We are more likely to get a knee replacement or have a cat scanner, have an MRI. LT. COL. BETTY GARNER, RESEARCHER, U.S. ARMY: Welcome to Germany. 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. I mean, that sounds like a really dire situation. (CROSSTALK) UNIDENTIFIED MALE: That's not -- yes. The Dartmouth study showed the patients in places like Miami were receiving more care. And I think those discussions that we between the patient and the provider about lifestyle disincentives. What the Dartmouth group discovered is that the patients in the most costly regions where Medicare spent more money on patients, those patients did not have better health outcomes. The first description that the play makes about the fire escapes is "The apartment faces an alley and is entered by a fire escape, a structure whose name is a . Considering that hospitalization itself is listed as the third leading . Fifteen years later, you can't walk into your average hospital today and get acupuncture after an operation. Because what we think is best for us often isn't. It's been a wild ride. JONAS: There's very large randomized trials done at multiple centers that have demonstrated that acupuncture works, so we put together a study to see if we can actually insert this simple acupuncture technique during the aerovacs of wounded soldiers into Walter Reed and other medical centers in the United States. I'd rather be shot again than go through withdrawals of coming off that medicine. GUPTA: I think the numbers are surprising to a lot of people, even people who work in hospital. And, in fact, they were more likely to die. A heart cath, get another stent. YATES: Wow. (END VIDEO CLIP) GUPTA: Dr. Erin Martin, that's a primary care doctor you just saw in the film. Let's be honest. If they are surgeons, they get paid for each procedure. DR. ANDREW WEIL, PROFESSOR OF MEDICINE AND PUBLIC HEALTH, UNIVERSITY OF ARIZONA: Hippocrates said let food be your medicine and medicine be your food. Putting patients first. UNIDENTIFIED MALE: Oh, yes. And for the large majority of people we help, they often don't understand what many of the charges are. BROWNLEE: If I think about what healthcare could be like, it would have a lot more care in it. 27 cardiac catheterization and well over seven stents. They become more productive. I lost him. I was shutting down emotionally. UNIDENTIFIED MALE: I've been to the emergency department a few times before, and the last time I was having chest pains, not like this. We just spent $1,000. RICE: You know, I think, the biggest incentive for patients is that they are going to leave a higher quality at longer life. Sometimes it's related to what the individuals actually have access to. Korengal, the (INAUDIBLE), it's the most intense battleground that you can ever be in. GUPTA: You feel better when you're healthier too. (END VIDEO CLIP) NISSEN: I was doing a Google search, and what I found was a Web site in the United Kingdom where the clinical trials done with Avandia were actually partially disclosed. You're doing this radical intervention, you know, I say radical? (BEGIN VIDEO CLIP) COMMERCIAL ANNOUNCER: Managing Type 2 diabetes can be hard. And then, being paid, on top of that, a bonus if they can demonstrate, if they have improve the quality of care and have also may cause saving. So I decided to leave. Select Open transcript . Still bothers me to this day. WENDELL POTTER, FORMER HEAD OF COMMUNICATIONS, CIGNA: I don't recall any time telling a lie, but I know that there are many times that I didn't disclose full information, and I was the company's chief spokesman. As an overall system, no, we're not anywhere near the best in the world. I mean, to talk about how we shift toward -- away from disease intervention toward disease prevention and health promotion, I mean, that -- that requires a massive rethinking about medicine and healthcare at all levels of society. MARSHALL: It doesn't matter if I do one stent or five or ten stents. YATES: I've chose to get off all narcotics, all medicine, everything. UNIDENTIFIED FEMALE: If there is a 50-minute queue, I'm sure we can probably squeeze them into the schedule. People eat what's cheap and what's available. UNIDENTIFIED MALE: So uncomfortable and I need to pee again. She had bypass surgery in her 30, 27 cardiac cauterization and well over seven stents before she went to the Cleveland clinic for treatment. UNIDENTIFIED FEMALE: Oh. GUPTA: Erin, do you want to respond to that? They did not tell physicians. MARTIN: Because of the bottom line, because of the cuts that are coming through the government, if it came to the point where they couldn't pay me anymore, that would suck, but I'm not afraid. Came off the mountain with only eight. (LAUGHTER) Infinitely. UNIDENTIFIED MALE: But Mommy, what are you going to do? I mean, give me a break. UNIDENTIFIED MALE: Well, that had to be something to do with my diabetes. And I had a massive heart attack. And Doctor Nissen is in salaried as well. It would be a very different system that probably would be less high-tech and more high touch. Those are the kind of things that would actually have an impact. OK. UNIDENTIFIED FEMALE: How are you? free fire short headshot status #viral #shorts #youtubeshorts#youtubeshorts #viral #freefireshorts #free #gaming #freefire #ff #youtube #video #gam #ffstatus. UNIDENTIFIED MALE: When do we want it? That's my routine. Look at this. And that is where the affordable care act can help which is bringing more competition to the bidding and pricing of these items. NISSEN: There's litigation involved and the company set aside $6 million to settle lawsuits. I mean, when the cost of some of the things we use on a regular basis. People say you're doing this radical intervention. Suture, one that's used in every operating room in the world. It's not visible, but it's there. That isn't true in Canada. CARNES: Release the breath in a smooth, even stream out. If it happened to me, it happens to a whole lot more people that are almost invisible to the system. Aladdin (2019)/Transcript. I was in the hospital for two weeks. Until my doctor said to me, I don't know what else to do for you. How to make a healthy choices. Frankly, be suspicious of doctors who recommend one and frankly, think that they're just trying to make money off of me. We have to teach young physicians that prevention comes first. UNIDENTIFIED MALE: Yes. Jonas, Wayne B., commentator. Probably put him on the bottom on the other side. YATES: OK. Am I going to be paying more? It is just tragic to think of the answer being there but just in the -- in the moment not able to see it. And I thought, once I get this, I won't have the blockages anymore. Escape Fire Background.The video essay Escape Fire (2012) was heralded as a breakthrough in the understanding of and . 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) And chromosomes have all genetic information on them. It is important to keep in mind. Where does that money come from? It was so consistent. GRUBER: Well, Sanjay, I think If you look at the affordable care act in the hole, it will. It's too much paying for it. People go in and out of health plans. The folks who were there were not trying to shirk their responsibilities. You just never get to the bottom of what's causing al he these problems they're having. UNIDENTIFIED FEMALE: He was issued the bottle today with 20 in it and 10 are missing. If we can prevent that and even reverse it, that's how we're going to make true health care, not just sick care available. GUPTA: How big a problem is this then? UNIDENTIFIED MALE: We have had enough. GUPTA: There was something in the documentary that caught my attention. If you can delay treatment, then that man is not at risk for side effects during that period of time. It has to do with the training of physicians. Going to go look for it. So, these models that I'm talking about are based on fee for service, then, they are being paid for a care coordination fee. We don't have to spend ourselves into poverty on healthcare. The psychological trauma of every one of those multiple catheterizations, every time she had a chest pain coming into the E.R., and unfortunately, there are lots of Yvonnes out there. They promised me that I could make the practice whatever I wanted it to be, and if I don't want to see six patients an hour, I don't have to see six patients an hour. And so 15 firefighters were trapped. Rescue care is second to none. He knew that they would lose the race back to the top of the ridge, so he suddenly stopped. When medicine became a business, we lost our moral compass. I mean, couple weeks, I felt like I was okay. She ended up having another open heart operation, another bypass operation. NISSEN: Now, the leading cause of death in diabetes is heart disease. Having a diabetes drug that increases the risk of heart attack by nearly one-third is a public health DR. STEVEN NISSEN, CHAIRMAN, CARDIOVASCULAR MEDICINE, CLEVELAND CLINIC: Having a diabetes drug that increases the risk of heart attack by nearly one-third is a public health catastrophe and the company didn't tell anybody. 1 hr 39 min PG-13 Documentary A powerful and thought-provoking documentary that exposes the U.S. healthcare system as one designed to profit on disease rather than health. And that being applied to health care just doesn't work. Something like that. When a team from Dartmouth Medical School mapped Medicare payments, it found some disconcerting differences from one part of the country to another. Heart cath, get another stent. How long were you there? And I say that as doctor. UNIDENTIFIED FEMALE: I'm just going to go ahead and put the last one in. Compared to having your chest cut open? And somebody's going to teach me how to do that, so I'm going to -- I'm going to do it. NISSEN: We do have a problem in America, and that is we have misaligned incentives. MARTIN: I think what the American people need is, they need good health care. BURD: Yes. They either couldn't afford it, or they worked for small employers that had been purged by big insurance companies. And the basis of that turning around by paying primary care doctors more is to incentivize primary care doctors to participate as members of comprehensive health care teams just so that the kind of challenges that Erin faced out there by herself can now be accomplished by pulling a team together, then, let them work hard to save dollars and improve quality of care and then, the primary care doctor benefits from those economic savings and those financial incentives. There are answers, we know what safe care looks like. Escape Fire: The Fight To Save American Health Care Aired March 10, 2013 - 20:00 ET THIS IS A RUSH TRANSCRIPT. UNIDENTIFIED FEMALE: OK. (CROSSTALK) (COMMERCIAL BREAK) UNIDENTIFIED FEMALE: Overmedicating is a huge problem in society and the military is no exception. DR. ELIZABETH BLACKBURN, NOBEL PRIZE IN MEDICINE, 2009, UNIVERSITY OF CALIFORNIA SAN FRANCISCO: Telomere are the ends of chromosomes. It's much better to try to work at a deeper level. UNIDENTIFIED REPORTER: Did you have, you know, a lot of money at stake here? This -- medications I was on. Treated for sciatic nerve, back, L-3, L-4, L-5, swelling left side of my brain, and extreme PTSD. DAVENPORT-ENNIS: So, I think with some patients it clearly will. BROWNLEE: Fee for service rewards physicians for doing more. MEL LEFER, PETALUMA, CALIFORNIA: 25 years ago I had five restaurants in San Francisco. CARNES: Ready? WEIL: In Western medicine, all of our effort is on dispelling evil. That doctor in Cleveland who stents do little to prevent heart attacks and in many cases doctors put them in to make more money. And feel yourself observing all these constantly changing sensations and thoughts and feelings. NISSEN: When I watch the networks, half the ads are for pharmaceutical agents. Obesity leads to heart disease and strokes and diabetes. UNIDENTIFIED FEMALE: I just want to see what they've given him. It's not just we know it, we actually can go and visit it. (BEGIN VIDEO CLIP) GUPTA: To give you a couple of quick examples. So at this point, we will administer the medication. Never needed you. UNIDENTIFIED MALE: People often think it has to be a new drug or a new laser or something really high-tech and expensive for it to be powerful. And doctors wanting to please their patients will often prescribe it. And so behavior becomes a form of currency for people to accomplish their lifestyle changes. It includes the mandate, the requirement that we all have to buy their coverage. GUPTA: I think it's an important point to make because to lay it squarely at the feet of a profitable disease care system, that may be true, 50th in the world, I think a lot of people really struck by that. She needs a follow-up within three month with an echo. You just never get to the bottom of what's causing all of these problems that they are having. The study was conducted by Dr. Dean Ornish, who looked at patients with early stage prostate cancer. There has to be a different way of doing things. You almost forget that what you're doing is providing health insurance. ROSS: Well, what do you think about your diet - UNIDENTIFIED MALE: More healthy diet? GUPTA: And I want to leave all of you at home with a thought as well. There are lots of people like that, like I said, less than 30 percent of the people that end up with a stent are basically in that category. UMBDENSTOCK: We don't have enough primary care clinicians to provide that important fundamental level of care. If I burn the fuel around me, then when the fire comes and it takes me, I'm safe. But we end up being this revolving door. 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. I smoked six cigars a day, 10 cups of coffee, a lot of wine. You almost forget that what you're doing is providing healthcare. The kinds of interventions that we have come to favor in this country are inherently costly because they are dependent on expensive technology, and that includes pharmaceutical drugs. As Berwick says in the film, "We're in Mann Gulch. There is no doubt, they always have. The way that the system is set up, you can't be effective. UNIDENTIFIED FEMALE: The army says this is all linked to the rising number of soldier suicides. GUPTA: For everybody here. The problem is not that it doesn't work, the problem is that we haven't figured out how to get it into the system so that we can make it widely available to the population. It's still a struggle. Our health care system. This is Prazosin. We want that. Original Airdate 08/17/2022. Try to break a sweat every day. NIEMTZOW: So you haven't taken anything? Exhale. SGT. BROWNLEE: The vast majority of doctors in this country are paid by a fee-for-service system. UNIDENTIFIED MALE: I lost about 120 pounds over the course of three years. Impressive. It goes into the other areas, and it's just not sustainable. The really astonishing part about the fact that we spend more is we have worse health outcomes. I felt like there's got to be something different, something better. CARNES: I will be at your side should anything challenging come up for you. Co-directed by Matthew Heineman and Academy Award-nominee Susan Froemke (Lalee's Kin: The Legacy of Cotton), Escape Fire looks at a U.S. healthcare system designed to profit on disease not. We're talking about a $3 or $4 billion a year drug. We're on track for that on Tuesday. They had to live with some of the new consumer protections in the bill that does make it illegal for companies to just cancel someone's policy because of a preexisting condition. Now that Medicare is going to cover the heart disease program, the next step will be type 2 diabetes. You can you visit a hospital that's stopped infections, you can visit a hospital that's ending wastes slowly but doing it, you can visit systems that coordinate care nearly perfectly. It was massively marketed, and by 2006, this drug became the largest selling diabetes drug in the world. Maybe even a provider service. (COMMERCIAL BREAK) DR. WAYNE JONAS, PRESIDENT, SAMUELI INSTITUTE, MILITARY MEDICAL RESEARCH: If our civilian healthcare system is smoldering and we see it's going to catch on fire and burn pretty soon, it is going to be unsustainable because of the costs, the military system is already on fire. He said, it was a year. A lot of that comes you spoke - we spoke about are driven by people who don't have access to the system. Hold my beer while I shoot this gator, you know? Can't wait to be there. Sometimes I go to the hospital and that's the only health care I ever got. It was wonderful. The emergency department is the safety net of health care. Let me just take a listen to you. detail. So Doctor Rice, let me start with you. And ironically, it was only two hours away at the Cleveland Clinic. WEIL: Right. We cut people open, re-bypass their blocked arteries and he would tell them they were cured, and they'd go home and more often than not eat the same junk food, smoke, and not manage stress, not exercise, and then often their bypasses would clog up, so we cut them open, we bypass their bypass, sometimes multiple times. Just do something. To see if lifestyle changes can affect your (INAUDIBLE) even telomeres. What that means is, the money we spend on prevention improves our health greatly per dollar spent. Recognize that you are this spacious, welcoming, open awareness no matter what thought, no matter what feeling, no matter what sensation or circumstance happens to arise. UNIDENTIFIED FEMALE: Now you pick your spot. They'll say, it took years to develop something like this, the research and development costs are significant. This is a lot worse. It was a passion for healing. Sometimes we're talking about them on a daily basis. I mean, give me a break. In Latin, it means, above all, do no harm. GUPTA: Why not just pay them more money? You didn't think you could take care of patients and get reimbursed enough to do the work you need to do. She got her cholesterol under control, her weight under control and things were great for her after that. There's saving money and there's cost effective. On my way. And it wasn't because procedures were more expensive in Miami than in Minneapolis. That's almost as much as the rest of the world combined. GlaxoSmithKline worked very hard to keep these numbers from the public. UNIDENTIFIED FEMALE: Just take a couple of minutes to kind of arrive. That Medicare bidding demonstration. So I said, if you follow them very carefully and you treat them at the first sign of progression. NIEMTZOW: Normally you would? Both of these approaches are necessary, but it would be great if we had a better balance in Western medicine. The balloon is inflated to widen the blocked areas. Escape Fire Clip 14,141 views Oct 14, 2014 55 Dislike Share IHI Open School 9.49K subscribers *Note: You can purchase the full-length Escape Fire documentary on iTunes and Cinema Now, or you. BERWICK: It's really easy to find articles or speeches 30 years ago in which leaders were calling for change, unsustainable costs, problems and outcomes in quality. I think to, to be clear, this is incentive that the paying last to be healthy . MARTIN: What's hot was that commercials on television, why do we need to wait, we can just take a pill right now. I have an acutely suicidal patient in my office that I need help with. Wag Dodge had an idea. CHO: If I spent five minutes with you and put in one of these stents, probably get paid $1,500. But you end up being this revolving door. COSGROVE: Cleveland Clinic was founded by four physicians, and they realized they did better working as a team than as individual practitioners. Thank you so much. These calories are cheap only when you buy them, but when you look at the overall cost to society, these cheap calories are just so junky, they are really the most expensive. And how do we shift this huge enterprise of disease intervention in that direction. And you've had heart attacks. Did you have a good day today? But I'm doing it. You can't have a cafeteria that doesn't have calorie counts on it. Incentivizing them to be healthy or not charging them as much if they're healthy. It's just so much more than money. A lot of unnecessary stents? You know? Also, Dr. Jeffrey Marshall, his specialty is implanting stents. YATES: I was on Parazasin just for nightmares. Jeffrey marshall, his specialty is implanting stents 3 or $ 4 billion a year drug never get the... The course of three years are having us often is n't Fire and. Was something in the film something better that we between the patient and the provider about lifestyle disincentives first. Cho: if I do one stent or five or ten stents the third leading suicidal in... Of health care think with some patients it clearly will of care likely to get off all narcotics, of! Mean, that sounds like a really dire situation are driven by people who work in hospital worse... Really astonishing part about the fact that we between the patient and provider... In America, and that 's not just we know it, we 're anywhere... Less high-tech and more high touch are the ends of chromosomes litigation involved and the about. 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