[00:00:00] Stacey Richter: Hello, all you Relentless Tribe members. We originally recorded this conversation with Dr. Marty Makary in 2019, and it's about his book, The Price We Pay.
But if you listen today, it is striking how it is actually far more relevant now than maybe it was when it was first released. As Dave Chase pointed out in a recent LinkedIn post, he wrote, "100 million Americans living in medical debt isn't a bug in the system. It's a core feature of nearly every health plan. Most of the people carrying that debt have insurance, but the card in their wallet isn't protecting them. As a result, the out-of-pocket cost of care has become the number one comorbidity in America, with catastrophic consequences. Roughly half of all Americans now avoid the healthcare system due to cost, often waiting until it's too late."
And look, for years, just underlining this point, if you asked doctors their number one problem, it has been, with bells and whistles, hassle, like prior auths and other excessive documentation.
But breaking news, in athenahealth's Physician Sentiment Survey, patient access to affordable healthcare has officially become physicians' top policy concern for the very first time, which might not come as a shock if you were paying any attention to the election a few weeks ago.
But how frustrating to prescribe maybe life-saving treatment and have a patient say, "Sorry, Doc, can't afford it. Hopefully, I won't get gangrene"?
Fifty-two percent of doctors named affordability as a top priority, and among rural physicians, that figure is 63%. Sixty-three percent of doctors named affordability as their top concern.
So in this episode, Dr. Makary gets into the mechanics behind inflated sticker prices and predatory billing practices where non-profit community hospitals take, for example, low-wage workers and even their own nurses to court to garnish their paychecks. As Dr. Makary points out, billing quality is medical quality. When a hospital delivers an unexpectedly large bill, especially a bill that is not only large but also incorrect, and that bill ruins a family financially, that is an adverse medical complication.
And as Kimberly Carleson has pointed out in episode 480, a staggering percentage of hospital bills contain errors. So there's also that. Go back and listen to that episode.
My guest today, as I have said several times already, is Dr. Marty Makary. He has been a pancreatic surgeon at Johns Hopkins. He was recently over at the FDA.
And he's also the author of The Price We Pay: What Broke American Health Care—and How to Fix It, which again, is the topic of the conversation that you will hear today.
Dr. Makary breaks down the business of medicine and offers advice and a call to action for how doctors, hospital board members, and plan sponsors can restore public trust, eliminate predatory pricing, and bring really the honesty back to American healthcare.
My name is Stacey Richter. This is Relentless Health Value. Stay tuned for another episode specifically about affordability with Dr. Jeffrey Levin-Scherz coming up here pretty soon. And I'm also going to play another episode from several years ago about affordability because, wow, that topic should be on the top of everyone's minds.
Thank you so much to Aventria Health Group, our founding sponsor. Thank you so much to Payerset for their series sponsorship in 2026. Thank you so much to Patient Rights Advocate for providing a really nice donation that helps us continue our work around here. I also very much want to thank Dr. Scott Conard, Dr. Mike Tuggy, and Larry Bauer for their continuing support.
My name is Stacey Richter. This is Relentless Health Value. Let's get to it. Here is my earlier conversation with Dr. Marty Makary.
[00:04:21] Stacey Richter: Dr. Marty Makary, welcome to Relentless Health Value.
[00:04:24] Dr. Marty Makary: Great to be with you, Stacey.
[00:04:26] Stacey Richter: So let's talk about your new book, which is called: The Price We Pay: What Broke American Healthcare—and How to Fix It. And the book gives multiple examples of egregious pricing. Are we talking about outliers here, or is this pervasive?
[00:04:41] Dr. Marty Makary: Most doctors and hospitals try to do the right thing and serve their communities. But if there's been one trend in the last 5 to 10 years, it's been the massive growth of overinflated bills.
You know, the reason these bills are often overinflated, Stacey, is that hospitals have said, "We just need negotiating leverage with insurance companies, so we wanna give them a big discount for their customers." By inflating the prices, the discounts look big. And so it's been this game. It's been an insider game.
And many times when we've presented these big bills back to hospital CEOs, they'll often tell us, and the advocacy group that I'm working with, the students with Restoring Medicine, they'll often tell us, "Look, nobody pays those bills. No, nobody is responsible for paying these highly marked up bills."
So we basically took them to task and said, "Okay, let's do some formal research just as we do formal cancer research and public health research, and let's ask the question: Are Americans responsible for paying these marked up sticker price bills?"
And the reality is, a ton of people are being shaken down for these bills. Not just the uninsured, but those receiving out of network care, even at in-network facilities, those with high deductibles. You look at most Americans, they have less than $400 of cash in savings to their name. So when they get hit with a $6,000 bill or even a $4,000 bill, it can be catastrophic to that family.
So in the book, The Price We Pay, decided to take two years, tour the United States and talk to every stakeholder in healthcare: drug companies, middlemen, hospital executives, nurses, doctors, frontline people and patients. And what I learned is that a lot of people in healthcare are doing very well. We have tens of thousands of new millionaires that have been created who are non-patient facing in healthcare, and that's okay.
We need good managers, but the damage has really been done to the hardworking American family or individual that has a job, has insurance, but is really getting screwed by the money games right now.
So I don't know if you saw the movie The Big Short.
[00:07:03] Stacey Richter: Yep.
[00:07:04] Dr. Marty Makary: I mean, I don't know what you thought of that. I loved that movie.
I just thought it broke down a complex subject so well and made it entertaining. That's what I wanted to do with the book, The Price We Pay. I wanted to explain the complexities of the business of medicine so any person could understand exactly how it works.
So it's not a nebulous cloud, because that cloud was part of the mirage of the banking industry. That cloud is one of the reasons why the money games in the banking industry continued to go on with very little public accountability because the argument was, "Look, these are very complex banking instruments and systems. You have to leave it to us, the experts."
Well, guess what? It wasn't that complicated. They were spending our money, spending money they didn't have. They were spending borrowed money. Anybody can understand it, and that movie, The Big Short, explained it.
And the same thing needs to be done with healthcare today. There are money games. If you break it down to any person, it doesn't matter what political party they are, whether or not they work in healthcare or outside, whether or not they're a hospital CEO or they're a mechanic taking care of the ambulances, they will tell you this is not right.
And I think doctors and nurses have suspected for a long time our system was never intended to be this predatory, to have this much price gouging, to have this many money games in the system.
And, you know, the subject can be very depressing, so what I did is to try to really identify all the bright spots, all the positives, all the innovators, all the disruptors that are really challenging the status quo and succeeding because of it because there's tremendous demand, I believe, right now for honesty in healthcare.
[00:08:50] Stacey Richter: Personally, I found the book a page-turner. There's so many very impactful and very interesting examples. But what you said about The Big Short, drawing that parallel, really strikes a chord because as many have said, healthcare is very not transparent, the opposite of.
And as any number of behavioral economists, including Daniel Kahneman, have said, you know, under the cover of darkness, people do things which they might not do if people could see into the closed door meeting, to which there are gag clauses in certain cases to even prevent that complexity from being revealed.
And I think one of the quotes from the book which really struck home with me relative to predatory pricing is the billing clerk who said, you know, "We can charge someone out of network as much as we want. The law says we can."
[00:09:39] Dr. Marty Makary: I tried to identify in the book, The Price We Pay both the really positive stories and the egregious stories.
And so there are hospitals that I highlight that are doing a terrific job serving their communities with fair billing practices and are very forgiving and merciful to their patients. And then we saw the opposite, right? We saw hospitals doing price gouging routinely, predatory billing, sort of gotcha small print, asking patients to sign their financial life away when they come in sick to the emergency room.
Look, hospitals were created in America as a safe haven for the sick and injured, okay? Many were established with a charter founded by churches with a charter to serve anyone regardless of, "Their race, creed, or ability to pay". This is the great heritage of medicine, okay? This is what every doc and nurse should be proud of.
We come from this lineage of taking care of people when they need us. And look at the people applying for the Johns Hopkins Medical School or any medical school. They're bright and creative and altruistic, and they wanna help people, right? This is the incredible heritage of medicine, and unfortunately, that public trust is now being eroded by predatory pricing and unfair billing practices, and it's a disgrace.
It's an anathema. It's a disgrace, and we found hospitals that routinely sue patients. In one town, the small hospital had sued half the town. I mean, healthcare was never designed to be that predatory and to take advantage of people. I believe it's basically taking advantage of people when they're sick and vulnerable.
[00:11:22] Stacey Richter: Exactly what you just said, these kind of bad eggs that are spoiling the barrel, to mix metaphors there. The Edelman Trust Barometer showed the trust in hospitals nosediving seven points this year, and it might very well be because of the spotlight that's being put on some of these bad practices from hospitals.
But, you know, something that you just said struck me. Every time anybody goes to an ER or is admitted to a hospital, or even just goes to the doctor, there is that ubiquitous form that you're asked to sign.
So if I am a doctor or a nurse or someone in administration and I know that's going on at my hospital or practice or clinic, is there anything that I can do?
It just feels like a tough situation to change at an individual level. What's your advice?
[00:12:11] Dr. Marty Makary: Look, I think we in healthcare need to speak up about this problem. I'm a surgeon, I get it. I believe doctors and hospitals need to be paid for their work. But I've got some colleagues who tell me, "Marty, why are you working on all this stuff about hospital billing practices and the appropriateness of medical care? Don't you love being a surgeon? I mean, isn't that enough?"
And I tell them, "Look, I love being a surgeon, but a quarter of the public doesn't trust us right now. A quarter of Americans don't pick up their prescription for fear of the price of the drug. A quarter of Americans are worried about putting food on their table when they get a medical bill or when they seek medical care.
If this is a barrier to getting people quality medical care, it doesn't matter if you cured cancer. If you can't give people that cure, if you can't deliver those state-of-the-art therapies, that public trust having been eroded is the frontier of delivering high-quality medical care in the United States.
And for doctors, for nurse managers, for leaders, for hospital administrators who hear about this type of stuff and they say, "This is a disgrace. This is an outrage. This is wrong. This is not who we are as a medical profession.” Talk to your hospital leaders, community, people in the you know, concerned citizens. Find out who's on your hospital board and have a civil conversation with them.
I get emails all the time of people who got an egregious medical bill, and I tell them: “Have a conversation with your hospital.” You shouldn't have to be fighting with some call center representative that's out of town about a medical bill.
These should be civil conversations. That's how any accountable business would work. I'm on the board of a large hospital system. The people on the board are often unaware of what's happening with the hospital's billing practices or with issues of appropriateness. Let them know. I mean, they are the sort of front people or liaisons to the community.
So I say get to the people who are on the boards and the leadership and just tell them in a very polite way, "This patient showed up for an emergency room visit, was charged $10,000. It seems egregious. Now the patient is being sued or they're being sent to collections or their FICA score is getting destroyed. This doesn't seem to be consistent with the hospital's mission statement, and can you look into this?"
If we all speak up, we can make changes. And in the book, I highlight many of the positives that are happening right now. And on the website, restoringmedicine.org, we put some tools for patients on both how to fight their medical bills, but also how to enact social change, right?
We shouldn't be playing whack-a-mole with high bills. We should be talking about an honest and fair billing system.
[00:14:56] Stacey Richter: Yeah. There's a quote from Dr. Keith Smith from Oklahoma that is in The Price We Pay. It's, "How can we take an oath to treat a patient and then allow their lives to be ruined financially?" And I thought that summed it up very well.
If I'm on the board or I am an administrator in a hospital, what's your advice to me? I may or may not know that this is going on. Let's say I discover that in certain cases it is. How can I make myself accessible, or how do I enable the physicians or the PCPs in the community who might be realizing that their patients are in this situation?
[00:15:31] Dr. Marty Makary: So I think these civil conversations are powerful, and believe it or not, most leaders in healthcare have no idea how bad things are and how ugly it looks on the ground. I'll meet hospital leaders that will give me a very rosy picture of how lenient they are and how generous with financial aid they can be, and how they work with individuals, and a story of somebody where they gave them free care, and it sounds so rosy.
And then what I'll find on the ground is an intense and relentless pursuit of patients to pay bills that they cannot afford, that are marked up bills, they're unfair bills, and sometimes they're for services that should have never been rendered or for services that represent complications that were avoidable.
And so when we have these conversations, they're powerful. You know, if I can, you know, share something very personal, my own employer, Johns Hopkins Hospital, was one of the hospitals found to be suing patients.
Now it blew up, and I can tell you the leaders of the hospital were—the vast majority had no idea this was happening. When we've gone to hospitals in the United States, and Hopkins had cases of suing some people, but I'll tell you, we found cases in the United States where a hospital in Virginia, a hospital in New Mexico sue the crap out of people, okay?
They're suing the crap out of people, and they've sued in one town twenty thousand patients. The town only has twenty-eight thousand people in it by census data.
[00:17:08] Stacey Richter: It's horrifying.
[00:17:09] Dr. Marty Makary: Right. And we asked the doctors, "Are you aware that the patients you're treating are getting sued in court to have their paycheck garnished for life almost sometimes?"
I mean, if you have a $12,000 bill, how long does it take to garnish a minimum wage paycheck to get that paid off? I mean, it takes sometimes the rest of the person's life. For a bill that's marked up four or five times what Medicare would pay for the same thing or what a commercial payer would pay, it's not right.
So when we talk to the doctors, they have no idea, and they're outraged. When we talk to the hospital leaders, many times they have no idea, and many times they're outraged.
So these conversations are powerful. I believe that billing quality should be a measure of medical quality. In other words, a hospital, a provider group, should be evaluated not just by their medical complication rate, but by their billing complication rate.
Financial toxicity is a medical complication, and we've talked to US News and World Report, my team has talked with CMS and their five-star rating system, Healthgrades, you name it. Medical billing quality is medical quality, and we need to start evaluating hospitals so we have some accountability. Most hospitals do the right thing, and I think when we can appeal to the best in people.
Look, everybody who's in healthcare went into healthcare out of a deep sense of compassion. Hospital administrators, business leaders, doctors, nurses, physical therapists, you name it. We all went into medicine to help people in some way, and I think when we can show how ugly things are on the ground right now, how bad the public trust has been eroded by predatory billing and price gouging, how dishonest the practice can be of providing out-of-network care at in-network hospitals on an elective nonurgent basis without ever telling a patient, without giving them any choices, look, we can do better.
We can restore honesty in healthcare, and I think that's really our great heritage.
[00:19:12] Stacey Richter: Given that CEOs tend to, and doctors and leaders at provider organizations and board members are unaware of what's going on. How is this happening? Is it some rogue billing clerk or, like, the finance department just went off the rails?
Like, how does this happen unbeknownst to leadership?
[00:19:33] Dr. Marty Makary: Yeah, so oftentimes the billing practices and the collection strategies fall under the CFO, and there's oftentimes one or two layers of outsourcing this to other agencies or companies or law firms.
Now, language matters, Stacey. So when, if you're at a hospital and your CFO tells you that, "We recovered 23% of our bad debt," you think, "Oh, okay, that's a good report. 23% is above average for bad debt collection."
When you call it bad debt. I believe we're mischaracterizing what it is. Okay, these are egregious, unfair, marked up bills, and the billing practices can be predatory, and shaking people down is inconsistent with the mission of medicine.
So look, if you have plastic surgery and you're wealthy, you can go shake that patient down as much as you want, okay? There should be a contract in place where they understood the price of the plastic surgery, and you can go after them. You can take them to court for all I'm concerned.
But these are low income working people that don't qualify for government or local financial aid programs. They've done nothing wrong. Their deductibles are through the roof because healthcare costs have spiraled out of control. Insurance companies manage high costs by simply jacking up the deductible.
And these are well-meaning people who have saved $2500 so their son can go to college, and they get hit with these bills.
So I'm on a hospital board, and I can tell you, I don't think anyone on the board knows how aggressive the hospital is with collecting bills. I think if we, instead of calling it bad debt, call it, price gouging. Instead of calling it hospitals using legal action to collect bad debt, why don't we call it predatory billing? Instead of calling it hospitals recovering uncompensated care, why don't we call it patients being asked to pay prices for prices that were not disclosed to the patient at the point of care for nonurgent care?
I literally hear stories of individuals begging the doctors in the hospitals and the leaders and the administrator on call, "Please, I want to know the price of this elective heart surgery." And they, it is a massive runaround. It's a circus.
I don't think we got bad people who are diabolical and trying to hide the price. I just think hospitals have been burdened with regulatory requirements and other things where they've been busy, and they have not had the time, energy, and resources to actually itemize services.
I mean it's pretty clear. Hospitals have, instead of, say in most businesses itemize the cost of an individual service, they will actually... hospitals will just look at total revenue and total expenses and try hard to stay on top. But we need to know exactly how much a service, an infusion therapy, an operation costs, and we need to price that fairly.
And what I love about Keith Smith in Oklahoma is he charges the same amount regardless if you're paying out of pocket or if you're an insurance company paying. One fair and honest price. It's not the lowest price, but it's a pretty darn good price, and it's fair, and it's honest, and it is eliminating that middleman repricing industry.
Think about all the money we spend hounding people for payments and fighting insurance companies on the hospital side, and insurance companies fighting hospitals on pre-authorizations and peer-to-peer approvals. This is the stuff that drives us doctors nuts. I mean, the pre-authorization, the peer-to-peer, it's like, let us just do our job.
You know, I don't believe doctors are lazy people. We just don't wanna spend our time on things that don't matter, and it's like, let us take care of patients.
So some of these hospitals that have been egregious in their predatory billing and price gouging, shaking people down in court trying to garnish their wages to the point where half the town has been sued, these are low income working Americans have been sued to have their paychecks garnished by their local community nonprofit hospital.
I'll go in there with my advocacy group, and we will offer to provide free representation to the patients getting sued. I mean, this Friday we've got three hundred and forty patients lined up at the docket where the hospital is suing them to have their wages garnished, and we're gonna go in there and we're gonna defend them.
Now, I can tell you, every time a patient agrees to let me put my name on the case as the medical expert pro bono, every time that hospital sees Marty Makary on the case, they cancel the bill. Every bill is getting canceled. Why? Because I think they know it's egregious. These are egregious bills. They're not fair, and people are hungry for honesty in healthcare right now.
[00:24:26] Stacey Richter: I would suspect that you're right because if they felt that the only reason that they would cancel the bill is that they didn't want the public relations, and why wouldn't they want the public relations? It's because they didn't want the bill to be made public. Why wouldn't they want the bill to be made public? Because there's a problem with it. Do you like my deductive reasoning there?
[00:24:43] Dr. Marty Makary: Yeah, exactly. I mean, it's, it's unfortunately many times they're forgiving these bills just out of a PR move, and they give us some corporate speak, you know, statement. And I've put these statements and their responses in my conversations with the hospital CEOs in the book.
But, what we're seeing right now is this sort of mass outrage that's going on in the general public. We've asked hospitals to take a code of ethics pledge, and we've got it on the website, restoringmedicine.org. Asking them to agree to fair billing practices. There are certain things hospitals can do to be very fair.
And look, hospitals will tell you they're about—they're on the brink of going out of business. That's true of some of the rural access hospitals, but Axios, the media firm, just completed a study showing, based on early 2019 data, large hospitals are on track for the largest profit margin in their history, 5.1%.
So basically, the take-home message is large hospitals are crushing it financially while small hospitals are closing, rural hospitals are closing. They're not collecting billions of dollars from suing patients, garnishing their paychecks, okay? These are hardworking Americans.
1) people getting sued in the state of Virginia, where we completed a large study that's come out in one of the medical journals, Walmart employees.They're the number one people that are sued by Virginia hospitals. 2) food service workers. 3) US postal workers. Are these wealthy Americans? No. These are people who are working hard for their paycheck, okay? They have health insurance. They've done nothing irresponsible by going without health insurance. 4) hospital workers. Hospitals suing the very nurses and housekeepers and individuals who work at their hospital, have committed their lives to taking care of people.
[00:26:40] Stacey Richter: So ironic.
[00:26:40] Dr. Marty Makary: And this is what they do when they seek care? I mean, it's a disgrace.
[00:26:44] Stacey Richter: That being said, let's talk about employers for a sec, because obviously, if your workers' wages are getting garnished by the local hospital at scale, that is knowable. You can see the wages getting garnished.
Obviously, employers do have a stake in this. Is there any advice that you would have for employers, many of whom listen here? Should they be teaming up with any of your advocacy groups, or what's your advice to them?
[00:27:13] Dr. Marty Makary: First of all, I love employers. Right now in healthcare, they are the bright spot.
And overall, I'm very optimistic about the future of healthcare because we're seeing a redesign of care, a return to honesty. And employers are smart enough to say, "Hey, we wanna work with the honest hospitals, not just the ones that advertise at the NFL games." Like, we can see through this stuff, and we see the egregious pricing that's going on.
And we want people that we're willing to pay for quality, but we want honest and fair pricing, and we want to be able to see how you're doing in terms of quality. And billing quality is medical quality, and employers are seeing that.
So we've talked to Walmart. We've told them, "Hey, your employees are getting sued like crazy in the state of Virginia. Here's the data. My research team from Johns Hopkins has done the research on this. We've got the studies. Here's the data from the state of Virginia. Walmart employees are the number one employees that get sued and have their wages garnished. Will you help us?" Right?
Employers have tremendous clout in healthcare, tremendous. Not only do they serve on a lot of the boards of hospitals, but once they find out about things, when they learn about things, they get involved, and so we're seeing that now with employers. So all those employers out there, gosh, you guys are the future. You guys are driving competition in local marketplaces, and we just need good metrics, just like the food industry developed food labels.
The industry initially fought food labels, the food industry, saying that, you know, this—companies are gonna close, we're gonna have food shortages, people are gonna be laid off. All of this gloom and doom when food labels were introduced as a national transparency policy.
None of it happened. It didn't happen. What we got was an incredibly informed consumer, and that's what we see in healthcare with employers.
[00:29:07] Stacey Richter: So if I am a lone doctor who's listening to this podcast and I have embraced the mission and I see that my organization is not aligned with my mission, is there a way for me to accelerate this other than talking to my leadership? Or does it all boil down to get involved at the higher levels of any of the organization and try to fix this from the inside?
[00:29:29] Dr. Marty Makary: Well, there's an incredible groundswell of physicians and nurses who are saying, "Let's be a part of a grassroots movement to just scrap the current healthcare system and start from scratch."
Now, these are largely driven by primary care physicians, and they're basically saying, "Look, this model of 10, 15-minute visits and cramming all these patients in, this is for the birds. We don't like it, doesn't make sense, not good for patients. This is not how we ever, you know, intended to practice medicine."
[00:29:59] Stacey Richter: Do you wanna talk about practicing wisely, which I was fascinated by?
[00:30:03] Dr. Marty Makary: Yeah. So the Robert Wood Johnson Foundation funded Choosing Wisely several years ago, which I think is just a wonderful project with this incredible leadership from ABIM [American Board of Internal Medicine] Foundation and Dan Wilson, and they've really done a tremendous job creating awareness around the issues of over-treatment.
Well, our thought was, can we take things a step further by providing actionable data to individual physicians beyond the sort of public awareness campaign within the medical community and for the public? Can we go a step further? And that's really the genesis of Improving Wisely, which was another grant from the same Robert Wood Johnson Foundation to say, Let's share individual data with physicians on how they perform.
Let's do it in a confidential way, and let's let doctors define what the quality metric is. Let's let doctors create, develop, and endorse how they should be measured on appropriateness. And let's not just look at complication rates, which is what the entire quality industrial complex has been measuring.
Let's look at the appropriateness of care. Did that patient need a knee surgery? Should your patients, your senior patients in your practice be on fifteen medications when the national average is less than eight?
So what we did is a benchmarking program, sending physicians reports on how they perform around an appropriateness measure that was defined by the experts in the specialty.
And what we found in some of these projects is that it had a tremendous impact. Take skin cancer surgery, for example. We just published in one of the JAMA journals that when you send doctors who do Mohs surgery, their average number of blocks per case or stages per case, those on the extreme, those who are practicing outside of a boundary of what the peers consider to be reasonable variation, they autocorrect.
When they're sent that letter, they autocorrect. It's kind of like when the, um... I discovered in the research for the book, The Price We Pay, the San Diego coroner, when he found a patient who died of an opioid overdose, he sent a letter to the doctor, the prescribing doctor who was prescribing opioids, and guess what happened to that doctor's prescribing patterns?
They plummeted, and it's the simple courtesy of civility and closing the loop that had this powerful autocorrection impact on physician behavior. Nobody got in trouble, no one got penalized, no one went to jail. There was no expensive consultant. This was simple peer-to-peer benchmarking using sound data that was developed by physicians.
The Mohs surgery project we published in JAMA cost a $150,000 to run that project nationally. That project has resulted in an eighteen million dollar savings to CMS in payouts in the first 1.5 years.
So it's had a tremendous impact. People are recognizing that, number one, we need to measure appropriateness of care, not just complication rates, and we can do it by en-engaging doctors, and they will police their own house and encourage their outliers to autocorrect.
I call the outliers those who need help rather than those who are, you know, bad doctors. This has tremendous implications for healthcare, so that's part of this improving wisely, practicing wisely effort.
[00:33:32] Stacey Richter: Marty, is there anything that I have neglected to ask you that you feel would be important to mention?
[00:33:37] Dr. Marty Makary: I mean, I can tell you a little anecdote here that I love being a surgeon. And being a doctor, I think, is the greatest profession in the world. To have a patient tell you things they wouldn't tell their own spouse within seconds of meeting you just because you're the doctor, it's an incredible public trust.
Or they'll trust you to put a knife to their skin within a minute of meeting you because of heritage of medicine and the public trust. It's an incredible profession. Doctoring, being a nurse, respiratory therapy, you name it, it's an incredible profession. And but patients sometimes don't know how to navigate the system.
I've got patients who show up in my office, and I'll ask them, "How did you decide to come to Johns Hopkins?" And I'm thinking they must know that we do more pancreas surgery than any hospital in the world. And they'll say something like, "Well, the parking here was really good, so that's why I decided to come here."
And you realize people are not shopping on value. Employers are not shopping on value. Instead healthcare has competition now, but it's competing at the level of parking and billboards and NFL ads. We should be competing based on price and quality. People are willing to pay for quality, but they just want honesty with quality metrics and with pricing information.
So I think we're about to see an unleashing of more competition in healthcare that's for the good. It's badly needed.
[00:35:00] Stacey Richter: Dr. Marty Makary, thank you so much for being on the Relentless Health Value podcast today.
[00:35:04] Dr. Marty Makary: Great to be with you, Stacey.