There are numerous challenges facing the health care system in the United States with millions of Americans uninsured and unable to pay for a doctor's visit, for the health care is hard to come by.

Dr. Ricardo will works at a hospital where cost is second to care.

In his new book he chronicles the lives of five patients who turned to his help after facing financial barriers and he joins us to discuss what America needs to do to fix its health care crisis.

>> Thank you so much for joining us.

To give our audience a bit of background, you are writing this story about the safety net hospital in Houston.

What is the safety net hospital?

>> It is a hospital that provides health care even if people don't have health insurance.

The safety net hospital I am running about his part of the system, this health care system in Houston Texas that provides health care for people who can't access health care or can't afford health care.

Which is becoming more and more in our society.

The safety net hospital is a public health care system in Houston.

This is generated by property taxes to help assure that everybody has health coverage.

Chris Houston the highest uninsured rates in the country.

More than one million people are uninsured in Houston, Texas.

That is more than 5 billion people.

In the United States, that is 40 million people.

We had health insurance to employment.

As employment changes, people get laid off and we see more people at the safety net hospital.

>> What is the kind of experience that a young doctor can get at a safety net hospital that they might not be able to at a fancier one?

>> Etiquette is that contact with people.

I think it is the ability to feel the responsibility.

That is what kept me in the safety net hospital.

A feeling of responsibility.

We are in a crisis of burnout for our profession.

A lot of that has to do with the bureaucracy of our health care system but when that is spread away and you can just deal with what you are trained to do which is sit and think through problems with people, I think -- one of the reasons why people come to the safety net of a hospital, they come to see the different illnesses that manifest in patients.

That is why a lot of students really want to come to safety net hospitals to learn how to train.

It makes them better doctors.

>> Less talk about some of the things that you're more likely to see than in other places.

One of the patients you described is a woman named Ebony.

To put this in the context of maternal health challenges in the United States, the Orient specifically to black women and what they face.

>> She had a problem, she was bleeding during her pregnancy and that put her at high risk.

She moved from estate in California where she had Medicaid or health insurance provided by the state but she moved to Texas where she was uninsured.

When the bleeding started, she was shuttled between emergency rooms until she found safety net hospital.

The placenta was blocking the birth canal.

That meant it cannot be borne without causing a catastrophic leak.

Doctors at that moment offered her medical abortion.

There would be the best way to ensure that Ebony's life was saved.

>> If she came to you with the same symptoms today in Texas, what would she be facing given how the political landscape has changed?

>> She would be phasing risking her own life for that birth.

Not even the choice.

That is the thing.

Ebony selected to proceed with the pregnancy but this happens and many women don't want to risk their lives.

In my mind, that is their liberty.

In Texas, it is very confusing for doctors on what advice to give patients.

>> Is it harder in Texas for Dr. at a hospital or doctor anywhere to have an honest conversation with a woman about her health care?

For fear of being sued by a third party if the word abortion enters the conversation?

>> Undoubtedly.

My dad is enough to attrition.

My colleagues are obstetricians.

I have spoken to some of them about this but one of the things that sets safety net hospitals apart is then transparency and conversation and knowledge that we will be trying to help the person make the best decision for their own lives.

That has changed because of the abortion laws in Texas.

>> We talk about one of the patients called Geronimo and he had needs for a liver transplant.

Tell us a little bit about him.

>> He was a gas station attendant.

He had liver disease that had gone to the point where he was very ill and he made too much, he qualified for Medicaid but when he started to get his disability payments, it -- he was not poor enough for Medicaid.

It was taken away from him right at the moment when he needed a liver transplant to survive.

The safety net system does not have transplant capabilities.

The infrastructure needed to build transplant centers and to have the personnel, so much high investment that a safety has system has to be utilitarian with these funds and transplant are just not something it can afford.

One of our goals is to see if they can follow up with this.

>> There is an entire demographic you have seen more at this hospital -- a document to people.

You wrote about Roxanne.

An undocumented woman from El Salvador that had competitions from a cancer related illness and she needed a few patients.

It is just startling that something like that could slip through the existing tracks and get to you.

>> It is an example of how broken our system is.

We don't have the standards or they may be for patients.

Roxana came to the safety net hospital because she suffered a great cap legation during a life-saving surgery.

The life-saving surgery she had was an incredible manifestation of the American health care system.

It showed we have surgeons capable of doing amazing things.

We just can't complete the job and give people chronic care.

When she changed from an emergency patient to a chronic care patient, she was discharged out into her apartment with gangrenous arms and legs and there was no plan for how to deal with her.

Thankfully she lived in the city where she could go to the public health care system funded by property taxes, members of the community where she can get those applications and the care she needed.

Quickly or in a state with conservative values and you have a legal climate that create other challenges for you.

You are also saying this hospital could be a model for the rest of the country to still have these conservative values and show compassion.

Chrysler has played this in America is trying to bring these two concepts together.

They are represented by political sides.

They want to provide health care for everyone in this country.

But because it is so Spencer -- expensive, it is difficult to provide for everybody.

These conservative values of cost-cutting come together with the more liberal values of providing to everyone regardless of citizenship or insurance status.

I think one of the reasons that has happened is because there has been conversations in order to make the system work.

Seven out of 10 Texans believe the federal government has oval in providing basic insurance to everybody in the country.

Think about that.

Across the political spectrum, there is agreement.

We just have to focus on that agreement and I am proud that I worked in a system where we found ways through those clinical ideologies.

>> One of the interesting things in the book is how the hospital is able to cost about half the national average per patient but at the same time, you are the fastest in the country for figuring out whether somebody is having a heart attack or not.

How can you keep the costs where they are and still have the level of expertise that the rest of the country hasn't got yet?

>> This is the philosophy of quality improvement.

Making sure that the health care goes to what is needed.

They just isn't waste in the system like there's waste in the private health care system.

Since we are not performing more health care than is necessary, we can focus on emergencies like heart attacks, strokes, trauma and building protocols to identify those and take care of those in offender manner.

If you think on the other side, the resources are used for other things that are not as essential and vital for those things.

That is one of the reasons why we can demonstrate quality while demonstrate and cost.

>> What is the cost of what you're spending per patient?

How do you quantify the level of efficiency this safety net hospital has?

>> Great question.

There are ways to look at how much Medicare is paying for.

Private insurance pays less but only because Medicare is for patients 65 and older who usually utilize health care services.

If you take apples to apples, -- our health care system can look and see and what the overall budget is and how many people are in the system and -- or it is 30% of the total cost.

One of the things I do in my book is follow a patient and the medical bill he incurs in our public health care system where it is that profit motive.

One of the patients had treatment for cancer that involved x-ray therapy, surgeries, admissions, his total bill was less than a pickup truck according to him.

People in health care system know how little that is according to the equivalent in the private system where there is a private loan.

>> I wonder if there is a hesitation on the parts of doctors.

Especially in a state like Texas to come out and speak like you are, we are talking about the difficult climate, having reproductive health care conversations with women and we're talking about compassion and were talking about compassionate care for undocumented, we are talking about universalized health care.

And I wonder if there is a concern that even having these conversations, being out front, I wonder if it was a bull's-eye on your back.

>> I feel hopeful in my system because for instance, I feel the local government is supportive of this safety net.

Because it is a public health care system, it is subject to the politics of what is going on locally.

I think we are also arriving at a >> Rate here.

Physician burnout is occurring and it is a big problem for the United States.

You think about how much society pours into doctors studying and performing all the acts they do, my colleagues, many of them are leaving the profession early.

It just means we will have less doctors with more health care that is needed for this country.

We have hit a point where we need to think about -- we are spending so much money on health care.

It is a problem -- we just kick the can down the road.

What has happened is the profession itself is people are leaving it and not wanting to go into it.

That is one of the reasons why people like me are speaking up about it.

We are genuinely concerned about that experience patients have with the health care system.

And also that collies are leaving the profession already.

>> You are from El Salvador.

You also read about your grandmother who came to you for advice.

I just went through the algorithm it was a normal test.

I dissent I don't know what your sentiments is due to.

Later that she got another test and she went back to El Salvador and she found out she had a solvable cancer.

The overreliance on algorithms, I stopped thinking about the person of my grandmother the moment that test came out and what I wished I had done was follow that symptom.

Say this is negative.

If it was an unnecessary surgery in El Salvador after she suffered greatly from that.

She could have been diagnosed in a more precise manner.

It still weighs on me today.

>> We can come together to solve this health care prices.

This health care crisis manifests in 70 ways that we do not think about.

It affects real people's lives.

We can solve this problem if we just think about will be in for.

We need to decrease costs and we need to give health care access to everybody.

There is strength in numbers.

If we can think about building a health care system rather than just passing one up since the early 1900s, I think we can solve this problem.

>> The book is called the People's hospital.

Thank you so much for joining us.