Here’s the full transcript from the David Gratzer interview—if you prefer the podcast version I’ve linked to it here. There are lots of comments there too.

Matthew Holt: This is Matthew Holt, and we’re back with another podcast on the Health Care Blog, and today my guest is David Gratzer. David is a psychiatrist who is still practicing psychiatry, but is also, part-time, a Fellow at the Manhattan Institute, and has written a new book called "The Cure", subtitled "How Capitalism Can Save American Health Care." David, welcome to the Health Care Blog.

David Gratzer: Good afternoon.

Matthew: Let me start off, David. Obviously, with your subtitle, you’re a proponent of free markets in health care, but you come at this from a couple of interesting backgrounds. One is that you’re a Canadian who has moved down to the U.S., to practice medicine down here. The other one, which I found was very interesting is, at the very start of the book, in the introduction, you raise the entire issue of what it’s like to be somebody who has a relative, in this case your wife, who has no insurance in the U.S. and needs medical care. You raised the issue of your wife’s treatment, and I hope she’s fine now, without being overly personal about her, how did you end up in the situation that you were in the U.S. without insurance? David: Well, it certainly was an unfortunate circumstance. A lot of people go without insurance for a variety of reasons. I had access to American health care, but not access to American health insurance. My wife had, as you know from the start of the book, injured her back on the bunny trail on a ski trip. She tells the story slightly differently involving a large mountain, gale-like winds, and heroic efforts on her part. But she had ruptured a disc in her back, and she, as a result, needed surgery. And I’d certainly read much about the American health care system, but what came across me then was not just the confusion about pricing, and I talk about the foot-and-a-half-long bill that I had received, which, as a doctor, I could see was completely inscrutable. But also just the issues around quality.

There we were, trying to find a neurosurgeon, and I went to the Internet and found no information. I went about calling neurologists and trying to get their opinions on neurosurgeons in western New York. So I have a greater appreciation of the frustration that millions of Americans, not just those, incidentally, without insurance. I think even if you’re insured, health care is such a black box of uneven quality, of difficulty gathering basic information, and at the end of the day you’re left with ever-rising prices, with inscrutable bills. I wanted to start the book that way because even though I think there’s greatness in American medicine, and I think one should never lose sight of that, and there’s never been a better time to be, frankly, a patient or a doctor than today, I also wanted to emphasize, literally from page one of the book, that there were huge problems with American health care. And, that even though I took a free market approach to looking at reforms, I wasn’t going to undermine that or downplay that. Matthew: And I understand that. Were you living in the U.S. as a resident at the time? David: I was actually, as I am now, dividing my time. I opted not to get health benefits when I joined the Manhattan Institute. To provide the answer to the insurance question, that’s why. Matthew: The reason I raised that is, and to get to the nitty-gritty of it, you’re not going to get any argument from me about the U.S. health care system having many, many problems, but you’ll get an argument from me about the solution to that. But one of the things that I find curious, from those people that are on the right – the thinking libertarians, to tease my colleagues at the Cato Institute about being, and I think you voice a similar opinion in the book, is the solution to the problem of access. There are many different ways you can talk about solving the problem around pricing and transparency, and getting to understand what people are purchasing, and I think people agree that there needs to be more of that, however it comes out. But the question is, how do you get people to not be uninsured? And I think you’re basically suggesting a voluntary solution here. Do you want to say a bit more about what you think the solution is to dealing with the lack of insurance?

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