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Ask Maggie Mahar

Meet Maggie Mahar. You’ll be seeing more of her on the JOURNAL this week, when we present MONEY-DRIVEN MEDICINE, a film produced by Academy Award winning filmmaker Alex Gibney (TAXI TO THE DARKSIDE, ENRON: THE SMARTEST GUYS IN THE ROOM). Ms. Mahar was kind enough to take questions from The Moyers Blog readers, so, over the next two weeks, as you watch the debate over health care reform unfold please submit your questions here. We’ll post her answers after next week’s edition of the JOURNAL.

[Note: We are no longer accepting questions for Maggie Mahar, but you can read her answers here and here.]

Why Maggie Mahar? She was kind enough to introduce herself below.

I began to learn about the healthcare industry while I was a writer and senior editor at Barron’s -- from 1986 through 1997. During that time I covered both Wall Street and Washington, and wrote stories on a wide range of subjects.

Many of those stories focused on healthcare companies: drug-makers, device-makers, insurers and for-profit hospitals. I also wrote about managed care, the FDA and its battle against Big Tobacco. I analyzed the Clintons’ plans for healthcare reform. I compared non-profit HMOs to for-profit HMOs.

What I learned, during those years, is that in our health care system, profits often trump patients. A great many people are selling and selling hard. By law, for-profit corporations are supposed to put their shareholders’ interests first: this means that they must strive to maximize profits. And this goes a long way toward explaining why U.S. healthcare is so expensive.

In 2003, I began writing MONEY-DRIVEN MEDICINE: THE REAL REASON HEALTH CARE COSTS SO MUCH. (Harper/Collins, 2006) At the time, I believed that when President Bush left office, the country would be ready for a political pendulum swing—and health-care reform would, once again, become a possibility. (Admittedly, I didn’t foresee that Bush would be re-elected. The book was early.)

When I began to gather material for the book, I knew that I wanted to talk to a great many doctors—and I started calling them. The great majority did not know me. I expected responses from perhaps 20 percent. Instead four out of five called back. Most talked for 30 minutes—or longer. To a man, and to a woman, they were most passionate about what many saw as the declining quality of health care. With few exceptions, I was struck by their genuine concern, not only for themselves, but for the plight of their patients, the state of their profession, and their own inability to cope with the problems.

“We want someone to know what is going on,” explained one prominent Manhattan physician as he explained how much care had deteriorated in many of New York City’s major hospitals. “But please don’t use my name,” he added. “You have to promise me that. In this business, the politics are so rough, that would be the end of my career.”

Currently, Ms Mahar edits the blog Health Beat,a project of The Century Foundation, where she is a fellow. As a financial journalist, she wrote for such news organizations as INSTITUTIONAL INVESTOR, THE NEW YORK TIMES, BARRON’S and Bloomberg News. Her first book BULL! A HISTORY OF THE BOOM—1982-1999, was recommended by Warren Buffet in Berkshire Hathaway’s annual report.


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I am always looking for more information on this subject as well as others. I found your site very informative and well written. Your layout is simple to follow and I appreciate your contribution to the subject.

I enjoyed the discussion on Money Driven Medicine. I have been a nurse for over 40 yrs and could add much to the debate that has not been even mentioned. However, I would like to ask Ms. Mahar a question of whether she included workers compensation costs in the data of cost of health care. I think you will find most unnecessary surgeries and care will fall under this umbrella. I am a case manager and see many surgeries, mostly back surgeries that were not indicated by testing or exam and the patient later wonders why he/she feel no better after the surgery and in some cases they will never work again. The outcomes are often not good and the cost is very high. A spinal fusion may be around 100,000 or even higher if further surgery is needed. I will buy her book as it is very relevant to the debate. Another addition to above, in workers' compensation it is a medical legal environment and patient, attorney, physician and other medical providers are thinking of the monetary value to them rather than what is best for the patient. The providers are paid at 100% and sometimes forced to proceed with unnecessary care due to the legal environment it is in. I also think there are duplications of reimbursement and of course other factors I will not go into here.

Posted by: Judy Guinan | August 29, 2009 2:25 PM

I found this on Winship's page about Tom Delay and Woodstock. It was pretty good, so I imported it over here. People get in a hurry and post on the wrong page sometimes.

National Medical Whistleblower Conference
Sept. 11-13, 2009
Lawrence Union Pacific Depot Conference and Visitor Center
402 N 2nd St, Lawrence, KS 66044

Lawrence Kansas will be hosting the first ever National Medical Whistleblower Conference on September 11-13, 2009. This will be a conference very different from other conferences you have attended on this issue. Here in the heartland of the USA, we will address the real day to day problems experienced by whistleblowers from many different professions and disciplines. We shall gather together to share experiences and to gain insight on how to move forward with life after blowing the whistle with more confidence and hope. We will be highlighting the ways to heal from emotional trauma of being targeted for whistleblower retaliation and providing meaningful exchange between people so that social support can truly happen for those who participate. We will be joined by the welcoming spirit of the Interfaith Community of Kansas who shall be providing an enlightening exchange about how to emotionally and spiritually support whistleblowers within their communities through faith and community based organizations.
We warmly welcome our partners in this battle, the dedicated patient advocates, to join us in this exploration of possibilities for mutual advocacy. We openly encourage all law enforcement officials, police officers and attorneys to join us in discussion of common concerns and new avenues for future collaboration and cooperation. We thank our social service agencies for their dedication and hard work and wish to engage them in discussion of innovative ways to provide meaningful services to whistleblowers in the future.

Also if you are unable to attend in person much of the program is available over the internet by either blog talk radio or by webinar. National Medical Whistleblower on BlogTalkRadio Call in +1 347 857 4599 or by internet link at

Join the National Discussion about protecting Medical Whistleblowers so that they can inform our governmental leaders effectively about needed reforms in the Health Care system.

Protecting Medical Whistleblowers

Webinar ID: 251216291

Date/Time: Sat. Sep 12, 2009 2:15 PM - 3:00 PM CDT
Registration Web Link:
United States Attendee: +1 516 453 0014, access code 440628368
Webinar Password is: Medical Whistleblower

+1 347 857 4599

Join us in the Discussion.

Dr. Janet Parker DVM
Medical Whistleblower

A recent writer complained that she had paid "I think" 50 dollars for a two minute visit with a doctor who gave her a shot. Firstly, I find it hard to believe that a doctor spoke with her, probably took x-rays, and then gave her a shot in two minutes. Even assuming the doctor lunged at her with the injection as soon as he came in the room and the visit really did take 2 minutes- I'm not sure what her complaint is. Should she have been charged 10 or 20 dollars for an injection by a physician. Perhaps she would like to have paid in pennies.

Maybe I'm the one that is wrong, but yesterday I had an electrician over to my house. He charged me 200 dollars for ten minutes and he didn't even fix the problem. I paid him and thanked him for his time.

My point is that I believe some people have unrealistic expectations regarding personal health care costs. I realize doctors are held to a very high standard, but I never complain about their compensation. My wife had cancer and I paid all our copays and deductibles without a complaint. It hurt, but I was so happy to have trained doctors and nurses who could (and would) help us. I'm sure we have all had bad experiences with doctors, but on the whole I think we should all be careful what we wish for. Doctors could very easily opt out of all insurance (as many already have started to do) and charge whatever they want. Then there would really be a disparity in health care. Furthermore, if we continue to target doctors there will be less doctors staying in medicine. Why would anyone want to be in a profession where people complain about them, call them at 3 in the morning asking for their help, and then not want to pay them (and maybe even sue them)?.

Lastly,I hate to be too harsh, but to put things in perspective I'm sure most doctors make less than Mr. Moyer and probably about the same as most lawyers.

Money Driven Medicine. My problem is that greed, lobbyists, market insiders on health care have already spent millions on buying votes on the Hill of the Catpital steps, through campaign donations.Its called a bribe. Freedom is what you invest in. And the Health and Pharmaceuical industry has done it. So 18,000 Americans die each year for not having enough or no insurance at all. We have a 9/11 six times a year. Has any one noticed that at all. And we say we have the best health care in the world. Yes we do. BUT, only for the ones that can afford it. I did a very simple idea. I went to my Congressmen Murphy's Office in Doylestown Pa. I gave them a copy on "Money Driven Medicine" With a letter, and to give this to President Obama. And his office said that will be hard to do. WHY? And then I said Obama keeps saying he needs ideas and information. And I also said he does have a door to knock on. Besides the back door deals with all the pharmaceuticals. I feel that this mess is a vacum. Do we want change or not. Go to $8.00 And order a copy of this book and give it, in person for your Congressman. And tell him to read it.!!! And band all lobbyist's of the whole health care money driven medicine out of any and all negotiations!!! demand it. or vote them out, for independent politicians. The two party system has failed. Why are we lettig none elected corporate entities dictate our health care policy etc.. I think most Americans are afraid of change, because of our own corruption that dictates any change. Remember this. Health care is a form of a dictatorship of control and limited care for profit and not the rights of Americans and there health care needs. Profit of humanity..

Fifty million people in this country don't "qualify" for health care. My previous employer didn't mind paying for my insurance, but when I made a claim the premium doubled and I was dropped. Later I bought my own insurance through a group, but when I made a claim the premium went up. They said it was a regional increase. I said goodby. I wonder where all the state and federal medicaid money goes since no one seems to qualify!

Florence Speiser wrote, in part, "I am experiencing the consequences of money-driven medicine. There is only one type of medicine I can take for an autoimmune disease and I have to worry I will not be able to get it now (there is a nation wide shortage) or in the future. The medication is not the "standard" treatment although it was before the 1960's."

Thank you for your whole post. I believe that there is tacit agreement that in the future, the only medicines that will continue to be manufactured are those that require no man-power. The older medicines needed human beings around to adjust the quality as it was being manufactured - think of wine-making, for instance, you sample the wine at many different timepoints. This bit of "insider" info about manufacturing is the only piece of the puzzle that is missing from your story. I wanted to share because it helps illuminate one of the genius theories in place regarding "profit" - the real motive behind all the manufactured political perfidy that follows about "bad medicine" - low salaries and finally no salaries :-)

One area of insurance reform that must be addressed is the ERISA preemption of state rights pertaining to health and disability insurance. See and

I am experiencing the consequences of money-driven medicine. There is only one type of medicine I can take for an autoimmune disease and I have to worry I will not be able to get it now (there is a nation wide shortage) or in the future. The medication is not the "standard" treatment although it was before the 1960's. What has happened since the 1960's was the creation of a new medicine. The drug manufacturers of the new medication, Synthroid, has given very generously to the American Association of Clinical Endocrinologist and The American Thyroid Association. Physicians that receive fees and funding from the drug manufacturer are on FDA committees. The message from the drug manufacturer is that their medication is the best treatment for hypothyroid and the old medication is not to be trusted. The money they have donated to medical associations over the last thirty years has definately paid off in that almost all segments of medicine now state that levothyroxine(generic name) is the only treatment for hypthyroid. I can not take levothyroxine because it causes me to become more ill and unable to function effectively. I have never been so exhausted, anxious, nevervous, with palpitations, muscle/join pain, hair loss as when taking levothyroxine. Yet blood test showed "normal" thyroid hormone levels. However I am not believed by the medical community because of the staunch belief that everyone can take levothyroxine. I am not the only one that gets worse on levothyroxine but we are the people the medical community is willing to sacrifice in order to keep the money coming from the makers of Synthroid flowing to all the medical interests that are accustomed to receiving this kind of money. If Synthroid makes less money because people use the old medication, then these associations and consulting physicians may receive less money. With doctors on FDA committees with financial ties to Synthroid makers, the ability to obtain the old thyroid medication could become very hard with the FDA 2006 guidelines. I was hoping the Journal could help, however, I see that Dr. Sidney Wolfe of Public Citizen has been on the Journal. Dr. Wolfe and this organization do not have the correct facts on desiccated thyroid medication and spread incorrect information calling it a bad medicine. If it were not able to obtain desiccated thyroid medication, I would become more ill especially if I took levothyroxine. I would need more medication to handle the side effects and need more doctor visits to monitor all the medications. This is just what Money-Driven Medicine is about; spending more money on doctors and tests and medicine instead of a small amount for an effective inexpensive medication that allows me to function properly.

Jack Martin, "The primary asset each person has in life is their working years and the health necessary to be productive during that short time."

Pushing out everyone (even the "obedient" ones) over 50 years old who were working in the Medical Industrial Complex and then filling up corporate cubes with sociopaths and OCD minutia-miners who numb any rational attempt at lucid thought with their minutia is the PLAN for "cutting costs" and that's what the "unemployment numbers" ARE.

So much for a government that PROTECTS the individual against force and fraud, huh?

Told you that it's going to get stolen back :-)

Pualani Ramos | September 3, 2009 5:21 AM
Everyone thanks Moyers and Maher, but thank you Pualani for thinking about capitalism and private property at 5:21 in the morning.

A child's understanding can provide enlightenment about the puzzles of injustice through money, but people are not encouraged in these times to question the basics of earning, distribution and ownership. A couple of questions? Why is it that the idea of "capping executive compensation" (at a time when a few receive multiple millions, or even sometimes a billion within a year) elicits such a negative reaction? Why is it that a single pool payroll financed health insurance system is said to be "off the table?

A reasonable person with only a million dollars could spend $1000 a week for more than 20 years before having to earn more.
That would be more than enough to satisfy any basic needs. The command of large monetary amounts, then, is only a license to interfere in the lives of others, command their labor unjustly and to produce conditions of extortion and slavery. Why do we allow a wealth gap and an income gap so irrational and unjust when any thoughtful person can see that it could be remedied by caps or by a sharply progressive tax system? We are now in such an insane mindset of "Jackpot Mentality" that we subconsciously think our oppressors are contest winners and public officials game show hosts. (It's a rigged game!)
Global corporate capitalism is now so fragile that a constant insane frenzy of unrealistic expectation is required to sustain it.

The primary asset each person has in life is their working years and the health necessary to be productive during that short time. No only has the money frenzy displaced the value of this sacred and singular gift, but it has perverted existence by making the invasion of many lives by one the primary obsession of living. At some point a sadistic hierarchy of dominance takes life and makes existence unbearable.
Even the winners measure their enjoyment in the suffering of others as wealth is measured only by debt.

Pualani Ramos, for the sake of your son and all living people, please try to maintain the awareness you achieved at 5:21 this morning throughout the day, and the years to come, so that you will be able to ask the meaningful questions most of us dare not.

Good health and good coverage to you and yours.

It's time to declare our independence from the American health insurance industry:

Thank you Bill Moyers and Maggie Mahar for doing such fine work. Freedom of information is a big factor in making a democracy work to our best advantage.

As such, I have often wondered if it is possible to maintain democratic principles in a capitalist society? Our ideas demand equality in health care and other things. But if money is the driving force behind our health care system, how can we ever achieve fairness and real caring for those in need of medical attention?

It seems that the real concept of democracy came from Native American roots; a society that did not have private ownership.
As contemporary Americans, we may all have "inalienable rights", but if everything costs money, it seems inevitable that those with the most money, will have access to the most "rights".

How can this problem ever be solved? How can people with little or no money have equal access to the basic needs of life?

When my son was little I remember attempting to explain money to him, as he didn't understand why he couldn't just take things off the shelves at the store and bring them home. I tried to explain that we had to pay for those things. He thought for a bit and then said, "Mom, if no body had any money, we'd all be rich."

How can we let our elected officials know that we want real reform, not just more privatization i.e. mandated health insurance via private for-profit insurance companies like Massachusetts has now? I've already e-mailed my senators and congressman. What more can be done? Do we need to start a grass-roots campaign?

Hi everyone,

I am from Germany and have been following American politics ever since I have been to your country, where I have experienced lots of friendliness, hospitality and generosity from your people.

I am deeply moved when I hear about decent, hard-working people in the US, who lose their jobs and their homes and descend into poverty just because they happen to become ill, and as a consequence of that poverty, are denied access to medical care except for an emergency.

I am so sorry to hear about such fates, such as described above in this thread.

I feel that this is just wrong, morally wrong. Doesn't America's right boast to be a christian nation? Doesn't christian doctrine prescribe to help the unfortunate? Therefore, what is so christian about dropping all those decent and hard-working people into poverty just because they became ill? That is not my understanding of christian doctrine and christian values. Jesus himself went out to heal sick people! Nowadays, it doesn't take a Jesus anymore, we have science, technology and medicine at our disposal to heal many sick people, and yet you exclude some 50 million fellow Americans from that? Would Jesus have advocated that?

Being from a country that has had a public health care system ever since I've been alive (I'm 34), being from a working class family I've always been enjoying the benefits of the public health care system.

As a matter of fact, I have always viewed it as a major accomplishment of my country to organize health care for its population at much less cost than in the US, and I've always been proud of that facet of my country.

Now that I'm following the debate over public health care currently going on, I can only say that I'm utterly confounded by the argumentation. I simply cannot believe how simple and simply wrong the arguments proposed by Obama's political enemies are, and what puzzles me much more is why people who would actually benefit from the public option fall for it!

What is this talk about "Death Panels"? Where does that come from??

Why are you calling Obama's plan "Nazi Policy"? The public health care system in Germany has been introduced by Bismarck in 1883 - 1883!! - making Germany the first country in world history to have a public health care system, and that was 50 years - fifty years - before the nazis seized power in Germany. So what are these people talking about "Nazi Policy"? I just don't get it!

What is this thing with complicated schematics and the talk about "putting a bureaucracy between you and the doctor"? Do you really believe in European countries you have to navigate a bureaucracy before you can go see a doctor? What happens is that some 7% of your gross income is subtracted and goes into the health care system - the same amount is paid for by your employer. This stops at a certain income, 3675 Euros or some $5,000. If you make more, you pay 7% of 5,000 bucks nonetheless, i.e. the percentage paid for health insurance DROPS. (So this regulation is good for rich people.) At the same time, if you make more than that, you have the option to choose a private health insurance carrier that might offer additional coverage.

Also, you don't deal with bureaucracy, you simply get issued an insurance card. You go to any licenced doctor of your choice, pay 10 Euros at the first visit within a quarter, show your insurance card and that's it. No death panels, no Hitler salute, no bureaucracy.

So basically, the Republican propaganda is presenting you with utter lies, wrong information and lies.

However, it's really painful to watch from abroad how the American public is falling for the manipulation that is being pushed forward by whoever.

As a German, I can only say to you Americans: You are being lied to! Don't fall for it!

I was quite impressed by the statements that Bill Moyers made when he appeard on Real Time with Bill Maher. I believe he is a true humanist in the best sense of the word, and it reminded me of some of the words of our constitution:

Article 1: Human dignity

(1) Human dignity shall be inviolable. To respect and protect it shall be the duty of all state authority.

And moreover:

Article 20:

(1) The Federal Republic of Germany is a democratic and social federal state.

It says right there in the constitution that Germany is a social state; this article promises institutions like a public health care system.

Certainly, the reality offers a different picture sometimes.

Maybe to assuage the corporations over there: We in Germany have problems with lobbyism as well. Drugs and medical equipment cost much more in Germany than in other European countries, and that is due to lobbyism in Berlin.

As the health care system became more expensive, the government made cuts to the services provided to the citizens, while the obscene profits of the pharmaceutical companies remained untouched and kept on soaring.

So therefore, not to worry. Even if you have socialized medicine, lobbyists will find a way to exploit the system at the expense of the general population. This will not change even with a public option, if that's what you're concerned about.

In the end, I simply cannot understand how an ordinary American citizen can be against public health care, when she or he's the one that benefits, like they show on TV in those "Town Hall Meetings".

I just do not get it. I really don't. If you're an ardent christian, it violates core christian values. If you're a humanist, it's morally wrong.

So just what is happening over there?

Dear Mr. Moyers...Again and again, we thank you for your penetrating insight and courage. Your Journal on healthcare and money was excellent! Marjorie & Ellis Katz, Encino, CA

Maggie, thanks so much for "Money-driven Medicine" film and thanks, Bill, for airing it on The Journal. I am so disgusted with the conservative propaganda machine and likes of the "US Chamber of Commerce" from which I just got a flyer with a picture of a family of sourpusses that is SO distraught over the thought of "government bureaucrats making healthcare decisions". Like insurance company bureacrats are doing such a good job? I did a quick search about this orgnization and according to what I've found, it is a huge lobby paid for by the pharmaceutical and oil industries. And, judging by what I've seen in the media at the townhalls, a lot of (non-informed) people are buying this propaganda. Horrors! Socialized medicine like what Canada and European countries have! Lower costs and longer life expectancy - we can't have that! It's not only the likes of the chamber, but politicians like Senators Grassley and Boehner that have spreading the half-truths. I know that one of the things that make our country great is access to information, but why is there no law against spreading misinformation as these lobbies and sentaors are doing? I am hoping that people who watch Pox (er, I mean Fox) News will watch PBS and your shows and get the real story. Thanks! Bruce Juntti

I just watched Bill Moyers Critical Condition.No government role was mentioned in the entire film.
No corporate health insurance role came into the picture either.
No malpractice attorneys voiced a view.What the movie does, is try to convince people, that capitalism and free market competition is the main culprit.

I have been a nurse for almost 30 years and have seen the conditions deteriorate ever since. I have two questions/comments: one: nobody talks about why the pts get charged so much for each item. why does a suture cost $200 or a little device to prick an infant's heel for blood cost $35! What is the real cost and how does it multiply? Second, no one ,neither patient, nurse or provider needs to take responsibility or can when we do not know the cost of anything at the time of care. When the Obstetrician recommends a non medically indicated C/S, saying that baby us just too big, the pt has no idea what the cost to her and her infants health might be and does not know the financial implications of that decision! I could go on and on! I recently went to see a podiatrist for a follow up visit for increased foot pain. I paid my $20 specialty copay and saw the doc for 2-3 min and he gave me a cortisone shot. When I got the statement from my insurance company, it said that I had had surgery and the cost was $103! Had I known that, I might have just taken more Motrin. In the end, I paid I think $50 and sent a note to this doctor expressing my deep displeasure! I will not be going back and it is not because I do not have insurance, I do and do not want to be treated this way!$100 for 2 min! I usually go to naturopaths, chiropractors etc and rather pay out of pocket and get to decide if I can afford it at the time of the service provided and get the time and attention and caring and hands on care that makes a difference for my health!

Is this not about:

a) the next round of political campaigns?

b) the corporate squabble over which entities take how many taxpayer dollars?

c) returns on investment?

d) something else that we're being distracted from?

How is it that one burning question hasn't been addressed at all, namely, "Why are Americans so sick that they need so much healthcare?"


Why do Americans invest in healthcare, including retirement accounts, exploiting the medical hardships of themselves and others in hopes of a secure future in old age?


Why aren't Americans aware that causes of chronic illness from cancer to heart disease to asthma to Alzheimer's to diabetes and on and on are known (and are easily created in labs), but nothing is said or done?

Why does "preventive care" tend to amount to "fishing for diseases" to diagnose & treat, rather than refer to cleaning up the diet, detoxifying the body, one's surroundings, and the environment?

Why are Americans slipping in the global standings for education simultaneously with healthcare? Is the answer to that question linked to why we forget to ask questions? What is dulling us down?

How did our current, largely petroleum- and coal-based medical treatment system eclipse all other systems of healthcare in the public's awareness and knowledge, and why are Americans okay with this? What are this system's financial ties to agriculture? Water treatment?

Who decides what our physicians and healthcare professionals are taught...and not taught?

Who decides what is healthcare 'truth' and what is not? How much does it cost to be in charge of such 'truth'? Who pays? What is truth when its price is out of reach? What is medical 'truth' if it must first profit investors?

Why is it that only rarely do doctors know anything about mercury toxicity and deny it is and has been occurring? Why hasn't dentistry or medical care given it up in human implants and injections?

Why are we silent on health effects of chemicals, GMO's, etc.?

Why is it most doctors don't understand or even know of the methylation (detoxifying) processes of cellular, energy production center mitochondria? Why aren't patients made to understand these things in taking care of themselves and their families?

Why wouldn't nutrition and a clean environment be the first and foremost things physicians are taught in medical school?

How do all these things fit into capitalism, or worse, disaster capitalism?

With medical advances often causing as much or more harm than good, why are nature's time-tested remedies (often found in own's own backyard or at the touch of another) still demonized?

If mainstream healthcare is so overpriced and ineffective, why are Americans (and their employer corporations) still buying so much of it, whether through insurers or not?

to MHekler Stratford CT,


you would be well advised to stop reading so many books and talk to independant docs who are unrelated to hospital and insurance conglomerates and specialty syndicates.

I agree the AMA has been an obstacle. But arent you aware, the AMA reprsents only a minority. They are one hand taking from the industry and on the other pandering to trial lawyers.

Independants docs are not being heard. You will not read this in a book, Sir

And the most direct evidence of it is Medicare Part D. Fleeced an entire demographic of seniors with the help of the same industry groups, govt economists and legislators. Did anyone go to jail for this . Oh No. The same class is crafting the new reform bill. Wow... another wasted decade is on the way, many thanks to whitecollar fraud in the healthcare industry

Bill, Once again thanks for producing this program. As much or more than any journalist, you have been adding significantly to the understanding of this debate regarding the high cost of health insurance and care. I’ve seen a number of comments to the effect of: once we return control of medical delivery to doctors everything will be better. I agree that having doctors in charge of medical delivery is better than having health insurance companies or non-medical hospital CEOs making the decisions. However, I think comments like these are missing the larger picture. Each citizen, or patient, should be the ones in charge of their health care. Doctors and the health care delivery system in general are in fact subordinate to the patient. Doctors work for the patient. Doctors provide a service to the patient. Looking at this from the very largest view, that the individual health care “customer” has been convinced that they are not in charge of their own health care is at the root cause of this health insurance and health care chaos we find ourselves in.

The employer tax deduction for employee health insurance is another means by which most citizens have been separated from being in charge of their own personal health care. In continuing this employer tax deduction, Congress is telling American citizens that Congress knows what is best for each citizen in terms health insurance. This employer tax deduction puts employers and insurance companies in control of the vast majority of health insurance dollars. Of course, health insurance dollars can be viewed as each individual’s health care dollars. Some individuals may want forego health insurance and pay for health care directly. Bill, you would be doing a great service to have a full program devoted to the history and full current effect of the federal tax deduction for employee health insurance. This tax deduction is in fact the single largest tax deduction, larger than home mortgage insurance. I am convinced that once this tax deduction is eliminated and each employee has control of their health care dollars then we will be on the road to sanity in this current health insurance and health care death spiral. The big question is: if and when Congress eliminates the tax deduction for employee health insurance will employees receive pay increases equal to the employer’s previous health insurance costs? You see, sometimes when Congress steps in to do the “right thing”, over the course of time, very negative results can occur. I think this is one of those times. It has been said that many tax deductions, or give-a-ways, as I like to call them, have been used by Congress to “socially engineer” our society. Some of these tax deductions have been useful others have been detrimental.

By the way, in addition to eliminating the employer tax deduction for employee health insurance, a single-payer non-profit national health insurance company would be best. This should produce the lowest health insurance cost. If that is not possible, a public non-profit national health insurance company in competition with for-profit health insurance would be the next best arrangement.

Do you really believe Doctors earn too much. Should we continue make luxury cars, i.e.: Mercedes, Lexus, Infinity, etc, who would you give them to if you were able?

Lawyers, Politicians, Sports figures, entertainers, etc. and would doctors even qualitfy for condsideration by you?

You are sick. See a Doctor!

John Krieger

I think it's interesting that the doctors are playing the victim in this incarnation of this debate. Anyone who takes the time to read some of the many good books out there on the history of this issue in America knows that Americans would have had a national health care system decades ago if it the AMA and doctors had not blocked it. Granted those particular doctors are long gone but I really doubt that most doctors don't care about the money - if that were the case then we would not have all of the new docs going into specialties.

The ONLY reason the docs are on the side of single payer or a public option is that the insurance companies have made their lives just as much a hell as they have the patients!

I agree with Bill from Belle Haven - Employer sponsored health care will soon go the way of pensions - the writing is on the wall.

Anyone who support single payer or the public option might be interested in attending a Health Care Town Hall on Sept, 2, 2009 at Norwalk (CT) Hospital, 34 Maple Street, at 6:30PM.

Blogging is great but showing up to be counted is even better!

Stratford, CT

To whom it may concern,
Why do I get the strange feeling that the Democrats are treading water and not concerned about important social issues? What happened to change and doing what is right for the nation?
Everyone is playing the wrong tune while the ship sinks. People are in desperate situations and the people who are supposed to do something are running around like chickens with their head cut off.

I am currently un-employed (uninsured too). I recently sustained an injury that is costing me 60,000.00 in hospital bills...a mere ten thousand less than my ONLY non-home investment. I am unqualified for Medicare. I do not wish to file bankruptcy as my investment will be lost - JUST as I am negotiating to trade it for a small business.

What are people like me - uninsured and unqualified for assistance, suppossed to do, other than lose our ENTIRE life's savings?

Ms Mahar & Mr Moyers

Why not then. Both of you have an accomplished record of honest journalism and public interest. Why then have I for months of trying unable to find a single journo interested in the topic of medical fraud ie whitecollar crime. I am referring to the mounting tales of physicians persecuted by powerful Insurers like BC/BS and UnitedHealthcare and hospital conglomerates, with the aid of corrupt state licensing boards. All this just for speaking up about patient safety and patient care issues.

Why have seasoned journos failed to answer our calls and emails. Why have none of you done an expose on the National Practitioner Data Bank NPDB. Intended to out docs with malpractice claims but actually used to silence and banish into gulags any physician who speaks up. Where is your investigative story. You pick the venue and I will gather my peers to tell you real stories about medical whistleblowers being persecuted everyday.

You know healthcare reform of any stripe is doomed to fail unless you first deal with whitecollar corruption. Where is your story about the meteoric rise of midlevels and Nurse Practitioners UNfit to practice but actually replacing qualified physicians. Where is your story on medical cost control, Tort Reform and what is called Sham Peer Review SPR where doctors are legally persecuted according to the skewed bill HCQIa passed in 1986.

How can you control cost without Tort Reform. Which Journo will take that story. Regardless of what reform passes you dont have a prayer unless you allow doctors to Unionize and protected in doing their job and the freedom to serve their patients without retaliation leading to oblivious irrelevance.

Right now I cannot find a single journo to do a story about a 69 YO plastic suregon incarcerated in solitary confinement + clothes taken away. He languishes in Houston fed prison x4.5 months. And I cant find anyone amongst you to take an interest in such stories.

I am not sure I heard any nurse practitioners mentioned on the show. It seems to me that more RNs would get the training required to fill the void left by the shortage of primary care physicians. It also seems to me that clinics should be required to post rates for the cost of office visits and other standard care like minor illnesses and monor injuries so folks can get some idea of how costs compare at clinics in their area.

On this one issue President Obama has failed in his promise for real leadership in health care reform. He cannot claim to lead while making backroom deals with Pharma and the likes of Billy Tosen. I knew that many members of congress were bought & paid for by insurance companies, but it is painful to watch as the President fiddles with minutiae, while health care reform is set ablaze by moneyed interests. Has the President forgotten those who trusted & worked their hearts out to elect him?

Will elected Representives and Senators, specifically Democrats, have the integrity to stand up to the threats of the insurance industry? Will the fear of losing the 2010 elections caused them to bend over? The answer to these questions will reveal the future of health care reform.

With the current debate on health care, auto industry and bank bailouts previously, stimulus bills, the financial meltdown of last fall (remember Hank Paulsen holding a gun to his own head and demanding the money by Monday, no later), it's quite simple, really; capitalism is an addiction, democracy is the cure

Didn't take to many posts till I ran into some troll claiming Italy had "socialized medicine". What? The only Country in western Europe with any thing like "socialized medicine" is England, and you would be hard pressed to sell the people there our system. All the rest of the western European Nations have some form of regulated private insurance. Most Americans have never been been out of this country and it shows. And I'll bet the big corporations paid nothing for this gratuitous lie. People should ask for money for posts like that.

There are many threads and stories to the "business" of health care.

My personal favorite is the story of how one minor league "investor" (under 50K) in a biotech company ultimately ended up with a jail stint because the investor "lied" to the FBI about having insider information (daughter was dating the Medical Director of the biotech at the time).

Pop quiz time - anyone know who I am talking about?

Anyone want to trust the "process" people and the "industry" leaders with the "intelligence...?

Whatever "reform" that is in those 1000 pages and whatever "facts" that were cherry-picked to rationalize the "costs", the bottom line is that the INTENT (moral and ethics) is not present in our society (never has been on this issue, either, has it?) and because "government" simply keeps coming up with "laws" to protect the updrafted profits of the elite 1%, I am embarrased that I, once again, got sucked into a weapon of mass DISTRACTION - the health care debate.

But I'll forgive myself. Mostly because there is NO aspect of my life (and no "freedom" to retain some dignity) that is not open to political and religious manipulation for PROFIT.

One option seems to be to become a mime :-) Shouldn't be hard to "channel" the "emotions" via street theatre performing ahhrt...

Correct answer: Martha Stewart.

When the Industrial Military Complex TEAMS up with the Industrial Medical Complex, it can't be "good".

When you think about eveything else that we could have been doing to secure USA for a future of 12 billion people instead of saying "no" to children's dental work and rabble-rousing a "holy war" to clean out 3 trillion in surplus, it boggles the mind...

Mime act to follow....

OK Bill, You said that if congress read this book, perhaps they would look differently at the reform bill coming through (ok, you only said something to the effect...) So make sure that each member of congress has the book, then they can't have excuses. While you're at it, perhaps you can make sure they all know what the ex-insurance executive had to say on your previous show. Good luck and God speed.

Because I respect the work being done by IHI, it was great to hear Don Berwick’s endless passion for improving healthcare. His comment that “This is about two people meeting and that all it’s about” is a powerful descriptor of the patient-doctor relationship within a medical care model.

As a nurse, I believe it is important to recognize that medical care is provided within a broader context of healthcare. The notion that “two human beings in a relationship”… “is all it is about” falls short in recognizing that healthcare is about a clinically focused TEAM in partnership with the patient; a multidisciplinary team who also care deeply about their patients.

Nurses, social workers, dieticians, psychologists, physical and occupational therapists, to name just a few, are critical players in creating the comprehensive healthcare SYSTEM we dream of.

Regarding Bill Moyers' response to Bill Maher's question about the appropriate metaphor for use in describing the moral issues of health care (Bill Maher, HBO, 8/28/09), Bill Moyers said, "We're all in the same boat." I suggest we use, "We're all in the same lifeboat, and right now we're throwing women and children overboard."

It was a great show! One small issue that I'm sure has been pointed out before now ... Truman was NOT president in 1953 (save for the 20 days before the inauguration of Eisenhower)

Great P.B.S.: Thank you bill and maggie; There is so much truth in your story that to me my mind is still spinning. A item that was left out or one that a whole program could be done on is medicial bankrupcies . Is this why we all worked for 30/40 year.s so we could leave all our labour to a hospital etc? Just like the rest of this country they will soon price themselve,s out the picture . GOD HELPS THE NEEDY NOT THE GREEDY!!!!!!!!!

I am convinced something needs to be done... but since it appears that the powers that be (read: insurers, pharma, etc. and their $) will stop us from getting what we really need (read: a single payer national system, or even a public insurance option at this point), where do we go now?

How are Medicare costs per enrollee calculated by region for comparison in the U.S.?

Comparing Medicare Costs between NJ and Iowa: I suspect that the lower cost in Iowa is primarily due to the difference in re-imbursement rates for the same procedures, rather than fewer procedures.

Did you look into this?

Hi Maggie,
A friend of mine asked me to watch the Moyer PBS video and I did----What can I do to help? I am a teacher and the VP of a large union that wants to help--tell me what to do and I will---860-227-6668--give me a call--Tom

Maggie Mahar,
When do we put an end to Robbing Hood and his band of Henchman?
It used to be that moneyed people were concerned about the welfare of the people in their society.
It was called Noblesse Oblige (The obligation of the noble not buyer beware).
When empathy goes away, all we have left is sociopathic machines.
Without removing the cancerous corruption (lobbyists, self-centered politicians and crooked institutions) there is no hope for a just and equitable society. Institutions are not people; they are organizations with no concern for people. Their only concern is their own agenda.
Without regulation institutions become a threat to humanity (That is us).
If the economy crashes; there will not be enough hospitals to care for the millions of casualties.
Robbing Hood is guarding the treasury and is running up trillions of dollars of debt. It is the demand side of economics (you and me) that need the money not the supply side of the economy (banking, stock market and corporations) that need money. We need cost of living wages) to support the supply side of economics that are getting all of the handouts.
That is the only way we will be able make our economy successful.

Almost ten years ago, I had a rare medical condition occur to me but my experience was the opposite of what this film presents in terms of waste and unnecessary treatments and tests. In my experience, I found that there were not enough tests ordered and performed. I am not sure if it was because of inept doctors who just did not know what to do, or if it was because doctors are told not to order expensive tests to save money. Indeed my daughter's orthodontist admitted to us that insurance companies tell them to do the switch and bate routine--to tell patients they need one type of care when they need another. In addition, I personally heard a nurse verbally attack an insurance rep on the phone to not change medical codes. Apparently, the insurance company changed the code on the doctor's sheet to something cheaper). In my case, I had to go to five different doctors to finally get my condition even diagnosed and even then it was a toss. The first three thought that I had an ear infection and gave me antibiotics, which did not work, and never ordered any tests (well, except a hearing test, but nothing for diagnosis). One doctor wanted me to just sit in a hot bath and let the steam in my ear. The third doctor had me on a very high dosage of Augmentin, which eventually made my stomach hurt; he actually got annoyed when I questioned him about continuing that line of treatment. He eventually gave up and said "let's just see what your body will do". The fourth finally ordered a MRI and gave me additional medication, which again did not help, and he still did not know what was wrong with me, but at least admitted that he was stumped and sent me to another doctor. Bear in mind that I am getting worse and worse and still no fancy tests or diagnosis other than an ear infection. In the meantime, I am loosing my hearing and can hardly get out of bed (this went on for a year). The fifth doctor orders another MRI and more meds but admits surgery is probably necessary. He still does not know what is wrong. Also bear in mind that I told all the doctors that my mother had a rare tumor in her ear when she was young and asked if it was possible if had a tumor and they just shrugged it off. Eventually I had to have surgery, which in all essence was exploratory and the doctor said that he found some kind of growth or tissue and that there was something unusual about how I did not have any lining or skull in that area. The doctor never knew what was wrong with me until he received the pathologist report a week later that I had brain tissue in my ear canal. My points in this narrative are:
1). the debate concerning healthcare reform and points made in this film entails questions about waste due to unnecessary medical protocols, but my experience was the opposite. I was given very little medical treatment. What was the reason?
2). my experience and some of my family's medical experiences have been either canned medical diagnoses (after a while I could predict what the doctors were going to say), or none at all. It was take two aspirins and I might get back with you.
3). To sum up--me and my family typically receive very little care when it comes to any kind of health problems. Doctors have been very economical with us.

On a final note:
Although we have not experienced too much trouble from our insurance company when we needed medical attention in the past, we now have seen a reduction in medical services and have seen an increase in what we have to pay out of pocket. I fear that some of the changes made to our insurance policy, or lack of will deter us from seeking medical attention because of the additional cost on our part due to reduced benefits on their part.

I scanned this whole page and found numerous references to Wall Street; but zero references to the 'other' street, K Street.

Isn't it possible that the upper muckity mucks in the Democratic Party have something else in mind other than real beneficial reform of Healthcare?

What are the odds this is actually a big pander-fest to take K Street away from the Republicans?

I am registered as a Democrat, and watched last years longest Prez campaign ever re-hash endlessly over health-care reform, and everyone commented about how little difference there was between Hillary's and Barak's plans, except for mandatory plan membership or not. We assumed the question was the nature of reform, not whether if there would be any.

Now today we have, just as one example, White House deals with PhRMA behind closed doors, after a promise is would all be on C-Span. Not only is PubOption just a sliver, Single Payer is not even an also-ran.

I hear now that even John Boehner is practically foaming at the mouth with anger over the White House PhRMA deal. I don't personally have proof of intent, but I have to ask, is all this geared towards ensuring that in 2010 and 2012, all the lobbyist money diverts to the Dems as a reward for playing ball with insurance companies and other health vendors?

I was aww struck, this was great journalizem,I am one of many Americans stuck without health care insurance or help from the government,I suffer many diffrent illnesses,and I have to scrape just for money for a office visit, I am greatful for the slideing scale they have.
I do have a Neuroligest who refuses to look deeper into why and how can we fix it instead pushing medicens that don't work and has no comprehention of my last visit visites are spaced 3 months apart and always tells me my Tremors are better when he can see they are not.
I fired one Dr. for not careing one ounce and he took care of myFather when he had Pancreatic Cancer, he didn't care one bit, and assembly line Dr.'s is what they are, or at least he was.I sit here right now trying to keep awake due to my medicens just so I can say Brovo!! Mr.Moyers

Re., Health-Care Reform(?!)

My friend Hugh Cowan suggested this:

This Health Care Plan includes those services received by federal politicians.

It's a private plan, but a very good, efficient one.

No need to REFORM, and no need to outlaw what are perfectly legal American business enterprizes - The Medical Profession and the Health INDUSTRY, including Health Care Insurance Companies.

The problem with reforming or outlawing anything is that those approaches can be as wrong as the current system.

Make the Federal Employees plan available to every American who wants it? Every taxpayer FEELS as if he's working for the government, even as he KNOWS that it is supposed to be the other way round.

And the other companies have to compete with it for cheaper and better service?

Isn't that the AMERICAN WAY?

Capitalism. It works.

Great idea, Hugh.

If you agree, please tell BO, your Congressman and Senators.

Ann Slaby:
"We live in a city of dreams.
We drive on a highway of fire.
If we awake to find it gone; remember this our favorite town." (David Byrne)

We have faced many wars and continue to...
We continually face upheavals and catastrophes.. (9/11 inside job, Katrina-like neglect for profit)
Maybe the people like you hungry for the next spectacle of suffering are the very thing keeping this nightmare in motion.
Contemplate rather an herb garden, an afternoon assembling a puzzle with retirement home inmates, a Saturday walk around the neighborhood soliciting discussion on health care reform, a bird count at your feeder, or a craft you can master by long diligence. We are all made of the same stuff but what matters is how we arrange it. Someday you will tell off the bastards who are spoiling your joy to their face, and they will thank you for caring. (I have been infected with the ailment you are suffering but was cured by exercises of the heart.)

Here's a typical ultrasound radiology report, where the radiologist recommends "further evaluation" that is completely unnecessary but surely will increase revenue potential:

1. patient with history of biliary atresia
2. Reversal of flow in the main portal vein.
3. Numerous collateral vessels and varices. MRI may be useful for
further evaluation.
4. Splenomegaly

i hear alot about "doctor shortages" and as was mentioned on the program primary care docs are needed. i have a couple of questions:
1.would it help to give primary care docs a "free ride (no tuition)" thru med school if they commit to 10 years as a primary care physician after school?
2.i was poking around the net one night and found that there are lots and lots of med school applicants but just not very many slots at schools for them?
would it help if more schools (the education industry) expanded their med school programs to simply take more students?

Why can't we review all existing Health Care programs provided by other countries an choose the best items from each to meet our needs?

RE “Money Driven Medicine”. There are many levels of greed and injustice, but corporations are bound to their shareholders, and we can't expect anything different e.g. from device manufacturers who lobby congress for higher reimbursement for doctors who use their devices. Can we expect anything different from the doctors who use those devices to add $100,000 to their incomes? Even “good” non-profit, patient centered systems like the Catholic organization. I worked for saw devices as a way to survive low reimbursement for primary care. There needs to be a process to decide what our society’s health goals and priorities are and assign value to the extent that services result in meeting those goals. Tremendously expensive “Rescue medicine” such as organ transplants don’t contribute significantly to long term health. For example, valuing prevention of kidney failure higher and kidney transplants lower should increase survival for renal disease.
A separate and also difficult issue to resolve is competing hospitals buying the latest technology to attract doctors resulting in duplication and overutilization,
“Money Driven Medicine” documents that the goal of the “health” industry is for profit with the health of the patient too often secondary.
How do we bring health of the patient back as the central goal?
Hans Dankers, M.D.
PS. I am also extremely disappointed in President Obama's apparent selling out to the health care lobby as have so many in congress!

I am relieved to finally hear and see some of the truth about the medical health care industry exposed. It is important to note that primary care physicians are ordered by the insurance companies as to precisely what services they can offer. My primary care physician had a thriving practice in NJ until managed care came along. Then he was ordered to eliminate his on-site x-ray suite and laboratory services. He was told which moles he could remove and which ones had to be referred to a specialist, etc., etc. The bottom line is dictated by the insurance companies, an arm of the banking industry. Executives and others at insurance companies don't go to medical school or treat patients. They really shouldn't be calling the shots. At the heart of the issue is medical education. Most physicians have minimal education about indications for use of sophisticated diagnostic imaging procedures. There is also limited education on use of drug treatments. There is no such thing as one-size -fits-all testing or treatments.
The same pioneers (Senate Majority Leader Bill Frist, Senator Charles E. 'Chuck' Grassley) at HCA in Nashville that initiated these early economic changes are now behind the new faces in Washington who are also trying to do the same thing with continuing medical education. They want the insurance companies and health care corporations to run the show. Contact your government representatives and demand that continuing medical education remain independent through educational grants and NOT controlled by insurance companies, the government or hospital corporations.
And, finally, Chelsea has it right. 'Heaven' is where life is and this 'life' is just a dream.

Thanks for the excellent documentary. The insurance companies are really for health insurance "reform" so that it delivers millions more patients for them to cover. They are the ones against the public option. and we will never get real patient-centered reform without taking away the profit motive.All the people against reform have to watch your documentary. Is there any way for more people to be able to see it?
I almost was talked into unnecessary surgery myself recently. It depended on the opinions of 2 different neurosurgeons, and my primary care MD. The family MD warned I was in danger of paralysis, the neurosurgeon said I can do the surgery on you and don't worry, it will take care of the problem.2nd neurosurgeon said since your symptoms went away, you don't need surgery, most people have disc degeneration and since you had 2 MRIs you can see the problem, HOWEVER,you don't need major surgical treatment! Wow, I dodged that bullet. 1st neurosurgeon de-emphasized the possible surgical complications.Thanks to my dad, a retired MD, he was there to intervene and say let's slow down and consider the alternatives to surgery.Most patients are not so lucky and are persuaded by surgeons to treat aggressively.

I watched the show tonight at 6pm and have been crying non stop. What, oh what, can I do as an individual to help stop this rape of our medical system? I want to do something!!!! Please advise

Wow! What an insiteful and appropriate message.
Thanks Bill and those responsible. It will be interesting to see how this all plays out.

Though the presentation was on for profit companies (that wouldn't dream of trying to provide the lower-profit care Medicare recipients often need), has anyone looked at the improvements in VA care a few friends surprised me with? One pointed out an excellent example of providing care that was not as financially rewarding as it was soul satisfying. They said many Vietnamese refugees and their children became doctors and nurses in the VA system as a way of repaying our Veterans for their service made in behalf of their country. They claim them as "their Veterans"

To All:

The common man on the street does'nt watch PBS,not to mention they don't know Bill Moyers.

The question thereby lies on the fact that how do we get "Billy Joe" to know what is going on.

EXCELLENT work! Thank you.
Question: What do other countries do about malpractice claims?

It's amazing to me how many of our elected official fain ignorance at the basic issues at hand and instead weave tall tales based on their own sensibilities or sponsors. There is real truth in this matter, and PBS is a good start. Without this medium those few of us who care to read and think would have one hell of a time figuring all this out.
Thank you PBS

Many Canadians are shocked at the US system of medicine. Its not socialized medicine in Canada-its just plain "saving lives", when did health care become a matter of what is in your wallet as opposed to what is right and decently taking care of the sick and dying? Isn't that in the constitution also-the right to life even after the fetus is born? Where are the christian moralists now that health care costs is killing more people than abortions? I am surprised we haven't heard from them. Canada controls their costs for doctors, hospitals, etc., and their system works fine-anyone who says otherwise or that it is socialized medicine is a shill for the insurance industry. Medicine is not an industry it is a human right.

Just watched your program. I had a problem hearing a lot because the background music was too loud. I do think it was a very good and informative program, at least the part I could hear and understand. Why is the music so loud?

EXCELLENT DOCUMENTARY. The inherent conflict between a patient-centered health care system and a profit-driven health care industry will continue to be resolved in favor of corporate greed unless and until:
1. Contributions to elected officials by health care corporate entities are PROHIBITED BY LAW.
2. Elected officials are NO LONGER ENTITLED to tax payer subsidized health care greater than that which is available to ALL Americans.
3. America acknowledges health care as a BASIC HUMAN RIGHT and not an industry subject to principles of capitalism.

Health care and waste seem to go hand and hand these days. Two incidents come to mind immediately.

I was diagnosed with cancer last year. Gratefully, I have insurance through my employer and was given a clean bill of health one year post. However, my medical journey has been challenging to navigate.

We live in rural Georgia and travel to Atlanta for 95% of my health care. One reason for this is waste. The local regional hospital feels that a CT scan is required for everything. Example: During chemotherapy, I became dehydrated. Rather than travel two hours for IV fluids, I went to the local hospital. This facility was well aware of my medical issues. Upon admission, it was made clear that the problem was a direct result of chemo side effects. Yet they insisted on performing a CT scan even though they were "99% sure this is related to the chemotherapy." Well, hello! Let's not. How about we work toward stabilization and returning me to the comfort of my home? I declined the test for two reasons 1) it cost me over $600 in copays for the test at the local hospital AND 2) it was not necessary. Why would I agree to that?

After the initial surgery in July, I joined that 1% group that develops infection. This required a second surgery four weeks later. I was discharged with home oxygen this time. Approximately one month later, the home oxygen was no longer necessary. We notified the home health company to pick up the tanks and machine. That was early October. The week of Christmas, after several more phone calls, they finally picked up the equipment. Of course they billed Blue Cross for me "storing" their equipment for that six week period. In March, I received a bill from the home health care company for the oxygen used during December 2008 through February 2009. Since I did not use their services nor did I have any of their equipment, I contacted the company to dispute the bill. I also notified BCBS. The next month, a bill came again for an additional month of service not used. Again I notified the company and in no uncertain terms, let them know from my point of view, the billing was simple fraud. Blue Cross got the second call. I explained to the rep that I was doing quite well achieving my lifetime max with legitimate charges. My position was simple: get your money back and do not charge against my max. This song and dance went on until May 2009.

The company filled a form out wrong which allowed their system to continue billing me and my insurance plan for services not rendered. It took 6 months to resolve this issue. Meanwhile, over $1200 in charges had been billed and paid. BCBS continued to pay. Despite knowing the charges were for services NOT rendered, they continued to pay. No flag was placed on my policy. No second review notation for the provider was placed on my account.

Blue Cross could have cared less about these charges. And I am but one individual. Think of how many other people have the same thing happening?

This system is plagued with waste from unnecessary procedures to overcharging.

Oddly, I shared this story in depth with my two senators and my congressman. One never responded, two sent form letters that showed they have no interest in any form of health reform. I also sent a letter to the late Senator Ted Kennedy. It was his office only that sent a response that showed my comments had been read. Astonishing to me since I vote in Georgia.

And don't get me started about pre-existing conditions and having to stay at a job I can no longer physically perform without the aid of painkillers, but need the insurance so badly, I do it anyway.


forgive the typos please...that should be 'is having' and '$600.00 MRI (ie the cheaper one should be the one to go with)

I liked the show.

Im not a medical person so I dont know what qualifies as 'waste'. I do know that Ihave a disorder for there are no cures and a doctor I encountered just wanted to run a bunch of tests. I let him run one and it found found no answers so that was it for me.

I think we need to determine exactly what 'waste' is. I understand that tonsilectomies and appendectomies are done when a patient i shaving problems. It may not be required right at that moment but its done anyway.
I could be wrong about that.
Liek I say Im not a medical person.

I was, however, a technician.
When somebody brought in a TV and it needed an IC replaced, I also did 'preventive touchups' because Ididnt want to see the unit coming back into the shop. Would this be considered 'waste'. i dont think so.

If waste is 'unnecessary paperwork' then I believe that thhe House reform bill addresses that. Obama has said we need to reduce unnecessary treatment.
If one MRI is 99.5% acurate and costs $600.00 while another MRI is 99.6% accurate but costs $4000.00
then it makes sense to go with the $400 MRI.

Some people in this therad have presented good ideas and questions. i cant remember them all.

One final thing: this show wasnt about telling you what to think. Bill Moyers never is. He just shows a situation and gives his opinion along side some others opinions. It works for me. The doc and his daughter got to me. as someone else said 'Protocols'.
who makes these protocols and why? is it doctors? is it lawyers????
BTW - most states already some amount of tort reform. its wrong to take away the teeth of punitive damages.

Physician spouse and I watched and were confused by the sad story of the little girl with leukemia. The treatment of childhood leukemia is one of modern medicine's great success stories, something we know personally as my sister was one of the earliest survivors, despite a relapse (first treated at age 7 now 40 yo). It wasn't clear to us what the point was.

Might I recommend a great book by a Stanford professor who interceded aggressively in his own cancer therapy, someone with a deep understanding of statistics:

Finally, the biggest problem in our medical system isn't with the doctors. For instance, the real money made off diagnostic imaging is by the owner of the equipment, which without doubt should never be the doctor performing the service.

re: Obama selling out to PHrMA...

I dont really know whats on Pres Obamas mind but it seems to me that he needed a way to decrease big PHrMAs interest/desire in stopping progress (reform). I simply have to hope and trust that he didnt want to 'sell out'. I could be wrong but it makes me feel better.
Its a possiblity (and a probable one at that)

I seem to be the only American to see that it is not an insurance problem. It is a cost problem for the services rendered. In 2005 I had a sleep study, a one night stay at a clinic to check for Sleep Apnea. The bill submitted to my medical insurance carrier was $3300.00. A friend of mine had the same study at a different facility around the same time period and his insurance was billed over ten thousand dollars. This is in the realm of the $1200.00 oil change for your vehicle, or $75.00 for a gallon of milk. I call our present system “Greedcare”. The current healthcare bill that is proposed from all indications is to perpetuate the high cost for procedures and impose high taxes on everyone. The old argument is still in place which I believe to be a lie that the costs are high because of the past, not collecting money from others who did not pay their bills. If this is the case to some degree, they need to clean the slate and start over when a real healthcare coverage system the could be enacted that does cover everyone so that the next time someone has a sleep study like it did it would cost only $250.00 tops, and the cost would be paid by a real healthcare plan that does not rip anyone off, or intrude into our lives. Maggie, why can’t this happen? Why can’t they take the greed out first and then talk about insurance covering Americans?

I have been working as an advocate for health care reform, including the public option, for many years. One of the issues that is neglected in this discussion is the enormous amount of money that could be saved by tightening up physician self-referral laws. 30 cents of every dollar is spent on testing, and research has shown that 7 times more tests are performed when physicians have imaging equipment in their their offices or are investors in imaging centers, where they must meet quotas in order to capitalize on their investment. Patients are not only denied the choice of going to a radiologist owned and operated imaging center, but often pay higher costs for the same imaging exam, especially when told to have the exam at a hospital that owns the doctor's practice. Yet, we hear almost nothing about this obvious conflict of interest, and it appears that bills to address the loophole are going nowhere. It amazes me that such a common sense solution to help lower the cost of health care is being ignored. Why?

Bill & Maggie,
We have CURES for 98% of all diseases. Problem is outside the healthcare industry. I was an RN for many years... Today, I am an esoteric physician... Again. WE ALREADY POSSESS SCIENTIFIC TECHNOLOGY in the nmarket place THAT CURES DISEASE. yOU wont find it in medicine. I POSSESS THIS TECHNOLOGY!! Talk to me.

The protocols appear to be a part of the problem. So perhaps one question would be who came up with the idea of protocols and why? Would it be an end result of people's demands of oversight of physician care or would it be a result of hospital executives wanting a way to control or would it be something government came up with?

Something else to consider is that when people have insurance and have trouble paying for their medicine, co-pay can be yet another barrier to treatment. Public option where people would be forced to try to pay for insurance premiums is yet another financial barrier, another financial burden.

At what cost, Justin? Three weeks of daily spinal taps on a child? Radiation that is so severe that the child has to be put to sleep for it and kept in a room with padding all around it so that she wouldn't hurt herself due to the effect of the treatment for a few extra months?

I'm all for treatment but there should be a point during treatment of this magnitude on a child who has relapsed after previous treatment where a parent can say "Let's talk this over" or "This is too much pain for too little reward. It's time to stop."

Ms Maher, Dr Weinstein's story is not the shocking example that you intend--a series of treatments successfully prolonging his daughter's life for 12 years. Demonizing doctors, medicine, and science will not result in better health outcomes.

Mr Moyers, It is time for a follow-up on "Healing and the Mind". Many of the unnecessary procedures paid for with insurance and tax dollars fall under Complementary and Alternative Medicine (CAM). Accupuncture, laying of hands, aura fluffing, etc. accompany scientifically proven treatments at every major hospital with no proven effects.

Why would for-profit hospitals order expensive medical procedures that require calibrated equipment, national certification, and standardized training when the public appears satisfied with fake treatments under CAM?

Tony, define Socialized Medicine, please, and then tell me how this links to what was being said in this program?

This is the problem with the way Americans think. And this is a major problem in the way we respond to information that doesn't sit well with us.

The story is kind of a one sided view. It didn't even mention problems with socialized medicine. Just sang its' praises and that anyone that was against it, was because he was bought by big insurance companies.

I know there must be problems that exist even with socialized medicine. For example, I lived in Italy for two years and they HATE their socialized medicine. They would take anything over their socialized medicine.

I like seeing representative government being bought by the rich, as much as the next ordinary American. But I would also like to see a balanced, make up your own mind, news report. I guess I’m not an ordinary American. And/Or the episode wasn’t a report on facts, just a television program about opinion.

If insurance companies are so worried about competing with the government in health insurance, why aren’t they worried about competing with Medicare?

Mr. Potter says that insurance companies are worried about competing with the government in health insurance. But then he says that government Medicare is much more efficient and has higher customer satisfaction ratings than insurance companies. Why aren’t insurance companies worried about competing with government Medicare?

Also the baby boomers are a huge population that are going to retire during the next few years, why aren’t insurance companies worried about loosing all those customers to government Medicare?
I know when my dad became old enough to enroll in Medicare, he canceled his policy with Blue Cr*p/Blue Sh*t right away.

I have been a general practitioner for three decades and have witnessed firsthand a phenomenal growth in healthcare expenses. Physicians (I am referencing primary care physicians: family physicians, pediatricians, psychiatrists, gynecologists, obstetricians) are horrendous businesspersons. We think we know what we are talking about in terms of business, but in fact we are more easily deceived than the general public. We have been duped. Most of our families only realize this when the will and testament is being explained to them.
Two simple facts: The healthcare system is not going to be fixed in my grandchildren’s lifetime, so certainly not in mine. Our healthcare system cannot be fixed, but rather must be totally demolished and rebuilt from scratch.
Two simple, no cost, immediate healthcare Band-Aids: Permit general practitioners to practice medicine on a no-frills, limited scale (eg. annual income less than $175,000.00), without threat of malpractice or requirement of malpractice insurance. Permit general practitioners to organize collectively, yes unionize. This would temporarily offset the unfair advantage held by corporate healthcare and insurers.
Of course, these are "finger in the dyke" temporary patches meant to forestall catastrophe while the entire system is torn down by a radicalized Congress and White House, certainly not this one.

Mr Moyers.
Thank you so much for continuing to speak truth to power. As the veil continues to be lifted on the corporate spider-web that controls our nation another facet of corruption is revealed.

As an RN for 30 years I watched the transition from non-profit to for-profit healthcare systems.

As I observed the continued rift develope separating many from access to even minimal healthcare, I decided to return to school and now work as a PA-C in a geriatric environment.

If I had one suggestion to make as we continue the conversation on healthcare reform (while our system crumbles from insustainablility) it would be...start the process at the the bedside.
It is absolutely insane to see the skeleton crews that care for acutely ill people while ever deepening levels of Bureaucracy continue to be created.
I would love to take those making policy on a tour of the geriatric facilities in which I work. Registered Nurses spend most of their time in a back office filling out appropriate state mandated documentation. It doesn't take a rocket scientist to determine that all this documentation does not assure good care.

I love medicine and have no illusions about how screwed up our system is. Hopefully from the implosion will rise a phoenix that will honor the sacred relationship of the patient with healer.
Thanks again.

Wow! Loved this documentary! Very moving and honest!

I'm sorry to say however, the producers short-changed one of the most devestating components to our healthcare dilemma:
It's everywhere in healthcare. (I work in healthcare and see it everyday.) In fact, it seems waste is the primary fuel for the fire. Waste has to be dealt with, in all forms. Then and only then can we start slowing this out-of-control machine down. In my opinion this is where we'll get the most bang for the buck. This is where the reform effort must be concentrated. From my experience, waste is the fact nobody can or will deny.

Hello Maggie&Bill
Just finished parts I&II of Money-Driven Medicine.The relationship between private Hospitals and Doctors seems rather specious to me. Doctors, especially cardiologists and radiologists operate as independent practice groups.Some Hospitals have large executive staff with robust marketing and business development sections. It seems that Doctors and Hospitals are in collusion to do as many MRI's, xrays, ultrasounds, cardiac catheterizations, etc., as possible to maximize profit/revenue. "Evidence Based Medicine" (
seems contray to earnings potential, and generally not well received in places outside of Mayo Clinic, Johns Hopkins or Geisinger Health System.

after watching Bill Moyer with Maggie Mahar last night i was surprised at how much i did not know about the way that money plays such an important role in how our healthcare system is it seems that it should have been obvious to me & i know there are others out there like a senior citizen i remember how healthcare used to be. doctors had private practices & didn't have to belong to large healthcare systems in order to be able to afford to practice medicine.
i am so disappointed that the president is allowing the lobbyists to control him or is simply trying to get something passed rather than getting to the bottom of this mess...i have contacted my congressmen & women & received canned answers to my concerns, not even we'll take your concerns into consideration, how frustrating. i pray that the public will educate themselves enough to pressure washington to do the right thing. thank you..............

BARACK OBAMA: The pharmaceutical industry wrote into the prescription drug plan that Medicare could not negotiate with drug companies. And you know what, the chairman of the committee who pushed the law through went to work for the pharmaceutical industry making $2 million a year. Imagine that. That's an example of the same old game-playing in Washington. I don't want to learn how to play the game better. I want to put an end to the game-playing.

BILL MOYERS: Now look at this recent story in the LOS ANGELES TIMES. Lo and behold, since the election, the pharmaceutical industry's $2 million dollars a year superstar lobbyist Billy Tauzin has morphed into President Obama's pal. Tauzin says the President has promised not to pressure the drug companies to negotiate with the government for lower drug prices and has agreed not to allow cheaper drugs to be imported from Canada or Europe - contrary to the position taken by candidate Obama…
Denise Neville

It is sad that President Obama promised so much and now that he is in office is doing so little. It seems he has become the little sheep that lost his way and gone astray. Kowtowing to vested interests is destroying any chances of fixing Health Care and many other people services. It is the demand side of economics that is failing not the supply side.

I have two questions:

1) How much does the US government currently spend on health care? (Federal+State+Local government total expenditure)

2) How much would fully funding a US version of the British National Health Service cost?
(if the cost per person in the US was the same as the cost per person in the UK)

I always enjoy "Bill Moyer's Journal"; but this edition was especially personal. The story of Brianna on a much smaller scale, happened to me about 24 years ago when my son was born. I had taken him to his pediatrician for his initial check-up and seen by a nurse who threatened to "call the cops" if I did not immediately take him to the hospital without much of an explanation. Later I had to tearfully argue with our insurance company to pay the bill!

From many of the comments posted on the web site about Dr. Weinstein's story about the care received by his daughter for her childhood leukemia, it's clear that many viewers missed the point that Maggie and the filmmakers were trying to make: that much of medical care in the US is not based on science or evidence, or any knowledge about what works and doesn't work. As Maggie explained, the doctors say, "It's what we do in cases like this." This is a direct result of the guild-like way that doctors are apprenticed and trained. Instead of practicing with scientific rigor, research, and evidence, doctors are instructed to "see one, do one, teach one," thus perpetuating the generations-long reliance on chance and ingrained practices to cure and heal their patients.
Maggie mentioned the Dartmouth Institute finding that 33% to 40% of medical care in the US is waste and overtreatment. I wish she had also mentioned the Dartmouth finding that less than 60% of medical care is based on any science or knowledge at all. It's hard to understand why the filmmakers would have pulled their punches on this crucial issue, resulting in the loss of the take-home message by many of their viewers (including some doctors, apparently).

I hope that one day all americans will have health insurance but as long as healthcare is run by business men then they will always forgo quality care for profit.

Very depressing that Obama has already sold out and the cost will just go up and up

I am an aspiring physician and to be frank I dont know if i could practice in a profit-driven atmosphere...i would like to see more physicians come out and and speak candidly about the issues that they face without feeling any pressures but one, the hipocratic oath they swore to uphold...I would like to thank Bill and Maggie Mahar for this enlightment and all the others who put this together.....the major media networks should be playing this on primtime, but they have investors to look after and this program would not be conducive to profit...thanks again

Hi Maggie and Bill Moyers:
If I told you that I had a solution to Health Care, would you be interested in helping my company design and implement it? Let's talk solution. The process needs to be documented and written in a book, not for profit, so that everyone will know how to do it.


Charles E. Campbell, CEO Campbell Enterprises, Inc.

I know someone who's always going on about tort reform. Do malpractice suits really have that much effect on healthcare costs?

Thank you for airing this show.

Another point about the little girl with leukemia. Did the leukemia kill her or the "cure." Wasn't the point of her story more to give full disclosure instead of threats of lawsuits? The parents and even the child need to know what the protocol is and when to stop, something doctors may not be inclined to do. How much pain and suffering does a child have to endure... until it kills her? Doctors who threaten lawsuits are protecting themselves and their egos.


Are you saying it was appropriate for the doctors not to give complete information and to threaten the parents? Are you saying that you believe that is correct behavior on the part of the doctors? If this is true, I will never go near a doctor again until I check my legal rights!

Dear Ms. Mahar: A brief comment on your program
RE: James Weinstein daugter's illness. His duaghter developed childhood leukemia which appears to have be correctly treated. He claims that he did everything right and still his duaghter died. I fail to see any relationship to bad practice of medicine( hematology) as the treatment for childhood leukemia does not always achieve success. What is the point of this story in
" Money Driven Medicine"?
Marvin Kagen, M.D.
Board Certified in Hematology.




Always enjoy Bill Moyers program. What struck me here was the juxtaposition/use of comparison b/t "music row" and "health row". A sharp literary style device that stays with you.

The matrix chart of health care companies was also very startling. Health care needs to be put back into the hands of the doctors. Hospital/healthcare/health ins. companies director and CEOS should be MDs.

Dear Ms. Mahar: A brief comment on your program
RE: James Weinstein daugter's illness. His duaghter developed childhood leukemia which appears to have be correctly treated. He claims that he did everything right and still his duaghter died. I fail to see any relationship to bad practice of medicine( hematology) as the treatment for childhood leukemia does not always achieve success. What is the point of this story in
" Money Driven Medicine"?
Marvin Kagen, M.D.
Board Certified in Hematology.

Loved the program! I immediately looked to buy the film, but only to find out that "This item has been discontinued by the manufacturer." Wonder ... what's going on?

Bill, thanks for this program. You are performing a great service for all Americans with your many programs on health insurance and health care.

When I was growing up in the 50s and 60s, I remember that the French people were always striking, I don’t remember what they were striking about, but it seemed like every month or so the news reported a general strike in France. Everybody stopped working. Now I read that the French have the best medical system. Could the best medical system in the world have anything to do with the fact that the French have a tradition of general strikes? In order for Americans to turn the tide on the tyrannical health insurance and health care industries maybe we need a general strike in the United States over health care and health insurance. However, Americans do not have large scale work stoppage as part of their tradition. Is that because we have bought into the capitalism-work-ethic mythology? In addition how could a general strike against the health care and insurance industries occur?

Well, it is not as simple as a general strike for higher wages or lower food prices. It is not that simple because of the intricate weave between and among: insurance companies, employers, employer tax deductions, employees, medical technology, medical delivery, and drug companies. Once again Shakespeare comes to mind: “Oh, what tangled webs we weave when we first practice to deceive.” A single-payer, non-profit national health insurance company would help. This company could be either owned by the federal government or not, but a minimum it would have to be federally regulated. However, single payer does not solve the problem of a technology-driven medical industry. Even with single-payer, there would still be government regulations attempting to control the cost and profit margins of medical providers and drug companies. These attempts would almost surely be unsuccessful because of the influence the “health-care-complex” has on Congress, as does every large industry. So, what we need in America is a GENERAL STRIKE against the health insurance, health care, and drug industries. Instead of a general strike like the French would employ, Americans prefer the market place. However, in order for the market place to work, each citizen must have the ability to “vote” with their dollars. But American citizens do not have control of their health insurance dollars at this time.

In 1961 Eisenhower warned us of the ever-growing military-industrial complex, but he did not warn us of the ever-growing health insurance, health care, drug complex. The parallels between the two are most striking. It is interesting to note that Eisenhower originally termed the complex the military-industrial-congressional complex. And for health care the health-care-congressional complex would also be appropriate. This is a very tangled web, but following the money is a very good way to untangle the web. In this case following the money starts with employers’ tax-deduction for employees’ health insurance. Whether a single-payer or a public/non-profit option is ever achieved, ending the congressional give-away in the form of the health insurance tax-deduction is an absolute must. You see, this is where the tangled web begins – follow the money. Purchasing health insurance through employers must end. Once each employee has control of their health insurance dollars then the market place will begin to work once again. As we’ve come to learn, essentially all American businesses actually do not want the market place to work, but instead want control of the market place through whatever means possible. In this case the health insurance industry understands that controlling the market place means controlling each employee’s health insurance dollars and that means using tax-deduction legislation to take health insurance purchasing decisions out of the hands of individual citizens. So at this point in this convoluted mess American citizens do not have the ability to strike, or vote with their dollars, because their employers are in control of their health insurance dollars. Once each citizen has control of their health insurance dollars then many who currently purchase insurance may decide to forego insurance and pay for health care directly. This will force the insurance companies to be much more competitive and in turn the medical delivery industry much more responsible with the treatments they recommend. Health insurance will become much more like life insurance. It all begins with freedom to choose. At this time the American citizen does not have the freedom to make a choice regarding health insurance, and indirectly health care, because Congress has given out a tax deduction. Of course in return for the tax deduction members of Congress receive campaign contributions from the health insurance industry. In general we should review all federal and local tax deductions with this in mind.

Now, you might be thinking that this analysis and recommendation is coming from a right-wing conservative. On the contrary, I have voted exclusively Democratic. I consider myself an Independent, but one who has not found a Republican in a very long time for whom I could vote. More and more I consider myself a Progressive. Among other things, I consider that a Progressive attempts to make sense out of nonsense and at this time we have a very high level of nonsense in the health care industry. In addition I believe a true Progressive is one who believes in removing shackles that prevent individual freedom whether those shackles have been imposed by government or business or a combination of both. At this time I believe that French citizens have much more freedom than American citizens do and it is reflected in their superior health care system.

A couple of comments: The fact no seniors want to give up their Medicare is not an endorsement. I think it is far from that. The reason they want it is because it was bought and paid for with a lifetime of work. Private insurance is not available. Medicare, the "public option", "single payor", or any other plan that does not address the real drivers of the costs cannot solve the problem. Each of these is a special interest group and the way Washington wants to manage it is by reducing everything to Medicare levels. Folks, Medicare is broke and one of the poorest managed agencies in the federal government. A good study would probably find the administrative costs, waste, and fraud in Medicare equals or exceeds all private insurance carriers combined. The White House DID make a deal with the drug companies. If they really cared about costs why would they do that? Why do we have all these "no cost to you" powered wheelchair commercials on TV aimed at Medicare recipients? These things cost as much as a car. Who is approving that? Why are the medical supply companies delivering diabetic supplies to your door at "no cost to you". Want to bet what the mark up is on those spikes? But to a senior, Medicare is better than nothing. That's why seniors support it but no one with a choice would want to buy it. I don't think America can financially support it's population with a Medicare type system.

There are so many levels of greed and injustice, but we can't expect anything different from corporations such as device manufacurers who lobby congress for higher reimbursement for doctors who use their devices. Even the Catholic org. I worked for saw devices as profit centers and encouraged overutilization.
There has to be a process to decide what our health priorities are and assign value to the extent that actions result in meeting those goals. Rescue medicine is sexy but doesn't contribute significantly to health.

Competition by hospitals for doctors that results in duplication and overutiliazation is a difficult issue to resolve but is a major factor in high costs.

How do we bring health of the patient back as the central goal?

Hans Dankers, M.D.

PS. I am also extremely disappointed in President Obama's apparent selling out to indusry!

While I appreciate the critique of the medial system, which I understood to be medicine based on capitalism, I did not perceive reasonable solutions. One cannot merely make for-profit insurance illegal. Perhaps you could explore TR Reid's ideas on not-for-profit coverage. How would we transform our profit systems for a non-profit? What would the laws have to dictate? Would such a change be Constitutional?

In our Market driven system, actual price is not driven by market forces. As Mr Potter mentions, cost shifting to the consumer by Consumer Driven Healthcare products, is in our future. Under the current system, there seems to be no consumer advocate to fight the overcharging, inefficiency, and corporate culture for delivering procedures, testing, medical devices, and drug costs to "Covered Lives". Even if we do obtain universal coverage in insurance, all involved parties will continue to drive up prices. Providing increased insurance only ensures some sort of payment for a 'covered life' - it offers no advocasy for the person/patient. Unless 'usual and customary' prices are scrutinized, nothing will change. What is needed is a 'patient advocate service' to steer the patients thorough the maze of the healthcare system as it relates to specific 'disease and wellness' conditions at a local level. Treatment needs to be ordered and decided by physicians and advanced practitioners, but implemented and coordinated by medical professionals (i.e. Registered Nurses) who understand the details of the local marketplace and represent the medical, social, and economic needs of the patient. This is a true advocate of the 'person', who navigates the high technology, the complex insurance requirements - utilization review - and marketing "hype" to the consumer. Having non-phyicians and non-employees of hospital systems -- as independent advocates for consumers will provide a ballast in the fight for efficient care at reasonable pricing. The person will have more input in decision making with an educated direction of where money will be best utilized as it relates to the individual choice and the market price - not as it relates the rigged decisions in a profit oriented provider network. This will influence the price and efficient delivery of 'care' - not just ;services; - each market place.

Bravo Bill and Maggie!As a registered nurse that has worked inpatient hospital for the past 15years and been employed for 31 years in hospital,all of this rang true!The waste that the current medical system perpetuates is frightening, and the american public should be outraged!The insurance companies dictate to the physicians who are all terrified and over-order diagnostics due to fear of liabilty.It's all about procedures-(procedures pay!)and the days of using clinical judgement and basing the true need for diagnostics on exam are sadly gone.We are entrenched in an illness based model of care and not a wellness based model.Pharmaceutical and insurance companies are the dictators in a system that is out of control-they need to be regulated....

Thank you for airing this program. I have been stating that which was said for more years than I can remember. If our new health plan passes, we better be sure that 'patient safety' and delivery of quality care, is a major component. There are more problems than one realizes within the system now related to preventable errors that result in taking lives or leaving one without quality in their life. Since the 1999 Institute of Medicine Report, To Err Is Human, there has not been any significant decline in preventable errors. Scared???? You well should be. Perhaps we need to return to the 'basics of delivery of care'. Educated patients and their loved ones can prevent errors from harming themself or their loved ones.
Roberta Mikles, RN, Director

Why is there very little if any recognition of the fundamental problem that underlies our health care conversation? Why not consider American capitalism's comodification and exploitation of nearly everything, which self-serving greed has yielded today's expanding moral vacancy and spiritual void.

The Insurance business profits are not necessarly in stock investements, but in running the business. Much of it goes to CEO's, investments and equipement to compete.

As to the Town Hall meeting subject brought up..not much of those are on TV. The loudest, seemed to have the least facts. That's funny but not much value there.

People's time could be better spent by education...facts, not hype.

I do hope that PBS will air the healthcare series again. It is something the people need to watch.

Thank you Mr. Moyer.

I sold my healthfund at Vanguard and lost money on it. Where is all the ungodly profit I was supposed to be getting?

The Healthcare debate:

John Mccain held a talk in Sun city Phoenix. Nobody was given the chance to shout, but if this happened he or she was escorted out.

This did not happen when the Democrats did their talk. Why?.

Are the Democrats one step behind in everything they do?.

Nobody commented on why a Black woman was dragged by about 4 burly White men from a noisy get-together. Why?.

This same thing happened in Selma. The white sherif, I think his name was Clark, was seen in those historical movies, dragging this black woman. Nobody did anything of said anything. Not even the media. Why?.

Dear Bill Moyers,
If only someone the likes of YOU would be our President. You are the thoughtful voice of moderation and intelligent discourse. I just don't really get why J.Q. Citizen does not want the reform of a corrupt system. To me, they must be misinformed or have their fingers in the pot. I could go on but many before me have expressed my concerns.

I appreciate what Bill Moyers has done for almost 40 years? on Public Television but very few folks probably saw the Aug.28 broadcast of Critical Condition because it aired opposite the Teddy Kennedy Live Memorial Wake in Boston prior to Saturday's funeral.I hope you will repeat the broadcast wherever possible as it was moving,powerful and necessary.Thank you Bill Moyers Journal staff.


Does the deep financial situation that Obama inherited have anything to do with Obama's ca=hanging committment to bring Healhcare Reform?

If we assume that Insurance people would fill the unemployment lines, that would slow down a recovery.

Perhaps Obama is between a mountain and the Devil.

Still, when knowing the USA's healthcare system is rated lower than other does that give a pride in our nation's society?

Having spent 10 years in the medical industry in the early 70's I am surprised it has taken this long for the money story to hit. Watching it all happen made my stomach turn I had to get out.
I could not sleep last nite thinking my man Obama was now in bed with he likes of Billy Tauzin. Say it ain't so!! How can we get this story in front of Obama and find out what his reaction is?

The modern all-American health care system is based upon six fundamental principles:
1. Always claim the origin of disease is mysterious and unknown.
2. Always use therapy that is the most expensive and the least effective.
3. NEVER cure anything. Diseases are TREATED, not cured.
4. Since 95 percent of disease is caused by bad diet, ALWAYS encourage bad eating habits (alcohol abuse, etc.).
5. If therapy causes the mutilation or death of a patient, it is the patient's problem, not the health care system's problem.
6. Adverse reactions to prescribed drugs, the improper prescription of antibiotics, unnecessary medical and surgical procedures, unnecessary hospitalization, and price gouging are rampant in the U.S.

The most stunning statistic is that the American medical system is one of the leading causes of death and injury in the US, with treatment killing an estimated 100,000 patients each year. By contrast, the number of deaths attributable to heart disease in 2001 was 699,697, while the number of deaths attributable to cancer was 553,251. Price gouging by drug companies results in patient under-dosing with insulin and other drugs. This results in an estimated 89,000 excess diabetic deaths each year. When price gouging amounts to nothing more than mass murder it is a criminal act that needs to be stopped immediately. The initiation of meaningful reforms is long overdue.

The following Internet sites are recommended as a starting point for obtaining current health care statistics:,,,,,,,,,,,,,,, and There are many items, such as deaths from under dosing, that require you to conduct your own research or derive estimates from available data. Remember that the Internet is strictly censored so that anything the "establishment" does not like is not on the Internet. US health care spending reached $2.4 trillion in 2008, representing 16 percent of the nation's gross national product. No reversal of the trend is expected in the near future.

The United States is unique in that the objective of health care is not to cure disease, but to leave the patient bankrupt. In 2005 the average medical debt for those who filed for bankruptcy was $12,000. 68 percent of those who filed for bankruptcy had health insurance. 50 percent of all bankruptcy filings included large medical expenses. Every 30 seconds someone files for bankruptcy a result of a serious health problem.

The British system could be phased into the U.S. over a five year period thereby solving the problem. But again, this would be telling the truth.

8/29/09 12:51 PM

Dear Mr. Moyers:

I want to thank you immensely once again for dogging the health care reform issues.

Now I dare to ask you to present the unasked question: How does the popularity of “alternative medicine” and the billions it contributes to our economy figure into the debate without even being mentioned, so far as I have heard?

Why is it never mentioned when it is such big business?

Is this because “alternative medicine” – a name indicative of the rootlessness of the whole discussion – violates the profit motive of those upholding the status quo since it sells health and wellness rather than disease?

It is wild to me to see that “the world’s richest and most powerful nation” is powerless to make natural health the basis of its operations because greed and disease have such a monopoly over our thinking.

I think you could do more wonders by opening this matter up and pursuing it to the point that more people see the truth of the illness – mental, emotional and physical – that the status quo approach is enforcing by imposing such great and unnecessary illness and cost on us, contrary to our nature and our wishes.

Thank you for giving me someone to say this to who can hear it and get the ear of so many.

More power to you.

Janet K Bloom

Bill Moyers,
The year is 1517. The place is the campus of the University of Wittenberg. A man dressed in monk's clothing is walking slowly along the street. In his right hand he holds a hammer and nail. In his left hand he holds a sheet of paper.

The monk arrives at the large wooden front door of All-Saints Church, holds the paper against it, then drives a nail to keep it there. The top of the sheet of paper reads MY THESIS. Below that are these famous words: Indulgences cost too much. The paper is signed Martin Luther.

By the 1500s the case was not that the Christian Church was in need of some REFORM. What the gigantic institution was in desperate need of was REFORMATION.

Health care for human beings, planet wide, is not in need of Tinkering. It needs a new social contract between two divisions of humans: Healers and nonhealers. These two bodies first need to clarify the role that capitalism will play in their affairs. If Person A will profit from illness, injury and suffering of Person B then SAY SO.

The system by which any society distributes health care to its members is that society's answer to the question: Why have a society in the first place?

This was another great program. Thank you, Mr Moyers! I am so shocked and disheartened that doctors threaten to sue patients or parents for wanting to lessen the suffering they are going through. Did the leukemia kill the child depicted in the film or did the "cure" kill her? If the culture now is for doctors to threaten patients or parents, then instant this happens, the patient or parent should find a health advocate or even a lawyer and more the patient to another facility. How dare any doctor threaten someone. I hope any doctor who threatens someone is exposed and reported! My father was a doctor, a general practitioner, it would never occur to him to harm let alone threaten a patient!

There is so much more to be done to reform health care than I imagined! There are so many issues. I want single-payer health care. But now, I think the best thing to do is to identify all the problems and begin to make changes instead of Congress and Obama trying to ram through a bill, any bill, just to claim a "victory." It will be no victory is there isn't real reform.

Thank you, again, Mr Moyers!

I loved the quote that we are a society not an economy. An economy that fails it's society is a cancer in and of itself. And also, for the first time since this debate began I finally understand the reason why costs are rising. Thank you Maggie.

I enjoyed and appreciated the documentary “Money-driven medicine”, but I felt that two things were presented in a misleading way.

First, I think it is crucial to emphasize that a huge problem with “profits” in the health care industry is that they are going to investors who play no role in delivering health-care services. This point is badly botched in the movie. In the documentary, a doctor is shown saying that it constitutes “profit” when someone is paid a fee or salary for providing a service, and that is not correct. When a medical service, or any other good or service, is provided, paying the people who provided it is part of the cost. If an organization charges only the cost of paying employees, purchasing materials, and operating their office or hospital, that is a “cost-recovery” basis. One can pay the employees more or less, or lease a fancier or plainer space, but if everything that comes in, goes out, that is not profit. Salaries and costs are, in a market economy, kept in check by competition.

A step toward profit would be, when more is charged, but the extra funds are invested in research or improved equipment, enabling the organization to improve the services they provide. In health care, I think we would all agree that some research and investment in new technology is required. It is also possible for a private, for-profit organization to take in more than it needs to provide a service, and simply enrich its owners with the excess. Keeping this tendency in check is, again, the proper role of competition.

What we have going on in our present health-care “system” is a whole different situation. Public, for-profit health care is (and this is stated later in the movie) by law managed to profit shareholders. The excess funds taken in are redistributed to wherever investors choose – fancy cars, big houses, yachts – whatever. These funds are no longer available to the health care system. Companies compete not based on providing better or cheaper health-care services, but on providing more or less “shareholder value”. To get costs under control, we need to eliminate or greatly reduce the amount of money that is lost in this way. It’s not just a matter of reducing the number of costly treatments that are available to patients.

My second issue was with the way in which the situation of the family with the leukemia-stricken daughter was presented. Since I have a nephew who has struggled with leukemia and the side-effects of its treatment for 12 of his 17 years, I have learned more about these grueling and protracted treatment protocols than I ever would have wanted to. Such protocols have about an 85% cure rate for the first onset of leukemia, and a much poorer prognosis if a relapse occurs during the 3-year regimen. Re-starting the regimen because of a relapse has an even lower chance of achieving long-term remission than the initial treatment. Therefore, it is not realistic to undertake these regimens, especially a second time, with the expectation that the child will be cured if you do everything specified. I was surprised to hear the parent, a physician, express that oversimplified expectation twice in this movie.

Is this a conflict of interest? Blue Cross Blue Sheild is the manager of the Federal Employees Health Benefits Program...hmmmm.

And everyone knows "It's the Lobbyists". So who's gong to step up and be the Hero to stand up to "the Dragon"?

Why did the film devote so much time to the episode of the doctor's child who died of leukemia? It was a sad story certainly, and the father was clearly upset at what happened to his daughter. But he didn't indicate what he would have preferred--either from a personal or societal perspective. That she be allowed a more dignified earlier death, before being subject to years of horrific treatment? That her doctors be more honest about the terminal nature of her cancer? That our healthcare system focus more on preventive care than futile end-of-life treatment? Any of these might be legitimate reasons to include the segment in a story about why US medical care costs so much, but the film didn't clarify the story's relevance to that larger issue.

Words like ‘change’ and ‘reform’ engender fear in a great number of people, especially in seniors and especially so when discussing medical care. I contend that health care reform advocates made a major blunder in naming the issue. In addition to being simple and succinct, the phrase 'Medical Security' brings to mind the two most successful and familiar (and sacred) U.S. government programs: Medicare and Social Security. Perhaps there is still time to reverse the damage by replacing, ‘Health Care Reform’ with 'Medical Security’ in future conversations.

Meaningful health care reform will not cure this country's true sickness-corruption of the spirit,greed,pursuit of the wrong meaning of profit, corrupted and distorted values and systems, equality and more. I like what an earlier poster wrote. The parasite forgets the host can die. This country is not too big to fail. I enjoyed the program but tire of the debate.

I am mixed up by the comments about salt. I do not understand the point the commentator was attempting to make. Here is a fact: we Americans eat far too much of it. Salt has a huge effect in raising high blood pressure. Salt is added to much of our food. Unless you read the label, you'll never know.
Regarding health care: I simply have NO understanding why so many Americans feel that universal health care is something that is BAD, or that a public option is BAD. To me it is simply obvious that I do not want any insurance company or pharmaceutical manufacturer making a profit off my health. That is not the reason I exist. People certainly have a right to their own opinions, but when their reasons are irrational my mind simply cannot let them in.
Unfortunately, I do not know what can convince the nay-sayers except a terrible experience that somehow penetrates their consciousness. But that is a horrific thing to wish on anyone. How do you penetrate a teen-age boy's mind to tell him he must not drive drunk or on drugs or too fast. How do
you convince the law makers that we need universal health care? Europe had WWII. Japan had WWII. What will it take for us?

Back in the 1940's,every store had a canister for 'The March of Dimes' and we all contributed as much and as often as we could. Then Dr. Salk came with a vaccine that eliminated this terrible disease, and the March of Dimes gradually disappeared. In the ensuing 50-60 years, individual giving has been replaced by massive doses of government infusions into research for major illnesses, but in that time, there has not been a single cure for any major disease such as cancer, diabetes, Aids, MS, etc, etc. Every so often, we hear of a "breakthrough" on some disease but won't be available until some future date. (Yrs.) I have yet to see or hear of any of them reaching the marketplace. In the meantime we continue to spend millions on drugs that do not cure but maintain the status quo. God forbid but is there some conspiracy to make sure another Salk tragedy does not repeat itself in the phamaceutical industry? Would appreciate comments.
I am an 82 year old WWII vet who's kitchen looks like the corner drug store.
Thank you

Monopoly powers lead to high prices.

Monopolies in manufacturing
Monopolies in delivery
Monopolies in services

Lets see a table of medical prices for all developed nations from drug manufacturing to delivery services.

Finally, what is the indirect costs comparison for all the developed nations.

That is the doctors, nurses and those that work with patients costs compared to total system costs?

Let's talk about bureaucratic waste. Why not eliminate the cost and stress of all that paper pushing/documentation/time on the phone for the small items in healthcare. Currently most of the money spent for a visit to a primary care provider goes to paying people for processing paper work related to the visit. Government and insurance companies will be reluctant to give up their total control/domination of every aspect of healthcare, so it may require a bill which forbids third-party intereference for encounters with primary care doctors, with the exception of programs for the poor. It would restore the doctor patient relationship by bringing profit-driven medicine to its least corrupt form: The patient paying the doctor for service. The doctor is motivated, and his or her income/success depends on whether he or she provides the best service for the money. That will drive down the cost of healthcare at least for primary care, and motivate honest hard-working independent-minded physicians to be primary care providers once more. This will increase access and improve health outcomes while not costing the governement a dime except for those in poverty. Why has this not been proposed?

Great program. Cutting to the chase....the nature of the corporation needs to be addressed. Yes, it is legally responsible to its stockholders, but why can't it be legally responsible to its stake holders. Corporations may be the heart of our economy, but in our current body politic we have a major artery severed. The heart has one purpose, to pump blood, and will continue to beat even though there can be lethal consequences. The corporation will pump profits without an intact circulatory system even though it may be lethal to the body politic in which it resides. I think diagnosing this illness of our healthcare system requires a deeper look into the nature of our economy. Without legal corporate responsible to stake holders we be sick for a long time.

President Obama is looking more like Grover Cleveland

Hello -We already have death panels- they are the health insurance companies and drug companies!

47 million Americans are uninsured and the ten's of millions who are insured often don't get covered if they fall ill with something serious- Are we stupid or what? We already have death panels they are run by the drug companies that make trillions off of dangerous drugs that can kill you. Being totally profit driven, there are NO incentives to find cures and there are no check and balances! And if you don't have health insurance and you get sick and lose your job - tough - you might starve and die in the gutter. THEY DON'T CARE!!!! Death panels are already happening! WAKE THE HELL UP! If you don’t have health insurance you can die and many do. And the same is true if you have health insurance!

Since profits are apparently the root of all evil, perhaps the goverment should take over our factories as well.....

Posted by: Kent | August 28, 2009 9:29 AM
It's not so much profits being the root of all evil but HOW MUCH profit. When the ruling ideology is 'whatever the market will bear' then you simply have a system of exploitation. This kind of thinking seemed to come in vogue in the 1980's. If the prevailing thinking is taking a reasonable profit, say 10-15%, then the system more or less works out. Still not ideal but better.

Please comment on the article in the Atlantic by David Goldhill -"How American Health Care Killed My Father". Would these types of Health Savings Accounts work?

1 month ago today, I lost my beautiful 18 year old daughter to complications from radiation treatment of a reccurence of osteosarcoma (after 2.5 years of treatment). I, too was "threatened" with legal action. Actually, when I asked the general question of her oncologist early on, "Is there ever a point where you would say "This Cancer is too widespread...better to just go on a family vacation?" She said, "No, we will always keep treating the patient, and if you, as parent. refuse treatment, we can get a court order against you...What she failed to mention was that by the time of the recurrence, they were shuffling her to so many different doctors at so many different hospitals that no one was actually consistently monitoring her condition. My daughter suffered with a perferation in her esophogus for too long. She was supposed to be done with treatment and preparing for college when they finally discovered it and put her on a feeding tube ("temporarily...until the tissue heals itself") She was barely 18 at the time and they didn't bother to explain the surgery that was planned when they got her signed consent...she was so offended? yes! indignant? yes pissed off? yes! Then she gave up. She said, "My doctor doesn't think I'm going to make it..."

As good as Ms. Mahar's film is, it did not discuss what I believe to be the critical issue, the power of corporate money in congress. The format of Harry and Louise has changed, but not the basic thrust and its effectiveness. One well-defined question in this context is: Why isn't business, especially Detroit, leading the charge for single payer?
Thanks very much, Art Williams

I just wanted to respond to the comment about heroic leukemia treatment. To me the most significant part of the father's story was that he was told if he refused heroic treatment for his daughter he would be sued. Then at the end, he found some peace in his younger daughter's sense that heaven is a better place. Culturally, we have a tendency to fight death (failure) so hard that we often accept great burdens and suffering. I appreciated the way the father didn't give an easy or pat answer. His child suffered incredibly. They gained some good times together. These are tough decisions.

What does it say about us as a society/nation that even with facts laid out on the table,the powers that be continue to spin things in their favor and win ?
Two things come to mind: Ben Franklin's " Every nation gets the government they deserve" and this observation, " Republicans and Democrats have been asleep at the wheel for so long that history has moved them both to the back seat".

The recent program on "Money Driven Medicine" was otherwise excellent except for the central focus on the doctor's daughter who died from leukemia after having received heroic treatment. There are certain types of cancer which have an extremely poor prognosis from the outset no matter what is the treatment. This segment was a distraction which detracted from the main point of the program.
W. D. Clarkson, M. D.

BILL MOYERS: And remember that television ad Barack Obama made as a candidate for president?

BARACK OBAMA: The pharmaceutical industry wrote into the prescription drug plan that Medicare could not negotiate with drug companies. And you know what, the chairman of the committee who pushed the law through went to work for the pharmaceutical industry making $2 million a year. Imagine that. That's an example of the same old game-playing in Washington. I don't want to learn how to play the game better. I want to put an end to the game-playing.

BILL MOYERS: Now look at this recent story in the LOS ANGELES TIMES. Lo and behold, since the election, the pharmaceutical industry's $2 million dollars a year superstar lobbyist Billy Tauzin has morphed into President Obama's pal. Tauzin says the President has promised not to pressure the drug companies to negotiate with the government for lower drug prices and has agreed not to allow cheaper drugs to be imported from Canada or Europe - contrary to the position taken by candidate Obama…

Punked again!

BILL MOYERS: Each of these stories illuminates the scarlet thread that runs through Maggie Mahar's book - the story of how today's market-driven medical system gives Wall Street investors life and death control over our health care, turning medicine into a profit machine instead of a social service to meet human need. That's the conflict at the heart of next month's showdown in Washington.

To quote Calvin “Cheese” Wagstaff from The Wire, “This is some shameless sh** right here.”

Folks, "Money Driven..." is ONE opinion!!! There are many more out there, yours among them! It was interesting to see how the medical profession thinks about this aspect of their lives. Gave me a ton of info to think about.

If you didn't like it, you'd probably like "Sicko", Michael Moore's tome on health care. BUT to stop donating (if you ever have) to PBS because YOU didn't like ONE program, is insipid!!

It's like "I'm not donating to PBS' Reel Cinema, because I can't stand Paul Henreid" Jeebus, there's other actors out there, y'know.

There are more than one opinion out there, start looking at those opinions as information, instead of your enemy! G-d gave you brains, USE THEM!!!

I am tired of hearing the "tort reform" argument. As someone who watched her grandmother increasingly disabled due to the loss of two of her vertebra via doctor malpractice and who watched her grandparents decide not to sue and struggle with bills and an inability to get help (we lived halfway across the state) as she became more and more crippled, I strongly disagree. When doctors make mistakes it can have lifelong effects.

Before she died, she had a severe bend in her spine. She would put her head on her knees to nap. She literally could not lay on her back. She had an ulcer on her stomach due to the unnatural positions her organs took after her spine started shifting positions but which doctors couldn't repair through surgery due to the eventual fragility of her body tissue. She was in a lot of pain which was continual. So, as far as I'm concerned, you can take your "tort reform" and...

I did not watch the show from the beginning, so perhaps this was mentioned. What I did watch was excellent, but there are two things about the medical/insurance relationship that have concerned me for a number of years.

1) No one ever talks about is the how the patient has been pushed completely out of the loop. Patient goes to hospital. Hospital bills insurance co. Insurance company pays bill. Hospital sends bill for "remainder" to patient.

The patient has never even seen what he/she is being billed for and many times some of what is on the bills is bogus. Neither the hospital nor the insurance companies seem to care. Patients who try to get involved are just an irritating part of the business.

I know this from first hand experience. I once found out about a medical company charging for an expensive item that I never received. It took a number of calls and letters before I got these charges removed and the insurance company got their (my) money back.

It's patients who pay the premiums for the insurance to pay these bills. They should at least know what's being paid for.

2) Doctors and hospitals have pre-negotiated payments and know how the game is played. It is patients without insurance that really get the shaft. Here are two scenarios of what happens daily.

Insured patient receives care. Hospital sends bill to insurance company for $1200. Insurance sends EOB to patient showing the $1200 charge, but that the service was only valued at $300 and they’ve paid $139. The patient’s responsibility is $161.

Uninsured patient receives care. Hospital sends bill to patient for $1200. Patient is expected to pay $1200, for a service which is obviously worth $300.

Doctors and hospitals are just as much to blame for the outrageous cost of health care as are the insurance companies, drug companies, medical supply/equipment companies and attorneys.

how can we compete with other countries to keep our businesses here when most of the health care costs are put on employers? why should they stay here and take on that burdon when they can go to a country that the budon is put on their government and not their employers.....pretty smart if you ask me.....wake up people, keep our businesses here, its more important. this is one reason GM is in the position that they are, those poor people got all kinds of health care cuts when they went under.

I had a work related injury in December of 2000, had lower back surgery and through an MRI they found scar tissue hitting my nerve. Due to a request from my attorney I applied for Social security disability, and since the Bureau sent me to one of their doctors who said I was at maximum medical my money was cut and now I cant afford to get my thyroid medication, hormone meds or cholesterol medication.
My next avenue was the welfare office to get a medical card, in which i was told could take up to six months, told her i need my meds now and she gave me a paper for some clinics I could go to based on your pay scale.
I have worked my whole life up to 2003 and now i get to go see a doctor i dont even know, cant go to my doctor......where are my choices?
Please help to get this reform passed now.

I cannot believe the comments made by Bill Moyers regarding President Obama and Billy Tosen are true. Please verify and present an update on next week's show.

I sent the following message to the White House:

Please respond to the comments made by Bill Moyers on Friday night regarding President Obama and former congressman, now health industry lobbyist, Billy Tosen.

Is it true that they are now "good friends" and the President has promised Tosen that there will be no negotiated prices for drugs?

If this is true I am disgusted. I was a very early supporter and precinct captain for Obama because I thought he offered hope for real progressive change in Washington. Most Obama supporters want the current system overthrown. If Obama turns out to be just another politician gaming the existing system I and many others will be extremely disheartened.

Its too bad you fine expression of the real problem in healthcare will be just talk. Both you and Bill have no power, and your great words just fall on deaf ears. Its about late stage rapacious capitalism.

"Humpty Dumpty had a great fall!
...and all the kings men couldn't put Humpty together again..."

Start somewhere, anywhere and just get this done. To the members of Congress: we have tried to provide you with what you need to get your work done. Are you going to give in to the lobbys JUST to get re-elected? Just how good is YOUR HEALTHCARE, salary and perks that all you care about is yourselves? Stop listening to the media, the lobbyists, the 'squeaky wheels' back home and just DO IT? Gather up your staff, your commitees, whatever, shut the door, sit down and GET IT DONE! Please listen to me I voted for you!

Start: teach the american public they are RESPONSIBLE for their own health, teach prevention, teach wellness, tort reform, ease obtaining medical services. Couldn't a SOME medical services be mobile? Couldn't vaccinations, blood tests, strep tests etc... be available at your local pharmacies? Physicians where they are needed; not bunched around a hospital. How about posting rate schedules, what's wrong with co-ops? C'mon now let's get going! START

We've decided that it's in the best interest of our society to provide access to the professional services of educators to all citizens. We all share the costs.

Why isn't access to the professional services of medical personnel for all citizens deemed to be in the best interest of our society, as it is in the rest of the industrialized world? Why are we as a nation so unwilling to share these costs?

Why does our country insist on education for all - legally require it until a certain age - and yet tolerate the fact that millions of our citizens have no access to medical care, except in case of medical emergency?

Maggie, speaking of spreading the cost of care across the whole population, why hasn't the American auto industry made it clear - as part of the national health care debate - that they will never be able to compete in the global market as long as the cost of health insurance for their workers adds about $1500 to the cost of every car they make?

The fundamental issue in the development of a dysfunctional health care system is the application of actuarial strategies, the expertise of the insurance industry, to problems that require the clarification of the nature of the individuality that constitutes the ethical practice of medicine as defined by the Helsinki Accords. In the absence of personalization, the war-like strategies that include depersonalization, regimentation, rationing, and exploitation dominate the healthcare policy. This problem is not unique to healthcare, and is made worse by the enhancements in efficiency provided by information technology. The parallels to the collapse of financial markets, where the depersonalization of lending practices was facilitated by IT and exemplifies the dangers of a toxic bureaucracy including that of American medicine. The fundamental question is Why would boomers, who have created theses systems, have accepted the depersonalization of healthcare, when we tend to personalize those things we care about? It is in the exploration of the answer to that question that the riddle of why the USA has not followed suit with the rest of the industrialized worlds commitment to ethical care for all can be understood. Our system has not valued the effort to truly apply technology to the nature of human individuality, as this requires a willingness to carefully examine the deep nature of human behavior as it can be understood in an evolutionary theoretical application to complex systems. We have distracted ourselves with a debate about creationism and evolution that is unnecessary. Even if created the data is clearly best organized in the context of evolutionary theory, and it would be an affront to the creator to ignore all that hard work.

As a note to Ms Mahar, I have prepared a manuscript detailing my experience in addressing these issues in the context of ethical practice over the past 20 years, and have continually encountered the support of the patients whose outcomes are the test of the validity of the clarification of the causal mechanisms that underly health. The depersonalizing role of business structures are antagonistic to strategies, as they engage a bayesian hypothesis building analysis of data that conflicts with the actuarial approach. I believe you would be interested in the work, and I would be interested in developing a dialogue beyond what is possible in this blog space. I have tried to clarify the debate which is stagnating over the recognition on the part of the public that while the reform bills attempt to limit the exploitation, they do so by increasing the efficiency of depersonalization, as will insurance proposals, but this industry disguises that effort, while using it to discredit the reform proposals, another war-like strategy, i.e. a smoke screen. Repersonalization when effective, improves both outcomes and costs, and would benefit all healthcare systems. It has not been anticipated that this is possible now, and has been assigned to those working on genomic solutions, but it is in fact possible to cost-effectively apply available technology to the problem in the present. I hope that this is sufficiently intriguing to prompt further discussion.

great work by Bill and Maggie. I commend you on a very informative and thought provoking program.
The following link is to the U.S. Chamber of Commerce. To truly understand an issue it is imperative to review information from those whose opinions differ from your own. I would like to see the author sit down with the author James Gelfand and discuss this issue further. I would also recommend all of those in favor of a single payer system to visit the link and give the opposition fair and equal time.

I trust that next week The Journal will focus on giving some positive possibilities for changing the health care system. We heard a lot of what is wrong, a lot of stories; now let us hear what can actually be accomplished if anyone assumed the needed leadership to do it: how about tort reform - never mentioned when talking about doctor and hospital costs. How about letting insurance companies compete on a national level rather than state. How about just reviewing the piece on the Lehrer Report this evening about learning from the seeming success programs of other nations, e.g. Germany, Netherlands, and implementing successful practices in ways that work for us- keeping in mind that we serve millions more people. How about giving credence to the Wyden-Bennett bill instead of shoving it off the table as suggesting change (what a concept!) that the country couldn't be led, by the right leader, to understand and accept. David Brook mentions it often. How about growing up and suggesting people take some, some responsibility for managing their own health care. Looking forward to next week.

Society is, as it should be, all of us taking care of and doing the best for and with ourselves and each other

If sccialized medicine is so bad, how is it NONE want to give up their MediCare? and ALL I know love their MedicCare and wouldn't give it up??

As none I know want to give up police, firefighters, rescue workers, public libraries and other such 'socialized' benefits of living in a civilized decent society which occasionally gets it right by understanding that caring for and lifting each other to our greatest good is something we each and all benefit from.

And to the outraged person whose dad's incompetent care was terminated because they needed the bed to overcharge the next person for insufficient care**, that not only happened yrs has happened most every day since in too many hospitals and care facilities in this great country where we can do the many caring healers, nurses, therapists and physicians would like to be able to do. But first the fear and greed must stop.

**[incompent, insufficient care like my Mom got at Cedar Sinai Hospital in L.A. when the surgeons CAUSED her stroke by not giving her needed blood and then DID NOTHING for 24 hrs even tho I standing bedside w/ the Cedar Sinai surgeon correctly pointed the stroke signs out to her arrogant surgeon who left and did NOTHING, no blood given nor hyperbaric oxygen which likely would have not only ameliorated but could have ELIMINATED her stroke damage if given w/in 24 hrs, which it could have been as she was already in the hospital for a planned operation. And like the inept insufficient treatment my Dad got at Pomerado Hospital in North San Diego County where he contracted E-coli and then NEVER in his 3 wks he had to stay then to be healed from the E-coli he was given there, he NEVER ever got the 3x promised therapy needed to fix the injured shoulder he arrived in the ER with, instead the nurses had him pulling HIMSELF up using a damaged shoulder making it even worse [so not only NOT getting care, but actually DOING HARM..whatever happened to the "first do no harm" oath??] Scripps missed his stroke, I knew the neurolgist we all went with him to was wrong and not listening, anther appt. they put false notes in his records [luckily my sister was at that appointment and able to know and note that the notes in his record were false]. and his other Scripps M.D. re-prescribed a medication he'd done horribly on despite it being pointed out to her... yes, the same medication which ruined his special birthday trip also ruined the next major trip overseas....and what competent doctor changes brain medication 3 days before a patient is leaving the country to be half way around the world?? esp. when it is medication he did awfully on the first time she herself prescibed it!!]

There is so much wrong with this idiotic program.
I don't even know where to begin. The complete logical dissonance of the arguments in this program is staggering. Its a parade of arguments that contradict each other from one paragraph to the other. Arguments that simply don't belong after each other, and vapid bromides that mean nothing.

Why is single payer health care so toxic that it can NOT be discused by the network or cable news stations for what it really is non profit health coverage for all like medicare. That would replace the large for profit health insurance companies. This of course is very toxic for these health insurance companies, which are very powerful & seem to control many of our policies from washington.

Why are groups like the physicians for national health care with 18,000
doctors as members being totally ignored by the media
& not allowing them to air their health care commercials on CNN or any other cable news station.

Thank You for sheading some light on these important health care issue.

I am Canadian, living in Canada and,according to most reports in the USA, enjoying the benefits of a wonderful Health Care service. To be honest, I've never really appreciated the wonderful health care coverage we have here because I've always taken it for granted. Now after reading and watching what Americans are faced with, I feel very fortunate.
But I am concerned that the American Health conglomerates must find it uncomfortable to be so close to the Canadian system and must be trying to change our Canadian system to bring us closer to your system rather than trying to improve health care accessibility in the USA. Is this a possibility?

About Obama's back tracking on pharma's. Didn't he force a big concession by the industry to take a 20% cut in profits? I don't want to overly defend him, if that is still sucky, but he deserves some credit for his effort to eliminate a huge adversary.

Anybody who still thinks our system is too marvelous to change, except by eliminating patients the right to justice through tort actions, has not been to an emergency room in the last five years. I was impressed at how accurately, the show portrays the problem of people caught needing care when their primary care-giver is not available, like in the middle of the night, or on weekends. A new walk-in clinic that is open on Saturdays has been a god-send for our family, in need of care for unexpected injuries. Otherwise for example (and my neighbors tell similar stories), my son waited in agony with a tonsil abscess for three hours, in our hospital ER palace with acres of empty rooms, filled with expensive equipment and still the staff claimed it was a problem of not enough beds. He had insurance, but was unable to get care anywhere else because his specialist was on vacation. When the doctor finally saw him, he exclaimed at how dangerously acute my son's situation was. The triage staff were disinterested and clueless about what shape he was in.

If you are going to prop up profitizing as "the way," you can't have a system that does not protect consumers. The system we have now steals sick and injured people's wallets by fear, intimidation and the selling of ignorance.

I wonder how that sweet little girl they tortured with chemo, would have fared under the protocol's of Canada, France or England. Could the care there have been any worse?

I do not think America has the moral courage any more to pass health care for all.

A Different Perspective:

I recently served as a caregiver on the team that tended to my mother who recently passed away from cancer. I wonder why proposals for national health coverage aren't accompanied by calls for people to do more for themselves and their families and elevate their level of medical understanding?

To me its ironic that so many of the suggestions for healthcare reform sound like pleas to restore a healthcare system that could have existed had the right decision been made during the 1970s, 1980s and 1990s.

Why was ERISA allowed to be used in a manner that sabotaged the 1972 HMO Act?

Why were the open enrollment and community rating provisions that were part of the original HMO Act jettisoned?

I have just watched your one hour edited film on TV. Although relatively balanced when it comes to admitting to significant waste in the system- about one-third, it is still loaded with left-wing canards starting with the profitablity of private insurance companies.

No data was provided. I happen to have it courtesy of NPR, which is less than 1% based upon gross revenues for the industry as a whole. Doesn't look like much cost saving is available there- just perhaps $8 billion out of a $1 trillion revenue industry if you want to eliminate all profits from insurance companies and their incentive for cost saving would go as well.

I do not understand how a well-paid physician can whine about how medicine should not be for profit and not be commoditized or commercialized while he makes 5 to 10 times the wage of an average worker. Where does he and the film producers think all this money that the insurance industry reimbursements and government reimbursement goes for? Lounge room entertainment? The cafeteria workers?

I mean, is this guy willing to work for free then? Will medical device manufacturers and drug producers also work for free as well and donate their products to hospitals and private clinics?

I might be quite conservative in my political views, but hey I will be for a British or Canadian style system the moment they give up their enormous salaries. Even private insurance would be affordable if he were willing to work for free or at least take an 80% pay cut, which would bring him down to that of a beginning school teacher's salary in North Dakota (one of the lowest in the country, perhaps).

Medicine costs money because it is a service. If this physician and filmmaker want to lower the cost and make it more affordable to the average person, perhaps he should be aware of how much a doctor's salary takes up as part of the system, not to mention nurses and other assistants and technicians.

Nothing, with the exception of rooting out waste as the film maker noted, will do anything to lower costs other than to work for less. The industry is nothing more than manual labor inside of an office building. There is no way to replace a physician or technical assistant with a robot like at auto assembly plant.

And yes, both private insurance plans (40 percent of health care spending) and government insurance (45 percent), Medicare in particular, do incentivize waste- something libertarian economists have been pointing out for about two decades now.

Our system does resemble the former Soviet bloc countries economic system where information about prices and choices about different services were limited by the government. The filmmaker deserves some credit for pointing out the lack of information and how useful it is for making far more rational economic choices.

Medical care is just like other commodities and information about prices and availability of services are both ethical and rational just like it is for food, housing and clothing. Incentivizing waste as Medicare and private insurance providers have done for the past four decades is both inefficient and ineffective as the filmmaker has done a reasonable job of pointing out.

Let’s compare a public plan with a private plan. I have an excellent perspective because I have been on both types during the past decade.

Two years ago my husband lost his job because his company went out of business. Two months ago he finally found a job.

When he was unemployed we had insurance through our state: Pennsylvania:

We paid $70 per month for the two of us under the public plan. No yearly deductable, $5 copay to our family doctor, $10 for a specialist, and $5 for a medicine It did not include dental, vision, or mental health.

When he got a job we were kicked off our state plan because our income increased:

We currently pay $220 per month for the two of us under our private, employer sponsored plan. A $4000 deductable, $30 copay to our family doctor (only after the deductable is met), $60 copay for a specialist (only after the deductable is met), and the full price of any prescription. It does not include dental, vision, or mental health.

So our real costs (if we get sick this year) have increased annually from $840 per year, to $6640, not including any copays. Our income only increased $10,000 when my husband went from unemployment to full time employment.

What is more alarming is that this employer based plan is much worse than any plan I have had from an employer during my 35+ years of employment. And I suspect it will only get more costly in the future if reform is not initiated NOW!

Would I prefer a public plan similar to what we have in PA? Certainly.

Who wouldn’t?

Thank you for making this film and for writing the book. As an expat living in Canada, I applaud your efforts to make the problems with health care in the US understandable... I am curious about the story of the little girl with leukemia...while the treatment "protocols" were described as required-to- be- followed under pain of lawsuit which seems unbelievable and insensitive and inhumane, what was the point of that story? Wouldn't she still have the same outcome in a different system? Did they actually HAVE to do treatment? Was there no option to stop treatments after the first relapse?? Was this a child protection issue?

Thank God for journalists/researchers like Maggie M. & Bill Moyers and the incredible caring doctors like those in her piece.

It made me think of my wondrous superb NYC physician, Dr. NAOMI POOL,

who also practiced in Westchester County, NY. I thought they broke the caring physician mold when God made her; it seems there are a few others [tho far too few, as Naomi has said, "I'm so embarrassed by my profession...greed, greed that's all it is."] I think she'd like the doctors I listened to in Maggie's piece, and they for sure WOULD LOVE HER!, and she'd be proud of she surely should be immensely proud of herself.

I remain so grateful to have known Naomi Pool and been blessed by her competent, skilled, down-to-earth compassionate care and having her as my doctor for too short a time. I wish I could have carried her with me when I moved to L.A.; where I have NEVER been able to find a primary care doctor who would take my medical insurance.

I am so praying that

If we had that, I wouldn't have been waiting now for over 6 monts for the MRI I need, and I wouldn't be wondering whether the 'meat-cleaver-in-the-top-of-my-head' severe pain was a brain tumor, anurism, or what??, and I likely could have prevented the blindness of my left eye that is being caused by whatever is going on in my brain.

The last doctor, a neurological opthamologist in Palos Verdesm CA, while telling me to "be patient" they were getting me an appointment, in fact lied and did NOTHING, never even bothered to fill out the 'treatment request form' needed until having to be coerced by the doctor's office who referred me. It is this quality of care I fear will be the 'public option' if it not a universal Medicare for ALL system that has a real chance of fixing what is wrong and a real chance of creating a system of compassionate care.

But mine is just one of the "so many stories, all day long, all's so hard being on this [benefits] line, and there is nothing that I can do." which reduced the MediCal insurance WORKER to crying so hard that her colleague had to take over for her.

When even the workers are overwhelmed and made to say "I feel so bad", there is too much seriously wrong... and as the R.N. at the hospital said, "It [Medicare for ALL] is the ONLY thing that will work" to fix it.

And then perhaps we will also include prevention and other modalities [which has kept me healthy most of my life despite painful disabling caused by a violent crime yrs ago]
and would also include and utilize the expertise of such as my enormously gifted NYC acupuncturist Dr. Li and so many others who deserve to work in tandem with alopathic physicians......everyone would be better for it [pun intended]

Dear Ms. Mayer:

I am very discouraged with the health care system. My Dad became very ill and had to get tests for his incontinence. Centegra Hospital had called me and said he was ready to come home. When I got there he couldn't leave the bathroom because he was in such bad shape. He still was not over his illness. They could do nothing more for him and he had to leave so they could fill the bed he was using. I was outraged over his care. This is unacceptable. This happened quite a few years ago.

Socialized medicine, no.

Non-profit hospitals and health care organizations, YES!

Why, I ask you, would I want to trade my cold, heartless insurance bureaucrats for your cold, heartless, LAZY, and INCOMPETENT government bureaucrats?

Bill, restating the health care problem is a waste of my time at this point. I want solutions and reform... And your leaving a vacuum where solutions should be will not, at this point, lead to the socialized medicine I suspect you are nudging us toward. Sowwy.

Ms. Mahar, What organization should I contribute to in order to support needed reform of the medical health system?

Like the story of the woman whose husband died after receiving all the procedures at the end. People who work for a living make too much money to qualify for Medicaid or Medicare until they have lost everything, and by then it's too late.

Ms. Mahar:
It seems to me that we have a horrible situation in which the health insurance industry (and as your research points out, the hospital industry - not unlike higher education -) has so much wealth and power that reform is nearly impossible. I am wondering what you think of Health Insurance Cooperatives (I belong to my local Credit Union and my local Food Coop). I recently read an article on a Coop called Group Health Cooperative in Seattle, Washington and thought that their model sounded promising. I am also wondering about your thoughts on physicians who are moving to a "retainer based" system for patient care. While I would love to see a single payer system put in place, it seems to me that the goal now is to figure out how to move towards that in a way that undermines the power that the insurance companies have over the system. I have to wonder if forming health insurance cooperatives combined with the use of doctors via a "retainer service" would provide individuals with adequate coverage and care while taking their money out of the system that is denying them real care. Just curious what the thoughts of an expert in this area might be.

Dear Ms. Mahar: Thanks much for your insights. I'm trying to find out the name of an author and book written just a few years ago on the topic of US health care. The only clue I can relate to you concerning the book is that she (the author) claimed that 700 to 800 hundred people in the US die every three day from preventable medical mistakes. If, in your research, you have encountered her text could you post her name and title-Thanks again.

Kudos to Maggie, Bill and PBS for the informative, and balanced report on our country's healthcare industry. Individual citizens are pawns in the system. What can we do to improve the situation when ultimately greed trumps all.

I watched the Maggie Mahar special. very enlightening. I was a bit unsettled by the doctor who's child was put through all the chemo. He seemed unhappy that different proticols were used to try and solve his childs illness. My simplistic question is what did he want? Would he have been content with an apathetic doctorial staff? I would hope that every avenue to save my child would be pursued. He mentioned being sued, did that allow him to subject his child to procedures that he felt were not needed. As my grandson would say "just askin"

My husband passed away in 2005 after being very ill for 5 1/2 years. He received excellent healthcare at UCSD and was a medicare patient.

When I think of all the doctors and nurses and procedures that they did to try and save him, I thank God at how fortunate we were that he had Medicare... unfortunately, he had two bad kidneys, diabetes that was so advanced, congestive heart failure, heart valve damage from years of no health care -

Had we had better healthcare prior to his advanced stage of illness, he might still be alive....but then, he would not have qualified for medicare either -

This system is broken in so many ways and it breaks my heart that people have to be near death before they are given care - and had they received preventive care earlier, they would not need all these high cost procedures at the end of life which in the end cost more than on the whole of their lives.

Thank you for all your efforts on behalf of America. God Bless you.

Bill Moyers was an excellent guest on Bill Maher's HBO program tonight. Mr. Moyers is consistently the best thing on television.

And Ms. Maggie Mahar's program was also wonderful. I agree - single-payer health care is what we need. Mr. Moyers is correct: progressives must demand that President Obama do what we elected him to do.

My husband passed away in 2005 after being very ill for 5 1/2 years. He received excellent healthcare at UCSD and was a medicare patient.

When I think of all the doctors and nurses and procedures that they did to try and save him, I thank God at how fortunate we were that he had Medicare... unfortunately, he had two bad kidneys, diabetes that was so advanced, congestive heart failure, heart valve damage from years of no health care -

Had we had better healthcare prior to his advanced stage of illness, he might still be alive....but then, he would not have qualified for medicare either -

This system is broken in so many ways and it breaks my heart that people have to be near death before they are given care - and had they received preventive care earlier, they would not need all these high cost procedures at the end of life which in the end cost more than on the whole of their lives.

Thank you for all your efforts on behalf of America. God Bless you.

Dear Ms. Mahar: I would like to get permission to show your movie as edited to Bill Moyers Journal to First Year Medical Students at Loma Linda University School of Medicine. I am a pediatrician, but teach evidence based medicine to first year students and Social Justice in Medicine to first and second year students. I would also encourage your highlighting the major concern that many of the hospitals you mention claim not for profit status, gain monoplistic status within communities or regions (e.g. Central Oregon), promote over utilization, and have created a culture of over utilization. Further, physicians such as myself are forced to practice considerable defensive medicine that costs our system billions because of a medical liability system that is not driven by evidence or by standards, rather juries who are often uninformed. Please highlight that in our current health care reform debate, medical liability reform is no where to be seen.


T. Allen Merritt, M.D., MHA
Professor of Pediatrics, Loma Linda University Children's Hospital

Good piece tonight Maggy. There was nothing said about patients having to be advocates for themselves in the hands of healthcare. We are brought up to believe MD's have all the answers and their word is truth. The public must educate themselves about their bodies, illnesses and CHOICES and ask questions.

Thank you for tonight's program. Profit before people is the American Way. We all must work very hard to change this thinking, whether it applies to health care, education, housing, or any other human need.

Maggie, a great report--a terrible report.

Great, because you had the good sense to check in with Don Berwick.

Terrible, because you assumed that the past must be prologue to the future.

Even Don didn't mention that YOU DON'T NEED TO DEPEND ON MD'S as the be-all and end-all of healthcare delivery.

I can tell you that it's a forlorn hope to think that enough MD's will step forward to deliver the primary care--and the primary ELDERcare, or geriatric services--at affordable costs.

If you assume that only MD's can deliver quality service to the public, you're locking yourself into an inefficient, costly, and (even now) male-dominated model.

You also haven't dealt with benefit design, technology assessment, and basic risk assessment and financial management, and how these important elements are shared by providers and recipients of services.

Go back to the books and read Paul Starr's unmatched, Pulitzer Prize-winning book, "The Social Transformation of American Medicine." And understand the deep meaning of that book, not the superficial story of how physician- and hospital-based medicine emerged in the 20th century as the paradigmatic model for health care.

You also haven't talked about the huge underlying lobby, tapping in a privileged manner into the capital markets, that develop and profit from new technologies.

There are better ways. They involve much deeper changes than you've addressed, and fundamentally they involve a major adjustment (NOT the destruction) of the physician- and hospital-based system. This extends to related social systems such as the legal and insurance systems, and even bedrock expectations on the part of the 'consuming public' (patients) about their obligations and what they can expect in return.

Thanks for a very valuable and thought-provoking book (and spinoff video).

Dr. Churchill is on the mark in his description of our health care system as being fundamentally broken in terms of the kind of conflicts it raises in the minds of physicians and in the minds of the patients. “We're now treating medicine as if it were an industrial product… no matter what their condition, or how many kinds of problems they have, or how complicated their diagnoses, or how much reassurance they might need, is an idea that you can treat medicine like a production line product, and you can turn out patients in the same way like we produce widgets. That's a commercialization and an industrialization of the relationship.”

I was a nurse employed by a large for-profit hospital corporation, where ill patients requiring complex care are reduced to standardizable, predictable units of production with one-size-fits-all solutions. Business concepts of efficiencies and productivity determine health care priorities. Templates that make the hospital look great and in complete compliance for regulatory agencies and (CYA) meaningless forms and paperwork take priority.

The midnight census (number of patients at midnight, which is the lowest volume, determines daily staffing), patient acuity systems, clinical pathways, and benchmarking (no matter how many warnings about how deeply flawed these theories - managing costs rather than managing care - are when it comes to dealing with the complex care of ill patients; deteriorating working conditions; and poor patient care) trump compassion and quality of care. Nurses are told to work harder and smarter, to do more with less, and to ignore the totality of their patients’ needs.

Ill patients and their families do not make perfect customers. When patient satisfaction surveys plummeted, staff was asked to identify dissatisfied patients, so that they could be excluded from post hospital surveys, and to identify extremely satisfied patients, so they would be targeted for the surveys. Making dissatisfied patients and families disappear. “You juke the stats.” Improved patient satisfaction scores are now being heralded. Managers become assistant vice presidents, assistant vice presidents become executive vice presidents, taking what is not progress and what is not valid, and glossing it up and to say, "We're doing a great job."

As David Simon said, “You show me anything that depicts institutional progress in America… anything that somebody can get a promotion on. And as soon as you invent that statistical category, 50 people in that institution will be at work trying to figure out a way to make it look as if progress is actually occurring when actually no progress is… the same game is played everywhere. That nobody's actually in the business of doing what the institution's supposed to do.”

As Dr. Churchill said, “It shouldn't be any surprise that there is a huge disconnect between the amount of dollars that actually poured into health care and the health indicators because this system was not designed to serve this end. That's a fundamental realization that we need to come to. And until we do we'll still be trying to tinker with the market in some kind of funny way. Just a little tweak or adjustment to make it work better, but it was never designed, actually, to meet health care needs.”

Thank you, Ms. Mahar for the wonderful expose you've written on our broken system, if we can call any of the healthcare mess a system. The film nicely drives home key points you've made in the book.
The discussion on Capital hill is very difficult to follow for anyone: Democrat, Republican or Independent.
I'm a physical therapist and owner of a private practice in Western Colorado. I can understand how healthcare personnel are anxious about possible cuts and cost-containing measures; however, I don't follow the fears of the middle class and lower socio-economic persons who will likely benefit from strong healthcare reform of healthcare costs. Our company's healthcare premiums, just this last week, went up 35% for the year. How can the small business employer continue to shoulder the crushing burden of healthcare costs? What, if anything, is proposed in Congress that might begin to curb the terrible inflation to purchase healthcare? Perhaps the more radical bills in Congress, which would remove the tax exemption for healthcare insurance for employee would unbind the 'beast' of healthcare costs. I would be interested in your thoughts. The irony of being a healthcare provider AND feeling the crush of cost is not lost myself and my family or our employees. Thank you. Britt Smith PT, DPT

Ms. Mahar, One of the final points of Mr Moyer's show was that medicine should not be money centered, and the implication was that it should be politically centered; i.e. run by the government. I have a serious problem with that.

From an economic standpoint (yes, I'm back to money...) do you believe that if patients bought their own insurance, paid their own physicians, and received reimbursement from their insurers, that the interaction between patient and physician would become both less expensive and more caring.

Americans tend to believe health care is free, and they believe it is the system's responsibility to make them well regardless of the degree of unhealthy actions they undertake. Gov't health care won't change that, and I don't believe that American politicians have the will to not add more and more costs and coverages to a govt run system in order to buy votes.

Compare the admin costs of auto or homeowners insurance to those of health insurance. The enormous disparity is due to govt interference in the "market" (in actuality, there is no market), and the insurers ability to 1) manipulate the environment and 2) change the environment to their advantage via buying politicians.

Right now, insurers control both ends of the health care economy - they set the rates oligopsonistically to employers, and the set the prices oligopolistically to providers. Neither the pt nor the physician has any significant role in the system. Physicians are presented with take it or leave it contracts, amd patients are treated essentially like walking billing statements. The only economic incentive physicians have is to do "more care", because their profits per unit of care are essentially fixed, and fixed badly.

The notion that a more rigid adherence to the hippocratic oath will fix medicine is naive, at best. Business cannot be separated from medicine at the individual level unless govt runs it, and busoiness cannot be separated from medicine at the government level unless lobbying laws are changed substantially. I believe changing the basic paradigm of employer-supplied, physician contracted health care is the core issue of both for profit and non-profit medicine in America, and it would be less difficult to change this paradigm than to change lobbying laws - not that it would be easy, bu any means.

If you could comment on these basic principles of insurance I would appreciate it.


Albert R Davis, MD

Why don't you mention the costs of Malpractice insurance and the fact that there are 1,143,358 lawyers in the US with a population of 303 Million which is 1 for every 265 persons. France, for example has 45,686 lawyers with a population of 64 million or 1 for every 1,403 people.
These lawyers all make an exobinate amount of money. One firm in Florida got over 1 billion in the tobacco settlement.

What was really telling in the Obamacare infomercial is that the role of litigation and government involvment in driving up health care costs was never addressed. The entire focus was on the evil corporations that drive up cost while no real analysis was done on why or how this came about. Real reforms such as the following werenever addressed: tort reform (loser pay and caps on punative damage), tax reform (a tax deduction for individuals rather than empolyers) which would give consumers greater control and result in wiser decisions since they care more about their health than their companies, the use of vouchers for uninsured people to buy decent private insurance rather than inefficient government programs-again more control and better decisions, and the expansion of insurance pools nation-wide rather than limiting them to individual states was never addressed. If we paid for medicine like we do for car repairs on a fee for service basis with insurance reserved for major illness or injury (as car insurance is for major accidents) consumers would have more control, make wiser choices and doctors would once again be able to have private practices that they could run as costs would be reduced dramatically (especially with the other reforms mentioned).

If only those that are ranting and raving across America about socialism, and government control would watch this program. The truth is such a powerful thing, and that truth was delivered tonight. Thank you Bill, and PBS.

The most ubiquitous and salient fact of everything I have read and heard is that all other industrial countries do more and better with less.

I am a RN Medicare Case Manager for a non-profit nursing home in Iowa. Our society has lauched a program called "Where is the soul in all of this?" Thank you for airing this program that affirms my vision for where our country must travel to indeed find the "soul in all of this". There is hope.

Is it possible to reverse the discussion on health care reform cost from, " It will cost a trillion or more dollars for the U.S. to do this" to what is the monthly cost for americans in each monthly income bracket to pay for health care. I don't understand trillions of dollars but I do understand what it will cost on a per month basis. We can then add up the income from the program and decide who will pay the difference between what will be coming in and who will pay the difference to maintain quality health care.

Dave identifies the central problem with the US system: It is employer based. Hence, you lose your insurance when you lose your job. The employer based system is a direct consequence of Federal tax policy. Employer-based health benefits are tax free; private plans are paid for with after tax dollars. People are NOT irresponsible if they work a lifetime and then lose their insurance when they lose their jobs; government has been irresponsible by a tax policy that has made this the norm. In a sense, this is because "insurance" is, in an emploer-based system, confused with "salary". My problem with Moyers is that he tells us the horrific case, but does not explain the cause, or propose the solution that addresses the cause: All insurance is for the insured individual, regardless of who pays for it.

I thought the segment was very informative. As long as we assign any one segment of society, ie, (business , health insurance, American Medical Assoc. , government, )to oversee medical care in this country , we will have many problems with providing health care as it should be provided. What is not helpful with health insurance ruling care is that too many patients are blamed for health difficulties without consideration of the human condition and our environment. Even if you have money, and can afford care, you will not get the best care if you have lung cancer and smoked. You will be blamed for the cancer. this is a result of insurance actuary tables . Nothing else. Oversight is not good . I favor the least intrusive system so that doctors and patients can work out the care based on what the patient needs instead of what someone else decides the patient deserves. thank you for allowing me to chime in

No one seems to question the euphemistic and misleading term "health care" in the debate. As a metaphor we use to think about our situation and its alternatives, the term is flawed. Arguably, we do not have an actual health care system in the sense of promoting either health or care as primary objectives--rather, we have a disease management system--and a broken one at that. "Health care" is a sanitized and amorphous spin concept that can quantified at will into flexible units. Did anyone catch what Dr. Berwick had to say toward the end of the show?

In referring to the sytem broadly, when we speak of health care we are committing a category error. If we could correct our metaphors, maybe we could make more meaningful progress in addressing the very real shortcomings of our disease management system.

Thank you for this excellent program. Making our health into a commodity to turn a profit has had disastrous results, and will end with the rich enjoying care and the rest of us destitute and dying. We need a single payer plan a.s.a.p.

What if enough doctors got together and decided to change the rules by changing the way they treat patients: e.g. prescribing fewer drugs and unwarranted tests? Doctors have more power than they realize. They are the link in this chain that the drug and insurance industries can't profit without.

I significantly improved my health by adopting an allergy free, mostly vegetarian diet, and focusing on prevention, thanks to an integrative care approach. All this with a few basic blood tests, supplements and good nutrition. Meanwhile, my catastrophic Blue Cross plan paid for almost nothing, (I'm self-employed,) since I made healthy, sensible choices instead of needing emergency care. The "industry" "rewards" those who get sicker, because that's their profit motive.

Civilizations have fallen before because of greed- this one is on the decline.

Leave it to Bill Moyer's to inform the public about the true problems with health care. An excellent presentation, confirms my understanding from 33 years in the industry (20 as a management consultant, and trustee of several non-profit health research service, and insurance organizations and 13 years as a patient advocate) about the fundamental changes that the industry must undertake. Maggie got it right about the incentives and the clash between for-profit medicine and the public good that medicine provides. Dr Berwick, who I have seen working on the vanguard of application of systems models to health care hit the nail on the head in his statement about support for the relationship between patients and doctors in patient centered health care systems.
I am disappointed that the conclusion seems to give the win to the insurance industry, who will gain 45 million paying customers for stopping their unethical practices, and the drug companies continue exploitation of American consumers. Also no mention was made about the promise of information technology to prompt the re-engineering of medical practice (already in the law as economic stimulus with $19B for electronic medical records).
The next show should address what the president can do to turn this into a win for the public, and what patients can do to gain the partnership in the process needed for true reform.

I am still looking over Steve's plan. He makes a number of suggestions worthy of consideration. I would like to question just one for now. He says that the present plan under consideration "Mandates that private insurers cover those with pre-existing conditions", and goes on to comment that
"This nonsensical plan encourages irresponsible citizenry. It is like requiring insurers to sell fire "insurance" to people only after their house has burned down; this is not "insurance".
Well yes - how to discourage such "irresponsibility" is the question - or all off us end up having to pay in the long run for such irresponsibility.
Well in the UK health insurance is mandatory via a health insurance tax on earnings. But your coverage is not terminated by a job loss. Is this fair on all taxpayers? Who knows? But at least kids etc don't go uninsured. In Mass so I understand health insurance is also mandatory but cannot be strictly enforced because there is no mechanism to do so. Is a payroll deduction the only way to compel people to be "responsible"? If so, I say go for it. Also, are people "irresponsible" if they have payed for health insurance all their lives, suddenly lose their job, and cannot afford health insurance premiums? There was a tragic case on Moyer's show a week ago where a woman had pains, went to doctor, was told she had cancer, came home to find husband was laid off in the recession - health insurance gone - then was uninsurable because of "pre-existing condition". This type of thing is a disgrace to our country, and must be fixed. Steve, what would you suggest on this issue?

One 'detail' struck me: that, even with insurance, people are not able to get care. They have to wait months for an appointment.

My son has insurance. He also has Lymne Disease. He told me he was going to go to the hospital because every place he tries to get an appointment he will have to wait about 2 months. I did not quite believe him. I do now.

I too will no longer donate to PBS. The Moyer's piece was an example of disinformation. First, repeating what Angela, Steve, and others said, why just one mention of malpractice? The fact that Obama refuses to even consider tort reform makes clear that cost containment and quality of care is not his concern. Second, Moyers complains that Obama has let the pharma representative into the room, after promising in the campaign that he would not. What does he expect? Political processes not to be governed by politics? This is the reason why market mechanisms are always preferred; they are corrupted only by the profit motive; public programs are corrupted by the profit motive and many other things. Further, the piece deplores the fact that various hospitals compete to have the best equipment that offers the best care, hoping to attract more doctors and patients. And this is a problem ... why? Today, we spend 54% of the GDP for necessities (food, shelter, health, clothing). In 1960, we spent 52%. There is simply no global cost issue driving people into poverty; we are spending more on health and less on food, clothes and shelter. And we are getting much more. As a student just 35 years ago, we had no tools to battle viruses, no idea what caused cancer, and no way to personalize medicine. Today, we have all of these, and are near to creating routinely personalized patient care, relieving doctors of the need to use statistics (now called "comparative effectiveness research") to select between therapies. While human biology makes life longer than 100 years or so unlikely, a healthy life could become the norm well into the 9th decade. Is 16% of the GDP too much to pay for this? And why did Bill Moyers not mention this? The United States has driven this advance, in part because nowhere else can one get so rich by commercializing medical innovation. Moyers and Mahar evidently do not understand this, at the core of what makes real economies work. Lacking the profit motive, British hospitals are undercapitalized, understaffed, and grim. Why was this not mentioned, or the lower survival rates of cancer patients being cared for in systems that lack "money driven medicine"?

It is interesting that many on the right of the debate berate government intervention in healthcare, while ignoring the role of Wall Street in healthcare.

The U.S. has the highest concentration of wealth in the industrialized world, and a for profit healthcare system.

These profits ultimately flow to Wall Street. This provides another vehicle in addition to sub-prime mortgages, credit cards, banking and payday loans that just increase the wealth of the top 1% at the expense of everyone else.

Don't expect the system to change any time soon

Ms. Mahar's book, the film, and the commetary from Mr. Moyer's regarding MONEY-DRIVEN MEDICINE, coincides with my next week's lecture for my Honors Biomedical Ethics preparation (The Honors College, FIU in Miami). Thank you both as for offering exactly what I needed to articulate our "broken system" following this week's delivery of ethics terms, ideas, definitions. The transition into explaining our healthcare system will be easier after your program. I thank you for your collective works.

Just finished reading Creating a World Without Poverty by Muhammad Yunus who's micro-credit lending has changed so many lives for so many people. They are now setting up health facilities in Bangladesh with a structure called 'social business." Basically, a social business is a company or business
(Hospital) that is cause-driven rather than profit-driven, with the potential to act as a change agent in the world. It works!!! I know firsthand!

I know because I've worked among the poor in Asia for over 20 years. See the website

My wife and I practice Oriental Medicine which is one of the worlds most widely practiced medicines. The World Health Org. has listed over 60 (sixty) disease conditions that acupuncture can treat. It is a shame this has not surfaced in any discussions. It answers so many of the needs. For instance ~
1. We do get to spend an hour with our patients because what they have to say is incredibly important.
2. We do get to focus on quality and NOT how many treatments are given or billed..
3. We do get to counsel on lifestyle issues, therapeutic diet, and nutrition.
4. We treat holistically (body, mind, sprit) so we are able to affect a whole range of issues.
5. We focus on health prevention not disease orientation and our medicine is without side-effects.
6. The one-on-one time we have with our patients is one of the richest times available ~ the observations, their voices, expressions, skin tone, muscle twitches, and a whole host of other observable signs are information to us a sure as a CAT scan or MRI. We cherish those times ~ NOT ~ limit them.

One of the oldest medical text from Chinese Medicine says that the superior physician prevents the disease before it occurs and that the inferior physician waits until the disease manifests before treatment. From antiquity, it also expresses that if you set your mind on the money to be made ~ you cannot have a true intention ~ which will affect your healing abilities.

My wife and I have just moved to a city in Virginia to set up an acupuncture clinic that is based on this social business platform. It's not that we hate money ~ we don't ~ but there is something in my core that seems quite immoral about profiting excessively from the suffering and pain of many. Besides, in our model we can touch a lot of people because our charges are such that it doesn't serve just the rich. Besides ~ we don't receive insurance re-imbursement anyway ~ the powers that be have seen to that!

Thanks again for the segment ~ I know you went to China and saw the medicine practiced there, particularly acupuncture. We've saved people thousands and thousands of dollars and prevented unwanted surgeries, hospital stays, and excessive medication. And we love getting to spend time with our patients. There is a different kind of wealth that is not measured by gold or silver.....we found ours yet again.

P.S. It's a shame so many people think we have the best medicine in the world when most have never been exposed to many powerful types of medicine. It's a shame that the American Medical Association limits the physicians and the medical schools in this country and controls with an iron grip "THEIR" definition of medicine. The one they espouse is the one built on greed and the accumulation of money.

(NOTE" A social business is not a charity, it's a business in every sense of the word. It has to recover it's full cost while achieving social objectives.)
Ken Harbour L.Ac.

Ms. Mahar,
As a doula (professional labor support), I am interested in issues affecting pregnant and birthing women. One often overlooked place to save millions is the replacement of OB/GYN's with certified midwives offering in-home or center-based care for low-risk women. Not to mention the additional bonuses of higher customer satisfaction and greater self-responsibility on the part of the mother/family. Is this topic covered in your book?

Kenneth Arrow, the Nobel prize-winning economist, wrote about this subject in 1963 and it has been taught ever since as a normal part of the welfare economics course every undergraduate economics student takes, called the principal-agent problem. This is that, unless you know as much about medicine as your doctor, you can't evaluate the quality of advice he gives you. And while it is true that this can prevent competition from having desirable consequences in the health care industry, and is likely the cause of some fraud and simple overuse - tho in many cases to protect against malpractice lawsuits - it is not really the cause of either the high cost or the unavailability of health care. It will not do to blame hospital cupidity, when they are being forced to close every day, or blame physician greed, when they are forced to leave the profession because of high insurance prices. It will not do to blame insurance cos, when they make far lower profits than most other industries. These things are caused by an attempt to make efficiencies in a system in desperate need of something to stay afloat, but regretably they often are ineffective and only cause more problems.

So WHY is it so expensive?! Well, first of all, it is clearly only expensive for an unfortunately increasing number of Americans, and not for all. We see the same thing happen, when, for instance, oil or gold is found in some 3rd world country. Prices rise as ppl charge what the mkt will bear, which means fewer ppl can afford what they could before when their work had relatively more value and suddenly they can no longer feed themselves. We saw this in this country, when fewer and fewer ppl could afford to buy American cars and increasingly all that were made luxury gas-guzzlers, their assemblers could no longer afford to buy, or in the rise in house and land prices. This is caused not by selfish corporations and their shareholders, but by a financial system that MAKES prices rise and, at the same time, shifts the distribution of wealth, and that can ONLY be a function of increasing debt: printing money, creating bank credit, running Federal deficits, or by being subsidized by the labor of others elsewhere. More debt means more money, which means higher prices, especially for commodities, real estate and other assets, and the ppl who own these become increasingly wealthier than others in a vicious cycle, because as they become relatively wealthier, the rest become destitute both relatively and absolutely. That kind of economy is contracting. High prices mean POVERTY, not wealth. People, then, cannot afford health care, because they have simply been priced out of the market.

Let me tell you further that therefore the more welfare the government provides the more it will have to provide, and the more it has to provide, the less it will be able to afford to provide, and not because of dependency, but because of the simple economics of money.

There are only three ways to "motivate" ppl as Montesquieu among others pointed out: fear, bribery, or honesty. We have fought and still fight against fear, and this report is one of this kind. It is relatively easy to point fingers at others, but we have a society built not on fear but on bribing ppl, and we ought by now to have recognized its shortcomings. It is past time we began the fight against that as well.

Dear Ms. Mahar,
I have searched high and low for the answers to two questions: 1. We all seem to agree that we spend about 16% of GDP on health. Where can I find comparable numbers for what we spend on other things? What percent of GDP do we spend on automobiles or cell phones or housing or defense or vacations? 2. What does "affordable" mean in "affordable health insurance" or "affordable health care"? What does President Obama mean when he says "affordable." I am willing to spend time on research, but I need a hint on where to go. Sincerely yours, David Sage Tampa

Your story is a good case against Goverment control, your story told how doctors are not going into private practices because they don't make enough money (no incentives)what incentives will goverment give

I don't see how failing to consider drug price negotiation, or tort reform (my doctor's annual malpractice insurance fees top $30,000, the equivalent of approx. a 48,000 pre tax earned income), and imposing government deduction from my checking account, and finally direct intervention in my parenting practices and my automobile purchases, which ALL are part of the current bill, helps anything.

I think there needs to be some very large demonstrations to support single payer as well as other issues that the democrats have become weak-kneed about.

I'll be happy to help out.

Great presentation on PBS. We overuse medicine in this country just like we do gasoline. If we had higher deductibles instead of small co-pays I think we would start asking how much proceedures cost and the necessity of them. Mecal cost consume over 16% of GDP but does anyone have a clue as to what their doctor charges per office visit, or how much a simple x-ray costs? It is time to start shopping medical care just as we do cell phone rates or CD rates.


Within a decade employer provided healthcare as we know it will disappear. It is currently on the same track as another long cherished employer provided benefit – the pension. Those who are complacent in the healthcare debate because they still have generous employer provided health insurance benefits need to recognize the changes in the job market that are already well underway. Look at the history of pensions for American workers.

Up until the early 1980's most company pension plans were defined benefit plans which provided a monthly payment for life that was fixed at the time of retirement. Employees were not required to contribute toward the plan. Defined contribution plans began replacing the defined benefit plans in the 1980's. The defined contribution plans fixed an employer’s contribution to the pension plan but did not guarantee the amount of the benefit. Some of the risk was shifted from the employer to the employee by such plans. Employees weren't required to contribute to the defined contribution plans either. 401(k) plans began replacing the defined contribution plans by about 1990. 401(k) plans shifted the financing of retirement from an employer managed plan to the employee. Employers matched a significant part of the employee's contribution to his or her plan under the 401(k) model. Over the last several years employers have stopped matching their employees' contributions.

The same slippery slope applies to employer provided healthcare. Up until about 1980 employers paid 100% of the cost of healthcare insurance for employees and their families. During the 1980's employers stopped providing healthcare insurance for family members of employees. Employees had to pay the additional costs of insurance for their family members via payroll deduction. By the 1990's employees had to start contributing toward their own health insurance. First it was only 2%; then 5%; then 10%; then 20% and now sometimes reaching 50%. Like it or not we are a few years away from a best case scenario where employees pay 100% of the cost of health care insurance with the benefit of buying it at the employer's group rate and a worst case scenario where former employees are rehired as consultants who have to pay for 100% of the cost of their health insurance without the benefit of group rates. In the worst case scenario the new consultants will enjoy the right to pay self employment taxes on their income before they pay their health insurance premium. Think that won’t happen? It’s the way the tax code treats health care premiums for millions of self employed individuals and new age reclassified consultants now.

It's now more important than ever for American workers to recognize the road that health insurance benefits are on and to vocally participate in the once in a generation movement of reform because to do otherwise will let the moneyed well entrenched special interests dictate the terms of reform from which they alone will benefit at the expense of the rest of us.

another excellent program. My thanks and the thanks of many health care reform folks.

Personally I am a supporter of HR676, single-payer healthcare. Single-payer is the way to go to correct many of the ills of the healthcare field.

Another avenue: Nationalize the entire healthcare industry.

This program was excellent. I have two concerns that I did not feel were addressed and I would like to know how much you think these issues contribute to our broken system. As an RN for 22 years, I have spent a large part of my work time and energy doing things to avoid being sued. As healthcare professionals we are at constant risk of doing everything "right" and still losing everything because of a law suit over a bad outcome. We give certain medications, run certain tests, and do certain monitoring regardless if it is good for the patient because we need to be able document that we did "everything" we could in case we are sued. The amount of time nurses spend documenting what we do so we can "prove" we didn't do anything wrong is enormous - not only resulting in regular paid hours but often overtime pay as well. The other issue that I find very troublesome and which seems to be getting worse is no one seems to be addressing the fact that patients need to take some personal responsibility for their own health and health care, especially in long term chronic illness and conditions. Everyone just wants the "magic pill" that will fix everything without having to take care of themselves. These are the same patients I see hospitalized over and over again because they refuse to change their diet, can't stop doing meth or quit smoking or drinking. These patients are a huge drain on our overstressed healthcare system. I would really love to know Maggie's thoughts on these two issues.

As a retired primary care physician I agree with most of Ms Mahan's conclusions except that she glosses over the improved medical outcomes enjoyed by the public since Medicare and Medicaid were introduced. She should have pointed out the declining premature mortality from heart disease cancer and stroke that resulted from advances made possible by these programs.

Dear Maggie Mahar,

I do not understand much about HMOs and the health care system but I am very concern when it comes to my health. I finally qualify for my employer health coverage but now here comes the problem I just realize. I must choose between two health providers, HIP and Blue Cross and Blue Shield. I just recently received notice that I will probably retain my position for about a year. After that time, when I am no longer employed by my employer, I know I will lose my employer coverage. Should I take my employer coverage or find another health coverage elsewhere, that I could carry from job to job, and where do I start looking for other health coverage?

Thank You,
S. Lebourne from new york city

I have been asked to say what should be done to improve the system, lower cost, and improve result. Here it is.
1. Tort reform.
Susan Estrich, Michael Kinsley, and other rational individuals from across the political spectrum agree: The easiest way to lower cost and improve care is to get rid of the medical malpractice lawsuit lottery. It would save $100 billion to $200 billion each year to have Senator Daschle's Federal Medical Board adjudicate malpractice claims, not conspire to use statistics to restrict patient care. Mandatory arbitration of malpractice claims by an expert board can be enacted now; its cost benefits would be immediate.
2. Remove tax preferences for employer-provided care.
Since removing tax free status of employer-provided care is no longer possible (President Obama demonized Senator McCain for proposing this during the 2008 election), make private health insurance available in pre-tax dollars.
3. Enable low cost catastrophic policies.
Routine medical care should be paid out of pocket. Just as it makes no economic sense for citizens to pay someone else to pay for groceries, it makes no sense to do so for annual checkups, or any medical cost that is not financially threatening. Remove all mandates from medical insurance, allow interstate insurance competition, and allow personalized policies that are portable, even when paid by employers.
4. Cease to reward personal irresponsibility.
We do not doubt that irresponsible citizens will, when healthy, not buy insurance before they become sick, even if they can afford it, expecting to be able to present themselves after they become sick to emergency rooms with "pre-existing conditions" demanding care paid by others. They may even demand that government mandate insurance providers to give them "insurance" despite this "pre-existing condition". This "moral hazard" is the expected consequence of four decades of American politicians telling Americans that "someone else pays". We cannot let irresponsible citizens die. But we can have the government enforce contracts between them and their care providers. Policy should direct the irresponsible citizen who present himself having not purchased catastrophic insurance to repay the provider for the cost of health care after the care is complete ("post-insurance").
5. Enforce insurance contracts.
There are undoubtedly cases where insurers drop clients after they become sick. With the reforms proposed above, and policies to individuals not employers, this should no longer be a problem. Nevertheless, we recognize a government role in enforcing contracts that prevent them from doing so.
6. The Federal government can be the insurer of last resort.
We recognize that insurance companies can go bankrupt, as can pension providers or any other private entity that is party to a contract that has a very long term. We also recognize that affordable policies may have caps (e.g. two million dollars); for extra-catastrophic care, market mechanisms may not be able to provide coverage. I have no objection to the government being the insurer of last resort, just as it is the pension provider of last resort or, under FDIC, a banker of last resort. The policy, however, must be actuarially sound with inflation adjustable premiums. In many ways, this program already exists (Medicaid). We urge Senator Nelson to oppose any legislation that expands government intervention in health care, except as an actuarially sound care provider of last resort.
7. Geriatric care, the biggest cost issue.
Payroll taxes are enforced savings for geriatric care, just as Social Security taxes are mandatory savings for geriatric food, clothing, and shelter. Given today's technology, the average person cannot live for 80 years (roughly today's life expectancy at age 25), work for just 40 of these (from age 25 to 65), and generate enough wealth in their working lifetime to cover the medical intervention that they will seek if they retire at 65. The geriatric care that individuals receive needs to be economically rationalized to the Medicare payments that they have paid, and ultimately to the wealth that they have produced in their working lifetime. This is not a problem; medical advances also allow individuals to be economically productive long past age 65. If individuals want more care, they can now work longer and pay into Medicare longer. No one likes to work, but so what? Socialism fails because of economic reality. Work is required to get wealth. We urge Senator Nelson, as his sole act to control Medicare costs, allow individuals to work longer and defer Medicare eligibility in return for receiving more Medicare benefits.
8. Care for the uninsured.
After these policies have been adopted, the problem with uninsured citizens will become trivial to manage under Medicaid and other existing safety net programs. No new "public option" should be adopted.
9. Dramatic intervention at birth.
The third most significant cause of increased medical expenditures is another success of medicine: Babies who would otherwise have died at birth, live. This creates a pre-existing condition from birth, one that current policy is unable to handle. We urge Senator Nelson to support an honest discussion on how public policy should adapt to recognize the success of medical intervention at the beginning of life.

It should be noted that the House bill does not adopt any of these suggestions. On the contrary:
1. It mandates that private insurers cover those with pre-existing conditions. This nonsensical plan encourages irresponsible citizenry. It is like requiring insurers to sell fire "insurance" to people only after their house has burned down; this is not "insurance".
2. It does nothing to control costs. On the contrary, it requires private policies to be "qualifying", and therefore expensive. It makes inexpensive catastrophic coverage and individual insurance, impossible. It will cause millions to lose their employer health insurance.
3. It makes Federal health decisions not reviewable. At the same time, it proposes a massive invasion of civil liberties, denying Americans basic Constitutional protections.
4. It enforces statistical approaches to "comparative" health care just at the time that science is making these obsolete. As a result, it will obstruct future medical advances and the ability of citizens to benefit from them.

We, as a society, have taken the steps of limiting the cost of our utility bills (thru the creation of public utility commissions) where customers are protected from sky rocketing utility bills; utility services must substantiate a rate hike to the commissions, before the commission approves. The utility companies have made the decision to work within this system, rather than fleeing to offer their services to foreign entities, as some have suggested would happen in health care. If the government would, first, at least, put a lid on the cost of health care, by financing state run public ‘med-cost commissions’, who would have the power to set the cost of medical procedures and drugs, the present insurers would be able to reduce the amount of paid benefits without renegotiating contracts with health care providers. The savings would prompt them to insure more of the public, at possibly a lower rate, since their expenses would be reduced (the profit motive). Health care providers would see an increase in their business, since more people could afford health insurance. If they want to maintain their bottom line, they will be forced to operate more efficiently to reduce their business expense; an increased clientele with insurance would only help their profits, while lowering the individual’s cost. Also, giving individuals the choice of insurers doesn’t give them the power to negotiate with health care providers. If the government did something to contain the cost of health care, like effective price controls, the consumer wouldn’t have to worry about ‘getting a good deal’. Setting up another costly entitlement program just transfers the obligation of payment to the taxpayers. Health care providers (and drug companies) would be forced to operate much more efficiently in order to make a profit, and if necessary, can be given some tax relief to help with the changes. Right now, some people end-up going bankrupt because of the cost of health care, while doctors and drug companies make a much higher income average than any other industry. They don’t negotiate prices or care protocols with patients now; they direct the patient to accept responsibility for payment of their bill beyond whatever the insurer pays and they want a signature for that acceptance without even providing an estimate for the care. Let’s focus on reducing the cost by controlling what the provider and drug producers can charge! Then the problems of the uninsured and run away medical inflation may slow down, or maybe even be reduced, without the government proscribing coverage limits and care limitations for individuals, while setting up another entitlement program to be paid for by the taxpayer.

/b Thank You b/
to both Maggie and Bill for presenting this! I think copies should be sent to both houses and the Whitehouse - BY EVERY CITIZEN! Maybe then they would listen? Lets face it the fresh faced, overpaid, healthcare lobbyists can afford to march on washington they get paid for it! But most Americans are slaves to healthcare and the bills that follow! My brother is losing his home and I lost mine due to healthcare costs that should not have been near that high! I live in TN where HCA is king and they're raping the small towns around Nashville! We need help and I mean fast. As for the guy who says he won't post anymore - good - but it makes me wonder if he's actually one of those fresh faced overpriced healthcare advocates that get paid to post on blogs like this one just to stir things up and make people doubt their own opinions. This is a wretched country we live in when we cannot get basic needs met. Socialism, Facism, or Federalism - we are NOT getting care NOW.
I don't care how they label it as long as we get the CARE back in HealthCARE!

As a physician who shares many of the sentiments of Ms. Mahar, I was moved by the film, bearing the same title as her book. I am thrilled that finally people are talking about the pink elephant in the room, the takeover of medicine by the insurance industry. I have many thoughts about that, but this post is to say that I felt the film was biased in it's presentation of what I would call "paternalistic medicine" as reflective of all of us. I refer to the discussion of the lack of collaboration between doctor and patient in decision making. Unfortunately, no mention was made of "the Women's Health Movement," which in the 1980's sought to change that paradigm. In 1979, Dr. Lila Wallis, a pioneer, founded The National Council on Women's Health, which I became president of in the early 1990's. Our mission statement was and continues to be the following "A working partnership of health care professionals and consumers whose mission is to educate the public and policy-makers on women's health and empower women to make informed health care choices." We were the first national women's health care consumer organization in the country and we put on educational programs for many years until there was no longer a need. Our initiatives have focused on prevention including "The Race Against Teen Smoking," a race in Central Park, NYC, to raise awareness of a growing problem and more recently we founded the "Girls Get Healthy" program to help prevent the rise of obesity in the teenage population. So not all medicine is about doctors "telling" their patients what they need to do. I would venture to say that that model is more a male model, while female physicians in my experience tend to be more collaborative. I would hope the researchers at Dartmouth who have done such stellar work remember to study gender and racial differences as we in medicine have learned is essential to understanding the human condition.

Just finished watching the Maggie Mahar film. As a senior citizen, I experienced the same type of medical envioronment that Bill Moyers described in his opening. I long for the return of having a physician who asks "How's the tennis?" again.

My primary concern with the emphasis on cutting costs by controlling care is that people may be denied finding the most direct route to solving their problem. It comes from personal experience.

After 6 months of x-rays for hip and leg pain, visits to two different physical therapists, a visit to an arthritis specialist who told me that there was no sign of arthritis, my leg finally collapsed as I got out of bed. An MRI was ordered and disclosed a herniated disc pressing on the thecal nerve sac. A microdiscectomy produced a complete solution to the problem. All of that money spent, all of that pain endured. All could have been avoided had the MRI been ordered first!

I want the right to determine what tests will be made. From the little I have read of the current bill in congress, the emphasis is too much on measuring results and cutting costs and not enough on patient empowerment.

thanks for the program.

Excellent film and program, thank you. A previous commentor laments the lack of detailed information on the health reform bills being proposed by Congress so I want to share an excellent resource that's run by Ellen Shaffer, a former staffer with the late Senator Paul Wellstone. The Center for Policy Analysis website has sections critiquing the major health reform bills being written by the House and Senate.

For example, here's the link to the Senate HELP Committee bill analysis The website also has a section of analysis for the House Health Reform Bills as well as a good Flyer explaining what needs to be done to improve all the various bills.

Ted Kennedy shared the vision that many of us continue to embrace, that is a vision to create an effective and humane system of national health insurance in America.

The Senate HELP bill, and all the other major bills-- except for Conyers' HR 676-- fall far short of realizing this vision of equitable and quality care for all. What this means to me is that we must work harder, together, to make sure we get there. Maggie's and Bill's work are essential tools for this historic effort. Thanks again.

under a bridge

Thanks so much for showing Money-Driven Medicine. I have already written my Senators an Congressmen? What else can I do? Having lived in Canada and having a daughter in the Czech Republic, I know how poorly our health care system compares, but it is hard to convince other people.

I am pretty disgusted and alarmed at the negative adds and retoric I've been seeing. Still, I have not been seeing very competent responses. (BMJ has always been a good start but often just whets my appetite for more information) Is there a place where we can get reliable facts/stats/ numbers so we as the public can make informed decisions?

Thank-you so much for this show .I agree with you 100%. It is a sad sad situation in this country where profit rules not the people.

My med costs may put me under a bride one day, so I agree with Zora Renee,storm the gates!

This is in response to Steve who is so mad at the documentary he won't contribute to PBS any more.
Goodness gracious!! No-one is necessarily suggesting adopting a UK or Canadian style system (but at least no-one goes bankrupt there as a result of having a health emergency if you lose your job). Surely you must see that the present system is unfair and needs reform. Make your own suggestions, don't just hammer on other peoples.

EXCELLENT! I really don't get why it's so difficult for mainstream TV networks to air identical programs instead of feeding American people dirt. EVERYONE, from the townhall rioter to the pseudo congressman should see this. Oh, and kuddo for the canditate Obama "retrospective". What a huge disappointment this guy is...doesn't have the chops after all.

I agree that the incentive in our health care system is profit, not health. People respond to incentives.
Would the way to change the incentives more to results be to require publication of Hospital & Individual Dr. outcomes AND costs on a monthly basis, or at least quaterly at the same time as quarterly profit reports? Then we would have some information on how much we pay and the quality of our care.
This would even be in the financial interest of the insurance companies.

Where do we go frm here? What pieces of broader healthcare can we look to pass? HOw? Where can we best follow the true path of the ongoing healthcare debate?

Thought the show was excellent, but I have an additional concern that didn't really come through. In our area when some doctors prescribe tests they are done in a lab or other facility that is owned or partly owned by that same doctor. So clearly the profit motive gets in the way of the need for the test.


What a powerful expose! Thank you for reminding all of us why change in this sector, like many in our lives, is so essential. Hospitals, education and government used to be the sectors where caring and benevolence showed themselves daily. Unfortunately, they have become targets for economic domination, exploit and commercial interests. We need to lead all Americans and seemingly our President to these greener and holistic ends.

Ms. Mahar - How can an allied health professional resist pressure from management to mindlessly maximize profit at the taxpayers' expense - without losing his job?

Thank you and PBS for one of the best pieces I have seen. I wonder from the Mr. Moyers opening, if our policy makers have reviewed the research from some of the Doctors and institutes? I have been studying Health Care reform, been to several town hall meetings and written to my federal legislators, but don't think they have studying this problem closely.

The 8/28 PBS "Money Driven Medicine" rang true for me and lots of my older friends who are just under 65 and pay too much for health insurance in Florida. They are all profit driven and we need to drive them out of business with a Federal One-Payer system of health care for all. Come'on Democrats! Start making noise! We won the election!

Dear Maggie,

I graduated from medical school 2 years ago and entered an MPH program. My ideal was to become a primary care physician to treat patients one-by-one. This is not enough. I am older and dealing with realities of taking care of a mother whose finances are limited. I do believe that the reliance on technology is ridiculous. When an x-ray is sufficient, a CT and MRI are ordered. This how young doctors are trained. More money for the institution and fewer diagnostic skills required for the M.D..

Bill and Maggie,

Thank you very much!!!

Maggie, I am a family physician from Gettysburg, Pa. who has been in the trenches for the last 24+ years as a family physician. I thought that your presentation of the state of healthcare finance and healthcare in our nation was excellent!

I have become an advocate for a One Payer Solution to Healthcare reform over the last year. We are trying to gain traction with a grassroots swell of support in our county as well as throughout the state for the Family and Business Health Security Act in Pennsylvania.

Do you have any advice for us in our attempts to enlighten the citizens of Pennsylvania and encourage them to join the cause?

This pbs "documentary" is outrageous. I have long contributed to pbs. I will not do so again.
Federal tax policy is what placed an HMO between us as patients and our doctors. By doing so, it further destroyed the possibility that individuals could buy individual catastrophic insurance, and this was aggravated by regulations requiring that "insurance" include routine care. The refusal of the Democrats to consider tort reform creates much of the unneeded medicine. And the high cost of Medicare comes primarily because the population as a whole is aging, and then because care selection is disconnected from price entirely, as are premiums (no, Medicare is not "free health care"). And after age 40, the "single payer" British system has people dying earlier from cancer, heart disease, and diabetes.
Instead of a balanced documentary that would put thee facts onto the table, pbs has aired a program that claims that the problems arising from placing HMOs and doctors will be resolved by placing a bureaucrat there, that the problems arising because of insurance regulation will be solved by more regulations, that issues of cost will be corrected by a trillion dollar new entitlement under political control, and that quality will be improved by imposing the British system (wthout the "evil profit motive") on the US, even though the British system does not provide the utopia of personalized physician interaction (and much of the US system does).
Shame on Bill Moyers

Bravo Mr. Moyer for another quality and informative program. I just wish with all my heart that everyone could see your programing. Keep up the excellent work. I can not accept that we have lost the battle again.
"It aint over till it's over, and the fat lady sings."

Medical diagnostic testing is over-utilized by physicians that own their own equipment.It is well understood that is the case by all. Thomas Jefferson University study showed that physiciaqn owned imaging centers did 400% more testing than independent medical imaging centers. There was just a bill in Congress that was supposed to be in Health Reform that would have closed this loophole. It was not included, and not voted on because the AMA has a stronger lobby than the independents. There are abuses in many ways in this fragmented system.

America's health care is not market driven. It is a network of monopolies - and that's why it fails. An open, competitive market would not allow the "inefficiency" to exist. So...,
1) eliminate the monopolies, and, 2) put the doctors on wages and benefits, 3) don't worry about MBA administrators. They're also patients.

Finally an American journalist that seeks to present the truth of the issue and not the sensational! Thank you, Mr. Moyers!

Finally an American journalist that seeks presents the truth of the issue and not the sensational! Thank you, Mr. Moyers!

The root of this debate should center on the power of the lobbyists. Control their ability to purchase influence and their role in the Health care fiasco would greatly diminish. The book, "So Damn Much Money", provides a frighten ing view as to where this country is headed!

Why does no one talk about the huge difference between what those without insurance are charged compared to what the negotiated price is with insurance companies. Sometimes the negotiated insurance charge is only 20% of what is charged to the insured. I have personally seen cases where a hospital charges $800 per day while accepting only $200 from the insurance company. There is no rational economic justification for this disparity.

Help! You illustrate the problems clearly and cogently. Please give us ideas and ways to help us mobilize and work effectively to create a just, viable system. Any suggestions you offer would be welcomed! We value this program and the work you have done. Yet, we feel powerless and need direction from you and others like you. Please!

Even the simplest things are hopelessly messed up with the current system of health insurance. The daughter of a fried suddenly became ill - turning blue. Her friends took her to the nearest hospital, where she received good treatment. But later she was told it was not a hospital associated with the health insurer - and the insurance claim would therefore bedenied. The last thing you want to think about when a medical emergency hits is whether you are being treated in the "right" hospital.

Healthcare reform is so necessary, but looks so hopeless. Is it?

Your broadcast was EXCELLENT, especially the part where you showed the Obama pre-election ad against what is happening (now) post-election. Your broadcast and this book should be required reading for congress and voters alike. Go get-em Bill....

Thank you Mr. Moyer for broadcasting this documentry. People like you make me pround to be an American. America is a great nation not because we are rich and powerful but because we care for poor and weak as well. This healthcare debate will decide the destiney of our greatness. I like to believe we will do the rigth thing.

I wonder what Ms. Mahar thinks about the Mental Health and Addiction treatment systems. They are 'fee for service' and for profit as well as government funded. Yet, the standards of care, especially in mental health, are low, with no outcomes to prove that what each provider is doing is even close to working. Example: Elecro Shock Therapy. Cost is high, outcome can be devastating. Thoughts?

I would like to know why it is legal for hospitals to bill more than 40% of the cost for procedures contracted with Insurance Carriers and then write off the difference as a discount? Recently I had a procedure done for which the hospital billed $50,000 plus dollars yet accepted $12,000 as agreed for the procedure with the insurance company. Did they get a tax write off of $38,000? If I had not have had insurance, I would have been liable for the entire bill. How fair is this to the uninsured in America. I would appreciate your feedback.

Thank you Mr. Moyer for broadcasting this documentry. People like you make me pround to be an American. America is a great nation not because we are rich and powerful but because we care for poor and weak as well. This healthcare debate will decide the destiney of our greatness. I like to believe we will do the rigth thing.

What can we do as citizens to overcome this Goliath of a problem?
I saw over 60 doctors for a simple problem that nearly killed me and was finally treated in another state when I lost conciousness!
I am now over 170 grand in debt and not much can we call this the best country in the world when our poor, sick, and dying are being raped financially?
What can WE do about it?!

This information is startling to me but more than that - it is extremely frustrating to the point that I wonder if I really want to learn more. I feel so powerless and the more I learn the more powerless and hopeless I become.

Thank you Mr. Moyer for broadcasting this documentry. People like you make me pround to be an American. America is a great nation not because we are rich and powerful but because we care for poor and weak as well. This healthcare debate will decide the destiney of our greatness. I like to believe we will do the rigth thing.

When all is said and done, I always come away with that awful feeling that there are no real solutions being offered to fix things. Is it just me, or am I missing something?

Thank you to Maggie Mahar, the film's directors and producers, Bill Moyers and PBS for helping me understand the health care issues in their most basic and profound ways.

Trying to find out WHAT the different proposals say is very difficult. WHY and HOW gets even shorter schrift. The American public deserves better!

And the best quote concerning the health care in America issue has been:

Are we to believe that Health Care is a HUMAN RIGHT OR is it a COMMODITY to be sold for PROFIT?

The reasons for the people of America to be loyal to its government are getting fewer by the day.

Kent misses the boat completely.

Healthcare costs are expected to increase by over 2 trillion dollars over the next ten years if we do nothing. This bill which would add a public insurance option will slow that rate of increase in healthcare costs. (according to both the Lewin Group andthe Commonwealthfund)

You will pay much more if you do nothing. The absolutely most expensive thing todo is simply mandate health insurance for everyone but require it be implemented by private insurance companies (just likethe Republicans did with Med Part D).

The progressive democrats have been fighting hard to get and keep a strong public option which well both provide more care and lower overall healthcare costs. The CBO only looked at the effect on the federal defecit. they did not take into account the decreases in private insurance premiums or the decreases in out of pocket expenses that would likely occur (again according to the Lewin Group and also the Commonwealthfund)

Its pure foolishness to fight so hard against a strong public option.
but unfortunately the Republicans are more concerned with scoring political points and both Republicans and blue dog democrats are inetrested in making insurance companies richer.

Its really frustrating.

support a strong public insurance option. Itsthe best idea weve got.

If you dont -- you are seriously screwed for a very very long time.

Kent understands the Obama mindset perfectly. Dr. Ezekiel Emanuel (Rahm's brother) does not practice medicine, but like a typical academic, wants to tell others how to. Emanuel, our President's important health legislation advisor says that "Doctors take the Hippocratic Oath too seriously... as an imperative to do everything for the patient regardless of the cost or effects on others." In other words, kids, start thinking communally - particularly if you're much over 55. Lenin failed to create the New Soviet Man; but it seems these calculating guys in the current U.S. administration think that they can do it for him.

Dear Mr. Moyers,

Why aren't the religious leaders calling out for change? Surely there are many pastors, priests and rabbis whose congregants have been affected by the lack of health insurance or faced bankruptcy because of a medical condition.

God bless you Mr. Moyers for your hard work and dedication to this important matter. I hope and pray that we are able to throw the money lenders out of the temple, as you so eloquently stated in your piece about Wendell Porter.

And please keep speaking truth to power. If you don't, who will?

Kent missed half the boat. Farmers aren't making much profit now. Got milk? And whose fault is that? Corporate syndicalist parasites! Insurance companies are much the same. No one begrudges heath care providers a living by mark-up but if you only provide delay, denial and a heavy monkey on the back, what good are you anyway? Kent must be workin' for the Big Monkey Man.

I think smart people will remember how Congresswoman Sue Myrick clouded the Health delivery debate with propaganda. Practical solutions will eventually overcome the agitprop or America will get sicker. Who benefits? Parasites forget that the host can die.

Since profits are apparently the root of all evil, perhaps the goverment should take over our factories as well. And the evil retailers who keep people from getting what they want because they want to make money.........well, let's take them over too. And the farmers........those cruel people shouldn't be making money growing the food we need to survive, should they? I guess we just need to trash our whole economic system and become a commune. Yeah, that's it! It'll solve EVERYTHING!

Instead of attacking the overall healthcare system, is there any merit to government reigning in the pharmaceutical and insurance industries instead? They seem to be a large part of our "healthcare" problem in this country.

Pelosi and Reid are pretty much useless. They can't even find one person like DeLay. They only need one person who can strong-arm a few votes and then ram this thing through. For the million of Americans who need this, I hope someone will step up on their own.

I am looking forward to watching the Journal tomorrow night. Do you think the Single Payer/Improved Medicare for All approach would find more "traction" in Congress if we pushed for 52 single payer systems (each state running its own with the federal govt. only determining a minimum set of coverage requirements)? In Canada, each of the 10 provinces runs its own program, so its really 10 single payer programs, not one.

Awesome article! I have gradually become fan of your article and would like to suggest putting some new updates to make it more effective.

In the discusssion on health care reform in the U.S., there have been many references (a lot of them erroneous) to the Canadian single payer system. We actually have 10 single payer systems because each Province runs its own. The only Federal role is a law setting the minimum standards for the Provincial plans. While most Canadians support this system (with all its imperfections) I believe very few would support a Federal Goverment run health insurance for all 30 million Canadians.
As for us having a "socialized" system, my Doctor is a private corporation like almost all of them but my Doctor's bills are paid by the Provincial insurance plan. The OECD rates Canada's system 30th and the U.S. 37th in terms of outcomes. So we have nothing to brag about. If you manage to come up with some good new ideas, I hope we can learn from them - just don't try to make us go private.

My local news recently reported that 'banks in Texas are doing better than in other states because they are invested in energy, healthcare and agriculture'.
It got me to wondering just how much the banking industry is trying to stifle healthcare reform.

The Republicans should be pushing for Single-Payer healthcare reform. God knows they need a winner in the worst kind of way.

Countries such as Britain, France, and Germany have a Single-Payer National Healthcare System. Their businesses are more competitive because they are not saddled with the huge healthcare drag American businesses are burdened with. Their national healthcare cost are 50% less than the United States.

All we have to do is clone one of those existing healthcare systems and the American business community and the United States get all those benefits. Seems like a Win-Win to me.

The cost and resource benefit to all American businesses cannot be calculated but it would be HUGE. No more guaranteed retirement healthcare benefit plans, no more COBRA, no more annual shopping for healthcare insurance, no more healthcare consultants, increased employee productivity, no more HR managing healthcare insurance, no more fine print,....this list goes on and on. “All” of the American business community would benefit. Restaurants, Mac Donald’s, Walmart, Jack-In-The-Box, shoe stores, Dupont…if you got a business it includes you.

Consider the benefit to state and local government. Their employee and retirement healthcare burdens would disappear (ok, California you can drool). All the taxpayer funds expended annually to maintain/adjust healthcare laws, rules, regulations, and boards would go away…. this list goes on and on also, would be saved.

What perplexes me is this, what I said seems obvious to me. If it is obvious to me, then why are there no Republican Conservatives (the real ones, not the wackos) pushing this? If nothing else it removes a huge burden off “All’ American businesses. It reduces the United States cost of healthcare by 50% and at the same time eliminates 47 million uninsured, stops all medical bankruptcies, eliminates the need for healthcare fairs…etc.

Its not like there are any political risks in cloning one of those Single –Payer healthcare systems. They all work. They are right there operating every day with all their good points and warts. The argument: We get all these benefits but will initially have to live with "these" warts. We'll work on those warts later. Not a hard political position to make.

It strikes me that pushing this is tailor made for the "traditional" Republican Agenda: huge financial/resource benefit to all American Businesses, huge financial/resource benefit to all State and Local Governments, and the cost of healthcare expended by the United States reduced by 50%.

So where are the “real” Republican Conservatives? Have they left the party?

I love the area of health, I'm waiting for this movie, hopefully a success.


Re: The Absolute Necessity of the Public Option in Health Care

Dear President Obama and Staff, Monday, August 17th, 2009

This so-called democracy-but-really-an-oligarchy of ours is not working...there are just too many woefully uniformed, insanely misinformed and downright stupid-to-the-point of dangerousness; these people do not know anything at all about any issue, particularly this nemesis, health care reform. They, these utterly brainless, totally uneducated, irrational gun-toting and idiotic fear-mongering masses that comprise a full and startling HALF of this country's population, have nothing constructive to say or do as they and their unconscionable Republican SS commanders lie and bait and hate and monger incessantly to the morons. This is insanity.

My question to you, President Obama, and to your staff: Do you really think it is in the peoples' best interest to cave in on and waste time bickering with fools? The paramount importance of the public option in health care reform is undeniable and must be irrevocable. That is why we, the rational and intelligent ones, i.e. the other half of the country, voted for you to be the supreme ruler and further, for you to steamroll heavily over the crazed nutcases who oppose you.

And Another thing:

Subject: ON BEING REPEATEDLY RAPED...I, for one, am sick of it...

Insurance, particularly health care insurance, is the greatest scam in history. We pay thousands upon thousand of dollars each and every year and, increasingly, we get NO GOODS OR SERVICES. In essence, we pay out billions of dollars each and every year for ABSOLUTELY NOTHING. We are in fact, making a handful of these huge industry titans, i.e. the top echelon CEO's CFO's, etc. of the so-called health care industry, a veritable FORTUNE.

Simply stated, when any industry is driven by profit and profit alone, AS IS HEALTH CARE, they, the greedy and unconscionable controllers of the industry, reap dizzying and obscene amounts of money. WE, on the other hand, LOSE consistently and constantly. Profit-driven health care is an absolute NEMESIS.

As this health care industry makes record profits from not providing health care to those who pay for health care, the industry also becomes much stronger and much more influential (witness the ULTRA-powerful and ULTRA-wealthy lobbyists who fight tooth and nail to keep things the way they are).

How long does it take the average person to figure out that we are all getting UTTERLY and UNABASHEDLY RAPED????


Christina Marlowe

And by the way...

To the Bastard Politicians, Republican and Democrat alike:

It is unthinkable that there are so many Democratic obstructionists, not to mention the old fear mongering by the Republicans and Democrats alike. We, the American people, voted for OBAMA, in large part because he promised to effect systemic and CONCRETE change in several areas, not the least of which is the health care system which is utterly failing us all; all, that is, except for you politicians who enjoy full, lifetime health care benefits on our tax dollars. This is simply criminal that there are so many belligerent obstructionists in both parties. I will never forgive any of them who are casting their lot with the insurance and pharmaceutical corporations. It is simply disgusting. Did you not read the recent WSJ poll which stated that a full 76% of American citizens want the public option? And is it that you really don't care WHAT we want?

Irately Yours,

Christina Marlowe


I am writing in support of a strong public option for health care insurance, because I feel it is the best way to create competition among private insurance companies and get the kind of coverage my family wants and needs.

There are a few key things that would improve my family's current health insurance situation. If these things are not part of health insurance reform for the average family, what's the point of any reform at all?

1) Lower insurance premiums so that we don't have to choose between helping our children go to college and health care for ourselves. Recently our family income increased by 20% (about $10,000), but our health care premium increased at the same time by 300%, so that more than 1/4 of the recent income increase goes to health insurance coverage. Plus there is a $4000 yearly deductable on our plan. And this does not even cover dental, vision, or mental health expenses. At this time, we literally are regularly forced to make the following type of decision: between buying one text book for our college aged daughter ($250) and getting one of our broken teeth fixed ($280 - $1,800).

2) Insurance that is continuing, so that each time my husband changes jobs (or his company switches insurance providers), we don't have to keep changing our primary physician. (This has happened to us 4 times in the past 10 years, and I would like to have more continuity of care than that, especially as we get older.)

3) Insurance that doesn't disappear when my husband or I get sick. We have been very healthy all our lives, but we are both 50ish and worry that if we get seriously injured or ill, our insurance company may stop covering us even though we have each continuously paid heafty health insurance premiums for the past 30+ years.

4) Insurance that is portable, so that if a "pre-existing condition" such as a diagnosis of cancer (the type of illness my husband and I probably would be most likely to get) occurs, we can still more freely from one job to the next to improve our family financial situation without the threat of losing our health coverage.

As far as I and my family are concerned - health care reform is the most critical issue facing our family today. We can do our part to keep our excellent health, such as through exercise, diet, and safety precautions, but we purchase insurance in case of an unforeseen event. Since we live responsibly, and purchase this type of insurance, we don't want any dirty tricks should such an unforeseen event occur!

Please have Mrs Mahar include these mundane, yet important, key issues the average family faces.

Thank you very much for your consideration.

I have a question regarding the reimbursements in the healthcare system. Why are the uninsured getting blamed for revenue losses for hospitals in this country? When I recently began looking at the reimbursement rates from private insurers based on claims submitted, the insurance company only pays about 1/4 to 1/3 of the billed amount. For our insurance, the balance is then discounted after our co-pays. If a person is uninsured, they get billed by the doctor or hospital for the entire amount and are expected to pay it. If they don't, it is sent to a collection agency. Then the media states that there is a revenue loss to hospitals because of the uninsured. Why not put the blame where it belongs...on the private insurance companies who don't pay what is billed?

Thank you Maggie,

There are some definite dysfunctions in our health care system, and I find the biggest one is that people are not empowered to properly care for themselves in order to prevent many of their illnesses.

There are many safe and effective ways that people can addresses symptoms and illnesses in a very natural, inexpensive way. Unless we teach them, we are just encouraging dependency and illness. Like that quote, "Give a man a fish, feed him for a day; Teach him to fish, feed him for life." We have to ask ourselves what it is that we are doing and what do we really want to do.

Let's discuss how we can empower people to live healthy lives, to use energy techniques, and to implement more natural remedies so that they don't end up in their doctor's office as much.

The effect of less business in the hospital will naturally be that hospitals will become less of a business. Things will change quickly when business slows. We all know about supply and demand. Hospitals will become empowering preventative education centers with trauma care centers to mainly treat acute illnesses and accidents. There will less of a need for maintaining illnesses, because people will be improving and maintaining their own health and that of their family's health with their own two hands, in a safe and natural way that doesn't cost any money.

There is a plethora of free information on the internet that can profoundly improve someone's health right now! Just start Googling. From energy techniques like BodyTalk and EFT to advice using nutrition, herbs, exercise, and meditation. No one needs to be without means to help themselves; let's find a way to really spread this information. Only then will we really talking about reform.

Thank you again for bringing attention to the problems with health care and health care reform, and thank you even more for being open to solutions.

In Health and Happiness,

Ms Mahar, I meant to include the "Who Is Paying?" and "What Are We Paying For?" pie-chart illustration pages that appear just before the Preface if possible, in my request! Please!

[Sorry, I forgot to mention those in the question to Ms Mahar in my last post.]

I would like to ask Maggie Mahar if it would be possible for her to have the Preface of her book "Money-Driven Medicine" posted somewhere on this or another website (with a link on this website)?

It is by far the best, most succinct, and well written summary of the most important and compelling facts of the current healthcare reform debate.

I would be willing to make an extra donation to The Journal or PBS to help encourage such a posting.

"Critical Condition" is the saddest movie I've seen in some time. It should be required viewing for everyone in Congress, though a lot of them still wouldn't get it. One question: why did the Dove family (in Austin) not qualify for Medicaid? As I recall, their income was very low.

Yesterday I attended a Congress on the Corner. A young woman in a wheel chair struggled to voice her support for a public option. Her breath was labored, but she managed to repeat "You think you're insured until you get sick" over and over. Her young son picked up his mom's megaphone and continued for her. Some of the anti health care protestors started to pick on the boy. One told the mother to "get a job." The mob reflected the heartless, greedy, selfish condition of those who are fighting health care reform. America the beautiful? I am ashamed of our Congress. Pass that bill NOW!

This reality turns my stomach. I don't no whether to cry or throw up. This is NOT America. It hasn't been for a long time. This corporate greed is no less evil than anything I have ever witnessed or read about. I am embarrassed and ashamed.


I do have one question:

How difficult would it be, once laws are passed to prohibit for profit companies in the health insurance industry, for companies to actually switch from for profit to non profit? Just curious.

Thank you,

Dawn Bushman

We should start calling the single payer system what it really is: socialized medicine. We should also start calling socialized medicine what it really is: the solution, and not "the scourge of democracy" that oppents of reform would have you believe.

The truth: socialized medicine is used all over the world. Canada, Italy Great Britain, Japan, and everywhere people love the system, the goverment pays less, and the life expectancy is higher. Japan ,for instance, has the highest healthy life expectancy in the world and they have a brutally socialized system.

Dear Mr. Moyers,
I am a long time watcher and admirer of your program. I must say however that I was a little surprised at the recent documentary “Critical Condition.” As was previously posted by Alice White, I wish that the report had featured individuals from the middle class (ala Harry and Louise) with similar heart wrenching stories of illness and doing battle with insurance companies.
As a Republican who is wholly sympathetic to the subject and need for health care reform I felt that you did the cause a disservice with this documentary. “Sadly, we're a very judgmental society and the fact that one woman was morbidly obese and a poor family was about to have its 4th child makes a lot of people turn away.”
It is amazing to me that the Democrats have lost control of an issue that virtually everyone agreed was desperately needed only six months ago. The problem as I see it lies in recapturing the hearts and minds of the middle class – the rich don’t need reform and the poor are too beaten down to have or give voice. Unfortunately, while 47 million Americans don’t have health insurance, the majority does have it and pays a small fraction of its cost while their employer pays the lion’s share. This coupled with the fact that most Americans are healthy and have never personally experienced a tragic accident or life threatening illness results in a lack of reality on the limitations of those health care policies. If they truly had an understanding of how ephemeral their coverage would be if the job connected to their insurance is lost, or what happens when a lifetime cap is reached or what it costs to cover a family of four through COBRA, they might feel differently about supporting this issue. People need to have their noses rubbed in what exactly 80/20 coverage is and how devastating the financial consequences are to a working family if they suddenly have to pay 20% of a 100K or 200K plus bill. People need to look beyond today to what may happen to themselves and their families five or ten years in the future.
I am now over fifty and have worked for my current employer for nearly 30 years. My company is struggling with the current recession and for the first time in my adult life I feel vulnerable. Although I’m currently healthy, I’m also at that age where aches, pains and bad eyes are starting to come to the fore and I realize now that if I were to lose my job and my healthcare, replacing either would not be the given that it was a few years back. The gap between 50 and 65, when one qualifies for Medicare, is a very long 15 years indeed.
At the end of the day, the middle class must come to the realization that there is no free lunch and the only way to resolve this debate is through some type of health care tax similar to SSI. When people ask how other countries can afford universal health care - the answer is they pay higher taxes. Like Medicare, the initial bill will be far from perfect but if we get the initial framework passed at least we have something to work with. Given the current alternatives I find this to be a reasonable and viable solution. Obama was a fool to make the “no new taxes” pledge during the campaign and it will come back to haunt him. Frankly, I think it would be worth having him as a one-term president if he got health care reform passed paid with a health tax. I don’t need a two-term president; I need one that gets something done

What is the benefit of a bi-partisan bill? I think it is a way to ensure political funds from insurance, pharamaceuticals, hospitals, etc., continue the flow of funds to both Democrats and Republicans. The Democrats don't want their name alone on real health care reform. That will cut them off from financial support from these powerful special interest funders.
The two parties may diverge on some social issues, but when it comes to economic issues and corporate power, both are wedded to continuing the corrupt status quo.

I left the practice of medicine in 1999 after only 22 years as a family practioner. The system was already broken back then. Profit is the driving factor there is only a paper trail to give the illusion of quality of care.

Why isn't there any mention of extending Medicare to younger enrollees; say to age 50 as a trial. Then, if this works, all ages. This would help shore revenues for medicare and create a basic care package for all. There are already cost-containments working in medicare and these could be refined. The Rx 'part D' needs a complete overhaul to include contracting or best price and extending these savings to the patient. The administrative infrastucure is already in place and people understand 'medicare' whereas none of know what the 'publie option' really is? So, why aren't we hearing about this option?

I appreciate the 'Journal' website maintenance staff for truncating my (BVA) original post [August 21, 2009 11:06 PM, at this same web page "Ask Maggie Mahar"] of the entire text of George Lakoff's most recent HuffingtonPost blog "The PolicySpeak Disaster for Health Care" (criticizing the administration's political mistakes in promoting healthcare reform, from a cognitive science point of view). It was way too long. Thank you very much.

I apologize to other commenters and readers for the length of that post. It was silly as you can read the entire text on the HuffingtonPost website especially in the print view mode [at or at if you prefer]. (What was I thinking!) (It is worth reading the entire text of it if you have never read any of Lakoff's more recent books and/or Drew Westen's most recent book on cognitive science and political campaigning 'The Political Brain'.)

Wow! I just noticed that the newest violent and mindless cartoon at the movies is titled: GI Joe: The Rise of COBRA. While it is not about medical care per-se, it may be an awkward way for the corporate mind to load future zombies with a prejudice against a government mandated program requiring that laid off workers be given a chance to continue health care coverage. They smother minds in the cradle, don't they? So kill all the zombies you want, Talibans: We'll make more. War is a force that yields great profits.

Totally off topic, but being unemployed and joining Cobra in October, I have a deep interest in this debate. I can only follow with your podcast and unfortunately, the second part of the file download
(Critical Condition Pt 2)
contains a repeat of the first part file (criticalcondition1.m4v)

Can you have someone fix this? Thank you.

Have you looked into "medical necessity" and what effect its going to have?

I'm looking, looking everywhere and can't find this info.

If I spend $100 on "health care" where does the money go. Can anyone track every cent of that $100? I've seen the insurance industry says they make 1% profit... so they get $1 of it... *cough*... other say they get 2-10%.... but ok, how much does the doctor get? How much covers clinic overhead? How much is paying for malpractice insurance? How much is profit for the company that owns the patent on the MRI? What about the drug company? etc?

I think it should be mandatory that every member of the house and senate watch this documentary before casting a vote on healthcare.

I don't understand how so many don't see our health care system is broken. I'm among the "have's," blessed to have been covered for most of my life, while seeing others in sad situations such as the people in this series. As the result of injuries received in his youth, my husband has had both hips replaced at a cost of $20,000 each. With our 10% copay, he had to pay $2,000, which we fortunately had in savings. He works and walks and moves so well that most would never know he'd had both hip joints replaced. When my migraine headaches became more frequent a year ago, my doctor ordered an MRI to rule out a brain tumor. None was found. I'm very thankful for the health care I've received and believe all Americans should have the same.

The opposition is rooted in money. No matter what argument is used, it always comes down to money.


please make it abundantly clear that creating a public insurance option will slow the rate of increase in healthcare costs (according to the Lewin Group and many other think tanks) and this is good for all Americans.

we can do more if we do it more efficiently.

There are certain ironies created by the Republican strategy of 'maximum mendacity' in the war against healthcare reform. One of them is that those voters now receiving Medicare coverage who bought into the lie, 'that healthcare reform will reduce their benefits', will most likely suffer the most draconian reduction in healthcare benefits (not to mention a similarly draconian reduction in pension benefits) if there is no rational healthcare reform! Even though Obama keeps touting the financial unsustainability of the current system, a majority of retirees do not realize (or believe) that if healthcare cost inflation is not dramatically reduced for the entire medical services and products industry, not only will Medicare will be bankrupted (most likely in less than ten years), but also Social Security shortly thereafter (and, if anyone cares, probably the rest of the federal government). That of course does not mention all of the private companies, trust funds, co-ops, and foundations dedicated to providing healthcare that will also be destroyed in bankruptcy court. To avert this financial catastrophe either the so-called 'public option', or a much stricter program of medical insurance company regulation (then is now being contemplated in current version of reform legislation) is an absolute necessity.

[If one or both of the two massive safety networks (for the elderly) stopped functioning we would eventually have another Great Depression. Social Security and Medicare constitute a giant economic 'flywheel'. Both steadily pump a large amount of purchasing power into the economy every month and thereby smooth out the ups and downs.]

There are other things some retirees are also blithely unaware of. One caller to an NPR talk show complained that she was being forced into Medicare coverage and resented it greatly. But astoundingly, none of the media or experts on the show gently explained to her that unless she was very rich no private healthcare insurance company would insure her at a affordable premium! I don't know if they were similarly lacking in knowledge or if they were surprised into dumbness. This was on NPR!

[To any of you who are dismayed at of my 'nakedness of any my assertions' (no citation of a authoritative source), well if the Republicans can tell outright lies (no matter what spurious citation they use, or don't use) why should I have to worry about sourcing any fact (or factoid) I might include in a post on the internet. Its just my little contribution to the destruction of effective democracy. This is not a good time to have your kids following current events if you are having a very local problem with mendacity.]

[To the person who lost all of his original post, 'Susan D' I think, and had to rewrite it. I always temporarily copy my posts into 'Wordpad' before I click any web page buttons. You can also see your mistakes in grammar easier in a word processing application.]

Dear Ms Mahar,

I have a question: The president and congress have already bailed out the insurance companies with billions of dollars, isn't this so called health care reform debate really only about how to give them more?

And do you believe like me that the real solution to health care in America is education reform?

I recently toured a federally sponsored high school that gave kids who had difficulty finishing their own high schools a second chance to receive a diploma and also to learn some skills of a trade. At the morning induction breakfast for new students they as I were served donuts and pastries, white toast with jam, white flour pancakes with corn syrup or fake maple syrup, eggs and pig meat, and fruit punch.
Health care reform?
Shouldn’t we give our children first and foremost something healthy to eat?
And rather than Euclid’s geometry of a theoretical perfect circle, what about a class on eating a real apple.
Shouldn’t we simply start right there?


Here is another question. In 2003 I had surgery that went bad. The total cost was $300,000. Now, the HMO picked up the cost. However, I was informed by a reliable source that the insurance companies actually pay only about 30% of the billed cost. Is that true? Are the non-insured and under-insured actually subsidizing the insurance companies by paying over 3 times as much for the same service?

Posted by: Stephen Huber | August 21, 2009 10:56

I think I can answer that. Yes, your friend is correct. Big insurance entities negotiate with health care providers (doctors, hospitals) for less expensive rates for medical care and procedures. 30 percent paid versus billed charges is probably about right, although that can vary.

And while it is true that the uninsured and ,in some cases, the under-insured are charged the full bill I don't think you can say they are subsidizing the health insurance industry. I think it's safe to say that most of the uninsured simply can't pay the highly inflated health bills they may incur. Therefore the insured end up paying for the uninsured that receive care in the form of higher premiums, deductibles, copays etc. Look for employers to shift more of these costs to employees if no reform takes place. Just one of the many absurdities of health care in America.

After watching the program last night I am again appalled by our inability to take health care--from drugs to actual care--out of the hands of profit driven companies. I am a self employed visual artist and unable to purchase conventional health care insurance because of a past illness. No one will sell me a policy. My only recourse has been to purchase insurance from my state's high risk pool which uses Blue Cross. The only policy I was able to afford carries a $10,000 deductible and a 20% co-pay. In addition, if I want to upgrade the policy and lower my deductible, I am prohibited from doing so.

I am well educated, exhibit internationally and continue to receive numerous awards and fellowships for my work. Still, I would not be able to take care of my health care needs should something major occur. I would face bankruptcy.

Last year I spent four months in France as part of a special fellowship. I did visit a doctor there and was stunned when I only had to pay $30 (22 Euros) for the visit. I was also stunned by the fact that care for minor injuries, etc. can be obtained at the pharmacy. I'll be returning to France again this year on another fellowship. If I need to see a doctor, let it be there.

It seems to me that we are now a country run by the corporation and for the corporation. Frankly, I've had enough.

As someone who has been very poor (dirt floor no indoor toilet) I always wonder since so many well to do people claim they are willing to pay more for others to have health care why don't they create a fund to do it. How can the same people with numerous homes, private planes and warehouses of expensive cars, jewles, furs bemone inequality?
This goes for the Pope too.
The church has billions worth of art and realestate; he will "champion the poor" but not willing to liquidate those assets. He condemns others for not giving more while sitting on Billions.

Alice White said it all. I cringed when I saw the people you featured in this documentary. Most Americans who have insurance don't give a flip about these people. Their attitude is "It sucks to be you'. I wish you had featured people who had insurnace and how it failed them.

I'm waiting for those who think government is inefficient and incompetent to start calling for dismantling and privatization of the FBI, CIA, Secret Service, Army, Navy, Air Force, Marines, and all police forces at state, county, and local levels. (said with rolling eyes and partially tongue in cheek but starting to wonder if that's where these people are actually heading)

While this was an excellent documentary it will do little to convince those with insurance to help those without.

Sadly, we're a very judgemental society and the fact that one woman was morbidly obese and a poor family was about to have its 4th child makes a lot of people turn away.

Many of us are aware of the plight of the uninsured, but more people are concerned about themselves and their families. Most wouldn't be willing to wait an extra day to see a doctor if it meant someone,they consider beneath them, can get in first.

I'd like to see the filmmakers turn their attention to middle class families and individuals who are ill and having health insurance issues.

Those stories will resonate more effectively with voters. It's sad to say but we relate best to people who mirror our own lives. And, while the haves may feel sorry for the have nots...they're not willing to share.

As background, I am unemployed and fortunately covered under my wife's employer based group health policy. Interestingly we have both paid claims in the Life and Health Insurance industry for over twenty-five years. After watching this documentary last night I feel confident that, to a person, no American would wish the pain these families went through on their worse enemy. What many of us have a real problem with however is placing such a serious issue in the hands of Washington politicians and bureaucrats. I cannot think of any program run by the government that is truly efficient or economical, usually just the opposite is true! The private sector does a much better job of delivery, and speaking for all claims professionals, we take our responsibilities very seriously! One of the main problems I see with the current situation is treating "health care reform" as a single issue. It's not, it is several distinct problems that need to be addressed individually. One big step would be standardizing and centrally regulating the private insurance carriers. Each state has various regulations and degrees of efficiency. McCarren Ferguson is outdated and the NAIC has been totally ineffective in standardizing the industry. Some states regulate claim loss ratios and there are also major discrepancy with State mandated language covering benefits and exclusions. We now have fifty different sets of insurance regulations overlaid with numerous Federal mandates. Insurance carriers have whole departments set up just to monitor regulatory compliance! Another separate issue is cost containment. The rapidly spiraling costs not only effect the Insurance industry but have virtually bankrupted Medicare/Medicaid. Without really dealing with this problem a "public option" will exacerbate the problem. Trying to limit costs by applying a variation of the Medicare reimbursement schedule will not work. If you know anyone on Medicare/Medicaid just finding a doctor to accept an assignment is a challenge. Payment for services needs to be reasonable but should be only paid for the real services provided. Under the current system private coverage is really subsidizing Medicare, Medicaid, and the uninsured. Eliminating cost shifting would greatly reduce the expense. A thousand percent markup on OTC meds and cental supply is used to offset other costs. We can't manage costs if we don't really know what they are. Reining in uncontrolled drug costs would make a huge difference. If Canada and Mexico pharmacies sell patent drugs at a fraction of the cost and still make a profit, so can we. Another real problem that no one wants to touch is tort reform. Some practitioners pay in excess of $250k per year in malpractice insurance premiums This is a cost that's a direct pass through and "defensive medicine" is a significant cost factor on top of it.
Again each state may have varying degrees of statutory tort reform that effect all medical and insurance costs. Patient's rights can be protected without the trial bar hosting a "Wheel of Fortune" industry. Lastly and most importantly, providing health care to the uninsured is paramount. No one in this country wants to be in the position those poor folks on the program found themselves but creating a "one size fits all" solution is not the answer. Properly funding public health for the uninsured will be expensive but I think we will all get behind that if we really feel it is being administered effectively. For many of us putting millions of dollars for sidewalks and bike paths in a health care bill equates to a typical Washington fiasco. This is what scares many of us when talking about a program of this magnitude. This is an emotional issue but it would be very productive if the media would remember the means only justify the end if we have "means". If we kill the economy we all lose. Thanks, John Greenwood, flmi, alhc, clu

I find private insurance to be worse than any kind of socialism. When you look at it, they take in money from a pool of people, and ration it out to who they see fit, as little as possible. Obviously whether public or private insurance, they can't pay for everyone, no group of Americans will be too healthy for that to be true. But the private insurers have additional obligations to Wall Street and shareholders, ultimately less money to dispose to their customers. Death panels are already in place in that they can deny treating your life-threatening illness because they found out it was a preexisting condition, or simply does not fall under their service because of any fine print clause. Insurance of any kind will always be socialism, not necessarily a good socialism though, because the most in need of treatment are rarely the ones to get it.

Private insurance does not contribute to anything, they don't help with new drugs, don't come up with cheaper treatments, a majority don't offer incentives for being healthier Americans, not even fancy financial engineering (only in that they trick you to pay more). They aren't more efficient than the public by any means, that terms only applies in their ability to gut the old/unhealthy who they lose money on, they're workers don't work faster, their technology isn't better, infact they take much more time to pay doctors than medicare, doctors don't even feel safe around them because they don't know how much they're getting paid each time. All private insurance ends up being is a greedy entity that interjects itself between the people's money and the hospital's revenue, and end up badly damaging both.

Single payer provides the greatest risk pool, and the greatest benefit for the masses. Everyone is included, meaning they are plenty of young folk to cover for the old, who aren't gutted here because its health before profit margins. From there it would be in the government's interests to lower how much it has to tax people so nothing would stop preventive care from finally getting serious ground and stop making americans so fat, diabetic and costly to treat in the first place. We can go further than that, the health of every American should be a SUBSIDY. What greater benefit than this country having healthier and harder working folk, more and smarter entrepreneurs, more inventors, more college graduates? The sick and the unfit in great numbers can't become any of those. Why not gut useless military spending, needless wars, farm subsidies only benefiting a few corporations, unsustainable parking lot, highway, and housing subsidies. Technology exists to make those profitable and competitive, the health of our people should be the easiest thing we're willing to go into debt for.

Yes we have a bad government to expect to deal effectively with this, but if you have a bad car, do you just toss it and never drive again? We'll lose in a footrace against the world who can depend on the protection, power and speed of their vehicles. I'd say we fix the parts of this car making it such a pain to deal with, if the whole thing is a mess, trade it in a for a whole new vehicle. Write an entirely new constitution and create a government that actually protects people from interests, not interests from people. Have it finally work the majority, the handicapped, the rejected, the underprivileged!

Hello, Mr. Moyers:
Your documentaries look too important to not share what they are about. I use twitter instead of facebook, and so I sent tweets with URLs back to the website.
Thank you for such effective and ground-breaking programming.

This was even more powerful than Michael Moore's Sicko. As a Canadian living in Toronto, I am confused and perplexed as ever about my American neighbors. There is such a disconnect between these real life narratives- of suffering, fear, despair, futility, amongst ordinary citizens; and the rhetoric that is spouted 24-7 on the conservative media outlets, amongst the protestors showing up at the townhall meetings, screaming no to affordable health care. Your situation defies rational and moral sense! How did the land of the Brave and Free become the Land of ingnorance and Greed?!
I realize that Canadians take our their single payer 'socialized medicine' for granted- even complaining openly about how unsatisfactory it is. I forget how: if I have an ache in my shoulder, I just go to see the doctor. No co-pays, deductibles, no hospital finance department visits nor collection agencies.
Why can't you all see that this is how it should be? We all pay a nominal amount into the health system and whenever we need healthcare, we get it. No matter what your income or employment status, you are entitled to get the same high quality care as the wealthiest person in town.
My, oh, my how stark the differences are on the other side of the 49th parallel!
There's absolutely nothing wrong with people looking after people, and providing care for others when they need it. That's what civilized Nations do.

It just nauseates me to see how your profit driven health and insurance industrial complex can trick you into fighting for/maintaining a system that provides you and your fellow citizens with so much suffering and despair.

Is that America?

As a Canadian I am flabbergasted by all the fear mongering about "nationalized" health care. After living here for ten years now I can assure you that the level of care is no different between the two healthcare systems. The only difference is in the way that is paid for and the amount we pay for it.

Hugh Chapman

"Fire your 401(k) - Make your own pension plan!"

I just watched Bill Moyers Critical Condition about the lives and often deaths of the uninsured in America. Mr. Moyers is correct that while all of those who loudly support or oppose health care reform are busy drawing attention to themselves, many go without care and often die of treatable illnesses. Those who shout the loudest are also probably the fortunate ones who have group insurance or are poor enough or old enough to be on Medicare or Medicad. We 40 million uninsured are not just the working poor; we are the over-educated with graduate degrees, including masters and doctorates who are self-employed or teaching for small private schools. Until one year ago, we had not-so-good private insurance. As we grew older into our late 50's, we developed chronic eye diseases or kidney stones. The 20% of tests, etc. the insurance did not pay for amounted to 10's of thousands of dollars. We resorted to borrowing from credit card companies to pay off medical bills. We still owe those companies thousands of dollars. And of course, our health insurance skyrocketed after we filed claims. We did what the company intended: we cancelled our insurance. This year, after nearly dying, my husband, who is a veteran, was diagnosed with severe biscuspid value disease. His doctors have told him he should have the surgery ASAP. He has continued to work in order to pay off bills. If the VA doesn't cover this, we will not be able to afford the surgery. We have a sixteen-year old son to put through college. We, of course, were denied coverage by private supplement companies and told to check our state's risk pool insurance. We did: it is $800 a month for my husand alone. But what about those who are uninsured and not veterans? The former insurance executive on your show has the insurance companies pegged: they are fear-mongers, whose motive is to keep their huge profits while many people do without life-saving surgeries. Since that program several weeks ago, I have listened to the CEO of Mayo, where better care is less expensive, praise Tri-care and a guest on FOX praise the Swiss system, where private insurance is more affordable. Why do the states regulate insurance? Why doesn't Washington? Blue Cross, according to friends who have had it in several states, is much worse in our state. Why not cooperatives or exchanges?
Yes, insurance is rationed to those who are insured. A local professor moved to Canada where he receives local care without waiting and where his wife had two major surgeries without waiting. His daughter, who stayed in the US, was denied coverage because she has scoliosis. It is a moral outrage that only the wealthy are treated well. Blue Cross also limits doctor choice and parents' taking their children out of state to a children's specialist hospital. What will happen to the US if the educated middle class teachers and scientists move to Canada in order to receive medical care? We are near bankruptcy and dying because we cannot afford insurance or life-saving surgeries. But we are also not important because we are not insurance or pharmaceutical lobbyists or Wall Street investment bankers, who have caused our son's pre-paid college fund to lose 25% of its value. We uninsured but good taxpayers must fill the blogs and airways with our stories and ideas. PBS and some doctors are the only ones who speak the truth and care about all citizens. Health care is life or death, not politics and political action groups.

With the profit driven health care industry's focus on profits for its shareholders and Congress strong armed by high roller lobbyists and pundit demagoguery, what if anything is a citizen to do? not only for its stake in this debate-but to be heard in earnest with out a "Yes,but" in the wing.

I firmly and sadly believe that the majority of citizens who want a strong public option will never be heard-unless it comes with a $5,000 per person fee for the auditory honor. If this is so, then what about the doctors, nurses, and medical technicians who have a Empirical and personal knowledge of the facts on the ground. Why are they not marching en masse to congress. Surely the Hippocratic oath and their contribution to society should get them a more than token seat at the table of Heathcare decisions that is being formulated on Capitol Hill. Or have they like the rest of us given in to the larger than life power of Ingsoc: 2+2=5, Freedom is Slavery, Lies are the Truth.

I know on an instinctive level that doctors and their helpers do care about patients, thats why they went into student debt and the grueling academic path to get there. My only "Yes, but" is: What training you as medical professionals went into, what ideals you hoped to achieve, cannot be unless the powers that be are opened to the raw reality of your experience. the polished events in committee hearings will not invoke a lazy nod from the Senate. We need a bigger Earth Day protest in the capitol just for Washington wake up let alone do something substantial. Beat the astroturfers at their own game-Think Earth Day of 1970, which galvanized the creation of the Environmental Protection Agency. Now...Think bigger, Think of the people and of what more you will lose that will lead to harmful and mischievous behavior from your hands as directed by the Insurance Industries expanded powers of whim.

OECD comparative public health statistics including life expectancy, infant mortality, per captita healthcare expenditure, and total healthcare expenditure as % of GDP for 7 developed countries and the USA (8 nations total) at webaddress below.

emmy: The only way you'll get into another country with good health care is big bucks or marriage. I know: I've tried. Even Canada threw me out.

I've seen this documentary twice before, and it always makes me cry. I'm one of the lucky ones who has insurance, but I pay thousands of dollars per year for it. What I don't have is a doctor, or any plans to partake of the medical system, because I have a deductible of almost $4000/year before the insurance pays for anything. I don't have cable TV or a fancy phone and I haven't been to a shopping mall for a few years. I drive a 12-year old car. Insurance is by far my biggest expense. And the kicker is that I know that the insurance company might find a way to not pay if I do get in an accident or get a serious illness, so it doesn't really give me peace of mind. And now Republicans have settled on health-care reform as their latest "wedge issue". While previous wedges were very serious to relatively small numbers of Americans, this one is a menace to the entire country. Those people care only about the political contest, and the Democrats need to stop trying to "make nice" with them. Of course, Congress critters don't really have to care about health reform. They are well-covered by taxes from people like me, and the only way that I can "win" is to move to another country...which I'm considering at this point...somewhere where people don't feel compelled to bring weapons to a political debate.

I would like to see a not-for-profit company set up to insure people who are uninsured. I would support the government paying for some of the companies costs. I would like to be able to support this institution directly from my pay check.
I do not like goverment run or single payer because that would put too much power in the hands of too few and it would be ripe for abuse.
It is obvious that politicians don't care that much about the uninsured. If they did they could collect money amoungst themselves to pay for peoples healthcare needs. I can hear the laughter. It would never happen. That is exactly why they should not be in charge of healthcare.

Zora Renee: I don’t believe the American people have the stomach for storming the gate. They don’t have the _ _ _ _ _ to throw their representatives & senators out at the next election, either. The new guy might not bring home the pork.

Emily Horswill: I am so sorry for your losses & pain, but just remember… we wouldn’t want a new system that would “ration healthcare.” No, we wouldn’t want to do that, would we? [and in case anyone missed it, that drips with sarcasm]

George Lakoff - The PolicySpeak Disaster for Health Care - The Huffington Post - August 21, 2009
Posted: August 20, 2009 10:39 AM

George Lakoff - Author and Professor of Cognitive Science and Linguistics at UC Berkeley

Barack Obama ran the best-organized and best-framed presidential campaign in history. How is it possible that the same people who did so well in the campaign have done so badly on health care?


Here is another question. In 2003 I had surgery that went bad. The total cost was $300,000. Now, the HMO picked up the cost. However, I was informed by a reliable source that the insurance companies actually pay only about 30% of the billed cost. Is that true? Are the non-insured and under-insured actually subsidizing the insurance companies by paying over 3 times as much for the same service?

I've been considering why Obama has been so obsessed with getting a bipartisan healthcare bill. I think that politicians are not so concerned with the political "cover" of bipartisanship when they know they have a winning bill that will really help people and be popular. But the public option as currently written (by House Democrats) probably will not help anyone until 2013. This will be a real slap in the face for those who desperately need help now. And the question of affordability is also still not resolved, because it has not been specified how much premiums will cost for those who make too much to be eligible for subsidies. So, even if a "public option" is passed, people who have no health insurance are probably not going to be celebrating in the streets and thanking the Democrats. No wonder they would prefer to have the cover of bipartisanship (or someone else to blame for not getting a good bill). I read that in the sixties, Medicare was passed in the Senate with 49 votes, and a month after the final bill was signed, they began signing people up for the program (not four years later). There was plenty of opposition, but the Democrats made sure they had a bill that would actually help a lot people, and thus, gain public support. Times have certainly changed!

Sorry for the double post. I accidentally hit the post button twice & the site told me it didn't work & to come back later & try again. I believed it & didn't check. Oops.

I am so angered and sickened by what I have just seen that I don’t think I can say much. R.E. Darby is right - How has it come to pass that we don't even question our acceptance of the idea that an economic system is more important than Human quality of life or even Human life itself?

I am fed up to the gills with this country. And so ashamed of us. How do we allow any system that charges a woman $1100 per MONTH for a medication?!

People talk about a health care system but there really is not a healthcare system. There are four or five separate industries (doctors, hospitals, nurses, pharmacuetical companies, insurance companies) that have no real link to one another but are combined by have a part in providing some avenue of healthcare. Each one of those industries are composed of many separate businesses. A business can only survive if it makes money. Once it does not make money the business goes bankrupt. Every person (all 130,000 of us) in the company that I work for expects to get a pay check. There is a cost. Ever watt of electricity that we use to develop or manufacture a product is purchased. Only 2% of the chemicals that start out as drug products actually make it to market. All 98 % of the failures cost money. You are correct, we live in a for profit society. Making healthcare a government run institution will not reduce the costs to run healthcare. Where will the money come from to pay for a federal plan, taxes. We will pay no matter what the plan is. In order to reduce costs I believe that a single payer system will regulate the amount of care that you are allowed to recieve. Which will be similar to what happens today.

I have a question on the "money" side of healthcare. I noticed in tonight's edition (8/21/09) that after a person dies, the spouse is hounded by bill collectors. Is it not the case that when a person dies, any of his/her assets goes to paying the bills and then whatever is left over goes to heirs? Bills ARE NOT transferrable to heirs, i.e., the bill collectors can not go after the spouses (though they won't admit to that!). Why won't anyone tell this to the heirs?
This situation happened to me when my father passed away. The one glimmer to the sadness was that I could tell the bill collectors to go stick it!

I am so angered and sickened by what I have just seen that I don’t think I can say much. R.E. Darby is right - How has it come to pass that we don't even question our acceptance of the idea that an economic system is more important than Human quality of life or even Human life itself?

I am fed up to the gills with this country. And so ashamed of us. How do we allow any system that charges a woman $1100 per MONTH for a medication?!

You know, I hear everyone talking about issues, but few of us question the fundamentals. It's as if we long ago lost our perspective. How has it come to pass that we don't even question our acceptance of the idea that an economic system is more important than Human quality of life or even Human life itself?
The truth that lives in my heart is gut wrenching. How did we lose our way so completely? Perhaps we should all try to find our way back to our Humanity before we engage in these seemingly endless and unproductive debates.

As a regular watcher I am fascinated that comparisons are drawn to Canadian and British health care delivery systems without followup to debunk the mis-information blasted out by opponents to your Health Insurance Reform debate. Look into it. Americans really need to see all nearby delivery systems to enable an informed opinion don't you think? Rather than just the negative pablum fed to them by less-than-informed media. Just a thought.

Don't forget!!.

Its not only Healthcare Reform but...

The crooked clause of restricting people over 65, in doing extra jobs to earn a better living is taxes half the amount. This cap that the congress makes up is Capitalism at its worse, Think about it, just because you make a little extra money, when you are old - The government or the so-called law taxes you, half the amount. Why?.

What happened to all the comments yesterday.
Where do I find my replies?.

All comments today are the same. Healthcare complaints!!.

The problem exists with the Republican Party.

Lobbyists are in control and the republicans love it>

If anything is to be done is to get rid of the Republican party and the lobbyists, if this is not done the Healthcare system will cause the people to suffer....

To Mr. Allenwrench-
"And stop calling it a single payer it what it is...socialized medicine."

While I have no objection to socialized medicine, single payer is NOT socialized medicine. Single payer is what it sounds like- health care is privately provided as it is now and paid for by a single entity, likely the federal government. Medicare is an example of a single-payer system (more or less). Socialized medicine (or nationalizing the health care system) means that health care providers are on salary and government owns hospitals, etc. I don't know why there is such hysteria about that possibility. Most of us work for a salary- why should doctors be in a special class?

The "public option" won't give people more medical treatment or reduce costs. In fact, it will probably make people pay more.
Only a guaranteed, universal, single-payer health plan that includes a mechanism to periodically review the effectiveness of its administration can increase availability without driving costs beyond what people can pay.
However, the ability to pay for treatment is only part of the answer. There has to be people to get treatment from and medicines to be treated with. There's been a lot of talk about money, but we need to listen more about people.
The Journal needs to do a show where you examine how each of the issues you cover in various shows affect one another. It would give your audience a chance for an even deeper understanding of the issues.

As I have my own experiences with insurance that refused to cover all of my care, and I read here and elsewhere how people are suffering at the hands of these Congress people that refuse to do right by their own constituents, it begs a couple of questions (1) do these constituencies see how badly their needs are not being met? and (2) why do these people keep to an ideology that is bankrupting the average American for what, a junket to play golf?

How can they look at themselves in the mirror?! A devastated housing market, bankers giving themselves bonuses for FAILING, 48 million without health-care, etc. WHEN WILL THESE TYRANTS STOP OR WILL THE PEOPLE HAVE TO STORM THE GATES!!!

From a friend in Australia. The world backs health reform-not only on its merits but because a defeat means a defeat for Obama which has widespread repercussions for WORLD issues-climate change, war etc!

From a friend in Australia. The world backs health reform-not only on its merits but because a defeat means a defeat for Obama which has widespread repercussions for WORLD issues-climate change, war etc!

Larger scope and stakes seen abroad!!!

Australia backs our health care reform:

From a friend in Australia. The world backs health reform-not only on its merits but because a defeat means a defeat for Obama which has widespread repercussions for WORLD issues-climate change, war etc!

Can you please elaborate on the co-op alternative and just exactly what that would mean for the middle class?

Mr. Moyers,

After listening to your program featuring Wendell Potter I sent e--mails to 5 members of the house of representatives and two senators from my state Ohio.

My husband and I support the Presidents health reform. I agree with Ms. Maggie Mahar that single payer plan is best.

Our local newspaper Plain Dealer is doing a good job of daily health care fact checking.

We hope the facts will prevail over the scare tactics of the health industry.


Karl & Sarah Toth

Mr. Moyers,

After listening to your program featuring Wendell Potter I sent e--mails to 5 members of the house of representatives and two senators from my state Ohio.

My husband and I support the Presidents health reform. I agree with Ms. Maggie Mahar that single payer plan is best.

Our local newspaper Plain Dealer is doing a good job of daily health care fact checking.

We hope the facts will prevail over the scare tactics of the health industry.


Karl & Sarah Toth

BTW, I didn't vote for Prez OB or support him. Nor did I vote at all since 1974.

I think ALL politicians are power hungry, lying rhetoricians. So, my vote is Abstention when it comes to individuals.

But I do support socialized medicine and would bother to register to vote YES for it.

OK, my question is why the decision of socialized medicine is not put in the hands of the populace?

It obviously can never be passed in DC. We have a Dem controlled DC and they still cannot get it done. Let the people decide.

All the bells and whistles have been long worked out by England, France, Canada and Cuba. Just copy what they have and be done with it.

And stop calling it a single payer it what it is...socialized medicine

There is no such thing as negative or positive attitudes. What is viewed as negative to one person may be viewed as positive to another.

There are no such things as 'opinionated' - 'provocative' 'controversial' subjects.

These are only subjective and prejudicial states of mind.

Russell Cromwell tells us - "With the same material one man builds a palace and another only a hovel." So we must allow people to build as they choose.

If one sticks to: true, false or don't know in one's replies they can avoid this trap by arguing facts and not personalities.

Those that can't argue facts argue they have done with all these scare tactics about Prez OB.

My daughter is dying of a tumor on her brain—easily correctable, but by the time she was declared an emer-gency it was too late. to began, my son-in-l aw, at 54 years of age, died of cancer. It took him a year and my daughter ran out of money, of the 5 rental houses which she had personally maintained, and land a few miles from the ocean. Now the whole family pitched in to keep him as comfortable as possible. The bill, close to $65,000, bankrupt Ann, her Uncle and impoverished me. Three 3 months after he died Ann began having migraine headaches, then vertigo. she was crawling before she became an "emergency," and could get the catscan we couldn't pay for. The tumor sucking up her brain was big as a baseball. Doctors operated for 21 hours, why I don't understand, they knew it was too late. Now the bank owns the rentals she had maintained with her own hands for 10 years, their 10 acres of land has shrunk, and she lies dying slowly and painfullly. I have run out of tears.

I've been trying to understand how Congress allows monopolies to exist in the drug industry. I've been a type 1 diabetic since 1966 and in the 1980s Recombient DNA human insulin assisted me in controlling my condition. It cost $9.00, about $4.00 above beef/pork zinc insulin. Today it's $45 to $112 per vial. I've was given the old FTC/FDA spin by the Bush hacks and a muddled 'they're still examining copyrights' answer by Senator Ron Wyden as to why there is no generic insulin. So, two questions:
1- Dr Banting [he gave us insulin] gave away his copyright in the 1920s, so "the people can live'-how can a corporation 'own' human DNA and exploit we who're 'captured' and dependent?
2- If it's over twenty years since human insulin became available, why is there no generic insulin? Why does Canada have the same insulin, made by Lily or Nordisc, at a third of it's USA price?
The French, Germans, and Japanese all have drugs controlled as non-profit because of the inherent greed and manipulation built into for-profit.
Thank you

Think again. Salt is an essential element in the diet of humans, animals, and even of many plants. It is one of the most effective and most widely-used food (and Egyptian mummy) preservative. Its industrial, medical and other uses are almost without number. It has even been the subject of the subject of music, art, and poetry; and is viewed with great historical interest all around the world.

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