Richard Master: Over this period of 35 years, the company grew from zero to 170 million in sales and became the leading company in both the picture frame industry and mirrors. From 1980 into the nineties, we were doubling our size every two and a half to three years. As a result of foreign competition, our gross profit margins deteriorated. We had to watch every penny of overhead.
And we've gone to our customers with a price increase. They've rejected. All right? So we've got to figure out, in order for us to maintain profitability and margins, we've got to figure out how to do things more efficiently.
So here we are, we're mobilizing our resources very carefully, we're controlling costs. And the one area that was so confounding was healthcare costs. We saw the passage of the Affordable Care Act.
Barack Obama: We are done.
Richard Master: But the cost to our company and our workers continued to rise dramatically. We would be faced with double-digit, sometimes high double-digit, increases.
Debbie Figueroa-Seigel: The premiums in total for healthcare costs has actually doubled over the last 10 years. That's an exorbitant increase, that's more than any other expense has increased over that same 10 year period.
Richard Master: Pity the company that's more labor-intensive than us. They are going to suffer dramatically. And if they are having bad years, if they're on the verge of collapse, this is going to push them over.
Debbie Figueroa-Seigel: Picture frames aren't an expensive product, so even a few cents on picture frames makes a big difference in how we sell that product. So we are looking at every penny, every half penny on this product makes a big difference in how we can sell this product and how profitable we are.
Richard Master: After years and years of incurring these significant cost increases, I started to look into healthcare. The one great thing about MCS is if there is a problem, we deal with it straight ahead. We investigate, we resolve, we fix.
Dann Konkin: A worker making minimum wage could work full time for an entire year, not earn enough to pay for a healthcare benefit.
Uwe Reinhardt: For an average family of four, this year's number is $23,000. That's what a typical American family ensured that way costs.
Wendell Potter: And they have this false sense of security that they're in a plan that provides them protection. But regrettably, all too often people find out when it's too late, after they've been sick, have they been hospitalized or injured and requiring expensive treatment, that their coverage was not nearly what they thought it was.
Dann Konkin: The shock only comes when you have to use your insurance. You feel like you have healthcare insurance and that entitles you to healthcare, but it doesn't.
Walter Tsou: You might as well say it's not really an insurance plan. That's how outrageously price our healthcare plans are today and how unaffordable they are.
Wendell Potter: And insurance companies are able to charge older people three times as much as younger people for the exact same policy.
Patrick Noonan: Their potential employer sees them as a risk.
Michael Gusmano: The age 50 to 64 age bracket includes very high rates of uninsurance within the US market and it's because these are very expensive employees.
Wendell Potter: It makes it less likely that employers will even consider hiring someone in their fifties for example, or early sixties.
Jim Stanford: There's all kinds of costs and unintended consequences that come with having your healthcare depend on your job. It may be that you want to move to a different job or it may be that you got laid off because of a recession or a downturn in the business.
Wendell Potter: I've talked to people who who've told me they've not gotten a raise in five years because the money they would otherwise have gotten in raises has gone to insurance companies.
Michael Gusmano: We've created a very fragmented system in which coverage is tied to employment in ways it isn't in most other countries in the world.
Patrick Noonan: If you and your family lose their whole health insurance because of a change in your employment status, that's an incredible insecurity, an incredible burden for families to have to bear.
Wendell Potter: So the whole idea of having insurance that protects us from financial ruin, it just doesn't exist anymore for most people.
Dann Konkin: And this is why of a million bankruptcies in the United States, over 60% are associated with medical conditions and the great majority of those are people who have health insurance.
Donna Smith: We went through years of working hard only to lose everything, lose our home, go bankrupt. What a shameful thing to do to people.
Dann Konkin: You see these numbers of people who don't have insurance and families who are driven to bankruptcy.
Donna Smith: If you talk to most families, they can identify at least one person in their family who's really struggled with healthcare issues and how to finance those issues.
Dann Konkin: 40,000 unnecessary deaths every year because there's no health insurance. And these are real people who are suffering and who are dying.
Faith Wildrick: Of course, I had health insurance, but I never actually thought a whole lot about it. I paid the premiums. I wasn't using anything that much. My out-of-pocket expenses were pretty much nil, but then Bill got sick and he was hospitalized. So all of a sudden, these bills started rolling in and my insurance wasn't covering everything.
Richard Master: In 2014, a family that was paying four to 5,000 as a premium share and MCS was paying 13,000 to 14,000 as their share of the coverage, that family could pay another six or $12,000 if one or two people got sick.
Debbie Figueroa-Seigel: It's really devastating to a lot of people when they can't afford healthcare and when it's impacting their family life and you are already afraid because there is a family member who is sick and now your expenses have increased while your income has decreased.
Faith Wildrick: We're up around $10,000 in expenses. What would happen if I would get sick? Our expenses would be probably up around $16,000 a year. That's unbelievable. If anything happens to me, that's we're done.
Richard Master: Let's look at an employee who makes between 18 and $19 an hour, makes $1,500 every two weeks, has a take home pay of $935. That employee, if someone gets seriously ill in the family, will essentially be wiped out.
Faith Wildrick: All those years that I've worked and that bill has worked, it's going to be for nothing. We're going to lose everything that we have. All you feel is hopelessness. You don't feel like there's any way that you can get out of this, that you're stuck. This isn't fair. This should not be happening in the United States.
Richard Master: The thought that my employees, members of my work family are susceptible to this challenge from medical cost is not acceptable to me. It should not be acceptable to any employer in the United States.
John Callahan: My father, late in his life was an over-the-road truck driver. He had some modest success and kind of went from one truck that he drove himself, buying a second and third truck and ultimately having a couple of employees that drove for him. He had achieved in some very modest and small way late in his life, the success that I think he always had dreamed of. Unfortunately, he suffered a really a kind of catastrophic truck accident where his truck actually flipped over a guardrail and landed on the highway beneath him.
I will never forget being there when he woke up in the ICU and his immediate reaction was to try to rip the lines out of him and get out of there. And I said, "Dad, it's OK. You're in the hospital and you're in the ICU. It's going to be all right." And he said to me, "No, you don't understand," he said, "I can't afford this. I got to get out of here." And it bankrupted his company. So the two folks he had working for him didn't have a job anymore. Doing all the right things, playing by the rules, working hard, was all eliminated like that, with one accident. And I never forget kind of what it did to him. It kind of broke his spirit quite honestly, and he was never really the same man after that.
Patrick Noonan: Every employer I know, and I'm talking about small to medium guys mostly, they dread the next hike in their insurance rates. So we've got people who fear they're going to be put out of business if they have one employee or one spouse or one child that has some kind of a huge healthcare event.
Frank Mondillo: Hemophilia is one of the most expensive diseases to have. Right now, my medication is a upward to around $50,000 a month. There is no cure for hemophilia, so at least $50,000 a month for the rest of my life. It shouldn't happen where you're hired for a job and then to find out that they're going broke because they're trying to afford healthcare for me.
Dave Steil: Current costs of the system are becoming intolerable, and as they become intolerable, their business naturally is going to look for other solutions.
Chuck Pennacchio: It distracts businesses from doing their primary function, precludes them being able to budget for hiring, for investment, for expanding their enterprise.
Gerald Friedman: Why are we creating an extra hurdle for business? It's tough enough out there. Why are we making it harder for people to provide goods and services to the American public while employing people and providing tax revenues?
Michael Lighty: I often ask folks that I work with who own businesses, tell me one thing in your business that you spend the kind of money you spend on health insurance that adds no value to your business. There's a middleman, an insurance company that isn't improving your employee's health, that isn't saving you money and that is not doing what's in the best interest of our economy.
Richard Master: Healthcare costs are going up two to two and a half percent above the projected growth of gross domestic product, so it is running away from us. Healthcare costs have gone up to three trillion dollars.
Gerald Friedman: We've gone from 7% of the economy back in 1971 being healthcare to 18% today.
Dann Konkin: When the rest of the world is spending less than 10% of their economies and getting healthcare to all of their citizens.
Richard Master: There's been a reduction in consumer purchasing power that can be directly associated to the increase in medical costs in the country.
Gerald Friedman: If you now have $1,000, $2,000 deductible, that is money that is not available for you to get a new car.
Sean Flaherty: More disposable income to spend translates into more demand for the goods and services that employers are in business to produce and sell.
Chuck Pennacchio: In the city of Philadelphia where school teachers are being laid off by the thousands and where classroom sizes are escalating above 40 students per teacher and you don't have proper security in schools, children are being taught on the fourth and fifth floors of buildings that don't have air conditioning or proper heating. We are undermining our capacity to function, let alone compete as a society because of the rising costs of healthcare.
Walter Tsou: People don't realize that the huge federal deficit that we have in this country is related to the fact that we have this enormous healthcare cost bill.
Chuck Pennacchio: Part of the indirect cost of healthcare that most people are not aware of is that their taxes will continue to go up to pay for this broken healthcare system.
John Callahan: We're here in the Bethlehem wastewater treatment plant here in Bethlehem, Pennsylvania, and this piece of equipment behind me is a 40-year-old piece of equipment that's been basically taken out of service. We've got a rental unit that we now pay $17,000 a month to lease that piece of equipment, so that's $17,000 of additional cost monthly expense is going to get passed on to the sewer customers in a form of rate increases. And this plant in general is just one small example of what the true impacts are of the spiraling costs of healthcare. And our inability, whether it be here in the city or as a country to address the infrastructure needs that we have throughout this country. And essentially what we had to do is starve other departments and other areas of the city in order to continue to accommodate those increases in healthcare costs.
If an ICU stay costs $30,000 a day, we're shelling out as an employer by virtue of being self-insured, $30,000 a day that's half a police officer for a year. Depending on the amount of long-term or significant illnesses you have in any given year can mean swings of millions of dollars on an annual basis. An average tax bill in the city of Bethlehem might be $2,500. If you figure that for every dollar is 33 cents on the dollar, it's about a $750 bill every year that the taxpayers of the city of Bethlehem are paying to provide healthcare for our employees. How are we going to make the ends meet, provide the city services that our residents deserve and do it without having to raise taxes? Senior citizens are struggling to stay in their home as it is, and you can literally tax people out of the home that they've had all their life.
Richard Master: I remember 35 years ago when healthcare was affordable, MCS had great insurance, full coverage with minimal deductibles. US employers across the country provided well for their employees. No worries. That's all been eroded by a relentless increase in healthcare costs. Today, there's a dark cloud of anxiety in the country, a dark cloud over our employees. They're one diagnosis, one accident away from financial disaster. A few sick employees can take down a company. The dark cloud hangs over our cities, no money for infrastructure, no money for schools, high taxes. That dark cloud hangs over our whole economy causing flat wages and no money to spend to fuel real growth. It's a problem that we have to solve.
Gerald Friedman: In 1969, blue Cross Blue Shield had community rating. Everybody paid the same rates. It was a truly nonprofit. And in every state, Blue Cross Blue Shields were regulated to serve the public interest. That's what we gave up on.
Wendell Potter: Some executives at Life Insurance Company saw an opportunity come in to this area, come into this space and make some money. So they came in and started offering cut rate policies, but only to those who were younger and healthier.
Gerald Friedman: The group of people subscribing to the Blue Cross Blue Shield became less and less healthy, more and more expensive, forcing the Blues to raise their rates more and more. And by the late seventies, early eighties in every state in the union, the old Blue Cross Blue Shield model was dying. These companies were going bankrupt. Nonprofit companies couldn't make it.
Wendell Potter: For-profit insurance companies over the years became so dominant that they actually came to control the healthcare system. They bought a lot of the Blue Cross plans. A lot of the Blue Cross plans now are for-profit companies.
Dave Steil: The U.S. has one of the shortest length of stays in hospitals of any country and we're told we have to shorten it. We go to the doctor about 4.2 times a year. The Japanese go 13 times. So we're told that we use too much healthcare and we have to restrict access to save money when in fact we're below average when it comes to comparable countries.
Gerald Friedman: The whole system is set up to discourage people from using healthcare.
Donald Light: The insurance companies are specialists at figuring out ways of covering less or paying less the sicker you are.
Wendell Potter: So not only are people having to pay more money out of their own pockets for care in these plans, they're finding that the choice of providers has been narrowed.
Donald Moore: As a primary care physician, I have selected the specialists that I'm most comfortable working with. As it stands right now, I've got to say to my staff, "Check if Dr. Brown is a member of this patient's insurance." And so referrals are so much more limited in the current system.
Kevin Outterson: People have precious little choice today. Frequently people will look at their plan and realize that their doctor is not on any of their plans.
Donald Moore: The choice we need is that choice between insurance companies. As a matter of fact, we don't choose our insurance companies in general, it's your employer if you are getting your insurance through an employer that chooses the insurance company. And that's really not based on the quality of the insurance most of the time, most of the time it's based on the cost to the employer.
Wendell Potter: One of the reasons I left the industry was because I was expected to be a cheerleader for consumer driven plans or plans which have high deductibles and to persuade the American public, employers in particular, that everyone needed to have more skin in the game. What the companies were doing to meet Wall Street's financial expectations was to make it less likely that people could get care that they needed, that they could afford insurance. And that's when I decided that I had to find some other way to earn a living. I was being paid, in my view, to mislead people and I couldn't in good conscience keep doing that.
Michael Gusmano: Medicare, and they talk about that it's broken, that it's unaffordable, that the costs are escalating, and this is an enormous distortion of the reality of Medicare. In fact, Medicare has been a runaway success.
Gerald Friedman: Well, Medicare can take care of the sickest and the oldest in our society and they can do it actually at far less cost than the private insurance companies could do it.
Wendell Potter: They don't have the same kind of cost that the private insurance companies have. They don't spend enormous amounts of money on their sales and marketing teams and on advertising, and they don't need to have an infrastructure in which they're going back and forth with healthcare providers on a daily basis to try to determine whether or not something is a covered benefit, which is also something that eats up an enormous amount of our premium revenue.
Donald Berwick: I was the administrator of the Centers for Medicare and Medicaid Services, it runs both of those programs, and the children's health insurance program. We had 5,500 employees in that system to cover the whole country. Our budget, the amount of money going out to the healthcare system was about $820 billion a year, nearly a trillion dollars. Total overhead budget, that is the administrative budget that I had, was about eight billion dollars, one percent of the total. That probably undercounts, so let's make it three percent, four percent of the total budget. Right now by policy in this country under the Affordable Care Act, we are trying to argue insurance companies down to 15% overhead.
Walter Tsou: The American taxpayers are saddled with the poorest in our society and the oldest and those who are with chronic disabilities and those on dialysis, and we're putting them in the government programs and saying, "All you healthy people from 18 to 64, we're going to hand it over to private insurance companies." And still even with doing that, Medicare manages to actually control healthcare costs better than the private insurance companies can.
Victor Rodwin: If you suffer from end stage renal disease in the United States, irrespective of your age, you are covered by Medicare and if you are blind, you also are covered by Medicare, even if you're a child who is blind. So we've established the precedent already in this country of having one payer pay for all the care needed for two organs by just adding the heart and the liver. That would've gotten us a long way towards universal coverage.
Michael Gusmano: Medicare isn't the problem. It's a wonderful example of the kind of solution that actually works and is consistent with the international standards in healthcare.
Sean Flaherty: It's the system as a whole that creates the inefficiency. The fact that there are so many different payers and so many different plans and so many different ways in which bills have to be made and collected.
Hisham Abu-nabba: So having multiple insurances and having multiple ways of even billing for that patient is adding to the inefficiencies of the patients. You look at quality and variability, they're opposite of one another. The more variability that you have, the more entities, provider, payer, insurance, manufacturers and so on, the more chances of error, the more inefficiencies, the more cost.
Wendell Potter: One of the reasons why hospital bills are so high, why we are charged so much by doctors is because they have to spend a lot of resources, they have to hire staff who do nothing more than engage in a nitpicking war with insurance companies on a daily basis to make sure that they are getting paid appropriately.
Martha Kuhl: It makes me angry to see so much waste in healthcare, that there are nurses who are pulled away from actually providing hands-on patient care and they're pulled into administrative duties. And they're pulled into those duties because we have an incredibly complex billing system, we have many different payers in our billing system, we have people who can't pay, people who have this insurance, people who have that insurance. So there's nurses whose full-time job is to help get authorization so that a patient can get the care they need and that's ridiculous.
I would really love to be a nurse without having to think about whether or not a patient can get the care they need, whether or not a patient is sent home from the hospital without the proper medications because they can't afford it, whether or not a patient is going to be able to get a treatment that a doctor recommends because their insurance company won't pay for it and they can't afford it. I'll go into a patient room on a day of discharge and I'll find a patient who tells me they're not ready yet to go home. They say, "I'm fearful, I still have pain." The doctors and the nurses share these frustrations that an insurance company would make a decision to send a patient home too soon.
I have seen parents make decisions that would put them into bankruptcy to get their children care. They love their children and they want to do everything possible. They didn't understand their actual health insurance. Health insurance is a really complex system. Families will sit in rooms and cry over whether or not they're going to be able to face this, whether or not they're going to be able to afford it, whether or not they're going to be able to keep their job, whether or not they're going to keep their insurance, what's going to happen to their house, et cetera. Nurses see this on a day-to-day basis and it does break your heart.
Dwight Michael: We as a small practice of five doctors and one provider deal with about 20 different insurance companies at this point. We have a middle office that has three people in it and an office manager that deal with essentially insurance issues and payment issues all the time. If I write a prescription and they want more information, my nurse has to call up that company, wait for their telephone system to come up with a live voice, give them the particulars of the patient and the medication, but it's not uncommon that they spend 30 minutes with one appeal. So we're trying to figure out the game so that we spend the least amount of time doing that kind of bologna. Every physician spends $84,000 a year just to interact with the private health insurance industry.
Yasin Khan: To care for my patient in a proper fashion, in a day-to-day basis, I need at least two people to take care of all these denials. I have a patient who specifically, for example, needs an epidural because they have a herniation of disc, they have a proven MRI, they have physical exam, they have all the documentation. I still get denied.
Jennifer Ambrose: Doctor wanted an MRI ordered. Patient was in excruciating pain, unable to walk. We attempted the MRI and we were told no, patient had to have six weeks of physical therapy. He endured six weeks of physical therapy. His symptoms got worse, but in the meantime, he had five office visits, two ER visits, an admission, a transfer to another hospital and finally a rehab hospital. And it just blew my mind that we could not get the MRI approved without six weeks of therapy when we had a person that could not walk. We deal with insurance companies all day long and we document every conversation we have, who we spoke with, when we spoke with them because depending on who you get on the phone, you'll get a different answer every time you call in. If we did not have the staff that we did, we would not be questioning half of the claims that we do. It's very time-consuming and it's extremely frustrating.
Michael Lighty: So insurance companies increasingly are the force in the room, unseen but powerful. When you're in the hospital room, that's who is really driving a lot of the decisions that are made. How long you're going to be in the hospital, what drugs you're going to be given, what access to providers or tests that you have, those things are increasingly driven by the insurance company reimbursement.
Donald Moore: Multiple insurance companies telling me to bill less and do less to the patient and based on their reimbursement are giving me 10 minutes to see a complex patient. That is not possible. Hello. [inaudible 00:29:13]. So we concluded the only way we could continue to do what I was trained to do, what I thought was the right thing to do was to get rid of these insurance companies. We made a decision to move to a single payer. We started taking Medicare and Medicaid and other government insurances. That's how we moved to a single payer. We had to give up almost 70% of our practice, which were commercial insurance. I certainly have a lot less patients than I had before.
Richard Master: MCS pays one and a half million dollars a year for its health insurance and where does it go? Three cents of every dollar goes to an insurance agent that represents MCS in selecting an insurance plan and negotiating price. The next 20 cents of our premium dollar goes to the insurance company for its sales and marketing expense and for its staff to pre-approve and deny care and its administrative expense. And then you have at the provider level 10 to 15 cents that goes to hospitals and doctors to interface with my insurance company. They face massive amounts of paperwork and phone time dealing with pre-approvals and denials and payment issues. None of it is related to care. That's 33 cents of our dollar before the actual cost of care is paid for. My insurance company is supposed to negotiate better prices from the providers, but on average, they end up paying 20% more than Medicare does. They pass that extra cost onto my company. I don't see what private insurance brings to the table.
Wendell Potter: What keeps insurance company CEOs up at night is the worry that other CEOs that will eventually come to realize that they add more cost than value to our healthcare system and that more and more employers, corporate executives are beginning to understand that. Since I have been known as an outspoken critic of the industry and an advocate for change, I've gotten calls from a lot of people I used to work with who've said, "Thank you for doing what you're doing. You are telling the truth."
Donald Berwick: I cannot read my insurance policy. I don't understand it. I can't figure it out. With all due respect, if I can't figure it out, most people probably can't. That is waste added. It's not transparency, it's confusion. When you have a publicly accountable system as we could have with single payer, you can have less confusion.
Richard Master: Over and over again. We're hearing the same plea, "The system is too confusing." We need to have simplification to control cost and to improve quality. And what about single payer health insurance? What does it mean? We get rid of the hundreds of complicated insurance plans and we have one comprehensive plan that covers everybody. It's simple and efficient. You go to any doctor or any hospital you want, present a card and you're covered. There are no deductibles, no out-of-pocket expenses and no contentious pre-approval before treatment. Everybody is covered, nobody is left out. Single payer is not a government takeover of healthcare. The doctors and hospitals remain totally independent just like they are with Medicare.
Michael Lighty: If I told you that every one of your employees could get the healthcare they need guaranteed, that your costs would go down, everyone would pay less and get more, you might be skeptical. But the truth is most every country in the world does that.
Tsung-Mei Cheng: The benefits in Taiwan's single payer system are comprehensive. You have inpatient care, hospitalizations, visits to doctors, drugs, dental care, pre child delivery, dialysis, all of that is paid for. Patients have complete freedom of choice of providers. Taiwan spends 1.6% of its total operating budget on administration and that is a tiny fraction of what we spend in this country. It's the peace of mind that it gives people, which Americans don't have yet. I hope every American has that someday.
Michael Gusmano: One of the myths about universal healthcare systems is that they engage in rationing, that they, in order to cover everyone and operate within a budget, they have to severely limit access to specialty care and surgical care. And our research has shown that that's just not the case.
Chuck Pennacchio: Our current broken healthcare system is the most rationed healthcare system in the world. That's why a third of Americans don't get the healthcare they need.
Uwe Reinhardt: The idea that you can have high deductible policies and that you're not rationing healthcare by income class, I would say where were you educated? That isn't even requiring a PhD. That's just common sense. Think of a waitress making 30,000 and you ask her to cough up 10,000 out of pocket.
Gerald Friedman: One of the biggest differences between the United States and the rest of the world studies by the Commonwealth Fund and others find Americans are much, much more likely than people in other countries to defer medical care because of cost.
Victor Rodwin: We have a large number of people dying from causes that should be preventable. So when one takes all these causes of death, which one should not die from given access to appropriate and effective medical care, the US comes out as number 19 compared to France, which in fact is number one, or Australia, which is number two. No question in my mind that our low ranking unavoidable mortality is due to the fact that we still have financial access barriers to the most basic kinds of services in the United States of America.
Richard Master: The data shows very compelling information about single-payer systems. And so it was imperative that we visit a single-payer system and experience what life was like on the ground. Fortunately, we've got a single-payer system operating to our north in Canada.
Bruce Fleming: This is our high resolution CT scanner and it's a very important part of the equipment that we use to make a prompt diagnosis for our folks with a variety of disorders, medical conditions and trauma. And this is Dr. Connell and he's currently speaking to a group of residents in a room with, as you can see, the flat screen technology.
Doug Connell: Since around October of 2013, we've had onsite 24 hour a day staff radiologist coverage here, our subspecialty staffed with emergency trauma radiologists full time and we're the first site in the world to offer 24 hour a day cardiac CT scanning.
Khati Hendry: There was a short time after I'd moved here and I had a house, I was looking out over the lake and I just had this strange feeling, I'm trying to put my finger on it. This is a peaceful feeling, an absence of stress. I found that I was really quite unencumbered when it came to seeing the patients, that I could concentrate on doing medicine and not worry about other things, and that was quite a change from what my experience had been. And then I worked in community health centers in Oakland, California for many years. I was the medical director there and the medical director also of a consortium of community health centers also in the East Bay Area. I left there in 2004 and moved to Canada. Sometimes when I'm driving around here, I think, "Oh my gosh, I'm back in a Marcus Welby episode or something." First family practice department meeting that I attended here in Canada was quite an experience. People actually seemed happy. No one was talking about the latest outrage that had occurred from some insurance company. No one was complaining that they couldn't see their patients anymore.
Danielle Martin: As a Canadian physician, I sort of laugh when I hear people talk about government telling me what to do or government run healthcare. That's certainly not been my experience of working in the Canadian healthcare system. I have an enormous degree of clinical autonomy.
Khati Hendry: People seem to think that because there's a single payer that you are working for the government, you're an employee, they tell you what to do. Nothing could be further from the truth. Just take a listen and see how blood pressure's doing today. I'm in practice. I'm a small business person. They're not running my business for me. They don't come in and review me and tell me, "You're not doing this right. You're not doing that right." They're the ones that pay me for the work that I do.
Laura Smith: This is what I do to bill for one patient. I bring up the patient, click on new, type in the codes, a billing item and a diagnosis code. The date is already filled in for me. I create bill and it's done.
Khati Hendry: It is very simple. Basically, you come in, I see you, I send off a bill. Two weeks later, there's money in the bank. The patient doesn't have to pay.
Laura Smith: I once had to deal with an American insurance company. In trying to collect six or $700. It took me probably six months, probably six faxes, six phone calls, and then we received a portion of the payment.
Bonnie Kiddell: We are billing on behalf of University Health Network for four hospitals for diagnostic tests to the Ministry of Health. We don't see any situations where the ministry is second guessing the doctor's clinical decision on the test. We bill weekly electronically and there are approximately 10,000 claims on those weekly billings, and those are handled by approximately 10 people within the department.
Danielle Martin: This myth about Canadians dying on waiting list is simply that, it's a myth. When people have something really urgent that needs to be dealt with in the Canadian healthcare system, it gets dealt with. The notion that having a single payer somehow causes wait times, is not actually borne out by the international evidence on healthcare system design. We see healthcare systems internationally where it's a single payer system and there's virtually no wait time at all. Taiwan being a good example of that. We see systems that have multi payers where wait times have been a big problem.
Jim Stanford: There's a lot of mythology out there that somehow there's a big tax burden or a big cost that comes along with the Canadian publicly funded model.
Carol Sadler: In my 25 years as a cross-border tax consultant, I'd say I've prepared at least 5,000 US returns and about the same amount, 5,000, Canadian returns. The surprising thing is that even though on an income of $50,000 of tax rates in Canada and the US are about the same, in Canada, that tax covers primary healthcare. In the US, there'd be additional cost to that person either through their own insurance or employer insurance.
Gerald Friedman: Canada now spends half as much per person as we do in the United States, yet their life expectancy has increased faster than ours.
Theodore Marmor: What it's a story of is universal health insurance that very few Canadians would ever imagine reversing, and it's a story of Canadians looking south of the border and noticing we have both spectacular centers of excellence and spectacularly expensive, complicated and hard to justify distribution of medical care.
Dann Konkin: I am Dann Konkin and I'm the President of Ampco Manufacturers. We're a family owned business and been in business for over 47 years. I'm a member of the Conservative Party of Canada and we stand for removing waste, being more efficient and finding ways to grow our own businesses, and one of the greatest ways that we can grow our business is to reduce cost and that's why we embrace the Canadian healthcare system. What I don't understand is why my fellow conservatives in the United States tend to fight this.
Terry Alexander: So my name is Terry Alexander and I work for Ampco Manufacturers and I've been an employee here for 17 years. From what I've experienced, the Canadian healthcare system is amazing. I've felt very well taken care of. I didn't feel like there was any treatment that was available that they weren't providing for me. My appointments were very quick. While I was going through my treatment of my surgery and the chemotherapy and the radiation therapy, it was absolutely exhausting and very stressful and lots of anxiety. If I had had the added burden of coming up with thousands of dollars for my healthcare coverage to fight this disease, it would've been devastating. It would've been horrible. When I hear that people say our Canadian system isn't good, it makes me a bit angry because I'm quite proud of our Canadian system.
Jim Stanford: There is a huge amount of mythology and propaganda that I know is promoted in the United States, all kinds of lies about the supposedly poor quality of our healthcare, the supposedly huge cost of our healthcare system.
Wendell Potter: And there was concern within the industry that more and more Americans could believe and buy on to the idea why do we need insurance companies anyway? Why don't we just have a Canadian style system? Our costs would be lower. We could have access to good quality care. So it was very, very important to discredit the Canadian system in particular, try to find someone willing to tell some sad story.
Speaker 45: Under the Canadian single payer health plan, he was told it would take another eight months, then would likely come [inaudible 00:44:41].
Wendell Potter: You look for the one or two that seem to be compelling that you can use and to get people to think that that is common, that's the way it is. When there are obviously far, far, far more stories in the U.S. about people who are not being able to get the care that they need than you'll ever find in Canada.
Theodore Marmor: Canadian hospitals and Canadian doctors have more bed days per thousand and more visits per capita than in the United States.
Wendell Potter: I knew that what I was doing was really at odds with the way the system was really run and also with the fact that Canadians are far happier with their healthcare system than American citizens are with our system, and I regret what I did. There's no doubt I misled people and it's a shame that I did that because people have an opinion of the Canadian system partly because of the work that I did that is just completely wrong. I feel terrible about that. I often say that what I'm doing now is in many ways trying to make amends for misleading people.
Dann Konkin: We looked at opening up a US operation. We wanted to be closer to our customer base. We wanted to be closer to our supply base. But the more we looked at it, the amount of cost that we would've incurred by having our company relocate into the United States just through the insurance coverage cost alone just made it a non-starter. If I had to increase my cost by over a million dollars in my company because of insurance coverage costs, that alone would probably drive me to bankruptcy.
Jim Stanford: In fact, up here in Canada, the major American auto companies, Ford, General Motors and Chrysler actually made a public declaration, a public statement that the publicly funded healthcare system in Canada was an important competitive advantage for their operations in Canada.
Theodore Marmor: What we have now by comparison with Canada are the consequences of complexity, of not knowing what you're entitled to, of excessive preoccupation with choice of insurance plan, of facing high deductibles and co-insurance, which the Canadians don't, and of living with a situation in which even if you are insured, the fearfulness of things falling outside the insurance package worry Americans.
Jim Stanford: How could you prefer a system where the employer has all the hassle of providing private health insurance, the huge cost of it and the risk and uncertainty of it.
Speaker 46: Other thing that we have to address is the issue of concession bargaining and [inaudible 00:47:14].
Dave Steil: Labor negotiations are always a very contentious thing and we hear about them today, particularly, in the public sector, in state government, municipal government, school districts, very contentious labor negotiations. And almost always one of those contentious issues is healthcare. If healthcare is no longer part of the bargaining process because it's now covered under a single payer healthcare system, that issue is off the table.
Donald Berwick: And if you look at corporate interests, those usually associated with the right side of politics, the conservative side, their interests are enormously tied to reform of healthcare.
Dave Steil: As a business owner and also as a former Republican legislator, I've said that conservatives should be supportive of single payer because it costs less.
Donald Berwick: Talking with corporate executives, a lot of them, I think, get this. They know what waste is. They wouldn't be running successful companies if they tolerated waste in their production system and they can see the waste on the healthcare side. This crazy transactional system is costing them money without value.
Dave Steil: Business, when they look at the single-payer model, will come quickly to the conclusion that it is the least expensive, the most supportive of a free market and will have the most direct effect on their cost of operation.
Richard Master: The cost of my company and its employees goes down with single-payer. Instead of high insurance premiums with high deductibles, there's a simple payroll fee, like we pay for social security. My company gets out of the healthcare business.
Donald Berwick: I did a study myself, which estimated 34% waste in American healthcare. The National Academy of Sciences did a study that came between 30 and 40%. The RAND Corporation has a study about 35% I think it is. One out of $3 wasted. One out of $3 trillion is $1 trillion of non-value added activity in care. It's hard to get that out with a multi-payer system.
Kevin Outterson: In every city, every day there's people who pay 10,000, 20,000 and 40,000 for the same procedure. The doctor doesn't change their quality based on how much they're being paid. In Massachusetts, the attorney general issued subpoenas to get this information. And what we found, even for people that are health policy experts and thought they understood this area, the variation in what hospitals are getting paid was more dramatic than we thought.
Donald Berwick: How are the prices set? I'll wager you have no idea, and I don't think anybody does.
Kevin Outterson: This is a situation where nobody really knows what it costs and nobody really knows what's being billed because it varies all over the map. And what the healthcare systems have learned is that they can charge whatever they want, so pretty soon you've got the MRI that costs $12,000 when in fact it may cost them 300 to provide.
Donald Berwick: You see, there's no accountability. The buck doesn't stop anywhere. The system is not in control. With a single payer, there's more clout, there's more chance to push back and to push back on prices, to say no to price increases and forms of pricing that just make no sense.
Gerald Friedman: The reason traditional Medicare has controlled prices better than the rest of the healthcare sector is because they've controlled hospital prices and physician rates. They don't pay just what people want. They pay according to a more reasonable schedule that's more equitable. The only place in the United States where you get drugs at Canadian prices, the Veterans Administration. The VA using competitive bidding and a formulary list gets lower prices and they pay 41% less on average than does the rest of the United States. Are the drug companies losing money selling to the VA? No, they wouldn't do it if they were losing money. It's just they're making a lot more money off the rest of us.
Stephanie Woolhandler: There's actually excellent data showing that when you have an excess number of hospital beds and excess number of specialists and particularly an excess number of facilities like MRI scanners and operating suites, you get much higher healthcare costs due to much higher rates of intervention, but there's no improvement in population health. So from a population point of view that money for the excess is wasted.
Donald Berwick: I don't mean to be critical of the motivation, intent or goodwill of the providers. They care a lot about what they do. Hospitals believe in what they do. It would be easier if they were bad guys. They're not. They're good guys. But they need somebody on the other side of the table with the authority and the resources to speak up for the people, for the public, and I think that's what a single payer can be.
Dave Steil: The reality is every study, including ones done by the Lewin group, has found savings from single payer. There's not a single study that's ever been done that says single-pay will cost more.
Richard Master: Single payer makes economic sense. We save 198 billion by eliminating insurance administrative cost and profits. We save 242 billion by reducing the administrative cost to doctors and hospitals that no longer waste time and staff interacting with multiple insurance companies. We save 116 billion by establishing a fair standardized fee schedule for hospitals and providers of care. We save 154 billion by negotiating bulk pricing on medical devices and drugs, like all other advanced industrialized countries. The total savings is $710 billion a year. The $710 billion in savings means we can lower the overall cost of healthcare, we can afford 77 billion to cover the uninsured and afford 129 billion to eliminate out-of-pocket expenses. It's about shifting resources from wasteful spending to actual care.
Gerald Friedman: We're talking about cutting some of the obvious low hanging fruit, getting rid of some of the most wasteful aspects of healthcare, while still leaving plenty of money for doctors to be well reimbursed, hospitals to be well-funded, drug companies will still be making profits. The great irony of all this is when somebody says, "Oh, can we afford single payer," is we can't afford the current system, the only thing we can afford is single payer because single payer is the only way that we can bring costs under control and bring the rate of growth in healthcare costs to a rate sustainable over the long term.
Donald Berwick: There would be jobs lost in the insurance industry, but a multiple of jobs gained in companies that now can stay in America, don't have to go offshore, can build a new plant, can pay their employees more, putting more money into circulation to support people in other businesses. Overall, it's a job win for America. There's no question in my mind about that.
John Nichols: You're not going to have to worry if you get sick halfway through that effort to create a new business. You're going to not going to be ruined if your child gets sick. We're going to make sure that that issue's off the table. We unleash immense entrepreneurship. We unleash immense creativity in this country.
Gerald Friedman: Much of the time that is now spent by doctors processing paper for the insurance industry will be turned into time spent with patients.
David Himmelstein: It really holds out the hope of reclaiming our profession as a caring profession instead of a business. And it says to our colleagues, you are going to be able to take care of your patients according to your best judgment medically. A small private practice would be viable under single payer and regaining control of medicine as a calling would be viable under single payer. And that's why it's popular with our colleagues.
Chuck Pennacchio: The national movement for single payer continues to expand and continues to grow. There are well over 20 states that have solid organizations working on both national and state level. Single payer continues to gain the support of Republicans as well as Democrats, business leaders, as well as nonprofit leaders. It brings in educators, nurses, doctors. We've got constituents all the way across the board.
Wendell Potter: What I would love to see is that policy makers could come to the table, park their ideology at the door and just say what we're going to do here is take a look at what makes the most sense for this country, what makes the most sense for our businesses, what makes the most sense for the people who work for those businesses and for others in this country, what makes the most sense in terms of creating a healthcare system that really is the best in the world.
Richard Master: Just imagine what it would mean for this country if we could cut our healthcare bill by 25%. Imagine what it would mean for our infrastructure, for disposable income, for our overall economic vitality. Imagine what it would mean for our business community not to have this albatross around their neck. It would be extraordinary.