captning snsored by public affairs television >> this week on "bi mers journal." >> moyers: a reality check, why do we need health care reform in the first place? >> a lot of people are dying, and they're dying because they don't have healthcare. >> medical care is definitely a right. nobody should be turned away.

>> the big issue is your money or your life. >> you spend most of your life working, but once you don't have life insurance, everything you've worked for your whole life, will just go. >> it shouldn't matter whether you've got a $20,000 a year job. your life is just as important as somebody else's that makes a lot of money. >> moyers: stay tuned.

>> from our studios in new york, bill moyers. >> moyers: wco to the journa some years ago, rgeons opened myaughter's skull and removed a brain tumor th threateneto ll or ind her. less thaa month later,hen one my arteries sdenly ut do, open heart surgery saved my life. those skilled physicns and hospital stilllow in my family's memory. but the dual crisis in our lives st tens of thousands of dollars. when the iurance came through, bathed a sigh of relief.

the economist and nobel laureatepaul krugman, ys that's thehing about health insunce; you'll never know when y will need it. if you nd it and don't have it, you'ren deep, deep trble. th'shahappened tthe families tt u willeein is wees oaas thfimaker roger weisbe, whose workasong been decated to putting a hum ce on publ polic traveled the country to meet people who desperately needed healtcare that they couldn't afford. what they went throu and what they had tsaabout it is potent reminders that the need r heal care reform is a national emergency. here's a look at "critical condition." >> joe and i have been together 22 years. they say you find one love in life. for me it was joe.

>> just go to the next one. >> what are you doing, playing with it? my christmas tree? >> joe was a doorman for almost 15 years. >> you want a bow in your hair? >> he didn't make great money, but he always said the benefits were good. we cannot find the angel. >> what are you putting on top then? >> you! >> so what are you hoping for, for christmas? what do you want? >> my health, i guess. that's what i would wish for. >> when joe first got sick he was diagnosed with liver disease. i guess they felt that he just couldn't do his job no more. so joe got terminated. right after that, they stopped his health insurance.

and now it's like, what do we do? >> hello. >> hello. >> how are you doing today? >> not too good. >> what's happening? >> well, my leg is still swollen. >> well, you know that you have this underlying liver disease. it's not related to alcohol use or to hepatitis virus. it's just really from the liver, um, the liver not working right, and then it develops into cirrhosis. and that's really the main reason that you've got all this swelling in the legs. the diabetes is sort of a separate issue, but it still... still complicates things dramatically. so how often are you taking insulin? >> i take it once a day. >> you should be probably taking that three times a day. >> but we skip because the tabs are expensive. >> this is a really tough thing to deal with, not being able to get the medicines that you need or that we think you need. it makes it all... all the more

tough for you. especially for your liver disee. these diuretics, i consider these life-saving medications the same way i would with the insulin. we have some samples of the insulin. we didn't have much, unfortunately. okay? >> okay. dr. mcwilliams, thank you again. i appreciate your time. >> thank you. >> we'll see you soon. >> i don't want to live like this. i mean, can't get social security, i'm too young. can't get welfare, make a little bit too much. in the meantime, i've got $50,000, $60,000 in doctor bills. >> so, you need to stop worrying about those collection agencies and the medical bills that we're getting. >> well, i'm dying anyway, put me in collection. >> joe, i'll be damned i'm going to let you sit there and give up hope. >> oh, without a liver, i'm not

going to get better. liver transplant costs about $150,000 to $200,000. if you're broke, you could get the medicine, you could get the hospital, everything else. but if you work hard all your life, you get nothing. >> things will work out. if joe had insurance, he would have never had to skimp on his medication. he would never have used the same needle six to nine times. so yeah, you cut medical corners. it's like playing russian roulette with your life.

>> 452. >> oh, my god. normal is 120. >> is that more bills? >> yep. lehigh valley, physician's business center. oh, my goodness. this is from when you were in the hospital the last time. please call our collection department. joe, i don't want to go into collection anymore. >> here. $28,000. >> i can't believe they think we can pay that. >> i can't believe they charge so much. >> ridiculous. but when we go in, we go in honest and we say this is what we have, and we have nothing, and you can't get blood from a

stone. >> maybe i could win the lottery. >> ah, you never know. >> approximately five months ago, the pain started on my lower stomach area, that's when i started getting concerned about cancer. a lot of the doctors wouldn't see me because i didn't have insurance, and they actually turned me away. that was a denial of service, out and out denial of service. i called the cancer society and told them that i didn't have insurance, and that i was having trouble being diagnosed. and, dr. smith's office called and asked if i would like to

have a visit with her. i was like, what? u're who? and you want to see me? >> why don't you lay down and put your feet up here. >> okay. >> did you go a while without seeing a doctor? >> yes. >> do you have any pain when you press here? >> yeah. over there. >> it's worse? >> yes. >> with what we see in your blood and what we feel on examination, we have to take your ovaries out. >> okay. >> if these ovaries look like they're cancer, we're going to have to make a big incision. >> okay. >> i'd like for us to operate next wednesday. >> next wednesday, okay. >> karen, you're going to meet the financial counsels, you'll meet all sorts of people who'll help you working on the bill part. >> okay.

>> but you know, right now it's bills be damned, let's do this. >> okay, thank you. >> okay? >> the first visit with dr. smith was $1,139. >> what we can do is we can set up a payment plan. so what are you going to be able to feel comfortable paying? >> i'll say $40 a month and try to do $40 a month. >> okay. >> i worked like the dickens to keep insurance. i was an apartment manager for 10 years, and i had insurance that whole time. the apartment complexes kept getting bigger and i couldn't do the stairs anymore because i've got pulmonary disease. me not being able to handle the job physically, i had to let it go. that meant i lost my insurance, too. >> what'd the doctor say?

>> they're talking about surgery. >> i'm glad it was better news. >> me too. i'm still worried. >> it's got to be done. >> i love you. >> i love you too, baby. >> we've been married 30 years and we've always worked. ronnie's working two jobs. he's working for a merchandising company, and then he's grounds keeper for an apartment complex. >> i make a little over $14,000 max for the year. we were able to pay our bills and put a little bit aside, too. of course, all of the stuff that we had put aside is lo gone now because we had to use it

immediately whenever she first got ill. we didn't have insurance. >> once you don't have insurance, you don't really know what the problems are for you. about 15 years ago, my back really started to rt. slowly it was just bending and bending until it got to where i am, so i lost about seven inches. my wife tells me, "let's go to the park to play with the kids." i just cannot play with them because it's just... painful.

>> 25 years ago when i came to the united states, i felt very happy to become a u.s. citizen. right now, i am a chef working for a french restaurant. a year i make $45,000.

many years ago when i had insurance, they were giving me... it was just medication that you can buy over the counter. and expenses is starting to go up, rent it went up, so it got to the point that i just needed that money that i was paying for the insurance in order to support my family. so i had to discontinue the insurance. what i didn't realize was that when i was taking all this medication for my back pain, that i was, like, bleeding inside of me. >> one time you had some health insurance, but you could no

longer afford the... the premiums. is that right? >> that's right, yes, that was. >> carlos came to this health fair six months ago. he looked very pale, because he was missing almost 70% of his blood. and when we saw you in september you were taking tylenol, and motrin, and the other thing you were taking... >> naproxen. >> naproxen. how many of those a day? >> i was taking 10 pills. >> so the medicine you take for pain causes ulceration, so you'd almost bleed to death. we said you need to go the hospital right away. was that correct? >> and i said to dr. dowling, "but it going to cost to go to a hospital, besides i have to go to work." and dr. dowling tell me, "no, i don't think you're going to work, right now you're going to go to the hospital, because on your way to work you can die." i was scared. it really scared me. >> we successfully convinced him to go to the hospital emergency room, where he was admitted and transfused.

so the bleeding was all due to the medicines he was taking for his chronic pains. i wondered if you would stand up for a minute. i just wanted to see your back, if that's okay? >> yeah, it's fine. >> although his bleeding has resolved now, he's still very worried about his back problems. we don't know what the reason is, but it's very painful. and he's still without health insurance, so he's got some real challenges down the road. >> hi, i'm doctor smith. hi, good to meet you. >> ronnie dove. >> that's my husband and my mom. >> got any plans? >> i hope. i hope we're going to get this

over with. >> well, let's go in there, let's get it out and fix you. all right? see you back there. >> all right. thank you, doctor. >> it's time for a hug and a kiss. >> can i have a marking pen please? >> it is cancer. it's cancer of the ovaries. it's spread in the upper abdomen.

in a couple of weeks, she'll get six courses of chemotherapy. it's given one day every three weeks, until she's done six of them. >> how far advanced was it, as far as stage one, two, three? >> it's stage 3c. and most people with this stage of cancer die of their cancer. most people... >> karen had been sick for several months before she finally got the diagnosis. even though, you know, in the back of my mind i felt like i knew what was going on, you still can't be prepared for it when it's someone this close to you as... as your wife. >> that looks pretty good. >> the hardest thing was being diagnosed. i had a cancer specialist and he

knew something was wrong, but he just didn't want to follow through with more costly tests. had i had insurance, i really believe it would have been diagnosed a lot earlier. it probably would have not been in stage three. if we had some kind of medical system where everybody could get in there and be tested, they could stop some of this heartache. they could stop a whole lot of it. >> we were doing a lot better financially until the cancer hit and all the doctor bills started coming. i've racked up some pretty good size bills, and i have no idea what the hospital bill will be. and that's twice a day.

i take 14 pills a day. potassium that's three times a day. and the medication alone is $2,500 a month. for a while i was desperate to get my medicine because i didn't have any. and i did go to mexico and buy some medicine. that's once a day. with my insurance, when i had it, that medicine was $50. in mexico it was $4.95. >> oh, they do keep coming, huh? >> yeah. >> of course, i'm scared. i'm scared about the chemo. i realize that i've still got a battle ahead of me.

it's been rough. i've lost about 40 pounds. you just can't seem to get the strength that you used to have. >> you sure you don't want some eggs? >> this is all i can do. >> you got questions for the doctor? >> yeah. how soon before i can start hitting on you again? >> right. >> do you have to do anything else to get ready to go? >> cover up my bald head. >> you need another nausea pill? i'm sorry.

>> i'm tired of not being able to hold down food. >> the hardest part is just seeing what karen has to go through on a daily basis. it's real hard to keep from worrying. >> hi. how are you? >> i just threw up. >> she's been throwing up while you were out. >> now if you get over to the hospital and you don't feel better and you're still vomiting, i'm going to ask you to stay there. we're still at a very touch and go time. >> do you want to take care of that now? >> no, i'll have to put that on my bill and pay it out. >> all right. >> the financial part of this has been very difficult because you think about owing thousands of dollars that you never expected to owe, and thought you might own a house one day, but come to find out it's all going

to go on medical bills, and you're not going to have anything for old age either. >> because joe has liver disease, joe has edema. and he's filling up with fluid. this is about the fourth time we've gone to the hospital this year with this problem. >> i'm hoping that you come home soon. >> i hope so, too. we have... i have to come home. >> actually, you take 12, 13... there are 14 medications here that you're suppose to take daily. >> daily, yes. i don't even know what i'm going to do when we come out. we have no money to pay for this medicine. >> i know. and i don't know how we're going to pay for this hospital bill.

>> if i paid for the medicine, i wouldn't have been in the hospital to begin with. i'm going to have pain in a minute. >> it's okay. you want to hold my hand? breathe in through your nose, out your mouth. count, remember count, focus on your fingers. well, i'm hoping that they can figure out what's wrong with you and get this water out. >> why am i so blown up? >> well, you're blown up because you know that you have the cirrhosis of the liver. >> yes. >> and when you're on your medicine, the diuretic regimen, that helps prevent the fluid build-up. so i think if we can keep you on these medicines, we'll try, we'll get you out of trouble. >> i know, but i have no money for the medicines, which gets me into trouble. >> there are people that are dying, because they cannot

afford their medication. i don't want my husband to be one of those victims. when i come home and he's not here at night, it's hard. it causes me anxiety. it causes me a lot of stress. and we already have these bills that we are not able to pay. every time joe is in the hospital, you're thinking, "oh god, how much is this costing? how am i going to pay for this?" it's just really hard.

>> for the last 15 years, i have never seen a specialist. i just wish that i see someone that can really give me, tell me, what i really have. >> unless you're a trauma case or you're in a car accident, there going to have to triage people. it's a crisis situation with people waiting and waiting and waiting. >> if i see a specialist, at least it will be a chance that the doctor will say that the pain will go. that will be really a miracle for me. >> looking at your x-rays, you've got ankylosing spondylitis. >> uh-huh. >> so, like, on your hip right

here, this used to be a clear line, like this. there was a joint here. your body responds by turning your ligaments and your tendons into bone. that's the underlying disease. but at least we know what you have... i mean, this is the real deal. now, the problem is it's a disease that continually progresses. the most important thing is we have to keep your head looking forward. carlos is not at the point where he requires surgery. if he were fused in a bad position we can go in and we cut the spine, realign them and get them to heal a new position. but it's a very large scale surgery, very high risk. if he can avoid a surgery of that magnitude, i'm all for that. that's pretty dangerous. as long as he can look straight ahead, we're not going to touch you. very good. let's see him back here in a year, okay? >> okay. >> i was kind of disappointed. i am in a lot of pain and it's

going to just get worse. i think it all matters about the money because we're talking about maybe $150,000 for a surgery. my cousin in mexico, she's a nurse, and she's been telling me to go down to mexico, to see if surgery can be done.

>> the doctor in mexico, he gave me a lot of hope. $40,000 will cover the whole surgery and a month in the hospital. and the doctor says there's going to be no more pain.

>> when you don't have insurance, you have to worry about how long is your resources going to last? >> now what about medications? are you... >> i have some nausea medicines and hopefully i won't have to get anymore of that because one of them is $1,100 a month. >> what are you taking for pain? >> just some tylenol. >> tylenol usually doesn't do it for cancer pain. >> yeah, it doesn't, but i just try and bear with it. the main pain is in my hands and feet. >> no, that's not good, karen.

if you're having more pain than what tylenol will cover, i want you to go to dr. smith and ask her what she would give you. >> okay. >> but i don't want you walking around in pain. >> all right. >> okay? >> yeah. i really never knew how much a cancer patient had to deal with, until it was put in my face. >> ma'am, stevens health care has placed you folks in our office for a past due bill $578.08. this call is an attempt to collect. any information will be used for that purpose. >> all i can do is come in and start making some payments. >> okay. >> but i can't promise more than $20 a month. i'm trying to pay out several people. >> okay. i can't secure it for that low. >> the cancer center did have to finally turn us into the collection agency. i turn off my phone because the

collectors calling so often that you can't even rest. it's removal of ovary tubes, but they charge you for each tube. well, so far we still got all of these. it's $23,775.89. i'm ready to pull my hair out, what hair i've got left. i can't stand it no more. it's driving me crazy. our full debt is probably $80,000, and we only made $16,000 last year. >> you're going to sell those? >> yep.

we have to get rid of as much as we can so we can pay the bills and try and make it until we can get moved. i think we can get some pretty good money on this. >> it's got to stay, baby. >> how often do you play it, ronnie? that's how we're going to get money. we've thought about possibly filing bankruptcy. if we can pay off the bills, we would prefer to pay them off. i think the stress and strain has finally hit me, you know. but i just have to keep reminding myself things could be worse. >> surprise! >> hi, i didn't expect all y'all here.

>> the last year and a half it's been pretty stressful. >> happy birthday! >> thank you. >> you're welcome >> it has gotten better knowing that the cancer is in remission. still it's always in the back of my mind, what if it doesn't last? what are we going to do then because we still don't have insurance. this is something that i'll have to think about as long as i'm lucky enough to have karen with me. >> ♪ happy birthday to you! happy birthday dear karen! ♪ happy birthday to you! ♪ >> oh, those are cool.

i think that was my junior year picture. the bald headed one, of course. well, i'm glad to be 50, and i'm glad to still be here. life is to be lived to die and that's just the way it is. everybody's going to be there one day. i just look at it i got another day, i'm happy. >> joe is getting all this expensive treatment, but honestly it doesn't make any sense. if he'd just had basic care and the medication that he needed, i don't think joe would have been this sick.

this is the worst i've ever seen joe. this should be the best time of our lives. i mean, we've been together over 20 years, we should be enjoying each other. this should have been our time, and it's not. we're supposed to be the richest country in the world, and yet i live the poorest life, and my husband worked all his life and paid taxes, so could somebody explain that to me, because it doesn't make no sense. >> you're looking at me. >> i love you. >> i love you, too. what? are you going to tell me something? tell me. >> i'm finished. >> you're finished?

that's not true. i love you. you can't leave me. >> i'm finished. >> no. >> i can't walk. >> don't make a difference. i'll take you any way i could take you. i always told you that. >> yeah. >> don't leave me, joe. when i drove home that night, there was a peace within me that said it was okay, dale, to let joe go. that he was suffering; he was in pain and couldn't even tell you he was in pain. and that i had covered everything of all the years we had spent together, and he knew when his time came that i really did love him.

two days before joe passed away, joe was approved for medicaid. i figured, "what's the point now?" >> i was trying to go back to mexico and have the surgery done, but $40,000 dollars for me is impossible to come up with. when i realized that it was not going to be possible, i was sad. i wasn't expecting much from life really.

>> just relax now. if carlos had health insurance something would have happened by now. so we do ration care in this country. people don't like to hear that, they don't like to say that, but the truth is, we do ration care based on abilityo pay. i want you to breathe in and out through your mouth, okay? whenever you're ready. okay, deep breath. public hospitals in los angeles are overwhelmed, and in the private system things move quicker. and carlos? he's just a nice guy with three kids and he needs a break. so i'm trying to get him through with the private system. well, the goal is to evaluate you and then refer you to the orthopedic surgeons at u.c.l.a. and see whether the surgery would be merited. if they feel they can help you,

they've agreed to do this all for free because we know there's no way you could possibly afford it. they will give you their honest opinion. >> right. >> and we'll go from there. and i don't know the answer. i don't, i don't know. >> the lumbar curve is, uh, is compensating quite a bit. can you bend forward? okay, all right, very good. straighten back. he's got quite a significant kyphosis here. >> 80 degrees maybe. >> 85 degrees here. so this is eight years later, and it's progressed from an 85 to a 97 degree curve. and what we look for to determine whether anything surgical can be done is a few things. whether the curve is

progressive, which in your case has been, and the other thing is pain.... >> oh, yeah... >> ...which you've been experiencing. so the two reasons are good reasons to have surgery. this is a surgery we do for patients who... this condition affects their life. the fact that carlos is getting this care for free is only a testament to the fact that he was lucky, nothing else. he's lucky because he met the right people at the right time, and so this is a very unique situation. >> everything going okay? >> very well.... >> and for carlos, i think, being a part of this documentary, he's getting a lot more attention than the average patient. >> i'm very pleased that we are able to help this one individual out, but what we're really talking about is 47 million americans who have no public or private insurance. we can't do endless surgery on uninsured people. it begs a national solution.

>> and then gradually increase your activity. >> for me, it means a lot. that means, that you know, the pain is going to stop. that maybe i will not have to deal with pills anymore. it means a lot, maybe my whole life. >> i know you've given this a lot of thought. and i want you to be aware that this is a big surgery. when we straighten the spine, the nerves can be stretched and that can damage the spinal cord and it may make you paralyzed. because it is such a big surgery, there is about a 10% risk of dying from this surgery. we're going to do our best for that not to happen obviously, but we can't predict the unexpected.

>> okay, here we go. this is where you say, "i'll see you later." >> carlos' case is certainly in the rank of one of the worse i've seen unfortunately. the worse the curve, the higher the risk involved with this surgery. give me the screwdriver please. if carlos had insurance, we could've probably intervened and addressed his deformity before it got as severe as it is today. i think if we just compress down here a little bit, that might help us out. if carlos were to pay for his

surgery, it would cost $200,000 to $300,000. tough angle. this is a big operation. ú÷

>> hey, dr. shamie. >> nice to see you. how are you? >> good to see you. >> you look more upright! you look great. >> yeah, yeah i look better. >> how'd you feel? >> i can breathe a lot better. yeah. >> fantastic. >> yeah. i told my wife, at least, you know i'm at the same height as you now. because i was shorter you know? >> don't aertise that because when you're going to have people coming in wanting to get taller, and it's a big surgery for that. >> right, right. >> you gained a little over three inches in three weeks. >> which is really good, yeah. >> so this has been a remarkable journey. >> it has been. >> for you and your family. >> and i thank you so much.

i have no words to describe how much i feel. you have practically saved my life. >> dr. dowling you started our dream, and dr. shamie you ended it. >> ironically, it all started two years ago this past weekend. >> yes, exactly, two years ago. >> at the medical student health fair, which we had again this weekend, and we still saw throngs of people with health problems with no health insurance. so that's part of the bigger issues is how do we care for everybody in this country? >> after 15 years of having a lot of pain, i feel that i'm new. i can be a better father with my kids, be a better husband. >> say cheese! >> cheese! >> and i feel like i'm very lucky.

>> moyers: since producer roger weisberg first reported on the families in "critical condition," here's what has happened to them. in the aftermath of joe's death, his widow dale has been struggling to raise their granddaughter alone. she still receives collection notices for outstanding medical bills and continues to blame joe's passing on his lack of insurance. carlos benitez is without great pain for the first time in years and four inches taller since his surgery. he returned to his chef's job at that french restaurant, but still has no insurance. even if he could pay, his pre-existing condition probably means no insurance company would cover him. he takes pain medication that he buys much more cheaply in mexico and he has a st tissue lump on his chest, which remains undiagnosed. he can't afford the x-rays he

needs. six months after "critical condition" was completed, karen dove had a recurrence of her cancer. she opted for an oral drug protocol, but a serious side effect of the treatment sent her back to the hospital, where she contracted pneumonia and died, only 50 years old. her husband ronnie is living with his daughter. he got a job at a grocery store that has an insurance plan. but the medical billfor his wife's treatment keep coming. they m pile up to as much as $150,000. ronn, o lives from paychk to paycheck, has only been able to pay back a tiny fraction of what he owes. if you want to find out more abt the families and producer rog weisberg's work, log onto pbs.org and click on "bill moyers journal." we'll link you to p.o.v.'s "critical condition" websi and some oroger's other docuntaries. contrast these real-life experiences with the wheeling and dealing in washington, where

the alth care negotiatns now turn on such arcane factors as "bending the curve," "advanc informatn technology," and "actuarial projections meanwhe, on the airwaves, factns of every stripe are hammering eh other in 30 and 60 second spots, each characterizing the other side in the health care debate as evything fromauding shar... >> let's take on the real predat health insurance companies. >> moyers: ...to dr. frankenstein. >> now we face his most dangerous experiment of all, governmentake overf healthcare. moyers: and on the ground, those ressional town hall meetings have been hijacked by yelling, jeering, and belligerent shock trps of protest who have turned the media spotlight on themselves, away from the issue of how to get health care to the people who need, but can't afford it. when all thela and fy have turned to ash, here's what remains: o present system trts medicine as a profi

center instead of a human need and public service. next week, we'll hear om some doctors who think that's a scandal. the oscar-wiing filmmaker alex gibney has tmed up with producers petebull, chris matonti, and director andy fredericks to oduce a film based on maggie mahar's powerful book "money-driven medicine." take a look. >> the current medical system is not designed to meet the health needs of the population. it's designed to turn a profit. it's designed to meet the needs of the people in power. >> the worst thing that could happen to the director of a hospital is that everybody, all of sudden woulbe healthy. what they're selling is hospital beds. >> many pele think they know what'srong with the healthcare system in this country. millions of people are uninsured, and sure that's part of the problem, but that's not the whole problem. the whole problem is bigger than that. >> hey, this is somebody's mother.

this is somebody's father. th is somebody's brother, and if i don't do right by them, just understand that people die in my pression. >> when you have is a system built by revenue and that money is not being put back in the system to help people. we've lost our way. >> moyers: join next weekor "money-driven medicine." i'm bill moyers. see you then. captioning sponsored by public affairs television captioned by media access group at wgbh access.wgbh.org

>> we are pbs.