ANNOUNCER: THE UNITED STATES SPENDS FAR MORE THAN ANY OTHER NATION IN THE WORLD ON ITS HEALTHCARE SYSTEM, BOTH OVERALL AND PER PERSON, YET WE DO NOT HAVE THE LONGEST LIFE EXPECTANCY AND HAVE HIGHER RATES OF MANY CHRONIC, DEBILITATING ILLNESSES.

FOR DECADES, HEALTH POLICY HAS BEEN ONE OF THE MOST CRITICAL ISSUES OF ITS CONTENTION IN AMERICAN POLITICAL LIFE, YET AN APPARENT MISMATCH PERSISTS BETWEEN WHAT WE ARE PUTTING INTO OUR HEALTHCARE SYSTEM AND THE RESULTS WE ARE GETTING OUT OF IT.

ARE THERE TRULY INNOVATIVE APPROACHES TO REFORM THE DELIVERY OF HEALTHCARE IN THE UNITED STATES?

AND COULD SOLUTIONS COME FROM THE BOTTOM UP, THE PEOPLE ACTUALLY WORKING ON THE FRONT LINES OF CLINICAL CARE AND HEALTH ADMINISTRATION?

[THEME MUSIC PLAYING] THIS EPISODE OF "THE WHOLE TRUTH" IS MADE POSSIBLE BY...

THE CHARLES KOCH FOUNDATION, AMETEK, CNX RESOURCES, BUCHANAN, INGERSOLL & ROONEY, AND BY... FOR HUNDREDS OF YEARS IN ENGLISH-SPEAKING COURTROOMS AROUND THE WORLD, PEOPLE HAVE SWORN AN OATH TO TELL NOT ONLY THE TRUTH, BUT RATHER THE WHOLE TRUTH.

THE OATH REFLECTS THE WISDOM THAT FAILING TO TELL ALL OF A STORY CAN BE AS EFFECTIVE AS LYING, IF YOUR GOAL IS TO MAKE THE FACTS SUPPORT YOUR POINT OF VIEW.

IN THE COURTROOM, THE SEARCH FOR TRUTH ALSO RELIES ON ADVOCATES ADVANCING FIRM, CONTRADICTORY ARGUMENTS AND DOING SO WITH DECORUM.

ALL OF THESE APPLY TO THE COURT OF PUBLIC OPINION, WHAT JOHN STUART MILL CALLED "THE MARKETPLACE OF IDEAS."

THIS SERIES IS A PLACE IN WHICH THE COMPETING VOICES ON THE MOST IMPORTANT ISSUES OF OUR TIME ARE CHALLENGED AND SET INTO MEANINGFUL CONTEXT SO THAT VIEWERS LIKE YOU CAN DECIDE FOR THEMSELVES "THE WHOLE TRUTH."

THERE MAY BE NO PUBLIC POLICY ISSUE THAT MORE COMPLETELY CROSSES OVER FROM THE POLITICAL WORLD OF PRESIDENTIAL CANDIDATE DEBATES AND CONGRESSIONAL HEARINGS INTO THE WORLD OF AMERICAN KITCHEN TABLE AND FAMILY CONVERSATIONS THAN HEALTHCARE.

IT IS, AT ONCE, A PUBLIC AND PRIVATE MATTER OF THE GRAVEST CONSEQUENCE.

ON TODAY'S EPISODE, WE ARE GOING TO DO SOMETHING DIFFERENT.

RATHER THAN OUR USUAL PANEL OF GUESTS WITH A VARIETY OF POSITIONS AND PERSPECTIVES, THIS WILL BE A ONE-ON-ONE CONVERSATION WITH DR. STEPHEN KLASKO, PRESIDENT OF THOMAS JEFFERSON UNIVERSITY AND CEO OF JEFFERSON HEALTH.

DR. KLASKO IS WIDELY CONSIDERED A FORWARD THINKER, A REFORMER ON HEALTHCARE DELIVERY AND MEDICAL EDUCATION, AND WE WANT TO DELVE AS THOROUGHLY AS OUR TIME ALLOWS US INTO HIS VIEWS ON THE PRESSING ISSUES RELATED TO THE AMERICAN HEALTHCARE SYSTEM.

DR. KLASKO, THANK YOU FOR JOINING US ON "THE WHOLE TRUTH" TODAY.

THERE'S LOTS WE WANT TO COVER, SO LET'S JUMP RIGHT IN, BUT AS WE DO, "BLESS THIS MESS," YOUR FOURTH BOOK, ABOUT THE--A PICTURE STORY OF HEALTHCARE IN AMERICA.

ONE OF THE THINGS THAT I ENJOY ABOUT DOING THIS PARTICULAR SUBJECT ON "THE WHOLE TRUTH" IS THAT I THINK THE HEALTHCARE SYSTEM IS VERY COMPLICATED.

IS IT TOUGHER OR EASIER TO BECOME A MEDICAL DOCTOR TODAY, WOULD YOU SAY?

MORE OR LESS TRAINING?

I THINK IT'S MORE.

IT'S ALMOST IMPOSSIBLE, WHEN WE THINK ABOUT MEMORIZING, AND WE CAN TALK ABOUT HOW WE NEED TO SELECT AND EDUCATE DOCTORS DIFFERENTLY, BUT THERE'S SO MUCH MORE KNOWLEDGE.

I MEAN, THE KNOWLEDGE USED TO EXPAND AND DOUBLE EVERY 10 YEARS, THEN 5 YEARS; NOW, LITERALLY, OUR KNOWLEDGE EXPANDS AND DOUBLES LITERALLY EVERY 3 OR 4 WEEKS, WHEN YOU GET TO GENOMICS AND PROTEOMICS AND MICROBIOMES.

SO I THINK THE KEY FOR US IS STARTING TO LOOK AT HOW WE CAN LOOK AT A.I.

AND ROBOTS AND LET THEM BE BETTER ROBOTS THAN WE ARE AND HOW WE CAN START TO SELECT AND EDUCATE DOCTORS TO BE HUMAN.

ONE OF THE QUESTIONS THAT HAVE OCCURRED TO US IS THAT AMERICA SPENDS MORE MONEY--I BELIEVE MORE MONEY PER CAPITA-- ON HEALTHCARE THAN ANY OTHER NATION, YET WE DO NOT HAVE THE LONGEST LIFE EXPECTANCIES AND SO FORTH.

WE HAVE A MIXED SYSTEM, I GUESS YOU WOULD CALL IT, WE HAVE A VERY COMPLICATED SYSTEM.

WOULD YOU CONSIDER IT TO BE EFFICIENT OR ARE THERE MORE EFFICIENT WAYS OF SPENDING MEDICAL DOLLARS TO ACHIEVE DESIRED OUTCOMES, LIKE A SINGLE-PAYER SYSTEM?

WHAT'S YOUR VIEW ON THAT?

YES, SO THAT IS A PRETTY COMPLICATED QUESTION.

I WOULD SAY THAT AMERICA HAS THE BEST HEALTHCARE SYSTEM FOR THE 50% OF PEOPLE THAT HAVE UNLIMITED RESOURCES, AND THAT'S WHY PEOPLE FROM ALL OVER THE WORLD WANT TO COME HERE.

THERE'S 4 OR 5 THINGS, DAVID, AROUND PHARMA PRICING, AROUND END-OF-LIFE ISSUES, AROUND HOW WE PAY OUR SPECIALISTS VERSUS OUR PRIMARY CARE DOCS, AND THIS THING CALLED INSURERS-- THEY GET 15 OR 16 CENTS ON THE DOLLAR TO BE THE GO-BETWEEN BETWEEN THE EMPLOYERS, THE PROVIDER, AND THE PAYERS-- THAT DON'T EXIST IN OTHER COUNTRIES THAT HAVE FULL ACCESS.

MM-HMM.

SO, IF YOU LOOK AT THE UNITED KINGDOM OR YOU LOOK AT CANADA, NOBODY HAS TO MORTGAGE THEIR HOUSE FOR CANCER CARE.

THAT'S THE GOOD NEWS.

THE BAD NEWS IS, IF YOU NEED SOMETHING ELECTIVE, YOU KNOW, YOU DON'T HAVE 25 ORTHOPEDISTS THAT ARE READY TO DO A KNEE REPLACEMENT ON YOU TOMORROW UNDER A MORE CAPITALISTIC SOCIETY.

IF IT'S ELECTIVE, AND YOU'RE IN THE NATIONAL HEALTH INSURANCE, IT MIGHT TAKE YOU A YEAR OR SO...

RIGHT.

TO GET THAT.

HERE'S THE PROBLEM: THERE IS NOT AN UNLIMITED POOL OF MONEY, SO THE QUESTION BECOMES HOW DO WE TURN HEALTHCARE INTO LITERALLY THE SAME KIND OF CONSUMER-DRIVEN SYSTEM THAT EVERY OTHER THING WE DO...

RIGHT.

HAS ACHIEVED?

YEAH.

ON THE SUBJECT OF CONSUMERS AND SO ON, ONE ASPECT OR ONE SIDE OF THE HEALTH EQUATION ARE PRACTICES AND HABITS THAT PEOPLE HAVE THAT ARE UNHEALTHY.

YEAH.

ONE OF THE THINGS THAT HAS CREPT INTO THE PUBLIC DIALOGUE, I'VE NOTICED, IS THE DEBATE ON ENVIRONMENTAL QUESTIONS, WHETHER BEEF CONSUMPTION IS A GOOD IDEA.

CERTAINLY, SMOKING HAS BEEN DEALT WITH THIS WAY AS A-- TO WHAT EXTENT, WOULD YOU SAY, THIS FOCUS ON HEALTHCARE AS A PUBLIC QUESTION IS GOING TO SPILL OVER INTO, I WOULD SAY, REGULATING PERSONAL HABITS?

YOU KNOW, I'D RATHER NOT USE THE WORD "REGULATING."

[CHUCKLES] I THINK WHAT WE NEED TO BECOME CHAMPIONS OF IS FROM US BEING SICK CARE TO BEING HEALTH ASSURANCE AGENTS.

HOW DO WE HELP PEOPLE BE HEALTHY?

I BELIEVE THAT MOST PEOPLE, NOT EVERYBODY, WOULD LIKE TO BE ABLE TO THRIVE WITHOUT HEALTH GETTING IN THE WAY.

AND HOW DO WE GET INCENTIVE FOR THAT?

LET ME GIVE YOU AN EXAMPLE IN PHILADELPHIA.

YOU SPEND A LOT OF TIME IN PHILADELPHIA.

PHILADELPHIA HAS 6 ACADEMIC MEDICAL CENTERS.

RIGHT.

SOME OF THE BEST IN THE NATION.

RIGHT.

WE HAVE THE GREATEST DISCREPANCY IN LIFE EXPECTANCY OF ANY CITY IN THE COUNTRY.

NO.

IF YOU GO 5 MILES EAST OF THE "ROCKY" STATUE...

RIGHT, RIGHT.

THE AVERAGE LIFE EXPECTANCY IS 65; IF YOU GO 5 MILES WEST OF THE "ROCKY" STATUE, IT'S IN THE 80s, SO THAT'S THE DISCONNECT.

AND ANY ONE OF US, WHETHER IT'S US OR--PENN WOULD SAY, "IF YOU COME INTO MY HOSPITAL, YOU'LL GET GREAT CARE."

BUT WHAT IS OUR OBLIGATION AROUND FOOD, EDUCATION, AND HOUSING?

WHAT I BELIEVE WILL START TO HAPPEN IS THAT POPULATION HEALTH WILL GO FROM PHILOSOPHY TO PRACTICE... MMM.

THAT I WILL BE RESPONSIBLE FOR A POPULATION IN EDUCATING THEM AROUND FOOD EDUCATION-- BUT AT WHAT POINT DOES THIS BECOME COERCIVE?

IN OTHER WORDS, IF HEALTH IS--CAN BE FUNDED MORE AND MORE THROUGH SORT OF RATIONALLY PLANNED ALTERNATIVES, REPUBLICANS AND DEMOCRATS COME TOGETHER UNDER THIS COMMISSION, WE BEGIN TO SET HEALTH POLICIES, AT WHAT POINT DOES THE RIGHT TO HEALTHCARE BE--ALSO CARRY WITH IT OBLIGATIONS?

YOU KNOW, AND I THINK-- WHEN DOES IT BECOME COERCIVE?

IT'S GOING TO BE WHETHER DISCUSSION STARTS TO HAPPEN WHEN WE GIVE EVERYBODY ACCESS.

ONE OF MY MENTORS FROM WHARTON WAS A GUY NAMED BILL KISSICK, WHO TALKED ABOUT THE IRON TRIANGLE OF ACCESS, QUALITY, AND COST.

I KNOW HIM.

YES, RIGHT.

AND HE SAID, "IF YOU INCREASE ONE ANGLE, YOU GOT TO DECREASE ANOTHER, ET CETERA.

I SEE.

HEH HEH!

SO IF ANYBODY EVER TELLS YOU YOU'RE GOING TO INCREASE ACCESS, INCREASE QUALITY, AND DECREASE COST, AND IT'S NOT GOING TO BE PAINFUL-- SO YOU'RE TALKING ABOUT "WHAT'S THE PAIN?"

WELL, ONE OF THE PAINS MIGHT BE THAT-- THAT MEDICAL INSURANCE BECOMES A LITTLE BIT LIKE AUTO INSURANCE.

IF YOU'RE A SAFE DRIVER, AND I DECIDE TO GET 6 SPEEDING TICKETS AND, YOU KNOW, MAYBE...

RIGHT.

MAYBE HAVE AN ALCOHOL-RELATED OFFENSE, I'M GOING TO PAY A LOT MORE FOR AUTO INSURANCE THAN YOU ARE.

BUT, ASSUMING I HAVE A CHOICE, AND I DECIDE TO SMOKE 3 PACKS A DAY AND EAT McDONALD'S, AND YOU LEAD A HEALTHY LIFESTYLE, THAT'S SORT OF ALL PUT INTO THE SYSTEM.

RIGHT.

SO THOSE ARE SOME TOUGH--THAT-- WELL, WE'VE IRONED THAT OUT OF OUR SYSTEM, HAVEN'T WE, WITH THE NO PRE-EXISTING CONDITION-- WELL, AND THAT'S WHAT ADDS SOME OF THE COST... YEAH.

BUT IT'S NOT BORNE WITH THE CONSUMER.

RIGHT.

SO THAT'S WHERE THE INSURERS THEN INCREASE THE COST FOR EVERYBODY.

SO I THINK WE'RE GOING TO HAVE TO DEAL WITH SOME OF THOSE REALLY TOUGH SOCIETAL ISSUES.

YOU JUST CAN'T GIVE EVERYTHING TO EVERYBODY.

RIGHT.

AND I THINK THE DEBATE HAS MISSED THE TOUGH THINGS.

YOU HARDLY EVER HEAR ABOUT END-OF-LIFE ISSUES.

HERE'S ANOTHER ONE-- END-OF-LIFE ISSUES, WHICH MEANS--THAT IS WHETHER YOU'RE GOING TO PROLONG LIFE, LITERALLY, AND YOU'RE EVALUATING THE QUALITY OF LIFE, RIGHT?

RIGHT.

BECAUSE MEDICAL SCIENCE HAS ACHIEVED THE ABILITY TO EXTEND LIFE SO FAR.

IF YOU HAVE MEDICARE FOR ALL, AT WHAT POINT DOES IT SAY, "WE'RE NOT GOING TO COVER THIS..." YEAH.

"BECAUSE THIS REALLY REQUIRES PALLIATIVE CARE"?

RIGHT.

AND AGAIN, YOU JUST-- THESE ARE TOUGH ISSUES, AND, YOU KNOW, REMEMBER, IF YOU REMEMBER, THE LAST DEBATE, IT WAS, YOU KNOW, IT WAS THAT THERE'S GOING TO BE THESE DEATH PANELS, ET CETERA.

BUT EVERY OTHER COUNTRY THAT HAS GIVEN EVERYBODY ACCESS... HAS DONE IT.

HAS DEALT WITH IT, AND-- BUT I'M SAYING "DEATH PANELS"-- A PEJORATIVE WAY OF LABELING A PROCESS THAT HAS TO EXIST... HAS TO EXIST, YEAH, YEAH.

HAS TO EXIST IN ONE WAY OR ANOTHER.

IN OTHER WORDS, YOU, AT SOME POINT-- NOW-- SOME DISTANT ENTITY IS GOING TO DECIDE WHETHER CERTAIN KINDS OF TREATMENTS ARE, IN FACT, COVERED BY AN INSURANCE PLAN OR ARE, IN FACT, AVAILABLE.

RIGHT, OR NECESSARY.

NECESSARY, SO THAT'S--THERE'S NO GETTING AROUND THAT.

NO, THERE'S MORE PROTOCOLS.

PEOPLE COME INTO THE EMERGENCY ROOM NOW-- LET'S SAY YOUR SON HIT HIS HEAD, AND THE PROTOCOL IS TO GET A SKULL X-RAY.

PEOPLE SAY, "OH, NO, I WANT AN MRI."

RIGHT.

NOW, IN OUR COUNTRY, SURE.

THE DOCTOR MAKES A LOT OF MONEY FOR THE MRI, THE HOSPITAL MAKES A LOT OF MONEY FOR THE MRI, AND THE PATIENT--IT'S WHAT I CALL IN MY BOOK O.P.M.-- "OTHER PEOPLE'S MONEY."

RIGHT.

THE INSURANCE COMPANY PAYS FOR IT, SO WE DO IT.

RIGHT.

IN MOST COUNTRIES, IT WOULD BE, "WELL, NO, OUR PROTOCOL SAYS..." RIGHT.

"IT'S A SKULL, SO THAT'S ALL YOUR SON NEEDS."

WELL, IT COMES OUT OF EVERYBODY EQUALLY... YEAH.

IN THE FORM OF-- NOW, YOU WANT AN MRI?

THAT'S FINE IF YOU'RE IN THE U.K.

RIGHT.

WE'LL BE HAPPY TO DO THAT, BUT YOU DON'T NEED IT, AND IT'LL COST YOU MONEY.

AT WHAT POINT IS IT--YOU KNOW, WELL, I'M BURNING WITH QUESTIONS HERE.

YEAH.

THE MEDICAL PROFESSION MUST BE AWARE OF THE FACT THAT THEY ARE IN THE EYE OF A STORM HERE, THAT THIS IS, UH-- WE'RE DEBATING THE LENGTH OF LIVES, WE'RE DEBATING THE QUALITY OF LIVES.

I CAN'T IMAGINE ANYTHING THAT IS OF MORE DIRECT INTEREST TO PEOPLE.

THERE MUST BE A PRETTY LIVELY DISCUSSION, AND I WOULD NOT BE PRIVY TO THIS, BUT A VERY LIVELY DISCUSSION WITHIN THE PROFESSION ITSELF ABOUT THE ETHICAL QUESTIONS THAT ARE ARISING BECAUSE OF THE TREATMENTS THAT ARE BEING DEVELOPED, THIS WHOLE NOTION OF TWO-TIERED MEDICAL SYSTEMS, THE...

TAKING INVENTORY-- OUR PRO-- YOU ARE AN MBA AND AN M.D.

YEAH.

SO THE PROFIT-DRIVEN AMERICAN SYSTEM AND ITS RELATIVE-- BUT WHAT KINDS OF ETHICAL QUESTIONS ARE YOU ROUTINELY DISCUSSING, WOULD YOU SAY, WITH YOUR COLLEAGUES, OR ARE THEY BEING DISCUSSED?

NO, I THINK THEY ARE, AND THERE'S SOME VERY VIBRANT DISCUSSION.

PROBABLY THE ONE THAT'S, INTERESTINGLY, HAPPENING THE MOST IS AROUND GENOMICS.

YEP.

SO WE HAVE A PARTNERSHIP WITH A COMPANY CALLED COLOR, WHERE WE'VE OFFERED FULL GENOMIC SUBTYPING TO EVERY ONE OF OUR 32,000 EMPLOYEES 'CAUSE WE'RE NOW AT THE POINT, FOR THE FIRST TIME, OF CHANGING CARE BASED ON YOUR GENOMICS.

SO THE NEXT QUESTION STARTING TO COME, AND THIS IS A BIG DEBATE, OF WHO OWNS THAT DATA.

IN THE PAST, YOU KNOW, A PATIENT WOULD COME IN, AND AS LONG AS IT WAS DE-IDENTIFIED, YOU COULD USE THAT DATA FOR NIH RESEARCH, ET CETERA.

PATIENTS ARE SAYING, VERY LEGITIMATELY, "MY GENOME IS ME."

[SCOFFS] "THAT'S NEVER GOING TO CHANGE, "AND IF THAT'S GOING TO GET MONETIZED, "EVEN IF IT'S AN NIH FUND, I WANT THAT MONEY TO GO TO ME, NOT TO THE UNIVERSITY, NOT TO THE HOSPITAL."

RIGHT.

IN OTHER WORDS, THEY HAVE A TRADEMARK.

YEAH.

MY SON'S AN ACTOR... YEAH.

AND WHEN HE DOES A COMMERCIAL... HA HA HA!

EVERY TIME IT GETS AIRED, HE HAS AN APP...

RIGHT.

THAT LITERALLY-- THEY LOOK AT IT THE SAME WAY, THAT "IF MY GENOMIC-- EVEN DE-IDENTIFIED-- "IS GOING TO BE USED, I WANT TO KNOW, "OH, THIS IS BEING USED FOR A TRIAL?

GOOD.

I'M GOING TO MAKE THE DOLLAR."

SO THOSE ARE THE KIND OF DISCUSSIONS THAT WE'RE HAVING.

THE SECOND THING TO RECOGNIZE THAT'S DIFFERENT ABOUT HEALTHCARE, DAVID, IS THAT EVERY DOLLAR THAT GETS SAVED-- WE HAVE TO MOVE A DOLLAR AND A QUARTER DOWN TO A DOLLAR.

SOMEBODY'S GOING TO GET HURT.

MM-HMM.

AND EVEN--YOU TALK ABOUT HOW WE PAY DOCTORS.

WE'RE THE ONLY COUNTRY IN THE WORLD THAT PAYS OUR DERMATOLOGISTS AND OUR NEUROSURGEONS AND OUR ORTHOPEDISTS 10 TO 15 TIMES MORE THAN WE PAY OUR FAMILY DOCS.

MM-HMM.

BUT WE WANT OUR FAMILY DOCS TO BE THE QUARTERBACK OF THE SYSTEM.

RIGHT.

MY FAMILY DOCS SAY, "YOU WANT ME TO BE THE QUARTERBACK, STOP PAYING ME LIKE THE KICKER."

RIGHT.

SO, LITERALLY-- BUT THAT'S WHAT IT'S TURNED INTO.

YEAH, SO-- IN OTHER WORDS, WE HAVE SO MANY BRANCHES AND SO MANY SPECIALTIES AND, IN FACT, SO MANY OPTIONS.

BUT IT'S ALSO BECAUSE INSURANCE WILL PAY ME...

RIGHT.

LITERALLY $2,000 TO REMOVE A PIMPLE, BUT PAY A NEUROLOGIST $200 TO SPEND 45 MINUTES WITH A PATIENT WITH MULTIPLE SCLEROSIS.

HUH.

YOU COULD CHANGE THAT TOMORROW... YEAH.

BUT YOU CAN IMAGINE THE LOBBYING EFFORT-- LOOK AT ALL THE LOBBYING EFFORTS THAT HAVE GONE ON WITH PHARMA OR INSURERS.

WHAT--YEAH, WHAT IS THE MOMENTUM IN THIS GENOMICS FIELD?

IN OTHER WORDS, WHAT KINDS OF BREAKTHROUGHS DO YOU EX-- OR WHAT KINDS OF THINGS ARE COMING ONLINE?

WE'VE HEARD A LOT ABOUT EXPERIMENTAL TREATMENTS AND THINGS LIKE THAT.

ARE PRODUCTS COMING TO MARKET, SO TO SPEAK, IN THIS AREA IN A VERY RAPID WAY?

I THINK IT'S INCREDIBLY EXCITING.

I THINK IT'S INCREDIBLY EXCITING IN A FEW DIFFERENT WAYS.

ONE IS WE'RE ACTUALLY, FOR THE FIRST TIME, REALLY STARTING TO BE ABLE TO DO SOME RESEARCH ON-- BASED ON YOUR SUBTYPE, WHAT--HOW WE WOULD CHANGE THE TREATMENT THAT WE'RE GIVING YOU.

SO, FOR EXAMPLE, THERE ARE CERTAIN SUBTYPES THAT WE KNOW THAT IF YOU'RE DEPRESSED, WHAT WE CURRENTLY USE WON'T WORK.

SO IF YOU KNOW THAT, THEN YOU WOULDN'T BE GIVING THAT PATIENT THAT DRUG.

RIGHT.

SO WE'RE STARTING TO SEE SOME OF THAT.

WE'RE STARTING TO SEE SOME REAL, REAL BREAKTHROUGHS IN GENE EDITING, YOU KNOW.

GENE EDITING?

GENE EDITING, YOU KNOW.

EDITING.

NOW, THAT-- NOW, EDITING, MEANING PROVIDING YOU ANSWERS TO, I WOULD SAY, DIAGNOSTIC QUESTIONS AND TREATMENT-- AND POTENTIALLY EVEN BEING ABLE TO CHANGE A GENE SO THAT-- THAT'S WHAT I WAS DRIVING AT.

YEAH, WE CAN NOW CHANGE GENES?

YEAH, SO THAT IT DOESN'T-- HA!

LITERALLY SO THAT IT DOESN'T AFFECT IT IF YOU'RE HIGH-RISK FOR TAY-SACH'S DISEASE OR ONE OF THOSE DISEASES.

SO WE'RE REALLY STARTING TO MAKE SOME PROGRESS IN THAT WAY.

WE'RE STARTING TO, AS YOU KNOW-- SOME PROGRESS, BUT, I MEAN, IS THIS-- HOW OLD IS THIS, AND BY "SOME PROGRESS," WHAT DO YOU MEAN?

IS THIS EVERY 2 OR 3 WEEKS, AS YOU SAY, KNOWLEDGE IS DOUBLING, OR IS THIS A 5-YEAR THING?

I THINK, IF YOU LOOK AT THE ADVANCES WE'VE MADE IN IMMUNOTHERAPY FOR CANCER, WHICH IS REALLY PART OF THAT WHOLE THING, THAT'S BEEN INCREDIBLY RAPID.

I MEAN, WE NOW CAN CURE THINGS THAT WE COULDN'T, BASED ON CAR T-CELLS AND THAT KIND OF THING, SOME OF WHICH IS HAPPENING AND ARE BEING PIONEERED IN PHILADELPHIA.

SO YOU LOOK AT SOME OF THE NOBEL PRIZE WINNERS, IT'S A LOT AROUND THERE.

MMM.

I THINK THE CONCEPT OF THE FIRST THING YOUR DOCTOR SEES ON HIS OR HER ELECTRONIC MEDICAL RECORD BEING YOUR GENOME, AND HAVING THAT BE MORE IMPORTANT THAN YOUR HISTORY AND PHYSICAL, THAT, WE'RE PROBABLY ABOUT 5 OR 6 YEARS AWAY.

WOW.

I'LL GIVE YOU ANOTHER REALLY COOL ONE.

WOW.

ANOTHER COOL ONE IS WE'RE STARTING TO DO BIO 3D PRINTING.

WE ACTUALLY HAVE A PROTOTYPE DOWN... YOU MENTIONED THAT, YEAH.

SO THAT, LITERALLY, INSTEAD OF PLASTIC 3D PRINTS OF A HEART, YOU CAN ACTUALLY TAKE CELLS AND DO 3D PRINTS OF A HEART.

NOW, THEY'RE NOT FUNCTIONAL YET, AND THIS IS PROBABLY THE 10 TO 15 TO 20 YEARS, BUT WE WILL GET TO THE POINT, I BELIEVE, WHERE YOU'LL BE ABLE TO MAKE A KIDNEY FROM THE PATIENT'S CELLS... YEAH.

THAT, IF SOMEBODY NEEDS A KIDNEY TRANSPLANT, YOU WON'T HAVE TO FIND A COUSIN OR SOMEBODY MATCH, YOU'LL BE ABLE TO MAKE YOUR OWN KIDNEY.

THOSE ARE THINGS THAT ARE NOT SCIENCE FICTION ANYMORE.

YEAH, NOW WE'RE COMING AROUND TO A VERY INTERESTING SORT OF REALM OF SPECULATION.

I SAT IN--I HAD A CONVERSATION AT THE FACULTY CLUB ABOUT 3 YEARS AGO WITH A DOCTOR I'D BEEN HAVING LUNCH WITH AS PART OF A GROUP, AND HE WAS IN MEDICAL SCHOOL, AND HE SAID SOMETHING THAT WAS REMARKABLE.

HE SAID THAT THE TECHNOLOGY EXISTS NOW TO EXTEND HUMAN LIFE TO ABOUT 135 YEARS.

WHAT IS MISSING IS BRINGING PRODUCTS TO MARKET AND ESSENTIALLY ENGINEERING THIS.

WHAT CAN'T WE DO IN THE MEDICAL FIELD?

ARE THERE ORGANS AND LIMBS THAT CAN'T BE REPLACED?

WHERE IS THE UPPER LEVEL OF LI-- WHERE IS THE LIMIT HERE?

WHERE IS THE CEILING?

IS THERE ANY SENSE THAT THE MEDICAL PROFESSION IS A RUNAWAY HORSE IN MANY WAYS AND THAT WE ARE-- WE ARE REALLY ENTERING REALMS HERE THAT ARE COMPLETELY NOVEL, FOR WHICH WE HAVE NO FRAME OF REFERENCE?

IT'S A GREAT QUESTION.

LOOK, THE TWO QUESTIONS THAT I GET ASKED A LOT IN COCKTAIL PARTIES IN THAT KIND OF WAY ARE-- ONE IS "DO YOU WANT TO LIVE TO BE 135?"

RIGHT.

I MEAN, BECAUSE, WHILE WE MIGHT BE ABLE TO HAVE YOUR HEART CONTINUE TO BEAT FOR 135 AND BEAT ALL YOUR CANCERS, YOUR BR--WE STILL HAVEN'T FIGURED OUT HOW TO GO OVER THE CELL LOSS THAT OCCURS IN THE BRAIN AND YOUR JOINTS, ET CETERA.

SECOND QUESTION THAT'S BECOMING VERY INTERESTING-- THERE'S A GUY NAMED CRAIG VENTER, WHO IS THE PERSON THAT DISCOVERED THE HUMAN GENOME.

HE'S NOW STARTED SOMETHING IN SAN DIEGO CALLED THE CENTER FOR HUMAN LONGEVITY, AND HE BELIEVES WE'RE GETTING CLOSE TO THE POINT THAT, BASED ON YOUR GENOMICS AND PROTEOMICS AND MICROBIOMICS, THAT THEY'D BE ABLE TO PREDICT WHAT YOU'LL DIE OF AND ABOUT HOW LONG YOU'LL LIVE.

HEH!

SO THE SECOND QUESTION OVER A COCKTAIL OR A CUP OF COFFEE IS...

BUT THEN-- WOULD YOU WANT TO KNOW?

WOULD YOU WANT TO KNOW, BUT I THINK EVEN THE THIRD QUESTION THERE IS, SINCE THEY KNOW, CAN THEY DISRUPT OR INTERRUPT THE PROCESS?

WELL, THAT'S THE OTHER THING.

I MEAN, THAT-- THE ISSUE WITH--IN MY FORMER JOB AT UNIVERSITY OF SOUTH FLORIDA, WE HAD ONE OF THE ALZHEIMER'S DISEASE RESEARCH CENTERS, AND WE ALWAYS HAD THAT QUESTION ABOUT BEING ABLE TO PREDICT PEOPLE THAT WOULD GET ALZHEIMER'S WHEN YOU DIDN'T HAVE A CURE.

RIGHT.

JUST KNOWING YOU WERE GOING TO GET--NOW, THERE IS SOME ADVANTAGE TO KNOWING THAT, ALSO, EVEN PEOPLE--FOR EXAMPLE, MY SPECIALTY OF OBSTETRICS.

PEOPLE DECIDE TO GET TESTED FOR THE BABY WITH DOWN SYNDROME EVEN IF THEY KNOW THAT THEY WOULDN'T DO ANYTHING ABOUT IT, SO I THINK THAT BECOMES AN INTERESTING QUESTION.

BUT, YOU KNOW, I WANT TO GET BACK TO YOUR TECHNOLOGY PIECE 'CAUSE I THINK THAT THERE IS A FEAR OF TECHNOLOGY, BUT I THINK TECHNOLOGY CAN ALSO BE VERY DEMOCRATIZING, AND WHAT I MEAN BY THAT IS, YOU KNOW, ONE OF MY MENTORS, MY LAST COMMENCEMENT SPEAKER, WAS A GUY NAMED JOHN SCULLEY, WHO WAS THE FORMER CEO OF APPLE.

AND HE SAID, "YOU KNOW, YOU GUYS HAVE TO STOP TALKING ABOUT TELEHEALTH.

"WE DON'T TALK ABOUT TELEBANKING.

"WE DON'T GET UP IN THE MORNING AND SAY, 'I THINK I'M GOING TO TELEBANK.'

"IT'S JUST THAT BANKING HAS MOVED FROM 90% IN THE BANK TO 90% AT HOME."

AND THEN, IF YOU TAKE THAT INTO THE SOCIAL EQUITIES POINT OF VIEW, ANOTHER ONE OF MY MENTORS, AMBASSADOR YOUNG, USED TO SAY, "I CAN TELL HOW SOMEBODY'S GOING TO DO BASED ON THEIR CREDIT SCORE."

SO TECHNOLOGY HAS MADE IT EASIER FOR, LET'S SAY, YOUNG, MINORITY FOLKS TO START TO LOOK AT THEIR CREDIT SCORE AND IMPROVE THAT, AND NOT HAVE TO RUN TO THE BANK OR DO THOSE THINGS.

RIGHT.

I THINK, IF WE CAN START TO USE A.I.

TO ACTUALLY HELP TO SOLVE SOME OF THE SOCIAL INEQUITIES-- GIVE YOU AN EXAMPLE.

YOU KNOW PROJECT HOME IN PHILADELPHIA...

RIGHT.

A BIG--A VERY NATIONALLY RENOWNED HOMELESS CENTER.

THEY'RE ONE OF OUR BIGGEST USERS OF JEFFCONNECT, OUR TELEHEALTH PROGRAM.

WHY?

RIGHT.

BECAUSE MANY OF THEM DON'T HAVE CARS OR, IF THEY HAVE CARS, CAN'T AFFORD GAS OR PARKING, BUT THEY HAVE PHONES.

SO THE KEY FOR US IS HOW DO WE GET THAT A.I.

TO BE A DEMOCRATIZER...

RIGHT.

AND BE A HEALTH ASSURANCE AGENT?

WELL, I WOULD SAY INTERNET TECHNOLOGY AND SO FORTH HAS BEEN A DEMOCRATIZER...

YES.

IN SO MANY WAYS, AND SO WHAT YOU'RE SAYING HERE IS THAT IT CAN BE IN THE MEDICAL ARENA AS WELL.

NOW, THE OTHER CONTROVERSY, AND WHAT I SPEND-- MOST OF MY RESEARCH HAS BEEN ON WHAT MAKES DOCTORS DIFFERENT THAN, DEPENDING ON THE AUDIENCE, EITHER OTHER PEOPLE OR NORMAL PEOPLE, IN HOW WE HANDLE CHANGE.

SO ONCE I HAVE A ROBOT NEXT TO ME, WE STILL SELECT AND EDUCATE DOCS BASED ON SCIENCE GPA, MED-CATS OR A MULTIPLE-CHOICE TEST, OR ORGANIC CHEMISTRY GRADES, AND WE'RE AMAZED DOCTORS ARE MORE EMPATHETIC, COMMUNICATIVE, AND CREATIVE.

MM-HMM.

THAT IS BECAUSE, IF YOU WERE A DOC AND I WAS A DOC, AND I KNEW 19 REASONS SOMEBODY HAD A HEADACHE, AND YOU ONLY MEMORIZED 15, I WAS A BETTER DOC.

NOW THERE'S GOING TO BE A ROBOT NEXT TO ME THAT'S GOING TO BE BETTER THAN THAT, SO WE'RE LOOKING AT MODELS AT JEFFERSON, WE'RE CHOOSING STUDENTS BASED ON HOLISTIC CRITERIA: SELF-AWARENESS, EMPATHY, COMMUNICATION SKILLS, CULTURAL COMPETENCE.

BY THE WAY, WHEN YOU DO THAT, YOU TRIPLE DIVERSITY.

HOW DO CONSUMERS KEEP UP WITH THIS?

HOW DO ORDINARY CITIZENS KEEP TRACK OF THIS FIELD?

IT'S STAGGERING.

WHAT'S THAT MEAN?

YEAH.

YEAH, SO CONCEPT BEHIND THE BOOK IS THAT THE UNITED STATES HEALTHCARE SYSTEM FINALLY GOT INTO THE INTERGALACTIC COUNCIL OF GREAT HEALTHCARE SYSTEMS 'CAUSE WE FIGURED OUT HOW TO SEND A BELIEVABLE, UNDERSTANDABLE BILL, WHAT WE CALL "THE BUB FACTOR."

AH!

I THINK SOME OF IT IS ON CONSUMERS, YOU KNOW.

I DID A PODCAST WHERE I SAID THAT I THINK PART OF THE PROBLEM IS CONSU--PATIENTS HAVE TOO MUCH RESPECT FOR DOCTORS.

AS YOU CAN IMAGINE, I GOT IN TROUBLE FOR THAT.

MM-HMM.

BUT WHAT I MEANT WAS, IF--IF...

IF YOU HAVE AN APPOINTMENT WITH ME AT 8:00, AND I SHOW UP AT 8:45, THE CHANCES ARE YOU'LL SAY, "OH, THAT'S OK, DOCTOR.

I'M SURE IT WAS AN EMERGENCY."

SIMPLE FACT IS THAT'S TRUE ABOUT 12% OF THE TIME.

MM-HMM.

THE OTHER 88% OF THE TIME, HE OR SHE WAS DOING SOMETHING ELSE, MAYBE AT A LECTURE OR WHATEVER, BUT THEY KNOW YOU'LL TOLERATE THAT.

YOU WOULDN'T TOLERATE THAT IN ANY OTHER INDUSTRY.

MM-HMM.

I THINK ONE OF THE CHANGES THAT WILL START TO HAPPEN IS THAT MILLENNIALS WILL DEMAND THAT KIND OF TRANSPARENCY AND UNDERSTANDING, THAT MILLENNIALS WILL NOT TOLERATE THAT.

I'LL GIVE YOU ONE REAL QUICK EXAMPLE.

RATING SYSTEMS.

YEAH, ONE OF MY DAUGHTERS BASICALLY CALLED ME UP AND ASKED ME ABOUT A HOSPITAL.

SHE WORKS AT A UNIVERSITY HOSPITAL CAMPUS.

THERE WAS A HOSPITAL 5 MILES AWAY, AND SHE SAID, "DAD, IT'S $200 OF MY MONEY IF I GET IT DONE AT THAT HOSPITAL, "$800 OF MY MONEY IF I GET IT DONE AT THE UNIVERSITY HOSPITAL.

"BY THE WAY, I WENT ON HEALTHGRADES, "I WENT ON LEAPFROG.COM, AND I WENT ON PATIENTSLIKEME.COM.

THE GRADES ARE EXACTLY THE SAME."

WOW.

"NOW WHY SHOULD I GET IT DONE THERE?"

NOW, THAT'S NOT SOMETHING YOU OR I WOULD HAVE DONE.

RIGHT.

YOU PROBABLY WOULD HAVE JUST GONE TO THE UNIVERSITY HOSPITAL.

THAT WILL ALSO HAVE AN EFFECT LONG-RANGE OF DRIVING DOWN COSTS.

WHAT WE'RE TRYING TO DO-- WE CALL IT HEALTHCARE WITH NO ADDRESS.

MM-HMM.

WE WANT, 5 YEARS FROM NOW, PEOPLE TO BE ABLE TO-- TO BASICALLY IDENTIFY JEFFERSON BASED ON OUR CARE AND CARING.

I HOPE, IF YOU COME TO PHILADELPHIA, AND YOU SAY, "WHERE'S JEFFERSON?"

5 YEARS FROM NOW, NOBODY CAN TELL YOU.

"YOU MEAN JEFFERSON ON MY PHONE, OR JEFFERSON AT 12 MICRO-HOSPITALS?

"OH, THE PLACE WHERE REALLY, REALLY SICK PEOPLE GO?

THAT'S AT 10th AND WALNUT."

WELL, DR. KLASKO, STEVE, IF I COME TO JEFFERSON, I HOPE I CAN FIND YOU.

HEH!

NOW, THIS HAS BEEN A TERRIFIC DISCUSSION, AND THANK YOU VERY MUCH FOR JOINING US.

THANK YOU.

I'VE REALLY ENJOYED IT.

THANK YOU, DAVID.

THANK YOU.

GREAT.

GOOD.

THE UNITED STATES CAN BE CREDITED WITH A LARGE, EVEN DISPROPORTIONATE PERCENTAGE OF THE WORLD'S ADVANCES IN MEDICAL SCIENCE.

THIS IS PARTLY BECAUSE LARGE SECTORS OF OUR HEALTHCARE SYSTEM ARE IN THE BUSINESS OF MAKING PROFIT, AND FREE ENTERPRISE MAXIMIZES INNOVATION, WHILE MOST OTHER NATIONS TREAT MEDICINE AS A KIND OF NOT-FOR-PROFIT PUBLIC UTILITY.

BUT THE FLIP SIDE OF THE SAME COIN SEEMS TO BE THAT AS AMERICAN HEALTHCARE FOCUSES ON THE APPLICATION OF TECHNOLOGY TO INDIVIDUALS WHO ARE ILL, THERE IS FAR LESS FOCUS IN THE SYSTEM ON BROAD MEASURES FOR PUBLIC HEALTH, COMPARED TO OTHER NATIONS.

FOR EXAMPLE, AMERICAN HOSPITALS AND DOCTORS WILL ROUTINELY PERFORM COMPLICATED, EXPENSIVE, AND LUCRATIVE SURGERIES-- LIKE HIP REPLACEMENTS ON PATIENTS WHO ARE UPWARDS OF 85 AND 90 YEARS OF AGE-- WHILE SUCH PROCEDURES ARE FAR MORE RARELY PERMITTED IN THE MEDICAL SYSTEMS OF OTHER ADVANCED NATIONS.

BUT IT TURNS OUT THAT EXTENDING THE LIVES AND THE QUALITY OF LIVES OF THE NUMBER OF ADDITIONAL INDIVIDUAL PATIENTS, TO WHICH AMERICAN HEALTHCARE PROVIDES SUCH HIGH-TECHNOLOGY INTERVENTIONS, DOES NOT EXTEND OVERALL AVERAGE LIFESPAN OR OTHER GENERAL MEASURES OF THE HEALTH OF THE NATION AS A WHOLE.

AS WITH SO MANY OF THE ISSUES WE DISCUSS ON THIS SERIES, THE WHOLE TRUTH OF THIS COMPLICATED AND IMPORTANT QUESTION SEEMS TO ME THAT THE HEALTHCARE POLICY IS ABOUT PRIORITIZING AMONG A NUMBER OF VALUES, EACH OF WHICH IS IMPORTANT IN ITS OWN RIGHT, BUT ALL OF WHICH CANNOT BE SIMULTANEOUSLY MAXIMIZED.

THIS IS A TRUTH OUR POLITICIANS MUST BECOME MORE WILLING TO ADDRESS PLAINLY FOR THE NATION TO MAKE INTELLIGENT CHOICES.

FOR "THE WHOLE TRUTH," I'M DAVID EISENHOWER.

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