[upbeat music]
- [Reporter] As us hospitals begin
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to buckle under the weight of the new coronavirus,
doctors and nurses issued a grim plea for more supplies
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to treat patients and to protect themselves.
- This is a big,
big issue for the whole system.
- [Reporter] Healthcare payments are keeping
many local residents from getting the treatments they need.
- 37% of Americans go without recommended care.
- Your statement says please pay $220,850.
- Right.
- [Reporter] The amount she owed,
more than $40,000.
- I'm not human to them.
I'm a dollar sign.
- [Reporter] The average cost of treatment
for patients rose to $63,000.
- [Reporter] $17,000 for a lab test.
50,000 for a stay in the NICU.
- [Reporter] From $18 a tablet,
jumping to $750 a tablet.
- [Reporter] About 34 million Americans know someone
who died because they couldn't pay for medical treatment.
- [Reporter] You have surgery
and you get a medical bill six months later saying
you owe thousands of dollars.
- We have to do something about the price of healthcare.
- It's a right in our country
and you should have a right to healthcare.
- [Crowd] Justice in healthcare. Justice in healthcare.
- Our healthcare is in a crisis.
This bubble is going to burst.
[heartbeat monitor flatlining and relaxing piano music]
[upbeat dramatic music]
- [Narrator] Healthcare, is it a right or a privilege?
Do we want a system based on profit
or rather prevention?
Will we place our future in the hands of bureaucrats
or that of the people?
These are the questions to ponder.
Our healthcare system is broken.
Rising costs and growing inefficiencies
are putting a heavy burden on the economy.
It seems like everyone has a story to tell.
[dramatic music]
[ambulance siren wailing]
[monitor beeping]
[wind rustling in trees]
- My father was going to the doctor, he said,
but didn't see a man rear-ended my truck.
And I blew out my other shoulder
and tore the ligament out of it.
And my left elbow they had to reconstruct the nerves in it.
That particular brace they gave me
after my thumb surgery when I woke up paralyzed,
because the nerves in my leg aren't working right
and the muscles and I got a clubfoot now.
- Did you get any sort of therapy inpatient anywhere?
- Well, there was a problem at the hospital.
I was there a week and they wanted me to go to
a inpatient rehab.
And so we were waiting there to get the okay to go.
The lady came out and said I was a good candidate
and that they would take me.
And we were waiting and waiting to go for a couple
of days at the hospital and we never got a call
or anything and we kept asking the doctor when we're going?
And he said I don't know.
So finally, we waited another day and came home
and found out that the insurance company
didn't send all the approvals to the rehab center
and they wouldn't take me until they got them.
And so I've never gotten to go to the inpatient rehab yet.
And that happened actually three times.
The hematologist recommended for them
to massage out the edema in my leg three times a day.
But when the insurance company was told they said
they don't have enough funds for that to be done.
[somber piano music]
The one thing we have a problem with is
when the doctor orders something that,
because the insurance has to pay for it
and they don't always know,
I guess, or they have vendors that set those appointments up
or therapy places and it's a different person
that calls every time that don't even know what's going on.
And it takes four or five vendors just
to get one appointment.
And sometimes it's weeks and months even
before they get all that worked out
while you're just sitting there waiting for therapy
and things like that.
What really doesn't make sense to me is I needed a MRI
and so I called around and asked what they cost for
with my insurance?
And they gave me a price to $1,200 to about $800
with my insurance.
Then I called around to some,
I said what if I just pay you cash,
I don't want a receipt or anything for it
and it was 295 out the door.
And I didn't go towards my deductible
but I don't understand why I could pay 295 instead
of $800 gets billed my insurance.
That doesn't make sense to me.
[somber piano music]
- We got married in 1985 at the First Presbyterian Church.
So we're married 34 years this year.
Well, after he came home from the hospital they sent him
to different doctors trying to figure out
what all had gone wrong during his surgery?
And they were looking at parts and pieces of him
and finally, we got a referral approved
for the psychologist and we went there
for a full day evaluation.
We got a phone call from the therapist saying
that the 13th meeting was to be the last session
because they had received an email
from the insurance company saying
that they were cutting off the sessions.
They weren't gonna authorize any more and it had to end.
So that next day we went to his last session
and he was very upset the last day we met.
- They said they wanted me to keep coming
but the insurance wouldn't authorize any more.
- And he looked at the therapist and said,
oh, you're leaving.
And she said I'm not leaving,
I'll still be here but you've done really well.
And he started crying and was very upset
because she's impacting him so positively.
- It seems like all they do is one doctor refers you
to another doctor.
They're doctors, but they only wanna treat one thing
and you may have other things wrong with you
but they won't even look at you and all you can do is wait
to go see another doctor
to treat whatever other problems you have.
So you end up seeing multiple doctors--
- Who don't talk
to each other. - Who don't talk to each other
and all they wanna look at is your big toe
if that's what kind of doctor they are.
What's aggravating is you can't even see the other doctor
until that doctor refers you to that doctor,
so that's two months later sometimes
just to get some kind of treatment.
[somber music]
- My name is Angelica.
I am 24 years old and my first story
about healthcare is that when I was
around elementary school I was diagnosed
with type two diabetes.
Since then, when I found out I was heartbroken.
I was little.
I didn't know what to do.
I didn't know what was good or bad.
I've seen people pass away and it's so hard
because my parents tell me, you know,
take care of yourself 'cause that could happen to you.
You can lose a leg.
You can lose a finger.
You can lose anything.
[Angelica sniffing]
- For me, my surprise came at 45.
I noticed something,
I ignored it.
Then I went to see my doctor
because I'm sure it's nothing
but let's just get it out of the way.
Well, she couldn't find anything,
referred me to somebody else.
She couldn't find anything,
we need to do a colonoscopy.
Bingo,
there it was.
I had to then see a surgeon to figure out what it was,
probably wasn't good.
It ended up being stage three colon cancer.
- I was 37 years old,
never been in the hospital other than being born.
Woke up, had chest pains,
went to the hospital.
That morning they gave me a quadruple bypass surgery.
Later on, 12 years later,
I guess, I had chest pains,
went back to the hospital.
I had bypass surgery again.
- I became sick with this mysterious illness.
One of the doctors,
I'm a nurse.
I was completing my bachelor's degree
and I could barely even think,
have any memory,
short term memory.
Went to an infectious disease doctor
that treats at the hospital where I worked
and he basically looked at me and told me I needed
to go see a psychiatrist,
that all my symptoms were in my head.
- You have to fight tooth and nail to prove
why you are actually sick or why you are actually this
and that and then you have to prove
that you did not do it to yourself.
- When I got diagnosed with cancer they fired me,
and that was from a health institution.
- As time went on I got worse.
I would have to do injections and injections aren't cheap.
I'm not gonna lie to you guys that one injection
that I need to take $600,
and I need to take them mostly every Monday and it's hard.
I can't afford that.
In my job I get paid maybe $200 a week.
- Over 15 doctors that I visited,
I found a nurse practitioner and I came back positive
for tick borne illness.
The main one for me was ehrlichiosis,
Coxsackie virus, Epstein-Barr,
Parvo virus, and I had quite a bit positive line bands.
- It's training in healthcare and the lack of training
and the lack of empathy.
I remember waking up after surgery,
then the pain instantaneously kicked in.
I'm like, oh my goodness.
Wow, that hurts.
Holy cow, that hurts.
They couldn't calm my pain,
so they kept giving me different pain meds
to try to make it better and it didn't work.
And I said, oh my goodness,
what are we doing,
what are we doing after different times?
Who knows how much it's costing,
but they kept giving me different things.
And the nurse finally said, well,
if we can't calm you down you're gonna have a heart attack.
- Once I got to the surgeon we had several meetings.
We had the surgery and he cut a nerve
that was very important to your body,
the nerve that controls your brain and your GI system.
So my GI system no longer works.
- I lost my 17-year-old daughter to suicide
on March 28, 2017.
[somber piano music]
The run-around that we received so many times
throughout her illness which went on
for you know a good six,
seven years, was depressing.
It was frustrating and it's just not where we need to be.
Some of the things that went on, I mean,
it began at the beginning with her seeing a psychologist,
her seeing a doctor and of course was
It never failed multiple times
that once she would get on a medication
that was actually working insurance would say,
well, now you need to change it
because it's too expensive.
- The the whole medical merry-go-round
because this is what we have to do,
is we have to fund the medical merry-go-round.
- I got in debt.
It was so much money.
Healthcare didn't help me.
They left me there like nothing.
They said I got rejected because of the fact
that I'm diabetic.
- I was not worth it to the healthcare system to be treated.
- Went back for my six-week checkup,
we weren't done.
It was in the lymph nodes.
So I decided on an aggressive form of treatment
which meant chemo and radiation.
And I would go to this facility for,
in all total with the surgery,
about a year's time.
It cost a lot and it cost a lot many times.
- When you're hitting $10,000 deductibles
and your copays don't count and you have to pay
for labs and you have to pay for X-rays,
and you go to the pharmacy and you get a medicine
that they think is a trial medicine,
and they tell your copay is $3,000.
Well, at $3,000 you walk away and say,
I guess I don't need that medicine,
or I need it but I don't have $3,000 to pay.
- It's not the $99 or $33 or 189 for a family anymore.
People are paying up to $1,500 a month for healthcare
for their whole family.
And add that with the rise of housing,
you're paying 15 to $3,000 a month for housing,
depending on what type of housing do you have.
So people cannot afford it.
- Haley was hospitalized many times with suicidal
attempts.
And she was in the hospital,
she was in the inpatient for sometimes six to eight weeks.
But the minute that you started
to see the light come back in her eyes insurance would say,
okay, you're done,
it's time for you to get out.
- These hospitals, mega hospitals are
just reaping and pillaging.
It's like, what can we get away with?
How much can we charge this person?
As soon as some physician tells you
have excellent insurance,
you should be leaving that office.
- Supposedly, healthcare is supposed to help you.
It's supposed to
help you with anything you can.
It's not helping me.
It's making me in debt.
- We move forward.
In the healthcare system, you know,
you know it, you hear it.
Now it's you.
So how do you adapt?
How do you get diagnosis?
Which path should you take?
There's no book for that.
- I have been from doctor to doctor to doctor.
They don't look at the side effects.
They don't research anything.
It's all just cookbook medicine.
One, two, three,
if you don't have one of these three things,
you're more complex.
I'm sorry, I don't have time for you.
- We fought for our daughter.
I didn't give up.
But there just wasn't enough out there
and there wasn't enough resources.
So like I said,
she was in a place in Maitland, Florida and
there's a big,
huge list of hospitals.
So then you go to your insurance.
Okay, which one's on this?
And then you find one that's on there.
Oh, well that's for sexually abused children
or that's for addicts and that was not our daughter.
Our daughter had mental illness.
I didn't wanna expose her to any more things.
So in March, 2017,
I found a place in Knoxville, Tennessee,
which was that one step up from what we had been in before.
So she was not looking forward to
and didn't wanna go back to the hospital,
so I waited to tell her.
I thought, okay,
she's at an appointment with her psychologist
on Tuesday night.
So my husband was gonna meet me there.
I picked up Haley from,
well, I went home to pick up Haley.
She wasn't home.
That was the day she went missing.
She was missing for 10 days before she was ultimately found
and she had taken her own life,
but I'll never say suicide took my daughter.
Mental illness took my daughter.
- If we had a healthcare system that was pro health
and we really focused on prevention,
rather than treating symptoms,
our healthcare costs will go down
and there would be a lot healthier people walking
around the United States.
- And I ended up having to pay five or $6,000 out of pocket.
Well, five or $6,000 not knowing that you're gonna have
to pay is kind of cuts into other things in life
that you would like to do.
And you have to forfeit those to be able to pay
and then you worry about, well,
what does the future hold?
What am I gonna have wrong with me next?
- Practically my whole life
I've been rejected with healthcare.
I've not gotten one, single penny,
not at all.
- Seeing people discounted and tossed aside,
they should be onto their next phase
of their life but they weren't.
They needed help. They needed care.
They needed somebody to guide them
and people were just giving up.
And it was just so disheartening for me to see that
because many didn't know what to do.
I just, I can't believe that there's not more empathy
and more care.
- It's sad that people have to pick healthcare,
food, your housing,
it shouldn't even be like that but that's how it is.
- Until we start getting more help and more resources
for people I don't know how we're gonna change this epidemic
because that's what it's turning into.
- You're almost ready to pay any price
but there becomes a point that you cannot continue.
[dramatic violin music]
- [Narrator] Our Congressmen were elected
to represent the will of the people.
If only it were so simple.
- And the answer is the greed and corruption
of the drug companies.
- [Narrator] Device of party line politics,
special interest lobbying and bureaucratic entanglement
all account for something quite different.
- If you look at the US healthcare system,
in many ways we have the best healthcare system anywhere
in the world.
[dramatic music]
Our outcomes at the top if you need high level,
intensive medicine anywhere in the world you're gonna look
at the United States.
It's why people from from all over the world come here
when they need the best healthcare
that the world has to offer.
You have quality,
you have cost and you have access.
We're doing very well on quality, again,
highest quality available anywhere in the world.
The cost is the most expensive healthcare anywhere
in the world, driven by,
in large part prescription drugs and some of the rules
that revolve around the distribution
and use of prescription drugs.
But on access we have done better in recent years
of making healthcare more accessible to people
but there are people who can't afford it,
people whose life circumstance doesn't allow them
the opportunity to purchase healthcare insurance
for themselves or for their families,
and that's a big problem in this country.
The folks that don't have healthcare don't disappear,
they still live their lives
and they still walk among us in society.
They're our friends and neighbors and co-workers
and members of our families.
And when you don't have healthcare
and you get sick you go to the hospital,
and you show up and you will get treated.
And somebody is gonna pay for the cost of that care.
You may not pay for it but somebody is going to pay for it
and that's the unfortunate cost shift that happens
when the insurance premiums come in
and they're up 12 to 15%.
Part of the reason for that is
because they're covering the costs of the people
who can't afford healthcare on their own.
They get treated but the bill comes to somebody else.
- I think there are a lot
of ethical dilemmas today in healthcare.
I think one is the idea that you have to treat everybody
and this concept about religion coming into play.
As a healthcare provider myself,
when I went to school we were taught in ethics
that you treat everybody.
You don't look at who the person is,
who they love,
what their religion is,
what country they came from,
any of those things,
that this is your ethical obligation
to treat everyone the same.
And what I'm seeing today is that there are people
who are saying,
we don't wanna treat those, thems.
I call them, the thems.
Them dejour, whoever the them happens to be.
And that's very scary to me because we have always believed
in this country ethically,
that's part of your code of ethics is
that you treat everyone the same.
- The main idea of profit motive is that people are driven
to do things and they're driven to do things for profit,
and profit doesn't always mean money.
Profit can mean leadership.
Profit can mean extra time with your family.
Profit can mean a better community.
Whatever profit means to you or the individual,
is something that drives them.
So we mainly understand this in the workplace
that a business is in business to profit.
But what we don't think about is the second level there,
that an employee is working for that business
to profit themselves and the profit doesn't usually go
along necessarily with the company's.
They wanna pay their mortgage.
They wanna pay their car bill.
They wanna spend time with their family
and that doesn't mean making more money for the business.
A manager understands the profit motives of their employees,
then they can be a better manager.
And so what I do in the book is talk about that
but then we expand it out and we talk
about profit motives in media,
profit motives in politics,
profit motives in healthcare.
So profit motives in healthcare are really interesting
because the patient is only paying for about 10%
of the healthcare they receive,
and that's 10 cents on the dollar.
So if you went into a grocery store
and you were only paying 10 cents on the dollar
for whatever you could buy,
you would buy a lot more groceries or
It would change the way that you shop and in fact
that is what we see in healthcare.
People have these gold-plated plans that they don't use much
of and don't get the value out of,
but since they're only paying 10 cents on the dollar
and since the companies get to write it off
of their taxes we see this expansion
in what we're paying for in healthcare.
We have these government regulations
that really change the way that the hospitals
and the doctors and the practices think
because if a patient's only paying 10 cents on the dollar
and the hospital's getting reimbursed by the government
or an insurance company,
then the patient is no longer the client,
they're no longer the payer.
And so instead of the hospital
or the doctor treating the patient they're thinking
of billing and they're thinking of the businesses
and they're thinking about the insurance companies.
- Healthcare costs too much.
We're having to pay too much because it costs too much.
We're perhaps using it too often or not using it correctly.
There's a lot of focus now on the drug companies
and drug prices are of course very,
very high and something clearly needs to be done about it.
When drug companies are only funding five to 10%
of your your budget it's a lot easier
to speak out about something than
when they're paying a far higher amount.
They say that they represent patients, consumers,
but they never say anything about drug prices
because they're getting so much money
from the drug companies.
The other things that was resonated for me the most
when I started covering healthcare was seeing the list
of the countries that spend the most on healthcare
and the countries that have the sickest people.
And we spend the most and among the
developed countries, we have the sickest people.
So there's gotta be a better way to do it
and one of the things the other countries
are doing much better is offering social services.
- Profit motive is really broken in healthcare
because what you want is a doctor,
patient relationship where the patient is the client
and therefore the hospital and the insurance company
and the employer are all focused on treating the patient.
And in this case they're not,
they're all focused on saving money
for whoever the payer is.
- The number of times you go to the doctor,
the number of tests and services that they order
and that they run,
the more often they're paid.
And there was no incentive to keep costs down
because the more treatment you provide,
the more you're going to be paid.
We are moving away from that.
We're moving to a value-based reimbursement society
where you're expected to provide high quality care
at the lowest possible cost.
Currently when you go to the doctor
and you end up having a surgery,
you'll get seven different bills in the mail.
You'll get one from the surgeon,
one from the primary care physician,
one from the anesthesiologist,
one from the people who took your blood,
one from the X-ray,
on and on it goes.
And in the past they haven't coordinated as well
as they possibly could have so there was a lack
of coordination, a lack of cost control,
and again, no incentive to keep costs down
because you're reimbursed based upon the volume of care,
not the quality of care.
So the way you solve the problem of cost
in part is by cracking that part of the system,
getting in to value-based arrangements where people,
physicians, providers are reimbursed based
upon the quality of care,
not the quantity of care that's offered.
People have taken a step back to think,
well, I'm more comfortable with government intervention
in the healthcare system because none
of those bad things I was told were going to happen
have actually happened.
So the debate today is framed by a much greater acceptance
in the public of government intervention
in the healthcare system.
So when a candidate talks about Medicare for All
or single-payer healthcare system
there are policy implications to that,
when you dig deeper,
that may concern the public.
But the theory of it is not nearly as concerning
to the public as it has been in the past.
Regulatory capture is an economic theory
that was put forward by George Stigler in 1971,
Nobel Prize winning economist.
And he argued that it was possible
within a regulated environment for the industry
that was being regulated
to control the regulatory authority.
So the theory of regulatory capture is exactly that,
that you have entities that are being regulated,
that through campaign contributions,
through political and other public activities
gain a dominance within the regulatory authority over
which they're being regulated.
Regulatory capture in the healthcare
let's say, the prescription drug market,
where the Food and Drug Administration looks first
to the pharmaceutical companies and asks their opinion
of things before they make a determination on drugs.
The same would go for healthcare providers.
And the issue with the theory of regulatory capture is,
I think, the view that in all cases it's gonna lead
to bad outcomes.
You have people who are making decisions
that are not in the public's best interest based upon
an industry dominance of the regulatory body.
I get asked all the time from my experience at Washington,
what are the most powerful lobbying groups
that you see in Washington?
And clearly the gun industry,
the Israel lobby,
the AARP, the seniors lobby,
they're all in and of themselves very powerful.
But as a group,
as an industry no group yields more power
or participates more forcefully
in the advocacy process than the healthcare industry.
You have the pharmaceutical companies, Big Pharma,
you have the generic drug makers,
you have the pharmaceutical distributors,
you have the hospitals,
you have the physicians,
you have the medical device industry,
you have consumers,
you have all sides.
There are probably hundreds of people sitting
around their kitchen tables all across the country
with the bills out looking at their healthcare expenses,
thinking about what it means for them?
It's the largest driver of bankruptcies,
of any issue in the country.
20% of our GDP goes to healthcare.
The money that's involved in healthcare
in this country leads to a huge public discussion
about the future of our healthcare system.
The problem with the perception people have
of lobbying within the healthcare industry is the money
that gets spent to influence outcomes,
and that's when you run into the danger
of not having the most effective outcome.
- I think we need very strong leadership
in some of these areas,
just basic things that we used to do
that we're not doing anymore, why?
If they get sick,
if the thems get sick they expose the uses to getting sick
and that's not really looked at today anymore.
So I think we need some strong leadership in Washington,
people to speak out the way they used to speak out and say,
this just isn't right.
- In the Senate,
most of the senators have issue-driven staffers.
So they'll have somebody dedicated solely to healthcare,
somebody dedicated solely to taxes,
somebody dedicated solely to foreign affairs.
In the House generally there are three people
with a portfolio of issues,
domestic policy which includes healthcare, education,
social security, those issues,
a budget person that looks at budget and taxes,
and a foreign affairs person that looks at the military
and trade in foreign affairs issues.
And the problem is there's sometimes a lack
of coordination between the policies
because when you deal with healthcare you're dealing
with the tax system in this country.
You're not just dealing with providing healthcare,
you're dealing with how you pay for it as well,
and if the Congressional Office doesn't deal with that well
they lose part of that debate.
And that's why it's so difficult
to have healthcare reform discussed in those silos
of how are we gonna pay for it,
what's the level of care and what's the quality of care?
You really do have to look at it all together
and that's difficult to do with an issue
that's as big as healthcare.
[dramatic upbeat music]
- I'm here in McLean,
surrounded by some of the biggest,
most expensive houses you've ever seen
and they're owned by people who are lobbyists
so there's a lot of corporate interests at play here.
Even if you don't care about these people,
you are paying for them
and economically it doesn't make sense
for them to not have care, covered care.
- If you don't have the support of the American people
behind you it is gonna be very difficult
to pass legislation.
When people come in and you as
the people who are setting the budget
for the country it's a zero sum game.
And you have to decide this year
are we gonna spend more money on MS or Alzheimer's
or cancer or HIV or diabetes or heart disease?
How are we gonna spread that money around?
And that is so powerful and that's why healthcare is unique.
And for all the money that's spent
on lobbying in this country,
that's what wins the day.
It's not money,
it's the face of the people that are impacted
by healthcare the most.
[upbeat humming music]
- [Narrator] With over a trillion dollar deficit
and the national debt exceeding $23 trillion dollars,
can the economy withstand the cost of universal healthcare
with unchecked spending?
- My name's Carl Asche.
I'm a PhD economist.
I've been working in healthcare economics
for all of my career.
A lot of us endure what I call is financial toxicity.
Healthcare in itself is very expensive in our country
and I'm not always confident that it's being spent
in the most appropriate manner.
The United States spent roughly $3.65 trillion
on healthcare services,
which represents a 4.4% increase
from the year before in 2017.
The quality of healthcare and related services,
are they justified by the costs?
- My name's Ken Kies and I'm a tax lawyer in Washington, DC.
[dramatic upbeat music]
One might wonder as you think about what we do
in healthcare currently and social security and so on,
what about the debt we already have accrued?
For millennials in particular,
the 23 trillion total government debt that we currently
have should be alarming because we're adding
about a trillion a year to it.
And the problem is at the political level
almost no one is talking about it anymore,
and to me that's more alarming than ever.
And it's both Democrats and Republicans.
It's as if it doesn't exist and yet for young people,
the millennial generation,
they're being stuck with it.
That's a big change from, say,
when I was at the Joint Committee in '97
and we did the '97 budget deal which was a bipartisan deal
between Bill Clinton,
a Democrat president,
Newt Gingrich, the Sepublican Speaker of the House,
did a deal.
We balanced the budget and paid off half a trillion
of debt by 9.11, 2001.
Most people can't even imagine paying off any debt
at this point and so we're adding a trillion a year
under our current spending levels.
So when we think about spending more
at the federal government level,
no matter what you're talking about,
you have to realize we already have an enormous debt
and it should be something that scares everyone.
What's the bad news for millennials who are concerned
about paying $1,000 a month for health insurance?
The bad news is most people like their health insurance
because they like healthcare.
What other countries have done to lower costs
is something that Americans are not prepared to do,
which is ration healthcare.
That's what the UK does.
That's what Canada does.
Americans have come to really expect
that they're gonna have healthcare relatively on demand.
They don't like sitting in emergency rooms waiting.
It's a real dilemma that we face because we like
what we have but we don't like what we're paying for it.
So the question is do we wanna give up what we have
or do we wanna find somebody else to pay for it?
And the problem is the somebody else is gonna
be the millennials too because it's gonna come
in the form of taxes.
For employers providing health insurance
it's a deductible expense,
which of course makes sense because it's part of the cost
of employing people.
So there's a lot of interactions with the tax system,
both individual income tax and corporate tax,
that are relate to the health insurance system that we have.
Corporate taxes only produce about 200 billion a year
of revenues out of multiple trillions that we collect.
Our tax system basically collects money from individuals
in the form of social security taxes and income taxes.
That's where most of the money comes from.
The estate tax which gets a lot of attention
because it's a tax on people when they're wealthy and die,
it doesn't produce that much money either.
There are no easy answers here in terms
of changing the status quo to something
that's more acceptable because people like their healthcare.
- Modern monetary theory in a nutshell says
that the government can print as much currency
as it wants and there will never be any net effect
on purchasing power of that currency.
Meaning that lots of free stuff can be promised
to everyone whether it be college,
medical services, jobs,
food, housing and anything else the general populace demands
from the government.
So if they print 100 currency units,
they just tax the rich the same amount.
So 100 goes in and 100 comes out.
And their way of thinking is a simple transaction
and the net cost is a wash.
However, history tells us this is never what happens.
Every flat currency in the world in the course
of the last hundred years
that disappeared suffered its demise
because of this very theory.
This can be summed up that there is a limited amount
of wealth but an unlimited number of currency units.
Modern monetary theory is the road being paved
to economic health.
- You know, there's a lot of proposals
that are being made by various presidential candidates
to expand the role of government in healthcare, for example.
And so that does raise the question of do we have
to worry about what government's already providing
and can we afford it?
The social security system, for example,
we know by about 2032 or 2033,
which is not far away,
it is gonna hit a point where there's no reserves left
in the social security trust fund
and incoming taxes will only be adequate
to pay 70% of benefits.
Now, that's a horrific thought
that we're gonna cut social security benefits 30%,
that's just not gonna happen.
So we already know that we have other demands
that we're gonna have to fund one way or another,
without expanding existing programs.
That's part of what we have
to think about as we consider whether to,
for example, expand healthcare
that's provided by the federal government
because we already know that we have obligations staring us
in the face within a decade or so
that are gonna demand enormous resources.
A reasonable question one might pose is,
can we improve the healthcare system by taking money
that we're already spending
at the federal government level and spend it
on healthcare rather than where we're spending it currently?
If you walk out and interview 20 people on the street
and say where should we cut spending?
They will all say get rid of foreign aid.
Foreign aid represents such a minor part
of the federal government spending that it's barely a blip
in terms of the total that the federal government spends.
You have to realize what the federal government is,
it's an insurance company with an army.
And when I say that,
what I mean is the three biggest pieces
of the federal government aren't social security,
Medicare and Medicaid and defense.
You add interest on the national debt and you have 80%,
90% of total federal government spending.
So then what that means is if you wannna reallocate,
you would have to take money from defense
and spend it on healthcare
because that's where the money is.
Everything else is small potatoes.
- Coverage of healthcare in the context
of the 2020 Democratic presidential campaign amounts
to asking a yes or a no question about support
for Medicare For All.
The Medicare for All crowd accuses the others
of being incrementalists.
And the Medicare For All critics say
that this is the pie in the sky stuff that won't work.
What's missing here is any deep analysis of the cost
and feasibility of Medicare For All,
and more important,
what some of the alternatives might look like?
So unless the candidates can get beyond the talking points
to connect their plans to these pocketbook concerns,
any plan will have trade offs and landmines.
More healthcare costs more and we have to decide
how to pay for it?
- The thing about healthcare also,
that people like the healthcare they have,
they expect to get it.
And you might say, well,
we're spending too much money on healthcare.
That's a pretty common notion that you hear.
The rest of the world spends 15% on healthcare,
10% on healthcare,
why are we spending 20%?
Well, it's one way to spend our money.
We could be spending it on alcohol,
which I'm okay with.
It's not the worst thing in the world
to be spending money on which is to provide good healthcare.
And there's a reason many people around the world come
to the United States to the Cleveland Clinic,
the Mayo to you-name-it,
it's 'cause we provide the best healthcare in the world.
There are reasons that the current system actually
has a lot to be said for it.
- It is clear that the healthcare system
in the United States needs to change in the future,
to limit spending while maintaining quality
and expanding access.
For us to get to the point where we can show the impact
of a alternate payment plan,
improving our economy and the quality care for our patients
we need better data.
A lot of these proposals are wonderful in the sense
that they offer us hope that money will be saved.
But at the end of the day,
I still worry about the quality of care.
Affordable healthcare as I understand it
is something we all aspire towards.
The path to getting there is convoluted.
The sheer magnitude of what we're experiencing now,
which is roughly $3.65 trillion is daunting in itself.
These facts speak for themselves.
We have a real issue here.
- Imagine that we were to experience another ramp up
in interest rates like we experienced in the 1980 period,
which by the way,
happened in like a two-year period.
It would mean our borrowing costs would triple
but nobody seems to care and people keep talking
about an inflation as being a consequence of this
and yet inflation has been astonishingly low
for a number of years now.
But I personally believe that there is a point out there
and I don't know where it is or when it's gonna happen,
when there's gonna be a consequence to all of this.
It just seems to me you can't borrow this kind
of money indefinitely without
having some significant impact.
- There's a storm brewing and quite honestly,
we can't afford this.
It's totally out of control, it's crazy.
[dramatic music]
- One of the things
when I started covering the Affordable Care Act
and through now,
one of the things I've noticed is
that just as it's wonderful that people
in Downtown Washington where I work with kids of color,
teaching them health reporting,
just as they have insurance now it's not doing as much
for them as it should be doing,
just as the people that I hear from all the time
who are self-employed say it's not doing enough for them.
They might as well have catastrophic insurance.
They can't afford to go to the doctor.
- Obamacare, the Affordable Care Act
has had a real significant impact on people.
People don't have to worry about not being insured.
I don't think I know anybody who doesn't
have a pre existing condition.
I mean, in my world with people with disabilities,
there are a lot of people with disabilities
who if they didn't have Medicaid or Medicare,
would not have coverage for, say,
they needed a wheelchair or they need physical
or occupational therapy because maybe something
is becoming weaker or there's something
that needs to be fine tuned.
- Politically, I listen to a lot of people talk
about Medicare for All.
I don't think there's enough people that are willing
to give up their commercial insurance that they like.
I happen to have commercial insurance that I like.
I don't love the network but I like it and if I were
to have fewer choices I'd be very unhappy of doctors.
So I do,
I think there's a tremendous benefit in having everybody,
particularly the less fortunate and the sicker,
have access to healthcare that is affordable,
if not free is great.
- There is a lack of understanding about healthcare
and payment options.
Every time I hear Medicare for All I get a little scared
because there's a difference between Medicare and Medicaid.
The financing end is one but I'm most interested
in the services provided.
So for example,
Medicaid provides a whole slew of services for people
with disabilities that Medicare doesn't.
And the idea of getting rid of Medicaid
and giving everyone Medicare doesn't help a lot
of the people I serve.
So for example,
if you have a spinal cord injury and you need someone
to get you out of bed in the morning so you can go to work,
and someone to put you to bed at night so
that you can go back to sleep,
Medicaid covers those kinds of services.
Someone to come in and cook a couple of meals,
get you ready for the day, that's covered,
help you get your medication,
help transfer you from your wheelchair to the bed,
those things are covered.
They're not covered under Medicare.
So getting rid of Medicaid and putting it
into Medicare is scary because a lot
of services are healthcare go away.
If you have a job and you need someone to come
and catheterize you at work,
Medicaid will pay for that.
If you're within a certain income bracket
or if you can buy into Medicaid there's a special program
that lets you buy into Medicaid.
So if you get a job and depending on the state,
I'm not gonna get into the weeds
but there are certain requirements,
you can keep Medicaid,
pay for it,
buy into it so that you have this independence in services.
Medicare for All doesn't cover that.
So it kind of scares me when they talk
about Medicare for All that it doesn't look at the weeds,
it looks at the clouds.
- People that are paying a lot of money out
of pocket every month and these crazy high deductibles,
it is like catastrophic insurance,
it's hard to convince people,
particularly young people that you really need it
in case you get cancer or one of these other awful diseases
and this really is better than it was
before the Affordable Care Act where people
that had cancer as an example,
couldn't get insurance.
There's gotta be a better solution.
It has to be something where insurance is more affordable
and doctors are willing to take the insurance.
The young people and their parents in Washington
who I work with,
it's almost impossible for them
to find a mental health provider.
I have friends that are in their 50s
who just lost their primary care doctors here in McLean,
Virginia, or Great Falls,
an even wealthier town next door.
Their doctors have now gone concierge so they wanted
to find a regular doctor that takes their insurance
and they cannot find a doctor that will take them
and they're perfectly healthy.
The Department of Health and Human Services is trying
out some interesting possibilities how
of healthcare down while making people healthier,
but boy, it's very slow going.
[relaxing music]
[relaxing dramatic music]
- [Narrator] Wouldn't it be nice if there were a way
to save money while also bypassing bureaucracy
and improving the provider, patient relationship?
- So I've been advocating for free-market healthcare
for a long time.
And in that time I have had a congressional healthcare,
I've had a healthcare plan that was provided to me
by the State of Florida,
I had one from the National Center for Policy Analysis.
And now I run my own business and I had a great plan there.
Obamacare passed and I had a worse plan
that cost more money
and I've slowly been getting a worse plan
that cost more money.
And then I looked around and said,
I've been advocating for free-market healthcare
for 10 years.
These healthcare sharing ministries,
I've heard good stories about them.
I've seen them doing good things.
So I actually joined one last year
and it's been interesting.
I still think it's the Wild West.
It's an emerging market.
The frontiersman were called frontiersman for a reason,
they were out on the edge doing something.
But when you look at the economics behind them,
the economics is solid.
If you look at their books,
the books are solid.
If you read stories on the way
that they've paid for patients,
they're all solid.
And in fact,
it's one of the biggest things in this market,
is that they all don't want anybody to mess up
because since it's cutting edge
and since it's a little different
than the being a Blue Cross and Blue Shield member,
they don't want anybody to have a problem.
And so they're all kind of working together
to make sure that the system works for people.
And so I've had a great experience being on it.
There's a learning curve because you have to unlearn some
of the things that you have been used to from insurance.
But it's wild,
even the people that work at the offices are kind
of amazed at the prices that you end up getting
because you're paying cash.
It's really kind of a good feeling
to push the healthcare system ourselves
while being insured in some form or fashion.
- Obamacare helped sick people access coverage
that they maybe couldn't have in certain cases
which is kind of a lie.
Because before Obamacare most people
who were sick could get care,
it might've been a bit more expensive
and run by the state government.
It's called a reinsurance pool
for the sick, uninsured pool.
And otherwise, if you are somewhat healthy,
your private insurance on the individual state level
is pretty affordable.
And Medicaid was there for the poor,
Medicare for the old and disabled.
We had a pretty good system.
Now it's a pretty good system for the people
who are really sick,
their premiums are subsidized a bit.
For the vast upper middle class,
they're getting hurt by having to pay
what effectively is a mortgage for healthcare.
So they're either leaving insurance,
as a million people have for sharing
to get coverage that's affordable,
or they're going uninsured which is risky.
I don't know what they're doing to qualify
for a subsidy on the exchange,
but if you don't have a subsidy you're paying
over a grand a month in healthcare
and then several thousand dollars in deductible.
So effectively, you have become a cash-pay patient
because it's hard to reach 5,000,
$10,000 of a deductible.
Most people don't get that sick.
10% of Americans spend three grand on healthcare a year.
So those who use it are sick and need it,
they need the help.
The vast majority need something cheaper,
less comprehensive, just make sure you don't go bankrupt
from cancer, a heart attack or a bad accident.
You can pay little and have that protection.
It doesn't pre pay for things you might want,
but there's trade offs in life.
[relaxing dramatic music]
- My name is Jeff Kanter.
I'm the founder of yourfreedomhub.com
and we are a disruptor in the freedom industry.
So we're also involved in healthcare and a variety
of other areas all about freedom for individuals.
What we're able to do is provide you an assistant,
as it were,
so you've got an expert in the field to be your helper.
So if you're a member with us as an example,
you just call a simple phone number and you're talking
to a health expert who can help you figure out
how to get a better pricing on an MRI,
find a different doctor,
shop around for surgeries.
'Cause again, you probably don't know how to do that.
You don't have the time, for one,
you don't have the interest in learning any of that stuff
but you want the solution.
So we're gonna give you a fast way to get
to the most proper solution possible.
- A million people who are fairly well-to-do
or even have modest income have left insurance for sharing.
They've bit the bullet,
they're happy, they're accessing the same doctors
in the hospital but they're just paying half as much,
so they're happy.
Then there are those who like the idea
of becoming a cash patient.
You'll see for primary care what are called
direct primary care practices proliferating nationwide.
And especially if you're kind of a high user of healthcare,
if you have a lot of meds,
if you're a chronically diseased person,
you're gonna go in a lot,
pay it, pay that monthly fee of 75 bucks or 100 bucks.
Your primary care physician will give you unlimited
or low cost care.
He has access or she has access to lab's tests,
good recommendations, 24-hour access for the kids
who are gonna have the cold in the of the night.
That's a great innovation in the market, DPC.
It will cut the cost of a catastrophic in half
and will also double your money in a spending account,
we call it a medical spending account
for the low level stuff that you know you're gonna have,
if you're gonna have maintenance meds,
you wanna go to the chiropractor more often.
There's now a Forbes feature medical spending account
that doubles your money over three years,
effectively making all your out of pocket 50% less.
So Health Excellence Plus is the name of that solution
where not necessarily the primary care part
but the sharing for the expensive stuff and the account
for your first dollar discretionary stuff is pretty cheap
for 400, 300 a month.
So that's gonna make people's eyes open up
and we make you into a cash payer,
so now there's no networks.
And we didn't even talk about how insurers handcuff you
with networks that exclude the best doctors or hospitals.
That's something that we're definitely telling people about.
It's not just your price,
it's also the handcuffs and networks.
We make you into a cash payer so there's no networks
and there's no need for networks.
We'll help you shop nationwide,
wherever you wanna go to,
medical tourism internationally,
more natural care where a lot of folks wanna go.
Health Excellence Plus is to plan for the individual,
family or small business person in open enrollment
to cut your costs in half,
become a cash shopping patient and really take control
of this awful health system.
- The question oftentimes is how important is it
to be a cash payer?
And the reality is it's very important.
The market understands pricing signals.
Everyone's familiar with going to a corner
where there's a gas station every corner
and they're all fighting for that price.
So I get to see the pricing signals and I know where to go.
Same thing when it comes to medical care,
if I don't understand what anything costs,
all I'm worried about is what's my copay?
So the idea of cash is at the whole program
and anything I'm gonna have done is all defined
on one set price.
So I can decide as a consumer
which is the place I wanna patronize
and without a pricing signal I'm never gonna know that.
So being a cash payer is mission-critical
to the success of healthcare in America.
So we call it medical cost sharing.
Oftentimes, under the concept of sharing it's more
of a religious approach.
But realistically, it's a very old mentality
of how to deal with things.
It's everybody pooling their resources.
A common occurrence is to talk about the Amish because
in the Amish community they don't really have insurance.
Because let's say your barn burns down,
tomorrow every neighbor shows up to build you a new barn.
So the same thing with the community of
is everybody's pooled their financial resources,
so if anybody within that community actually
has a medical expense we're gonna be able
to make sure that that's met.
And it's a most effective methodology
because it's very ethical and it's very inexpensive
by comparison 'cause you're not layering
it up with a lot of added costs and stuff
built in there for no good reason
just to pump up the price.
It's like any little cartel that formulates over time.
If you can kinda get control of an industry
and then there's only a couple players after a while,
they tend to start to collude together.
Whenever any cartel formulates,
its sole goal is monopolization of what's going on
and to thwart anybody entering that market.
And invariably they have got the participation
of government when it comes to that,
because they have lobbyists
and they patronize them as far as getting votes
or giving them money for campaigns,
and in return, they're gonna help pass
those regulations that they're seeking.
So it's definitely a fixed little world.
- Yeah, have you ever heard someone say,
"Have you considered sharing?"
Well, it's half the cost of insurance.
It's the third way in politics too.
And you know what, it's not new.
It's 100 years old,
it's mutual aid.
Most folks before World War II got their healthcare
through groups that they belonged to
and they paid a monthly fee,
they had a kitty to pay all the bills.
Sometimes they had an in-house doctor
that was part of large systems they belonged to.
We're engaged in a big change taking on the cartel
where 90% of people get their healthcare
through insurance companies that they don't like.
We're here to empower patients
and to give them more choices
so that we can save this market and make it better,
not more controlled and worse.
- The advantages of being a cash-pay patient
are actually kind of almost hysterical
if other people weren't getting taken advantage of
by the system.
But if you go to Keith Smith's Oklahoma Surgery Center,
you'll pay about 10% of what you would pay
at the hospital down the street,
and that's just because he doesn't have a full
billing staff that he has to hire.
He doesn't have to wait 90 to 180 days for payment,
and then not be sure if he's going to get the payment.
And because of this system
where he can get payment now, he can even negotiate.
So instead of getting paid in cash,
he's gotten paid in Bitcoin.
It's kind of an exciting thing in healthcare
to see when you're paying with cash what changes.
And even going to your normal doctor's office,
you can see price cuts of anywhere from 10%
to 90% on different procedures or office visits.
- I mean, the goal also is about your wealth, right?
I mean, in reality, there's two important things
in your world,
your health and your wealth.
You need both of those.
Everything else kind of builds off of those.
So when it comes to your wealth,
there's a lot of areas that you need to think about,
my personal finances,
my cost of healthcare,
how much I spend,
where do I get the money to pay for all those things?
So we've got a few different mechanisms.
In the healthcare world,
most people are understanding the idea
of a health savings account.
And so we're able to help you with those too
where you can actually get money invested.
Most people just have it set aside.
They think a little tax break,
but they're not growing that money.
And the government's giving you permission
to grow that money,
so we're gonna help them understand
how they can grow dollars in a health savings account.
But then also we have a medical benefit savings account,
which as Charles was mentioning,
allows you to double your dollars and even more,
to pay for first dollar medical expense,
because that's the challenge for a lot of people.
I've got my insurance or whatever it may be
if something bad happens,
but you know what, I have a lot of other
independent things I have to spend money on.
Where does that money come from?
And so that's another area we wanna address
to make sure that you're covered in terms
of where you're gonna provide for yourself
from one extreme to the other.
- Now, when we look out into the long run,
what we need is a patient-doctor relationship,
a doctor-patient relationship,
and the way that we do that is
by giving the patient the power,
making the patient the payer.
So health savings accounts
are really the primary solution for that.
John Goodman wants to make them Roth
health savings accounts,
which makes them post-tax dollars,
and that is a way to further make healthcare money
more equal to other money.
And so really,
when you get into the economics of healthcare spending,
instead of having cheap dollars for healthcare,
you should have a choice between healthcare,
savings and buying should all be equal.
- Within the healthcare industry,
I have created a distribution system
for a cash-based platform that really
enables the free market system to sort of begin
to change things from a system right now
that doesn't work very well for patients or providers.
So what our program does is it takes
a technology that is very inclusive,
and acts as a platform which allows physicians
to receive cash payments for medical services
that they decide how much they'd like for them to cost,
and allows them to put their services
really onto a free market type of platform.
We go to employers and we say,
let us talk to your employees about making sure
that whatever doctors that they'd like to see
on that platform be on there,
then we set up a system that lets them
pay cash for everything that they might need
as a healthcare consumer,
except for hospitalizations and emergencies,
which is really the only thing
that you need a catastrophic insurance plan for.
- I still believe in a place--
- Going back to 1990 when Bill Clinton
becomes president and his wife
tried to take over the healthcare system
by shoving everyone into HMOs
with Medicare pricing controls,
that woke me up and a lot of folks to the alternative,
which is to open markets to allow supply
to expand and prices to come down
and options to expand,
and people to shop around like any other markets
and get what they want,
whether it's allopath natural, here or overseas.
So we work with all the innovators
both in politics and in entrepreneurship,
namely healthcare disruption,
with various events like weekly podcasts
where we give the cash patients that we create
some examples of the best doctors and hospitals
and integrated therapists that are accessible
to them because we make them cash payers.
And that is the secret niche in this debate
that is not discussed anywhere.
If you don't create cash payers
and help them shop around,
you can't have a supply and demand in a market.
The demand is flat, it's horrible.
People right now are slapping down
third party insurance cards and expecting
someone else to pay for it.
That's unsustainable.
You can't have smart others running a market.
You have to run the market.
We give you the cash to shop around.
And then politically, as people educate themselves
paying cash to save money and learn about choices,
they start to be suspicious of the people
in control who tell them they can't access
a life-saving drug or a natural therapy,
or go overseas, or see this kind
of payment company, et cetera, et cetera.
- There's so much information out there,
we don't know who to trust,
but they trust their benefits broker.
So benefits brokers are really,
and a lot of people are saying this,
are the key to really helping mobilize
this free market system that's out there.
And so we seek to work with folks
that are in that arena.
All the big healthcare systems,
they wanna be the center of excellence,
but they're gonna at some point
come to a reckoning where they realize
that they've got to become much more consumer-friendly
and pay attention to all the things that other
industries have had to pay attention to as well.
We're not trying to cut anybody out.
We just have a system that arranges
for anyone who can add value and bring the things
that consumers need and want to really
stay as healthy as possible.
There's plenty of room for them
if they're doing the right things.
- One of the things we see on Capitol Hill
is actually something that the founders set up,
and that's that it's actually hard to pass a law,
it's hard to pass a bill.
We have the House,
and the House is representative,
they're called representatives,
but it's representative of the country.
The House is hot, it's the teacup.
You never know what's gonna come out of it,
and you never know what they're going to say,
but they're representative of the country at large.
And then you have the Senate,
and the Senate is the tea saucer.
So it sits below the hot tea,
and so when the hot tea spills out into the Senate,
it's the cooling place.
So in the Senate,
one senator can stand up and stop a bill,
and that I think is an important thing
for the country because that means
that the minority is always represented.
But it can be frustrating when we wanna pass a bill.
We want something to pass now,
but one senator can stand up and stop it.
All of the senators have to understand
how important a free-market healthcare is,
how important a functioning healthcare market
is for it to work.
- People are typically very smart.
Oftentimes I've had dealings,
and I've been in the industry over 30 years,
and I've had dealings with some inner city areas.
And the person in that area
may not be a highly educated person
as far as book-learned,
but the reality is that they're extremely smart
when it comes to common sense.
So that's a universal trait most people
have across all spectrums and colors
and ages and whatever it may be
if you allow that to occur.
And so that's what's been the passion
is how do we get more autonomy and freedom
into all markets, and the most egregious
by far is health.
So that's really kind of the low-hanging fruit
because it affects everybody,
everybody's gonna get sick at one point.
And if that's not a free market,
we're all gonna suffer.
Your health is gonna be affected one way or another,
and you would think it'd be really important
for people to pay attention to that,
and sadly they don't.
So we're here to stimulate traffic,
to get people to become more aware,
and frankly, when everybody does become aware,
they get more involved.
- And what that's doing is building the grassroots
information of what's going on in the system.
The more people that are Medi-Share members,
healthcare sharing members,
the more people that go to a DPC practice,
the more voters understand about what's going on,
the more Congress will listen.
So when you look at a staffer,
they're 28 years old,
they don't make much money,
they're up working in the Capitol
to make America a better place,
but the people that are coming in to the office
that might offer them a better future
happened to be the lobbyists for the hospitals
in the big healthcare providers.
Those are the people that come in with the money.
So if you're a staffer and you're looking
to help somebody,
are you going to help a sharing plan
that only has one lobbyists on Capitol Hill
that isn't paid the same as the middle Blue Cross
and Blue Shield lobbyist?
Their profit motive is to help
the big healthcare providers more.
So what we have to do is change the grassroots,
we have to educate voters,
we have to change the marketplace.
And I think that we're on our way to that,
but it's going to be a long road
before we get all the way there.
- I started covering Washington the year
that Reagan got inaugurated and Tip O'Neill
was a Speaker of the House.
I used to know President Reagan's chief speechwriter,
and I knew Tip O'Neill's press secretary, Chris Matthews,
and President Reagan used to get together
and they got along, they disagreed.
It's very sad that that doesn't happen anymore,
and I find it really unfortunate
that we're not seeking a middle ground.
But I do see promise,
and I see things like the Koch brothers
have a foundation Stand Together
that's working on health, education,
criminal justice reform.
More people just need to realize there are ways
to solve the problem by working together.
It doesn't have to be so divisive.
[slow dramatic music]
[moves to slow music]
- [Narrator] Inefficiencies in the healthcare
system are avoidable.
What if there was a way to predict risk,
promote prevention, coordinate complex care,
and consolidate medical records at the same time?
Well, now there is.
[uplifting music]
- Daniel, how you doing?
So my name is Paul Roberts,
and I'm the owner of Roberts Consulting,
which is a medical case management firm.
I've been a medical case manager
and RN for about 20 years.
Over that time, those 20 years,
it taught me what's really important,
which is patient advocacy.
A lot of times, insurance companies wanna cut costs,
they wanna cut corners.
But my view of things is we're nurses,
we went into nursing because we care about people.
I've seen the problems with the current healthcare system.
I've been able to develop an alternative
healthcare plan to the current
mainstream healthcare in the country.
I call the plan Coordinated Care for All,
and the parts of the plan include prediction,
education, prevention, efficiency,
and cost containment.
Starting with prediction,
it's now possible to look at genetics,
family history, and current medical status,
and integrate those in a functional way
to predict outcomes and risk.
Education is important because patients
need to understand how to prevent a condition,
and also the deterioration of that condition.
Prevention is important because obviously
you need to make sure that a certain condition,
or at least the deterioration
of a condition doesn't progress.
You can provide the education,
and you can have a focus on prevention,
but it doesn't necessarily mean
that someone will do it.
We know there are a lot of competing forces
and motivational factors.
We have to account for that.
So my plan is not something that says we expect
everybody to follow this prevention protocol.
So there's really a couple different
kinds of case management.
There's telephonic case management.
A medical case manager, an RN, is on the telephone,
they're coordinating care kind of behind the scenes.
And then there's also what's called
field case management.
With field case management,
you're actually going out into the community
on site with the doctor and the patient.
Field case management is actually useful
in more complex and catastrophic cases.
Medical case management is usually reserved
for people that have some condition that is advanced,
or requires that kind of coordination.
One of the primary roles of a medical
case manager is to coordinate medical care.
A lot of times a person's medical care is very complex,
and they can't handle it on their own,
and they need someone to advocate
and do that for them.
A medical case manager, a registered nurse,
is in a position to understand the medical side
of things and make sure things don't slip
through the cracks,
that everybody's on the same page,
things happen, and they get coordinated.
If you don't have medical case management,
a lot of times what can happen is
you get a delay in treatments,
there's misunderstandings, miscommunications.
I think that RNs are good at conveying
information to a patient,
because for one thing, they care,
and because they understand what's going on
from a medical side,
but also really from a interpersonal side.
A lot of times, medical cases,
they're handled by an adjuster
or what's called a claims examiner.
This is somebody that they're great,
but they don't necessarily understand
the medical side of things.
And they administer the claim,
they pay the benefits and all the stuff
that goes along with that,
but they don't necessarily understand
the medical terminology,
or even what's going on medically.
It helps to have somebody with medical training
in the middle to collaborate and interpret that information.
RNs understand a wider breadth across a larger
spectrum of the healthcare field.
They're used to dealing with the best doctors,
some of the best ancillary treatment,
for example, physical therapy,
the doctor orders an MRI.
That's gonna happen somewhere.
So a medical case manager understands
the best resources for that.
RNs also know the most efficient pathways to recovery.
They can also identify when there's over-utilization.
The identification of over-utilization
is helpful because you're flagging
when something is used too much.
And you're not making a decision on the use,
you're simply identifying it.
And then another doctor, an MD,
would have say over whether or not something
is actually over-utilized.
And so developing this healthcare plan,
I realized we have something that's so important
to use and it's just underutilized.
The idea that I had was let's expand that.
Let's broaden medical case management
to the entire healthcare sector.
- With a case manager, you have people who,
by definition of managing your care,
of working with the physician,
of working with all the specialists that you see
and trying to keep you well and healthy
and out of the system so that you make good decisions.
And that extends not just from the doctor's
office or the hospital setting,
but to your home as well,
helping you maintain your chronic health condition,
if that's the situation,
helping you stay healthy,
if you've had a condition in the past,
and working with the insurance company
to make sure that the billing
that goes along with that is as clean
as it can possibly be.
- I am a medical case manager,
and I can tell you a story that happened this week.
It's an amazing service.
I have friends that live in the Washington DC metro area.
I came from Miami after living there many years,
and their mother was really, really sick,
and she's like 96.
And she was going to doctors' appointments,
she didn't know what was happening
to her at those doctors' appointments,
and so I called a friend of mine
who's a case manager and I got them together,
I made a marriage, and now this woman is,
I think she's gonna live another 10 years past 100.
Her blood counts were off,
they were all over the place,
and the case manager was able to go in there
and look at the history and say to the doctor,
"Well, what are you doing about this?
"You tell her to come back in two weeks,
"you test it, it's off again, what's the plan?"
And now there's a plan,
and there's a plan for her whole life.
We're looking at the house, the house,
certain things, getting rid of throw rugs
so she doesn't fall, we're looking at prevention,
we're looking at her whole situation
and looking at what her individual needs are.
And that in a nutshell is case management,
is what does this person need,
how can we get it for her,
and how can we make her life better?
- When we have your orders for,
let's say upcoming surgery,
we'll need a pre-op clearance, we'll need labs,
chest X-rays, maybe an MRI, CT.
Giving all that information,
giving the orders directly to case management
representative, and they have a direct line
of communication that those orders
can get to that person in more an efficient process
in that way that can be expedited.
- Most people wanna do the right thing,
but they just have a hard time doing it.
I get too busy.
It's like a New Year's resolution.
I'm real good for a week or so,
and the next thing you know,
I'm back to eating Fritos.
You need someone that's gonna help keep you
on track and kinda hold your hand and kinda...
Every time you start to roll off course,
they'll just bop you back on there.
- Case management, it's a big part of healthcare.
We manage people as cash payers.
We tell you to go pay cash and you have a discount,
that's all we want you to do.
'Cause most people are so controlled
by the third party system,
they don't know how to be cash payers or cash shoppers.
We discover that through operations in life.
So we give 'em a concierge to hold their hand.
- Prevention is the key to the whole thing,
because keeping people healthy and well
and out of the healthcare system is the ultimate
way to prevent healthcare costs from going up.
Because if you're not utilizing the services,
there's nothing pay for,
so you're not paying for the services
except for your insurance.
The prevention side is keeping you out of the system.
And it's like going over Niagara Falls, right?
If you stop somebody from going over the falls,
you have saved a lot of bad things from happening.
Once they've already gone over the falls,
you clean up the mess
and that's a lot different circumstance.
So if you prevent people from getting sick,
if you help people with chronic
healthcare conditions to manage and maintain
rather than getting very sick
because of those health issues,
you're most importantly gonna improve
the quality of life for people
that ultimately is what's most important,
but you're also going to save a ton of money
because you're not gonna be providing those services.
- Medical records are strewn about, it's fragmented.
As a case manager, it's hard to get medical
records in a timely way for treatment
and coordination of care.
So by consolidating medical records,
we're really improving efficiency.
Telemedicine as a part of this efficiency model
makes sense because a lot of folks
just don't have access.
If someone is living out in a rural area,
maybe they only have access to one provider.
But with telemedicine, you're giving them
access to many providers.
- Telemedicine is definitely an important adjunct,
and our organization offers telemedicine.
It's also especially helpful for behavioral health.
It's a very important adjunct
and it allows medical care to be delivered
to people who might not otherwise have healthcare.
And for instance, think of a health visitor
who's visiting a poor family in a rural area.
They can't travel into the center
where the physician is,
and it's probably not financially viable
for the physician to make a house call
50 miles out into the country.
But the health visitor can go.
They can set up their video camera
so that the physician can see the patient,
the patient can see them.
They have a stethoscope so the physician
can listen to the patient's heartbeat.
- I think telemedicine offers tremendous
possibilities in healthcare.
You can't even find a psychiatrist
or a psychologist that will take you
if you're paying out of pocket,
and you have the money to pay out of pocket.
What happens to the person who doesn't have the time,
they have an hourly job,
they have every reason to be depressed and anxious.
I mean, here in Northern Virginia,
we're depressed and anxious perhaps genetically,
but perhaps because we're worried our kid
isn't gonna get into Princeton.
There's First World problems,
and then you have the very real challenges
of the less fortunate,
and they need to be able to see
a mental health professional,
and they need a lot more education
about why these are not character flaws.
- With the cost containment aspect of the model,
what I'm really referring to is legislation
for the pharmaceutical industry,
and also standardization of billing practices
with surgery centers and hospitals.
One of the ways to contain costs
is through pharmaceutical legislation.
It's not really fair, is it, if one drug company
increases their profits 500% in one year.
That's crazy.
We need something to control that.
Also, we have an opioid epidemic in America,
and so legislation to curb opiate abuse
is also important.
Another cost containment feature
is hospitals and surgical centers
that have unstandardized billing practices.
So for example, you may have a procedure
in one hospital at a certain cost,
and you can shop around and find
a very different cost structure at another hospital.
If you don't have universal healthcare,
really what you have is the current system,
which is what's called as the private sector.
So you've got different insurance companies
that are large conglomerates,
and they're fighting each other,
it's a very competitive game,
and they're trying to get more patients.
Universal Healthcare is great at consolidating
all of this into one system.
You can still use these principles
in the private sector as well,
and it's okay if private companies are competing
with a universal healthcare system.
My vision in order to combine all of these ideas
together in a functional way is a centralized
computer system that is prevention-based,
provides education automatically,
triggers case management,
whether that's telephonic or field case management,
and also combines and consolidates medical records.
You can use genetic information,
along with family history and current medical status
to predict outcomes and risks as well.
- Technology, and I was gonna say on the horizon,
except that it's here,
that allows interconnectivity
is a fantastic achievement.
It's gonna revolutionize healthcare.
There's a national push,
in fact the HITECH Act of 2010,
the one that talked about HIPAA,
also created an Office of the National Coordinator,
ONC, and they have called together a number
of private government collaborations consortia
to work on interconnectivity.
Interconnectivity is now here.
So they know where your medical,
every doctor you've ever been to,
where you've been is available.
If you give permission,
your doctors is going to be able to have
that integrated into their electronic
medical record system,
and that's gonna be a huge boom.
The integration of genomics with the information
in the electronic medical record
and with the history in the physical examination
is gonna have a profound impact on medicine.
- A personalized medicine, as they call it,
or understanding through genetics
as to how a particular treatment might better
manage the person's illness,
all that comes into play.
So as we gather all this data through genomics,
what have you, it all works towards better
diagnosing and better managing a patient ultimately.
- When you look at the future
of where we're going with our healthcare system,
it is miraculous the things that we're going be able to do,
to take a drop of blood from somebody
and look at their DNA and know what diseases
they're susceptible to or likely to get
throughout their lifetime.
- If you have a pre-existing condition, it's okay.
Everyone is covered.
And it's also okay if the private sector
competes with this plan.
So we're not cutting out the private sector
and saying, "You can't compete."
And either way, I think it's beneficial
for either a universal healthcare system
or the private system to adopt these principles
of case management.
The reason it's important to have case management
in either system is because it improves efficiency
and it helps to reduce medical costs.
- I'm not a liberal, I'm not a conservative,
I'm just looking at this as an individual
and I really see how things have really gone wrong,
and it's refreshing to see something,
some of the things that are being done
to make people healthier.
- Healthcare should not be a political issue.
It's become one.
But much of what we do seeks to make healthcare
an apolitical issue.
It's really about people,
it's not politics,
and we try to do everything we can
to keep it in that vein.
- I think that there is a way forward
and there's always going to be a way forward
for a solution on Capitol Hill.
I wouldn't be working in DC,
I wouldn't be walking the halls of Congress
if I didn't think there was a solution.
- Healthcare is a unique issue
unlike any other political issue
that we deal with in that it touches everybody.
Every business, every family, every individual
in this country every day in some way
deals with the cost of healthcare.
- Because of the burden of Medicare-for-all,
it's important to have an alternative
that is much more cost-effective.
Medicare-for-all costs about $3.5 trillion a year,
and it's important for people to understand,
that places a huge burden on the economy.
But the plan that I've developed,
you save about 40% of that, which is $1.4 trillion,
and that's important to save the economy.
[inspirational music]
- [Narrator] The healthcare system is broken,
but it doesn't have to be.
Whether we subscribe to Universal Healthcare,
the private system, or a combination,
innovative options like free-market healthcare
and coordinated care for all provide solutions.
Perhaps more innovation is just on the horizon.
Legislative change needs your support.
- My name is Paul Roberts.
I'm the executive producer and the writer
for the documentary "Diagnosing Healthcare".
I've been in case management,
medical case management for about 20 years
and own my own medical case management company,
and in that time understood the value
of medical case management.
And what I mean is coordination of care,
making sure everybody's on the same page,
things aren't falling through the cracks,
going to bat for patients and being a patient advocate.
And so I understood the value of this,
and I started questioning why is this
really only being used in the workers'
comp sector mostly, with a few other exceptions,
maybe hospital discharge and that sort of thing?
And why can't this be expanded,
the skillset be expanded to the wider healthcare sector?
To me it didn't make sense, so.
So I started thinking about it and developing
this healthcare plan that I have that's called
Coordinated Care for All,
which is kind of a play on Medicare-for-all,
coordinated care for all,
but it's really using those same principles
to improve the efficiency of the system.
I actually, I saw these presidential candidates
one after another saying, well,
we don't really have any other choices for healthcare.
We have basically Medicare-for-all,
which is universal healthcare,
or we basically have nothing,
or an expansion on Obamacare, ACA.
I'm thinking, well, I have these other ideas,
why not write to these presidential candidates
and see if I can get their attention
and share these ideas with them.
Well, I wrote to each one, never heard back.
Tried writing to my congressman
and working with my congressman,
didn't get anywhere.
I've got friends that are lobbyists in DC
that have been doing it 20 years
and just not moving the ball,
just not getting anywhere with healthcare reform.
So I thought, well, what's it gonna take?
We need this grassroots movement.
And that's where I get the idea
of doing a documentary is to create
a grassroots movement to urge Congress
for change for the better.
Yeah, the production process,
we just finished filming, as you know.
And I've been very happy with the filming process.
And now we're going to be moving on to the editing process,
and I'm looking forward to being involved in that.
That's pretty exciting.
I mean, I think everybody is affected
by healthcare in one way or the other.
We're all affected by it.
And I see these gross inefficiencies,
and I formulated a more comprehensive plan
for that reason incorporating prevention,
education, and genetics and all these different things,
consolidation of medical records
along with case management.
So I'm trying to do my part.
Yeah, and I'm just hoping that other people
get that and understand the value
and share that with other people.
[gentle music]