Journalist Philip
Moeller answers your questions about health, aging, and retirement.
Phil is the author of the book, “Get What’s Yours for Medicare,” and co-author of “Get What’s Yours: The Revised Secrets to Maxing Out Your Social
Security.” Send your questions to Phil.
Add Dr. Marty Makary’s name to the expansive
list of health care experts who are fed up with the system, don’t think we can
afford to wait for Congress to enact reforms, and have useful ideas about how
people can become healthier and perhaps save a bundle of money in the process.
A surgeon at Johns Hopkins in Baltimore and a
widely published writer on health issues, Makary presents his take on how to
fix health care in his new book, “The Price We Pay: What Broke American Health Care – and How to Fix It.”
His account begins with an extended and
emotional lament that many of his colleagues have abandoned the Hippocratic
Oath in favor of charging inflated prices for surgeries and health procedures
that are not in their patients’ best interests — or may not even be needed at
all.
“Patients are willing to let me put a knife to
their skin within minutes of meeting me, or to divulge secrets they’ve kept for
a lifetime – just because I’m a doctor,” he writes. “For centuries, medicine
was based on an intimate relationship between doctors and patients. But behind
the scenes, a gigantic industry emerged: buying, selling, and trading our
medical services. Health care industry stakeholders are playing a game, marking
up the price of medical care, then secretly discounting it, depending on who’s
paying.”
Markary’s research uncovered no shortage of
bad actors in health care, including the Carlsbad Medical Center in New Mexico,
which has sued thousands of people for unpaid medical bills in the last several
years.
The company’s owner, Community Health Systems,
has been repeatedly fined for overcharging patients. In a New York Times story about Makary’s research, a Carlsbad
spokesperson defended its collection practices but declined interview requests.
The hospital later said it would stop suing certain low-income patients and
discount prices to uninsured patients.
While such horror stories make for interesting
reading, Markary treats them as a perhaps-necessary prop to interest readers in
paying attention to the solutions he and others propose. His goal in writing
the book, he said in a phone interview, “has been to create health care literacy
by taking a complex topic and making it relatable and understandable.” He does
that by telling stories that highlight the tools people and businesses can use
“to get a better deal on their health care.”
The book reflects Makary’s largely positive
views about the future of health care as he lays out ways to deal with the
system’s current shortcomings.
The three main health problems he addresses
are health care pricing failures, middlemen who make huge profits on health
care while adding little to patient well-being, and the enormous amount of
inappropriate care that people receive. For each problem area, he tracked down
people and companies doing innovative work to help lower costs and help people
gain access to higher-quality care.
In one example, a former pharmacist used
medication lists to find out how much money pharmacy benefit managers were
pocketing for their services as an intermediary between employers and
pharmacies. Once employers knew the difference, they were able to renegotiate
their pharmacy benefit manage contracts and save “millions of dollars.”
“People blame doctors, hospitals, payers,
pharma, device companies, and even patients for not taking better care,” he
writes. “But the money games are so established and the revenue stream they produce
is so steady that experts don’t want to discuss altering the business model.
But every one of us in health care, every stakeholder, needs to look inward and
address the waste in our own backyard.”
In other words, “there’s no diabolical
villain,” he said on the phone. “We have, structurally, a broken system.”
“There’s
no diabolical villain. We have, structurally, a broken system.”
Makary said the drivers of health care costs
are hospitals, insurance companies, drug companies and other middlemen, such as
pharmacy benefit managers.
“There are so many hands taking money out of the system that there’s no silver bullet solution to save money. To lower costs, we must take on the powerful stakeholders,” Makary writes.
“There are so many hands taking money out of the system that there’s no silver bullet solution to save money. To lower costs, we must take on the powerful stakeholders,” Makary writes.
Disclosing the actual costs of health care is
a powerful start. This includes the often inscrutable prices charged by
hospitals and other care providers but also should include the final prices –
often negotiated sharply downward — that insurers and providers agree upon.
Health care consumers usually only know their own out-of-pocket costs but these
mask the inflated costs that insurers have paid for their care.
Makary’s advice: Ask for a price for every
medical service you are considering. Doing so can help identify providers who
take advantage of consumers by prescribing unnecessary tests and procedures
that carry inflated price tags. “Price transparency alone will not solve all
the problems of predatory screening and unnecessary medical care, but it could
save the health care system hundreds of billions of dollars, Makary writes.
“Health care is perhaps today’s most divisive,
territorial political issue,” the book concludes. “But many of the needed
solutions are not partisan; they’re American. We are at a pivotal juncture.
Spending on health care threatens every aspect of American society. The time
for commonsense reform has arrived.”
Despite all the problems he encountered doing
research for the book, Makary said, he wound up being optimistic that “good
stuff is happening” and that “the innovators can help us dig out of our cost
crisis.”
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