Name: Why it costs so much to get sick | Chasing Life
Uploaded: 2025-11-24T16:51:55.000Z
Duration: 39 min 35 s
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Well, Dr. Rosenthal, thank you for joining us.

Yes, every day I feel like I'm chasing life, and particularly about this topic that I'm obsessed about.

I'm just trying to figure out how to make it better for people, which has kind of been my journalistic mission for decades.

Yeah, well, I do want to get into that background because I find it fascinating, and I think you and I share a lot of connective tissue in this regard.

But what is the specific topic that you find fascinating?

Well, you know, generally our health care system doesn't deliver to patients in terms of quality of care and in terms of the prices we get charged.

So what I worry about right now, and particularly in this season of renewing insurance, is, is that people avoid going to see doctors and avoid going to the hospital because they're just afraid of the bad experiences they've had.

And they don't trust doctors or hospitals because they've had bad and very expensive experiences.

We did a podcast and a series of articles called Diagnosis Debt, and it's about 100 million Americans have medical debt now, and that's just going to go up if people don't have insurance.

And what we're seeing now threatens to leave millions of more people uninsured.

So when you talk about the bad experience, you're primarily talking about it from a financial standpoint.

There's other things, obviously, but the sort of diagnosis debt, as you call it, no, I think it's multifaceted, because I think most hospitals run as businesses now.

I mean, I think you and I both know that.

And so, you know, there's one thing I'm obsessed with is ER boarding, how much time people spend in emergency rooms.

And, you know, that's largely a financial decision.

It's probably tmi, but my husband who died earlier this year.

Well, he, in his final admission, spent three days in the er, and I knew there were elective admissions coming into the hospital.

But I think, you know, this is an older guy with stage 4 cancer who's just going to take up a bed and won't generate any revenue and will be a placement problem, you know, if he doesn't happen to die on this admission, which he, in fact, did.

I mean, you try and make an appointment for physical therapy or a neurologist or an endocrinologist, and it's, you know, two, three months out because, you know, hospitals want to run as full ships all the time and the weights are terrible, the phone trees.

You know, talk about a bad use of AI assistance.

You know, there are multiple bad experiences that go well beyond the cost, but I think they're all related to, you know, what?

I wrote my book about how healthcare became big business.

And I'm not sure there are good ways to take it back individually, frankly.

Okay, well, that's sort of a little bit of what I wanted to pivot some of this conversation around, which is how did we get here and how do we get out?

Because, you know, you and I have both evaluated healthcare systems around the world, and I think when you do that, the consensus always is, look, there are things that work well with our healthcare systems, but many, many things that don't.

Some of which of you have alluded to, did we get here through a process of natural evolution or what were the weird sort of forces that got us to this place?

Well, I would call it more unnatural evolution.

You know, basically the idea of insurance goes way back to the turn of the last century where it was really more like, you know, you know, disability insurance.

It was pay, which you got because you couldn't go to work.

And, you know, hospital stays were inexpensive.

So it didn't, it really wasn't about that.

Then around that time, a teacher's union in Texas decided to have insurance for their employees.

And some employers developed, you know, on site clinics to help their employees.

But the big change was really post World War II when there was a labor shortage and companies started offering health insurance as a perk, you know, and that was a big thing.

So then there were all these people who had insurance which was tied to their jobs, and more people got insurance that was tied to their jobs.

And then in 1963, you, you know, people over 65 didn't have jobs, so they were just like flailing in the wind, unable to bear the cost.

And the problem is, and I call insurance the original sin.

Not because it's bad to have insurance, it's kind of a must have, but because it for many years separated the patients from the cost.

So, you know, when I had my children in the 90s, I paid nothing.

So I didn't really care how much was being charged.

And of course, what happens kind of organically or evolutionarily is some doctors realize, hey, you know, entrepreneurial doctors, it doesn't matter how much I charge because the patients aren't going to feel it right then what the.

Another big step which I learned when I was writing my book was, you know, in the 1990s, there was this era of HMOs and they were really putting the squeeze on hospitals.

And so hospitals called in business consultants like McKinsey & Bain, Boston Consulting Group, and they said they looked at hospitals procedures and how they operated.

And they said, guys, you're leaving all this money on the table.

Like, you know, when I was an ER doctor, I came with the er, but the inside of business was like, wow, you can charge separately for that doctor and for that IV bag and for the nurse who's inserting the needle.

like, when patients are in the recovery room, why are you giving that away for free?

And not only that, you can charge in 15 minute intervals.

Like, why are people in the recovery room?

Sometimes it's because they need to like, come out of anesthesia.

And sometimes the extra half hour is because their team is having dinner.

And so, you know, we've gotten to this place where everything is billed, each little, every pill, every interaction.

And then what happened is as a reaction to that, the insurers said, oh, we've got to, you know, let patients have some skin in the game.

You know, there was, there were CO pays which were kind of minimal, and there was a deductible which wasn't very much.

But those little bits of change didn't really.

So over time, the deductibles have gone up.

So I think some people have $9,000 deductible plans.

In addition to CO pays, there's coinsurance, which is 20% often for hospital stays.

And you know, man, if you're in the ER for, you know, four hours, that's 10,000 bucks probably, and your portion is 2,000.

We're at this kind of critical juncture where we put efficiency ahead of patient care.

And we've sacrificed a lot of patient care in the name of efficiency.

And you know, I say we as a kind of lapsed physician, but we've lost the population in that process.

You know, I think this was something of a big deal during the pandemic when, you know, physicians were saying you need to get vaccinated.

But a lot of people didn't have a doctor they trusted.

I do want to get at this idea of where we should go, but let me focus in on something that you brought up a couple times.

This idea of cost sharing, of having skin in the game.

When you had your kids back in the 90s, it was free.

Patients were largely insulated from cost.

So they weren't effective negotiators in terms of trying to bring those costs down because they didn't really care.

Then you started having more cost sharing, sort of incremental at first in terms of co pays, but higher, higher sort cost sharing with high cost deductible plans, things like that.

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Why it costs so much to get sick | Chasing Life

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