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CNN Larry King Live

Health Care Reform: Fact vs. Fiction

Aired August 12, 2009 - 21:00   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

WOLF BLITZER, CNN ANCHOR: Tonight, death threats over health care reform -- the issue could be tearing America apart.

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE: We had scheduled this town hall meeting to go fwd.

(CROSSTALK)

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BLITZER: What do critics fear?

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE: We're all afraid that we're going to lose something.

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BLITZER: Will you be able to keep your doctor?

What about your current insurance?

Are lives at risk if things change?

Confusion, chaos and questions.

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE: How are you going to look at my children, in their eyes, and tell them they're going to have a better future?

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BLITZER: Does anyone have the answers?

Next on LARRY BLITZER LIVE.

Welcome to LARRY BLITZER LIVE.

I'm Wolf Blitzer sitting in tonight for Larry.

We have an outstanding panel of four physicians. We're all going to get smarter in the next several moments, as we try to understand what's going on in this health care debate. Joining from us now from the CNN Center in Atlanta, Dr. Sanjay Gupta. He's our chief medical correspondent. He's a practicing neurosurgeon.

Joining us from Nashville, Tennessee, former U.S. Senator Bill Frist. He's a professor of medicine and business at Vanderbilt University. He's a heart transplant surgeon, former Senate majority leader. His new book, tomorrow, entitled, "A Heart to Serve: The Passion to Bring Health, Hope and Healing." That comes out in October. We're looking forward to that.

In Cleveland, Ohio, Dr. Michael Roizen. He's the chief wellness officer and chairman at the Wellness Institute at the famed Cleveland Clinic. He's the coauthor of the number one best-seller, "You Staying Young."

And in Austin, Texas, Dr. J. James Rohack. He's the president of the American Medical Association. He's a cardiologist himself.

Let me start with Dr. Gupta -- Sanjay, viewers are confused out there. This debate is raging across the country.

What's the single most important thing that we have to understand about this debate right now?

DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Well, it's a good question. And, obviously, there's a lot of different issues here. But let me try and boil it down, as much as I can, to get back to the basics.

Almost since the beginning of this, you've heard the president talk about the health care and the economy. And when asked, how could he afford to do all of this with regard to health care right now, his response has always been how can we afford not to do this?

And the reason that's important is because this idea of -- of trying to cut costs in an effort to increase access has really been at the heart of all of this.

You have -- what you're hearing out of -- out of these various bills is, first of all, is the president doesn't have a specific plan. The Senate is currently debating one. It's only so far in the House that you've actually had a bill passed, trying to fill in the gaps of the 46 million people who don't have insurance.

And that's really where a lot of the crux of this debate lies -- how are you going to do it, how are you going to pay for it?

The House bill, incidentally, Wolf -- and a lot of debate swirling around this -- according to the Congressional Budget Office, is going to come up about $240 billion short in terms of being able to pay for itself. Some of it would be paid for by -- by cutting inefficiencies, by focusing on prevention and wellness, those sorts of things.

I've read through this bill, Wolf. It's almost 1,200 pages. There are a lot of things in the bill that I think are confusing, still, to people.

Will there be federal subsidies for abortion?

What will happen with illegal immigrants?

What about end of life care?

And what is the government's role going to be in this eventually, as things sort of play out -- Wolf?

BLITZER: All good questions. And we're going to try to get into some of those answer.

Dr. Rohack, does the American Medical Association support the president's efforts right now to reform health care?

DR. J. JAMES ROHACK, PRESIDENT, AMERICAN MEDICAL ASSOCIATION, SUPPORTS OBAMA'S HEALTH CARE PLAN: We support the goal of affordable quality health insurance coverage for every American, because, simply put, if you don't have health insurance in America, you live sicker and you die younger. And for us, as physicians, who care for patients every day, we want to make sure that the one second where a patient suddenly loses their job and doesn't have health insurance -- that's something we want to change.

And so we address the goal of affordable quality health insurance. And that's the reason why the AMA has been engaged in this for many years and now, at this important historic time in our nation.

BLITZER: You support the goal, but I just want to be precise, you're not ready to say you support the House language, this 1,000 plus page document that Dr. Gupta was referring to?

ROHACK: Well, we supported H.R. 3200, which was the bill to move the process forward. We knew that if something didn't come out of the House, then nothing would happen at all. And the status quo, basically, is unacceptable for millions of Americans who don't have health insurance or those who have a prior condition, try and buy health insurance, and then find that that insurance won't pay for that preexisting condition.

So we want to move the process forward so we can have affordable, quality health insurance for everybody. You can have your doctor. The doctor and you decide what's important for you. And we think that bill allows some of this to move forward so we can come up with a conclusion that's important for America.

BLITZER: Senator First, you're a physician, among other things, right now.

Where do you stand, because you obviously were a politician for a long time?

Where do you stand right now on whether or not this should go forward or they should go back to the drawing boards? BILL FRIST, HEART TRANSPLANT SURGEON, FORMER SENATE MAJORITY LEADER, OPPOSES OBAMA'S HEALTH CARE PLAN: Well, Wolf. You're right. I spent 20 years practicing medicine in heart surgery, in heart and lung transplantation, and 12 years in politics. And my perspective is this. We've got the best health care in the world -- the very best -- the heart transplants, the technology, the innovation, the cancer therapy.

But we have huge gaps and disparities that have to be addressed. The fact that we have about 20 million people who are uninsured that really deserve, in a country as rich as ours, to be addressed, so that they do have afford about access to health care. And Dr. Rohack is right, if you don't have health insurance in this country, you tend to live a less healthy life and to die earlier. They deserve that.

The real problem, though, is the overall cost going up about three times -- your premiums going up three times faster than wages. And that really can't be sustained. We have a moment now in time where we can address both of those.

And unlike what the AMA has done and endorsed that House bill, which I don't think does anything in terms of bending -- or so-called bending the cost curve or slowing down the growth of health care costs, that will drive up the deficit $239 billion over a period of time, actually makes the system worse.

I think that we need to stay at the drawing board, listen to the Senate very carefully, listen to Max Baucus, listen to Chuck Grassley, listen to the Senate Finance Committee, who are putting forth a bipartisan effort to do both of those things...

BLITZER: All right...

FRIST: ...address the hard core uninsured and bend that cost curve down.

BLITZER: Spoken as a former member of the Senate, so, obviously, you have your -- your friendships there involved, as well, Senator Frist.

Let me bring Dr. Roizen into this conversation. You're at the Cleveland Clinic. It's one of the great hospitals in the world. You're on the front line. From your perspective, should this health care reform process that the president would like to see happen, should it go forward?

DR. MICHAEL ROIZEN, CHAIRMAN, WELLNESS INSTITUTE, CLEVELAND CLINIC: I think it has to go forward. It is for our competitiveness, for jobs and for our society as a whole. We're twice as expensive as Europe, three times as Asia, because we have twice the chronic disease of Europe, three times of Asia. It's like we have a sink that is overflowing with chronic disease.

And what we've got so far is people are giving us more military operations -- more access. Or the insurance companies are telling us to mop faster. The real question is what can we do to turn off the faucet of chronic disease and unplug the sink.

And Senators Wyden, with co-sponsors on the Republican side, Cornyn, and another, Senator Hatch, if you will, from the Democratic side, have got a bipartisan solution. It's called Take Back Your Health, where they actually pay to do lifestyle treatments of chronic disease that will save enormous amounts of money.

So the key is don't just mop faster, don't just give us more mops. We've got to turn off the chronic disease. And what gets paid for in medicine gets done. And that's what this bill does, it lets us turn off the chronic disease faucet.

BLITZER: All right. Now, we're just getting started. I know that Dr. Gupta wants to weigh in. He's got a good question for some of his colleagues here on this panel.

I want to take a quick break. We're also standing by. We're going to speak with Dr. Andrew Weil. He's standing by via Skype. I want to get his -- his perspective, as well.

Lots more coming up on LARRY KING LIVE.

(COMMERCIAL BREAK)

BLITZER: What do you think about health care reform?

Go to CNN.com/larryking. Click on blog. Tell us what you think. Do you, A, support President Obama's health care plan; B, do you oppose it; or, C, don't know enough about it. Remember, cnn.com/larryking the place to go.

Joining us by broadband is Dr. Andrew Weil, the famed physician. He's the founder and director of the Arizona Center for Integrative Medicine. His Web site, by the way, is www.DrWeil.com. His new book entitled, "Why Our Health Matters: A Vision of Medicine That Can Transform Our Future." It goes on sale, by the way, September 8th.

Good luck, Dr. Weil, with the book, although I'm sure it will be a huge best-seller.

What's your perspective on this debate that's underway across the country right now?

DR. ANDREW WEIL, FOUNDER, ARIZONA CENTER FOR INTEGRATIVE MEDICINE: I have a somewhat different perspective. I think that unless we change the content of health care, any attempt at reform is doomed. Any system we set up, whether it's single pay or universal coverage, is going to be taken down by uncontrollable costs. We have to lower the costs of health care. And the kind of medicine that we now practice is not sustainable because it relies on extensive health solutions.

BLITZER: So what does that mean to change the content?

WEIL: So I think the trick is to figure out how do we get these costs down?

The first step is prevention, obviously.

But, secondly, we have to train physicians and other health professionals to use low tech interventions for common health problems.

BLITZER: Give me an example.

WEIL: Well, you know, I -- I wrote a recent blog about the treatment of GIRD -- gastroesophageal reflux disease. The standard way of managing this is to give proton pump inhibitor drugs. These are expensive drugs that suppress acid production in the stomach. They may be useful for some people. They're not intended for long- term use. There are simple measures -- dietary adjustment, use of natural products like EGL, a licorice extract which increases the mucous coating in the stomach.

The problem is our -- our physicians are not trained to use these less expensive, low tech interventions. And this is what we should be doing first, before we go to the expensive kinds of medicine that we now use for everything.

BLITZER: What -- what responsibility, in your opinion, do physicians out there -- do doctors have for this problem, as you see it?

WEIL: Well, I think, it's -- it's up to physicians to learn these other ways of dealing with disease. You know, physicians are as discouraged and angry as patients today. And great numbers of physicians are leaving the practice of clinical medicine because they've lost their autonomy. They're very discouraged that what's done in medicine today is dictated by policy reimbursement, not really by science, not really by evidence or good physician's judgment.

So I think, you know, there's -- there's enormous discontent among both physicians and patients. We -- this is a huge problem. And we can't change it just by trying to give more people access to the present system. The present system is a disaster. It doesn't work. We have to -- I'll just repeat, we have to change the content of health care, the nature of what we do in medicine and health care, if we're going to have a sustainable system.

BLITZER: Is that your explanation, basically, why the World Health Organization recently rated the United States -- and I'm looking at the study right now -- 37th in health outcomes, even though the U.S. spends, per capita, a lot more money?

WEIL: Well, this is the -- this is what should make us so furious. We spend more per capita on health care than any people in the world and we have nothing to show for it. Our health outcomes are dismal.

Now, that's largely the result of the fact that we have such a large percentage of uninsured people who don't have access to health care. But this is -- you know, when you -- when you hear people say that we have the best health care in the world, I'm sorry, that's not true. We have excellent health care for a select number of people for select conditions.

But even now, we're seeing outsourcing of health care. We're seeing Americans going to Thailand; to India, of all places; for high tech operations -- coronary bypass, hip replacement -- because they can get better care in those countries.

We aren't -- we do not have the best health care in the world. And we should be embarrassed by the amount of money that we spend and what we have to show for it.

BLITZER: Dr. Weil, thanks for coming in.

I appreciate your perspective.

We're going to take another quick break.

We'll get back to the other physicians. They have different perspectives on what's going on, when we come back.

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BLITZER: Crowds turned out once again today. As we indicated earlier, some people had serious questions. Some had their own agenda.

Here's what they were talking about Wednesday in Maryland and Iowa.

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UNIDENTIFIED MALE: And your cohorts up there on Capitol Hill, how are you going to look at my children?

(APPLAUSE)

UNIDENTIFIED MALE: If we don't get health care costs under control, our national debt will continue to grow.

UNIDENTIFIED MALE: We, the American public, are given the time to really understand and digest that and that we not run this through like we did the stimulus package, like they did cap and trade in the Congress.

(APPLAUSE)

UNIDENTIFIED MALE: If anybody is criticizing me for negotiating, you've got six weeks to look at a bill that you wouldn't otherwise have.

UNIDENTIFIED MALE: What we expect is for you to fight for us. We do not want this nation to be socialist. Fight for us. Stand up. Don't give an inch. Democrat or Republican, for whoever, senator or congressman, vote for this bill, we will vote you out.

(APPLAUSE)

(END VIDEO CLIP)

BLITZER: We'll get back to our panel of physicians in a moment.

(COMMERCIAL BREAK)

BLITZER: We're back with Dr. Sanjay Gupta, Dr. Bill Frist, Dr. Michael Roizen and Dr. James Rohack.

Sanjay, I understand you've got a question you want to ask one of your colleagues.

GUPTA: Yes, Dr. First, you and I have talked about this, in addition to being a heart transplant surgeon and the former Senate majority leader, you also have a -- a pretty inside knowledge of the insurance industry through your family.

I was curious, when Wolf was asking earlier, do you trust the -- the insurance industry, the way it stands now, to be able to solve some of the problems you outlined?

And...

FRIST: You know...

GUPTA: And -- and also, I mean, how would this all sort of play out without a public option?

FRIST: Yes. First of all, just on Dr. Weil's comments. We do have the best health care. If you're a woman listening right now, you're not going to England because breast cancer is not treated as well. Survival is not as good -- or to Canada or a heart -- if you need a heart transplant, people come here. That's number one.

But number two, I think you're exactly right, Sanjay. What they need this time, this round, is insurance reform. Now, President Obama has said no longer health care reform, but health insurance reform.

But the problem is there's not enough health insurance reform in the existing bills today. A huge problem today is the cherry picking that insurance companies do. If you have a preexisting illness today, right now, it is next to impossible to get insurance. And that doesn't cost anything.

And so when we're talking about not bending the cost curve, the deficit being added to, effect insurance reform should be addressed in these bills, but there are not today.

BLITZER: All right...

FRIST: Now, the insurance industry shouldn't be sort of the bogeyman out there that everybody is going after, because that's not the fundamental problem. The fundamental problem is the lack of consumerism, of information, of being able to have choice itself.

But the -- the teachable moment now, the active moment should be insurance reform right now.

BLITZER: Well, on that point, Dr. Rohack, you're the president of the American Medical Association. The president says if there were a public option -- a government run-insurance agency that would compete with the private insurance companies like UnitedHealthcare, Blue Cross Blue Shield -- it would make them more competitive, more efficient and would bring down costs across the board.

How does the AMA feel about that?

ROHACK: Well, we already know that there is a government system that's subsidizes and that's called the Medicare system, as well as the Medicaid system. And both of those don't really cover the costs that it costs a physician to have a practice.

So with Medicaid, you have access issues. With Medicare, the reason this bill is very important is because there is a fatally flawed Medicare physician formula that, if nothing is done, a 21 percent cut in reimbursement January 1st, 2010 that's going to affect seniors' access to Medicare.

So sometimes people have said well, there's nothing in there -- in this bill for seniors or for physicians. And we would strongly disagree. Prior Congresses have not addressed the issue. At least in the House bill, it fixes this fatally flawed formula once and for all and allows us to look at what we can to innovate, to invest in health information technology, to bend that cost curve downward.

BLITZER: Let me bring in Dr. Roizen of the Cleveland Clinic in.

Dr. Roizen, you're the chief wellness officer there. I want you to react from what we heard from Dr. Andrew Weil, that there are these alternative medicines. For example, if you have acid reflux, don't take the Prilosec or the Nexium, but there are cheaper ways, more efficient ways to deal with a problem like that.

Does he have a good point?

ROIZEN: He has a very good point. But I would bend his point to being we have basic problems. We overeat. We, in fact, don't eat the right foods. We don't do physical activity. We still smoke too much and have too much stress. If we deal with those, that's the lifestyle, the easy treatments that, in fact, we can get and bend the cost curve.

That's why Senator Wyden came to the Cleveland Clinic, to study what we were doing, because we bent the cost curve down for our patients. Yes, we're 50 percent of the national average for our own employees, too. And we lowered that a substantial amount last year by, in fact, getting fact food that is healthier identified easier for them; by offering free physical activity and encouraging it; by, in fact, changing the way we have stress; and by offering free tobacco cessation. Those things, if we incent physicians to rebuild primary care, exactly as Dr. Weil said, but it isn't just with an alternative to a protein pump inhibitor, it's maybe changing diet so the problem doesn't occur, or at least we can treat it with diet alone and exercise alone.

Those are really keys. And for 16 years, we've shown if you do those four things healthy, you decrease the -- both the cost and the incidence of chronic disease by between 80 and 90 percent.

BLITZER: Well, this is a subject very close to Dr. Gupta's heart, as we know.

Sanjay, what can we do, because so much of the -- the medical costs would go away if people just listened -- they exercised, they ate properly, they didn't smoke -- the things that everyone knows they have to do, but people still do it.

What can the country do to force people -- to get people to just straighten out their lives, because billions and billions of dollars would be saved and their lives would be -- they would live a lot longer?

GUPTA: Yes, I mean, I think, in some ways, you hit -- you hit the nail on the head, Wolf. People know the right things to do here. I think -- I do believe that.

As you know, I travel around the country talking about this at college campuses and various programs.

And, you know, one thing that sort of strikes me about what -- what Dr. Roizen is saying, he's obviously made this work at the Cleveland Clinic. But this idea in any way of -- of being able to legislate behavior, I think Dr. Roizen would agree, people with the very best access to health care, people who have access to the very best things in our health care system are still overweight and obese.

(CROSSTALK)

GUPTA: They still smoke sometimes.

I -- I'm curious as to how you can -- health reform will get people to change behavior.

(CROSSTALK)

GUPTA: And this is a problem, no doubt.

But how do -- how do you change that?

FRIST: Well, I -- I think that's a really important point for -- for your viewers to understand. No matter if you'd promise everybody insurance, promise everybody the same health care that a United States senator has, that's not going to change the outcome of health or the cost of health in the United States of America. Health, the burden of disease, the cost is more than just medical services, more than just universal care, more than just hospitals and doctors. It's what all of us had talked about, but you can't really legislate it.

It's behavior. Behavior is twice as important as universal health care or doctors and who's actually delivering that care, because behavior is obesity, number one. It's smoking, number two. It's wearing seat belts. It can't be legislated, though.

So to promise huge health savings in legislation in Washington which does nothing about behavior is just flat out wrong.

BLITZER: Excellent points from all of the physicians.

Unfortunately, doctors, we have to leave it right there.

We're going to bring you back on LARRY KING LIVE, no doubt about that.

Dr. Sanjay Gupta. Dr. Bill Frist, Dr. Michael Roizen and Dr. James Rohack of the American Medical Association.

We'll continue our coverage of health care reform -- is it going to happen, is it not going to happen?

We've got a political discussion on the practical results of what's going on right now when we come back.

(COMMERCIAL BREAK)

BLITZER: We want your opinion about health care. To be heard, go to CNN.com/larryking and express it. Do you, A, support President Obama's health care plan; B, oppose it; C, don't know enough about it?

You're going to see the questions on Larry's blog. Say as much or as little as you want. LARRY KING LIVE -- that's where you have to go, CNN.com/larryking.

Let's talk a little bit about the politics of health care reform -- is it going to happen, is it not going to happen?

Joining us now, Paul Begala, our CNN contributor, the Democratic strategist, and Cheri Jacobus, the Republican strategist. She's a columnist for "The Hill" newspaper here in Washington.

Listen to this exchange that happened at Democratic Senator Ben Cardin's town hall meeting in Maryland today.

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: What are you going to do to restore trust and faith in the American people that you know what you're doing and that you're not putting us and our children and grandchildren in debt over health care, cap and trade and -- and creating the illegals to get out of our country? What are you going to do?

(APPLAUSE)

SEN. BENJAMIN CARDIN (D), MARYLAND: We're going to have a -- there's going to be some disagreement in this room and I understand that.

(CROSSTALK)

CARDIN: I -- I think that the Obama administration has already started to restore trust in health care by the...

(BOOS)

(END VIDEO CLIP)

BLITZER: This is in Maryland, which is a pretty Democratic state, Paul. Where are the Democrats at these town hall meetings? We hear a lot of Republicans and conservatives showing up, complaining socialisms, taking the country away from the people. Where are the Democrats?

BEGALA: Well, actually, there's been a lot of very supportive meetings as well. Tom Perriello, a new Congressman from Charlottesville, Virginia. He's had eight town hall meetings in the last nine days. He's come away a stronger supporter. In fact, one report I read said the toughest questions he got were from the left; why aren't you for single payer health care?

BLITZER: Do you think the Democrats are doing a good job making their case?

BEGALA: I think the Republicans -- not the Republicans. Most Republicans are more like Dr. Frist. They're more like Cheri. They're responsible, reasonable people. They're not these hate- mongers. The problem is, in the absence of real Republican leadership, that's all we see. The clip we showed from Hagerstown, Maryland is perfectly fine for me. That's nothing wrong about that at all.

But painting a Swastika on Congressman David Scott's office sign --

BLITZER: He's a Democratic Congressman from --

BEGALA: Supports the president's health care plan. These politicians know that they're going to get elected or defeated because of swing voters or independents. When you start painting Swastika on somebody's door, you're probably not an independent voter.

In fact, it's back-firing. I see reports from Kathy Castro, the congresswoman from Florida, who had maybe the most contentious town hall meeting. She says this: it has strengthened my resolve. She says healthy debate is good. But rude behavior is not helpful. I think it backfires. I think it -- BLITZER: Does it backfire?

JACOBUS: I don't think this is backfiring. You take the single incident like the Swastika. That's obviously not helpful. But over all, we've seen this going on all around the country, Wolf, with literally thousands of people coming out, taking part in democracy. Hagerstown, Maryland, by the way, is my home town. You do not see people get that involved and that excited unless it's a football game between North High and South High.

So this is real. This is not manufactured. These are not people on an email trail being pushed by special interest groups. This is real.

Now the trust issue that we heard asked of Senator Cardin, with regard to President Obama -- the reason Americans don't trust this, and don't trust the president, is because he tried his hardest to get this rammed through Congress, before the members of Congress could go home and talk to their constituents. I think had they voted for this, and had this bill passed in the Congress, these town hall meetings would be a heck of a lot worse.

BLITZER: Is this August is break, five-weeks of recess, in which these people go to these town hall meetings -- they energize. They get themselves excited about all of this -- going to make it more difficult for the president to get what he wants?

BEGALA: No, actually. No. I base that -- I did some actual reporting today. I called around to a bunch of members of Congress, a bunch of their staffs. I haven't picked up one person who was for the Obama health plan and now, having been screamed at or called a Nazi, or threatened with death, even, who switched to no.

My old boss, Lloyd Doggett, gave me my first job in politics. The Democratic congressman from Texas. You've interviewed him. He says this has made him stronger. It has strengthened his resolve. So this kind of kook fringe is backfiring. It's disgracing and discrediting the legitimate Republicans and the legitimate opposition.

BLITZER: But it's energized a lot of Republicans and conservatives from the other side.

JACOBUS: Not just Republicans. I think it's unfair to say these are just Republicans out there at these meetings. I think the worm has turned on us a little bit. We heard Ben Cardin say today, at this meeting, that he would never vote for a bill that increased the deficit. Now, President Obama says that his bill is deficit-neutral. The CBO, Congressional Budget Office, say completely something else. They say it's well over 200 billion dollars that it would increase the deficit by that much.

So I think this is Ben Cardin's get of jail free card. I think you're going to see a lot of Democrats use this as their excuse to not vote for the bill, go back to the drawing board. Dianne Feinstein is also -- has some reservations because of the deficit question. So if it comes down to that, I think they're going to see a lot of Democrats have a real good excuse to not vote for this bill.

BEGALA: I think the deficit is one thing and death threats are another. There is a legitimate --

BLITZER: The death threats may be a tiny little fringe element out there. There's always going to be a crazy, lunatic fringe.

BEGALA: I think that's what the politicos are saying. They're saying just that. Look, there's always going to be a crazy, lunatic fringe. But the mainstream in this country knows this, they can't sustain the status quo. They're terribly worried about the status quo.

My worry, though, is that in not calling down this lunatic fringe, the real responsible Republicans -- and they are the majority of their party. I'm not a hater. But they're not calling these crazies down.

BLITZER: I don't know a Republican who supports Swastikas or death threats.

BEGALA: Where are the Republicans standing up and saying no? Stop the threat. Stop calling people out. Rush Limbaugh -- Rush Limbaugh --

(CROSS TALK)

BEGALA: He's the unchallenged, self-proclaimed leader of the Republican party.

JACOBUS: Rush is a wonderful conservative voice on the radio. He's not the leader of the Republican party.

BEGALA: He compared our president to Nazis. Glenn Beck called our president a racist.

JACOBUS: You're marginalizing the folks at these events, Paul, by saying that they're fringe, and pulling out these individual things that happened that are nasty, when there are literally thousands and thousands of people, who have never really been active in politics before, who are coming out and exercising their free speech, and want to have this discussion with their members Congress.

When you marginalize them by calling them names, that I think does backfire.

BEGALA: They have marginilized the Republicans, these fringe kooks, because the responsible Republicans don't have the courage to stand up to them, to stand up to Limbaugh, to stand up to Glenn Beck, to stand up to the guy who brought a gun to the president's rally in New Hampshire. He brought a loaded gun.

BLITZER: He had a license for that.

BEGALA: That's fine. It doesn't mean he should do it. It's not appropriate. JACOBUS: People are not afraid to stand up. I think we're seeing that at these town hall meetings. They're very eager and energized to stand up and talk to their members of Congress and let them know how they feel. I think it's wonderful that this vote did not go through.

BEGALA: You're not worried about the fringe? Honestly, Cheri, you're not worried about the fringe? You're not worried about violence? You're not worried about Swastikas? You're not worried about calling our president a Nazi? That doesn't affect you? As a conservative, they're trashing a perfectly legitimate political movement.

JACOBUS: I think I'm more concerned about Nancy Pelosi calling these people un-American.

BLITZER: They said disrupting debate is un-American. And it is.

BLITZER: We've got to leave it there, guys, unfortunately. But we'll continue. This debate is not going away. Paul Begala, Cheri Jacobus, thanks for coming in.

There are some interesting developments in the Billy Mays story. He's the TV pitchman who died last month. Was there a mistake with the autopsy? We'll have the latest for you on that when we come back.

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BLITZER: Billy Mays rose to fame endorsing all kind of products on TV. His death at the age of only 50 shocked so many of us, as did this from the autopsy report: cocaine use caused or contributed to the development of heart disease. That's from the report. We'll be talking about that with our guests tonight.

Let's bring them in, Dr. Cyril Wecht. He's the forensic pathologist, attorney, former coroner of Allegheny County. That's where in Pittsburgh is, in Pennsylvania. Jane Velez-Mitchell, she's the host of "Issues With Jane Velez-Mitchell" on HLN. And Dr. Reef Karim, psychiatrist and addiction specialist.

And Jane, let me go to you first. Give us some background for our viewers who may not have been paying attention to the whole Billy Mays story.

JANE VELEZ-MITCHELL, HLN ANCHOR: Well, essentially, Wolf, there's this huge controversy over the autopsy report, with Billy Mays' family saying it was unnecessary to release these sordid details. Others say, hey, don't be in denial and don't blame the messenger.

As you mentioned, the coroner's report essentially said that he died primarily from heart disease, but that cocaine was a contributing factor. They didn't actually find cocaine in his system, but they found byproducts, which they concluded meant he had used it in the days leading up. They also found several prescription meds, including Valium, Vicodin and Xanax, plus alcohol. So they were very upset that this was released, saying it was unnecessary and speculative. That brought of a lot of attention on it.

All of a sudden, you have the very famous pathologist Dr. Cyril Wecht taking a look and saying, uh-uh, he actually died of a drug cocktail, which is potentially even more damaging than what the original autopsy report said, in terms of Billy Mays' image. So it's almost like when you protest these facts that are given, and saying the toxicology report has to be wrong, it brings attention to it. And the problem can get worse for the family.

BLITZER: Let me bring Dr. Wecht into this conversation. Dr. Wecht, you reviewed the autopsy, the toxicology report. You've got some serious problems with what they concluded.

DR. CYRIL WECHT, FORENSIC PATHOLOGIST: Yes, Wolf. There are six brain-depressant drugs, including alcohol. As Jane has mentioned, Xanax and Valium, which are benzodiasapines (ph), anti-depressants, and then three narcotic-type drugs, Hydrocodone, Oxycodone, and Travedal (ph). And then alcohol, which many people don't appreciate, which is also a brain depressant drug.

Cumulatively, even those each of those is at a sub-toxic, sub- lethal level, when acting in concert, act to depress the respiratory system, and then can lead to cardio-respiratory arrest, cardiac arrhythmia and death.

In my opinion, Wolf, the release of the finding of hypertensive and arteriosclerotic-cardiovascular (ph) disease within the day or so after the autopsy was premature. You have a 50-year-old man dying suddenly. I think you should wait until the toxicology comes in.

They did not. They just released that. Subsequently, when the report came back, they seized upon cocaine, which is also present, not one of the drugs that I mentioned. Cocaine is a stimulant. I do not believe that cocaine played a role.

There is, as Jane mentioned, a metabolite, benzoleconine (ph). And that can tell us that, indeed, cocaine was used, probably any time within the last two or three days, which may also be true of all the other drugs. Then they talk about cocaine --

BLITZER: Hold on a second, Dr. Wecht. I want to bring Dr. Reef into this conversation. Billy Mays' wife, Deborah, has disputed a lot of this, saying, releasing these report, which she described as speculative, were not necessary. She also said she was simply unaware of any non-prescription drugs that he might have been taking. Based on your experience in this kind of an issue, is this realistic?

DR. REEF KARIM, PSYCHIATRIST: Yes, I agree with your other guest here, it's a central nervous system stimulant, cocaine is. And there's many other medications on board. But if they're taken in therapeutic doses, it's very possible that someone could just go around and their family members aren't aware of the drugs they're taking, or the combination potentially being lethal.

What we're talking about here is a couple of different things. We're talking about cocaine stressing the heart. That is not uncommon. That actually is very common. In fact, it increases heart rate. It increases blood pressure. And the heart has to work harder to pump out blood. And sometimes, you get atherosclerotic plaques, which are the build up of fatty deposits in the arteries, which causes turbulent flow. So the flow is not going the way it's supposed to. That itself can change a heart rhythm.

Additionally, the combination of cocaine and alcohol create a byproduct that make the affects of cocaine even more pronounced. Then, when you add the sedative, hypnotic combination, and the narcotic analgesics (ph), all those other prescription pills that he was taking, they together can decrease respiratory drive, and potentially create cardiac arrest.

BLITZER: Guys, hold on for a moment. We're going to continue this conversation. I just want to point out that LARRY KING LIVE did reach out the office of the Hillsborough County Medical Examiner, seeking reaction to the criticisms from Dr. Wecht and from Billy Mays' widow. We were told that a statement could only be provided by their public information officer, and that he was out until Friday.

We'll continue our conversation with our three guests. Also, this year's medal of freedom recipients were honored today over at the White House. We'll be back in 60 seconds with that.

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BLITZER: President Obama awarded 16 people the nation's highest civilian honor today. The Medal of Freedom Ceremony took place at the White House this afternoon. Here's a look at some of the recipients.

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BARACK OBAMA, PRESIDENT OF THE UNITED STATES: The recipients of the Medal of Freedom did not set out to win this or any other award. They did not set in pursuit of glory or fame or riches. Rather, they set out guided by passion, committed to hard work, aided by persistence, often with few advantages, but the gifts, grace and good name god gave them.

Professor Steven Hawkins; he has become one of the world's leading scientists. His work in theoretical physics, which I will not attempt to explain further here, has advance our understanding of the universe.

A judge and Arizona legislator, cancer survivor, Sandra Day O'Connor is like the pilgrim in the poem she sometimes quotes, who has forged a new trail and built a bridge behind her for all young women to follow.

It's been said that Sidney Poitier does not make movies; he makes milestones. Poitier once called his driving purpose to make himself a better person. He did. And he made us all a little bit better along the way.

Billie Jean declared a goal to be the number one tennis player in the world. We honor what she did to broaden the reach of the game, to change how women athletes and women everywhere view themselves.

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BLITZER: Desmond Tutu, Senator Edward Kennedy, Harvey Milk, Jack Kemp were among the other Medal of Freedom honorees. Congratulations to all of them.

The case of the wrong-way driver, in which eight people were killed. What really happened on that highway? The dispute over the driver's condition; we'll assess that when we come back.

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BLITZER: Authorities say Diane Shuler was impaired by marijuana and alcohol when she caused a head-on collision that killed eight people, including herself, back in July. She drove her minivan the wrong way on the Taconic State Parkway, running into an SUV. Her husband disputes the toxicology results, which raises this question: could they have been wrong?

We're going to assess what happened with Dr. Cyril Wecht, Jane Velez-Mitchell, Dr. Reef Karim, and Mark Geragos when we come back.

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BLITZER: The heartbreaking story, what happened on the Taconic State Parkway. Jane, explain to our viewers some of the background, because I want to get into the story a little bit. For viewers who aren't familiar with what happened, eight people are dead?

MITCHELL: Yes. This is another case of a significant other challenging a toxicology report, and getting a huge backlash with people saying, hey, you're in denial or perhaps you're lying. But, which ever, you're insulting our intelligence, because we have to believe that they maybe did an autopsy on the wrong body, since they found that this wrong-way driver had the equivalent of ten drinks in her system, plus pot, plus they found a vodka bottle in the minivan.

Essentially, the husband of the dead drive held a news conference and said, no one she's an alcoholic. No way she was drinking. When I said good-bye to her at the campground, everything was fine. The reason there was that vodka bottle was that we drink so little, we would drive back and forth with it all summer long.

Well, of course, the relatives of those that lost their lives in this crash, especially the van that was hit head-on, were absolutely outraged, saying they felt victimized again, saying this is not an accident, that this is a killing, and there's no way that he couldn't have known that his wife had a problem. And this raises the whole issue, Wolf, of a society, not just a family, but an entire society in denial about what is the face of alcoholism, what is the face of addiction. What does it look like? It's not just the crack addict and the drunk in the gutter. It's a middle class problem.

BLITZER: Because Shuler's husband, Daniel, Dr. Wecht, insists she was not a drinker, that she was completely sober. The toxicology report, the autopsy, has a very different assessment. Something is wrong here.

WECHT: Well, I suggested that the medical examiner's office repeat the test, have it done by an independent lab. And I think it's intellectual professional arrogance on their part not to do this. There are eight people who are dead. I don't challenge the validity. I'm sure that the test is correct.

There was alcohol found in her stomach. There was a bottle of vodka found in the car. And she had that rather high level of cannabis, marijuana. So I don't challenge it. But repeat the test. The family has a right to go to court and ask for biological specimens to have the test done themselves. They are not doing it, because they really know that the test results are correct.

So because of these two dichotomies, the end result is that it's out there and people are challenging the validity.

BLITZER: Hold on a second. I want to bring Mark Geragos into this conversation. Mark, you're a famed criminal defense attorney. Eight people are dead. The driver is dead. Legally speaking, does any of this make any difference?

MARK GERAGOS, DEFENSE ATTORNEY: No, not really. I know that there's so much anger over this, and rightfully so. But the fact is, they are never going to charge the husband. And the husband may be out there, ideally, to try and dampen down any kind of civil liability.

But the fact remains that Cyril is absolutely correct. If she had survived, and had been charged with eight counts of manslaughter or eight counts of murder, she would have had the right to have retested her own. So why not retest? It's a simple thing. It costs 125 bucks. You send it over to a lab and you are done with it. That's the end of the story.

It's an awful case. And the problem is that people want to strike out, and understandably so -- they want to find somebody to blame it on and, unfortunately, there really isn't. Everybody is dead who had some accountability.

BLITZER: Dr. Reef Karim, is it possible for an alcoholic or a drug user to hide this kind of information from a loved one?

KARIM: It's definitely possible to hide this from a loved one. But if you have six grams of undigested alcohol in your system, you've got that much THC, marijuana on board, you are driving with bunch of kids in the car -- I mean, someone would have to not want to ever deal with you to not see this happen. There are definitely warning signs about someone when they start getting into addiction and their addiction increases.

BLITZER: And Mark Geragos, when you look at this whole story, it's such a heart-breaking story, among other things, because kids are involved. Where, if anywhere, does it go from here?

GERAGOS: Well, I think that what you're going to see is a civil lawsuit. I think it's unlikely that any criminal charges will be filed. Clearly, I would expect within the next 30 day, if not sooner, you will see a civil lawsuit. People are going to get sued. If there's any kind of way that they can trace back who gave the marijuana and things like that, you might find somebody get creative in that event as well.

I just think this whole thing is going to be played out in the civil arena, and they will fight it out there. And then you'll probably find that somebody, at some point, some insurance company, is going to pay to have her retested and the samples retested. That's how it's going to play out.

BLITZER: And, Jane, do you agree with that?

MITCHELL: Yes, absolutely. There's also a lot of talks about lawsuits. The bigger problem is that there are so many families living in denial. And it's something called co-dependency and enabling. It's very hard to see the reality when it's your loved one. You can look at a stranger and say, that person has a problem. But when it's in your family, it can often be ignored, precisely because you don't want to admit the reality.

BLITZER: We've got to leave it there. We'll continue the conversation. Guys, thanks very much for coming in. I'm Wolf Blitzer, sitting in for Larry King. Let's go to for Anderson Cooper right now. "AC 360" starts right now.