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CNN Larry King Live

America's Health Care; Is There a Crisis?

Aired July 13, 2007 - 20:00   ET


LARRY KING, HOST (voice-over): Tonight: Is America's health care system in crisis? Nearly 47 million uninsured. Others who have coverage still end up broke from medical bills. So, why do some say that the USA has the best setup in the world? What's wrong? What's right? Is there a fix for the problems? Who will pay for it?

We will hear from health care providers, insurance industry leaders, advocates for reform, and ordinary folks with some painful stories to share.

It's all next on a special edition of "LARRY KING LIVE."


KING: There's no more important topic in the world than health.

And that's why we're here with a special edition of LARRY KING LIVE on an hour earlier than usual. We will have a major panel joining us throughout the program.

But we begin in the first segment with Dr. Sanjay Gupta, who will be with us throughout -- he's also kind of co-hosting -- CNN's chief medical correspondent, practicing neurosurgeon at the County Hospital in Atlanta.

And here in Los Angeles are Jessica, Christopher and Jack Bath. Jessica's Blue Shield insurance policy, which covered young Jack, was canceled after he was scheduled to undergo surgery for a life- threatening hole in his heart. Their story is told in the July 23 edition of "People" magazine.

And handsome young Jack is with us.

Also with us is their attorney, Don A. Ernst, representing the family in this matter.

Sanjay, let's first get an overlook on insurance in America. The number of Americans that don't have health insurance is how many?

DR. SANJAY GUPTA, CNN SENIOR MEDICAL CORRESPONDENT: It's 47 million. And you are going to hear varying numbers between 43 million and 50 million. But 47 seems to be a pretty accurate number.

Of those, important to point out, as well, Larry, 8.3 million are children. And -- and 8.6 million are between the ages of 18 and 24. And that all comes from the -- from the census report, Larry.

KING: How did we let this -- how did this happen?

GUPTA: How did we get so many people uninsured?

KING: Yes.

GUPTA: Well, you know, it's obviously a complicated question.

One thing that is interesting, though, is to look at who some of these people are, in terms of their incomes as well, in terms of financial situations. For example, people that are making less than $25,000, between $25,000 and $50,000, are 15 million, between $50,000 and $75,000, 8.3 million, and over $75,000 a year, 8.7 million of those people.

So, there are certainly a large number of people who simply can't afford it, Larry. There are large number of people who are sort of in between jobs and can't afford their COBRA payments to keep the insurance.

And there are a large number of people who simply choose not to have insurance as well, Larry. So, these all sort of add up as part of the access problem.

KING: We're the only major nation without national health insurance, which was first proposed, I think, by President Truman in 1948, right?

GUPTA: That is correct. And then in the mid-'60s, you had federal entitlement programs like Medicare and Medicaid sort of predicated on some of what Truman started in '48. And that's sort of built in over the last 40 years.


GUPTA: But those programs have intermittently had trouble. And I think that's also part of the access problem.

KING: We have a case here. And then I want to get your comments on it, Jessica, Christopher and Jack Bath, their attorney, Don Ernst.

What happened, Christopher, in Jack's case?


CHRISTOPHER BATH, FATHER OF JACK: Well, I will let my wife talk.


KING: All right, Jessica.


JESSICA BATH, MOTHER OF JACK: I will go ahead and talk. See, I was 25, college student. And my husband and I decided we wanted to have a child. So, the most important thing we thought was, let's get health insurance. So, I found a health insurance agent.

KING: You took it out in college?

J. BATH: Well, no, I wasn't insured in college. So, I got a private -- went through private, found an agent.


J. BATH: He got me health insurance.

See, about a year later, I got pregnant with my son, had my son on April 8, 2003. He was born. And the second day in the hospital, after he was born, he was diagnosed with a major heart defect. He had a hole in his heart and a constricted pulmonary valve. So, he wasn't getting enough oxygen.

KING: So, they scheduled surgery.

J. BATH: Scheduled surgery for five months later at Stanford. A month before our scheduled surgery, we got a letter in the mail from Blue Shield saying they have dropped myself and Jack.

KING: They knew about the surgery?

J. BATH: Yes. So, they had covered me through the whole year.

KING: Just dropped you surreptitiously, bam, dropped?

J. BATH: Dropped.

KING: Did they give you a reason in the letter?

J. BATH: The reason was that I had not disclosed all the information on my application.

But the truth of the matter is that I disclosed everything to my agent.

KING: How did he get the surgery, Chris?

C. BATH: We scrambled. First, we were in fear and shock and panic. And we scrambled for insurance. And Medi-Cal was there for us. We weren't married at the time, so Jessica qualified. And that's how he's -- was enabled to go forward with the surgery.

KING: And he is OK now?

C. BATH: He is -- he's fine right now. He gets a once-a-year- checkup through Stanford.

And he -- sorry, I'm looking at the pictures there. He -- he needs a checkup every year, and there may be a second surgery required. KING: Are you suing Blue Shield?


KING: Even though the surgery was done by someone else and was OK?

ERNST: We maintain that Blue Shield wrongfully rescinded the policy belonging to the Bath family. We believe that they breached the covenant of good faith and fair dealing. We believe that what they did to this family was unspeakable.

KING: Have you got insurance now?

J. BATH: Yes. Well, as, obviously, my son is uninsurable at the moment, so we had to go through an open enrollment policy. That's the only way we could get insured.

KING: He is uninsurable?

C. BATH: Well...

J. BATH: He's is uninsurable, unless the open enrollment policy, which they don't look through the background.

C. BATH: Through a group policy, I was able to get insurance through my work. And they had an open enrollment. And then I put everybody on the family on there, and they accepted preexisting conditions.

KING: So, you're covered now for anything, except anything relating to his illness for which he was operated on?

C. BATH: We're covered for everything right now.

KING: Blue Shield has given us a statement. And I want to get it up here.

and it says: "We rescind" -- I know, but I can't read the screen -- "We rescind a minute" -- this is a statement from Blue Shield about this case. "We rescind a minute percentage of policies, less than one-tenth of 1 percent. If we didn't even rescind those, and we allowed applications to stand, it would only result in higher premiums and less availability of coverage for everyone. Blue Shield of California is a not-for-profit health plan. It's been a leader in fighting for universal health care. We're pleased that Jack Bath was able to get care through a public program and that he's now healthy."

Why doesn't that suffice, Don?

ERNST: Because Blue Shield wrongfully rescinded their insurance policy.

In fact, they didn't even contact Jessica or Chris or the agent about what occurred. They just rescinded it. They didn't even call him and inquire about anything on their application. KING: What did they say was false about the application, Jessica?

J. BATH: They had said that I disclosed I had used an anti- anxiety medication.

KING: All right, Sanjay, this seems -- why -- why would they do this?

GUPTA: Well, you know, it's hard to say, obviously. I mean, they -- the...

KING: From what we know.

GUPTA: Well, these applications are so different. The anti- anxiety medication, I'm not sure if that's a red herring, or if they thought maybe -- you know, do anti-anxiety medications increase the likelihood of birth defects?

I am speculating here. And I think anybody would be speculating. So, it is hard to guess why they would do this. But it's insurance companies. This happens, as they say, one-tenth-of-1-percent of the time. And it can be heartbreaking. I mean, looking at those pictures was just -- it's hard to do. It's great to see him so healthy now. But, boy, those pictures are tough to see.

KING: Boy.

Isn't the purpose of insurance to help?


You know, and I do think that the vast majority of times, it does for people who do have insurance, I should add, Larry. I mean, these cases are obviously in the minority, but they do happen, as you just witnessed, but health insurance for the most part does seem to work for a lot of people. So, I think it's worth pointing that out as well.

KING: Jack, have a long and healthy life. Thanks for coming.

J. BATH: Thank you.

KING: Good luck.

Thanks, Don. Thanks for joining us.

C. BATH: Thanks for having us. Appreciate it.

J. BATH: Thank you.

KING: We will take a break. And, when we come back, we will meet our complete panel on this special LARRY KING LIVE, "Health in America."

Don't go away. (COMMERCIAL BREAK)

KING: Our subject is America's health care. Is there a crisis?

We have just seen one example of what might be a crisis.

We're going to meet our entire panel now. Dr. Sanjay Gupta remains with us. He will be with through the entire program. He may also ask questions, as he chooses, as well.

In Ann Arbor, Michigan, is Jonathan Cohn, author of "Sick: The Untold Story of America's Health Care Crisis and the People Who Pay the Price." He's senior editor of "The New Republic." In New York, Dr. Irwin Redlener. He is president and co-founder of the Children's Health Fund. He's associate dean, Columbia University Mailman School of Public Health. He was a member of the White House Task Force on Health and Reform under Clinton.

In Washington is Karen Ignagni. She is president and CEO of the American Health Insurance Plans, a trade association of the nation's health insurers. In East Lansing, Michigan, Dr. Ronald Davis, president of the American Medical Association, the nation's largest and most influential physicians association. And, in Cincinnati, Kevin Lofton, chairman of the board of trustees, American Hospital Association, president and CEO, Catholic Health Initiatives.

We have got it very well covered.

Is our -- answer the question, Jonathan. Is there a health crisis?


And, look, we have 45 million Americans who don't have health insurance. And, over a two-year period, the number of Americans who don't have health insurance will be twice that. So, you are talking about almost a third of the American population that, over a two-year period, will not have health insurance.

And then that doesn't even count all the people who do have health insurance, who think they're secure, who think their insurance will be there to cover them, and will find themselves in a situation where it won't cover their costs, because an insurance company won't approve it or because the deductibles will be more than they can afford, or because maybe, like the family you just had on, they will think they have secure insurance, only to find that, when they file a claim, their insurance has been canceled.

KING: Yes.

KING: Dr. Redlener, in your opinion, is health a right?

DR. IRWIN REDLENER, COLUMBIA UNIVERSITY'S NATIONAL CENTER FOR DISASTER PREPAREDNESS: Yes, I think it is a right. In a civilized society like ours that's as advanced and as wealthy as we are, there should not be any -- any people, anybody in this country, who cannot get the health care that they need. We're talking about at least access to a basic package of health care.

It's not only in the interest of every person in the country. It's also in the interest of America's future to make sure that our children and everybody else is as healthy and as productive as possible. There's all sorts of reasons why this should be an absolute right and an obligation of Americans to have their health care taken care of.

KING: Karen, I know so many are uninsured. And your represent the insurance industry. Where, in your opinion, is your industry failing?

KAREN IGNAGNI, PRESIDENT & CEO, AMERICAN HEALTH INSURANCE PLANS: Well, I think that one of the things that we have tried to do, Larry -- and thank God that Jack is still alive -- we have tried to work very, very carefully and very hard to make sure that people understand the policies that they're buying in the case of individuals purchasing on their own, where they don't have an employer to do that for them, but also to make a follow-up call to verify the information, because all the information that's submitted will determine how the entire group is rated and what price they pay.

So, I think that we have learned that we can do more in terms of reaching out to families, making sure they understand what they're purchasing, under what circumstances.

And, as you indicated and Sanjay Gupta indicated very clearly, less than -- far less than 1 percent of insurance policies are in the category that we were talking about just a moment ago.

KING: Dr. Davis, what more can doctors do?

DR. RONALD DAVIS, PRESIDENT, AMERICAN MEDICAL ASSOCIATION: Well, Larry, we know that we have a sick health care system, but we need to talk about the cure.

The AMA has developed a plan over the last 10 years to get us to universal coverage. This would provide tax credits or vouchers to allow individuals to select and purchase and own health insurance, to carry it with them when they change jobs, and most importantly to give more help to those who need it by giving a larger tax credit or a larger voucher to the poor, which would be an equitable way to provide health insurance coverage, as opposed to the way it is now, where most health insurance comes through employers, and it benefits mostly those who have good jobs and who are more well off.

We need to help the people who really need it the most.

KING: And, Kevin Lofton, we will get the thought of the hospitals.

We will take a break. Bill Schneider will check in. And then I will ask Dr. Gupta to ask some questions of the panel.

Kevin, what's the role of the hospital in this crisis?

KEVIN LOFTON, CHAIRMAN, AMERICAN HOSPITAL ASSOCIATION: Well, hospitals take care of everyone that comes through our doors. We're always prepared...


KING: Everyone?

LOFTON: For everyone that comes through our doors.

We are ready 24 hours a day, seven days a week. We have to make sure that hospitals play a role in helping people with prevention, people who have chronic illnesses, and the fact that we need to look at redoing the payment system. It is outdated, has to be changed. And we have to make sure that payment is geared for prevention, so that people who need care convert the system from an illness care system to a health care system.

The AHA is developing a framework that will move towards our ability to be able to accomplish those things.

KING: Bill Schneider will be with us to give us an update on where the politicians in this country look at this. We will have a question or two for him. And then Dr. Gupta will chime in with questions for the panel.

You're watching a special edition of LARRY KING LIVE. Don't go away.


KING: Welcome back.

Health care, what to do about it, a major political issue in the 2008 presidential campaign.

CNN senior political analyst Bill Schneider takes a look at that. Let's watch.


WILLIAM SCHNEIDER, CNN SENIOR POLITICAL ANALYST (voice-over): Remember the fierce debate over first lady Hillary Clinton's health care plan 14 years ago?

SEN. HILLARY RODHAM CLINTON (D-NY), PRESIDENTIAL CANDIDATE: Back in '93 and '94, we tried to come forward with a plan. We weren't successful. I have the scars to show for that experience.

SCHNEIDER: The issue's back, big time. What's driving it? Costs, for one thing. Premiums for family coverage have nearly doubled since 2000. Plus, the growing number of insured Americans, more than 15 percent of the population. That's about 47 million people.

SEN. BARACK OBAMA (D-IL), PRESIDENTIAL CANDIDATE: My belief is that most families want health care, but they can't afford it.

SCHNEIDER: Many businesses have to eliminate or reduce employee coverage to remain competitive. Voters are also aware that President Bush has done very little about these problems. But some states have done things.

UNIDENTIFIED MALE: Governor Romney in Massachusetts, Governor Schwarzenegger in California have raised the idea that we could do something significant, and it could be done bipartisan.

SCHNEIDER: Democrats are talking about ways to cut costs and expand coverage, some using mandates and government subsidies.

JOHN EDWARDS (D), PRESIDENTIAL CANDIDATE: I believe, unless we have a law requiring that every man, woman and child in America be covered, we are going to have millions of people who aren't covered.

SCHNEIDER: How to pay for it? End the war in Iraq, some Democrats say, or end President Bush's tax cuts for wealthy Americans. Republicans talk about using tax incentives to empower consumers.

RUDOLPH GIULIANI (R), PRESIDENTIAL CANDIDATE: If you want to cover people that aren't covered, give them a voucher. Give them a tax credit. Make them empowered consumers.

SCHNEIDER: Mitt Romney can claim a track record on this issue from his time as governor of Massachusetts. But he is running for the Republican nomination. So, he argues, the Massachusetts model may not work for every state.

MITT ROMNEY (R), PRESIDENTIAL CANDIDATE: Give states the flexibility they need from the federal government to allow them to most effectively deal with their concerns.

SCHNEIDER: With so many ideas and proposals from candidates in both parties, what are the chances something will actually get done?

UNIDENTIFIED MALE: If we really have a very strong leader that can work in a bipartisan, less confrontational way, I think we could see millions of Americans covered over the next four years. But, if we don't have a leader with those skills, I think we could find ourselves having this issue go the route of the immigration legislation.


SCHNEIDER: Or the route health care reform went back in '94. What went wrong then? Most middle-class insured Americans said that they were happy with their health care and their health insurance. They just wanted to be sure they wouldn't lose it. Their concern was that, under the Clinton plan, the government might take it over and make it worse.

And that's why Democrats are being cautious this time, Larry.

SCHNEIDER: Bill, aren't some people saying just put everything on Medicare?

SCHNEIDER: Well, yes, they are. And Republicans say, my goodness, that's socialism. But Medicare is government-run and it is very popular. So, why wouldn't it work for everybody?

I asked Professor Blendon (ph) that question. The problem, he said, is that Americans start out with a deep distrust of government. They think Medicare is fine for mom and dad and retired people, older people, who are not in the work force, but they don't want to give the government that much influence over their own lives, the same sentiment that defeated the Clinton plan in 1994.

SCHNEIDER: Dr. Sanjay Gupta -- thank you very much, Bill, Bill Schneider, our chief political correspondent and chief analyst of things political. I don't know anyone better in the business.

Sanjay, do you have any questions for anyone in particular on the panel?


GUPTA: Absolutely.

I will just pick up on that theme. Dr. Redlener is on our panel.

And you just were talking about universal health care, Dr. Redlener. And 14, 15 years ago now, it was proposed and failed, as Bill mentioned. Can it happen now? And, if so, what's changed?

REDLENER: I think it can actually happen now. And I think there's been tremendous change in the environment in the United States, for one thing. People who felt secure about their health care, as Bill was saying, in 1993 and 1994 no longer feel that.

The costs have been rising out of sight. The benefits have been dropping. People are extremely insecure. And, furthermore, there's another very interesting phenomenon that's happened, Sanjay. And that is that business itself is feeling the brunt of the health care crisis right now, so, that we all know, for example, that costs General Motors an extra $1,500 per car to insure their workers. These costs get translated to the marketplace and really have an effect on our competitiveness internationally.

So, there's a tremendous surge in the business community's interest in changing things. And I think that's one of the things that's going to tip this over to a place where we will see change, if, in fact, we have the right leadership in the White House.

GUPTA: Perhaps some new allies there, I think you are referring to, in favor of national health care.

Jonathan Cohn, there's still that distrust of the government, though. And this is something you write about and talk about. Is that something that people can overcome? Is that something that people will look the other way and still vote in favor of some sort of national health plan?

COHN: Well, I hope they will. Look, that's a political question. Is the public ready for it? I honestly don't know.

What I do know is that the public should be ready for it. I think by any objective standard, Medicare is a better health insurance program than most of the private health insurance plans we have out there. And you don't have to take my word for it. Look at the opinion surveys. Americans who have Medicare, senior citizens, are happier with their coverage than Americans with private insurance.

And the reason is, it doesn't do the kinds of -- it doesn't cancel policies. It doesn't tell you, oh, gee, you have a preexisting condition, so we won't cover you. It doesn't make it harder on you when you get sick. Medicare is always there for you. And it gives you free choice of doctor. And it's no wonder it's more popular.

GUPTA: You know, the one thing that's sort of striking, though, Dr. Davis, talking about Medicare -- and these are some numbers that I thought were very interesting -- as far as preventive care, which is something that you really focus on, only about 3 percent of the Medicare budget goes towards prevention, things like letting nurses come into homes to monitor your blood pressure, monitoring blood sugars, things like that.

Preventive care is at the heart of this. Medicare hardly spends any money towards that, which causes chronic disease costs to go even higher. How can you apply that sort of system nationally?

DAVIS: We give a lot of lip service to the importance and value of prevention. But we're not practicing what we preach.

We have what you might call a prevention deficit disorder in this country. And Medicare is a prime example. The U.S. Preventive Services Task Force, which is the main federal organization that makes recommendations for preventive services, has recommended about 75 based on the evidence. But only about a dozen of those are covered by Medicare and they're only covered when Congress changes the law.

The Centers for Medicare and Medicaid Services can't update Medicare rules by administrative action. And so we have a very cumbersome federal bureaucracy that is not covering prevention to the extent that it needs to be.

KING: I have got to get a break. We will come right back with Sanjay Gupta and our panel -- more questions for the panel and another case study.

Don't go away.


KING: We're back with more of a special edition of LARRY KING LIVE. Our panel remains. We're joined now by Dana Christensen. Her late husband's cancer-related medical bills left her about a half million dollars in debt despite the fact that he had insurance purchased through MEGA Life. Her story is told in the latest edition of "People" magazine. What happened, Dana?

DANA CHRISTENSEN, IN DEBT FROM MEDICAL BILLS: Well, my husband and I bought a health insurance policy which we were told was a good, comprehensive policy by the agent who sat at our ding room table for a couple of hours and explained the policy. Unfortunately when we went to use it, we found out the coverage we were promised wasn't there. My husband bought a chemotherapy rider which we were told covers up to $100,000 of chemotherapy. What we weren't told is it only covered a thousand dollars a day. And his chemotherapy sometimes ran up to $18,000 a day.

KING: Eighteen thousand ...

CHRISTENSEN: Eighteen thousand dollars a day. So we were left paying $17,000.

KING: What did he die of?

CHRISTENSEN: Cancer. Metastatic chondosarcoma (ph).

KING: Where is that?

CHRISTENSEN: It starts in the bone but it went to his lymph nodes.

KING: What did the insurance company say to you when he had the terrible disease?

CHRISTENSEN: They didn't know why when we went to the hospital for a prescheduled surgery we had to pay $8,000 up front to be admitted. When I asked them why, they didn't know why. They told us that that didn't happen to people. That we were the first people that it happened to.

There was no out of pocket cap. When my husband passed away, I was left with half a million dollars in medical bills.

KING: Which you owe now?


KING: Or have you paid it already?

CHRISTENSEN: I have paid everything. I sued the insurance company. MEGA Life Health Insurance and the National Association for the Self-Employed. Without admitting guilt, they paid me $1.7 million. I refused to sign a confidentiality agreement because this should not happen to people.

KING: So you can talk about it here?

CHRISTENSEN: I want to be able to talk about it. My husband said it may be too late to me but this should not happen to people and I agree.

KING: Did you speak to human beings at the insurance company?

CHRISTENSEN: I certainly did.

KING: What did they generally say to you?

CHRISTENSEN: About the policy?

KING: About your husband, the condition, the policy.

CHRISTENSEN: They were sorry about the condition but there was nothing they could do about it. That they told me that we told you people up front exactly what this policy covered. And we're sorry if you didn't understand that. But they did not. They showed me paperwork at our home. They had us sign an application to be accepted. And we were sent the policy about a month later in the mail.

KING: Did the agent deceive you?

CHRISTENSEN: Absolutely.

KING: Is it his fault or her fault rather than the company's?

CHRISTENSEN: I think it's both. We actually got a declaration from a former MEGA Life insurance representative and he declared under penalty of perjury that he was trained to misrepresent the policy.

KING: I'm going to -- I want to read a statement from the insurance company and then I'll ask Karen a question about it and then I want to Sanjay to get in on this, as well. But this is what the insurance company, the Christensen's former insurance company MEGA Life and Health, a subsidiary of HealthMarkets had to say.

"In January of 2005, HealthMarkets' subsidiary, the MEGA Life and Health Insurance Company made a fair and reasonable settlement offer to Mr. Christensen to avoid protracted litigation after the difficult struggle she endured with her husband's illness and death. At the time of the settlement, Mrs. Christensen was under no obligation to accept our settlement offer.

"Mrs. Christensen, with the assistance and advice of her attorney, elected to settle the case which included no admission of wrongdoing on the part of the company. Since both sides voluntarily agreed to settle the case two and a half years ago, HealthMarkets considers its involvement with the matter completed.

"Since the January 2005 settlement, Mrs. Christensen and her attorney have repeatedly tried to litigate the case in the media. We strongly disagree with the facts as presented by Mrs. Christensen and we note that no court has ever ruled in their favor on any of these claims."

Before I ask Karen about this, why do you keep it up?

CHRISTENSEN: Why do I keep up talking about?

KING: You took the settlement, yeah.

CHRISTENSEN: I took the settlement but I want to be able to talk about it. I want people to know what these companies do. I want them to be aware that they have to be very, very careful about what they're promised and what they're given.

KING: Karen, are you aware it's possible agents are deceiving?

IGNANGNI: We have a real issue now, Larry, with respect to as the individuals are buying on their own, the issue is how much do agents know? Do they know enough with respect to the conditions of the families? What they may face and what the companies have to offer by way of insurance coverage? My understanding in looking at the press is this was a supplemental policy, not meant to be a comprehensive policy.

But one of the things I'd like to talk about is -- you have asked every panelist, every other panelist this question about reform. We have laid out a very specific set of proposals that would address this issue as well as the issue of getting all Americans access to coverage.

We believe that all Americans have to have access to coverage. We've proposed a three-prong way to get that. We have to repair the safety net, we have to subsidize coverage so people who are in the situation who need a helping hand can get it and we have to help the states move along to help us achieve the objectives within federal guidelines so we ...

KING: Are you confident ...

IGNAGNI: ... believe these are challenges. Mrs. Christensen is right to put it on the table. I think we need too look very carefully at what happened in this situation and what steps need to be taken to make sure it doesn't happen again.

KING: Are you confident it's going to happen for you, Karen?

IGNAGNI: I'm sorry.

KING: Are you confident it's going to change?

IGNAGNI: It has to change. I believe Dr. Redlinger (ph) said this very, very well. We have to make a commitment to have access to health insurance coverage for all Americans. We should be doing that in this country. There's no excuse for it. And the most expensive thing, Larry, and the most inhuman thing to do is to continue the current system.

So we've proposed a strategy to address that and I think there's a greet deal of agreement now in the policy community not only that this needs to be done but there can be a public/private approach to getting it done and getting it done soon.

KING: Dr. Sanjay, are many of your patients not insured?

GUPTA: You know, they are. Most of my patients are not insured. I work at a county hospital in Atlanta. So the vast majority of the patients don't have health insurance or they're underinsured as Jonathan Cohn was sort of referring to as well. What that means is basically they have some insurance but anything sort of tips them over the edge. They can easily sort of fall into financial ruin very easily.

You know, what I've noticed from that, Larry, it sort of has this domino effect. A lot of people who have insurance think people that don't have insurance, it is not their problem. Well, it is because a lot of patients, they go to other hospitals and the health care costs keep going up. Everyone, even if you have insurance, are affected by the people who don't have insurance in this country.

KING: We're take a break and come back. Good luck, Dana. Thank you very much for coming. Our panel remains with us for the remainder of the panel. Sanjay will have more questions, as well. I think we can take off the question, is there a crisis and say, there is. We'll be right back.


KING: And before we get back to Dr. Sanjay, more questions of the panel, as much as we can get in as time flies when we have this many people and this intriguing a group. But Jonathan Cohn wants to respond to something that Karen said. Jonathan?

COHN: Well, that's right. You know, I was very happy to Karen saying that the Health Insurance associations of America are in favor of dealing with this crisis. Here's the problem. This is the same group that during the 1990s gave us the Harry and Louise commercial that spread mistruths about what universal health care would do and is the same group even as she is on this show busy pouring thousands of dollars into organizations and candidates that have consistently opposed universal health care.

So I guess I just wanted to ask her since she is on the show does she support - I know she says she supports making health care access better. Does she support guaranteeing health insurance to every American just like every other country in the developed world does?

IGNAGNI: I support the first part of that. Guaranteeing access to all Americans. I don't support a particular one size fits all approach, whether it be Canada, England, Cuba as advertised in the Michael Moore show. No, I don't necessarily think that's the right strategy for us but I do think we can have a public/private approach to build on what works to take care of the safety net, repair it, which badly needs repairing. To give people a helping hand who can't afford to purchase health insurance coverage and have very specific standards within a structure so that we would have standards, hospitals would be standards, doctors would have standards and we would know exactly as a society how we're going to address this crisis.

KING: We have an e-mail ...

COHN: Guarantee ...

KING: OK. Quickly. Go ahead.

COHN: Guarantee insurance to every American? Would you do that?

IGNAGNI: Yes. We have to guarantee access to healthcare and insurance.

COHN: Not access. Insurance ...

IGNAGNI: Yes. And the way we actually get or deliver the insurance will be different. Maybe for me versus you. Clearly for people under the poverty level, we have to have a Medicaid program that works.

KING: You do favor it. The universality of it you favor?

IGNAGNI: Of course.

KING: We have an e-mail question from Chris in Apex, North Carolina. "I can't afford to even visit a doctor. So why should it matter to me how advanced American medical technology is?"

Dr. Davis?

DAVIS: Well, it is important for people to have access to physicians' services and that's one of the problems with Medicare that has not been mentioned. While a comment is made earlier that Medicare is working well, in many ways it is not. For example, Medicare wants to cut payment to physicians by five percent every year because of a flawed formula that determines Medicare payment to physicians.

And we're slated for a 10 percent cut by Medicare on January 1. As a result, many physicians are threatening to drop out of the Medicare program. We don't want that to happen. We want to take care of seniors but they can't make ends meet in running a small business so that's one of the many problems for Medicare that need to be fixed.

KING: I don't want to leave Kevin Lofton, I don't want to leave him out, he has only had one response. The American hospital representative. Do you have a question for him, Sanjay or should I?

GUPTA: Absolutely. Kevin Lofton, one of the things driving this is the costs, the costs so high and they are going up. Why are the costs so high in hospital? Why are they getting higher?

LOFTON: It comes back to the basic problem, the fact we have 47 million uninsured. Those individuals have to use our emergency departments as their medical doctor, as their primary care provider.

Over one third of the patients need to be in medical homes where they can receive care on a preventive basis. We also have to make sure we recognize that there's a cost of being open 24 hours a day, seven days a week and that people -- health care is a people business. Hospitals invest their moneys into providing quality nursing, quality pharmacy, high quality physician care, and that takes up roughly about half of the costs of the hospital expenses.

So, the bottom line still comes back to the fact that we have that many uninsured who are being treated in the wrong place. And in addition to that, several components of the AHA plan have been mentioned but I'd like to add the fact that coordination of care is another one of the areas that we have to focus on to make sure that as patients go between organizations, between facilities, between providers, they're taken care of and finally we have to make sure that we have widespread use of information technology so that the care and information is provided across the full continuum where patients receive care so it's a combination of those factors but we still have to recognize that we have an outdated, antiquated reimbursement system that must be changed now.

KING: We'll have a question for Dr. Redlinger and more when we come back and more. More on the state of the healthcare and insurance industries as well. Don't miss the second hour of LARRY KING LIVE tonight. We have got a double thing coming at you. We'll be reaching for the heavens on the 60th anniversary of an infamous UFO sighting and among our guests, coming up at the top of the hour, Apollo 11 astronaut Buzz Aldrin and wait until you hear what he did in his famous moon mission. That's all coming up on the next hour of LARRY KING LIVE, part two.


KING: We're back on this special edition of LARRY KING LIVE and Dr. Gupta with a question for Dr. Redlener.

GUPTA: We are talking a lot about solutions tonight. That's the focus of the show. You talked about universal health care, Dr. Redlener. There's concerns about the suspicion of government which you address. Waiting times. Taxes going up.

Let me ask a different question, though. In the spirit of solutions, will there be a degradation overall do you think in the quality of health care that this country provides and is that a concern of yours?

Well, yes. I am concerned about that. We are already seeing a degradation in quality. All you have to do is look in a big city emergency room and see unbelievably overcrowded conditions. People waiting hours and hours. The doctors are rushed. There's all kinds of issues about payment, et cetera.

REDLENER: But the good news, Sanjay, is that even though it's interminably long, we are into a presidential election season and a very important one.

And the benefit of that is maybe it will help us focus on what are the solutions and there's really three things that I want to say about the solutions that I think people should pay attention to.

Number one, we're really talking about not just access to or the ability to buy health care or health care insurance but we want to actually guarantee that people have the coverage they need and that everybody has that.

Number two, we have to make sure that the quality of care is where it needs to be in this country. It is not good enough for people who have the resources to go to the best medical centers and get really state of the art care when other people are getting no care. That doesn't work in America.

So we have to be only be paying for those things that work and stop paying for those things that don't work so we need the evidence to show us which direction we should go in and the third thing is that we really as voters and as it have sevens, we have to make sure that we don't let our politicians get away with demonizing fixing the health care system.

This name calling that we've already started to hear a little bit, it's government medicine. It's socialized medicine. That's absolute nonsense and it really does retard our ability to solve this problem which I think is soluble.

Don't forget, we are spending almost $2 trillion a year, 16 percent of our gross domestic product, way more than any country in the world. It's like we are paying luxury car prices and getting an old jalopy for our money. We are not getting our money's worth and we really have to fix it and '08 may be the right time.

KING: We have a King Cam question from one of our viewers. Watch.


UNIDENTIFIED MALE: I'm very concerned about health care. Will there be any? And why is the United States the only industrialized country that doesn't have universal health care? I think that's a question that all politicians have to answer.


KING: Why, Jonathan?

COHN: Well, part of the reason like I said is lobbying by industries like the health insurance industry that's traditionally opposed it but part of the reason, I think, is this misplaced fear if you have universal health care you will lose access to treatment and won't get the most cutting edged care and point to a country like France where, you know, they have free choice of doctor. They don't have long waiting lines. They have some of the best cancer care in the entire world and yet they managed to cover every single person and they spend less than we do.

And there are other countries like that. Germany, Switzerland, Japan. If all the countries can do it that way, why can't we? Are we not as good as those countries or is there maybe something about the unique system where we don't have universal health care that causes us to do this? KING: We'll get a break and come back with the remaining moments. We have only skimmed the surface. Sanjay Gupta might have a question or two left. Don't go away.


KING: We have only a couple of minutes left. Time for a final question from Dr. Gupta to who?

GUPTA: Jonathan, let me ask you really quick, following up on something you were talking about earlier, in the world of the universal health care plan, would you imagine everyone people would all have sort of a minimum level of health but not necessarily have access to the specialty centers that Dr. Redlener was talking about? Would it cause people to not all have the same level of access?

COHN: The system I would like to see would work like Medicare in the sense that everybody would get basic insurance that would pretty much cover all services. You have access to everything. I don't mind a role for private insurance in that as a supplemental policy maybe to cover the co-payments or deductibles. Again, that's how they do it in France and I think that system works well. I don't mind private insurance as an opt out alternative for people who don't like the public system but I think at the end of the day you should have a good, public program that provides a very high level of benefits for most people and I think we have seen that that kind of program can work. It works in France and frankly all things considered, relative to private insurance in this country, I think it works for Medicare.

KING: Karen, are you confident of big changes?

COHN: I'm confident of big changes, Larry. We're supporting big changes. That's the point that I would really like to leave everyone with.

On the other hand, I would like to say something directly to what Jonathan just said. We had a group of leading physicians here just two days ago in Washington from California talking about the value of health plans in Medicare. We have done a better job in Medicare than the traditional program on treating cancer, on early intervention, on coordinated care and disease management and I think the doctors telling the story is very compelling. We have a lot to contribute to this system than we have brought to improved care working hand in hand with physicians an hospitals.

KING: We'll be doing a lot more on this. Thank you, Dr. Sanjay for all of your help together.

GUPTA: They say the society will be measured by how we take care of those that can't take care of themselves. I'm glad we did the show, thank you.

KING: Well put. I'm glad we did too. Thanks very much, everybody for joining us. LARRY KING part two is next on UFOs. Now there's a cronella (ph). Don't go away.