Fixing a broken health care system: One surgeon’s thoughts

AUSTIN, Texas - Imagine you went on a travel website to buy airline tickets. But the website listed airline information without including the price of the tickets. How would you know whether to book a flight on one airline as opposed to another? How would you know the cost?

Then image the airline told you they would send you a bill after you took the flight. If the plane was delayed or there was a staff shortage or something else happened during the flight, the airline would change the price.

It seems like an absurd scenario, yet that is exactly the scenario American consumers face when they receive health care.

A bestselling author and health care leader called for disrupting the health care marketplace during Sunday’s opening session of the National Association of Health Underwriters annual convention. Dr. Marty Makary is a surgeon and public policy research at Johns Hopkins University. He also is the author of The Price We Pay: What Broke The American Health Care System – And How To Fix It.

Makary told NAHU members the three main health problems he sees 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.

Americans are suffering under the weight of high medical expenses, Makary said. He cited an American Cancer Society study that showed:

• 73% of cancer patients are concerned about medical debt related to their care.
• 38% of cancer patients cut back on food so that they could afford their medical care.
• 28% of cancer patients used all of most of their savings.
• 45% of cancer patients said they were likely to delay receiving care or avoid receiving care because of the cost.

“This is not how a civil society treats its most vulnerable members – this is a disgrace,” he said.

Makary also cited the number of Americans who are sued or who have their wages garnished over unpaid medical bills. He cited at report in the Journal of the American Medical Association that said an estimated 20% of American consumers had medical debt in collections in 2014. Medical debt has been increasing with direct patient billing, rising insurance deductibles and more out-of-network care delivered, even at in-network hospitals. He said bills sent directly to patients may use the hospital’s undiscounted price, and can lead to financial hardship and avoidance of care.

“This is predatory billing,” he said. “Many times, doctors are unaware it is happening. Paychecks are garnished and patients continue to pay off their bills until they die.”

Makary helps to defend people who are sued in court over bills they are unable to pay. He said the majority of those whose paychecks are garnished work in low-income retail or other service jobs.

In defending people in court, Makary said, he asks the judge, “Where is the contract to pay that amount?”

“In America, we function by contract and agreement,” he said. “If the patient did not sign an agreement to pay, there is no obligation to pay.”

Makary said that inappropriate medical care leads to wasteful spending.

“There are things we are doing that we should not have been doing,” he said. Unnecessary surgery is one example, he noted. Makary said that when he studied medicine, he was taught eight medical reasons to perform surgery for diverticulitis. Today’s medical students are taught there are two reasons when such surgery is appropriate. As another example, he said that appendicitis often can be managed with antibiotics instead of having a patient undergo surgery.

Over-prescribing medications is something else that leads to unnecessary spending, he said.

“We are prescribing medication with good intentions and bad science,” he said. “The No. 1 way to reduce medication cost is to stop taking medications we don’t need.”

“Maybe we should be treating more diabetics with cooking classes instead of throwing insulin at them,” Makary continued. “Maybe instead of discussing gastric surgery with patients, we should discuss food as medicine or teach patients about their gut microbiome. Instead of treating high blood pressure by prescribing one drug after another, why not discuss stress reduction and sleep? Let’s look at the environmental exposures that cause cancer instead of chemotherapy.”

Makary said all these considerations would lead to a movement he calls “the redesign of health care.”

Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at Susan.Rupe@innfeedback.com. Follow her on Twitter @INNsusan.

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