'Perverse' Incentives Examined in New Health Care Documentary

This year, August recess for members of Congress comes with a hefty (home)work load. As the Sept. 15 due date set by President Obama for health care reform approaches, the raging debate has both Democratic and Republican lawmakers encountering town hall meetings that often turn into free-for-alls.

On Tuesday, Obama travelled to Portsmouth, N.H., for the first of three health care town meetings, using the presidential bully pulpit to counter criticism of the health care reform proposals.

"There's been a long and vigorous debate about this, and that's how it should be. I hope we will talk with each other and not over each other," Obama told the crowd of 1,800 listeners.

Amidst the finger pointing and the shouting comes a quiet new documentary that offers another diagnosis of what's ailing the country's health care system. The documentary is called "Money Driven Medicine."

Reporter and author Maggie Mahar, who wrote the book that inspired the film, says the root of the problem is that the health care system has become profit driven. In an interview with "Nightline" anchor Terry Moran, Mahar said, "What I learned, knowing Wall Street pretty well, is that our health care system was profit driven. Those people who made money on the health care system were really in charge.

'They Pay What They're Told'

"They could charge whatever they wanted to," she said. "If you have cancer, and you're told the cancer drug is $10 million, even if you had to pay out of pocket, you probably would mortgage your house to do it. This isn't about skin in the game; this is about people who are really sick. Eighty percent of our health care dollars are spent when people are really sick. They don't have a lot of choices as consumers to shop around or to demand a lower price. They pay what they're told they have to pay, whatever the market will bear."

Veteran filmmaker Alex Gibney, who directed "Money Driven Medicine," wanted to hear the stories of doctors on the frontline who understood the issues. "We went out and photographed a lot of doctors and, indeed, doctors who had opted out of the system to become spokespeople for a new idea, to say, 'You know what? Our system is not the best in the world,'" said Gibney.

"It's the best in the world at some small things, what they call 'rescue care,' these high-octane, very technologically proficient procedures. But we're terrible compared to other industrialized, democratic nations in primary care or preventive care. So, you know, they were saying, 'It's broken, we gotta fix it.'"

Health Care Quality Versus Quantity

According to these doctors, it's the treatments, test, surgeries and pills that get paid for, not healthy results. That in turn creates what Gibney calls "supply driven demand, meaning, the more supply you create, the more people demand. And the way it works is this: If you have five big MRI machines in your hospital, next thing you know, there are pressures on the doctors in the hospital -- 'Well, you know, how about another MRI, let's take a look at that.'

"And next thing you know, the MRI machines are being used around the clock," added Gibney. "But you don't always need an MRI -- a good orthopedist can kind of feel your knee or look at an X-ray, which is cheaper, and figure out what's going on much more simply."

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