All language subtitles for Diagnosing.Healthcare.2020.720p.BluRay.x264.AAC-[YTS.MX]

[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]