T.R. Reid talks about the good news in U.S. healthcare

T.R. Reid, author of “The Healing of America” and documentary filmmaker, has once again joined forces with PBS to present a film looking at healthcare. “U.S. Health Care: The Good News,” a one-hour program scheduled to be broadcast nationwide on Feb. 16 on PBS (check local listings), examines communities in the United States that are providing high-quality care at lower costs. Reid spoke to Healthcare Finance News about his new documentary and healthcare issues facing the country.

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.’

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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. …

Our original plan had been to go to the low cost counties and then go to the high cost counties and make a film like that. … We ran out of time. We had so much good news. I could have done two more communities. Good news communities. We just ran out of time so I never got to the bad guys – to the high cost regions. And that’s another reason why the film is so positive. There are definitely bad examples but we didn’t get to them in this film.

Q: So will that be a follow up?

A: (Laughter)

Q: ‘And Now the Bad News …’

A: We just had a screening in New York on Monday. Here’s what happens. You work pretty hard on a film. You never know if anybody’s going to like it or not. On this film, generally, we’ve had a pretty good reception. … So I go to these screenings and I expect everybody to pat me on the back and say ‘Fabulous job,’ you know. That didn’t happen in New York. In New York, we got a lot of people who said ‘Well, I learned a lot,’ which is the idea, but there were a couple there from high cost hospitals – places that score poorly in the Dartmouth ranking – and they really went after me. ‘You can’t generalize from a few little communities.’ Well, one of them is Seattle. You can’t tell New York to do the same thing they do in western Colorado. … Many people were positive but there are people who don’t like the Dartmouth Atlas rankings, I guess because they come out looking pretty badly. And they have their reasons. ‘Well, you know, we have ethnic differences and we have diversity and we have all these poor people’ kind of thing. I’m sure those are all factors but the people at Dartmouth say they’ve taken that into account.

Q: Do you think they’re angry because they feel like they’re coming up short? Maybe there’s some sort of subconscious, or not subconscious, thing saying, you know, ‘We could be doing more but we’re too fill-in-the-blank to do it?’

A: Yeah, I think there are a couple of possibilities. One is they’re right. That the kind of generalizations that the Dartmouth Atlas makes are unfair and they don’t take into account regional differences. That would be their argument. But I think another possibility is they never felt the need to get some control over costs and therefore they don’t like it when they’re criticized for that failure. … I think another factor is you can’t tell New Yorkers to learn something from another town. They don’t like that notion. I wrote a book saying we could learn a lot from the health systems in Germany and Japan and Switzerland, you know. A lot of Americans don’t like that either. They really don’t like the idea that other countries might do something better than we do or that we could learn from that. So I think we got some of that flavor in New York too….

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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.

I didn’t get around to this in the movie but if we’d had time I was going to go after the payers, employers, insurance companies and Medicare for tolerating the kind of variation that exists in the cost of healthcare. I’m a tax payer in Colorado. Why should I pay doctors and hospitals in Miami three times the cost for a Medicare patient than I’m paying for a guy in western Colorado? Clearly there’s room for some regional variation but not 300 percent. To me that’s the unanswered question. So why is this going on? People don’t know they can do it. Certainly what we saw in New York was they believed it was impossible to get costs down to the levels we saw in Seattle. Actually I’m sure they could do it but they didn’t feel that. But beyond that, if I get costs down, I have less income. If you remember at the end of our film, I say to the guy at Dartmouth-Hitchcock Hospital if you do less stuff you’ll make less money. He got all mad at me. He said that’s not what I’m here for. But you know a lot of doctors – a lot of people – I wouldn’t say just doctors – a lot of people are there to maximize income and that’s a natural human response. We can’t blame it.

I think the burden should be on the payers. Employers should demand – an employer with 2,000 workers should demand that the hospitals in his town act as efficiently as the ones in our movie. Medicare, which has the data, should man that. I’m pretty sure I know why the latter doesn’t happen. Why Medicare doesn’t do it. This is my theory. I think it’s right. I mean a lot of economics would agree with me on this. In many congressional districts the big hospital is the biggest employer. Certainly in any big-city congressional district the big hospital is a very important economic member of the community. Congressmen protect them. So if Medicare goes after some high cost, inefficient hospital the local congressman protects them. I think that’s definitely happening. I wanted to get into that in the film but we just ran out of time. We just didn’t have time for all that stuff cause we had so much good news. Really, I’m serious. I wanted to get the good news across. This is a model. Demand it in your community. …. I hope people active in their community will see this and go down to the hospital exec and say ‘Hey George. How are we doing? Are we as good as these guys in Seattle or in Dartmouth or in wherever?’ That’s kind of what I hope comes out of it because that’s the kind of pressure that can force this change.

Follow HFN associate editor Stephanie Bouchard on Twitter @SBouchardHFN.