this is 90 minutes. >> hello everybody and welcome to our second conversation on science munication my name is dan fagin emma professor of the recording program in the communication workshop. you are here at the arthur l carter journalism institute at

nyu. we are pleased that c-span is here with us as well as her usual live streaming and we been encouraged to watch the live stream and tweet questions using the # calvary combo. it is a real pleasure to have marty ma mark they have found wo great journalism and great reporting. while also accruing very large audiences. we have a number of people in the room who would love to do exactly that. as well as people who are joining us online. our host as always, is robert who is the wall street journal and a resident here at the carter institute.

in moderate the discussion and do the introductions so take it away. >> thank yothank you, sir. our purpose is to dig in to how we report the story of science and medicine. and to do that, we bring together the best in science journalism, the best in science communications to explore a new research reaches the public. what can journalists learn about reporting from scientist? what can scientists learn about sharing their work from those who cover them closely. what to their differing perspectives tell us about how the news of science is changing? how it reaches the popular culture and how journalists and scientists and doctors might see the whole thing a lot better than we do now. to repeat, these conversations are sponsored by the foundation.

this is the second innerspring series. looking forward on march 27, we bring together producers to impact the trade secrets of science videos that reach millions of years. on april 24, we are going to probe coverage of behavior and misbehavior with psychologist and reporter and podcast are alex teagle who podcast has been having a million downloads frequently. tonight we consider a public matter of life and death. the hazards of american healthcare. bad doctors, medical mistakes,

crushing costs, and a lack of transparency that too often shields them. were going to conduct a media autopsy. as we go, i encourage you all to offer your questions. use the microphone please so those of us were watching online can join in and you and the invisible beyond their integer questions to us using the #. with this conversation tonight we are joined at one of the most influential voices in medical coverage. laura beil is a reporter in the order of the six part podcast doctor death. it's a tale of willful medical malpractice which is been downloaded about 30 million

times. joining us from texas tonight, laura is a veteran award-winning freelance health and science writer and most recently she won the 2018 victor cohen prize for excellence and medical science reporting from the council for the enhancement of science writing. by her side is one of the nations leading healthcare critics. surgeon and health policy professor from john hopkins university. he is unaccountable of what hospitals will not tell you and how transparency can revolutionize healthcare. it exposed the medical culture that leaves surgical punches inside patients. and amputate the wrong leg and overdoses children because of sloppy handwriting. his forthcoming book, which i'm proud to have a copy of right here. it's called, the price we pay. what broke american healthcare

and how to fix it. it's coming out in september. forbes calls this a luxury for every american in business leader. so each of you is conducting experiments in the public understanding of science and medicine. i want to treat you a vers firs. i want to ask you a little bit about your work with doctor death and i would begin by saying this is the strangest assignment ever heard of. the story was already well recorded. the doctor in question had already been grabbed by the power and brought to justice. you are given this assignment by podcasting company and you had virtually no podcasting

experience. how on earth did this come to be? >> a completely fell in my lap one day. i am a print reporter and i was contacted by a company that makes podcast, and they had read the story of christopher dent from up listener of a previous podcast called dirty john. which was unsuccessful and they did that for the lawsuit will times. a listener from dirty john e-mailed them and said have you heard of christopher dent? than not. even though the story got a ton of media attention locally in the dallas area, it had not gotten a lot of national attention.

>> -- he was a back surgeon and as you might get from the title the podcast, he killed people. >> yes to people. he had less than 40 patients, more than 30 of them ended up injured in today. and so they contacted me to tell the story about what happened. in my first reaction was, i'm a print reporter, i don't know anything about telling an audience a story, i'll know a lot more now than i did then. and that was only the first challenge a train to do this. a part of it was doing stories that you had to allude to how to tell stories of things 30 no. tell a story the 30 author and how do you start out, for them

hefromthe first five minutes ane could google and find out what happened. it didn't have a suspense that you have with some podcast what you don't know what is going to happen. one was willing to take a chance on me and i was willing to take inches on them. i had not listen to dirty john. so we had this trust in each other to tell the story. the ended up being great and supportive and they're not a journalism organization. >> another not. >> which i also was a little leery. they were good journalists and sense i did my part, they've now worked with a lot of journalists and then not a journalism organization. they don't pretend to be journalism organization. in the respect and support the tenets of journalism that tell a good story.

>> i just want to make sure anderson quickly. this is not just like a job, didn't ask you to go to google and cover with 30 been cover. they ask you to rerecorded from scratch is not right? >> yes it was clear given the scope of the story. i'm a freelancer, so if you're a freelancer, you don't get paid by the hour. they were asking me too commit months and months of my time to telling this dory doing it in a format that i've never used. i did have one experience telling an audio story from this american life, i done one episode a few years ago. again, i knew nothing, i learned some from working with them because this american life, there's a good at telling audio stories. i learned a little bit from that. that was a 30 minute episode. this was hours of content. >> how did you read cord this?

>> the recording itself was the same. in terms of who you go to resources, where you get documents, that is the same. reporting is reporting no matter what platform you do it on. what did change, is how you interview, how you ask questions, that was different. in the recording process itself. i signed off with thinking it was going to be the same process that this american life was where there was an audio producer there doing the recording. so i would do what i normally would do someone else was doing the recording and all would be well. you can imagine my tear a week after i agreed to do this. when i get an e-mail that says okay here's the fedex tracking number for your recording

equipment. i and never used any recording equipment other than my phone before. >> give us a quick thumbnail for those of us who have not heard parts of this podcast. i highly recommend it that you do listen to. give us a little thumbnail of just about a bad doctor can be. >> that is a good question because that's what i really had to establish. it wasn't that the first episode is pretty tough. it's somewhat graphic to describe because i thought to understand the story you have to understand how bad a surgeon that he was. so he was making mistakes that surgeons never make. for example, he was a back surgeon so he was putting

hardware into a patient's back and it's supposed to be screwed into the bone and into the hardware itself because of together. so in one surgery, he put a screw into a back muscle. and grid into the woman's muscle. he left a sponge inside one patient. i had doctors tell me that he didn't even seem to know basic anatomy. he had this habit of cutting arteries on patients. which he did several times. one of his patients who died actually blood to death. he was so bad that one dr. who came along behind him and saw how bad he had done thought it had to be in imposter because no one should have finished medical school business back. someone coming up the street

could've done this. that's how terrible he was. >> i'm going to ask about this, but i wanted to include with a little bit here, how could a surgeon as dangerous as you've described, how could that doctor be allowed to harm dozens of patients before he is stopped? are the boards and procedures and reviews? >> that's a critical question on the podcast. it became clear that within very little reporting that this is not a story about christopher dent. that's the thing about the podcast. it's not a story about him, it's a story about the healthcare system. how he operated for almost two years in dallas and he was passed from hospital to hospital and there were safeguards that failed at every turn.

that is a central question of the podcast. how does this happen, i've described it as unlike some crime podcast, ultimately he was convicted in a criminal court. this was not whodunit. you knew who did it from the first podcast. but it was a wife. how did that happen. >> how did this happen. you written a lot on this topic, and the academic and also in the general press press. in your first book is accountable and looking at this question of medical error and signifies it. could this happen with any other troubled doctors is or something unusual about this case? or is it a problem that many hospitals wrestle with in your experience? >> that's a great question and thank you for having me here

it's great to be here the reason i love the doctor death podcast so much is that it tells a broader story of what is wrong with the accountability within the profession. first of all, those doctors are good people. they always try to do the right thing for the vast majority of the time are trying to do the right thing. the one struggle that those of us who write about quality and safety we evolve together as writers and researchers in parallel has been how to prevent sensationalism? you don't want to create hysteria out there. even sometimes the publicist behind the books or the editors that throw the titles on the articles in the newspapers, all

of a sudden you're the most sensational thing out there and they were seen as creating hysteria. that is always been a challenge. even in the write up about unaccountable referring to doctors kill people with sloppy handwriting. that's ten years ago, we don't use handwriting anymore. >> we have changed to electronic health records. the handwriting is so bad. >> we have a whole bunch of problems in the handling. patient -- there's a be bermuda triangle and accountability. the hospitals would say it's a state medical board has two polices . . .

the doctors start talking and once they start talking and a drink or two is in their system, they start to be very honest, and within an hour or two they start to unload and tell you witthefee-for-service system tht measures us and pays us by the most spine operations is driving all of our partners to do unnecessary surgery and essays just this week it dominates the

field and isn't the one off if you look at the number of prescriptions that we prescribe ten years ago it was 2.4 billion. in ten years of double. wa double.we have a crisis of appropriateness. we are seeing patients in segments where they are demanding thing. it's one that gets little attention and is one of the biggest drivers and the industry is now the number one industry in the united states.

>> in your book on accountable you make the point of discussing how difficult it is for us as the practitioner being practiced upon to get access to treatment cost into the incident rate and complications. i saw a testimony of yours in congress a couple of years ago where i think you said there was something on the order of 150 different registers but actually track the patient outcomes and get almost none of those outcomes are made public. this is a conversation about bad medicine but it's not just the problem of bad medicine. it is how come this story which has been told so often because

forgive me you are not the first medical writers i know you know to come across the bad doctor and you are not the first doctor who's called attention to this. what is it that keeps us in a loop is it just a transparency problem? >> one of the complicating factors if medicine is an art it isn't like flying a plane. you want to tailor your treatment to an individual patient and their goals. it isn't a recipe. if we measure outcome is, they've got to be sort of factored into the complexity of the patient and their unique situation and their social situation and how sick were they and that is what we call the risk adjustment that is never really perfect. we have used that as an excuse to say let's not do any measurement and bite of a

measuremenby the waymeasurementh any stakeholder. no individual stakeholder in medicines as we need to measure every single observation that's ever been done or that will be done with this new device. when the robots came out, why were we not measuring the outcome of every patient that had the surgery with a robot from day number one but it was introduced if we did it wouldn't have taken ten years to blow the whistle. it's a sometimes dangerous and has no benefit and a whole host of operations and it's costing a ton more money than the standard treatment which is pretty good. we were not measuring our outcomes 99% of the outcome today is still unmeasured.

the instruments that we do have are completely inaccurate and misrepresented. or you look online and some of these reading tools. so, consider the vast majority of the patients ended up paralyzed or dead in at 4.5 stars on health grade. one of the striking things about it they all thought they were researching him including the very last patient. he looked online and searched every tool he possibly could and found the patient testimonial he

thinks from what he can tell and from what we as patients can tow it something different than you or i would do. he goes into surgery with them, so as to not. >> so you are reporting this and other people have reported this and you go to the hospital and what did they say? >> of that hospital has closed and the other hospitals in my

story or not talking as you might imagine. of the reviews, some of them were fake and a lot of these online tools i think are a disservice to patients because they don't know that they can be manipulated. they don't know that they can be scrubbed. how did you proceed in your reporting to make it fresh what

kind of things did you do is adjust the actuality of the voices on tape that made this such a compelling podcast? >> i had to decide m.i. going to tell if assuming that people know how it comes out. i wasn't going to be attention to anything else how the safeguards did it work and every safeguard they all broke down.

he was an obvious hotwire i saw a paper that worked out for medical errors like the third leading cause of death in the united states. there are a lot of great factors out there. we are not trying to malign them as a whole but figure out why is journalists and public intellectuals, policy people we can somehow get the system to respond in a useful way. you don't need to defend. we get it. we all have doctors we like and trust and respect. don't perk up your own work.

i did make the decision but i started listening to a lot of podcasts after i got the assignment and i didn't have a lot of the tools other journalists telling stories have. for example, there were not going to be any plot twists. the guy that you think is guilty, he really was guilty. there wasn't going to be a surprise ending or anything you a lot of podcasts have that keeps them going. it's a story that you already think you do. so, i knew that the one thing i had to do was trust. that is the great thing that i had going for me the whole

success of the story as you might think you know the story but you really don't know so i was digging out a lot of stuff that nobody had ever heard. stanek and giving it while you are teaching yourself to be a podcast or. >> i still don't know. >> to flip it around a little bit, you are trained, very successful but that is an occupation that is kind of time-consuming and i should have wondered, number one, where you find the time and energy to write three books, two of which i mentioned that we were talking about earlier, and how did you develop the reporting tools because one of the things that is interesting to me is that it's not a kind of spoken from

on high policy voice. this is a love on the ground reporting. what led you to play? >> i realized there is a lot i don't know about journalism, and it's a moment where an insurgent says i have no idea what i'm doing here but i've had that moment. i've been talking to so many journalists over the years other stories and research and i was fascinated by the fact you can have a two-week deadline on conflicts of interest or fraudulent research 100 times faster than we can do in a two-year study that goes into the peer review and journal that hasn't processed but by the time it comes out it is outdated and they've already passed a law. i reached out to marshall allen

who is a reporter, very seasoned reporter who has done several pieces on patient safety and medical errors. i asked him would you edit this book for me. i discovered in one town in america that the hospital had sued about half the people further unpaid medical bills that take them down and garnish their wages. there's $300 in savings on hand and when there's been a surprise bill from the doctor or

hospital, that is catastrophic. even though it killed me and i spent countless weekends flying the towns in america, it was at the time we were done with the book and in new york and baltimore he would call me down and ask if you travel to new mexico yet, you need to get down there on the ground. we have all of the records, we have the interviews, he's like you have to get on the ground. i have cases on monday, surgeries. seems like you have to get on the ground. so i met one woman who invited me to her house and she is a single mom with two kids and i couldn't believe the conditions that she was living in.

she told me the story of how her car was in the shop and she couldn't afford the bill to get the car out of the shop so she couldn't get to work. she worked two minimum-wage jobs and has been devastated by the bill when her kid went to the emergency room. it is based on the weapons pricing and shouldn't have exceeded $600. i could only get that on the ground. i learned so much on the ground visiting how an air ambulance company gouges patients. talking to insurance companies, talking to doctors. i am concerned to be so convinced it attracts good people that we hav but we have e incentives and the system is messed messed up. when you talk to people they will tell you how does a business by health insurance?

there are health insurance brokers. i didn't know that this profession existed and they have their own conferences. i went to a conflict and yo conu get a drink or two and they will tell you our system is messed up. we get paid giant kickbacks from health insurance companies so we don't always present all the options to the businesses and they are getting ripped off left and right we are making a killing and it's wrong and it's the untold dirty secrets. i was able to do a deep dive on how the health insurance sold to the businesses and give them guidance on how you should buy health insurance for your employees and promised benefit plans and we have so much stuff that was like we've got to tell somebody. >> that's the thing, you've got

to tell somebody. nyu trains a lot of scientists who want like you, to reach out to the public directly. maybe they have issues they care about and they are all a little nervous about doing this because there is a widespread belief that there can be a professional cost to putting yourself out as a researcher in either this is a show off or you are really telling tales and revealing the dirty secrets. so i'm kind of wondering you are not a journalist, you're a surgeon. the work by referrals and have hospital privileges. if a network. so does this cost you anything, is there a backlash that you keep going off about this? >> i think anytime you read a book or even an article, it will

be perceived by some as self-promotional and especially with the media essentially generalizinsensationalizing thei think there is a little bit of courage that it talks. i was talking with a doctor, prominent u.s. surgeon. they have a borderline indication and if they have a very favorable type of insurance, he said this openly and my friend to come it is weighing on his ethics and consciousness. so he's hearing this and struggling with it and i'm thinking say something. talk to the department chair.

i think one of the reasons we don't have for example some negotiated price transparency is paying commonsense reforms is almost everybody's picking up on health care today. all the experts and the big panels and conferences they are beholden to some giant special interest. they either work at a hospital, one of the three biggest lobbies in the united states, beholden to insurance companies. i know doctors that come up to me and say i totally agree with everything you're saying about the inappropriate care i see it all the time and i say why don't you say something and teach this to your students.

who's going to challenge the special interest. when i met jennifer in new mexico she is getting hammered by the system and getting crushed by the medical bills. people are getting gouged one in five americans has medical debt and collections. that's not who we are as a profession. he wanted every kid in the world to get it and didn't want money to get in the way.

our profession is getting contaminated. >> here you report it in quite dramatic detail. the medical community about the stone walls how did you get it to untold? >> my inbox i think is still on fire. i got so many e-mails from people who said i can't believe this happened to i can totally see how this happened. i would say if i had to group a

majority of response is a would have to be nurses. i heard a lot from nurses who said it's hard when we because of the power imbalance, it is hard when we see a doctor that t we don't think should be operating because a lot of times it is the surgeon and then the nurses, surgeons operate by themselves and a lot of times they have a huge dilemma. i heard from a lot of nurses that said we've been talking, we can't stop talking about what we would do if we saw this and we've had a lot of lively discussions about how if he could speawecould speak up whatr jobs if we did. i've heard from other doctors who again say this prompts a lot of discussions because the surgeons who are pushing back

say themselves they had a lot of pushback at the time from their fellow doctors like why don't you let this go, why is this your problem and other doctors policing themselves. i've heard from medical schools. residencies because remember he got out of residence and he was operating out of a residency and one of the unanswered questions of the podcast because they wouldn't speak at all is how did he get out of residency. this and ho bad habit he finisha residency problem. a lot of directors said how could this happen. really all walks of the medical community by gratifying things of telling a story like this is i can tell you there's been a lot of soul-searching and i will tell you one of the most moving stories i got from a doctor, an

anesthesiologist and i don't want to give any details that would reveal anything to geographically that he had witnessed a bad surgeon and he knew he said this particular surgeon had been responsible he fought for patient deaths like five or six and now that surgeon was at another hospital and he said i can't tell you how much your podcast affected me because this surgeon was so terrible and i knew he was terrible and i never had to pick which to say anything and hearing these doctors who did have the courage he said it's affected me so much i've had to retire because i cannot practice any more because i am so guilt ridden. >> said, you used to work for the dallas paper.

with a podcast, it's a one off more or less. you've told the storyou told thn you walk away. at the moment when you are getting an awful lot of great tips and follow-up material that anin another universe or on a different day would have been the source of many follow-up stories and sustained reporting perhaps to address the problem that we all agree is a national issue of course that expresses itself as all things do, what do you do with all of this wonderful follow-up material? >> it would be depressing if i didn't know that this was uncommon the number of messages that i've received from people saying you should really look into this doctor.

>> so what did you do with that? >> in some cases it's been so bad i've contacted local reporters after papers because i can't do another six part podcast about another bad dr. so i've had conversations across the country with local reporters saying here is a tip from somebody you should keep an eye on this doctor but it's hard because local papers as you know are struggling and don't have the manpower to do this but i've had several conversations with local papers about doctors in their communities i just want to put them on their radar because i can't follow-up about, you know and i don't want to actually do another story about another bad surgeon. i think that should be the job of someone locally and i have an

advantage because that was in my backyard and it would be hard to report on one particular surgeon in cleveland or in a city that i didn't live in or have local contacts and couldn't follow-up or be on the ground and drive over to someone's house. >> it seems you do a big investigative project and shake the trees and you are kind of got into position to make use of the fruit that falls. >> but i try to pass it on to people who can. >> i think we have a question here. >> this is from someone on this or who wants to know you either did to the fact you are a freelancer and taking on the project wasn't necessarily easy. how do you make freelancing work for you day-to-day? >> that is a really good question. freelancers ask that of themselves all the time.

in terms of making the call to do the podcast, it wasn't easy in fact freelancers have a terrible, everybody has their horror story of work they did that they were not paid for because they did work for a publication and then it went out of business and they did and get paid. even magazines that are brand name that you recognize sometimes they declare bankruptcy and give them that it was a new company i haven't heard of and they were asking me to cut meant a substantial amount of time, i said this is all well and good but i want to talk to your ceo and i want to know how much money you have in the bank. >> you are a practical person. [laughter]

>> i said i want to talk to your ceo and tell me how much money you have and i want to know i'm not going to do all this work and a few months and you are going to say our company doesn't exist anymore. to their great credit they said okay. i talked to the ceo and founder of how much money they have and i signed onto the project but it's hard. i didn't come up with this but it's a great advice when you are freelancing you want to rule, and i've heard different numbers but let's save the 5-1 rule for freelancing if you are doing fine stories you want the one you are really passionate about the one that you really enjoy and want to do even though you may or may not be getting enough money to live off of and then you've got the four others that

you are doing because your family has to eat so you've got the one you are going all the time that you are passionate about and really enjoy and you just supplement out and diversify and do assignments that you may not enjoy and that's how you keep it going but i would recommend you want to keep a variety of paying customers along the way so if you lose when you are not high and dry that the issue with the podcast if i lost a particular when i was completely screwed. >> did you negotiate movie rights and things like that? there was an hbo thing i think. >> i was completely new to an audio contract so i didn't do as much negotiation because i had no idea about any of this.

i didn't negotiated much. it seemed reasonable to me and i want to say they were not up to completely take advantage of me either. i was new to them because when they did this they worked with christopher guthrie, reporter for the la times so they pay his salary and they didn't have to negotiate with an individual writer so it was new territory for them also. i didn't do much negotiation so for example, doctor death is going to be made into a movie and i don't get any of that but i can tell you with contract number two -- [laughter] >> it's interesting because there was an air of their magazine stories were kind of picked over by one of the producers very heavily and podcasting has become the next source of major tv.

>> d. have a question? >> i do. i'm ready. so we have been talking a lot about what journalists always do which is they look for the compelling examples and try to show that they are part of a systemic problem. one thing we are really bad at and it's hard enough to find the example that we are even worse at writing about the policy, dick picture healthcare. this might be totally naïve on my part, but it feels in the next few years we may be moving towards a very large expansion of medicare maybe something single-payer and we could be writing about that but i think the struggle and one of the reasons it isn't clear what that

would mean for quality of care so can you each talk about that a little bit, what doctor death have had a harder time killing his patients if the incentives were different and we have an incentive type system and the same for your explanation. >> i can tell you in this one situation, the question is how the income stream affects the care. i was very conscious of the fact and reported that actually in the story one of the things that kept propelling and enabling him to get a job is that he was a neurosurgeon and they make a lot of money for the hospital, and i am of the great quotes i talked to a neurosurgeon in dallas about that too wa was terrific s

been around a long time and i said why did hospitals keep hiring him even though there were all these red flags and he said because i am a cash cow. he said that exactly. so to answer the question i can't say single-payer would have stopped him sooner but a lot of the reason he kept practicing how to do with the fact that there was money to be made and he could bring in a lot of money. >> you've given it a lot of thought to the prescription. what would you say to answer the question? >> it's a great question he brought up and i would say to a group of rising journalists and healthcare i would point you to

a few healthcare journalists that have done a lot of work to figure out who is writing about certain things and who has new ideas i would say there's about four healthcare journalists that have taken so much time to get to know me and research. they visited our research group. we've had long conversations. when i put out an idea they will run it by the other stakeholders and test it and i think it is those deep relationships where the journalists come up with a goal and so it is on the groundwork and building relationships. one of my colleagues at johns hopkins i think is the world expert on drug pricing. he's got great ideas. there's a small group of journalists and i love seeing people interested in journalism. we need more people.

but we do in medicine, we have hundreds of thousands of writers and researchers writing in a world to see two or three or five year lifetime and then journalism that is very fact checking but it's one week or one month or six month turnaround time and affects policies and we are talking into separate silos. there's a bunch of us now in medicine. they are trying to merge that divide. one of our biggest struggles is the traditional editors of the medical journal. it's the internal commotion and medical schools where you may get promoted if you publish certain gerbils. we had a back and forth with one of the top editors to number two and number one in leadership

watering down our peace and rewriting individual sentences. taking out a sentence that says congress should repeal a 1987 amendment that makes pharmacy benefit managers exempt from the sherman antitrust act. that's the policy outcome. they said we don't like to recommend legislative action and they cut it right out even though it is a sort of commentary format and the reason i'm a little afraid to say this with you in public with the cameras on we are all afraid of getting blackballed. i'm against it i don't care what people think of me and we will find a place to publish it if the leading journals don't take it that we feel we have to write in a certain way and it hasn't changed in 100 years. can we say we can talk to the public we don't have to do it in this robotic format and by the way hardly anyone reads these things we can write in "the wall

street journal" that's where we put out our research. i've literally told our team this piece on hospitals suing patients is going to be coming out. if the medical journals don't take iforget we will take it stt to the american people and wall street journal and "new york times." so, thank you for doing journalism. if we had more healthcare journalists, we could have more accountability around one fifth of the u.s. economy. there's an unlimited amount of stories just talked to the doctors and surgeons. >> thank you. i am a new reporter and i'm interested in exploring medical issues and healthcare, where would i look? with stones should i be turning over? >> of the smartest health policy minds and he will say

yes. i can't speak for him but our colleagues have great ideas. they've been on the ground. they have feasible ideas not just pie in the sky. medicare just released demanding more transparency into some of the stuff that's come out of the writing we have demanded the claims data saying that taxpayers pay for it and deserve to see it. we now have data on the physician process patterns and we can tell which doctors have a practice pattern that is extremely dangerous. when i researched the data and we could see the name we think holy crap what do we do with this and we're asking the question right now. no one has come to look at the individual practice patterns. who brings them back more than

50% of the time to read and size it they have the names. what do we do with it? been looking for healthcare journalists to write about that and the other 400 practice patterns we have in the national data. the doctors need help and accountability so let's start in a civil way that if they don't respond, maybe we talk about sending the names to the professional society to say just so you know here are the top ten most extreme doctors in the competition practice pattern that we see in the medicare data and we encourage you to address this with them and create some accountability. >> i have another question from twitter. we are asking about journalism for the truth. "the new york times" is waging a war on trump and the premise of truth. what is the danger of defining what it is in a particular situation?

>> journalism has a great tradition, incredibly noble tradition and i know so many journalists unfortunately that are out to take trump down. thethey allege that personal see of patriotism they feel get into their writing. i've got to be honest with you i met within a few weeks ago and the secretary and the head of cms all separately and have been so impressed with the responsiveness to some of the new ideas we've put out there. the pharmacy rebates, it's not a rebate, it's a kickback to the middleman. they call it a rebate like it's a nice thing. it's a kickback to the middleman. we explained it, they got it and they were on top of it and announced no more kickbacks they

want 100% of those so-called rebates to go directly to the patients who exhibit the middleman taking money out of the system. system. we'll see if it passes the rules and legal challenges that they are listening and they are doing some good stuff so there is good and bad and when we see some of the good announcements i know too many healthcare journalists that are saying basically this makes him look good as we are not going to cover it. i see the bias. "the wall street journal" just this week said the administration is going to push for total transparency of the negotiated prices that are paid at that amount from insurance companies and hospitals, totally lifting the veil on price transparency would create intensive competition and cut waste, lower premiums. not one wall street journal article thank you by the way, they covered it but it's like major news. it's gigantic so something to keep in mind.

>> do you see a difference between facts and truth? >> no journalist that i know i don't think would willingly report anything that's wrong, lakewood and set out and do a story with an idea that what they are reporting isn't right or that the facts are wrong. the trap i can see and that i do see is journalists falling into the trap of their own confirmation bias. >> i wanted to ask about that. >> journalists who might think in their head i know you get a

tip on a story and think this is it and therefore you find the facts and the individual facts might be true. i don't think any individual journalist would report a fact that is incorrect if they know that it is incorrect, but you can put the facts together and see the facts that support the narrative that you already believe and feed into that and you publish your story and you would have a story that would be factually true, the individual might be the overarching truth might not be. i don't even know if journalists realize that but i can see and i do see and i'm sure we have read stories like that where

journalists are not constantly asking themselves what is an alternative explanation for what i'm seeing, every journalist, if a person falls victim to their own confirmation and that is what i could see happening. individual facts would be true and i don't know if they would report facts that are not true that i could see them being pieced together in a way that is not true. >> it's a sort of pack of journalism. >> it happens when they might not ask the hard questions are in the early days of robotic surgery you want to report the story so you report on the other side something that may or may not be true.

i can't see a journalist willingly reporting something that isn't true but i can see them being blinded by their own confirmation. >> often times the difference between a policy person that you are out doing journalistic thing talking to people at health fairs you are confident in your policy judgment and i think, i don't want to speak for you but we are trained before they are trained not to do that is somebody else's job to come up with a solution so you didn't really answer the question so i would like to bring it back. our the things we are talking about, these systemic walls made

of the costs you are passionate about, are these baked into the system and if we change the system to use the example forward, a single-payer model with those problems disappear? >> i am from washington, d.c. so we are good at not answering questions directly but i would say here's the problem single payer is. attractive especially right now because it cuts him off of the middleman out. the pharmacy benefit manager kickback from all those things get eliminated instantly. it's attractive right now with record levels of waste. ten years, 20 years and come everthen comeevery country in tt have adopted it invariably cannot resist a tightening of the belt a little more every year. you go down the road and it's a massively underfunded

infrastructure we've already seen it with medicare. every year cutting a little bit more and a little bit more. the middle of the nigh night noe up someone's appendix at 2 a.m. alf. 2 a.m.all kinds of difficud get paid $230 or something like that. that used to be a thousand dollar case but every year it gets cut. i don't think medicare for all ithey care for allis a lasting . it's a short immediate appeal but over time with me give you a million times better alternative to medicare for all. make trades to the price transparency including negotiated prices for all services totally transparent and let competition eliminate the waste in the system that's why i wrote the book the price we pay because i heard so many people in their professions and medicine, their job in the

healthcare industry say my job is a total joke if we had fair competition i wouldn't even need to exist. health care became the number one business in the united states. that isn't something to be proud of. record rates of doing things. i don't think medicare for all is a real solution. we need price transparency. the administration right now but one article they are considering total price transparency so you can see the real price and not a jacked up artificial price is 25 times higher than they would take from an insurance company for the same service. it's a joke going on and it's on the american patient jacking up the bill and having a secret deal. if you go to a restaurant there is not a menu for you and you

and minority and person that works for this company and special interest. there is one menu and if we had that for healthcare, people could shop. >> i wonder if people are aware if people think better to get the medicine operates under the rules of capitalism when it doesn't because i've heard this argument we need to make the market forces to popular theme and i don't know if they realize it might have the illusion of capitalism but it does sound really. how much awareness do you think people have. >> more and more thanks to health care journalists like sarah cliff and others writing about the absurdity of a 40,000-dollar rabies shot and

stories like this. right now the price transparency train has left the station with tremendous momentum. the american people love it. who doesn't like transparent that right now there is an attempt to hijack it with this argument. people don't shop based on price. few people look at the prices and when they do they think the more expensive thing. that is a distracting conversation because even though only a fraction of people would use the price to shop, proxies use the price, health plans and employers who are shopping on your behalf. insurance companies are scoping the dissenters use this comes with the proxies use the prices and we are hearing this argument that is an old argument of study you show somebody that price and they are not paying they pick the most expensive thing.

the average deductible in the united states is like $5,000. people are starting to pay and some people look at prices and that will drive the market to change. then the proxy will drive the market to change so don't let anyone ever tell you price transparency isn't going to work if people don't look at prices. that's a distraction. >> if he wen you went back and d they have agreed story i want to do a podcast on price transparency, would that have been? >> it depends. you would have to find a way to tell the story and this is the e challenge about other leaders would have to find a way to talk the story that makes it relevant and engaging for people. marshall is a master at being able to tell policy stories in a way that makes them completely

engaging to people so i think yes it would just depend on how you tell a story and one reason journalists don't do it more, it is hard to do this and i think also still, a lot of journalism, with endless but it's still happening, they don't have the resources, but i'm come of the ability to tell the stories of individual patients and how they are affected city answer the question guess it just depends on you would have to figure out a way to tell it in such a way people will go past the first 15 minutes and not think it's boring. >> is that a theoretical question because if she wants to do a podcast on the book i'd be excited about that. >> it's not a theoretical question in the following way.

as we saw at the beginning of ts is a much told the story. there is no secret that america has a problem and healthcare system with cost and medical error and these are things that articulate policy analysts and brilliant medical journalists have discussed but we are still in the nation and the train pulls out this band was to single-payer or if it's the state board certified surgeons need to be performed we seem to be stuck and i find it curious because every journalist wants to change the world and free health care policy analyst wants to change the world. it's curious to me why this seems to be so intractable.

>> i can't answer that. i'm not a policy person. i don't know. i'm telling the story to get things to change but i'm not in a position to make things change, so i don't know but it's a good question i can't answer. >> what we are seeing right now with an playewithin players fedh traditional ways of doing business they are doing direct contracting based on values to hospitals and we are seeing bundles moving away from the fee-for-service system and young people believe in holistic care that's good primary care not just overtreatment. i'm very optimistic about the future of healthcare. sometimes things just have to totally shattered for us to start over. a lot of it is messaging that's why i look up to journalists.

storytelling kind of journalism and research needs to all blend together and i agree marshall allen is that while. we saw the uninsured in america in part of the problem got addressed rallying around one member, 44 million people have no health insurance and guess what, that galvanize people into the rallied around and it's much lower today. right now i think we need to talk about the bubble, 24% of americans avoiding medical care because the fear of bills into the predatory billing and change the lexicon. the movie i loved the most was the big short and i loved it because it took a boring complex subject and made it understandable. that's what i try to do in the price we pay i call it the big short for healthcare because all

this stuff is so complicated how do you present it in a way that is understandable for people can say it's not up to the experts and we can't understand that it's pretty simple but banks are spending money they don't have. there's overcharging and a lack of transparency. >> i have a question here in the shadows should emerge into the life. >> an interesting thing from fact check i was curious about the kind of classic journalistic problems when dealing with sources who have suffered from traumatic event and i was curious if you could speak to that especially with the personal medium of the voice and what that was like an reporting process on the podcast. >> it's a great question. all of us who write about medicine, you have this dilemma

of how to talk to people and you are regularly asking you to tell about the worst thing that's ever happened tthat everhappeneu get that story and tell their story in a way that's respectful and get doesn't exploit the pain they feel and getting the balance right is extremely important especially when i was doing a story like doctor death because of these people had been through was terrible. it was absolutely horrible but they have suffered and i didn't want to use their suffering for purpose of entertainment and yet at the same time you also have to know how terrible a surgeon

he was. the first episode is pretty intense describing the details of what he did wrong and the suffering. as the story goes on, there's less and less of the details. less about the patients after the first episode but his friend who ended up a quadriplegic. i felt like you didn't need to know the suffering of every patient after that so that was one of my solutions and then every detail i agonized over how much do i say and how much is enough to convey without crossing that line and i can tell you the first episode altogether there were probably about 40,000 words of copy over

the whole script for the first episode was probably rewritten ten or 12 times at least. .. . >> these are not props.

>> like the famous janet malcolm to do the thing. >> sometimes they are very compelling details but not about him personally but his relationship with his children and his own personal life details that we left out because we didn't want to talk about the relationship with his children because it's not their fault. that is something always to be conscious of.

so as a journalist you will do this your whole life. . >> and distinguished writer in residence. >> that i guess it's okay to get back to the question that you have asked twice now but i will ask a third time and ask it differently you mentioned the big short i think i understood that. what got me about the big short is at the very end almost as a postscript for epilogue that by the way they

come back and we will call it something different. and almost ten years later after the crash. everyone who graduated after 2009 there was a story in class and it was about the fact that all the evidence says the best way to treat heroin addiction among prisoners they come in and they are addicted to heroin in particular is to give them here when the evidence is pretty clear and nobody debates that i would just call

the war didn't say why in the earth are you not giving heroin to prisoners. we should do that but also we should call the guy who is running against the legislature who's running on the platform don't give heroin to prisoners in the guy against him assaying the scientific evidence says so. so first to figure out who will win that election but in texas what we're up against you have great journalism and great books we are convinced that we convince ourselves but yet actually translating policy excuse me evidence into good policy remains as far as i'm concerned journalism and

legislation so how do we do that quick's because we have known about this for a long time. so what do we do? so what do you do you have command. >> and to talk about all the stories and that's my life.

but i actually believe it is important to tell the story of misconduct or a fraud. and that is really important because what happens and we do that all the time. sometimes they do it sometimes they don't. and we all have incentives but

but then to connect those stories to the actual policy and marshall is one of them and we have to do that but. >> one of the people referring to what other outlets are doing but unfortunately we have become intoxicated with a false lexicon so guess what? you don't need to prove that parachute and we can look at the outliers of that gender

group from the patient that had brain count one - - brain cancer. it turns out they had and infection. we can learn more from that false lexicon. and then to be back at the ending of the big short. and that horrible messaging of hormone replacement therapy with a study that never made those conclusions despite the "new england journal of medicine" and doctors believe it, that is a giant thing that needs to be overturned and

that is high-impact. how good of a job with media like on gray's anatomy how good of a job with a doing with these issues. >> great job - - question. i got a call from hollywood to say we want to turn into a tv series. but to bring these issues to the general public because it

is not medically super accurate sometimes but about the medical device industry. at if i can say this in public but what about medical billing. and overtreatment on season number one. so when obama went on the late show some people only get their information from avenues like this. we need to educate people about the issues. >> we are running to the end. >> and what that issue is doing highlighting the issues.

>> my daughter watches gray's anatomy. i can speak on that at all. . >> i do have an article from the "wall street journal" so in that article it said if you're the only hospital in town does it matter so is transparency the only solution? . >> first of all, we can call out gouging and it is completely inconsistent with the hospital nonprofit. we have been calling hospital ceos talk about price gouging to say we know exactly

what is happening this patient has had a horrible financial hardship so to take an oath to treat a patient that is not who we are as a profession so we are trying to create accountability as a journalist how do you feel about transparency? . >> i am in favor of it. but to come to the end of this conversation but the two of you have taken something that has plagued us for more than a generation and hoping that there are some solutions out there. and for that, i thank you

both.

[inaudible conversations] welcome to new america with a policy forum accelerating 5g for all americans. i direct the wireless feature program here at new america