it costs to look this cheap." The same can be said about American health care.

You have no idea how much it costs to run this poorly. We spend $2 trillion a year on health care. And $1 trillion is a lot of money.

Put this in perspective. A million seconds ago was last week. A billion seconds ago, Jimmy Carter was inaugurated president. A trillion seconds ago was 30,000 BC.

For $2 trillion, we can take good care of everybody in this country and have a lot left over. And you don't have to look outside the US for proof. If everybody practiced medicine as efficiently as they do in Rochester, Minnesota, in Salt Lake City, Utah, Medicare could pay 30% less to doctors and hospitals. And everybody would get better care.

[BELL]

But it won't happen on its own. Because one person's waste is another person's revenue stream. That's why we need a cop on the beat.

And the only cop with the clout to get the health care industry to play by the rules is the federal government. My side has given you several reasons to vote for tonight's resolution. But the most compelling one of all is your own self-interest.

Because a health care system that doesn't work for everyone may not work for you when the chips are down. Take it from me, an ER doc, no one can predict when a life threatening emergency may strike. But if it does, you'll want your doctor to go the extra mile, not your ambulance.

Thank you. Thank you, Art Kellerman. Our final speaker, speaking against the motion, is Michael Cannon. He is the Director of Health Policy Studies at the Cato Institute, which is the nation's leading think tank formed around the philosophy of libertarianism, which can very crudely in primitively simplistically be summed up as, live and let live.

But I suppose the question is do you need insurance to follow through on that? Michael is arguing broadly and firmly against the notion of universal health coverage being the responsibility of the federal government. Michael.

Thank you. We do have a moral obligation to care for those who are in need of medical care. But that's not where the disagreement lies tonight. Where we disagree is over whether universal coverage is going to help us fulfill that moral obligation or, as I will argue, make that moral obligation harder to fulfill.

So you've heard a lot of things about how wonderful universal coverage will be. You've heard that it will probably be all things to all men and women. It'll make us taller and thinner. And it'll save us money.

So let's look at a couple of the actual likely effects of adopting universal coverage here in the United States. First off, it's not going to save us money. Yes, other countries do universal coverage.

And they do it on the cheap. Or they do it for less money than we do. But there's absolutely no way that can happen in the United States.

And here's why. Expanding insurance coverage means more people are going to go to the doctor. More people are going to use medical services.

That costs more money. The Urban Institute estimates that it would cost at least $120 billion. That's at least. It's going to cost a lot more than that.

Now, with the government in control, it's tempting to think that we'd be able to ratchet that spending down over time, so that we're more aligned with other nations. But with the government in control of whatever universal coverage scheme you could dream up, the industry is going to prevent the government for doing just that. Art Kellerman is right.

The industry does have too much influence over government spending in the Medicare program. And they use that influence to prevent the government from reducing spending, from eliminating inefficient spending, wasteful spending. They've done it for Medicare's entire history.

So although it's tempting to think that we could do universal coverage and we could save money on it in the process, we would have an easier time moving the uninsured to Switzerland, than we would have moving Switzerland's spending levels here to the United States. Now, you've also heard that universal coverage would improve the quality of care. We actually have some pretty systemic problems when it comes to quality here in the United States.

I'm not a big proponent of the US health care sector. The experts tell us that the uninsured only get what the evidence said is the best recommended care about half the time. But you know what?

Quality problems are so systemic that people in Medicare and Medicaid and people in the United Kingdom's national health service, which is their universal cover system, also only get what the evidence says is the best care about half of the time. And the reason is that government doesn't pay for quality. And it's been lagging the private sector in coming up with quality improving innovations.

Now, in the private sector, we have the same quality problem. But I'll have more to say about that in a moment. One big quality problem is that we have alarming rates of medical error here in the United States.

Universal coverage is not going to help to prevent these medical errors. It's not going to help nurses read doctor's chicken scratchings and avoid the errors associated with those. It's not going to encourage physicians and other clinicians to wash their hands between patients, so they're not passing on infections.

Nor is it going to prevent errors by encouraging doctors to follow standardized protocols when inserting a central line. The same Institute of Medicine– I'm surprised this statistic hasn't come up tonight. But I'll bring it up.

The Institute of Medicine– and I'm on a commission that Dr. Kellerman served– estimated that 18,000 Americans die every year from lack of health insurance. I believe that. That seems plausible to me.

The same Institute of Medicine, however, estimated that up to 100,000 Americans die every year due to medical errors in hospitals. All universal coverage is going to do is bring more people into that broken system. It's not going to do anything to fix that system.

And yes, we might save this one life over here, from this person who didn't have health insurance. We'll be ignoring these five deaths over there. Another quality problem that we have in the United States is we have alarming disparities in health outcomes.

We have disparities between different racial groups of 15 to 20 years in terms of life expectancy. And some American face mortality risks similar to what you see in Russia and sub-Saharan Africa. Universal coverage is not going to do anything to solve that problem.

Sherry Glied, who's the head of the Mailman School of Public Health at New York's Columbia University wrote recently quote, "socioeconomic differentials in health are large and growing and appear to be growing in countries that have universal coverage as well as in those that do not," end quote. Now, it's true, universal coverage may save some lives. It may save this one life over here.

So that seems to be something in its favor. But I actually hear the news isn't even all that good. Because health economists tell us that if you have a dollar to spend on improving health, there's absolutely no evidence that spending that dollar on universal coverage is going to get you more of an improvement in health than spending that dollar on any number of other things, including clinics, reducing medical errors, improving nutrition, fighting poverty, or even improving education.

So ironically, to vote for universal coverage does not show how much you care about your neighbor's health. It actually shows how little you care about your neighbor's health. Because you're willing to forgo the added health benefits that might come from spending that dollar on some of those other strategies.

Now, there is something very wrong with America's health care sector, something the universal coverage will not solve. You can see what it is, I think, when you look at the Veteran's Health Administration. Now, I can't remember if this has come up already, if Professor Krugman mentioned the Veteran's Health Administration.

But this is hailed by people who support universal coverage as exhibiting the superiority of government in dealing with the problems presented by health care. I think that the VA story is very important. But I don't think that it tells the story that supporters of universal coverage think that it tells.

The VA has made impressive strides using electronic medical records to focus on preventive care, improving quality, avoiding medical errors. The reason is not some inherent superiority of government. The reason is really just two features of the way the VA is organized.

They're called integration and prepayment. If anyone cares, we can talk about what those mean later on. But those features are not unique to the Veteran's Health Administration. They exist in private health plans all over the country.

You know them as plans like Group Health Cooperative, Kaiser Permanente.

[BELL]

And those plans are using health information technologies to reduce cost, improve quality, and reduce errors. Now, why don't you have electronic medical records, like you have electronic financial records? Why doesn't the hospital remember your medical history, your child's medical history, your allergies, and these sorts of things?

Well, the biggest reason is America's pursuit of universal coverage. Medicare is America's great experiment with universal coverage. And it's also the largest purchaser of medical care in the nation.

And Medicare actually penalizes doctors and hospitals if they use electronic medical records to reduce costs or to avoid medical errors. Electronic records help avoid duplication. But Medicare pays for duplication.

So if you adopt those, you make less money. Health information technologies help to avoid medical errors. But Medicare pays for medical errors.

So if you adopt those health information technologies, you lose money. So providers make less money if they do these things that are in patient's interests. Meanwhile supporters of universal coverage are trying to keep those private health plans that had used these things from participating in Medicare.

Why doesn't Medicare–

[BELL]

–stop paying for duplication and errors?

[BELL]

Because government resists change.

[BELL]

So I don't think the–

[BELL]

–VA's success has demonstrated government's brilliance–

[BELL]

–so much as how government actually impedes the pursuit of– [BELL]

–quality, affordable health care. Thank you.

Thank you, Michael Cannon. Well, you've now heard all of the opening statements. And we're at the point of being able to share with you the poll results we took among you, the audience, when you first arrived.

And they'll come up on the screen behind me. Before the debate again, 49% of you were for the motion, 24% against, 27% undecided, which you know means that if you three leave right now, you've won. Yeah. I think we're past that point.

John Stossel, Art Kellerman suggested that there's a conflict between keeping people healthy and making money keeping people healthy. What about that?

There are conflicts always in making a profit and delivering service to your customers. And you get rich if you service your customers well. The hospital that keeps people healthiest gets a reputation for doing a good job. And that's how capitalism works. You get rich by doing well.

But I heard you also argue that you feel that there would be much less innovation in the US system if there were not profit motive behind development.

Totally. We take the benefits of the profit motive for granted all the time, the fact that I can go to a foreign country, stick a piece of plastic in the wall, and cash will come out. And I can give that card to a total stranger, who doesn't even speak English, and he'll rent me a car for the week. And when I get home Visa or MasterCard will have the accounting correct to the penny.

But the government can't even count the votes accurately. And yet our instinct is to go to government.

Art Kellerman?

We had a lot of talking about cars earlier. And I think everybody's familiar with economic problems that GM is having right now. And actually, I think GMs cars are better than Trabants.

But they're carrying about $5 billion a year in health care costs. Several years ago, the CEO of GM testified before Congress and said, $2 billion out of their bottom line every year was just for drugs. Now meanwhile, Pfizer, the second largest pharmaceutical company United States, last year reported $19 billion in profit, 37% profit margin.

I'm a big believer market economics, too. But I don't want our auto industry to end up in Ontario. I'd like to keep a lot of it in Michigan. So I don't understand. I mean, I do think profit is good.

But I think when one industry can basically drive another one into the ground and harm our country, regulation is out of whack. And let me just– one other point. The FDA cannot take the cost of a drug into consideration when it approves the new drug.

It just has to be better than nothing. That's not by accident. Congress prohibits the FDA from considering cost effectiveness of new drugs. That's not the case in UK. It's not the case in other countries. It should not be the case here.

But it's precisely–

Paul Krugmen, I'll come to you in just a moment. Michael Cannon, against the proposition.

for the reason you raise earlier, Art. The industry has way too much influence when the government gets involved. And it's nice to think that we could have this wonderful universal coverage plan.

And we could just get the industry. We could just not have the industry be a part of it. We could cut off their influence.

But we know that the industry's always going to be around. We know that there will always be drug companies, and greedy private health insurance companies, and Republicans who will mess things up like they messed up FEMA, and they mess up everything else. So you can't say that universal coverage is this wonderful idea and we can separate out this part.

This is an inherent part. All the rent seeking from the industry, and all the buffoonery from the Republicans, unless you have a plan to abolish Republicans, they're part of your plan.

Paul Krugman. Paul Krugman for the motion.

Maybe we could put them in camps.

That came–

Death camps.

Paul Krugman for the motion.

Did I [INAUDIBLE] happy camp.

That came wonderfully into exactly what I was going to say. We have had Katrina used as an example. And I thought to myself, as I always do, it must be wonderful to be a conservative.

Because you can take control of the government, make a mess of things, and say see? That proves my point. Isn't that wonderful? And I would also add, since John Stossel has used vote counting, you know, it's not that this particular government isn't able to count votes. It was sort of that they didn't want to.

Michael Cannon.

What's your plan to deal with Republicans? Do want to abolish them? Or are they part of your plan?

Medicare has its problems, but has continued to function. If we have a well-established system, it continues. Social security is a system that's working with high efficiency. The point is to get this thing– it is. If you have paid any attention, it works fine.

If you pay attention to Medicare, you have to know that one third of the money spent is wasted. That it rewards doctors for medical errors.

And private insurance? That's the thing. I actually just– I wanted to ask a question.

Please [INAUDIBLE].

I wanted to ask, actually two questions, to the audience. First, how many Canadians? Would Canadians in the room please raise your hands.

We have about seven hands going up.

OK. Not as many as I thought. OK Of those of you who are not on the panel who are Canadians, how many of you think you have a terrible health care system?

We see almost all of the same hands going up.

Bad move on my part. I've got a selected– all right. I won't try it. But I will say that–

We should check the papers.

No. It's a-

Sally Pipes. Let's bring Sally Pipes into the conversation. She is against the motion.

I just want to talk a little bit about Medicare. Remember in 1965 when Medicare and Medicaid came in and the cost is about $3 billion? And it was projected to cost $12 billion in 1990.

Well, in fact, it costs $107 billion. Last year is cost $427 billion dollars. It's estimated in 2017 to cost $884 billion dollars.

The Medicare trustees say the program will be broke in 2019. There is no cost control in Medicare. It's completely out of control. I think we need to give vouchers to people on Medicare and put consumers and seniors back in charge of their health care. But the issue is is everyone loving Medicare?

The recent congressional commission said that one in three Medicare patients is having a very hard time getting a doctor. And I have talked to many seniors who are having a hard time getting a doctor under Medicare. Because the reimbursement rates by the government for the 8,000 procedures on the list are too low. And docs say I'm not going to do it.

Sally Pipes, hold on just a moment. Because I want to come back to you for another question. I want to, at this point, tell the audience that in a couple of minutes I will be coming to you for questions.

And there are microphones being held by ushers toward the rear. And if you raise your hand, they will find you. And then I will find you.

So just wave in my direction to get my attention. Sally Pipes and Michael Rachlis, you're both born, raised, trained in Canada. But hearing you, Michael, argue for the proposition and, Sally Pipes, hearing you argue against it, are you from the same country?

It's hard to tell.

But seriously? What about the Canada that Sally described?

I think that– well, you've heard the other side say you can't trust research. So I guess that we just have to go on gut feeling and spin, is that right?

Did we say that?

No.

I think that–

Can we check the record?

–Sally has mentioned, well, disparaging the international research. In fact, one of the people in the audience is one of the key people doing international research. Maybe she can speak for herself as to whether or not it is useless. But I feel that the international research is valuable.

And it shows that by and large other countries are delivering the same level of care. The unfortunate thing that happened to your mother, Sally– I'm very sorry for that– that could easily happen in the United States. It could happen in any other country.

A family doctor, who doesn't for a variety of reasons take a particular complaint seriously, that stuff happens. The rate of medical error in all developed countries is about the same. Although, the studies have been done slightly differently, eight countries have done studies in all countries. 5% to 10% of all deaths are preventable deaths that occur in hospital.

Modern health care has some very serious problems. And this country, in fact, is a leader in looking at quality in health care. Dr. Donald Berwick, the Founder of the Institute for Health care Improvement, is the preeminent person in the world on this issue.

Sally, what about that?

But Canada doesn't have problems with coverage. And neither does Germany or France. And we don't have problems with affordability. We have second order problems, because we haven't dealt with the quality issues.

Michael, let me give Sally a chance to respond.

Well, I mean, If you look at the Canadian health care system, it's not free, as Michael Moore said. Canadians pay dearly for the system through their taxes. What tax increases would we have to have here in America to provide another $120 billion for universal coverage?

I think you could cut taxes.

Well, I don't– I don't–

That's what the budget office said in 1994. Adopting the single payer system would save so much money on extra administration. And then you could cover everybody.

Art Kellerman–

You ration care in Canada. And people are wait– and my mother is not a single example. There are thousands of examples in the mainstream media from The Toronto Star to The Globe and Mail, it's all there.

A woman stood up on Parliament Hill when Paul Martin was Prime Minister. And she stood there with her Canada Health Card. And she said, what good is this Canada health card when I don't have access to the health care system?

Art Kellerman, our ER man.

First of all, I heard some really interesting comments made from the other side earlier. I just want to say, y'all can't make stuff up. Because none of you are running for president.

I'm ineligible.

Second, thing, Sally, you mentioned about Medicare. You know, we've had a recent experiment with private health plan efficiency. Private health plans have start administering Medicare.

They're getting paid an average of 12% more per enrollee. That's nearly $1,000 more per person than traditional Medicare administers the same program. This is going to add $8.5 billion to the cost of Medicare this year in 2008.

And since 2004, those plans will of sucked an extra $33 billion out of Medicare trust fund without improvement care of beneficiary. So again, Michael, I think you're right.

We got a lot of people that have gotten their hands around the federal till. And it made federal government a cash cow. I think federal government needs to be a watchdog.

Let's bring the audience into it.

I want to agree with Art. I want to agree with him about–

This is Michael Cannon.

–how Medicare advantage costs the taxpayers more. I want to agree and disagree with Sally. I don't think that we do any better in terms of health outcomes here in the United States. But those things don't get you where you think they do.

The fact that private insurance companies are ripping off the taxpayers through Medicare is problematic. But the alternative is let the doctors in the hospitals do that. Because they're the ones who've been doing that for the first 40 years.

I want to say one other thing.

No. I'm not done yet. And I don't think we lead the world in terms of health outcomes. But that just means we're doing poorly. Other nations are doing poorly. No one is innovating in order to make those improvements in medical errors.

Except we got the Kaisers and the Group Healths out there that are actually doing this. And you just made an argument against having them participate in Medicare. You're trying to keep those innovations out of a government program.

Art, hold your response to that to perhaps your summing at the two minutes. Because we do want to go to the audience.

Can I just add–

Gentleman. Now, if you're a member of the media, we ask you to identify yourself by name and organization. Otherwise, it's your choice. Sir? And remember, 30 seconds.

It isn't a dirty secret that we cannot afford to have everyone have all the health care that they would possibly want. And so in America, we ration it by price. And other countries ration it by lottery.

Paul Krugman, let hear from you on that.

Yeah. No. That's definitely true. Although, it's not clear that we're really at the point where that's the critical limitation. At this point, just eliminating health care that actually does no good at all would probably be enough to save a large amount.

That's what the Congressional Budget Office says. In the very long run, what happens when we have the $30 million immortality treatment, that sort of thing? This becomes a big problem.

I just want to break one more thing. We've been talking a lot about quality of care. But there's one other thing that is very important, which is the financial ruin that often comes from medical expenses.

And that is preventable. And that's only in America, the individual, the family that is financially ruined. Every time I look at one of those studies that says, well, we can't show that providing health insurance makes that much difference in health outcomes, first of all, I don't quite believe it.

But secondly, there is a tremendous difference in terms of not the medical side, but the economic side. And this is something, again, there's a risk, a fear, a terror of medical expenses, which happens, among wealthy countries, only in America.

I'm glad, Professor Krugman, that you're letting some economics creep into your remarks tonight. I want to point out though that the AARP recently released a study that showed that bankruptcy rates are rising fastest among those people who are covered by our only universal coverage program. Not only are they rising faster among that group than for other groups. But for other groups, those bankruptcy rates are falling. How is that consistent with what you said about universal coverage protecting us from financial ruin?

No. I'm not talking about bankruptcy rates. I'm talking about all kinds things.

Well, what? Give me another financial ruin.

Those are eldery, right? The elderly.

Give me another measure of financial ruin.

No, come on. There are–

All right. Let's go back to the audience in the middle. You may want to identify yourself.

Yes. I'm Betsy McCaughey from the Hudson Institute. I'm worried about seniors and what the impact will be of a Medicare for all system on them. In countries with Medicare for all, seniors are denied treatments that seniors in the US can get.

The thinking is that the public health dollars are better spent on young people, because the benefits will be more lasting. For example, two years ago the British National Health Service decreed that seniors with wet macular degeneration could not get the drug Lucentis until they've already gone blind in one eye. Then they could get it to save the other eye. Why should seniors in the United States take that risk and support a Medicare for all system?

Sally Pipes.

Well. The thing is that in Britain, there are other examples. Tarceva, the drug for lung cancer that is available here, it's NIHCE, the National Institute for Health and Clinical Excellence a government bureaucracy, says Tarceva is not cost effective, and therefore you're too old I have it, you're denied it. You can go out and pay for it in the market.

But all of your services provided then under the National Health Service are no longer available to you. Is this what we want? This is what we're talking about in Congress right now with the CER, the Comparative Effectiveness Research. We want to do this in the United States. This is going to destroy the innovation that John Stossel was talking about. And it's going to destroy our ability to live longer and healthier lives. It's not what the American people want.

Sally Pipes is against the motion. Gentleman on the right.

There are a lot of personal stories being told tonight. And I'm glad to say that I have health insurance. And the idea of increased wait times for a medical procedures terrifies me.

But then I think about the 15% of America who have no insurance. And how long are their wait times? So basically what I can't wrap my brain around is how can a system based on companies that make a profit on denying our care be made responsible for paying for our care?

John Stossel. Well, you're right. The insurance companies have a conflict. And the insurance company has to balance.

They want a pay for nothing. They hope none of you ever get sick. And if you get sick, they don't want to pay.

But of course, if they do that, word gets out. And they don't get any new customers. So that's how they have to balance that. That's how all businesses balance that.

Or they wouldn't if you were able to choose your insurance company.

That's the other problem. You have to buy insurance here in New York from in New York insurance company. And because the politicians, always wanting to give you more, have loaded it up with all these extra guarantees. You must pay for Viagra, and in vitro fertilization, and acupuncture, or hypnosis, or pastoral counseling. I forget what's all on the list of mandates.

All right, this is–

You're not allowed to buy from Wisconsin where insurance costs a fourth as much.

The reason you have to buy from a New York insurance company is because New York has community rating, which means that an insurance company cannot turn you down if you have a preexisting condition. And if they throw it open across the country, then people who don't have a preexisting condition, people who are healthy, can go shopping.

And it's not some kind of crazy thing, because they want people to have hypnosis. It's because they're trying to protect people who would not otherwise be able to get insurance. And that gets at the irresponsibility of the arguments that are made so often.

Thank you, Paul Krugman. Art Kellerman.

They've been so many points out here that I wish we could address. One I want to talk about is waiting times. Because you hear that all the time.

The waiting times that matter are the waiting times for things like when you go to the ER and how quickly you see a doctor for a heart attack, how quickly you get stroke care, whether or not if you've got acute or worrisome symptoms you can see your doctor that day or the next day, or you end up having to be in an ER. We're turning away one ambulance per minute in this country from overcrowded, private as well as public hospitals in the United States. If you've got to limp around for two months on the bum knee until you get a new titanium knee, I'm sorry.

That's not going to kill you. You don't get to me for 30 or 45 minutes, because you've been diverted from three hospitals. You're going to die. That's the waiting times that we need to worry about in the United States. And it's not going to happen if we ignore this problem.

Michael Cannon, against the motion.

Professor Krugman mentioned that community rating laws like you have here in New York are intended to help the sick obtain health insurance. The leading researcher in the country on insurance markets, specifically the individual market where you buy insurance directly, is a man named Mark Pauly. He's at the University of Pennsylvania. And what he's found after researching what actually happens in insurance markets is that those laws, the community rating laws that Professor Krugman favors, reduce the number of people with health insurance.

And they don't provide health insurance to many more sick people. And the reason is that unregulated markets really do a remarkably good job of providing health insurance to people with expensive chronic conditions, provided they purchase health insurance while they're still healthy. So these regulations–

Yeah.

And, yeah. And it's expensive and difficult to do. But you cannot have an insurance market unless people do that. Because no one will buy insurance until they need it.

You can't have a homeowner's insurance market if people can buy coverage after their house burns down. That is the market's way of encouraging people to do the right thing and pay into the pool, while they're still healthy.

Question from the audience, ma'am.

Yes. I have a question about America's competitiveness and how it's influenced by these issues. Art Kellerman mentioned GM. I was also thinking about another engine of growth, which is entrepreneurs in America.

Most new jobs are generated by entrepreneurs, not by the companies. And usually, entrepreneurs cannot offer health care, because the rates are so prohibitive. So this in fact, decreases our competitiveness.

And this is just one issue along with the big companies. I mean, globalization is not going to go away. I think it would be a relief to many sectors if health care wasn't a drag on their process.

So your question is?

I'm looking at big business and how it affects globalization–

But you would like to know? But you could kind of like to know what?

OK. I would like to know the six panelist's views on how can we possibly keep going forward the way we are is we're status quo when we're going to have huge competition from India, China, and other places that can out-compete us?

Well, John, I think that's right up your alley, that question.

We already have huge competition from China and India and Europe, these countries with universal care. And by and large, we're cleaning their clocks. America's created 20 million new jobs while Europe created 2 million. So yes, GM has to pay more for health care than steel. And that's awful. But in these other countries, they have to pay huge amounts in taxes. And that's even more crippling.

Point of fact, I think the United States created 23 million jobs when some other guy was president. And actually, employment growth in Europe has been faster since 2000 than the United States. So it's a little bit out of date.

And I like to add that–

Michael Rachlis, for the motion.

You think you're cherry picking times. He picked the 20 years? The United States has created ten times as many jobs.

I don't know what that 20 million figure refers to. I think that was a number just sort plucked out of the air.

OK, let's stop there. I think Michael Rachlis–

Yeah. In all this talk about health care with traditional economic models, really that is one of the main reasons why you folks have not been able to make progress is using traditional marketplace models focused on that as your ideology to analyze health care, which is not in any way close to being a traditional economic market. And to apply some sort of economic language the way we're hearing from the other side to a system, where the supply side is massively regulated for good reasons– do you want to have to look up every single provider that you see to find out whether or not they passed their licensing exams or not? Now, the extension of this argument would be Milton Friedman's one of just absolutely no regulation whatsoever. But–

Fine with me.

–that doesn't deal with health care where, by and large, for key decisions consumers can never be at the same information level as the agent who is recommending those services.

Sally Pipes, you look like you're dying to say something.

I'm just dying to say that we got a lot of the mess that we're in this country, including part of the 46 million, is because the federal government gave employers a tax advantage to provide health insurance. And as a result, 60% of people in America, get their health insurance through their employer. If you lose your job or your quit your job, we don't have affordable health insurance.

If we make a few simple tax changes, such as refundable tax credits or an income tax deduction, we really need to focus on growing the individual market, so that people can buy insurance across state lines, people can get the type of insurance that fits their needs. We can grow the individual insurance market. Because competition will work.

And when we have 1900 mandates on insurance across this country, it's impossible for an insurer to provide a stripped down policy, which 2/3 of the uninsured are in that 18 to 30 age bracket. And they don't want to buy insurance with, as John said, in vitro fertilization, alcohol rehabilitation. We can open up this market and cover a lot of those people.

Because of the 46 million uninsured, 17 million earn over $50,000 a year. And 10 million earn over $75,000. A lot are young. They're healthy. And they don't want to pay $4,000 a year for insurance to cover things that they don't need to care fore.

Thank you, Sally Pipes. Question down front.

Many of those folks have illnesses. And they cannot get insurance no matter how much money they pay.

If you open up the market, new competitors would come into the market.

No.

And they would be based on competition.

Health care is not a market like other markets.

Well, it's not a right.

It's not even close to being a market like other markets.

Timeout. Too many people talking at once. It's not making sense. Michael, go ahead. Michael Cannon, speaking against the motion.

Health care presents a lot of interesting challenges. And the question is not, oh. Well, it's special. So therefore markets can't do it.

The question is, well, you know, markets and governments have advantages and disadvantages. And which one works best? Which set of tools works best for this particular problem?

I've always enjoyed hearing from proponents of universal coverage that the US has this market driven, for-profit health care sector. You know, the government controls half of the money in our health care sector. And because of government tax policy, employers control another quarter of it.

So 75% of the money is controlled by someone other than the consumer. How in any way is that a free market? I'm reminded of a favorite expression of my brother's.

He likes to say, you know, you're pissing on my shoes, and telling me that it's raining. What's driving these costs, and what's driving these quality problems, are those 75%. And I'll stop there.

Thank you. Question upfront.

I have a quick question for Dr. Kellerman. You mentioned the Mayo Clinic as a model of efficiency. And I think we all recognize that it is a model of great health care.

What's the impediment right now of having more Mayo Clinics in this country. Why don't we have them? Can the market provide that?

And I don't know that we could look anywhere. People come all over the world to Mayo Clinic. Why doesn't universal health care coverage provide that in other places?

The Mayo Clinic has a great philosophy. It's very heavily focused on primary care. They're very heavily focused on efficiency.

You don't have to be efficient to be successful in this country. I just have to talk you into getting all the tests that I want you to get. I need to talk you into getting the procedures you want. You know, we just talked about economics.

Everybody these days is complaining about gas prices with good reason. But if we ran our oil industry the way we're running our health care industry, gasoline would cost $16 a gallon. And one out of every six American cars couldn't burn it. We can do better than that.

Question from the back there.

My name is Tony Meyer. And I care about this issue, too. And in 2002, I founded a company that today is one of the largest managers of defined contribution programs for corporate America. And we work with General Motors and Ford and Chrysler and many other great American industrial companies.

This had better be a question and not a commercial.

There is. There is. This is not an advertisement. My question– and Miss. Pipes., you just mentioned it– no one has talked about the fact that we have a unique health care delivery system, which is really managed by and large employers. It's unique in the world.

Nobody's talked about whether that's a problem or a solution. Should it be reformed, discarded, modified? I'd be curious to what the panel thinks of that approach.

I think it does need to be changed. Because if your employer–

[INAUDIBLE].

Yes. I mean, if you're employer is paying about $15,000 for your health coverage, that might not be the kind of health coverage that fits you as an individual. You may not want that type. But if we open up the market and give individuals the same tax incentive– because if you go out in the individual market and buy insurance, you don't get a tax break on that.

But if you get it in decreased wages, but through your employer, it's cheaper. And you're able to get it, because you're part of that pool. So we need to, as John says, actually discard that model and move away from it. You know, we can move away from it overnight. But we can make some changes in the tax code that will allow the individual market to grow.

And we don't get our life insurance, we don't get our long-term care insurance, are home insurance from our employer. As I said, this was a gift during World War II. And it was a terrible gift that has distorted, in my mind, a great deal of the health care system.

Paul Krugman.

It's not the system you would design if you were starting from scratch. And it's not the system we want to end up with. But it's a system that at least did the basics of risk pooling for a lot of people.

It's a system that did deal with the problems of preexisting conditions and people being screened. And it does somewhat reduce the problem of insurance companies competing not to deliver care, but who can do the best job of finding who really needs insurance, so as not to give it to them. I have no grief for that system.

But the idea that what we need to do is scrap it and move to an individual insurance market, which has never worked anywhere– it's the most amazing thing that what we have coming from the conservative side is the belief that universal health care, which works all across the world, is undoable and the individual market, which has never worked anywhere is the answer to our problems. Extraordinary leap of faith.

Are you familiar with Professor Pauly's research on the individual market?

Yeah. I've seen some. But you know, there just isn't enough out there.

Well, if you've seen some, that's where reality enters the discussion.

Time is up for this section. Thank you very much, the audience, for actually terrific questions. I want to remind you just before we move to the summing up section in which each of the panelists will have two minutes, I want to remind you of how you voted when you came in if we could put the slide up again.

Before the debate, 49% of you agreed with the proposition that universal health coverage should be the federal government's responsibility. 24% of you were against that motion. And 27% were undecided.

In the next 10 to 12 minutes, you will hear us summing up. And then we will vote one further time. And our first panelist to begin his two minute summary, John Stossel.

Oh, OK. If you think health care is expensive now, wait till you see how expensive it is when it's free. When it's free, there are no controls. I don't think this side is saying the American system is a good system. It's not a market.

We're spending other people's money. Government is already involved spending about half the money. Third parties pay for about $7 out of every $8. This is an awful way to pay for things.

Think how it would work if your car insurance worked that way. If they paid for your gas and your oil, you wouldn't care what gas costs. And people would sell you $100 oil changes.

That's what's going on in health care under insurance companies paying or the government. And employment based insurance makes no sense when 4 out of 10 Americans change jobs now every year. Government is not the answer. We don't have government steel mills or government airlines anymore.

Because they were awful. And once they had competition, they went out of business. Michael says medicine's different. But every profession says that.

It's true. You're not an expert. You don't know whether which doctor's the best. But you don't know which car is best.

You're not car engineers. But through word of mouth, the good news spreads. The bad companies go out of business. The good doctors will take over.

And we see this now where there is a market, the tiny places like cosmetic surgery, Lasik eye surgery. The doctors give you their email addresses. Does your doctor do that?

They give out their cell phone numbers. The waiting rooms are nice. And the prices are going down, while the quality is going up. The post office can never give us what FedEx can.

Thank you, John Stossel. John Stossel, speaking against the motion. Speaking for the motion in his summary, Paul Krugman.

Ah. In the course of this debate, I actually felt– I don't know whether the audience will agree– but I actually felt that John Stossel in effect conceded when he held up that Trabant at the end of the– because that just shows if all you can do is say Communism Communism, East Germany. I don't want us to move to East Germany. I just want us to move to France. Now, look. Government health care is imperfect.

Actually, government health care is not even the issue. Government insurance is imperfect, so is private insurance. There are horror stories.

The nature of health care is that lots of bad things happen. You don't generally seek health care, because you're feeling great. But we have extensive experience.

We have Medicare, which is a system that is flawed, but has actually shown slower cost inflation than private health insurance over the past 40 years. We have the Veterans Health Administration, which is our little island of true socialized medicine in the United States and does very well. And above all, what we have is a system right now– remember what the proposition is.

The motion is that the federal government should guarantee health care, not that the government should run everything, not that everything should be under government control, not that we should nationalize the steel industry, which keeps on being raised. But you know, it's not on the agenda, or nationalize the auto company, but whether there should be a federal guarantee of health care for everybody. And that I think is something that America values, that our fundamental morality says is something we should be doing.

Thank you, Paul Krugman. In making her two minute summary against the motion, Sally Pipes.

Although it would a nice if the federal government could solve all of our health care challenges, current events both at home and abroad show that it cannot. As a Canadian, I watched firsthand the promise of free health care. And I saw it devolve into the reality of a high tax bill and long lines for advanced care.

As a waiting lists grew over the years to more than four months in 2007, an increasing number of Canadians have traveled to the United States for treatment and paid out of pocket, whether it's Mayos, the Cleveland Clinic, or UCSF system. The number of illegal private clinics in Canada has grown significantly over the last few years. The government is afraid to shut them down even though private health care is illegal in Canada for fear of an immense outcry.

In June, 2005, the Canadian Supreme Court ruled in a monumental decision that the ban on private health care in Quebec is a legal. Quebecers are entitled to life, liberty, and the security of the person. Long waiting lists do not give you that security. Madam Chief Justice Beverly McLachlin said, "access to a waiting list is not access to health care."

Claude Castongay, Chair of the Quebec Royal Commission on Health Care in the 1960s recommended that Quebec adopt government health care. The Quebec government followed his advice. And they called him the Father of Quebec Medicare, just like Tommy Douglas the father Medicare.

This year, he released a report an official government report, evaluating Quebec's ailing health care system. His conclusion, it's in crisis. He now urges legalization of private health insurance.

Americans believe in freedom and personal responsibility, not big government. They don't want big government controlling our lives. The question is who do you want to control your health care decisions, an HMO bureaucrat, a government bureaucrat, or you yourself? By supporting universe choice in health care and empowering consumers, we will achieve universal coverage. Thank you.

Thank you, Sally Pipes. We're next going to hear from Michael Rachlis. Michael, your two minutes begin now.

Yes. I want to mention that there is virtually no flow of Canadians south of the border. The Canadians getting health care south of the border, 99% percent of them are like my daughter who had a catfish spine through her palm, people on vacation. The waiting list issue, I mentioned that it is a problem in Canada.

But other countries with universal systems don't have waiting list problems. It is not a problem of universal coverage. In fact, in Toronto right now, because of public response to the concerns about waiting lists, if you need cataract surgery, if you need your knee replaced, if you need a hip replaced, phone one number. You can be seen in an assessment clinic within one week usually.

And you can get your surgery within a month after that. And it doesn't cost you any money directly. Because you pay it in your taxes.

And the taxes in Canada, as a share of GDP, are almost as low as they are in the United States. And we've had surpluses for 11 years. I think what you're hearing from the other side are a whole series of anecdotes.

And yet, the overall research indicates that every other wealthy country in the world where you would feel comfortable visiting and living has universal system. And I think what you really have to watch out for is what The New Yorker commented on April 20, 1992, referring to then, the first President Bush, "the compulsion that derives President Bush to distort the facts about Canadian health care suggest that official American policy is in the process of becoming what conservatives in discussing the Soviet Union used to call a total ideology, a system blindly convinced of its absolute truth.

And yet, so fragile in its relationship to reality that it is incapable of considering even the most obvious reform. Surely, we should have learned by now what happens to ideological systems that begin to deny facts that their people can discover for themselves just by crossing a border." Cross the border.

Come to Canada. Anybody in the audience, contact me. I will show you the Canadian health care system.

And then America should do universal coverage in its innovative fashion. Make health care a right. And then do it right.

Michael Rachlis, summing up for the proposition. Summing up against the proposition, Michael Cannon. Michael.

At the reception before we came in here, I was standing across from a man who was reading his program. And when he came to the part with my picture on it, he looked at the picture. He looked up at me.

And he said, hey, that's you. And I said, yes. That's me. And he said, you're against universal coverage?

And this look came over his face. The question that was forming was something like what kind of a moral reprobate could be against universal health insurance coverage? And I know that I have a lot of family here tonight who are asking themselves the same question.

My opposition stems from two beliefs. One is that people should have the right to choose their doctor. They should have the right to choose their health plan.

And those things are often lost in systems of universal coverage, almost uniformly. No, I think totally lost. And second, universal coverage is not going to make us healthier.

We have serious problems here in the United States with rising costs, with low quality care. And we have health plans in the private sector that are trying to innovate with ways to reduce those costs and to improve the quality of care. The only problem is you can't choose them, because the government has said you can't.

The only problem is that the government controls half of the money in our health care sector. And so the industry is able to block those innovations. Because they want to protect their incomes.

You can have a health care sector that guarantees universal coverage. Or you can have a health care sector that continuously makes medical care better, cheaper, and safer, making it easier to deliver on that moral obligation that we have to help less fortunate among us. You cannot have both.

Thank you, Michael Cannon. Finally the last word goes to Art Kellerman. Art Kellerman is not a surgeon, as I incorrectly said before. Art Kellerman is an ER doctor at Grady Memorial Hospital in Atlanta and a professor at Emory summing up for the motion universal health coverage should be the federal government's responsibility. Dr. Art Kellerman.

Have you all heard the expression that there are no atheists in foxholes? I can tell you in my experience there are no libertarians in intensive care units. It's widely said that Americans can pick their doctor.

The fact of the matter is if you're on a non-group plan, or you're in a plan that doesn't contract with these doctors over here, but you can over here, every day I see patients whose care is disrupted because their plan has shifted doctors. They didn't get the deal they wanted. We've surrendered an enormous amount of freedom in this country to the private insurance industry and to the rest of the industry.

We can collectively together do better. In just a few moments, you're going to vote again. And the six of us care a lot about how that vote turns out.

But that's really not the vote that matters. The vote that matters is coming up on November the fourth. And I encourage every one of you to do your homework and do your homework on the candidate's positions on health care. Because they are strikingly different.

And they, to some degree, break down along the lines of the debate tonight. And it should make a difference in the choice that you make then as well as the choice that you make tonight. I want to close by going back to the bedside of that family.

I didn't tell that mother the whole truth that night. But by staying silent and withholding the truth, I left her with something we both needed, which is hope, hope that her son would beat the odds. Sometimes we see young people come back from catastrophic injuries and do OK, hope in Georgia and every other state in this country would develop efficient, effective regionalized trauma and emergency care systems so everyone can have access to lifesaving emergency care. And most important, hope that this great nation of our, the United States of America, will soon, finally, do the right thing and cover the uninsured so no mother need ever ask again will my son get the care he needs. Please, vote for tonight's resolution.

[APPLAUSE]

Well, we're done. But for your part, this was a really terrific debate. And I want to just, for all six– this isn't just Art's applause now- – for all six.

[APPLAUSE]

So pick up those voting keypads. You may recall that when you came in here 49% of you were for the motion that universal health coverage should be a federal responsibility. 24% of you were against. And 27% of you were undecided.

So you can begin the voting process, which you seem to have gotten down the first time quite quickly. Number one, you're for the motion. Number two, you are against the motion.

Number three, you remain undecided or became undecided. Everybody's good? OK. I want to thank you.

Before we go to the results, I just want to thank the panelists and especially all of you in the audience. Because the questions were first rate and moved the discussion into interesting places. I want you to also know that our next debate will be Tuesday, October 7, 2008.

The motion is going to be America is finally winning the war in Iraq. Panelists for this motion will be Fred Kagan of AEI. He is widely seen as the architect of the surge.

And also, retired Four Star General Jack Keane for the motion. Against the motion is Charles Ferguson, the writer director of the Iraq War documentary No End in Sight. And Sir Malcolm Rifkind, the former Foreign Secretary and Defense Secretary of the UK and a current member of Parliament.

These debates that you are taking part in as audience members can also be heard in more than 150 NPR stations across the country. Please check your local NPR member station listings for the dates and times of the broadcast. Also, copies of books by the author's are on sale in the lobby in plentiful supply.

You can learn more about their ideas in depth. And I'm quite serious about that. Finally, we're pleased to announce that our December 2 debate, where the motion is Bush 43 is the worst president of the last 50 years, will– not voting now, please– be recorded for broadcast on BBC World News Television.

To accommodate for that taping, we will be moving the debate to a larger space, Symphony Space Theatre on 95 and Broadway. This means that there will be more seats available. A limited number of tickets will be made available.

And now, to the results. The question of who won the room before the debate, for 49%, against 24%, undecided after the debate. 58% are for the proposition. 34% against. 8% undecided.

The applause you hear was actually for both sides of this debate. Because in terms of sheer numbers, the majority of the audience came into the debate supporting the side for motion. And that was true afterwards.

However, in terms of persuasion, the side against the motion managed to change more minds throughout the evening. Their support went up 10%, while the side for the proposition went up 9%, a mere 1% difference. So congratulations to both sides.