The Politician-Doctor Weighs In: An Interview With Former Oregon Gov. John Kitzhaber

"Should 95-year-old grandpa's quadruple bypass surgery be paid at the expense of his 6-year-old granddaughter getting immunizations and a routine checkup at her pediatrician? That's the larger question."

On the Lack of Preventive Care:

"Most countries have a much higher emphasis on preventive care, on wellness, and other things that affect the health of their population."

"[Our system] rewards doing things to people. It rewards procedures. It's a system that sort of lies in the weeds until people are very, very sick and then rushes in with extraordinarily marvelous and expensive high technology to help you recover on the back end."

"We don't have a health-care system in the U.S., we have a sick-care system. If you get sick or badly injured or have an exotic disease, this is the best place in the world to be. If you want to stay healthy and stay out of the health-care system, this is not the best place to be."

On What Today's System Would Look Like If It Had Been Proposed As Legislation, Rather Than Evolving Unplanned Over Time

"You might have a section that says there should be no explicit policy objective adopted to guide the allocation of $900 billion of public health-care resources. No responsibility will be assigned for financing health-care needs of Americans who can't afford to do so themselves."

"Section one might read, 'All those over the age of 65 regardless of their income will be entitled to publicly subsidized health care. … All working people under the age of 65 regardless of whether they can afford health care for themselves or their children will be required to contribute a portion of their taxes each month to pay for the health-care needs of wealthy people over the age of 65.'"

"Yet another section … might read 'Medicare, the program for the elderly, is prohibited from covering long-term care services in spite of the aging of the population. Medicaid, the program for the poor, will be required to cover long-term care services. … The elderly who need long-term care services will be required to spend themselves into poverty in order to become eligible for Medicaid, at which point their needs compete directly with those of poor women and children, and in many cases their own children and grandchildren.'"

On the Factors That Determine a Person's Health Status:

"About 40 percent of what affects people's health status are behavioral choices and lifestyle decisions whether you smoke or drink, dietary considerations, exercise. About 30 percent has to do with your genetics, who your parents were. About 15 percent are social factors, whether you have a job, whether you have a house, whether you have a healthy neighborhood. Then 5 percent are environmental factors, which [means that] the U.S. medical system … has about a 10 percent impact on people's overall health status."

On the Problem of Baby Boomers and Medicare

"There's about 49 million people on Medicare today. There's 78 million people in my generation, and we're going to start hitting the age of 65 in 2011 -- five years from now."

"The demographics of the American population is really what's going to drive us over the edge. … When my generation fully reaches the age of 65 and becomes eligible for Medicare, the unfunded entitlement in the Medicare program alone will exceed $65 trillion."

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