Adam Ruins the Hospital

Jul 23 2017

Not feeling well? In this episode, Adam diagnoses how arbitrarily inflated hospital costs have created a system that’s entirely unaffordable and unfair, reveals why antibiotics are worthless and explains why mammograms might not be as helpful as we think. Here are his sources.


"Oh, American health care isn’t the best in the world. But despite that we spend more per person annually on health care than any other developed nation."

Susan Brink. “What Country Spends The Most (And Least) On Health Care Per Person?” NPR, 20 Apr 2017.

"This neck brace is only worth $20 dollars. The hospital charged him $154."

Elisabeth Rosenthal. “As Hospital Prices Soar, a Stitch Tops $500.” The New York Times, 2 Dec 2013.

"This IV bag costs less than a buck. They charged her $137."

Elisabeth Rosenthal. “As Hospital Prices Soar, a Stitch Tops $500.” The New York Times, 2 Dec 2013.

"The Chargemaster is a secret document full of insane prices that hospitals use to charge us whatever they want!"

Tina Rosenberg. “Revealing a Health Care Secret: The Price.” The New York Times, 31 July 2013.

“But after the rise of insurance companies, hospital billing got
 complicated. In part because these gigantic corporations demanded gigantic discounts.”

Christopher P. Tompkins, Stuart H. Altman, and Efrat Eilat. “The Precarious Pricing System For Hospital Services.” Health Affairs, Jan 2006.

"Let’s make one Tylenol 37 dollars. Three stitches: 2200 dollars."

Elisabeth Rosenthal. “As Hospital Prices Soar, a Stitch Tops $500.” The New York Times, 2 Dec 2013.

"Seven dollars for a single alcohol swab?? That’s ridiculous."

Steven Brill. “Bitter Pill: Why Medical Bills Are Killing Us.” Time, 4 Mar 2013.

"If you become uninsured you’ll care! Because here’s the evil part: If you don’t have insurance, you ACTUALLY get charged these “fake” prices!"

Barry Meier, Jo Craven McGinty, and Julie Creswell. "Hospital Billing Varies Wildly, Government Data Shows." The New York Times, 8 May 2013.

"Let’s see... heart X-rays. That’ll be 33,000."

Elisabeth Rosenthal. “As Hospital Prices Soar, a Stitch Tops $500.” The New York Times, 2 Dec 2013.

"Hospitals make a TON of money off of overcharging out-of-network patients. It’s a real cash cow, and we’re the ones getting milked."

Ge Bai and Gerard Anderson. “US Hospitals Are Still Using Chargemaster Markups To Maximize Revenues.” Health Affairs, Sep 2016.

"A treatment that costs seven thousand at one hospital might cost 100 grand down the road."

Jeffrey Young and Chris Kirkham. “Hospital Prices No Longer Secret As New Data Reveals Bewildering System, Staggering Cost Differences.” Huffington Post, 8 May 2013.

"The health care industry spends more on lobbying than the defense and oil industries combined."

Steven Brill. “Bitter Pill: Why Medical Bills Are Killing Us.” Time, 4 Mar 2013.

"Before antibiotics, if you got an infection, there was a high chance you’d die of it."

Infectious Diseases Society of America. "Combating Antimicrobial Resistance: Policy Recommendations to Save Lives." Clinical Infectious Diseases, 1 May 2011.

"But this all changed in 1928, when one scientist got super lucky."

Howard Markel. “The real story behind penicillin.” PBS NewsHour, 27 Sep 2013.

"But sometimes — like if you don’t finish your antibiotics or through random chance — a few of these bio-bullies develop resistance."

"Antibiotic Resistance Questions and Answers." CDC, 17 Apr 2015.

"Over time, these protected pathogens can spread all over the world."

“What is Antibiotic Resistance and Why is it a problem?” Alliance for the Prudent Use of Antibiotics, 2014.

"But bacteria became resistant to it within just a few years."

Henry F. Chambers and Frank R. DeLeo. “Waves of Resistance: Staphylococcus aureus in the Antibiotic Era.” Nature Reviews Microbiology, Sep 2009.

"And we are speeding that process up, because antibiotics are super

Katherine Fleming-Dutra, Adam Hersh, Daniel Shapiro, et al. “Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011.” JAMA, 3 May 2016.

"According to the CDC, at least one third of the antibiotics are unnecessarily prescribed.”

"1 in 3 antibiotic prescriptions unnecessary." CDC, 3 May 2016.

"And 80% of these precious drugs aren’t used for medicine at all — they’re
 given to farm animals."

Stephanie Strom. “Report on U.S. Meat Sounds Alarm on Resistant Bacteria.” The New York Times, 16 Apr 2013.

"In fact, we haven’t had a new class of antibiotics since the 80s."

Global Risks 2013 Eighth Edition. World Economic Forum, 30 Oct 2012.

"All of modern medicine is built on a foundation of effective antibiotics."

Maryn Mckenna. “When We Los Antibiotics, Here’s Everything Else We’ll Lose Too.” Wired, 20 Nov 2013.

"In the 80s, the American Cancer Society even released an ad that said, 'If you haven’t had a mammogram you need more than your breasts examined.'"

Gerd Gigerenzer. “Breast cancer screening pamphlets mislead women.” BMJ, 25 Apr 2014.

"The American Cancer Society, the US Preventive Services Task Force, and the American College of Physicians have all recommended getting mammogram screenings less frequently and beginning them later in life."

"Breast Cancer Screening Guidelines for Women." CDC, 19 Apr 2016.

"And here’s how many women might end up dying from breast cancer after getting mammograms over that same decade."

Heidi Nelson, Rochelle Fu, Amy Cantor, Miranda Pappas, Monica Daeges, and Linda Humphrey. “Effectiveness of Breast Cancer Screening: Systematic Review and Meta-analysis to Update the 2009 U.S. Preventive Services Task Force Recommendation.” Annals of Internal Medicine, 16 Feb 2016.

"That’s what a lot of people think. But the truth is a lot more complicated."

H. Gilbert Welch. “Mammograms can help--and harm.” CNN, 11 Nov 2013.

"But the problem is, mammograms can’t tell the difference between these types of cancer."

"In the U.S. one out of every ten women who gets a mammogram will get a false positive."

"Over half of women in the U.S. who get annual mammograms over a decade will experience a false positive."

"That’s what we call overdiagnosis. And the best estimates are that 1 in 5 cancers might be overdiagnosed."

“Breast Cancer Screening Physician Data Query.” National Cancer Institute, updated 4 Apr 2017.

"The same is true of thyroid and prostate cancer screenings, by the way!"

Christie Aschwanden. “The Case Against Early Cancer Detection.” FiveThirtyEight, 24 Nov 2014.

"There is good news. Breast cancer mortality is way down."

Rebecca L. Siegel, Kimberly D. Miller, and Ahmedin Jemal. “Cancer Statistics, 2016.” CA: A Cancer Journal for Clinicians, 7 Jan 2016.

"None of us do. In the United States, we undergo a hundred million CT and MRI scans a year. Almost ten billion lab tests."

Atul Gawande. “Overkill.” The New Yorker, 1 May 2015.

"We’re overtreating ourselves to the tune of 226 billion a year."

Donald M. Berwick and Andrew D. Hackbarty. “Eliminating Waste in US Health Care.” JAMA, 11 April 2012.

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