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    How can doctors cure America’s ‘sickness’?


     ME: You identify many culprits for the current state of healthcare in the U.S. today, from hospitals to insurance companies to pharma. Is one more to blame than the others?


    ER: One thing I came to believe in writing the book is that it is the interplay of the different parts that is the most important factor. That doesn’t mean that things like pharmaceutical prices and device prices shouldn’t have better kinds of price controls, but I wouldn’t say they are the bad guy. I think we need to address each sector where we can.

    For hospitals, most are nonprofits, but they run with “operating surpluses.” And they spend that money on things that maybe their community wouldn’t say are benefitting patient care or the community. I lived overseas for 10 years. To say a U.S. hospital looks like a Hilton would be an understatement. Perhaps it is more like a Four Seasons. In most of the world, hospitals look more like junior high schools. They are not fancy places.

    This is where patients come in. Americans fall for this stuff. They say, “I love that hospital, it has beautiful art and free coffee.” So we allow our healthcare dollars—and encourage hospitals—to fund those things rather than more community clinics or knowing infection rates to see if this is the hospital we want to go to.


    Hot topic: Do younger doctors outperform older physicians? 


     ME: Now the $3 trillion question: How do we fix healthcare in this country? What is a true, actionable start to solve all the ills you outline in the book?


    ER: It is hard. And it doesn’t mean just saying “single payer” and we are all fine. That doesn’t mean single payer won’t work here and couldn’t be gotten to in a gradualist way. You could get there by saying, as Hillary Clinton said, we are just going to lower the Medicare age every couple of years. Thirty years from now, or at some point, everyone would wake up and say, “We have single payer”—what happened?”

    Medicare does a decent job in controlling prices and keeping overhead low. Yes, it has its problems, but more and more patients and physicians I hear from are telling me things like, “I’m so sick of this system, I could live with [single payer].”  


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