Dr. Marty Makary wrote the book “The Price We Pay” to spotlight the issue of rising healthcare costs in the United States.

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Why do healthcare costs continue to rise? Dr. Marty Makary made it his mission to highlight why, as well as our need to overhaul our healthcare system. Getty Images

Why does healthcare cost so much in America? It’s the question that plagues not only politicians, but anyone who has been afraid to go to the hospital or see a physician due to the potential bill.

In 2018, the United States spent $3.6 trillion on healthcare, according to the federal government. And that number has been growing.

But all of this money doesn’t make America the healthiest country in the world.

In fact, we’re lagging behind comparable countries like Australia, the United Kingdom, and Germany in life expectancy.

These high costs have also led about 40 percent of Americans to avoid or delay getting medical tests or treatment.

To uncover just what’s behind the rising costs of medical care, Dr. Marty Makary, a professor of surgery at Johns Hopkins University, has been traveling the country looking at hospitals or outreach programs both big and small.

In his recent book, “The Price We Pay,” Makary puts a spotlight on what happens in a hospital billing office and how deals with insurance companies may lead to higher overall medical costs.

He’s also working with the Restoring Medicine movement, which aims to help alleviate escalating healthcare costs by advocating for policy change.

We spoke to Makary about what he uncovered while working on his book and what people can do when a massive hospital bill arrives in the mail.

This interview has been edited and condensed.

Healthline: When you’re working with patients, do you talk to them about cost?

Makary: I can tell you 500 different facts about pancreas surgery, except for one, and that is how much it costs. And as much as I didn’t want to have to be bothered with learning that additional information, I realized that it’s important to patients.

And while I can’t guarantee prices, I can speak with enough confidence about the general ballpark range of what the bill will be for certain things.

Can you talk about some of the most surprising moments you had as you were doing the research?

I observed that doctors and hospital leaders themselves were shocked when they learned how out of control their billing offices had gotten in shaking people down and in charging more than a reasonable amount for a service.

I found a system not of bad people, but instead a fragmented system of good people… But the bigger question is how do we fix healthcare? It was clear to me that the way to fix healthcare is to address two underlying root causes of our cost crisis that we’ve not been talking about, and that we need to talk about.

And that is, No. 1, pricing failures, and No. 2, inappropriate care. There is broad consensus that people want shoppable services defined by their value proposition before choosing those services. We have a crisis of [excessive treatment in healthcare] today in America. As much as a fifth of care is unnecessary.

Many Americans have a fear that they’re going to go to the hospital and be treated by an out-of-network doctor and get a giant bill with no plan for what to do next. What can people do to protect themselves?

I think the most important thing for patients to know is that they do have rights and that we live in a free country. When you’re told you have to do something, it’s not necessarily true. For example, if an ambulance shows up at your house, you don’t have to get in the ambulance.

Over 60 percent of medical care is nonurgent, or what we call shoppable, and you should ask a lot of questions. People should ask for a price.

If you get a bill that’s egregious or out of line with what’s been presented to you, there’s many things you can do. And they include things like checking your bill, asking for an itemized bill, asking for the free market price, or looking up the going price on certain websites.

Involve your doctor if you’ve been billed unfairly. Many people are afraid to bother us as physicians with issues with their bill. But doctors need to be aware because they can be your advocate.

Do you think that other doctors are interested in figuring out the cost of their medical care?

Some doctors are very in tune with the prices of their services and the other services their patients need. And other doctors don’t know for a myriad of reasons.

The prices may be changing so quickly. In my book, I described how at the same hospital in America, the price of an operation could spike by 60 percent in 1 year. I don’t think they asked the doctors for their permission to spike those prices.

As a matter of fact, we know that there’s a crazy game in healthcare of hospitals spiking prices. At the same time, they [raise] up the insurance discounts. I’ve been working with policymakers to make secret discounts in healthcare between insurance companies and hospitals to be public information.

One hospital has said, “We can’t do that — we have over 300 different contracts with different discounts [with various insurance companies.]” And I responded by saying that’s exactly the problem, “Why do you have 300 different discounts? If you go to a restaurant, there’s not 300 different menus.” And we need to get to more honest pricing.

Financial toxicity is a medical complication. So when we take care of a patient, we should be taking care of the entire person. It doesn’t make sense for us to accept people with open arms, treat their ailment, and then ruin their life financially.

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Dr. Marty Makary. Image via Dr. Marty Makary

Makary and his team have a full list of how to fight a hospital bill on their website. He talked to us about some of the top things people can do to fight a hospital bill.

Talk to your doctor

“When we told doctors that their patients had an extreme form of predatory billing, whereby the hospital sues the patient to garnish their paycheck, we find that doctors generally have been outraged by this practice,” Makary said. “They feel that these patients came to them for care.”

Call the hospital

“Talk to the revenue cycle people at a hospital and make your case,” suggested Makary. “Show them the going price found via Medicare data or via other data sources. Explain any hardships.”

Reach out to top hospital officials or the media

“If you continue to be hounded for an unfair bill, we’ve explained that patients can go to not only hospital leadership, but to the media,” Makary said. “Hospital board members are responsible for the oversight of a hospital’s leadership. Those board members often are business and community leaders who are liaisons between the community and the hospital.”