More of our conversation with T.R. Reid about healthcare's good news
T.R. Reid, author of “The Healing of America” and documentary filmmaker, has once again joined forces with PBS to present a film looking at healthcare. “U.S. Health Care: The Good News,” a one-hour program scheduled to be broadcast nationwide on Feb. 16 on PBS (check local listings), examines communities in the United States that are providing high-quality care at lower costs. Reid spoke to Healthcare Finance News about his new documentary and healthcare issues facing the country. Today concludes our two-part Q&A with him.
Q: You’re hoping that people in their communities will put pressure, so how does a whole community agree to some sort of model for their community, because they have very different, in a lot of cases, goals?
A: Grand Junction to me is astonishing because it was the doctors who did it. If you talk to any doctor in America – doctors all over America know that it is difficult for a Medicaid patient to get an appointment and as you know the reason is Medicaid pays them less. In Colorado, Medicaid pays about 25 percent of what say Aetna or Blue Cross would pay for basically the same treatment of the same ailment. We all know this and all doctors know that therefore it’s often difficult for a Medicaid patient to get an appointment. She’s got coverage but she can’t get in to see the doctor. Most doctors know this and most doctors deplore it. They don’t like this system. They think everybody should have access to care. …. And what happened in Grand Junction was the doctors – they were all friends and they were sitting around and they said ‘let’s do something about this’ and they worked out this intricate cooperative plan. I’m kind of hoping that some doctor will see our movie and go to the country club the next morning and say to his fellow physicians ‘let’s work out something so that our Medicaid patients can get in to see the doctor.’ …. So yeah I’m kind of hoping the force of example will drive change. I don’t think that people know that this is going on. I don’t think people realize there are places providing good care at way below the national average costs. Health policy types know it. I bet your readers know it but I don’t think most people do.
Q: Something I find stunning is how many people within the healthcare community don’t know about costs. There’s such variability coming from the different payers. To me, that seems like such a gigantic problem. As a patient, it drives me crazy to get six different bills from people I’ve never seen. How do I know I’m not being gypped? I have no way of knowing because no one can tell me from the outset how much a procedure costs.
A: That’s exactly right. And the other thing is you don’t really know if that procedure is necessary. If your doctor orders you to get a $1,200 scan there are really no good standards for whether that is needed or not and that’s why the rate of scans ordered for the same ailment varies by a factor of five county to county. I kind of blame the med schools for that. I mean, people didn’t learn this? The doctors’ answer is it’s more of an art form than a science. Well, you know, maybe that’s true, but I think one of the funniest moments in our film is when Jack Wennberg says … (people go to the doctor expecting) treatment that is proven by science and works and I say ‘Don’t they?’ and he says, ‘well, no.’ That’s really striking to me. That’s really intriguing that there are no standards. And my argument is that the payers have the power to set the standard if they want to and they don’t.
Q: But do you think the American public would go for that? I think they fairly well distrust payers to begin with so couldn’t they argue that payers are trying to deny access to care if they’re setting the standard of care?
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A: I don’t think that would be a problem if there’s some medical body that (sets) the appropriate interval for check ups after a diagnosis of hypertension. The problem is nobody has said that. So doctors don’t learn that and the system pays for (it). … As long as it’s based in some kind of medical science, I don’t think people would complain, if your doctor goes along with it, but that’s a good question because one of the complaints about Obamacare is ‘the government’s getting between me and my doctor.’ Well, I mean the insurance company is already between you and your doctor. What’s the difference? You might trust a government agency more than a for-profit but leaving that aside would people accept it? It’s an interesting question. Would people in Miami complain that they can only go to the doctor once a year instead of once a month when they have high blood pressure? Maybe. … I had this exchange (in the movie) with Elliott Fisher about when you should go back for a check up after your hypertension is under control. (It) ranges in America from one month to one year. In Sweden, in Germany, in France the answer is never. They give you a blood pressure checker and if the number is high you call the nurse and if not you don’t go back and see the doctor, if you follow me. They have boards that determine these things and issue rules. We don’t. To some extent we do but not much and that’s why there’s so much variation in American medicine and it’s costly. It costs us a lot. As Elliott says in the film, there’s 30 percent overtreatment. We’re paying for 30 percent more medicine than we need to be healthy. Once you’re in a $2.6 trillion industry 30 percent is a lot of money. Certainly enough money to cover all the uninsured.
One of the reasons our system is so much more expensive than other countries is because they do have regimes and controls and recommendations to limit that kind of overtreatment that we really haven’t put in place. Our insurance companies are trying to do that. Medicare is certainly talking about doing that. The Independent Payment Advisory board … could work.
Q: Do you think it’s a matter of trust? That these things work in other countries because there’s a certain level of the public trusting their government or whoever sets the controls whereas in the United States there’s a lack of trust?
A: I think there’s some of that. Certainly Europe and Japan are (places) that like government more than we do. They trust government. They see government as their ally rather than their enemy. I do think that’s a distinction, but in America a lot of these decisions are made by insurance companies. That is, they’re made in the private sector and we’re supposed to like capitalism. We like the private sector.
Q: Is there anything else you’d like to add that we haven’t covered?
A: I hope people watch this movie and clamor for low cost care and efficient care in their regions. That’s what I hope is the result. We’ll see if that happens. You know, I wrote a book, “The Healing of America,” about how other countries managed to cover everybody and spend half as much as we do. In that book I explained how they do it. You read that book, you’ll know how you can cover everybody and it’s not all socialized medicine. A lot of countries do it in the private sector. Don’t get me started. Germany doesn’t have Medicare. Everybody stays with private insurance. There’s less socialism than the U.S. system. It’s all laid out right there and I thought people would say ‘Wow. We could do that, too.’ Nothing. The book sold very well, but policy impact, zero. U.S. healthcare is strongly resistant to change. Professor Uwe Reinhardt taught me that. Strongly resistant to change. If you think about it, that’s understandable. It’s a $2.6 trillion business. A lot of people are doing great on our current system and therefore they resist change. I think our film shows that change is possible. That our system could be much more efficient with no sacrifice in quality. That seems to be the message.
Follow HFN associate editor Stephanie Bouchard on Twitter @SBouchardHFN.
