You believe WHAT?

The world of medicine has changed radically since I was a kid in East Texas. Back then, Dr. Sam Tenney made house calls for a couple of bucks a visit. Dr. Granbury raced to a patient's side with such speed you could hear his tires screeching around the courthouse square blocks away. And if you needed a prescription, Dr. Wyatt would offer to drop it off at your door on his way to the hospital - a non-profit community hospital, by the way, run by civic-minded citizens who counted every penny.

If any of them were around today, they would surely marvel at our high-tech medicine. But as prudent folks, they would also marvel - in a horrified way, I think - at the cost of it all. How did we get here?

Maggie Mahar wanted to find out. She's one of our best financial journalists - now, after years of research, she has written: MONEY-DRIVEN MEDICINE: THE REAL REASON HEALTH CARE COSTS SO MUCH. During their summer recess, if every member of the House and Senate would read it before returning to Washington, the outcome of the health care debate might be very different.

In this broadcast we will share with you a film based on Maggie Mahar's work. The book and the film couldn't be more timely as our country wrestles with what to do about money-driven medicine.

DR. NORFLEET: All right, I'm Dr. Norfleet. And Joel has been talking to you about the build-up pain you're having right now.

MR. WILLSMALL: Yes ma'am.

DR. NORFLEET: Is it the same kind of pain you've had before Mr. Willsmall?

MR. WILLSMALL: Uh, no. It started about a month ago.

DR. NORFLEET: The pain you are having now?

MR. WILLSMALL: Yeah.

DR. NORFLEET: And who is your primary doctor?

MR. WILLSMALL: I don't have one right now.

DR. NORFLEET: Okay. You've been admitted to the hospital before though? You've been here before?

MR. WILLSMALL: I've been... I was admitted to the Centennial Hospital.

DR, NORFLEET: Okay.

MR. WILLSMALL: I had chest pains and that's when they found the hepatitis.

DR. NORFLEET: Oh boy. Hepatitis B or C or both?

MR. WILLSMALL: Both

DR. NORFLEET: Wow! You have a history of ulcers or anything like that?

MR. WILLSMALL: No ma'am.

DR. NORFLEET: And you haven't seen anybody else about this, huh?

MR. WILLSMALL: No ma'am.

DR. NORFLEET: Okay.

MR. WILLSMALL: I went to the downtown clinic cause when this happened I wasn't able to work. I lost my job. I lost my apartment.

DR. NORFLEET: Okay.

MR. WILLSMALL: And so, I'm just trying to get help.

DR. NORFLEET: Yes, Sir. We are going help you, okay?

He's complaining of vomiting blood. It's been going on for a month so it's not really considered an emergency anymore. It's considered a chronic problem, but we get a lot of patients like that, that the emergency department is the only place they know they can go to, to maybe address their problem.

He didn't have the luxury of having a primary care provider, which is a luxury in this country, which is kind of sad. We're like the richest country, you know, and a lot of our people don't have doctors so they use the emergency department in order to see a physician.

NURSE: Say, "Ah." You've got a lot of congestion in the back of your throat. Do you feel like its kind of sitting there?

DENTIST: Well, that second to last tooth is infected and the very back tooth looks broken off.

PATIENT: All right.

MAGGIE MAHAR: Over the last 12 years a number of people visiting America's emergency rooms has soared. Yet here's what's surprising: The number of low-income people going to ERs has not increased. The increase has come almost entirely among middle-class people and many of them have insurance.

NURSE: Whose insurance do you have?

PATIENT: Blue Cross.

NURSE: Do you have your card with you?

PATIENT: Yeah.

MAGGIE MAHAR: So why do they go to the ER? Why aren't they seeing their own doctor? Many people think that they know what's wrong with the health care system in this country. Millions of people are uninsured. And sure, that's part of the problem. But that's not the whole problem. The whole problem is bigger than that.

DR. JOHN NIXON: I am on top here. Any problem up there? Any problem in the back?

DR NIXON: There're just not enough resources out there for, not only your uninsured patients, but also your insured patients. Insured patients have a problem also because their doctors, when they call their office and says, "I need to see..." ... "We can't see you for three weeks." "Well, what am I going to do for three weeks?"

DOCTOR: Open your mouth.

Health care costs keep going up, up and up and up. But the access seems to be going down down down down.

All right. Do you need anything for pain right now? You do? Okay, we'll get you something all right? We've got to run some tests and we'll be back.

PATIENT: Okay, thank you.

I'm just glad, you know, that there's a place to come to, you know. I mean, dying is not no big deal to me, but you know, people have to go through a lot before they get there.

MAGGIE MAHAR: When I was a financial journalist at Barrens, I wrote many stories about health care. And what I learned was that much of what we think we know about health care isn't true. And much of what is true is counterintuitive. So eventually I decided to write a book about health care. And when I did I knew I wanted to talk to a lot of doctors. So I began putting out phone calls. I didn't know most of the doctors I was calling. I was hoping that maybe 20 percent of them would return my call. To my utter surprise 5 out of 6 of them called me back. And they talked. They talked for 30 minutes. They talked for longer than that. They said, "Please, we want someone to know. Please tell people." To a man and to a woman what they were most passion about was the declining quality of care in this country. Not about how much they were paid or how much they weren't paid. They were concerned about the quality of care, about what was happening to their profession and how little power they had to do anything about it.

DR. DONALD BERWICK: It is, I guess, politically correct, widely believed, that to say that American health care is the best in the world. It's not. There's a much more complicated story there. For some kinds of care my colleague Brent James calls it rescue care. Yes, we're the best in the world. If you need very complex cardiac surgery or very advanced chemotherapy for your cancer or some audacious intervention with organ transplantation, you're pretty lucky to be in America.

You'll get it faster and you'll probably get it better than in at least most other countries. Rescue care we're great. But most health care isn't that. Most health care is getting people with diabetes through their illness over years or controlling the pain of someone with arthritis or just answering a question for someone who is worried or preventing them from getting into trouble in the first place. And on those scores: Chronic disease care, community-based care, primary care, preventive care. No no, we're no where near the best. And it's reflected in our outcomes.

We're something like the... We're not the best health care system in the world in infant mortality rates. We're like number 23. There is an index that is used in rating health care systems, which is the rate of mortality that could have been prevented by health care. There are at least a dozen countries with lower rates of preventable mortalities than the United States and not one of those countries spends 60 percent of what we do on health care.

MAGGIE MAHAR: Dr. Donald Berwick is a pediatrician and a revolutionary, really. He wants to overthrow a health care system he sees shot