Second opinion

Dr. Ben Carson grew up poor but gifted, and for three decades now has given despairing parents the great gift of hope that their desperately ill children can be well. He has turned that hope into reality with pioneering operations such as separating Siamese twins with conjoined heads, and taking out the diseased half of a child's brain in a way that allows the healthy half to take over, with minimal changes in cognitive function.

Carson's latest book, America the Beautiful, is a love song to a country that made his ascent possible. Today, he serves as director of pediatric neural surgery at Johns Hopkins hospital. Here are edited excerpts from an interview before students at Patrick Henry College.

Your new book is titled America the Beautiful, not Washington the Beautiful. It seems like logic there has simply been thrown out of the window. We've empowered special interest groups because we have so many people who want to maintain their office all the time, so they have to have money all the time. This was not foreseen by the Founding Fathers because they didn't think people would want to be in office all the time because it was a sacrifice. Now, it's not a sacrifice. Now, it's gravy.

Do we need change in our healthcare system? We do. We spend twice as much per capita on healthcare in this country as most other nations do, yet we have terrible access and efficiency problems. That's largely because we do things the wrong way. An appendectomy in New York, in Los Angeles, in Baltimore: All have different costs, different ways of submitting bills, different ways of collecting, all of which justifies the mountains of paper and the armies of people to push them around, all paid out of the healthcare dollar. Absolutely asinine.

Can we streamline that? Yes. Every diagnosis, every procedure, can be coded, and we have computers, which means that all billing and collection can be done instantaneously without all that cost. We don't do it that way because insurance companies say, "If it were that easy, some practitioner would say he did two appendectomies when he only did one so he could get paid twice."

Would cheating be a big problem? Very few doctors would do such a thing. For those who would, the answer is not a gigantic expensive bureaucracy but the Saudi Arabian solution: Chop their limbs off. I wouldn't necessarily do that here, but a doctor would face loss of license for life, no less than 10 years in prison, loss of all personal assets. You think anybody would even think about cheating? No.

Why not have government take over all of medicine? The government is big enough and intrusive enough as it is. If you go back and read the ideals the Founders had, you'll see they never intended for the government to grow so large. They said it is critical, if the United States is to maintain itself as a free and prosperous nation, that the people be well-informed and active in government. We're becoming a nation for, of, and by the government. As that continues, we become less of a "can-do" nation and more of a "what can you do for me?" nation.

If Obamacare can be stopped, where should we begin to make improvements? Start with the electronic medical record and electronic billings systems. Make the government responsible for catastrophic healthcare, and insurance companies only responsible for routine healthcare because they hide behind the catastrophic things to keep jacking up their rates. If you made them responsible for only routine healthcare, you could predict how much money they're going to have to put out. You can regulate them just like you do utilities.

Where would you draw the line between catastrophic and routine problems? I would do it at the $200,000 level. It has to go hand in hand with tort reform: A lot of the cost-driver is that doctors are afraid not to do something because they would be sued. Until we get a handle on tort reform, we'll never get a handle on a lot of other costs.

What about those with no health insurance? Set up a system similar to food stamps where you set up an electronic health account and it's replenished every month, just like food stamps are. People would be incentivized not to blow it by going to the emergency room, where it costs five times more than a clinic visit does. Now, when Mr. Brown gets that diabetic foot ulcer, instead of going to the emergency room he'll go to the clinic. They do the same thing in both places but in the emergency room they patch him up and send him out. In the clinic, they patch him up and say, "Now Mr. Brown, let's get your diabetes under control."

Did the White House ask you for advice concerning its healthcare plan? Two phone calls. In the first, I was having a decent conversation with the gentleman about some ideals I have. He was pretty enthusiastic. Then he said, "What did you do for the president during the campaign?" I said, "I'm an Independent." Clunk. End of that conversation.

There was another call. Two months later. I said, "I'm in the middle of teaching a class right now. Can we talk in about 40 minutes?" The individual was incensed. I mean, how could you possibly be doing something more important than talking to the White House? That was the end of that conversation.

But you had some contact. I did talk to senior administration officials about good things in Obamacare, like lifetime limits and coverage of pre-existing diseases. I said, "These are things everybody can agree with, that perhaps should be placed on the table for a vote-but don't just try to jam this gigantic thing through because it will alienate people." They wouldn't listen, and we find ourselves in exactly that situation.

How has socialized medicine in countries like Canada and Great Britain worked? Great Britain and some other places with socialized medicine are looking at privatization because they're running out of money. The problem with socialized medicine is that you can't seem to keep up with costs over the course of time, so you have to ration. That's why in a lot of places with socialized medicine, if you're 60 years old, you may not get a kidney transplant, you may not have a hip replacement: Sorry, you're just too old.

Would you have an age limit? We have 80- and 90-year-olds who are vibrant and contributing to society. You don't make those decisions based on age; you have to make those decisions based on condition, and socialism in general has a problem of not distinguishing things. Everything has to be this. Everything has to be that. When you do that, individuality disappears-but that's what America is all about.

For more excerpts from this interview see "Most likely to succeed," Aug. 25, WORLD Magazine, and "No useless knowledge," July 25, and "Rock solid," Aug. 14.

Watch Marvin Olasky's complete interview with Ben Carson: