Weve got to close that emergency room because not enough people come at night in the rural area. That is not why we keep Emergency Rooms open at night. We keep them open because people are sick and there might be an emergency but the logic of this is applied to hospitals, the kind of structuring of hospital care, we end up with a lot of weird decisions. Again and again people say to me i get all these requests asking for money and Hospital Executives thing medicare doesnt pay them enough, medicaid doesnt pay them enough. The first thing i say is walk into the lobby of your local hospital and tell me it feels like a poor suffering place. We have both been involved in well the Teaching Hospitals but hospitals today look like 5star hotels. I spoke to one Trauma Center who wanted me to look at their zen garden. This is a weird priority. Some hospitals now hire a Hotel Executive to improve the customer experience, they will advertise great meals. I think that is all great. I dont think hospitals have to be like prisons but i think we patients have to wise up to what is important. Most hospitals in europe look kind of like high schools, they are much more basic. What are hospitals doing . Do they feel like charities . Do they feel like they are serving the community . I recommend that everyone look at the 990 tax form of their local hospital, look how much the executives are paid. The highest paid executive in most cities is the ceo of the local hospital and i dont want anyone going broke on healthcare, i dont think you have to take a vow of poverty but i dont think most hospitals need the top 20 administrators paid over 1 million a year and wednesday say healthcare, the Ford Foundation is complicated too and operates in 90 countries and the ceo of the Ford Foundation doesnt make as much as the 15th administrator in new jersey, that is a kind of false narrative. The aca did something important and that is one of the things i am afraid will go away, reporting on what you are doing for hospitals to deserve tax breaks, what are you doing to benefit the community . What are you doing in the way of charity care . That was transparency, we never defined what is the level we want . What are the Community Benefits in the tax break . As communities we should take the next step. It doesnt have to come from washington, some local mayors take away their taxes and status and hospitals are not really going to serve communities with what communities need like cheaper rates or maybe remediating mold infested housing or treating kids at school, maybe you could better use those tax dollars. As someone said to me apple gives away a lot of computers each year but that doesnt make the charity. What is the bar we expect of these big wealthy institutions in our midst in order to deserve a tax break. Long answer but something i think every mayor and every city council should be looking at. Your book takes on the whole a negative view of the healthcare system, are there any good parts of healthcare in the United States . Anything we should feel good about as citizens, taxpayers . I think there are many good people in the system. I think there are parts of medicare it worked very well for patients. I run a facebook group, people in the group, there are 9000 members and they talk about arriving at the Promised Land of medicare so they dont have to deal with the unpredictable and crazy bills they deal with in the commercial world. I think it is true that there are some kinds of treatments we get first, the narrative we hear over and over again. Yes, drugs often come to the us first. They often come to the us first because they are pricier here and it makes sense commercially to market them first in the us because then you set a high bar for prices and the rest of the world. I would say also that reliance on the profit motive to bring us new drugs and new treatments lead to some pretty bad result, the overuse of expensive treatment, some great new machines like Proton Beam Therapy which was invented for a small segment of patients who couldnt be treated by other means and now it is used far more widely in the us, there is one proton beam machine in canada and the uk still sense patients to the us. There are dozens in the us now and for that reason they are used at many patients dont need them and wont benefit from them. Yes we get them first and people who really need them, that is great but there is this kind of diffusion to places where these treatments are not useful. Also the flipside of that is treatments that are not useful, that are not remunerative you sometimes dont see in this country because there is not a business model. The experience of one of my kids in princeton during the meningitis the outbreak there were vaccines against meningitis be on the market in australia, canada and england and all these other countries but it had never been marketed in the us because it was clear it was going to be used in a limited way for outbreaks on College Campuses and it wasnt worth going through that whole fda approval process for the manufacturer, we get some kinds of treatments much quicker and there are others which eventually that vaccine did arrive in the us but only after the cdc and the fda jumped through a bunch of extraordinary hoops, it was close to a year before that vaccine finally arrived. I love my doctor, im proud a lot of the care we get. In this book you wont on the whole find anyone who is unhappy with the results of their treatment but they are very unhappy about the process of getting that treatment and the cost and the burden that put on them. That is where we have to focus our energy and research too. It is more efficient to have a heart surgeon running two operating rooms at once but is that what you want for your medical care . That paper was presented at the American College of cardiology last year. To me that is not medical research. That is Business Efficiency research and im not sure there is a real medical case for even trying to do that. We are nearing the end of the hour. It has been terrific to listen to your description of the book and i highly recommend the book. It really personalizes a lot of these issues. There is a lot more we can talk about, im looking forward to what you do with your reporting going forward. Any comments on what you plan to do next based on what you have learned . Im editorinchief of Kaiser Health news, we are a Nonprofit Health news, what im trying to do is continuing to look at why economic theories of healthcare dont work on the ground, what makes the system so excessive. One thing we havent talked about very much is the area of drug prices is why we are not doing what everyone else does in the world which is to negotiate at a national level. There are bipartisan support now every time there is an epipen crisis or we should allow medicare to negotiate a we should allow a person to hold imports or reference pricing with canada. Those dont go anywhere and one of the reasons they dont go anywhere his lobbies. We are looking more at how lobbying affects the healthcare we see in the us today. It has been a pleasure. I wish you luck with your book and Kaiser Health news and i look forward to talking to you in the future. Good to be talking to you again, take care. Sunday night on afterwards. Someone like steve jobs can sell this product and forever be associated with it when that is just a shade of the story. He was certainly handson, have a lot to do with it but the truth is even the iphone insofar as it was developed with apple never would have happened without scores of people working around the clock. Reporter brian merchant on the creation and development of the iphone in his book the one device. He is interviewed by New York Times reporter steve laura. Part of the story is the iphone was born with the interaction paradigm was born behind steve jobss back. This crew of guys started basically experimenting. It was freewheeling research. It was fun, wild kind of stuff. A projector rig they were using to hack different products together and create what would become the iphone. Watch afterward sunday night at 9 00 eastern on cspan2s booktv. On thursday, jay powell from the Federal Reserve board of governors