Original subtitles

[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

Official YIFY movies site: YTS.MX

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]