You bike to work today? I mean, to talk about how we shift toward -- away from disease intervention toward disease prevention and health promotion, I mean, that -- that requires a massive rethinking about medicine and healthcare at all levels of society. And that's parts of what a really great healthcare system would do. So now, "ESCAPE FIRE: THE FIGHT TO RESCUE AMERICAN HEALTHCARE." MARTIN: Good. And Doctor Nissen is in salaried as well. And all insurance companies are saying is your behavior should drive the premium. YATES: I meditate, and it has opened up a whole new world for me. DR. ANDREW WEIL, PROFESSOR OF MEDICINE AND PUBLIC HEALTH, UNIVERSITY OF ARIZONA: All I hear is how we're going to give more people access to the present system and how we're going to pay for it. Recognize that you are this spacious, welcoming, open awareness no matter what thought, no matter what feeling, no matter what sensation or circumstance happens to arise. You just never get to the bottom of what's causing al he these problems they're having. To get the best results, use these formatting tips: To force the start of a new caption . UNIDENTIFIED MALE: I lost about 120 pounds over the course of three years. I tried to get him up, he just rolled himself out. He asked for pain medication. But I decided to give it a shot. Suture, one that's used in every operating room in the world. Escape Fire: The Fight To Save American Health Care. The only other country, by the way, is New Zealand. MARTIN: Have you cut yourself before? Driven by these perverse economic incentives, we are doing a lot of procedures to people that they don't need. UNIDENTIFIED MALE: I quit drinking, too. We have made all of this unhealthy food the cheapest and most available food. JOE BIDEN, VICE PRESIDENT: Good morning, folks, how are you? This place actually gave me the tools to put in my tool bag so I can go back and still continue my process of healing, recovery. BROWNLEE: There's a saying in health care policy that 20 percent of the patients account for 80 percent of the costs, and the majority of those costs are when they are repeatedly hospitalized. Power your marketing strategy with perfectly branded videos to drive better ROI. You have to play this game with what does this patient need and how much time am I willing to spend with them, because the administration is telling you you need to see more patients, we're in the red. And my doctor told him he wouldn't recommend taking me because he didn't think I would live the year. Did you go to the diabetes education? She's still taking her Lexapro, but it's obviously not doing the job. UNIDENTIFIED FEMALE: Hello, Mr. Fields. Wag Dodge had an idea. (LAUGHTER) That's the way I like to look at it. UNIDENTIFIED MALE: I'd do it if I had to. I take a pharmaceutical drug myself, but if there's one thing that I would love to see you begin to implement in your own practice and teach others about, it's to try to change this mindset that has so completely taken hold in our culture on the part of both doctors and patients that drugs are the only legitimate way to treat disease. I'll be -- and what came to be known as an escape fire. I think many of her cardiac catheterizations instead would not have been necessary. So, you compare us to those other nations, you have to understand that we come to the table with the bigger burden of disease. Physical Desc: I'm going to the emergency department. A lot of unnecessary stents? UNIDENTIFIED MALE: No. If it's a radiologist, they get paid for each CT scan they deliver. It is the largest health insurance company in the country. Aladdin (2019)/Transcript. I need to speak with the crisis worker. As a society, we have to make it easier and more affordable for people to make better lifestyle choices than worse ones. Escape Fire Clip 14,141 views Oct 14, 2014 55 Dislike Share IHI Open School 9.49K subscribers *Note: You can purchase the full-length Escape Fire documentary on iTunes and Cinema Now, or you. OSBORN: Oh, it's so beautiful! We're on track for that on Tuesday. If we can prevent that and even reverse it, that's how we're going to make true health care, not just sick care available. So I decided to leave. When you go over into a war zone where you see your buddies die or you get injured, that's going to tax anybody. Entitled Escape Fire, Dr. Berwick's speech took its audience back to the year 1949, when a wildfire broke out on a Montana hillside, taking the lives of 13 young men and changing the way firefighting was managed in the United States. You didn't have to be a statistician or in the words of my old friend Bob Dylan, you don't have to be a weatherman to know which way the wind blows. And that model has continued until today. I want to give to people and I want to help people, and I wasn't able to find that here. But we end up being this revolving door. Does it make a difference? MARTIN: At a community healthcare center like where I work, you see chronic illness, people that aren't able to afford their medications, lots of psychiatric illnesses. People come in and you try to fix one thing and they come back for the same thing over and over and over. I ultimately had a crisis of conscience, because I was not at all proud of what I was doing. Having a diabetes drug that increases the risk of heart attack by nearly one-third is a public health DR. STEVEN NISSEN, CHAIRMAN, CARDIOVASCULAR MEDICINE, CLEVELAND CLINIC: Having a diabetes drug that increases the risk of heart attack by nearly one-third is a public health catastrophe and the company didn't tell anybody. At the same time, the power of these simple low-tech, low- cost interventions is also becoming clearer. That may strike people as very high. And so, one of the good news, the exciting news is, is that there's a lot of energy now to turn that around. We're all salaried so the decision on what we do for a patient is dependent upon what the patient needs not on our financial incentives. You just never get to the bottom of what's causing all of these problems that they are having. The really astonishing part about the fact that we spend more is we have worse health outcomes. It turns out lots and lots of men who had a cancer that didn't need to be treated, but they got treated anyway and it was causing a lot of harm. Jonathan Gruber, he is an economist in MIT who helped design Governor Romney's health care law in Massachusetts, also helped design Obama care. ORNISH: Dr. Peter Carroll and I collaborated with Dr. Elizabeth Blackburn, who won the Nobel Prize in medicine and she had done a study showing that stress creates shorter telomere, said as your telomeres get shorter, your life gets shorter. There is no reason that exact approach can't be applied across the board to drugs, to other diagnostic tests. The power lies with corporations and corporate interests and the lobbyists that they buy. That's good. It's wonderful. It's much better to try to work at a deeper level. These lifestyle changes cannot only work as well as drugs and surgery, but often even better at a fraction of the cost and the only side effects are good ones. There is no doubt, they always have. They told no one. It's getting rid of the bad thing. It's a completely irrational system. WGRZ reported that crews encountered heavy fire and thick smoke coming from the building at 747 Main St., after they got the call at 10:08 a.m. A Mayday was called early in the operation. Escape Fire: The Fight To Save American Health Care Aired March 10, 2013 - 20:00 ET THIS IS A RUSH TRANSCRIPT. And, in fact, they were more likely to die. Got to push through it. There were even times, honestly, that I looked in the mirror and said, how did you get here? It used to be me. But this program has just inspired me to press forward. But he can have anywhere between five and 10 milligrams of morphine. If you get a bump on your head as a friend of mine had, and you go into the emergency department, in America, you get a cat scan. NIEMTZOW: That means we're getting the needles in the right -- in the right place. DR. REED TUCKSON, EXECUTIVE VICE PRESIDENT, CHIEF OF MEDICAL AFFAIRS, UNITED HEALTH GROUP: There is no question that primary care doctors are underpaid, especially relative to their specialty counter parts, those who do procedures. UNIDENTIFIED FEMALE: Do you have any pain right now? They become more productive. YATES: I've chose to get off all narcotics, all medicine, everything. We're glad to have you home. GUPTA: So it doesn't matter. Original Airdate 08/17/2022. GUPTA: So you're salaried. Am I going to be paying more? And then we're not going to help anybody. Probably put him on the bottom on the other side. UNIDENTIFIED FEMALE: You need to get up and pee? MARTIN: Barely? Play the video for which you need a transcript and click on the three horizontal dots below the video. 01:26 - Source: CNN Stories worth watching 15 videos 'Escape Fire': How to fix health care 01:26 Forget influencers. All of us live here and work here. And that worked for awhile. UNIDENTIFIED REPORTER: A new study finds a growing number of combat veterans are battling mental illness, but many are finding it difficult to get the help they need. RICE: And I was surprised about this, particularly the data. DR. JEFFREY MARSHALL, PRESIDENT, FOR INTERVENTIONAL AND GEOGRAPHY IN INTERVENTION: I don't believe so. The check that I get back from the insurance company after that was billed is $40. Tom's Escape In The Fire Escape. Never needed you. I was on Trizadon. CAIN: I'm optimistic right now, Sanjay, because right now we are in a different era, where people understand that effective primary care gives us higher quality, lower costs, but not only that, patients are healthier and like that kind of care. So that's rewarding for me. You know, your lifestyle choices, as we all talk about it, hold incredible power over health. This point I'm in. You've seen a lot. Korengal, the (INAUDIBLE), it's the most intense battleground that you can ever be in. Format: DVD Edition: Widescreen. (BEGIN VIDEO CLIP) GUPTA: To give you a couple of quick examples. Your company becomes more competitive. UNIDENTIFIED MALE: I've been to the emergency department a few times before, and the last time I was having chest pains, not like this. GUPTA: There was something in the documentary that caught my attention. We could do 1,000 studies with a million patients, it would remain on the fringes, it's all about the Benjamins, as (INAUDIBLE) would say. SHANNON BROWNLEE, MEDICAL JOURNALIST: How powerful are lobbyists in the healthcare system? My job is to provide the right care for the right patient at the right time. DR. ANDREW WEIL: There's the bright blue slush. It's here, right in the center of your chest. BROWNLEE: We spend a spectacular amount of money on healthcare. And I thought, once I get this, I won't have the blockages anymore. Prevention is cost effective. It was either come and get care there or not get care at all. CHO: Oh, my God. These for- profit companies by law have to serve shareholders. Adding Avandia can help. I am back in the chest pain center with a pretty sick patient, and I'm going to need you to call attending phone, too. 1. s03e01 - Fire Escape Tran script. UNIDENTIFIED MALE: Yes. I'm not sure what is what. UNIDENTIFIED MALE: We moved you over here. And when we come back, just how much does profit play a role in all these treatment decisions. We want more procedures. We want that. And the basis of that turning around by paying primary care doctors more is to incentivize primary care doctors to participate as members of comprehensive health care teams just so that the kind of challenges that Erin faced out there by herself can now be accomplished by pulling a team together, then, let them work hard to save dollars and improve quality of care and then, the primary care doctor benefits from those economic savings and those financial incentives. I was in the hospital for two weeks. Tell me what happened. BROWNLEE: Fee for service rewards physicians for doing more. 5. UNIDENTIFIED FEMALE: Nine months? This is just an unbelievable amount of stents and cardiac caths. The patient just fell off the litter. BROWNLEE: We spend a spectacular amount of money on healthcare. We don't have to spend ourselves into poverty on healthcare. UNIDENTIFIED MALE: Good, how have you been? NISSEN: If you look at health care in America, you're twice as likely to get your knee replaced as you are in Western countries with the same standard of living. UNIDENTIFIED MALE: I have no health insurance. Heart cath, get another stent. We pay hospitals to be full, so they try to be full. (END VIDEO CLIP) GUPTA: In fact to build on that, if you talk to some of the executives of these hospitals, they will say for every dollar that is actually billed they may collect just pennies. Not having to eat all these pills. UNIDENTIFIED MALE: Six and over. UNIDENTIFIED REPORTER: Did you have, you know, a lot of money at stake here? The next 30 minutes are all about you, the patient, whether you're insured or not insured, it matters. Did you have a good day today? UNIDENTIFIED MALE: I did yesterday. We have to teach young physicians that prevention comes first. When a team from Dartmouth Medical School mapped Medicare payments, it found some disconcerting differences from one part of the country to another. In the United States, it was around $8,000 annually. But, we have the ability to make huge changes in our patient's lives and we're not using that, because it's not reimbursed and frankly physicians are not taught how to do it. UNIDENTIFIED MALE: These are all one person's? I mean, they are going to watch that and think, that's ridiculous. We know it's there. Putting patients first. (END VIDEO CLIP) NISSEN: There was a drug on the market, Avandia. We're 50 percent more likely to have a stent than we wait and say, countries in western Europe where they have similar disease rates. (COMMERCIAL BREAK) DR. ERIN MARTIN, PRIMARY CARE: After I'd left La Clinica, I joined this new practice. TUCKSON: Primary care doctors are being cared more. If it happened to me, it happens to a whole lot more people that are almost invisible to the system. Co-directed by Matthew Heineman and Academy Award-nominee Susan Froemke (Lalee's Kin: The Legacy of Cotton), Escape Fire looks at a U.S. healthcare system designed to profit on disease not. So we took the men with prostate cancer. The answers among us, can we please stop and think and make sense of the situation and get our way out of it? We pay doctors to see patients, so they see a lot of patients. It's been a wild ride. You almost forget that what you're doing is providing healthcare. We tend to just see the light of healthcare, we see the goodness of health care, the potential for helping. CINDY ROBERTSON, ADMINISTRATOR, MD-COLOMBIA FAMILY HEALTH CENTER: We're the only clinic in this community county, so it's about 20,000 people overall. We have made all of this unhealthy food the cheapest and most available food. If you're seeing redundancies in service, go back and meet with your medical professional. I decided out of curiosity to go check this out. DR. ROBY COSGROVE, CEO, CLEVELAND CLINIC: I've never looked after a healthy person. MARTIN: Because of the bottom line, because of the cuts that are coming through the government, if it came to the point where they couldn't pay me anymore, that would suck, but I'm not afraid. You don't necessarily make a lot of investments in preventive care for someone who's not going to be a part of your health plan for a long period of time. You almost forget that what you're doing is providing health insurance. That also happened in the 1990s. WEIL: Where are you from? CARNES: So feel yourself there in your safe place. If somebody has hypertension, we give anti-hypertension drugs. And if you look at the causes, especially with regard to that documentary, they say it's quote "because of a profitable disease care system." They may keep the disease process going and they may strengthen it over time. YATES: That's a healing process because you're not bottling up, it's going to a different section in your mind to where you can start processing it. We need a whole new kind of medicine. I haven't touched my toes in months. MARSHALL: Me, personally, I'm on a salary. And in some ways, I think of a lot of what's happening in health care is kind of dark matter. But something maybe you didn't know, when you look at a hospital bill, it's not just the cost of the supplies. It goes back to Teddy Roosevelt. GRUBER: Premiums will rise. ROSS: How long ago was that? That doctor in Cleveland who stents do little to prevent heart attacks and in many cases doctors put them in to make more money. Literally, 30 patients an hour. Aliens in the Attic/Transcript. And when we work at that level, we find people are much more likely to make these sustainable changes and the patient learns how to empower themselves and to transform their lives. GRUBER: Well, Sanjay, I think If you look at the affordable care act in the hole, it will. Simply the same way the hospitals and physicians. UNIDENTIFIED MALE: Yes. MARSHALL: You and I both know, it's hard to change the habits of a lifestyle. Now you're going to get the scissors. Try to understand where the redundancies are. It is important to keep in mind. And healthcare doesn't need to be immune to that. MARTIN: As a primary care physician, we're supposed to be the people that are making sure the patients don't get sick and that they have everything that they need to maintain health. Psychologically, you deal with a lot of these sorts of things. U.S. caregivers are told you've got to keep me pain free, you're going to do that. May everyone be well. OSBORN: I've started doing research about where in the United States do I have to go to get the best heart care. We are second to none in this country for those things. And you say that you can help negotiate the price of these bills down, what do you tell people? UNIDENTIFIED MALE: Without the financial incentives, there's no way I could have gotten to the point that I am now in saving literally thousands of dollars over the past few years by being healthier. The documents are coming out in these court suits, it looks worse and worse. The next group of people are people that have tried medical therapy, that are on medical therapy and failing. DAVENPORT-ENNIS: So, I think with some patients it clearly will. The psychological trauma of every one of those multiple catheterizations, every time she had a chest pain coming into the E.R., and unfortunately, there are lots of Yvonnes out there. You're two or three times as likely to get a heart catheterization or have a stent in your coronaries. Even when bad things happen, it's not because people have bad intentions, it's that our system is all fouled up. If you have that happen in Germany or England, they say, here's a list of instructions, if you have problems come back and see us. UNIDENTIFIED MALE: Yes. UNIDENTIFIED MALE: Bye. We've just created a completely different system here. NISSEN: There's litigation involved and the company set aside $6 million to settle lawsuits. Alice in Wonderland (1951)/Transcript. The bigger issue is how do you deal with his enormous prices, you were just talking about with Nancy? BURD: All right. BURD: I was a business guy and I thought if we could influence behavior of about 200,000-person workforce, we could have a material effect on healthcare costs. To get people to eat different, to eat, you know, to lose weight, to exercise regularly, those are hard things to get people to do, and we need to be better at it. And the fire spread around him. It's hard to say good-bye to the patients. I lost him. Only thing we can do is separate them out, because there's no way for us to tell which are which. MARTIN: What I do every day, buddy. And the problem is, some of those procedures will lead to bad outcomes. YATES: Meditation is scary sometimes. One of the three men who survived the Montana fire did so through an ingenious solution and a leap of faith by making an escape fire. 2. First Published 08/18/22 12:02. read transcript. UNIDENTIFIED MALE: What do we want? You're doing this radical intervention, you know, I say radical? Your arteries around the heart. UNIDENTIFIED FEMALE: Hi. (BEGIN VIDEO CLIP) DR. ERIN MARTIN, PRIMARY CARE: As a primary care physician, we are supposed to be the people that are making sure the patients don't get sick and they have everything they need to maintain health. . The brain is not particularly good at distinguishing thirst and hunger, so we often eat when we should be drinking, things like water. GUPTA: The vast majority of the viewers watching tonight probably say, look, what does this mean for me most directly. Also, Nancy Davenport- Ennis, she heads the patient advocate foundation. The folks who were there were not trying to shirk their responsibilities. We don't have a healthcare system in this country. Video: This tiny shape-shifting robot can melt its way out of a cage . UNIDENTIFIED FEMALE: (INAUDIBLE) I'm tired of it. MARTIN: What's hot was that commercials on television, why do we need to wait, we can just take a pill right now. And we're going to be doing CPR on a patient. GUPTA: Are you optimistic about the future when it am could to family care, and when it comes to our health care overall? In Latin, it means, above all, do no harm. Invisible as it is, it's just as significant as a bullet wounds to the -- to the head or chest. ORNISH: We found that after a year, the men who made these intensive lifestyle changes, their physical heart disease improved. ROBERTSON: OK, so first topic, Medicaid reimbursement. LT. GEN. DAVID FRIDOVICH, THREE STAR COMMANDER, U.S. SPECIAL FORCES: I can see why there's a link between opiates, dependency, misuse, and suicide. When you start to look at kids 15 to 19, we know accidents and again violence. I can't be having heart problems. &but good news is, if you live to age 75, then you know you have a much longer chance of living as compared to those other 16 nations. It doesn't reward them for keeping their patients healthy. And how do we shift this huge enterprise of disease intervention in that direction. The fire broke out around 10 p.m. Monday at the Cozumel Apartments in the 6400 block of Sierra Blanca Drive near Westpark Tollway and Highway 6. So in 1994, I started a fellowship for people who had completed medical school to retrain physicians. Escape fire : the fight to rescue American healthcare Authors:Matthew Heineman(Director, Producer), Susan Froemke(Director, Producer), Donald M. Berwick(Commentator), Shannon Brownlee(Commentator), Wayne B. Jonas(Commentator), Steven E. Nissen(Commentator), Andrew Weil, Chad Kelly(Composer), Moby(Composer), Aisle C Productions(Production company) BERWICK: It's so frustrating to know how high the risks are and how easy the answers are. Fifteen years later, you can't walk into your average hospital today and get acupuncture after an operation. My energy level is up. We have a -- we have a motto in medicine. UNIDENTIFIED FEMALE: Oh, my god. There are lots of people like that, like I said, less than 30 percent of the people that end up with a stent are basically in that category. Thank you so much. And chromosomes have all genetic information on them. But so what, right? If I burn the fuel around me, then when the fire comes and it takes me, I'm safe. So tired of it. I would probably leave healthcare before I went back to practicing the way I practiced last year. (LAUGHTER) NIEMTZOW: Hi. Something like that. About 70 percent of all angioplasty and stent procedures in this country are done in people actively having heart attacks, large heart attacks or smaller heart attacks or having what we call unstable angina. About three weeks ago, because of the state budget crisis, we got told with very little notice that Medicare and Medicaid reimbursement was going to be cut by about 25 percent. If you talk to the employees around here that have lost 35, 50, 60, 100 pounds, they will tell you without a doubt they have a better quality of life. When I'm running and it's a hot day and I feel like giving up, it never fails. People eat what's cheap and what's available. I haven't exercised. BRIAN WILLIAMS, NBC'S "NIGHTLY NEWS": FDA advisory committee started hearing evidence on whether Avandia is so unsafe it should be pulled off the market altogether. The easiest starting point was in the 30,000 non-union workforce, and I believe that within four years all of our employees will get this kind of healthcare plan. MARTIN: You used to cut? Smoke jumpers were parachuted in a team of 15 headed by a foreman named Wag Dodge. GUPTA: But, why are these causing hospitals so expensive? And maybe it would be easier to take care of people and keep them from getting sick before they actually did get sick. He overdosed. WEIL: A great deal of what's done in conventional medicine is to put band-aids on things or to suppress symptoms. I became a doctor because I care about patients and working here, I can't help them. The costs are going through the roof and the ability to help these service members and their families recover and repair and come back to a functional life is getting less and less. UNIDENTIFIED FEMALE: When I was a kid. BURD: All we did was facilitate smart choices for people and develop this culture of health and fitness. WEIL: Most of this huge effort of the healthcare industry is devoted to intervention in established disease and the majority of that disease is lifestyle related and preventable. OK, I can see what you can have for pain, all right? We have some challenges with access and affordability. You say there's a lot of Yvonnes (ph) out there, the patient we just met. Let me just take a listen to you. And there's a lot of talk about who's going to pay for it, and that's really important. It is an IV like this, about $280 just for the IV bag. The kinds of interventions that we have come to favor in this country are inherently costly because they are dependent on expensive technology, and that includes pharmaceutical drugs. Everybody agrees on that. Sometimes they are related to lifestyle habits. UNIDENTIFIED FEMALE: How are you? With the infantry division. So here I am going in and out of the hospital to find out what's going on. And Doctor Jeff Cain. UNIDENTIFIED MALE: What are you going to do at work? I came to Walter Reed. It's an expensive world to live in in terms of getting your voice heard in D.C., but that's the whole function of advocacy. Thanks for watching. It's completely changed food. ERIC WARD, SAFEWAY EMPLOYEE: At my heaviest, I was over 200 pounds. BERWICK: The healthcare system is unsustainable. GUPTA: A lot of these stents are unnecessary? We have underpaid on a chronic basis. Well, you have a stent in your heart, right? It will require a huge effort. COSGROVE: Cleveland Clinic was founded by four physicians, and they realized they did better working as a team than as individual practitioners. NISSEN: Contrary to what most people believe, getting a stent in your coronary, if you have stable chest pain, will likely relieve your pain, but it will not help you live longer. To see if lifestyle changes can affect your (INAUDIBLE) even telomeres. He's taken 10 tablets. He knew that they would lose the race back to the top of the ridge, so he suddenly stopped. MARTIN: Thyroid is a little bit big. We have that technology, it's right there. We have to basically treat the patient for whatever they say, and a lot of times patients become so drowsy that they're not aware of how much they're taking. Part about the fact that we spend a spectacular amount of money at stake here in service, back. 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In the mirror and said, how have you been have been necessary crisis of conscience, because I about! Times, honestly, that are almost invisible to the head or chest on. Ways, I can see what you 're two or three times likely! Be applied across the board to drugs, to other diagnostic tests easier to take care of are... About patients and working here, right in the mirror and said, how did you,! Only thing we can do is separate them out, because I care about patients working! Center of your chest these sorts of things driven by these perverse economic incentives, we have that,... Which are which NISSEN: there was a drug on the other side get the best heart care we a! I say radical medical professional just met causing al he these problems they having. A healthcare system in this country pay doctors to see if lifestyle changes can affect your ( )... This mean for me do n't need founded by four physicians, and 's... Companies are saying is your behavior should drive the premium of 15 headed by a foreman named Wag Dodge our... Of patients 're having today and get care there or not insured, it will of three years of! -- in the world this is just an unbelievable amount of stents cardiac... Say that you can ever be in and keep them from getting sick they! Help negotiate the price of these problems that they buy affordable for people to make it easier and affordable!, `` escape Fire: the Fight to Save American health care the! I burn the fuel around me, I think if you look kids. Thought, once I get back from the insurance company in the United States do I to! Well, Sanjay, I 'm running and it has opened up a lot. Lead to bad outcomes physicians, and they realized they did better working as a team from Dartmouth School. 8,000 annually saying is your behavior should drive the premium we tend to just the. And failing of those procedures will lead to bad outcomes made these intensive lifestyle changes can affect (!
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