Jonathan Cohn's Critical Condition
In Sick: The Untold Story of America's Health Care Crisis — and the People Who Pay the Price, author Jonathan Cohn looks at case studies of patients struggling with the U.S. health-care system to explain why a profit-based model means some people don't get the care they need. Cohn, a senior editor at The New Republic, advocates a government-regulated single-payer system.
Other segments from the episode on April 11, 2007
DATE April 11, 2007 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
PROGRAM Fresh Air
Interview: Actor/writer/director Peter Berg discusses his TV
series "Friday Night Lights," adapted from nonfiction best seller
by Buzz Bissinger
DAVE DAVIES, host:
This is FRESH AIR. I'm Dave Davies, senior writer for the Philadelphia Daily
News, in for Terry Gross.
(Soundbite from "Friday Night Lights")
Unidentified Actor #1: Good morning, West Texas. Lem and Sammy Kneed coming
at you from Texas Football Radio, 470 AM on your dial. It's Monday morning
and we all know what that means. Only four days till Friday night, the night
that our Dillon Panthers bring the hammer down on the Westerby Mustangs. Who
wants to talk Panther football? I'm all ears.
Unidentified Actor #2: Hey, Sammy, this is...
(End of soundbite)
DAVIES: The season finale of the series "Friday Night Lights" airs tonight,
and while NBC hasn't decided whether it will be back next year, critics are
practically begging for another season of the Peabody Award-winning show about
a Texas town's obsession with high school football. Mimi Avins of the LA
Times wrote that the first thing anyone who hasn't discovered the show should
know is that it's not about football. It regularly deals with issues of
parenting, race, class and drug abuse. Tom Shales of The Washington Post said
the show brings plenty of realism, as well as passion, soul and heart at
levels rare in episodic TV.
Our guest is the series creator, Peter Berg, who also directed the movie
"Friday Night Lights," based on the nonfiction best seller by Buzz Bissinger,
who happens to be Berg's cousin. In this scene from the TV show's first
episode, players are talking to a local news crew about their upcoming season.
(Soundbite from "Friday Night Lights")
Unidentified Actor #3: We go in undefeated. Shattering records. Taking
these high expectations to unimaginable new heights. State champions.
Unidentified Actor #4: What's after high school, Brian?
Actor #3: Me and Mac Brown going to get our win on Pasadena. Get my national
championship on. Get my Heisman on.
Actor #4: It's known that a couple of years ago your father passed away, and
he's not going to be able to see you play.
Actor #3: Now look. I don't want to talk about that, all right? You want to
ask me football questions, I answer your football questions.
Actor #4: OK. Let's shift gears a minute. There's been talk of racism
around this squad. Have you experienced anything like that?
Actor #3: I don't let that faze me. I just keep my blinders on and keep
moving. I got things to do.
Unidentified Actor #5: That's not racism, man. I just don't like them. They
can be from Saudi Arabia or Sweden or Czech. That dude could be Santa Claus,
and I still won't like him.
Unidentified Actor #6: Name's Tim Riggins. I play fullback.
(End of soundbite)
DAVIES: Peter Berg has worked for 18 years in film and television as a
writer, producer, director and actor. He was a regular on the TV series
"Chicago Hope." His films include "The Last Seduction" and "Cop Land."
Well, Peter Berg, welcome to FRESH AIR. I thought we'd talk a bit about the
movie "Friday Night Lights" first since it--you adapted this from Buzz
Bissinger's book about the 1988 football season of the Odessa Permian
Panthers. You spent some time in Texas getting acclimated here. Can you talk
a little bit about that experience?
Mr. PETER BERG: Mmm. Sure. When Buzz Bissinger wrote the book, he moved
his family down to Odessa, Texas, and lived down there for a year, and I think
that that time spent, you know, really immersing himself in the culture was
very evident in the book in terms of the level of detail and the subtlety that
he was able to capture in the book. And when it became apparent to me that
the film was in fact going to get made, it was important for me to go back and
sort of retrace his footsteps. I knew we were going to shoot the film in
Austin, not Odessa, so I chose to spend most of my time in Austin, Texas, with
a high school called Austin Westlake High School, just outside of the city,
and I spent about six months with different families and coaches and their
families, and traveling with the team, and that time spent was, I think,
critical in terms of getting myself in the right mind-set so that I was able
to bring to the screen what Buzz Bissinger did so successfully in his book.
DAVIES: I thought maybe we should hear a cut from the film here, and this is
a moment fairly early in the film where Coach Gaines, played by Billy Bob
Thornton, is addressing his team, not before they're ready to go to battle but
at the end of a practice there.
Mr. BERG: Mm-hmm.
DAVIES: They're about to begin the season. And he kind of has a moment with
them. Let's listen.
(Soundbite from "Friday Night Lights")
Mr. BILLY BOB THORNTON: (As Coach Gaines) It's a good day, gentlemen. It's
a good day to think about responsibility. It's a good day to ask yourself if
on a personal level, you're willing to accept that. If you're willing to
accept the responsibility that you have to protect this team and this school
and this town, then make no mistake about it, gentlemen, we are in the
business of protecting this town.
(Soundbite of music)
Mr. THORNTON: (As Coach Gaines) We're in the business of winning. The
expectations couldn't be any higher. We will win state.
(End of soundbite)
DAVIES: And that is Billy Bob Thornton from the movie "Friday Night Lights,"
directed by our guest, Peter Berg.
Do you want to say a little bit about that speech?
Mr. BERG: Well, you know, as I was listening to it, I was tempted to
initially respond that it might really not be quite that intense and that
perhaps coaches don't frame high school football seasons in terms of
protecting towns and protecting dreams, but I actually do stand by that and,
you know, I'm still caught up in the magic and the spectacle that is high
school sports. Not just in Texas but really, anywhere in the country.
Whether it's hockey in Minnesota, basketball in Indiana or New York, you can't
help but be touched by the fact that when you go to these games and you
experience these communities, the intensity and the level of importance placed
upon winning is quite remarkable, and I was certainly struck by my time in
Texas with how mature and poised and skillful these young kids, 15, 16 years
old, were in terms of handling that pressure, and I was equally impressed by
the reality of that pressure, that families really do get caught up and their
identities get very much caught up in the culture of athletics, and winning is
very, very important to these communities.
DAVIES: You know, I read a piece by the beat writer for the Odessa American,
the daily the paper of Odessa, Texas, who had covered the Odessa Permian
Panthers in 1989, loved Buzz Bissinger's book but didn't like the movie
Mr. BERG: Mm-hmm.
DAVIES: ...he felt it strayed so far from the book. And it, of course,
raises a difficulty that anyone who adapts a great book to a movie faces,
which is, you can't get it all in. How did you decide what choices--what
choices did you have to make about that adaptation, things that maybe just
weren't going to work in the movie?
Mr. BERG: You know, that was sort of the big question. How to adapt a book
and put it into a 90-plus minute format, and I think the first big decision
that I made that, you know, probably irked this reporter from the Odessa
newspaper was, you know, Bissinger was--what Bissinger did so successfully was
he used high school football as a backdrop to explore, you know, very
legitimate social issues, racism, education, family values, religion. This
was really the heart of "Friday Night Lights," particularly issues like racism
and education--those were two huge issues in the book--and I decided not to
try and tackle racism as a theme in the film. I didn't think that we'd be
able to service it and give it the respect and treat it with the complexity
that it warrants, so we dealt with it in a much more subtle manner and decided
to focus primarily on the concept of football, the concept of that one special
moment in a life in which everything really seems to make sense, which is
certainly a theme that Bissinger hit in his book, and that to me was the most
interesting theme, and you know, for all the criticism that "Friday Night
Lights" the book took when it came out, particularly in Odessa, Texas, where
Bissinger received death threats after the book was published because they
felt that they were being portrayed as overly fanatic and racist, and people
who had their academic priorities completely backward. Bissinger really first
and foremost presented a world in which sport was a beautiful and magical
experience, and Bissinger believed that, and that was what I hoped to focus on
primarily in the film and let these other issues percolate but certainly not
DAVIES: My guest is writer, actor, director Peter Berg. We'll talk more
after a break.
This is FRESH AIR.
DAVIES: If you're just joining us, my guest is Peter Berg. He's an actor,
writer and director. He is also the creator of the NBC TV series, "Friday
We spoke a minute ago about some of the challenges of trying to adapt a book
with all of the complexity that "Friday Night Lights" brought to the issue of
football and the social milieu it operates in into a 90-minute or two-hour
movie. In a TV series, you've got a lot of time to work on some of those
things. Was that one of the reasons you wanted to make this into series?
Mr. BERG: Absolutely. And, you know, during the filming of "Friday Night
Lights," I knew that we were not going to be able to really get deep and
scratch in a real substantive way the surface of what Bissinger was able to do
so well in the book, and I felt very, very strongly that the medium of
television would provide us the opportunity to do that, to take six or seven
episodes and explore the ways that high schools allocate their resources
financially. In Texas, the training departments, the sports medicine
departments, have larger budgets than English departments, and these were
themes that we weren't able to really deal with in a way that was satisfying
to me or Bissinger in the film, but we felt that a television series would be
a perfect medium to get deeper into these issues, and I've, you know, been
very happy with the way things have worked out so far.
DAVIES: Now you spent time in Texas, sort of getting into the frame of mind
to portray Texas High School football, but the series itself was actually shot
Mr. BERG: Yes.
DAVIES: Now I'm sure this could have been done on sound stages in Los
Angeles. What did doing it in Texas bring to the series?
Mr. BERG: Well, I mean, this, you know--it was part of what I was talking
about earlier in terms of wanting to make things feel and actually be as real
as possible, and it was critical, you know. It was a dealbreaker for us. We
had to shoot the show in Texas. It's just too unique of a culture, and the
network was very supportive of it. We didn't want to build any sets, and we
haven't. Actually, that's not true. We built a locker room, but other than
that, we shoot the show entirely in real locations with, you know, as many
Texas actors as we can. We wanted to avoid bad Southern accents wherever
possible, and I think that, you know, putting the show in Texas was and is a
critical aspect to why this show, you know, is working creatively.
DAVIES: You know, I was going to ask you about this. There was a DJ from an
Houston radio station who said about the series, `If you already have this
impression of Texas as a bunch of podunk hicks in the country, and all we care
about is football and having sex on washing machines, this series totally
supports that.' I actually don't agree. One of the things I like about this
is that you show this as...
Mr. BERG: I'm sorry. Sex where? In washing machines? Or on washing
DAVIES: On washing machines, which I don't recall seeing in the series.
Mr. BERG: I don't either. That's a good idea though. We're going to do
Mr. BERG: Someone's going to have sex in a washing machine.
DAVIES: All right, well, I hope this DJ doesn't demand credit or payment for
Mr. BERG: Yeah, that's good.
DAVIES: But I do think one of the things that I like about it is that it's
not one-dimensional, and it does show the complexity of a culture that is
rooted in a real place with real traditions and accents.
Mr. BERG: I mean, yeah, I'm not clear on where that gentlemen's coming from
or what his point of view is. I mean, I think that--you know, I think there's
certainly an inherent sensitivity to how any culture is portrayed . And Texas
is obviously a very, very proud and, you know, culturally oriented state.
It's one of the things that I love about Texas and, you know, it doesn't
surprise me that anytime someone, especially outsiders come and sort of set up
camp in that state, there's going to be a response, and there's going to be an
I remember when I was up in Odessa researching the making of the film. I was
at a high school football game in Permian at Radcliffe stadium with 20,000
people on a Friday night watching this football game, and I was standing up in
the top of the stadium, looking down, and there was a long stairway that went
all the way from the top to the field, real long, couple of hundred yards, and
I was up at the very top, and I was looking down, and a woman was kind of
coming up the steps towards me from the bottom, very purposely, and she had a
baby in one arm, and a big thing of popcorn, I remember, in the other arm, and
she was just chugging up those steps. And I was watching her and I was, you
know, noting that she seemed to be coming straight at me with purpose, and she
got right up to me and she pointed a finger in my eye and she said, `Are you
here to make a movie about "Friday Night Lights"?' And I said, `Well, yes, I
am,' and she looked at me and she was just glaring at me and she had this baby
in her arms. The baby was looking at me. She said, `Are you going to make us
look like monsters?' And it really hit me, and I said, `No, ma'am, I
don't--no, I 'm not going to--no.' And she looked and me and she said, `Let me
tell you something. We're not monsters.' And she turned around and walked
down those steps, and I was, you know, stunned and thought about that for a
long time and, you know, thought about it as I was making the film every day
and thought about it as I was writing the pilot for the television series,
and, you know, there is certainly a responsibility. We aspire to honor what
Buzz Bissinger did and the respect that he had for those players, and that's
the spirit of what we're trying to do, and, you know, I don't think you'll see
many young couples having sex on or in or generally even near washing machines
in our television show.
DAVIES: I want to talk just a bit about the production, you know. I mean, TV
series typically are done on tight schedules and scenes are carefully blocked
out and camera angles...
Mr. BERG: Mm-hmm...
DAVIES: ...have been carefully considered to get exactly the lighting and the
angles that they want. Your technique here is very different. Describe how
you do this.
Mr. BERG: Right. Well, we generally walk into a location that's a real
location, so if we're shooting in a restaurant, we just take a regular
restaurant the way it is, the way it's lit. We'll generally, you know,
approach the restaurant a day before and tell them if they have regular
clientele that come and, you know, want to hang out for a day, be part of a
show, that they should just come. We hire the--we use the local cooks, local
waitresses in their costumes. We tend to not dress them. We bring the actors
in with a minimal amount of equipment, you know, grip equipment, rigging and
lighting. We let them kind of walk around rehearsing the scene. We encourage
them to improvise and make the dialogue their own, change things. We don't
call them scripts. We tend to call them vague guidelines. And then we come
in with a bunch of handheld cameras, and we tell everyone to just sort of go,
and it's over very quickly. And for people that aren't used to it, it's
somewhat traumatic and they wonder kind of what happened when we say, `OK, we
got it,' and we move on to the next location.
DAVIES: And do you do it several...
Mr. BERG: That's basically our project.
DAVIES: ...do you do the film several times?
Mr. BERG: We do. We tend to not cut--what we do is we put long magazines of
film in. You know, it's our philosophy that everytime you cut on a film set,
everything sort of comes to a grinding halt, and you have to restart
every--you know, again, every time you go for another take so what we like to
do is just basically shoot until the camera's run out of film, and then rather
than cutting, we'll just reload, you know, if an A camera rolls out, we'll
reload that while the other B and C cameras are still shooting so we'll just
keep going and going and going until either we've run out of film or we've got
DAVIES: How do the actors not step on each other's lines?
Mr. BERG: Oh, they do, you know, they--which we like. They'll step on each
other's lines. They'll mess things up. They'll get lost and have to kind of
find their way out of it, but the actors absolutely love it, and it makes for,
you know, a more organic experience when you're doing it and I think for
something that feels a bit more real when you see the finished product.
DAVIES: We had one more cut maybe I thought we would play, and this is a
quieter moment. I mean, there's a lot of, you know, a lot of really intense
stuff, but this is a moment in the hospital where Jason Street, who began the
season as the star quarterback, lies at this point, possibly paralyzed and his
coach is talking to him, and Street asks the coach how his replacement, a
probably underprepared quarterback named Matt Saracen's doing. Let's listen.
Mr. BERG: Mm-hmm.
(Soundbite of "Friday Night Lights")
(Soundbite of music)
Unidentified Actor #7: (As Jason Street) How's Saracen doing?
Unidentified Actor #8: (As Coach) Saracen's doing fine. He's throwing like a
girl but he's doing fine. He's doing fine. It will take some time.
Actor #7: (As Jason Street) You know, I was kind of like that kid, you know.
I know he's a lot different than me, yeah. He doesn't need
the...(unintelligible)...like I do. He's kind of creative, you know? Listens
to Bob Dylan and draws pictures and stuff. I don't know. He's a good kid. I
think you bring him up a little bit out there on that field, he'll make some
things happen for you.
(Soundbite of a deep sniff)
(Soundbite of music)
Actor #8: (As Coach) You're a good man. You're a good man. You're what make
guys like me want to coach. You are a good man.
(End of soundbite)
DAVIES: And that's from the series "Friday Night Lights," which was created
by our guest, Peter Berg.
Any thoughts about that scene, Peter?
Mr. BERG: That's--I mean, I have to say I find that very emotional. When we
were filming the movie, we spent a lot of time filming real playoff games. We
used that footage in the film. We'd shoot real high school playoff games and
then cut that into the film, and we were filming a playoff game at Austin
Westlake High School in Austin, and it was a game between the Westlake
Chaparrals and a school out of San Antonio, Texas, and in the fourth quarter
there was a big, very violent collision and a 16-year-old boy named David
Edwards, who played quarterback for San Antonio, broke his neck, and in that
moment, you know, went from being a beautiful, extremely athletic young
teenage boy to being an instant quadriplegic and lost all the movement in his
body from his neck down. That was obviously a very, very emotional and
profound experience for me and for all of the crew and for everyone in the
stadium that experienced that and went through that, and the storyline of
Jason Street hurting himself and trying to, you know, to reclaim his identity
after such a traumatic incident was inspired by David Edwards.
DAVIES: Peter Berg created the film, the TV series "Friday Night Lights," and
directed the film. He'll be back in the second half of the show.
I'm Dave Davies, and this is FRESH AIR.
(Soundbite of music)
DAVIES: This is FRESH AIR. I'm Dave Davies, filling in for Terry Gross.
My guest is actor, writer and director Peter Berg. He directed the film
"Friday Night Lights" about high school football in West Texas, and he created
the NBC TV series, which explores issues of race, class and parenting around
the football team of the fictional town of Dillon, Texas. "Friday Night
Lights" recently won a Peabody Award for broadcast excellence.
You've been around television for a long time, and this series has gotten a
lot of critical acclaim and has a very devoted audience but not a huge
audience. Why do you think it's struggled to find the big numbers that the
Mr. BERG: I think that there's two reasons that we're struggling with the
ratings right now. I think one was a preconceived idea that the show was
going to be exclusively about high school football, and that was off-putting
to a lot of people and was off-putting to women. It was off-putting to high
school football players who were concerned that it wouldn't be realistic. It
was off-putting to sports fan who, you know, are getting their fill of
football. Getting over the initial hurdle of football was a big problem.
And the second, you know, problem, which is equally significant for us, is,
you know, a question of time slot. And when you put a new show on
opposite--first we were opposite this television show, "Dancing with the
Stars," which was hugely success. And now we're up against "American Idol,"
which is, you know, possibly the most successful show on, you know, in the
last 15 years on television. And these shows are just, you know, beating us
up regularly, and we can't win that way.
DAVIES: Well, I probably thought we'd talk a little bit about some of the
long career you had before this "Friday Night Lights." And you've done a lot
of acting. You were a regular on "Chicago Hope," and a lot of people remember
you from the 1994 film, "The Last Seduction," where you're a small-town guy
smitten with a very hard-edged, manipulative woman, played by Linda
Fiorentino. It's a very sexual relationship. She wants nothing more than
that initially, protecting secrets about her life. And that film is all about
that relationship. I wonder if you could just describe it a little bit and
what it was like playing it.
Mr. BERG: That film, to me, is really about how we tend to just project
whatever we want to upon another person, whether it's a man projecting onto a
woman and just refusing to see the reality of who that person is. You know, I
played a guy who is so desperate to be in love and to get out of this small
town that I was willing to ignore the most glaring of warning signs
imaginable. And I paid big time for it. You know, so it's a real cautionary
tale for, I think, anyone to not ignore the reality of what you're seeing in a
relationship. I think it happens a lot. It's certainly happened to me in my
life, where you just refuse to see who a person really is because you don't
want to. And before you know it, you're in prison for the rest of your life,
and you're like living a Johnny Hooker blues song.
DAVIES: I think the first film that you wrote and directed was "Very Bad
Mr. BERG: Hmm.
DAVIES: Which was a black film, some would say very black comedy about guys
who go to Vegas for a bachelor party and end up accidentally killing a
prostitute, then just decide to conceal it, leading to further mayhem. I mean
Mr. BERG: All the wrong moves.
Mr. BERG: Right. All the wrong moves.
DAVIES: It was a controversial film. I guess, looking at it--going back,
that was in '98, I guess, that you did that.
Mr. BERG: Mm-hmm.
DAVIES: How do you look at that? Was it a misunderstood film? Would you do
it differently today?
Mr. BERG: I don't think I would. You know, it was my first film, and I
wrote it with a large amount of irreverence, and it was fun to write, and I
was really left to my own devices, and I was allowed to do exactly what I
wanted to do. And at the time, that was, you know, that was really where my
head was at. I thought it was just outrageous, and it was very funny to me,
and it was funny to the people I was working with and to--you know, and it's
still, you know, I think if you added up the reviews, definitely we lost. And
if you look at--and as I say, I'm friend with Michael Manno, and we were
talking about bad reviews the other day. And I said, `You know, I've gotten
the worst all-time review ever.' He said, `No, I have.' And we were arguing
about who got the worst reviews, and he was talking about a review that he had
gotten for an earlier film. And I said, `Well, you got to read Kenneth Turan,
the film critic for the LA Times review of "Very Bad Things."' And I
still--you google it, you can pull it upon line.
DAVIES: I did read that. It's nasty.
Mr. BERG: Right. But I--and I say to all my friends now who are filmmakers,
I say, you know--and who take, you know, hits from the critics--I say, `Look,
no one is going to take a harder hit than I took from Ken Turan, and I'm still
standing, and, you know, I still seem to be functioning in the business
despite his clear attempt to take my head off and make sure I never got
anywhere near a film set again.' But, you know, I think, look, I think if I
was still making "Very Bad Things" today, you know, as the father of a
seven-year-old kid and someone who, you know, I think has matured in terms of
what he wants to do and say with film, and I'm not that person anymore. And,
you know, that was who I was at a point in my life. And the great thing about
being able to make films is you get the opportunity to grow and, you know,
mature as an artist. And I'm just, you know, thankful that Ken Turan didn't
completely derail my career and I've been able to make more films.
DAVIES: Well, Peter Berg, thanks so much for speaking with us.
Mr. BERG: It's my pleasure. Thank you very much.
DAVIES: Actor, writer and director Peter Berg.
NBC is still considering whether his series "Friday Night Lights" will be back
for another season. Berg has just finished the feature film, "The Kingdom,"
an action drama set in the Middle East. It's scheduled for release this fall.
Coming up, Jonathan Cohn on the crisis in American health care.
This is FRESH AIR.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Interview: Writer and editor Jonathan Cohn discusses his new
book on universal health care
DAVE DAVIES, host:
The New York Times/CBS poll taken in February found a majority of Americans
favor a government guarantee of health insurance, even if it means higher
taxes. My guest Jonathan Cohn has written a new book exploring the need for
health care reform and options for achieving it. The book is an argument for
universal health care, told mostly in the form of individual stories, not of
the desperately poor but of working people, many educated and enterprising,
whose families were financially ruined and emotionally devastated by illnesses
that were uncovered or undercovered by the current health insurance system.
Jonathan Cohn is a senior editor at the New Republic and a contributing editor
at The American Prospect. His book is called "Sick: The Untold Story of
America's Health Care Crisis and the People Who Pay the Price."
Let's look at some of the case studies that you share with us that illustrate
weaknesses or problems in American health care. Now, one problem is insurance
companies denying coverage or overpricing coverage to people with the very
health condition that makes insurance critical for them. And you cite the
example of a woman named Janice Ramsey. What's her story?
Mr. JONATHAN COHN: We catch up with Janice in a little after 2001, 2002, and
Janice has built herself a very nice business. She's a consultant working
with some realty companies, and she's also taking care of her mother who is
sick at the same time. Her problem is that she has diabetes. Now, if you are
part of a large group insurance plan, that shouldn't make too much of a
difference because in a large group, they'll take anybody and they will price
everybody at the same price, and that's fine. But when you try to apply for
insurance on your own, where it's part of a small business, the insurance
industry will want to know, `Well, what kind of conditions do you have that
we're going to be insuring?' And if they discover that you have something like
diabetes, which she does, then they are going to be very wary of providing
that coverage. And, in fact, she tried very hard to find coverage and every
policy that came back was either denied outright, or sometimes they would tell
her, `Well, we'll give you the coverage, we just won't cover anything related
to your diabetes.' Now, if you know anything about diabetes, you know that
pretty much almost any medical problem in the world could be plausibly blamed
on diabetes. So she did the math and said, `Well, gee, this isn't really
going to cover anything for me.' And so she didn't go for any of those plans,
and that sort of set her up for the next stage of what was going to happen to
DAVIES: Which was what?
Mr. COHN: Well, as often happens, people in that situation find themselves
pretty desperate to find an insurance policy that works. So one day along
comes this insurer with a very nice-sounding insurance plan. She lives in
central Florida, and they're hooked into the best networks of doctors and
hospitals in the area. She looks over the plan. This looks great. And the
best part is they say they will charge her an affordable premium, and they
won't exclude her pre-existing conditions. So she is just ecstatic. She
signs up for the plan. They start withdrawing the premiums, and she thinks
everything is fine, until a few months later she has to go to the hospital for
something and she gets taken care of.
She goes home, and then a few months after that, she starts getting calls from
the hospital. The bill hasn't been paid. Well, she figures there must have
been some mix-up, so she calls up the insurer, and they say, `Oh, yes, yes,
yes. We're just reviewing the claim.' So she doesn't think anything of it.
Well, a little more time passes. The bill still hasn't been paid. She
finally complains to the state, and that's when she finds out that, in fact,
her insurer was a fraudulent insurer, and she's been paying premiums to this
scam all along. And this actually turns out to be a very common problem.
They are literally hundreds of millions of dollars in premiums were paid to
fraudulent insurers, many of them doing exactly what this insurer did, which
is targeting people who can't find affordable coverage in the small business
market or the individual insurance market. And then what happens is these
people buy the insurance, and they suddenly find themselves uninsured, and
they really have the worst of all worlds. Now they're stuck with medical
bills that aren't covered because, of course, they don't have insurance now to
cover them. They can't buy insurance because now they have these pre-existing
conditions. And so they end up with medical debts, health problems and really
nothing they can do about it.
DAVIES: So the problem here are--is people who don't get health insurance
from their work, often people who are self-employed, and are--do insurance
companies have complete discretion to deny them coverage or price it so high
that it's unaffordable?
Mr. COHN: Well, different states have different laws. But the fundamental
problem here is, in the absence of a universal health care system, there's no
way to force an insurance company to insure somebody who had these conditions.
And when you think about it, in fairness to the insurance companies, they have
a good reason for not wanting to insure these people. You know, the old Blue
Cross plans, originally they would insure everybody. They offered coverage to
everybody. And what ended up happening was eventually other commercial
insurance companies came into the business and started picking off the
healthiest consumers and charging them lower rates. And what ended up
happening was Blue Cross got stuck with all the very sick patients. They had
to raise their premiums in order to cover those costs, and then they started
losing customers. So for an insurance company operating in a competitive
marketplace, there just isn't any way to make money if you don't--if you're
not ruthless about who you cover and who you don't.
DAVIES: Are companies getting more aggressive about seeking to determine what
pre-existing conditions might exist? I mean, there's a lot of information out
there for people who are aggressive about getting it.
Mr. COHN: That's right. I mean, they've always been aggressive about that.
The change is now that there's more--they have more information at their
disposal. And really looking ahead, I think one of the most worrisome trends
is the development of genetic technology. Now, we think of unlocking the
genome as this great potential for medical breakthroughs, and it is. We might
be able to cure all sorts of things. We can screen people for conditions
before they develop them. I mean, that is a wonderful medical tool. The
problem is that insurance companies can use those tools, too, and they can
find out that, `Oh, gee, you're at risk for getting breast cancer' or `You're
at risk for developing diabetes.' Well, they find that out and they either
will jack up your rates or they won't cover you at all. And, in fact, there's
already been a study out there that has suggested that there are women not
taking the genetic test for breast cancer precisely because they fear someday
that information might fall into the hands of insurance companies. And
that's, to me, a classic example of the way our system, the way it is
structured, actually works at cross purposes to what we want in terms of
DAVIES: You know, I think a lot of people who have health insurance or at
least haven't experienced a health financial crisis assume that when people
can't afford care, it will be provided, and then somebody will absorb the
cost. And if you check into a hospital, they will treat you, and if you can't
pay, they absorb the cost.
Mr. COHN: Well, first of all, there are two fallacies with that statement.
The first is that it is not true you can always get medical care if you can't
afford it. Hospitals will see you if you have an emergency. They are
required by federal law to do so, but good luck trying to get preventative
care or any kind of nonessential emergency care. That's a whole other story.
So people who don't have insurance often have trouble getting access to
preventative care, which, of course, then leads to emergencies down the road.
The second problem, that even when they do treat you--they will treat you.
They will stabilize you. They will make you better, and they will send you
home, and then they will expect to be paid. Now there's a great quandary over
what how much they can expect to be paid and what effort they should make to
help you find assistance. But there are documented cases all over the place
where people go into the hospital. They don't have health insurance. They
get the emergency stabilizing care they need. They go home. The next thing
they know is they owe bills that are five or even six figures. And if they
can't pay them off, sometimes they are lucky and they can get taken under the
wing by a state agency or maybe the hospital will write off the charge as bad
debt, but a lot of times these hospitals will farm out the collection of these
to collection agencies.
DAVIES: My guest is Jonathan Cohn. His new book is "Sick: The Untold Story
of America's Health Care Crisis and the People Who Pay the Price."
Well, let's talk about some of the difficult policy issues that we confront if
we talk about addressing the problem of insuring the underinsured in America.
Now, one argument that you hear against a national health insurance program is
that private enterprise can simply do things better. Government bureaucrats
will find ways to waste money and provide shoddy care, but, you know, an
organization that has to meet a bottom line is going to do a better job. What
do you think of that argument?
Mr. COHN: Well, that is one of the most powerful arguments that has been
used historically against universal health care. I like to think we've had
basically an 80-year running experiment to test this, and the experiment has
been this is basically how we've run our health care system. And if you can
compare how our private health insurance system has worked against other
countries that have universal health care or if you want to compare it even in
this country, compare the performance of private insurance vs. our best
public insurance program, Medicare, I think the evidence is overwhelming that
the private sector simply doesn't do this better.
The basic problem here is that at some fundamental level, you cannot make
money by taking really good care of people who are sick, and you will not make
money by helping people who don't have enough money to get their health care
afford it. These are not ways that you can make a profit. And the private
market--that's what the private market tries to do. It tries to make a
profit. And I think our 80-year experiment has shown that fundamentally the
private sector, the private market doesn't work very well at providing health
insurance. And, frankly, there's a good reason to believe the government
could do it better.
DAVIES: Now, you say that a simple argument for universal health care comes
when you compare what the United States spends on its health care and the
results it gets to what other nations spend and their results. What do you
Mr. COHN: Well, again, this is pretty unambiguous. We by far spend more on
health care as a percentage of our wealth than any other developed country in
the world, and yet we do not have better results to show for it. Health
indicators, you know, if you want to look at very crude indicators--how long
do we live, what are the infant mortality rate, that sort of thing--we don't
do better there. If you want to look more closely at statistics, there are
various statistics people have come up with like potential years of life lost,
which are really an effort to zero in on the effect of the health care system
and sort of void out things like, `Well, do we have higher poverty here and
such?' Again, we don't do any better and in some ways we do a little worse.
And even if you look at things like how--at what rate do we cure various
diseases, this is an argument you hear a lot of coming from conservatives who
oppose universal health care, and they will point out the one or two diseases
where the United States does better. Well, yeah, there are some where the
United States is better. There is also some where the United States does
worse. And if you look at the evidence as a whole, if you look at the crude
indicators, the good indicators, I think it is virtually impossible for
anybody with intellectual honesty to make the case where our system is better.
And yet, we're spending all this extra money, and that's just talking about
And let's not forget the fact that we're really--other countries don't have
this situation where there are major financial barriers to medical care. You
don't have masses of people filing for bankruptcy because of medical debt.
You don't have all sorts of people making trade-offs like they do here
between, `Gee, one, can I afford my rent or am I going to pay for my drug?'
You just don't see that in those other countries. And you look at that
evidence, you see all the extra money we're spending, and I think you have to
ask, `How on earth did you say that this is a better system?'
DAVIES: Well, one of the things that opponents of national health care say is
that we're wasting a fortune on malpractice insurance because of
out-of-control jury settlements. How much of a drain is that on the system?
Mr. COHN: Well, there is a separate conversation to be had about the
malpractice system. I don't happen to like our malpractice system, and there
are, I think, some smart ways we could reform it. But if you're trying to ask
the question as you just did, does malpractice insurance drive up the cost of
health care? Every study looking at it has suggested it has a minimal impact.
DAVIES: My guest is Jonathan Cohn. He's written a new book called "Sick:
The Untold Story of America's Health Care Crisis and the People Who Pay the
Price." We'll talk more after a break.
This is FRESH AIR.
DAVIES: My guest is journalist Jonathan Cohn. His new book is "Sick: The
Untold Story of America's Health Care Crisis and the People Who Pay the
Price." When we left off, he was discussing the prospects for universal health
The other argument against a national health care system you hear is people
will drag up some horror stories from Canada or Great Britain of long waits
for care and shoddy treatment. What stock do you place in those stories?
Mr. COHN: I actually think this is probably one of the most powerful
arguments against universal health care politically, and there are a few
points to be made here. First of all, there are waiting lines in some other
countries with universal health care. Now, those countries spend a lot less
than we do. If they spent closer to what we did, they probably wouldn't have
such long waiting lines. In addition to that, and purely in terms of health
outcomes, you just--it may be that people are waiting for treatment. There's
nothing in the statistics to suggest a place like Canada is really suffering
serious adverse health effects from it. Again, that opposed to the United
States where we have--there's a large body of evidence to suggest that people
who don't have health insurance are suffering severe medical consequences. We
don't see that, at least to that extent, in countries like Canada.
But the most important point I like to stress is that there are a lot of
countries with universal health care that don't have rationing and waiting
problems like we do here. You go to France or you go to Germany or Japan, all
the evidence compiled by the big international authorities, like the OECD or
World Health Organization, they don't have waiting problems there. In fact,
in many ways, they get more health care than we do. They have better access
to health care than we do.
Americans sometimes like to think, `Oh, gee, if we have universal health care,
we won't have all the high-tech gizmos we want.' Well, it's not entirely clear
that we actually benefit from having all those high-tech gizmos. But quite
apart from that, people who say that should know that we don't actually--we
are not the country in the world that has the most MRI machines and CT
scanners. That distinction belongs to Japan, and Japan has universal health
insurance. So this idea that if we have universal health care then we're
going to have rationing and all be waiting for our doctors, it just isn't
true. There are, in fact, countries that have both universal health care and
free access to medicine, frankly, freer than we have here.
DAVIES: So do you think the climate has shifted here? I mean, is the
groundwork there for a successful movement for universal health care?
Mr. COHN: The conditions on the ground are shifting. This problem is
getting worse. It is worse now than it was 10 years ago. It is going to keep
getting worse, and it might start to get worse at an accelerating pace. But I
think, at this point, there's a lot more work to be done, explaining not just
what's going on but why it's happening. And people need to understand that
this isn't some complicated problem that nobody can fix. It's actually a very
fixable problem, we just need the will to do it.
DAVIES: You know, a number of states are experimenting with efforts to
provide universal health coverage. Massachusetts has gotten a lot of
attention. I mean, I wonder how--do you regard these as distractions from a
needed national effort or are they maybe laboratories where you can see what
works and steps towards a real reform?
Mr. COHN: I think they are, in general, going to move us closer to universal
health care, if only by political example. I think it is highly significant
right now that we have two states, one that has passed a universal health care
plan and one that is actively talking about creating a universal health care
DAVIES: Let's just be clear here. We're talking about Massachusetts and...
Mr. COHN: California.
DAVIES: Right. Right.
Mr. COHN: So now, admittedly...
DAVIES: Pennsylvania is also talking about some major steps, too. But go
Mr. COHN: Sure. Yes. No, I mean, the states are busy working on this.
But, to me, I think the Romney and Schwarzenegger examples are really the most
vivid because I think they create political room for this discussion. I mean,
it's been--it was not that long ago when to even to talk about universal
health care was considered out of bounds. And even in the 2004 presidential
election, when most of the Democrats were promising universal health care,
with the exception of Dennis Kucinich, none of them were actually offering a
plan that would have actually achieved universal health care. So now that has
changed, and I think--I don't think it's coincidental that now that Romney and
Schwarzenegger have put this on the table that we see this flurry of activity
now. We have private sector interests. We have the Business Roundtable. We
have the CEO of Safeway, people like that. Everyone is coming out for
universal health care. So, politically, I think it certainly advances the
Now whether as policy that helps, that's a much harder question. It was very
hard in general to do this on a state-by-state level. California might have
better luck at it than a lot of states simply because it's so big that it has
a certain leverage with the insurance industry than other states wouldn't.
And there are also--Massachusetts and California are also both trying out this
model which is called an individual mandate, and this has become a very
popular model for doing universal health care right now. The idea of a
individual mandate, the word that the phrase comes from, that we are mandating
or requiring individuals to buy insurance, to buy private insurance. Some
people might still be eligible for programs like Medicaid, which you can keep
in place. But the general idea is that we're saying, `Look, we want everybody
in the system, and we're going to make you be in the system.' The same way
that you have to buy auto insurance if you want to drive a car. Well, if you
want to live in our state you have to buy health insurance. Now, if you get
it through your employer, that's fine. If you don't, then you have to buy on
your own. The state then turns around and says, `We understand that it's hard
to buy insurance sometimes. Sometimes it won't be available to you because of
your health conditions, and sometimes you simply won't be able to afford it.
So in exchange for requiring you to buy insurance, we will, number one, make
sure that there is insurance available to you. We will make sure that, even
if you have diabetes or you're a cancer survivor, that you can still buy
insurance at a reasonable rate. And, number two, if you're poor or even not
that poor but you find insurance hard to pay for, we're going to give you
subsidies so that you can afford it. And that's a sort of two-way street.
Now, you're required to do this. We, in return, will do that.' And that is
the basic idea behind the individual mandate.
DAVIES: And the drawbacks are?
Mr. COHN: Well, the drawbacks are it is very easy to say, `We're going to
make affordable insurance available to you.' The problem they're running into
in Massachusetts is that it's a lot harder to do that in practice. Insurance
companies will want to be paid a certain amount of money. The state will want
not to spend more money than it has to on subsidizing people. There's only so
much money going around, so you end up, inevitably, in a very complicated
discussion about, `Well, what should we require people to have? How much
should we expect them to pay for it? And how do we actually make this all
Again, this experiment is ongoing, so I hesitate to say it will or won't work.
I think it's very interesting to watch. And I'm actually glad the states are
trying this out because I do think this is a case where, quite honestly, the
lessons we see in Massachusetts and California, should they pass this kind of
law, would actually be helpful on a national level.
DAVIES: Well, Jonathan Cohn, thanks so much for spending some time with us.
Mr. COHN: Thank you. This has been a pleasure.
DAVIES: Jonathan Cohn's new book is "Sick: The Untold Story of America's
Health Care Crisis and the People Who Pay the Price."
DAVIES: Finally, we want to welcome our new listeners tuning into FRESH AIR
on Radio GIPA in Tbilisi, which is based in the nation of Georgia. Radio GIPA
is part of the Georgian Institute of Public Affairs, which runs a graduate
program in journalism for students from Georgia, Azerbaijan and Armenia. We
hope you'll enjoy listening to the program.
For Terry Gross, I'm Dave Davies.
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