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Lou Dobbs Tonight

Health Care in America

Aired October 29, 2009 - 19:00   ET


LOU DOBBS, CNN ANCHOR: Wolf, thank you very much.

House Speaker Nancy Pelosi's massive government takeover of the healthcare system -- here it is, 1,190 pages of it, at least $1 trillion, and that's the first estimate, partly paid for with about $700 billion in new taxes and revenue and about a half trillion dollars in cuts to Medicare and how much more to Medicaid -- what rationing.

We're going be to talking about health care here tonight. What is the state of health care in this country? What are the biggest problems and how can those problems be fixed? We'll be addressing all of those issues and concerns with a special panel of the people least heard from in this debate.

Tonight, four of the countries most distinguished doctors join us here. We will also be talking about the governor's race in New Jersey. Democrats saying it's too important to lose, other voters saying how important is it and an Independent saying he may decide the outcome.

ANNOUNCER: This is a special edition of LOU DOBBS TONIGHT; "Health Care in America" for Thursday, October 29th. Live from New York, Mr. Independent Lou Dobbs.

DOBBS: Good evening, everybody. Another health care milestone -- Speaker of the House Nancy Pelosi today proposing what is, at the very least, a massive plan to overhaul the country's health care system. The 2,000 page bill will cost taxpayers almost $1 trillion over 10 years. That's the initial estimate.

There is no scoring from the Congressional Budget Office and it's understood that that's a low estimate. It will be paid for, in part, with new taxes, new revenue and cuts to other programs. Unlike the measure that passed the Senate Committee, the Pelosi plan includes the controversial public option. Dana Bash reports.


DANA BASH, CNN CONGRESSIONAL CORRESPONDENT (voice-over): A march to music down the Capitol steps, a ceremony staged to unveil a health care bill and signal momentum.

REP. NANCY PELOSI (D-CA), HOUSE SPEAKER: We are about to deliver on the promise of making affordable quality health care available for all Americans. BASH: After months of intense work with a divided caucus, House Democrats say their proposal would cost $894 billion for new health coverage, but add Medicare changes and the price tops $1 trillion. It would require all Americans to get health coverage, expand Medicaid to help those who can't afford it and provide subsidies to small businesses to cover employees.

PELOSI: The bill will expand coverage including a public option to boost choice and competition.

BASH: But that is not the kind of government run insurance option the speaker wanted. It allows doctors and hospitals to negotiate what the government pays. That pleases moderate Democrats, but may cost votes with liberals who prefer a public option that mandates lower rates.

UNIDENTIFIED MALE: I'm personally leaning no, others are as well.

BASH: But other progressives are more pragmatic.

REP. JERRY NADLER (D), NEW YORK: They couldn't get 218 votes for that. There's no point crying over spilled milk.

REP. ANTHONY WEINER (D), NEW YORK: We have a weaker public option. There's no disputing that. It's not what I would have liked, but I can tell you now we're going to have a sliver of competition.

BASH: How would all this be paid for? In part with cuts in Medicare spending and a 5.4 percent tax on all individuals making $500,000 a year and couples making $1 million. That income level was raised but changed aimed at calming concerns of vulnerable Democrats like Jerry Connelly (ph).

UNIDENTIFIED MALE: It will affect a lot fewer folks in my district than the previous version.

BASH: We spent time with Connelly (ph) this summer as town hall anger raged. Then he was undecided -- now...

UNIDENTIFIED MALE: And I'm pretty close to...


REP. JERRY CONNOLLY (D), VIRGINIA: But I want to absolutely reserve the right to look at the bill carefully.


BASH: Now, other moderate Democrats who are more undecided than that say that they won't say yes or no until they read the bill as well. It's going to take quite some time for them to do that because it is nearly 2,000 pages. But Lou, House Democratic leaders promise that lawmakers will have 72 hours to read this and that meaning the final bill after changes that will expect will be made before they have to vote. They are expecting to start debate next week. Lou. DOBBS: Dana, I think it's really important we be straightforward and honest with everyone watching us right now and listening to us. This is 1,000 -- if we can show this -- 1,992 pages. This is House bill 3962. This is Senate 1796. It is -- it's crazy. This is 1,502 pages here under my left hand.

This is a committee report out of the Senate Finance Committee. This is 418 pages, Dana. We're talking about 72 hours to read this. We're talking about wanting to take this up next week. It's being put on the Web, as I understand it, if it has not already been moved to the Web.

BASH: It is.

DOBBS: There's no way in the world folks can read this bill in one week. So, what are we really saying here?

BASH: Well, we are saying that they are certainly going to try. And I can tell you in talking to a lot of lawmakers they are intending to spend a lot of time doing that, but part of the challenge beyond just actually reading the legislative language, which will take a long time, as were grappling with this, I have to tell you just in the past several hours, is trying to figure out the cost.

As you well know, when it comes to Democrats, the cost of this is absolutely essential, especially to moderate Democrats. They have said that they will not vote for anything until they know exactly how much it's going to cost and they also want the cost to be below about $900 million (ph). And to make sure it actually does what it's supposed to do, which is to make the health care costs in this country go down.

It's still at this moment very unclear how that will happen, if that will happen. According to this, we were trying to get the information from the Congressional Budget Office, which does have some numbers out. But there was a letter sent to the Congressional Budget Office just a few hours ago from so-called Blue Dog, moderate Democrats trying to get answers because there are a lot of questions.

DOBBS: A lot of questions, and yet the Steny Hoyer, the House majority leader saying that this is the most deliberative, transparent and open process that he's ever participated in as a legislator over 29 years -- 1,000 pages of it, we don't know even where it came from.

BASH: Well actually in terms of the process, never mind the size of the bill, in terms of the process it actually is...

DOBBS: Never mind the outcome -- is that -- is that the point?

BASH: Well no, never mind the actual legislative language and how long it's going to take to read it. But in terms of the process, believe it or not, and maybe this is telling a fact on how Congress works, this does give lawmakers more time than they normally get. Remember what happened with the stimulus bill.

DOBBS: I do remember. I do remember indeed. And we have seen, what, just about a fourth of that money be spent some eight months later and 30,000 jobs be created -- I think that's the latest estimate -- oh no, it turns out that was 25,000, they overestimated the impact. We appreciate it, Dana. This is going to be quite a process.

BASH: Yes, it will.

DOBBS: Thank you so much.

BASH: Thank you.

DOBBS: The nation's economy shows some small signs of life. And in fact, the economy grew at a very strong rate. The Commerce Department reporting that GDP rose 3.5 percent over the third quarter -- that is the largest three month gain in over two years. It is the first economic expansion in more than a year. Those numbers are encouraging, but with record high unemployment, any talk of full recover -- recovery may be premature in the minds of many. Ed Henry has the report from the White House.


ED HENRY, CNN WHITE HOUSE CORRESPONDENT (voice-over): It was the best economic news the president has gotten since he took office.

BARACK OBAMA (D-IL), PRESIDENT OF THE UNITED STATES: The 3.5 percent growth in the third quarter is the largest three-month gain we have seen in two years. This is obviously welcome news and affirmation that this recession is abating and the steps we've taken have made a difference.

HENRY: But unemployment is still at 9.8 percent, the worst since 1983. So the president was careful to say the recovery still has a long way to go.

OBAMA: While this report today represents real progress, the benchmark I use to measure the strength of our economy is not just weather our GDP is growing, but whether we are creating jobs, whether families are having an easier time paying their bills, whether our businesses are hiring and doing well.

HENRY: That's why Friday, the White House will unveil a report making its case the stimulus package has saved or created hundreds of thousands of jobs. Republicans insist Mr. Obama is having a hard time backing up his claims.

BOEHNER: The president said when he signed the bill into law that unemployment would not exceed eight percent. It's now nearly 10 percent. And so I'm pleased that the GDP numbers this morning were up. But the question is, where are the jobs.

AUSTAN GOOLSBEE, WHITE HOUSE ECONOMIC ADVISER: Republicans have been playing the role of the old East German judge at the Olympics that it doesn't matter what any report says, how many private forecasters look and say the stimulus had a big impact. We could hit the triple lucks (ph) and they are still going to give the administration a two. (END VIDEOTAPE)

HENRY: The problem is many people across the country though are still not feeling that good economic news in their pockets. That's very worrisome for a White House who is facing an off year election next week, some key governorships up for grabs, where the economy will be front and center. Lou.

DOBBS: What does one do with an economic adviser who doesn't appreciate that some people like neither ice skating nor economics.

HENRY: Yes, you know it's sort of those two-handed economists that Harry Truman used to talk about on one hand, on the other hand...

DOBBS: I think also Goolsbee just took off his shoes as well. I mean when we get through the partisan nonsense here, the ridiculousness of talking about the size of the stimulus and its impact, it is too premature. We've just seen the first estimate of 30,000 jobs have to be revised lower by 20 percent to $25,000, raising the cost of each job to about $85,000 each and to hear Boehner basically talking down the economy. This is -- this is a level of discussion in Washington, D.C. unworthy of the jobs held by two of the primary voices conducting the discussion.

HENRY: It's a frustration many across the country must feel right now as they watch what's going on in Washington and in their own homes they are still struggling to pay their bills. That's why tomorrow is going to be a big moment and a lot of people will be paying attention to it. Vice President Joe Biden is going to be releasing a report about the stimulus and more details than we have gotten so far. We're going to be digging into that very closely. And in fact I'm going to be interviewing Vice President Biden tomorrow. And I'll come back on tomorrow night, Lou, if you will have me, and I'll explain exactly how he defends whether or not they're really these jobs out there, Lou.

DOBBS: We'll have you. But I'm just curious -- I'd be curious to know if Mr. Biden, if the vice president, the president, John Boehner, Mitch McConnell, the Republicans will get down on their knees and say thank you Lord for 3.5 percent growth in the third quarter. They didn't have much to do with it, but they ought to be doggone grateful for it. I appreciate it...

HENRY: Still anemic as well and a lot of people are expecting a much stronger growth next year, it's the big hope out there, Lou.

DOBBS: Well partner, I have been covering the economy for a long time and 3.5 percent I'll take and be grateful in doing so. Thank you very much Ed Henry.

HENRY: Thanks, Lou.

DOBBS: Thank you.

Up next, an in-depth discussion on the state of health care in America. We'll be addressing the issues that matter most in this debate -- affordability, accessibility and yes, something you don't hear much about, the quality of health care.

Also, what are the real problems with this health care system in America? What are the politicians not talking about? Tonight, you're going to hear from the people who actually know. We'll be joined by four of this country's most distinguished physicians. And by the way, I'm turning over the broadcast to Dr. Benjamin Carson (ph). He will lead this discussion. I'm going to facilitate. We'll be right back.


DOBBS: Tonight, an in-depth discussion on the real state of health care in this country and what we should be doing to improve accessibility, improving affordability and quality. Some of the nation's most prestigious medical professionals joining me now -- Dr. Benjamin Carson is director of pediatric neurosurgery at Johns Hopkins Children's Center. And Doctor, it's good to have you.

Dr. Donlin Long, distinguished service professor of neurosurgery at Johns Hopkins Hospital -- I got nearly all of those words right -- good to have you with us, Doctor. Dr. Daniel Foster, he's (INAUDIBLE) McGarry Distinguished Chair and Professor of Internal Medicine at the University of Texas Southwestern Medical Center -- good to have you, Doctor with us here. Dr. Howard Weiner (ph) from New York University's (INAUDIBLE) Medical Center will be joining us here shortly.

Let me say to you first that this discussion begins with Dr. Carson. He and I were having a discussion some weeks ago. I was so impressed with his view, and his statements about the health care system that I felt it was a disservice not to have his voice heard and amplified and have him bring with him people he has chosen to talk about this issue from a perspective we simply don't hear, which is crazy -- the doctors -- and I'm turning this broadcast over to you right now, Dr. Carson.

DR. BENJAMIN CARSON, DIRECTOR OF PEDIATRIC NEUROSURGERY: Well thank you. I appreciate the opportunity because one of the problems that has occurred over the years is that physicians who used to be very integrally involved in health care have kind of moved to their laboratories and their clinics and their operating rooms and kind of left it up to everybody else to deal with. And as a result, we have created quite a significant mess.

Now what do you need for good health care? You need a health care provider and you need a patient. Along came the middleman to facilitate the relationship. Now, the middleman has become the primary entity with the health care providers and patients at its beck and call and it is enormously expensive. Bear in mind that we spend twice as much per capita in this country as the next closest nation.

And yet, what do we have to show for it? We do have excellent care, but we don't have good access. And so I think it's critically important at this point and time for physicians to get involved because if the Brooklyn Bridge fell down, who would you get to rebuild it? Would you get structural engineers or would you get people who like to talk about building bridges? DOBBS: At this point, Doctor, I wouldn't even want to talk to people who like to talk about it.


CARSON: So what I would propose is that we start looking at ways that we can bring that relationship between the physician and the patient back to where it started, before we insinuated everything in between it because that will solve a great deal of problems. If you come to me as a patient, I'm not going to order five CAT scans on you if that relationship exist between you and me and there's not some third entity out there nor are you going to let me.

We're going to discuss it and we're going to determine what is really best for you. That's going to solve a lot of problems. Now, think about this in terms of how we get there. We have got to reduce the cost of health care insurance to the point where people can afford their own health care insurance. Right now, it's so expensive you pretty much have to have it through your employer or through some other source.

DOBBS: Right.

CARSON: So how do we get it down there? What are the big cost centers? You know billing and collections, a huge amount of every practice, 20 to 30 percent. Now, every single diagnosis in medicine has something known as an ICD9 code. Every single procedure has something known as a CPT code and we have computers, which means all the billing and collection can be done electronically without creating the mountains and mountains of paper and the armies of people to push those papers around. It can be done for substantially less money.

DOBBS: How much less?

CARSON: I would say one to two percent as opposed to 20 to 30 percent, so we're talking hundreds of billions of dollars and...

DOBBS: Why isn't this a major part of the current discussion?

CARSON: Well you know when you talk to people and I have talked to a number of congressional people and they say oh yes, yes, yes we're doing that, but I'm not seeing it. So maybe it's somewhere in the midst of all that. I haven't found it, yet, so...

DOBBS: You know when -- when folks with physicians' IQs say that they look a little daunted by that, I feel a little better. But where are we going with this? I mean you're talking about eliminating -- bringing the patient and the physician closer together.

CARSON: Right. So what I'm talking about are ways to do that. That's one way to do it. Now you know there are a lot of details that have to be worked out in order to do that. We have to standardize. We can't have every single insurance company, every entity, Medicare, Medicaid having a different way of doing this.

But we can't standardize that because for instance we have standardized tax forms that go out. So we have the ability to do that. The other thing to keep in mind is we have 47 or 40 or 30 or 20 or 15, or whatever millions of people who don't have health care insurance. Now, it's not actually true because they do have insurance. They can go to the emergency room. But, we pay five times as much when they go to the emergency room as if they would go to a local clinic.

DOBBS: We're going to be back in just one moment. We're going to take a quick break.


DOBBS: Somebody has gotten in between the physician and the patient here. And we're delighted that our sponsors are with us tonight doing so. Coming up we'll have more with our distinguished panel of physicians -- we'll be talking about that.

We'll talk about government health care. A lot of people call it a public option or an opt-out public option. We just call it government health care. We'll try to understand what that means from the perspective of the people who provide health care in this country, the physicians. We'll be right back.


DOBBS: We're doing something different here tonight. We have turned over the broadcast to people who actually know what they are talking about when it comes to health care in this country. No lawyers, no politicians, no television hosts. And I want to return the broadcast to Dr. Benjamin Carson -- Doctor.

CARSON: Well thank you. First of all what you just said, people who know what they are talking about, I guarantee you tomorrow morning there will be people saying oh they are just doctors, they don't what they're talking about. They're just brain surgeons, what could they possibly know?

DOBBS: They're not rocket scientists. They're just brain surgeons.

CARSON: But I want to get back to those millions of people who aren't covered. They are covered, but we pay five times as much as we should, so what we need to be thinking about is how do we get those people into a clinic setting and, you know, there's a very good example. And it's the food stamp program.

Food stamps are reallocated or replenished once a month, unless something has changed. And those people learn very quickly not to go out the first five days and buy porterhouse steak and starve the rest of the month -- same thing would happen if we gave the indigent people an electronic health account, which is replenished at the beginning of the month.

Now, when Mr. Brown has that diabetic foot ulcer, he's not going to go to the emergency room and blow half of it. He's going to be incentivized to go to the clinic. Same treatment in both places, but the difference is the emergency room they patch him up and send him out. In the clinic they patch him up and they say now Mr. Brown let's get your diabetes under control so you're not back here in three weeks with another problem.

A whole other level of savings -- these are the kinds of things that need to be in there or need to be somewhere else. And talking about preventive health care and wellness, particularly as our population ages and you know this is an area that Dr. Dan Foster in Texas is particularly adept at talking about.

DOBBS: Dr. Foster, your thoughts?

DR. DANIEL FOSTER, MCGARRY DISTINGUISHED CHAIR & PROF. OF INT. MED.: Well, Ben asked me to say a word about prevention. The medical system now is people get sick, go to the doctor, as he said, get an ICD9 code diagnosis and we pay for it. We actually do a lot of prevention now, vaccinations, mammograms, sort of clean prevention would be in heart attacks. It's very simple. You take a statin and an aspirin and you cut heart attacks very sharply and you get a bonus for that because statins and aspirin cut colon cancer 50 percent and probably cut Alzheimer's as well, but...

DOBBS: What is a statin for those...

FOSTER: Oh, a statin is a drug that lowers the cholesterol. You read all about the -- you see them on television all the time. And the lower the cholesterol gets, the fewer heart attacks you have. There's no bottom line about it, so it's a very -- it's for people over 50 and so forth. You probably need to do that. But, I want to talk about a different aspect of that.

DOBBS: Sure.

FOSTER: There is an absolute epidemic of diabetes and obesity throughout the world, millions of people and that's a different kind of prevention and many physicians are wondering whether a health plan can pay for that. By chance a paper appeared in Lancet (ph) this morning of a protective program in diabetes that was -- been carried on for 10 years. And what they did was take about 3,000 patients and a third of them didn't get treated.

A third took a drug called metformin (ph), which is a drug that can be used for diabetes and a third focused on changing lifestyles. And they followed these patients now for about 10 years. And what's really remarkable, none of them had diabetes to start, but they were at high risk. There was either overweight or their blood sugar was a little bit up.

There was a 58 percent drop in the appearance of diabetes, surprisingly in the lifestyle change and 31 percent with the drug. That's an absolutely remarkable thing. And you have to follow it for a long time. The problem is who is going to pay for this? Because in the grant that was done, you have to have dietitians, you have to have physicians, you have to have nurses and you have to follow them.

They followed them every three months. They had lectures about exercise and so forth. That's an expensive proposition over 10 years. But what was interesting is that if you didn't convert to diabetes, it was safe for 10 years along these lines. So the question is, if we try to do that and this massive epidemic, will there be payments for this? I mean most diabetes care is given by family practitioners and general interns and not diabetologists (ph) and how can they get a dietician or a nurse that's available. We wonder how this is -- how this would be paid for.

CARSON: Well Dan, can I just ask you a question. The cost of that preventive program, how does that compare with the cost of taking care of somebody who has many of the complications of late-stage diabetes.

FOSTER: Well it costs -- diabetes, it gives you catastrophic illness. It's the late complications that, you know it's the leading cause of amputations. It's the leading cause of blindness. It's the leading cause of kidney failure. It has massive importance for heart attacks and more recently a variant of this called the metabolic syndrome has given us liver disease. Once you get to the catastrophic level, it's going to cost a fortune, but the delay in cost, I think the question is going to be early on when you try to prevent this occurring, you won't save as much. Later on, the catastrophic costs are going to be out of this world. So, it will be in the long run, it's a huge savings.

DOBBS: And what you're saying Dr. Ron (ph), just counter to what some of the so-called experts in Washington, DC have said, the calls for preventive medicine will actually cost the government more than ever imagined. And, point of fact, add costs beyond to any health care legislation that's being contemplated right. What you are really saying is it may look that way in a shallow and superficial manner at first blush, but the facts are quite different.

FOSTER: Yes, it's a matter of delayed gain. It's always in business or anything else. Whether you are willing to wait for a delayed gain, but we will save -- there are millions of people who have obesity and diabetes. Let me just explain what obesity does. Type two diabetes --

DOBBS: Doctor, I hate to interrupt, but we have got to break for a commercial.


DOBBS: In my weight, I'm a little sensitive about the obesity discussion.


We'll be right back.


DOBBS: We're back with our panel of distinguished physicians. Joining us now is Dr. Howard Weiner. He's a professor of Neurosurgeon and Pediatrics at New York University (INAUDIBLE) Medical Center. Good to have you with us, Doctor.

Let's turn it back to Dr. Benjamin Carson.

CARSON: OK. Well, I think we should let Dr. Foster finish up what he was saying and then --

FOSTER: Yes, well, I'll do that really quickly, Ben. Type 2 diabetes has plenty of insulin but it didn't work very well. It advance on resistance and obesity in addition to that has insulin resistance.

So, when you put these things together, we have these fat kids at 12 years old have diabetes like adults and so forth and so on. Trying to prevent this is very difficult. Only 5% of people who want to lose weight actually do it.

So, we have to solve those problems and how we are going to do that, I'm not sure yet, but we need to do it.

CARSON: All right. Thank you, Dan. You know, listening to what Dr. Foster is just saying here, I think helps people to understand that these are the kind of issues that really need to be dealt with by people who work with this stuff on a day-to-day basis. And, a less input by insurance companies, quite frankly.

Now, part of the problem we are facing right now is we have a system, in which insurance company can actually make money by denying someone care. That absolutely doesn't make any sense and in a way, I sympathize with them because, you know, I know a little about business. If you tempt somebody to make money, they are going to make it. OK, so maybe we need to remove that temptation from them and we'll talk a little bit more about that. But, this I think would be a wonderful opportunity for Dr. Weiner to give us a little insight into some of the things that he encounters.

HOWARD WEINER, NEW YORK UNIVERSITY: Sure, absolutely. So, I deal with families in crisis. Families whose children are suffering from severe neurologic illness. They seek out very specialized care and they do this through a variety of means, through other parents, through a variety of things on the internet, through medical literature and they are savvy and they have their children as a priority.

Oftentimes, what happens is when they seek out medical care, they hear about a specialist who happens to be an expert in this particular condition and they seek out care from that specialist, which is appropriate.

They do their homework and they are ready to go and they come into your office with very, very excellent questions and educated. Now, the problem is that when trying to arrange for these type of very highly specialized procedures, insurance companies will tell the families they must seek the care at their local hospital, oftentimes denying them the ability to even see the specialist.

We will plan for months ahead of time trying to get these things in line and even up until the very last minute, families who are already suffering as a result of the illness of their child are mentally suffering with the worry, how am I going to pay for this. How is this care going to be paid for? I heard a story last night of a family that actually carried around a bill for about $500,000 in their pocket, worrying about this after the surgery, not knowing whether this was going to be paid. I mean, the patient has to come first and that's sort of our role as doctors, and this is how we function.

So, we worry about the patient. We worry about delivering the best medical care that we can deliver and we try not to worry about these other factors. They tend to work themselves out. I had a situation where I saw a patient in the office who did not need surgical care and I wanted to do an MRI scan that was indicated based on my clinical judgment. And, it required about four or five phone calls by me personally to the insurance company dealing with red tape in addition to the family, in addition to my office the tremendous inefficiencies and stress that families have to deal with. So, I think this should be eliminated and this can provide for a better health care system in general.

DOBBS: How do you eliminate it?

WEINER: I think that there has to be, once again, very patient centric care. I think that right now, as Dr. Carson was saying, there are probably incentives for denying this, for passing the buck for the red tape. But, I think it has to be patient first and if that were the priority, then I think we could eliminate a lot of these problems.

CARSON: Right, that comes back, again, to some of the principles of good medicine, which we need to talk about.

The kind of thing that Howard just mentioned. This is not rare. You know, I saw a patient today in the hospital who had to be admitted to the emergency room who has a dermal sinus tract. A little tract that allows bacteria to get down into the spinal canal and the patient has meningitis, which we are treating and is going to need an operation.

The insurance company is not one that is compatible with the hospital and you know, I was told that, you know, there may not be any payment. But, the fact of the matter is, whether there's payment or not, we have to deal with this child. We can't just send them out there, you know, we are passionate people. And, very frequently, the insurance companies can hold you over a barrel because they say, well, you know, you don't participate, our hospital doesn't participate with this program. The patient is there, go ahead and take care of them, but we're not paying you.

You know, these kinds of things were ridiculous. So--

DOBBS: We're relying on your compassion and principles as a physician.

CARSON: Right, and it's very easy to take advantage of physicians because most physician are very compassionate people. They'll allow themselves to be sacrificed for somebody else that's the way we grow up and we need obviously protection from that.

But, in terms of being able to deal with insurance companies, it would be necessary to regulate them and the only way I see that happening is we remove from them the responsibility of catastrophic health care. hat is one area where, in fact, the government could be helpful, but it has to be done in a very managed way.

DOBBS: Move the catastrophic care from the insurance companies. That would be within the domain then of government health care?

CARSON: That could be in the domain of government health care but --.

DOBBS: If we may, Doctor, I'm going to interrupt for another commercial break. We'll come right back with Dr. Carson and our panel. We'll be right back. I hope you're learning as much as I am.


ANCHOR: Let me re-introduce our panel discussing the real state of healthcare in this country. Dr. Donlin Long, he's from John Hopkins Hospital. Dr. Howard Weiner from New York University (INAUDIBLE) Medical Center. Dr. Daniel Foster from the University of Texas Southwestern Medical Center, and of course, Dr. Benjamin Carson from John Hopkins Childrens Center.

Dr. Carson.

CARSON: Yes, we were talking a little bit about the health insurance industry and if we remove from them responsibility of catastrophic health care then it becomes much easier to predict how much money they're going to have to put out. If you can do that then they can be regulated, just like we regulate utilities.

If we never regulate utilities, you would have a hard time paying for your electricity and your water, and all the other things as well. If we can regulate them, we can still allow them a reasonable amount of profit just like those utilities are allowed a reasonable amount of profit.

DOBBS: All right, the average profit for those companies providing healthcare, and I said average, is 2.2% profit as a percentage of revenue which is 35th in all of the industries, of 53 industries and represented in the Fortune 500.

So, when people talk about the horrific profits, there's another side of that story too. There are also (INAUDIBLE).

CARSON: Right and -

DOBBS: Reality.

CARSON: And my suspicion is that the health insurance industry would be probably welcome an opportunity to shed cash off to healthcare. We would have to put some safeguards in placed making sure that physicians, families, clergy whatever are involved in those catastrophic decisions. But bear in mind, 40 to 50 percent of health care dollars are spent during the last six months of a person's life.

DOBBS: Say that again?

CARSON: Forty to 50 percent of health care dollars per capita are spent during the last six month of a person's life. It's an enormous expenditure poking and prodding people and putting them in units when in fact, in many cases, we should be looking at comfort care for individuals.

Now, you know, I can hear some people saying well, you're talking about death panels. It has nothing to do with death panels. If this is done in a reasonable (INAUDIBLE) way and should not be something that a bureaucrats are doing. And speaking of...

DOBBS: It should be a decision between the physician and the family.

CARSON: The physician and the family. And this would be the ideal situation. And I think this is an area Dr. Long has thought about this long and hard about what ideal health care should look like for the individual and for the family. And I would like him to spend a few minutes talking about that.

DOBBS: The idea of talking about quality of health care is something that is absent from the general discussion on health care reform altogether.

DR. DONLIN LONG, DISTINGUISHED SERVICE PROFESSOR OF NEUROSURGERY: Virtually not mentioned. The only time we talk about health care in the current system is cuts in Medicare, cuts in Medicaid, restriction of care for the elderly, for the dying.

I think, we have to refocus on what is best quality medical care for the American public? Now, immediately, everyone will say well, we can't afford best quality. I believe we can. I believe that if we institute the best quality, the efficiencies and the improved outcomes will more than pay for the cost.

Best care medicine doesn't mean most expensive. It simply means best. I think we need to refocus health care reform on what would be ideal medical care for the American public. In saying that, I think we have to begin with the family physician, the personal physician or the institution committed to the care of individuals and families.

That's the fundamental basis of medical care in the United States. And that relationship has been fundamental in western medicine for two millennia. We need to reestablish that so the patient and the physician are interacting so that each knows the other well.

Once we have done that, we have to provide those physicians and patients with the specialty care they need. And it needs to be immediately available and it needs to be efficient.

DOBBS: And you're talking about a lot more family practitioners, general practitioners, internists in this country. LONG: I think that's going to be a requirement. And I think the specialty manpower needs need to be carefully studied so we understand how many we need in various specialties, and we need to allocate dollars to train people in those fields.

As Howard was pointing out, there's another step. Those primary physicians and secondary specialists need a tertiary group to treat the unusual, the complicated, the particularly difficult.

DOBBS: You're talking -- to just a television host here. What's a tertiary group?

LONG: That means a group of specialists, super-specialists to whom the specialists refer. These are the people who do what nobody else does and you don't need a lot of them. One or two centers per state. The larger states might need more. But they are a major part.

It's the patient needs access to those people who do what their own local physicians can't do. And that's excluded right now.

DOBBS: Dr. Long, we're going to take just a quick break. We'll be right back. And Dr. Carson can take us from there. We'll be right back with our panel in just a moment.


DOBBS: We're continuing with our doctors in just a moment. But first, coming up at the top of the hour, will be Campbell Brown.

Campbell, what have you got?

CAMPBELL BROWN, CNN ANCHOR: Hey there, Lou. Tomorrow, the president sits down for a crucial meeting with the Joint Chiefs of Staff about what to do in Afghanistan. Tonight, we're going to look at some of the top choices and we're not just talking about more troops, but how far are we willing to go to win over the Taliban? What is being looked at and just (INAUDIBLE) right now.

Plus, we're hearing some better news on the economy, but what about the jobs? One of the nation's business reporters -- best business reporters is going to join us with some surprising thoughts on all of this.

Also, is Michelle Obama being all she can be as first lady? We're going to look at that. Plus actress and comedian Wanda Sykes here with a couple -- her take on the first couple and on motherhood as well. Lou?

DOBBS: All right. I assume she's for all of the above.

BROWN: Of course.

DOBBS: All right, Campbell. Thank you.

We're back with our panel. I'll turn it to you, Doctor. CARSON: All right. Well, thank you. I just want to throw out one radical idea here. You know we're lacking in primary care specialists. One of the reasons for that is because people come out of medical school owing $100,000, $150,000, $200,000, $300,000.

Why don't we make medical school free? A lot of other industrialized nations make it free. They don't have this problem, they have plenty of access. So just an idea, if you want to use stimulus money in a way that will have a long-term effect.

Now I'm going to ask each one of our panelists if they can give us sort of their one-minute summary and then I'll close. Let's just start with Dr. Long and go with Dr. Weiner and then Dr. Foster.

LONG: Well, health care has to focus on the patient. And health care reform should change its focus from who pays and how much and for what, and from rationing to providing the best quality care as a beginning. Then we can take those political and social issues and deal with them in the appropriate arenas. But we first have to decide what's best care for the American public.

WEINER: It is such a privilege to be a physician and to serve my patients and to be there for them. I trained my whole life to do this and it's an absolute privilege.

And I think the key thing that we have to do is we have to recognize that special relationship that we have with our patients. They look up to us. They depend on us. And nothing should be able to take that way. And I think that cannot be lost in this discussion. We have to be at the table. We have to be held to high standards. We have to pursue excellence.

But I think that as long as those benchmarks are recognized and we maintain these standards, then I think we can do what we need to do without having to deal with inappropriate red tape and bureaucracy. And I think that's the most important message I want to convey today.

DOBBS: All right.

CARSON: And Dr. Foster? Dan?

FOSTER: I want to focus on your efficiency about the billing and so forth. One of the sadnesses about medicine these days is that doctors don't have time to talk to their patients when they find out they've got a cancer and so forth.

It's so sad, somebody's walking through the valley of the shadow of death and the doctor doesn't have time because -- to do that. So I hope that we can make it a more efficient system and give them their time back.

CARSON: Thank you. Well, you can tell from listening to these three, and these are a small number of incredibly talented physicians that I know across this nation, who have wonderful things to add to this discussion. You probably noticed that we didn't say a word about tort reform, even though we all feel very strongly about it. It's a very, very important issue. It needs to be dealt with. And it's a complex -- we could take a whole another hour to talk about that. And that's the reason that we really didn't want to get into that right now.

But the things that we have to do in order to solve this problem, again, is recognize that we're already spending twice as much as anybody else. So it's not that we haven't committed the resources. The problem is that we are not using them appropriately. There are too many hogs feeding at the trough.

We've got to get rid of the things that are not necessary, bring that cost down so we can reestablish that relationship. If everybody owns their own health care insurance, guess what? Now we can say, if you get an annual physical exam, you get a 3 percent discount. We incentivize people to do that. We begin to catch things early. And that's going to save us a whole another level of money.

DOBBS: Incentivize rather than mandate.

CARSON: Exactly. We have the ability to do this. And I think, you know, again, this is not a slam on anybody. I'm a nonpartisan. I'm an independent. But I would hope that at some point we could kind of grow up and stop acting like third graders. And say what is it that is there for the people?

And I appeal particularly to the representatives. Make sure that you remember what this country was about. When the founding fathers founded this country, they established a system of representation, teachers, dog catchers, farmers. They would come to Washington, they would represent their constituency, they would go home.

They weren't there for life, and -- but they represented their constituency. I heard someone on television say not too long ago, people who don't support this or that bill, you know, are selfish and they're just thinking about being re-elected.

Where did that come from? I thought they were supposed to represent the people where they're from. Please think about, whoever you are, represent your people.

DOBBS: All right. Dr. Carson, thank you very much. Doctors, thank you all. We all appreciate it and you've given us all a standard to refer to with your concern, your clarity. We appreciate your time.


DOBBS: Thank you very much. And we'll be right back.


DOBBS: Thanks for being with us tonight. Next, Campbell Brown.