Why corruption is ruining your health care [PODCAST]

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

“Doctors help patients, and they love us for it. We fix bones, replace joints, cure killer infections, and control diabetes with insulin. We use painless scans for diagnosis. Liver, kidney, and heart transplants are now routine. Some patients get cured of lymphomas, leukemia, Hodgkin’s disease, and testicular cancer. Lives are prolonged for myeloma and amyloidosis. Vaccines have saved millions worldwide.

We have complex technologies such as the heart bypass machine and dialysis. We replace diseased heart valves with artificial ones that work. Cardiologists permanently correct irregular rhythms using techniques that would seem natural on Star Trek. Other specialists gift infertile couples with children.

For a lot of the rest, supporting evidence that it works is lacking.”

Robert Yoho is a cosmetic surgeon and author of Butchered by “Healthcare”: What to Do About Doctors, Big Pharma, and Corrupt Government Ruining Your Health and Medical Care. He can be reached at his self-titled site, Robert Yoho, MD.

He shares his story and discusses his KevinMD article, “How I was wrong about health care.”

Did you enjoy today’s episode?

Please click here to leave a review for The Podcast by KevinMD. Subscribe on your favorite podcast app to get notified when a new episode comes out!

Do you know someone who might enjoy this episode? Share this episode to anyone who wants to hear health care stories filled with information, insight, and inspiration.

Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Robert Yoho. He’s a cosmetic surgeon and is the author of the book Butchered by “Healthcare”: What to Do About Doctors, Big Pharma, Corrupt Government Ruining Your Health and Medical Care. And he submitted an excerpt of that book to KevinMD titled “How I was wrong about health care.” Robert, welcome to the show.

Robert Yoho: Thank you, Kevin.

Kevin Pho: So we’ll get into your article and book in a little bit, but first off, can you briefly share your story and your journey to where you are today?

Robert Yoho: Sure. I spent the last 35 years in cosmetic surgery, doing liposuction, facelifts, breast augmentation, and that sort of thing. And I’m sort of like Rip Van Winkle. I haven’t studied general medicine for decades. I was lost in this rabbit hole.

And what happened to me was I had two fatalities in my surgical center within four months, and as you might imagine, it was just a horrifying experience. You can read about that in my book. But it sort of woke me up to the idea that my career was nearing an end, and I started to read about general medicine, health care, and I got into medical corruption for some reason. I started with the SSRI antidepressants, which I had prescribed for most of my career, and I found out that they were largely ineffective. And I went on to study the rest of health care, over three full years of working nearly half time on this book. I sort of woke up, and I had a perspective that was almost outside of health care, because what I was doing was so specialized.

Kevin Pho: All right, so let’s jump into your article and book, because there is a lot wrong with our health care system, and I’m interested in hearing your take on it. So again, your book is titled Butchered by “Healthcare”: What to Do About Doctors, Big Pharma, Corrupt Government Ruining Your Health and Medical Care, and the excerpt is titled “How I was wrong about health care.” Now, Robert, for those who didn’t read that excerpt, can you just walk my audience through it and maybe share the story of why you decided to share it with the KevinMD audience?

Robert Yoho: It essentially is the list that introduces the major topics of my book. If you look at the big problems in health care, in order, probably number one is the insurance companies, which skim about 25 percent of the nearly 3 trillion that we spent on health care right off the top. And it’s something that doesn’t happen, for the most part, in other countries. And their administration actually produces deleterious effects. They’re not motivated to conserve costs, because they get their money off the top.

Number two is hospitals, and they are over a third of our total expenditures. And again, they’re sort of capitalist organizations that are not designed to deliver good health care. They’re designed to deliver money. And most of those are actually nonprofits, and the nonprofits are an illness in our society, because there’s no oversight. There’s no board oversight. They can do whatever they want. And what they do is they just expense any profits, and their profits are phenomenal, but they spend them buying up medical practices and so on and so forth.

Another important precept is how much the money influences professionals, and what do we do about conflicts of interest? Most people think that you can, at least the industry trope is that you can abolish conflict of interest by revealing it. Well, we have a large studies literature about influence, and influence due to money is profound, pervasive, and unavoidable. Anytime money changes hands, basically, the well is poisoned.

So in medicine, we have this shower of money coming from the very top in the form of these third-party payments, and then we combine that with sort of a capitalist system that is fee-for-service, largely, or profitable activity for the hospitals, and it basically poisons the whole thing. What happens is the large organizations come back, and they bribe off our Congress, they bribe the physicians, they bribe the standards people. And I don’t use that term lightly. Bribe is a legal term, but it should be thought of as bribes. And I believe that prosecution is the only one way to get around this stuff. But the problem is we’re already bought. The money is already spent. The doctors, nobody recognizes that these conflicts of interest create pervasive problems.

Kevin Pho: So let’s talk about the first thing on your list. You mentioned third-party payers and insurance companies, and I don’t think it’s disputed that the administrative costs in the United States health care system are exorbitant compared to the rest of the world. Some of the counterarguments are that the insurance companies are so entrenched in our health care system that it’s very difficult to divorce ourselves from that. So what is your solution to divorce ourselves and maybe take a step away from those third-party payers, especially when they’re already so entrenched?

Robert Yoho: It’s a little bit of a discouraging story. In the end, the solution for the patient is to understand what’s going on, and really, the first step for everyone is to understand what’s going on. I think you can get a pretty good feel for it by reading my book. The physicians who have read my book are not aware of the whole story, and I have a revelation.

But for patients, if you understand the limits of health care, if you understand that the doctors really can’t save you from death or mortality, if you understand that science is limited, you can sort of start to develop a philosophy of your own, which I get into in the last chapters, that will help you.

But as far as the global picture goes, I think if everyone starts to realize how corrupt the entire thing is, maybe there’s a prayer of changing something. And I think ultimately this stuff has got to be prosecuted. The people that have tried to prosecute health care companies have had a very difficult time. We’ve thrown 20 percent of our gross domestic product at health care, and in return, we get these mobsters move in. And I don’t use that word lightly. That’s not my word; it’s Peter Ross’s word, who is describing the companies that he worked for. He says they behave like mobsters. In return, we get these mobsters move in who don’t have our physician ideals.

And physicians still have ideals. I mean, we’re trying as hard as we can in a system where we’re spending 50 percent of our time screwing around with medical records because of statutory requirements.

Where the thing got the most out of hand was a 2003 law, where Bush signed this thing into law, that said that we can’t negotiate with Medicare any longer. We had to pay 107 percent of the wholesale, and that sounds reasonable, but what happened is they’re allowed to price fix. And now we’re something like 4.5 percent of the world’s population. We pay 40 percent of the drug costs in the world. I mean, it’s just a crazy, crazy deal. Even the VA negotiates with pharma for their costs.

Kevin Pho: In your vision, what’s the role of government in terms of regulating both the pharmaceutical industry and even regulating the insurance industry?

Robert Yoho: There’s no easy solution, and I don’t think a single payer is the way to go. Now, Medicare does protect the patient better than any other solution that we have currently. Part of the problem is that these entities that we’re dealing with, the hospitals and the doctors, compete for the third-party payment dollar with the insurance company. So everybody submits competing bills, and they’re just incredibly outrageous.

I mean, my wife has a problem, and she went and paid cash. She’s Medicare. She paid cash at a California institution for two chemotherapy treatments, two doctor visits, and a bone marrow. Guess what the price was, the retail price? $266,000. I’m not kidding. It was not a hospital stay. So that was bargained down to $40,000, which is still insane. But anyway, they’re just out of control.

Now, fee-for-service has got to go. I did fee-for-service my whole career, and I thought it was ethical, but even as little insight as you have into your own behavior, I’m sure that I did things that were not 100 percent in the patient’s best interest.

Kaiser has a pretty good system. It’s imperfect, but they have internal controls. They have the freedom to practice without fear of reimbursement problems, or they don’t have to pay their office staff. And I think giving the money to entities like Kaiser, who can compete against each other, is a reasonable first step, and that’s the best thing I discovered. I don’t think that anything like what we’re doing now, like Medicare for All, it’s still fee-for-service. Kaiser integrates the three entities, right? The hospital, the doctor group, and the insurance company. So those three things don’t compete against each other in theory, and in theory, they’re not like trying. I mean, they’re growing like a weed too.

The health care is so well funded that these guys are getting double-digit growth rate every single year. They’re building new facilities and everything else, and this is crazy, because we’ve got way too much health care right now. Everybody says, “Oh, we need health care.” The things are shut down during the pandemic, so people are dying because they can’t. This isn’t true. We are delivering twice the health care that other countries are. It’s costing us 20 percent, roughly. I mean, it’s not 20 percent yet, but it’s close to 20 percent of our GDP. All the other first-world countries are around 10 percent. Singapore gets by for 5 percent, and their numbers are better than ours. We’re like 40th in the mortality in the timeline. So I think our health care is ruining our lives, and we don’t need more health care.

So what if we were able to get a system like Kaiser in place? Not for the whole thing, because central administration will screw it up. We get these entities, and they compete against each other, where they don’t have to, where the insurance company doesn’t have a separate set of stockholders and other idiots that they’ve got to satisfy. They don’t have to pay their CEOs $20 million each. Kaiser, the top of the pay scale, I think, is around $3 million or something like that, and he probably deserves it. So if we get these entities like Kaiser competing, it’s my opinion that we could squeeze them and get our costs down.

Kevin Pho: So we’re talking to Robert Yoho. He’s a cosmetic surgeon, author of Butchered by “Healthcare”: What to Do About Doctors, Big Pharma, Corrupt Government Ruining Your Health and Medical Care. Robert, if you were to give us a take-home message, and perhaps the next step in terms of fixing the problems you articulate, what’s the next step that we should take?

Robert Yoho: Step is, learn as much as you can. And my take-home message is, as negative as I am about the whole thing, and as many stories as you’re going to hear, and you’ve just scratched the surface of the corruption of both the doctors and this industry here, as negative as I am, I want to emphasize that half of what we do is very, very important. And the other half, we don’t know about, and a lot of it doesn’t work. But half of what we do is important.

And I don’t want to present the idea that I’m some sort of alternative doctor who believes in nuts and berries and nutrition and that we can just give up on all of health care, because there are miracles that are happening every day. They’re too expensive. The system’s set up to make them cost hundreds of thousands to even millions of dollars a year for some of these things, but they are tremendous improvements. And my take-home message is that patients and doctors have got to be very skeptical about what’s going on.

Kevin Pho: Robert, thank you so much for sharing your insight, and thanks again for being on the show.

Robert Yoho: Thanks, Kevin. I really appreciate it.

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes