EP242: The Price We Pay: What Broke American Health Care—and How to Fix It, With Marty Makary, MD

In this health care podcast, I speak with Dr. Marty Makary about his new book, which is entitled The Price We Pay: What Broke American Health Care—and How to Fix It. I could not recommend this book more highly. It's a page turner for hospital execs trying to do the right thing, employers trying to do right by their employees, insurance carriers looking for better ways to actually drive health care value, and doctors and nurses who are feeling burnout because they see their organizations demanding them to do things misaligned with their mission to do the best they can by patients. Dr. Makary tells me in this interview that his intent with this book was to shine light on some of the issues, mainly around the price we—as patients, taxpayers, employers, basically all of us—pay. Dr. Makary says that understanding the situation is the first step toward navigating and redressing it. The Price We Pay gives multiple examples of egregious pricing. I'm going to split these examples into two categories: First, your basic price gouging, including surprise billing and what amounts to predatory pricing done at scale. The second category are high total prices because the services rendered were some shade of unnecessary. So high prices based on the price of the unit, and then high prices based on the number of units delivered. Dr. Makary and I talk about both challenges in this health care podcast. We also talk about the multiple instances where doctors and nurses and others are doing the right thing and really working hard to correct issues. Their efforts are glimmers of hope for all of us working hard to do right by patients. You can learn more at martymd.com or connect with Dr. Makary on Twitter at @MartyMakary. Martin "Marty" Makary, MD, is an American surgeon, New York Times best-selling author, and Johns Hopkins health policy expert. He has written for The Wall Street Journal, USA Today, Time, Newsweek, and CNN and appears on NBC and Fox News. He has written extensively on organizational culture, the science of measuring quality in medicine, and health care reform. Dr. Makary is the author of two best-selling books: Mama Maggie, a book about a Nobel Prize nominee, and Unaccountable, a book about health care transparency. He also just released a new book, The Price We Pay: What Broke American Health Care—and How to Fix It. This book offers a road map for everyday Americans and business leaders to get a better deal on their health care and profiles the disruptors who are innovating medical care. Dr. Makary is principal investigator of a Robert Wood Foundation grant to lower health care costs in the United States by creating physician-endorsed measures of appropriate medical care and directs the national "Improving Wisely" project to reduce waste in medicine. He speaks nationally on disruptive innovation in health care. Dr. Makary is a frequent medical commentator of NBC and Fox News, commenting on the health care cost crisis, the impact of new technology, and interpreting the latest medical research for everyday consumers. Dr. Makary is director of the Center for Opioid Research and Education and founder of solvethecrisis.org, a website that shares expert opioid prescribing recommendations for common medical procedures for clinicians and patients. At Johns Hopkins, he has served as the endowed chair of gastrointestinal surgery, director of surgical quality and safety, and founding director of the Johns Hopkins Center for Surgical Outcomes Research and Clinical Trials. Dr. Makary is a surgical oncologist specializing in minimally invasive surgery and teaches health policy and management at the Johns Hopkins University School of Medicine. He currently serves as the chief of the Johns Hopkins Center for Islet Transplantation and director of the appropriateness in medicine project. 02:11 Marty's new book and its multiple examples of egregious pricing in health care. 02:41 The reason why hospital bills are often overinflated. 03:31 "Are Americans responsible for paying these marked-up, sticker-priced bills?" 04:58 Explaining the complexities of medicine, simplistically. 07:27 Balancing stories of price gouging with responsible billing. 07:59 "Hospitals were created in America as a safe haven for the sick and injured." 09:29 How everyone can work toward changing this at the individual level. 11:23 "Have a conversation with your hospital." 12:59 Marty's advice to hospital administrators and board members. 16:56 "We can restore honesty in health care." 17:01 How billing practices happen unbeknownst to hospital leaders. 17:35 Bad debt and mischaracterizing bad billing practices. 19:12 "Why don't we call it 'predatory billing'?" 22:12 "People are hungry for honesty in health care right now." 22:55 A code of ethics pledge for hospitals on restoringmedicine.org. 23:25 "Large hospitals are on track for the largest profit margin in their history." 24:50 Marty's advice for how employers can help address these egregious prices. 25:47 "Billing quality is medical quality." 27:03 Overtreatment as an element of overpricing in health care. 28:07 The "crisis of appropriateness." 30:19 "How can we talk about the root drivers of poor health?" 31:18 The grassroots movement to start the health care system from scratch. 32:04 Relationship-based clinics. 37:08 Choosing wisely. 37:39 Improving wisely. 43:48 "People are willing to pay for quality, but they just want honesty." You can learn more at martymd.com or connect with Dr. Makary on Twitter at @MartyMakary