Tune in to our radio show on your local public radio station, or sign up for the free podcast and listen at your leisure. Here’s what it’s about:
• Does the U.S. have the best health care system in the world?
• Why are hospital bills so high?
• Do all Americans get the care they need–eventually?
• When you get sick, is it your own fault?

Dr. Bill Roper is one of the country’s leading health care experts. We talk with him about the state of health care in this country. Dr. Roper discusses medical myths and why they matter. He describes how our health care system could be greatly improved. What is the ideal health care system for the U.S.?
Guest: William Roper, MD, MPH, served as administrator of the Health Care Financing Administration, where he oversaw Medicare and Medicaid, under President Reagan. He also served on the White House staff for President G. H. W. Bush and directed the Centers for Disease Control and Prevention. He has held leadership positions in the insurance industry, the Institute of Medicine, the National Quality Forum and academia. He is currently dean of the School of Medicine and vice chancellor for Medical Affairs at the University of North Carolina at Chapel Hill, where he is also CEO of the UNC Health Care System. The website is http://www.unchealthcare.org/site
The podcast of this program will be available the Monday after the broadcast date. The show can be streamed online from this site and podcasts can be downloaded for free for four weeks after the date of broadcast. After that time has passed, digital downloads are available for $2.99. CDs may be purchased at any time after broadcast for $9.99.

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  1. Gallien L.
    Reply

    According to health care experts; the future of health care would be in safe hands. As every day we have found different types of health reform; health program and health care projects in our regions to provide a better health care service. Therefore the health care standard is higher than our expectations. In the above article we have found certain facts & myths about health care from Dr. Bill Roper to develop the health care system of US. In my point of view an ideal health care system is the one through which patients are getting affordable and quality medical care service.

  2. MDAR
    Reply

    I thoroughly enjoyed listening to Dr. Roper. It was very enlightening. I feel that everyone needs insurance. When people have health insurance they tend to be healthier. People complain about the healthcare mandate but there are already several mandates that go back before I was born. When people without health insurance go to the hospital that cost is paid by the taxpayers anyway. Why not have insurance for everyone. Healthcare cost will go down for everyone. Are all the people that are against the mandate insured and have good health and know they and their family will continue to have good health? Their are people that are physically and mentally unable to work so this mandate would help them with the government giving them subsidies. May God help us.

  3. Faith S-B, Apex NC
    Reply

    To SCD, I am a “Welfare” baby. My mother was a heroin addict as was my father so my grandmother and grandfather (who both worked full time jobs) raised me and my sister and brother with no help from either of my parents. I agree that the welfare system needs an overhaul but taking away social services all together would not only hurt the parents but also the children that are in need and the grandparents that help with so many of the younger generations.
    You also have to consider the economic affect of removing the welfare system because that puts money back into the system when they shop for food they are making purchases which puts money back into the system. I am not against a social system overhaul but removing the welfare system all together would just be wrong to so many innocent people.

  4. DD
    Reply

    Interesting discussion on a complex problem.
    I understand how in our culture we want to blame everything one does as the “cause” of an illness, but have we totally thrown out genetics? Especially, now that we have the genome sequenced, it seems like we would lean heavier on tendencies for illness and a greater effort to educate and minimize the effects of our negative genetic codes. There is also the danger of being denied coverage while you have health insurance because a physician orders a genetic test and they discover you have a genetic tendency for your problem.
    This happened to a friend who was given a genetic test without her knowledge or consent and was told by her healthcare company she had a “pre-existing condition” for a problem she didn’t know she had and they denied to pay for her hospital stay because it was in her genetics.
    I’d like to hear more on this topic from a variety of experts with alternative solutions.

  5. REP
    Reply

    If you are over 70 you only get palliative care in European health systems? That is the most ridiculous lie I have ever heard. My uncle lives in Germany. He is 79 and has diabetes and heart disease. Believe me, he gets excellent care.

  6. RFL
    Reply

    KK,
    “Let he was is without sin cast the first stone” is a quote that might come to mind here. As with all such things there is no certainty therefore can we seriously deduce that one’s actions did cause the affliction. But, you might say, the preponderance of evidence points to…. To which I might allude to the history of the desirability of coffee in one’s diet, good, bad, good , bad,….
    Life is uncertain.
    I would also ask about the influence of environmental factors in disease/conditions. There are numerous “conveniences” that we take for granted that leach known carcinogens and neuro-toxins into the environment in general or into one’s bowl of porridge, how does that get factored in?
    Besides, are you not sure that some innovative attorney/insurance bureaucrat/other will not identify something you did as deleterious to your life, keeping in mind the living is terminal.
    Pointing fingers is a dangerous game as the basis often comes back to haunt one.

  7. RFL
    Reply

    Ah, Mr. Gal, factions in this country have far exceeded the simplistic approach of the former Soviets in quieting dissent. Massive campaigns to disseminate misinformation based upon fear and innuendo are proving more effective. Simply disenfranchise voices, viz the fact that some quarter of the American voting public appears to believe that our President is either a Muslim or foreign born. No, locking people up for dissenting opinions is too crude for current America, well except for a select few who have made a mess of some urban parks or tied up traffic. You need to start thinking 21st century!
    Now those who ignore history are doomed to repeat it, I realize. Buy tulips!!! Or home prices will always rise. Or a home is the American dream. Ignite the fear of losing out. Or feed the preexisting bias. We used to talk about propaganda, monopolies, oligopolies, restraint of trade, truth in advertising (the oxymoron of all oxymorons), but now it is easier….play to irrational fears. A little setting up of the economy to enter a massive abyss helps make the message credible. Oh, yes, massive influxes of money from limited sources also helps.
    I fear less the bureaucrats and more the oligarchs who our legislative representatives as marionettes. No, your fears are based upon the scenery that you have passed, the plight of the rear facing seat on the ride.

  8. REC
    Reply

    Greetings,
    Cost of MRI of shoulder (approximately 15 minutes time …. machine operation by technicians …… “read” by radiologist) in US – $1400.00 to $1500.00
    dollars.
    Cost in Japan (similar to Europe in that govt each year uses a bidding process to negotiate fees from providers for that year) – $99.00.
    Cost in India …… there is no insurance there …. prices are all cash and thus there is no artificial manipulation of the market by large corporate interests ….. simple supply and demand and what people can afford to pay … the cost is approx. $18.00 .
    I would propose that the medical systems in both Japan and India are just as sophisticated as those in the US and that the medical personnel are just as well trained.
    The insurance companies and the pharmaceutical companies/healthcare delivery personnel (individual and hospital) have had a symbiotic relationship for decades. Both have profited from this relationship which has continued to spiral upwards.
    Though the insurance companies and large health care entities (clinics/hospitals/pharmaceutical) may not have liked each other, they were willing to split the increasing profits.
    Now we have reached a crisis point where people can no longer afford either the insurance or the drugs/health care.
    You are dealing with an area (and unfortunately this has become true of all US businesses ) where greed has become the norm and patients have become prey due to their ignorance.
    Where these businesses once talked of “decimal” markups (cost x .3 or cost x .6, etc) and percentage markups of less than 100%, they now routinely speak of multiple whole numbers (cost x 3, cost x 6, etc) and percentages up to 1000’s of percent.
    I have been in health care for 22 years and I have personally witnessed all of these processes/events.
    Over the course of the last several years, things have reached a point where the things I am seeing are, from my ethical upbringing, are criminal in nature.
    I actually become physically ill from the things I see, sometimes becoming nauseous …. literally wanting to vomit … at the total lack of principles with which I am confronted.
    Seeing people “legally” robbed has given me the feeling that I am now living in a criminal colony.
    Entities, such as Congress and the FDA, whose missions include the protection of the public from unscrupulous business entities have been compromised thru legal bribery in the political process.
    Approximately a decade ago, pharmacists warned the FDA and Congress of the repercussions of legislation (proposed by the pharmaceutical companies themselves) that would ultimately make the FDA dependent on funds from the drug companies to maintain their operation.
    The pharmaceutical companies got their way and now I wouldn’t trust any new drug approved by the FDA actually being safe and effective.
    80% of all clinical trials are now being done in foreign countries without any physical oversight by the FDA. I guess we’ll just have to trust the drug companies to oversee themselves.
    Other agencies (ex. FTC and SEC) have been neutralized by budget reductions that prevent them from pursuing their missions of protecting the public.
    Once the FTC kept competition alive thru preventing horizontal and vertical mergers. Those days are gone.
    It was once said that the practice of medicine was a calling rather than a business.
    Now it is obviously first a business …. and we are now faced with oligopolies and defacto monopolies in some areas.
    And rather than using economies of scale to pass along savings to customers like Walmart does, the large hospital/clinical associations use their positions to negotiate higher fees/returns.
    People now go to India to have expensive medical procedures and even dental procedures done …. and come out ahead even after large travel expenses.
    Perhaps trying a cash-only structure would be worth a try in this country.

  9. Jonathan L. Gal
    Reply

    One of the great dangers of centralized healthcare is the abuse of the system for political gain.
    The poster, “RFL”, who dismisses my comparison to the Soviet Union as irrelevant may need to education him/herself a bit further on the practices of the Soviet Union. Locking up dissidents, either as criminal or as mentally disturbed, is one of the key tactics used by central planners to handle dissidents. Such “forced silencing of dissent” runs counter to the core principles of the United States Constitution and Bill of Rights.
    I should also add that centralized healthcare could be very damaging to the “Alternative Healthcare Industry”, as the central authority, corrupted by mainstream healthcare interests might shut down the alternative medicine industry altogether in an effort to protect its financial interests.
    Jonathan L. Gal
    Harvard ’89
    Editor In Chief
    Galatian Free Press

  10. KK
    Reply

    It may be a bit harsh to say it’s someone’s own damn fault for contracting an illness, but isn’t it fair to say that people contribute by their lifestyle choices? And if that’s the case, isn’t it also fair to expect someone who makes choices that lead to their illness to shoulder more of the cost of their care?

  11. RFL
    Reply

    Mr Gal takes the stereotypical approach of likening a centralized system to the Soviet central planning failure. But, of course, there are numerous successful medical systems operating in Western countries that he fails to offer as working examples.
    The approach of using black and white comparisons is simply to draw out emotional reactions rather than rational thought. It has been and is increasingly used to denigrate any aspect of our society that is being, or has been, socialized, such as public education, single payer or centralized health care, and so on.
    Growth is not about exclusively selecting between philosophies of governing and servicing a society but by integrating the best aspects and contributions of each into a beneficial whole. Mr Gal and libertarian approaches disdain that method of building new constructs.

  12. BB
    Reply

    What about health share systems? Some farmer friends of mine participate in one and it has been great. They’ve had some major medical issues (a heart condition, farming accidents) and all of their bills got paid. It seems like such a sensible way of doing things and gets rid of all the middle men.

  13. Jonathan L. G.
    Reply

    Your guest describes America Healthcare as a “crazy quilt” instead of a “system.” The same could be said of the computer industry of the past 30 years, but it is still the best computer industry in the world. Competition in a free market system often produces an array of options that can seem “crazy” or “chaotic.”
    The American computer industry has gone through periods of change, during which “chaos” was literally the best word to describe it; but chaos is not necessarily bad. Throughout the chaos, the American computer industry has consistently produced the most advanced & innovative technologies AND the greatest access to computers of any nation.
    Those who seek to design a centrally planned healthcare system, because it appears more orderly and less chaotic to their analytical minds fail to learn the lessons of history. The recent example of the Soviet Communist government proves, beyond the shadow of a doubt, that central planning simply does not work.
    I’ll take American “Free Market Chaos” over Soviet Central Planning any day. Let’s just say that a government mandated stay in the Gulag is not on my “bucket list.”
    Jonathan L. Gal
    Editor In Chief
    Galatian Free Press

  14. Bruce W.
    Reply

    Thanks for your program with Bill Roper. It certainly surfaced the difficult but very real issues. I have some observations.
    An area which I did not hear discussed was development of standards for the recording and exchange of medical data. Having rigorous standards would avoid non-value-added reinterpretation and possible corruption of the data. In the exchange of engineering design data between various disciplines the use data standards is very important.
    For those who would say “I don’t have to buy health insurance,” I don’t know of anyone who says, “I shouldn’t have to pay taxes to support the fire department.” Does this mean that house has priority over health?
    Community is a core aspect of all life, human and otherwise. The challenge is to learn how to engage in civil discourse, and to gain a perspective and empathy of other’s situation.

  15. RFL
    Reply

    It boggles the mind when you see comments like SCD’s and BAB’s and what it says about these United States…..it is a sad commentary about who we are, or are not.
    Pogo said it all!

  16. Pati W.
    Reply

    I am commenting on Health Care in America.
    My husband and I are part of the 50 million uninsured. I worked in the healthcare field for 22 years and left (as did 7 others in one year) due to the “corporatizing” of our health care system. The people who left with me were doctors, secretaries and therapists.
    The reason we had to cancel our insurance has 2 reasons. 1)High cost (almost $1000 a month ) for self employed healthy (but not rich) people. They also would not pay for any medical tests dealing with my thyroid. I have a benign nodule on my thyroid and my insurance would not pay for the very tests to make sure I was still healthy.
    What is health care for? This was considered a “pre-existing condition,” even though I was healthy and the nodule was benign. We would gladly pay for some form of health care but at 57 years old-it is hard to find an insurance that isn’t extremely expensive and is ilimited. I thought for $1000 a month I should have gotten better care. That amount of money was a huge chunk of what my husband and I make per year.
    We are hard working artists, house painters, house cleaners and pet sitters. We are NOT LAZY. We pay taxes. We need to come up with plans that are afordable. Not all of us make huge salaries (it doesn’t mean we don’t work hard). This is why people choose not to have health care. I also have had many friends who had insurance only to be dropped when they were in dire need (Cancer or heart health). They were people who took very good care of themselves. I am ANGRY at our system.
    I don’t trust our medical big shots-Sorry- we’re not as caring as some would lijke to think.

  17. Kevin B D, in Texas
    Reply

    I find the preveous comment falling right in line to what Joe mentioned he usually hears. Perhaps that is why the phones were not opened for questions and comments. I was just chomping at the bit to call in and say I just can’t believe Dr.Roper ever had anything to do with the government. He just makes waaaayyyy too much good sense. I’ts a wonder they didn’t take that outta him. It’s a pitty it didn’t rub off on anyone in the administrations.
    I start up this conversation with folks and they start frothing up around the mouth and muttering Obama and get all worked up about it being for (fill in their least favorite minority) and I turn it around and make it a lil more personal with a story such as this.
    Ya have a man 50 y/o and he’s working cows and gets a lil dizzy falls and gets stomped pretty good, but this is nothing new so he turns to his vast medical supply, mercurochrome, epsom salts and bearing grease but his wound just don’t heal and he gets so bad hes outta his head and a neighbor takes him to hospital. Well it don’t take em long to decide to take his leg off, and tell him why he got dizzy was because he is diabetic.
    Well he has a policy he has been paying good money on for years but turns out it don’t pay for anything hardly. So now he gets home wayyyy behind on his crop and he couldn’t run his tractor even if he could get up on it …and now he’s getting bills from more doctors than he knew they had in that hospital. Well he’s took a pretty hard hit and starts feeling sorry for his self (in city talk SEVERE DEPRESSION) and he can’t figure what to do but along with that hospital bill his bank note is coming due he didnt make a crop so all he can do is sell off his herd, most of his equipment is so wore out it wont bring anything.
    Now he has been paying in social security, twice what town folks pay because he is self employed but the back log is so long and the process so onerous he has to get a half wit lawyer to do the paperwork and that takes bout 18 months. Well the tax assessors figure out he has no cows and no crop so now his taxes go to 20 times what they were before and he was having a hard time paying that, so the land grabbers go to circling like buzzards and prompting those in charge to hurry up and sell that “great location” that has just been being wasted not having tract houses on it.
    Now he gets his first check for being DISABLED and he really gets to feeling sorry for hisself (depressed) thinking more and more about his beloved soulmate who died in child birth and he cant figure what to do so he looses his place for taxes cause theres no way that 1000 a month he’s getting is gonna do any good. Sooooo now we have a 52 year old man who was a highly productive and respected member of his comunity who has no place to live, no family alive and his only option is to go to a nursing home allowing him 25 dollars a month of his check and taking the rest plus a passel more kicked in by the state and he’s gonna live for 20 years like this till the county has to pay to bury him.
    This ALL could have been prevented by a decent national health service that he could have paid into and gotten 500 bucks worth of tending a year to tell him he had diabetes and tell him what to do …..So by now who ever Im talking to gets a lil pale in the face and dont have much to say when I ask em TELL ME A HEALTH SERVICE IS TOO EXPENSIVE …cause they all know they are just one mishap from being that very feller.
    We will spend mony to the vet for a cow but theres never enough to afford to see a doctor ourselves with all the test and huplah. How come it cost twice as much to go in and pay cash as what they get from an insurance company??? and we always carry high deductable hospitalization cause thats all we can afford. We are way too proud for Medicare and couldnt qualify with so many assets it takes to just squeek out a living .
    This is just one story from the naked (un and underinsured ) country. Theres millions more of em out there

  18. Mike MacGregor
    Reply

    This was an extremely informative program and I wish every person in America could have heard it. I like that Dr. Roper took no political sides, that he very carefully chose his words, and that he seemed very objective. Plus, of course, he’s got the vast experience that few others have. We need a lot more qualified people like him to inform a public that is more used to hearing (and repeating) slogans. I plan to get the podcast of this program and send it to my friends, as we’ve been having quite a bit of discussion of this topic.

  19. Lynn B. H.
    Reply

    Re “blaming the victim.” As I sat several years ago in the office of my oncologist discussing a treatment protocol for my non-Hoskins lymphoma, I saw a chart on the wall that read “Twelve steps to avoid cancer.” I said, Doctor, I do all twelve of those things. He replied, Yes, but sometimes you still get cancer.”

  20. CLP
    Reply

    With all due respect, the good doctor is dead wrong in his closing comment. Our system will improve when we pay from our own pockets for the care we receive. We need to eliminate intermediaries everywhere we can.
    Let’s look at things that are affordable in our country: food, clothing, electronics and over-the-counter meds. Competition is fierce, and people go elsewhere for alternatives when prices are too high. On the other hand, everything we buy with intermediaries is expensive: health care, prescription meds and military come to mind.
    Yes, we need coverage for major health expenditures, but it should be purchased by individuals with their own money, not by employers. When employers are involved,again as intermediaries, they are naturally motivated to shun those with illness who are otherwise employable.

  21. jsh
    Reply

    Program #859 with Dr. Roper of UNC was excellent — it showed that there is at least one cool head who can speak to the state, the problems and the solutions for healthcare in American healthcare. The calm, factual discussion in this program should be required hearing THREE TIMES for all congresspersons and senators. Dr. Roper has served in Republican administrations in positions of great responsibility and vision, and his views are very similar to the Democrats’ healthcare bill. So, how come our representatives and senators ARE NOT LISTENING to a healthcare professional who understands today’s systems and tomorrow’s risks and hopes. We must end our paralytic party bickering soon!!!

  22. jsh
    Reply

    Program #859 with Dr. Roper of UNC was excellent — it showed that there is at least one cool head who can speak to the state, the problems and the solutions for healthcare in American healthcare. The calm, factual discussion in this program should be required hearing THREE TIMES for all congresspersons and senators.
    Dr. Roper has served in Republican administrations in positions of great responsibility and vision, and his views are very similar to the Democrats’ healthcare bill.
    So, how come our representatives and senators ARE NOT LISTENING to a healthcare professional who understands today’s systems and tomorrow’s risks and hopes. We must end our paralytic party bickering soon!!!

  23. JC Cooper
    Reply

    Dr. Roper made points clear which some people with a broad public forum on the radio intentionally deny to be true for political reasons.
    I find it incredible people can make a fortune in America by stating lies and hiding the truth.

  24. SD
    Reply

    Why does EVERYONE deserve healthcare?

  25. BAB
    Reply

    Keep in mind that socialist systems, like Europe, have tax systems that take 50% or more of an individuals’ earned income. Also, and this is also the case with Obamacare, if you are over the age of 70 or so, you will only receive “comfort care” or pain relief, but no actual treatment. This doesn’t seem any more effective than the current system, but national health coverage doesn’t seem any better. How about we get rid of insurance altogether? That would solve a lot of our problems; if you can’t pay, you don’t get care.

  26. SCD
    Reply

    Get government out of people’s personal lives… no more social welfare programs! If you won’t/don’t work, you don’t deserve to eat or get health care. I’m so tired of paying for the lives of the largely lazy unemployed. Since I know that there are people who fall on hard times, at least make social welfare programs severely limited (ie. one is only eligible for welfare for 1 year in 10).

  27. MJW
    Reply

    I will be eager to hear this broadcast, although it is clear that we already know the answers to some of these questions.
    1. We do NOT have the best healthcare system.
    2. Hospital bills are to high because of vested interests and the profit motive.
    3. Many Americans never get the care they need.
    4. Sometimes it’s your own fault, such as if your diet is laden with sugar and other garbage, or if you never leave the couch, or if you rush to take a pill rather than seek the emotional cause of a symptom.

  28. cpmt
    Reply

    No we do not have the best health care in the world. Some countries in Europe have better system than here. It is unthinkable that one person – 26 yrs old woman- died untreated form breast cancer. This is incredible in a country like ours.

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