The Costs Of Health Care, Political And Financial

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The Costs Of Health Care, Political And Financial

TERRY GROSS, host:

This is FRESH AIR. I’m Terry Gross. One of the goals of health care reform is
to control ballooning health care costs. My guest, Maggie Mahar, is the author
of the 2006 book, “Money-Driven Medicine: The Real Reason Health Care Costs So
Much,” which has just been adapted into a film by Alex Gibney, who also made
the documentaries “Enron: The Smartest Guys in the Room” and the Academy Award-
winning “Taxi to the Dark Side.”

The film “Money-Driven Medicine” will soon be available on DVD. Mahar is a
health care fellow at the Century Foundation, where she writes the blog Health
Beat. She’s a former financial journalist. Mahar says we need to reform the
system because in a decade, health care costs will double where they are now,
and studies show that one in $3 spent on health care is wasted on redundant or
ineffective treatments.

Maggie Mahar, welcome to FRESH AIR. One of your main concerns is that we need
to eliminate unnecessary and ineffective treatments.

Ms. MAGGIE MAHAR (Health Care Fellow, Century Foundation; Author): That’s
right. But then, that has to be done very carefully. I mean, this is not fat
that’s hanging out on the edges of the steak where you can see it. This is fat
that’s marbled through the meat.

So we need to take a scalpel and very carefully excise that waste. And that’s
why we need a panel of physicians, health care experts, looking at the
evidence. That’s what President Obama has proposed: having an independent,
bipartisan panel of doctors and other medical experts that is shielded from
Congress and lobbyists to a large degree that is simply looking at the medical
evidence and making decisions about which are the most effective treatments for
patients who fit a particular medical profile, and then issuing guidelines -
not rules, but guidelines – that will help doctors and steer them and patients
toward the most effective treatments.

GROSS: In the book, in your book, you write that market forces have splintered
the health care system, and that it’s now this (unintelligible) marketplace
where it’s a war of all against all, and it’s pitting the health care
industry’s players against one another, hospital versus hospital, doctor versus
hospital, doctor versus doctor, hospital versus insurer, insurer versus
hospital, insurer versus insurer, insurer versus drug-maker, drug-maker versus
drug-maker. That’s making it more expensive. I mean, market forces are supposed
to keep prices down through competition. You’re saying that’s making it more
expensive.

Ms. MAHAR: That’s right. In health care, market forces don’t bring prices down.
We’ve seen that everything becomes more expensive every year: drugs, hospital
stays. In other markets, the consumer has the power to bring prices down as
producers compete with each because the consumer can say, you know, that laptop
is a little expensive. I’m going to wait until a competitor, a rival, comes out
with a less-expensive laptop that will meet my needs.

When you’re sick, you can’t say I’ll wait until a less-expensive cancer drug
comes out. Eighty percent of our health care dollars are spent on patients who
are seriously ill, suffering from chronic diseases like cancer. They don’t have
the choice to wait.

They need what they need at that moment, and so they can’t help bring prices
down by comparison shopping, by putting off the purchase, by any of those
things. They essentially have to take whatever it is that the doctor or the
hospital tells them that they need at that time.

GROSS: So what kind of systemic change do you think we need to change this
competitive relationship to a collaborative relationship?

Ms. MAHAR: Recently, I attended a conference sponsored by the Institute for
Healthcare Improvement and Dartmouth, and at that conference, they looked at 10
communities where health care spending is low and quality of care is very high.
And these are diverse communities, ranging from Sacramento to Tallahassee,
Florida.

These are communities - what they have in common is in each of these
communities, doctors and hospitals have gotten together and agreed to
collaborate. In many cases, they’ve agreed also to get away from fee-for-
service payments, and instead they accept what are called bundled payments,
where the hospital and all the doctors involved in an episode of care receive a
lump sum that usually goes to the hospital and that then is divided up among
them.

This means that they have motivation to work with each other. The House
legislation has many suggestions for reforming the way Medicare pays for care
and suggestions for how Medicare can provide incentives that would change the
way doctors and hospitals deliver care so that it would be more patient-
centered, more cooperative, less competitive.

GROSS: Do you think that there are perverse incentives in the system right now?

Ms. MAHAR: Definitely. The biggest one is paying fee for service. Because when
you pay fee for service, you are telling the doctor: We want you to do more.
The more you do, the more we’ll pay you. We’re going to pay you for the
quantity of work you do. We’re paying you for volume. We’re paying you piece-
work, as if you are a factory worker.

What we should be doing is paying doctors for the quality of work they’re
doing, for good outcomes. We have more than two decades of research from
Dartmouth showing that one out of three health care dollars is wasted.

Doing more, more aggressive care, more intensive care, more tests, more
treatments, does not lead to better outcomes. Often, outcomes are worse because
the patient is being over-treated, and that means he’s being exposed to
treatments that provide no benefit, yet every treatment has some risk. So he’s
being exposed to risks without benefit.

GROSS: When I go to my doctors, I always feel like they looked so rushed and
harried, and I assume that that’s because there’s pressure on them by insurance
companies or their institutions to see a lot of patients. I don’t get the
feeling like they want to do more procedures so that they can personally make
more money. Are there pressures on them from either the institution they work
for or the health insurance company to see as many patients as possible?

Ms. MAHAR: Certainly not from the health insurance company. The health
insurance company would rather they did less, because then the health insurance
company would owe them less. Some institutions, perhaps, but basically this is
an internal pressure. As doctors will tell you, very honestly: I have to see a
patient every 15 minutes, or I can’t keep the lights on. I can’t keep my
practice afloat. The only way I can make it financially is if I see a patient
every 15 minutes. I hate this. I wish this weren’t the case, but that’s the way
it is.

Now, in terms of primary care, that’s because we don’t pay enough for primary
care. The fees that we pay primary care doctors are very low. Many primary care
doctors make $110,000, $115,000 a year. If they have recently graduated from
medical school, they may have $250,000 in debt. So they don’t want to have to
churn patients, but they have no choice if they’re going to stay financially
afloat.

GROSS: So there’s a big gap now between what primary care doctors earn and what
specialists earn?

Ms. MAHAR: Yes, absolutely. Specialists often earn three, four, five, six times
as much as primary care doctors. Now they’ve gone to school longer, so they
should be - it makes sense that they’d be earning some more, but does it really
make sense that they would earn four or five times as much every year over the
course of a 30 year career? Probably not.

One thing that the House legislation is doing is – first of all, it calls for
raising primary-care fees by at least five percent, and by 10 percent in
regions where there’s a shortage of primary care doctors.

That would also apply to geriatricians and pediatricians under the public
sector plan. So these are increases in fees under Medicare First and under the
public sector plan.

In addition, the House legislation gives Medicare the freedom to set fees with
an eye to benefit to patients. Right now, fees for specialists are set with an
eye to what it costs the specialist to provide the treatment. Nowhere in the
equation does anyone ask how much does the patient benefit. It’s all about how
much that it costs the doctor.

The new legislation would let Medicare begin to set fees more with an eye to
benefit for patients. That means that some specialist fees for certain
treatments that we know are only marginally effective might go down. At the
same time, it’s definite that fees for primary care would be going up. And in
addition to raising the fees, the House legislation calls for loan forgiveness
for medical students who choose to become primary care doctors.

Right now, many med students feel they can’t afford to go into primary care. It
just doesn’t pay well enough.

GROSS: My guest is Maggie Mahar, the author of “Money-Driven Medicine,” which
has just be adapted into a film. She write the blog Health Beat. We’ll talk
more after a break. This is FRESH AIR.

(Soundbite of music)

GROSS: My guest is Maggie Mahar, the author of the book “Money-Driven
Medicine.” She’s a health care fellow at the Century Foundation, where she
writes the blog Health Beat.

As we look to reform the health care system in the United States, what are some
of the things you think we can learn from the successes and failures of
Medicare?

Ms. MAHAR: It’s a good question. One of the failures of Medicare is that it is
spending millions, billions of dollars on ineffective and unnecessary
treatments because it hasn’t sorted out and looked at the comparative
effectiveness of various treatments. So that’s something that needs to be
reformed and changed about Medicare, and that’s something that the current
administration already is planning on doing.

Successes of Medicare, I think, is that it’s a consistent program that provides
equal care for everyone. It doesn’t matter how much you put into the system. It
doesn’t matter whether you’re wealthy or poor. Everyone gets the same quality
and amount of care. And that, I think, is terribly important, and we want a
health care reform system that provides equal care for all at the same price.
And that’s something that is going to happen under the legislation, which says
that private insurers will no longer be able to charge you more if you have a
preexisting condition, and they won’t be able to take your insurance away
because they discover a pre-existing condition.

Everyone will pay. Everyone in a given community will pay the same amount,
except private insurers will be allowed to charge older people up to twice as
much as they charge younger people. This, I think, is very unfortunate.

GROSS: And what you’re saying is that younger people have to pay to make the
larger system work. So if only sick people are buying insurance, it’s going to
be incredibly unaffordable.

Ms. MAHAR: Yeah, well, I mean, younger people will also be under a mandate to
buy insurance. The question is whether they pay less for the insurance than
older people. If younger people pay less, then older people have to pay more,
or there won’t be enough money in the pool. But I think that the Obama
administration realizes that young people in this country, many of them are not
happy about the mandate, about the idea that they’re going to have to buy
insurance. And in order to soften the blow, the administration and
congressional Democrats are saying you do have to buy insurance, but since
you’re young and healthy, you don’t have to pay as much for it.

GROSS: Let’s take a look at insurance companies. A lot of people feel like
they’re suffering under the burden of enormous health care costs, even if they
have insurance. How are the insurance companies doing?

Ms. MAHAR: They’re not doing very well, either, because the cost of health care
has been spiraling. In recent years, private insurance companies have been
paying out more and more each year for health care.

Reimbursements have been going up eight percent a year, year after year. That
means insurance companies are paying out eight-percent more each year to
doctors and hospitals, and that’s – they’ve been raising premiums at a very
rapid rate, as well, trying to pass those costs along, but they’ve just about
kept up with rising costs. That’s why your premiums have been spiraling.

The insurers’ administrative costs have not gone up. Their profits, in many
cases, have not been very good. The insurers who have done well are the
insurers who offer Medicare Advantage because the Bush administration decided
that if insurers would offer Medicare, this is for-profit, private insurers, we
would pay them 13 percent more than Medicare spends to treat the same patients.

So we gave them a bonus, really corporate welfare, and that has helped many
insurers be profitable in recent years. However, under the current health
reform legislation, those Medicare Advantage bonuses are going to be cut, and
insurers are going to be in trouble. Insurers are going to have to become more
efficient in order to survive.

GROSS: What will that likely mean for us, the patients?

Ms. MAHAR: It should actually mean good things, if insurers are wise. Insurers
are going to be forced to compete with the public sector option, and insurers
are going to be told you can no longer cherry-pick. You can no longer avoid
sick patients and only insure healthy people.

So that means insurers are going to have to pay more attention to the quality
of care that they are providing. That means they’re going to have to try to get
the very best hospital and doctor networks together and provide some sort of
bonuses or encouragement for those doctors and hospitals to collaborate, to
focus on patient-centered medicine, to focus on quality of care.

Up until now, insurers have largely focused on keeping their costs down, and
not so much on encouraging the highest-quality care from their providers. But
that is going to have to be their focus if they want to compete with the public
sector option and survive.

GROSS: The word choice is a word you hear coming up a lot. People want choice.
They want to be able to choose their doctors. And I’m wondering what choice
means to you and if you think there are choices that, as the system is
reformed, we’re going to have to give up.

Ms. MAHAR: I think that people are unnecessarily fearful, partially because
they don’t understand that the health care they have now is not very good. The
U.S. does not have the best health care in the world, and medical researchers
and doctors will tell you this.

If you read in medical journals, you’ll see studies done by American doctors
comparing outcomes for various diseases. Outcomes are often not the best in the
U.S. In terms of managing chronic diseases, we rank quite low.

So no one wants to believe this because people want to feel I can trust my
doctor, and I know my doctor is the best, and what he’s doing is the very best
possible thing he could do for me. They think anything else is scary.

So when people worry about losing something, they’re worried about losing
something in the context of thinking what they have now is better than it
really is. Secondly, if we didn’t reform the system, you have to remember what
the president said in a recent press conference, which is the system we have
now is a plan where costs are going to double in the next 10 years, and many of
you who now have insurance will find yourself uninsured, alone in a market
where you have to, somehow or another, come up with the money to pay for
insurance that is twice as costly as it is today. That’s the alternative to
health care reform.

So whatever an individual may feel he’s giving up, A, it probably won’t be
something that actually helps him, and B, the alternative: not reforming health
care is catastrophic.

GROSS: I think a lot of people are worried that they won’t be able to afford to
buy their own insurance in the new system after the legislation has passed, and
that the public option will be an inferior plan, and that if they take the
public option, they won’t get the kind of health care that they want. Are you
concerned about that?

Ms. MAHAR: Not at all. The public option will be very similar to Medicare. Most
people who have Medicare are very happy with most of the coverage. It doesn’t
include long-term care, and this troubles people, but on the whole, if you look
at satisfaction and you poll people, what we found is that people with Medicare
are much happier than people with employer-based, private insurance.

The public sector option, if you actually read the House bill - the 1,018 House
bill, which I have read - you find that the public sector option covers
virtually everything that you can think of, including mental-health care,
including dental care and vision care for children. It also stipulates that
there be no co-pays for primary care, which means people won’t put off going
for primary care, and it really covers, you know, hospitalization, doctor care,
etcetera, etcetera, etcetera. It’s a full menu of very comprehensive coverage.

In terms of being able to afford the public sector option or private insurance,
the subsidies are also very generous. The subsidies cover people up to four
times the poverty level. So the subsidies will be available to families earning
up to about $88,000 a year. The statistical middle class is clustered around
people earning $60,000 for a household a year.

So we’re talking about offering some subsidy to most of the middle class and a
tiny bit of the upper-middle class, as well. So the - you know, this will be
affordable. Certainly, it will cost something, and people may find themselves
spending as much as 10 percent of their income, their gross income, on health
insurance.

For people who now have employer-based insurance with their employer paying,
typically, 75 percent of the cost, if you’re an upper-income employee, those
people may find that they’re paying more for insurance if they decide to give
up their employer-based insurance or if their employer decides to drop the
insurance.

GROSS: If you had your way…

Ms. MAHAR: Right.

GROSS: …what kind of system would you create? Would it be a single-payer
system? Would it be a whole lot of options, like is being proposed now?
Obviously, you don’t want to keep the system the way it is. You’ve made that
very clear.

Ms. MAHAR: Right. If I were czarina, this is what I would do. I would create a
hybrid system much like the system that the Obama administration is trying to
create where you have both public sector insurance and the option of private
sector insurance. I would like to see that private sector insurance be
nonprofit insurance, in other words, insurance companies that don’t have to
worry about generating a profit, that don’t have to try to juggle priorities -
should I try to please my shareholders, or should I try to please my customers?

We have some very good nonprofit insurers in this country. Kaiser Permanente in
Northern California is excellent. Geisinger is excellent. I would like to see
them in the mix, along with a government insurance program. I’d like to see
everyone paying the same percentage of their income into the pool to help pay
for health insurance for all of us.

Why don’t I want a single-payer plan? First of all, it would be enormously
difficult to persuade everyone in this country who has employer-based insurance
to give it up and go into an unknown government plan.

Secondly, and maybe even more importantly, a government plan, if that was all
we had, depending on the politics of the government, could take away things
that many of us feel are necessary to health care. It could become very stingy.
It could decide only to cover certain people. It could decide to penalize
people who were fat or who were – had other, you know, problems - mental-health
problems, etcetera. And that’s why I would always want escape hatch. I’d always
want alternatives to the public sector plan and for Americans to be free to
choose which plan they wanted.

GROSS: Well, Maggie Mahar, I want to thank you very much for talking with us.

Ms. MAHAR: Thank you.

GROSS: Maggie Mahar is the author of “Money-Driven Medicine,” which has just
been adapted into a film that will soon be available on DVD. She’s a health
care fellow at the Century Foundation, where she writes the blog Health Beat.
I’m Terry Gross, and this is FRESH AIR.
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'In The Loop' With Armando Iannucci

TERRY GROSS, host:

This is FRESH AIR. I’m Terry Gross.

A verbal gaff that unintentionally leads the British to join the U.S. in
planning a war against a country in the Middle East, gaff and spin and
ideological political agendas that lead to war are the subject of the political
satire, "In the Loop."

The war in the film is against an unnamed country in the Middle East but the
film makes intentional parallels to the lead up to the war in Iraq.

My guest is the writer and director of the film, Armando Iannucci. The main
characters in the film are adapted from his BBC series, "The Thick of It."
Early in the film, the British minister for International Development is asked
by a journalist about the possibility of war. He responds that war is
unforeseeable, which is incorrectly interpreted as inevitable which is not what
the official government position is.

This leads to a series of disastrous misunderstandings in England and in the
U.S. where the minister is sent to meet with other midlevel officials. Here's a
scene right after that unforeseeable gaff. The minister, played by Tom
Hollander, is in hot water because of the gaff. Things get even worse when he
runs into a pack of reporters.

Mr. TOM HOLLANDER (Actor) (Cabinet Minister): Hello there. Hi.

Unidentified Actress: So is war (unintelligible), Minister?

Mr. TOM HOLLANDER (Actor) (Cabinet Minister): Look, there are all sorts of
things that are actually very likely are also unforeseeable for the plane in
the fog the mountain is unforeseeable but then it is suddenly very real and
inevitable, right.

Unidentified Actress: Is this your opinion or is this the government position?

Mr. TOM HOLLANDER (Actor) (Cabinet Minister): The plane, the mountain in the
matter for it's a completely hypothetical mountain that could represent
anything.

Unidentified Actor: But I'm sorry but, I'm unclear what it...

Unidentified Actress: Who is the plane and who is the mountain?

Unidentified Actor: Yeah. But then the government is lost in the fog.

Mr. TOM HOLLANDER (Actor) (Cabinet Minister): And what I'm saying is that to
walk the road of peace sometimes we need to be ready to climb the mountain of
conflict. Thank you so much.

Unidentified Actor: Would you be climbing the mountain alone, Minister?

(Soundbite of reporters talking)

Mr. TOM HOLLANDER (Actor) (Cabinet Minister): Thank you very very, this
interview is over. Thank you.

GROSS: Armando Iannucci, welcome to FRESH AIR. There's a spin that's so
important in your movie and political language and invasive political language.
Were you listening very closely during the lead up to the Iraq War, both
because you wanted to know what was going to happen but also just to hear the
words that the politicians were using to say or hide what their intentions
were?

Mr. ARMANDO IANNUCCI (Writer, director): Oh absolutely. I mean I was listening
very intently principally because I was frustrated by the fact that you could
clearly see there was a headlong unstoppable rush towards war coupled with all
these public statements that every avenue was being explored, every possible
attempt to defuse the situation was being explored. And so there was this
conflict between what was clearly happening and what we were being told was
happening. And the whole rush towards war was full of these illogicalities -
these arguments that said for example you know, Saddam would attack us if we
invaded him therefore, we have to invade him to stop him using the weapons that
he's going to use in us once we invade him. It’s a sort of an abusive of
argument and an abuse of language. And Rumsfeld was very very famous for it.
You know remember his there are no known knowns and known unknowns and you
know, his very enigmatic press conferences.

GROSS: What's one or two of the favorite lines you and your writers came up
with for your movie?

Mr. IANNUCCI: Well, Malcolm...

(Soundbite of laughter)

Mr. IANNUCCI: ...once the minister says war is unforeseeable, Malcolm Tucker,
the government's chief spin doctor then rings around all the press and tries to
rollback from that. And he does, there is a shot of him walking out of Number
10 Downing Street on the phone to a journalist saying, you may have heard him
say that but he did not say it, which I quite like. It's that truth is really a
very relative thing. Truth is what you make it that I think sort of underpins
the comedy and the thinking behind the film really.

GROSS: I think I have a scene that will illustrate that that...

(Soundbite of laughter)

GROSS: ...I'd like to play. And this is a scene from early in the film where
the head of a secret war committee is meeting with his aide and the head of the
secret war committee's name is Linton Barwick. Tell us a little bit about this
character before we go to the scene.

Mr. IANNUCCI: Linton Barwick is, he's the, officially he's the undersecretary
of state in charge of policy at the State Department and he is fundamentally an
amalgam of all the intellectually driven neocons like Paul Wolfovich and John
Bolton and Rumsfeld, who - there is a sort of an arrogance about their belief
in their intellectual rightness that overrides everything else. And talking to
people who worked with them, I arrived at this impression that they were sort
of bullies but they were intellectual bullies, and they're bullying to the form
of just deciding that not to connect with anyone who disagreed with them.

GROSS: So here is neocon, Linton Barwick meeting with his aide who has just
gotten back from London.

Mr. DAVID RUSH (Actor): (as Linton Barwick) Now, what else happened in London?

Unidentifiable Actor: (As character) Generally positive. Two glitches.

Mr. DAVID RUSH (Actor): (as Linton Barwick) Really? What?

Unidentifiable Actor: (As character) Karen Flag, a report by one of her
staffers.

Mr. RUSH: (as Linton Barwick) Really?

Unidentifiable Actor: (As character) She’s obviously trying to use it as some
kind of roadblock. It's called a quip pip.

Mr. RUSH: (as Linton Barwick) Quick what?

Unidentifiable Actor: (As character) Quick pip.

Mr. RUSH: (as Linton Barwick) What is it a report on bird calls? What does it
even stand for?

Unidentifiable Actor: (As character) I can't recall but it’s fact, she’s Intel
for and against intervention.

Mr. RUSH: (as Linton Barwick) We have all the facts on this we need. We don't
need anymore facts. In the land of truth my friend, the man with one fact is
the king. All right you said there was something else. What is that?

Unidentifiable Actor: (As character) In the meeting with the foreign office the
committee was accidentally and briefly alluded to.

Mr. RUSH: (as Linton Barwick) Which committee?

Unidentifiable Actor: (As character) The war committee, sir.

Mr. RUSH: (as Linton Barwick) All right. Karen is not to know about this, huh.
She is an excitably, yapping she-dog. Alright, we’ve got to get a hold of those
minutes. I have to correct the record.

Unidentifiable Actor: (As character) We can do that?

Mr. RUSH: (as Linton Barwick) Yes we can. Those minutes are an aide memoir for
us. They should not be a reductive record of what happen to have been said. But
they should be a more full record of what was intended to have been said. I
think that's the more accurate version don't you?

Unidentifiable Actor: (As character) Sir.

Mr. DAVID RUSH (Actor): (as Linton Barwick) Right.

GROSS: And I really like that that the minutes should be a memoir for us...

(Soundbite of laughter)

Mr. IANNUCCI: Yes. Yes.

GROSS: ...of what we intended to say.

(Soundbite of laughter)

Mr. IANNUCCI: And so it's not that thing of like you know the truth is what you
make it. And a lot that - I came out to research the film and spoke to people
in the CIA and the Pentagon and so on they were all saying that the evidence
that was being presented to the neocons was evidence that they want to hear.
You know there was already a sort of selective filtering going on because
nobody wanted to lose their job.

And when they were actually given evidence that said there are no weapons of
mass destruction, rather than the neocons saying oh well, let’s call the whole
thing off, their attitude was well, that must mean they're hiding them. So it's
that notion that they’ve made their conclusion in advance and then you go out
and you find knowledge that would back up that conclusion rather than the other
way around.

GROSS: If you're just joining us, my guest is Armando Iannucci and he's the
writer and director of a new British film that's a political satire called "In
the Loop." Let’s take a short break here and then we'll talk some more.

This is FRESH AIR.

GROSS: If you're just joining us, my guest is Armando Iannucci and he's the
writer and director of a new British satirical film called "In the Loop" and
it's basically about the run up to a war in an unnamed Middle East country.

One of the dynamics in the film is that when the British political aides comes
to the United States to meet with American leaders there, they're seen as
relatively inconsequential.

Mr. IANNUCCI: Oh absolutely and they go out to Washington feeling that they are
quite important and are going to be feted and are going to have a major say.
And then they turn out to be, the phrase they use is room meat. Meat in the
room. Just numbers, bulk for the different factions that they want them out
there. And that's based on two things. I'd say that's based on what actually
happened when Blair and his entourage came out to Washington.

Blair thought he was coming out to try and stop George Bush going to war, but

in fact, it was Blair's presence in America and his presence standing beside
George Bush that actually encouraged the pro war faction to go to war. And so
Blair was really there as a number. And also, they, from all accounts, they got
a little bit giddy. They kind of lost their cool and got slightly kind of
excited being in the White House and being in the Oval Room and being on the
international stage and being considered public figures.

And I reminded the UK cast when were shooting these scenes, I said try and
remember what it was like the first time you went out to Hollywood and you went
out to LA, and you had all sorts of meetings and all sorts of agents came and
talked to you and said how great you were and how you thought it was all going
to change. And then after your stay in Hollywood for what, three or four days
you went home empty-handed with nothing and how you felt used and soiled. And
yet, when you got home, how you had returned to a very drab, gray, rainy London
and were already pining for those hot, sunny days in LA when people were
telling you how great you were. And so the...

GROSS: Well it sounds like this happened to you.

(Soundbite of laughter)

Mr. IANNUCCI: Well it did actually.

(Soundbite of laughter)

Mr. IANNUCCI: There was a, the film is a sort of an offshoot of a TV show I do
with the BBC called "The Thick of It" which is set in a government ministry in
London. And there was an attempt to make - they made an American pilot of it
for ABC, set in Congress. And I came out to LA, and it was my first trip out,
and you know I was wined and dined and everyone told me how great it was going
to be, and everyone I met was called vice president. They were all about 23
years old.

(Soundbite of laughter)

Mr. IANNUCCI: But they were all vice president commissioning, vice president
comedy artifacts, vice president valet services - so all these vice presidents
said how good it was going to be. And then I realized I was a tiny cog in a
huge machine. I went to one meeting. My whole involvement in the project was go
to one meeting, which was a meeting to talk about the costumes and the color of
the ties that the cast were going to wear and there were 30 people in the room.

And after that meeting I just thought this is ridiculous. And the pilot itself
was, it wasn't terrible. It was just dull, so despite the fact that all these
vice presidents were working on it, in fact, the quality of it wasn't that
high. And I thought that was kind of an interesting eye opener, really, that
the fact that you know you, when you're on the outside and you look in you
think these things are going to be glamorous. And similarly - and you know you
go through Washington, you see these buildings you know the Pentagon, the State
Department, they looking very imposing. You think the behind them who work in
them know what they're doing. And yet, you know walk in, you find out that you
know in fact, they didn't know what they were doing.

I remember reading an account of, I think it was in one of Bob Woodward's book
on the behind the scenes in the lead up to Iraq. They were talking about when
there were meetings at the White House, when somebody said so once we've
invaded then what do we do? And, of course, no one had really thought that
through. And what happened, whenever anyone asked that question was everyone
else in the room would just bow their heads and stare at the carpet, like that
thing you do at school if you don't know the answer. You look down trying to
tell yourself that if you can't see the teacher the teacher can't see you. And
I just thought that's interesting. They're behaving like kids.

GROSS: So did you go to Washington yourself and get into the big impressive
buildings and try to see what goes on inside?

Mr. IANNUCCI: Yes, I did a couple of above the board meetings with staffers and
people who'd worked in the CIA, and the Pentagon, and the State Department. But
I’d also, I just...

GROSS: How did you set them up? Did you call and say I'm a filmmaker. I'm doing
a political satire...

Mr. IANNUCCI: Yes. I...

GROSS: ...in which you will be mocked, so please let me come meet with you?

Mr. IANNUCCI: Yeah. More or less. Yes. That is the interesting thing.
Politicians love it when they are being portrayed in drama and in comedy and it
doesn't really matter how terrible they're being portrayed. The film opens with
Malcolm Tucker walking out the front door of Number 10 Downing Street and
mostly, most often when you're doing that in a film you have to go to a set.

We wrote to Number 10 and they said yes because they were big fans of the
television show. So here was this character who was the embodiment of how crass
and evil and corrupt politics is, being welcomed into the heart of government.
And when we arrived to shoot the scene all the real Malcolm Tucker's who worked
in Number 10 had brought their cameras with them because they were all excited.
They all wanted to see, meet Peter Capaldi who plays Malcolm Tucker and they
all wanted a big team photo with Malcolm and then all of them.

And similarly, when I was out in Washington, you know, I was speaking to
Biden's chief of staff who was this sort of young, good looking, really
intelligent, quite charismatic guy who was saying what an exciting job it is
that he has because he meets all these exciting people and he said do you know
who we had? We had a reception last week. We met - I met Bradley Whitford who
plays Josh in the "West Wing."

(Soundbite of laughter)

Mr. IANNUCCI: I’m speaking. But you’re Josh, you’re the real Josh. Why you’re
excited to be an actor who is only a part-time Josh. And there is that thing I
think may be because the political world is such an enclosed bubble that
they’re delighted to meet someone from, you know - a real person from outside,
on to whom they can offload all their observations about how the system works.
So I met – I hooked up with people in Washington and I was fairly clear. I said
look, I’m not making a documentary. I’m not out to name names, I’m not out to
bring anyone down. In many ways I want to know the dull stuff rather than the
juicy stuff. I want to…

GROSS: So, what else stuff the people tell you that you’re…

Mr. IANNUCCI: Well, I want to know what time people get in, what time they go
home, who is they work with, what people are like. And also the little things
like, you know, the golden rule in Washington politics is never leave the room,
never leave a meeting. If you leave a meeting you leave power. And that’s
because the big things are decided very, very quickly at meetings. You know?
And you could be out of a meeting for 20 minutes, may be taking a call and
something pretty major was decided when you’re gone.

And there’s no way you can get back in to and trying claim credit for that
decision. So Madeleine Albright, when she was secretary of state she taught her
staff bladder diplomacy which was basically how to last in a meeting for up to
six hours without having to go to the bathroom. So, it’s things like that -
that makes you realize that, you know, international politics are being
conducted on this petty office scale.

GROSS: So, when you were in Washington…

Mr. IANNUCCI: Hmm.

GROSS: …you arranged meetings with some people. Did you also arranged to be in
places that you weren’t supposed to be?

Mr. IANNUCCI: Well, I’m – I intrigued as to what the state department looked
like in the inside, because the film is set a law in the state department. And
a journalist in Washington said do you have any kind of BBC pass or anything.
And I’ve got this pass, the BBC pass, and it looks very, very primitive. It’s
basically just my photo and my name and the words BBC. There’s no watermark or
serial bar and anything like that. It’s just a basic. A child could have put it
together. And they said go up to reception and say BBC, I’m here for the 12:30.

So, I did and I got in. I got in to the state department and I thought I would
be escorted with, you know, 50 state department officials, you know, high
security. No, I was just in there on my own, myself and my researcher. And we
wandered around the state department for about half an hour.

(Soundbite of laughter)

Mr. IANNUCCI: …and I thought well let’s take some photos because I need to
bring them back to London and to tell the art designer what it looks like. So,
we’re just photographing the inside of the state department unchallenged.

And then this big burly guy came down and just came up to us and went - excuse
me? And I said I’m here for the 12:30. And he said yes, over there, and just
pointed us - we ended up at the 12:30, which was a very, very dull press
conference given by Condoleezza Rice’s press spokesperson. But I was amazed by
how easy it was to wander around. Part of me was thinking it was exciting.
Another part of me thought this is technically international espionage we’re
doing here. I hope I’m not extradited…

(Soundbite of laughter)

Mr. IANNUCCI: …or rendered.

GROSS: Armando Iannucci, thank you so much for talking with us.

Mr. IANNUCCI: Been a pleasure.

GROSS: Armando Iannucci wrote and directed the new political satire, “In the
Loop.” Coming up, rock historian Ed Ward on the rediscovery of an anti Beatles
band from the 60s. This is FRESH AIR.
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The Monks: A Transatlantic Gambit Gone Awry

TERRY GROSS, host:

Contemporary rock fans always like it when they discover an obscure act from
the past, which they can point to as a forerunner of what they’re into today.
The Monks, a band of ex-GIs who achieved notoriety, if not fame, in West
Germany in the mid-Sixties are a prime example of this. The reissue of their
album, “Black Monk Time” plus the DVD release of the documentary, “Monks: The
Transatlantic Feedback” has put them back in the spotlight. Rock historian Ed
Ward tells their story.

(Soundbite of song, “Monk Time”)

THE MONKS (Group): (Singing) All right, my name’s Gary. Let’s go, it’s beat
time, it’s hop time, it’s Monk time now! You know we don’t like the army. What
army? Who cares what army? Why do you kill all those kids over there in
Vietnam? Mad Viet Cong. My brother died in Vietnam! James Bond, who was he?
Stop it, stop it, I don’t like it! It’s too loud for my ears. Pussy Galore’s
comin' down and we like it. We don’t like the atomic bomb. Stop it, stop it, I
don’t like it. Stop it! What’s your meaning Larry? Ahh, you think like I think!
You're a Monk, I’m a Monk, we’re all Monks! Dave, Larry, Eddie, Roger,
everybody, let's go! It’s beat time, it’s hop time, it’s Monk time now!

ED WARD: In 1965, if you were in the Army, there was no better place to be than
West Germany, mostly because it wasn’t Vietnam. The Torquays knew this. GIs
Gary Burger, Larry Clark, Dave Day, Eddie Shaw and Roger Johnston came together
in Gelnhausen, one of those German bases where there wasn’t a whole lot to do
unless the Russians were invading, and they weren’t. The Torquays weren’t all
that good but they could play Chuck Berry and surf music, and, even better,
they could back up singers.

They got to tour a bit, and when they mustered out in 1965, they decided to
stick together and see if they could make some money. As it turned out, they
could. In the wake of the Beatles making Germany famous as a place for rock
bands to play, there were jobs all over the place. And the fact that the
Torquays were American, not British, was an added advantage. Before long, they
were tight enough to be playing Germany's hottest rock scene, Hamburg, and
enter the villains, although not everyone sees them like that.

Walther Niemann and Karl-Heinz Remy were two former advertising students from
German design schools looking for a project where they could put some of the
theory they had studied to use. One night, they walked into a Stuttgart club
and heard the Torquays. Having dismissed the Rolling Stones as baroque and the
Beatles as stuff for grandmothers, they realized that in the primitive sound of
the Torquays was the clay they could mould to fit their ideas.

(Soundbite of song, “Complication”)

THE MONKS: (Singing) Complication, Complication, Complication, Constipation!
People cry, Complication, People die for you. People kill, Complication, People
will for you. People run, Complication, Ain’t it fun for you. People go,
Complication, To their deaths for you. People cry, People cry, People die for
you. People cry, People kill, People die for you. People cry, People run.
People die for you. People cry, People go, People die for you…

WARD: Niemann and Remy knew that a visual image was important. So, the new
anti-Beatles had the tops of their heads shaved, wore robes, and became The
Monks. The guys in the band weren’t too enthusiastic about this at first. But
they at least realized that nobody else was doing anything like it. The next
thing was lyrics - instead of love, hate, negation. And the music - a single
beat was to pervade all the songs, which was to be keyed to a dance called “The
Hop.” These principles were typed on sheets of paper the band had to carry with
them at all times. And most important was, you are Monks, you are not Torquays.

They cut a demo and it found its way to Jimmy Bowien, producer of Polydor, one
of Germany’s largest labels who was impressed with Niemann and Remy and thought
The Monks were a historical turning point in pop music. He gave them a
contract. In order to get ready to record, The Monks hit the road. Audiences
hated them.

(Soundbite of song, “Shut Up”)

THE MONKS: (Singing) Got a reason to laugh. Got a reason to cry. Believing

you’re wise. And being so dumb. World is so worried. World is so worried. Be a
liar everywhere. Shut up, don’t cry! Be a liar everywhere. Shut up, don’t cry!

WARD: March, 1966, they recorded an album, “Black Monk Time,” with a stark
black cover, supposedly influenced by the Konstantin Malevich. The band went on
German TV when it came out and the tape is excruciating. The band does its
best, but the kids are utterly confused. The Monks toured but audiences
remained mostly hostile. More and more of their daily management fell to their
tour manager, Wolfgang Gluezczewski, as Niemann and Remy lost interest.
Finally, in September, 1967, the band called it quits. They returned to
America, slammed by culture shock, to which they reacted in different ways.

A couple had German wives but the marriages didn’t last. The saddest story was
banjoist Dave Day, who returned to Germany with his wife, who left him shortly
thereafter. He lived on the streets for a couple of years and refused to talk
about it when he finally made it back to the States. The Monks remained unknown
until they were rediscovered during the punk era, although they had influenced
some of the later generation of Kraut rock musicians. Polydor reissued the
album, which again didn’t sell again. Bassist-vocalist Eddie Shaw, who had
become a novelist, wrote a book about the band. And in 1999, they did the first
of several reunion gigs.

At last they seemed to be enjoying themselves but they called it quits in 2006.

Drummer Roger Johnston died shortly afterwards. And Dave Day died in 2008. The
film of “The Transatlantic Feedback” plays frequently on cable TV. It’s kind of
depressing, but it’s a window on a very odd time and place and an extremely odd
band.

GROSS: Ed Ward lives in the south of France. The documentary about The Monks is
called, “Monks: The Transatlantic Feedback.” The reissued album is called,
“Black Monk Time.” You can download Podcasts of our show on our Web site,
freshair.npr.org.

I’m Terry Gross.
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