BRIAN LAMB: Matt Heineman, one of the things on your bio sheet that I noticed is that you developed a multimedia undertaking called the Young Americans Project in the last few years. What was it?
MATT HEINEMAN, FILMMAKER: It was a film project called Our Time. It was I actually studied history in college. I went to Dartmouth College, and no intention of being a filmmaker. I actually wanted to be a teacher, and I got rejected from Teach for America and sort of was sitting around with my college friends and trying to decide what to do. And we hatched up this plan to drive across the country for three months interviewing kids from all walks of life to try to figure out what our generation’s about.
And we got sponsorship money, got an RV, and ended up driving around the country. And that was my first film. And I learned a ton about filmmaking, a ton about life, and I sort of fell in love with the process. We had a blog, you know, shot a film, tried to write a book nothing came out of the book but from that film, it led me to a job at HBO and sort of started me down this crazy path of making documentary films.
LAMB: One quick question about the Teach for America. How big an ego, you know, destroyer is that when they don’t pick you? I mean, how many young people try to become Teach for America?
HEINEMAN: I couldn’t believe it. I mean, you know, I thought you know, I’m trying to go out there and help help people and be a teacher, and I didn’t know that you could get rejected. But it hurt my ego, but I think, you know, I wouldn’t be sitting here if that hadn’t happened, and I ended up interviewing Wendy Kopp, the founder of Teach for America, for my first film, so it kind of came full circle.
LAMB: Go back to the whole project of going across the country. Where did you go? What year did you do that? How many people were with you? And how much did it cost you?
HEINEMAN: So we did it in the fall of 2005. I did it with three of my best friends. And it was really cheap. I mean, we were scrapping together money from family and friends. We got sponsorship money from Nantucket Nectars and Penske Corporation, and but it was really, you know, bootstraps, you know, rough guerilla filmmaking.
And, you know, I’d never held a camera before, I’d never taken a film class before, and it was just learning as we went. And it was really an exhilarating experience. I mean, what an honor to be able to go up to anyone across the country and get their story and speak to them about truths and, you know, depths of their lives, and it was just it was really a meaningful experience.
And it was it was wonderful, because we had a sort of wide range of characters from you know, half the interviews were planned, from Mark Zuckerberg, the founder of Facebook, to a drug dealer on the street, to a cancer researcher, to, you know, a homeless kid. So it was really a kaleidoscopic adventure.
LAMB: What did you learn about young people?
HEINEMAN: I learned a lot. I mean, I learned that I think no matter where you know, it’s sort of cliche, but no matter where you’re from, no matter what your background is, is that, you know, everyone has this burning desire to be better, to do better, to improve their surroundings, to improve themselves, and I I sort of walked away from that trip because we sort of went into that trip with all these preconceived notions that, you know, people in other generations were calling us apathetic and spoon-fed and directionless. And I walked away feeling inspired, that our generation, you know, does want to fix this country, does want to fix this world, and, you know, I don’t know if it’s going to happen overnight, and I think our world is changing every day.
And I think the way we communicate, the way we effect change is going to be different than, you know, my father and my mother who grew up in the ’60s. I mean, you know, we’re not out there in the streets protesting. I think we communicate and spread information in a much different way.
LAMB: So where did you grow up?
HEINEMAN: I grew up I was actually born in D.C., grew up in Connecticut, went to school in New Hampshire, so...
LAMB: What was the atmosphere of your family? What did your parents do?
HEINEMAN: My mother was a journalist, actually. She was a science writer. She wrote for the Washington Post for many, many years.
LAMB: Was her name Heineman or did she have a...
HEINEMAN: Cristine Russell.
HEINEMAN: So she kept her maiden name. My dad, Ben Heineman, is a lawyer. He started out in the public sector and then ended his career for 20 years working for General Electric and now teaches up in Boston. So...
LAMB: This is the well-known Ben Heineman, that it wasn’t there wasn’t his father also well-known?
LAMB: Explain that. I mean, actually, this is the first that I’ve learned this from you, but how do they fit into the past and...
HEINEMAN: I had a, you know, very my parents and my grandparents are amazing people. I feel very lucky.
LAMB: What’d they do?
HEINEMAN: My grandfather was a completely self-made man. He his father actually killed himself in 1929 after the stock market crash, and he was left sort of alone to fend for his family, and went to school, climbed his way into law school, and was started out as a lawyer, and then ended up running Northwest Railroad and a number of other businesses in Chicago and was very civic-minded, too. He was an adviser to President Johnson and others. And I think my dad and I have sort of inherited a lot of his social beliefs and and I think I carry a lot of that into the filmmaking that I do for sure.
LAMB: So why did you decide at Dartmouth to study history?
HEINEMAN: I didn’t know what else to study. I really I didn’t know what I wanted to do with my life. I didn’t have a lot of direction. I was actually I played a sport in college, and I you know, I’d always been fascinated by history. I’d been fascinated by the Civil War, took a trip in high school to Gettysburg and loved history, so I decided to major in it. And I think it really taught me to be analytical, to think critically about events, and I, you know, really try to learn from the past to affect the future.
LAMB: Why film, though? What did you think film would do for you?
LAMB: Actually not did you do film or did you do tape?
HEINEMAN: Tape, video.
LAMB: But why video?
HEINEMAN: Again, I think I sort of stumbled into it. I I sort of fell in love with the process. And I think film has this amazing power to really tell stories in a way that touches audiences and touches people viscerally in a way that the written form can’t do. I mean, you can really speak great social truths through the power of through the power of the documentary form.
And it’s such a malleable form. I mean, in this film ”Escape Fire” that, you know, I’m sure we’ll talk about is, you know, we we shot vιritι scenes. We had talking head interviews. We lit a hill on fire. We had animation. I mean, we it was really a hybrid form, with all these different techniques that we used, to really tell this story of our broken health care system.
So I think it’s it’s a beautiful form. And I love I love documentaries.
LAMB: We’ll get to ”Escape Fire” in just a second, but the go back to that first documentary you did or was it a documentary, when you did the travel across the country?
HEINEMAN: We thought we were going to make a documentary, and, you know, we shot about 150 hours of footage. But we didn’t again, we didn’t know what we were doing. I mean, we were just filming and meeting people and following our gut, and we sort of came home three months later and said, ”What the heck are we going to do with this?” And bought Final Cut Pro, which is a cheap editing program, read some books, and just started playing around with the footage.
And I ended up cutting together a little short film. We were actually in New Orleans three months after Katrina, so I made a little short about that day that we were there. And, again, I just I kind of was amazed at how about this form, about how moving it was to do this. And I just fell in love with the process.
LAMB: So you’ve got this video somewhere that you really haven’t used in any kind of a long format?
HEINEMAN: And then and then we ended up cutting together a film. We submitted it to a bunch of film festivals, got rejected by a bunch of film festivals, kept getting rejected, and kept getting teased by people. People kept saying, ”Oh, this is really brilliant, but I’m not sure if it fits for us.”
And eventually, I got it in the hands of an executive at HBO, and he brought me in, he said, you know, ”I love the film, we love the film here, we don’t want to buy it, but we want to hire you to help produce ’The Alzheimer’s Project,’” which was a big public health campaign that they were doing. So I was hired as one of their producers.
LAMB: So you still have all that video you haven’t used?
HEINEMAN: And then I continued to edit the film and eventually sold it to the Documentary Channel, where it aired there. It’s now available on excuse me, on Amazon and Hulu and other digital platforms, as well.
LAMB: And the name?
HEINEMAN: ”Our Time.”
LAMB: Make the transition into ”The Alzheimer’s Project.” How did how did that go? When did it go? I know on my home set, it’s still there. It’s on-demand, I believe.
HEINEMAN: You can still I think you can still watch it on-demand.
LAMB: But you can also buy it.
HEINEMAN: Yep, you can buy it on DVD. I think you can stream it online, as well, still. Yeah, so again, I submitted my film, ”Our Time,” which my first film, ”Our Time.” And I got hired ending up getting hired as a producer to work on ”The Alzheimer’s Project” and...
LAMB: Why did HBO want to do this project?
HEINEMAN: I think HBO it’s just they’re a wonderful channel, because they’re they produce a ton of content, but they’re really socially conscious, and every couple years, they produce large public health campaigns, first did one on cancer, then addiction. You know, I worked on ”The Alzheimer’s Project.” And then they most recently did a big public health campaign on obesity.
LAMB: So what did you learn? What were the big things you learned from ”The Alzheimer’s Project”? And how many different shows were there?
HEINEMAN: So there’s four different films that are part of that series. And I you know, I was a producer on one of them, on it’s called ”Momentum in Science,” which was sort of where we are in the science of Alzheimer’s. There’s a film for children. There’s a film for caregivers. And we I mean, I learned a ton. You know, I’d gone from working on my own in my in a closet in my apartment, editing my first film, to working with, you know, Oscar-nominated, Emmy Award-winning filmmakers who were became my mentors. I mean, John Hoffman, you know, who’s the executive and producer of the project, who hired me, you know, has really been a mentor. I worked he’s a wonderful man, who’s been very kind to me throughout my career.
I also collaborated with Susan Froemke intimately, and, you know, we got along really well and ended up deciding to work on my our latest film together.
LAMB: Who’s Susan Froemke?
HEINEMAN: Susan Froemke is a multi-Emmy-Award-winning, Oscar-nominated documentary filmmaker. Her first film was ”Grey Gardens.” And she’s made over 30 films in her career, so you know, it’s really been a privilege it was a privilege working there at HBO with such talent, and it was sort of my film school.
LAMB: So how close are you to your 30th birthday?
HEINEMAN: I’m a year away from my 30th birthday.
LAMB: So you’ve done all this and you’re 29?
LAMB: The reason we asked you here, besides all this background, is because you have a documentary that’s just been released within the last month or so about what?
HEINEMAN: So the film that was just released was called ”Escape Fire: The Fight to Rescue American Healthcare,” and it’s really about how and why our health care system is broken, why it doesn’t want to change, and really people out there who are trying to change it. We started making the film in 2009, just as the health care debate was heating up, and there was there was so much fear and confusion around the topic, it was really it was dividing our country, the topic of health care.
And I think both Susan and I really wanted to try to understand, you know, how the system came to be. Why did this perverse system exist? But we also wanted to find solutions and people out there who were who were trying to change it. So we didn’t want to make it just a polemic. We wanted to make a film that highlighted solutions, as well.
LAMB: Let’s just jump into a cut. This is we have about 10 minutes of your hour and 39 minute documentary that we’re going to run during this discussion. Let’s just jump in, and then you can tell us who the people are that we’re seeing.
UNIDENTIFIED PARTICIPANT: OK, I need some help over here. The patient just fell off the litter
UNIDENTIFIED PARTICIPANT: Did he try to get up without anybody knowing?
UNIDENTIFIED PARTICIPANT: No, I tried to get him up and he just rolled himself out. He’s like really not listening very well.
UNIDENTIFIED PARTICIPANT: Yeah, that’s why you don’t want him to fall again. Probably put him on the bottom of the other side.
UNIDENTIFIED PARTICIPANT: I’m going to check his chart real quick and find out what he got at the CASF.
UNIDENTIFIED PARTICIPANT: Let me get that jacket away from him. He’s, like, clutching his meds.
UNIDENTIFIED PARTICIPANT: Here you go. This is what he’s got left of the morphine.
UNIDENTIFIED PARTICIPANT: He was issued this bottle today with 20 in it, and 10 are missing. He’s taken 10 tablets.
UNIDENTIFIED PARTICIPANT: Oh my god. That is ridiculous.
UNIDENTIFIED PARTICIPANT: That’s why he’s a little high right now.
UNIDENTIFIED PARTICIPANT: At some point he could stop breathing if he took too much narcotics, and we’re going to be doing CPR on a patient.
LAMB: What is where are you?
HEINEMAN: We are on a medevac flight from Ramstein, Germany, to Andrews Air Force Base. And we were really looking at the military as a microcosm for the rest of America, in that they have this sort of default reliance on pharmaceutical drugs. And, you know, in America, we spend $300 billion a year on drugs. And that’s as much almost as much as the rest of the world combined.
So we really wanted to try to explore this, and we ended up deciding to explore it through the military. You can almost not pick up the paper every day and not see something about over-medication or suicide in the military. And so when we had heard that the military was actually trying to fix this problem, and that they were trying to, you know, do a study to try to see if acupuncture could work in lieu of drugs on this medevac flight, we it just was sort of a home-run story that we wanted to explore.
And it took us about a year to get access to get on that plane. And we had to get permission from the U.S. Air Force, the U.S. Army, and, you know, it took a long, long time. Two weeks before getting on that plane, we didn’t have permission, and I was sweating bullets. It was right before New Year New Year in 2010. And then finally, at the last minute, we got permission to get on that plane, and what we see there is we don’t see one of the the people who are in that study. We actually ended up following a character named Sergeant Yates, who was heavily, heavily over-medicated, and what we see in that clip is really sort of the what happens when we have a fragmented system, when we have a bunch of different doctors picking at different pieces of us, but not looking out for our whole person.
I mean, there’s no way a human being should be on as many drugs as he was on in that plane. I mean, he almost died on the plane.
LAMB: Yeah, they hold up he holds up a bag at some point which is just full of containers of pills.
HEINEMAN: And the nurses and doctors on the plane, they couldn’t figure out what he was on, how many drugs he was on, and, you know, his blood pressure dropped to a really dangerous level, where he almost died. I mean, the whole plane was literally on, you know, shut down. Everyone was on, like, high alert.
LAMB: That was in the air when you shot that?
HEINEMAN: We were in the air, across the Atlantic.
LAMB: You came from Ramstein in Germany?
HEINEMAN: Ramstein in Germany to Andrews Air Force Base. And Sergeant Yates, the young man who we see in that clip, was really ended up being sort of the heart and soul of ”Escape Fire,” heart and soul of our film, somebody that we ended up following for about six months, so...
LAMB: Did he agree before or after that you could use this?
HEINEMAN: He agreed before.
LAMB: Did he sign something?
LAMB: So the whole trip, you were allowed to shoot whatever happened to him?
HEINEMAN: Yep. We got we basically got free reign to film anything with the military, you know, obviously, within reason. But for patients that we were following intimately, we needed to get a release from them, and the military needed to get a release from them, as well. So he signed something before we got on that plane.
LAMB: Did the military have any say as to what you could use?
LAMB: How many people were with you on the plane?
HEINEMAN: We had a very small crew. I mean, the way we work is really intimately, so, you know, we’re as unintrusive as possible. It was just myself, my cinematographer, Wolfgang Held, and my sound man, Peter Miller. And, you know, I was filming a little bit, as well.
I mean, I think the key to that scene is that none of that would have worked I mean, in many ways, I think that’s sort of the emotional crux of the film. And, you know, it’s where we really sort of get into the belly of the beast of our system and see sort of it’s the most one of the most raw moments of our film. And none of it would have happened if we hadn’t been able to plug into the nurses’ headsets to be able to understand what was happening, because it was so noisy in there, you couldn’t even hear yourself think or talk. I mean...
LAMB: Where is Sergeant Robert Yates today?
HEINEMAN: So we we ended up following him after this plane ride for many months, as I said, and he ended up entering himself into an innovative program at Walter Reed, where they ended up using acupuncture, using meditation, using other techniques to wean him off of all the drugs that he was on, and through this program, he actually was able to walk out of Walter Reed on his own two feet.
So, you know, I really commend the military for two things, for one, for allowing us to tell this story, both the good and the bad, but for recognizing this problem, by recognizing that there is this problem of over-medication, and that they are looking for outside-the-box ideas on how to fix it.
I mean, that’s sort of the whole thesis of the film, really, this the metaphor of ”Escape Fire” is that, you know, the status quo isn’t working and we need to start looking for outside-the-box ideas.
LAMB: Explain, because we haven’t seen it, what is ”Escape Fire”?
HEINEMAN: You want the short version or the long version?
LAMB: Well, just so people have an idea why the name.
HEINEMAN: So ”Escape Fire” is a metaphor that Dr. Don Berwick draws for us between our health care system and a forest fire that happened in 1949. And basically what happened was these forest firefighters were dropped in to fight this fire, they filled with the latest and greatest technology, and filled with hubris. They called it a 10 o’clock fire, meaning it would be beat by 10 o’clock the next morning.
Suddenly, they found themselves the wind shifted directions, and they found themselves running up this hill for dear life. And the leader of this group, this guy, Wag Dodge, lit a match, he burned the area around him, so when the fuel excuse me, when the fire came and overtook him, he’d be safe in what’s now known as an escape fire. And he called for all of his men to join him, but nobody did, and they kept they all kept running up the hill for dear life. They all died, and he remained he survived unharmed in his escape fire.
And it’s really this metaphor that our health care system is burning, and we’re all running up the hill, sticking to the status quo, when the answer is right here, right in front of us.
LAMB: Here’s another couple of people that we see a lot of in the documentary, the journalist former journalist Sharon Brownlee and Dr. Leslie Cho. Sharon Brownlee was U.S. News Shannon Brownlee, excuse me, was U.S. News at one point. Why did you pick her as a spokesperson?
HEINEMAN: She’d written a book Shannon Brownlee had written a book called ”Overtreated.” And that book was sort of seminal for us in understanding that this that more is not better when it comes to health care, that more can actually hurt us. And it was her book that really explained that to us, and therefore, you know, I sought her out to be in our film.
LAMB: Here she is, and others.
(BEGIN VIDEO CLIP)
BROWNLEE: The vast majority of doctors in this country are paid by a fee-for-service system. And that simply means that they get paid for each office visit. If they’re surgeons, they get paid for each procedure. If it’s a radiologist, they get paid for each CT scan that they deliver.
DR. LESLIE CHO: If I spend five minutes with you and then put in one of these stents, I’d probably get paid $1,500. For me to spend 45 minutes on an established visit with a patient to make sure they’re doing their exercise, make sure their diabetes is going OK, and to try to figure out what their true problem is, probably get paid $15. It’s a completely irrational system.
BROWNLEE: Fee-for-service rewards physicians for doing more. It doesn’t reward them for doing a better job. It doesn’t reward them for keeping their patients healthy. It rewards them for delivering more care.
(END VIDEO CLIP)
LAMB: Who what do the doctors think of the fee-for-service? Did you find out?
HEINEMAN: Nobody’s happy with fee-for-service. I mean, it’s an antiquated, broken, perverse system that nobody’s happy with, that is the predominant way in which medicine is reimbursed in our country. You know, we pay for pieces, and we get pieces. As they explain in the clip, you know, we pay for individual procedures. We pay for, you know, prescribing drugs. We pay for pieces. Each service that a doctor provides, they’re paid for. And when you’re paid in that system, you’re incentivized to do more. You’re not incentivized to do what’s right for the patient. You’re incentivize to, you know, do more procedures or give more pills.
So what the problem with that is that, you know, you don’t you don’t really get to the bottom of what’s wrong with somebody necessarily. You don’t have the time to spend 45 minutes trying to understand what’s going on with their heart condition or whether there’s other ways of perhaps, you know, changing lifestyle or other things. It’s much easier to just say, hey, we’ll go into the cardiac cath lab and put a stent in.
LAMB: How did you get to the Cleveland Clinic and Dr. Leslie Cho? And there’s another doctor from Cleveland Clinic you have in the documentary. And how did you find Yvonne Osborne?
HEINEMAN: So we we were reading the New York Times, and there was an article about a man a doctor outside of Washington, D.C., who had was basically being arraigned for putting in way too many stents. And this article sort of explained, again, overtreatment, and one of the doctors quoted was Dr. Steve Nissen, a leading expert the head of cardiology at the Cleveland Clinic.
And so we gave him a call and asked him to be in our film, and he agreed, and it’s sort of through him that we started to learn about more about the Cleveland Clinic as really a model for health care. And, you know, in speaking with them, we met Dr. Cho and what you know, Yvonne Osborne was one of Dr. Cho’s patients.
LAMB: Here’s some more with Yvonne Osborne to continue this that part of the story.
(BEGIN VIDEO CLIP)
CHO: How are you?
OSBORNE: I am great. Look at the thinness.
CHO: I know. You look really good.
OSBORNE: I have lost since last year, I’ve lost 21 pounds.
CHO: Oh, my god. Yvonne came to see me when she was sort of at her wit’s end. She had had bypass surgery at an early age, 27 cardiac catheterizations, and well over seven stents.
This is just an unbelievable amount of stents and cardiac caths.
I’m sorry. It’s going to get pretty tight, huh? Sorry.
I can’t tell you how shocked we were when we saw her the first time, because here was a young woman whose diabetes was not well controlled, her cholesterol was never well controlled, and her high blood pressure was never well controlled.
Breathe normally for me.
If someone had talked to her, I think someone had really teased out her chest pain and her shortness of breath, I think many of her cardiac catheterization and stents would not have been necessary.
(END VIDEO CLIP)
LAMB: Twenty-seven catheterizations? How often did you find that to be the case?
HEINEMAN: That’s definitely an extreme case, but it’s not that extreme. I mean, people, you know, often so many people have stents that don’t need them. In fact, 97 percent literally, 97 percent of stents don’t actually aren’t helpful or aren’t useful.
LAMB: Why do they do it, then?
HEINEMAN: Because that’s what they’re taught to do. That’s what, you know that’s it’s easier to put in a stent than to spend 45 minutes talking to a patient than spending time, you know, getting them to change their lifestyle or putting them in cardiac rehab. And, frankly, it pays more. You know, as we see, it pays you know, you get paid $1,500 to put in a stent or you get paid $15 to spend 45 minutes. What would you do?
LAMB: How often did you have the feeling, as you went about your research, that hospitals or doctors or doctors groups actually wanted to generate more money instead of take care of patients?
HEINEMAN: I don’t think anyone goes I mean, I’m not a cynic. I don’t think people go into medicine to hurt people. I don’t think people go into medicine to make money off of people. But we’ve set up a system that allows doctors to profit off of sickness, that allows doctors to profit off of doing these procedures.
And if that’s if those are the incentives you’re given, then what are you going to do? As Dr. Nissen says in our film, to a man with a hammer, everything looks like a nail. And, you know, that really holds true, when it comes to this fee-for-service model, that they’re they’re paid that way, they’re taught that way, that’s the culture, and that’s what they do.
LAMB: The woman, Yvonne Osborne, what were your arrangements with her? And how long did it take you to find her as the one you were going to video?
HEINEMAN: It took us a couple weeks. You know, for us, casting is incredibly important. We never like to film people who and leave them on the cutting room floor as much as possible. I mean, when we film someone, we really want to know we’re going to use them, so we’re very judicious in finding who we want to film and speaking to them at length beforehand. And so, you know, it’s a several-week-long process in finding her and ultimately following her.
LAMB: Who’s Dr. Leslie Cho?
HEINEMAN: She’s the head of cardiology for the women’s clinic at the Cleveland Clinic.
LAMB: And she talks about the fact that she gets $15 to talk to somebody for 45 minutes and $1,500 to do the catheterization. Fifteen dollars?
HEINEMAN: So she’s saying that, in in traditional medicine, that’s what happens. At the Cleveland Clinic, it’s a different model, where they are paid on salary, so she doesn’t get paid any more to do more. She doesn’t get paid any more to give more care. She gets paid a flat salary, and she gets incentivized to do a better job.
LAMB: But where I’ve never seen a case where it’s only $15 for a visit.
HEINEMAN: It’s how much she the doctors themselves get paid.
LAMB: Not the hospital.
HEINEMAN: Not the hospital. Yeah.
LAMB: You’ve got another doctor that you feature, a young woman with a small child, at least one child that we saw in the documentary, Dr. Erin Martin. Where is she?
HEINEMAN: She’s based in Hood River, Oregon.
LAMB: And why did you go to her?
HEINEMAN: I think Dr. Martin for us really represented the frustration of doctors. I think we as Americans everyday Americans who aren’t in the medical field, you know, I think most Americans aren’t happy with health care, with the health care that they get, with the time that they get with their doctors.
But what they don’t what I didn’t really recognize is how unhappy doctors are. Fifty percent literally 50 percent of doctors would get out of medicine if they could.
LAMB: Get out, all the way?
HEINEMAN: Get out, yeah. There’s a study that just found that 50 percent of doctors would get out of medicine if they could. And so what Dr. Martin really represents to us is not only the frustration of doctors, but the frustration of primary-care doctors, which really should be the basis of health care. You know, we have this obsession with specialists. Specialists get paid more. Doctors are more incentivized to go into specialty care. And we sort of have this dearth of primary-care physicians.
And, you know, primary-care is really the basis of health care. It’s how we have preventive care. It’s how we move from having a disease care system to having a true health care system.
LAMB: She is in a community health clinic. What were the what was the situation there? Who pays for that health clinic, do you know?
HEINEMAN: That’s a sort of government-run clinic, for the most part. They mostly get paid by the state and through Medicare and Medicaid.
LAMB: Let’s introduce everybody to Dr. Martin.
(BEGIN VIDEO CLIP)
MARTIN: Instead of basing things on outcomes, on how good of a job we’re doing, the government sets the reimbursement completely on the number of patients that we see. It doesn’t matter how complicated they are, how much time that we spend on them. It’s just a number, one, two, three, four, five.
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 if you try and buck the system, someone says, ”What can we do to get your productivity up?” I’m not interested in getting my productivity up. I’m interested in helping patients.
(END VIDEO CLIP)
LAMB: What happened to her?
HEINEMAN: She as you can kind of see in that clip was not happy with where she was. She was not happy with the revolving door of patients. She was not happy with being forced to put, you know, Band-Aid fixes on much deeper problems. She really she was handcuffed by the system. She couldn’t practice the medicine that she was taught to practice. She couldn’t help these people.
She wasn’t given the time. She was forced to see so many patients. And so she was just so frustrated that she ended up leaving. And so that was actually her last day at that clinic. And we follow her over many months as she sort of seeks out, you know, a different clinic that perhaps will allow her to succeed in a more meaningful way.
LAMB: Did you know when you went to Oregon and videotaped her that she was leaving that...
HEINEMAN: We knew that she was leaving, and we knew that was her last day.
LAMB: Where did she end up?
HEINEMAN: She ended up going to a fellowship with Dr. Andrew Weil, who, you know, is a big proponent of lifestyle medicine, of preventive medicine. And what he has done is he really thinks that there’s a gap in medical education, that most medical schools only spend four hours on nutrition. You know, if you look at heart disease, I don’t know the exact number, but there’s a huge percentage of heart disease is based on nutrition and lifestyle choices. And doctors are and heart disease is the number-one killer in America. And doctors are taught four hours of nutrition.
So I think what he’s trying to do is, he basically brings in doctors from all over the country and sort of reteaches them in a way, a much more holistic look at the body, teaches them preventive medicine, teaches them nutrition and other things, and these are these are not just primary-care doctors. These are specialists, as well, that are coming from all over the country.
So she goes to this clinic. Excuse me, she goes to this fellowship program where she’s sort of reinvigorated by it and ends up finding another clinic to go practice at.
LAMB: So when the audience sees Dr. Andrew Weil at the University of Arizona, very well-known book-writer, lecturer, and Dean Ornish in this, what message is that? Who’s going to say, ”Ah, I know now where they’re coming from.”
HEINEMAN: I think a lot of people view Dr. Weil and Dr. Ornish sort of as fringe doctors who advocate for, you know, alternative medicine. You know, I I think that’s an unfair viewpoint. I think they’re first of all, I think they’re both incredibly smart, incredibly passionate about fixing our health care system, and they both strongly, strongly believe that we need to move away from this disease-care system to a much more preventive-based health care system.
You know, Dr. Weil himself, you know, is dedicating himself to education, in that you know, through education, he can really change the culture of medicine. Dr. Ornish has really used science to show that lifestyle can actually reverse heart disease. I mean, it’s amazing what he’s done recently. Also, he’s shown that you can shorten your so telomeres are the ends of your chromosomes. And, you know, when you’re stressed, your telomeres get lessened. When you don’t eat well, when you don’t exercise, they get lessened. And when you’re when you have shorter telomeres, you’re much more susceptible to disease.
Well, he’s shown that if you increase your lifestyle, if you exercise more, if you eat right, if you destress, you can actually lengthen your telomeres and protect yourself against disease.
LAMB: Another name we’re going to see, this gentleman is somewhat known in this town, because he was a recess appointment to run Medicaid and Medicare, Dr. Berwick. The Republicans blocked him, but people would write that the Republicans really liked him, as well as the Democrats, but because of the situation here in town, what led to your decision to use Dr. Berwick as one of the chief spokesmen in your documentary?
HEINEMAN: Two things. One, he’s one of the leading minds in health care, and I think he’s one of the few people that can actually fix our system. But the real reason why we were led to him was that he wrote an essay, which was previously a speech he gave, called ”Escape Fire: Lessons for the Future of Health Care.”
So about a year-and-a-half, our film was called ”A Tale of Two Systems,” which is pretty much the most boring film title of all time. And we were literally scratching our heads, couldn’t figure out what to call the film, and somebody sent us this essay called ”Escape Fire,” in which, you know, Dr. Berwick draws the metaphor between our burning health care system and a forest fire.
And instantly when we read that we knew that that’s what we wanted to call our film. We knew that’s how we wanted to start our film. And so we sought him out to be interviewed for the film.
Ultimately, he ended up being sort of a sage-like character in our film, you know, coming in and out as one of our sort of chorus of experts that we interweave through the film.
LAMB: Once again, we see Shannon Brownlee, the former U.S. News reporter, and Dr. Donald Berwick. Let’s watch.
(BEGIN VIDEO CLIP)
BROWNLEE: We spend a spectacular amount of money on health care. Just sheer numbers, $2.7 trillion per year. The average per capita cost of health care in the developed world is about $3,000. In the United States, it was around $8,000 annually. We spend one heck of a lot of money.
BERWICK: The health care system isn’t affordable anymore. Who pays for that? Where does that money come from? This is all coming out of our pockets. It’s your money.
BROWNLEE: The really astonishing part about the fact that we spend more is that we have worse health outcomes.
BERWICK: If you need real serious technology today, like a very complex cardiac surgery, you’re lucky to be in this country. Rescue care is second to none. As an overall system, no, we’re not anywhere near the best in the world. I mean, look at our results. Our lifespan isn’t even in the top 20.
BROWNLEE: We have a disease care system, and we have a very profitable disease care system. And the disease care system actually I mean, if it really was honest with itself, it doesn’t want you to die, and it doesn’t want you to get well. It just wants you to keep coming back for your care of your chronic disease.
(END VIDEO CLIP)
LAMB: You know, the polls show that a lot of Americans really think we’re the best in the world, we have the best health care anywhere. They’re very happy with the health care system. Who’s going to be the most unhappy with this film?
HEINEMAN: People always asked us, you know, who are the villains? Who...
LAMB: I didn’t ask you that. I wanted to know who you think will be unhappy, though. I mean, who will sit out and and say that they that point of view is just baloney.
HEINEMAN: I think the status quo will be unhappy with the film. And the status quo is really, really powerful. You know, as Andy Weil says in our film, there’s rivers of money flowing to very few pockets, and the owners of those pockets don’t want to see anything change. And the owners of those pockets are the big insurers, the pharmaceutical industry, the medical device industry, and, you know, they’re making a lot of money off of this sick care system, off of this disease care system that we have, and they don’t want to see anything change.
But I think what we see in that clip is that we we spend twice as much as any other developed country in the world, but we’re at or near the bottom on almost every metric of health care. We’re 50th in lifespan. Infant mortality, you know, we’re, I think, in the 20s. Literally, almost on every metric of health, we’re at or near the bottom. So, clearly, we’re spending more, but we’re getting way less. And this has to change.
LAMB: One of those that was obviously and visibly critical of the insurance companies was a former insurance company executive by the name of Wendell Potter where I’m going to show that in a moment who is he?
HEINEMAN: Wendell Potter was a former executive at Cigna who visited a place called Remote Area Medical. Remote Area Medical was started by a TV personality from Britain. They would send airplanes into third-world countries to provide health care. He realized that there’s places in the U.S. that weren’t getting that needed equally needed that type of care.
And so he literally flies in these jumbo jets and provides health care at fairgrounds, you know, NASCAR grounds. And when Wendell Potter went to go visit one of these Remote Area Medical missions, he saw thousands and thousands of uninsured people who were standing in line to get health care in animal stalls and barns, and he had this crisis of conscience, and he realized that what he was doing he was denying people access to care.
LAMB: He was with Cigna...
HEINEMAN: He was with Cigna.
LAMB: ... insurance at the time?
HEINEMAN: Yep. And he realized that he couldn’t continue doing what he was doing.
LAMB: Did he speak out before he left the company or after he left the company?
HEINEMAN: He stayed in the company for a couple months and then just couldn’t keep looking himself in the mirror and decided to resign.
LAMB: How does he make his money now?
HEINEMAN: He wrote a book about his experience, and he speaks and lectures, and yeah, and writes.
LAMB: Have the insurance companies done anything to try to stop him?
HEINEMAN: I think you know, he doesn’t like being called a whistleblower. He’s not really a whistleblower. I think it’s hard for them to try to stop him, because he’s he’s a really grounded I mean, a lot of whistleblowers are, you know, extreme and polarizing. He’s really well liked by everyone, even people in the industry.
So it’s hard to he doesn’t have too many enemies. I mean, I know I’m sure certain people in the insurance industry don’t like him, but, I mean, he’s not he’s not he’s sort of unveiling something that people sort of already knew, but really speaking the truth about it.
LAMB: Here’s Wendell Potter.
(BEGIN VIDEO CLIP)
WENDELL POTTER: There’s the assumption that people who run government are elected officials or members of Congress, but it’s true in many cases. The power lies with corporations and corporate interests and the lobbyists that they buy.
VICE PRESIDENT JOE BIDEN: Good morning, folks. How are you?
RICHARD UMBDENSTOCK, AMERICAN HOSPITAL ASSN.: I was almost as surprised as anybody to see the reports that I was the most frequent visitor to the White House during the health reform debate. It was important to keep expressing the hospitals’ position.
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.
SHANNON BROWNLEE: How powerful are lobbyists in the health care system? Infinitely.
(END VIDEO CLIP)
LAMB: Why did the head of the American Hospital Association talk to you?
HEINEMAN: You know, they wanted to give their perspective, and we wanted the perspective of a lobbyist. You know, I don’t I don’t think he’s a bad guy at all. I think he’s just doing his job. His job is to advocate on behalf of hospitals, and that’s that’s the way our system is set up.
LAMB: Shannon Brownlee laughed about the money thing, $1.1 billion. What did the health care industry get for that $1.1 billion?
HEINEMAN: The health care industry well, specifically, insurance industry got a bill that didn’t have a public option and got a bill that was essentially giving them 30 million more customers. So there’s you know, I think, you know, the real winners of the health care bill was the insurance industry, that that got many, many more customers. And people don’t really think about it that way, but it’s sort of what happened.
LAMB: How much money a year do we spend on pharmaceuticals?
HEINEMAN: $300 billion.
LAMB: And that $1.1 billion wasn’t all pharmaceuticals?
HEINEMAN: No, it was a number of different health care lobbyists.
LAMB: What did the hospitals get out of the bill?
HEINEMAN: It’s unclear what exactly the hospitals won from the bill. I mean, I think what’s one of the things that’s a beneficial thing coming out of the bill, for sure, is that there are many demonstration projects in which they’re trying to examine different forms of payment, where hospitals, instead of getting paid for this fee-for-service, instead of getting paid for doing more, they’re given a lump sum of money and said, you know, you have to take care of these people and you have to be more judicious with how you’re paying for them.
So it’s much more of an emphasis on quality versus quantity. You know, and it remains to be seen whether that’s going to actually work.
LAMB: You say you’re not cynical, but you went through the whole Alzheimer’s discussion for HBO. Now you’ve been through this documentary on health care. If you watch your documentary, the pharmaceuticals get knocked, the government gets knocked by the fact that they determine that as we saw the doctors have to see so many patients a day in order to make the money and all that. How do you I mean, are we better off today than we were before the health care bill was passed? How did you come out of this?
HEINEMAN: You know, I think with our film, we’ve really tried to be agnostic politically. You know, so many of these documentaries you know, you sort of walk out of them feeling depressed and hopeless. And we really did not want to make that type of film. From day one, we wanted to make a film that highlighted not just problems, but solutions.
But we also wanted to make a film that wasn’t partisan, that wasn’t tied to a piece of legislation, that essentially would allow a sane and meaningful conversation. I mean, that’s the whole goal of the film, is to sort of change how our country views health and healing, and to to bring all stakeholders to the table.
LAMB: Here’s the CEO of Safeway. Before we show that, why did you talk to him?
HEINEMAN: So Safeway was really a model that both sides again, speaking to that that both sides sort of lauded as as how the private side can be part of the solution.
LAMB: Let’s watch Steve Burd.
(BEGIN VIDEO CLIP)
UNIDENTIFIED PARTICIPANT: One company has figured out how to lower health care costs by more than 40 percent.
UNIDENTIFIED PARTICIPANT: It’s an idea that’s received national attention.
OBAMA: Following the example of places like Safeway...
UNIDENTIFIED PARTICIPANT: The Safeway supermarket chain looked for a way to reign in spiraling premiums and hit on what seems to be a win-win solution.
BURD: In 2005, we had a $1 billion health care bill rising at the rate of $100 million a year.
UNIDENTIFIED PARTICIPANT: These are the costs of all of our drugs in order, so diabetics are the number-one cost to prescriptions. You can see how many scripts and the average script.
BURD: What we discovered was that 70 percent of health care costs are driven by people’s behaviors.
ERIC WARD, SAFEWAY EMPLOYEE: At my heaviest, I was over 200 pounds. I’d have my pizza. I’d have my comics. I’d have my DVDs. And that was the weekend.
KRYSTAL BRACY, SAFEWAY EMPLOYEE: You realize one day, wow, you know, I haven’t worked out, I haven’t exercised, and, you know, you kind of get busy, and it just it’s the last thing that you’re really concerned about.
WARD: I was chronically coming down with colds, and I knew that there was a history of cancer in my family, diabetes, heart disease. I was a walking dead man.
BURD: Now, as a business guy, I thought if we could influence behavior of our 200,000-person workforce, we could have a material effect on health care costs. 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 health care plan.
(END VIDEO CLIP)
LAMB: A billion-dollar health care bill going up at $100 million a year. One of the messages it seems like you’ve put through on this documentary is stop eating so much and exercise.
HEINEMAN: Yeah, I mean, 75 percent of health care costs, three-quarters of health care costs go to preventable diseases, heart disease, some forms of cancer, diabetes. And so we really, as a society, need to figure out how to become more healthy. We need to incentivize people to do so. We need to give them resources to do so. We need to stop, you know, subsidizing the wrong foods. I mean, it’s a multi-factorial problem.
You know, Americans are also lazy people, you know? We want you know, part of the I think what we see in the film and that we all experience in our daily lives, I mean, if we don’t go to the doctor and we don’t get a pill to fix something, you know, we’re unhappy.
So I think one of the messages that we really hope comes across in the film is that we do have this amazing power to heal, that we do have ownership over our own health. Sure, some people have genetic predispositions and, you know and because of their socioeconomic status aren’t don’t have the same resources. But within all of us, we have this, you know, capacity for healing.
LAMB: How much can you tell us about how much this cost you to do?
HEINEMAN: The film?
HEINEMAN: I don’t know. I don’t feel comfortable...
LAMB: Who funded it?
HEINEMAN: It was we had one investor, but the majority of the funding came from grants from foundations and from individuals all across the country who believed in what we were doing.
LAMB: How can somebody get this if they want it?
HEINEMAN: So it is we just released it in select theaters across the country. It’s also available on iTunes and video on demand.
LAMB: Do you want to make money with this?
HEINEMAN: I think to us, no. I mean, of course, I need to make money to live and put, you know, Cheerios on the table. But and to get by. But I think for us, this film is much more than just a film. It’s much more than just a commercial product. It’s we really hope that this film can be used for social good, and we’re seeing that happen already.
I mean, two weeks ago, we screened it at over 62 medical schools across the country, all in one night. And I was at Johns Hopkins, you know, just north of here, and just to see the energy for change I mean, I think there’s really this powerful movement out there that people want to change the system, that people want to fix this problem.
And then, you know, a week later, we screened at the Pentagon, hosted by the U.S. Army Surgeon General. She said, you know, ”This film is going to really propel us to change how we practice medicine in the military.” I mean, that’s powerful stuff.
And I think what I’m most optimistic about is that we you know, I don’t know if we can wait for change to happen in Washington. I don’t know if we can wait for national change. What I’m most optimistic about is change happening at a local level, community by community, hospital by hospital, clinic by clinic.
LAMB: Final clip for our discussion, Dr. Erin Martin back and also Dr. Nissen from the Cleveland Clinic.
(BEGIN VIDEO CLIP)
DR. ERIN MARTIN: We’re taught with the commercials on television, why do we need to wait? We can just take a pill right now.
DR. STEVE NISSEN: When I watch the networks, half the ads are for pharmaceutical agents. That isn’t true in Canada. It’s not true in the United Kingdom. It’s not true in France and Germany. The only other country, by the way, is New Zealand, and New Zealand and the United States, only two countries in the world where you can advertise prescription drugs. What does that do? Well, it drives demand. You know, the ads always end with the same phrase, ”Ask your doctor.” And people do. And doctors wanting to please their patients will often prescribe it.
(END VIDEO CLIP)
LAMB: Do you know when this started, having pharmaceutical ads on television?
HEINEMAN: To be honest, I don’t know. I think it was in the ’70s, but I’m not exactly sure. But, you know, we’re the only other country other than New Zealand that’s allowed to do this.
LAMB: Why? Why are we the only ones? And why New Zealand?
HEINEMAN: That’s a good question. I don’t know why New Zealand. And why are we allowed to? God, who knows? I mean, it’s it’s really I mean, you know, restless leg syndrome. I mean, these some of these agencies have created diseases that we’ve built drugs around and people are making millions of dollars off them.
LAMB: Did you look into why we see these ads and they often appear on the evening news shows, where they will advertise something and say, ”Your left arm might fall off. Your right ear might go away,” and they go on and on and on of what the side effects are. Why do they have to do that? And why do they do it?
HEINEMAN: They’re legally obligated to to list the side effects. It was a it was a law that was passed that forced them to list the side effects. We actually had a sequence in the film, you know, of tragicomedy, listing sort of all of the side effects. You know, your head will fall off, your arm will fall off, you know, you’ll your private parts will fall off. I mean, it’s crazy that these these things actually happen to people and that we’re giving drugs to people that have these side effects.
I mean, in the film, we see the story of Avandia, a drug that was used for diabetes, and, you know, it ended up killing between 50,000 and 200,000 people because the company, GlaxoSmithKline, really sat on the evidence and hid the fact that, you know, this was causing heart attacks in a subset of patients.
LAMB: What’s next for you?
HEINEMAN: I don’t know. I don’t have any plans for another film. I’m really dedicated to getting this film out there. I really believe in this message. And I plan on traveling around the country with this film to you know, right now, we’re in sort of the traditional release in theaters, on-demand and on iTunes, but, you know, I want to continue to take the films into medical schools, into businesses. We’re planning on doing something with the V.A. And I want to continue to work with the military to really make sure that this film can have an impact.
LAMB: All right. For those that like documentary filmmaking, what’s a big lesson you learned in doing this particular film that you’ll never do again?
HEINEMAN: Boy. I don’t know if I’m I’m ever going to take on such a big topic like this. I mean, I think one of the biggest hurdles for us was twofold. One, health care when you scratch beneath the surface it’s a pretty boring, wonky subject. And so we really, you know, from day one had to figure out how to make it interesting.
And then it’s also just such a complex topic. I mean, presidents since Teddy Roosevelt have been trying to fix this problem. So to kind of make it digestible for audiences, I mean, it was a really it took us three-and-a-half years to make this film.
So I think what I’ve learned personally for myself is I think for my next film, I want it to much more character-driven, you know, following one person or one institution, and having that say a larger truth.
LAMB: Just kind of a wrap-up. Born in D.C., grew up in Connecticut, went to Dartmouth, did a whole project traveling across the country. The name of that film available is what again?
HEINEMAN: It’s called ”Our Time.”
LAMB: And you did ”The Alzheimer’s Project” that came out on HBO what year?
HEINEMAN: I was one of the producers on that, and that was came out in 2009.
LAMB: And this documentary is called ”Escape Fire: The Fight to Rescue American Healthcare.” Our guest has been Matthew Heineman, and we thank you.
HEINEMAN: Thank you so much.