A Kelley Blue Book for Hospitals? He's Got a Fix for Surprise Bills
WHY YOU SHOULD CARE
Because there’s ample common ground on health care if you look for it.
By Andrew Hirschfeld
Wanda Brooks works at an assisted living facility in Fredericksburg, Virginia. She saw a doctor at Mary Washington Hospital after a series of headaches and received an MRI and CT scan, both of which came back normal. Months later, she was slammed with a bill for $8,000. She couldn’t pay it, so the hospital sued her and garnished a portion of her $25,000 annual salary — making her one of 24,200 patients it has sued. Stories like Brooks’ caught the attention of Dr. Marty Makary, who outlines his plan to reinvent the American health care system from the inside out in his recently published book, The Price We Pay.
Whether you want to rip the Affordable Care Act out by its roots or ban private health insurance in favor of a single government-run system, you probably see the need to fix surprise medical bills. That’s the health policy space in which Makary operates. He has consulted for both the Obama and Trump administrations with the same message of how to improve health care for consumers: transparency.
Growing up in rural Pennsylvania, in the shadows of the Geisinger Medical Center, Makary was inspired by the immense public trust in doctors, including his father, Dr. Adel Makary. “There was a sense of responsibility; it was inspiring. And it’s something I wanted to be a part of,” Makary says. He went on to earn degrees from Bucknell University, Thomas Jefferson University and Harvard. But as time passed, Makary recognized the bloating of the health care industry — and dedicated his career to fixing it.
Health care is perhaps today’s most divisive territorial political issue, but many solutions are nonpartisan.
Dr. Marty Makary
Makary, 48, is a surgical oncologist specializing in minimally invasive surgery. He teaches health policy and management at the Johns Hopkins University School of Medicine, but his passion is reinventing American health care, from the way it’s taught to the way it’s practiced to government policy.
Somehow, Makary has stayed above the fray of modern American politics. “Health care is perhaps today’s most divisive territorial political issue, but many solutions are nonpartisan,” he says. Most of all, he points the finger at cable TV news for covering “not the core issues” of health care, but rather aspects “designed to polarize.” Conveniently, this leaves out the legislators and policymakers Makary tries to influence, and who remain bitterly divided on a way forward.
Earlier this year, taking Makary’s advice, President Donald Trump announced a big move to address the issue of surprise billing, requiring hospitals to post a searchable list of sticker prices. Trump called the move “a historic first step in much bigger efforts around transparency.” Brian Blase, former special assistant to the president for health care policy, was the one who brought in Makary to discuss transparency measures with White House officials. “Dr. Makary is one of the most influential outside people in health care policy,” Blase says.
In The Price We Pay, Makary suggests a consumer guide for health care with prices, similar to what the Kelley Blue Book is for automobiles. Surprise bills, which patients mistakenly thought would be covered by insurance, include not only lab work, facility charges and imaging tests but also behind-the-scenes doctors whom a patient might not know about, such as pathologists or radiologists who don’t have a negotiated rate with the patient’s insurance company.
Dr. Edward Hoffer of Harvard believes Makary’s proposal is an oversimplification. Car buyers can do their homework before going to a dealership, he says, then “if you cannot get a good deal, you keep your old car another year even if you have to do some repairs.” By contrast, “if you develop chest pain, you go to the nearest emergency room and pretty much do what the doctor tells you.” In the case of an elective procedure, Hoffer says, you often pick a surgeon based on recommendations by your doctor — with little way to evaluate skill.
Part of Makary’s prescription starts at medical schools, where, he contends, doctors need to learn how to be better communicators instead of using “code words.” Dr. Stephen Klasko, president of Thomas Jefferson University and CEO of Jefferson Health, agrees that “humility and compassion” need to be stressed early. “We select people based on GPA, MCAT score and organic chemistry and somehow we are amazed” when their human skills are lacking, Klasko says.
Makary stands out among his colleagues, both for his approach to health care and his lifestyle. He lives in a modest house in a socioeconomically disadvantaged community in Baltimore. His colleagues will often get lost when they come to visit him at home, Makary says.
America spends more on health care per capita than any other industrialized nation — about double the rich country average — with some of the worst outcomes. Physicians in the United States believe that 25 percent of diagnostic tests, 22 percent of medications and 11 percent of medical procedures are unnecessary.
The wake-up call, Makary reckons, should be the opioid crisis. The total number of prescriptions filled in the U.S. rose 85 percent from 1997 to 2016. Disease did not double in that time. Those numbers, Makary says, represent a strained American health care system struggling with an ineffective cure.
OZY’s 5 Questions With Marty Makary
- What’s your favorite film? I love The Big Short.
- What’s your favorite sport? I am a big football guy. Being from Pennsylvania, I love the Eagles. I love how sports is the great equalizer. I don’t know many other situations where I would hug a drunk stranger.
- What’s your go-to cuisine for a night out? I am really into farm-to-table cuisine.
- Who’s your hero? My father. He inspired me to become a doctor.
- What’s one item on your bucket list? I want to play a round of golf at St. Andrews.
- Andrew Hirschfeld, OZY Author Contact Andrew Hirschfeld