captioning sponsed by public affairs television this week on bill moyers journal. >> moyers: how our healtcare system surgicay removes your llet. >> the current medicalare system is not desied to meet e health nds of the population. 's designed to turn a profit. it's designeto meet the needs the people in power. millions of people are uninsured. and sure, that's parof the proble t that's not the whole problem. the whole problem is bigr than that >> when yohave a system that's builaround generation of renue, and tt money is not being put back into the syst to help people, we've lost o way. >> from our sdios in new york, bill moyers. >> mers: welcome to the journal. the world ofedicine has changed radically sie i was a kid east texas. back then,r. sam tenney made use calls for a couple of bucks a visit. dr. granburyaced to a patient'side with such speed you uld hear his tires screeching around the courouse square blocks ay. and you needed a prescription, dr. att would offer to drop it offt your doorn his way to the hospital-- a nonrofit communy hospital, by the way, run by cic-minded citizens who counted everpenny. if anyf them were around today, they would surely mvel at o high-tech medicine. but prudent folks, they would also marvel- in a horrifd way, ihink-- at the cost of it all. how did we get here? maggieahar wanted to find out. she's one of ourest financial jourlists. now, after yea of research, she has itten: "money-driven medicinethe real reason health ca costs so much." during the summer recess, if evy member of the house and senate would rd it before returning to whington, the outcome the health care debate might be ry different. in this oadcast we will share with you ailm based on maggie mar's work. the ok and the film couldn't be more timely as our untry wrestles with what to dobout monedriven medicine. >> all right, i'dr. norfleet. and joel has been talking to you about the build-up paiyou're having right now. >> yes ma'am >> is it t same kind of pa u've had before mr. willsmal >> uh, n it started about aonth ago. >> the pain you are havi now? >> yeah. >> and who is yo primary doctor? >> i don't have one ght now. >> okay. yove been admitted to the hospital before though you've been he before? >> i've been... was admitted to theentennial hospital. >> okay. >> iad chest pains and that's wh they found the hepatitis. >> oh, boy. hepatis b or c or both? >> both >> wow! you have a histo of ulcers or anything likthat? >> no, mam. >> and you haven'teen anybody elsebout this, huh? >> no, ma'am. >> okay. >> i wento the downtown clinic cause when thihappened i wasn't able to work. i lost my job. i lost my apartmt. >> okay. >> and so, i'm just trying t gehelp. >> yes, sir. we are going thelp you, okay? he's complning of vomiting ood. it's been going on for a mon, so it's t really considered an emerncy anymore. it's condered a chronic problem, but we get a lot patients le that, that the emergency department ithe only place they knothey can go to, to maybe address their problem. heidn't have the luxury of having a pmary care provider, which is luxury in this couny, which is kind of sad. we're like the richest coury, you kn, and a lot of our pele don't have doctors so they use the emergency depament in order to see a physician. >>ay, "ah." you've g a lot of congestion in the bacof your throat. do you feel like its kind of sitting there? >> well, that second to last tooth infected and the very ck tooth looks broken off. >> a right. >> over the last 12 yeara numb of people visiting america's ergency rooms has ared. yet re's what's surprising: the mber of low-income people going to e.r.s has n increased. the increase has come almo entirely amongiddle-class people and many ofhem have insurance. >> whose insurance do u have? >> blue cros do you have your card with you? >> yeah. >> so why do thego to the e.r.? why aren't ty seeing their own doctor? many people thinthat they know what's wrong with e health care system in thicountry. millions of ople are uninsure and sure, that part of the probm. but that's not the wle problem. the whole problem is bigr than that. >> i am on top here. any problem up there? any problem in the back? there arjust not enough resources outhere for, not on your uninsured patients, but also your insured tients. insud patients have a problem also because tir doctors, when they call their office andays, "i need see... we can't see you for three weeks." "well, wt am i going to do for three wes?" >> open your mouth health care costs keep goi up, up and uand up. t the access seems to be goi do, down, down, down. all ght. you need anything for pain right now? you do? okay, we'll get u something all right? we've got to run some tests d we'll be back. >> okay, thank you. i'm just glad, y know, that there's a place to come to, u know. i mean, dyinis not no big deal me, but you know, people ha to go throh a lot before they get there. >> when i was a nancial journalist at "barrens," i wte manytories about health care. and what i learned was tt much of what we think we know aut heal care isn't true. and ch of what is true is counterintuitive. so eventually i decideto write a book about health care. and when i d i knew i wanted to talk to a lot of ctors. so i began putting out phone calls. i didn't kw most of the doctors i was callin was hoping that maybe 20% of them would return call. my utter surprise, five out six of them called me back. d they talked. they talked for 30 minutes. they tked for longer than that. theyaid, "please, we want someone tonow. pleaseell people." to a man and to a womawhat they were most pason about was the declininquality of care in this country. not about how much they re paid or how much they weren' paid. they were ncerned about the quality of car about what was happening to theirrofession and how little pow they had to do anything about . >> it is, i guess, pitically correc widely believed, that to say that erican health care the best in the world. it's not. there's a mu more complicated story ere. for some kinds of re my colleague, brent james, lls it rescue care. yes, we're theest in the wod. if you neevery complex cardiac surgery or very advanced chemotherapy for your canc or some audacious interntion with organ transplantation, you'r etty lucky to be in america. you' get it faster and you'll probab get it better than in at lea most other countries. rescue car we're great. but most health care isn't tt. most health care igetting people with diabetes tough their lness over years or controlling the pain of soone with arthritis or just awering a question for someone who i worried orreventing them from getting into troub in the first ple. and on those scores: chron disease care, commity-based care, primarcare, preventive care. no, no, we'rno where near the best. and it's reflected in our outcomes. we're somethg like the... 're not the best health care systemn the world in infant mortalitrates. we're like number 23 there is an indethat is used inating health care systems, which is the re of mortality that could havbeen prevented by health care. there are least a dozen countries wi lower rates of preventable mortalitiethan the united states, and not one o those cotries spends those countries spen 60% of what we on health care. >> dr. donald berwicis a pediatrici and a revolutiony, really. he wants to overthrow a alth care system he sees shot thrgh with waste, inefficien, self- interest and disrespect r tients. berwick believ that the people working inur health care system are by d large dedicated and cari people, but they're stuck in atupid system and he calls tt a national tragedy. >> if you look at the y we pay for re in the country and say, "well, wt is the underlying theme here?" we payor doing things. a piece of surgeryperforming a test, doing a procedur even a visit is a thing. so specialti or medical practices that do a lot of thin, a lot of tests, a lot of surgeries, a lot oprocedures; they'll tend to be the hher income earning spealties. medical udents leave medical school today witenormous debts. primary care specities are the lowe paying. you have a choice beten taki 15 years to pay off your de or seven, you might decide on seven, and that mns you can't be a priry care doctor. >> wonder what your blood presre is first thing in the morning. >> wt's interesting about the fee schedule is at it's all about at it costs the doctor to pduce the service in terms of time and education. ver does anyone ask, "how mu benefit is there f the tient?" this might be a seice that, on erage, lengthens the patient life by five months,s opposed to having yo diabetes controlled for 30 years, wch means that you live a t longer and you never have a ampution. and yet weould pay much more for that technicly very skilled procedure that ge you another couple of months because we look at it entily in terms of the work othe part of the doctor, rather than t benefit tohe patient. >> he s a very soft, like maybe one or maybe two out o sisystolic near the apex. take aisten; let me see if we've evervaluated that... >> so we don'talue primary care doctors, generasts, mily doctors highly at all. the compensations relatively low and that's why we ve fewer and fewer of the >> albany med's internal medine residency this year, i believe, none of tm are going to pmary care. they're all going sub specialize in cardiology gastroenterogy, endocrinology, etc. believe it's none are going intorimary care. >> i think i can hear it. it's very soft. >> yeah. it's versoft. it's a little mid-stolic thing. it's probly nothing. >> finances doeslay into the decision. people say that going into primary care c be a burden compensaon-wise and the worry about their future. at does the future hold in terms of health care? 's really hard to make a decision i wish tre was an easy way. >> if the llars to dollars tio were even vaguely simila to specialty andrimary care, i'd choose it ain every time. i like theariety. i li doing different things. i wouldn't like doing thsame thing all day long. and i'm willing to take an incomeit to be primary care, but it's affected thquality of primary... thebility to deliver qualy primary care ithis country, because not enough peoplare going into itnd, makes it harder to put together an integrated sysm. and everyo pretty much acknowledges tt if someone doesn't have a primary car doctor they go to muiple speciasts, there is more duplication of servis at high total health care cost. >> there are very w relationships inhich we're asked to take f our clothes and be examined by people th the idea that it's going to safe to do that and ll them about intimate partsf our story that we probably don't tell anyone else about. that mak it special. at's making oneself vulnerab and sometis a fairly profound way. or going und anesthesia for an operation. if somne says, "i'm going to put you to sleep and wre going to cutou open and do certain things to you and its all going to be ne and good for you,that's a pretty big leap of faith. >> larry churchill is bio- ethist and one of the heroes of hisrofession. a discline that struggles with the hardest moraquestions regarding medici. doesn't just ask his studen to wrestle with enof life care or stem cell reseah. heakes a clear-eyed look at the most difcult ethical questions regaing how you deliver care in a profit dven system. we're now treating medicine as if it we an industrial oduct. througput. how ma units of care can you deliver? the idea that you are gog to e a patient on average for between and 15 minutes, no matt what their condition or how many kinds of problems ey have or how compcated their diagnoses or how much reassurance they ght need, is an id that you can trt medicine like a production line product and you canurn t patients in the same way like we produce widget that's a commerclization and an industrialization othe relationsh. so thiis a system which is fundamentally oken in terms of the kind of conflicts it rses in t minds of physiciansnd, also, in the minds of the patits. >> hi, dr. espinoz nice to meet you. w are you? karen, daughter? wonderful, pleasur okay. dr. lynn was kind enough tsend you in my diction is that correct? >> y, it is. >> do u have an understanding of why you're hereo see me? yocan't just fix things in medicine. medicine is a process. it's a duration of treatnts that ours over the course of somebody's lifetime. yeah, there are things tt we do that are very sysmatic and ry matter of fact, so to speak,here you fix and "boom" theye on their way, but it's just not good way to develop a relationship. yoneed a rapport, you need trt, you need thatatient, you know, having the abity to say, y know, "yeah, dr. espinoza, that's my ctor." >> how'vyou been? >> fine. >> the thing i ms most is being able to sit in a rooand talk to a patient for an hr. but, y know, we're so compressed with our ti and the amount opatients we have to see, you know, 1minutes is a long time the days. that's a long time. basicall you know, you get the assembly line. >> have we met bore? >> i think so. >> just get hooked uand the chain keepmoving. hello. it doesn't allow you to haven inmate relationship with somebody witut someone else trying to always pryyou know, that relationship art. >> because you had td me to go to wte house, i think, and i couldn't gethere because they told me my insurance wldn't cover it. >> ah,kay. thinsurance companies, you know, are clearly in the rm with us. you know, employers are the room with . you know, you t into these issues of out of networkin twork; we're only going to p 20of your hospital visit versus 50% if you to this spital. these are all brokeredeals and negotiated conacts and things like that, thain larger insurance companiehave with specific hospitals, whh specific testing cters. you know, so you're deing with a lot things that, you know, thiss not stuff that's taught at medical school,his is not uff that, you know, your partners are familiar withther an being exposed to it. you know, d we've kind of turned the blind eyer done the osich thing with, you know, burying ouheads in the sand saying, "you know wh, we're just doctors we want to st al with what we do." buall of those other entities now live in oubed, in our beoom with us. you ow, you can't just pay attention your wife and go to sleep at night. yore sleeping with six or seven othepeople that are trying to break your marage up. that's aig problem. that's aig problem. >> when yogo see the doctor and the doct listens to you and then sends you aill, there's profit in thatill. that's the doctor's inme after or she has paid the receptioni and the lights and heat andhe rent and the equient. he keeps t rest. that's profit. just as long as it's human enterise, yeah, at some level, someone's got toake some money or w would... they won't do it. so wre going to have profit evenf you call it a non-profit system. what are the incentives? ght now the incentives in america are if y want profit, do me. you make money bdoing stuff anthere's no limit. so we do a do and do and we get is oversupply, this excess activity because thas how people, hospitals, dtors make money. >> carl, you gave him alady a lile cocktail from the bar. all righty. if you need anything more,ust leus know. right w you are going to get a lile bit of a local anesthetic down here in your g. let's start with the right heart. you ow, if you're a hammer, everything looks like a nail yoknow, i'm an interventional cardiologist and thas what i door a living is i fix blockages. six front checks b35, plse. does the hospital likeou doing lots of procedures? sure, you know, these procures are reimrsed, fairly substantially. you kn, even within your own grouthere is a component of productivity. you know, you wish tngs would juste about taking care of patients and doing theight thin but, you know, are there external pressures? absolute. ablutely. >> dyou have to push the cath or does it find its way jus naturally? >> alloads lead to rome. >> terrific. >> b, at the end of the day, if you just remember the fundamental prciple that you have to have done somethinfor th patient in order to make them feel better, liveonger, you know, engage in a lifeyle that they weret able to engage in before, and if you sticto those principles, it allows u not to, kind of, drift from at you know is ght and fall in to is arena where, you know, you're just slamming a sti in every blockage that yosee. because you did that, then early it becomes... i would hate to use e term immoral, t it becomes an issue where you are ing things just to do them, t because it's the right thing too. >> there's an awful lot of technology iolved even in ordinary outpatient kind of encounters now weave been so good at finding new and novative ways to treat illnes and we love this. the idea that technologi can be turneinto cures is really a fundamtal thing in our society. i'd like to suggest that if looked at the population of people with a proble back pa. d said how many m.r.i.s do y thk we need to do as a nation? we could pbably cut the number in half d not have hurt anyby. yet we keep oping more and re m.r.i. machines and do mo and moreictures. they're beautil, they're inedible, incredible technology. but th that causes somebody to have to make a decisn about a back surgery that mae they didn't need. >> i think the main driver, e differce between our costs and other countrs costs that have health care systs as good or better than ours, is sply- drivenare. it's this work tt elliot fisher and jack wennberg he explored adartmouth. it's that we oveuild and, therefore, we use. and there's no lits, there's no cap, there's control. and so we just spin the whee >> what's truly staggeri is homuch waste there is in our health care stem. upo one out of every three of the more than two trillion dollars that we spend is wted on iffective, often unproven procures, overpriced drugs and devices that areo better than the drugs and devices that they're replacin necessary hospitalizations, unnessary tests. now this may seem like an overstatement. i mean, how cait be that 1/3 of the money is wasted? we actually havelose to three decades of rearch done by doctors at dartmth university proving how much was there is the system. what t dartmouth research ended up doing was lookingt heal care all across the country anwhat they discovered is that in se high treatment ates, like new jersey, medicare was speing 20% more per patient than the average anin other low treatment stateslike iowa, medicare was spending 25% less th average. they tend to focus in on what happenedo patients during their final two years life. so in th way you're comparing apples to apples, prettyick tients, and they began looki at sk patients who had the same dease, etcetera, finding these enormous differences i what medicare spen some people sa, "well maybe patits in new jersey are simp more demanding than the stoic tizens of iowa." but, in fa, very few people dema a chance to spend more days in the spital during their final two yearof life. very f people cry out for a chan to die in an i.c.u. or to have that fourth produre or to be poked and prodded by or 12 specialists during yr final simonths of life. in the states where medire spends more, these are the things that happ to people. they're gettg more aggressive, intensive, a expensive care. and he's the stunner: the outces are no better. often they are worsen average in stes like new jersey or new yorkr california, than they are in low treating stat like iowa or north data. >> you have a situion where the doctorrovides a service, is paid for providing this service, and controls, ta significant extent, the dema fothat service. 's not i saying, "i'm going get a high definition television." this ia doctor saying, "you ought toave a high definition television." more correctly"you ought to have an m.r.i. or a c.a.t.can. it's called for this situation." who in the world i don't have the abity to say "ithis m.r.i. necessary?" >> theact of the matter is that iurance companies tried saying no in the '90s, ithat erof manage care, when the great many h.m.o.s would s, "no, we're not going to pay r that." the probm is that h.m.o.s made their decisions on what th are going to pay forased, too often, simply on cost. if something was too pcey, they wld say no. but they wer't looking at the quality of t procedure. they weren't askg, "well, would it reallbenefit the paent?" theyere simply saying, "well, where do it fit on our schedule of costs? so, sometimes, they nied inefctive, unnecessary, expensive care and somimes they denied very good, effective, expensi care. there was backlash, needless toay, in the media, on the part of paents, on the part of docts, so by the late '90s h.m.o.s began to s, "okay, okay, we w't try to manage care. and large, we will pay for whatever medicare ys for. medire tends to pay for whatev the f.d.a. approves. we'll justass the cost along toou in the form of higher premiums." and that why, since 1998-99, premiums he just skyrocketed. >> in fact, the erage total emium for a family of four last year topp ten grand. >> docto here in boston say they're seeing an incrsing number of patients w cannot afford t most basic preventative hlth measures, like a blood tt. >> 72 million americans ha trouble paying for medical ce last year. >> hostal bills are now a leading cause of persona bankruptcy >> i thinkt's interesting that a country that has 12-trillion dollar budget spends a six of it on health care. and our work would sugge that we're nospending it wisely. the dartmouth ogan is "vox clamantis in deserto which is that voice cryg out in the wierness, and i thought it was a good anagy for me because i came here beuse i heard another voice, jack liberg, talking abt the disparities in the delivery of ouhealth care system and the irrationali of its utization. and, now, hang been here for 12 or so years, i realize it an uphill battle. you can't fighcity hall, but we're gointo try. >> in the early 19s dr. jim weinstn made a courageous cision. he decided to walk ay from tenure and an endod chair in the university of iowao go to dartmout where he would participate inevising ways to lp patients become involved making decisions about the own care. as a surgeonweinstein had long lt that patients just weren't getting a fair ske, as he put it. they weren't getng the inrmation they needed about the risks treatments. too ten, informed consent was informed persuasion. ultimately, illness in his o familyould drive that lesson home. >> my dahter's name is brienna. she had beautiful blueyes, curly brn hair; your first child, the light of yourife. 13 months ter i get a call from o pediatrician saying, "cld you come over to the hospital?" and i wa into the pediatrics spital and i ask my wife wh's wrong and she says, "they won't tell me. they won't tell me." the doctor walks in wi about, it seems like, t other people, other pele. very irusive. and id, "i think your daughter has leemia and we need to treat her, immedialy." the protocol for treatment was very intense cmotherapy. she would lose her haiquickly. she would be sick. shwould develop sores in her mouth. she wouldn't be able teat because of sores from the chemotherapy iher esophagus. she would have all kindsf rashes. her blood counts would balmost zero so her risk of infectn would be very high. we couldn't takeer any place. she had to be protted. anit sounds, "well, that's not so bad, we can do that for week." but the protocol was for tee years. she did pretty well r about, i think, two yrs and then the leukemia came back and they said, "we need re-induce her wi the bad medicines again and have to consider brain and snal radiation. so spinal taps every d for three wes." i said, "i d't get it. i mean, you st told us if we follow this protocol, these are the result we did everythinyou said and it is stilnot working. and now you want us to do something rse." "well, you he no choice and if you dot do that we will sue you." i sa, "what?" "if u don't do what we tell you, we'll sue you." >> why wld doctors threaten to sue a pare whose child is dying? in a probability, the physicians were concerned at if they didn't follow the protocol and go on with e rther treatment that they ha planned give her, they might be sued for maractice. even though e doctors couldn't explain the otocol or give them any assance that they kn that the next treatments would brienna any good. in a way, i think it a response to the uncertaintthat they say, "we arthe doctors. we know at we're doing and this is the way we do and this iwhat we do next." and if anyone, whether it a residenta patient or a relative, says, "well, why they s, "because it's the way we do it. period." you know, doctors are trained, i hope, in every ca to think about what's bestor thperson that they are taking caref. they're trained give medications, to do operaons, to meare different tests with bld sugars or blood pressures. theye not really trained well in this decision proce of ging information to patients to empower them to me decisions. thats a big short fall in the american health careystem. >> we have really od data that show when u take patients and you reallynform them about their oices, patients make more frugal choices. they pick more efficient choes than the health care syste does. woerful work of a researcher named annette o'nnor studied patient shar decision-making with respecto surgery. what she found across a rangof studies was when pients actually goto participate in the decisionsurgery rates fell by almost 25%. and sasfaction in outcomes improv. so an activad patient really enged. i'm not talking about paymt here. i'm notalking about shifting burden of cost. st engaged with knowledge an shared decisn-making. better outcomes, lower cost, higher satisfaction. you knowwhat more could you want? >> intensive care requis a finely orchestrated teamed by physiciansnd nurses passiona about patient care. >> some of the world's fist... >> it's interesting how hospitals advertis who would ma a decision about where to have their by or whe to be treated for caer based on aad they saw on tv? >> number one for hea surgery in new york ate. >> a magnet hospital for nursin cellence. >> hospitalsre not advertising to the patient. hospitals are adverting to doctors. hospitals don't ve patients, doctors have patients. and hospitals want dtors to bring theiwell-healed, wel insured patients to th hospital. >> our award winning full service cardiology deparent habeen nationally recogned as the bt in the region. anin the... >> hospitals have gaged in, what many call, a "medal arms race." >> using advanced micro technology physicians dermine... >> tically, four or ve hospitals with a five mile, ten mile, 15 mile raus will all buy the sa technology cause they're competing with each other. >> when you neeus, rest assured, we will delivern exceptional performae. >> oneime dr. donald berwick called a hospital in texas a said, "we've heard y have a very gooprocedure for treating a particular disease we'dike to learn more about your protocol sother hospitals can use it." and the spital said, "we can't tell you that. it's a cpetitive advantage in our market that 're better at treating ts disease and it is very lucrative sohis is proprietary information." >> we believe in marts, right? isn't th the american way? well, markets mean competion. isn't th the american way? competition makes thgs come out righ well, what does thatean in health care? mo hospitals so they compete wi each other. more doctorsompete with each other. more pharmactical companies. we set up war. wait a minute,et's talk about the patient. thpatient doesn't need a war. >> the patient isn the center of a collaboration. the patient is the vtim of a competition. there'a saying in swahili, "when..." i can't remeer this one, "when the elephants fig, the grs is trampled." the tient is essentially the grass. >> ♪ if yove got the money, hone i've got the time ♪ we'll go honky tonkin' we're gonna ♪ have a time we'lhit all the night spots, ♪ dance, drink beer andine if you got theoney, honey, ♪ ie got the time ♪ >> somebody ys, "nobody in nashvillmakes anything. we just do stu and people send us money." i've bn told they never had a recession inhe history of the ace. this is music row. every one of these hses is now a recording studio there's love monkey music, flashville, sharp objects muc, seasac, whatever that is. is is the heart of "music city" u.s.a. here's what a nurse to me. "telpatients to remove the foil froa suppository before sertion." >> cfton meador has had many careers. he's beean author, a family doctor, an epidemiolist, a health care administtor and the youngest ever deanf the university oalabama medical school. ov the years, he's watched the business of alth care rn to a driving force in the us economy. muchf it headquartered in nashville. >> this is marilyn way. marilyn way is a center ro of marilyn farm marilyfarms is a huge complex. the predominant business in re is health ca corporations of one sort or another. th goes on and on for over a mile here d this is not called for-prof hospital row, or anything like that, t this, this is thequivalent of the music rothat we went down for the cording industry. >> ♪ if u've got the money, honey, i've got the time ♪ we'll go honky tonkin' we're gonna ha a time ♪ but if you run short money, i'llun short of time ♪ 'cause u with no more money, hone i've no more time ♪ >> this titled "the nashville health care dustry, the family tree 2006." evy little square re is a health ce business industry or spin-off. we have three mother rporations here: h.c.a., whi is theospital corporation of america,pun off all of tse. hospital affiliates, whichs a spin-off of h.c.a., un off all of these. and health trust, ich is a spin of spital affiliates and c.a., spun off all of these. so thiis a massive, industrial health cplex that's headquarted here in nashville. >> after world war i while other countries let thei vernment begin to intervene health care toake sure everyone got care, to regute it tmake sure it was good carein this country doctors very, ry strongly opposed any governme involvement or anyone being involved in lling a door what to do. after dicare w passed in 1965, elderly patients we getting far mo care than they had been bore then. then that's whenur industrial medical complex, i wld say, took off. by the early '70s, there were so much money involved that suddenly pple began to say, "you know at? medine is too important to be manageby doctors. we all know doctors arbad managers. what we ne are businessmen managing health care." and that's when heal care went om being physician centered and controll, to a large degree, by doctors to ing corolled by the corporation and e c.e.o.s of those rporations. and,ver time, more and more e c.e.o. of the hospital wou not even be somedy with a m.d. he would be somebody wita m.b.a. and c.e.o.s bent on growthbent on higher quarterly earnings quarter after arter, and year afr year, are always pushing for more sales, more revens, more and more and mo. it proces more. but more may not be tter for our health. >> i've hearit said that the official bd of health care is a crane. look aund at any hospil in your communityhere's a crane on top adding ros. you kn, we just, we overbuilt it. and then, having overbuiltt, we use it and en we think using it is necessary. it's a sral. >> the wst thing that could happen to a dictor of a hospital is that everybo, all of t sudden, would be healthy. i'm not saying that he's overjoyed when there'sn epidemic clearly,e isn't. i'm not saying that 's overjoyed when people arsick. clearly, they' decent folks. but they're running someing ere what they are sellinis hospital bs. >> if you can believe itrashi fein has survived fi decades of the battle for health car reform. in 195he served on president truman's comssion on the health needs of america a timehen truman was pushing for univerl coverage. then he worked with j.f.k. wn he fought unsuccessfullyor medicarea battle that l.b.j. wod later win. as a professor omedical ecomics at harvard, fein has never given up. heirmly believes that medicine should n be all about money. as he putst, "we live in a soety not just in an economy." >> well, we spend re than any her country and we spend a higher pcentage of our gross domest product and our gross domestic proct is larger than mo other countries'. we are spending per capita one heck of a lot re than anybody else, ich ought to be disturbingif only because there are lo of other things we could be doing with mon. we could have re money for education or more ney for infrastrture or more money for bridges d transportation or we could put moneinto high-speed trainsr we could have tax cuts. on t other hand somebody could say, "well, weave chosen to spend money on health ca and that's also a good thing." true. buinterestingly, disturbingly, frighteningly, pick your o word, we spendore money and we are not althier. don't live longer. we don't seem to be getting much value foroney. >> it shouldn'be any surprise th there is a huge disconnect between the amount of doars that actually pour into health care and the health dicators of a population beuse this system was not desigd to serve this end. at's a fundamental realizati that we need to me to. and until we do i ink, you know, we'll still be tryinto tinker witthe market in some kindf funny way. just a littltweak or adjustment to maket work tter, but it was never designed, actually, to mt health carneeds. >> we got through and had a w wes over the years of no treatment and eryday without a ile. ever. she was a grt big sister. they had a lot of fun tother as sisters. i was in germany ging a lecture and i could ll in my wife's voiceomething was wrong when i called me. gone oneay. and she wouldn't tell mehat she'd had another relapse. i gohome from germany, and she said, you know, "brina relaed again." so i picd my daughter up and i hugged h. you know, said, "this ist possible. we've done erything." so back to t doctor. another protol. radiation she has to be t to sleep for, s has to be taped down onto a table. imagine the effects of radtion on your child'brain, on the spinal chord when it's veloping. will there be brain dage, doct? "oh, your daughter'so smart, there'll be no problem willhe get a secondary tumor om the radiation? "oh, it's possiblebut it's 20 years away "oh, okay. i guess i'm supped to just accept that." we take her foradiation. shd have to go for five days in aow. they put her to sleep. she'd come homand she, we couldn't comrt her. we had to put paddinall around the room so she wouldn't hur herself. it upseter so much and bother her brain so much. am i helping her? am iurting her? is this barbaric? is this trtment? eventually, she had her fil relapse when she waswelve. her sister, shely, is probably about ght at this time. and i said, "shelsey, i thin your sister's gog to go to heaven soo" and she grabbemy hand, and she said, "daddy, that's oka" she said, "i always though heavens where life is and that life is just a dream." i sa, "shelsey, i hope you're right. i hope this is just a eam and that we're going to some place where lifeeally is." and i've always... that'such a profound stament, for anybody. it made such increble sense to me. when shelsey and i went r a walk, her sier died. >>ood morning, ms. elma. how you doing? >> hurtingright now. you're hurting? >> i hurreal bad. my pain is from here allhe way . >>'m sorry. i'sorry. i'm sorry. it hurts that bad? yes. >> when did this firsttart? >> yesteay. >>hat time yesterday? that hur just touching you? that hurts. >> up here when you uch me. >> this doesn't hurt >> no. it's just comfortable, but it doesn't hu. >> medicine is everything i thought it would be and whole buh of things i didn't put into thequation. bui just love doing what i do so much, tt it just doesn't bother me to do those extr things. i'm willing to go e extra mile, becaus hey, this is somebody's mother, this is somedy's father, this is somebody's broth. and if ion't do right by them, justnderstand, people die in my profession. unlike other professns where, oh, i get a recall, i'll tel you what, i' give you a free sandwich... no i can't t you a free mamma. you can't haveine. mines good. and you just have toeep the one you've gotnd i'm going to help you do thgs to keep her around does it hurt to lift your ar >> no. >> you don't he any problem combing your hair? >> no. >> has anyone ever tolyou that you have high bloopressure? >> it justappened today? no, no, no. i don't beeve that. >> i was upset, because i t here. i was suosed to see dr. knox or somebody, so s was not here. >> well, she'sot here anymore. >> wl i don't know. you can take it again becausi never hahigh blood pressure. >> what i trto do is to make sure that i inform my tients and get them to unrstand what'soing on with them. inform tm of what's going on. yeah. she y not have got it right. 's even higher. you should have taken the on she gave you. you know, let e patient know. you've got a sta in it. it not something magical i'm going to do,ou know, wave my wand and you're gointo be better. i don't. i mean, you've g high blood pressure; you will have gh blood pressure when you leav here. but i'm going give you a way in which you can mane the problem. d, so, manage the problem. just don't standhere. do something. anything change out your family history >> no. no chest pain or shortness brth? >> no. >> prevention is the keynd we in this trench need to maksure we prevent cerin things, rath than wait for certain things to happen. >> no, i get headaes. i'veeen having them for years. >> you'll always have a bill, but the thing is, you n't always have od health. that's a window, sometng you work on, and if you' got it, maybe yocan keep it. and even that's not a omise. but, the things, if you ignore it and neglect it, we n expect to have more recs of people o want to end up in the emerncy om and when they go to the emergency room, ey find that they havmetastatic cancer. that's just t the way it's supposed to wo. you know, access tcare, and someone who does ce about what's going on, not theollar at comes into your pocket, b tually cares about that person, whathey represent, is whate need more of. >> a physician takes aoath to put his patit's interests ahead of his own. a corporation legally bound to put its shareholders' interestfirst. and this is part of e inherent confli between health care as a business, part of oueconomy, and health care as a publigood and rt of our society. health care habecome a growth industry. that mns higher health care bills. thateans more and more middle class people cant afford health care in this country. >> for americans rht now i think the primary questions, "how vulnerable am i in tes of e current system? am just a pink slip away from being uninsured and potentlly uninrable?" and i think there's very ofound question about whethe we arereating a health care system tt is sustainable over time. some pple have suggested, and i ree with them, that, actually, the d product of all of this ss and confusion in technologil innovation, is ing to be a system that cann be susined, because it will be so expensive that only the extremely wello do, the elite, will have acce to it. >>hen you have a system that's builaround generation of revenue, when that renue is going somewhere,nd that money is n being put back into the stem to help people, you've really kind of lost, you kw, we've lost ouray. >> ihink that health care improvemenat the systemic level has me of the properties of major social movementin thisountry: civil rights, vironment. so many oxen to gored, and a lot of people withxen that n't get gored but think they will. and this, you know, the coalitioof the people who would be better off d the peop who are needlessly afraid of cnge, that is, they don't ne to be afraid of change but they are, th's an immense coalition. at's 80% of america. >> in myife, my daughter caus me to change my life. and i said"i don't want otherpe thale wo vehadosht e people thave to do what she hato do." we have the compsion. weave some knowledge. we have tenology, but we let so manthings get in the way of the re ideals, the hippocratic principles, thate get lost in that system that brina shouldn't havead to face and so my millions of other people shouldn't have to ce. >> i thi health care is more about lovehan about most other things. if there isn't at the coref this two han beings who have agreed to be in a relatiship where one isrying to help relievthe suffering of another, whi is love, you n't get to the right answer here it begins so much r me in that relationship that erything that's built around that h better make damn se that it's supporng them and not hurting it. ana lot of the structures that i talking about-fragment structures, transactn-oriented structurescompetitive struures, forget that... forget thathis is about two people meeting and that'all it's about. >> moyers: "money-driven medicine a film produced by alex gibney, peter bull an chris matonti; directed by ay fredericks; and sed on maggie mahar's book of the sameame. log on to pbs.org and clk on "bill moyers journ." maggie mahar will behere to answer your questions line. we'll link you to th"money- driven medicine" website wre ere's more info about the bo anthe film. we'll also link you to se analysis of what advocates o reform are up agnst in taking on the health inrance industry, the drug lobby, an the wall seet equity firms. take a look at this recentover of "business week." reporterchad terhune and keith stein write that the c.e.o.s of t giant insurance companies should be smilin eir lobbyists have already won. "no matter what specifics erge in the volumous bill congress y send to president obama th fall, the insurance indust will erge more profitable." and remember that levision ad bara obama made as a candidate for president? >> the prmaceutical industry wrote into therescription drug plan that medire could not negotiate with drucompanies. and you know what,he chairman of the committee who pusd the w through went to work for t pharmaceutical iustry making $2 mlion a year. imagine that. at's an example of the same old game-playing in shington. don't want to learn how to play the game better i wa to put an end to the game-playing. >> moyers: now look at ts recent story in the "losngeles times." lo and behold, since t election, the pharmautical industry's2 million dollars a ar superstar lobbyist billy tauzin hasorphed into prident obama's pal. tauzin says e president has omised not to pressure the drug companies tnegotiate with the government for lower dru pres and has agreed not to alw cheaper drugs to be imported from cana or europe contrary to the sition taken by candidate oma. eachf these stories illuminates the arlet thread that runs through maggie mah's bookthe story of how today's market-driven medicasystem gives wall street inveors life and death control er our heth care, turning medicine to a profit machine instead a social service to me human need. that's t conflict at the heart of next moh's showdown in washington. i'm billoyers. see u next time. ptioning sponsored by publ affairs television captioned by media access gup at wgbh cess.wgbh.org

Related Keywords

New York , United States , New Jersey , Rome , Lazio , Italy , Germany , Texas , Iowa , Boston , Massachusetts , California , South Korea , Washington , District Of Columbia , Americans , America , Han , American , Billy Tauzin , Maggie Mar , Maggie Mahar , Brent James , Pa Uve , R Sam Tenney , Alex Gibney , Elliot Fisher , Keith Stein , Donald Berwick , Larry Churchill ,