In 1949, a forest fire broke out in man gulch, Montana.
Smoke jumpers were parachuted in,
a team of 15, headed by a foreman named wag dodge.
The fire exploded.
It was 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 overtakes me, I'm safe.
I'll be in 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's just tragic to think of the answer being there,
but just in the moment not able to see it.
That's how imbedded 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 man 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.
We have had enough!
What do we want?!
Healthcare!
- When do we want it?! - Now!
All I hear is how we're gonna get more people access
to the present system and how we're gonna pay for it
and to me that's not the only issue.
The present system doesn't work and it's gonna 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.
People often think it has to be a new drug or a new laser
or something really high tech and expensive
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.
We're in the grip of a very big industry
and it doesn't want to stop making money.
At the executive level, what's most important
is meeting wall street's expectations and they have to.
These for profit companies,
by law, have to serve the shareholders.
You almost forget that what you're doing is providing healthcare.
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 of healthcare,
we're talking about the health of the nation.
Mommy, what are you going to do?
I gotta go to work.
What are you gonna do at work?
What I do every day, buddy.
I love you.
I love you, too!
Bye.
Bye!
In a community health center like where I work,
you see chronic illness,
people that aren't able to afford their medications,
lots of psychiatric illnesses,
but the government pays you
based on how many patients you see.
I think we have about 25 patients for today for Dr. Martin.
I think 5 or 6 of them are on the waiting list.
If they're an easy 15 minute,
I'm sure we can probably squeeze them into the schedule.
Hello, Mr. fields?
I need to listen to you.
All right. Who's next?
- Hello. - Hi.
How are you?
Well, first of all,
my son's in the air force
and he's going to be 21 on Sunday.
Mm-hmm. And he's not here.
Where's he at?
- Germany. - Yeah?
And you're missing him?
I am.
And I moved out from my boyfriend in December
and I work 6 days a week,
5:30 to 7:30 and I'm tired.
Whoa. Yeah.
So, it sounds like you're feeling really overwhelmed right now.
Sorry.
Don't be sorry.
Did you have anything in mind when you came in here today?
I was on Celexa for a while and that seemed to help.
So, you were thinking about medication?
If you can think of anything else.
I'm a little bit wishy washy on the medication
because medication is not the problem.
- It's not. - Yeah.
The problem in your life is that you've got
too many things going on and you're overtired.
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, 2, 3, 4, 5.
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.
In the era of for profit medicine,
the time allowed for patient visits has shrunk to a point
where you've got 7 minutes with a patient.
Can you feel this?
Yes.
Barely?
- Yeah. - Ok.
Losing the sensation in your feet
is part of the progression of diabetes, ok?
It could get worse.
People talk about 2-minute doctors...
Hmm.
Literally, 30 patients an hour.
Things could move in that direction here.
And this is not the choice of the doctor.
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're having.
Michelle?
Tell me what happened.
I just tried to cut my arm off.
What were you trying to do?
I just wanted to just end it and...I'm tired of it.
I'm so tired of it.
- Are you taking your medication? - Yes.
A great deal of what's done in conventional medicine
is to put band-aids on things or to suppress symptoms.
Have you cut yourself before?
When I was a kid...
- You used to cut? - Mm-hmm.
Lexapro is the only thing you're on right now?
Mm-hmm.
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.
I'm gonna make a phone call and try to get some wheels in motion
so that we can get you the help that you need, ok?
Ok, 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 lunch time?
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, uh...Not doing the job.
Where I'm at right now, patients are in desperate need of care
and 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 gonna 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.
I'm gonna go look for it.
The history of how the American health care system grew
is not one of order,
it's one of sort of haphazard chaos.
Everybody's 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's doing their job.
We just designed the jobs wrong.
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.
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.
The healthcare system isn't affordable anymore.
Who pays for that? Where does that money come from?
This all coming out of our pockets.
It's your money.
The really astonishing part about the fact
that we spend more is we have worse health outcomes.
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.
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 was really 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.
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,
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.
There is this tremendous innate healing capacity that we all have.
When I sit with a person who's sick,
always at the back of my mind is the question,
what is blocking healing here? What is preventing it?
What can I do from outside that can facilitate that process?
That perspective is missing
from the training of our health professionals.
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.
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.
Many clinicians come here frustrated,
they're overworked, they're overwhelmed,
buried deep underneath insurance forms
and 10-minute visits and 30 patients a day.
Where are you from?
I'm from Virginia.
I actually practice emergency medicine
- at the university of Virginia in charlottesville. - Good.
There have been some trends
in healthcare that make me uncomfortable.
I felt like there's got to be something different,
something better.
Almost 40,000 people have been studied...
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 a heart attack
or stroke or cancer or things like that.
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 gonna teach me how to do that, so I'm gonna do it.
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're dependent
on expensive technology and that includes pharmaceutical drugs.
I think there's some very good drugs out there.
I thing 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?
We spend $300 billion a year on pharmaceuticals.
That's almost as much as the rest of the world combined.
$300 billion on drugs.
In the 1950s, Americans took pharmaceutical medication
at about 10% of the rate that they do now.
We're taught with the commercials on television,
why do we need to wait? We can just take a pill right now.
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.
New Zealand and the united states are the only
2 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.
Overmedicating is a huge problem in society
and the military is no exception.
This is a national problem for us.
You know, we're seeing the military just being a microcosm,
I think, of the problem society's having.
Soldiers' use of prescription drugs
has tripled in the past 5 years.
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.
I can see why there's a link between opiates,
dependency, misuse, and suicide.
I was taking 64 pills a day
of combinations of roxicet and oxycontin.
There's a contradiction to what we do.
You as caregivers are told,
you've got to keep me pain free.
You're gonna do that.
And 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 stack of pills.
If it happened to me, it happens to a whole lot
more people that are almost invisible to the system.
I've been shot this deployment.
8 I.E.D.'S just this deployment.
I carry a lot of weight because I'm infantry.
The mountains of Afghanistan
are not easy to climb, so compressed my back.
I was treated for sciatic nerve, back,
l-2, l-3, l-4, l-5,
swelling, left side of my brain,
and extreme p.T.S.D.
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 gonna tax anybody.
And we see that suffering.
During the air evacs of wounded soldiers,
the approach to pain that currently exists is to get medications.
Do you have any pain right now?
Ok, I can see what you can have for pain, all right?
He asked for pain medication.
They don't say how much they gave him,
but he can have anywhere
between 5 and 10 milligrams of morphine.
I just want to see what they've given him.
- Because he's real sleepy? - Yeah.
It's very hard for us as nurses to treat for pain
because there's no thermometer that we can stick in
and say, oh, it's 7 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.
- Are you ok? - I'm so uncomfortable.
And I need to pee again.
You need to get up and pee? All right.
Ok, I need some help over here.
The patient just fell off the litter.
Wait, what?
Did he try to get up without anybody knowing?
No, I tried getting him up and he just rolled himself out.
He's like really not listening very well.
Yeah, that's why you don't want him to fall again.
Probably put him on the bottom on the other side.
I'm gonna check his chart real quick
and find out what he got at the casf.
Let me get that jacket away from him.
He's like clutching his meds.
Here you go. This is what he's got left of the morphine.
He was issued a bottle today
with 20 in it and 10 are missing.
He's taken 10 tablets.
- That's why. - Oh, my God.
That is ridiculous.
That's why he's a little high right now.
That's the point.
He could stop breathing if he took too much
narcotic and we're gonna be doing c.P.R.
On the patient, so at this point,
we won't administer the medication.
We moved you over here.
Take them away from him.
Do you want to do a pill count with me?
We'll do it up at the front.
Ok.
Ok, so, we have 10 dilaudid.
Ok, this is prazosin.
He's got Lunesta.
And he also has valium.
Right here's the lortab, naproxen.
He has Percocet and he has norco, which is Percocet.
I'm not sure what is what.
Um...
They're not in there?
- These are all name brands. - Oh.
The only thing we can do is separate them out
because there's no way for us to tell which are which.
These are all one person's?
But they're combined, so we don't know what they are.
Where are you coming from?
Afghanistan.
How long were you there?
- 9 months. - 9 months?
We're glad to have you home.
You wanna tell me about some of those that you lost?
A platoon of 23.
Came off the Mountain with 8.
Off the Mountain with only 8?
You've seen a lot.
Lift, lift! Lift!
Go!
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 healthcare is kind of dark matter.
It's unseen, but it's there,
and it's very, very powerful.
We tend to see just the light of healthcare.
We see the goodness of healthcare,
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 healthcare 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 that 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.
If you look at healthcare 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 2 or 3 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
and the entire healthcare 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.
Ok, ready?
Now, I'm going to get the scissors.
Yeah.
I started getting sick in my 30s.
I started having really, really bad chest pain.
There we go, a flower for ya.
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'd 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.
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, is that some of those procedures will lead to bad outcomes.
I had 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 2 hours away at the Cleveland clinic.
How are you?
I am great.
Look at the thinness.
I know. You look really good.
I have lost... since last year I have lost 21 pounds.
Oh, my God.
Yvonne came to see me when she was sort of at her wit's end.
She had had a bypass surgery at an early age,
27 cardiac catheterizations, and well over 7 stents.
Deep breath.
This is just an unbelievable amount of stents and cardiac caths.
I'm sorry, it's gonna get pretty tight.
Oh, it's all right.
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.
Breathe normally for me.
If someone had talked to her, I think someone
had really teased out her chest pain
and her shortness of breath,
I think many of her cardiac catheterizations
and stents would not have been necessary.
You know, you have all these stents
and, you know, these stents, once they go in,
they never come out, and they're 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're gonna do is do procedures.
The vast majority of doctors in this country
are paid by a fee for service system.
And that simply means that they get paid for each office visit.
If they're surgeons, they get paid for each procedure.
If it's a radiologist,
they get paid for each C.T. scan that they deliver.
If I spent 5 minutes with you
and then 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're doing their exercise,
make sure their diabetes is going ok,
and to try to figure out what their true problem is,
probably get paid $15.
It's a completely irrational system.
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.
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 cardio catheterizations,
every time she had a chest pain, coming into the E.R.,
and, unfortunately, there are lots of yvonnes out there.
Although we've made progress technologically, you know,
we know how to do things for diseases we couldn't have done before,
we haven't really experienced the systemic improvement
that we want the new healthcare system, that we're really after.
We pay for fragments of care.
A doctor visit, a hospital stay,
a lab test, an ambulance trip,
so because we pay for pieces,
we have pieces and so people who really need a coordinated system,
they don't get that.
Medicine is very now.
Medicine is very specialized.
And this is really a big problem
when you go to the hospital because
there are so many different people
who lay their hands on you and if they're not
talking to each other, you can't necessarily get the right diagnosis.
You can get repeated tests.
You can get things happening to you
that put you in harms way because nobody's really keeping track
of you as an individual patient.
A recent study found that 187,000 patients die
each year from harmful care in the hospital,
which includes medical errors and deadly infections.
Based on these numbers,
this would be the third leading cause of death
in the United States,
just after heart disease and cancer.
Hello. Dr. Ross.
I am back in the chest pain center
with a pretty sick patient
and I'm gonna need you to call attending phone, too.
The emergency department is the safety net of healthcare.
We see a lot of the chronic conditions that effect
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.
There's a saying in healthcare policy
that 20% of the patients account for 80% of the costs
and the majority of those costs
are when they are repeatedly hospitalized.
They're patients with heart failure,
they're morbidly obese patients.
They are often poor patients, but not always.
One of the ways to think about saving money
in healthcare is to focus our energies on that 20%
of patients and think about treating
those people in a more effective way.
I just want to review this pain.
It's here right in the center of your chest.
Ok. And is it still traveling into your neck?
It's traveling down my arm and my neck,
and my head and ears are buzzing and ringing.
Ok. What was it, Mr. litton,
that finally made you say, ok, that's it?
I'm going to the emergency department.
You see, 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.
How long ago was that?
That was a month and a half ago.
When I had my first heart attack,
did the cardiac catheterization, you know,
put the thing up there and then put a stent in my heart
because I had a clogged artery,
and that worked for a while.
I mean, for a couple of weeks I felt like I was ok,
and then all of a sudden I started getting chest pains.
So, here I ham going in and out of the hospital
to find out what's going on.
Do you have any eating habits
that you think might be...
no, I eat the regular food and stuff.
What's the regular food?
Eggs, sausage, grits, bacon.
Well, what do you think about your diet?
- A healthy diet? - Yeah.
What do you think about that?
I'd do it if I had to.
If you had to.
Well, you have a stent in your heart, right?
- Yeah. - All right.
And you've had heart attacks and you're here today with chest pain,
when do you think it would be good to try it?
Once I found out what's really wrong with me.
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 a client to healthcare just doesn't work.
Most diseases don't happen over night.
Sometimes they're related to lifestyle habits.
Sometimes it's related to what the individuals actually have access to.
I have no health insurance.
Some days I go to the hospital
and that's the only healthcare I ever got.
I never had a personal doctor, family doctor,
nothing, all my life.
I stopped taking my medicine months ago
because it was too much, can't afford it.
If you go out and buy heart healthy diet food,
it's gonna cost you more money than anything.
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 responsible for Insulin resistance
and metabolic syndrome and obesity
and the artificial colors are not good for you.
This is a major reason why we see kids getting fat in this country.
Let's see what we got here.
One of the great contributions in 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 and promote weight gain
in genetically-susceptible people, which is most of us.
Some people, this is all they eat is food of this sort.
It's not whole food as nature produces it,
it's completely changed food and, you know,
and 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.
McDonald's put salads on the menu,
but as it turns out, the salad is $6.00,
the burger is 99 cents,
and if you're on a fixed income,
what are you gonna do for your family?
These calories are cheap only when you buy them,
but if you look at the overall cost to society
of these cheap calories that are so junky,
they're really the most expensive.
It's scary how fast obesity is spreading in our country.
Obesity leads to heart disease and strokes and diabetes.
If trends continue through 2020,
up to 1/5 of healthcare spending,
or almost a trillion dollars annually,
will be devoted to treating
the consequences of obesity.
If you want to understand how Americans
are getting more and more overweight,
it's because we haven't really rethought things
that were put into place a long time ago
when nobody really thought
what the unintended consequences might be.
The department of agriculture subsidizes all the wrong foods.
We subsidize corn, we subsidize sugar, we subsidize wheat.
We don't subsidize carrots.
We don't subsidize celery and we don't subsidize apples.
You can lay it at the feet of a guy named rusty butz.
He was the secretary of agriculture during the Nixon administration.
He was the one who thought that we should subsidize
commodities because it would allow us to sell
these commodities on international markets
and we've made one heck of a lot of money.
The other reason we subsidize certain things
is because they have powerful lobbies.
The money that's involved ends up being
funneled towards congress and congress doesn't want to fix it.
The American healthcare 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.
I don't recall anytime telling a lie,
but I know that there were many times
that I didn't disclose full information.
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 a 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 the 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 healthcare 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 4 and 500 Miles away
waiting to get care that's being provided to them 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 many of them work
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
that 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 old 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 I said, how did you get here?
I just could not continue doing what I was doing.
Good morning.
Our forefathers in medicine were really about patients.
It was about a passion for healing.
When medicine became a business,
we lost our moral compass and I think we've gotten
into a great deal of trouble because of that.
Since I have type 2 diabetes, I try to do what my doctor says.
Managing type 2 diabetes can be hard.
Adding Avandia can help.
There was a drug on the market, Avandia.
It got fast tracked by the fda.
It 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.
I got my blood sugar under control.
He really did.
Can adding Avandia help you?
I was doing a Google search and what I found was a website
in the United Kingdom where the clinical trials done
with Avandia were actually partially disclosed.
And what I saw, it 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 statistician or in the words
of my old friend Bob Dylan,
"you don't have to be a weather man to know which way the wind blows."
There was obviously a problem,
about a 30% 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.
Cleveland clinic cardiologist Dr. Steven nissen
decided to do his own review.
Now, the leading cause of death in diabetes is heart disease.
70% of all the deaths in diabetes are due to heart disease.
Having a diabetes drug that increases
the risk of heart attack by nearly 1/3
is a public health catastrophe.
And the company didn't tell anybody.
A senate investigation accuses the food
and drug administration of ignoring research.
Finally, the fda put severe restrictions on the drug.
You do have, you know, a lot of money at stake here.
Glaxosmithkline worked very hard to keep
these numbers from the public.
An fda advisory committee starting hearing evidence
on whether Avandia is so unsafe
it should be pulled off the market altogether.
There's litigation involved and the company
set aside $6 billion 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 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.
It is very hard to get legislative action to improve the fda
and to better regulate the... particularly, the pharmaceutical industry.
It is the assumption that people who run
government are elected officials,
are 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.
Good morning, folks, how are ya?
I was almost 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 hospitals' 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.
How powerful are lobbyists in the healthcare system?
Infinitely.
What gives lobbyists power is the amount of money
they have for campaign contributions.
We have been trying to reform
the healthcare system for 100 years.
It goes back to Teddy Roosevelt.
But these companies will do whatever it takes
to make sure there are no new laws or regulations
that will hinder their profits.
I was a part of efforts going back
to the Clinton administration to make sure
there was no patient's bill of rights passed
because it would have expanded patient's ability
to sue their insurance company
or their employer if they had been denied needed coverage.
So, we created a front group called the health benefits coalition.
I'd like to welcome you to the first press conference
of the health benefits coalition.
Corporations are very careful to choose names
for these organizations to make people think
that they really are grassroots organizations
and they're really nothing of the kind.
Part of the whole effort is to get people ultimately to vote
against their own self-interest.
The spin was to scare people into thinking that premiums
would go up because more people would be filing
frivolous lawsuits, but, of course, these people
had no idea that they were being made to believe
this by the insurance industry.
The patient's bill of rights had bipartisan support,
senator John mccain and senator Ted Kennedy were co-sponsors,
but it was so opposed by the powerful insurance industry,
no bill was ever passed.
The healthcare reform bill that was enacted
achieved 2 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 2 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.
It does make it illegal for companies
to just cancel someone's policy
because of a pre-existing 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.
Because of the money that's involved,
getting people to do the right thing
for the American people has become extremely difficult.
People now, they hit the pitch we throw.
If we change the pitch, they'll hit that one, too.
Between the healthcare we have
and the healthcare we could have
lies not just a gap but a chasm.
That's how big the difference is
between what we could be doing and what we are doing.
I think we have to recognize as a country,
we could have a care system that we can sustain for the long haul
and it will be far more better performing
than what we have now if we get together and work on it.
I don't blame anybody, they're just doing what makes sense,
and we have to change what makes sense.
If our civilian healthcare system is smoldering
and we see it's gonna catch on fire and burn pretty soon
and is gonna 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.
I was in the worst place in Afghanistan.
The korengal, the waterpur,
it's the most intense battleground that you can ever be in.
I lost a lot of good men.
It still bothers me to this day.
I'm 2 1/2 months out of combat.
My very best friend from war, he was on narcotics.
He overdosed, respiratory shut down.
I lost him...
And from that point on,
I realized that I don't want to be on this side.
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 antidepressants.
I was on trazodone, clonidine.
I was so dependent on my pain medication.
This...
Is the medications I was on.
Do you understand?
That is 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.
As we've pushed medical innovation and capability
to the leading edge of the battlefield,
where we can save their life, we've got some guys that have
some horrific injuries and they're getting narcotics for longer period of time.
They certainly are at risk to develop dependency.
And that's what we're trying to avoid.
The army surgeon general directed that we establish
the pain management task force
to take a look at alternatives to narcotics.
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 air evacs 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're on,
so by the time they get back,
they're not snowed under on multiple medications.
Guten morgen. Welcome to Germany.
And welcome home.
I know you are heading home and you are excited.
What it first seems like strange bed fellows...
healing-oriented mind/body practices
and sort of the hard-core military...
Actually is an opportunity
that they jumped at because of the pragmatic need
in nature that the wars have driven them to respond to.
There's a very, very small chance
of you having infection or any of those kind of problems.
I am very skeptical about it,
this idea that putting some little stick pins
in your ear is gonna cure pain on a 9-hour flight.
It wears on your lower back wearing, you know,
a 40-pound vest and it's got to the point where the pain
is radiating from my back
down to my hips and then down into my thighs.
That's it.
That's my daily routine.
The first one's going in.
How's your pain, sir?
I feel like I'm warming up a little bit.
It's pretty impressive,
especially for it to react that quickly.
When you put the acupuncture needles in the ear,
you see the activity drops down.
So, what has happened is you have reduced the signals,
or the processing, of the pain.
When you provide a small stimulus like that,
the body responds by trying to heal itself, trying to repair itself.
It'll go right there.
Ok.
Go ahead and bend down.
That's pretty good.
Any pain?
Not when I'm doing that.
- Normally you would? - Oh, yes.
I haven't touched my toes in months.
That means we're getting the needles in the right place.
- Ok. - I haven't even gotten near my toes
in months, unless I do this, you know?
How are you doing?
I'm doing good.
Yeah, actually, I want you there when I go into surgery.
Hi. How are you feeling?
I have pain, but it's more of an annoyance than it is pain.
Just sore.
If you didn't have the acupuncture needles,
how do you think you would be feeling now?
I'd be chomping narcotics.
- Oh, you would? - Oh, yeah.
Oh, so, you haven't taken anything?
- No. - Because of that?
- Yep. - That's good.
15 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.
Appreciate it.
Thank you very much.
15 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.
In the last few years a profound change has begun in American medicine.
Dr. Dean ornish has studied and written
about diet and heart disease for decades.
In medical school I was learning how to do bypass surgery
with Michael debakey, the heart surgeon.
We cut people open, we bypassed 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'd cut them open,
we'd bypass their bypass, sometimes multiple times.
I said there's got to be a better way.
We spend so much time in medicine mopping up the floor
around the sink that's overflowing
without also turning off the faucet.
If we just literally or figuratively bypass the problem
with angioplasties and stents or lifetimes of drugs
or other kinds of interventions,
then more often than not, the same problem comes back again.
But what we're finding is that if you turn off the faucet,
if we treat the underlying causes,
which to a large degree are not so much our genes
but our lifestyle, that our bodies have a remarkable capacity
to begin healing themselves and these chronic diseases
can not only be prevented,
but even reversed much more quickly than we had once realized.
When I went to medical school,
I started reading all the medical literature
and realized that in dogs and cats
and pigs and rabbits and monkeys,
you could cause them to get heart disease
if you put them on a bad diet and "x" didn't let them exercise
and put them under emotional stress,
but you could reverse it if you changed those same things.
So, I thought, why should people be any different?
And everybody said, that's a crazy idea.
There's no way that's gonna work,
you know, what's the matter with you?
I spent more than 30 years of doing these studies,
showing that heart disease could 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
and he or she assembles a team of 5 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 that people are much more likely to make
these sustainable changes and the patient learns
how to empower themselves and to transform their lives.
25 years ago I had 5 restaurants in San Francisco.
It was a great life.
I smoked 6 cigars a day, 10 cups of coffee,
and a lot of wine.
It was wonderful.
And I had a massive heart attack.
I was in the hospital for 2 weeks.
I could hardly, uh...
Just about walk 3 steps and I'd have to stop and rest.
I was popping 20 or 30 nitrates 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 gonna die 'cause I was in such bad shape.
And now 25 years later, and I'm in pretty good shape.
Ha ha ha ha.
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 shown 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, you know, there was a huge amount of skepticism and resistance.
People would say, oh, but you're doing this radical intervention, you know.
I say, radical? Yeah, like compared to having your chest cut open?
I mean, give me a break.
We need to empower people to change their lifestyle.
And if we can make it reimbursable,
that really brings it into the mainstream.
Now, as you know, heart and blood vessel diseases
kill more Americans than virtually everything else combined
and it's treated with things like angioplasties and stents
and bypass surgery and yet, what does the evidence really show?
Unless you're in the middle of having a heart attack,
which 95% 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.
And in our studies for the last 33 years,
we've used very high tech, expensive,
state-of-the-art measures to prove how powerful
these very simple and low tech and low cost interventions can be.
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.
More than half of men over the age of 50, get a p.S.A.
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.
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,
and so there's a subset of men who have diagnosed,
biopsy-proven prostate cancer,
who elect not to get treated conventionally.
My path crossed with Dean's because we both wanted him
to try and bring rigorous clinical trial testing
to this hypothesis that lifestyle intervention
could have an important impact in men with early stage prostate cancer.
How are you?
Steven. Nice to see you.
I'm one of the busiest surgeons in the country.
However, I don't believe every man
with prostate cancer needs immediate treatments.
So, I simply 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.
Hey, Liz.
Come on in.
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 telomeres.
So, as your telomeres get shorter, your life gets shorter.
Telomeres are the ends of chromosomes
and chromosomes have all our genetic information on them.
When telomeres 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.
I thought most things in biology go both ways,
so if bad things make your telomeres shorter,
maybe good things will make them longer.
So, we took the men with prostate cancer to see
if lifestyle changes can affect gene expression and even telomeres.
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.
We found that the men who underwent
lifestyle intervention, their p.S.A. Rates
generally went down and they were less likely to require treatment.
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.
And even drugs, even pharma, hasn't been shown to do that.
This puts a language of numbers
and molecular redox, through Dean ornish and those interventions,
that many in the medical field, I think, feel more comfortable with.
These lifestyle changes can not 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.
Almost one year into the fellowship,
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 wanna see 6 patients an hour,
I don't have to see 6 patients an hour.
We're the only clinic in skamania county,
so it's about 20,000 people, overall,
that we're the only providers for.
We're part of the community.
All of us live here and work here.
How are you today?
- Pretty good, how are you? - Good.
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.
- Yeah. - Ok?
We just have to keep working towards that.
And interestingly, patients really respond to that.
Did you go to the diabetes education?
Yes.
How did that... what did you think about that?
It was ok. It kind of gave me a more idea of what to eat.
Ok. Ok. You lost 5 pounds.
Mm-hmm. I quit drinking, too, so...
How much were you drinking before?
- 6 and over. - A day?
A day, for 25 years, so...
Wow. What made you decide to do that?
Well, that had to be something to do with my diabetes.
Mm-hmm. I'm really, really pleased.
You just look different.
So, that's rewarding for me.
I feel different.
- I had to do something. - Mm-hmm.
I guess I need to come back in a month or so.
Come back in one month.
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.
Yeah, your thyroid is a little bit big. Ah.
What's happened today is we found ourselves in a position
where we don't have enough primary care clinicians
to provide that important fundamental level of care.
When was your last mammogram and pap smear?
Have you...
Uh, 2008.
Why? We have underpaid on a chronic basis,
under rewarded primary care.
Some would say over rewarded specialty and sub-specialties.
Ok, so, first topic... medicaid reimbursement.
About 3 weeks ago because of the state budget crisis,
we got told with very little notice
that medicare and medicaid reimbursement
was gonna be cut by about 25%.
So, to make up that difference
in the reimbursement rates decreasing,
we're changing to shorter appointments next week,
we're on track for that on Tuesday.
So, right now the only way we have to make up
the difference is basically to see more people?
Right.
That's a little... it 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.
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 patients
and they don't reimburse for nutritional counseling
or anything like that,
but we're gonna talk to them about still, you know.
We all know there's things we can do
and those things make us all feel good
and we like to do them,
but we're gonna feel really bad
if our doors close and then we're not gonna have anybody.
Conventional wisdom is over the next 2 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
in to primary care, it goes into the other areas
and it's just not sustainable.
Dr. Martin has a lot more time with patients right now
because she's really ramping up her schedule,
but she's not covering her costs,
so the rest of the physicians are covering her costs right now.
Because we're a physician-owned and a physician run practice,
she's in charge of her own schedule,
but if that reimbursement level is smaller
and smaller, she's gonna have a lot less time
to spend with patients, so that we can at least
cover our costs and stay in business.
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 is possible.
Did you have a good day today?
Uh...Yes.
Yeah?
I would probably leave healthcare before I went
back to practicing the way I practiced last year.
I chose to get off all narcotics,
all medicine, everything.
So, just take a couple of minutes to kind of arrive.
All right, so take a breath.
I'm a redneck, South Louisiana boy,
just an old hillbilly, you know.
I don't believe in that stuff, you know, in eastern medicine.
Anybody else would laugh, you know, be like what is that for?
Hold my beer while I shoot this gator,
you know? But I decided to give it a shot.
So, we going to open up some chi?
We gonna open up some chi.
That's a good way to think of it.
Oh, wow. That's the way I like to look at it.
Because of this program that's here, there's yoga...
I'm just going to go ahead and put the last one in...
I meditate and it has opened up a whole new world for me.
I'm going to leave these in for about 5, 7 minutes,
something like that, ok?
Roger that.
It's wonderful.
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.
Post traumatic stress disorder, or p.T.S.D.,
it's an individual's reaction to the exposures and experiences of war.
War is hell. It's always hell.
So, you pick your spot.
Soldiers know if they go to war and if they get a leg blown off,
that your medics 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 wound to the head or chest.
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.
Catching it very, very early after their exposure
and allowing them to process that
is so critical in the long-term recovery.
Release the breath in a smooth, even stream out.
Ok, so, let's go into our meditation practice.
Meditation is scary sometimes.
Sometimes when you go,
you go to bad places in your head.
I will be at your side, should anything challenging come up for you.
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.
So, feel yourself there in your safe place.
And remember that you can return to this place
at anytime 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 arms heavy, your legs heavy.
You're good. You're good.
I know, I know.
That's some sweat.
You done some sweating.
I was on prazosin just for nightmares.
Meditation, it takes the place of that.
Notice where you are in the room, the people around.
The pain...It's hard, you know, it's really hard.
You got to push through it.
But this program has just inspired me to press forward.
The medication depresses you.
It makes you think that...
Is all you're ever gonna be in.
We'll end the practice today with the completing statements.
May everyone be well...
May everyone be healthy...
May everyone be happy.
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.
Ready?
Yes, ma'am.
The limitations of high tech medicine have never been clearer,
at the same time that the power of these simple low tech,
low cost interventions is also becoming clearer.
We could do a thousand studies with a million patients.
It would always remain on the fringes.
It's all about the Benjamin's, as the rappers would say.
It's all about the reimbursement.
If we can change reimbursement, it's a game changer.
We change medical practice
and we Chang medical education.
Trying to get medicare to cover the 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's the rosetta stone.
If we get medicare to cover it,
then everyone else will cover it and if everyone covers it,
then it becomes the standard of care.
I wanted to bring you up to date on our progress.
We've been making a lot.
Medicare finally is going to cover our reversing heart disease program.
That was 16 years in the making, as you know.
It's not like there's one lifestyle program
for heart disease and another one for diabetes
and another one for changing your gene expression,
another one for prostate cancer, it's essentially the same program.
It's just a question of the degree that people
are willing to make these changes.
That's the key point, Dean.
People, so to speak, have a constitutional right to be foolish.
- Ha ha ha. - We have to respect that.
But if we're really talking about true freedom of choice,
they already pay for the drugs and surgery,
what we also want them to pay for are
for those people who are motivated and who want to change,
to give them the support that they need in order to be able to do that.
That's probably too logical for the federal government
to pick up on immediately, but we didn't get into this
situation with so many Americans obese,
with this level of juvenile diabetes, by accident.
We got into because there were a whole host of policies
that led us down this path to sick care,
rather than the focus on prevention and wellness.
Now, that medicare's gonna 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 gonna make true healthcare,
not just sick care available,
at a time when the medical system is so badly broken.
One company has figured out
how to lower healthcare costs by more than 40%.
It's an idea that's received national attention.
Following the example of places like safeway.
The safeway supermarket chain looked
for a way to reign in spiraling premiums
and hit on what seems to be a win-win solution.
In 2005, we had a billion dollar healthcare bill,
rising at the rate of $100 million a year.
These are the costs of all of our drugs in order,
so diabetics are one the number one cost of prescriptions.
You can see how many scripts and the average script.
What we discovered was that 70% of healthcare costs
are driven by people's behaviors.
At my heaviest, I was over 200 pounds.
I'd have my pizza, I'd have my comics,
I'd have my d.V.D.S and that was the weekend.
You realize one day, wow, you know, 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.
I was chronically coming down with colds
and I knew that there was a history of cancer
in my family and diabetes, heart disease.
I was a walking dead man.
Now, as a business guy, I thought if we could influence behavior
of our 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 4 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 dictate 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 premiums starts here
and if you have a body mass index less than 30,
you get a discount.
If they are a confirmed a 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.
Without the financial incentives,
there's no way I could have gotten to the point that I am now.
It's saving literally thousands of dollars
over the past few years by being healthier.
Are we ready to roll?
Yes, we are.
All right! Let's go! Whoo!
All right.
Whoo!
I never was a runner
before I started the safeway running group.
Little by little as we were here in the gym,
they just kind of drafted us in
and we've been running ever since.
All we did was facilitate smart choices for people
and developed this culture of health and fitness.
Did you bike to work today?
I did yesterday.
All right.
I'm going to do it again on Friday.
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.
For a long period of time, I was hiding.
I had a full beard.
I had dreads down to my waist.
I was shutting down emotionally.
I not only have a second chance,
I have the greatest chance because I have
a chance to make my next 50 years
better than my last 50 years.
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's like, it used to be me.
Let me have a salmon steamer basket.
Coming right up.
You can't say you're interested in the 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.
Safeway's healthcare costs have remained flat
compared to a 40% jump for most other companies.
30% of our smokers have quit.
21% 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 adapted
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.
Safeway corporation, they've actually been able to bend the cost curve,
those are the kind of things that actually have an impact.
Making money and doing good in the world are not mutually exclusive.
I lost about 120 pounds over the course of 3 years.
Even if I lose 30 more pounds,
which probably is my ultimate target,
I'm not gonna 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 see my son grow older
and go to college and all that fun stuff.
If we really can, public and private side,
begin to migrate payment 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.
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 visit a hospital that stopped infections.
You can visit a hospital that's ending waste slowly but doing it.
You can visit systems that coordinate care, nearly perfectly.
The Cleveland clinic was founded by 4 physicians
and they realized they did better working as a team
than they did as individual practitioners
and they formed a group practice.
They decided that would pay themselves a salary
and the money that was left over would go back
into growing the organization.
And that model has continued to this day.
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.
6 years ago, before I became c.E.O.,
I was sitting down saying, what profession am I in?
And I said, well, I'm in the healthcare profession.
And then 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.
- How are you? - Hi.
How are you?
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 with me in 3 months with an echo before.
People with chronic disease, who come in and out hospitals,
bounced in and out of e.R.S,
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 to Yvonne 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.
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.
It's really easy to find articles or speeches
from 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 a nation
when we deal with waste in healthcare.
We only give lip service to prevention
and we have to ask why as a society we are 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 the 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.
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 motto in medicine, primum non nocere.
In Latin it means "above all, do no harm."
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 part of what a really great healthcare system
would do, it would empower patients.
It's so frustrating to know how high the risks are
and how easy the answers are.
The answer's among us and only by accepting the fact
that the American healthcare system is badly broken,
that the status quo isn't working,
that it's bankrupting our nation,
will we be able to seek out the escape fires,
the potential solutions,
we create a sustainable and patient-centered system for the future.
Here's the paper.
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.
I'm going back home.
Home to the infantry division, airborne, air assault.
I can't wait to be there.
See you, dude.
I don't need you.
Don't need you.
Never needed you.
They didn't foresee me even trying to walk yet,
but I'm doing it, maintain my pain.
Not having to need all these pills.
It's been a wild ride, still not over it,
but it's better from Germany, I promise you that.
Look at this.
It's a happy time in my life right now.
I'm so excited just to finally leave this hospital.
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 and recovery.
The boy from Campbell... See you soon.
From Noah.
I feel like I'm changing.
Thank you so much.
I'm not changed... But I'm changing.