Transcription of Dr. Noy Noy speaking about free market healthcare on The Stossel Report
Interviewer: I’ve reported on American health care for decades, but now it’s more personal. Several weeks ago a surgeon at that hospital cut a small malignant tumor out of my lung. I picked that hospital. Well frankly, I didn’t really pick it. My doctors recommended a surgeon there, and what do I know about the best place to go? I got a couple second opinions, but frankly I spent much more time researching which cellphone to buy. That hospital is rated best in New York by a magazine. It’s the kind of things hospitals sometimes advertise.
Advertisement: Proud to be named the number one hospital in Tampa Bay by US News and World Report.
Interviewer: Good for them, but what does that really mean? Are the ratings accurate? Do they really help people shop for the best health care? We rarely have as much information about hospitals as I had shopping for this phone. So, how should we shop for health care? Let’s ask two people who think about that a lot. Dr. Ron Noy is an orthopedic surgeon who says Americans should get more personalized healthcare. David Goldhill is CEO of the Game Show Network. When a hospital killed his father, he put his business experience to use and wrote this book about how to fix American health care. So, David, a hospital killed your father?
David: Well, my father died of an infection he acquired in the hospital that was regarded as preventable. And as you know, the estimates of deaths from errors in hospitals are somewhere between 200,000 and 250,000 a year.
Interviewer: It’s the third biggest cause, yeah.
David: Third biggest cause of death every year and I’ve asked the question, “Why does that happen? Why are hospitals not incented to do…?” Again these are errors, and many of them are regarded as preventable, so where has the incentive gone wrong?
Interviewer: But they have an incentive not to kill you.
David: Of course they do. The question is, are they strong enough? And the argument I’ve made is that, unfortunately, the customer of the hospital isn’t the patient. It’s the insurer, it’s Medicare, it’s Medicaid, and that difference explains a lot of the things that we see and are dissatisfied in the American healthcare system.
Interviewer: Let me just turn to what I wrote in the article, which ticked a lot of people off. For all I know, my care was good, but the customer service was awful. You had to fill out the same forms, again and again, the same information. Sometimes, they’d say, “The doctor’s coming,” and he would come two hours later and they don’t bother to email you and say, “Yeah, he’s not going to be there for awhile.” Or, when they dismiss you, you wait two hours, nobody talks to you. Why?
Ron: There’s no reimbursement for good personalized care. My parents were in the hospital recently and like you said, every hour they had an appointment for their pre-operative stuff. But every single place made them fill out the exact same information and when they said, “Hey, why am I refilling this out? I just did this two seconds ago.” They go, “Oh the systems don’t talk to each other.”
Interviewer: You have a group Leapfrog that is trying to change the way we rate hospitals.
David: Leapfrog, for roughly 20 years, has been publishing data on hospital safety and now, published as a grade. Just a single A-F grade on how committed a hospital is to safety and how good the results are compared to other hospitals.
Interviewer: I just discovered that New York Presbyterian got a C grade. Below average on infections. Good on specially trained doctors. Below average on responsiveness of staff. I didn’t know about this stuff.
David: Below average on a couple of never events, too, things that should never happen in a hospital.
Interviewer: But patients don’t know about this.
David: That’s right. What would really help, though, is if we were the customer. Because when we’re the customer…
Interviewer: If the patients pay, they…
David: Because then, the providers chase you. They push the information in front of you.
Interviewer: When I argue that, people say, “We can’t afford this.” That only the rich would get good care.
David:I don’t know where they think all the money in health care’s coming from. It’s $3 trillion a year. It’s coming out of everyone’s pocket. We’re spending $800,000 per life. If people don’t think they’re paying for that, they’re kidding themselves.
Interviewer: Back to customer service. I complained that machines beeped at night and the nurse would come in or wouldn’t come in. Finally, she’d say, “Oh, old batteries.” But after my column was published in the Washington Post, a hospital worker wrote to complain about this customer mentality, “A hospital is not a restaurant, not a Burger King. You don’t get to have it your way.”
Ron: You can’t sleep in a hospital with all the beeping and everything else and the lights are on and you got all those florescent lights that are right in your eyes. How are you supposed to get better if you can’t sleep? If you don’t get good food? These are really important things that they’re…
Interviewer: People don’t eat the food…
Interviewer: Compared to the surgery?
David: There’s probably no part of the economy in which good service would mean more to producing the product. People feeling cared for. People feeling taken…When my son’s appendix burst, having to fill out the same form while he’s waiting for emergency surgery, over and over again is terrifying. Adds to the discomfort. Makes him sicker.
Interviewer: And let’s go back a few years and remember why we got that “have it your way” slogan.
Advertisement: Hold the pickle, hold the lettuce, special orders don’t upset us, all we ask is that you let us serve it your way. All right.
Interviewer: Burger King ran that campaign, because McDonald’s, which has long dominated the fast food market made it tough for customers to customize their burger. So, Burger King said…
Advertisement: We can serve your grilled beef flopper fresh with everything on topper any way you think is proper. Have it your way.
Interviewer: Competition made them both better, but people scream at me and say, “You can’t compare it. Medicine is much more complex than hamburgers.”
Ron: The medicine is standard, okay. If somebody comes in, complaining of some certain symptoms, we know where we’re going to, what tests we’re going to do, what treatments are probably going to be. And it’s just trying to figure out which one is the best for that person. But there’s more to a hospital than just figuring out the diagnosis and treating. You can’t tell a patient, “Don’t move until this catheter is removed, and somebody will be with you in half an hour,” and then, nobody comes there for eight hours and they sit around. And then, they’re increasing the risk for blood clots or other complications.
Interviewer: A woman named Michelle writes, “Stop whining and say thanks. You know how ridiculous you sound, Stossell? Email a physician, you think an M.D. has time to respond to patients’ email?”
Ron: I give every single patient my email, my cellphone.
Interviewer: You’re a free-market doctor…
Ron: And they email me all the time.
Interviewer: What if they bug you?
Ron: They do but that’s my job.
David: Every industry would love to have a pass like that, right? “Service does matter, doesn’t count.” For $3 trillion, it’s okay for us to expect the health industry to have the same information technology and commitment to service that every other industry has. We’re paying for it.
Interviewer: Some other criticisms, “In a truly free market, society wouldn’t subsidize the cost of Stossell’s smoking. In a free market, he’d be dead.” But just to be clear, I never smoked. Some people get lung cancer who didn’t smoke. And in a free market, I would have gotten better care. I wouldn’t be dead. Another one, “Let’s see him negotiate the price of chemo versus surgery when he’s in the ambulance on the way to the hospital. Medical care is not amenable to the usual market force.”
David: This is something that I hear all the time that is just bizarre. Nobody who says this has ever actually been in our healthcare system, which is so complicated, so difficult to navigate. So impossible to figure out how to get approval for things you need even during an emergency. In a consumer-driven system, where the providers are competing to get customers, you do less work not more work.
Interviewer: And they would have reputations, you wouldn’t make the decision in the ambulance. You’d know which hospital was cheaper or better.
David: You wouldn’t have unreadable bills, because they’d want you to pay them.