Why American Health Care is So Expensive

Our healthcare system, which some call a sick care system, is expensive and severely broken, but there’s no quick fix. Even a single-payer system providing universal access, like Medicare-for-All, is not enough. Besides, the medical industrial complex does not want reforms that impact their cash cow.

WHAT’S POSSIBLE — Reforming our broken healthcare system to match the spending and outcomes of other rich nations could save our nation over $2 trillion in expenses EVERY YEAR!!! But doing that would require strong political will to resist industry pressure, and it would require knowing Why American Healthcare is So Expensive in the first place. The underlying profit motive helps explain the high costs, as this Vox video does simply and effectively.

In the video, Ezra Klein mentions each of the top issues I write about here at Modern Health Talk, including the political influence of a medical cartel that profits more from treatment in a fee-for-service business model than they do from providing cures or prevention.

The video forms the basis of this long article and also gives me an opportunity to expand on some of the many issues contributing to our high costs, with a short description of each and with links to reference articles. Expect to spend about a half-hour if reading the whole thing, or simply jump to one of the listed topics.

1. There’s No Easy Fix
2. Single-Payer Medicare-for-All is Not Enough
3. Public Health Programs are Effective
4. Obesity and Chronic Illness
5. Aging Populations Stress Support Systems
6. Market Forces Don’t Work in Health Care
7. A Medical Cartel Influences Public Policy
8. Direct to Consumer Drug Advertising
9. Incentives are Misaligned with Goals
10. Health is Not a Policy Objective but a Political Weapon
11. Industry Consolidation
12. ACA Sabotage
13. Inequality affects Health Wealth, Opportunity & Influence
14. Medical Schools teach Diagnosis & Treatment, not Prevention
15. Disruptive Business Models Break From Fee-for-Service
16. Tech Solutions Define the Future of Healthcare
17. Important Documentaries

1. There’s No Easy Fix

It’s interesting to compare what Donald Trump said before the 2016 election, and after he became President:

• October 2016: “You’re going to have such great health care at a tiny fraction of the cost. And it’s going to be so easy.”
• February 2017: “Nobody knew that health care could be so complicated.”
• March 2017: “I never said repeal and replace Obamacare. You’ve all heard my speeches. I never said repeal it and replace it within 64 days.”
• May 2017: “This is a repeal and replace of Obamacare, make no mistake”
• July 2017: “We’ll just let Obamacare fail. We’re not going to own it. I’m not going to own it.” (Others call his actions intentional Sabotage, and they’re preparing a lawsuit.)

For almost a decade the Republican Congress have tried and failed to repeal Obama’s Affordable Care and Patient Protection Act (ACA) and replace it with something better. Each attempt was along party lines with bills crafted in secret and without public hearings, debate or testimony from stakeholders with different perspectives. If fixing healthcare were as easy as they said, why do the costs keep going up? Maybe the politicians and special interests had other motives, including voter suppression.

A true fix would not just change how we pay for care but also greatly reduce overall costs, improve care delivery, and reduce the need for care in the first place. But that was never part of their plans. As we see from the issues below, fixing health care must be approached systemically and without partisan politics.

2. Medicare-for-All is Not Enough

Democrats like Robert Reich and Senators Bernie Sanders and Elizabeth Warren argue that basic healthcare should be a right and guaranteed for all Americans. Apparently 70% of the nation agrees, if you believe this 4.5-min video, which outlines five principles of Universal Health Care.

1. Public health insurance eliminating the need for many private health insurance policies;
2. Universal coverage so everyone is covered;
3. Comprehensive, covering medically necessary services that include dental, vision, and long-term care;
4. Free at point of service, so no deductibles, copays, or out of pocket fees, and with medication costs capped at $200 annually — all funded by a bevy of progressive taxes; and
5. A just transition, including severance, training & tuition costs for those who’s job is affected.

Sanders proposed a single-payer Medicare-for-All system to eliminate the administrative complexities of different private insurers, policies, and reporting practices and forms. Such a single-payer system would help with those objectives, but I believe that no version of Medicare-for-All is enough by itself.

As Steven Brill described it his TIME report, Medicare’s administration and management cost of processing over one billion claims a year (less than $3.80/claim) is far less than what it costs Aetna to process its 229 million claims ($30 each). That’s because there’s no profit motive, marketing costs, or outrageous executive compensation.

Beyond those savings and the ability to negotiate physician and hospital costs, Medicare does little to reduce care costs. To reach the $2 trillion/year savings potential I write about so often, we need policies, funding and incentives aimed at improving wellness and care delivery. We need that along with incentives to inspire innovative new technologies and disruptive new business models. Today’s fee-for-service business models simply encourage more — more testing, more doing, and more prescribing.

3. Public Health Programs are Effective

Public Health, which started with mass vaccinations to control and prevent infectious diseases, has proven to be one of the most cost-effective investments in the health of our nation. It has since grown to include food safety, smoking cessation, sewage & water treatment, and more. History shows that health policies aimed at improving public health are more effective and less costly overall than those aimed at maximizing profit.

Unfortunately, state and federal public health agencies face major funding pressures and an uncertain future. To better understand that trend and envision alternative futures, the Robert Wood Johnson Foundation and the Kresge Foundation funded Public Health 2030: A Scenario Exploration. It’s a futurist investigation of possible scenarios to help shape decision-making and strategic public investments.

In his article, A Disease-Creation Economy, Dr. Mark Hyman presents ways to improve our Food Policy to encourage the production of fruits and vegetables. He notes that 80% of government subsidies presently go to soy and corn that are used to create much of the junk food we consume. He also recommends changes to Public Airwaves, Public Schools, and Medical Education, all aimed at improving public health and wellness. Hyman is a practicing physician and an internationally recognized authority in the field of Functional Medicine — a revolutionary business model that emphasizes health and wellness.

4. Obesity and Chronic Illness

According to HBO’s 4-part documentary, The Weight of the Nation, obesity has become the largest threat to our nation’s health, wellness and future survival. It’s an epidemic that needs swift action and an unprecedented public health campaign. A third of our children are overweight or obese, and 70% of adults are. Over $190 billion, or 21% of annual medical spending, goes to treating obesity-related illness. That’s because weighing too much increases your risk for chronic diseases such as hypertension, type 2 diabetes, high blood pressure, coronary heart disease, asthma, sleep apnea, and other serious illnesses.

There’s also a direct relationship between poverty and obesity. Amazingly, public health officials can accurately predict obesity and longevity rates by zip codes, and average lifespan can vary by over 20 years between affluent and poor neighborhoods on opposite sides of the same city. Disadvantaged communities are at higher risk for many preventable health conditions, including obesity, diabetes, heart disease, asthma, HIV/AIDS, viral hepatitis B and C, and infant mortality. That’s partially due to the lack of fresh and nutritious food at affordable prices, the lack of safe places to play and exercise, and pressures from job, money, divorce and violence.

5. Aging Populations Stress Support Systems

Aging is a global problem but more so in the U.S., where health care costs already exceed $4 trillion/year and are the highest in the developed world. It’s telling that the US makes up almost half of the global healthcare sector, consuming about 18% of GDP. Compare that to Netherlands (the next highest at 12%), Canada (11%), and UK (10%).

The difference of what we spend is like a tax of over $8,000 per household, compared to Switzerland, the next most expensive healthcare system. American families spend more than $20,000/year on health care – more than families in Singapore, the current leader with even better health outcomes and longevity.

Even with all we spend, we still live sicker and die younger, according to the World Health Organization. Our Life Expectancy is ranked 25^th in world, which is below Chile & Greece (Japan leads). And Infant mortality, at 47^th, is 2nd lowest in the developed world. Still, Congress chose to defund the Children’s Health Insurance Program (CHIP) so it could give massive tax breaks to wealthy people and corporations who are already flushed with cash.

At the current pace, our health care costs could reach $6.8 trillion by 2030 and bankrupt the nation, thanks largely to obesity and the 70M Baby Boomers who will soon retire and take Social Security. This “boomer” generation is a huge demographic that has strained institutions every step of the way. 76M boomers were born between 1946 and 1964, and America wasn’t prepared for that growth. Neither were other nations. There weren’t enough hospitals or pediatricians, or schoolteachers, textbooks or playgrounds, or even bedrooms in our homes. Boomers as infants and children had no voice, but now they’re politically active, and they represent a substantial voting bloc.

Given these statistics, and more from our growing collection, a dramatic new approach to health care is needed, and its urgency is near critical. But politics are guiding our decision-making, not common sense.

6. Market Forces Don’t Work in Health Care

Don’t the laws of Supply & Demand encourage innovation and create vibrant competition? Well, NO — not in healthcare. That’s because there’s no such thing as Free Market Capitalism without rules governing Property, Monopoly, Contracts, and Bankruptcy. And who makes those rules? Unfortunately, it has become those wealthy enough to buy influence and elections.

Patients don’t behave like consumers in other industries. When they’re afraid, in severe pain, or unconscious, they are in no position to comparison-shop or negotiate prices. When they face endless suffering or death, they will pay anything for relief, so it’s easy to take advantage of them. That’s why governments in other advanced nations negotiate for them and impose strict restrictions on the cost of drugs and services. We don’t do that but should.

7. A Medical Cartel Influences Public Policy

Although few people realize it, American health care functions like a monopoly, with a medical cartel of wealthy hospitals, insurers, drug companies, testing companies, equipment providers, and the American Medical Association wielding immense political power.

According to Seven Brill and his famous Bitter Pill report in TIME, “The health-care-industrial complex spends more than three times what the military-industrial complex spends in Washington.” That’s to protect their perverse $4+ trillion/year revenue stream from treating illness and injury, with no financial incentive to prevent it. Clearly, Big Money in Politics Corrupts, and some of the actions of this cartel make our healthcare system seem downright evil. The profit motive tends to do that to people, especially CEOs of public corporations who are legally obligated to serve the investment interests of shareholders rather than the public.

“Two places in society [that] should not be run by corporate-minded individuals are healthcare and government. The for-profit model fails to provide proper services or fairness,“ says the former wrestler and Minnesota governor. (Watch his 3:51 video on YouTube)

Medicare is often criticized as being a bloated entitlement program and a drain on the economy, but let’s contrast health insurance costs in the public and private sector. Brill describes Medicare as probably the most efficient part of our healthcare system. The agency’s administration and management cost of processing over one billion claims a year is less than $3.80 and in some cases as low as $0.84. That’s far lower than Aetna’s cost of about $30 to process less then 230 million claims, and Aetna is said to be one of the most efficient private insurers.

Even Medicare, however, could be made more efficient. It’s currently not allowed to negotiate prices with hospitals and doctors, and thanks to the political influence of pharmaceutical lobbyists, Medicare can’t negotiate lower drug prices either. As a result, many patients buy their drugs from Canada or overseas. They’re forced to buy prescription drugs illegally because the costs is so much less than the same drug developed & tested here, manufactured here, and then shipped abroad, before being shipped back here again.

Besides extensive political lobbying to influence policy, the cartel has been known to hire willing doctors to represent their interests with paid research, conference speeches, and academic papers. And then there are reports of doctors and institutions covering up for each other to avoid lawsuits from medical errors and malpractice. These practices undercut the credibility of of the profession and safety of patients, but worse is how it eliminates incentives to change.

There seems to be no end in sight to how much money they medical cartel could justify spending to protect and grow their $4+ trillion per year revenue stream. It’s entirely feasible that they could easily spend $1 trillion in just one election cycle to avoid losing trillions per year to progressive health reforms.

8. Direct to Consumer Drug Advertising

“Your money or your life” — Drug companies spend more than $5 billion/year advertising directly to consumers (DTC) to influence public attitudes. You know the ads: they make medicine look fun and sexy but list a ton of side effects, including possible death. They usually end with a call-to-action such as, “ask your doctor,” knowing that patients will ask and doctors will comply.

The U.S. is one of only two nations that permit direct-to-consumer advertising by the pharmaceutical industry. It started in 1997 when the FDA first allowed such marketing. Before then, policymakers thought only doctors had the medical expertise needed to make informed decisions about prescription drugs. But wealthy drug companies argued that patients have a right to know all of their options and that TV advertising would benefit them. Regulators eventually bowed to industry pressure, and now an average of 80 of these drug ads air every hour. The TV ads also promote medical devices and scooters.

DTC advertising drove increased drug use and higher prices. Beyond that, some worry that “The limited resources of the FDA’s Division of Drug Marketing and Advertising are a major barrier to successful regulation of the pharmaceutical industry’s multi-billion dollar marketing budget.” Recent efforts under the Trump administration to defund federal agencies and deregulate industries will likely criple the FDA, impact patient safety, and further increase drug prices.

But that’s not all. Because of intense lobbying by the medical cartel, drug companies have been able to game the patent system to extend their government-provided monopolies, pay competitors to delay the introduction of generics, and prevent Medicare from negotiating prices. Former Labor Secretary Robert Reich describes these problems as he looks at how to lower drug prices.

9. Incentives are Misaligned with Goals

Fixing our broken healthcare system requires getting the incentives right, aligned to the right goals and objectives. But what exactly are our goals as a nation? And what’s the objective of healthcare policy? Is it to shift the burden of who pays for care, or is it to extend lifespan, improve workforce productivity, and dramatically lower costs through wellness and innovation?

I write often about the potential of saving over $2 trillion/year in healthcare costs, but the total economic impact of good health is even greater than that. And the savings can occur every year, not spread across ten, as politicians look at spending.

While some companies see employee salaries as expenses to be cut, others view employees as strategic assets, and they invest in their health, skills and productivity. Shouldn’t policymakers look at our population the same way – as our greatest national asset?

Think of the economic benefits of policies and incentives that are aligned with the goal of improving the health, skills and productivity of our entire workforce. Imagine the impact on absenteeism, profits, wages, GDP, and global competitiveness, not to mention happiness and trust in government.

That world view can could be extended beyond healthcare policy and prompt similar changes focused on poverty, the food supply, the environment and more. It all comes down to getting the incentives right — matched to the right objectives.

In Get the Health Incentives Right, I explore the different incentives of (1) capitalism and private sector organizations that measure success in business terms such as profit, ROI, and payback period, contrasted with (2) the public sector, which measures success quite differently and over much longer time periods. To combine the best attributes of public and private organizations, we might want to craft a hybrid public/private healthcare model that exploits both.

In “Is Health Care a Right or a Privilege,” I conclude that the answer requires us to dig deep into our souls and understand the plight of others before deciding on goals. I pondered what it must be like for those living a life of privilege.

I like to think I’m a compassionate person, but I found that’s not always easy. The embedded video had such an impact on me that I hope it affects you too. It certainly relates to our political debates over fixing healthcare.

10. Health is Not a Policy Objective but a Political Weapon

Democracy thrives when elections and policy debates are fair and transparent, but it seems that ‘Winning at all Cost, without ethics” is the new normal in politics. I can’t help but question the goals and motivation of our current President [Trump] and Republican Congress, because they seem less interested in improving health care and more driven by a need to win and satisfy wealthy donors.

The best example of that was when they passed trillion-dollar tax cuts for the wealthy while refusing to fund the Children’s Health Insurance Program (CHIP) and repealing the ACA insurance mandate, knowing that it would result in some 13 million people losing all healthcare.

In Politics and The Modern Killing Fields, I describe policies that would intentionally deny certain populations access to health care as a form of voter suppression, allowing them to die early as a result. The article is very critical of such tactics and describes them as a form of political genocide. (Yes, I know it’s a harsh term, but…)

11. Industry Consolidation

Vertical and horizontal consolidation throughout the healthcare industry is decreasing competition, increasing costs, and driving more care through ever-larger hospital systems. Between 2012 and 2015, the number of physicians employed by hospitals and health systems grew by nearly 50%, with a corresponding decline in the number of independent physician practices. Some 40% of hospital admissions now come from hospital-owned physician practices that have built-in conflicts of interest.

Consolidation among insurers has reduced competition in many states and has led to market dominance by a few powerful insurers in many states, with “take-it-or-leave-it” bargaining power over physicians and patients who are often in no position to negotiate.

Examples of vertical integration include payers entering relationships with hospitals and other care providers to expand their role in care delivery; mergers between large insurers and pharmacy benefit managers (PBMs); and pharmacies acquiring or partnering with insurers, PBMs and health care providers to establish a dominant, one-stop option for patients.

12. ACA Sabotage

According to A Manufactured Crisis: Trump Administration and Republican Sabotage of the Health Care System, “The Trump Administration dedicated its first six months in office to sabotaging the health care system for partisan gain, threatening to reverse years of progress that have reduced the uninsured rate to historic lows. These destructive efforts by the Administration are causing uncertainty for insurers and resulting in significantly higher premiums for consumers.

“Perhaps even more egregiously, President Trump and Congressional Republicans are using this manufactured crisis to justify their efforts to pass Trumpcare, which will cut taxes for the wealthiest Americans and special interests while cutting nearly $1 trillion in funding from Medicare and Medicaid. Trumpcare would result in tens of millions more uninsured and impose higher costs on working families, including older adults and individuals with pre-existing conditions. Republicans claim that “Obamacare is in a total death spiral,” as a justification for passing this tax cut bill masquerading as a health bill. But they cannot pretend they are acting to improve the health care system while they are actively working to undermine it.”

Trump’s sabotage includes getting rid of the individual mandate and the CSR (cost-sharing reduction) subsidies, and state governments are part of undermining the market too. Republican controlled states have been modifying rules for short-term duration insurance policy alternatives that were originally designed to last only 3 months. They’re being pushed up to a year, with the possibility of renewal, and don’t even have to adhere to ACA coverage requirements.

Rather than reducing healthcare costs, these partisan efforts are raising costs and leaving tens of millions more low-income people without health insurance. Republican sabotage will likely result in the unnecessary deaths of millions of people, according to a Harvard Medical School mortality study, which found that up to 25% of people without health insurance will die as a result.

Another Harvard study found that uninsured, working-age Americans have 40% higher death risk than privately insured counterparts, and 45,000 die each year without insurance.

13. Inequality affects Health, Wealth, Opportunity & Influence

People often talk about the widening income & wealth gap, but for people below the poverty line, there’s also an Opportunity gap that keeps them in their place, and Political inequality that threatens our democracy. Because people have no idea what inequality really looks like and how bad it has become, this article starts with an excellent video infographic and then summarizes key points from embedded videos.

It’s important to understand what’s behind the trends in wealth & income inequality. One benefit of our capitalist form of government is to encourage risk-taking, investment and innovation among those with capital to do so, but that same system also causes the capitalists to seek profit by almost any means.

That includes either augmenting worker performance with skills training or replacing them with automation, AI, robots, and outsourcing. Over time, those capital investments, and the accelerating pace of tech innovation, has helped to dramatically increase productivity; but studies show that almost all of the benefits have gone to the owners, not the hired workers. Republicans have directed trillion-dollar tax cuts toward wealthy people and corporations while the rest of us worry that automation (income from capital) is replacing jobs (income from labor).

14. Medical Schools teach Diagnosis & Treatment, not Prevention

Even Benjamin Franklin knew two centuries ago that, “An Ounce of Prevention is worth A Pound of Cure.” You’d think Washington politicians would know that too. But they’re influenced by special interest lobbyists like The American Medical Association.

Besides controlling curriculum and certification testing, the AMA also controls state boards of licensing and tends to label alternative methods as quackery. As a result, new doctors spend precious little time learning about wellness and the pillars of health (nutrition, exercise, and sleep). Obviously, that’s because prevention is less profitable than the fee-for-service business model — MUCH LESS. Consider this (from Dr. Hyman’s article referenced above):

“All of the major drivers of disease and health care costs are lifestyle — and therefore preventable — factors. If these factors were addressed, we could eliminate 90% of heart disease and diabetes, yet only 1-in-4 medical schools have a nutrition course, and only 28% of schools meet the minimum 25 hours of nutrition education recommended by the Institute of Medicine. Most of those nutrition hours are about nutritional deficiencies disease like scurvy and rickets.

If we were successful in reducing heart disease by half or reducing diabetes (along with its complications) by 80%, many hospitals would go bankrupt, pharma would see their profits plummet, and many physicians would be looking for another line of work.”

Why is it that our medical schools teach new doctors how to diagnose illness and manage disease by treating symptoms with expensive drugs? Why do the schools focus more on “sick care” than wellness? Could it be that modern medicine – western medicine – is extraordinarily profitable, and that prevention is not? It’s no wonder the medical cartel spends so much on lobbying to protect their perverse revenue stream.

It’s questions like this that caused Dr. Lane Sebring of Wimberley, Texas to question his teaching and design a practice based on Functional Medicine. His approach shuns the allopathic medicine taught in medical school, which depends on modern chemistry with a dark history involving billionaire John D. Rockefeller, who spent millions on teaching programs and research on new drugs but relied himself on more-traditional homeopathic treatments.

15. Disruptive Business Models Break from Fee-for-Service

New payment models aim to provide superior primary care from excellent, energized and satisfied practitioners at a reasonable cost. The vision is to not only do disease management, but prevention of illness and preservation of well-being. Examples include medical tourism, telehealth, private memberships, and concierge services. These approaches are driven by doctors who are pressured to see more patients and frustrated by having little time to listen, think, or do other critical activities. But patients are frustrated too.

Dr. Stephen Schimpff  thinks insurers may start buying memberships or retainers for their clients as cheaper alternatives for better care. They’re already starting to pay for medical tourism procedures and telehealth video calls when it makes good business sense to do so.

In The $49 Remote Doctor Visit, I introduce telehealth as an alternative to searching for a doctor, calling for an appointment, taking time off work, and then driving to the doctor’s office and waiting. Just connect online with video from your phone, tablet or computer. Rural patients especially like having remote access outside of office hours and find it’s often as good as an office visit but much more convenient.

Telemedicine, a related term, describes the added ability of doctors to remotely access data and images from medical devices. This lets them check the vitals of chronically-ill patients in real time and with context to understand what they may be doing to affect measurements. Remote docs can even adjust medicines or treatments without requiring the patient to come in.

Telehealth and telemedicine markets are gaining steam as they overcome regulatory roadblocks such as requiring in-person visits before allowing remote ones. Such roadblocks were put in place to guard against a remote service competing with local physician practices. Modern Health Talk strongly endorses relaxed regulations that allow telehealth to reach across town and across state lines or even international borders.

Medical Tourism is another growing trend. Over 8 million people worldwide, and 1.3 million Americans, crossed international borders for better and cheaper care in 2014. That trend will only increase with high-deductible insurance policies that encourage consumers to seek the best value in health care and make better lifestyle decisions. They’ll find it cheaper and often better to visit a specialist in the Cayman Islands, which is known for excellent healthcare facilities, inviting coral-sand beaches, laid-back island culture, and tax-free status. Other destinations for great care include Argentina, Brunei, Cuba, Colombia, Costa Rica, Honk Kong, Hungary, India, Jordan, Lithuania, Malaysia, The Philippines, Singapore, South Africa, Thailand, Saudi Arabia, UAE, South Korea, Tunisia, and Ukraine.

The Future of Medicine is … Not Medicine. That’s the subject of a talk Dr. Lane Sebring gave at a World Future Society dinner. He described studying anthropology to understand why, even with modern medicine, so many of our diseases today didn’t even exist 150 years ago. Heart Disease was almost unknown, and Cancer was rare, not even making the top 10 as a cause of death. And then there’s Alzheimer’s, which appeared about the same time as the electric light bulb, causing many to see a connection between light, sleep, and the disease. The more Sebring looked into the cause of illness, the more he became disillusioned and frustrated with modern healthcare and the traditional practice of providing “sick care” with just another pill to “manage disease” with no cure.

To focus his practice on health & wellness, Sebring became an expert in Functional Medicine, which he describes as a form of evolutionary, integrative, holistic, or alternative medicine. Sebring attributes much of today’s disease to changes in diet, exercise, and sleep, because these are the three pillars of good health. He and others like him believe functional medicine can replace 70% of traditional medicine, and I agree. But that naturally goes against the profit interests of traditional medicine.

16. Tech Solutions Define the Future of Healthcare

As digital stethoscopes, medical imaging devices, and related diagnostic tools keep getting exponentially cheaper, smaller, more accurate, and easier to use, much of medicine will move down-market — from doctors in clinics and hospitals to consumers at home.

Whether it’s mom taking care of a sick child or a nurse practitioner making a house call, they’ll have access to new tools, like the Star Trek medical tricorder, and they’ll go online for help when needed. That could be a video consultation with a doctor or specialist, or electronic help from an expert system like IBM’s Watson. Imagine speaking to Siri on your iPhone and having Watson search through its global database to recommend personalized treatment based on your personal health record, and knowing how your unique genotype and phenotype differs from the millions of other patients with similar conditions. This is the Big Data analytics challenge the two companies seem ready to accept.

While Big Tech is in cloud services, Tiny Tech today is wearable, ingested, or implanted. It’s disappearing into our environment in the Internet of Things: light bulbs, doorknobs, clothing, and your toothbrush. And it’s enabling the eventual blending of science and technology (INFO + NANO + BIO + NEURO).

But disruptive new technologies alone won’t bring down the costs of healthcare either. Even though the Americans go to the doctor less often than other advanced nations, and we consume fewer prescription drugs, we pay much more for each procedure. And the volume of high-tech services like MRI scans is way higher.

17. Important Documentaries

• Why American Healthcare Is The Worst In The Developed World is an excellent 10-min video about our for-profit healthcare system, comparing its cost and outcomes with other rich nations.
• FIX IT – Healthcare At The Tipping Point examines how our dysfunctional health care system is damaging our economy by suffocating our businesses, discouraging physicians, and negatively impacting on the nation’s health. It stresses problems with employer-provided private health insurance and contrasts the US system versus Canada’s single-payer system.
• Escape Fire: The Fight to Rescue America’s Healthcare is like An Inconvenient Truth for the healthcare debate, presenting our current path as unacceptable so we’ll commit to changing it.
• Money-Driven Medicine: Understanding America’s Healthcare Crisis reveals how a profit-hungry medical-industrial complex has turned health care into a system that squanders millions of dollars on unnecessary tests, unproven and sometimes unwanted procedures and overpriced prescription drugs.
• Health Care: America vs. the World examines how four other nations achieve universal care for less money, with better outcomes. This PBS special used examples in Houston to stress how the U.S. spends far more on health care than other wealthy nations while its citizens die at greater rates from preventable diseases.
• The Waiting Room is like a punch to the gut for people cast off and left out of our U.S. medical care system, what some call the best in the world.
• Sicko is a Michael Moore documentary that takes an in depth look at how the state of healthcare in the United States is harming its citizens.
• The Weight of the Nation is a four-part HBO documentary about America’s uphill battle with obesity, intended to focus our attention on nutrition, wellness, and poverty.
• Choosing to Die is Terry Pratchett’s documentary about Assisted & Dignified Death.
• The Line is an important documentary about poverty in America. It covers stories of people across the country who live at or below the poverty line. They have goals. They have children. They work hard. They are people like you and me. Across America, millions are struggling every day to make it above The Line.
• A Place at the Table shows how hunger has serious economic, social, health and cultural implications for our nation, and how the problem of hunger can be solved once and for all.
• Fed Up is a Katie Couric documentary about the food industry that reveals a 30-year campaign by the food industry to mislead and confuse the American public. What’s worse is that the resulting obesity epidemic was aided by the federal government and special interest lobbying, and the food lobby has been fighting back with misinformation to discredit the movie.
• Food Chain$ is an exposé about Florida farmworkers’ battle for fair wages and working conditions, against the $4 trillion global supermarket industry.
• Selling Sickness: The Pharmaceutical Industry and Disease Branding is a Big Pharma documentary. Disease branding and direct-to-consumer advertising aims to destigmatize shameful problems to sell new drugs that can put healthy people at risk from dangerous side effects.
• Inequality for All features former Labor Secretary Robert Reich and is described as “a game-changer” in our national discussion of income inequality.
• Big Money Agenda: Democracy on the Brink looks at the role of Citizens United and big money have had on impeding the success of healthcare reform in the United States, as well as common sense solutions that will get our democracy back on track. This film explores why Americans are sicker than they should be, poorer than they ought to be, and less safe than they deserve to be. (2-min trailer)
• Saving Capitalism is about widening economic inequality, growing distrust of our political system, and the rise of Donald Trump. It’s streaming now on Netflix for free.
• The Corporation describes the curious history, inner workings, controversial impacts and possible futures of the corporation as a legal entity.
• Wall-E is a warm-hearted commentary on environmental pollution that portrays future humans as super-obese couch potatoes living in a robot & technology dominated world.
• Robot and Frank shows the challenges and benefits of companion robots for the elderly who don’t warm easily to technology.

Clearly, some people do understand the problem, or at least part of it. But overcoming the obstacles to affect real change is difficult, because as I said up front, “There’s No Easy Fix.” So I’ll close this article with a favorite TEDMED video by ZDoggMD, a funny physician who uses humor and rap videos to teach patients and colleagues alike. Enjoy.

ABOUT THE AUTHOR

Wayne Caswell is the Founding Editor of Modern Health Talk, an altruistic website and blog with hundreds of published articles on healthcare policy, technologies, and solutions for independent living. It started in March 2011 as a nonprofit effort to share the unique perspectives of a retired IBM technologist, market strategist, digital home consultant, futurist, and consumer advocate.  The intent was never to generate income but just to help people age-in-place and avoid the higher cost of nursing home care. It soon became clear that fixing our broken healthcare system requires fixing our politics. And to do that, we must get big money out and address the widening wealth gap that corrupts our system.