Presidential guest speaker, Benjamin S. Carson, MD, addressed a packed ballroom and a crowded overflow room during the 2015 AAOS Annual Meeting in Las Vegas. (See "Ben Carson: Freedom Is the Abiding American Value," AAOS Now Daily Edition, Friday, March 27, 2015.) But afterward, he sat with AAOS Now editorial board member Stuart J. Fischer, MD, for a more intimate conversation.
Dr. Fischer: Dr. Carson, thank you for coming to our annual meeting. The first thing I want to ask you, as an experienced neurosurgeon, is: How does it feel to be in a chamber surrounded by thousands of orthopods?
Dr. Carson: I've done a lot of surgery with orthopods, and have a lot of orthopod friends, so it feels like I'm right at home. Actually, the person who got me involved with skeletal dysplasia was an orthopaedic surgeon.
Dr. Fischer: Let me begin by asking you the question everyone is wondering: Are you going to run for president?
Dr. Carson: And the answer is we have an exploratory committee, and I, like most surgeons, like to look before I leap. So I want to be very certain that I have the base of support that I need to do this in a serious way.
Dr. Fischer: By base of support, do you mean political? Financial?
Dr. Carson: Financial, primarily. I've got a lot of political support; I want to make sure I have as much financial support as will be necessary because I don't believe in debt.
Dr. Fischer: If you become president, what's your first priority going to be?
Dr. Carson: The first thing I would do is call a joint session of Congress and make it clear to everybody that we, as members of the government, work for the people; they don't work for us. We need to change our attitude completely and recognize that the people are at the pinnacle and that what we are doing has to be good for all of them.
Dr. Fischer: Many people have come into the office with that idea and meet a very reluctant Congress. You could be a Republican president with a Democratic Congress that digs its heels in and says, "Dr. Carson, great ideas, great programs, but our constituents aren't that receptive." What do you do?
Dr. Carson: Well, I do the same thing I've done throughout my life when people tell me that something couldn't be done. I think about how it can be done. Whatever you have, you work with what you have to accomplish your goals.
Dr. Fischer: Do you think you'd be good at political arm-twisting?
Dr. Carson: I think I would be good at whatever I needed to be good at to get it done. But the one thing you absolutely have to understand is when you set a goal, you must accomplish it. There are lots of different ways, and you can't be daunted if way #1 doesn't work.
Dr. Fischer: You quoted American history quite a bit, but if you look back at American history, in the past century, the three presidents who have had the least amount of prior political experience have been the least successful. If you don't have prior political experience...
Dr. Carson: I would not compare myself to any politician at all. And I never intend to become a politician. I tend to do things the way a scientist would, and that is, you look at evidence, and you utilize that evidence and create solutions. And that's not something that we've really had with this [politics].
Dr. Fischer: Let's suppose that you did try to gain the presidency, but somewhere along the way, somebody else succeeded and he offered you a choice of Cabinet posts. What would be your first choice?
Dr. Carson: Probably Health and Human Services. I'm not 100 percent sure that I would even accept a Cabinet post because once you do that, you're constrained quite a bit. Right now, I'm not constrained and by continuing to go about speaking publicly, on television, radio, newspapers, I might be able to have a more profound effect.
Dr. Fischer: Do you think that, as a civilian, you'd have a more profound effect advocating for health savings accounts (HSAs) and electronic medical record (EMR) chips and that kind of thing?
Dr. Carson: Hard to say, but I think there's a very good chance that you could have a wider influence outside of the executive office.
Dr. Fischer: If you were in a position to have that wider influence, do you think you could go out and establish a program so that everyone had that electronic portable record and get it done? I think everyone agrees it's a good idea, but there's no one there to catalyze the effort. Could you be that person?
Dr. Carson: That's one of the reasons that, if I ran, I would run for president because the bully pulpit is a very powerful place from which to get things done, particularly during the first year. That's when most presidents have gotten good things done. As you start running into more and more political enemies, it gets more difficult, but that first year is your golden time to get things done. And you really want to have it in place already.
Dr. Fischer: So you would lay the foundation, lay the groundwork, and have your staff start making friends, liaisons in the Congress, and start building a groundswell, or a base of support.
Dr. Carson: Absolutely. But I would not try to repeal Obamacare until you had something in its place. You have to have a viable alternative; you can't just pull it out from under people.
Dr. Fischer: And if the Congress right now doesn't have a viable alternative, what should they do about Obamacare?
Dr. Carson: They should be talking to those of us who do have good solutions—and they have. I've been up on Capitol Hill, I've been talking to Congress, and they're very receptive. In fact, they were going to call their bill the Carson bill, and I said, "Don't do that." We want a good bipartisan bill that makes sense. I think when you have something that really makes sense, which Obamacare does not, it's easy to understand and you don't have to force it on people. If you're going to present something, and it's going to have government backing, it should not be something you have to force people into.
Dr. Fischer: You've advocated HSAs as the other part of your healthcare reform. Aren't they going to be difficult to fund?
Dr. Carson: No, because you fund HSAs the same way you fund health care now for 85 percent of the people and, for the indigent, you fund them through Medicaid. But you can use a lot fewer of those Medicaid dollars to fund those 80 million people.
Dr. Fischer: In your view, would HSA contributions be voluntary or mandatory? Would they be based on income? How would you establish what level has to be put into the system?
Dr. Carson: You use the same monies that are being used today to pay for health care; you just divert it and when you get rid of the bureaucracy that's around it, each dollar goes considerably farther. So 80 percent to 85 percent of encounters that a person has with the health professions are things that could easily be paid for out of the HSA. You don't need a third person involved at all.
Dr. Fischer: You used the example of somebody needing a blood test or phlebotomy; is that person going to shop around for the lowest price when that person has fever, joint pain, and is sick?
Dr. Carson: Well, I tell you, it is very much the same kind of question that people asked when the food stamp program began. They said, "Oh, these people, they're not going to know how to take this money and they're not going to be able to use it in a responsible way to feed themselves. But what happens is that people learn very quickly not to go out and buy porterhouse steak the first 5 days and starve the rest of the month. They learn very quickly how to buy some beans and rice and some ground beef and how to make it last. People will learn the system. We've gotten to the place in this country where we don't trust people. We believe that only the government can do things, and it's just not true.
Dr. Fischer: Of course not, but with HSAs, the money would have to grow, and I would compare it to a private retirement account, which has grown very well for some people and not so well for others. Wouldn't you have to have some sort of safety net for that person who doesn't have any relatives or who gets sick early on?
Dr. Carson: Oh, you clearly have to have catastrophic insurance. I'm not advocating that we do away with catastrophic insurance. I'm just telling you by having the HSAs, the costs of having catastrophic insurance dramatically go down so it becomes eminently more affordable.
Dr. Fischer: Would HSAs be a mandatory requirement?
Dr. Carson: No, absolutely not. I think you make a system that is so attractive that people will go to it. If they want to do something else, they can.
Dr. Fischer: But what about someone who is uninsured and unable to anticipate the emergencies. Don't we have to take care of them then?
Dr. Carson: Well, they will fall upon the mercy of the system. We have to bring responsibility back. We can denigrate responsibility from now till doomsday, but all that will do is degrade the society.
Dr. Fischer: You compare the United States to Great Britain in the 19th century and to ancient Rome centuries before that as a "pinnacle nation." But you also said that we are a responsible and compassionate society. How can we be both a responsible and compassionate society and maintain our status as a pinnacle nation?
Dr. Carson: By using our resources wisely. For instance, we have a growing dependent class in our nation. The so-called 47 percent that Romney talked about. I believe that many of those people would be willing to work if they were just given the right kind of direction. If I had time today, I was going to talk about some of the programs around the country that I've been associated with, one of which came out of Memphis, Tenn., called "HopeWorks" where they go out on the street and they find people who are down and out and they bring them into the program, a 13-week program, free-of-charge, clean them up, new clothes, help them find jobs, talk to their employers, teach them job skills, and in 6 months, 70 percent of those people are off the dole. One young lady who was in the program was homeless when they found her and a drug addict and she was 3 months away from getting her PhD when I talked to her. It's an example of what can happen when we're willing to invest in our fellow Americans. What we have to do is a whole new paradigm shift. Instead of the government taking care of people, which they've tried to do since the 1960s and the Great Society programs and they've spent $17 to $19 trillion trying to do it. Instead of doing that, let's have the private sector do it, business and industry and academia and Wall Street and churches and community groups. Because those are the kind of problems that develop relationships with people and it's those relationships that give people the incentive to move out of the dependency programs. We had 1.4 percent of the people on food stamps in 1969, and now it's 14.7 percent, more than a 10-fold increase. In fact, everything that was supposed to get better has gotten worse. Obviously, smart people would stop and say, "Hmm, maybe we're doing the wrong thing. Maybe there is a better way to do things." That's what we have to do.
Dr. Fischer: If you were in a leadership role and you wanted to scale back the Great Society, how would you go about doing it?
Dr. Carson: For one thing, I mentioned how to scale back government. The bigger you make government, the more people you have saying, "Well, we need to do this program and we need to get involved here." When you scale them back, a lot of that also scales back dramatically.
Dr. Fischer: You've advocated a proportional tax, compared it to a tithing. Nonetheless, we all know that when you declare a flat tax or a consistent rate, many people are going to try to diminish their incomes as much as possible on paper to try and beat the system. How are you going to get around that?
Dr. Carson: I don't think you're going to have as much of a problem with that as you think. If we get rid of all the loopholes and all the deductions, then you're going to be talking about a rate somewhere between 10 percent and 15 percent. It's not going to be worth their while to be going through all kind of shenanigans for that, particularly when you look at how much money the superwealthy spend on tax lawyers and accountants. I think most of them are going to say, "Look, I'm paying the same as everyone else; this is not worth it. Let's be happy and pay that money." Already the top 1 percent pays 47 percent of the taxes.
Dr. Fischer: In your book One Nation, after every chapter, you quote a proverb. You also mention that your middle name is Solomon and that may confer some wisdom. If you had to choose one proverb that you feel has meant the most to you, what would it be?
Dr. Carson: Probably Proverbs 22:4, which says by humility and the fear of the Lord are riches and honor and life.
Dr. Fischer: Do you feel yourself very much guided by the Bible?
Dr. Carson: I start every day and end every day reading from it.
Dr. Fischer: Do you think you could bring that into a more public sector?
Dr. Carson: I think we as a nation need to stop being ashamed of our Judaic-Christian heritage and of our faith. I think it would make a huge difference. There is such a thing as right or wrong; there are real things associated with morality that I think enhance society.
Dr. Fischer: What can we as orthopaedic surgeons do to improve both the medical system and the system at large?
Dr. Carson: All the things that I just talked about. I think the key thing is to utilize your sphere of influence in a way to encourage responsible behavior on behalf of all the people you can influence. That would mean a tremendous amount in terms of strengthening the fabric of this nation.
Dr. Fischer: If you do aim for higher office and don't succeed, what will you do?
Dr. Carson: Actually, I would say "Whew!" because it's not something I ever really wanted to do, and the only reason I'd consider it is because there's so many people across the nation clamoring for me to do it. I don't feel that I can turn my back on my fellow citizens, and they deserve a choice. They deserve to have somebody who comes from among them, who has lived at every socioeconomic level in our society, who understands the people there and has a thorough understanding of our Constitution and respects it, and who will put out solutions that make sense as opposed to things that conform to any political ideology.
Editor's Notes: As of January 2015, 69.9 million people were enrolled in Medicaid and the Childrens' Health Insurance Program, according to the Centers for Medicare & Medicaid Services.
According to the Internal Revenue Service, the top 1 percent paid 35 percent of all income taxes in 2011, the last year for which figures are available.