We Americans, or half of Americans, think health care is a commodity. Other countries view health care as a social service that should be collectively financed and available to everyone on equal terms. My wife and I just interviewed the German minister of health, and it was an exhilarating experience, because it was a totally different language. It was obviously important that everyone should have the same deal in health care.

The bad things are that our financing of health care is really a moral morass. It is a moral morass in the sense that it signals to the doctors and hospitals that human beings have different values depending on their income status.

The good things at the U.S. health care system are that we have a well-trained labor force, particularly physicians; I don't think any nation trains doctors better. We have the latest technology, simply because we throw so much money at it. We are really technology-hungry in this country. That's a good thing. Our system more treats patients like customers, which is a good thing; that it's very customer-friendly. And it's very innovative, both in the products we use, in the techniques we use and the organizational structures we use. Those are all very good things, highly competitive.

Everybody should have health care, on the one hand. But on the other hand, if you ask Americans, "Are you willing to pay for it?," they say no. So I've never been able to understand this contradiction.

We Americans, or half of Americans, think health care is a commodity. Other countries view health care as a social service that should be collectively financed and available to everyone on equal terms. My wife and I just interviewed the German minister of health, and it was an exhilarating experience, because it was a totally different language. It was obviously important that everyone should have the same deal in health care.

Americans believe that the private sector is always more efficient and cheaper than big government, and particularly when you go among Republicans, even after five beers, they still believe it. But I always say, "If it's really true, why would they need that 12 percent extra on a traditional government program? Explain to me why something that costs more saves me money as a taxpayer.".

The bad things the U.S. health care system are that our financing of health care is really a moral morass in the sense that it signals to the doctors that human beings have different values depending on their income status. For example, in New Jersey, the Medicaid program pays a pediatrician $30 to see a poor child on Medicaid. But the same legislators, through their commercial insurance, pay the same pediatrician $100 to $120 to see their child. How do physicians react to it? If you phone around practices in Princeton, Plainsboro, Hamilton - none of them would see Medicaid kids.