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Escape Fire: The Fight To Save American Health Care

Aired March 10, 2013 - 20:00   ET


DR. SANJAY GUPTA, HOST: Good evening. I'm Dr. Sanjay Gupta. Up next, CNN Films presents "ESCAPE FIRE: THE FIGHT TO RESCUE AMERICAN HEALTHCARE." Stay tuned because afterwards, we're going to have a very important discussion regarding what we can all do to live longer and healthier lives and maybe avoid unnecessary costs and procedures.


DR. DON BERWICK, HEAD OF MEDICARE/MEDICAID, 2010-2011: In 1949, a forest fire broke out in Mann Gulch, Montana. Smoke jumpers were parachuted in a team of 15 headed by a foreman named Wag Dodge. The fire exploded, it's moving over 600 feet a minute, faster than most people could ever run. And so 15 firefighters were trapped.

Wag Dodge had an idea. He knew that they would lose the race back to the top of the ridge, so he suddenly stopped. He lit a match and he lit a fire at his own feet. And the fire spread around him. I imagine the other smoke jumpers thought the guy was crazy, but his idea was this. If I burn the fuel around me, then when the fire comes and it takes me, I'm safe. I'll be -- and what came to be known as an escape fire.

He tried to get the other smoke jumpers to join him, and nobody did. The fire overtook the crew, killing 13 men and burning 3,200 acres. Wag Dodge survived, nearly unharmed, in his escape fire. It is just tragic to think of the answer being there but just in the -- in the moment not able to see it. That's how embedded people get in the status quo. They can't recognize an invention when it's among them and they can't give up their old habits.

We're in Mann Gulch. Healthcare, it's headed for really, really bad trouble. The answers among us, can we please stop and think and make sense of the situation and get our way out of it? It's the same challenge.

UNIDENTIFIED MALE: We have had enough.

UNIDENTIFIED MALE: What do we want?

PROTESTERS: Healthcare.

UNIDENTIFIED MALE: When do we want it?


DR. ANDREW WEIL, PROFESSOR OF MEDICINE AND PUBLIC HEALTH, UNIVERSITY OF ARIZONA: All I hear is how we're going to give more people access to the present system and how we're going to pay for it. And to me, that's not the only issue. The present system doesn't work and it's going to take us down. We need a whole new kind of medicine.

Healthcare reform was a good place to start, but it will do little to address the root problems. We don't have a healthcare system in this country. We have a disease management system.

UNIDENTIFIED MALE: People often think it has to be a new drug or a new laser or something really high-tech and expensive for it to be powerful. And they have a hard time believing that these simple choices that we make in our lives each day can make such a powerful difference.

SHANNON BROWNLEE, MEDICAL JOURNALIST: We're in the grip of a very big industry, and it doesn't want to stop making money.

UNIDENTIFIED MALE: At the executive level, what's most important is hitting Wall Street's expectations, and they have to. These for- profit companies by law have to serve shareholders. You almost forget that what you're doing is providing healthcare.

BERWICK: The healthcare system is unsustainable. We're spending almost twice as much in America as any other country on earth. We're really mortgaging the future. Not just the health, but healthcare, the health of a nation.

UNIDENTIFIED MALE: But Mommy, what are you going to do?

DR. ERIN MARTIN, PRIMARY CARE: I got to go to work.

UNIDENTIFIED MALE: What are you going to do at work?

MARTIN: What I do every day, buddy. I love you.

UNIDENTIFIED MALE: I love you, too!



MARTIN: At a community healthcare center like where I work, you see chronic illness, people that aren't able to afford their medications, lots of psychiatric illnesses.

UNIDENTIFIED FEMALE: I think we have about 25 patients for today for Dr. Martin. I think five or six of them are on the waiting list.

UNIDENTIFIED FEMALE: If there is a 50-minute queue, I'm sure we can probably squeeze them into the schedule.

UNIDENTIFIED FEMALE: Hello, Mr. Fields. Let me take a listen to you. All right. Who's next? Instead of basing things on outcomes, on how good of a job we're doing, the government sets the reimbursement completely on the number of patients that we see. It doesn't matter how complicated they are, how much time that we spend on them, it's just a number, one, two, three, four, five.

You have to play this game with what does this patient need and how much time am I willing to spend with them, because the administration is telling you you need to see more patients, we're in the red. And if you try and buck the system, someone says, what can we do to get your productivity up?

I'm not interested in getting my productivity up. I'm interested in helping patients.

WEIL: In the year of for-profit medicine, the time allowed for patient visits has shrunk to a point where you've got seven minutes with a patient.

MARTIN: Can you feel this?


MARTIN: Barely?


MARTIN: OK. Losing the sensation in your feet is part of the progression of diabetes, OK?

WEIL: It could get worse. People talk about two-minute doctors. Literally, 30 patients an hour. Things could move in that direction here, and this is not the choice of the doctor.

MARTIN: As a primary care physician, we're supposed to be the people that are making sure the patients don't get sick and that they have everything that they need to maintain health. But we end up being this revolving door. People come in and you try and fix one thing and they come back for the same thing over and over and over. You just never get to the bottom of what's causing all of these problems that they are having.

Michelle? Tell me what happened.


MARTIN: What were you trying to do?

UNIDENTIFIED FEMALE: (INAUDIBLE) I'm tired of it. So tired of it.

MARTIN: Are you taking your medication?


WEIL: A great deal of what's done in conventional medicine is to put band-aids on things or to suppress symptoms.

MARTIN: Have you cut yourself before?


MARTIN: You used to cut? So Lexapro is the only thing you're on right now?

WEIL: This is a problem with a lot of our suppressive treatments. They may keep the disease process going and they may strengthen it over time. It's much better to try to work at a deeper level.

MARTIN: I'm going to make a phone call and try and get some wheels in motion so that we can get you the help that you need. OK?


MARTIN: So we need the crisis counselor, then. Yes, this is Dr. Martin over at La Clinica. I need to speak with the crisis worker. There's no crisis worker at lunchtime? I have an acutely suicidal patient in my office that I need help with. She's still taking her Lexapro, but it's obviously not doing the job.

Where I'm at right now, patients are in desperate need of care. The way that the system is set up, you can't be effective. I became a doctor because I care about patients and working here, I can't help them. To feel that way when you come home is demoralizing. There has to be a different way of doing things. So I decided to leave.

It's hard to say good-bye to the patients. I took care of them and I was responsible for them and just worrying about if somebody else is going to do for them what they need. I want to give to people and I want to help people, and I wasn't able to find that here. Going to go look for it.

BROWNLEE: We spend a spectacular amount of money on healthcare. The really astonishing part about the fact that we spend more is we have worse health outcomes.


BROWNLEE: The history of how the American healthcare system grew is not one of order, it's one of sort of happen hazard chaos.

BERWICK: Everybody is doing what makes sense to them individually. We pay hospitals to be full, so they try to be full. We pay doctors to see patients, so they see a lot of patients. We create a public expectation that more is better, which isn't actually true so people seek more. Everybody is doing their job, we just design the jobs wrong.

DR. STEVEN NISSEN, CHAIRMAN, CARDIOVASCULAR MEDICINE, CLEVELAND CLINIC: Physicians are well intentioned. Even when bad things happen, it's not because people have bad intentions, it's that our system is all fouled up.

BROWNLEE: We spend a spectacular amount of money on healthcare. Just sheer numbers, $2.7 trillion per year. The average per capita cost of healthcare in the developed world is about $3,000. In the United States, it was around $8,000 annually. We spend one heck of a lot of money.

BERWICK: The healthcare system isn't affordable anymore. Who pays for that? Where does that money come from? This is all coming out of our pockets. It's your money.

BROWNLEE: The really astonishing part about the fact that we spend more is we have worst health outcomes.

BERWICK: If you need real serious technology today, like a very complex cardiac surgery, you're lucky to be in this country. Rescue care is second to none. As an overall system, no, we're not anywhere near at the best in the world. I mean, look at our results. Our life span isn't even in the top 20.

BROWNLEE: We have a disease care system, and we have a very profitable disease care system. And the disease care system actually -- I mean, if it really was honest with itself, it doesn't want you to die and it doesn't want you to get well. It just wants you to keep coming back for your care of your chronic disease.

WEIL: Most of this huge effort of the healthcare industry is devoted to intervention in established disease and the majority of that disease is lifestyle related and preventable. I mean, to talk about how we shift toward -- away from disease intervention toward disease prevention and health promotion, I mean, that -- that requires a massive rethinking about medicine and healthcare at all levels of society.

It has to do with expectations of patients. It has to do with the training of physicians. It will require a huge effort. What's wrong with medical education is that it simply doesn't address whole subject areas that are absolutely essential to understanding human beings, health, illness, and treatment.

I mean, an obvious one is nutrition, which is almost omitted from medical education. So in 1994, I started a fellowship for people who had completed medical school to retrain physicians.

DR. TIERAONA LOW DOG, FELLOWSHIP DIRECTOR, ARIZONA CENTER FOR INTEGRATIVE MEDICINE: We want to expose clinicians to a broader way of seeing the patient a deeper understanding of healing and a larger toolbox from which to choose for therapies.

WEIL: Where are you from?

DR. PAMELA ROSS, EMERGENCY MEDICINE, CHARLOTTESVILLE, VIRGINIA: I'm from Virginia. I actually practice emergency medicine at the University of Virginia in Charlottesville.

WEIL: Right. Good.

ROSS: There have been some trends in healthcare that make me uncomfortable. I felt like there's got to be something different, something better.

DR. CLIVE ALONZO, HOSPITAL INTERNIST, CROWN POINT, INDIANA: My medical training was just focused on giving these patients pharmaceuticals or giving them expensive tests to treat the condition after it occurred. I had no knowledge of ways to prevent heart attack or stroke or cancer or things like that. MARTIN: I had to do the fellowship because it was kind of my little ray of hope that things could be better, things can be done differently. And somebody's going to teach me how to do that, so I'm going to -- I'm going to do it.

WEIL: In Western medicine, all of our effort is on dispelling evil. If somebody has an infection, we give anti-infectious agents. If somebody has hypertension, we give anti-hypertension drugs. It's getting rid of the bad thing. We do nothing about supporting the good, that the body can and wants to be healthy. Both of these approaches are necessary, but it would be great if we had a better balance in Western medicine.

The kinds of interventions that we have come to favor in this country are inherently costly because they are dependent on expensive technology, and that includes pharmaceutical drugs. I think there's some very good drugs out there, I think drug treatment has its place. I take a pharmaceutical drug myself, but if there's one thing that I would love to see you begin to implement in your own practice and teach others about, it's to try to change this mindset that has so completely taken hold in our culture on the part of both doctors and patients that drugs are the only legitimate way to treat disease.

I mean, where did that idea come from?

BROWNLEE: We spend $300 billion a year on pharmaceuticals. That's almost as much as the rest of the world combined. $300 billion on drugs.

WEIL: In the 1950s, Americans took pharmaceutical medication at about 10 percent of the rate that they do now.

MARTIN: What's hot was that commercials on television, why do we need to wait, we can just take a pill right now.

NISSEN: When I watch the networks, half the ads are for pharmaceutical agents. That isn't true in Canada. It's not true in the United Kingdom. It's not true in France and Germany. The only other country, by the way, is New Zealand. The New Zealand and the United States, only two countries in the world where you can advertise prescription drugs. What does that do? Well, it drives demand. You know, the ads always end with the same phrase, ask your doctor. And people do. And doctors wanting to please their patients will often prescribe it.

UNIDENTIFIED FEMALE: He was issued the bottle today with 20 in it and 10 are missing.

UNIDENTIFIED FEMALE: OK, I need some help over here. The patient is so --



(COMMERCIAL BREAK) UNIDENTIFIED FEMALE: Overmedicating is a huge problem in society and the military is no exception.

GEN. RICHARD THOMAS, ASSISTANT SURGEON-GENERAL, U.S. ARMY: This is a national problem for us, you know, we're seeing the military just being a microcosm, I think, of the problems society is having.

UNIDENTIFIED MALE: Soldiers' use of prescription drugs has tripled in the past five years.

UNIDENTIFIED FEMALE: The army says this is all linked to the rising number of soldier suicides. In fact, more soldiers died last year from non-combat injuries than during war.

LT. GEN. DAVID FRIDOVICH, THREE STAR COMMANDER, U.S. SPECIAL FORCES: I can see why there's a link between opiates, dependency, misuse, and suicide. I was taking 64 pills a day of combinations of Roxaset and Oxycotin.

There's a contradiction to what we do. U.S. caregivers are told you've got to keep me pain free, you're going to do that. We have to be mindful to those points in time where you can intervene and say enough's enough.

We have to find the right mix of treatments for the guys, and the answers are not in a sack of pills.

If it happened to me, it happens to a whole lot more people that are almost invisible to the system.

SGT. ROBERT YATES, INFANTRY, U.S. ARMY: Been shot. This point I'm in. Eight IEDs through this deployment. Carry a lot of weight because I'm infantry. Mountains of Afghanistan are not easy to climb, so pain in my back. Treated for sciatic nerve, back, L-3, L-4, L-5, swelling left side of my brain, and extreme PTSD.

DR. WAYNE JONAS, PRESIDENT, SAMUELI INSTITUTE, MILITARY MEDICAL RESEARCH: With 10 years of ongoing wars, the amount of suffering that's going on in the military right now is tremendous. When you go over into a war zone where you see your buddies die or you get injured, that's going to tax anybody. And we see that suffering. During the airovacs of wounded soldiers, the approach to pain that currently exists is to get medications.

UNIDENTIFIED FEMALE: Do you have any pain right now? OK, I can see what you can have for pain, all right? He asked for pain medication.

UNIDENTIFIED FEMALE: They don't say how much they gave him. But he can have anywhere between five and 10 milligrams of morphine.

UNIDENTIFIED FEMALE: I just want to see what they've given him.

UNIDENTIFIED FEMALE: Because he's real sleepy?

CAPT. KATY KASCH, HEAD NURSE, AIR MOBILITY COMMAND: Yes. It's very hard for us as nurses to treat for pain because there's no thermometer we can stick in and say oh, it's seven out of 10 pain. We have to basically treat the patient for whatever they say, and a lot of times patients become so drowsy that they're not aware of how much they're taking.

UNIDENTIFIED MALE: So uncomfortable and I need to pee again.

UNIDENTIFIED FEMALE: You need to get up and pee? All right.

UNIDENTIFIED FEMALE: OK. I need some help over here. The patient just fell off the litter.


UNIDENTIFIED FEMALE: Did he try to get up without anybody knowing?

UNIDENTIFIED FEMALE: No. I tried to get him up, he just rolled himself out. He's like really not listening very well.

UNIDENTIFIED FEMALE: Yes, that's why you don't want him to fall again. Probably put him on the bottom on the other side.

UNIDENTIFIED FEMALE: I'm going to check his chart real quick and find out how -- what he got at the CASF.

UNIDENTIFIED MALE: Let me get that jacket away from him. He's, like, clutching his head. Here you go. This is what he's got left.

UNIDENTIFIED FEMALE: He was issued this bottle today with 20 in it and 10 are missing. He's taken 10 tablets.


UNIDENTIFIED MALE: That's not -- yes.

UNIDENTIFIED FEMALE: Oh, my god. That is ridiculous.


KASCH: That's why he's a little high right now. At some point he's going to stop breathing if he's taken too much narcotics. And we're going to be doing CPR on a patient. So at this point, we will administer the medication.

UNIDENTIFIED MALE: We moved you over here.

UNIDENTIFIED FEMALE: Take them away from him.

UNIDENTIFIED FEMALE: Do you want to do a pill count with me?

UNIDENTIFIED FEMALE: We'll do it at the front.

UNIDENTIFIED FEMALE: OK. Ten allotted. OK. This is Prazosin. He's got Lunesta and also has Valium.


UNIDENTIFIED FEMALE: Loratab, Naproxen. He had -- he had Percocet then he has Marco which is Percocet. I'm not sure what is what.


UNIDENTIFIED FEMALE: These are all name brand.

UNIDENTIFIED FEMALE: Oh. Only thing we can do is separate them out, because there's no way for us to tell which are which.

UNIDENTIFIED MALE: These are all one person's?

UNIDENTIFIED FEMALE: They are all combined. We don't know what they are.

UNIDENTIFIED FEMALE: Where are you coming from? Afghanistan? How long were you there?


UNIDENTIFIED FEMALE: Nine months? We're glad to have you home. Do you want to tell me about some of those that you lost?

UNIDENTIFIED MALE: A platoon of 23. Came off the mountain with only eight.

UNIDENTIFIED FEMALE: Came off the mountain with only eight? You've seen a lot.

UNIDENTIFIED FEMALE: You know, I'm only 34 years old. I can't be having heart problems. So I went into the hospital and they told me I had had a heart attack.


SHANNON BROWNLEE, MEDICAL JOURNALIST: Dark matter is a discovery by astronomers that there is a huge amount of the universe that we can't see. It's not visible, but it's there. We know it's there. And in some ways, I think of a lot of what's happening in health care is kind of dark matter. It's unseen, but it's there and it's very, very powerful.

We tend to just see the light of healthcare, we see the goodness of health care, the potential for helping. When I was at U.S. News and World Report, I wrote cover stories about how great the newest and greatest treatment and pill and procedure was. But, in fact, the more I looked, the more I found that there's all this stuff in medicine that we don't think about that is actually harmful.

When a team from Dartmouth Medical School mapped Medicare payments, it found some disconcerting differences from one part of the country to another. For example, in 2007, the average Medicare recipient in Miami tallied more than $15,000 in health care bills, whereas a recipient in Minneapolis only cost the government about half that amount. And it wasn't because procedures were more expensive in Miami than in Minneapolis. The Dartmouth study showed the patients in places like Miami were receiving more care. More tests, more drugs, more time in the hospital, more invasive operations than patients in other parts of the country. Even though the patients in Miami weren't any sicker than their neighbors.

But so what, right? We want more specialists. We want more procedures. We want more tests. Or at least we think we do.

And that's the problem. Because what we think is best for us often isn't. What the Dartmouth group discovered is that the patients in the most costly regions where Medicare spent more money on patients, those patients did not have better health outcomes. And, in fact, they were more likely to die.

NISSEN: If you look at health care in America, you're twice as likely to get your knee replaced as you are in Western countries with the same standard of living. You're two or three times as likely to get a heart catheterization or have a stent in your coronaries.

We've set up a system that often pushes physicians and hospitals in the entire health care system into doing more. Driven by these perverse economic incentives, we are doing a lot of procedures to people that they don't need. To a man with a hammer, everything looks like a nail.

YVONNE OSBORN, CALEDONIA, OHIO RESIDENT: Okay, ready? Now you're going to get the scissors.

I started getting sick in my 30s. I started having really, really bad chest pain.

UNIDENTIFIED CHILD: There we go. A flower for you.

OSBORN: Oh, it's so beautiful!

I just had been ignoring it, because I thought, you know, I'm only 34 years old. I can't be having heart problems. But one evening, I sat straight up in bed with the worst chest pain. So, I went into the hospital and they told me I had had a heart attack.

I was 35 at the time and was scheduled for open-heart surgery. And I thought, once I get this, I won't have the blockages anymore. You know, they'll actually fix it. Little did I know that it was followed by years of the same thing over and over and over again. A heart cath, get another stent. Heart cath, get another stent. Until my doctor said to me, I don't know what else to do for you. There's nothing else I can do.

NISSEN: Contrary to what most people believe, getting a stent in your coronary, if you have stable chest pain, will likely relieve your pain, but it will not help you live longer. And it will not protect you from having a heart attack. It only reduces symptoms. And the problem is, some of those procedures will lead to bad outcomes.

OSBORN: I've started doing research about where in the United States do I have to go to get the best heart care. And ironically, it was only two hours away at the Cleveland Clinic.


OSBORNE: I am great. Look at the thinness.

CHO: I know, you look really good.

OSBORNE: I have lost -- since last year I've lost 21 pounds.

CHO: Oh, my God.

Yvonne came to se me when she was sort of at her wit's end. She had had bypass surgery at an early age. 27 cardiac catheterization and well over seven stents. This is just an unbelievable amount of stents and cardiac caths.

I'm sorry, it's going to get pretty tight.

I can't tell you how shocked we were when we saw her the first time, because here was a young woman whose diabetes was not well controlled. Her cholesterol was never well controlled, and her high blood pressure was never well controlled.

If someone had talked to her -- I think someone had really teased out her chest pain and shortness of breath, I think many of her cardiac catheterization and stents would not be necessary.

You have all these stents, and these stents, once they go in, they never come out and are part of you. Now we're kind of dealing with the consequences.

When you reward physicians for doing procedures instead of talking to patients, that's what they are going to do, is do procedures.

BROWNLEE: The vast majority of doctors in this country are paid by a fee-for-service system. That simply means they get paid for each office visit. If they are surgeons, they get paid for each procedure. If it's a radiologist, they get paid for each CT scan they deliver.

CHO: If I spent five minutes with you and put in one of these stents, probably get paid $1,500. For me to spend 45 minutes on an established visit with a patient to make sure they are doing their exercise, make sure their diabetes is going okay, and to try to figure out what their true problem is, probably get paid $15. It's a completely irrational system.

BROWNLEE: Fee for service rewards physicians for doing more. It doesn't reward them for doing a better job. It doesn't reward them for keeping their patients healthy. It rewards them for delivering more care.

CHO: I was trying to figure out how much Yvonne's care would have been over the years, and I think it's well over $1.5 million. But it's more than cost. It's just so much more than money. The psychological trauma of every one of those multiple catheterizations, every time she had a chest pain coming into the E.R., and unfortunately, there are lots of Yvonnes out there.

DR. ANDREW WEIL: There's the bright blue slush. We have made all of this unhealthy food the cheapest and most available food. People eat what's cheap and what's available.


DR. PAMELA ROSS, EMERGENCY MEDICINE, UNIVERSITY OF VIRGINIA: Hello, Dr. Ross. I am back in the chest pain center with a pretty sick patient, and I'm going to need you to call attending phone, too.

The emergency department is the safety net of health care. We see a lot of the chronic conditions that affect many Americans that have gone untreated for sometimes months, but sometimes years. And, of course, the natural end point is going to be in the emergency department.

Let me just take a listen to you.

It would be so wonderful if their chronic health conditions could be prevented through effective primary care.

BROWNLEE: There's a saying in health care policy that 20 percent of the patients account for 80 percent of the costs, and the majority of those costs are when they are repeatedly hospitalized. They are patients with heart failure, they are morbidly obese patients. They are often poor patients, but not always.

One of the ways to think about saving money in health care is to focus our energies on that 20 percent of patients and think about treating those people in a more effective way.

ROSS: I just want to review this pain. It's here, right in the center of your chest. Okay. And is it still traveling into your neck?

UNIDENTIFIED MALE: It's traveling down my arm, my neck, and my head and ears are buzzing and rings.

ROSS: OK, what was it, Mr. Linton, that finally made you say, okay, that's it. I'm going to the emergency department.

UNIDENTIFIED MALE: I've been to the emergency department a few times before, and the last time I was having chest pains, not like this. This is a lot worse. They sent me home with them.

ROSS: How long ago was that?

UNIDENTIFIED MALE: That was, what, a month and a half ago?

When I had my first heart attack, did the cardiac catheterization, put the thing up there and put a stent in my heart, because I had a clogged artery. And that worked for awhile. I mean, couple weeks, I felt like I was okay. Then all of a sudden I started getting chest pains. So here I am going in and out of the hospital to find out what's going on.

ROSS: Do you have any eating habits --

UNIDENTIFIED MALE: No, I eat the regular food and stuff.

ROSS: What's the regular food?

UNIDENTIFIED MALE: Eggs, sausage, grits, bacon.

ROSS: Well, what do you think about your diet -

UNIDENTIFIED MALE: More healthy diet?

ROSS: What do you think about that?

UNIDENTIFIED MALE: I'd do it if I had to.

ROSS: If you had to? Well, you have a stent in your heart, right?


ROSS: All right. And you've had heart attacks. And you're here today with chest pain.


ROSS: When do you think it would be good to try it?

UNIDENTIFIED MALE: Once I found out what was really wrong with me.

ROSS: We've become a culture where you drive up, you get what you want, you get it fast, you get it right away, and you drive off. And that being applied to health care just doesn't work.

Most diseases don't happen overnight. Sometimes they are related to lifestyle habits. Sometimes it's related to what the individuals actually have access to.

UNIDENTIFIED MALE: I have no health insurance. Sometimes I go to the hospital and that's the only health care I ever got. I never had a personal doctor, family doctor, nothing, all my life. I stopped taking my medicine months ago. It's too much paying for it. If you go out and buy heart healthy diet food, it's going to cost you more money than anything.

DR. ANDREW WEIL, PROFESSOR OF MEDICINE AND PUBLIC HEALTH, UNIVERSITY OF ARIZONA: Hippocrates said let food be your medicine and medicine be your food. And I think that's a good place to start. As a society, we have to make it easier and more affordable for people to make better lifestyle choices than worse ones.

There's the bright blue slush. This is major reason why we see kids getting fat in this country. Let's see what we got here. One of the great contributions of America to world cuisine, you know, fake bread. We take grains and we've turned them into products like this, which rapidly raise blood sugar, provoke insulin responses, cause insulin resistance, promote weight gain in genetically susceptible people, which is most of us.

Some people, this is all they eat, food of this sort. It's not whole food as nature produces it. It's completely changed food. And you know, our grandparents did not eat stuff like this. We have made all of this unhealthy food the cheapest and most available food. People eat what's cheap and what's available.

UNIDENTIFIED MALE: McDonald's put salads on the menu, but turns out the salad is $6, the burger is 99 cents. If you're on a fixed income, what are you going to do for your family? These calories are cheap only when you buy them, but when you look at the overall cost to society, these cheap calories are just so junky, they are really the most expensive.

DR. DON BERWICK, HEAD OF MEDICARE/MEDICAID, 2010-2011: It's scary how fast obesity is spreading in our country. Obesity leads to heart disease and strokes and diabetes.

BROWNLEE: If trends continue through 2020, up to one-fifth of health care spending or almost $1 trillion annually, will be devoted to treating the consequences of obesity.

WENDELL POTTER, FORMER HEAD OF COMMUNICATIONS, CIGNA: Insurance companies have always been able to regulate the rates they charge. They can pretty much get away with increasing the rates as much as they want to.


WEIL: The American health care system, it's generating rivers of money that are flowing into very few pockets. and those are the pockets of the manufacturers of medical devices, the big insurers, the pharmaceutical companies. And the owners of those pockets do not want anything to fundamentally change.

WENDELL POTTER, FORMER HEAD OF COMMUNICATIONS, CIGNA: I don't recall any time telling a lie, but I know that there are many times that I didn't disclose full information, and I was the company's chief spokesman. I was head of corporate communications, which means I was the top public relations officer for the company.

When you're in the inner circle of the health insurance company, what's most important is meeting Wall Street's expectations. And they have to, these for-profit companies by law have to serve shareholders.

People go in and out of health plans. They may be a member of a health plan for a year and maybe no longer. You don't necessarily make a lot of investments in preventive care for someone who's not going to be a part of your health plan for a long period of time. It just doesn't work out financially.

The only way that you can continue to make the profits that you are expected to make is to charge more for the policies. Insurance companies have always been able to regulate the rates they charge. They can pretty much get away with increasing the rates as much as they want to. You almost forget that what you're doing is providing health insurance. It's all about the numbers and how many millions of dollars, if not billions of dollars, you're earning in profits.

In the summer of 2007, I read about a health care expedition that was being held by Remote Area Medical a few miles from where I grew up. I decided out of curiosity to go check this out. All these folks have driven from 400 and 500 miles away, waiting to get care that was providing to them for free. The folks who were there were not trying to shirk their responsibilities. They couldn't get insurance. They either couldn't afford it, or they worked for small employers that had been purged by big insurance companies. It was either come and get care there or not get care at all. And every year they have to turn people away.

It was like something that I could never have imagined I'd ever see in this country. And I knew what I was doing for a living was making it necessary for those folks to stand in line to wait for care in animal stalls and barns.

I ultimately had a crisis of conscience, because I was not at all proud of what I was doing. I had difficulty sleeping at night. There were even times, honestly, that I looked in the mirror and said, how did you get here? I just could not continue doing what I was doing.

NISSEN: Good morning.

Our forefathers in medicine were really about patients. It was a passion for healing. When medicine became a business, we lost our moral compass. And I think we're in a great deal of trouble because of that.


COMMERCIAL ANNOUNCER: Managing Type 2 diabetes can be hard. Adding Avandia can help.


NISSEN: There was a drug on the market, Avandia. It got fast tracked by the FDA. Got approved very quickly. It was massively marketed, and by 2006, this drug became the largest selling diabetes drug in the world. We're talking about a $3 or $4 billion a year drug.


UNIDENTIFIED MALE: I got my blood sugar under control.

UNIDENTIFIED MALE: He really did. Can adding Avandia help you?


NISSEN: I was doing a Google search, and what I found was a Web site in the United Kingdom where the clinical trials done with Avandia were actually partially disclosed. And what I saw actually made me physically ill. As I looked at trial after trial, there were more heart attacks in the Avandia group. It was so consistent. You didn't have to be a statistician or in the words of my old friend Bob Dylan, you don't have to be a weatherman to know which way the wind blows. There was obviously a problem. About a 30 percent increase in the risk of heart attack and related complications.

And the company did nothing. They told no one. They did not tell physicians. They did not tell the FDA, and they did not tell patients.

ANNOUCNER: Cleveland Clinic cardiologist Dr. Steven Nissen decided to do his own review.

NISSEN: Now, the leading cause of death in diabetes is heart disease. Seventy percent of all the deaths in diabetes are heart disease. Having a diabetes drug that increases the risk of heart attack by nearly one-third is a public health

DR. STEVEN NISSEN, CHAIRMAN, CARDIOVASCULAR MEDICINE, CLEVELAND CLINIC: Having a diabetes drug that increases the risk of heart attack by nearly one-third is a public health catastrophe and the company didn't tell anybody.

UNIDENTIFIED REPORTER: A Senate investigation accuses the Food and Drug Administration of ignoring research.

NISSEN: Finally, the FDA put severe restrictions on the drug.

UNIDENTIFIED REPORTER: Did you have, you know, a lot of money at stake here?

GlaxoSmithKline worked very hard to keep these numbers from the public.

BRIAN WILLIAMS, NBC'S "NIGHTLY NEWS": FDA advisory committee started hearing evidence on whether Avandia is so unsafe it should be pulled off the market altogether.

NISSEN: There's litigation involved and the company set aside $6 million to settle lawsuits. The documents are coming out in these court suits, it looks worse and worse. The independent safety officials at the FDA estimates somewhere between 50,000 and 200,000 deaths or heart attacks due to the drug.

We're not talking about a handful of people here. This drug was the number one selling diabetes drug in the world in 2006. It's just a terrible tragedy for patients.

WENDELL POTTER, FORMER HEAD OF COMMUNICATIONS, CIGNA: There's the assumption that people who run government, elected officials, members of Congress, but it's not true in many cases. The power lies with corporations and corporate interests and the lobbyists that they buy.

JOE BIDEN, VICE PRESIDENT: Good morning, folks, how are you?

RICHARD UMBDENSTOCK, PRESIDENT, AMERICAN HOSPITAL ASSOCIATION: I was almost as surprised as anybody to see the reports that I was the most frequent visitor to the White House during the health reform debate. It was important to keep expressing the hospital's position. It's an expensive world to live in in terms of getting your voice heard in D.C., but that's the whole function of advocacy.

SHANNON BROWNLEE, MEDICAL JOURNALIST: How powerful are lobbyists in the healthcare system?



NISSEN: What gives lobbyists power is the amount of money they have for campaign contributions.

POTTER: We have been trying to reform the health care system for a hundred years. It goes back to Teddy Roosevelt. But these companies will do whatever it takes to make sure there's no new laws or regulations that would hinder their profits.

UNIDENTIFIED MALE: The healthcare reform bill that was enacted achieved two of the insurance industry's major objectives. It includes the mandate, the requirement that we all have to buy their coverage. That was job number one for them. Job number two was to make sure that there was not a public option. They didn't want to have a new competitor.

They had to live with some of the new consumer protections in the bill that does make it illegal for companies to just cancel someone's policy because of a preexisting condition. What the insurance industry's objective is, is to try to weaken those consumer protections over time and to try to influence how the law is being implemented.

NISSEN: Because of the money that's involved, getting people to do the right thing for the American people has become extremely difficult.

SGT. ROBERT YATES, INFANTRY, U.S. ARMY: Medications I was on. Do you understand? That is how many medications I was on.


DR. WAYNE JONAS, PRESIDENT, SAMUELI INSTITUTE, MILITARY MEDICAL RESEARCH: If our civilian healthcare system is smoldering and we see it's going to catch on fire and burn pretty soon, it is going to be unsustainable because of the costs, the military system is already on fire. It is a burning platform and they see this. The costs are going through the roof and the ability to help these service members and their families recover and repair and come back to a functional life is getting less and less.

YATES: I was in the worst place in Afghanistan. Korengal, the (INAUDIBLE), it's the most intense battleground that you can ever be in. I lost a lot of good men. Still bothers me to this day. I'm two and a half months out of combat. My very best friend from war, he was on narcotics. He overdosed. Respiratory shutdown. I lost him. And from that point on I realized that I don't want to be on this. I don't want to go down the same path.

I came to Walter Reed. I was on Valium just for the anxiety. I was on anti-depressants. I was on Trizadon. I was so dependent on my pain medication. This -- medications I was on. Do you understand? That was how many medications I was on.

When you're injured they feed you, feed you, feed you all this stuff. It's addictive. It is so addictive. I'd rather be shot again than go through withdrawals of coming off that medicine. No soldier should have to go through this.

GEN. RICHARD THOMAS, ASSISTANT SURGEON-GENERAL, U.S. ARMY: As we've pushed medical innovation and capability to the leading edge of the battlefield where we can save their life, and we've got some guys who have had some horrific injuries and they're getting narcotics for a longer period of time, they certainly are at risk to develop dependency, and that's what we're trying to avoid.

The army sergeant general directed that we establish the pain management task force to take a look at alternatives to narcotics.

JONAS: There's very large randomized trials done at multiple centers that have demonstrated that acupuncture works, so we put together a study to see if we can actually insert this simple acupuncture technique during the aerovacs of wounded soldiers into Walter Reed and other medical centers in the United States. The question was, can we relieve their pain and reduce the amount of medications that they are on so by the time they get back, they are not snowed under on multiple medications.

LT. COL. BETTY GARNER, RESEARCHER, U.S. ARMY: Welcome to Germany. And welcome home. I know you're heading home and you're excited.

JONAS: What it first seems like strange bedfellows, healing oriented mind/body practices and sort of the hardcore military actually is an opportunity that they jumped at because of the pragmatic need and nature that the wars had driven them to respond to.

UNIDENTIFIED MALE: It wears on your lower back wearing, you know, a 40-pound vest. And it's got to the point where the pain's radiating from my back down to my hips and then down to my thighs. That's it. That's my routine.

UNIDENTIFIED FEMALE: First one's going in.

UNIDENTIFIED MALE: How's your pain, sir?

UNIDENTIFIED MALE: I feel like I'm warming up a little bit. Impressive. Impressive for it to react that quickly.


UNIDENTIFIED MALE: That's pretty good.

NIEMTZOW: Any pain?

UNIDENTIFIED MALE: Not, not when I'm doing that.

NIEMTZOW: Normally you would?

UNIDENTIFIED MALE: Oh, yes. I haven't touched my toes in months.

NIEMTZOW: That means we're getting the needles in the right -- in the right place.

UNIDENTIFIED MALE: Haven't gotten near my toes in months unless I do this. You know?


NIEMTZOW: Hi. How are you feeling?

UNIDENTIFIED MALE: I have pain, but it's more of an annoyance than it is pain. Just sore.

NIEMTZOW: If you didn't have the acupuncture needles, how do you think you'd be feeling?

UNIDENTIFIED MALE: I'd be chomping narcotics.

NIEMTZOW: Oh, you would?


NIEMTZOW: So you haven't taken anything?


NIEMTZOW: Because of that? That's good.

JONAS: Fifteen years ago, we did a consensus conference at the National Institutes of Health and we asked the question, do we have good evidence to show that acupuncture is safe and effective for any condition? They said, absolutely, it's been demonstrated that acupuncture is safe and effective, especially with post-operative and injury pain.

Fifteen years later, you can't walk into your average hospital today and get acupuncture after an operation. The problem is not that it doesn't work, the problem is that we haven't figured out how to get it into the system so that we can make it widely available to the population.

DEAN MICHAEL ORNISH, PREVENTIVE MEDICINE RESEARCH INSTITUTE: When you're doing something that has never been done before, it's not universally accepted, to say the least. It was -- with a huge amount of skepticism and resistance. You're doing this radical intervention, you know, I say radical? Compared to having your chest cut open? I mean, give me a break.


UNIDENTIFIED REPORTER: In the last few years, a profound change has begun in American medicine.

DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Dr. Dean Ornish has studied and written about diet and heart disease for decades. ORNISH: In medical school, I was learning to do bypass surgery with Michael DeBakey, the heart surgeon. We cut people open, re-bypass their blocked arteries and he would tell them they were cured, and they'd go home and more often than not eat the same junk food, smoke, and not manage stress, not exercise, and then often their bypasses would clog up, so we cut them open, we bypass their bypass, sometimes multiple times. I said, there's got to be a better way.

I've spent more than 30 years of doing studies showing that heart disease can be reversed by changing what we eat, how we respond to stress, how much we exercise, and how much love and support we have in our lives.

In our model, the physician acts as a quarterback. He or she assembles a team of five other people to work with, a nurse, a yoga teacher, an exercise physiologist, a registered dietitian, and a clinical psychologist. And when we work at that level, we find people are much more likely to make these sustainable changes and the patient learns how to empower themselves and to transform their lives.

MEL LEFER, PETALUMA, CALIFORNIA: 25 years ago I had five restaurants in San Francisco. It was a great life. I smoked six cigars a day, 10 cups of coffee, a lot of wine. It was wonderful. And I had a massive heart attack. I was in the hospital for two weeks. I could hardly just about walk three steps and I'd have to stop and rest. I was popping 20 or 30 Nitrols a day.

But then Dean Ornish was starting his program to see if you can reverse heart disease through a lifestyle change, and he went to my doctor and asked if he could approach me. He told Dean, how long is the program? He said, it was a year. And my doctor told him he wouldn't recommend taking me because he didn't think I would live the year.

So he figured I was going to die because I was in such bad shape. And now I'm -- 25 years later and I'm in pretty good shape.

ORNISH: We found that after a year, the men who made these intensive lifestyle changes, their physical heart disease improved. It caused their blockages to become less blocked in their arteries. And that was the first study showing that heart disease was reversible. But when you're doing something that has never been done before, it's not universally accepted, to say the least. It was with a huge amount of skepticism and resistance. People say you're doing this radical intervention. You know? I say, radical? Compared to having your chest cut open? I mean, give me a break.

You can empower people to change their lifestyle and if we can make it really reversible, that really brings it into the mainstream. Now as you know heart and blood vessel diseases kill more Americans than virtually more than everything else combined. And it's treated with things like angioplasty and stems and bypass surgery, and yet what does he have (INAUDIBLE)? Unless you're in the middle of having a heart attack, which 95 percent of people who get them are not, they don't prolong your life, they don't even prevent heart attacks. We have a model that works simply by making changes in diet and lifestyles.

ROBIN ROBERTS, ABC NEWS: Now to a new study that shows diet may be a key tool in the fight against cancer. The study was conducted by Dr. Dean Ornish, who looked at patients with early stage prostate cancer.

BROWNLEE: More than half of men over the age of 50 get a PSA test every year to try to detect prostate cancer early. It turns out lots and lots of men who had a cancer that didn't need to be treated, but they got treated anyway and it was causing a lot of harm.

ORNISH: There's very little evidence that these conventional treatments make you live longer, but they cause many men to be impotent or incontinent or both.

DR. PETER CARROLL, CHAIR, DEPARTMENT OF UROLOGY, UNIVERSITY OF CALIFORNIA SAN FRANCISCO: My path crossed with Dean's because we both wanted to bring rigorous clinical trial testing to this hypothesis that lifestyle intervention could have a impact on men with early stage prostate cancer. I'm one of the busiest surgeons in the country, however, I don't believe every men with prostate cancer needs immediate treatment.

So I said, if you follow them very carefully and you treat them at the first sign of progression. If you can delay treatment, then that man is not at risk for side effects during that period of time.

ORNISH: Dr. Peter Carroll and I collaborated with Dr. Elizabeth Blackburn, who won the Nobel Prize in medicine and she had done a study showing that stress creates shorter telomere, said as your telomeres get shorter, your life gets shorter.

DR. ELIZABETH BLACKBURN, NOBEL PRIZE IN MEDICINE, 2009, UNIVERSITY OF CALIFORNIA SAN FRANCISCO: Telomere are the ends of chromosomes. And chromosomes have all genetic information on them. When telomere wear down and get frayed, the genetic material would get messed up. That prevents tissues from renewing themselves in the body and diseases take hold.

ORNISH: I thought, most things in biology go both ways, so if bad things make your telomere shorter, maybe good things will make them longer.

So we took the men with prostate cancer. To see if lifestyle changes can affect your (INAUDIBLE) even telomeres.

ROBERTS: The research found that embracing a low-fat vegetarian diet, exercising half an hour a day, and taking part in daily stress reducing activities can actually change the regulation of genes that are key players in cancer development and contribute to better overall survival.

CARROLL: We found that the men who underwent lifestyle intervention, their PSA rates generally went down and they were less likely to require treatment.

ORNISH: The program increased the telomere length. We even found that when you change your lifestyle, over 500 genes were changed. And in fact turning on the genes that prevent disease, turning off the genes that promote breast cancer, prostate cancer and colon cancer. These lifestyle changes cannot only work as well as drugs and surgery, but often even better at a fraction of the cost and the only side effects are good ones.

BROWNLEE: The doctor that has the greatest impact on your health is primary care doctors.

UMBDENSTOCK: We don't have enough primary care clinicians to provide that important fundamental level of care.


DR. ERIN MARTIN, PRIMARY CARE: After I'd left La Clinica, I joined this new practice. Hello, how are you? They promised me that I could make the practice whatever I wanted it to be, and if I don't want to see six patients an hour, I don't have to see six patients an hour.

CINDY ROBERTSON, ADMINISTRATOR, MD-COLOMBIA FAMILY HEALTH CENTER: We're the only clinic in this community county, so it's about 20,000 people overall. We're the only providers for. We're part of the community. All of us live here and work here.

MARTIN: How are you today?

UNIDENTIFIED MALE: Good, how have you been?


There's been a lot of change in me in that transition between La Clinica and here. I can act more as a guide for patients, taking the time to educate them and having them understand that there are choices that they have the power to make for themselves. If you have that desire to quit smoking, we'll get there eventually.


MARTIN: OK? We just have to keep working towards that.

And interestingly, patients really respond to that. Did you go to the diabetes education? How did -- what did think about that?

UNIDENTIFIED MALE: It was OK. Kind of gave me more idea on what to eat.

MARTIN: OK, OK. You lost five pounds.

UNIDENTIFIED MALE: I quit drinking, too.

MARTIN: How much were you drinking before?


MARTIN: A day?

UNIDENTIFIED MALE: A day, for 25 years.

MARTIN: Wow. What made you decide to do that?

UNIDENTIFIED MALE: Well, that had to be something to do with my diabetes.

MARTIN: Uh-huh. I'm really, really pleased. You just look different. So that's rewarding for me.

UNIDENTIFIED MALE: I feel different. I had to do something. Come back in a month or so?

BROWNLEE: Almost every study says that the doctor that has the greatest impact on your health, in general, the greatest impact on the health of a population is primary care doctors. We need primary care doctors.

MARTIN: Thyroid is a little bit big.

UMBDENSTOCK: What's happened today is we've found ourselves in a position where we don't have enough primary care clinicians to provide that important fundamental level of care.

MARTIN: When was your last mammogram and pap smear? Have you --


UMBDENSTOCK: Why? We have underpaid on a chronic basis. Underrewarded primary care. Some would say overrewarded specialty and subspecialties.

ROBERTSON: OK, so first topic, Medicaid reimbursement. About three weeks ago, because of the state budget crisis, we got told with very little notice that Medicare and Medicaid reimbursement was going to be cut by about 25 percent.

So to make up that difference in the reimbursement rates decreasing we're changing the shorter appointments next week. We're on track for that on Tuesday.

UNIDENTIFIED MALE: So right now the only way we have to make up the difference is basically to see more people.


MARTIN: That's a little -- might be a little bit of a culture shift, too, for the patients. And if they have a relationship with you, feeling truncated. That's going to be a little bit of a change and a little unfortunate.

ROBERTSON: It's a financial necessity. That's the only reason we're making the change. Right? I mean -- but you have to have the time to educate your patient.

MARTIN: And they don't reimburse for nutritional counseling or anything like that. But we're going to talk to them about it still, you know?

UNIDENTIFIED MALE: We all know there's things we can do and they make us feel good and we like to do them, but we're going to feel really bad if our doors close. And then we're not going to help anybody.

ROBERTSON: Conventional wisdom is, over the next two years, we will likely go out of business. We're fighting everything for that not to happen, but it's because there isn't the funding going into primary care. It goes into the other areas, and it's just not sustainable.

MARTIN: Because of the bottom line, because of the cuts that are coming through the government, if it came to the point where they couldn't pay me anymore, that would suck, but I'm not afraid. Because I've gotten a lot of inspiration from the fellowship. A different perspective that there's a different way of doing things, that it's possible.

Did you have a good day today?



I would probably leave healthcare before I went back to practicing the way I practiced last year.

YATES: I've chose to get off all narcotics, all medicine, everything.

UNIDENTIFIED FEMALE: Just take a couple of minutes to kind of arrive. All right, so take a breath.

YATES: I'm a red neck south Louisiana boy, just old Hill Billy, you know? I don't believe in that stuff. No eastern medicine. Anybody else would laugh, you know? I mean, what is that, boy? Hold my beer while I shoot this gator, you know? But I decided to give it a shot.

So we're going to open up some chi?

UNIDENTIFIED FEMALE: We're going to open up some chi, that's a good way to think of it.



That's the way I like to look at it. Because of this program that's here, the yoga.

UNIDENTIFIED FEMALE: I'm just going to go ahead and put the last one in.

YATES: I meditate, and it has opened up a whole new world for me.

UNIDENTIFIED FEMALE: I'm going to leave these in for about five, seven minutes. Something like that. OK?

YATES: OK. It's wonderful.

UNIDENTIFIED REPORTER: A new study finds a growing number of combat veterans are battling mental illness, but many are finding it difficult to get the help they need.

DAN BULLIS, WALTER REED ARMY MEDICAL CENTER, DEPLOYMENT HEALTH CENTER: Post-traumatic stress disorder, PTSD, is an individual's reaction to the exposure and experiences of war. War's hell, it's always hell.

UNIDENTIFIED FEMALE: Now you pick your spot.

BULLIS: Soldier know if they go to war and they get a leg blown off, your medic is going to take care of you and the same thing needs to apply that if you have post-traumatic stress. Invisible as it is, it's just as significant as a bullet wounds to the -- to the head or chest.

ROBIN CARNES, WALTER REED ARMY MEDICAL ENTER MEDITATION INSTRUCTOR: The first thing I'd like to do is teach you a breathing exercise with a targeted effect on post-traumatic stress. All right? So inhale. Exhale.

BULLIS: Catching it very, very early after their exposure and allowing them to process that is so critical in the long-term recovery.

CARNES: Release the breath in a smooth, even stream out. OK, so let's go into our meditation practice.

YATES: Meditation is scary sometimes. Sometimes when you go, go to bad places in your head.

CARNES: I will be at your side should anything challenging come up for you.

YATES: That's a healing process because you're not bottling up, it's going to a different section in your mind to where you can start processing it.

CARNES: So feel yourself there in your safe place. And remember that you can return to this place at any time during the meditation. Let go of thinking, drop back in awareness and notice how a thought may show up, seemingly out of nowhere, or an image may show up and then disappear. And feel yourself observing all these constantly changing sensations and thoughts and feelings.

Recognize that you are this spacious, welcoming, open awareness no matter what thought, no matter what feeling, no matter what sensation or circumstance happens to arise. Your harm's heavy, your leg's heavy. It's OK. You're good, you're good. You've done some sweating.

YATES: I was on Parazasin just for nightmares. Meditation takes the place of that.

CARNES: Notice where you are in the room, the people around. YATES: The pain, it's hard, you know, it's really hard. Got to push through it. But this program has just inspired me to press forward. The medication depresses you, it makes you think that it's all you're ever going to be in.

CARNES: We'll end the practice today with the completing statements. May everyone be well. May everyone be healthy. May everyone be happy.

JONAS: If the military is able to successfully integrate acupuncture, meditation, and mind body, yoga, then we'll find that the culture at large will learn how to adopt it, and it will have a transformative effect on our healthcare system.

CARNES: Ready?

UNIDENTIFIED MALE: Without the financial incentives, there's no way I could have gotten to the point that I am now, at saving literally thousands of dollars over the past few years by being healthier.


UNIDENTIFIED REPORTER: One company has figured out how to lower healthcare costs by more than 40 percent.

UNIDENTIFIED REPORTER: It's an idea that's received national attention.

BARACK OBAMA, PRESIDENT OF THE UNITED STATES: Following the example of places like Safeway.

UNIDENTIFIED REPORTER: The Safeway supermarket chain looked for a way to rein in spiraling premiums and hit in what seems to be a win-win solution.

STEVE BURD, CEO, SAFEWAY: In 2005 we had a billion-dollar health care bill rising at the rate of $100 million a year.

UNIDENTIFIED FEMALE: These are the costs of all of our drugs in order. So diabetics, (INAUDIBLE) costs.

BURD: Yes.

UNIDENTIFIED FEMALE: Prescriptions, you can see how many scripts in the under script.

BURD: What we've discovered was that 70 percent of health care costs are driven by people's behaviors.

ERIC WARD, SAFEWAY EMPLOYEE: At my heaviest, I was over 200 pounds. I'd have my pizza, I'd have my comics, I'd have my DVDs, and that was the weekend.

UNIDENTIFIED FEMALE: You realize one day, wow, I haven't worked out. I haven't exercised. And, you know, you kind of get busy. And it's just the last thing that you're really concerned about. WARD: I was chronically coming down with colds, and I knew that there was a history of cancer in my family, diabetes, heart disease. I was a walking dead man.

BURD: I was a business guy and I thought if we could influence behavior of about 200,000-person workforce, we could have a material effect on healthcare costs. The easiest starting point was in the 30,000 non-union workforce, and I believe that within four years all of our employees will get this kind of healthcare plan.

All Americans have accepted for 50 or more years in the automobile insurance industry that driving record dictates premium. And all insurance companies are saying is your behavior should drive the premium. And healthcare doesn't need to be immune to that. So we provide incentives for people to engage in healthier behavior.

Our healthcare premium starts here, and if you have a body mass index less than 30, you get a discount. If they are confirmed non-smoker, we give them a discount. If you have cholesterol under control, a discount. Blood pressure under control, a discount. And so behavior becomes a form of currency for people to accomplish their lifestyle changes.

UNIDENTIFIED MALE: Without the financial incentives, there's no way I could have gotten to the point that I am now in saving literally thousands of dollars over the past few years by being healthier.

BURD: All we did was facilitate smart choices for people and develop this culture of health and fitness.

You bike to work today?

UNIDENTIFIED MALE: I did yesterday.

BURD: All right.

UNIDENTIFIED MALE: I do it again on Friday.

BURD: All right.

If you talk to the employees around here that have lost 35, 50, 60, 100 pounds, they will tell you without a doubt they have a better quality of life.

WARD: For a long period of time I was hiding. I was shutting down emotionally. It's still a struggle. When I'm running and it's a hot day and I feel like giving up, it never fails. I'll look up and I'll see a person who's overweight across the street. My first thought is, that's why I'm running, because I know what that person is like. It used to be me.

BURD: You can't say you're interested in a culture of health and fitness without providing a first-class gym. You can't have a cafeteria that doesn't have calorie counts on it. Our approach here is completely holistic.

UNIDENTIFIED REPORTER: Safeway's healthcare costs have remained flat compared to a 40 percent jump for most other companies.

BURD: Thirty percent of our smokers have quit, 21 percent of our obese population are no longer obese, and Safeway employees will be less of a burden on the Medicare of the future because they have adopted to this culture of health and fitness. You allow and encourage your employees to become healthier. They become more productive. Your company becomes more competitive. I mean, I can't think of a single negative in doing this.

If I'm frustrated by anything, it's that more of the nation hasn't adopted this.

SEN. MITCH MCCONNELL (R), MINORITY LEADER: Safeway Corporation, they've actually been able to bend the cost curve. Those are the kind of things that would actually have an impact.

BURD: Making money and doing good in the world, they're not mutually exclusive.

UNIDENTIFIED MALE: I lost about 120 pounds over the course of three years. Even if I lose 30 more pounds, which probably is my ultimate target, I'm not going to stop doing this. My energy level is up. All my health issues have gone away. It's nice to know that I've got a long time to spend with my family and I'm going to get to see my son grow older and go to college and all that fun stuff.

ORNISH: The limitations of high-tech medicine have never been clearer. At the same time, the power of these simple low-tech, low- cost interventions is also becoming clearer. We could do 1,000 studies with a million patients, it would remain on the fringes, it's all about the Benjamins, as (INAUDIBLE) would say. It's all about the reimbursement.

If we just change reimbursement, it's a game changer, we change medical practice and we change medical education.

Trying to get Medicare to cover a heart disease program has been by far the hardest thing I've ever done in my entire life. Most insurance companies will follow Medicare's lead, so I realize that Medicare is the Rosetta stone. If we get Medicare to cover it, then everyone else will cover it and if everyone covers it then it becomes a standard of care.

Now that Medicare is going to cover the heart disease program, the next step will be type 2 diabetes. Half of Americans will be diabetic or pre-diabetic in the next 10 years. Half. If we can prevent that and even reverse it, that's how we're going to make true health care, not just sick care available. At a time when the medical system is so badly broken.

DR. ROBY COSGROVE, CEO, CLEVELAND CLINIC: I've never looked after a healthy person. And maybe it would be easier to take care of people and keep them from getting sick before they actually did get sick.

(COMMERCIAL BREAK) DR. DON BERWICK, HEAD OF MEDICARE/MEDICAID, 2010-2011: If we really can't begin to change, from paying for volume, paying for how much you do, to paying for outcomes, paying for how well you do, how well the patient does, that will change the game, people will start to say, well, now the money is in health and well being and safety and vitality, not in more, more, more, more, more.

There are answers, we know what safe care looks like. It's not just we know it, we actually can go and visit it. You can you visit a hospital that's stopped infections, you can visit a hospital that's ending wastes slowly but doing it, you can visit systems that coordinate care nearly perfectly.

COSGROVE: Cleveland Clinic was founded by four physicians, and they realized they did better working as a team than as individual practitioners. And they formed a group practice they decided that they would pay themselves a salary and the money that was left would go back into growing the organization. And that model has continued until today.

We're all salaried so the decision on what we do for a patient is dependent upon what the patient needs not on our financial incentives.

Six years ago before I became CEO, I stopped to think, I've never looked after a healthy person and maybe it would be easier to take care of people and keep them from getting sick before they actually did get sick.



DR. LESLIE CHO, CARDIOLOGIST, CLEVELAND CLINIC: You know how people say it takes a village to raise a child? It takes a village to make an unhealthy patient healthy. It really does.

She needs a follow-up within three month with an echo.

People with chronic disease who come in and out of hospitals, bouncing in and out of ERs, that's what they need, someone to really take an interest. Hold them accountable and then talk to them, you know, on a weekly basis. Sometimes we're talking about them on a daily basis.

That requires so much work, but we do it because we're committed to having her stay out of the hospital. Committed to her living longer and better.

NISSEN: You know, DVT and pulmonary emboli. We've just created a completely different system here. And the actual costs for care here is among the lowest in the country. And yet the outcomes, the survival rates are at the highest levels. We don't have to spend ourselves into poverty on healthcare. We just have to do it differently.

BERWICK: It's really easy to find articles or speeches 30 years ago in which leaders were calling for change, unsustainable costs, problems and outcomes in quality. But I think the economic imperatives are much stronger now. We're dealing with the health of the nation. What we do with waste in healthcare.

DR. ANDREW WEIL, PROFESSOR OF MEDICINE AND PUBLIC HEALTH, UNIVERSITY OF ARIZONA: We only give lip service to prevention and we have to ask why as a society are we not working to prevent disease and promote health. And how do we shift this huge enterprise of disease intervention in that direction.

We need to change the nature of medicine. And I hope our new generation of health professionals will catalyze this social movement that's necessary and enough people get aroused enough about the situation and see it for what it is and then start some kind of grassroots movement to change the political balance of power.

UNIDENTIFIED MALE: What I'm arguing for is not to make things tough on industry, it's to make things safe for patients. Putting patients first. We have a -- we have a motto in medicine. In Latin, it means, above all, do no harm.

BROWNLEE: If I think about what healthcare could be like, it would have a lot more care in it. It would be a very different system that probably would be less high-tech and more high touch. We have a lot more power over how healthy we are than we are willing to take credit for or willing to take responsibility for. And that's parts of what a really great healthcare system would do. It would empower patients.

BERWICK: It's so frustrating to know how high the risks are and how easy the answers are.

The answers among us, and only by accepting the fact that the American healthcare system is badly broken and the status quo isn't working, is bankrupting our nation, will we be able to seek out the escape fires, the potential solutions, and create a sustainable and patient centered system for the future.

YATES: That's every single signature that says that you're good to go to get out of Walter Reed and move on with my travel right there. Going back home. With the infantry division. Can't wait to be there. Don't need you, don't need you. Never needed you.

They didn't foresee me ever trying to walk yet. But I'm doing it. Maintaining my pain. Not having to eat all these pills. It's been a wild ride. It's still not over, but it's better from Germany, I promise you that.

Look at this. It's a happy time in my life right now.

This place actually gave me the tools to put in my tool bag so I can go back and still continue my process of healing, recovery.

See you soon. On my way. I feel like I'm changing.

Thank you so much.

I'm not changed, but I'm changing. (MUSIC & CREDITS)

GUPTA: We can't leave the conversation right there. I'm Dr. Sanjay Gupta.

The next 30 minutes are all about you, the patient, whether you're insured or not insured, it matters. You will learn if your health care costs are going to go down any time soon. You're your options might be, if there is a doctor surgeon on hometown. And how to know if you're being prescribed unnecessary procedures. You are going to hear from many different voices with varying opinions and backgrounds tonight.


DR. ERIN MARTIN, PRIMARY CARE: As a primary care physician, we are supposed to be the people that are making sure the patients don't get sick and they have everything they need to maintain health. But you end up being this revolving door. People come in and you try to fix one thing and they come back for the same thing over and over and over. You just never get to the bottom of what's causing al he these problems they're having.


GUPTA: Dr. Erin Martin, that's a primary care doctor you just saw in the film. She joins us now. Also, Doctor Reed Tuckson, he is the chief medical officer for the united health group. It is the largest health insurance company in the country. And Doctor Jeff Cain. He is the president of the American Academy of Family Physicians.

Thanks all of you for joining us.

Let me get right to it, Erin. It sounded like it was so bad that you basically had to leave your practice. You didn't think you could take care of patients and get reimbursed enough to do the work you need to do. I mean, that sounds like a really dire situation.

MARTIN: It was a dire situation and there are many times that myself and my colleagues would have the conversation of, you know, we are going to miss something, this could be really bad, and actually having the fear that this was going to be harmful to our patients at some point.

GUPTA: Doctor Tuckson, I mean, one of the concerns -- and again, we will get right to it, it's simply not reimbursing enough money for primary care doctors.

DR. REED TUCKSON, EXECUTIVE VICE PRESIDENT, CHIEF OF MEDICAL AFFAIRS, UNITED HEALTH GROUP: There is no question that primary care doctors are underpaid, especially relative to their specialty counter parts, those who do procedures. And so, one of the good news, the exciting news is, is that there's a lot of energy now to turn that around. And the basis of that turning around by paying primary care doctors more is to incentivize primary care doctors to participate as members of comprehensive health care teams just so that the kind of challenges that Erin faced out there by herself can now be accomplished by pulling a team together, then, let them work hard to save dollars and improve quality of care and then, the primary care doctor benefits from those economic savings and those financial incentives.

GUPTA: Why not just pay them more money?

TUCKSON: Primary care doctors are being cared more. So, these models that I'm talking about are based on fee for service, then, they are being paid for a care coordination fee. And then, being paid, on top of that, a bonus if they can demonstrate, if they have improve the quality of care and have also may cause saving.

GUPTA: Erin, do you want to respond to that?

MARTIN: I bill $213, let's say for a 45 minute face to face visit with a patient. The check that I get back from the insurance company after that was billed is $40.

GUPTA: United health care makes a lot of money. And there's nothing that people sort of get more antsy about is the idea of people profiting off of other's misery. And not just a little bit here, a lot of money, we're talking $5 billion, I think last year from United Health. What do you say to people when they say look, pay Erin Martin a little more money, you guys are making $5 billion.

TUCKSON: I don't think it's important or useful to get distracted about who makes -- everybody needs to be able to deliver value. If insurance companies don't deliver value, they won't be in business very long. Simply the same way the hospitals and physicians. This isn't a game of this person against that group, this sector against that sector, but at the end of the day, the American people need solutions and the one thing they don't need is a bunch of finger pointing that doesn't take us forward.

GUPTA: Erin, what did you think about that particular theme? Again, you were part of the documentary. But, the American people are going to want something like that and that is going to be their perception.

MARTIN: I think what the American people need is, they need good health care. And there's a lot of talk about who's going to pay for it, and that's really important. But, you know, we have the means to decrease disease. I do it in my clinic all the time. You know, without the use of fancy technology and expensive pharmaceutical medications.

The, you know, the food that we eat and the nutrition that we put in our body, that's been around since the beginning of time. We have that technology, it's right there. So putting more money into innovations and all of these things, yes, they're need in certain instances, especially emergency care, and things like that. We are second to none in this country for those things. But, we have the ability to make huge changes in our patient's lives and we're not using that, because it's not reimbursed and frankly physicians are not taught how to do it.

DR. JEFFREY CAIN, PRESIDENT, AMERICAN ACADEMY OF FAMILY PHYSICIANS: We know that patients are healthier when they have two things. When they have insurance and they have access to usual source of care, primary care. If we have better primary care that includes nutrition counseling, prevention and care of chronic disease, fewer people get sick. And here's the secret, healthier people cost less money too.

GUPTA: Are you optimistic about the future when it am could to family care, and when it comes to our health care overall?

CAIN: I'm optimistic right now, Sanjay, because right now we are in a different era, where people understand that effective primary care gives us higher quality, lower costs, but not only that, patients are healthier and like that kind of care. I'm optimistic about the future.

GUPTA: You feel better when you're healthier too.

CAIN: Exactly.

GUPTA: I mean, both physically and mentally.

We are going to take a short break. And when we come back, just how much does profit play a role in all these treatment decisions. How to know if you are being prescribed unnecessary medications or procedures, that's next.



UNIDENTIFIED FEMALE: I can't tell you how shocked we were when we saw her the first time because here was a young woman whose diabetes was not well controlled, her cholesterol was never well controlled and her high blood pressure was never well controlled. If someone had talked to her, I think someone had really teased down her chest pain and her shortness of breath. I think many of her cardiac catheterizations instead would not have been necessary.


GUPTA: And Yvonne I the patient in that video. She had bypass surgery in her 30, 27 cardiac cauterization and well over seven stents before she went to the Cleveland clinic for treatment.

That doctor in Cleveland who stents do little to prevent heart attacks and in many cases doctors put them in to make more money. An estimated 600,000 stent procedures are performed every year in the United States. I want to show you how it works. Special tubing with an attached deflated balloon is threaded up to the corner of your arteries. Your arteries around the heart. The balloon is inflated to widen the blocked areas. The small wire cage you see there is the actual step. It expands the artery to hold it open and allow the blood to flow.

Joining me to talk more about this is doctor Steven Nissen, he is the man in the documentary, the chairman of cardiology at the Cleveland clinic. He was featured in the film. Also, Dr. Jeffrey Marshall, his specialty is implanting stents. He is also a president of the society for interventional and geography in intervention.

Now, thanks to both of you for joining us.

From a patient perspective, from a physician perspective, you want to make sure obviously, that people are being educated correctly. Doctor , let me start with you. You say there's a lot of Yvonnes (ph) out there, the patient we just met. A lot of unnecessary stents? We say they don't prevent heart attacks, they don't lengthen life.

DR. STEVEN NISSEN, CHAIRMAN, CARDIOVASCULAR MEDICINE, CLEVELAND CLINIC: The problem is, if you have stable chest pain, we have very good studies dating back a number of years that show that getting a stint will not prevent a heart attack, and will not make you live longer. These are techniques that should be used to relieve symptoms. And some people even that are getting stents don't have symptoms. They have a blockage that's not causing symptoms and yet they're actually having a procedure.

GUPTA: A lot of these stents are unnecessary?

DR. JEFFREY MARSHALL, PRESIDENT, FOR INTERVENTIONAL AND GEOGRAPHY IN INTERVENTION: I don't believe so. About 70 percent of all angioplasty and stent procedures in this country are done in people actively having heart attacks, large heart attacks or smaller heart attacks or having what we call unstable angina. That is chest pain that is actually currently damaging the heart in patients. So, less than 30 percent are actually done in these people with stable ischemic heart disease.

GUPTA: You know, one can't help but walk away from the documentary, Doctor , frankly, they are scared of stents. Frankly, be suspicious of doctors who recommend one and frankly, think that they're just trying to make money off of me. That was the message that, you know, I think was the you got from that documentary. Is that a fair message?

NISSEN: We do have a problem in America, and that is we have misaligned incentives. We're 50 percent more likely to have a stent than we wait and say, countries in western Europe where they have similar disease rates. We are more likely to get a knee replacement or have a cat scanner, have an MRI. And that's because our system reimburses people for doing tasks and doing procedures, not for necessarily making people healthier.

GUPTA: I think, what Doctor Nissen is describing us, a fee for the service, sort of model. You get paid for the service that you're doing as opposed to for the overall care of the patient. This is what you do for a living. Is that how you get paid? So, if you have a patient comes in, you get paid a certain amount because you do a stent. Are you incentivized to do more stents?

MARSHALL: Me, personally, I'm on a salary.

GUPTA: So it doesn't matter.

MARSHALL: It doesn't matter if I do one stent or five or ten stents. My job is to provide the right care for the right patient at the right time.

GUPTA: So you're salaried.

MARSHALL: Yes, sir.

GUPTA: I'm salaried too as a physician. And Doctor Nissen is in salaried as well.


GUPTA: How big a problem is this then? These perverse incentives that you described?

NISSEN: We're not saying that people are doing these procedures for profit. We're saying that the system has created incentives in subtle and not so subtle ways drives more procedures. If you get a bump on your head as a friend of mine had, and you go into the emergency department, in America, you get a cat scan. If you have that happen in Germany or England, they say, here's a list of instructions, if you have problems come back and see us. We just spent $1,000.

GUPTA: Sometimes the patients demand this stuff.

NISSEN: Yes, but we have to educate patients.

GUPTA: I want to point out something. I think this is important because I think when people watch the film, they are left with the impression that Yvonne finally came to the Cleveland clinic. She got her cholesterol under control, her weight under control and things were great for her after that.

But, that's not the whole story. She ended up having another open heart operation, another bypass operation. I think that's an important point. It doesn't always work. I mean, the impression I think was a little misleading there, don't you think Nissen?

NISSEN: I do. Look. We can't prevent disease in everybody, but we have to try. The problem with Yvonne's case, is she had all of those stents before she had the risk factors controlled. That's not good medicine. We have to teach young physicians that prevention comes first.

MARSHALL: You and I both know, it's hard to change the habits of a lifestyle. To get people to eat different, to eat, you know, to lose weight, to exercise regularly, those are hard things to get people to do, and we need to be better at it. But, one of the best times to do that is when they have one of these catastrophic kind of things like a heart attack.

GUPTA: In the spirit of educating people out there, I think I have cardiac disease in my family. Who should get a stent?

MARSHALL: So, anybody that's having a heart attack should get a stent. It's the best treatment and it saves lives, period. Everybody agrees on that. The next group of people are people that have tried medical therapy, that are on medical therapy and failing. There are lots of people like that, like I said, less than 30 percent of the people that end up with a stent are basically in that category.

GUPTA: Stay with us.



UNIDENTIFIED MALE: If you need serious technology today, like a very complex cardiac surgery, you're lucky to be in this country. Rescue care is second to none. As an overall system, no, we're not anywhere near the best in the world. Look at our results, our life span isn't even in the top 20.


GUPTA: Time to introduce Dr. Valerie Montgomery Rice, she's Dean at the Morehouse school of medicine. Jonathan Gruber, he is an economist in MIT who helped design Governor Romney's health care law in Massachusetts, also helped design Obama care. Also, Nancy Davenport- Ennis, she heads the patient advocate foundation.

So Doctor Rice, let me start with you. One of the things I think that people are going to remember from that documentary is that when you talk about our life expectancy, we are 50th in the world, last in terms of the richest countries. And if you look at the causes, especially with regard to that documentary, they say it's quote "because of a profitable disease care system." What do you think?

DR. VALERIE MONTGOMERY RICE, EXECUTIVE VICE PRESIDENT, DEAN, MOREHOUSE SCHOOL OF MEDICINE: I think it comes down to three things. I think a large part of it is personal issues, where we have different behaviors that I think increase our burden of disease. Our health care system. We have some challenges with access and affordability. And then clearly we have social and economic issues that impact people's ability to access if you look at our percentage of un-insurers. So, you compare us to those other nations, you have to understand that we come to the table with the bigger burden of disease.

GUPTA: The children dying before the age of five exceeds any of the other 16 richest countries. If you account for that, we do much better. Why do so many children die so young here?

RICE: And I was surprised about this, particularly the data. They have talked about a child between age of one and four, having the third most common causes of homicide. And so, I think it points to the violence in our society. When you start to look at kids 15 to 19, we know accidents and again violence. And so, that's clearly one of the issues. And those are surprising. &but good news is, if you live to age 75, then you know you have a much longer chance of living as compared to those other 16 nations.

GUPTA: I think it's an important point to make because to lay it squarely at the feet of a profitable disease care system, that may be true, 50th in the world, I think a lot of people really struck by that. Jonathan, you know, we want better care and lower costs. I mean, everyone wants that probably in every system. I'm not sure every country in the world does it perfectly. But with regard to prevention, preventing disease, does that save us money?

JONATHAN GRUBER, ECONOMIST, MIT: Prevention, unfortunately, does actually saves us money, you know. Let me distinguish two terms. There's saving money and there's cost effective. Prevention is cost effective. What that means is, the money we spend on prevention improves our health greatly per dollar spent. Much more than money spent on much more expensive services. If you're in the system, do you access of if you are insured, if you are living in a safe neighborhood, your outcomes are great in America. A lot of that comes you spoke - we spoke about are driven by people who don't have access to the system. And that is why, our first priority has to be to equalize that access and then move on.

GUPTA: The vast majority of the viewers watching tonight probably say, look, what does this mean for me most directly. Are my premiums going to go up? Am I going to be paying more? I have an insurance now perhaps. What does it look like over the next few years?

GRUBER: Premiums will rise. There is no doubt, they always have.

GUPTA: For everybody here.

GRUBER: For everybody. What is really striking is how little they have written the last few years. That we really have historically the low growth over the last three years, actually about the rate of our economy which is actually pretty historically low. What we don't know, is that a fundamental change? That also happened in the 1990s. That ended and it rose quickly.

GUPTA: But, why are these causing hospitals so expensive? I mean, the average price tag for a single hospital admission can be really eye-popping. And I say that as doctor. So, we decided to give you a look at a typical operating room bill and that breaks down.


GUPTA: To give you a couple of quick examples. If you look at a hospital bill, you might see an IV bag charge. It is an IV like this, about $280 just for the IV bag. That may strike people as very high. A stapler, this stapler that is often to used in surgery, like this? Cost about $1200.

This is a chest tube. If someone has compression of one of their lungs, they might need a chest tube like this, $1100. That cost about 1,000You'll find examples like this all over a room. Suture, one that's used in every operating room in the world. This suture costs about $200. And if you look at even devices like -- this is a needle that's used for biopsy. So, if there's a concern someone has a tumor, they who use a needle like this. This is going to caused about %800 dollars.

It is important to keep in mind. If you ask the manufacturers a device like this, why so much money? They'll say, it took years to develop something like this, the research and development costs are significant. Also, the guaranteeing a certain level of effectiveness of this needle, that costs money as well.

But something maybe you didn't know, when you look at a hospital bill, it's not just the cost of the supplies. There's also administrative costs that are built in. There's the cost of covering people who simply don't have insurance or can't pay. That's built in these costs as well. And finally, keep in mind that what is charged and what is ultimately paid are two different numbers.


GUPTA: In fact to build on that, if you talk to some of the executives of these hospitals, they will say for every dollar that is actually billed they may collect just pennies. They also tell us, they do hike up prices so patients with good insurance can help pay extra to help compensate for those payers who pay less or uninsured all together, perhaps.

You know, Nancy, we talked a lot about these bills. And you say that you can help negotiate the price of these bills down, what do you tell people? I mean, they are going to watch that and think, that's ridiculous. What do you say when someone calls you?

NANCY DAVENPORT-ENNIS, FOUNDER, CEO, PATIENT ADVOCATE FOUNDATION: So, what we tell them first and foremost, is get a copy of the entire bill and look for redundancies. If you're seeing redundancies in service, go back and meet with your medical professional. Determine, did you indeed have two MRI's during the course of one week? Did you indeed have four different blood transfusions, you and your family may only recall one or two. Try to understand where the redundancies are. Sit down and look at hospital bills through the perspective of, are any of these services that I don't understand what they are? And for the large majority of people we help, they often don't understand what many of the charges are. So, you want to take a look at that and find out what it is.

You also want to engage the billing representatives and the financial representatives of the hospital in that discussion and have them understand, I need an explanation of these charges.

GUPTA: Can you actually get a-hold of those people?

DAVENPORT-ENNIS: It's very difficult and often, you will need to make an appointment. It's And we will say, it is important you request the appointment not only through a telephone call, but if you have an e- mail address, to try to do that.

GUPTA: I think the numbers are surprising to a lot of people, even people who work in hospital. I was a bit surprised. I mean, when the cost of some of the things we use on a regular basis.

John than, you'll have to excuse me because you're an economist I'm not. But, one of the arguments seems to be, you add more people to the system, you get a lot more people insured. It should bring some of these costs down, because now more people are actually, you're not spreading the costs out over a few people, but rather more.

Does it make a difference?

GRUBER: Well, Sanjay, I think If you look at the affordable care act in the hole, it will. But I think, to be honest, when you add more people to the system; that raises costs. Let's be honest. Why do we care about covering the uninsured? Because they're not using health care now. They are going to healthcare. We want that. that is going to raise cause. Not very much, but a little.

The bigger issue is how do you deal with his enormous prices, you were just talking about with Nancy? And that is where the affordable care act can help which is bringing more competition to the bidding and pricing of these items.

GUPTA: So, tell me how that would work? So, a hospital like the one you just saw there. What would happen?

GRUBER: Well, basically, Medicare actually - I don't have to tell - Medicare right on demonstration where they did bidding, where Medicare would pay -- would reimburse certain rates for medical devices and they had bidding across different manufacturers to be the low bidder, to brought that sources lower prices by 40 percent. That Medicare bidding demonstration.

There is no reason that exact approach can't be applied across the board to drugs, to other diagnostic tests. Maybe even a provider service.

GUPTA: There was something in the documentary that caught my attention. It had to do with the idea of essentially paying people to be healthy. Incentivizing them to be healthy or not charging them as much if they're healthy. Psychologically, you deal with a lot of these sorts of things. What do you think of that? Do you think that will make a difference?

DAVENPORT-ENNIS: So, I think with some patients it clearly will. There are certain patients that are very motivated to say how do I go back and recapture the wellness I used to enjoyed? And water, they are saying, I'm going to have to give up to get there.

GUPTA: Doctor Rice, What do you think about that. Again , when I'm talking about disincentives. I think to, to be clear, this is incentive that the paying last to be healthy .

RICE: You know, I think, the biggest incentive for patients is that they are going to leave a higher quality at longer life. And I think those discussions that we between the patient and the provider about lifestyle disincentives. How to make a healthy choices. This is incentives the system so that patient have a less specifically to be of picking the right choice.

Thank you all.

GUPTA: And I want to leave all of you at home with a thought as well. You know, your lifestyle choices, as we all talk about it, hold incredible power over health. You have the ability to reduce or raise the risk of many preventable diseases. Here's a couple simple tips. Try to break a sweat every day. Just do something.

Also remember this. The brain is not particularly good at distinguishing thirst and hunger, so we often eat when we should be drinking, things like water. And sometimes push the plate away.

Takes about 15 minutes for you. And by the way, they are number in the world and life expectancy.

Thanks for watching.