Check out more content from Marty Makary, M.D.:
- (Aug 26, 2019) #68 – The US healthcare system — why it’s broken, steps to fix it, and how to protect yourself
- (Jan 3, 2022) #189 – COVID Part 1: Current state of affairs, Omicron, and a search for the end game
- (Jan 24, 2022) #192 – COVID Part 2: Masks, long COVID, boosters, mandates, treatments, and more
In this episode, Marty Makary, Johns Hopkins surgeon and NYT bestselling author, discusses his new book, The Price We Pay, and his ambitious attempt to fix the broken U.S. healthcare system through educating the public, changing the lexicon, encouraging radical transparency in pricing, and more. We go in detail into the main drivers of inflated health care costs, the money games being played making it hard to understand, and the unfortunate system structure that has resulted in one in five Americans finding themselves in medical debt collections which can ruin the lives of people and families seeking basic medical care. Marty also shares some very practical advice and tips if you find yourself a victim of predatory pricing and stuck with an outrageous medical bill. In the end, despite the current state of the system, Marty discusses the many exciting trends gaining traction in healthcare and why he is very optimistic and hopeful about the future.
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*This episode of The Drive centers around the content of Marty’s new book, The Price We Pay, which is set to release September 10, 2019. If you’d like to dive deeper into this topic, Marty’s new book will be a great resource.*
We discuss:
- The science of delivering healthcare, how we need to do better as a system, and why no single person or entity fully to blame [10:15];
- The stories that prompted Marty to write his first book (Unaccountable) [19:15];
- The Surgery Checklist [26:15];
- The problem is with the system (not any one person or entity) and the misaligned interests of all the parties involved [28:15];
- Patients crave honesty and transparency, and the story of Peter’s back surgery gone wrong [33:00];
- Today’s med students and young doctors have less tolerance for predatory pricing and healthcare industry BS [44:30];
- Funny stories about John Cameron (legendary surgeon at Johns Hopkins) [48:00];
- How doctors are trained to internalize traumatic experiences which can result in a misunderstood form of “burnout” [57:40];
- The beat down of med students with traditional medical education and some exciting innovations to medical education [1:07:00];
- Exciting trends in healthcare and an optimistic view of the future [1:11:30];
- The Price We Pay (Marty’s new book), an attempt to illuminate the blackbox that is the US healthcare system [1:21:00];
- Why it’s not always in the best interest of the insurance company to negotiate the best price [1:28:30];
- Who is actually paying for medical costs, and Marty’s frustration with the healthcare lexicon [1:32:00];
- Pros and cons of a single payer system [1:37:00];
- How to fight outrageous medical bills and predatory pricing (and make a dent in the wasteful healthcare spending for the country) [1:49:30];
- Disrupting the healthcare industry with private healthcare facilities with market demanded transparency [2:05:45];
- The people hurt the worst by the current US healthcare system, the sad breast cancer statistic, and the importance of knowing that medical bills are negotiable [2:09:30];
- The healthcare industry bubble [2:14:00];
- Increased costs from unnecessary tests and procedures [2:16:30];
- Malpractice concerns due to the litigious culture in America: What influence does it have on unnecessary testing, healthcare costs, and overall quality of treatment [2:22:00];
- Drug pricing, price gouging, middle-men money games, kickbacks, and other drivers of healthcare costs [2:27:45];
- How can we possibly fix the healthcare system? [2:34:30];
- Helpful resources [2:46:15]; and
- More.
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The science of delivering healthcare, how we need to do better as a system, and why no single person or entity fully to blame [10:15]
Marty’s first book: Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care
*This has been made into a popular show on Fox called The Resident
What prompted you to write Unaccountable?
- “Unaccountable to me was an opportunity to … engage the general public in a way that both brings honor to medicine and at the same time warns people that it’s important to get a second opinion. It’s important to ask certain questions.”
The science of delivering healthcare
- During med school, Marty realized that there was a whole science around the actual delivery of medical care (patient safety, avoiding mistakes, etc.)
- Marty says discussion on policy is detached from the real world inside the trauma center (for example)
A system problem
- Marty tells a story about a broken elevator in a hospital
- A person walked into the open doors and fell to his death
- For some reason, they still didn’t put up a barrier
- Shortly after that, another person fell again (but did not die)
- Other examples include
- Broken elevator button to the emergency helicopter pad
- Person at the x-ray counter refusing to give you x-rays because of some policy they made up
- These stories and others prompted Marty to realize we have a system problem
- “It made me think about systems, hospital systems, redesigning the delivery of care. And I think all of those questions naturally open up the question of how can we do better, how do we not harm people?”
We need to change the lexicon in medicine
Doctors can’t take all the blame
- Marty says that doctors (understandably) get defensive when they hear the term “medical mistake”
- Doctors work their tail off to get through school and then to get blamed for “mistakes” that in many cases are more of a systems issue
- Marty says it’s important we change the lexicon
- Instead of “medical mistake”
- We should say “medical care gone wrong” which is a more of a patient term
The lexicon in medicine
- When you say “health care costs” it sounds nebulous
- But the price of health care has gotten out of control
- Medicine has a way of creating its own lexicon to “sterilize” everything (i.e., “preventable adverse event” to describe a death that didn’t need to happen)
“So one of the things I’ve tried to do, at least with the platform that I’ve been given for my surgical career at Hopkins is say, “How can we change lexicon? How can we look at the systems and the delivery of care? How can we make sure somebody’s in charge of the overall ship?”
The less absurd errors are far more scary
- The open elevator shaft story is egregious but far less common
- Peter says the scarier part is the less absurd errors that happen even at the best of institutions
- In residency at Hopkins, Peter remembers the weight of the responsibility he was given when he was very inexperienced
- And at the same time he has the “complete trust” and “absolute faith” of patients
- Marty tells a story about how he stuck a patient over 20 times trying to get an IV in because he was afraid of his chief resident walking in and saying “Why doesn’t this patient have a central line?”
- But that’s how med school is… you have to learn over time and by making mistakes
The stories that prompted Marty to write his first book (Unaccountable) [19:15]
Marty was seeing “mind-boggling” things he was seeing as a med student and resident
{end of show notes preview}
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Martin Makary M.D., M.P.H.
New York Times bestselling author
Johns Hopkins surgeon and Professor of Health Policy
Dr. Makary is the NYT bestselling author of The Price We Pay, a new book that breaks down the high cost of health care and shows how people can get a better deal on their health care. The book has been described as “a must-read for every American and business leader” by Steve Forbes and a “deep dive into the real issues driving up the price of health care” by Dr. Don Berwick. Makary is a frequent medical commentator on NBC and FOX News and a leading voice for physicians, writing for the Wall Street Journal and USA Today.
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. His current research focuses on the appropriateness of medical care, drug prices, and the impact of the health care cost crisis on low-income populations. Dr. Makary was the lead author the Surgical Checklist and later served in leadership with Atul Gawande on the World Health Organization Surgery Checklist project. Makary has published more than 250 scientific articles, including articles on health care transparency, vulnerable populations, and guidelines for prescribing opioids. As a gastrointestinal surgeon, he is also an advocate for healthy food and lifestyle medicine.
His last book, Unaccountable, was adapted for television into the hit medical series The Resident. His newest book, The Price We Pay, tells the stories of health care’s disruptive innovators and the new movement to restore medicine to its mission.