This article is going to be my review of the book “The Price We Pay: What Broke American Health Care – And How To Fix It” written by Dr. Marty Makary and published in September 2019.
Despite having a near-photographic memory and voraciously reading 2.5 books a week for the past 5 years, I very rarely share my most important takeaways.
I’m the type of person who highlights important passages and posts a fraction of what I read on Twitter and my email list.
But this book made me do a double-take after having it recommended by a high-level physician deeply entrenched in “sick care” medicine — it was too important to NOT talk about it with my audience.
As we transition into 2022 and embrace the birth of the Golden Age, it is imperative to understand the enemy we are facing.
I won’t get too much into the details of who Dr. Maraky is, but his credentials are extraordinary and give him the credibility needed to discuss America’s broken healthcare system:
- Professor at John Hopkins School of Medicine
- Editor-in-Chief of Medpage today
- Served leadership roles at the World Health Organization
- Over 270 peer-reviewed medical papers in his name
- Elected to the National Academy of Medicine
Without dragging this out, let’s get into the top 7 insights I took away from Dr. Maraky’s book!
Insight #1: We Are Over-Testing, Over-Diagnosing, And Over-Treating People
Right away, I was amazed at how Dr. Maraky immediately dived deep into the root cause of why healthcare is ludicrously expensive:
“I learned what no health care textbook or classroom could have taught. I learned the money games of medicine”
“For centuries, medicine was based on an intimate relationship between doctors and patients. But behind the scenes, a gigantic industry emerged: buying, selling, and trading our medical services. Health care industry stakeholders are playing a game, marking up the price of medical care, then secretly discounting it, depending on who’s paying”
“The operations I do today use the same equipment, anesthetics, sutures, and paid staff that I used ten years ago. So how is it that health insurance costs have been skyrocketing? It’s explained by the money games of medicine, loaded with middlemen, kickbacks, and hidden costs.”
“Overtesting, overdiagnosing, and overtreatment are now commonplace in some areas of medicine. And the prices are so high that patients can’t pay the bills. About one in five Americans currently has medical debt in collections and half of patients with certain medical conditions”
Let’s not forget Chris Rock’s amazing quote in one of his stand up comedy acts:
“The Money isn’t in the cure, IT IS in the Medicine”.
He then demonstrates this by telling a story about doctors who show up to community health fairs hosted by churches to perform “predatory screenings”:
“The person from the cardiology group was conducting a test that measures how the blood flow in the legs compares to the blood flow in the arms. The rationale: Something might be wrong if the blood pressure is lower in the legs. It could be caused by a narrowing of the arteries, a plaque that slows blood flow. It might warrant further investigation.
There’s just one problem with that notion: This test should not be performed unless a patient has serious symptoms, like crippling leg pain. For anyone else, it’s likely to lead to medical care they don’t need, which can be expensive and dangerous. That’s exactly why independent medical experts do not recommend the type of peripheral vascular screening I witnessed that day at the church”
Coupled with his anonymous survey of 2,100 doctors where 22% of prescription medications, 25% of medical tests, and 11% of procedures were unnecessary… billions of dollars wasted.
How many people do you know who are unnecessarily using DHT inhibitors like Finasteride and putting their sexual health at risk of permanent damage?
Or using an SSRI day after day for several years and possibly ruining their mental health through lowered testosterone levels?
But all it takes for many older and/or ignorant people to comply is a subtle nudge of fear and panic from a physician who may be doing what’s best for them… and NOT for the patient!
(Btw, Dr. Makary says a doctor can make $100,000 in a single day from leg artery procedures if they own the facility)
We’re even seeing this right now with the ongoing COVID-19 pandemic.
According to Dr. Scott Jensen, there is an immensely perverse financial incentive for hospitals to diagnose and treat the disease and it’s thanks to the higher Medicare payments they receive because of the CARES Act.
Here’s how the scenario plays out:
“Hospital administrators might well want to see COVID-19 attached to a discharge summary or a death certificate. Why?
Because if it’s a straightforward, garden-variety pneumonia that a person is admitted to the hospital for—if they’re Medicare—typically, the diagnosis-related group lump sum payment would be $5,000…
But if it’s COVID-19 pneumonia, then it’s $13,000, and if that COVID-19 pneumonia patient ends up on a ventilator, it goes up to $39,000.”
Even the so-called “fact-checkers” — and Dr. Makary himself — had to concede his estimates were correct!
Insight #2: People Are AVOIDING American Healthcare To Save Money
Myself and many physicians have noticed an increasing amount of Canadians coming to the United States for healthcare over the past five years.
This observation isn’t just an anecdotal guess as there’s plenty of data to back this up:
- The Fraser Institute, a Canada-based think tank, estimated that 52,513 Canadians received non-emergency medical treatment in the U.S. and other countries in 2014 (+25% from the previous year)
- In 2016, The Fraser Institute estimated the number to be 63,459 (a +28% increase from the year before)
- Second Street, another Canadian think tank, estimated 217,500 Canadians to have left their country for healthcare in 2017 (369,700 people including people who travel with patients)… $690 million spent on healthcare abroad, a +35% increase from 2013
The numbers keep going up with each passing year, and it’s not just the affluent doing this: Many people find themselves in a desperate situation where they are willing to go into debt in order to take care of a growing problem.
Notable reasons for departure include:
- Ridiculously long wait times beyond what would be considered reasonable for treating worsening conditions (The median waiting time for special treatment in 2019 was 22.6 weeks, 143% longer than the 9.3 weeks recorded in 1993)
- The steep costs of medical care in the United States can be partially reimbursed by Canadian healthcare (certain conditions apply)
- Access to treatment that is superior, experimental, illegal, or otherwise unavailable in Canada
Clearly, there are serious flaws with Canada’s publicly-funded universal healthcare system… otherwise people wouldn’t be leaving at progressively higher rates with each passing year.
But it’s sad to say we aren’t much better off in the land of the free, because Americans are also leaving the United States in order to avoid the exorbitant costs associated with hospital procedures.
In his book, Dr. Makary tells the story of a man named Henri and how his father Adam would have to pay $150,000 for a heart bypass operation following a minor heart attack:
“Henri and his parents had no way to know whether this was a fair price. They called a family friend who put them in touch with a good heart surgeon in France. Over the phone, the French surgeon explained that the quality of the operation would be the same in France as it would be in the United States. The family timidly asked how much the operation would cost in France. ‘About 15,000 U.S. dollars,’ said the French surgeon.
“Soon after, the local hospital representative who provided the $150,000 quote visited Henri’s dad again to ask about their plans… Without hesitation, the hospital representative dropped the price to $50,000.
“Alarmed at the sudden discount, Adam politely declined the offer and booked his flight to France. But as he walked out of the facility, the hospital representative approached him in the hallway one last time. Desperate to close the deal, the hospital official made a final offer: “Okay, we’ll do it for $25,000.”
“Henri’s family was disturbed by the ethics of a hospital that would try to charge $150,000 for something they would do for $25,000”
Obviously, I don’t have to tell you what Henri and his family ended up doing… this kind of price-gouging behavior is something you’d expect from a used car salesman, not a hospital.
The margins are huge: We’re talking triple-digit percentages and sometimes even four-digit percentages.
What makes matters worse is how the prices for hospital treatments and operations are a closely guarded dark secret, according to Dr. Makary’s book:
“In a study conducted by the University of Iowa, researchers called 101 U.S. hospitals and asked them what they would charge for the same type of heart bypass operation. Only about half of the hospitals—53 of them—would even provide the price. And for those hospitals that did, the average price was $151,271, just north of what Henri’s dad was quoted. The range of prices was astounding, from $44,000 to $448,000.
Did they use gold-plated surgical instruments? No. Was the center that charged ten times more the one with the best outcomes? Nope. Heart surgery outcomes are publicly available. The research showed no correlation between surgery price and quality.1
The analysis revealed some markups to be 23 times higher than what was paid by Medicare (the government’s insurance program) for the exact same service”
Just think about it… patients are shielded from knowing what price they have to pay in advance, and the increased costs don’t even correlate with increased quality of care!
It’s a very nasty game involving hospitals and insurance companies: Insurance companies cover part of the prices while demanding larger discounts, and the higher premiums on health insurance are placed upon the public (on top of “surprise” bills).
Costs go up in order to cover increasing expenses, and there are even software programs designed to calculate exactly how much prices must be inflated in order to meet key financial metrics.
NOTE: Dr. Maraky recommends using HealthCare BlueBook, a service that “collects pricing data from partnering employers who self-fund their health care, reviews all the prices that different patients pay, and uses them to establish a fair price amount”
Now do you see why it is MISSION-CRITICAL to take your health into your own hands?
Why preventative medicine and lifestyle habits are the only way to break free from a broken healthcare infrastructure beyond repair?
Insight #3: Hospitals Are NOT Your Friend
But don’t think for a moment that hospitals have your health as their #1 priority… what the overwhelming majority really care about is your wallet.
And there is no low they won’t stoop to in order to get paid.
Again, Dr. Makary’s book chronicles a very sad story about a small-town woman named Jennifer and her 3-year-old daughter:
“Her three-week-old baby girl became sick and had to be rushed to Carlsbad Medical Center, the town’s only hospital. Even though Jennifer and her husband had health insurance, her deductible was high and they couldn’t afford to pay the hospital’s inflated medical bill.
The hospital didn’t work with her or negotiate. Instead, the hospital sued her, won a judgment, and garnished her husband’s wages—meaning they took money from his paycheck without his permission.”
Jennifer found herself having to go to the hospital for her daughter again, five years later, due to a bad case of the flu.
The IV fluids given were infected, and the child ended up contracting sepsis:
“Jennifer explained to me that the pediatrician documented in her daughter’s medical record that the hospital had caused the infection. Regardless, the family got stuck with a huge bill. Jennifer and her husband couldn’t afford to pay the $2,400 portion not covered by insurance.
Again, the hospital didn’t work with the couple to help settle the bill—as medical facilities often do in these types of cases. Instead, the hospital sued them again. And they garnished Jennifer’s husband’s paycheck a second time.”
Dr. Makary also details numerous stories of hospital employees being SUED by their own employers after receiving bills for treatments they could not afford to pay off… and their salaries were slashed to pay off the lingering debts.
When people have to take on second and third jobs, cut back on basic expenses such as food and clothing, face the consequences of lowered credit scores, and borrow money from friends and family just to foot a medical expense, something is seriously wrong.
As a society, we are more afraid of the cost associated with treating a serious disease than the possibility of having a serious disease!
Myself, the only way I will ever set foot in a hospital is if I’m being treated for injuries following a serious accident such as a car crash or a gun shot wound.
And even then, I’d probably have to be airlifted and not conscious to consent to it happening.
Outside of that one scenario, I AM ALWAYS doing everything in my power to treat health problems on my own.
The only way out is to completely dismantle the modern healthcare industry and create a new system designed for fully optimized health.
Perhaps something like medical cost-sharing could be a viable solution.
Either way, whatever we’ve been doing for the past 50 years has clearly been a monumental failure.
Insight #4: A Physician’s “Bad” Actions Can Go Beyond Financial Incentives
Believe it or not, there are a staggering number of doctors who are surprisingly motivated by the idea of having more free time to themselves.
Dr. Maraky recalls a horrifying experience of a doctor who had a staggering 95% C-section rate when it came to delivering babies:
“The obstetrician on call (I’ll call him Dr. Dinner) had just completed his scheduled office visits for the day. Dr. Dinner had a routine. When on call, he finished seeing patients in his office by two o’clock. Then he would head to the hospital and perform a C-section on any woman in labor, whether she needed it or not. That way, Dr. Dinner made it home by five.
“…Letting labor progress naturally can take hours. No doctor wants to get called out in the middle of the night. Instead, Dr. Dinner used what we in medicine call the “one-hammer approach.” C-sections all around. By 2:15 in the afternoon, Dr. Dinner walked up to Ebony and uttered that famous phrase that nudges moms worldwide toward a C-section: ‘It might be safer for the baby.’
Ebony responded to Dr. Dinner’s nudge and the staff prepared the operating room. If she hadn’t agreed to the C-section, Dr. Dinner had another line he frequently dropped: “If the baby dies, you don’t want to be responsible, do you?”
By four o’clock, Ebony’s baby was delivered by C-section. Per his routine, Dr. Dinner went home in time for supper with his family.
If only Ebony could have seen Dr. Dinner’s pattern, his 95% C-section rate, she would have known the truth: that his recommendation was in neither her nor her baby’s best interest.”
(Without getting into the medical details, it is in the best interest for the mother and the baby to have a vaginal delivery when possible)
As Dr. Maraky pointed out, you would not be able to sue Dr. Dinner as he didn’t break any laws, while having both rigorous documentation and his bedside observations to back up his judgment call.
This story was just one of many examples of how people can be easily fooled by “healthcare speak”: It’s very easy to achieve a near-zero complication rate when you perform surgery on a healthy individual who does not need it.
The uselessness I just described is hardly rare nor is it limited to one type of treatment.
One article I found from Fortune Magazine describes how this observation is also noted with surgery for heart disease:
“If you’re an average adult, you likely know someone who has had a cardiac stent implanted to fight coronary disease. In the U.S., we place such stents in an estimated 100,000 patients each year who have stable heart disease, at a cost of roughly $30,000 per procedure, though prices vary considerably.
High-quality scientific studies show that stents in stable patients neither save more lives nor reduce the odds of a heart attack any more effectively than simply taking heart medicine and making lifestyle changes. But they are profitable.”
There is only one inevitable outcome for the old model of medicine, and that is a complete and total collapse.
Insight #5: The Rise Of “Scientism” Is Killing Our Ability To Think Critically
For those of you who have been listening to my podcasts, you know that I am prolific in my bashing of “scientism” and how people use science as a way to avoid self-awareness and true self-reflection of WHAT IS (inner awareness of the LIGHT of your BEING.
So to clear the air by what I mean, here is the difference between scientism and actual science:
“Science is basically the study of nature and behaviour of natural things and knowledge obtained through them. It includes observation, identification, experimental investigation, description, and theoretical explanation of the natural phenomenon. The Science Council has defined science as… ‘the pursuit and application of knowledge and understanding of the natural and social world following a systematic methodology based on evidence.’“
“Scientism is the view that science is the absolute and only justifiable access to the truth. According to this view, only science can render truth about the world and reality, and therefore, science should determine normative and epistemological values in society. Scientism is often a point of contention is philosophy. Moreover, it is often associated with logical positivism.”
John Romaniello did a beautiful write-up on “broscience” and how we’ve allowed pencil-thin geeks in lab coats to gain dominance over fully optimized bodybuilders who operate on foundational principles PROVEN to generate real-world results over the past century.
I highly recommend you give it a read to understand where I’m coming from.
But coming back to Dr. Maraky’s book, there’s an interesting passage where he calls out the ridiculous obsession with needing randomized controlled trials in order to believe anything is true:
“Where I’ve challenged academic elites is that the randomized controlled trial design of research was developed to test medications compared to a placebo. Thankfully, others have spoken up as well. An entire issue of the journal Social Science and Medicine was recently devoted to it, with many articles pointing to the shortcomings of randomized trials.
Here’s one way to think of it: randomized controlled trials are not the way one should evaluate whether a parachute is effective in saving the lives of skydivers.
Unfortunately, some physicians believe that a lack of a randomized controlled trial means there’s no evidence. That sloppy and dangerous thinking gets worse when the medical community conflates ‘no evidence’ with ‘not true.’ That’s a logical fallacy.
The term ‘no evidence to support’ actually means one of two things: it’s been studied and evidence does not support it, or it has not been studied and could be true. The liberal use of ‘no evidence to support’ has conditioned us to distrust anything not supported by trial.”
If you really dig deep into the literature, you find that observational studies and randomized trials examining the same phenomenon tend to have no significant difference in estimating effects.
Insight #6: Big Pharma Continues To Wreak Havoc On Human Health
Dr. Maraky makes a rather stunning admission in the book about his extremely liberal use of opioids post-surgery:
“For most of my surgical career, I gave out opioids like candy. I was unaware that about 1 in 16 patients become chronic users, according to the recent research by doctors at the University of Michigan. My colleagues and I didn’t realize we were fueling a national crisis. But today opioids are the leading cause of death in America of people under 50 years of age.
As a medical student and surgical resident, I spent thousands of hours learning how to diagnose breast cancer, how to cut out breast cancer, and how to recommend chemo and radiation after breast surgery. But at no point was I taught that the way we liberally prescribed opioids was creating an epidemic of addiction that would eventually kill more people in the United States than breast cancer itself”
Once he saw that his father was able to recover from an operation using nothing more than one tablet of Advil, instead of the usual course of 60 opioid tablets, he opened his eyes to the possibility that pain can be managed just as effectively — if not more — with non-opioid alternatives.
And having seen just how devastating the opioid epidemic has become in America, Dr. Maraky finally realized the magnitude of his mistake (and that of many other physicians)
“My dad practiced hematology: the science of blood disorders, leukemia, and lymphoma. He explained to me how we got into this mess. For decades, cancer patients were undertreated for pain.
But then things swung to the other extreme when pharmaceutical companies sold us on the lie that opioids were not addictive. Then pain became a vital measurement in medicine. The consumerist pain rating system elevated pain as a leading quality measure, overshadowing actual medical quality.”
I’ve railed against Big Pharma for most of my adult life and the fight against this malicious industry has never been bigger.
Whether it’s attempting to replace tried-and-true fish oil with an inferior product, suppressing therapeutic peptides, or buying out know-nothing health influencers to promote REAL misinformation, they have their greasy hands in every facet of health.
Reminds me of an unnamed pandemic we’re going through right now and the “products” they’re pushing to create the illusion of solving it. 😉
Long story short: You need to forcibly take the reigns, becoming the scientist of your own health instead of letting Big Pharma do it for you.
Insight #7: Preventative Lifestyle Measures Are ALWAYS Supreme For Fully Optimized Health
My final takeaway from Dr. Maraky’s book has to do with his own self-realization that living a fully optimized lifestyle is the ONLY thing guaranteed to have long-lasting positive effects on the quality of your life.
And it all started with a medication he had been taking for a long time:
“I heard the anchor announce breaking news of a medical study that found some heartburn medications like Nexium increased the chance of stroke and kidney failure. What? I sat straight up. Not only did I frequently prescribe the heartburn medication Nexium, but I was taking it myself.”
“My love affair with Nexium began when I told my primary care doctor that I sometimes get heartburn when I perform long operations. He wrote me a prescription for Nexium, a medication I had known personally for years and prescribed to thousands of patients after surgery. I told patients it was safe and would perfectly cure their heartburn the majority of the time.”
Shocked by this news, he visited a fellow gastroenterologist (a doctor who treats digestive disorders) and was sarcastically reminded of something called “lifestyle modification”.
Nevertheless, he followed his colleague’s advice and the outcome is exactly what you would expect:
“I reluctantly agreed to try the lifestyle modification protocol. I stopped eating a bowl of cereal before going to bed. I removed the jar of peppermint patties I had been dipping into at my front office desk. And I stopped buying processed foods altogether in favor of whole foods.”
“My heartburn was cured, this time without medication. With little effort, I had successfully avoided the risks of a drug, cut out the daily routine of popping a pill, and saved a lot of money for me and all the people paying premiums to my health insurance plan.
In total, I saved myself $480 a year, and I saved my insurance plan $1,440. Sure, the nonprocessed foods cost more, but net-net I came out on top. And I felt great. My own experience was a powerful lesson—getting off lifestyle medications can improve health and lower medical costs.”
Imagine that… a Harvard-educated doctor sitting at the echelons of medical success who needed to return to the basics!
Now, just think about where you would be if you did the same thing:
- Focused on measuring your inflammatory markers to avoid contracting age-related diseases
- Supplemented with Golden Age agents such as Metformin and therapeutic testosterone
- Exercised via intelligent weight training and frequent cardio
Sounds a lot better than relying on harmful drugs like statins to erase years of unhealthy living, if you ask me.
Leave the sickcare model of health and never look back — your body and your mind will thank you for it.
CONCLUSION: The Healthcare System Is More Broken Than I Possibly Imagined
Dr. Maraky’s book “The Price We Pay” is a captivating insider’s journey into every dysfunctional cog within the machine of modern medicine.
That he was legitimately shocked to find what he did speaks volumes about how bad industry practices have been allowed to start, grow, and mutate into monstrosities with no solution in sight.
It will take tens of thousands of unaware physicians and hospital leaders to become aware of what’s going on, along with hundreds of millions of Americans waking up, to put a full stop to the predatory practices described in Dr. Maraky’s much-needed expose.
I was only able to cover a small fraction of what he uncovered… if you want to dive deeper than I did, I highly recommend you purchase a copy of the book and give it a serious read.
I want to end this article with two important quotes that I feel best describe the battle ahead of us all:
“As I traveled across America for this book, what I saw was not a Republican/Democrat divide or a conservative/liberal divide. Instead, I felt a widespread sentiment among low and middle-income workers that the system was stacked against them, controlled by the powerful elite who make the rules.
Honest, hardworking Americans feel helpless against a ruling class who use power and access to their favor, creating fine print and laws to give themselves the upper hand. The folks I met often pointed out how the process of appealing a hospital bill or an insurance company denial was too complex and utterly exhausting.
A man from Georgia asserted that we have two justice systems, one for the powerful wealthy establishment and another one for lower- and middle-income Americans.”
Last, but most certainly not least:
“Health care is perhaps today’s most divisive, territorial political issue. But many of the needed solutions are not partisan; they’re American. We are at a pivotal juncture. Spending on health care threatens every aspect of American society.
The time for commonsense reform has arrived. All of us can play a part in driving badly needed reforms, both in the marketplace and in the policy world.
As Margaret Mead said, ‘Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.'”
Raise Your Vibration To Optimize Your Love Creation!
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