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- [00:05]
A
Hello, everyone, and welcome to Amanpour. Here's what's coming up.
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B
We need each other. I mean, the United States need Europe and Europe need United States.
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A
As the fragile stalemate in Iran continues and the Ukraine war drags on, could tension between the US And Europe benefit Russia? Christian speaks with Czech President Peter de Pavel. Then a call for US UK unity amid rising transatlantic tensions. Veteran journalist Ted Luce joins me as Washington welcomes King Charles. And all the kids in Palestine suffer.
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C
They want to just live their life normally, but they pay the price.
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A
Israeli settlers block Palestinian children from going to school. Abir Salman reports.
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D
And later, what's stealing money from your pocketbook and keeping you sicker is the way our health care system is treating you.
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A
A barbaric problem in American hospitals. Hari Srinivasan speaks to medical reporter Elizabeth Rosenthal about dysfunction in US Health care. Welcome to the program, everyone. I'm Bianna Golodriga. New York sitting in for Christiane on for There's a chain reaction happening across the world. The longer the war in Iran drags on, the more the US Drains its global supply of critical weapons, the longer oil prices remain high, the more Russia reaps the reward, leaving Europe increasingly exposed to Russian President Vladimir Putin's aggressive instincts, questioning whether he'll set his sights beyond Ukraine. Nonetheless, a diplomatic stalemate continues with US President Donald Trump signaling that he's unlikely to accept Iran's latest proposal to end the conflict. And Europe left on the sidelines, not consulted by the White House before the war and targeted by Trump for not supporting the US during the fighting. Well, now Europe is pushing back. In an appearance this week, German Chancellor Frederick Mertz criticized the White House.
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E
The Americans clearly have no strategy. And the problem with conflicts like this
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F
is always that you just don't go in.
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G
You also have to get out again.
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B
We saw that all too painfully in
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G
Afghanistan for 20 years.
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D
We saw that in Iraq.
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B
So this whole affair, as I said,
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F
is ill considered, to say the least.
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E
This entire nation is being humiliated by
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the Iranian state leadership, especially by these
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so called Revolutionary Guards.
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A
Our next guest is well placed to discuss all of this. Pyotr Pavel is president of the Czech Republic. He is former chief of staff of the Czech armed services and served as chair of NATO's military committee. An ardent supporter of the Western Alliance, Pavel serves in one of the most Eurosceptic countries on the continent. Christian spoke to President Pavel about the dangerous cross currents across Europe and the world at a conference in Prague. The conference, called Money, Money, Money, was hosted by Czech affiliate CNN Prima, here's their conversation.
- [03:18]
E
Thank you, Mr. President. Welcome to this interview. And can I just ask you, because I'm here a couple of weeks after the political landscape around this part, Eastern Europe is changing somewhat with the defeat of Prime Minister Orban. I just wondered how you're feeling about the relative balance of power now.
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B
Well, we may feel a little bit relaxed because Viktor Orban was representing blocking power, especially in the EU with regard to support to Ukraine. But I would rather wait for concrete deeds rather than words.
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E
But I just want to ask you, because the Trump administration has vocally said, whether it was J.D. vance, the Vice president in Munich, whether it's the State Department official, Mr. Sampson, who's been going around Europe allies and essentially instructing them that they need to be more right wing in terms of more maga. That's my shorthand. But have you come across that here?
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B
I would rather say that it was a misjudgment because JD Wentz clearly helped Peter Madhyar to win by his intervention.
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E
All right, so we'll leave it at that. One of the latest things that certainly Ukraine and all Ukraine's backers are very pleased about is that with the defeat of Orban, the pro Putin Orban, and with the election of Peter Magyar, this 90 plus billion euro loan to Ukraine, Ukraine has been released, it's been approved. And I spoke to the president of Ukraine, Volodymyr Zelensky last week who said it was critical. It was literally a matter of life and death. From your perspective, how important was it?
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B
Any support to Ukraine at this point is critically important, being the financial support just to run the country and acquire all equipment and material they need to effectively defend themselves, military support, ammunition support and on the other hand, continuing pressure on Russia. And while we maintain the same effort in supporting Ukraine, we somehow fail in maintaining pressure on Russia.
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E
Well, you know, President Zelensky said that to me. He said that actually the United States puts more pressure on him and he is the defender, as he says, than on the aggressor Russia. What do you think can be done to change that? Or is this how it's going to be?
- [05:57]
B
Clearly, Middle east has become a priority over Ukraine for American administration at this point and it gave Russia time to breathe. And they also see that diverting all material support, especially interceptors for air defense to Middle east and they are now missing in Ukraine gives Russia time to reconstitute their capabilities. Also increasing cost of oil gives Russia additional financial resources to support the war machine. And that also gives Vladimir Putin more hopefully that he can achieve more than he probably believed. A couple of months ago, you were
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E
the head of your country's military. You know about war. Is he right? Can he win this on the battlefield?
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B
I don't think so. First, the losses, the casualties that Russia is suffering are increasing. They are now exceeding capacity to recruit new manpower. People in Russia are increasingly tired and I would say also less capable to understand the rationale provided to them by Russian propaganda. The war fatigue is omnipresent. It's in Ukraine, in contributing countries, but also in Russia. And increasingly for Russian regime, it will be more and more difficult to convince people that it's in their interest to continue the war. And war initiative on the battlefield is not fast enough to control more territory and to express, to present it to Russian public as success. And this is what Vladimir Putin desperately needs, to somehow come to the end of what he calls special operation with a great success.
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E
But to my question about how then do you pressure him? How does the President of the United States, who's the head of NATO, the superpower in the world, use his leverage to pressure Vladimir Putin to at least come to the negotiating table?
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B
Well, one side of the coin is economic pressure continuing in sanctions, but also looking at third countries who are providing an opportunity for circumvention of sanctions. But also I think one part of it is diplomatic effort offering Russia not only a negotiation on Ukraine, but as a next step, negotiation on security regime in Europe in general. Because this is what Russia was calling for years. And I believe, let's use their own argument, that it's not just about Ukraine, it's about security in Europe. And there is a big debate ahead of us on treaties that have expired on conventional weapons, on nuclear weapons, on disarmament. There is a great room for negotiation on military exercises, on modernization, on trust building measures like open skies. And I think if we are ready to open all these chapters, it will provide an opportunity for Russia to think bigger than just Ukraine or Donbass.
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E
So, but first they have to end the war in Ukraine, of course. I see. So that's the condition.
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B
That's the first step.
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E
You just touched on the war on Iran. Clearly Europe and the rest of the world, Asia, Africa, the rest of the Middle east is feeling a real economic backlash right now.
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B
I believe that we will need a serious debate about all potential impacts on our economy. On the other hand, I also think that there is now a great room for negotiation to end up this conflict and to renew negotiation with Iran, especially on his nuclear program.
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E
The two sides are in stalemate, they have zero trust. Do you see any route to a negotiation from your side, from the west side, from President Trump's side?
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B
Well, first from the point of view of Central European country, what I miss is more involvement of other actors. It is now actually trilateral issue between Iran, Israel and the United States. I believe if Europe was involved from the beginning, at least through consultations, Europe would also be much more engaged in post conflict negotiation. Europe, EU has done a lot in concluding this GCPOA agreement some time ago. There is the nuclear deal, the 2015. Yes, there is a good expertise for negotiating this nuclear deal. I believe that Europe could do much more, but we are not part of it. European countries were blamed not to come to assistance. But how could we when we were not invited at the beginning?
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E
Yes. And President Trump has threatened all sorts of punishments on European countries, particularly NATO countries. Are you concerned? I mean, he's lashed out at Spain.
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C
Spain.
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E
He's just angry, calls you all cowards for not coming to help, you know, force the Strait of Hormuz open, for instance.
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B
Well, I know how difficult it is to tell to President Trump anything that he doesn't want to hear.
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E
Have you tried it?
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B
Well, I didn't have a chance. But I believe that what he needs to hear, that by having different opinion, we are not an enemy. We are on the same side. What we want is fair treatment. And I believe that should European countries were involved at the beginning, that there will be much more willingness to take part potentially in also supporting operations, for example in control access through Hormuz trademark. But now, when European countries were not treated as allies at the beginning and they are now blamed from being cowards, I fully understand that they take it, let's say, unfair and we want to be fair, we want to be fair allies. We have to talk to each other as equals, not as a dependent child.
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E
Do you think it was a mistake to for Trump to have pulled out of the jcpoa, particularly since there was nothing to put in its place? Because right now Iran is jacked up over the last few years, its enrichment to 60%.
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B
I heard number of times that it was a bad agreement, but I'm not supporting the idea that it might be better to have no agreement than a bad one. I think even a bad agreement is better than having nothing because a bad agreement can be improved while if we don't have any, then there are no restrictions. I think the only way will be to get again to negotiation, sit at the table together. Ideally not only United States and Iran, but Also European Union, potentially other actors like big countries that have a lot of trade with Iran, like China, India and then negotiating new deal that would be better than the first one. But I don't see any point in continuing military operation without having plan B for post war arrangement.
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E
Let's just talk about Israel for a moment. You've seen many of your European counterparts beginning to harden their views on how they send military aid to Israel, etc. What is your view of how your country should and the EU should have an engagement with Israel? Is it just blind support as there has been for decades for obvious reasons, or are there conditions that can be or should be attached?
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B
Well, this country is a longtime supporter of Israel. From the very beginning we stood behind, we assisted Israel in a number of ways in their original, original phase of forming the statehood and we are supporting Israel even today. But it's not black and white support. I think from time to time we have to distinguish between supporting Israel and supporting Benjamin and Netanyahu. Not all his steps could be approved without any concern. And I think we should be very firm but also very open and frank in maintaining support to Israel while keeping an opportunity and possibility to be critical to some decisions of Benjamin Netanyahu back to Europe.
- [15:59]
E
I mean people have been sitting around saying, I mean serious people that get ready, there's going to be war in Europe. That is Russia attacking Europe, let's say the Baltic states and then, and then. Do you subscribe to that fear? Do you think it's an actual living possibility? I know in theory one has to prepare. But do you think we're close to the war with Russia?
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B
I would probably look at it from two perspectives. One is historical where Russian and before that Soviet leaders maintained the argument that you cannot defend such a huge country without expansion. And that's why all the tsars and then the general secretaries of Communist Party and now the President, they try to create some zone of influence or buffer zone to protect Russia from external enemies. Today there is also another reason, and that is Russia has turned all its economy into a war machine. It's extremely difficult to turn it back. There is no switch to peace mode. And maintaining such an economy running in fact needs and output, where you would put all this production, you have now more than a million and a half trained soldiers, many of them, if the war is over, will retire with all the difficulties and problems of war. And then if you are in a position of Russian leader and you would see weakened Europe, weakened grip of United States over European security, and he would say, well, That's a good chance. Let's use it. So I would say let's look at it also from the point of view of opportunity for Russia not necessarily to launch a massive operation in Europe, but to humiliate NATO by starting, let's say, limited military action, for example, in the Baltics, and by doing that to clearly demonstrate that NATO is actually useless because
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E
it doesn't act unless it acts.
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B
Unless it acts. But the question is, if United States or President Trump continue in the narrative, we will not defend the countries that are not spending enough, we will withdraw our capabilities, then the whole Article 5 gets different meaning. Because Article 5 is not an automatic guarantee, it's an expression of political will.
- [18:56]
E
And of course that Article 5 is an attack on one, is an attack on all. Yeah, well, that's quite sobering to hear you say that as somebody who commanded sector of NATO and who commanded your own army. What about you then? This country is not paying its, is not spending its 2% GDP to bolster. In other words. Okay, why aren't you doing it?
- [19:20]
B
Well, you're right, that also makes me nervous because facing all these threats that are real, it's not just and hypothesis, we should be more credible not only to our allies, but mostly to our own citizens. We cannot maintain the idea that we are safe, encircled by allies and friends. The war is far, far away from us and if we express loud enough that we want peace, we would have it. And I think this is not the way to go. And I have lots of debates with our government to behave more responsibly, to not only express our willingness to spend the percentage demanded by our own commitment, but to spend on developing real capabilities that are expressed by NATO defence planning, all these capability targets that lead to ready troops that will be physically present and ready to defend us if we need them, because the war will not be fought with the charge, it will be fought with real soldiers and real equipment.
- [20:51]
E
You just earlier said Russia has turned its whole economy over to. That's kind of what's being asked of NATO countries as well. I mean, not the whole economy, but a huge sector of the economy is being asked to turn over because President Trump has made it clear that at least for the moment, you can't depend on the United States.
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B
That's true to some extent, but understanding that we were spending for at least a decade, much less was required. I think we now try to do with increased defense production is just getting to the level that used to be here, let's say 10, 15 years ago. And in the Past we all understood that about 2% of GDP was just good enough to meet all the criteria for collective defense. Now, it will be more for some time, but once we again get to a sufficient level where we will be in a position to say, well, we can effectively now defend this continent, then there will be no need to increasing trajectory. But obviously, how long will it take? Well, I believe it will take about one decade of increased spending to fill all the gaps that we created over the last decade.
- [22:23]
E
And I guess, final question. Do you fear that NATO will be busted? That even Trump talking about, you know, talking it down could just cause the end of the transatlantic alliance in that regard and therefore put all of you to have to defend yourselves and to have to have a whole other arrangement?
- [22:43]
B
Well, frankly, I believe that we need each other. I mean, the United States needs Europe and Europe needs United States, but we were actually never equal partners. I think Europe has to grow up to come up with own capabilities. To be a partner means not to be dependent, to be able to act independently from United States, but with clear preference of always acting together. But if United States for any reason decide not to take part in European defence, we should be able to do it on our own. And that's in my way, good partnership. That means we will be both equally strong, equally independent, but always preferring to work together. This is the end, in my view, for Europe to develop all strategic enablers to enable us to act on our own, to come up with substitute of American positions in NATO command structure, if necessary, to have some replacements, and also to create sufficient will in decision making to act within European pillar of NATO with or without American presence. That is, in my view, the end of, not the end. It's the way to better transatlantic partnership. Not the end of NATO, not the beginning of new NATO, but it will be finally NATO that we wanted from the very beginning.
- [24:22]
E
And you're going to NATO right to the summit?
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B
I believe so.
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E
And you will put this down on the table?
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B
Well, I think there is no need to change the practice that we used to have up to now.
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E
President Petapavlu, thank you so much. Indeed.
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B
Thank you.
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A
Well, normally the President of the Czech Republic would be going to the NATO summit, but this time there is a question mark surrounding his attendance with the Czech Prime Minister instead vying to represent the country at the talks. Just the latest dispute and a string of clashes with the President and the coalition government there. And do stay with cnn. We'll be right back after the break. Now there is pomp amidst the politics in Washington. Today, as the Capitol welcomes Britain's King Charles III and Queen Camilla. On this, the second day of his US Visit, King Charles attends a formal welcome ceremony at the White House, addresses a joint meeting of Congress, and it's just the second time that a British monarch will be speaking at the Capitol tonight. He will be attending a state dinner at the White House. The royal visit comes at a tense time between America and the UK Relations have been strained since the start of the war with Iran. Here to discuss, Ed Luce is U.S. national Editor for Britain's Financial Times, and he joins us now from Washington. Ed, you could argue that the relationship hasn't been strained between these two countries as much as it is now. You have to go back to the Suez connection crisis so many decades ago, and yet the president seems to have welcomed the king and the queen with open arms, quite affectionate towards the royal family there himself. And you write in your latest column that King Charles has to thread a royal needle this week. What exactly does he have to do, both to please President Trump, but also please his constituents back home?
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F
Well, thanks for having me on bjana. The threading of the royal needle is I think, obviously bringing fruits to the volcano, as some people say, trying to sort of bring Trump on side, but also to convey to the American people that he's here to celebrate their 250 years of independence. He's not just here as a guest of President Trump. And I have no doubt, because this is what King Charles is trained to do his whole life, speak about this, that he will subtly and through various illusions, speak to both audiences in his address to Congress. There have been plenty of difficult moments in Anglo American relations. I think the Vietnam War was another. Harold Wilson, the British prime minister, did not commit British troops to Vietnam. And LBJ Lyndon Johnson was not happy with that. But they didn't, they didn't get a royal visit to help ease tensions. This one, to judge by what President Trump said this morning, seems to be working from the British point of view.
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A
And he stuck to script as well. And that speaks positively of how the president feels towards King Charles and Queen Camilla. But there has been some breaking news this morning that may make at least Downing Street a bit uneasy in terms of the timing here. And that is Starmer's new ambassador to Washington, D.C. your reporter at the Financial Times actually leaked audio of the new ambassador telling students back in February of this year, British students visiting, that America's only true special relationship was actually with Israel. I believe we have a portion of that audio to play for Our viewers
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B
special relationship is a phrase I try not to utter because it's quite not it's quite backwards looking and it has
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F
a lot of baggage about it.
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G
I think there is probably one country
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B
that has a special relationship with the United States and that is probably Israel.
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A
He went on to say that he thinks it's extraordinary that the Epstein scandal, which cost his predecessor Peter Mendelsohn his job, hasn't touched anyone here in the United States as well. How much does this pull the rug out from under King Charles message today, if at all? And how is it being received back in London?
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F
So I'm guessing that when Charles addresses Congress, that's going to sort of blot out any other attention on the special relationship or not, as the case may be. It is unfortunate for Christian Turner. He turned up in January. He's sort of top of his field of his class in the British Foreign Office. And the fact that some teenager recorded this and leaked it is unlucky, I think. I suspect he'll survive this. He's Britain's top diplomat. It wasn't a controversial appointment and I suspect I might even say hope he'll get past this.
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A
The timing though, I would imagine isn't ideal. And we'll see if the president is asked about this specifically the Epstein part of this audio as well, because you know that he gets quite irked as he did with the 60 Minutes interview when he was asked about this would be assassins apparent motivation and manifesto that was found on him. Let's talk about just the span of relationships between these two countries over the last decade alone. We're nearly 10 years out from the Brexit vote and you still see a British economy that continues to be marginalized in the world. What exactly is it that if anything, that President Trump and the King can address behind closed doors to perhaps ease up on issues related to tariffs or other economic ties between these two countries to integrate them better.
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F
Well, there are a number of things, and I'd add to that list, that Britain and I think from what I understand the King personally are quite committed to the Ukrainian cause. And so I would be surprised if he didn't allude to that in some way in the speech, but also perhaps more directly with the president in private. This is an extremely difficult patch in UK US Relations. I tend to agree that special relationship is an overused, really overwrought term and usually used more by the British side than the American side. But at a time like this, you know, when there is huge divergence on things like the Iran War on things like multiculturalism, because the Labour government in Britain does embrace British multiculturalism, that it's going to be quite hard for a king, no matter how practiced or experienced he is, to do a huge amount to bridge those gulfs. These are deep and political and they're not just confined to UK US relations. Most European countries relations with the US are strained. What Charles can do is provide the King with the sort of royal company that he always seems to really like and crave, ever since his mother had him watching the coronation of Elizabeth when he was six years old. So there's a diplomatic balm that the monarchy brings, particularly with Trump. And I have to stress, the speech Trump gave this morning was more fulsome than anything I've ever heard about the UK US relationship. It was, I mean, arguably way over the top. But it does show that, you know, the royal magic works on President Trump.
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A
Does it change at all the President's perception, relationship with the Prime Minister at this point?
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F
Maybe for a few days. But, you know, if the Prime Minister doesn't, as he won't swing behind the Iran more in anything other than helping with the defense of allies in the Gulf and Israel, then Trump is going to continue to be irked by that. What he sees a political letdown by Britain and he's going to continue to refer to Starmer as somebody who isn't like Winston Churchill. So I don't think that's going to last for very long in terms of Keir Starmer, and neither might he in his job, which was, by the way, another portion of the sort of leaked comments that the ambassador made to those students back in February, Starmer is on the ropes.
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A
The reverberations of the Epstein scandal still being felt across multiple dimensions in the United Kingdom. Ed Loos, thank you so much. Good to see you.
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F
Great to see you.
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A
Well, now, while the world's attention is focused on the prospect of renewed war in Iran and Israel's ongoing attacks in Lebanon, despite a ceasefire, Gaza is still in ruins. And as people there attempt to pick up the pieces of their lives, US Secretary of State Marco Rubio says there have been some promising signs regarding the push for Hamas to demilitarize. Meantime, in the West Bank, Israeli settler attacks are surging, with Palestinians being subjected to a campaign of fear and violence, including reports of sexual assault, smashed water pipes, destroyed farms and forced displacement, to name just a handful of the issues that Palestinians there are experiencing. The most recent example of physical intimidation, settlers setting up a razor wire near a village blocking Palestinian children from going to school. Now students as young as five are protesting, calling on settlers and Israeli soldiers to reopen the roads. Abir Salman has this report.
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C
These Palestinian children have been demonstrating every day for two weeks. All they want to do is go to school, but razor wire is blocking their way. Rolled out by Israeli settlers from a nearby settlement in a deliberate move to stop them. 11 year old Huda struggles to hold back tears. Some of the kids here in Umm Al Khair in the occupied west bank are as young as as five years old. Along with their books and their backpacks, they carry signs and hold them up so settlers can see them as soldiers look on at the top of the hill. When settlers initially blocked the road, video shared with CNN showed soldiers with what appeared to be tear gas blowing around them. The children scream and run away. This striking image was widely shared online, even capturing the attention of NBA star Kyrie Irving, who made it his profile picture on Instagram. And the kids took notice. Omal Khair is not unique. In fact, the UN says there are 12 more Palestinian communities in this small corner of the west bank facing imminent threat of forcible transfer. That's 500 children and their families. Israel may reject the description, but a local leader is clear in how he sees things. And the occupation mostly based on apartheid system which give all the privileges to the settlers that prevent Palestinians from having any kind of right, even right to education and access their school safely. All the kids in Palestine suffer.
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D
They want to just live their life
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C
normally, but they pay the price.
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A
Our thanks to Abir Salman for that report. We'll be right back after this short break.
- [36:57]
F
I'm Jack McBrayer and I am back
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B
on the hunt to find even wilder.
- [37:01]
E
Oh no.
- [37:03]
F
Is this real?
- [37:04]
B
It is more outrageous. You like pink?
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C
It's my favorite color.
- [37:08]
E
Over the top houses on the market.
- [37:10]
B
Oh, look at this bathroom and meet the fascinating people who call these one of a kind places home. How does one obtain a comparison?
- [37:22]
G
Zillow gone wild all new season Friday at 9:30 on HGTV.
- [37:32]
A
Humiliating. That is how our next guest describes the conditions that her husband lived through in an American hospital emergency room while he battled the late stages of esophageal cancer. At a time when over a quarter of patients waiting more than four hours for a bed. In a worst case scenario, a patient could spend days in the hallway awaiting care. Author and former ER doctor Elizabeth Rosenthal describes the growing emergency room boarding crisis in a new article for the Atlantic. She joins Hari Sreenivasan to discuss Bianna.
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G
Thanks. Dr. Elizabeth Rosenthal. Thanks so much for joining us. You had a recent piece in the Atlantic titled, A Barbaric Problem in American Hospitals is Only Getting Bigger. What's the problem?
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D
Well, the problem is people who are admitted to the hospital, but there are no beds available, so they end up lying in the emergency room in a hallway, or actually out of the emergency room in a hallway or in an ER overflow area where it's not clear who's responsible for them. And you just don't have the normal care that an inpatient needs. And I think everyone knows who's cared for an older relative or a sick relative, that this happens and everyone's frustrated by it. But as one of the ER doctors said to me, it's a problem that everybody knows about but nobody cares enough to fix, which I think is the tragedy.
- [39:00]
G
Yeah, you wrote about this in a very personal way, too. You were writing about your husband, who was dying of esophageal cancer at the time. And you write, after we went to an emergency department near our home in New York City, he lay trapped on a hard stretcher with its rails up for more than 36 hours amid the alarms and calls for the code team, without any clues of whether it was day or night, and with access only to the few toilets shared by the dozens of patients and visitors in the emergency room. Tell us a little bit about. You know, I think people forget that the impact that the setting itself has. You don't know what's happening and the lights are the same and you don't know who's coming in to do what.
- [39:39]
D
Yeah, no, it's a scary place. It's a noisy place. It's. It's. I called it cacophonous. You know, it's. There are two or three bathrooms for everyone. You know, I think, you know, and in that particular admission where Andre sat in the ER for a couple of days, he had altered mental status. And, you know, if you have. Who wouldn't have altered mental status by the end of those two days? You know, he thought I was. The doctors were out to get him, like CIA people or something, and I was their paid conspirator trying to keep him there. So, you know, what. What happened over the course of his illness and he didn't have many ER boarding stays was because a lot of times when he should have gone to the emergency room, he refused. He said, I'm not going there because I know what's going to happen to me. I'm going to sit in the hallway. It's humiliating. A stretcher is Not a bed, you know, rails up is rails up. There are monitors, there are noises. You don't know who your neighbor is. You're in a hallway, you know, so it's humiliating as well as not good care.
- [40:59]
G
You know, unfortunately, your husband's care is not the exception. According to a study published in Health affairs back in 2025, it looked at across 46 million emergency department visits and 15,000 hospitalizations. This was between the years 2017 and 2024, during non peak months. So not even the months where its worst. More than 25% of the admitted patients waited four hours or more for a bed. And during winter months it was even higher. So why are patients waiting for, for a bed for so long? Why do we see human beings in the hallways of hospitals next to emergency departments?
- [41:42]
D
Well, I think the thing is, you know that four hour rule, more than four hours, any emergency room physician will say, or nurse will say, that's a joke. Everyone waits more than four hours. You're lucky if it's, you know, less than two days. I mean, we're talking days and nights for many people. And it's kind of a, it's a system problem. It's the way we finance care in America and the way hospitals, even not for profit hospitals, think about care and it's our lack of resources for people who are older, sicker, or at the end of life. So it's a multidimensional problem. You know, when I was an ER physician for seven or eight years before I became a convert to journalism and I worked in a very busy New York City emergency room, there were rarely people who boarded. But then the hospital always had some beds open to move people upstairs. If there were not, if there was not space in the emergency room, we could go on diversion. We would cancel elective admissions if there was no room. Now hospitals run like airlines, you know, they want every bed full all the time. Because an empty bed is a money loser. If you're thinking about medicine as a business, an empty bed, like you're paying for nurses, you're paying for the heating, the cooling, and you're not getting any revenue back. And more than that, I think you want those beds filled with revenue producing patients.
- [43:28]
G
Explain that.
- [43:29]
D
Well, you know, we prioritize procedures and healthcare reimbursement. So if you have someone coming in for a hip replacement or you know, a valve replacement or a cardiac procedure, that's big bucks. If you have someone who's older or sicker, who's just, just needs care, needs their antibiotics administered, you know, Needs to be turned at night so they don't get bed sores, they're not producing revenue, they're just there. And the secondary problem, just so I don't say, oh, it's the hospital's fault entirely, yes, they operate on a business model, so yes, it's partly their fault. They want a revenue. Revenue, revenue. But also the problem is they know that if one of those patients goes to a bed, we have an extreme shortage of rehab beds and long term care beds and hospice beds. So that person will most likely sit there in that bed and not move for days, for weeks. It could be even longer. And that's also not good.
- [44:44]
G
This was from the Health and Human Services about emergency department boarding. Exactly what we're talking about, right? This is the end of the Biden administration. It said, quote, emergency department boarding is a public health crisis in the United States. It concluded that patients who are sick enough to require inpatient care can wait in the ED for hours, days or even weeks. Boarding contributes to increased mortality, medical errors, prolonged hospital stays and greater dissatisfaction with care. I mean, that seems like the bat signal, the fire alarm, the red siren, I mean, whatever you want to call it. And why did nothing happen after this level of urgency is expressed by hhs?
- [45:26]
D
Well, you know, you could blame the change of administrations, but I don't know if that what would have happened if it was the Biden administration continuing, the panel would have been convened. It's a hard problem to solve as part of the problem. Right. One thing that is happening that was suggested by that report is starting in. There's a new rule that came out of CMS that takes effect this year, but actually you don't have to. Doesn't really require the hospitals to do anything until next year. As of 2027, they're going to have to report ER boarding times. It's optional. They can 2027, in 2028 it becomes required. And then in 2030 there is an idea that it somehow should affect Medicare payments. There should be penalties for excessive boarding time. Now, will that really help? I mean, it's a start. Then we'll know more about the depth and breadth of the problem. But it's years away. Right?
- [46:37]
G
Tell me a little bit about the money factor here. I think almost 500488 hospitals in the United States are now owned by different private equity firms. Is there a financial profit sort of pressure here as these hospitals get taken over at the expense of patient care or staffing?
- [46:56]
D
Well, of course, the invasion of private equity into healthcare is to My mind, not a good thing. The goal of private equity is to make something more efficient and then to resell it and make profit. Which hospitals have been pushing efficiency for years on their own. But this happens at not for profit hospitals too. I mean, most of the big teaching hospitals are not for profit and they all have huge boarding problems. They work on a kind of. They don't call it profit, but they, they think a lot about money. And the administrators are constantly thinking about, are we making money, are we losing money there? They have huge overhead, some men, much of which is medical. But then, you know, the CEOs of these hospitals are get paid packages that are often between 5 and 10 million. So, you know, they kind of act like businesses even though they're not for profit and they call their profit surplus rather than profit.
- [48:07]
G
But you wrote a book several years ago called An American Sickness, how healthcare became big businesses and how you can take it back.
- [48:15]
A
Now.
- [48:15]
G
You probably need to update that book considering, but because things haven't all been fixed right since you wrote some of these problems. But I guess the second part of the title, how can we take it back?
- [48:26]
D
In polling that we do at kff, you know, voters say health care and healthcare costs are one of their major priorities, but people don't vote their health care. And politicians haven't really offered much right, that like what is in 2016, the Democrats were talking about lowering the Medicare age progressively. They were talking about a public option which, which is a government provided insurance plan that you could choose if you didn't like the commercial plans on offer. You know, there were enhanced subsidies which the Trump administration let expire. So I'm always surprised that we know everyone is angry about health care. Everyone is angry about emergency room boarding. To my mind, you know, politicians, God, it's such a winning issue if you that when people talk about gas prices and mortgage rates, I'm like, guys, yeah, that's bad that there's that kind of inflation. But what's stealing money from your pocketbook and keeping you sicker is the way our health care system is treating you. So let's vote for that and ask more politicians to address that.
- [50:01]
G
In the article on near the end of his life, you went to the ER for the last time and you write, quote, I did what I promised myself I'd never do. I called a doctor friend who called the hospital's VIP office. Suddenly, Anders was whisked to a real hospital room with a bed that he could adjust to keep his head elevated, a tray he could eat from a mortal morphine pump, a tv, a bathroom, and a nurse call button at his side. Why did you finally do this? And what did that moment teach you?
- [50:32]
D
Well, he was in the emergency room on a stretcher for a few days and he was miserable. The first thing he asked when he got to the emergency room that night was, did you bring my shoes? He was so sick and all he wanted to do was leave and I couldn't take. He was too sick to have him at home and we hadn't been able to arrange hospice yet. So, you know, I knew he was dying at that in that admission likely. And I was not going to let him die sitting on a stretcher with rails up in the emergency room with his feet hanging off. You know, it was just too the opposite of a beautiful, dignified death. And death is never as I've seen it, you know, a wonderful experience. But it was a terrible way to go. And I knew because I practiced in hospitals that there were these VIP offices. And I knew because I knew the system pretty well that I could call someone to make that work for us. But, you know, writing about health policy for my entire life, it was not something I wanted to use. I want this to work for everyone, you know, not just calling a VIP office, but, you know, when your husband's dying, you do what you have to do for your loved one.
- [52:11]
G
Author and journalist and physician, Dr. Elizabeth Rosenthal, thanks so much for your time.
- [52:17]
D
Thanks for having me and letting me talk about this important issue.
- [52:22]
A
And finally, the mission to save Timmy. The humpback whale that became stranded off the coast of Germany over a month ago has finally been transported further away for shallow waters toward the North Sea. Despite previous failed operations, thousands of people across the world launched appeals on social media to save the creature. These efforts caught the attention of two German millionaires who have fully funded the plan to get Timmy home. Some good news to end on there for you. That is it for now. If you ever miss our show, you can find the latest episode shortly after it airs on our podcast through our. You can always catch us online on our website and all over social media. Thanks so much for watching and goodbye from New York,
- [53:15]
B
I'm Daniel Dae Kim. I'm going to South Korea to figure out how this small nation conquered the world with its culture. Join me and meet the artists and
- [53:23]
D
creators behind the phenomenon K everything streaming
- [53:26]
A
May 9th on the CNN app. Influential journalist Kara Swisher is taking a
- [53:32]
B
hard look at the longevity industry.
- [53:34]
A
There's so much bad information that the really good information gets drowned the new
- [53:38]
B
CNN original series, Kara Swisher wants to live forever now streaming on the CNN app.