UNIDENTIFIED FEMALE: Loratab, Naproxen. So, if there's a concern someone has a tumor, they who use a needle like this. NISSEN: Finally, the FDA put severe restrictions on the drug. This drug was the number one selling diabetes drug in the world in 2006. 0. ROBERTSON: It's a financial necessity. And it will not protect you from having a heart attack. Transcripts Dragons: The Nine Realms Fire Escape Script view. Do you understand? Just sore. How to know if you are being prescribed unnecessary medications or procedures, that's next. And I think that's a good place to start. The average per capita cost of healthcare in the developed world is about $3,000. They couldn't get insurance. People eat what's cheap and what's available. GUPTA: And I want to leave all of you at home with a thought as well. When medicine became a business, we lost our moral compass. That we really have historically the low growth over the last three years, actually about the rate of our economy which is actually pretty historically low. If you get a bump on your head as a friend of mine had, and you go into the emergency department, in America, you get a cat scan. I lost him. UNIDENTIFIED MALE: I feel different. RICHARD UMBDENSTOCK, PRESIDENT, AMERICAN HOSPITAL ASSOCIATION: I was almost as surprised as anybody to see the reports that I was the most frequent visitor to the White House during the health reform debate. Sit down and look at hospital bills through the perspective of, are any of these services that I don't understand what they are? BURD: All we did was facilitate smart choices for people and develop this culture of health and fitness. Obesity leads to heart disease and strokes and diabetes. NIEMTZOW: So you haven't taken anything? They did not tell the FDA, and they did not tell patients. Yvonne Osborn began suffering from severe chest pain at the age of 34. DR. STEVEN NISSEN, CHAIRMAN, CARDIOVASCULAR MEDICINE, CLEVELAND CLINIC: The problem is, if you have stable chest pain, we have very good studies dating back a number of years that show that getting a stint will not prevent a heart attack, and will not make you live longer. And Doctor Jeff Cain. Trying to get Medicare to cover a heart disease program has been by far the hardest thing I've ever done in my entire life. The independent safety officials at the FDA estimates somewhere between 50,000 and 200,000 deaths or heart attacks due to the drug. My first thought is, that's why I'm running, because I know what that person is like. GUPTA: Erin, what did you think about that particular theme? Escape Fire escape fire University Central Michigan University Course Introduction to Health Service Organizations and Systems (HSC 507) Academic year 2021/2022 Helpful?00 Share Comments Please sign inor registerto post comments. detail. I know you're heading home and you're excited. And when we come back, just how much does profit play a role in all these treatment decisions. UNIDENTIFIED FEMALE: Do you have any pain right now? the play Tom is seen standing in a fire escape during many acts. DR. REED TUCKSON, EXECUTIVE VICE PRESIDENT, CHIEF OF MEDICAL AFFAIRS, UNITED HEALTH GROUP: There is no question that primary care doctors are underpaid, especially relative to their specialty counter parts, those who do procedures. The patient just fell off the litter. That is chest pain that is actually currently damaging the heart in patients. And that worked for awhile. Seventy-three seconds into the 28 January 1986 . BERWICK: Everybody is doing what makes sense to them individually. Even when bad things happen, it's not because people have bad intentions, it's that our system is all fouled up. Published Feb 22, 2001. The next 30 minutes are all about you, the patient, whether you're insured or not insured, it matters. And by the way, they are number in the world and life expectancy. 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. If they are surgeons, they get paid for each procedure. GUPTA: So, tell me how that would work? You know, the ads always end with the same phrase, ask your doctor. I'm not sure every country in the world does it perfectly. GUPTA: I want to point out something. There's no crisis worker at lunchtime? UNIDENTIFIED MALE: I quit drinking, too. He's got Lunesta and also has Valium. And doctors wanting to please their patients will often prescribe it. We need to change the nature of medicine. We're talking about a $3 or $4 billion a year drug. BROWNLEE: Almost every study says that the doctor that has the greatest impact on your health, in general, the greatest impact on the health of a population is primary care doctors. CARNES: Release the breath in a smooth, even stream out. NIEMTZOW: That means we're getting the needles in the right -- in the right place. The army sergeant general directed that we establish the pain management task force to take a look at alternatives to narcotics. (LAUGHTER) That's the way I like to look at it. GRUBER: Premiums will rise. You will learn if your health care costs are going to go down any time soon. There's saving money and there's cost effective. And my doctor told him he wouldn't recommend taking me because he didn't think I would live the year. I think that's an important point. Dodge survived, nearly unharmed. If it's a radiologist, they get paid for each CT scan they deliver. We're glad to have you home. 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. BROWNLEE: The vast majority of doctors in this country are paid by a fee-for-service system. ESCAPE FIRE tackles one of the most pressing issues of our time: what can be done to save our broken medical system? Does it make a difference? So to make up that difference in the reimbursement rates decreasing we're changing the shorter appointments next week. If we just change reimbursement, it's a game changer, we change medical practice and we change medical education. That was how many medications I was on. UNIDENTIFIED FEMALE: These are the costs of all of our drugs in order. MARTIN: Good. GUPTA: So it doesn't matter. NIEMTZOW: Normally you would? 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. Try to understand where the redundancies are. BROWNLEE: If I think about what healthcare could be like, it would have a lot more care in it. I mean, I can't think of a single negative in doing this. That also happened in the 1990s. NISSEN: Yes. You know? A lot of that comes you spoke - we spoke about are driven by people who don't have access to the system. And ironically, it was only two hours away at the Cleveland Clinic. That was the message that, you know, I think was the you got from that documentary. I had difficulty sleeping at night. It is an IV like this, about $280 just for the IV bag. UNIDENTIFIED FEMALE: When I was a kid. UNIDENTIFIED MALE: I'd do it if I had to. It was important to keep expressing the hospital's position. And that's because our system reimburses people for doing tasks and doing procedures, not for necessarily making people healthier. DR. JEFFREY CAIN, PRESIDENT, AMERICAN ACADEMY OF FAMILY PHYSICIANS: We know that patients are healthier when they have two things. But so what, right? GRUBER: Well, Sanjay, I think If you look at the affordable care act in the hole, it will. If we get Medicare to cover it, then everyone else will cover it and if everyone covers it then it becomes a standard of care. (CROSSTALK) UNIDENTIFIED MALE: That's not -- yes. Credit: Battlestate Games. Aladdin (1992)/Transcript. You didn't have to be a statistician or in the words of my old friend Bob Dylan, you don't have to be a weatherman to know which way the wind blows. This suture costs about $200. BRIAN WILLIAMS, NBC'S "NIGHTLY NEWS": FDA advisory committee started hearing evidence on whether Avandia is so unsafe it should be pulled off the market altogether. There's a contradiction to what we do. U.S. caregivers are told you've got to keep me pain free, you're going to do that. We've just created a completely different system here. Going to go look for it. That may strike people as very high. Not just the health, but healthcare, the health of a nation. They are patients with heart failure, they are morbidly obese patients. UNIDENTIFIED MALE: I feel like I'm warming up a little bit. Because they're not using health care now. Doctor , let me start with you. About three weeks ago, because of the state budget crisis, we got told with very little notice that Medicare and Medicaid reimbursement was going to be cut by about 25 percent. I'm sorry, it's going to get pretty tight. UNIDENTIFIED MALE: We have had enough. So putting more money into innovations and all of these things, yes, they're need in certain instances, especially emergency care, and things like that. The only other country, by the way, is New Zealand. Putting patients first. BROWNLEE: We spend $300 billion a year on pharmaceuticals. As a society, we have to make it easier and more affordable for people to make better lifestyle choices than worse ones. MARSHALL: So, anybody that's having a heart attack should get a stent. That was job number one for them. Our approach here is completely holistic. Because I've gotten a lot of inspiration from the fellowship. It got fast tracked by the FDA. We just have to do it differently. They said, absolutely, it's been demonstrated that acupuncture is safe and effective, especially with post-operative and injury pain. But you end up being this revolving door. Yvonne came to se me when she was sort of at her wit's end. UNIDENTIFIED MALE: Yes. YATES: Wow. UNIDENTIFIED MALE: Without the financial incentives, there's no way I could have gotten to the point that I am now in saving literally thousands of dollars over the past few years by being healthier. Escape fire : the fight to rescue American healthcare Authors:Matthew Heineman(Director, Producer), Susan Froemke(Director, Producer), Donald M. Berwick(Commentator), Shannon Brownlee(Commentator), Wayne B. Jonas(Commentator), Steven E. Nissen(Commentator), Andrew Weil, Chad Kelly(Composer), Moby(Composer), Aisle C Productions(Production company) SHANNON BROWNLEE, MEDICAL JOURNALIST: How powerful are lobbyists in the healthcare system? Also, the guaranteeing a certain level of effectiveness of this needle, that costs money as well. We can't prevent disease in everybody, but we have to try. We spend one heck of a lot of money. And I say that as doctor. And that is why, our first priority has to be to equalize that access and then move on. Psychologically, you deal with a lot of these sorts of things. So, we decided to give you a look at a typical operating room bill and that breaks down. UNIDENTIFIED FEMALE: These are all name brand. That's not good medicine. UNIDENTIFIED FEMALE: We'll do it at the front. NARRATOR: The Great Fire of London destroyed three-fifths of the entire metropolitan area. CARROLL: We found that the men who underwent lifestyle intervention, their PSA rates generally went down and they were less likely to require treatment. 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. UNIDENTIFIED FEMALE: Take them away from him. That is ridiculous. OSBORN: I've started doing research about where in the United States do I have to go to get the best heart care. The bigger issue is how do you deal with his enormous prices, you were just talking about with Nancy? GUPTA: Doctor Rice, What do you think about that. And then we're not going to help anybody. JONAS: If the military is able to successfully integrate acupuncture, meditation, and mind body, yoga, then we'll find that the culture at large will learn how to adopt it, and it will have a transformative effect on our healthcare system. UNIDENTIFIED MALE: How's your pain, sir? All of us live here and work here. MARTIN: I'm going to make a phone call and try and get some wheels in motion so that we can get you the help that you need. Underrewarded primary care. We're dealing with the health of the nation. Unless you're in the middle of having a heart attack, which 95 percent of people who get them are not, they don't prolong your life, they don't even prevent heart attacks. Look at our results, our life span isn't even in the top 20. It's addictive. DR. VALERIE MONTGOMERY RICE, EXECUTIVE VICE PRESIDENT, DEAN, MOREHOUSE SCHOOL OF MEDICINE: I think it comes down to three things. I mean, look at our results. She's still taking her Lexapro, but it's obviously not doing the job. The present system doesn't work and it's going to take us down. I am back in the chest pain center with a pretty sick patient, and I'm going to need you to call attending phone, too. WEIL: Most of this huge effort of the healthcare industry is devoted to intervention in established disease and the majority of that disease is lifestyle related and preventable. We create a public expectation that more is better, which isn't actually true so people seek more. CAIN: Exactly. NISSEN: If you look at health care in America, you're twice as likely to get your knee replaced as you are in Western countries with the same standard of living. That patients are healthier when they have two things about you, the guaranteeing a certain level effectiveness. 'Ve started doing research about where in the world in 2006 I know you 're going to help.! 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