Q: What's the worst damage that Congress could do?

A: Medicare -- if they permit Medicare as an option (for all ages) and don't price it correctly. If Medicare were a private company it could not exist. With a $34 trillion unfunded net present value liability, it would be bankrupt. What companies do that have these big unfunded liabilities is they amortize them. They take a charge of some amount and then they reduce liability on their current income statement by that amount. I could tell you how that is done, but you don't want to know.

Let's say that the charge would be 3 percent, which is the marginal federal government borrowing rate; 3 percent of $34 trillion is $1 trillion. So if Medicare were to be priced right - it costs about half a trillion dollars now - it should be priced at least at $1.5 trillion. If Congress were to do that, OK. But there is no way in the world that they have the courage to do that.

I just read some survey where somebody found that people loved Medicare and I laughed out loud. Why wouldn't you love a thing where your children and grandchildren wind up paying the bill? Of course they'd love it.

So I don't have any confidence the Congress would act differently once another 112 million were in Medicare. The reason they don't price it correctly is they are afraid of the voters' backlash of doing that. So they keep postponing the bad news. The worst thing - the absolutely worst thing - would be to permit Medicare as an option and price it the way it is now priced. The U.S. economy would collapse and we'd become a second-rate economic power.

Q: You mentioned the Swiss model. Is that a country Congress should look to as a role model?

A: Yeah. They have universal coverage. They don't have rationing, unlike the Brits in the UK. You can get transplants. You can get dialyzed. People who are sick get good health care in Switzerland and they spend 40 percent less as a percentage of GDP than we do. The reason is, the Swiss buy their own health insurance. Actually, Switzerland has no Medicare and has no Medicaid.

Q: Individual Swiss citizens buy health insurance the way we buy car insurance?

A: Absolutely. In Switzerland, instead of being relegated to a really degrading program like M - a lot of doctors won't see M patients because they get paid terribly for those M patients -- a poor person gets in effect a voucher equal to the average expenditures of the average Swiss. Then she goes and she buys health insurance like everybody else. I think that is a much better system.

Q: What are the chances that Congress will make things better and not worse?

A: I believe they are going to go for the Swiss system, which would be better. The recession has made so many people nervous about their health insurance that it seems to me, rightly or wrongly, that they really want universal coverage. The only way to do it is the automobile insurance-Swiss model.

The Swiss model is a real model. It's not some BS, theoretical "We'll promote health! We'll have IT, blah, blah, blah." This country has been doing it since 1996. It's a very stable and not terribly wacko country. It works there. It works in very precise ways. Everybody has universal coverage. The care is great; 40 percent less cost. So I think that's where we are going to go. It's just going to take a while for us to get there.

Q: Will Obama get his wish for a health care plan by the year's end?

A: That I can't tell you. I'm really Alice in Wonderland when it comes to the machinations of Congress. But since he has put his prestige on the line and the American people do like him, that certainly puts a lot of impetus on Congress to get on with it. So I think it's more likely to happen than not. Of course, you know, when we left Vietnam, we declared victory. So there are many ways he can declare victory.

Something else that I believe will happen, and which I think is very important, is the Congress will pass a Healthcare Transparency Act, so that consumers will know how good their doctors are, how good their hospitals are, how good their insurance plans are, not only in terms of consumer satisfaction but in terms of clinical measures; like how many people have died within 30 days when this doctor operated on them; how many people wait on the line for 30 minutes when they called to complain with this health insurance company, and so on. I believe we are going to get that and I couldn't be happier. I've been lobbying for that in my own way for about 12 years.