differing points of view. we're awarding $100,000 in total cash prizes, including a $5,000 grand prize. >> be passionate about what you're discussing, to discuss no matter how large or small the audience will receive it to be, and know that in the grid is country in the history of the earth, your view does matter. >> for more information to help you get started, go to our website, studentcam.org. with dr. marty makary, the author of "the price we pay: what broke american health care and how to fix it." thank you so much for being with us. so, what broke american health care? guest: the story that nobody is talking about is pricing failures. doing the research for this book , there were three fundamental

reasons why health care is so unaffordable that all of the research pointed to, and that is not what the politicians are talking about. the research suggests that it is pricing failures, middlemen, and inappropriate medicare -- medical care. we need to talk about how to fix the broken health care system because people are getting crushed. people are getting hammered. touredd the country -- the country and met with hundreds of folks. patients in their homes listen to them about how the health care systems devastated them, and it is a mess. i do not believe we are divided country and i do not think the choice is put before spy health care -- by politicians are the right choices. there is tremendous consensus and the consensus is that we

need to address pricing failures. us after theilled flight they would be gouging us. if airlines did not have to show a price, you would simply fly, and then they would send you a bill, and they would be gouging all over it. that is what is happening in health care. it is ironic that hospitals are the center of scientific genius but we cannot give you a price, that is starting to change and it is the many disruptors who are starting to give optimism that is the reason why i wrote the book. host: we just heard from president trump back in may, in fact, we could see you right over his right shoulder. what role did you play in the administration's actions? guest: they asked me what i think about health care. they like meeting with academics. if somebody asked me about what i think i need to do, i will tell them.

issues,ose three pricing failures, middlemen, and inappropriate medical care that they need to address. they acted. they had that event on surprise billing, several announcements came out. i brought patients with me who told their story to the secretary, one of the smartest people i have met on health care, and president trump and the others were there. they listened and they announced the executive order owned -- on price transparency and that is one of the biggest stories in the last five years that has gotten almost no media attention. the secret negotiated prices between hospitals and insurers is part of the problem. i'm a doctor and i love it, but i do not believe in kickbacks and in secrecy. secret prices are enabling the price gouging that is going on. these money games, and predatory billing practices that threaten

the great public trust in the medical profession. book,reading through your i was amazed at one of the stories that you had about your surgery,nd his tendon where you asked how could one ofpital -- it was thousands dollars, 15,000 dollars or $20,000. you talk to another hospital and the price went down. talked to the surgeon who sent you to another hospital where the bill was $1500. it is amazing that the same surgery done by the same surgeon could have such a wildly different price at such different places. how do you as a consumer deal with this? guest: that was a crazy story and it was my friend's son. basically one doctor said, i do not know what this will cost you, as the hospital. when they gave you outrageous prices, the surgeon said i will do the same operation at another

hospital and it will be 1/10 the price. people need to know that there is a lot of tools they can use to navigate the system. we are starting to see a revolution in tries -- in price transparency regardless of if the government does anything. that is patient mag is -- navigation tools. you can look up on websites like fair health what the going price is your medical bills are often highly negotiable. it is insane. there is a researcher who called 100 hospitals that do heart surgery asking what is the price of the standard open heart bypass procedure. 50 gave him a price. price,50 that gave him a it ranged from $44,000 to $500,000. he compared it to the outcomes of the centers using the most

mature quality outcomes database in the country called the sds heart surgery database and found no correlation. there was no correlation between care, quality, charity despite the many claims at most centers. ist is happening right now the lack of transparency is enabling price gouging in the marketplace. we need to call it what it is and stop talking about health care costs and talk about medical prices. host: let us let our viewers join in. we are going to open up regional lines. that means if you are in the eastern and central time zone, 202-748-8000. in the mountains or pacific time zone, 202-748-8001. careu are in a health related financial trouble, we want to hear from you, you are at 202-748-8002. and keep in mind that we are always reading on social media and on twitter, face -- and

facebook. at you can text the show now 202-748-8003. remember, we need your first name, city, and state you live in, and make sure you be brief and on the point. let us go to cliff from tulsa, oklahoma. good morning. caller: yes. cost ofnt would be pills. my wife and i just changed her medication to time release medicine. $.12 to $22 a pill. host: that was something i did not have him talk about. talk about pills and prescription drugs. caller: input -- guest: employers are paying for health directly, sometimes not even using insurance, they are

just self funding. pharmacy benefit managers, in claiming to be an independent fiduciary to manage their pharmacy costs, they will actually gouge the employer's with medications that the employers do not know the names, dosages, or frequencies. in the book, i show an internal document that demonstrates the spread pricing, what they are gouging on the employers and charging versus what they paid a pharmacy. this middle industry has put a gun to the head of pharma companies and said if you want us to carry your drug in our plan, you need to pay us a kickback. it is called a rebate, it is not called a rebate, but this is not like a rebate on cornflakes. it is a kickback and it is only

legal because in 1997 congress passed an exemption allowing this to take place, otherwise it would violate the anti-kickback statute. there are many money games that bms play, there are a few that are more honest and pricing and we have listed some of them at restoring, met -- restoringmedicine.org. we have seen a lot of talk about getting rid of rebates and just allowing rebates to go 100% to the patient, at a 100% pass through. suppliers and hospitals do the same game. they do those kickbacks and those are called purchasing organizations. they set up pay to play fees, and that is why we have medications that we have had in the hospital for 50 years spiking. that is one of the reasons, there are many, but there is no one villain in health care. pie,one has a piece of the

and i want to explain health care to every american so that we can create health care literacy, employers can get a better deal, a better deal on their pbm and employers are $500,000.saving the big short dated for the banking industry, i wanted to do it to health care. host: surely from -- shirley from winter park, florida. good morning. caller: thank you for taking my call, and you are right. fell walking out of work on a wet floor that had no sign, broke the kneecap, dislocated it, overextended tendons, two now have aater i kneecap with no cartilage. there is constant pain.

comp, i being, workers would love to see president trump do workers comp like he did the veterans. they use every angle they cannot to pay what is needed, i could not walk. they told me go back to work. i had to go out on my own and get an mri. i called the hospital, how much is it? pay it.can i go to the hospital and asked the lady, this is all i have to pay, is there going to be another hidden cost? no. are there any other fees? no. a couple of months later i get this huge bill in the mail which i argued up and down and they finally dropped it. employer insurance, which i pay $800 a month, and i have a

good disability insurance on top of that. i pay for that, a premium every month, they do not kick in anything because it is a work-related injury. i cannot go to them for squat. the other piece of this puzzle are the attorneys, and i am sorry, they hide behind everything. you see these ads on television all the time round up or whatever it is, and they rake in 40% sometimes of people's misery. they get 40% of whatever the person is due. i am all for the attorneys being able to sue the company's because they are negligent. that is a florida state law clearly violated, and that needs to be upheld. honestpeople deserve prices. i cannot mow your lawn and send

you a bill for $400,000. people want honesty and health care, and one of the exciting things i learned about is that there is a movement for more honest billing and pricing in health care. look at the surgery center of oklahoma, they have a menu of prices and it does not matter if you are in and of spirit -- an insurance company, individual, or a small business, it is one price. if somebody is having a heart attack and we are going to do trauma surgery, you're not going to give you a price, but 60% of medical care is shop a bowl. airlines can give you a price even though they do not know if your flight is going to be delayed, canceled, or if you will consume a beverage. that creates a competent sometplace, even though people will not use pricing information if it is available. proxy shoppers keep prices in check, and in health care though

shoppers are health plans, employers, a high deductible and uninsured individuals paying directly for care. i do not shop for every law -- lemon and orange in the grocery store by price, and her mom does. her and her friends keep prices in check for the rest of us. host: one of the things -- one of the places you focus on is new mexico. why, what is going on? guest: i have a lot of patients who contact me who feel like they have been wronged by the system. the story caught my eye, of jennifer, a mom with kids for special needs. one of them went to the hospital and got a hospital acquired infection. jennifer could not afford the bill in the hospital sued her and garnished her paycheck. when she contacted me and said that many people have been sued, i went to this town, carlsbad. cnn did a piece on it.

i wrote about how this town has the only hospital in town has sued hundreds of people to garnish their paychecks, and i spent time in the homes of these individuals. they garnished -- they sued the judge in the courthouse because -- they sue indiscriminately. the hospital does not provide itemized bills. many of these are overpriced. i've compared them to to prices hopkins, andn these are threatening the trust of the medical profession. people deserve that are. one of the waitresses who i met in the hotel i stayed at is a single mom of three kids. she had her minimum wage paycheck garnished for a morning sickness when she was pregnant seven years ago and could not pay the bill. she has been sued, and people have been sued multiple times. i went to her home, she does not

live like me. god has been good to me, i am a licensed surgeon. she is like the other half of america in that they have less than $400 of cash in savings. that is how half of america lives. i think sometimes the medical establishment becomes disconnected. she had insurance, this is not her fault, this is our fault. suing patients is the most extreme violation of the great public trust in the medical profession in my opinion. we will defend these people in court, i will be there pro bono expert and we win 100% of the time. wasll the judges that there no legal contract and the patient was not given prices. if the hospital does not show prices they have no reason to garnish wages. the movement to restore honest prices is alive and well, that was the exciting thing about writing this book. from ae have a question

social media follower who wants to at -- wants me to ask you, how much taking personal accountability for your health factors into the overall cost? guest: that is number three out of the three fundamental drivers of our cost crisis, number one pricing failures, number two, middlemen, and number three appropriate medical care. 23% of medical care is unnecessary according to the 2100 physicians that answered the survey. that is 25% of diagnostic testing, 22% of medications 11% of procedures. we have been doing too much. there are two problems, overtreatment and under treatment, but overtreatment dominates. it is driven by a culture of people demanding auto buyout -- antibiotics when their kids have sniffles and perverse's

incentive system. the opioid epidemic is just one piece of that problem. physicians prescribed 2.4 billion prescriptions 10 years ago. last year it exceeded 5 billion. did disease double? no, we have a crisis of appropriateness. i get into the many folks trying to address that, reducing unnecessary medical care, and one of those big efforts is relation based medicine, which emphasizes spending time with patients. primary care that addresses the root causes, clinics that teach cooking classes for patients with diabetes, teach food as medicine and address the micro biome, and they are saying we can maybe treat more back pain cases with physical therapy and ice, than surgery and opioids. host: bob from illinois. good morning. caller: hello.

i want to vouch for the surgery center of oklahoma. 10 years ago my daughter, who lives out near south lake tahoe went to the reno hospital after she was diagnosed with thyroid cancer and she was quoted $25,000 to $30,000 for thyroid surgery. we went to the surgery center of oklahoma to $62,000. i had a colonoscopy in february, and the hospital billed my hmo $7,300. norman and two copy will do it for 16 -- $16.50. building quality is medical quality. financial toxicity is a medical problem. treating the patient includes treating the higher person. the exciting thing about the surgery center of oklahoma, and these many doctors and centers

who are saying that we want to give you an honest, -- an honest price is that they are disrupting markets, and it was a real privilege to be able to profile this exciting work of honest, fair transparent pricing that is disrupting markets in the book. here's another question from our social media followers who say, "rather than try to untangle the current billing scheme, why do we not just move to some flavor of universal care like every other first world nation?" is that a solution. we have seen some candidates talk about medicare for all and other flavors of universal care. guest: people are suggesting this with good intentions, it is a very noble idea to expand coverage through some government-sponsored initiative. the problem is that a research study we just completed with our business school and a professor

of accounting is that we already spend -- all of the expenditures in the united states, 48 percent goes to its health care in its many hidden forms, full -- social security checks being used, the defense department's health care system, v.a. health care system, the insurance benefits federal tax dollars paid for for the 9 million federal workers. interest on health care spending and test debt. if we are spending 48 percent of spending, what are we really proposing we increase that to? 60%, 90%, we have to cut the waste. if we can get better coverage through competitive markets, if we can clean up the price gouging by simply having a disruptive marketplace by those

who show prices, is that not the better solution? if you make $52,000, you are spending one third of your earnings on health care without even using the system. year, youe $250,000 a are spending 50,007 -- $57,000 a year between insurance and your federal tax dollars that go to health care. that is a disgrace. throwing good money after bad into a broken system is not a solution. let us let competition work. any system that has had this universal coverage over time, it always guaranteed dials down the spending year after year and 10 or 20 years into it you have a massive dilapidated system. it is with good intentions that people suggest it, but we already spend enough money to give every single person in this

country goldplated insurance, we just have to cut the money games and waste. host: let us talk to chris from texas. good morning. caller: good morning. i have not read your book. jesse was the show, talking about hospital cost as a percentage of health care and it was significant. i think you said it was over 40%. my comment is, i live in the dallas area, and parkland hospital is huge and beautiful. it is probably the best hospital in texas and maybe in the country. i think it was 2015, 70% of the babies born in parkland were to illegal aliens. we are talking about hospital costs, and nobody talk about this. and i as a person who has had insurance all of my life, when i walk into parkland to have a

surgery, i am probably going to pay at least a 60% premium to pay for one mexican child born in that hospital. if your book does not talk about this, i probably will not go and buy it. tell me if it discusses this? host: this was on a previous segment and i want to remind people of what i said. this comes from kaiser health news, "data shows that hospitals are the biggest cost in our 3.5 trillion dollar health care system. spending is growing faster than the gross domestic product and wage growth. representedpite -- 44% of personal expended for the privacy -- privately insured. a report from researchers at yale found that hospital prices fromased 42% from two -- 2007 to 2014 for inpatient care and 25% for outpatient care.

those are the facts according to kaiser health news. amused bym politicians talking about piling onto insurance companies while hospitals have been getting a free pass. what i love about this article by"the new york times," elisabeth rosenthal is that she says the reasons that these to my credit candidates are not talking about hospital prices is because they are getting a lot of campaign contributions in their districts from the hospitals. hospitals are run by good people, i believe that. i have met leaders who are good people working in a bad system. this crazy game of jacking up prices so they can give discounts to insurance companies is part of the reason we are spending a ton of money on health care, and hospitals, despite the cries that they are run on razor thin margins and are the bank -- are on the brink of closure, large hospitals are on track to make the largest

profit margin in human history, 5.1 percent that translates over to $100 million a year. at the same time the small and rural community hospitals are closing. honest, fair, and transparent pricing, just like we got nutrition labels for food in the industry told us they could not do that. now they are competing on the basis of ingredients and nutrition. hospitals need to be competing on the basis of value, quality, and price, not billboards at nfl games and valet parking. american safety net hospitals are doing a great job. i know people at parkland hospital, the surgeons they are friends of mine. illegal immigration care is not 70%, it is about 10%. hospitals, historically, have always taken care of those who

cannot pay. with these record margins, certainly that can be part of the mission. when american hospitals were built were meant to be a safe haven. many were billed by churches for their community, and their charter states that they take care of anyone regardless on " race, creed, or ability to pay." that is the great american medical heritage. that is what i am proud to be a part of. i am proud of the man who sold the insulin patent one dollar. and the man who refused to get a patent for the polio vaccine. that is our great american medical heritage. today these money games and the price gouging, and predatory billing is threatening the great public trust in american hospitals. host: from columbus, ohio, sent in a comment that says, "the core problem is that the patient does not pay.

every patient wants the best pick care, -- the best care. what if car buyers did not pay? on that havent 30% nothing to do with health care. what we have seen is a fleecing of everyday americans. when you have united health care on wall street, they are reporting in their quarterly report a 25% increase in earnings, how does a company that is an actuarial business that is supposed to pass along cost of health care to individuals through insurance, how is that going up 25% in one year? they set on the call that it was in part due to the pharmacy benefit manager, one of the middlemen. we have good people, but they are working in a bad system. we need to take a close look at the waist. i -- waste.

i believe we can do it by getting rid of secret pricing and getting rid of -- host: let us talk to christopher from daytona beach, florida. good morning. caller: good morning. love c-span, fantastic program. i was slightly taken aback a little while ago. you are speaking to the specific or anyhat any procedure, kind of visits is plausibly negotiable, and i was with all due respect, you are a doctor and i was a layman, and i was stunned that you would say that. it is probably my ignorance, so forgive me on that. i go into the doctor on a regular basis, since i turned

40, and i have had several serious procedures over the course of my life, a broken neck, a concussion, but i have always had pretty good health care through my employer's. -- employers. and i strive to take care of myself. i just -- i would not know how to do that. i would not know do -- know how heregotiate if i am hurt or away. i was at the mercy of where i went. saddleback fixed me up with my surgery and grafted my neck, and i am doing great these years, -- medical billsmes, are negotiable, you have to get to the right person. i do not speak on behalf of my

hospital, but when i interviewed people in charge of getting the bills paid on the hospital side, the revenue cycle or finance department, they would often tell me if somebody claimed a hardship, they would cut off 10% or 20%, or they will put somebody on a payment plan. beware of the payment plans or discounts, because sometimes they represent discounts off of a bill that is 200 percent or 700% higher than what the same hospital would except for medicare or an insurance plan. if you want to find out what that hospital will accept from a commercial insurance company, you can look it up at these websites, health care bluebook and fair health. one of the sites that you can use to actually price shop is mdsaves.com. the hospitalent to in carlsbad, new mexico where

there is a lot of price gouging and i have been representing patients. by the way, two hospitals already announced that they will stop suing patients. we sent letters begging them to remember that why we went into medicine. this receptionist in the basement of carlsbad medical center said that, the cat scan you are asking about costs $5,000. if you go to this website, mdsave.com. you see it listed for $500 at the same hospital. there is this date and switch with these crazy prices that are not real prices, and these platforms that are creating a true market for real prices, which is what we need to address the massive price gouging that is crushing every day americans. host: we have been doing a lot

of talk about we can do as consumers. what would you suggest doctors do about this problem. this affects them to. -- affects them too. what should doctors and medical professionals do to address these problems. guest: at the hospitals that have agreed to stop shoot -- suing patients. mary washington hospital had sued 25,000 people in a count of 28,000. the hospital announced that they would stop all lawsuits against patients. part of it was the doctors saying this is not right, and we want this to stop. we are going to uva where that hospital has sued people who live paycheck-to-paycheck, and even students over unpaid medical bills. this is an institution that takes public funding. fellowtalked to my surgeons there, because the surgical community is small nationwide, they were livid when

i told him there patients are getting sued because of their services. get as can do a lot, you bill that is egregious, take it to your doctor. bring us your bill and let us become your advocate. we need public accountability. that you canys negotiate or fight your medical bill. your financial life away when you come to the emergency room. hospitals are required to take care of you regardless of your ability to pay. card inive your credit the emergency room, hospitals are required to take care of emergency conditions. host: jerry, from virginia. good morning. caller: good morning. i have been listening to this conversation for the past half hour, and with all due respect, i do not think giving prices to people is going to solve the problem.

people in their -- when they are sick, when they go to an emergency room they cannot crawl to their pc and see what their procedure will cost. we have to have a medicare for all system. the board sets the prices and they have a board of medical providers and dock errors and they set a fair price. that is the only way you are going to solve this. leaving it to the markets is not going to solve nothing. we had it with the affordable care act and does not working. -- it is not working. withhave health care plans $10,000 that are subsidized by the government. guest: i would say let us give markets a chance because 20% of doctors are not accepting medicare. the trust fund is unsustainable. we have reimbursement rates that get cut every year relative to inflation.

the idea of simply applying medicare for all does not work with the current medicare system, let alone what it would look like in the future. let us give markets a chance. hurt and went to the local hospital, they got massively price gouge. was that because there is so many uninsured and homeless people at the ski resort? no. couching is because they do not have to -- gouging is because they do not have to show prices. if airlines build you after the flight they would be price couching you. it is absolutely correct that everybody will not use pricing information. -- pricinge price information. my mom does, and when she price

shops and that small fraction of people who compare grocery store to grocery store keep prices in check for everyone else. proxy shoppers will cut the waste because -- attributed to , and employers want to see those prices. an employer in boston had their employees delivering their babies at different hospitals, and the price ranged for an uncomplicated labor and delivery from $7,000 to $41,000. if i'm an employer and paying for these, i would like the women delivering to go to the hospitals that charged $7,000 and not the one charging $41,000 because they are both of equal quality and harvard affiliated. he decided to let his employees know that if you deliver at a $7,000 hospital, he will give

you free diapers and wipes for a year, and guess what, everyone is going to the $7,000 hospital even though they still have choice. that is the power of markets when we get to see honest pricing. host: you have been writing and talking about this for a while. in addition to your book you wrote ": unaccountable how trance -- unaccountable: how transparency can help health care." is there something that congress should be doing? what are they doing, is it possible that we will see something coming out of congress? guest: we need every day americans to say that we are getting crushed by our medical bills. that is what i saw when i traveled the country, and that is what i am hearing. every day americans are getting hammered by the high cost of health care. raising deductibles for insurance is not innovation. that is giving more share for

the patient to pay. members of congress need to do a couple of things specifically. they need to address surprise billing, create incentives for billing quality. we need ways to be able to say, if you provide honest and fair are on a sixthy grade reading level, delivering a baby should have a price. not machine-readable, giant codes that are outputs. we need honest and fair prices in english so people can understand them. willnt navigation tools create good ways so there is competition. we need congress to repeal the safe harbor exemption that allows kickbacks in the domain industry is, and we need the full implementation of president prices executive order on transparency that discloses the secret negotiated discounts between insurance companies and hospitals.

if you go to a restaurant and say i would like to see the prices on the menu and they say, who is your employer and we will give you a special price with secret prices that you cannot cannot see what the next table has on their menu and you are getting charge four times more. we would say the lack of transparency enables price gouging. i was disappointed to see many of our physician lobby groups and washington, d.c. oppose all forms of surprise billing legislation, and i realize that trade groups do not represent its members 100% of the time. the members of congress need to hear from every day americans, so you tell them about your surprise bills and all of these nightmares that almost everyone has a story about. 57 americans have received a surprise bill. it is affecting everybody. oft: i am seeing a version

this comment over and over again. the comment is basically, when i am sick i do not have time to go shop around. i need to get well and i need a doctor to deal with my health. i need to deal with that instead of the cost. is this something that we should be doing in advance. if you are alone and sick you are not thinking about what it will cost. what will you say to those people that were saying if you are in the middle of a health crisis you are not thinking about the cost or comparison shopping, you are thinking about getting well. what would you say? guest: if somebody is shot or having a heart attack, we are not giving you a price. we should be taking care of you. you should not be doing price shopping. over 60% of medical services in the united states are highly shop double and they are elective. we are talking about that gigantic market and somebody who has a knee replacement and gets a $70,000 bill that is the

insurance negotiated price when the federal market price is $28,000. we are talking about price gouging. just as an observation and doing the research for this book, and going to one of the area hospitals in virginia, it is loaded in the emergency room with ubers and lyft. why? people are afraid of the gouging of the ambulance, ground and air. people are already afraid of price gouging. pricesls can show their to proxy shoppers and a small subset who will make decisions. we are not going to address pricing for emergency care with price transparency, most of medical care is shop double. host: let us talk to him area from -- let us talk to mary from

pennsylvania. good morning. caller: i have been listening to the doctor, and he has basically correct. this is a problem that congress needs to fix, and this is under the emergency medical treatment have uninsured citizens in this country, undocumented people who go to the emergency ward, and it is billed to taxpayers of medicaid. this is costing us a fortune, and if you are uninsured, and under medicare, then medicare only pays 80% of your hospitalization. assets available to , the 20% yourance would have to pay, your assets

are taken away. i worked as a state worker for 45 years, in philadelphia county. takewe would actually people to court because the hospital mandated us to do so. they were losing money, and we would take your assets away from you as a citizen. we cannot do this for undocumented people because they are not paying into the system. it should be mandated that anyone who is in this country has access to a payment plan that will pay for their health care. host: go ahead and respond. guest: medicare does in fact have co-pays and deductibles. people think it is free, but the medicare trust fund cannot support all of the medical expenses, so they have set and

regulated prices. some doctors do not accept medicare because they think the prices have dipped too low. entirely free entitlement. if we are already spending 48% of federal tax dollars on health care, what are we suggesting we increase the number two? how much do we need -- the number to? how much do we need to increase taxes? the u.s. capitol building is a church where my team was tipped off that doctors were in their doing unnecessary health screenings to recruit patients for needless procedures. they are still procedures -- stint procedures that were featured in the wall street journal and i write about in the book. entirelys going on an funded by medicare two miles from where congress meets, throwing more money into the system will not fix it. let us give honest and fair

price print -- price transparency a chance, and we will see what we have seen in the small sectors of health care that has price transparency. look what has happened with with cosmetic surgery. these are areas of health care that have had price. -- price transparency for decades, and what do you see? a reduction of prices and healthy competition. let us give it a chance and restore medicine to its mission with fair billing practices. host: let us talk to charlie who is calling from new york. good morning. caller: how are you doing. are important. .e cannot go to las vegas we need to stop bernie sanders

single medicare for all. host: we are losing you coming in and out. i think i lost charlie completely. guest: i think i got enough pieces of what he was suggesting. know, there is broad consensus in my opinion in the united states on health care. not listen to the echo chambers of cable news. i know they are part of the funders of c-span. let us block that out and look at what the american people believe in. they believe in honest prices and americans are united that they do not want corruption in the government. there is broad consensus on some of the basic stuff we can do, and i think politicians need to hear from everyday americans are getting hammered with their medical bills. host: let us talk to larry from south dakota. good morning. caller: good morning. this is so interesting because i'm going through a situation

with two bad knees. having two bad knees, there is not an easy way to do this. bonenot a 70-year-old saul cutting off my legs -- saw bone cutting off my legs. they have stem cell regeneration, and insurance companies will not give you a nickel, so you are going on your own. that is one thing. the other things a friend of his combinet out of in the middle of the night, crawled to his car, crawled to his house and called to a friend who took him to the hospital. he got there, they looked at them, and found out that he dislocated his hip. they kept him there for three hours and said you are ready to go and he went home. he went home and he got a bill for $14,000. that wiped him out.

he drank himself to death a year later because he was out of money. that is another deal. of then you talked about all the big hospitals are constantly -- they have all this great technology and little hospitals are going broke. guest: people are getting hammered with medical bills. what is happening is that about 1/5 of americans are making difficult decisions about their personal finances including paying for groceries because of their medical bills. it is a disgrace. field, 1/3 of women with stage iv breast cancel -- with stage iv breast cancer report being harassed by medical practitioners. one quarter of the people of diabetes of these report rationing their insulin because of costs. we have people who do not trust us.

at johns hopkins we have great researchers sometimes my colleagues say, why are you interesting and health-care care costs and billing practices and the stuff about transparency? i tell them, we can have the cure for cancer and these great technologies and operations, but public does not trust us, they are rendered not good. we have to regain the public trust, and the money games of billing and predatory price gouging threatens the trust in the medical profession. host: i want to read a quick quote from your book that you wrote. "once a person admits to the mildest leg cramp or soreness it triggers a chain of events. the patient might as well be picked up and placed on an assembly line. it starts with the tests they did. if that warrants further checkup, that is also a subjective call, the doctor says

let us take a look with an ultrasound probe. i the time they are done ringing the cat -- by the time they are done ringing the cash register medicare has spent approximately $10,000 per person. private insurance will pay up to triple that amount for the same procedure. you mentioned the church affairs earlier, talk about what you are talking about. you would assume that doctors aking people to come and get checkup and make sure that your health is ok at these events would be a good thing. this does not make it seem like that. guest: most doctors do the right thing or always try to. we do not want to create hysteria. what we found doing the research was that, at this church two miles from here there was a pattern of doctors going in and doing these unnecessary screenings, and it was predominantly from a national study that we did to follow the observation, predominantly in

minority and low income communities in the united states. that was offensive. i grew up going to church, i love going to church. to see that the house of worship would be root -- a recruiting ground for doctors to -- who can get a hefty payment from the medicare system because of what they are doing. within two miles of the u.s. capitol building. i think that shows how disconnected the politicians are from the frontlines lines of american medicine. it shows that simply throwing more money into that system is not really the answer. doctors are good about nudging patients. no workarounds and how to document things so insurance companies will pay for things. most doctors do the right thing and always try to. a small fraction are extreme outliers, and in the book i talked about the improving program where we are now

addressing outlier physicians in a civil fashion so that we can shunt the resources used on a blanket basis against doctors like pre-authorizations and pay her to pay her calls, -- and calls, to the outliers. let us do not -- let us not bother doctors and let them practice medicine and spend time addressing outliers, doctors with an 80% c-section rate for elected uncomplicated deliveries. stints who dos tint -- with a practice pattern that is egregious. backe who do elective surgery. doctors who do spine surgery routinely on patients who have never seen a physical therapist once in the year preceding the elective surgery. these are patterns, and a new

way to measure quality that does not have a recording burden and it addresses the appropriateness of care, not just the complication rate once you do something. host: let us see if we can get a couple more in. remember, people briefed with your comments or questions so we can get as many people as possible. , from morgantown, north carolina. you have something quick for us? caller: i work for health care and i have been in health care for -- host: go ahead. caller: i have been in health care for more than 25 years. with transparency in pricing. as a patient, i have insurance but cannot afford to go to the doctor. colonoscopy, and it is supposed to be a routine,

because i just turned 50 years old. now i am getting all of these bills, pathology bills and these other bills. it is supposed to be just like less than $500, but bills are coming, so i think it is better to have transparent policy in health care costs because you do not buy a pair of shoes without knowing how much it is. your: thank you for service and working in health care. we attract amazing people. the sort of person in high school that says i want to be a nurse is different from their peers. folks interviewing for middle school school -- for medical school are impressive, the altruism and wanting a purpose above themselves. we attract great people, we have good people working in a bad system. we need honest pricing. , sick should be at home

and scared to come to the doctor's and that is exactly what i saw in telling the stories around this book. host: we would like to thank dr. marty makary, author of "the price we pay: what broke american health care and how to fix it." thank >> washington journal, live every day with news and policy issues that impact you. coming up monday morning, we will preview the week ahead and washington with robert costa. itn, a discussion of documentary of flint michigan's contaminated water supply. watch live at 7:00 eastern monday morning. join the discussion. >> caitlin emma is budget