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00:00Talk to you about the American Health Care Act before Congress really took it up in earnest. How did you react when House Republicans decided not to bring it up to the floor for a vote . Well I thought it provided an opportunity for us because I think that we're probably not doing that. What is the root cause of our problem. We've noticed that health care continues to increase in costs really driven by two things. First of all more older people and secondly more things we can do for people and rather than talking about how we move the money around to different groups. I think what we really need to do is to look at how we might reduce the cost of health care and keep it the curve from going up and this is something that's not just a problem for us it's a problem across the country across the world. I should say so. There are really two areas that you can begin to deal with that begin to reduce the cost of health care. The first is how we look after sick people. And the second is how we keep people from getting sick. And each one of those has things that you can do both legislatively and administratively to improve the cost of health care over time . And I think that that really is where we should be focused our attention rather than changing in a major way. The Affordable Care Act. To what extent do politics keep that out of focus . You listen to lawmakers from Cleveland or from Washington where you are today. What's keeping them from talking about these particular policy issues in earnest. Well I think that's a very good question. I think we've got to look down into the weeds a little bit of of how the law is actually administered and I think we would be much better if we thought about how we could begin to deal with the root cause of our problems. And I think not being a policymaker myself I think that you'd have to ask that question to people who are actually involved in Washington the legislative process there their real only major source that they have is legislation. And I think that that's what they're trying to do and I would direct them to a different way of looking at it. You're not a policymaker but you interact with a lot of them you're a hospital administrator you're a doctor . Why is consensus so elusive when it comes to health care policy in this country. Well I you know we are dealing with the same thing that almost every other country in the world is dealing with. If United States we look at how we're moving to increasing federal payment Medicare and Medicaid and no pay no income for 62 percent of the patients we see at the Cleveland Clinic in going up one or two percent a year. And so we're moving increasingly the United States to government pay and in Western Europe we're moving in the opposite direction to more and more emphasis on privatization of health care. So I think there really is no sort of perfect situation. And we have a very major industry which is growing up in a fragmented segment . So I think we're going to take some time to be able to sort this out. And I don't think there's an easy answer to it . Republicans have talked about rolling back the 10 essential health benefits requirement that's in Obamacare. Just explain to me what that would mean for both health care and insurance coverage if that were to disappear. Well I think that's unfortunate. It would be an unfortunate move and I think one of the things we don't don't realize particularly is if we reduce the coverage of people those people for example of 14 or 20 million people who will lose coverage under the current suggestions of a bill that is going to have a major ripples across the health of the entire health care delivery system because last year 52 percent of the hospitals in the United States lost money on operations. And if we have a great number of patients who are not going to have anybody pay for their health care this is going to put increasing financial strain on hospitals across the country . Granted we have too many hospital beds in the country right now and probably in excess of hospitals. But we do not want to put 50 percent of the hospitals in really in major financial problems. What can you tell us about the direction of this strategic and policy forum that's been convened by Steve Schwarzman chaired by Steve Schwarzman. What have you guys discussed when are you next meeting and what's what's on the agenda for all of you. Well the next meeting is going to be on April 11th and it's a wide variety of things going all the way from education to commerce. And there are we're breaking up into groups to begin to deal with those and meeting with people in the various portions of government are appropriate for those discussions and then meeting with the president after that. I'm not sure the part of that conversation is going to center on the budget. You had the White House presenting a skinny budget here they called for some cuts when you talk about reform in the context of health care. How worried are you about cutting back funding say to national science organizations. Well I'm worried about not cutting back on the National Science Foundation. I'm also worried about cutting back on Graduate Medical Education . We have a shortage of doctors in the United States right now we're a net importer of physicians from all over the world. And if we cut back on postgraduate education and graduate education we're going to find that we're having more and bigger and bigger shortage. We're short about one hundred thousand physicians by 2020. So I'm very concerned about that. I also think that you know our future is around the science and the development of new technologies. We have a lot of unsolved problems things like Alzheimer's and autism major issues and we need to have continue our research projects along those lines research financially always pays off in the long run and reducing cost .

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Cleveland Clinic CEO on Fate of Obamacare

Cleveland Clinic President and CEO Dr. Toby Cosgrove discusses why consensus on health care policy is so elusive in the United States. He speaks with David Gura on “Bloomberg Markets.” (Source: Bloomberg)

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