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. but i'm doing it. maintaining my pain. not having to eat all these pills. it's been a wild ride. it's not 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 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 change i changing.

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'll learn if your health care costs are going to go down any time soon. how to know if you're being

prescribed unnecessary procedures. you'll hear from many different voices with varying opinions and backgrounds tonight. >> as a primary care physician, we're supposed to be the people who make 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 all he these problems they're having. >> dr. martin, a primary care doctor you just saw in the film. also, the chief medical officer for the united health group. the largest health insurance company in the country. and jeff cane. thanks all of you for joining us. let me get right to it, 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 needed to do. that sounds like a really dire situation. >> it was a dire situation, and there are many times myself and my colleagues would have the conversation of, we're 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. >> one of the concerns -- and again, we'll get right to it, it's simply not reimbursing enough money for primary care doctors. >> primary care doctors are underpaid, especially relative to their peshlt counter parts, those who do procedures. one of the good news, the exciting news, there's a lot of energy now to turn that aroundp. and the basis of that is to incentivize doctors to participate as comprehensive health care teams. so the challenges erin faced out there by herself can be

accomplished by those financial incentives. >> why not just pay them more money? >> they are being cared more. these models are based on fee for service, and then a care coordination fee. and a bonus if they can demonstrate they can improve the quality of care. >> erin, do you want to respond to that? >> i bill $213 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. >> 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. a lot of money, we're talking $5 billion a lot of health. pay erin martin a little more money, you guys are making $5 billion. >> 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 enwot be in business very long. 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. >> what did you think about that particular theme? you were part of the documentary. the american people are going to want something like that. >> i think what the american people need is good health care. there's a lot of talk about who's going to pay for it, and that's really important. but we have the means to decrease disease. i do it in my clinic all the time. without the use of fancy technology and expensive pharmaceutical medications. the food that we eat and the nutrition 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, they're needed in certain instances, especially emergency care, things like that, they're second to none in this country for those things. 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. >> we know that patients are healthier when they have two things. insurance and access to primary care. if we have better primary care that includes nutrition counselling, prevention and care of chronic disease, fewer people get sick. here's the secret, healthier people cost less money too. >> are you optimistic about the future when it am coulds to family case, and when it comes to our health care overall? >> right now we're 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. >> you feel better when you're healthier too. >> exactly. >> both physically and mentally. how much does profit play a role in all these treatment decisions. how to know if you're being prescribed unnecessary procedures or medications, next. [ male announcer ] at his current pace,

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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 and checked out her chest pain, many of her cardiac catheterizations would not have been necessary. >> she had well over 7 stents before she went to the cleveland clinic for treatment. stents do little to prevent heart attacks and in many cases doctors put them in to make more money. 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 inflated. the wire cage you see is the step the. it expands the artery to hold it

open and allow the blood to flow. the chairman of card yalg at the cleveland clinic. also, dr. jeffrey marshall, his specialty is implanting stents and president of the society for an yog rah if i and intervention. from a patient perspective, you want to make sure people are being educated correctly. let me start with you, you say there's a lot of yvonnes out there, the patient we just met. a lot of unnecessary stents? they don't prevent heart attacks, they don't lengthen life. >> 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. >> a lot of these stents are unnecessary? >> i don't believe so. about 70% 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. chest pain that is currently damaging the heart in patients. less than 30% are actually done in these people with stable eschemic heart disease. >> one can't help but walk away from the documentary and be scared of stents. be suspicious of doctors who recommend one and think they're just trying to make money off of me. that was the message that you got from that documentary. is that a fair message? >> we do have a problem in america, and that is we have misaligned incentives. we're 50% more likely to have a stent than in countries in western europe where they have

similar disease rates. have a knee replacement or mri. because our system reimburses people for procedures. >> you get paid for the service 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? if a patient comes in, you get paid a certain amount because you do a stent. are you incentivized to do more stents? >> i'm on a samurai. >> so it doesn't matter. >> it doesn't matter if i do one, five or ten stents. my job is to provide the right care for the right patient at the right time. >> so you're salaried. >> yes, sir. >> i'm salaried too as a physician. >> and you're salaried as well. >> yes. >> how big a problem is this then? >> 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, you go into the e.r., 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. >> sometimes the patients demand this stuff. >> yeah, but we have to ed indicate patients. >> i want to point out something. when people watch the film, they're left with the impression that yvonne finally came to the cleveland clinic, got her cholesterol under control, her weight under control and things were great for her after that. 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. the impression i think was a little misleading there, don't you think? >> we can't prevent disease in everybody, but we have to try. the problem with yvonne's case,

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. >> it's hard to change the habits of a lifestyle. to get people to eat different. to lose weight. to exercise regularly, those are hard things to get people to do, and we need to be better at it. one of the best times to do that is when they have one of these catastrophic kind of things like a heart attack. >> in the spirit of educating people out there, who should get a stent? >> 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% of the people that end up with a stent are basically in that category. >> stay with us. this is so sick!

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if you need serious technology today, like serious 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. >> i introduce dr. valerie

montgomery-rice, she's dean at the morehouse school of medicine. >> and jeffrey dean, helped design obama care. and nancy davenport-ennis, heads the patient advocate foundation. let me start with you, dr. rice. one of the things i think people are going to remember from that documentary. when you talk about our life expectancy, we're 50th in the world, last in terms of the richest countries and if you look at the causes, especially with regard to that documentary, it's because of a profitable disease care system. what do you think? >> i think it comes down to three things, 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

uninsurers, you compare us to those other nations, you have to understand that we come to the table with the bigger burden of disease. >> the children dying before the age of 5 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? >> i was surprised about this. particularly the data between 1 and 4, having the third most common causes of homicide. i think it points to the violence in our society. you start to look at kids 15 to 19, we know accidents and again violence. that's clearly one of the issues, 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. >> i think it's an important point to make. to lay it squarely at the feet of a profitable disease care system, that may be true, 50th in the world, a lot of people struck by that, jonathan, you

know, we want better care and lower costs. everybody 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? >> prevention unfortunately doesn't actually save us money. now, 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 1k3e7bsi iexpensive s. if you're living in a safe neighborhood your outcomes are great in america. our first priority has to be to equalize that access and move on. >> the vast majority of the viewers watching tonight say, what does this mean for me most directly. are my premiums going to go up? am i going to be paying more?

what does it look like over the next few years? >> premiums will rise. we have historically low growth over the last three years. what we don't know, is that a fundamental change? that also happened in the 1990s, it ended and it rose quickly. >> the average stay for a hospital admission is cost letter. we decided to give you a look at a particular operating room bill and how it breaks down. >> if you look at a hospital bill, you might see an i.d. bag charge, about $280 just for the i.v. bag. that may strike people as high. a stapler used in surgery, $1200. if someone has compression of one of their lungs, they may

need a chest tube, $1100. you'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. if you look at devices like -- this is a needle that's used for biopsy. if there's a concern someone has a tumor, they who use a needle like this. if you ask the manufacturer's of 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. something 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. keep in mind that what is charged and what is ultimately paid are two different numbers. >> in fact to build on that, if

you talk to some of the executives of these hospitals. for every dollar that is billed they may collect just pennies. they do hike up prices so patients with good insurance can pay extra to help compensate for those who pay less or uninsured all together, perhaps. we talked about these bills, you say you can help negotiate the price of these bills down, what do you tell people? they're going to watch that and think, that's ridiculous. what do you say when someone calls you? >> what we tell them first and foremost, get a copy of the entire bill and look for redundancies, if you're seeing redone densecies 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 have four different blood transfusions, you and your family may only recall one or two, try to understand where the redone densecies 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. you want to take a look at that and find out what it is. you 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. >> can we get ahold of those people? >> it's difficult, and often you will need to make an appointment. it's important you request the appointment not only through a telephone call, but if you have an e-mail address, try to do that. >> 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, you're an economist i'm not. 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, now more people are

actually, you're not spreading the costs out over a few people, but more. >> does it make a difference? >> if you look at the affordable care act in the hole, it will, when you add more people to the system, that raises costs. let's be honest. why do we care about covering the uninsured? they're not using it. we want to cover them, they're going to use it, it's going to raise costs. that's where the affordable care act can help, bringing more competition to the bidding and pricing of these items. >> a hospital like you just saw. >> medicare actually -- 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, lowered prices by 40%. 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. 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? >> with some patients it clearly will. there are some patients that are motivated to say how do i go back and recapture the wellness i enjoyed. what do i have to give up to get there. >> we're not talking about disincentives. this is incentives, paying less specifically to be healthy? >> i think the biggest incentive is that they're going to live a higher quality life. how to make healthy choices, we must incentivize the system such that patients have a higher

probability of picking the right choice. >> i want to leave all of you at home with a thought as well. your lifestyle choices, hold incredible power over health. you have the ability to reduce or raise many preventable diseases. here's a couple simple tips. try to break a sweat every day. the brain is not particularly good at distinguishing thirst and hunger, we often eat when we should be drinking water. sometimes push the plate away. takes about 15 minutes for your brain to catch up to your stomach. stop when you're 80% full. the japanese call that harrahachi-boo. they're number one in life expectancy. thanks for watching. like helping hr departments manage benefits and pensions for over 11 million employees. reducing document costs by up to 30%... and processing $421 billion dollars in accounts payables each year. helping thousands of companies simplify how work gets done.