Just before the nationwide PBS release of his new documentary, “U.S. Health Care: the Good News,” author T.R. Reid talked to Associate Editor Stephanie Bouchard about the documentary and the healthcare issues facing the nation. Here is an excerpt from that February conversation. Go to www.healthcarefinancenews.com to read our two-part series.
Q: The documentary seemed pretty positive so on behalf of all healthcare journalists, I have to ask you: What were you smoking?
A: Yeah, I know. I think that’s really the striking thing about our movie: Nobody knows this. If you ask Americans about healthcare they say, oh you know, (it’s) outrageously expensive. All the doctors are buying a Lexis to drive to the country club. Americans think doctors are, you know, kind of greedy and into money. I think the most striking thing for me was meeting those docs all over the country who said ‘I gotta get my costs down. I gotta get my costs down. And I have an obligation both to the physical health and the fiscal health of my community.’
When we show the movie, that’s the most common reaction we get: ‘Why can’t our doctors care about costs like that?’ … There is good news out there. There are docs and hospitals that have found ways to provide really good care at reasonable cost. We don’t have to wait for Washington. This is just happening at the local level. So I do think it’s a good news story.
Q: If communities can take it into their own hands why aren’t more people following the examples? Is it just because they don’t know?
A: That’s the point of our movie. I don’t know the answer to that question. I think our movie raises that question. I think the film shows that in big towns and in small communities and urban centers you can provide high quality care at way below the national average costs. It’s definitely being done. So why don’t others do the same and therefore bring down our cost levels? That’s the question. The obvious answer is bringing down cost levels lowers income for doctors and hospitals, you know. My guru is the great Uwe Reinhardt at Princeton. As he always points out, any dollar of cost for one person is a dollar of income for another person, so it’s true. If you cut the cost of healthcare, you are cutting somebody’s income and I think that might be one reason that people don’t want to do it.
Q: Something I find stunning is how many people within the healthcare community don’t know about costs. There’s such variability coming from the different payers. How do I know I’m not being gypped?
A: That’s exactly right. And the other thing is you don’t really know if that procedure is necessary. If your doctor orders you to get a $1,200 scan there are really no good standards for whether that is needed or not and that’s why the rate of scans ordered for the same ailment varies by a factor of five county to county. I kind of blame the med schools for that. I mean, people didn’t learn this? The doctors’ answer is it’s more of an art form than a science. Well, you know, maybe that’s true, but I think one of the funniest moments in our film is when Jack Wennberg says … (people go to the doctor expecting) treatment that is proven by science and works and I say ‘Don’t they?’ and he says, ‘well, no.’ That’s really striking to me. That’s really intriguing that there are no standards. And my argument is that the payers have the power to set the standard if they want to and they don’t.