The Price We Pay!

Photo credit: Janet Donovan

What is the price we pay?  “So, The Price We Pay is a three year project to visit every healthcare stakeholder in America traveling around the country to get out what are the real drivers of high healthcare costs and who are the innovators who are lowering healthcare costs,” author Marty Makary, told Hollywood on the Potomac at a book party in his honor at Halcyon House in Georgetown, DC hosted by Jay Newton Small and Kate Goodall.  

“In the end, I was very optimistic at the disruptors who are changing the business of medicine – making it more transparent, more direct, focusing less on the billing throughput model and more on the relationship outcomes model that is rewarding quality over quantity. And what I found is that it was a revolt, a revolution, really among doctors to say, ‘Let’s redesign healthcare from scratch because our current system is completely broken.’ Obamacare is massively misunderstood by both supporters and critics. Obamacare delivered some patient protections that were bi-partisan. Let’s be honest and say that was big deal. It expanded coverage. We can argue that it was a clunky and expensive way to do it, but it did partially fulfill the goal of  expanding coverage. The biggest goal was to lowering health care costs and that it failed to do and that’s not only my opinion, but others as well.  It also means that getting rid of it is not because it failed in its attempt to lower healthcare costs. Getting rid of it doesn’t automatically lower the costs.  The real drivers of health care costs being so high are pricing failures and inappropriate care.  On those issues, there’s actually broad bipartisan consensus in the United States on how to fix the system. People just need to understand it.”  That’s a tall order.

Marty Makary

“People just need to understand the system and I believe if they do, there’s broad consensus in the United States on the solutions,” Makary added. He went on to make analogies like to the travel industry where “nobody thinks the travel websites should be eliminated and we should go to a system where air airlines bill you after the flight, not showing prices beforehand. If that were the case, there would be price gouging in the marketplace.” He also noted that doctors are sick of the money games in medicine because it violates the public trust in the medical profession. “We have patients in homes sick and scared to come to the doctor for fear of the bills that the hospital is gonna throw at them, violating the public trust in our great profession. And that’s why I think there’s been overwhelming support for this.  Among physicians, we want to restore medicine back to its mission. People should not be gouged anytime – that’s immoral. When American hospitals were built, they were built with the mission to be a safe haven for the sick, not to be a place where they come sign their financial life away without being able to see a basic price.”  

Jay Newton Small with Mark T. Smith

Guests joined Makary for a discussion and took questions from an interested and concerned audience.

“We provide haven for some incredible change makers, whether they’re using art or business to create social movement or a scalable social impact driven business and we do it with a very unique model in both areas. We provide residents with mentors and money and literally everything that you could possibly need to take an early stage venture with a great idea to create systemic change and turn it into something that is much greater than you,” said Kate Goodall when opening up the discussion. “I had the good fortune of meeting Jay Newton Small through this program as a fellow. She had started a company that is going to make sure that Alzheimer’s patients and dementia patients get the more humane level of care.”

“I lived here for five months when I was starting my business in 2017, so it’s a little like coming home,” responded Jay. “The amount of resources and the amount of support you get and just the people around you and the other fellows and how what they’re doing is just, it’s a really special people in a really amazing society and really a community of folks. So, I’m really proud and honored to be part of it. I’ve known Marty, I feel like six, seven years now, through lots of mutual friends in both healthcare space and in the media space.  I can see all the different stories he was telling me over the last couple of years, but it’s been amazing to see how the book has come together and it’s been incredibly timely.”

Christina Sevilla, Steve Rochlin, Kimball Stroud, Todd Flournoy

It was a long discussion and many questions so here is just one story Makary recalled about a woman from New Mexico that said it best:  “A woman there who has four kids – two with special needs – took one of them for a little asthma scare to the emergency room. They’re the only hospital in town and the kid was fine, but they started an IV during the short evaluation. The IV got infected. The kid ended up being fine, but spent a week in the ICU, the pediatric ICU, and she then she got hit with a quarter million dollar bill. I thought this represents everything wrong with health care and the real reasons why healthcare cost so much that nobody’s talking about  – unnecessary care, hospital acquired infection. Half of America has less than $400 of cash saved and when they get hit with the bill (even $2,000 for us it’s annoying but we’ll take care of it or find a way to pay it or get help) it is devastating. So it really opened my eyes. So we started going to hospitals around the country asking about how do they bill patients and are they billing using this crazy inflated master price which was really developed and inflated for the purpose of secret insurance discounts.”

Marty Makary

“It’s a game. It’s really a rich man’s game. So we started going to court and defending patients that were being sued. They have their wages garnished and we realized one hospital in Virginia has sued 25,000 people in a town of 28,000. We’d go to court and as a pro bono go in front of the Judge and say, ‘Your honor, this patient doesn’t have the money. There’s no contract. There’s no agreement.’ People have been asking for prices and healthcare for decades and for 50 years, hospitals have been given them the run around. If you don’t show prices, you don’t have a right to garnish their wages and put liens on their homes. Everyone in that town of Carlsbad, New Mexico had been  sued – the waitress and the restaurant staff.  Steph, a single mom with three kids, took a second waitressing job because her paycheck was garnished for a little medical bill, despite having insurance. We went to these courthouses and we win 100% of the time and the judges now know me and they see me coming in and the hospitals are canceling the cases.”

“To take advantage of somebody when they’re vulnerable,” he concluded,  “is wrong and it violates the public trust.”