The Price We Pay: What Broke Healthcare & How to Fix It | Dr. Marty Makary {Podcast #038}

We need health care literacy to navigate in today’s society.

It is important for individuals to get an insight into the health care system to understand, at least the general components of it, to receive safe and appropriate medical treatment.

Dr. Marty Makary, one of the nation's leading health care experts, shows how much of health care spending goes to things that have nothing to do with health and what you can do about it.

Dr. Makary challenges the medical establishment to remember medicine's noble heritage of caring for people when they are vulnerable.

Drawing from on-the-ground stories, his research, and his own experience, we explore price-gouging, middlemen, and a series of elusive money games in need of a serious shake-up.

Dr. Makary's work, including his book The Price We Pay, offers a roadmap for everyday civilians and business leader to get a better deal on their health care, and profiles the disruptors who are innovating medical care.

The movement to restore medicine to its mission is alive and well - a mission that can rebuild the public trust and save countries from the crushing cost of health care.

About Dr. Marty Makary

Dr. Makary is a New York Times bestselling author, Johns Hopkins surgeon and Professor of Health Policy.

His book The Price We Pay takes on the high cost of health care and reveals how individuals and businesses can get a better deal on their health care.

Described by Steve Forbes as “a must-read for every American” and a “deep dive into the real issues driving up the cost of health care” by Dr. Don Berwick, The Price We Pay is the “The Big Short” of American Medicine.

Makary is a frequent medical guest on NBC and FOX News and a leading voice for physicians, writing for the Wall Street Journal and USA today

Dr. Makary is a gastrointestinal surgeon and serves jointly as on the faculty of the Johns Hopkins School of Public Health.

He is an advocate for the re-design of medical care and studies innovations that improve health, reduce waste, and address the root causes of illness.

He currently serves as executive director of Improving Wisely, a national physician collaboration to reduce unnecessary medical care and is the founder of Restoring Medicine, an advocacy effort to help people who can’t afford their medical bills.

Dr. Makary has been elected to the National Academy of Medicine and named one of America’s 20 most influential people in health care by Health Leaders magazine.


In this Episode we Discuss:

The increase in medical complexities and sophistication and the increase of hyper-specialisations and sub-specialisations.

The Crisis of Medical Appropriateness

The prestigious John Hopkins Hospital conducted a study investigating what percentage of medical care is unnecessary.

21% was the average!

They asked a random group of physicians who broke it down in medications, diagnostic tests, surgeries and procedures.

When you have people in the industry saying that one fifth of all the services are unnecessary, that is a crisis!

The opioid crisis is one manifestation of the crisis of appropriateness.

10 years ago physicians in the US prescribed 2.4 billion prescriptions.
Last year (2018) it hit 5 billion.
Did disease double in the last 10 years? No, we have a crisis of appropriateness and inappropriate care.

Prescriptions opioids, which is one form of the medical error of over prescribing, was the number one cause of death in the United States in people under age 50.

We have the most medicalised generation in human history. At the same time we have the most sick

The most obese, the most hospitalised, the most medicated, the most procedurelised, the most diagnosed, the most disabled generation in the history of the world.

Revolutionising Medicine through the medical education system.

The problem with medical school are the exams.

Teaching regurgitation.

Medical error, if it were a disease, would rank as the third leading cause of disease in the United States

This study was published by Marty Makary and Michael Daniel from John Hopkins University.

Anti-microbial resistance is a public health crisis

This is a manufactured health care crisis. From over prescribing, huge antibiotics in our food chain, in the air (glyphosate) and of course anti-biotics.

Stopping Covid-19 corona virus in its tracks.

Why “Stay At Home” is a ridiculous recommendation for corona virus Covid-19.

Covid-19 may just be the fifth seasonal corona virus (in addition two the other 4 corona viruses.

How has COVID-19 been as is going to be a catalyst for positive changes to this broken healthcare system.

The medical system taking advantage of the elderly

  • Part of it is the loss of the family unit.
  • A loved one joining a senior and helping to become a partner in medical care.
  • Connecting patients with loved ones is a key too much better outcomes.

Healthy Skepticism & Trust

  • Healthy skepticism - required for the modern healthcare system.
  • We are loosing our trust in doctors and public medicine.
  • Trust is essential. It brings in the ability for the patient to let go. Surrender.
  • Ayurveda is the opposite.
  • The incredible public trust is being threatened - patients tell doctors things they wouldn’t tell their spouse, within seconds of meeting them!
  • Patients are hungry for knowledge.

The true heritage and purpose of hospitals and doctors

Price Gouging Medicinal Services

Quarter million dollars to half a million dollars - for an air ambulance.

Air ambulances do save lives, but when they break their leg on a ski mountain with a quarter million dollar bill.

Keep in mind Uber and Lift and ground transportation can be sufficient if it is not emergency.
Plus! they will be at your home quicker than an ambulance.

There was one accident scene where one victim was there, and 7 air helicopters showed up on the scene to get the business.

Where do you think all this money is going that we pay for in health insurance premiums? It is essentially coming from you and all those that pay health insurance.

Price fluidity is proof of how price gouging is occurring. - Negotiating.

How can anyone accept a service without knowing the price first?

Airlines could argue they can't give us a price [in advance] because they don't know if there's going to be a delay or a cancellation, or you might consume a beverage. But airlines have built in the predicted risk into their prices.

Suing Patients

For unpaid bills. Predatory billing. Not happening in Australia.

Garnishing their pay checks.

Bullying on a scale that is unimaginable.

Doctors Know the Nudges

If you tell a woman in labour anywhere in a world that “a C-section might be safer for the baby,” 100% of women are going to say do the C-section.

If you tell a person anywhere in the word that you have bone on bone in your knee joint, 100% of people will say just replace it.

If you tell somebody that minimally invasive surgery to remove a cancer could spread the cancer because the gas can spread the cancer cells (which is a total myth) - guess what? 100% of people are going to say “don’t do it that way, cut me wide open.”

Doctors have learnt the nudges.

Most doctors do the right thing, but people need to be aware of the mass variations in the way things are done. And they need to know about the other lifestyle and alternative treatment options.

Ask your doctor about their individual C-Section Rates

If you tell a woman in labour anywhere in a world that “a C-section might be safer for the baby,” 100% of women are going to say do the C-section.

If you tell a person anywhere in the word that you have bone on bone in your knee joint, 100% of people will say just replace it.

If you tell somebody that minimally invasive surgery to remove a cancer could spread the cancer because the gas can spread the cancer cells (which is a total myth) - guess what? 100% of people are going to say “don’t do it that way, cut me wide open.”

Doctors have learnt the nudges.

Most doctors do the right thing, but people need to be aware of the mass variations in the way things are done. And they need to know about the other lifestyle and alternative treatment options.

The importance of vaginal delivery

  • Squeezes their lungs so they sponge the fluid better.
  • IT colonises their GIT with bacteria from the vaginal canal which establishes their microbiome composition for life
  • Reduces the amount of scarring and distortion associated with C-sections.

It is not doctors who are responsible for this.

Not one single person or entity is to blame.

Disrupting the healthcare industry with private healthcare facilities with market demanded transparency.

Who is actually paying for all these outrageous costs.
“O, my insurance company pays for it, all good!.”

Solutions

How can we possibly fix the healthcare system?

  • Disrupting the market place of the medical system to help create honesty in health care.
  • Silver linings of Covid-19 to help redesign processes in the medical system.
  • Clinics that are being transparent with prices.
  • Innovators and disruptors.

Actions patients can take:

  • Ask about prices before going ahead with a prescription or procedure.
  • Use GoodRx to check what prices of medication should actually be!
  • MDSave - estimated national average for procedures. Shop around for medical services. https://www.mdsave.com

Resources

  • restoringmedicine.org
  • GoodRx
  • MD save
  • Did your hospital sign up?
  • Medpage today
  • texas free market and associations.
  • solvethecrisis.org - Opioid crisis.
  • sesamecare.com - online market place with fixed prices for medical services.
  • Sentinel air air ambulance brokers. -protection from unexpected air medical transport costs

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