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[upbeat music]

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- [Reporter] As
us hospitals begin

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Downloaded from
YTS.MX

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to buckle under the weight
of the new coronavirus,

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doctors and nurses issued a
grim plea for more supplies

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Official YIFY movies site:
YTS.MX

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to treat patients and
to protect themselves.

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- This is a big,

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big issue for the whole system.

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- [Reporter] Healthcare
payments are keeping

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many local residents
from getting the
treatments they need.

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- 37% of Americans go
without recommended care.

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- Your statement says
please pay $220,850.

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- Right.

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- [Reporter] The
amount she owed,

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more than $40,000.

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- I'm not human to them.

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I'm a dollar sign.

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- [Reporter] The average
cost of treatment

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for patients rose to $63,000.

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- [Reporter] $17,000
for a lab test.

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50,000 for a stay in the NICU.

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- [Reporter] From $18 a tablet,

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jumping to $750 a tablet.

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- [Reporter] About 34 million
Americans know someone

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who died because they couldn't
pay for medical treatment.

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- [Reporter] You have surgery

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and you get a medical bill
six months later saying

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you owe thousands of dollars.

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- We have to do something
about the price of healthcare.

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- It's a right in our country

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and you should have a
right to healthcare.

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- [Crowd] Justice in healthcare.
Justice in healthcare.

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- Our healthcare is in a crisis.

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This bubble is going to burst.

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[heartbeat monitor flatlining
and relaxing piano music]

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[upbeat dramatic music]

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- [Narrator] Healthcare, is
it a right or a privilege?

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Do we want a system
based on profit

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or rather prevention?

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Will we place our future
in the hands of bureaucrats

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or that of the people?

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These are the
questions to ponder.

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Our healthcare system is broken.

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Rising costs and
growing inefficiencies

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are putting a heavy
burden on the economy.

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It seems like everyone
has a story to tell.

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[dramatic music]

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[ambulance siren wailing]

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[monitor beeping]

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[wind rustling in trees]

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- My father was going
to the doctor, he said,

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but didn't see a man
rear-ended my truck.

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And I blew out my other shoulder

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and tore the ligament out of it.

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And my left elbow they had to
reconstruct the nerves in it.

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That particular
brace they gave me

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after my thumb surgery
when I woke up paralyzed,

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because the nerves in my
leg aren't working right

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and the muscles and
I got a clubfoot now.

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- Did you get any sort of
therapy inpatient anywhere?

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- Well, there was a
problem at the hospital.

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I was there a week and
they wanted me to go to

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a inpatient rehab.

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And so we were waiting
there to get the okay to go.

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The lady came out and said
I was a good candidate

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and that they would take me.

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And we were waiting and
waiting to go for a couple

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of days at the hospital
and we never got a call

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or anything and we kept asking
the doctor when we're going?

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And he said I don't know.

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So finally, we waited
another day and came home

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and found out that
the insurance company

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didn't send all the
approvals to the rehab center

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and they wouldn't take
me until they got them.

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And so I've never gotten to
go to the inpatient rehab yet.

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And that happened
actually three times.

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The hematologist
recommended for them

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to massage out the edema in
my leg three times a day.

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But when the insurance
company was told they said

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they don't have enough
funds for that to be done.

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[somber piano music]

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The one thing we have
a problem with is

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when the doctor
orders something that,

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because the insurance
has to pay for it

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and they don't always know,

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I guess, or they have vendors
that set those appointments up

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or therapy places and
it's a different person

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that calls every time that
don't even know what's going on.

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And it takes four
or five vendors just

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to get one appointment.

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And sometimes it's
weeks and months even

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before they get
all that worked out

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while you're just sitting
there waiting for therapy

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and things like that.

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What really doesn't make
sense to me is I needed a MRI

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and so I called around and
asked what they cost for

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with my insurance?

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And they gave me a price
to $1,200 to about $800

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with my insurance.

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Then I called around to some,

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I said what if I
just pay you cash,

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I don't want a receipt
or anything for it

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and it was 295 out the door.

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And I didn't go
towards my deductible

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but I don't understand why
I could pay 295 instead

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of $800 gets billed
my insurance.

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That doesn't make sense to me.

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[somber piano music]

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- We got married in 1985 at
the First Presbyterian Church.

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So we're married
34 years this year.

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Well, after he came home from
the hospital they sent him

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to different doctors
trying to figure out

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what all had gone wrong
during his surgery?

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And they were looking at
parts and pieces of him

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and finally, we got
a referral approved

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for the psychologist
and we went there

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for a full day evaluation.

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We got a phone call from
the therapist saying

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that the 13th meeting was
to be the last session

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because they had
received an email

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from the insurance
company saying

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that they were cutting
off the sessions.

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They weren't gonna authorize
any more and it had to end.

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So that next day we
went to his last session

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and he was very upset
the last day we met.

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- They said they wanted
me to keep coming

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but the insurance wouldn't
authorize any more.

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- And he looked at the
therapist and said,

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oh, you're leaving.

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And she said I'm not leaving,

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I'll still be here but
you've done really well.

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And he started crying
and was very upset

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because she's impacting
him so positively.

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- It seems like all they
do is one doctor refers you

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to another doctor.

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They're doctors, but they
only wanna treat one thing

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and you may have other
things wrong with you

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but they won't even look at
you and all you can do is wait

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to go see another doctor

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to treat whatever other
problems you have.

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So you end up seeing
multiple doctors--

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- Who don't talk

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to each other.
- Who don't talk to each other

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and all they wanna
look at is your big toe

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if that's what kind
of doctor they are.

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What's aggravating is you
can't even see the other doctor

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until that doctor refers
you to that doctor,

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so that's two months
later sometimes

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just to get some
kind of treatment.

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[somber music]

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- My name is Angelica.

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I am 24 years old
and my first story

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about healthcare
is that when I was

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around elementary
school I was diagnosed

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with type two diabetes.

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Since then, when I found
out I was heartbroken.

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I was little.

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I didn't know what to do.

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I didn't know what
was good or bad.

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I've seen people pass
away and it's so hard

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because my parents
tell me, you know,

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take care of yourself 'cause
that could happen to you.

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You can lose a leg.

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You can lose a finger.

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You can lose anything.

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[Angelica sniffing]

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- For me, my
surprise came at 45.

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I noticed something,

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I ignored it.

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Then I went to see my doctor

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because I'm sure it's nothing

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but let's just get
it out of the way.

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Well, she couldn't
find anything,

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referred me to somebody else.

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She couldn't find anything,

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we need to do a colonoscopy.

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Bingo,

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there it was.

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I had to then see a surgeon
to figure out what it was,

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probably wasn't good.

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It ended up being stage
three colon cancer.

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- I was 37 years old,

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never been in the hospital
other than being born.

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Woke up, had chest pains,

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went to the hospital.

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That morning they gave me
a quadruple bypass surgery.

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Later on, 12 years later,

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I guess, I had chest pains,

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went back to the hospital.

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I had bypass surgery again.

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- I became sick with
this mysterious illness.

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One of the doctors,

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I'm a nurse.

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I was completing my
bachelor's degree

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and I could barely even think,

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have any memory,

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short term memory.

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Went to an infectious
disease doctor

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that treats at the
hospital where I worked

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and he basically looked
at me and told me I needed

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to go see a psychiatrist,

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that all my symptoms
were in my head.

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- You have to fight
tooth and nail to prove

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why you are actually sick
or why you are actually this

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and that and then
you have to prove

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that you did not
do it to yourself.

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- When I got diagnosed
with cancer they fired me,

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and that was from a
health institution.

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- As time went on I got worse.

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I would have to do injections
and injections aren't cheap.

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I'm not gonna lie to you
guys that one injection

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that I need to take $600,

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and I need to take them mostly
every Monday and it's hard.

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I can't afford that.

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In my job I get paid
maybe $200 a week.

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- Over 15 doctors
that I visited,

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I found a nurse practitioner
and I came back positive

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for tick borne illness.

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The main one for me
was ehrlichiosis,

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Coxsackie virus, Epstein-Barr,

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Parvo virus, and I had quite
a bit positive line bands.

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- It's training in healthcare
and the lack of training

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and the lack of empathy.

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I remember waking
up after surgery,

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then the pain
instantaneously kicked in.

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I'm like, oh my goodness.

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Wow, that hurts.

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Holy cow, that hurts.

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They couldn't calm my pain,

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so they kept giving
me different pain meds

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to try to make it better
and it didn't work.

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And I said, oh my goodness,

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what are we doing,

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what are we doing
after different times?

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Who knows how much it's costing,

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but they kept giving
me different things.

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And the nurse
finally said, well,

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if we can't calm you down you're
gonna have a heart attack.

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- Once I got to the surgeon
we had several meetings.

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We had the surgery
and he cut a nerve

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that was very
important to your body,

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the nerve that controls your
brain and your GI system.

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So my GI system no longer works.

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- I lost my 17-year-old
daughter to suicide

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00:12:01,459 --> 00:12:04,201
on March 28, 2017.

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[somber piano music]

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00:12:10,904 --> 00:12:13,733
The run-around that we
received so many times

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throughout her
illness which went on

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for you know a good six,

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seven years, was depressing.

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It was frustrating and it's
just not where we need to be.

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Some of the things
that went on, I mean,

254
00:12:25,396 --> 00:12:28,312
it began at the beginning with
her seeing a psychologist,

255
00:12:28,356 --> 00:12:32,752
her seeing a doctor
and of course was

256
00:12:32,795 --> 00:12:36,973
It never failed multiple times

257
00:12:37,017 --> 00:12:38,932
that once she would
get on a medication

258
00:12:38,975 --> 00:12:41,195
that was actually working
insurance would say,

259
00:12:41,238 --> 00:12:42,500
well, now you need to change it

260
00:12:42,544 --> 00:12:44,938
because it's too expensive.

261
00:12:44,981 --> 00:12:48,811
- The the whole
medical merry-go-round

262
00:12:48,855 --> 00:12:51,161
because this is
what we have to do,

263
00:12:51,205 --> 00:12:53,816
is we have to fund the
medical merry-go-round.

264
00:12:53,860 --> 00:12:54,686
- I got in debt.

265
00:12:55,731 --> 00:12:57,777
It was so much money.

266
00:12:57,820 --> 00:12:59,779
Healthcare didn't help me.

267
00:12:59,822 --> 00:13:02,303
They left me there like nothing.

268
00:13:02,346 --> 00:13:05,001
They said I got rejected
because of the fact

269
00:13:05,045 --> 00:13:06,611
that I'm diabetic.

270
00:13:06,655 --> 00:13:09,789
- I was not worth it to the
healthcare system to be treated.

271
00:13:09,832 --> 00:13:11,094
- Went back for my
six-week checkup,

272
00:13:11,138 --> 00:13:12,574
we weren't done.

273
00:13:12,617 --> 00:13:13,923
It was in the lymph nodes.

274
00:13:13,967 --> 00:13:17,318
So I decided on an
aggressive form of treatment

275
00:13:17,361 --> 00:13:19,276
which meant chemo and radiation.

276
00:13:19,320 --> 00:13:21,539
And I would go to
this facility for,

277
00:13:21,583 --> 00:13:22,758
in all total with the surgery,

278
00:13:22,802 --> 00:13:24,020
about a year's time.

279
00:13:24,064 --> 00:13:28,764
It cost a lot and it
cost a lot many times.

280
00:13:28,808 --> 00:13:31,723
- When you're hitting
$10,000 deductibles

281
00:13:31,767 --> 00:13:34,117
and your copays don't
count and you have to pay

282
00:13:34,161 --> 00:13:36,728
for labs and you have
to pay for X-rays,

283
00:13:36,772 --> 00:13:39,209
and you go to the pharmacy
and you get a medicine

284
00:13:39,253 --> 00:13:40,863
that they think is
a trial medicine,

285
00:13:40,907 --> 00:13:43,866
and they tell your
copay is $3,000.

286
00:13:43,910 --> 00:13:47,130
Well, at $3,000 you
walk away and say,

287
00:13:47,174 --> 00:13:49,741
I guess I don't
need that medicine,

288
00:13:49,785 --> 00:13:52,701
or I need it but I don't
have $3,000 to pay.

289
00:13:52,744 --> 00:13:55,095
- It's not the $99 or $33
or 189 for a family anymore.

290
00:13:57,880 --> 00:14:02,885
People are paying up to
$1,500 a month for healthcare

291
00:14:02,929 --> 00:14:04,060
for their whole family.

292
00:14:04,104 --> 00:14:06,280
And add that with
the rise of housing,

293
00:14:06,323 --> 00:14:10,240
you're paying 15 to $3,000
a month for housing,

294
00:14:10,284 --> 00:14:12,982
depending on what type
of housing do you have.

295
00:14:13,940 --> 00:14:15,289
So people cannot afford it.

296
00:14:15,332 --> 00:14:17,813
- Haley was hospitalized
many times with suicidal

297
00:14:19,075 --> 00:14:20,598
attempts.

298
00:14:20,642 --> 00:14:22,209
And she was in the hospital,

299
00:14:22,252 --> 00:14:24,559
she was in the inpatient for
sometimes six to eight weeks.

300
00:14:24,602 --> 00:14:26,387
But the minute that you started

301
00:14:26,430 --> 00:14:29,694
to see the light come back in
her eyes insurance would say,

302
00:14:29,738 --> 00:14:31,131
okay, you're done,

303
00:14:31,174 --> 00:14:32,480
it's time for you to get out.

304
00:14:32,523 --> 00:14:34,090
- These hospitals,
mega hospitals are

305
00:14:34,134 --> 00:14:35,309
just reaping and pillaging.

306
00:14:35,352 --> 00:14:37,441
It's like, what can
we get away with?

307
00:14:37,485 --> 00:14:40,096
How much can we
charge this person?

308
00:14:40,140 --> 00:14:42,359
As soon as some
physician tells you

309
00:14:42,403 --> 00:14:43,621
have excellent insurance,

310
00:14:43,665 --> 00:14:44,927
you should be
leaving that office.

311
00:14:44,971 --> 00:14:48,235
- Supposedly, healthcare
is supposed to help you.

312
00:14:48,278 --> 00:14:49,540
It's supposed to

313
00:14:50,846 --> 00:14:52,413
help you with anything you can.

314
00:14:52,456 --> 00:14:53,370
It's not helping me.

315
00:14:53,414 --> 00:14:55,633
It's making me in debt.

316
00:14:55,677 --> 00:14:56,765
- We move forward.

317
00:14:56,808 --> 00:14:58,071
In the healthcare
system, you know,

318
00:14:58,114 --> 00:14:59,942
you know it, you hear it.

319
00:14:59,986 --> 00:15:00,943
Now it's you.

320
00:15:00,987 --> 00:15:02,945
So how do you adapt?

321
00:15:02,989 --> 00:15:05,861
How do you get diagnosis?

322
00:15:05,905 --> 00:15:07,384
Which path should you take?

323
00:15:07,428 --> 00:15:09,473
There's no book for that.

324
00:15:09,517 --> 00:15:12,737
- I have been from doctor
to doctor to doctor.

325
00:15:12,781 --> 00:15:13,956
They don't look at
the side effects.

326
00:15:14,000 --> 00:15:16,089
They don't research anything.

327
00:15:16,132 --> 00:15:18,265
It's all just cookbook medicine.

328
00:15:18,308 --> 00:15:19,570
One, two, three,

329
00:15:19,614 --> 00:15:20,615
if you don't have one
of these three things,

330
00:15:20,658 --> 00:15:21,746
you're more complex.

331
00:15:21,790 --> 00:15:24,880
I'm sorry, I don't
have time for you.

332
00:15:26,882 --> 00:15:28,101
- We fought for our daughter.

333
00:15:28,144 --> 00:15:29,319
I didn't give up.

334
00:15:31,408 --> 00:15:32,975
But there just wasn't
enough out there

335
00:15:33,019 --> 00:15:34,411
and there wasn't
enough resources.

336
00:15:34,455 --> 00:15:35,717
So like I said,

337
00:15:35,760 --> 00:15:38,633
she was in a place in
Maitland, Florida and

338
00:15:40,200 --> 00:15:41,027
there's a big,

339
00:15:41,070 --> 00:15:42,724
huge list of hospitals.

340
00:15:42,767 --> 00:15:44,030
So then you go to
your insurance.

341
00:15:44,073 --> 00:15:45,857
Okay, which one's on this?

342
00:15:45,901 --> 00:15:47,076
And then you find
one that's on there.

343
00:15:47,120 --> 00:15:49,861
Oh, well that's for
sexually abused children

344
00:15:49,905 --> 00:15:52,429
or that's for addicts and
that was not our daughter.

345
00:15:52,473 --> 00:15:53,778
Our daughter had mental illness.

346
00:15:53,822 --> 00:15:56,607
I didn't wanna expose
her to any more things.

347
00:15:56,651 --> 00:15:59,523
So in March, 2017,

348
00:15:59,567 --> 00:16:01,395
I found a place in
Knoxville, Tennessee,

349
00:16:01,438 --> 00:16:04,702
which was that one step up from
what we had been in before.

350
00:16:08,576 --> 00:16:11,013
So she was not
looking forward to

351
00:16:11,057 --> 00:16:13,102
and didn't wanna go
back to the hospital,

352
00:16:13,146 --> 00:16:14,408
so I waited to tell her.

353
00:16:14,451 --> 00:16:15,713
I thought, okay,

354
00:16:15,757 --> 00:16:17,324
she's at an appointment
with her psychologist

355
00:16:17,367 --> 00:16:18,499
on Tuesday night.

356
00:16:18,542 --> 00:16:20,327
So my husband was
gonna meet me there.

357
00:16:20,370 --> 00:16:21,719
I picked up Haley from,

358
00:16:21,763 --> 00:16:25,027
well, I went home
to pick up Haley.

359
00:16:25,071 --> 00:16:26,724
She wasn't home.

360
00:16:26,768 --> 00:16:28,335
That was the day
she went missing.

361
00:16:28,378 --> 00:16:30,859
She was missing for 10 days
before she was ultimately found

362
00:16:30,902 --> 00:16:33,035
and she had taken her own life,

363
00:16:34,950 --> 00:16:37,561
but I'll never say
suicide took my daughter.

364
00:16:37,605 --> 00:16:39,520
Mental illness took my daughter.

365
00:16:39,563 --> 00:16:43,828
- If we had a healthcare
system that was pro health

366
00:16:43,872 --> 00:16:48,746
and we really focused
on prevention,

367
00:16:48,790 --> 00:16:51,097
rather than treating symptoms,

368
00:16:51,140 --> 00:16:53,055
our healthcare
costs will go down

369
00:16:53,099 --> 00:16:55,753
and there would be a lot
healthier people walking

370
00:16:55,797 --> 00:16:57,407
around the United States.

371
00:16:57,451 --> 00:17:01,237
- And I ended up having to pay
five or $6,000 out of pocket.

372
00:17:01,281 --> 00:17:04,762
Well, five or $6,000 not
knowing that you're gonna have

373
00:17:04,806 --> 00:17:10,290
to pay is kind of cuts
into other things in life

374
00:17:10,333 --> 00:17:11,639
that you would like to do.

375
00:17:11,682 --> 00:17:15,338
And you have to forfeit
those to be able to pay

376
00:17:15,382 --> 00:17:17,427
and then you worry about, well,

377
00:17:17,471 --> 00:17:19,647
what does the future hold?

378
00:17:19,690 --> 00:17:22,650
What am I gonna have
wrong with me next?

379
00:17:22,693 --> 00:17:23,694
- Practically my whole life

380
00:17:23,738 --> 00:17:24,956
I've been rejected
with healthcare.

381
00:17:25,000 --> 00:17:28,656
I've not gotten
one, single penny,

382
00:17:28,699 --> 00:17:29,961
not at all.

383
00:17:30,005 --> 00:17:33,008
- Seeing people discounted
and tossed aside,

384
00:17:33,052 --> 00:17:34,836
they should be onto
their next phase

385
00:17:34,879 --> 00:17:35,967
of their life but they weren't.

386
00:17:36,011 --> 00:17:37,056
They needed help.
They needed care.

387
00:17:37,099 --> 00:17:38,796
They needed somebody
to guide them

388
00:17:38,840 --> 00:17:41,016
and people were just giving up.

389
00:17:41,060 --> 00:17:44,367
And it was just so
disheartening for me to see that

390
00:17:44,411 --> 00:17:46,282
because many didn't
know what to do.

391
00:17:46,326 --> 00:17:49,503
I just, I can't believe that
there's not more empathy

392
00:17:49,546 --> 00:17:50,808
and more care.

393
00:17:50,852 --> 00:17:53,463
- It's sad that people
have to pick healthcare,

394
00:17:53,507 --> 00:17:55,944
food, your housing,

395
00:17:55,987 --> 00:17:58,816
it shouldn't even be like
that but that's how it is.

396
00:17:58,860 --> 00:18:02,559
- Until we start getting
more help and more resources

397
00:18:02,603 --> 00:18:05,475
for people I don't know how
we're gonna change this epidemic

398
00:18:05,519 --> 00:18:07,738
because that's what
it's turning into.

399
00:18:07,782 --> 00:18:09,392
- You're almost ready
to pay any price

400
00:18:09,436 --> 00:18:12,439
but there becomes a point
that you cannot continue.

401
00:18:19,228 --> 00:18:22,666
[dramatic violin music]

402
00:18:31,936 --> 00:18:33,590
- [Narrator] Our
Congressmen were elected

403
00:18:33,634 --> 00:18:35,897
to represent the
will of the people.

404
00:18:35,940 --> 00:18:38,334
If only it were so simple.

405
00:18:38,378 --> 00:18:41,163
- And the answer is the
greed and corruption

406
00:18:41,207 --> 00:18:42,860
of the drug companies.

407
00:18:42,904 --> 00:18:45,863
- [Narrator] Device of
party line politics,

408
00:18:45,907 --> 00:18:48,953
special interest lobbying
and bureaucratic entanglement

409
00:18:49,867 --> 00:18:52,479
all account for something
quite different.

410
00:19:00,574 --> 00:19:02,706
- If you look at the
US healthcare system,

411
00:19:02,750 --> 00:19:05,622
in many ways we have the best
healthcare system anywhere

412
00:19:05,666 --> 00:19:06,710
in the world.

413
00:19:06,754 --> 00:19:09,539
[dramatic music]

414
00:19:10,671 --> 00:19:14,805
Our outcomes at the top
if you need high level,

415
00:19:14,849 --> 00:19:18,635
intensive medicine anywhere
in the world you're gonna look

416
00:19:18,679 --> 00:19:20,159
at the United States.

417
00:19:20,202 --> 00:19:22,248
It's why people from from
all over the world come here

418
00:19:22,291 --> 00:19:23,988
when they need the
best healthcare

419
00:19:24,032 --> 00:19:25,903
that the world has to offer.

420
00:19:27,296 --> 00:19:28,341
You have quality,

421
00:19:28,384 --> 00:19:30,256
you have cost and
you have access.

422
00:19:30,299 --> 00:19:32,519
We're doing very well
on quality, again,

423
00:19:32,562 --> 00:19:35,217
highest quality available
anywhere in the world.

424
00:19:35,261 --> 00:19:38,655
The cost is the most
expensive healthcare anywhere

425
00:19:38,699 --> 00:19:40,179
in the world, driven by,

426
00:19:40,222 --> 00:19:43,660
in large part prescription
drugs and some of the rules

427
00:19:43,704 --> 00:19:45,184
that revolve around
the distribution

428
00:19:45,227 --> 00:19:47,447
and use of prescription drugs.

429
00:19:47,490 --> 00:19:51,233
But on access we have done
better in recent years

430
00:19:51,277 --> 00:19:54,018
of making healthcare
more accessible to people

431
00:19:54,062 --> 00:19:55,716
but there are people
who can't afford it,

432
00:19:55,759 --> 00:19:59,110
people whose life circumstance
doesn't allow them

433
00:19:59,154 --> 00:20:01,417
the opportunity to purchase
healthcare insurance

434
00:20:01,461 --> 00:20:03,767
for themselves or
for their families,

435
00:20:03,811 --> 00:20:05,595
and that's a big
problem in this country.

436
00:20:05,639 --> 00:20:08,946
The folks that don't have
healthcare don't disappear,

437
00:20:08,990 --> 00:20:10,252
they still live their lives

438
00:20:10,296 --> 00:20:12,341
and they still walk
among us in society.

439
00:20:12,385 --> 00:20:14,561
They're our friends and
neighbors and co-workers

440
00:20:14,604 --> 00:20:15,866
and members of our families.

441
00:20:15,910 --> 00:20:17,172
And when you don't
have healthcare

442
00:20:17,216 --> 00:20:19,957
and you get sick you
go to the hospital,

443
00:20:20,001 --> 00:20:21,785
and you show up and
you will get treated.

444
00:20:21,829 --> 00:20:23,874
And somebody is gonna pay
for the cost of that care.

445
00:20:23,918 --> 00:20:26,747
You may not pay for it but
somebody is going to pay for it

446
00:20:26,790 --> 00:20:29,793
and that's the unfortunate
cost shift that happens

447
00:20:29,837 --> 00:20:32,579
when the insurance
premiums come in

448
00:20:32,622 --> 00:20:34,624
and they're up 12 to 15%.

449
00:20:34,668 --> 00:20:35,973
Part of the reason for that is

450
00:20:36,017 --> 00:20:38,280
because they're covering
the costs of the people

451
00:20:38,324 --> 00:20:40,587
who can't afford
healthcare on their own.

452
00:20:40,630 --> 00:20:43,372
They get treated but the
bill comes to somebody else.

453
00:20:43,416 --> 00:20:44,765
- I think there are a lot

454
00:20:44,808 --> 00:20:46,723
of ethical dilemmas
today in healthcare.

455
00:20:46,767 --> 00:20:51,467
I think one is the idea that
you have to treat everybody

456
00:20:51,511 --> 00:20:54,949
and this concept about
religion coming into play.

457
00:20:54,992 --> 00:20:56,516
As a healthcare provider myself,

458
00:20:56,559 --> 00:20:59,301
when I went to school
we were taught in ethics

459
00:20:59,345 --> 00:21:00,607
that you treat everybody.

460
00:21:00,650 --> 00:21:02,130
You don't look at
who the person is,

461
00:21:02,173 --> 00:21:03,262
who they love,

462
00:21:03,305 --> 00:21:04,915
what their religion is,

463
00:21:04,959 --> 00:21:05,960
what country they came from,

464
00:21:06,003 --> 00:21:07,353
any of those things,

465
00:21:07,396 --> 00:21:09,485
that this is your
ethical obligation

466
00:21:09,529 --> 00:21:11,095
to treat everyone the same.

467
00:21:11,139 --> 00:21:13,881
And what I'm seeing today
is that there are people

468
00:21:13,924 --> 00:21:14,969
who are saying,

469
00:21:15,012 --> 00:21:17,276
we don't wanna
treat those, thems.

470
00:21:17,319 --> 00:21:18,973
I call them, the thems.

471
00:21:19,016 --> 00:21:23,151
Them dejour, whoever
the them happens to be.

472
00:21:23,194 --> 00:21:27,634
And that's very scary to me
because we have always believed

473
00:21:27,677 --> 00:21:28,983
in this country ethically,

474
00:21:29,026 --> 00:21:30,941
that's part of your
code of ethics is

475
00:21:30,985 --> 00:21:32,769
that you treat
everyone the same.

476
00:21:34,380 --> 00:21:39,733
- The main idea of profit
motive is that people are driven

477
00:21:39,776 --> 00:21:42,736
to do things and they're
driven to do things for profit,

478
00:21:42,779 --> 00:21:44,868
and profit doesn't
always mean money.

479
00:21:44,912 --> 00:21:47,349
Profit can mean leadership.

480
00:21:47,393 --> 00:21:49,612
Profit can mean extra
time with your family.

481
00:21:49,656 --> 00:21:52,441
Profit can mean a
better community.

482
00:21:52,485 --> 00:21:55,575
Whatever profit means to
you or the individual,

483
00:21:55,618 --> 00:21:57,316
is something that drives them.

484
00:21:57,359 --> 00:22:00,449
So we mainly understand
this in the workplace

485
00:22:00,493 --> 00:22:03,539
that a business is in
business to profit.

486
00:22:03,583 --> 00:22:05,889
But what we don't think about
is the second level there,

487
00:22:05,933 --> 00:22:08,979
that an employee is
working for that business

488
00:22:09,023 --> 00:22:13,636
to profit themselves and the
profit doesn't usually go

489
00:22:13,680 --> 00:22:15,334
along necessarily
with the company's.

490
00:22:15,377 --> 00:22:16,596
They wanna pay their mortgage.

491
00:22:16,639 --> 00:22:17,814
They wanna pay their car bill.

492
00:22:17,858 --> 00:22:19,555
They wanna spend time
with their family

493
00:22:19,599 --> 00:22:23,733
and that doesn't mean making
more money for the business.

494
00:22:23,777 --> 00:22:26,780
A manager understands the profit
motives of their employees,

495
00:22:26,823 --> 00:22:29,043
then they can be
a better manager.

496
00:22:29,086 --> 00:22:31,437
And so what I do in the
book is talk about that

497
00:22:31,480 --> 00:22:33,134
but then we expand
it out and we talk

498
00:22:33,177 --> 00:22:35,310
about profit motives in media,

499
00:22:35,354 --> 00:22:37,704
profit motives in politics,

500
00:22:37,747 --> 00:22:39,401
profit motives in healthcare.

501
00:22:40,750 --> 00:22:43,753
So profit motives in healthcare
are really interesting

502
00:22:43,797 --> 00:22:47,061
because the patient is
only paying for about 10%

503
00:22:47,104 --> 00:22:48,497
of the healthcare they receive,

504
00:22:48,541 --> 00:22:49,933
and that's 10 cents
on the dollar.

505
00:22:49,977 --> 00:22:52,893
So if you went into
a grocery store

506
00:22:52,936 --> 00:22:54,895
and you were only paying
10 cents on the dollar

507
00:22:54,938 --> 00:22:57,288
for whatever you could buy,

508
00:22:57,332 --> 00:23:00,596
you would buy a lot
more groceries or

509
00:23:00,640 --> 00:23:03,077
It would change the way
that you shop and in fact

510
00:23:03,120 --> 00:23:04,818
that is what we
see in healthcare.

511
00:23:04,861 --> 00:23:09,213
People have these gold-plated
plans that they don't use much

512
00:23:09,257 --> 00:23:10,998
of and don't get
the value out of,

513
00:23:11,041 --> 00:23:13,392
but since they're only
paying 10 cents on the dollar

514
00:23:13,435 --> 00:23:15,481
and since the companies
get to write it off

515
00:23:15,524 --> 00:23:18,919
of their taxes we
see this expansion

516
00:23:18,962 --> 00:23:21,400
in what we're paying
for in healthcare.

517
00:23:21,443 --> 00:23:23,271
We have these
government regulations

518
00:23:23,314 --> 00:23:28,015
that really change the
way that the hospitals

519
00:23:28,058 --> 00:23:31,758
and the doctors and
the practices think

520
00:23:31,801 --> 00:23:34,456
because if a patient's only
paying 10 cents on the dollar

521
00:23:34,500 --> 00:23:37,590
and the hospital's getting
reimbursed by the government

522
00:23:37,633 --> 00:23:38,852
or an insurance company,

523
00:23:38,895 --> 00:23:41,376
then the patient is
no longer the client,

524
00:23:41,420 --> 00:23:42,943
they're no longer the payer.

525
00:23:42,986 --> 00:23:45,946
And so instead of the hospital

526
00:23:45,989 --> 00:23:48,470
or the doctor treating the
patient they're thinking

527
00:23:48,514 --> 00:23:50,733
of billing and they're
thinking of the businesses

528
00:23:50,777 --> 00:23:54,302
and they're thinking about
the insurance companies.

529
00:23:54,345 --> 00:23:55,825
- Healthcare costs too much.

530
00:23:55,869 --> 00:23:58,654
We're having to pay too much
because it costs too much.

531
00:23:58,698 --> 00:24:02,005
We're perhaps using it too
often or not using it correctly.

532
00:24:02,049 --> 00:24:04,007
There's a lot of focus
now on the drug companies

533
00:24:04,051 --> 00:24:05,792
and drug prices
are of course very,

534
00:24:05,835 --> 00:24:09,317
very high and something clearly
needs to be done about it.

535
00:24:09,360 --> 00:24:12,233
When drug companies are
only funding five to 10%

536
00:24:12,276 --> 00:24:15,628
of your your budget
it's a lot easier

537
00:24:15,671 --> 00:24:17,325
to speak out about
something than

538
00:24:17,368 --> 00:24:19,980
when they're paying
a far higher amount.

539
00:24:20,023 --> 00:24:24,201
They say that they represent
patients, consumers,

540
00:24:24,245 --> 00:24:27,291
but they never say
anything about drug prices

541
00:24:27,335 --> 00:24:28,989
because they're
getting so much money

542
00:24:29,032 --> 00:24:30,686
from the drug companies.

543
00:24:30,730 --> 00:24:33,559
The other things that was
resonated for me the most

544
00:24:33,602 --> 00:24:36,431
when I started covering
healthcare was seeing the list

545
00:24:36,475 --> 00:24:38,825
of the countries that spend
the most on healthcare

546
00:24:38,868 --> 00:24:41,915
and the countries that
have the sickest people.

547
00:24:41,958 --> 00:24:44,831
And we spend the
most and among the

548
00:24:44,874 --> 00:24:47,486
developed countries, we
have the sickest people.

549
00:24:47,529 --> 00:24:49,705
So there's gotta be
a better way to do it

550
00:24:49,749 --> 00:24:51,402
and one of the things
the other countries

551
00:24:51,446 --> 00:24:55,363
are doing much better is
offering social services.

552
00:24:55,406 --> 00:24:57,887
- Profit motive is really
broken in healthcare

553
00:24:57,931 --> 00:25:00,586
because what you
want is a doctor,

554
00:25:00,629 --> 00:25:04,590
patient relationship where
the patient is the client

555
00:25:04,633 --> 00:25:07,201
and therefore the hospital
and the insurance company

556
00:25:07,244 --> 00:25:11,379
and the employer are all
focused on treating the patient.

557
00:25:11,422 --> 00:25:12,902
And in this case they're not,

558
00:25:12,946 --> 00:25:14,904
they're all focused
on saving money

559
00:25:14,948 --> 00:25:16,819
for whoever the payer is.

560
00:25:17,951 --> 00:25:19,822
- The number of times
you go to the doctor,

561
00:25:19,866 --> 00:25:22,869
the number of tests and
services that they order

562
00:25:22,912 --> 00:25:23,826
and that they run,

563
00:25:23,870 --> 00:25:25,175
the more often they're paid.

564
00:25:25,219 --> 00:25:29,310
And there was no incentive
to keep costs down

565
00:25:29,353 --> 00:25:31,530
because the more
treatment you provide,

566
00:25:31,573 --> 00:25:32,835
the more you're
going to be paid.

567
00:25:32,879 --> 00:25:34,489
We are moving away from that.

568
00:25:34,533 --> 00:25:37,797
We're moving to a value-based
reimbursement society

569
00:25:37,840 --> 00:25:40,756
where you're expected to
provide high quality care

570
00:25:40,800 --> 00:25:42,584
at the lowest possible cost.

571
00:25:42,628 --> 00:25:44,499
Currently when you
go to the doctor

572
00:25:44,543 --> 00:25:46,936
and you end up having a surgery,

573
00:25:46,980 --> 00:25:48,895
you'll get seven different
bills in the mail.

574
00:25:48,938 --> 00:25:50,592
You'll get one from the surgeon,

575
00:25:50,636 --> 00:25:52,072
one from the primary
care physician,

576
00:25:52,115 --> 00:25:53,595
one from the anesthesiologist,

577
00:25:53,639 --> 00:25:54,857
one from the people
who took your blood,

578
00:25:54,901 --> 00:25:55,728
one from the X-ray,

579
00:25:55,771 --> 00:25:57,425
on and on it goes.

580
00:25:57,468 --> 00:25:59,906
And in the past they
haven't coordinated as well

581
00:25:59,949 --> 00:26:02,517
as they possibly could
have so there was a lack

582
00:26:02,561 --> 00:26:04,519
of coordination, a
lack of cost control,

583
00:26:04,563 --> 00:26:06,913
and again, no incentive
to keep costs down

584
00:26:06,956 --> 00:26:10,830
because you're reimbursed
based upon the volume of care,

585
00:26:10,873 --> 00:26:12,788
not the quality of care.

586
00:26:12,832 --> 00:26:14,921
So the way you solve
the problem of cost

587
00:26:14,964 --> 00:26:18,620
in part is by cracking
that part of the system,

588
00:26:18,664 --> 00:26:21,710
getting in to value-based
arrangements where people,

589
00:26:21,754 --> 00:26:24,844
physicians, providers
are reimbursed based

590
00:26:24,887 --> 00:26:26,585
upon the quality of care,

591
00:26:26,628 --> 00:26:28,587
not the quantity of
care that's offered.

592
00:26:29,762 --> 00:26:31,546
People have taken a
step back to think,

593
00:26:31,590 --> 00:26:34,244
well, I'm more comfortable
with government intervention

594
00:26:34,288 --> 00:26:35,942
in the healthcare
system because none

595
00:26:35,985 --> 00:26:38,727
of those bad things I was
told were going to happen

596
00:26:38,771 --> 00:26:40,337
have actually happened.

597
00:26:40,381 --> 00:26:43,906
So the debate today is framed
by a much greater acceptance

598
00:26:43,950 --> 00:26:45,734
in the public of
government intervention

599
00:26:45,778 --> 00:26:47,127
in the healthcare system.

600
00:26:47,170 --> 00:26:49,912
So when a candidate talks
about Medicare for All

601
00:26:49,956 --> 00:26:51,522
or single-payer
healthcare system

602
00:26:51,566 --> 00:26:53,916
there are policy
implications to that,

603
00:26:53,960 --> 00:26:55,178
when you dig deeper,

604
00:26:55,222 --> 00:26:56,658
that may concern the public.

605
00:26:56,702 --> 00:26:59,661
But the theory of it is
not nearly as concerning

606
00:26:59,705 --> 00:27:01,881
to the public as it
has been in the past.

607
00:27:02,751 --> 00:27:05,449
Regulatory capture
is an economic theory

608
00:27:05,493 --> 00:27:09,366
that was put forward by
George Stigler in 1971,

609
00:27:09,410 --> 00:27:11,717
Nobel Prize winning economist.

610
00:27:11,760 --> 00:27:14,850
And he argued that
it was possible

611
00:27:14,894 --> 00:27:17,592
within a regulated
environment for the industry

612
00:27:17,636 --> 00:27:19,028
that was being regulated

613
00:27:19,072 --> 00:27:21,988
to control the
regulatory authority.

614
00:27:22,031 --> 00:27:25,644
So the theory of regulatory
capture is exactly that,

615
00:27:25,687 --> 00:27:28,124
that you have entities
that are being regulated,

616
00:27:28,168 --> 00:27:30,736
that through campaign
contributions,

617
00:27:30,779 --> 00:27:33,086
through political and
other public activities

618
00:27:33,129 --> 00:27:36,916
gain a dominance within the
regulatory authority over

619
00:27:36,959 --> 00:27:38,831
which they're being regulated.

620
00:27:38,874 --> 00:27:41,747
Regulatory capture
in the healthcare

621
00:27:41,790 --> 00:27:43,705
let's say, the
prescription drug market,

622
00:27:43,749 --> 00:27:46,229
where the Food and Drug
Administration looks first

623
00:27:46,273 --> 00:27:49,232
to the pharmaceutical companies
and asks their opinion

624
00:27:49,276 --> 00:27:52,540
of things before they make
a determination on drugs.

625
00:27:52,583 --> 00:27:54,977
The same would go for
healthcare providers.

626
00:27:55,021 --> 00:28:00,809
And the issue with the theory
of regulatory capture is,

627
00:28:00,853 --> 00:28:04,813
I think, the view that in
all cases it's gonna lead

628
00:28:04,857 --> 00:28:06,032
to bad outcomes.

629
00:28:06,075 --> 00:28:07,990
You have people who
are making decisions

630
00:28:08,034 --> 00:28:11,211
that are not in the public's
best interest based upon

631
00:28:11,254 --> 00:28:14,736
an industry dominance
of the regulatory body.

632
00:28:14,780 --> 00:28:17,826
I get asked all the time from
my experience at Washington,

633
00:28:17,870 --> 00:28:20,742
what are the most
powerful lobbying groups

634
00:28:20,786 --> 00:28:22,265
that you see in Washington?

635
00:28:22,309 --> 00:28:24,311
And clearly the gun industry,

636
00:28:24,354 --> 00:28:25,834
the Israel lobby,

637
00:28:25,878 --> 00:28:28,271
the AARP, the seniors lobby,

638
00:28:28,315 --> 00:28:31,057
they're all in and of
themselves very powerful.

639
00:28:31,100 --> 00:28:32,449
But as a group,

640
00:28:32,493 --> 00:28:35,888
as an industry no
group yields more power

641
00:28:35,931 --> 00:28:37,890
or participates more forcefully

642
00:28:37,933 --> 00:28:40,631
in the advocacy process than
the healthcare industry.

643
00:28:40,675 --> 00:28:43,765
You have the pharmaceutical
companies, Big Pharma,

644
00:28:43,809 --> 00:28:46,159
you have the
generic drug makers,

645
00:28:46,202 --> 00:28:48,465
you have the pharmaceutical
distributors,

646
00:28:48,509 --> 00:28:50,163
you have the hospitals,

647
00:28:50,206 --> 00:28:51,599
you have the physicians,

648
00:28:51,642 --> 00:28:53,557
you have the medical
device industry,

649
00:28:53,601 --> 00:28:54,733
you have consumers,

650
00:28:54,776 --> 00:28:56,212
you have all sides.

651
00:28:56,256 --> 00:28:58,693
There are probably
hundreds of people sitting

652
00:28:58,737 --> 00:29:00,782
around their kitchen tables
all across the country

653
00:29:00,826 --> 00:29:03,916
with the bills out looking
at their healthcare expenses,

654
00:29:03,959 --> 00:29:05,700
thinking about what
it means for them?

655
00:29:05,744 --> 00:29:07,920
It's the largest
driver of bankruptcies,

656
00:29:07,963 --> 00:29:10,313
of any issue in the country.

657
00:29:10,357 --> 00:29:12,881
20% of our GDP
goes to healthcare.

658
00:29:12,925 --> 00:29:15,623
The money that's
involved in healthcare

659
00:29:15,666 --> 00:29:18,757
in this country leads to
a huge public discussion

660
00:29:18,800 --> 00:29:20,802
about the future of
our healthcare system.

661
00:29:20,846 --> 00:29:23,283
The problem with the
perception people have

662
00:29:23,326 --> 00:29:26,112
of lobbying within the
healthcare industry is the money

663
00:29:26,155 --> 00:29:28,767
that gets spent to
influence outcomes,

664
00:29:28,810 --> 00:29:30,377
and that's when you
run into the danger

665
00:29:30,420 --> 00:29:32,814
of not having the most
effective outcome.

666
00:29:34,163 --> 00:29:35,991
- I think we need
very strong leadership

667
00:29:36,035 --> 00:29:37,123
in some of these areas,

668
00:29:37,166 --> 00:29:39,386
just basic things
that we used to do

669
00:29:39,429 --> 00:29:42,171
that we're not
doing anymore, why?

670
00:29:42,215 --> 00:29:43,738
If they get sick,

671
00:29:43,782 --> 00:29:46,872
if the thems get sick they
expose the uses to getting sick

672
00:29:46,915 --> 00:29:50,223
and that's not really
looked at today anymore.

673
00:29:50,266 --> 00:29:53,922
So I think we need some strong
leadership in Washington,

674
00:29:53,966 --> 00:29:56,882
people to speak out the way
they used to speak out and say,

675
00:29:56,925 --> 00:29:57,970
this just isn't right.

676
00:29:58,013 --> 00:29:59,406
- In the Senate,

677
00:29:59,449 --> 00:30:02,844
most of the senators have
issue-driven staffers.

678
00:30:02,888 --> 00:30:05,934
So they'll have somebody
dedicated solely to healthcare,

679
00:30:05,978 --> 00:30:08,632
somebody dedicated
solely to taxes,

680
00:30:08,676 --> 00:30:10,983
somebody dedicated solely
to foreign affairs.

681
00:30:11,026 --> 00:30:13,724
In the House generally
there are three people

682
00:30:13,768 --> 00:30:15,509
with a portfolio of issues,

683
00:30:15,552 --> 00:30:18,599
domestic policy which includes
healthcare, education,

684
00:30:18,642 --> 00:30:19,948
social security, those issues,

685
00:30:19,992 --> 00:30:23,343
a budget person that
looks at budget and taxes,

686
00:30:23,386 --> 00:30:26,041
and a foreign affairs person
that looks at the military

687
00:30:26,085 --> 00:30:28,609
and trade in foreign
affairs issues.

688
00:30:28,652 --> 00:30:31,481
And the problem is
there's sometimes a lack

689
00:30:31,525 --> 00:30:33,832
of coordination
between the policies

690
00:30:33,875 --> 00:30:36,312
because when you deal with
healthcare you're dealing

691
00:30:36,356 --> 00:30:38,271
with the tax system
in this country.

692
00:30:38,314 --> 00:30:41,622
You're not just dealing
with providing healthcare,

693
00:30:41,665 --> 00:30:43,885
you're dealing with how
you pay for it as well,

694
00:30:43,929 --> 00:30:46,801
and if the Congressional Office
doesn't deal with that well

695
00:30:46,845 --> 00:30:48,629
they lose part of that debate.

696
00:30:48,672 --> 00:30:50,022
And that's why it's so difficult

697
00:30:50,065 --> 00:30:54,156
to have healthcare reform
discussed in those silos

698
00:30:54,200 --> 00:30:55,810
of how are we gonna pay for it,

699
00:30:55,854 --> 00:30:58,900
what's the level of care and
what's the quality of care?

700
00:30:58,944 --> 00:31:01,163
You really do have to
look at it all together

701
00:31:01,207 --> 00:31:03,078
and that's difficult
to do with an issue

702
00:31:03,122 --> 00:31:05,124
that's as big as healthcare.

703
00:31:05,167 --> 00:31:06,777
[dramatic upbeat music]

704
00:31:06,821 --> 00:31:07,909
- I'm here in McLean,

705
00:31:07,953 --> 00:31:10,303
surrounded by some
of the biggest,

706
00:31:10,346 --> 00:31:12,044
most expensive houses
you've ever seen

707
00:31:12,087 --> 00:31:14,829
and they're owned by
people who are lobbyists

708
00:31:14,873 --> 00:31:19,007
so there's a lot of corporate
interests at play here.

709
00:31:19,051 --> 00:31:21,227
Even if you don't care
about these people,

710
00:31:21,270 --> 00:31:22,837
you are paying for them

711
00:31:22,881 --> 00:31:25,318
and economically it
doesn't make sense

712
00:31:25,361 --> 00:31:28,887
for them to not have
care, covered care.

713
00:31:28,930 --> 00:31:31,759
- If you don't have the
support of the American people

714
00:31:31,802 --> 00:31:33,848
behind you it is gonna
be very difficult

715
00:31:33,892 --> 00:31:34,980
to pass legislation.

716
00:31:35,023 --> 00:31:38,809
When people come in and you as

717
00:31:38,853 --> 00:31:40,115
the people who are
setting the budget

718
00:31:40,159 --> 00:31:42,422
for the country it's
a zero sum game.

719
00:31:42,465 --> 00:31:44,163
And you have to decide this year

720
00:31:44,206 --> 00:31:47,862
are we gonna spend more
money on MS or Alzheimer's

721
00:31:47,906 --> 00:31:52,911
or cancer or HIV or
diabetes or heart disease?

722
00:31:52,954 --> 00:31:55,304
How are we gonna spread
that money around?

723
00:31:55,348 --> 00:31:58,917
And that is so powerful and
that's why healthcare is unique.

724
00:31:58,960 --> 00:32:01,180
And for all the
money that's spent

725
00:32:01,223 --> 00:32:03,356
on lobbying in this country,

726
00:32:03,399 --> 00:32:05,445
that's what wins the day.

727
00:32:05,488 --> 00:32:06,707
It's not money,

728
00:32:06,750 --> 00:32:08,752
it's the face of the
people that are impacted

729
00:32:08,796 --> 00:32:09,928
by healthcare the most.

730
00:32:12,191 --> 00:32:15,629
[upbeat humming music]

731
00:32:21,896 --> 00:32:24,203
- [Narrator] With over a
trillion dollar deficit

732
00:32:24,246 --> 00:32:27,597
and the national debt
exceeding $23 trillion dollars,

733
00:32:27,641 --> 00:32:31,732
can the economy withstand the
cost of universal healthcare

734
00:32:31,775 --> 00:32:35,040
with unchecked spending?

735
00:32:35,083 --> 00:32:36,258
- My name's Carl Asche.

736
00:32:36,302 --> 00:32:38,173
I'm a PhD economist.

737
00:32:38,217 --> 00:32:41,829
I've been working in
healthcare economics

738
00:32:41,872 --> 00:32:43,352
for all of my career.

739
00:32:43,396 --> 00:32:46,268
A lot of us endure what I
call is financial toxicity.

740
00:32:46,312 --> 00:32:48,792
Healthcare in itself is very
expensive in our country

741
00:32:48,836 --> 00:32:52,361
and I'm not always confident
that it's being spent

742
00:32:52,405 --> 00:32:54,755
in the most appropriate manner.

743
00:32:54,798 --> 00:32:58,280
The United States spent
roughly $3.65 trillion

744
00:32:58,324 --> 00:32:59,803
on healthcare services,

745
00:32:59,847 --> 00:33:02,806
which represents a 4.4% increase

746
00:33:02,850 --> 00:33:04,939
from the year before in 2017.

747
00:33:04,983 --> 00:33:07,289
The quality of healthcare
and related services,

748
00:33:07,333 --> 00:33:09,291
are they justified by the costs?

749
00:33:11,990 --> 00:33:15,776
- My name's Ken Kies and I'm a
tax lawyer in Washington, DC.

750
00:33:15,819 --> 00:33:18,561
[dramatic upbeat music]

751
00:33:18,605 --> 00:33:21,651
One might wonder as you
think about what we do

752
00:33:21,695 --> 00:33:25,003
in healthcare currently and
social security and so on,

753
00:33:25,046 --> 00:33:27,179
what about the debt we
already have accrued?

754
00:33:27,222 --> 00:33:28,963
For millennials in particular,

755
00:33:29,007 --> 00:33:33,663
the 23 trillion total government
debt that we currently

756
00:33:33,707 --> 00:33:37,015
have should be alarming
because we're adding

757
00:33:37,058 --> 00:33:38,799
about a trillion a year to it.

758
00:33:38,842 --> 00:33:42,281
And the problem is at
the political level

759
00:33:42,324 --> 00:33:44,631
almost no one is talking
about it anymore,

760
00:33:44,674 --> 00:33:47,068
and to me that's more
alarming than ever.

761
00:33:47,112 --> 00:33:49,331
And it's both Democrats
and Republicans.

762
00:33:49,375 --> 00:33:53,379
It's as if it doesn't exist
and yet for young people,

763
00:33:53,422 --> 00:33:54,945
the millennial generation,

764
00:33:54,989 --> 00:33:56,730
they're being stuck with it.

765
00:33:56,773 --> 00:33:58,906
That's a big change from, say,

766
00:33:58,949 --> 00:34:00,734
when I was at the
Joint Committee in '97

767
00:34:00,777 --> 00:34:04,999
and we did the '97 budget deal
which was a bipartisan deal

768
00:34:05,043 --> 00:34:06,218
between Bill Clinton,

769
00:34:06,261 --> 00:34:07,697
a Democrat president,

770
00:34:07,741 --> 00:34:11,223
Newt Gingrich, the Sepublican
Speaker of the House,

771
00:34:11,266 --> 00:34:12,876
did a deal.

772
00:34:12,920 --> 00:34:15,749
We balanced the budget and
paid off half a trillion

773
00:34:15,792 --> 00:34:18,578
of debt by 9.11, 2001.

774
00:34:18,621 --> 00:34:21,581
Most people can't even
imagine paying off any debt

775
00:34:21,624 --> 00:34:24,627
at this point and so we're
adding a trillion a year

776
00:34:24,671 --> 00:34:27,717
under our current
spending levels.

777
00:34:27,761 --> 00:34:30,198
So when we think
about spending more

778
00:34:30,242 --> 00:34:31,330
at the federal government level,

779
00:34:31,373 --> 00:34:32,809
no matter what
you're talking about,

780
00:34:32,853 --> 00:34:35,769
you have to realize we
already have an enormous debt

781
00:34:35,812 --> 00:34:39,251
and it should be something
that scares everyone.

782
00:34:41,166 --> 00:34:43,733
What's the bad news for
millennials who are concerned

783
00:34:43,777 --> 00:34:46,606
about paying $1,000 a
month for health insurance?

784
00:34:46,649 --> 00:34:50,871
The bad news is most people
like their health insurance

785
00:34:50,914 --> 00:34:52,264
because they like healthcare.

786
00:34:52,307 --> 00:34:55,919
What other countries
have done to lower costs

787
00:34:55,963 --> 00:34:59,140
is something that Americans
are not prepared to do,

788
00:34:59,184 --> 00:35:00,881
which is ration healthcare.

789
00:35:00,924 --> 00:35:02,187
That's what the UK does.

790
00:35:02,230 --> 00:35:03,710
That's what Canada does.

791
00:35:03,753 --> 00:35:06,539
Americans have come
to really expect

792
00:35:06,582 --> 00:35:10,717
that they're gonna have
healthcare relatively on demand.

793
00:35:10,760 --> 00:35:14,024
They don't like sitting in
emergency rooms waiting.

794
00:35:14,068 --> 00:35:18,159
It's a real dilemma that
we face because we like

795
00:35:18,203 --> 00:35:21,597
what we have but we don't
like what we're paying for it.

796
00:35:21,641 --> 00:35:24,600
So the question is do we
wanna give up what we have

797
00:35:24,644 --> 00:35:27,429
or do we wanna find
somebody else to pay for it?

798
00:35:27,473 --> 00:35:30,040
And the problem is the
somebody else is gonna

799
00:35:30,084 --> 00:35:32,869
be the millennials too
because it's gonna come

800
00:35:32,913 --> 00:35:34,001
in the form of taxes.

801
00:35:34,044 --> 00:35:36,917
For employers providing
health insurance

802
00:35:36,960 --> 00:35:38,788
it's a deductible expense,

803
00:35:38,832 --> 00:35:41,051
which of course makes sense
because it's part of the cost

804
00:35:41,095 --> 00:35:42,488
of employing people.

805
00:35:42,531 --> 00:35:44,881
So there's a lot of interactions
with the tax system,

806
00:35:44,925 --> 00:35:48,450
both individual income
tax and corporate tax,

807
00:35:48,494 --> 00:35:51,845
that are relate to the health
insurance system that we have.

808
00:35:51,888 --> 00:35:55,675
Corporate taxes only produce
about 200 billion a year

809
00:35:55,718 --> 00:36:00,680
of revenues out of multiple
trillions that we collect.

810
00:36:00,723 --> 00:36:03,683
Our tax system basically
collects money from individuals

811
00:36:03,726 --> 00:36:07,643
in the form of social security
taxes and income taxes.

812
00:36:07,687 --> 00:36:09,428
That's where most of
the money comes from.

813
00:36:09,471 --> 00:36:11,908
The estate tax which
gets a lot of attention

814
00:36:11,952 --> 00:36:14,998
because it's a tax on people
when they're wealthy and die,

815
00:36:15,042 --> 00:36:16,870
it doesn't produce
that much money either.

816
00:36:16,913 --> 00:36:18,915
There are no easy
answers here in terms

817
00:36:18,959 --> 00:36:21,614
of changing the status
quo to something

818
00:36:21,657 --> 00:36:24,660
that's more acceptable because
people like their healthcare.

819
00:36:25,487 --> 00:36:28,621
- Modern monetary theory
in a nutshell says

820
00:36:28,664 --> 00:36:30,492
that the government can
print as much currency

821
00:36:30,536 --> 00:36:33,756
as it wants and there will
never be any net effect

822
00:36:33,800 --> 00:36:36,106
on purchasing power
of that currency.

823
00:36:36,150 --> 00:36:38,892
Meaning that lots of free
stuff can be promised

824
00:36:38,935 --> 00:36:40,937
to everyone whether
it be college,

825
00:36:40,981 --> 00:36:43,244
medical services, jobs,

826
00:36:43,288 --> 00:36:47,770
food, housing and anything else
the general populace demands

827
00:36:47,814 --> 00:36:48,858
from the government.

828
00:36:48,902 --> 00:36:50,556
So if they print
100 currency units,

829
00:36:50,599 --> 00:36:52,949
they just tax the
rich the same amount.

830
00:36:52,993 --> 00:36:55,909
So 100 goes in
and 100 comes out.

831
00:36:55,952 --> 00:36:58,085
And their way of thinking
is a simple transaction

832
00:36:58,128 --> 00:36:59,913
and the net cost is a wash.

833
00:36:59,956 --> 00:37:03,743
However, history tells us
this is never what happens.

834
00:37:03,786 --> 00:37:05,832
Every flat currency in
the world in the course

835
00:37:05,875 --> 00:37:07,137
of the last hundred years

836
00:37:07,181 --> 00:37:10,271
that disappeared
suffered its demise

837
00:37:10,315 --> 00:37:11,838
because of this very theory.

838
00:37:11,881 --> 00:37:14,275
This can be summed up that
there is a limited amount

839
00:37:14,319 --> 00:37:17,060
of wealth but an unlimited
number of currency units.

840
00:37:17,104 --> 00:37:19,976
Modern monetary theory
is the road being paved

841
00:37:20,020 --> 00:37:21,021
to economic health.

842
00:37:22,414 --> 00:37:23,937
- You know, there's
a lot of proposals

843
00:37:23,980 --> 00:37:26,374
that are being made by various
presidential candidates

844
00:37:26,418 --> 00:37:29,769
to expand the role of government
in healthcare, for example.

845
00:37:29,812 --> 00:37:33,163
And so that does raise
the question of do we have

846
00:37:33,207 --> 00:37:35,862
to worry about what
government's already providing

847
00:37:35,905 --> 00:37:37,080
and can we afford it?

848
00:37:37,124 --> 00:37:39,344
The social security
system, for example,

849
00:37:39,387 --> 00:37:42,303
we know by about 2032 or 2033,

850
00:37:42,347 --> 00:37:43,783
which is not far away,

851
00:37:43,826 --> 00:37:46,699
it is gonna hit a point where
there's no reserves left

852
00:37:46,742 --> 00:37:48,309
in the social
security trust fund

853
00:37:48,353 --> 00:37:50,877
and incoming taxes
will only be adequate

854
00:37:50,920 --> 00:37:53,140
to pay 70% of benefits.

855
00:37:53,183 --> 00:37:54,707
Now, that's a horrific thought

856
00:37:54,750 --> 00:37:58,188
that we're gonna cut social
security benefits 30%,

857
00:37:58,232 --> 00:38:00,147
that's just not gonna happen.

858
00:38:00,190 --> 00:38:04,891
So we already know that
we have other demands

859
00:38:04,934 --> 00:38:07,110
that we're gonna have to
fund one way or another,

860
00:38:07,154 --> 00:38:09,852
without expanding
existing programs.

861
00:38:09,896 --> 00:38:11,071
That's part of what we have

862
00:38:11,114 --> 00:38:14,335
to think about as we
consider whether to,

863
00:38:14,379 --> 00:38:15,902
for example, expand healthcare

864
00:38:15,945 --> 00:38:17,599
that's provided by
the federal government

865
00:38:17,643 --> 00:38:20,950
because we already know that
we have obligations staring us

866
00:38:20,994 --> 00:38:23,823
in the face within
a decade or so

867
00:38:23,866 --> 00:38:26,913
that are gonna demand
enormous resources.

868
00:38:28,001 --> 00:38:30,482
A reasonable question
one might pose is,

869
00:38:30,525 --> 00:38:33,311
can we improve the healthcare
system by taking money

870
00:38:33,354 --> 00:38:34,877
that we're already spending

871
00:38:34,921 --> 00:38:37,706
at the federal government
level and spend it

872
00:38:37,750 --> 00:38:40,143
on healthcare rather than where
we're spending it currently?

873
00:38:40,187 --> 00:38:42,972
If you walk out and interview
20 people on the street

874
00:38:43,016 --> 00:38:45,018
and say where should
we cut spending?

875
00:38:45,061 --> 00:38:47,847
They will all say get
rid of foreign aid.

876
00:38:47,890 --> 00:38:51,198
Foreign aid represents
such a minor part

877
00:38:51,241 --> 00:38:55,245
of the federal government
spending that it's barely a blip

878
00:38:55,289 --> 00:38:59,119
in terms of the total that
the federal government spends.

879
00:38:59,162 --> 00:39:01,730
You have to realize what
the federal government is,

880
00:39:01,774 --> 00:39:04,951
it's an insurance
company with an army.

881
00:39:04,994 --> 00:39:06,126
And when I say that,

882
00:39:06,169 --> 00:39:08,911
what I mean is the
three biggest pieces

883
00:39:08,955 --> 00:39:10,783
of the federal government
aren't social security,

884
00:39:10,826 --> 00:39:13,916
Medicare and
Medicaid and defense.

885
00:39:13,960 --> 00:39:18,573
You add interest on the
national debt and you have 80%,

886
00:39:18,617 --> 00:39:21,271
90% of total federal
government spending.

887
00:39:21,315 --> 00:39:24,797
So then what that means is
if you wannna reallocate,

888
00:39:24,840 --> 00:39:27,669
you would have to take
money from defense

889
00:39:27,713 --> 00:39:29,367
and spend it on healthcare

890
00:39:29,410 --> 00:39:30,803
because that's
where the money is.

891
00:39:30,846 --> 00:39:34,023
Everything else
is small potatoes.

892
00:39:34,067 --> 00:39:35,895
- Coverage of healthcare
in the context

893
00:39:35,938 --> 00:39:39,202
of the 2020 Democratic
presidential campaign amounts

894
00:39:39,246 --> 00:39:41,857
to asking a yes or a no
question about support

895
00:39:41,901 --> 00:39:43,119
for Medicare For All.

896
00:39:43,163 --> 00:39:45,383
The Medicare for All
crowd accuses the others

897
00:39:45,426 --> 00:39:47,123
of being incrementalists.

898
00:39:47,167 --> 00:39:48,995
And the Medicare
For All critics say

899
00:39:49,038 --> 00:39:51,737
that this is the pie in the
sky stuff that won't work.

900
00:39:51,780 --> 00:39:54,174
What's missing here is any
deep analysis of the cost

901
00:39:54,217 --> 00:39:56,089
and feasibility of
Medicare For All,

902
00:39:56,132 --> 00:39:57,395
and more important,

903
00:39:57,438 --> 00:39:59,397
what some of the
alternatives might look like?

904
00:39:59,440 --> 00:40:02,443
So unless the candidates can
get beyond the talking points

905
00:40:02,487 --> 00:40:05,968
to connect their plans to
these pocketbook concerns,

906
00:40:06,012 --> 00:40:08,580
any plan will have trade
offs and landmines.

907
00:40:08,623 --> 00:40:11,496
More healthcare costs
more and we have to decide

908
00:40:11,539 --> 00:40:12,410
how to pay for it?

909
00:40:15,238 --> 00:40:17,806
- The thing about
healthcare also,

910
00:40:17,850 --> 00:40:19,939
that people like the
healthcare they have,

911
00:40:19,982 --> 00:40:20,896
they expect to get it.

912
00:40:20,940 --> 00:40:22,158
And you might say, well,

913
00:40:22,202 --> 00:40:23,725
we're spending too much
money on healthcare.

914
00:40:23,769 --> 00:40:25,945
That's a pretty common
notion that you hear.

915
00:40:25,988 --> 00:40:29,209
The rest of the world
spends 15% on healthcare,

916
00:40:29,252 --> 00:40:30,123
10% on healthcare,

917
00:40:30,166 --> 00:40:31,646
why are we spending 20%?

918
00:40:31,690 --> 00:40:34,040
Well, it's one way
to spend our money.

919
00:40:34,083 --> 00:40:36,346
We could be spending
it on alcohol,

920
00:40:36,390 --> 00:40:37,739
which I'm okay with.

921
00:40:37,783 --> 00:40:39,393
It's not the worst
thing in the world

922
00:40:39,437 --> 00:40:41,830
to be spending money on which
is to provide good healthcare.

923
00:40:41,874 --> 00:40:45,704
And there's a reason many
people around the world come

924
00:40:45,747 --> 00:40:47,923
to the United States to
the Cleveland Clinic,

925
00:40:47,967 --> 00:40:49,490
the Mayo to you-name-it,

926
00:40:49,534 --> 00:40:51,971
it's 'cause we provide the
best healthcare in the world.

927
00:40:53,059 --> 00:40:55,975
There are reasons that the
current system actually

928
00:40:56,018 --> 00:40:58,804
has a lot to be said for it.

929
00:40:58,847 --> 00:41:00,849
- It is clear that
the healthcare system

930
00:41:00,893 --> 00:41:02,808
in the United States needs
to change in the future,

931
00:41:02,851 --> 00:41:04,940
to limit spending while
maintaining quality

932
00:41:04,984 --> 00:41:06,464
and expanding access.

933
00:41:06,507 --> 00:41:09,118
For us to get to the point
where we can show the impact

934
00:41:09,162 --> 00:41:11,120
of a alternate payment plan,

935
00:41:11,164 --> 00:41:15,516
improving our economy and the
quality care for our patients

936
00:41:15,560 --> 00:41:17,039
we need better data.

937
00:41:17,083 --> 00:41:20,042
A lot of these proposals
are wonderful in the sense

938
00:41:20,086 --> 00:41:24,482
that they offer us hope
that money will be saved.

939
00:41:24,525 --> 00:41:25,657
But at the end of the day,

940
00:41:25,700 --> 00:41:28,747
I still worry about
the quality of care.

941
00:41:28,790 --> 00:41:30,792
Affordable healthcare
as I understand it

942
00:41:30,836 --> 00:41:34,927
is something we
all aspire towards.

943
00:41:34,970 --> 00:41:36,972
The path to getting
there is convoluted.

944
00:41:37,016 --> 00:41:39,845
The sheer magnitude of what
we're experiencing now,

945
00:41:39,888 --> 00:41:44,197
which is roughly $3.65
trillion is daunting in itself.

946
00:41:44,240 --> 00:41:45,938
These facts speak
for themselves.

947
00:41:45,981 --> 00:41:47,635
We have a real issue here.

948
00:41:48,549 --> 00:41:53,423
- Imagine that we were to
experience another ramp up

949
00:41:53,467 --> 00:41:57,297
in interest rates like we
experienced in the 1980 period,

950
00:41:57,340 --> 00:41:58,341
which by the way,

951
00:41:58,385 --> 00:41:59,691
happened in like
a two-year period.

952
00:41:59,734 --> 00:42:01,693
It would mean our borrowing
costs would triple

953
00:42:01,736 --> 00:42:05,523
but nobody seems to care
and people keep talking

954
00:42:05,566 --> 00:42:08,482
about an inflation as
being a consequence of this

955
00:42:08,526 --> 00:42:11,441
and yet inflation has
been astonishingly low

956
00:42:11,485 --> 00:42:13,443
for a number of years now.

957
00:42:13,487 --> 00:42:16,359
But I personally believe that
there is a point out there

958
00:42:16,403 --> 00:42:18,884
and I don't know where it is
or when it's gonna happen,

959
00:42:18,927 --> 00:42:21,756
when there's gonna be a
consequence to all of this.

960
00:42:21,800 --> 00:42:24,106
It just seems to me you
can't borrow this kind

961
00:42:24,150 --> 00:42:25,847
of money indefinitely without

962
00:42:25,891 --> 00:42:28,197
having some significant impact.

963
00:42:28,241 --> 00:42:30,591
- There's a storm brewing
and quite honestly,

964
00:42:30,635 --> 00:42:31,810
we can't afford this.

965
00:42:31,853 --> 00:42:33,289
It's totally out of
control, it's crazy.

966
00:42:33,333 --> 00:42:35,553
[dramatic music]

967
00:42:35,596 --> 00:42:36,858
- One of the things

968
00:42:36,902 --> 00:42:38,817
when I started covering
the Affordable Care Act

969
00:42:38,860 --> 00:42:39,861
and through now,

970
00:42:39,905 --> 00:42:41,863
one of the things
I've noticed is

971
00:42:41,907 --> 00:42:45,650
that just as it's
wonderful that people

972
00:42:45,693 --> 00:42:49,479
in Downtown Washington where
I work with kids of color,

973
00:42:49,523 --> 00:42:51,003
teaching them health reporting,

974
00:42:51,046 --> 00:42:54,746
just as they have insurance
now it's not doing as much

975
00:42:54,789 --> 00:42:56,269
for them as it should be doing,

976
00:42:56,312 --> 00:42:59,185
just as the people that
I hear from all the time

977
00:42:59,228 --> 00:43:02,797
who are self-employed say it's
not doing enough for them.

978
00:43:02,841 --> 00:43:05,234
They might as well have
catastrophic insurance.

979
00:43:05,278 --> 00:43:07,410
They can't afford
to go to the doctor.

980
00:43:08,586 --> 00:43:09,891
- Obamacare, the
Affordable Care Act

981
00:43:09,935 --> 00:43:13,025
has had a real significant
impact on people.

982
00:43:13,068 --> 00:43:15,636
People don't have to worry
about not being insured.

983
00:43:15,680 --> 00:43:18,247
I don't think I know
anybody who doesn't

984
00:43:18,291 --> 00:43:19,727
have a pre existing condition.

985
00:43:19,771 --> 00:43:21,816
I mean, in my world with
people with disabilities,

986
00:43:21,860 --> 00:43:23,775
there are a lot of
people with disabilities

987
00:43:23,818 --> 00:43:27,430
who if they didn't have
Medicaid or Medicare,

988
00:43:27,474 --> 00:43:29,824
would not have
coverage for, say,

989
00:43:29,868 --> 00:43:31,783
they needed a wheelchair
or they need physical

990
00:43:31,826 --> 00:43:34,394
or occupational therapy
because maybe something

991
00:43:34,437 --> 00:43:36,788
is becoming weaker
or there's something

992
00:43:36,831 --> 00:43:38,224
that needs to be fine tuned.

993
00:43:38,267 --> 00:43:41,836
- Politically, I listen
to a lot of people talk

994
00:43:41,880 --> 00:43:43,359
about Medicare for All.

995
00:43:43,403 --> 00:43:45,971
I don't think there's enough
people that are willing

996
00:43:46,014 --> 00:43:49,365
to give up their commercial
insurance that they like.

997
00:43:49,409 --> 00:43:51,933
I happen to have commercial
insurance that I like.

998
00:43:51,977 --> 00:43:57,460
I don't love the network
but I like it and if I were

999
00:43:57,504 --> 00:44:02,509
to have fewer choices I'd
be very unhappy of doctors.

1000
00:44:02,552 --> 00:44:04,076
So I do,

1001
00:44:04,119 --> 00:44:08,558
I think there's a tremendous
benefit in having everybody,

1002
00:44:09,951 --> 00:44:12,432
particularly the less
fortunate and the sicker,

1003
00:44:12,475 --> 00:44:15,261
have access to healthcare
that is affordable,

1004
00:44:15,304 --> 00:44:17,872
if not free is great.

1005
00:44:18,830 --> 00:44:20,919
- There is a lack of
understanding about healthcare

1006
00:44:20,962 --> 00:44:22,485
and payment options.

1007
00:44:22,529 --> 00:44:24,705
Every time I hear Medicare
for All I get a little scared

1008
00:44:24,749 --> 00:44:29,623
because there's a difference
between Medicare and Medicaid.

1009
00:44:29,667 --> 00:44:32,887
The financing end is one
but I'm most interested

1010
00:44:32,931 --> 00:44:34,062
in the services provided.

1011
00:44:34,106 --> 00:44:35,585
So for example,

1012
00:44:35,629 --> 00:44:38,719
Medicaid provides a whole
slew of services for people

1013
00:44:38,763 --> 00:44:41,113
with disabilities
that Medicare doesn't.

1014
00:44:41,156 --> 00:44:43,898
And the idea of
getting rid of Medicaid

1015
00:44:43,942 --> 00:44:45,813
and giving everyone
Medicare doesn't help a lot

1016
00:44:45,857 --> 00:44:46,901
of the people I serve.

1017
00:44:46,945 --> 00:44:48,424
So for example,

1018
00:44:48,468 --> 00:44:50,818
if you have a spinal cord
injury and you need someone

1019
00:44:50,862 --> 00:44:53,081
to get you out of bed in the
morning so you can go to work,

1020
00:44:53,125 --> 00:44:55,214
and someone to put
you to bed at night so

1021
00:44:55,257 --> 00:44:56,694
that you can go back to sleep,

1022
00:44:56,737 --> 00:44:59,174
Medicaid covers those
kinds of services.

1023
00:44:59,218 --> 00:45:01,829
Someone to come in and
cook a couple of meals,

1024
00:45:01,873 --> 00:45:04,745
get you ready for the
day, that's covered,

1025
00:45:04,789 --> 00:45:06,181
help you get your medication,

1026
00:45:06,225 --> 00:45:09,837
help transfer you from
your wheelchair to the bed,

1027
00:45:09,881 --> 00:45:10,925
those things are covered.

1028
00:45:10,969 --> 00:45:12,274
They're not covered
under Medicare.

1029
00:45:12,318 --> 00:45:14,929
So getting rid of
Medicaid and putting it

1030
00:45:14,973 --> 00:45:17,802
into Medicare is
scary because a lot

1031
00:45:17,845 --> 00:45:19,673
of services are
healthcare go away.

1032
00:45:19,717 --> 00:45:22,415
If you have a job and
you need someone to come

1033
00:45:22,458 --> 00:45:24,286
and catheterize you at work,

1034
00:45:24,330 --> 00:45:25,766
Medicaid will pay for that.

1035
00:45:25,810 --> 00:45:28,029
If you're within a
certain income bracket

1036
00:45:28,073 --> 00:45:30,902
or if you can buy into Medicaid
there's a special program

1037
00:45:30,945 --> 00:45:32,338
that lets you buy into Medicaid.

1038
00:45:32,381 --> 00:45:34,688
So if you get a job and
depending on the state,

1039
00:45:34,732 --> 00:45:36,081
I'm not gonna get into the weeds

1040
00:45:36,124 --> 00:45:37,865
but there are
certain requirements,

1041
00:45:37,909 --> 00:45:39,388
you can keep Medicaid,

1042
00:45:39,432 --> 00:45:40,999
pay for it,

1043
00:45:41,042 --> 00:45:43,436
buy into it so that you have
this independence in services.

1044
00:45:43,479 --> 00:45:45,525
Medicare for All
doesn't cover that.

1045
00:45:45,568 --> 00:45:47,092
So it kind of scares
me when they talk

1046
00:45:47,135 --> 00:45:49,877
about Medicare for All that
it doesn't look at the weeds,

1047
00:45:49,921 --> 00:45:51,792
it looks at the clouds.

1048
00:45:51,836 --> 00:45:55,230
- People that are paying
a lot of money out

1049
00:45:55,274 --> 00:45:59,365
of pocket every month and
these crazy high deductibles,

1050
00:45:59,408 --> 00:46:01,367
it is like
catastrophic insurance,

1051
00:46:01,410 --> 00:46:02,803
it's hard to convince people,

1052
00:46:02,847 --> 00:46:05,588
particularly young people
that you really need it

1053
00:46:05,632 --> 00:46:09,070
in case you get cancer or one
of these other awful diseases

1054
00:46:09,114 --> 00:46:11,899
and this really is
better than it was

1055
00:46:11,943 --> 00:46:14,815
before the Affordable
Care Act where people

1056
00:46:14,859 --> 00:46:16,425
that had cancer as an example,

1057
00:46:16,469 --> 00:46:18,036
couldn't get insurance.

1058
00:46:18,079 --> 00:46:20,603
There's gotta be
a better solution.

1059
00:46:20,647 --> 00:46:23,911
It has to be something where
insurance is more affordable

1060
00:46:23,955 --> 00:46:27,480
and doctors are willing
to take the insurance.

1061
00:46:27,523 --> 00:46:30,309
The young people and their
parents in Washington

1062
00:46:30,352 --> 00:46:31,571
who I work with,

1063
00:46:31,614 --> 00:46:33,399
it's almost impossible for them

1064
00:46:33,442 --> 00:46:35,662
to find a mental
health provider.

1065
00:46:35,705 --> 00:46:39,144
I have friends that
are in their 50s

1066
00:46:39,187 --> 00:46:43,322
who just lost their primary
care doctors here in McLean,

1067
00:46:43,365 --> 00:46:45,324
Virginia, or Great Falls,

1068
00:46:45,367 --> 00:46:47,108
an even wealthier
town next door.

1069
00:46:47,152 --> 00:46:50,677
Their doctors have now gone
concierge so they wanted

1070
00:46:50,720 --> 00:46:53,245
to find a regular doctor
that takes their insurance

1071
00:46:53,288 --> 00:46:55,856
and they cannot find a
doctor that will take them

1072
00:46:55,900 --> 00:46:57,336
and they're perfectly healthy.

1073
00:46:59,251 --> 00:47:01,949
The Department of Health
and Human Services is trying

1074
00:47:01,993 --> 00:47:06,171
out some interesting
possibilities how

1075
00:47:06,214 --> 00:47:09,565
of healthcare down while
making people healthier,

1076
00:47:09,609 --> 00:47:11,611
but boy, it's very slow going.

1077
00:47:11,654 --> 00:47:14,309
[relaxing music]

1078
00:47:16,877 --> 00:47:20,315
[relaxing dramatic music]

1079
00:47:25,190 --> 00:47:27,235
- [Narrator] Wouldn't it
be nice if there were a way

1080
00:47:27,279 --> 00:47:30,804
to save money while also
bypassing bureaucracy

1081
00:47:30,848 --> 00:47:33,763
and improving the provider,
patient relationship?

1082
00:47:38,072 --> 00:47:40,074
- So I've been advocating
for free-market healthcare

1083
00:47:40,118 --> 00:47:41,771
for a long time.

1084
00:47:41,815 --> 00:47:46,820
And in that time I have had
a congressional healthcare,

1085
00:47:47,777 --> 00:47:51,869
I've had a healthcare plan
that was provided to me

1086
00:47:51,912 --> 00:47:53,435
by the State of Florida,

1087
00:47:53,479 --> 00:47:57,265
I had one from the National
Center for Policy Analysis.

1088
00:47:57,309 --> 00:48:02,749
And now I run my own business
and I had a great plan there.

1089
00:48:02,792 --> 00:48:07,710
Obamacare passed and
I had a worse plan

1090
00:48:07,754 --> 00:48:08,929
that cost more money

1091
00:48:08,973 --> 00:48:11,758
and I've slowly been
getting a worse plan

1092
00:48:11,801 --> 00:48:13,455
that cost more money.

1093
00:48:13,499 --> 00:48:15,109
And then I looked
around and said,

1094
00:48:15,153 --> 00:48:17,546
I've been advocating for
free-market healthcare

1095
00:48:17,590 --> 00:48:19,244
for 10 years.

1096
00:48:19,287 --> 00:48:20,898
These healthcare
sharing ministries,

1097
00:48:20,941 --> 00:48:22,769
I've heard good
stories about them.

1098
00:48:22,812 --> 00:48:24,510
I've seen them
doing good things.

1099
00:48:24,553 --> 00:48:26,729
So I actually
joined one last year

1100
00:48:26,773 --> 00:48:29,907
and it's been interesting.

1101
00:48:29,950 --> 00:48:31,909
I still think it's
the Wild West.

1102
00:48:31,952 --> 00:48:33,432
It's an emerging market.

1103
00:48:33,475 --> 00:48:35,913
The frontiersman were called
frontiersman for a reason,

1104
00:48:35,956 --> 00:48:38,741
they were out on the
edge doing something.

1105
00:48:38,785 --> 00:48:40,743
But when you look at the
economics behind them,

1106
00:48:40,787 --> 00:48:42,223
the economics is solid.

1107
00:48:42,267 --> 00:48:43,485
If you look at their books,

1108
00:48:43,529 --> 00:48:44,530
the books are solid.

1109
00:48:44,573 --> 00:48:46,880
If you read stories on the way

1110
00:48:46,924 --> 00:48:49,578
that they've paid for patients,

1111
00:48:49,622 --> 00:48:50,884
they're all solid.

1112
00:48:50,928 --> 00:48:52,190
And in fact,

1113
00:48:52,233 --> 00:48:53,843
it's one of the biggest
things in this market,

1114
00:48:53,887 --> 00:48:57,064
is that they all don't
want anybody to mess up

1115
00:48:57,108 --> 00:48:58,805
because since it's cutting edge

1116
00:48:58,848 --> 00:49:00,415
and since it's a
little different

1117
00:49:00,459 --> 00:49:03,897
than the being a Blue Cross
and Blue Shield member,

1118
00:49:03,941 --> 00:49:06,117
they don't want anybody
to have a problem.

1119
00:49:06,160 --> 00:49:07,814
And so they're all kind
of working together

1120
00:49:07,857 --> 00:49:10,991
to make sure that the
system works for people.

1121
00:49:11,035 --> 00:49:13,472
And so I've had a great
experience being on it.

1122
00:49:13,515 --> 00:49:16,562
There's a learning curve
because you have to unlearn some

1123
00:49:16,605 --> 00:49:20,740
of the things that you have
been used to from insurance.

1124
00:49:20,783 --> 00:49:22,133
But it's wild,

1125
00:49:22,176 --> 00:49:24,004
even the people that work
at the offices are kind

1126
00:49:24,048 --> 00:49:27,225
of amazed at the prices
that you end up getting

1127
00:49:27,268 --> 00:49:29,053
because you're paying cash.

1128
00:49:29,096 --> 00:49:30,619
It's really kind
of a good feeling

1129
00:49:30,663 --> 00:49:33,231
to push the healthcare
system ourselves

1130
00:49:33,274 --> 00:49:37,583
while being insured in
some form or fashion.

1131
00:49:37,626 --> 00:49:40,890
- Obamacare helped sick
people access coverage

1132
00:49:40,934 --> 00:49:43,154
that they maybe couldn't
have in certain cases

1133
00:49:43,197 --> 00:49:44,372
which is kind of a lie.

1134
00:49:44,416 --> 00:49:46,548
Because before
Obamacare most people

1135
00:49:46,592 --> 00:49:48,463
who were sick could get care,

1136
00:49:48,507 --> 00:49:49,856
it might've been a
bit more expensive

1137
00:49:49,899 --> 00:49:51,118
and run by the state government.

1138
00:49:51,162 --> 00:49:53,120
It's called a reinsurance pool

1139
00:49:53,164 --> 00:49:54,730
for the sick, uninsured pool.

1140
00:49:54,774 --> 00:49:56,732
And otherwise, if you
are somewhat healthy,

1141
00:49:56,776 --> 00:49:59,779
your private insurance on
the individual state level

1142
00:49:59,822 --> 00:50:00,867
is pretty affordable.

1143
00:50:00,910 --> 00:50:02,347
And Medicaid was
there for the poor,

1144
00:50:02,390 --> 00:50:04,479
Medicare for the
old and disabled.

1145
00:50:04,523 --> 00:50:06,568
We had a pretty good system.

1146
00:50:06,612 --> 00:50:10,529
Now it's a pretty good
system for the people

1147
00:50:10,572 --> 00:50:11,834
who are really sick,

1148
00:50:11,878 --> 00:50:13,923
their premiums are
subsidized a bit.

1149
00:50:13,967 --> 00:50:15,534
For the vast upper middle class,

1150
00:50:15,577 --> 00:50:17,492
they're getting hurt
by having to pay

1151
00:50:17,536 --> 00:50:19,929
what effectively is a
mortgage for healthcare.

1152
00:50:19,973 --> 00:50:22,193
So they're either
leaving insurance,

1153
00:50:22,236 --> 00:50:23,803
as a million people
have for sharing

1154
00:50:23,846 --> 00:50:25,500
to get coverage
that's affordable,

1155
00:50:25,544 --> 00:50:27,894
or they're going
uninsured which is risky.

1156
00:50:27,937 --> 00:50:29,156
I don't know what
they're doing to qualify

1157
00:50:29,200 --> 00:50:30,462
for a subsidy on the exchange,

1158
00:50:30,505 --> 00:50:31,854
but if you don't have
a subsidy you're paying

1159
00:50:31,898 --> 00:50:33,769
over a grand a
month in healthcare

1160
00:50:33,813 --> 00:50:36,337
and then several thousand
dollars in deductible.

1161
00:50:36,381 --> 00:50:39,688
So effectively, you have
become a cash-pay patient

1162
00:50:39,732 --> 00:50:41,386
because it's hard
to reach 5,000,

1163
00:50:41,429 --> 00:50:43,170
$10,000 of a deductible.

1164
00:50:43,214 --> 00:50:45,129
Most people don't get that sick.

1165
00:50:45,172 --> 00:50:48,480
10% of Americans spend three
grand on healthcare a year.

1166
00:50:48,523 --> 00:50:50,917
So those who use it
are sick and need it,

1167
00:50:50,960 --> 00:50:52,092
they need the help.

1168
00:50:52,136 --> 00:50:54,573
The vast majority need
something cheaper,

1169
00:50:54,616 --> 00:50:57,054
less comprehensive, just make
sure you don't go bankrupt

1170
00:50:57,097 --> 00:51:00,013
from cancer, a heart
attack or a bad accident.

1171
00:51:00,057 --> 00:51:02,624
You can pay little and
have that protection.

1172
00:51:02,668 --> 00:51:05,105
It doesn't pre pay for
things you might want,

1173
00:51:05,149 --> 00:51:06,933
but there's trade offs in life.

1174
00:51:06,976 --> 00:51:10,893
[relaxing dramatic music]

1175
00:51:10,937 --> 00:51:12,721
- My name is Jeff Kanter.

1176
00:51:12,765 --> 00:51:14,810
I'm the founder of
yourfreedomhub.com

1177
00:51:14,854 --> 00:51:17,291
and we are a disruptor
in the freedom industry.

1178
00:51:17,335 --> 00:51:19,032
So we're also involved in
healthcare and a variety

1179
00:51:19,076 --> 00:51:21,904
of other areas all about
freedom for individuals.

1180
00:51:21,948 --> 00:51:23,993
What we're able to do is
provide you an assistant,

1181
00:51:24,037 --> 00:51:25,517
as it were,

1182
00:51:25,560 --> 00:51:27,301
so you've got an expert in
the field to be your helper.

1183
00:51:27,345 --> 00:51:29,216
So if you're a member
with us as an example,

1184
00:51:29,260 --> 00:51:31,349
you just call a simple phone
number and you're talking

1185
00:51:31,392 --> 00:51:32,959
to a health expert who
can help you figure out

1186
00:51:33,002 --> 00:51:34,917
how to get a better
pricing on an MRI,

1187
00:51:34,961 --> 00:51:35,831
find a different doctor,

1188
00:51:35,875 --> 00:51:37,920
shop around for surgeries.

1189
00:51:37,964 --> 00:51:39,661
'Cause again, you probably
don't know how to do that.

1190
00:51:39,705 --> 00:51:41,272
You don't have
the time, for one,

1191
00:51:41,315 --> 00:51:43,274
you don't have the interest
in learning any of that stuff

1192
00:51:43,317 --> 00:51:44,536
but you want the solution.

1193
00:51:44,579 --> 00:51:45,754
So we're gonna give
you a fast way to get

1194
00:51:45,798 --> 00:51:47,756
to the most proper
solution possible.

1195
00:51:47,800 --> 00:51:50,672
- A million people who
are fairly well-to-do

1196
00:51:50,716 --> 00:51:53,501
or even have modest income have
left insurance for sharing.

1197
00:51:53,545 --> 00:51:54,894
They've bit the bullet,

1198
00:51:54,937 --> 00:51:57,288
they're happy, they're
accessing the same doctors

1199
00:51:57,331 --> 00:51:59,725
in the hospital but they're
just paying half as much,

1200
00:51:59,768 --> 00:52:01,596
so they're happy.

1201
00:52:01,640 --> 00:52:04,208
Then there are those
who like the idea

1202
00:52:04,251 --> 00:52:05,687
of becoming a cash patient.

1203
00:52:05,731 --> 00:52:08,168
You'll see for primary
care what are called

1204
00:52:08,212 --> 00:52:11,867
direct primary care practices
proliferating nationwide.

1205
00:52:11,911 --> 00:52:14,740
And especially if you're kind
of a high user of healthcare,

1206
00:52:14,783 --> 00:52:16,916
if you have a lot of meds,

1207
00:52:16,959 --> 00:52:18,526
if you're a chronically
diseased person,

1208
00:52:18,570 --> 00:52:20,049
you're gonna go in a lot,

1209
00:52:20,093 --> 00:52:23,531
pay it, pay that monthly fee
of 75 bucks or 100 bucks.

1210
00:52:23,575 --> 00:52:26,578
Your primary care physician
will give you unlimited

1211
00:52:26,621 --> 00:52:27,883
or low cost care.

1212
00:52:27,927 --> 00:52:30,843
He has access or she has
access to lab's tests,

1213
00:52:30,886 --> 00:52:34,063
good recommendations,
24-hour access for the kids

1214
00:52:34,107 --> 00:52:35,717
who are gonna have the
cold in the of the night.

1215
00:52:35,761 --> 00:52:37,719
That's a great innovation
in the market, DPC.

1216
00:52:37,763 --> 00:52:40,809
It will cut the cost of
a catastrophic in half

1217
00:52:40,853 --> 00:52:43,943
and will also double your
money in a spending account,

1218
00:52:43,986 --> 00:52:45,510
we call it a medical
spending account

1219
00:52:45,553 --> 00:52:47,947
for the low level stuff that
you know you're gonna have,

1220
00:52:47,990 --> 00:52:49,209
if you're gonna have
maintenance meds,

1221
00:52:49,253 --> 00:52:51,037
you wanna go to the
chiropractor more often.

1222
00:52:51,080 --> 00:52:53,126
There's now a Forbes feature
medical spending account

1223
00:52:53,170 --> 00:52:54,780
that doubles your
money over three years,

1224
00:52:54,823 --> 00:52:57,913
effectively making all your
out of pocket 50% less.

1225
00:52:57,957 --> 00:53:01,090
So Health Excellence Plus
is the name of that solution

1226
00:53:01,134 --> 00:53:03,310
where not necessarily
the primary care part

1227
00:53:03,354 --> 00:53:06,313
but the sharing for the
expensive stuff and the account

1228
00:53:06,357 --> 00:53:09,925
for your first dollar
discretionary stuff is
pretty cheap

1229
00:53:09,969 --> 00:53:12,667
for 400, 300 a month.

1230
00:53:12,711 --> 00:53:15,279
So that's gonna make
people's eyes open up

1231
00:53:15,322 --> 00:53:16,889
and we make you
into a cash payer,

1232
00:53:16,932 --> 00:53:18,456
so now there's no networks.

1233
00:53:18,499 --> 00:53:20,719
And we didn't even talk about
how insurers handcuff you

1234
00:53:20,762 --> 00:53:24,070
with networks that exclude
the best doctors or hospitals.

1235
00:53:24,113 --> 00:53:27,073
That's something that we're
definitely telling people about.

1236
00:53:27,116 --> 00:53:28,205
It's not just your price,

1237
00:53:28,248 --> 00:53:29,771
it's also the
handcuffs and networks.

1238
00:53:29,815 --> 00:53:32,209
We make you into a cash
payer so there's no networks

1239
00:53:32,252 --> 00:53:33,645
and there's no
need for networks.

1240
00:53:33,688 --> 00:53:35,516
We'll help you shop nationwide,

1241
00:53:35,560 --> 00:53:36,430
wherever you wanna go to,

1242
00:53:36,474 --> 00:53:38,215
medical tourism internationally,

1243
00:53:38,258 --> 00:53:40,869
more natural care where
a lot of folks wanna go.

1244
00:53:40,913 --> 00:53:43,698
Health Excellence Plus is
to plan for the individual,

1245
00:53:43,742 --> 00:53:47,136
family or small business
person in open enrollment

1246
00:53:47,180 --> 00:53:48,616
to cut your costs in half,

1247
00:53:48,660 --> 00:53:50,879
become a cash shopping patient
and really take control

1248
00:53:50,923 --> 00:53:52,403
of this awful health system.

1249
00:53:52,446 --> 00:53:54,448
- The question oftentimes
is how important is it

1250
00:53:54,492 --> 00:53:55,623
to be a cash payer?

1251
00:53:55,667 --> 00:53:57,538
And the reality is
it's very important.

1252
00:53:57,582 --> 00:53:59,714
The market understands
pricing signals.

1253
00:53:59,758 --> 00:54:00,933
Everyone's familiar
with going to a corner

1254
00:54:00,976 --> 00:54:02,804
where there's a gas
station every corner

1255
00:54:02,848 --> 00:54:04,719
and they're all
fighting for that price.

1256
00:54:04,763 --> 00:54:07,809
So I get to see the pricing
signals and I know where to go.

1257
00:54:07,853 --> 00:54:09,289
Same thing when it
comes to medical care,

1258
00:54:09,333 --> 00:54:10,856
if I don't understand
what anything costs,

1259
00:54:10,899 --> 00:54:12,858
all I'm worried about
is what's my copay?

1260
00:54:12,901 --> 00:54:15,382
So the idea of cash is
at the whole program

1261
00:54:15,426 --> 00:54:17,602
and anything I'm gonna
have done is all defined

1262
00:54:17,645 --> 00:54:18,907
on one set price.

1263
00:54:18,951 --> 00:54:20,822
So I can decide as a consumer

1264
00:54:20,866 --> 00:54:22,650
which is the place
I wanna patronize

1265
00:54:22,694 --> 00:54:24,783
and without a pricing signal
I'm never gonna know that.

1266
00:54:24,826 --> 00:54:27,525
So being a cash payer
is mission-critical

1267
00:54:27,568 --> 00:54:30,049
to the success of
healthcare in America.

1268
00:54:30,092 --> 00:54:32,704
So we call it
medical cost sharing.

1269
00:54:32,747 --> 00:54:35,315
Oftentimes, under the
concept of sharing it's more

1270
00:54:35,359 --> 00:54:36,664
of a religious approach.

1271
00:54:36,708 --> 00:54:38,753
But realistically, it's
a very old mentality

1272
00:54:38,797 --> 00:54:39,885
of how to deal with things.

1273
00:54:39,928 --> 00:54:41,408
It's everybody pooling
their resources.

1274
00:54:41,452 --> 00:54:44,324
A common occurrence is to
talk about the Amish because

1275
00:54:44,368 --> 00:54:46,848
in the Amish community they
don't really have insurance.

1276
00:54:46,892 --> 00:54:48,589
Because let's say
your barn burns down,

1277
00:54:48,633 --> 00:54:51,897
tomorrow every neighbor shows
up to build you a new barn.

1278
00:54:51,940 --> 00:54:53,986
So the same thing
with the community of

1279
00:54:54,029 --> 00:54:56,031
is everybody's pooled
their financial resources,

1280
00:54:56,075 --> 00:54:57,990
so if anybody within
that community actually

1281
00:54:58,033 --> 00:54:59,731
has a medical expense
we're gonna be able

1282
00:54:59,774 --> 00:55:01,080
to make sure that that's met.

1283
00:55:01,123 --> 00:55:03,735
And it's a most
effective methodology

1284
00:55:03,778 --> 00:55:06,564
because it's very ethical
and it's very inexpensive

1285
00:55:06,607 --> 00:55:07,869
by comparison 'cause
you're not layering

1286
00:55:07,913 --> 00:55:10,872
it up with a lot of
added costs and stuff

1287
00:55:10,916 --> 00:55:12,657
built in there
for no good reason

1288
00:55:12,700 --> 00:55:14,746
just to pump up the price.

1289
00:55:14,789 --> 00:55:17,792
It's like any little cartel
that formulates over time.

1290
00:55:17,836 --> 00:55:19,751
If you can kinda get
control of an industry

1291
00:55:19,794 --> 00:55:22,580
and then there's only a
couple players after a while,

1292
00:55:22,623 --> 00:55:24,408
they tend to start
to collude together.

1293
00:55:24,451 --> 00:55:26,105
Whenever any cartel formulates,

1294
00:55:26,148 --> 00:55:28,803
its sole goal is monopolization
of what's going on

1295
00:55:28,847 --> 00:55:31,153
and to thwart anybody
entering that market.

1296
00:55:31,197 --> 00:55:33,068
And invariably they have
got the participation

1297
00:55:33,112 --> 00:55:34,722
of government when
it comes to that,

1298
00:55:34,766 --> 00:55:36,115
because they have lobbyists

1299
00:55:36,158 --> 00:55:39,336
and they patronize them
as far as getting votes

1300
00:55:39,379 --> 00:55:40,728
or giving them
money for campaigns,

1301
00:55:40,772 --> 00:55:42,817
and in return, they're
gonna help pass

1302
00:55:42,861 --> 00:55:44,906
those regulations
that they're seeking.

1303
00:55:44,950 --> 00:55:46,952
So it's definitely a
fixed little world.

1304
00:55:48,388 --> 00:55:49,694
- Yeah, have you ever
heard someone say,

1305
00:55:49,737 --> 00:55:50,869
"Have you considered sharing?"

1306
00:55:50,912 --> 00:55:52,740
Well, it's half the
cost of insurance.

1307
00:55:52,784 --> 00:55:54,351
It's the third way
in politics too.

1308
00:55:54,394 --> 00:55:55,961
And you know what, it's not new.

1309
00:55:56,004 --> 00:55:57,005
It's 100 years old,

1310
00:55:57,049 --> 00:55:58,442
it's mutual aid.

1311
00:55:58,485 --> 00:56:00,226
Most folks before World
War II got their healthcare

1312
00:56:00,269 --> 00:56:01,793
through groups that
they belonged to

1313
00:56:01,836 --> 00:56:02,968
and they paid a monthly fee,

1314
00:56:03,011 --> 00:56:04,665
they had a kitty to
pay all the bills.

1315
00:56:04,709 --> 00:56:06,058
Sometimes they had
an in-house doctor

1316
00:56:06,101 --> 00:56:08,234
that was part of large
systems they belonged to.

1317
00:56:08,277 --> 00:56:11,585
We're engaged in a big
change taking on the cartel

1318
00:56:11,629 --> 00:56:13,413
where 90% of people
get their healthcare

1319
00:56:13,457 --> 00:56:15,372
through insurance companies
that they don't like.

1320
00:56:15,415 --> 00:56:16,895
We're here to empower patients

1321
00:56:16,938 --> 00:56:18,375
and to give them more choices

1322
00:56:18,418 --> 00:56:20,855
so that we can save this
market and make it better,

1323
00:56:20,899 --> 00:56:22,857
not more controlled and worse.

1324
00:56:25,643 --> 00:56:28,167
- The advantages of
being a cash-pay patient

1325
00:56:28,210 --> 00:56:30,909
are actually kind
of almost hysterical

1326
00:56:30,952 --> 00:56:34,086
if other people weren't
getting taken advantage of

1327
00:56:34,129 --> 00:56:35,566
by the system.

1328
00:56:35,609 --> 00:56:38,046
But if you go to Keith Smith's
Oklahoma Surgery Center,

1329
00:56:38,090 --> 00:56:40,440
you'll pay about 10%
of what you would pay

1330
00:56:40,484 --> 00:56:42,137
at the hospital down the street,

1331
00:56:42,181 --> 00:56:45,445
and that's just because
he doesn't have a full

1332
00:56:45,489 --> 00:56:47,578
billing staff that
he has to hire.

1333
00:56:47,621 --> 00:56:51,669
He doesn't have to wait 90
to 180 days for payment,

1334
00:56:51,712 --> 00:56:54,628
and then not be sure if he's
going to get the payment.

1335
00:56:54,672 --> 00:56:57,239
And because of this system

1336
00:56:57,283 --> 00:56:59,764
where he can get payment
now, he can even negotiate.

1337
00:56:59,807 --> 00:57:01,940
So instead of
getting paid in cash,

1338
00:57:01,983 --> 00:57:03,245
he's gotten paid in Bitcoin.

1339
00:57:03,289 --> 00:57:05,552
It's kind of an exciting
thing in healthcare

1340
00:57:05,596 --> 00:57:10,862
to see when you're paying
with cash what changes.

1341
00:57:10,905 --> 00:57:13,865
And even going to your
normal doctor's office,

1342
00:57:13,908 --> 00:57:17,477
you can see price cuts
of anywhere from 10%

1343
00:57:17,521 --> 00:57:21,699
to 90% on different
procedures or office visits.

1344
00:57:23,309 --> 00:57:25,964
- I mean, the goal also is
about your wealth, right?

1345
00:57:26,007 --> 00:57:27,792
I mean, in reality, there's
two important things

1346
00:57:27,835 --> 00:57:28,836
in your world,

1347
00:57:28,880 --> 00:57:30,011
your health and your wealth.

1348
00:57:30,055 --> 00:57:31,273
You need both of those.

1349
00:57:31,317 --> 00:57:32,971
Everything else kind
of builds off of those.

1350
00:57:33,014 --> 00:57:34,451
So when it comes to your wealth,

1351
00:57:34,494 --> 00:57:36,801
there's a lot of areas that
you need to think about,

1352
00:57:36,844 --> 00:57:38,367
my personal finances,

1353
00:57:38,411 --> 00:57:40,369
my cost of healthcare,

1354
00:57:40,413 --> 00:57:41,893
how much I spend,

1355
00:57:41,936 --> 00:57:43,068
where do I get the money to
pay for all those things?

1356
00:57:43,111 --> 00:57:45,723
So we've got a few
different mechanisms.

1357
00:57:45,766 --> 00:57:46,898
In the healthcare world,

1358
00:57:46,941 --> 00:57:48,421
most people are
understanding the idea

1359
00:57:48,465 --> 00:57:49,857
of a health savings account.

1360
00:57:49,901 --> 00:57:51,511
And so we're able to
help you with those too

1361
00:57:51,555 --> 00:57:53,121
where you can actually
get money invested.

1362
00:57:53,165 --> 00:57:54,862
Most people just
have it set aside.

1363
00:57:54,906 --> 00:57:56,081
They think a little tax break,

1364
00:57:56,124 --> 00:57:57,648
but they're not
growing that money.

1365
00:57:57,691 --> 00:57:59,737
And the government's
giving you permission

1366
00:57:59,780 --> 00:58:00,825
to grow that money,

1367
00:58:00,868 --> 00:58:02,348
so we're gonna help
them understand

1368
00:58:02,391 --> 00:58:03,958
how they can grow dollars
in a health savings account.

1369
00:58:04,002 --> 00:58:06,526
But then also we have a medical
benefit savings account,

1370
00:58:06,570 --> 00:58:07,919
which as Charles was mentioning,

1371
00:58:07,962 --> 00:58:10,225
allows you to double your
dollars and even more,

1372
00:58:10,269 --> 00:58:12,271
to pay for first
dollar medical expense,

1373
00:58:12,314 --> 00:58:13,838
because that's the challenge
for a lot of people.

1374
00:58:13,881 --> 00:58:15,753
I've got my insurance
or whatever it may be

1375
00:58:15,796 --> 00:58:16,971
if something bad happens,

1376
00:58:17,015 --> 00:58:18,495
but you know what, I
have a lot of other

1377
00:58:18,538 --> 00:58:20,322
independent things I
have to spend money on.

1378
00:58:20,366 --> 00:58:21,628
Where does that money come from?

1379
00:58:21,672 --> 00:58:23,717
And so that's another
area we wanna address

1380
00:58:23,761 --> 00:58:25,502
to make sure that
you're covered in terms

1381
00:58:25,545 --> 00:58:27,112
of where you're gonna
provide for yourself

1382
00:58:27,155 --> 00:58:28,766
from one extreme to the other.

1383
00:58:30,115 --> 00:58:32,509
- Now, when we look
out into the long run,

1384
00:58:32,552 --> 00:58:35,860
what we need is a
patient-doctor relationship,

1385
00:58:35,903 --> 00:58:37,339
a doctor-patient relationship,

1386
00:58:37,383 --> 00:58:38,602
and the way that we do that is

1387
00:58:38,645 --> 00:58:39,951
by giving the patient the power,

1388
00:58:39,994 --> 00:58:41,822
making the patient the payer.

1389
00:58:41,866 --> 00:58:43,824
So health savings accounts

1390
00:58:43,868 --> 00:58:47,524
are really the primary
solution for that.

1391
00:58:47,567 --> 00:58:50,570
John Goodman wants
to make them Roth

1392
00:58:50,614 --> 00:58:51,702
health savings accounts,

1393
00:58:51,745 --> 00:58:53,921
which makes them
post-tax dollars,

1394
00:58:53,965 --> 00:58:58,099
and that is a way to further
make healthcare money

1395
00:58:58,143 --> 00:58:59,927
more equal to other money.

1396
00:58:59,971 --> 00:59:01,407
And so really,

1397
00:59:01,450 --> 00:59:03,844
when you get into the economics
of healthcare spending,

1398
00:59:03,888 --> 00:59:06,847
instead of having cheap
dollars for healthcare,

1399
00:59:06,891 --> 00:59:09,546
you should have a choice
between healthcare,

1400
00:59:09,589 --> 00:59:12,549
savings and buying
should all be equal.

1401
00:59:14,289 --> 00:59:15,856
- Within the
healthcare industry,

1402
00:59:15,900 --> 00:59:18,772
I have created a
distribution system

1403
00:59:18,816 --> 00:59:22,820
for a cash-based
platform that really

1404
00:59:22,863 --> 00:59:25,736
enables the free market
system to sort of begin

1405
00:59:25,779 --> 00:59:28,826
to change things from
a system right now

1406
00:59:28,869 --> 00:59:32,917
that doesn't work very well
for patients or providers.

1407
00:59:32,960 --> 00:59:35,354
So what our program
does is it takes

1408
00:59:35,397 --> 00:59:38,792
a technology that
is very inclusive,

1409
00:59:38,836 --> 00:59:42,970
and acts as a platform
which allows physicians

1410
00:59:43,014 --> 00:59:46,452
to receive cash payments
for medical services

1411
00:59:46,495 --> 00:59:48,889
that they decide how much
they'd like for them to cost,

1412
00:59:48,933 --> 00:59:50,978
and allows them to
put their services

1413
00:59:51,022 --> 00:59:53,720
really onto a free
market type of platform.

1414
00:59:53,764 --> 00:59:56,636
We go to employers and we say,

1415
00:59:56,680 --> 00:59:58,812
let us talk to your
employees about making sure

1416
00:59:58,856 --> 01:00:00,901
that whatever doctors
that they'd like to see

1417
01:00:00,945 --> 01:00:02,642
on that platform be on there,

1418
01:00:02,686 --> 01:00:04,513
then we set up a
system that lets them

1419
01:00:04,557 --> 01:00:08,082
pay cash for everything
that they might need

1420
01:00:08,126 --> 01:00:10,215
as a healthcare consumer,

1421
01:00:10,258 --> 01:00:13,479
except for hospitalizations
and emergencies,

1422
01:00:13,522 --> 01:00:14,872
which is really the only thing

1423
01:00:14,915 --> 01:00:19,528
that you need a catastrophic
insurance plan for.

1424
01:00:19,572 --> 01:00:22,662
- I still believe in a place--

1425
01:00:22,706 --> 01:00:25,752
- Going back to 1990
when Bill Clinton

1426
01:00:25,796 --> 01:00:27,885
becomes president and his wife

1427
01:00:27,928 --> 01:00:29,843
tried to take over
the healthcare system

1428
01:00:29,887 --> 01:00:32,672
by shoving everyone into HMOs

1429
01:00:32,716 --> 01:00:34,456
with Medicare pricing controls,

1430
01:00:34,500 --> 01:00:37,503
that woke me up and a lot
of folks to the alternative,

1431
01:00:37,546 --> 01:00:40,593
which is to open
markets to allow supply

1432
01:00:40,637 --> 01:00:42,639
to expand and
prices to come down

1433
01:00:42,682 --> 01:00:44,292
and options to expand,

1434
01:00:44,336 --> 01:00:46,381
and people to shop around
like any other markets

1435
01:00:46,425 --> 01:00:47,774
and get what they want,

1436
01:00:47,818 --> 01:00:50,559
whether it's allopath
natural, here or overseas.

1437
01:00:50,603 --> 01:00:53,606
So we work with
all the innovators

1438
01:00:53,650 --> 01:00:56,870
both in politics and
in entrepreneurship,

1439
01:00:56,914 --> 01:00:58,567
namely healthcare disruption,

1440
01:00:58,611 --> 01:01:01,832
with various events
like weekly podcasts

1441
01:01:01,875 --> 01:01:04,922
where we give the cash
patients that we create

1442
01:01:04,965 --> 01:01:07,838
some examples of the best
doctors and hospitals

1443
01:01:07,881 --> 01:01:10,710
and integrated therapists
that are accessible

1444
01:01:10,754 --> 01:01:12,930
to them because we
make them cash payers.

1445
01:01:12,973 --> 01:01:15,149
And that is the secret
niche in this debate

1446
01:01:15,193 --> 01:01:17,238
that is not discussed anywhere.

1447
01:01:17,282 --> 01:01:18,979
If you don't create cash payers

1448
01:01:19,023 --> 01:01:20,546
and help them shop around,

1449
01:01:20,589 --> 01:01:22,896
you can't have a supply
and demand in a market.

1450
01:01:22,940 --> 01:01:24,724
The demand is flat,
it's horrible.

1451
01:01:24,768 --> 01:01:26,334
People right now
are slapping down

1452
01:01:26,378 --> 01:01:28,206
third party insurance
cards and expecting

1453
01:01:28,249 --> 01:01:29,642
someone else to pay for it.

1454
01:01:29,686 --> 01:01:30,904
That's unsustainable.

1455
01:01:30,948 --> 01:01:33,820
You can't have smart
others running a market.

1456
01:01:33,864 --> 01:01:35,561
You have to run the market.

1457
01:01:35,604 --> 01:01:37,563
We give you the
cash to shop around.

1458
01:01:37,606 --> 01:01:40,305
And then politically, as
people educate themselves

1459
01:01:40,348 --> 01:01:43,090
paying cash to save money
and learn about choices,

1460
01:01:43,134 --> 01:01:45,440
they start to be
suspicious of the people

1461
01:01:45,484 --> 01:01:47,573
in control who tell
them they can't access

1462
01:01:47,616 --> 01:01:49,836
a life-saving drug
or a natural therapy,

1463
01:01:49,880 --> 01:01:51,969
or go overseas, or see this kind

1464
01:01:52,012 --> 01:01:53,884
of payment company,
et cetera, et cetera.

1465
01:01:53,927 --> 01:01:55,842
- There's so much
information out there,

1466
01:01:55,886 --> 01:01:57,322
we don't know who to trust,

1467
01:01:57,365 --> 01:01:59,890
but they trust their
benefits broker.

1468
01:01:59,933 --> 01:02:01,805
So benefits brokers are really,

1469
01:02:01,848 --> 01:02:03,937
and a lot of people
are saying this,

1470
01:02:03,981 --> 01:02:08,289
are the key to really
helping mobilize

1471
01:02:08,333 --> 01:02:11,379
this free market system
that's out there.

1472
01:02:11,423 --> 01:02:13,686
And so we seek to
work with folks

1473
01:02:13,730 --> 01:02:14,818
that are in that arena.

1474
01:02:14,861 --> 01:02:16,776
All the big healthcare systems,

1475
01:02:16,820 --> 01:02:18,865
they wanna be the
center of excellence,

1476
01:02:18,909 --> 01:02:21,955
but they're gonna at some point

1477
01:02:21,999 --> 01:02:24,523
come to a reckoning
where they realize

1478
01:02:24,566 --> 01:02:27,482
that they've got to become
much more consumer-friendly

1479
01:02:27,526 --> 01:02:30,790
and pay attention to all
the things that other

1480
01:02:30,834 --> 01:02:33,314
industries have had to
pay attention to as well.

1481
01:02:33,358 --> 01:02:36,187
We're not trying
to cut anybody out.

1482
01:02:36,230 --> 01:02:39,190
We just have a
system that arranges

1483
01:02:39,233 --> 01:02:41,975
for anyone who can add
value and bring the things

1484
01:02:42,019 --> 01:02:44,761
that consumers need
and want to really

1485
01:02:44,804 --> 01:02:46,806
stay as healthy as possible.

1486
01:02:46,850 --> 01:02:47,851
There's plenty of room for them

1487
01:02:47,894 --> 01:02:49,678
if they're doing
the right things.

1488
01:02:50,854 --> 01:02:52,812
- One of the things
we see on Capitol Hill

1489
01:02:52,856 --> 01:02:55,859
is actually something
that the founders set up,

1490
01:02:55,902 --> 01:02:59,079
and that's that it's
actually hard to pass a law,

1491
01:02:59,123 --> 01:03:00,472
it's hard to pass a bill.

1492
01:03:00,515 --> 01:03:01,386
We have the House,

1493
01:03:01,429 --> 01:03:03,780
and the House is representative,

1494
01:03:03,823 --> 01:03:04,998
they're called representatives,

1495
01:03:05,042 --> 01:03:08,045
but it's representative
of the country.

1496
01:03:08,088 --> 01:03:09,873
The House is hot,
it's the teacup.

1497
01:03:09,916 --> 01:03:11,788
You never know what's
gonna come out of it,

1498
01:03:11,831 --> 01:03:14,312
and you never know what
they're going to say,

1499
01:03:14,355 --> 01:03:17,706
but they're representative
of the country at large.

1500
01:03:17,750 --> 01:03:18,751
And then you have the Senate,

1501
01:03:18,795 --> 01:03:21,493
and the Senate is
the tea saucer.

1502
01:03:21,536 --> 01:03:23,364
So it sits below the hot tea,

1503
01:03:23,408 --> 01:03:27,412
and so when the hot tea
spills out into the Senate,

1504
01:03:27,455 --> 01:03:28,805
it's the cooling place.

1505
01:03:28,848 --> 01:03:30,328
So in the Senate,

1506
01:03:30,371 --> 01:03:32,983
one senator can stand
up and stop a bill,

1507
01:03:33,026 --> 01:03:35,420
and that I think is
an important thing

1508
01:03:35,463 --> 01:03:37,770
for the country
because that means

1509
01:03:37,814 --> 01:03:40,817
that the minority is
always represented.

1510
01:03:40,860 --> 01:03:43,863
But it can be frustrating
when we wanna pass a bill.

1511
01:03:43,907 --> 01:03:45,560
We want something to pass now,

1512
01:03:45,604 --> 01:03:48,825
but one senator can
stand up and stop it.

1513
01:03:48,868 --> 01:03:51,305
All of the senators
have to understand

1514
01:03:51,349 --> 01:03:53,917
how important a
free-market healthcare is,

1515
01:03:53,960 --> 01:03:56,223
how important a functioning
healthcare market

1516
01:03:56,267 --> 01:03:57,921
is for it to work.

1517
01:03:59,531 --> 01:04:01,098
- People are
typically very smart.

1518
01:04:01,141 --> 01:04:02,360
Oftentimes I've had dealings,

1519
01:04:02,403 --> 01:04:03,796
and I've been in the
industry over 30 years,

1520
01:04:03,840 --> 01:04:06,538
and I've had dealings with
some inner city areas.

1521
01:04:06,581 --> 01:04:07,887
And the person in that area

1522
01:04:07,931 --> 01:04:09,454
may not be a highly
educated person

1523
01:04:09,497 --> 01:04:10,759
as far as book-learned,

1524
01:04:10,803 --> 01:04:12,849
but the reality is that
they're extremely smart

1525
01:04:12,892 --> 01:04:14,415
when it comes to common sense.

1526
01:04:14,459 --> 01:04:16,243
So that's a universal
trait most people

1527
01:04:16,287 --> 01:04:18,419
have across all
spectrums and colors

1528
01:04:18,463 --> 01:04:20,160
and ages and whatever it may be

1529
01:04:20,204 --> 01:04:21,727
if you allow that to occur.

1530
01:04:21,770 --> 01:04:23,337
And so that's what's
been the passion

1531
01:04:23,381 --> 01:04:25,731
is how do we get more
autonomy and freedom

1532
01:04:25,774 --> 01:04:27,820
into all markets, and
the most egregious

1533
01:04:27,864 --> 01:04:29,126
by far is health.

1534
01:04:29,169 --> 01:04:30,823
So that's really kind
of the low-hanging fruit

1535
01:04:30,867 --> 01:04:32,042
because it affects everybody,

1536
01:04:32,085 --> 01:04:33,217
everybody's gonna get
sick at one point.

1537
01:04:33,260 --> 01:04:35,610
And if that's not a free market,

1538
01:04:35,654 --> 01:04:37,308
we're all gonna suffer.

1539
01:04:37,351 --> 01:04:39,527
Your health is gonna be
affected one way or another,

1540
01:04:39,571 --> 01:04:40,964
and you would think
it'd be really important

1541
01:04:41,007 --> 01:04:42,313
for people to pay
attention to that,

1542
01:04:42,356 --> 01:04:43,749
and sadly they don't.

1543
01:04:43,792 --> 01:04:46,143
So we're here to
stimulate traffic,

1544
01:04:46,186 --> 01:04:47,884
to get people to
become more aware,

1545
01:04:47,927 --> 01:04:49,798
and frankly, when everybody
does become aware,

1546
01:04:49,842 --> 01:04:51,278
they get more involved.

1547
01:04:51,322 --> 01:04:54,020
- And what that's doing
is building the grassroots

1548
01:04:54,064 --> 01:04:56,849
information of what's
going on in the system.

1549
01:04:56,893 --> 01:04:58,938
The more people that
are Medi-Share members,

1550
01:04:58,982 --> 01:05:00,157
healthcare sharing members,

1551
01:05:00,200 --> 01:05:02,724
the more people that
go to a DPC practice,

1552
01:05:02,768 --> 01:05:05,858
the more voters understand
about what's going on,

1553
01:05:05,902 --> 01:05:07,642
the more Congress will listen.

1554
01:05:07,686 --> 01:05:10,732
So when you look at a staffer,

1555
01:05:10,776 --> 01:05:12,473
they're 28 years old,

1556
01:05:12,517 --> 01:05:14,780
they don't make much money,

1557
01:05:14,823 --> 01:05:17,217
they're up working
in the Capitol

1558
01:05:17,261 --> 01:05:18,915
to make America a better place,

1559
01:05:18,958 --> 01:05:21,961
but the people that are
coming in to the office

1560
01:05:22,005 --> 01:05:24,485
that might offer
them a better future

1561
01:05:24,529 --> 01:05:27,488
happened to be the
lobbyists for the hospitals

1562
01:05:27,532 --> 01:05:29,795
in the big healthcare providers.

1563
01:05:29,838 --> 01:05:32,102
Those are the people that
come in with the money.

1564
01:05:32,145 --> 01:05:33,842
So if you're a staffer
and you're looking

1565
01:05:33,886 --> 01:05:35,322
to help somebody,

1566
01:05:35,366 --> 01:05:37,890
are you going to
help a sharing plan

1567
01:05:37,934 --> 01:05:41,067
that only has one
lobbyists on Capitol Hill

1568
01:05:41,111 --> 01:05:44,984
that isn't paid the same
as the middle Blue Cross

1569
01:05:45,028 --> 01:05:46,464
and Blue Shield lobbyist?

1570
01:05:46,507 --> 01:05:48,988
Their profit motive is to help

1571
01:05:49,032 --> 01:05:50,990
the big healthcare
providers more.

1572
01:05:51,034 --> 01:05:54,472
So what we have to do is
change the grassroots,

1573
01:05:54,515 --> 01:05:56,865
we have to educate voters,

1574
01:05:56,909 --> 01:05:58,955
we have to change
the marketplace.

1575
01:05:58,998 --> 01:06:00,565
And I think that we're
on our way to that,

1576
01:06:00,608 --> 01:06:02,436
but it's going to be a long road

1577
01:06:02,480 --> 01:06:04,177
before we get all the way there.

1578
01:06:05,439 --> 01:06:07,224
- I started covering
Washington the year

1579
01:06:07,267 --> 01:06:09,835
that Reagan got
inaugurated and Tip O'Neill

1580
01:06:09,878 --> 01:06:11,663
was a Speaker of the House.

1581
01:06:11,706 --> 01:06:13,926
I used to know President
Reagan's chief speechwriter,

1582
01:06:13,970 --> 01:06:16,711
and I knew Tip O'Neill's press
secretary, Chris Matthews,

1583
01:06:16,755 --> 01:06:18,757
and President Reagan
used to get together

1584
01:06:18,800 --> 01:06:20,802
and they got along,
they disagreed.

1585
01:06:20,846 --> 01:06:23,327
It's very sad that that
doesn't happen anymore,

1586
01:06:23,370 --> 01:06:25,372
and I find it really unfortunate

1587
01:06:25,416 --> 01:06:27,505
that we're not seeking
a middle ground.

1588
01:06:27,548 --> 01:06:29,028
But I do see promise,

1589
01:06:29,072 --> 01:06:31,204
and I see things like
the Koch brothers

1590
01:06:31,248 --> 01:06:33,337
have a foundation Stand Together

1591
01:06:33,380 --> 01:06:35,948
that's working on
health, education,

1592
01:06:35,992 --> 01:06:37,384
criminal justice reform.

1593
01:06:37,428 --> 01:06:39,952
More people just need to
realize there are ways

1594
01:06:39,996 --> 01:06:42,824
to solve the problem
by working together.

1595
01:06:42,868 --> 01:06:44,870
It doesn't have
to be so divisive.

1596
01:06:44,913 --> 01:06:48,091
[slow dramatic music]

1597
01:07:01,365 --> 01:07:04,585
[moves to slow music]

1598
01:07:06,544 --> 01:07:08,067
- [Narrator] Inefficiencies
in the healthcare

1599
01:07:08,111 --> 01:07:10,809
system are avoidable.

1600
01:07:10,852 --> 01:07:13,072
What if there was a
way to predict risk,

1601
01:07:13,116 --> 01:07:17,598
promote prevention,
coordinate complex care,

1602
01:07:17,642 --> 01:07:21,211
and consolidate medical
records at the same time?

1603
01:07:21,254 --> 01:07:23,474
Well, now there is.

1604
01:07:23,517 --> 01:07:26,303
[uplifting music]

1605
01:07:35,747 --> 01:07:37,749
- Daniel, how you doing?

1606
01:07:40,882 --> 01:07:43,015
So my name is Paul Roberts,

1607
01:07:43,059 --> 01:07:45,974
and I'm the owner of
Roberts Consulting,

1608
01:07:46,018 --> 01:07:48,586
which is a medical
case management firm.

1609
01:07:48,629 --> 01:07:49,804
I've been a medical case manager

1610
01:07:49,848 --> 01:07:51,937
and RN for about 20 years.

1611
01:08:02,165 --> 01:08:05,298
Over that time, those 20 years,

1612
01:08:05,342 --> 01:08:08,214
it taught me what's
really important,

1613
01:08:08,258 --> 01:08:10,129
which is patient advocacy.

1614
01:08:10,173 --> 01:08:14,177
A lot of times, insurance
companies wanna cut costs,

1615
01:08:14,220 --> 01:08:15,613
they wanna cut corners.

1616
01:08:15,656 --> 01:08:19,051
But my view of things
is we're nurses,

1617
01:08:19,095 --> 01:08:22,098
we went into nursing because
we care about people.

1618
01:08:22,141 --> 01:08:26,145
I've seen the problems with
the current healthcare system.

1619
01:08:26,189 --> 01:08:28,800
I've been able to
develop an alternative

1620
01:08:28,843 --> 01:08:31,150
healthcare plan to the current

1621
01:08:31,194 --> 01:08:33,152
mainstream healthcare
in the country.

1622
01:08:35,111 --> 01:08:38,157
I call the plan
Coordinated Care for All,

1623
01:08:38,201 --> 01:08:41,813
and the parts of the
plan include prediction,

1624
01:08:41,856 --> 01:08:45,295
education, prevention,
efficiency,

1625
01:08:45,338 --> 01:08:46,774
and cost containment.

1626
01:08:46,818 --> 01:08:48,907
Starting with prediction,

1627
01:08:48,950 --> 01:08:53,303
it's now possible
to look at genetics,

1628
01:08:53,346 --> 01:08:56,480
family history, and
current medical status,

1629
01:08:56,523 --> 01:08:59,526
and integrate those
in a functional way

1630
01:08:59,570 --> 01:09:03,182
to predict outcomes and risk.

1631
01:09:03,226 --> 01:09:06,751
Education is important
because patients

1632
01:09:06,794 --> 01:09:10,189
need to understand how
to prevent a condition,

1633
01:09:10,233 --> 01:09:13,149
and also the deterioration
of that condition.

1634
01:09:14,280 --> 01:09:18,632
Prevention is important
because obviously

1635
01:09:18,676 --> 01:09:21,505
you need to make sure
that a certain condition,

1636
01:09:21,548 --> 01:09:23,071
or at least the deterioration

1637
01:09:23,115 --> 01:09:25,117
of a condition doesn't progress.

1638
01:09:25,161 --> 01:09:27,032
You can provide the education,

1639
01:09:27,075 --> 01:09:29,208
and you can have a
focus on prevention,

1640
01:09:29,252 --> 01:09:31,515
but it doesn't necessarily mean

1641
01:09:31,558 --> 01:09:32,864
that someone will do it.

1642
01:09:32,907 --> 01:09:36,737
We know there are a
lot of competing forces

1643
01:09:36,781 --> 01:09:38,478
and motivational factors.

1644
01:09:38,522 --> 01:09:40,219
We have to account for that.

1645
01:09:40,263 --> 01:09:45,181
So my plan is not something
that says we expect

1646
01:09:45,224 --> 01:09:49,576
everybody to follow this
prevention protocol.

1647
01:09:50,490 --> 01:09:52,275
So there's really
a couple different

1648
01:09:52,318 --> 01:09:53,711
kinds of case management.

1649
01:09:53,754 --> 01:09:56,017
There's telephonic
case management.

1650
01:09:56,061 --> 01:09:59,760
A medical case manager, an
RN, is on the telephone,

1651
01:09:59,804 --> 01:10:02,720
they're coordinating care
kind of behind the scenes.

1652
01:10:02,763 --> 01:10:03,982
And then there's
also what's called

1653
01:10:04,025 --> 01:10:05,288
field case management.

1654
01:10:05,331 --> 01:10:06,593
With field case management,

1655
01:10:06,637 --> 01:10:08,900
you're actually going
out into the community

1656
01:10:08,943 --> 01:10:10,989
on site with the
doctor and the patient.

1657
01:10:11,032 --> 01:10:14,471
Field case management
is actually useful

1658
01:10:14,514 --> 01:10:17,952
in more complex and
catastrophic cases.

1659
01:10:17,996 --> 01:10:20,128
Medical case management
is usually reserved

1660
01:10:20,172 --> 01:10:24,872
for people that have some
condition that is advanced,

1661
01:10:24,916 --> 01:10:27,701
or requires that
kind of coordination.

1662
01:10:27,745 --> 01:10:30,704
One of the primary
roles of a medical

1663
01:10:30,748 --> 01:10:34,273
case manager is to
coordinate medical care.

1664
01:10:34,317 --> 01:10:38,843
A lot of times a person's
medical care is very complex,

1665
01:10:38,886 --> 01:10:41,585
and they can't handle
it on their own,

1666
01:10:41,628 --> 01:10:43,804
and they need
someone to advocate

1667
01:10:43,848 --> 01:10:45,066
and do that for them.

1668
01:10:45,110 --> 01:10:47,808
A medical case manager,
a registered nurse,

1669
01:10:47,852 --> 01:10:51,464
is in a position to
understand the medical side

1670
01:10:51,508 --> 01:10:53,771
of things and make
sure things don't slip

1671
01:10:53,814 --> 01:10:54,902
through the cracks,

1672
01:10:54,946 --> 01:10:56,948
that everybody's
on the same page,

1673
01:10:56,991 --> 01:10:59,472
things happen, and
they get coordinated.

1674
01:10:59,516 --> 01:11:02,040
If you don't have
medical case management,

1675
01:11:02,083 --> 01:11:04,303
a lot of times
what can happen is

1676
01:11:04,347 --> 01:11:07,306
you get a delay in treatments,

1677
01:11:07,350 --> 01:11:10,701
there's misunderstandings,
miscommunications.

1678
01:11:10,744 --> 01:11:13,747
I think that RNs are
good at conveying

1679
01:11:13,791 --> 01:11:15,445
information to a patient,

1680
01:11:15,488 --> 01:11:17,403
because for one
thing, they care,

1681
01:11:17,447 --> 01:11:21,407
and because they
understand what's going on

1682
01:11:21,451 --> 01:11:22,756
from a medical side,

1683
01:11:22,800 --> 01:11:25,716
but also really from
a interpersonal side.

1684
01:11:25,759 --> 01:11:28,458
A lot of times, medical cases,

1685
01:11:28,501 --> 01:11:30,416
they're handled by an adjuster

1686
01:11:30,460 --> 01:11:31,896
or what's called
a claims examiner.

1687
01:11:31,939 --> 01:11:34,420
This is somebody
that they're great,

1688
01:11:34,464 --> 01:11:36,466
but they don't
necessarily understand

1689
01:11:36,509 --> 01:11:37,728
the medical side of things.

1690
01:11:37,771 --> 01:11:39,556
And they administer the claim,

1691
01:11:39,599 --> 01:11:42,123
they pay the benefits
and all the stuff

1692
01:11:42,167 --> 01:11:43,255
that goes along with that,

1693
01:11:43,299 --> 01:11:44,735
but they don't
necessarily understand

1694
01:11:44,778 --> 01:11:46,345
the medical terminology,

1695
01:11:46,389 --> 01:11:48,173
or even what's
going on medically.

1696
01:11:48,216 --> 01:11:50,915
It helps to have somebody
with medical training

1697
01:11:50,958 --> 01:11:55,485
in the middle to collaborate
and interpret that information.

1698
01:11:56,442 --> 01:12:00,577
RNs understand a wider
breadth across a larger

1699
01:12:00,620 --> 01:12:02,274
spectrum of the
healthcare field.

1700
01:12:02,318 --> 01:12:05,799
They're used to dealing
with the best doctors,

1701
01:12:05,843 --> 01:12:08,802
some of the best
ancillary treatment,

1702
01:12:08,846 --> 01:12:10,891
for example, physical therapy,

1703
01:12:10,935 --> 01:12:12,545
the doctor orders an MRI.

1704
01:12:12,589 --> 01:12:14,286
That's gonna happen somewhere.

1705
01:12:14,330 --> 01:12:16,897
So a medical case
manager understands

1706
01:12:16,941 --> 01:12:18,551
the best resources for that.

1707
01:12:18,595 --> 01:12:22,947
RNs also know the most
efficient pathways to recovery.

1708
01:12:22,990 --> 01:12:26,167
They can also identify when
there's over-utilization.

1709
01:12:26,211 --> 01:12:28,692
The identification
of over-utilization

1710
01:12:28,735 --> 01:12:31,651
is helpful because
you're flagging

1711
01:12:31,695 --> 01:12:33,479
when something is used too much.

1712
01:12:33,523 --> 01:12:36,482
And you're not making
a decision on the use,

1713
01:12:36,526 --> 01:12:37,962
you're simply identifying it.

1714
01:12:38,005 --> 01:12:41,269
And then another doctor, an MD,

1715
01:12:41,313 --> 01:12:44,447
would have say over
whether or not something

1716
01:12:44,490 --> 01:12:46,100
is actually over-utilized.

1717
01:12:46,144 --> 01:12:48,712
And so developing
this healthcare plan,

1718
01:12:48,755 --> 01:12:52,977
I realized we have something
that's so important

1719
01:12:53,020 --> 01:12:55,414
to use and it's
just underutilized.

1720
01:12:55,458 --> 01:12:58,765
The idea that I had
was let's expand that.

1721
01:12:58,809 --> 01:13:01,551
Let's broaden medical
case management

1722
01:13:01,594 --> 01:13:03,117
to the entire healthcare sector.

1723
01:13:04,380 --> 01:13:07,078
- With a case manager,
you have people who,

1724
01:13:07,121 --> 01:13:09,559
by definition of
managing your care,

1725
01:13:09,602 --> 01:13:11,125
of working with the physician,

1726
01:13:11,169 --> 01:13:13,824
of working with all the
specialists that you see

1727
01:13:13,867 --> 01:13:15,739
and trying to keep
you well and healthy

1728
01:13:15,782 --> 01:13:18,524
and out of the system so
that you make good decisions.

1729
01:13:18,568 --> 01:13:21,005
And that extends not
just from the doctor's

1730
01:13:21,048 --> 01:13:22,528
office or the hospital setting,

1731
01:13:22,572 --> 01:13:24,008
but to your home as well,

1732
01:13:24,051 --> 01:13:26,793
helping you maintain your
chronic health condition,

1733
01:13:26,837 --> 01:13:28,186
if that's the situation,

1734
01:13:28,229 --> 01:13:29,622
helping you stay healthy,

1735
01:13:29,666 --> 01:13:31,494
if you've had a
condition in the past,

1736
01:13:31,537 --> 01:13:33,800
and working with the
insurance company

1737
01:13:33,844 --> 01:13:35,454
to make sure that the billing

1738
01:13:35,498 --> 01:13:37,282
that goes along with
that is as clean

1739
01:13:37,325 --> 01:13:38,675
as it can possibly be.

1740
01:13:38,718 --> 01:13:40,416
- I am a medical case manager,

1741
01:13:40,459 --> 01:13:43,767
and I can tell you a story
that happened this week.

1742
01:13:43,810 --> 01:13:46,073
It's an amazing service.

1743
01:13:46,117 --> 01:13:49,207
I have friends that live in
the Washington DC metro area.

1744
01:13:49,250 --> 01:13:51,688
I came from Miami after
living there many years,

1745
01:13:51,731 --> 01:13:54,691
and their mother was
really, really sick,

1746
01:13:54,734 --> 01:13:56,040
and she's like 96.

1747
01:13:56,083 --> 01:13:57,868
And she was going to
doctors' appointments,

1748
01:13:57,911 --> 01:13:59,260
she didn't know
what was happening

1749
01:13:59,304 --> 01:14:00,740
to her at those
doctors' appointments,

1750
01:14:00,784 --> 01:14:02,612
and so I called a friend of mine

1751
01:14:02,655 --> 01:14:05,615
who's a case manager
and I got them together,

1752
01:14:05,658 --> 01:14:08,182
I made a marriage,
and now this woman is,

1753
01:14:08,226 --> 01:14:11,925
I think she's gonna live
another 10 years past 100.

1754
01:14:11,969 --> 01:14:13,274
Her blood counts were off,

1755
01:14:13,318 --> 01:14:14,711
they were all over the place,

1756
01:14:14,754 --> 01:14:17,235
and the case manager
was able to go in there

1757
01:14:17,278 --> 01:14:19,150
and look at the history
and say to the doctor,

1758
01:14:19,193 --> 01:14:20,804
"Well, what are you
doing about this?

1759
01:14:20,847 --> 01:14:22,414
"You tell her to come
back in two weeks,

1760
01:14:22,458 --> 01:14:25,330
"you test it, it's off
again, what's the plan?"

1761
01:14:25,373 --> 01:14:26,766
And now there's a plan,

1762
01:14:26,810 --> 01:14:28,812
and there's a plan
for her whole life.

1763
01:14:28,855 --> 01:14:30,727
We're looking at the
house, the house,

1764
01:14:30,770 --> 01:14:32,337
certain things, getting
rid of throw rugs

1765
01:14:32,380 --> 01:14:34,774
so she doesn't fall, we're
looking at prevention,

1766
01:14:34,818 --> 01:14:36,863
we're looking at
her whole situation

1767
01:14:36,907 --> 01:14:39,083
and looking at what her
individual needs are.

1768
01:14:39,126 --> 01:14:41,085
And that in a nutshell
is case management,

1769
01:14:41,128 --> 01:14:42,695
is what does this person need,

1770
01:14:42,739 --> 01:14:44,262
how can we get it for her,

1771
01:14:44,305 --> 01:14:46,046
and how can we make
her life better?

1772
01:14:47,961 --> 01:14:49,746
- When we have your orders for,

1773
01:14:49,789 --> 01:14:51,269
let's say upcoming surgery,

1774
01:14:51,312 --> 01:14:53,532
we'll need a pre-op
clearance, we'll need labs,

1775
01:14:53,576 --> 01:14:56,013
chest X-rays, maybe an MRI, CT.

1776
01:14:56,056 --> 01:14:57,318
Giving all that information,

1777
01:14:57,362 --> 01:15:00,278
giving the orders directly
to case management

1778
01:15:00,321 --> 01:15:01,975
representative, and
they have a direct line

1779
01:15:02,019 --> 01:15:03,890
of communication
that those orders

1780
01:15:03,934 --> 01:15:06,850
can get to that person in
more an efficient process

1781
01:15:06,893 --> 01:15:08,721
in that way that
can be expedited.

1782
01:15:08,765 --> 01:15:10,680
- Most people wanna
do the right thing,

1783
01:15:10,723 --> 01:15:12,551
but they just have a
hard time doing it.

1784
01:15:12,595 --> 01:15:14,031
I get too busy.

1785
01:15:14,074 --> 01:15:15,293
It's like a New
Year's resolution.

1786
01:15:15,336 --> 01:15:16,512
I'm real good for a week or so,

1787
01:15:16,555 --> 01:15:17,425
and the next thing you know,

1788
01:15:17,469 --> 01:15:18,818
I'm back to eating Fritos.

1789
01:15:18,862 --> 01:15:20,298
You need someone that's
gonna help keep you

1790
01:15:20,341 --> 01:15:23,083
on track and kinda hold
your hand and kinda...

1791
01:15:23,127 --> 01:15:24,476
Every time you start
to roll off course,

1792
01:15:24,520 --> 01:15:26,086
they'll just bop
you back on there.

1793
01:15:26,130 --> 01:15:28,611
- Case management, it's
a big part of healthcare.

1794
01:15:28,654 --> 01:15:30,177
We manage people as cash payers.

1795
01:15:30,221 --> 01:15:33,050
We tell you to go pay cash
and you have a discount,

1796
01:15:33,093 --> 01:15:34,312
that's all we want you to do.

1797
01:15:34,355 --> 01:15:36,227
'Cause most people
are so controlled

1798
01:15:36,270 --> 01:15:37,794
by the third party system,

1799
01:15:37,837 --> 01:15:39,578
they don't know how to be
cash payers or cash shoppers.

1800
01:15:39,622 --> 01:15:41,928
We discover that through
operations in life.

1801
01:15:41,972 --> 01:15:43,887
So we give 'em a concierge
to hold their hand.

1802
01:15:43,930 --> 01:15:46,498
- Prevention is the
key to the whole thing,

1803
01:15:46,542 --> 01:15:48,718
because keeping people
healthy and well

1804
01:15:48,761 --> 01:15:51,459
and out of the healthcare
system is the ultimate

1805
01:15:51,503 --> 01:15:53,723
way to prevent healthcare
costs from going up.

1806
01:15:53,766 --> 01:15:56,203
Because if you're not
utilizing the services,

1807
01:15:56,247 --> 01:15:57,509
there's nothing pay for,

1808
01:15:57,553 --> 01:15:59,598
so you're not paying
for the services

1809
01:15:59,642 --> 01:16:01,861
except for your insurance.

1810
01:16:01,905 --> 01:16:04,516
The prevention side is
keeping you out of the system.

1811
01:16:04,560 --> 01:16:06,910
And it's like going over
Niagara Falls, right?

1812
01:16:06,953 --> 01:16:10,914
If you stop somebody from
going over the falls,

1813
01:16:10,957 --> 01:16:13,830
you have saved a lot of
bad things from happening.

1814
01:16:13,873 --> 01:16:15,919
Once they've already
gone over the falls,

1815
01:16:15,962 --> 01:16:17,050
you clean up the mess

1816
01:16:17,094 --> 01:16:18,617
and that's a lot
different circumstance.

1817
01:16:18,661 --> 01:16:20,880
So if you prevent people
from getting sick,

1818
01:16:20,924 --> 01:16:22,229
if you help people with chronic

1819
01:16:22,273 --> 01:16:25,319
healthcare conditions
to manage and maintain

1820
01:16:25,363 --> 01:16:27,495
rather than getting very sick

1821
01:16:27,539 --> 01:16:29,628
because of those health issues,

1822
01:16:29,672 --> 01:16:31,804
you're most importantly
gonna improve

1823
01:16:31,848 --> 01:16:33,284
the quality of life for people

1824
01:16:33,327 --> 01:16:35,155
that ultimately is
what's most important,

1825
01:16:35,199 --> 01:16:37,680
but you're also going
to save a ton of money

1826
01:16:37,723 --> 01:16:40,726
because you're not gonna be
providing those services.

1827
01:16:40,770 --> 01:16:43,686
- Medical records are strewn
about, it's fragmented.

1828
01:16:43,729 --> 01:16:46,689
As a case manager, it's
hard to get medical

1829
01:16:46,732 --> 01:16:50,867
records in a timely
way for treatment

1830
01:16:50,910 --> 01:16:52,303
and coordination of care.

1831
01:16:52,346 --> 01:16:54,871
So by consolidating
medical records,

1832
01:16:54,914 --> 01:16:56,829
we're really
improving efficiency.

1833
01:16:57,830 --> 01:17:01,355
Telemedicine as a part
of this efficiency model

1834
01:17:01,399 --> 01:17:03,967
makes sense because
a lot of folks

1835
01:17:04,010 --> 01:17:05,272
just don't have access.

1836
01:17:05,316 --> 01:17:08,145
If someone is living
out in a rural area,

1837
01:17:08,188 --> 01:17:10,713
maybe they only have
access to one provider.

1838
01:17:10,756 --> 01:17:12,671
But with telemedicine,
you're giving them

1839
01:17:12,715 --> 01:17:14,804
access to many providers.

1840
01:17:14,847 --> 01:17:19,983
- Telemedicine is definitely
an important adjunct,

1841
01:17:20,026 --> 01:17:25,336
and our organization
offers telemedicine.

1842
01:17:25,379 --> 01:17:29,296
It's also especially helpful
for behavioral health.

1843
01:17:29,340 --> 01:17:31,821
It's a very important adjunct

1844
01:17:31,864 --> 01:17:34,954
and it allows medical
care to be delivered

1845
01:17:34,998 --> 01:17:39,872
to people who might not
otherwise have healthcare.

1846
01:17:39,916 --> 01:17:42,745
And for instance, think
of a health visitor

1847
01:17:42,788 --> 01:17:47,010
who's visiting a poor
family in a rural area.

1848
01:17:48,315 --> 01:17:50,970
They can't travel
into the center

1849
01:17:51,014 --> 01:17:52,929
where the physician is,

1850
01:17:52,972 --> 01:17:55,714
and it's probably not
financially viable

1851
01:17:55,758 --> 01:17:57,890
for the physician
to make a house call

1852
01:17:57,934 --> 01:17:59,718
50 miles out into the country.

1853
01:17:59,762 --> 01:18:01,720
But the health visitor can go.

1854
01:18:01,764 --> 01:18:03,766
They can set up
their video camera

1855
01:18:03,809 --> 01:18:06,638
so that the physician
can see the patient,

1856
01:18:06,682 --> 01:18:08,292
the patient can see them.

1857
01:18:08,335 --> 01:18:10,729
They have a stethoscope
so the physician

1858
01:18:10,773 --> 01:18:13,079
can listen to the
patient's heartbeat.

1859
01:18:13,123 --> 01:18:15,778
- I think telemedicine
offers tremendous

1860
01:18:15,821 --> 01:18:17,780
possibilities in healthcare.

1861
01:18:17,823 --> 01:18:20,739
You can't even
find a psychiatrist

1862
01:18:20,783 --> 01:18:22,741
or a psychologist
that will take you

1863
01:18:22,785 --> 01:18:24,612
if you're paying out of pocket,

1864
01:18:24,656 --> 01:18:26,745
and you have the money
to pay out of pocket.

1865
01:18:26,789 --> 01:18:29,617
What happens to the person
who doesn't have the time,

1866
01:18:29,661 --> 01:18:31,097
they have an hourly job,

1867
01:18:31,141 --> 01:18:33,709
they have every reason to
be depressed and anxious.

1868
01:18:33,752 --> 01:18:35,449
I mean, here in
Northern Virginia,

1869
01:18:35,493 --> 01:18:37,669
we're depressed and anxious
perhaps genetically,

1870
01:18:37,713 --> 01:18:40,106
but perhaps because
we're worried our kid

1871
01:18:40,150 --> 01:18:41,717
isn't gonna get into Princeton.

1872
01:18:41,760 --> 01:18:43,066
There's First World problems,

1873
01:18:43,109 --> 01:18:45,764
and then you have the
very real challenges

1874
01:18:45,808 --> 01:18:46,765
of the less fortunate,

1875
01:18:46,809 --> 01:18:48,811
and they need to be able to see

1876
01:18:48,854 --> 01:18:50,029
a mental health professional,

1877
01:18:50,073 --> 01:18:51,814
and they need a
lot more education

1878
01:18:51,857 --> 01:18:54,860
about why these are
not character flaws.

1879
01:18:54,904 --> 01:18:58,081
- With the cost containment
aspect of the model,

1880
01:18:58,124 --> 01:19:01,606
what I'm really referring
to is legislation

1881
01:19:01,649 --> 01:19:04,304
for the pharmaceutical industry,

1882
01:19:04,348 --> 01:19:07,394
and also standardization
of billing practices

1883
01:19:07,438 --> 01:19:09,179
with surgery centers
and hospitals.

1884
01:19:09,222 --> 01:19:11,311
One of the ways to contain costs

1885
01:19:11,355 --> 01:19:14,750
is through pharmaceutical
legislation.

1886
01:19:14,793 --> 01:19:18,797
It's not really fair, is
it, if one drug company

1887
01:19:18,841 --> 01:19:23,715
increases their profits
500% in one year.

1888
01:19:23,759 --> 01:19:24,760
That's crazy.

1889
01:19:24,803 --> 01:19:26,849
We need something
to control that.

1890
01:19:26,892 --> 01:19:30,548
Also, we have an opioid
epidemic in America,

1891
01:19:30,591 --> 01:19:34,639
and so legislation
to curb opiate abuse

1892
01:19:34,682 --> 01:19:35,640
is also important.

1893
01:19:35,683 --> 01:19:37,729
Another cost containment feature

1894
01:19:37,773 --> 01:19:40,645
is hospitals and
surgical centers

1895
01:19:40,688 --> 01:19:44,823
that have unstandardized
billing practices.

1896
01:19:44,867 --> 01:19:47,913
So for example, you
may have a procedure

1897
01:19:47,957 --> 01:19:50,089
in one hospital
at a certain cost,

1898
01:19:50,133 --> 01:19:53,049
and you can shop around and find

1899
01:19:53,092 --> 01:19:56,530
a very different cost
structure at another hospital.

1900
01:19:56,574 --> 01:19:58,489
If you don't have
universal healthcare,

1901
01:19:58,532 --> 01:20:00,491
really what you have
is the current system,

1902
01:20:00,534 --> 01:20:03,102
which is what's called
as the private sector.

1903
01:20:03,146 --> 01:20:05,670
So you've got different
insurance companies

1904
01:20:05,713 --> 01:20:07,063
that are large conglomerates,

1905
01:20:07,106 --> 01:20:08,716
and they're fighting each other,

1906
01:20:08,760 --> 01:20:10,718
it's a very competitive game,

1907
01:20:10,762 --> 01:20:12,459
and they're trying
to get more patients.

1908
01:20:12,503 --> 01:20:15,245
Universal Healthcare is
great at consolidating

1909
01:20:15,288 --> 01:20:17,725
all of this into one system.

1910
01:20:17,769 --> 01:20:19,945
You can still use
these principles

1911
01:20:19,989 --> 01:20:21,599
in the private sector as well,

1912
01:20:21,642 --> 01:20:24,732
and it's okay if private
companies are competing

1913
01:20:24,776 --> 01:20:26,734
with a universal
healthcare system.

1914
01:20:26,778 --> 01:20:29,912
My vision in order to
combine all of these ideas

1915
01:20:29,955 --> 01:20:34,481
together in a functional
way is a centralized

1916
01:20:34,525 --> 01:20:38,485
computer system that
is prevention-based,

1917
01:20:38,529 --> 01:20:40,879
provides education
automatically,

1918
01:20:40,923 --> 01:20:42,663
triggers case management,

1919
01:20:42,707 --> 01:20:46,189
whether that's telephonic
or field case management,

1920
01:20:46,232 --> 01:20:50,802
and also combines and
consolidates medical records.

1921
01:20:50,846 --> 01:20:53,370
You can use genetic information,

1922
01:20:53,413 --> 01:20:56,547
along with family history
and current medical status

1923
01:20:56,590 --> 01:20:58,984
to predict outcomes
and risks as well.

1924
01:20:59,028 --> 01:21:02,248
- Technology, and I was
gonna say on the horizon,

1925
01:21:02,292 --> 01:21:03,641
except that it's here,

1926
01:21:03,684 --> 01:21:06,426
that allows interconnectivity

1927
01:21:06,470 --> 01:21:08,951
is a fantastic achievement.

1928
01:21:08,994 --> 01:21:11,823
It's gonna revolutionize
healthcare.

1929
01:21:11,867 --> 01:21:15,783
There's a national push,

1930
01:21:15,827 --> 01:21:19,875
in fact the HITECH Act of 2010,

1931
01:21:19,918 --> 01:21:22,878
the one that talked about HIPAA,

1932
01:21:22,921 --> 01:21:25,793
also created an Office of
the National Coordinator,

1933
01:21:25,837 --> 01:21:30,233
ONC, and they have
called together a number

1934
01:21:30,276 --> 01:21:35,978
of private government
collaborations consortia

1935
01:21:36,021 --> 01:21:38,154
to work on interconnectivity.

1936
01:21:38,197 --> 01:21:40,896
Interconnectivity is now here.

1937
01:21:40,939 --> 01:21:43,768
So they know where your medical,

1938
01:21:43,811 --> 01:21:45,813
every doctor you've
ever been to,

1939
01:21:45,857 --> 01:21:48,729
where you've been is available.

1940
01:21:48,773 --> 01:21:50,993
If you give permission,

1941
01:21:51,036 --> 01:21:54,170
your doctors is going
to be able to have

1942
01:21:54,213 --> 01:21:57,738
that integrated into
their electronic

1943
01:21:57,782 --> 01:21:59,958
medical record system,

1944
01:22:00,002 --> 01:22:02,526
and that's gonna be a huge boom.

1945
01:22:03,788 --> 01:22:08,010
The integration of genomics
with the information

1946
01:22:08,053 --> 01:22:10,838
in the electronic medical record

1947
01:22:10,882 --> 01:22:13,798
and with the history in
the physical examination

1948
01:22:13,841 --> 01:22:16,975
is gonna have a profound
impact on medicine.

1949
01:22:17,019 --> 01:22:19,282
- A personalized
medicine, as they call it,

1950
01:22:19,325 --> 01:22:21,719
or understanding
through genetics

1951
01:22:21,762 --> 01:22:24,374
as to how a particular
treatment might better

1952
01:22:24,417 --> 01:22:25,723
manage the person's illness,

1953
01:22:25,766 --> 01:22:27,072
all that comes into play.

1954
01:22:27,116 --> 01:22:30,162
So as we gather all this
data through genomics,

1955
01:22:30,206 --> 01:22:32,208
what have you, it all
works towards better

1956
01:22:32,251 --> 01:22:34,819
diagnosing and better
managing a patient ultimately.

1957
01:22:36,560 --> 01:22:37,909
- When you look at the future

1958
01:22:37,953 --> 01:22:40,172
of where we're going with
our healthcare system,

1959
01:22:40,216 --> 01:22:43,610
it is miraculous the things
that we're going be able to do,

1960
01:22:43,654 --> 01:22:45,743
to take a drop of
blood from somebody

1961
01:22:45,786 --> 01:22:49,268
and look at their DNA
and know what diseases

1962
01:22:49,312 --> 01:22:51,662
they're susceptible
to or likely to get

1963
01:22:51,705 --> 01:22:53,098
throughout their lifetime.

1964
01:22:53,142 --> 01:22:55,796
- If you have a pre-existing
condition, it's okay.

1965
01:22:55,840 --> 01:22:57,885
Everyone is covered.

1966
01:22:57,929 --> 01:23:01,889
And it's also okay
if the private sector

1967
01:23:01,933 --> 01:23:04,196
competes with this plan.

1968
01:23:04,240 --> 01:23:06,416
So we're not cutting
out the private sector

1969
01:23:06,459 --> 01:23:08,505
and saying, "You can't compete."

1970
01:23:08,548 --> 01:23:11,638
And either way, I
think it's beneficial

1971
01:23:11,682 --> 01:23:13,901
for either a universal
healthcare system

1972
01:23:13,945 --> 01:23:17,122
or the private system to
adopt these principles

1973
01:23:17,166 --> 01:23:18,515
of case management.

1974
01:23:18,558 --> 01:23:20,691
The reason it's important
to have case management

1975
01:23:20,734 --> 01:23:24,303
in either system is because
it improves efficiency

1976
01:23:24,347 --> 01:23:27,437
and it helps to
reduce medical costs.

1977
01:23:28,612 --> 01:23:30,309
- I'm not a liberal,
I'm not a conservative,

1978
01:23:30,353 --> 01:23:32,833
I'm just looking at
this as an individual

1979
01:23:32,877 --> 01:23:37,229
and I really see how things
have really gone wrong,

1980
01:23:37,273 --> 01:23:40,493
and it's refreshing
to see something,

1981
01:23:40,537 --> 01:23:42,060
some of the things
that are being done

1982
01:23:42,104 --> 01:23:43,975
to make people healthier.

1983
01:23:44,019 --> 01:23:46,064
- Healthcare should not
be a political issue.

1984
01:23:46,108 --> 01:23:47,370
It's become one.

1985
01:23:47,413 --> 01:23:50,851
But much of what we do
seeks to make healthcare

1986
01:23:50,895 --> 01:23:51,852
an apolitical issue.

1987
01:23:51,896 --> 01:23:53,941
It's really about people,

1988
01:23:53,985 --> 01:23:55,639
it's not politics,

1989
01:23:55,682 --> 01:23:57,249
and we try to do
everything we can

1990
01:23:57,293 --> 01:23:58,859
to keep it in that vein.

1991
01:23:58,903 --> 01:24:01,079
- I think that there
is a way forward

1992
01:24:01,123 --> 01:24:03,386
and there's always going
to be a way forward

1993
01:24:03,429 --> 01:24:05,083
for a solution on Capitol Hill.

1994
01:24:05,127 --> 01:24:06,867
I wouldn't be working in DC,

1995
01:24:06,911 --> 01:24:08,478
I wouldn't be walking
the halls of Congress

1996
01:24:08,521 --> 01:24:10,132
if I didn't think
there was a solution.

1997
01:24:10,175 --> 01:24:12,699
- Healthcare is a unique issue

1998
01:24:12,743 --> 01:24:14,179
unlike any other political issue

1999
01:24:14,223 --> 01:24:16,747
that we deal with in that
it touches everybody.

2000
01:24:16,790 --> 01:24:20,011
Every business, every
family, every individual

2001
01:24:20,055 --> 01:24:22,970
in this country
every day in some way

2002
01:24:23,014 --> 01:24:24,798
deals with the
cost of healthcare.

2003
01:24:24,842 --> 01:24:28,715
- Because of the burden
of Medicare-for-all,

2004
01:24:28,759 --> 01:24:31,718
it's important to
have an alternative

2005
01:24:31,762 --> 01:24:34,982
that is much more
cost-effective.

2006
01:24:35,026 --> 01:24:39,813
Medicare-for-all costs
about $3.5 trillion a year,

2007
01:24:39,857 --> 01:24:41,815
and it's important for
people to understand,

2008
01:24:41,859 --> 01:24:44,514
that places a huge
burden on the economy.

2009
01:24:44,557 --> 01:24:46,472
But the plan that
I've developed,

2010
01:24:46,516 --> 01:24:50,781
you save about 40% of that,
which is $1.4 trillion,

2011
01:24:50,824 --> 01:24:53,653
and that's important
to save the economy.

2012
01:24:53,697 --> 01:24:56,917
[inspirational music]

2013
01:25:03,315 --> 01:25:05,926
- [Narrator] The healthcare
system is broken,

2014
01:25:05,970 --> 01:25:08,015
but it doesn't have to be.

2015
01:25:08,059 --> 01:25:10,888
Whether we subscribe to
Universal Healthcare,

2016
01:25:10,931 --> 01:25:14,021
the private system,
or a combination,

2017
01:25:14,065 --> 01:25:17,242
innovative options like
free-market healthcare

2018
01:25:17,286 --> 01:25:21,028
and coordinated care for
all provide solutions.

2019
01:25:21,899 --> 01:25:25,511
Perhaps more innovation
is just on the horizon.

2020
01:25:26,556 --> 01:25:29,994
Legislative change
needs your support.

2021
01:25:42,441 --> 01:25:43,834
- My name is Paul Roberts.

2022
01:25:43,877 --> 01:25:47,142
I'm the executive
producer and the writer

2023
01:25:47,185 --> 01:25:50,188
for the documentary
"Diagnosing Healthcare".

2024
01:25:50,232 --> 01:25:51,711
I've been in case management,

2025
01:25:51,755 --> 01:25:56,194
medical case management
for about 20 years

2026
01:25:56,238 --> 01:26:00,242
and own my own medical
case management company,

2027
01:26:01,199 --> 01:26:06,030
and in that time
understood the value

2028
01:26:06,073 --> 01:26:08,380
of medical case management.

2029
01:26:08,424 --> 01:26:11,514
And what I mean is
coordination of care,

2030
01:26:12,515 --> 01:26:14,604
making sure everybody's
on the same page,

2031
01:26:14,647 --> 01:26:16,910
things aren't falling
through the cracks,

2032
01:26:16,954 --> 01:26:21,437
going to bat for patients
and being a patient advocate.

2033
01:26:22,394 --> 01:26:24,396
And so I understood
the value of this,

2034
01:26:24,440 --> 01:26:27,225
and I started
questioning why is this

2035
01:26:27,269 --> 01:26:31,229
really only being
used in the workers'

2036
01:26:31,273 --> 01:26:35,320
comp sector mostly, with
a few other exceptions,

2037
01:26:35,364 --> 01:26:37,670
maybe hospital discharge
and that sort of thing?

2038
01:26:37,714 --> 01:26:39,890
And why can't this be expanded,

2039
01:26:39,933 --> 01:26:44,024
the skillset be expanded to
the wider healthcare sector?

2040
01:26:44,895 --> 01:26:46,505
To me it didn't make sense, so.

2041
01:26:46,549 --> 01:26:49,160
So I started thinking
about it and developing

2042
01:26:49,204 --> 01:26:52,250
this healthcare plan
that I have that's called

2043
01:26:52,294 --> 01:26:55,253
Coordinated Care for All,

2044
01:26:55,297 --> 01:26:58,343
which is kind of a play
on Medicare-for-all,

2045
01:26:58,387 --> 01:26:59,736
coordinated care for all,

2046
01:27:01,694 --> 01:27:05,220
but it's really using
those same principles

2047
01:27:05,263 --> 01:27:07,700
to improve the
efficiency of the system.

2048
01:27:07,744 --> 01:27:10,834
I actually, I saw these
presidential candidates

2049
01:27:10,877 --> 01:27:14,272
one after another saying, well,

2050
01:27:14,316 --> 01:27:17,493
we don't really have any
other choices for healthcare.

2051
01:27:17,536 --> 01:27:19,712
We have basically
Medicare-for-all,

2052
01:27:19,756 --> 01:27:21,627
which is universal healthcare,

2053
01:27:21,671 --> 01:27:23,499
or we basically have nothing,

2054
01:27:23,542 --> 01:27:28,243
or an expansion
on Obamacare, ACA.

2055
01:27:28,286 --> 01:27:31,202
I'm thinking, well, I
have these other ideas,

2056
01:27:31,246 --> 01:27:34,336
why not write to these
presidential candidates

2057
01:27:34,379 --> 01:27:35,989
and see if I can
get their attention

2058
01:27:36,033 --> 01:27:38,949
and share these ideas with them.

2059
01:27:38,992 --> 01:27:42,169
Well, I wrote to each
one, never heard back.

2060
01:27:43,345 --> 01:27:44,998
Tried writing to my congressman

2061
01:27:45,042 --> 01:27:47,479
and working with my congressman,

2062
01:27:47,523 --> 01:27:48,611
didn't get anywhere.

2063
01:27:51,483 --> 01:27:54,660
I've got friends that
are lobbyists in DC

2064
01:27:54,704 --> 01:27:56,706
that have been doing it 20 years

2065
01:27:56,749 --> 01:27:58,098
and just not moving the ball,

2066
01:27:58,142 --> 01:28:02,102
just not getting anywhere
with healthcare reform.

2067
01:28:02,146 --> 01:28:05,367
So I thought, well,
what's it gonna take?

2068
01:28:05,410 --> 01:28:08,152
We need this
grassroots movement.

2069
01:28:09,458 --> 01:28:10,502
And that's where I get the idea

2070
01:28:10,546 --> 01:28:13,462
of doing a documentary
is to create

2071
01:28:13,505 --> 01:28:16,987
a grassroots movement
to urge Congress

2072
01:28:17,030 --> 01:28:18,771
for change for the better.

2073
01:28:18,815 --> 01:28:20,251
Yeah, the production process,

2074
01:28:20,295 --> 01:28:22,732
we just finished
filming, as you know.

2075
01:28:24,081 --> 01:28:29,304
And I've been very happy
with the filming process.

2076
01:28:29,347 --> 01:28:32,568
And now we're going to be moving
on to the editing process,

2077
01:28:33,656 --> 01:28:38,051
and I'm looking forward
to being involved in that.

2078
01:28:38,095 --> 01:28:39,357
That's pretty exciting.

2079
01:28:39,401 --> 01:28:41,098
I mean, I think
everybody is affected

2080
01:28:41,141 --> 01:28:43,143
by healthcare in one
way or the other.

2081
01:28:43,187 --> 01:28:44,536
We're all affected by it.

2082
01:28:45,407 --> 01:28:47,670
And I see these
gross inefficiencies,

2083
01:28:47,713 --> 01:28:51,848
and I formulated a
more comprehensive plan

2084
01:28:51,891 --> 01:28:54,807
for that reason
incorporating prevention,

2085
01:28:54,851 --> 01:28:59,464
education, and genetics and
all these different things,

2086
01:28:59,508 --> 01:29:01,597
consolidation of medical records

2087
01:29:01,640 --> 01:29:02,946
along with case management.

2088
01:29:02,989 --> 01:29:06,602
So I'm trying to do my part.

2089
01:29:06,645 --> 01:29:09,779
Yeah, and I'm just
hoping that other people

2090
01:29:09,822 --> 01:29:11,998
get that and
understand the value

2091
01:29:12,042 --> 01:29:13,739
and share that
with other people.

2092
01:29:14,479 --> 01:29:16,960
[gentle music]