Policy at Johns Hopkins university in baltimore. Policy at Johns Hopkins university in baltimore and also there. H or surgeon his latest book is the price we , good morning dr. Mccarrick. If you had to pick a breaking point for American Health care, where would you put it . Guest if you had to identify the issues that are driving our affordability crisis, it is number one pricing failures, number to the middleman industry, and number three in appropriate medical care. Collectively there is broad consensus in america about addressing these issues. Unfortunately our discussion has been sidetracked into this false choice we have into whether or not you are pro or con health care. I have yet to meet somebody who thinks that any industry has gone from nontransparent pricing to transparent pricing and then said this is a bad idea, lets go back to hiding prices. People are getting hammered out there. People are getting crushed. They are hungry for honest pricing and health care. It is ironic. I am a surgeon and i do pancreatic surgery. For most of my career, i could tell you 5000 things about pancreatic surgery except for 1 the price of surgery. People now need to know the prices. Think that is similar among your colleagues at Johns Hopkins and surgeons in general . Guest yes and it is not because we have bad people. We are just focused on taking care of the patient. When people come in, we like to take care of them. Have relied on our hospitals, our billing department, our administration to handle the billing processes. They are not bad people either. We have inherited this crazy system in health care where we mark up prices for the purposes of offering secret insurance discounts, secret and selective insurance discounts. Why do we have an army of staff negotiating discounts off of artificially inflated prices . This is the crazy game this crazy game has resulted in hundreds of insurance executives am a part saying i of this system, and i cannot say this publicly, but it is insane, after the book came out. Guest you host you went out into the field and interviewed people. Like your book says, you did your rounds. What type of people that you see . Guest like doctors do rounds on people, i thought it is time to do rounds on this issue as a professor of policy at Johns Hopkins we hear a lot of opinions. We hear a lot of stories of outrage and gouging in Health Wanted to take a comprehensive approach to identifying the factors leading our crisis. I spoke to hospital leaders, doctors, nurses, patients, who few people talk about. A lot of people are getting rich in health care, but not the one stakeholder the patients. Talking to pharma, large academic centers, i tried to put together a basic Health Care Literacy book so we can create a common language and really unite people by appealing to the best in them. People go into health care at every level at of a sense of compassion. People going to hospital administration, any aspect of health care, Insurance Companies, they work at any level for the purpose of contributing to society. We have got to appeal to the best in people and remember why we went into the field. Create price couching today price gouging today is threatening the public trust in hospitals. Host we would like to hear from you. Were talking about fixing the Health Care System. Talking about his new book. We would like to hear your experiences, your ideas. Here is how we are breaking down the phone lines if you get employer provider insurance, that number is 202 7488000. If you get your insurance through the Affordable Care act, that is 202 7488001. Through medicare or medicaid, that will be 202 7488002, all others, including uninsured, that would be 202 7488003, one of the things you write about early in the book leg pain. You said doing leg procedures for people who do not need them is one form of unnecessary treatment. The problem is even bigger in the preface i mentioned that doctors believe that 21 of things done in medicine is unnecessary. 11 of procedures are unnecessary. Aliens of dollars are spent on care we do not need. All of us have seen the tv ads on this. What do you focus on in the issue of treating leg pain . Guest when we surveyed doctors at Johns Hopkins in a National Survey and asked them what percent of medical care is unnecessary, they say it is about of a fifth of everything we are doing. 10 years ago we prescribed two point 4 billion prescriptions. Last year it hit 5 billion. Did disease really double in the last 10 years . No, we have a crisis of appropriateness. We have a consumerist culture, we have this fear amongst physicians that they have to cover themselves i doing things they know are not necessary and we have this problem of money on the table and this feeforservice system that incentivizes quantity over quality. I open with this story in the book of people being recruited for leg stent procedures at local churches here in washington dc because medicare is funding this entire system. There is no way to identify currently patterns of doctors doing this. Justify what they need to in the medical records, medicare to pay for it. Into throw good money medicare, that does not fix the problem. Politicians talk about different ways to finance health care we need to talk about how to fix health care. Host it is not just procedures, it is products like mobility devices and other types of medical devices provided through medicare. Abuse there is a lot of in a lot of areas. We have two issues in health care we have underuse and access issues and we have overuse. By far overuse is dominating our cost crisis today. Doctors are speaking up about it. Patternsing practice to identify actionable outliers who can then see results and we see that they autocorrect in the data. Host we have done a couple segments here recently about the in ruralf you will, hospitals. Some of these issues youre talking about, are they exacerbating it . Guest rural hospitals closing is a big problem. We are seeing a Record Number of closures. Big hospitals are on track to get record profits. At the same time, small and rural hospitals are closing. What we have got is this multiple multiple streams of cash into the big hospitals. You can name it. State subsidies, philanthropy. Small hospitals usually dont get that and they are the ones getting crushed. A bigJohns Hopkins is hospital. Is that a forprofit system . Nonprofit system. With that taxfree status comes an obligation to help the community. What we can see is if we can use the right lexicon, some hospitals are engaging in predatory building billing where they are taking patients to court. That is the most absurd conflict of a taxexempt organization. Before we get to the calls, the center for Medicaid Services the cost of health increased nearly 5 to forh 3. 6 trillion in 2018 11,001 hundred 72 per person. The insured share of that 11 ,172 dollars per person. 35 Prescription Drugs billion. Dental services, 135 billion dollars. We will hear from you. We go first to sneed phil, tennessee. Sneed phil we go first to tennessee. Caller i am with you on hospitals price gouging. Bandaid take a . 50 and charge the Insurance Company 15. That is ridiculous. Kind ofare needs some oversight over the price of whatever. They need to have a general standard they ought to have a guideline of pricing that they have to go by. That is not gouging the people. I was hooked on opioids. They came out with suboxone which is a great drug, but then you have the doctors who wont take your insurance and you have pay 300 25 ad to doctors visit, even though i had insurance i had to bay i 325 a doctors visit even though i had insurance. Guest it is a disgrace what is happening. Lets call it what it is it is price gouging. What i learned from going on tour, talking to Everyday Americans, and stakeholders in health care in the book is that most americans do not live like i do. Life has been good to me. Half of americans have 400 or less in cash on hand in their savings account. People are getting hammered with these crazy bills. If airlines did not have to provide prices on travel websites and instead argued that we have to bill you after the flight, we cannot tell you what the flight will cost, we would have gouging all over the airline industry. It would result in this loss of the public trust. Right now in health care, we have the same crisis. Host you put out there in your book, you do suggest that people asked the price. We do not do that. We do not ask before the procedure. How do you change that . Guest one of the exciting things happening is organizations are now showing you prices. Check out the mayo clinic price estimator. Check out the free medical freemarket medical Association Shop tool. Empty saves, sesame health, clear health costs. Md saves,ut the sesame health, clear health costs. It happened this week. A woman came in with the help a head cold and was charged 25,000 dollars. We need that bill forgiven and a public apology, and a systematic change in the system. The purpose ofor offering secret discounts is a crazy game that costs a lot of money to do and has nothing to do with bedside care. Callingts go to eric from rome, georgia. Caller the republicans and trump have no health care plan, but the democrats have several. Mcconnells medical health care is basically what you have to do in order to bring down the cost of medicare will stop care uncompensated care in hospitals. What you would have to do is that is where the largest prices are coming from. It is uncompensated so it is raising the prices on other people. You have to mandate that people pay a copay or some kind of payment at these hospitals. That would bring down the price. Next thing you would have to do is go to medicare for all. That is where you get the cheapest medicine. You drop the price down, you drop the age limit down slowly on it and what you do you negotiate the price of the drugs. Then the price of medicare is actually cheaper then any other insurance that is provided in the United States. First you have to have a plan. Medicare for all, drop the aide, stop the uncompensated hospital care. That is what is raising the problem. Host an additional comment from mark on twitter medicare for all, do you support that . Costs forimbursement health care. Guest we need to turn off the echo chamber of cable news that unfeasible,s these nonrealistic options and instead talk about where we have common ground. There is broad consensus on how to fix health care. We need to address pricing failures and inappropriate care. We have a study out of Johns Hopkins that shows that 48 of all federal spending right now is going toward health care in its many hidden forms, that is not just medicare and medicaid. Half of Social Security checks are going toward medicare copays and deductibles and coinsurance. It is the defense departments the defense departments divide half of the defense departments budget goes to health care. Partest on the debt is in interest on health care data. 4 of all federal spending think about this next time you file your taxes 48 of all federal spending goes to health care. Those arguing for medicare for all, what do they propose we twoe that 48 percent number to . Do we cancel all other National Priorities and spend all money on health care gecko even then we couldnt afford medicare for all. Do we cancelcut all other National Priorities and to spend all money on health with on health care . We couldnt afford medicare for all. We need those secret negotiated prices to be disclosed. Infuse transparency in the marketplace and do a lot of good. How about we give transparency a chance . Host the center for Medicaid Services with the figures for 2018 on spending private Health Insurance, 34 of that. 37 , doesedicaid is not include tricare outofpocket costs. 10 . Tulsa, oklahoma. Talkingwe are back to about price per pill. I am on the aca next year, she is on medicare. She has pain medication that hases . 12 a dose and she medication that costs 27 a pill. We need some Nonprofit Organization going and some kind of pricelist. I go into walmart, i know what im going to pay for something. If i go into the hospital i dont know one till i get the bill. This is getting too complicated with all the different types of insurance. My aca went from 250 a month to 1200 dollars a month. It is not really Affordable Care month. 0 a it is not really Affordable Care. It is ridiculous to pay 1200 a month for health care. I would love for you to address the guest it is important we filter what politicians are saying. During the democratic debates we heard a massive pylon on the insurance industry. There are things there that were correct. We do not have a primary insurance crisis in health care. We have a pricing crisis. That pricing is managed by insurance passed on to individuals. We have to address the underlying issues that are resulting in our affordability crisis. Spent 48 if we percent of all federal debt spendsrage household 20,000 a year on health care and then you get a bill on health care and here it is not covered people have a right to be angry right now. People are getting crushed. We need some public accountability around pricing. I recently met with an executive at google. Someone there had read the book and wanted to meet. When somebody googles the name of a hospital, instead of just putting the hospital, the address, and the phone number, how about put the name of the hospital, the address, the number, the average markup, sue patientst they and their markup quality doing host an callern earlier mentioned using opioids. If you have a chapter on that. For most of my surgical career, you write, i gave out opioids like candy. I was unaware that one in 16 patients become chronic users. My colleagues and i did not realize we were feeling a national crisis, but today opioids are the leading cause of death in america of people under the age of 50. As a medical student and a surgical resident, i spent thousands of hours learning how to diagnose Breast Cancer, how to cut out Breast Cancer, and chemo chemo and radiation after surgery, that at no point was i taught that the way we liberally issue opioids would kill more people than Breast Cancer itself. Tell people what you do differently in the pain medication arena now . About theeel terrible Opioid Epidemic because i contributed to it for many years with good intentions and arguably bad science. I did what i was taught and i prescribed opioids liberally after the surgical procedures i formed. As painful as it was to write about it, i think we need more humility in medicine. Out is Sutter Health paid 575 million in a settlement announced this week, part of the settlement was they would admit to no wrongdoing. I think we need more humility. The Opioid Epidemic is just one example. Opioids have become the number one cause of death in america among people under age 50. Doctors at construction sites were prescribing opioids to anyone who is injured and at certain sites, the majority of people longterm died from the opioid prescriptions that they were given. These are not people dying from injury or illness these are people dying from the care that they have received. T is a snapshot opioids are just one medication that we overprescribing. There are many more out there. Fatalas a particular addiction that has attracted National Interest that has gotten large, but there are many other issues. It is one glimpse into our problem of too much medical care. Host how do you handle pain relief now . Guest first of all, we went to the patients involved in the decision. Have a website called solve where we have patients watch a video. We do not want the pain to debilitate them where they cannot be active or walk. We use nonopioid alternatives and there are a lot of them. I had to educate myself on what we call multimodality alternatives, usually a combination of acetaminophen and local anesthetics. We use opioids judiciously. Our guidelines that should be specific to the operation, just why we have stated our consensus headlines on the website. Tony is on the line for those who get their insurance through the aca. Caller i came to the opinion that the government could service for the Insurance Companies by making comprehensive insurance required aca and also when they made it so businesses had to provide insurance for their itloyees and but it made so that they had, they were appointed as middlemen. Public a lot of harm because there was a lot of rate waste in the system because of people not shopping around when people are covered when something is covered. The other thing i think that is theput up with that other choice is to be price gouged and as dr. Macario was dr. Makary was saying, they rise the prices so they can start at a better negotiating position with the Insurance Companies. The entire thing got way out of hand from the beginning. Think we would definitely not have this requirement to ensure maintenance costs that a market would develop to lower prices. You need to have some taxes to who care of the people cannot become selfreliant, but certain people have enough good health and finances and maybe savings to not rely on the government. It would be like the equivalent of homeownership and you would not have to pay for host we will get a response. Guest we has a National Priority in the United States have basically realized that people deserve health care and no one should suffer because they cannot afford care. We already spend enough money on this country on health care to give every Single Person in our borders goldplated health care. We just have to cut to the waste. If we look at arkansas expenditure on health care, it is absurd. It is threatening every other National Priority. The amount of waste going on is apparent to any doctor or nurse practicing medicine today. There are a lot of priorities right now in health care. One of them that we need to put first is to create some public accountability around pricing. Employers have been given this mandate to provide insurance to their employees, what did that really came out of world war ii when salaries were frozen and employees took on this employers took on this task to make their jobs more attractive, that they would provide insurance benefits. It is not ideal. No one should have to worry about switching jobs because of their health, but it is the system we have right now. Host you make a comparison error between the Financial System and Health Care System before the 2008 crisis. Rippedmost are getting off on their health care plan. That is in part because they buy pharmacy plans for their employees on an open market where plans are sold by brokers. Isse brokers, that industry as corrupted as the subprime Mortgage Broker industry was before the 2008 financial collapse. The reason i learned about this entire industry is that brokers told me about that. Many brokers have said that we are sick of this game of kickbacks and, commissions. They said we will try to work as a true fiduciary and be independent. How was a broker independent when they are getting a 100,000 kickback from the Pharmacy Company . Many of these are not disclosed to the employers. Take for example in new york state if you are an employer and you buy Health Insurance for your employees, 4 of every dollar spent on Health Insurance premiums for life goes to that broker. That is a lot of money. That is a lot of money going to whoever sold you that one time plan. On top of that, the insurance or pharmacy plans will say to their broker, if you keep this employer with us, we are looking at giving you a bonus this year 30,000, 40,000, or 50,000. That is how our services as doctors and nurses are being sold on the market like energy on a grade. There are so much wasted there. Most businesses are getting ripped off. I provide tools for how you can go to some of these more enlightened advisers who will act as a true independent fiduciary and help you get into the right plan for your employees. Is calling from florida. He is on medicare. When i was first diagnosed, the doctor prescribed limit call at the time i had my own business. I made good money. I am on medicare now. I get 800 a month. Is 4400 adicine month now. That is just crazy. I take to aday. Aday. I hurt my eye real bad when i was a 60 and it hurts so bad, but the doctor prescribed oxycontin to me. I know how bad it is around here in florida. It is every day. That onek it for night. I do not know what it was. I woke up the next morning and it was terrible. I couldnt hardly focus. I looked at what it was and saw that it was oxycontin. First thing i did was flush it. My cousin bought me some smoked that in the pain was completely gone. I slept good the rest of the night. I woke up the next morning, i was not foggy, my head was not in the clouds. Question quick you said it was 4400 a month. Is that the retail price that you pay . Caller that is what i am supposed to pay. Host thank you. We will hear from dr. Makary. Guest what the patient is responsible for paying at the pharmacy counter can have no rhyme or reason. There is something called spread , which is the health plans behind the pharmacy counter. It is a middleman industry that sets the copays and charge the patient. Ges i go through the boca showing the gouging going on in america today. Most businesses are getting ripped off because they cannot interpret the doses, by some lawyers, and frequencies. They are hoodwinked by these price gouging prices. C. Need basic health care the goal of the bucket is that somebody could read this and renegotiate their insurance navigate people could their health care and make smart decisions. We need public accountability for american hospitals. Ask your beloved community you suing the department of health and Human Services to crush the initiative that they have announced . Right now the Hospital Association is trying to block Price Transparency. We have seen this assembly of u. S. Hospitals, there is no Media Coverage on this, but this is the biggest story on the Biggest Issue in the United States today. Hospital,ommunity create some public accountability are you joining the lawsuit to block Price Transparency . I think that is what we need in america, regardless of whether or not we get legislation or any more government action. We need basic concerned citizens speaking up and creating public accountability. Host the book is the price we pay, what broke American Health care and how to fix it. We welcome your tweets, texts, and your calls. I text from john david in Northern California he says price exposure alone not reduce prices. How do we control individual greed, Expose Corporate a specific question for you walk us through how you determine your fee for a routine surgery done a thousand times . Guest in maryland the rates are set. The price of a common procedure that i perform on the pancreas is about 40,000. Some hospitals have moved toward Price Transparency. I Johns Hopkins, my team conducted a study of medical centers that went from the standard way of doing business where there are no prices and patients who asked for prices were given the typical runaround. Look at what happened when they offered a set menu of prices what happened was remarkable. Not only were those prices belowmarket, but is this is this boomed at those centers. The market will reward Price Transparency. I have hospital ceos whisper to to offerhey would love transparent pricing, but our trends our insurance contracts wont allow us or other contractual obligations prohibit us. There has been an effort to prohibit Price Transparency that is going on why special interests. People should be aware of it and people should give their business to the hospitals that offer high quality and fair prices. If you want to charge twice as much as the next hospital, go ahead, but the quality should be better. We have some of the best prices in the country at Johns Hopkins and i would argue some great quality. Andidea that the hospital prices, why are they doing it . Is the quality that much better . No, they are taking advantage of people who are out of network and they can gouge and they are doing what the market will allow. Plethora oft a homeless, uninsured immigrant skiers on Vail Mountain who they have to jack their prices up to cover. No, these are wealthy, uninsured, outofnetwork patients. They have been gouging the outofnetwork patients. Mike inr next caller is north carolina. Caller Merry Christmas to both of you. I like what i hear from you, dr. Makary. I really do. First, i called in on the employer insurance line. I have been happy with it through my career. I have had blue cross blue shield, i have i am currently with sickness. Cignus. I would like to make a couple of comments. The gentleman before me who commented on how he noticed the price of a certain drug exploded on him when he went to medicare my mom passed four years ago. She was 90. I have personal experience with monitoring her medicare bills. She was a dementia alzheimers patient. As pretty much everyone knows, i do not know what the statistics are, but endoflife patients are the ones who get something 80 of medicare. My mother did not have to pay these bills, but they were paid by medicare to various providers. Once i saw the costs of some of these things, it rankles me. I figured out where that 60 it is theyear fraud and theft and mismanagement of medicare. This is something that medicare for all people never discussed. 60 billion a year, which is 1 5 of the entire medicare budget. I saw that personally. To want that for the entire country is just insane. Until we can fix that like dr. Makary has talked about, getting a handle on this corruption, this fraud, this waste, and abuse the other thing i want to ask about getting these costs under control is why isnt Health Insurance structured and priced similar to my Car Insurance or my Homeowners Insurance . Lets go with Car Insurance. My Car Insurance does not cover new batteries, windshield wipers, tires, oil changes. If it did my premium would be unaffordable. That is why in my humble opinion Health Insurance is unaffordable. As adults we should be responsible for our basic needs, just like we are responsible for we should pay for basic tests, xrays. The meat and potatoes. The really mundane stuff of health care. That is our responsibility as a citizen and as an adult, especially if we are working. We should not cover all of that stuff, just like Car Insurance only covers accidents. It doesnt even cover major engine failures. Host dr. Makary. Guest first of all, i am sorry about your mother. I am a cancer surgeon myself and i am reminded frequently have short life is. That is one of the reasons i speak up on these issues and i encourage my colleagues in medicine to do the same. With it come to grips dying in the United States. It is a tragedy often times we are put in a awkward situation talking about death with patients and their family members. There is waste that is going on there. When of the problems is we do not know who is going to get through and who is not when they are in the icu. There is no substitute for sound medical judgment. I have patients who study things to death and patients who say whatever you tell me to do i will do. We want people to be informed and to make decisions together. It is there is a tremendous amount of waste going on in health care. Some studies estimate that it is 30 to 40 . Look at the army of people we hire just to manage all of these crazy insurance discounts that we selectively provide. A clinic said they have 3000 separate insurance contracts. That is the problem. Why do you have 3000 different prices for the same service . Look at the amount of people we have to hire to negotiate those contracts . People are hungry for basic transparency and with the medical or medicare for all issue, i agree. Look at all the countries who have adopted a medicare for all system. Governments 100 of the time dial down expenditure on health care by tightening the belt every year as other National Priorities surface. You look at systems 10 and 20 years down the road and they are often underfunded and sometimes even dilapidated. I do not think we want that. Look at our own medicare funding system. We have been doing the same. You have been dialing down our expenditure, tightening the belt on medicare year after year relative to inflation, and many doctors will tell you that this trajectory is not sustainable longterm. I get the appeal. We want to cut to the waist, cuts the middleman, cut through the price gouging and there is an appeal there with medicare for all, but we have to be fiscally responsible and we cannot do that right now. Tocannot increase our 48 5000 . We have to give transparency a chance, cuts the waist. We already spend enough money on health care in the United States to give every Single Person in our borders old plated health care. Just have to cut to the waist. Gold plated health care. We just have to cut to the waist. Ste. He wa oft the average Expenses Health care on in other countries like canada is 8. 8 of their gdp. What are some things that are working . Guest go to germany and get an acl repair. To the go around, talk Different Centers about their performance and you can get a price. Most of the world you are going to get a price for everything from a tooth extraction to a hysterectomy. World, carehe generally speaking is less then the care we give in the United States. I have an uncle who practices cardiology overseas. Doctors have an reputation for over operating, over medicating. The rest of the world generally sees this access. How is it that we have u. S. Cities, post industrial cities, former steel cities that have been entirely revitalized on the business of health care. Is that this is is that something to be proud of . What is the export . What is the product . We have created this massive set of industries where a lot of stakeholders are getting wealthy, except for one and that is the everyday patient. We have businesses spending more money on starbucks. Spending more money starbucks is spending more money on health care than they are on coffee beans. We have a cost crisis that is threatening every major u. S. Business. It is one of the drivers of businesses leaving the United States. It is something we can fix by allowing pricing, Price Transparency to work, creating competition and allowing employers and proxy shoppers of health care to find value in the marketplace. Host we will hear from debbie next in roswell, new mexico. Caller am i on . Host you are. Caller i think you are being disingenuous. I do not think it is abuse. It is greed on your part. 40,000 for a pancreas operation . There is a big difference. It is called greed. I got hepatitis c. My insurance refused to pay for the medicine. I do not have 150,000 dollars to pay for the medicine, so what did i do echo you are not the only game in town. I went to india, saw dr. , got the medicine, and flew back. I got to admit i got the medicine for 440. Youre saying america is too stupid to figure this out. Every other industrial nation has figured this out. Havee too dumb, we do not the money. Maybe we should pull it from them the military. Personally, the greed parts . It is on you. Will let dr. Makary respond. Guest i get the frustration. To defend ind court any patient has who has been sued in court who has been sued by a hospital. People are frustrated. Thanof america has less 400 cash on hand. When they get gouged 25,000 for a service that should cost 13,000, people have a right to be angry. A researcher called 100 hospitals who do heart surgery, a standard procedure, and asked what is the price . After haggling and calling back and getting to the right person, and really fighting to get that price, he got the price at 50 out of the 100 hospitals he called. The price ranged from 44,000 dollars to half 1 million with an almost even distribution. He took those prices and correlated them with the outcomes in our National Database of heart surgery outcomes and guess what . There was no correlation between price and quality. None whatsoever. We took those prices and compared them to the charity care at those hospitals. There was no correlation. High prices are due to highquality or high prices are due to charity care is by and large a myth and it is a reflex out there when people in health care do not have basic Health Care Literacy. Host the review of your book had this headline this doctor is on a mission to make Surprise Health care bills hospital bills history. What said to you on this mission to address the problems in health care . You are a health care professor at hopkins and a surgeon and you are writing about an issue that is more broad than that . What made you take this up . A low income in housing part of town. Host in baltimore. Guest it is actually in arlington, virginia. I moved there as a resident when i could not afford much more. I liked it. I stayed there, i love the people there, it is a terrific neighborhood. Immigrantly an community from central america. I have become friends with my neighbors. They are getting hammered with bills. Theyre getting crushed and they get hot they work hard. It is a disgrace to our profession and a disgrace to our country. I started going into defending them to the hospitals and asking for mercy. What i found is that these hospitals who pay no taxes had no mercy whatsoever. When they argued we are a business, i said pay taxes. Hospitals were built mostly by churches and they were there to safe haven. Fuge and doctors and nurses worked there sometimes as volunteers. Hospitals like mine, Johns Hopkins, operated in the red for decades. Serve charter to joint that is our great medical heritage. When the polio vaccine was invented and the inventor was told to get a patent, he said no, this it will be the property of humanity. That is our great heritage. Right now we need to rebuild the public trust. Public trust in the medical profession is being threatened by collis beta spade price gouging being threatened by lets call a gouging. Pade, price we have inherited this crazy offerf price gouging to host we will hear from raymond next in michigan. Caller i would like to talk pricefixing for different procedures. I had athis 30,000 cold, ok . How i got it was this. I was down in florida. I went back to michigan. I went to the hospital for another reason. They said i had a cold. They separated the whole wing for two days. [indiscernible] cold. 0 for a thats what it is. Host you said the bill was 30,000 . Caller yes. I had a whole wing. Host we will let you go. Guest my students are some of the most encouraging people in this work. Generationillennial have social justice as a generational value. I see these stories of egregious price gouging where i have personally gotten involved outside of my capacity at Johns Hopkins, my students have said we will go with you, we wanted to get involved. We need to change the language. Ets talk about medical prices instead of talking about bills, lets talk about editorial billing. Lets talk about price gouging when the markup is not justified. People are hungry for honest prices right now. Proxy shoppers of health care if you are not paying for health shop proxy shoppers will on your behalf and they are just figuring out what hospitals are delivering babies for 4000 and what hospitals are delivering babies for 70,000. They are creating preferred networks and doing steering. People are hungry for honest pricing. And i go to court on behalf of patients who are being sued to have their wages garnished, a that we exposed this summer, all of these stories that came out were from us calling reporters and saying this is going on, we want to meet with you and talk about it. This has been the story of the year. Hospitals will go after patients to garnish their wages even though they are nonprofit institutions. Many hospitals have stopped suing patients. And i defend these patients in court, we win 100 of the time. Honor, iem, your cannot mow your lawn and send 3000. Ill for these are walmart workers, postal workers, these are not people who have done anything wrong. They work and have insurance and they have been terrorized financially. Billing quality is medical quality and financial toxicity is a medical complication. Host you say that we as consumers, we as patients should ask for prices each and every time we have any kind of medical procedure. Guest when people ask for organic food in restaurants, restaurants responded. The people asked for nutrition information, we got nutrition labels. Market response to demand. Right now there are centers around the country, hospitals that are telling you it will be 7,000 to deliver your baby all in with everything. Will not get a surprise bill for the epidural. Well get an allinclusive bill. That is the result of the demand for Price Transparency. It is really a revolution. I am optimistic about health care because we are seeing this demand rise right now. Host a couple more calls. First on twitter, this is a democrat saying we cannot afford to pay Insurance Companies. Forprofit insurance drives up the cost of care and it must go. Steve says health care should never be subject to the insidious nest of capitalism. Is starbucksat largest expense proves that we need National Healthcare and stop all the unnecessary procedures and medications. Steve is with us in anaheim, california. Draw thehy dont you short stock. I think the lady from new mexico was right, debbie. That basically you are having to trust the charge master which every hospital uses to set prices along with Insurance Companies. And there is a bill in congress right now, hr three which is now hr six, which addresses some of the diseases that need to be cured. Its sitting on the colonels desk. It hasnt gone anywhere. If you people are really tired of this and want to get some change, theres another bill sitting in congress which is hr one, the public funding which would finally get some of these people in congress who are feeding off of the special interests and lobbyists out of congress. Host on steves point in the health care bill, i think he may be referring to the Prescription Drug bill passed in the house. Are you optimistic that there is consensus on that issue in congress that they will pass some sort of Prescription Drug bill . Guest i think theyre going to pass something because people are fed up and they want to be able to show they are doing something. Are times the solutions bipartisan but the media sort of polarizes folks. Turn off these echo chambers of the right versus the left. Announceddent trump Price Transparency as a new rule hear ae dhhs, i did not single democrat speak in opposition to it. Opposed to Price Transparency . Yet the american Hospital Association filed a lawsuit the next week to block it. The media didnt cover the story at all, i believe in part because he did a right thing. He did a bipartisan good solution. Something no other president has done on this issue. You have a complete suppression of what is the Biggest Health care story of the last five years. The Price Transparency executive order. Get no attention in the media, no opposition would at the same specialaction and the interests in washington, d. C. Move in to block it. On the hill weve seen the Alexander Murray bipartisan bill to address spread pricing and disclosure of broker fees and kickbacks, to address many of the issues identified in the book. And essentially the bill gets modified even though its bipartisan and pieces of it get worked into the end of Year Spending bill but then get kicked out of the last second. Once again weve kicked the problem down the road. This is not a right versus left issue. This is an American People versus health cares powerful special interests. I think people need to be smart to interpret what they are hearing in the news to realize theres another story and that is the story of what Everyday Americans want and need and that is basic Common Sense Solutions to address our pricing failures. Thats why i wrote the book, to create rod Health Care Literacy around these issues in a way that we can have a consensus. Host its authors week. Our guest has been dr. Marty cspans washington journal, live every day with policy issues that impact you. Tomorrow morning, as part of authors week, we will talk about challenges facing native americans, from the book the girl in the 40 graph. Photograph. In the watch washington journal. Join the discussion. Watch authors week all this week starting at 8 00 a. M. 9 10night on cspan at attorney Justin Pearson speaking to the federal society about occupational licensing laws that he believes are unnecessary. I have spoken to people who have been arrested and prosecuted, and i have spoken to of braidinghe crime hair. Teams, fullago swat swat teams rated barbershops on the suspicion of unlicensed to barbering. This is what happens when you have these laws. They increase interactions with police, and things go astray. I wanted to give you an example. Beenve people who have arrested for braiding hair. One of those is someone in texas who is a hair greater, and she was hair braider, and she was byested for braiding hair police with guns who put her in handcuffs and put her in jail for the crime of braiding hair. She was able to fight back and the law changed, and she got into trouble again because she was teaching other people to braid hair. When people want to the fromsufficient and learn an experienced hair braiders, they could not because it was a crime for her to teach them. Tonight at