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What Broke our Healthcare System?

How do we fix it?

Nurses General Nursing Article Video   posted

J.Adderton has 27 years experience as a BSN, MSN.

Dr. Marty Makary is shedding light on what is driving up medical costs and eroding the public’s trust in healthcare. In his new book, “The Price We Pay:  What Broke American Healthcare- and How to Fix It”, Dr. Makary provides an inside look at how billing practices take advantage of America’s most vulnerable. 

What Broke our Healthcare System?
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Dr. Marty Makary, a surgeon at John Hopkins Hospital, became seriously concerned about widespread predatory billing practices that are eroding the public's trust in healthcare. In response, the best-selling author wrote the new book, “The Price We Pay: What Broke American Health Care- and How to Fix It” and is raising awareness around factors contributing to the problem. Let’s explore a few of the driving forces discussed in the book that are leading to higher healthcare costs and growing personal debt.

A Growing Burden of Debt

In his book, Makary identified 1 in 5 Americans as having unpaid medical debt. He also refers to a study by the Kaiser Family Foundation that revealed 70 percent of Americans have cut back on basic needs (i.e. food and clothing) in order to pay their medical expenses. The Kaiser study also found an eye-opening 58 percent of Americans take an extra job or work additional hours and 41% borrow money from family or friends to cover medical bills.

Makary highlights a local hospital in Carlsbad, New Mexico that had a practice of hiking prices and then suing patients who were unable to pay. A Carlsbad county clerk reported the hospital cases accounted for 95 percent of the town’s lawsuits. And according to the book, this was not an isolated incident. Thirty-seven percent of U.S. hospitals filed over 20,000 lawsuits in 2017, including nonprofit and faith-based hospitals.

Detached Hospital Administrators

In the book, Makary reveals hospital administrators are often unaware their hospital is suing patients. In an interview with FierceHealthcare, he states, “I found sometimes hospital executives, board members and certainly our research supports doctors not knowing about this practice. And when they find out, the clinicians are outraged. By and large, Board members want it to stop…”. Healthcare experts have argued with Makary that “it was not a problem that was ‘diabolical’, they just weren’t proximate to the issue”. Makary further claims all the revenue generated from suing patients amounts to less than the amount of the CEO’s pay raise for one year, ultimately making the lawsuits unnecessary.

Prospecting and Predatory Screening

Visit any churches, community center or senior living facility and you will most likely find advertising for an on-site health fair offering a variety of “free screenings”. Makary submits these screenings are not always medical professionals serving the public, but rather, a way to “prospect” patients for further testing and unnecessary treatments. For example, a vascular screening fair is conducted and patients are “nudged” by the sponsoring physicians into further testing and ballooning, stenting and lasering of non threatening plaques in leg arteries. The sponsoring physicians then make large amounts of money from unnecessary tests and procedures while insurance companies and the rest of us are left with the costs.

Bill Mark-Ups

In the FierceHealthcare interview, Makary expresses concern for the decline of public trust due to hospitals marking up prices as high as 23 times than what is paid by Medicare. Hospitals also use software called “chargemaster” to automatically inflate prices toward a desired profit margin to compensate for charity care. However, according to Makary, the data does not support this assertion.

Getting Rich in Healthcare

In his book, Makary makes points out price markups in healthcare extend well-beyond the hospital and people are getting rich. For ambulance and helicopter services, markups can result in patients receiving an unexpected surprise bill. With three companies now owning 75 percent of these helicopters, Makray writes “wealthy business people” are taking advantage of Americans “when they are most vulnerable.''

But, there’s more. Based on early 2019 data, U.S. hospitals were on target to reach their highest margin in history while rural hospitals are closing. According to Makary, large hospitals use sophisticated cost-shifting to buy new buildings, pay down debt and increase executive pay with hospital profits.

How Can We Fix Our Healthcare?

Makary highlights the Free Market Medical Association (FMMA) and making medical costs transparent and fair regardless of who is paying as a move in the right direction. For example, the Surgery Center of Oklahoma is now offering one fair price, regardless of who is paying instead of other complicated pricing methods.

What are your thoughts on the motives behind health fairs and free health screenings?

Additional Information

Free Market Medical Association

Broken American Health Care: Good People, Bad System and Health Powers Disruptors

J. Adderton MSN has over 20 years experience in clinical leadership, staff development, project management and nursing education.

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JabuJabule specializes in LTC.

The price of staying healthy in America continues to rise. I wish there was something us normal people/nurses could do about it. But the truth is, we're all just pawns in this healthcare system, whether you're taking care of people or not. Medications processed through the pharmacy and bubble packed (I used to be the order entry tech and med packer), delivered through the delivery service, all for meds people don't need, yet the nurse gives out every day. It's truly sad.

I only wish I knew more about the subject.

nursej22 specializes in med/surg,CV.

During my course work for my BSN, we were tasking with calculating the cost of 24 hours of care for a patient in our facility. I still remember how suspicious and evasive the billing department was when I inquired about the cost of a room on the tele unit for 1 day. The cost is different depending on your insurance or lack there of.

During my stint working on the pharmaceutical industry, the major corporations competed with each other to have the biggest and prettiest buildings, the fanciest lunches and most expensive amenities.

Seriously, how does fancy artwork on the walls of the corporate headquarters make their medications any better? How does this benefit the patients?

MSO4foru specializes in Hospice Home Care and Inpatient.

Healthcare and medications should be a human right. We also need a society that understands that we will all die and sometimes treatment will fail. And drugs need to Not be advertised on TV like candy bars- it degrades medicine and, I think, adds to the ' I Google searched so I know more' mentality. 😑

I know what broke our system. In the US we have always been glad to welcome a new treatment that was maybe 30% more effective, while being 300% more expensive.

We have even embraced treatments that are 10% more effective and 1000% more expensive.

As long as we think someone else pays for it.

Prilosec jumps immediately to mind. I was a new RN when it came out.

All the cheap 3 dollars a month stomach pills were quickly supplanted by expensive Prilosec at 100 dollars a month and its' cousins.

By themselves, the PPI's had the potential to nearly double medical costs.

But people felt like they weren't personally paying for it.

Or you could just reduce your food and alcohol intake. That would be hard.

Then 2 or 3 years later, all of a sudden premiums start jumping.

I could go on and on. We are paying for a huge bunch of inappropriate expensive tests and treatments.

nursej22 specializes in med/surg,CV.

I think the for profit model of health is what has broken healthcare. Many new drugs actually work better, with fewer side effects. For instance, when my son was diagnosed with type 1 DM, he used ultra Lente, and had terrible control. He now uses Tresiba, his a1c is <7. But the cost 100x higher. But what is that cost based on? I think I’m large part it is based on what insurance will pay, which is based on how high premiums are. It’s a vicious cycle.

MSO4foru specializes in Hospice Home Care and Inpatient.

For profit model, treating patients like customers- I remember working cardiac stepdown , pts scheduled for cardiac cath in am - family brings in Burger King for pt " hospital food not good". And now even doing hospice- families unhappy because we can only provide what we provide- that's is not nurse in home 24 hours a day or on call cna just for you. Again, I think system as is sets up a lot of expectations that can't be met, and often are unwilling to hear what is possible vs what they thought would be provided ( without factual information)

OUxPhys specializes in Cardiology.

It's two fold. You have for-profit medical systems and you also have the population not taking care of themselves. I have seen so many patients with re-admissions for heart failure because they refuse to take their meds or they eat and drink whatever they want then roll into the ER for SOB and wt gain saying "I don't know why this is happening".

It also doesn't help when you treat your hospital as a hotel. Pt's expect so much now that wasn't even an issue 20 years ago.

The change from a health care model to a business model, our society's utter lack of personal responsibility, greed and an increasing sense of entitlement.

Expensive drugs that are not worth what they cost, and unnecessary imaging that a good history would show is not necessary.

I will not be showing up for my third CT at the ENT. They have called.

I have a chronic eustachian tube dysfunction for the last year.

The ear is plugged. Snap crackle pop any time. But the hearing loss is quite mild and I am not a candidate for "tubes".

My insurance is being milked. My opinion only.

15 hours ago, Wuzzie said:

The change from a health care model to a business model, our society's utter lack of personal responsibility, greed and an increasing sense of entitlement.

You are precisely correct.


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