What do you think would surprise Obama most about this book?
Cost controls don't stifle innovations. You can cut cost and still get fabulous innovation. For example, anybody in America who has had a hip or knee replacement is standing on French technology. This deep-brain stimulus that's a huge breakthrough for mental disease, that's Canadian innovation. Even Viagra came from Britain. And those countries have strict cost controls. Second, foreign systems don't limit choice or keep people waiting all the time. Anybody in Germany can buy any one of 200 insurance companies' plans. If you don't like your insurance, you can cancel it; and the next guy has to cover you, and he can't raise your rates. So that's broader choice than anybody in America has. So when Obama is told by our healthcare industry, "Oh, geez, it's very hard to make these changes. We can't offer choices like that. We have to be cruel to people," no, it's not true.
Why does our healthcare system lag behind that of other countries?
A lot of it is ideology. Americans are convinced that free-enterprise, for-profit health insurance is the most economical way to pay for healthcare, and as a matter of fact, it's the most expensive, least efficient system in the world. Second, we're a very rich country, and, therefore, doctors and hospitals make more in this country. But the main issue . . . is just the crazy administrative burden of our system with hundreds of different payers, thousands of different forms. At the moment in America, there's one system for Native Americans. There's a different system for veterans. There's a different system for chronic renal failure sufferers. There's a different system for congressmen. No other country does that, and if you think about it, it's just a formula that has to create huge costs and confusion, which is what we've got.