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The last time I went to a doctor was in 1984. I was 16.

I’m 51.

And I was 18 the last time I had health insurance.

I think my deductible was $20.

Or $50.

Now healthcare is inflated.

People pay $2,000-$10,000 out of pocket. And doctors inflate your bill. They charge you for unnecessary tests. And procedures.

And bankrupt people.

Three more stats:

  1. One in five people have medical debts they can’t pay it back.
  2. Healthcare is the #1 cause of bankruptcy in America.
  3. We spent $3.5 trillion last year on health care costs.

And yet, hospitals still can’t make the gowns long enough to cover your backside?

I don’t get it.

“There’s a game going on,” Dr. Marty Makary said. He’s a surgeon at Johns Hopkins, a professor, and healthcare policy expert. He also advises on court cases. To help the little guy.

Because some doctors will take you tot court. And garnish your income. “Everyday Americans are getting hammered,” Marty said on the podcast.

But there’s a way around it.

“You just have to get to the right person,” he said. “We’ve seen bills slashed down 90%.”

“So how can I protect myself?” I asked. “What are hospitals not telling me that I should know?”

And he told me. That’s what this episode is about.

You’ll hear Marty explain hospital negotiation tactics, traps to avoid, the two qualities you need to look for in a doctor, the three blood tests you should request to reduce heart disease, and more.

And if you like this episode, read Marty’s two books:

  • “The Price We Pay: What Broke American Health Care–and How to Fix It”
  • And “Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care”

Here’s the episode:

  • Hear how you can get a free copy of my new book, “The Side Hustle Bible” – [0:00]
  • Episode preview – [2:01]
  • I welcome Dr. Marty Makary to the show and list some topics we’ll talk about: everything doctor sand hospitals are afraid to tell you, what you can do about it, and how the entire healthcare system can be improved – [5:03]
  • How Mark’s book, “Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care” became the TV show “The Resident” – [5:51]
  • The leading cause of bankruptcy in America is healthcare. One in five people in America have medical debts they can’t payback. I ask Marty to share insights from his book – [8:24]
  • Why Marty initially dropped out of medical school. And why he went back – [10:00]
  • Medical myths: Marty says if you take a step back, you see, “We’re telling people the wrong thing.” – [10:57]
  • The scary reason why the worst doctors make the most money… – [11:58]
  • Medical school is broken. And hurting our future care. Here’s why… and how to change it – [12:30]
  • What’s causing medical students to become entitled doctors – [15:00]
  • Why a quarter of patients don’t trust the U.S. healthcare system and they avoid care. – [15:51]
  • I tell a story from when I was a hedge fund manager. And John Paulson presented to me what was going to happen when the market eventually collapsed – [16:04]
  • The correlation between the financial crisis and the failure of the American healthcare system – [17:35]
  • The two underlying root problems of medicine are A. Inappropriate care and B. pricing failures – [18:26]
  • Marty breaks down “the ridiculous game” doctors and hospitals play to overcharge you – [19:53]
  • Surprise bills… Marty gives an example of how Americans are being overcharged for their medical care. He says, let’s say you go to the emergency room. And your doctor is out of network. But the hospital is in your network. Both bill you. But your insurance doesn’t cover the doctor’s bill… – [21:46]
  • I ask Marty why doctors and labs are not in the same insurance network as the hospital – [23:32]
  • What happens if you don’t pay your medical bills… and how much people usually settle for – [24:31]
  • What’s wrong with your deductible – [25:35]
  • How healthcare works – [27:02]
  • How the cost of insurance has changed overtime and what’s causing it: “medical inflation, a mass increase in the middlegame of healthcare with money games so sophisticated no one can understand them, and pricing failures” – [27:58]
  • Why hospitals charge you 4x, 5x, 10x, 20x of what medicare patients pay – [29:09]
  • How hospitals price gauge mothers in labor – [29:28]
  • Why some people get turned away from hospitals – [31:25]
  • Marty shows how hospitals exaggerate the amount of charity care they offer – [32:40]
  • The lack of transparency in the U.S. healthcare system is hurting patient care – [33:30]
  • “What we need in America is true price transparency: the real prices that the insurance companies and the hospitals negotiate…” – Marty Makary – [36:40]
  • How businesses go about choosing insurance networks for their employees – [38:16]
  • Insurance networks are artificial… “If we had fair, honest, transparent pricing, we wouldn’t have these network games.” – Marty Makary [39:02]
  • How much should a procedure cost? And how do you get the best deal? Marty mentions a tool “Healthcare Bluebook” that can give you a reference – [39:38]
  • 70% of providers out there accept Medicare patients. So we can assume that the medicare price is roughly close to the cost of the procedure – [41:00]
  • “Every hospital bill is negotiable. Every service is negotiable. You just have to get to the right person. We’ve seen bills slashed down 90%. And that tells you if they have that much room to come down then there’s a game going on.” – Marty Makary [41:42]
  • I recap the main issues: price gauging, the out of network trick to bill more, the inflation of deductibles, overprescription of services – [42:10]
  • Marty says another issue is that the doctors don’t tell you when they’re out of their network. So I ask why hospitals don’t force doctors to be part of their network. – [42:39]
  • Marty lists “the common sense reform we need right now” that’s also circling around Congress right now. I also ask, “Who’s against these bills?” – [43:55]
  • Why hospitals are against transparency – [44:28]
  • “Inaction is the worst enemy in healthcare and we’re seeing people enjoy the status quo” – Marty Makary – [46:09]
  • How and why someone who needs a simple set of stitches gets hit with 4 or 5 surprise bills – [47:36]
  • The problem with private equity groups buying doctor’s practices – [48:32]
  • How AI will help solve some of the problems – [49:09]
  • We dive into an example from Marty’s book that showcases inappropriate care – [49:19]
  • Why doctors aren’t good at admitting when they’re wrong or don’t know the answer – [50:20]
  • Johns Hopskins did a national study asking doctors, “How common is the problem of unnecessary surgery?” The doctors said 11%. I asked, “How much is a mistake and how much is malicious? – [51:36]
  • Movie recommendation: “Bleed Out” – [53:12]
  • In the same national study from Johns Hopkins, doctors said 21% of all medical care is unnecessary. Marty explains why – [54:30]
  • The impact of “the pill culture…” Marty says, “Ten years ago, we doctors prescribed 2.4 billion subscriptions. Last year, it hit five billion? Did disease double in the last five years? No. We have a crisis of appropriateness.” – [54:56]
  • Free medical advice: when you do and don’t need antibiotics – [55:22]
  • How the overuse of antibiotics is “creating resistant superbugs that are going to come back with a vengeance” – [56:00]
  • I ask Marty about Lyme disease – [57:24]
  • We circle back to inappropriate care. I ask Marty to reveal some more red flags. And also point out the way Marty researched for this book was by traveling around the world and seeing how hospitals are run firsthand – [58:01]
  • Why some doctors schedule unnecessary c-sections – [58:25]
  • I ask Marty the big question, “How can I protect myself? What are hospitals not telling me that I should know?” – [1:01:03]
  • Resource recommendation: (go there to learn how to fight your medical bill) [1:01:26]
  • Marty recommends some alternative solutions to prescribing drugs – [1:02:21]
  • “The field of nutrition has been corrupted in healthcare for most of its academic, modern history. We’ve been given the food pyramid and we’ve had the food industry tell us things like, ‘Breakfast is the most important meal of the day,’ That came from a General Mills marketing campaign.” – [1:03:34]
  • Is fat bad for? – [1:04:04]
  • Why don’t doctors have courses on nutrition? – [1:04:37]
  • Ideas for how to improve medical education. And if the apprenticeship model is possible – [1:05:53]
  • Marty touts the curriculum at Jefferson Medical school. “Steve Klasko is doing incredible work. He’s basically accepting students based on empathy and self-awareness. And then he says, ‘If you meet a certain benchmark grade point average (say a 3.4 or higher), I’m just going to hire based on empathy and awareness and communication skills.” – [1:07:28]
  • In Marty’s book, “Unaccountable,” he mentions that the school you go to isn’t the highest determinant of a successful surgery. Repetition is. [1:08:08]
  • Two qualities to look for in a doctor: 1. Someone who is responsive (ask the nurses if this doctor shows up in the middle of the night when their patient needs them. 2. Volume – [1:09:32]
  • What qualities to look for in a diagnostic doctor: humility and listening skills. I ask, “What is a diagnostic doctor?” [1:10:24]
  • How to avoid the trap of a specialist – [1:11:27]
  • The blood test that predicts early heart disease… and few doctors have heard of: Lipoprotein little A. Marty says, “Every person in the United States should get at some point in their life:” – [1:12:10]
  • I ask Marty about MRI’s and CAT scans – [1:12:59]
  • We discuss cancer testing. How do you test for cancers that are asymptomatic until it’s too late? [1:14:03]
  • The debate among doctors about mammograms and what age to start – [1:15:06]
  • Health podcast recommendation: The Peter Attia Drive Podcast – [1:15:34]
  • Another mistake in the U.S. healthcare system: it’s majorly based on anglo-saxion, Euro-Americans. And doesn’t account for other ethnicities – [1:16:35]
  • The range of problems women may face during menopause. And the ways doctors overlook it – [1:17:24]
  • How often is chemotherapy overprescribed? – [1:19:40]
  • The one emotion guiding people when they get a diagnosis – [1:21:08]
  • The gene test you can get that will tell you whether or not chemo will even work on a particular person with breast cancer -[1:21:57]
  • Where to find quick tips that help educate you when you go to your doctor – [1:22:40]
  • The three tests every American should get to see if they’re at risk for heart disease: Lipoprotein little A, Apoprotein B, and a C-reactive protein – [1:23:23]
  • The overprescribing of depression drugs, why loneliness is an epidemic in the U.S. right now, and how loneliness affects every psychological system in your body – [1:24:07]
  • Book recommendation: The Blue Zones by Dan Buettner [1:25:22]
  • The healthcare topics we’ll be talking about in 5-10 years: inflammation and your biome health – [1:26:18]
  • Why the medical research community dismisses studies that ought not to be dismissed – [1:27:55]
  • I recommend Marty’s book, “”The Price We Pay: What Broke American Health Care–and How to Fix It” – [1:28:26]
  • Marty gives me medical advice: (1) get the three cholesterol tests mentioned earlier/listed above, (2) get an assessment of your ethnicity and family history of heath disease (3) go oversleep and food. Marty says “Chronic bad sleep causes Alzheimer’s. I’m convinced. Just talk to the head of the Berkley Sleep Center.” – [1:29:12]
  • How to lower inflammation in your body: avoid simple sugars, have a low carb load in your diet, avoid pre-made food, avoid processed foods. Consider keto or the south beach diet. “Anything is better than the standard American diet, or what we call the SAD diet.” – [1:30:01]
  • How to avoid eating pesticides – [1:31:02]
  • Tip: Eat macadamia nuts – [1:32:28]
  • I ask Marty his philosophy on eating breakfast and we discuss fasting – [1:32:52]
  • “If you avoid carbs, you’ll notice you don’t need as much food to stay full” – [1:34:24]
  • Supplements: good or bad? – [1:35:03]
  • I thank Dr. Marty Makary for coming on the podcast – [1:35:55]

Links & Resources: