The Price We Pay: What Broke American Health Care--and How to Fix It

by Marty Makary

Jennifer’s story illustrates one of the greatest risks to our economy: health care costs are increasingly suffocating business in America.

“Sometimes they want to come do health fairs, but sometimes they want to come in on Sunday after the service and set up a screening area,” he said. The idea of the medical industry intruding on Sunday worship brought to mind the biblical account of Jesus throwing the merchants out of the temple.

The politicians debated how to fund health care, but what we really need to talk about is how to fix health care.

The modern-day surprise bills of medicine seem to violate a heritage of honest doctoring.

Centers that initiated full price transparency saw a 50% increase in patient volume, a 30% increase in revenue, and an increase in patient satisfaction.17 People are sick and tired of the game.

Those aren’t quite loan shark interest rates, but if you’re asking “What would Jesus do?” I’m pretty sure this ain’t it.

Data, when used properly, can be incredibly powerful.

“The goal here is to let outliers know that they are outliers and help guide them toward best practices,” I said. “The goal is improvement.”

My own experience was a powerful lesson—getting off lifestyle medications can improve health and lower medical costs.

For years, health care reform in Washington, D.C., has asked the question: How do we pay for health care? But the real question is: How do we fix the health care system?

“The goal is not to save money, but if you do the right thing, it does save money,” Fernandopulle told me.

Health care doesn’t have to be so different from any other business in America.

We spend enough money on health care in the United States that we should be able to cover every citizen. “It’s the waste that strains the system,” Sprowls added.

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 currently being wasted on the game. In the words of senator and physician Tom Coburn, getting price transparency right is the first step in fixing health care because it ushers in quality transparency. We need to see prices, so patients and health plans can determine which facilities are operating in a way that’s efficient, and which are just trying to maximize their profit. It’s common sense.

I was struck by the disconnect between those who deliver health care and those who sell it.

Some have called for legislation to shine light on the health insurance broker industry. Consumer protections are one approach. After all, after the crash of 2008, the mortgage industry benefited from tighter legislation. But market forces can also be a powerful change agent.

First, Congress should repeal the 1987 safe harbor law that exempts GPOs and PBMs from antikickback laws. This reform will end opaque drivers of price distortion.

Whenever a colleague mentions that a patient has a necrosis, I flash back to those four years of Latin. That’s followed by a sense of anger that I spent so much time learning stuff that doesn’t matter at the expense of not learning more important stuff that does.

medical school barely touches on the business of medicine. Nowhere in my training was I taught about pricing failures, overtreatment, or middlemen. The problems are staring us right in the face and the solutions are begging to be implemented. But instead of discussing them, we focus students on memorization—just as we did 50 years ago, before the Internet brought information to our fingertips nearly instantly.

Klasko believes in making medical education highly relevant to the medical, social, and financial needs of patients—the whole person.

“We select people based on GPA, MCAT score, and organic chemistry and somehow we’re amazed they’re not more empathetic,”

“We decided to choose students based on self-awareness and empathy.”

Several times, medical journal editors slap my wrist and insist that I use the wonky term instead of the plain English term. But to change health care, we need to alter the words we use to talk about it.

Transparency’s time has come. And for the sake of our patients, health professionals should lead this charge. It’s central to our great medical heritage. As witnesses to birth, sickness, and death, we know that all humans are created equal and deserve to be treated with fairness and dignity.