i can't wait to be there. look at you. don't need you. >> they didn't foresee me trying to walk yet. i'm doing it. maintain my pain. not needing all these pills. it has been a while, but it's still not over. it's better than 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 my tools back and still continue my process of healing and recovering.

the boy from campbell. see you soon. >> i feel young. thank you. >> i'm not changed, but i'm changing.

♪çót(xdñixd ♪fáokw3xdxdqñixd we can't leave the conversation right there. i'm dr. sanjay gupta. %ur(s& 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.xdq

what the options might be if there's a doctor shortage in your hometown, and 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 peopleá that arefá making sure ther patients don't get sick and that they have everything they need to maintain health.q but you end up being this people come in and you try to for the same thing over and over and over. you just never get to the bottoñ of what's causing all he these problems they're having.ñie1ko >> dr. martin, a primary care aw in the film.a5i]ejl% fpmedical officerkson, the chief 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 couldú)yzur

care of patients and get reimbursed enough to do the work you needed to do. that sounds like a really dire c situation. ok >> it was a dire situation, and any times myself and coklp my colleagues would have the lpi conversation of, we're going to miss something, this could be really bad, and actually having the fear that this was %w$ng to be harmful to our patients at xó some point.xdxd >> dr.xd tuckson, one of the right toxd it, it's simply not reimbursing o&ough money for primary care doctors. xd >> there'sxd no question that primary care doctors are underpaid, especially relative to their counter parts, those who do procedures. one of the good news, the r exciting news, there's a lot of energy now to turn that around.p and the basis of that is to participate as comprehensive c@ health care teams.jfi] just so that the kinds of challenges that erin faced out there by herself can be lpt(xdjq

accomplished by pulling a team together, and then let them work hard to save dollars and qualitr incentives toq accomplish those financial incentives. >> they are being cared more. these models are based on fee for service, and then a care and a bonus if they can demonstrate they can improve th( quality of care and made cost savings. >> erin, do you want to respond to that? >> i bill $213 for a 45 minute the check that i get back from the insurance company after that was billed is $40. >> united health care makes a s lot of money. and there's nothing that peopler sort of get more antsy about is the idea of people profiting off of other's misery.e1jf , alking $5 what do you say to people when

they say, look, ráur' a billion. >> i don't think it's important or useful to get distracted about who makes -- everybody needs to be able to deliver value.e1 if insurance companies don't ÷zn8business very long.e1 be in simplyw3 the same way hospitals and physicians. this isn't a game of th against that sector, but at the( end of the day, the american ñi one thing they don't need is a doesn't take us forward. 4ceaiq%u1i"átátñ you were part of the documentary.e1lpfá the american people are going t watch something likexd that and that's going to be their perception. >> i think w' the american people need is good health care. there's a lot of talk about that's really important. but we hrod the means to lp decrease disease. i do it in my clinic all the time.r without the use of fancy technology and expensive + pharmaceutical medications.xd the food that we eat and the i] nutrition we put in our body,

that's been around since the ok beginning of time.3wçó t's + right there. so putting more money into innovations and all of these things, they're needed in i]ññi certain instances, especially emergency care, things like that, they're second to none in this country for those things.çó we have the ability to make hug] changes in our patient's lives and we're not using that, lp$&h% because it's not reimbursed and ow to do it. >> we know that patients are healthier when they have two qñi things.ok insurance and accesst( to a usu ofy care. if we have better primary care that includes nutrition counselling, prevention and carr get sick.t(n÷ here's the secret, healthier q people cost less money too. ènuáure when it comes to familyf care, when it comes to our health care overall?xdjfxdfá

>> i'm optimistic right now because right now we're in a xd understand that effective primary care gives us higher quality, lower cost/4h!ut not only that, patients are healthier and like that kind of care. i'm optimistic about the future% of family medicine. >> you feel better when you're healthier too. >> exactly. >> both physically and mentallyd how much does profit play a role in all these treatment how to know if you're being prescribed unnecessary procedures or medications, next. wicks moisture away. l keep moving. stayfree. new griddle-melts to yourime usual breakfast sandwich. a lot more flavor. [ anouncer ] ihop's new griddle melts... made fresh and hot! hand crafted just for you. it's like a sexy sandwich. [ anouncer ] compare new griddle melts yourself. just $4.99. it's an epic breakfast sandwich. for over 75 years people ...with geico... ohhh...sorry!. director's voice: here we go. from the top. and action for over 75 years people have saved money with gecko so.... director's voice: cut it! ...what...what did i say? gecko? i said gecko? aw... for over 75 year...(laughs. but still trying to keep it contained)

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i can't tell you how shocked we were when we saw herne ñixd first time.lp mpwhose diabetes was not well controlled, her cholesterol wasd never well controlled and her high blood pressure was never well controlled.xdfáxd if someone had talked to her ani checked out her chest pain, mand of her cardw! catheterizationsq >> ivanxdjfi] is the patient in 27 cardiac catheterizations and well over seven stents stents dfittle to prevent 5a heart attacks and in many casesk doctors put them in to make moró 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.t( the wire cage you see is@w=q open and allow the blood to ñi çó joining me to talk more about that is dr.!u steven nissing, the chairman of cardiology at also, dr. jeffrey marshall, his ocietyxd forçó interventional angiography and intervention. from a patient perspective, you want to make sure people are ñr dr. nissing, let me start with you. you say there's a lot ofxd yavonnes out there.xdt( you say there arexd a lot of unnecessarye1 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 t(r'iques that should be used to relieve symptoms.d and some people even that are xd getting stents don't have q

fá causing symptoms and yet they're actually having a procedure. >> a lot of these stents are xd( unnecessary? >> i don't believe so.xdxdñi 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.xd that is chest pain that is currentlyçó damaging the heart patients. so less than 30% are actually done in these people with stable ischemic heart disease. >> one can't help but walk away from the documentary and be scared of stents. "ai55spicious of doceáp'd think just trying to make money off of me. that was the message that you got from that documentary.ñr is that a fair message? roblem in amerá1eu$at is we have misaligned incentives. we're 50% more likely to have a1

stent, than we would in where they have similar disease rates.óom t( knee replacement or umri because our system reimburses  the overall care of the patient. living. is that how you get paid? jer+átd paid a certain amount because ñd you do a stent.lp are you incentivized to do mosh stents? >> me personalliyt i'me1 ona5 calorie. >>lp doesn't matter. >> doesn't matter if i do one stent, fiveçó stents or ten stents. my job is to provide the right care for the right n!u)q't at xd the right time. >> so you're salaried. >> yes, sir. >> i'm salaried too as a physician.çó 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 k profit, we're saying that the system has created incentives ió subtle and not so subtle ways drives more procedures. if you get a bump on your head d as a friend of mine had, you gop into an emergency department>)s america, you get a c.a.t. scan. if you have that happen in çó germany or okengland, they say here's a list of instructions, if you have problems come back and see us. we just spent $1,000. çó >> sometimes the patients demand this stuff. >> yeah, but we have to ed t( educate patients. >> i want to point out something. i think this is important. i think when people watch the film, they're left with the impression that yvonne finally came to the cleveland clinic, got her cholesterol under control, her weight under control and things were great for her after that.lp that's not the whole story.e1 she ended up having another ope1 heart operation, another bypass operation.fá i think that's an important point.q 5iuju)yt( the impression i thiw6$u(áhp little misleading there, don't you think?

>> we can't prevent disease inr1 everybody, but we have to try. she had all of those stents before she had the risk factors controlled. that's not good medicin.v urp+e physicians that prevention comed qfá >> you and i both t(know, it's hard to changefáq the habits of lifestyle, toxd getxd peopleçó to exercise regularly, those are hard things to get people to do, and we need to be better at it. is when they have one of these 1 catastrophic kind of things like a heart attack.xd >> in the spirit of educating ç1 people out there, i have cardiac disease in my family, who should reá%jt+háhat's having a heart attack should get a stent. it's the best treatment and it saves lives, period, everybody agrees on that.fá people that have tried medical therapy, that are on medical therapy and failing.xdfáfáq that, like i said, less than 30% of the people that end up with a stent are basically in that category. >> stay with us. com

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technology today like complex cardiac surgery, you're lucky to be in this country. rescue care is second to none. as an overall system, no, we're not anywhere near the best in fá the world.

>> i want to introduce dr. valerie montgomery-rice, she's dean at the morehouse school of medicine. dr. jonathan !umygrubeh,i] he desi'ó obama care. patients7 advocate found da foundation. $u)u$ you, dr. rice. one of the things i think peopl are going to remember from that documentary.a5 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 >> i think it comes down to three things, a large part of it is personal issues, where we have different behaviors wxqjy think increase our burden of disease.xd our health care system. we have some challenges with access and affordability.w3 and then clearly we have social and economic issues that impactd people's ability to access. if you look at our percentage o(

çy those other nations, you have td understand that we come to the table with the bigger burden ofd disease. >> the children dying before the age of 5 exceeds any of the other 16 richest countries. if you account for that, we do d much better. why do so many children die so young here? >> i was surprised about this.id particularlyñi thejfçóxd data b one and e1four, having the thir most common causet(ñr as homici. 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 xdçó 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.çóu to lay it squarely at the feet of a profitable disease care ñi system, that may be true, 50th ( in the world, a lot of people

struck by that, jonathan, you e1 know, we want better care and lower costs. n every system. i'm not sure every country in çó the world does it perfectly, bu( with regard to prevention. preventing disease, does that save us money?e1 >> prevention unfortunately doesn't actually save us money. now, let me distinguish two terms, there's saving money and there's cost effective.ñie1j♪ñe1 prevention is cost effective, what that means is, the money we spend on prevention improves oud fá much more than money spent on much more expensive services.çó if you are insured f you're living in a safe e1neighborimod if you have access to the system, your outcomes are greater in america. cur first priority has to be to on. >> the vast majority of the v

viewers watching tonight say, what does tl directly. are my premiums going to go up? i have insurance now, perhaps. what does it look like over the next few years? >> premiums will rise.çóa5ú there's no doubt. they always have. >> for everybody. >> for xdñreverybody. how little they haveokñr risen overçót(t( three years. what we don't know, is that a fundamental change? that also happened in the 1990sr that ended and it rose quickly. >> why are these costs in hospitals so expensive? thew3 average price tag for a singlelp hospital admission cane eye popping. so we decided to give you a look at a typical operating room bill and how it breaks down. examples. if youñi lookt(jf at a hospital you might seet( an iv bag charg. about $280 just for the iv bag. that may strike people as high. a stapler used in surgery, $1200.çó

this is a chest tube, if someone has compression of one of their lungs, they may q"u%ár&l all over a room.i] ÷ used in just about every operating room in the world. this sutueácosts 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 would use a needle like this. thisxd will costlp about qñi$80. it'sq important to keep in mind if you ask the manufacturers of a device likee1 this, why so mu monqìc% they'll say, it took years to develop something like this, the research and development costs d also, the guaranteeing a certai1 level of effectiveness of this needle, that cost%9money as well.ó[ñ 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 q covering people who simply don't that's built in these costs as á

well. keep in mind that what is charged and what is ultimately q't numbers. you talk to some of the q, if executives of these hospitals. for every dollar that is billedá they may collect just pennies. they also tell us they do hike )ices so patients with good insurance can pay extra to help compensate for ess or uninsured all together, perhaps.ñr nancy, wet÷)q talk a lot about e bills. you say you can helpi] negotiat 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 u calls you?lp foremostt qitu+hju$e cá redundancies, if you're seeing redundancies in service, go back and meet with your medical professional, determine, did you indeed have two mri's during thf course of one week.e1xdi] did you have four different blood transfusions, you and your family may only recall one or two, try to understand where the

redundancies are.çó sit down and look at hospi,añ bills through the perspective xd of, are any of these services that i don't understand what r they are? and for the large majority of people we hmlc, 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.e1çójf you want to engage the billing representatives and the hospital in that discussion andd have them understand, i need an explanation of these charges. >> can we get ahold of those people? appointment.xdxdfá and we will say that it's important you request the appointment not only through a telephone call, but if you have >> i think thee1 numbers are surprising to people, even people wh]ó work in hospitals. i was ae1q bit surprised at the cost ofe1 some of the things we use on a regular basis. jonathan, you'll have to excuse me, you're an economist i'm not. one of the arguments seems to t( be, you add more people to the system, you get a lot more t( people insured.xd

which shoul0 happen over the next few years with the affordable care act, it should bringi] some of these39 costs d because now more people are actually, you're not spreading the costs out over a few people, but more.çó >> doesúio make a difference? >> if you look at the affordable care act in the whole,ç!jñ thin care act in íu will.e,ç!jñ thin when you add m people tow3 the system, that raises costs. let's be honest. why do we care about covering the uninsured?çó they're not using it. r(ju 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. lp >> tell me howt( that would wor. ou just saw there what would happen? >> medicare actually -- they did bidding where medicare would pay -- would reimburse cer$9ñ edical devices and rse cer$9ñ áj ((uu)ers to be iñ]*r the lower bidder to provide prices by 40%. there is no reason that exact ok

the board to drugs, to other diagnostic tests.q maybe even a provider service. people to be healthy.t( 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?xd difference? >> with some patients it clearly will. there are some patients that are motivated to say how do i go a5 i used to enjoywspá are the there. >>okó[ what do you think aboutk dye m% >> i think the biggest incentive for a patientñi is that they're going to live a higher quality and longer life.ñr i think those discussions that the provider aboutxd lifestylex choices, how to make healthy

choices, we must incentivize the system such that patients have a higher probabilithe right choic. >> thank you all. home with a thought as well. your lifestyle choices, hold t( or raise your risk of manyfá preventable diseases. here's a coupleñr of simple tip. try to8h break a s7 also remember this, the brain is not particularly good at distinguishing thirst and hunger, we often eat when we should be drinking watr5xd sometimes push the plate away. 2ujváh @&hc% brain to catch up to you stomach.çó stop when you're 80% full.e1 the japanese call that harrahachi-boo. by the w#ay they're number one in the world i expectancy. q just $4.99. it's an epic breakfast sandwich. you know you could just use bengay zero degrees. medicated pain relief you store in the freezer.