Dr. Elisabeth Rosenthal, Author of “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back”

Dr. Elisabeth Rosenthal

Mark Masselli: This is Conversation on Healthcare, I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well, Margaret, with all the discussions of the revived GOP
Healthcare Bill, it’s gotten me to think about healthcare co st. The revised bill
takes away many of the Affordable Care Act restrictions, but also many of the
protections. I think it is fair to say that if the bill goes through the House as
written, there’ll be many Americans who can no longer afford health cover age.

Margaret Flinter: And it will significantly shift the burden of paying for healthcare
onto the consumer and at the same time, it is going to cover a whole lot less.

Mark Masselli: It still leaves many unanswered questions for the health industry
m oving forward and what the potential impact of the loss of tax subsidies will
mean not only for the insurance market, but also the number of Americans, who
may end up uninsured. So not necessarily what we would call progress,
Margaret.

Margaret Flinter: And that’s something that has been on the mind of today’s
guest for sometime, Dr. Elisabeth Rosenthal is the Editor in Chief of Kaiser
Health News and she has just published a really riveting book, An American
Sickness, how healthcare became big business and how you can take it back.

Mark Masselli: And as well Lori Robertson stops by, the Managing Editor of
Factcheck.org, but no matter what the topic you can hear all of our shows by
going to www.chcradio.com

Marg aret Flinter: A nd as always if you have comments, please email us at
[email protected] or find us on Facebook or Twitter , because we love to
hear from you. Now w e’ll get to that interview with Dr. Elisabet h Rosenthal in just
a moment.

Mark Masselli: B ut first, here is our producer Marianne O’Hare with this week’s
Headline News.

Marianne O’Hare: I am Marianne O’Hare with these Healthcare Headlines.
Congress has come to agreement on a trillion dollar tem porary spending bill,
keeping Government from shutting down, at least until the end of September.
The spending package includes a number of measures including more money for
defense spending, but also more money for the National Institutes of Health and
a nyone expected under the president’s budget proposals and the House
Republicans have tried yet again to muster enough votes to support the latest
iteration of the GOP Healthcare Bill, something the president has been keen on
seeing move forward after the f ailure of the American Healthcare Act. Well, this
slightly revised bill technically retains protections for people with preexisting

Dr. Elisabeth Rosenthal

conditions, it still leaves that decision up to the States and that’s left some
moderate Republicans on the fence, that pot entially putting their vulnerable
constituency at greater risk. Health disparities have improved slightly since the
year 2000 to 2015, but African - Americans are still more likely to die earlier than
whites in this country. A recent report from the Center s for Disea se Control and
Prevention show the average life expectancy for black Americans is 75.6 years
and 79 years for whites. The study also found more African - Americans dealing
with or dying in their 30s and 40s from disease typically found in older a dults,
such as heart disease and diabetes, higher rates of obesity in that population
being considered as one of the causes. Cleveland Clinic will be getting a new
leader sometime this year. Dr. Toby Cosgrove, announcing he will be stepping
down after 10 years as CEO with many patents and breakthrough innovations to
his name. No successor has been named, but Cosgrove expects it will be an
internal promotion. He will be staying on as an advisor and so much for the
transformation of the American School Lu nch set in motion during the Obama
administration and promoted heavily by First Lady Michelle Obama. Secretary of
Agriculture under president Trump just signed a measure that rolls back certain
dietary guidelines that reduced salt, fat, and sugar contents in the typical school
lunch. Former Georgia Governor, Sonny Perdue, now the Agriculture Secretary,
signed a measure that delays sodium restriction in school lunches and leaves
more room for discretion in local purchasing for school cafeterias. Michelle
Obama had pushed the healthier food changes as part of a Let’s Move
Campaign in combating childhood obesity, which is expected to cost the
American Healthcare System hundreds of billions of dollars in coming decades. I
am Marianne O’Hare with these Health care Headlines.

Mark Masselli: We are speaking today with Dr. Elisabeth Rosenthal , Editor in
Chief of Kaiser Health News and the author of a newly released book, An
American Sickness, how healthcare became big business and how you can take
it back. Dr. Rosenthal was a well known reporter for the New York Times, where
she covered healthcare, as well as the environment. She earned multiple
awards for her two - year series on health pricing, paying till it hurts. She is a
graduate of Stanford University and Harvard Medical School. Elisabeth welcome
to Conversations on Healthcare.

Elisabeth Rosenthal : Oh, thanks for having me.

Mark Masselli: Yeah, you know first of all congratulations. It is wonderful, the
book, An American Sicknesses published by Pengu in Random House, which at
last check had risen to number six on the New York Times nonfiction bestseller
list and I think Americans of all political stripes are really trying to understand
what’s driving the American Healthcare to be the most expensive in the world
and may be you could share with our listeners using the emergency room as a
metaphor in American healthcare as a patient, could you describe the diagnosis
and what condition you think the patient is in?

Dr. Elisabeth Rosenthal

Elisabeth Rosenthal : The patient is appro aching critical condition I think. We are
reaching a tipping point of un - sustainability, both in terms of personal income,
where I hear from more and more people who are spending 20% to 30% of their
household income on health insurance and minor healthcar e, not even you know,
serious heart attack. We’ve all faced rise in premiums, deductibles, and I think
what we are seeing at the town halls now is people standing up and saying, you
know, wait I just can’t do this anymore. So, I think we really have to f ace this
central issue in American healthcare, which frankly we haven’t faced head - on
ever, which is the prices and how they got to be at this crazy place, where we
are, you know two three, sometimes hundred times as much with certain
procedures and that i s since as they are in the rest of the world.

Margaret Flinter: Well, Elisabeth, you started to focus on the nation’s health cost
crisis, a few years ago with your New York Times series, Paying Till It Hurts,
trying to determine what was driving the skyr ocketing cost of healthcare to almost
three and a half trillion dollar a year industry; take us to the beginning, what
unique insights do you think you can bring to help us better understand the roots
of the current crisis.

Elisabeth Rosenthal : Everyone knows it is too expensive and no one would have
designed a system like this, so how did we get here and that’s really what was
my personal odyssey in the first part of the book, the first step was the
development of employer sponsored health insurance in t he post World War II
era and that is not to say that health insurance is a bad thing, but what that set
off was this kind of disconnect between a patient paying for healthcare and what
was charged, because the insurers were paying. 10 - 20 years ago, your
e mployer provided you with insurance that was little out of pocket cost to you and
so it was all kind of funny money. It was invisible and what happened then is the
business of healthcare starts insinuating into a system that was focused on
caring and pati ents and this healing endeavor, which is where I started as a
physician in medical school and residency. You know, we weren’t paying it
directly, it was kind of a white collar crime, nobody was paying, so if you were
charging $50, you could charge $100, a nd then you would charge $500 and at
some along the way, business consultants started being involved. They went
into hospitals, consultants like Deloitte and McKenzie would go in and say, you
know, you could you make a lot more money doing the exact same things if you
just billed this way and that’s where we started getting the $17 charges for
Tylenol or the 200 bucks for every 15 minutes of oxygen therapy and of course
once the hospitals are making money, the doctors begin to sound almost kind of
Marxists , like you know, wait, we are the labor here, we want some of that too,
why are these guys all being paid a million plus a year, when we are producing
the value in this institution and likewise drugs, which were always kind of cheap
and devices which were traditionally kind of like Band - Aids, you know they were
just the ancillary things suddenly start charging a lot too and pretty soon you
have all this money kind of flashing around and a lot of people who are motivated

Dr. Elisabeth Rosenthal

by business and the values of busines s trying to grab for it and what’s lost I think
in that is the values that physicians and patients hold dear.

Mark Masselli: Elisabeth, you don’t pull any punches in your book. In it you say
that if we were trying to cure polio today, we still have poli o, but we’d have iron
lungs offered in seven different colors and it is hard to imagine a modern day
Jonas Salk, who would be willing to offer his cure for polio to the world and forgo
any profits from the discovery, I am wondering if you could talk about this aspect,
the high cost of medical and pharmaceutical research and the outrageous prices
of drugs today.

Elisabeth Rosenthal : I think we really have to think about our closely held belief
in this country that the profit motive is a good way to direct innovation and drug
discovery in healthcare. It does incentivise certain kinds of things that the
discoverer can charge a lot for. It does not incentivise cures that might lower
costs or be really cheap, so you know there are couple of examples in the bo ok,
one of which is a physician at Mass General, who has been researching a cure
for type 1 diabetes. Her work may not result in that cure, but it is kind of in
general a lot of excitement in the basic science community, but she can’t get that
funded by e ither pharma or the patient groups devoted to type 1 diabetes,
because as she said, she went to a bunch of pharmaceutical companies and
they said, vow, that’s really interesting, but how are we going to make money
from it. Treating diabetes is an industry worth a billions in this country and if
there was a cure for type 1 diabetes, that whole industry would go away, so
what’s our model for that kind of discovery. Of course in Salk’s days the idea
that you could patent this thing that was developed with pu blic research, it just
wasn’t a goal, but now of course, every university would be fighting over the
patent for that. You know, we look now at CRISPR technology, you know, which
is an important new technology prudentially, what have then news articles bee n
about? It’s about whether the Broad Institute or the University of California holds
the patent. When I wrote about healthcare reform, we always talked about lot of
these innovations were going to lead to patient centered evidence based care
and then wh en I started to write the book, I was like, wow, what other kind of care
could there possibly be and that we see in our country, it is financed based care.
Is there a profit in it for someone? It is business values, but those are not
necessarily what any of us want from healthcare.

Margaret Flinter: You point to another key driver behind the nation’s healthcare
sticker shock and that’s hospital costs. We know that many hospital rates are set
really in secrecy and you say that the other very menacing tr end is the
accelerating trend of hospital consolidation, which of course may do much to
eliminate competition in many markets. Talk with us more about how does the
average consumer get a hand on this without having a consultant after discharge
to help the m figure it out.

Dr. Elisabeth Rosenthal

Elisabeth Rosenthal : Yeah, right now it is hard, but there is a lot that can be
done. We need much greater transparency. You need to have a real price to
shop for anything, whether it is our employer shopping on our behalf or us
shoppi ng individually in this era of higher co - pays and deductibles and hospitals,
as you said, g o to great lengths to hide these list prices, even doctors,
particularly some of the younger doctors, I heard from one resident at a hospital
in Arizona, who was a r adiology resident and he wanted to know like how much
are you guys charging for an MRI and the business office wouldn’t tell him and I
hear this even from more senior doctors, who are increasingly concerned about
costs. All hospitals have this thing calle d the Charge Master, which is their
master price list, right. In almost all States those are top - top secret and guarded
as kind of trade secrets. In California, they have to be filed with the State. I
would like to see that in all states and I don’t see why it is not possible and I think
once those things are filed publicly, then advocates or physicians or just patients
who are really motivated can look at them and say, wow, you know, they are
charging a thousand bucks for every 15 minutes I was in the r ecovery room. I
was only there because the surgical team was having dinner that long, that
doesn’t make any sense. The other thing is I think that hospitals had to file these
costs and make them public. You know, my colonoscopy at a hospital in New
York was billed at $11,000. I know that if they had to list that price and put it in
the lobby, they would have never charged that. So, I think the first step is greater
transparency and you often hear a million different excuses why hospitals and
physicians can’t do that. You know, hospitals will say, well, nobody pays those
prices and if you ask, well, why do you charge them then, literally, one hospital
exec said to me, well because sometimes a foreigner with a big suitcase of cash
comes in and does pay i t. Another thing you hear is nobody really pays it well,
the uninsured often have to go after them for those big bills. There is a woman in
the book, who was billed over $350 thousand for surgery after a cerebral
aneurysm. The hospital would have accept ed under $100 thousand from
Medicare, from the VA, but because she did not have anyone negotiating on her
behalf, they went after her for 80% of the whole thing. It was nightmare.

Mark Masselli: We are speaking today with Dr. Elisabeth Rosenthal, Editor in
Chief of Kaiser Health News and author of the newly released, An American
Sickness, how healthcare became big business and how you can take it back.
Elisabeth, as we know the president ran on the platform of repealing and
replacing the Affordable Care Act and you say in your book that no reform of the
Affordable Care Act addresses the unsustainable cost of getting sick. What
needs to happen politically to lead to a better containment of health cost?

Elisabeth Rosenthal : You know the original proposa l by the Obama
administration did try and deal with this pricing issue head on. A lot of that the
truly price reducing and cost saving components were knocked out, but look who
is at the table. It was the insurers, the hospital associations, the medical trade
associations, pharma, but who is representing the patients and that is partly what
I want the book to do, to develop patients as a constituency that votes on this

Dr. Elisabeth Rosenthal

healthcare issue saying, hey wait a second, we want more of a say and how our
healthcar e works. There are various steps that I think people can and should
take. You know to look at these Explanation of Benefits Statements, literally
there is one person in the book, who he and his wife had a baby and they were
billed for circumcision. They knew their baby wasn’t circumcised. So they went
back and argued with the hospital. I think we have to start holding these
institutions accountable. They also don’t pay taxes because they are doing
service for our community. Okay, but let’s look at th eir 990 tax forms and say
what have you done for my city to deserve that big tax break and likewise, you
know, when you are going to your doctor’s office, and say I care about these
costs, will you work with me on it. Doctor please learn which of the x - ra y facilities
in this area will do it for $50 rather than $1,000. We need to learn how much
money did pharma contribute to my representative campaign last year. Who is
my State Insurance Commissioner? Right now, most of those insurance
commissioners are drawn from the insurance industry. As patients, we should
say no, those commissioners should be consumer advocates. You know, it is
sad that we in this country have to deal with these issues while we are dealing
with a medical crisis. You know when you go to an emergency room, do you
really want to have to say, okay, I’ve come to this in network hospital, but doctor
are you in my network, but I think right now we have to ask those questions with
the ultimate goal being if I go into an in - network hospital , hospital it is your job to
make sure that everyone who touches me is in my network. You know when I
was an ER doctor, it was just assumed that the ER doctor was part of the bill. It
wasn’t even separate billing, but now a lot of hospitals have wanted t hese ER
doctors to be contractors and the more entrepreneurial ones have seen it as a
good money making opportunity. The problem with their argument is you and
me, the patients, we are stuck in the middle and we have no hand to play in this,
in this negot iation.

Margaret Flinter: So, Elisabeth, it is hard not to come around to the idea of single
payer system, the moment you have this conversation about ways to look at our
Medicare colleagues and the degree to which they are able to control that
administr ative limit and stil l do quite a bit of innovation as we’ve seen over recent
years, we saw the State of Vermont try, almost got there with single payer,
couldn’t do it, talk to me about whether you think that would be a solution to the
problem and whether it is remotely possible in this country.

Elisabeth Rosenthal : Of course, it would be a solution. I mean it’s worked in
many other countries. I think every country has developed a system that needs
their kind of cultural preferences, their political rea lity, and their medical practices
and many of them have gone to single payer. When people say, oh, that would
never work in the U.S. Well, Medicare is a single payer system and while it has
its issues, I hear from a lot of readers in their 50s and 60s, w ho are all looking
forward to, you know the promised land of Medicare and of course I hear from
more and more physicians, who are now saying, fine, let’s just go with Medicare.

Dr. Elisabeth Rosenthal

You know, it doesn’t pay as well as some of the other payers, but it is fine, I can
live with it and it’s much less hassle.

Mark Masselli: We have been speaking today with Dr. Elisabeth Rosenthal,
Editor in Chief of Kaiser Health News and author of the newly released, An
American Sickness, how healthcare became big business and ho w you could
take it back. You could learn more about her work by going to American
Sickness.com or you can follow her on Twitter@rosenthalhealth. Elisabeth,
thank you for your work and for your book and for joining us on Conversations on
Healthcare Today .

Elisabeth Rosenthal: Thanks so much for having me.

Mark Masselli: At Conversations on Healthcare we want our audience to be truly
in the know when it comes to the facts about healthcare reform and policy, Lori
Robertson is an award - winning journalist and Managing Editor of FactCheck.org,
a non - partisan, nonprofit consumer advocate for voters that aim to reduce the
level of deception in U.S. politics. Lori, what have you got for us this week?

Lori Robertson: President Trump recently hit the 100 - day milestone of his
presidency and we looked back at the false and misleading claims he has made
in that time. On healthcare, Trump’s falsehoods were about ObamaCare. He
said that “ObamaCare is dead,” repeating a common talking point that the
Affordable Car e Act is in a death spiral, with rising premiums foreseeing relatively
healthy people to drop coverage leading to even higher premiums to covering
ever sicker group of beneficiaries. We found the ACA marketplaces are ailing in
some States such as Tennesse e, but flourishing in others including New York
and California and while some insurers have lost money are leaving, others see
opportunity and are getting in. The Nonpartisan Congressional Budget Office
and other neutral experts say the ACA marketplaces a re probably stable for
years to come. Trump has mentioned Tennessee several times, claiming that
half the State doesn’t have an insurance company selling policies on the ACA
exchanges and that “ the other half is going to lose the insurance company,” not
true, all of Tennessee’s eight insurance rating areas have at least one carrier
offering Affordable Care Act policies in 2017. For next year, Humana has
announced it will cease offering ACA policies. That would leave 79 thousand
Tennessee residents in th e Knoxville area without ACA coverage. A spokesman
for the State Department of Commerce and Insurance said the State is hopeful
an insurance carrier will offer coverage in that area next year. In his first 100
days, Trump also said that “many of our best and brightest are leaving the
medical profession entirely because of ObamaCare.” Actually, the total number
of active physicians has increased nearly 8% under the healthcare law according
to the Association of American Medical Colleges and that’s my Fact Check for this
week, I am Lori Robertson, Managing Editor of FactCheck.org.

Dr. Elisabeth Rosenthal

Margaret Flinter: FactCheck .org is committed to factual accuracy from the
country’s major political players and is a project of the Annenberg Public Policy
Center at the Universi ty of Pennsylvania. If you have a fact that you would like
checked, email us at www.chcradio.com , we will have FactCheck.org ’s , Lori
Robertson, check it out for you, here on Conversations on Healthcare.

Margaret Fl inter: Ea ch week conversations highlights a bright idea about how to
make wellness a part of our communities into everyday lives. Each year more
than one million babies die at birth and another three million die within the first
few weeks of life, often from preventable causes and when babies are born
prematurely, the risks escalate. Newborns, in particular the preemies have a
considerable amount of difficulty regulating their own body temperature and
without access to incubators, babies in the third wor ld often succumb to
hypothermia. That got former Stanford MBA student Jane Chen thinking how do
we develop a low - cost solution to the problem.

Jane Chen: My team and I realized what was needed was a local solution.
Something that could work without ele ctricity, that was simple enough for a
mother or midwife to use. We needed something that was portable, something
that could be sterilized and re - used across multiple babies and something ultra
low cost.

Margaret Flinter: Speaking at a recent TED talk, Chen said that they developed
a cocoon like device called simply Embrace, a thermal body wrap that encases
the baby and helps regulate body temperature for up to six hours.

Jane Chen: It looks like a small sleeping bag for a baby. It is waterproof.
The re’s no seams inside, so you can sterilize it very easily, but the magic is in
this pouch of wax. It is a wax like substance with a melting point of human body
temperature. You can melt this simply using hot water in that it is able to
maintain one const ant temperature for four to six hours at a time and it creates a
warm microenvironment for the baby.

Margaret Flinter: Chen and her developers have managed to keep the cost of
the Embrace Baby Warmer at around $25 per unit. Since launching the product,
they estimate that over 150 thousand babies’ lives may have been saved with the
device. A low cost high - tech portable temperature regulator designed to regulate
preemies body temperatures to ensure that they not only survive premature birth,
but ultimatel y thrive as well. Now, that’s a bright idea.

Margaret Flinter: This is Conversations on Healthcare, I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli, peace and health.

Dr. Elisabeth Rosenthal

Conversations on Healthcare broadcast from the campus of WESU at Wesle yan
University , streaming live at wesufm.org and brought to you by the community
health center.