Pearl, director of Kaiser-Permanente, speaks on what should be done to improve healthcare in the future, focusing on four topics.

One, he labels the current situation a cost crisis. He traces the roots of the problem back to the 1960s, when Medicare and Medicaid were implemented, and when union-acquired health benefits pervaded the workplace. Pearl sees every decade since as having seen a new solution to this crisis, but each has failed. He notes that healthcare costs have increased at twice the rate of GDP, though technology has generally leveled costs until the next recession each time.

Two, he speaks on what he sees as the significant factors to cost. The first is medicine's past success in prolonging, and improving the quality of, life. Second, the costs of pharmaceuticals has expanded, a result of the use of drugs to treat chronic diseases instead of acute problems. Drugs in America now cost two to three times the amount paid in other industrialized nations. The burden of regulations is third, discussing both HiPo and forced seismic retrofitting. Fourth is the threat of malpractice suits; he says it leads to unnecessary and defensive medical practices. Fifth, the shortage of healthcare works (RNs, technicians, pharmacists, etc.) drives up costs, claiming visa and immigration laws artificially keep prices high. Finally, he cites the fragmented structure of the medical delivery system, saying it has had the same system structure for the past century. He believes integration, such as at Kaiser Permanente leads to more efficient treatment.

Three, he says Americans do not receive the best care per dollar spent.

Four, Pearl offers five ways to slow down the rise of expense while increasing the quality of treatment. First, he calls for the modification of the current regulations, and suggesting an independent audit of every piece of new legislation. Second, he believes others should develop integrated delivery systems, saying equating choice with quality is a myth. Third, he believes America needs to engage in a national discussion about palliative care. Fourth, he calls for purchasers in the federal government to reward organizations with superior quality outcomes. Finally, he says healthcare leaders of the future need to be trained differently; arguing they ought to be experts in information technology, experts in ethics, visionaries, and comfortable implementing change in through influence in addition to current roles.

The question and answer session touches on a variety of topics. Pearl finds it morally reprehensible that there are uninsured in America, but does not believe in a federally run, single-payer system. He notes many Western Europeans come to Kaiser to research ways to make their systems better. In regards to Canada, he has a few favorable things to say, yet believes the system is failing, noting waiting lists are unacceptable. He says denial of care due to the cost of procedure is terrible. He does not see euthanasia as something that should be increased in the future.