Something You Should Know - How Trust Works & Taking Back Healthcare

Episode Date: December 30, 2019

Some people can’t imagine exercise without having their cellphone. You can listen to music, text and chat and it helps the time fly by. Well, there is also a problem with exercising with your cellphone and we will discuss what this is in this episode of the podcast. http://www.mensfitness.com/training/pro-tips/heres-how-your-phone-could-be-ruining-your-workout Have you heard of oxytocin? It’s sometimes called the “moral molecule.” Oxytocin is the brain chemical that helps us trust each other and feel good about each other. What’s interesting is that we know how to cause oxytocin to be released and when you understand how it works, it has implications for all our relationships with people who love, people know and even strangers. Neuroscientist Paul Zak, author of The Moral Molecule (https://alexa.design/2osVKNw) joins me for this fascinating discussion. People talk about healthcare a lot – but things only seem to be getting worse. And generally, I think people feel helpless to do anything. Perhaps you will feel more empowered when you hear Elisabeth Rosenthal, author of the bestselling book, An American Sickness (https://alexa.design/2pniwUd). Elisabeth was trained as a physician and spent years as a writer for the New York Times and is now editor-in-chief of Kaiser Health News. Everyone knows that arguing isn’t good. But actually it may just be the thing to keep your relationships alive. We’ll explore why in this episode of the podcast. http://www.nbcnews.com/id/38698442/ns/health-behavior/t/go-ahead-argue-it-can-be-good-your-health/ Learn more about your ad choices. Visit megaphone.fm/adchoices

As a listener to Something You Should Know, I can only assume that you are someone who likes to learn about new and interesting things and bring more knowledge to work for you in your everyday life. I mean, that's kind of what Something You Should Know was all about. And so I want to invite you to listen to another podcast called TED Talks Daily. Now, you know about TED Talks, right? Many of the guests on Something You Should Know have done TED Talks. Well, you see, TED Talks Daily is a podcast that brings you a new TED Talk every weekday in less than 15 minutes. Join host Elise Hu.

She goes beyond the headlines so you can hear about the big ideas shaping our future. Learn about things like sustainable fashion, embracing your entrepreneurial spirit, the future of robotics, and so much more. Like I said, if you like this podcast, Something You Should Know, I'm pretty sure you're going to like TED Talks Daily. And you get TED Talks Daily wherever you get your podcasts. Today on Something You Should Know, exercising with your cell phone. It makes the time go by We'll talk to you next time on The Time Out. makes us feel like we belong. I started thinking about the timeout that we use to punish kids. The timeout says, you're misbehaving, we don't want to be around you. So I invented the time in. The time in is you've got to sit in my lap and sit there and make eye contact with me and let me hold

you until you are calmed down and you feel appropriately loved and taken care of. Plus, you'll discover how arguing can actually make a relationship better. And then health care. Why is it so expensive? You know, when patients say to me, oh, I love that hospital. There's like free coffee in the lobby and it's so beautiful. I say, yeah, but we're all paying for that. We're paying through the nose for that. All this today on Something You Should Know.

Since I host a podcast, it's pretty common for me to be asked to recommend a podcast. And I tell people, if you like Something You Should Know, you're going to like The Jordan Harbinger Show. Every episode is a conversation with a fascinating guest. Of course, a lot of podcasts are conversations with guests, but Jordan does it better than most. Recently, he had a fascinating conversation with a British woman who was recruited and radicalized by ISIS and went to prison for three years. She now works to raise awareness on this issue. It's a great conversation. And he spoke with Dr. Sarah Hill about how taking birth control not only prevents pregnancy, it can influence a woman's

partner preferences, career choices, and overall behavior due to the hormonal changes it causes. Apple named The Jordan Harbinger Show one of the best podcasts a few years back, and in a nutshell, the show is aimed at making you a better, more informed, critical thinker. Check out The Jordan Harbinger Show. There's so much for you in this podcast. The Jordan Harbinger Show on Apple Podcasts, Spotify, or wherever you get your podcasts. Something you should know. Fascinating intel. The world's top experts. And practical advice you can use in your life. Today, Something You Should Know with Mike Carruthers. Hi, and welcome to Something You Should Know as we wrap up the year 2019 with this episode. I hope you're having a great holiday season.

And first up today, we're going to talk about exercise and cell phones. Because, well, exercise is good and cell phones are good, but the two don't mix well together. Using your phone when you exercise can actually mess up the quality of your workout. 44 students were put on treadmills for 30-minute sessions to test how talking, texting, and listening to music affected their workouts compared to working out with no phone at all. And it turns out that the phone is a big distraction. Here are the stats. Phone chatting reduced the subject's running speed by 10%.

Texting was an even bigger drag, lowering speeds by 10% and heart rates by 5%. Listening to music, though, boosted heart rate and upped overall average treadmill speeds. The problem is that it's very hard to just listen to music and resist answering texts and calls. But if you can do it, listening to music while you're exercising turns out to be a good thing. And that is something you should know. For the world to work, we all have to get along, or most of us have to get along to some degree. So in a world of billions and billions of people,

what is it that allows us to get along and trust each other and feel good about each other? Well, in large part, it could be certain brain chemicals, in particular, oxytocin, sometimes called the moral molecule. It's really fascinating how this chemical works, and neuroscientist Paul Zak is here to discuss this. Paul is author of several books, including one called The Moral Molecule, How Trust Works. And he's here to explain how oxytocin works and why it's important to understand. Welcome, Paul. Now, I've heard of oxytocin. I imagine most people have heard the word oxytocin.

But explain it in more detail as to what it is, why it's important, and why it's called the moral molecule. Right, so oxytocin is an evolutionarily old molecule in the brain that motivates connection to others by giving us a sense of safety. So it says, this person is safe to interact with. And when human beings, for reasons we can talk about, this system kind of works in hyperdrive. And so we not only care about our friends and family, we actually care about complete strangers, our pets. We even name our cars sometimes, right? So we're really this connecting species. We attach to lots of people and even objects. And this is all oxytocin at work?

This is oxytocin at work. And, of course, oxytocin interacts with other brain chemicals that can ramp up or ramp down the desire to interact with others. By the way, Mike, I should say I'm a complete skeptic, so I don't do experiments where I say, are you a great person or not? We actually tempt people in my lab with virtue and vice using money. And so we can actually quantify how much you care about someone else, how generous you are, how trustworthy, how charitable, by putting money on the line.

Wait a minute. Now, say that again. I didn't quite follow that. So we tempt people with different actions so that we can quantify how much they care about something. So I'll give you a concrete example. So we've studied, for example, trust. Why would you ever trust a stranger? So in these tasks, you get matched up with someone anonymously in the lab, and you can do whatever you want to do. You're a partitioned computer station. You can keep the money. But if you share money with somebody else, it grows in size,

but then this other person controls it. Then he or she can share it back with you, or he can keep it all. He can just leave the lab and take the cash. And so that's a way to quantify, do you really trust somebody? And if you trust them, do they reciprocate it? Are they trustworthy or not? And so we showed that the more money you send someone denoting trust,

the more their brain produces oxytocin, and the more oxytocin on board, the more they reciprocate. So we have an underlying biology of, you play nice, I play nice, the golden rule. Really? So when you kind of send out the signal that you trust them, they in turn, something's going on with this oxytocin that then they more likely trust you. That's right. So that's true for about 95% of the thousands of people

we've run through experiments in the lab and in the field. Now the 5% who don't get this are interesting. percent of the thousands of people we've run through experiments in the lab and in the field. Now, the five percent who don't get this are interesting. A couple percent of those are psychopaths, and these individuals don't have a sense of connection or empathy. And a couple percent are people who have bad childhoods. They need sufficient nurturing for this brain system to develop properly. And then a couple percent are like you or me when we're really stressed out. High stress will actually inhibit the release of oxytocin. And when we're in survival mode, it's all about us and not about connecting to other people.

Yeah, because I was going to say, well, how do you explain people who scam you and cheat you and, you know, those kind of things? That's right. So that's the 5% who are dangerous. So in about 1% of those are psychopaths, and psychopaths make up 40% of the prison population. So for these individuals, we really need the laws. We need enforcement. But for most of us, most of the time, we don't worry about where that bright line is

because we're this kind of internal thermostat, if you will, that uses oxytocin. Turn up the oxytocin, and all of a sudden I'm treating strangers like family, and by and large they're going to reciprocate with me, and turn it down, and all of a sudden I get a selfish behavior, aggressive behavior. In fact, I should tell you, Mike, that one of the most powerful oxytocin inhibitors is the most interesting hormone to half of the human race, and that is testosterone. And so when we administer testosterone to men, they become more selfish and more entitled. But at the same time, high testosterone males will invest their own resources to punish people

who don't behave properly, who don't share and behave in appropriate social ways. So this would explain why more men are, or more criminals are men, more road rage incidents are men, that kind of thing? That's right. But also why 85% of the active U.S. military is male. And women can do this job, but guys really dig it. Come on, blowing stuff up, flying jets, how cool is that? Right.

And women just, it's just not a... They don't get it. Yeah. Some of them do. Again, there's lots of variation. I'm talking about averages here. We have some experiments where we have the highest testosterone push in the experiment is a woman. But even, Mike, if you win a chess match, your testosterone goes up. So, you know, our bodies are constantly modulating the appropriate environment we're in. And if, you know, you win the salary lottery and you get $5 million this year, your brain will change, in particular, produce more testosterone, and it's telling you,

you're the thing, you're the best genes on the planet, and everything in the world should be all about you. So that's why we see bad behavior sometimes among movie stars and supermodels, because they have this sense that everyone's sort of kowtowing to them that changes the way your brain works. Well, that was kind of where I wanted to go with this, because as fascinating as this is, what's the so what? I mean, what do we do with this knowledge that oxytocin is in there and doing what it's doing, but so what? We found that there are individuals who I call oxytocin adepts, people who release lots

of oxytocin that, for, people who release lots of oxytocin that for the same simile as others release little. And when we characterize these individuals, they are much happier than people who release less oxytocin. But why are they happier? Because they have better relationships of all types. They have better romantic relationships, more close friends, they're closer to family. They're even nicer to strangers in these money-sharing tasks.

So because you can actually change the way your brain releases oxytocin, this suggests that we can consciously kind of build a world that's much richer to live in. And so how do we do that? So again, 10 years worth of experiments, we've found dozens of ways that the brain releases oxytocin. We have things like exercising together, praying, meditating, singing, dancing, petting a dog will do it. So all these behaviors help train us to feel comfortable, to connect, and by doing so we have a richer social network. Oxytocin actually even improves the immune system,

and so there's a sense in which we are building a life we want. And this not only scales from the level of individuals, it goes right up to countries. So countries that have higher levels of moral behaviors, they're more trustworthy, they're more tolerant, are also more prosperous, and they're happier. And so there's a kind of a path we can put ourselves on to create, I think, the kind of life that we'd like to live. Knowing that, what should I be doing differently? So here's one example, and something I started doing a number of years ago because we showed that touch releases oxytocin.

So I have just refused to shake hands for the last couple of years, and I hug everybody. So I ask them first, and I'll, of course, grab people. Look, I'm the oxytocin guy. They call me Dr. Love. I'm going to hug everybody. It turns out that just preannouncing that, because I know it really is oxytocin and other people, connects people better to me. But there are simple ways you can do it.

In my family, we have a no electronics rule. When we're going out as a family, all the electronic stuff stays at home, and we're focused on being really present. I mean, I think taking the time with your spouse to just sit there and listen and to understand that, you know, he or she may be not so pleasant today, but not because they're a bad person, but because, for example, stress hormones are inhibiting their ability to connect with you. So even simple things, like I have little children at home, and I start thinking about, you know, the timeout that we use to punish kids. It makes no sense.

The timeout says, you're misbehaving. We don't want to be around you. So I invented the time in. The time in is you've got to sit in my lap and sit there and make eye contact with me and let me hold you until you are calmed down and you feel appropriately loved and taken care of. So, again, I think there's lots of actionable items from our own families into the way we organize politics and society and even things like global economics. You know, civilization is not possible.

We live around unrelated humans unless we have something in our heads that says, you know, Mike seems perfectly fine and I'll release oxytocin and interact with him. But, I don't know, Bob doesn't seem fine and so I'm going to avoid him. So we have to have something in our heads that motivate us to be connected to our social group, and once we realize what that substance is, then we can work hard to make it work better. But is oxytocin the substance that tells me that

Bob's not so trustworthy? Well, that would be a stress hormone. So again, oxytocin is like this thermostat, right? So it turns up and turns down at appropriate times. So when I see the Bob guy, I'm going to, you know, get this,ostat, right? So it turns up and turns down at appropriate times. So when I see the Bob guy, I'm going to get this. Again, these are very subtle, old, evolutionarily old signals. You know, here my neck stands up.

I just feel uncomfortable. When you go to a cocktail party, you meet someone for the first time, and you go, great guy. I don't know why. He just seems like a wonderful guy. And then you meet someone else, and you're like, I don't know. I have this kind of bad feeling about this person. So the system doesn't have to be perfectly tuned to still be adaptive. Having said that, we're not automatons.

We're certainly not slaves to the chemicals in our brains. So having insight in how these work, it's like mindfulness meditation, right? If you kind of pull apart the way your brain's working, then you can be a little more aware of it and therefore be a little more in control of it. So how come I haven't heard of this before? Why are you the guy leading the way on the oxytocin story? Yeah, great question. You know, this was just sitting on the shelf to be discovered primarily because there's no medical disorder associated with too much or too little oxytocin other than preterm labor. And so it was just seen as this female hormone that wasn't that important. In fact, Mike, one of my colleagues, when I

started thinking about this 10, 11 years ago, told me, Paul, that's the world's stupidest idea. Everybody knows oxytocin is just for birth in women. But I say, hey, why would men's brains make oxytocin too? And there must be a reason why. And there was an extensive animal literature suggesting some mechanisms for oxytocin release, but it really had to be studied in humans. And the second reason is oxytocin is a very shy molecule. So it's a very short half-life. You don't want to leave this kind of positive social behavior lever on forever, again,

because you might run into a bob type. So, you know, you want to leave this kind of positive social behavior lever on forever, again, because you might run into a bob type. So, you know, you want to be wary. And so you have to coax it out of the brain and then capture it before it disappears. So it requires some delicate experimental procedures. But let me say, you know, this works in the laboratory. It's been replicated by lots of other labs in the world. And we've taken this thing on the road from, you know, weddings to the jungles of Papua New Guinea and shown that a variety of rituals, behaviors that human beings have invented are there because they stimulate oxytocin release, bring us closer to people around us,

and modulate or motivate good behaviors and then help reduce the bad behaviors. But as you say, there's other things working at the same time, either pro or con, with the oxytocin. Absolutely. Oxytocin was this kind of missing piece of that puzzle. So many neuroscientists had focused on the kind of the bad behaviors, you know, the fear response, fighting response, the aggressive response, but people really hadn't found this lever to understand positive behaviors. Those positive behaviors we call morals, those behaviors that sustain us in our social group. And again, I think, you know, being more conscious of how our brain works to motivate both positive behaviors and negative behaviors gives us an

opportunity to exercise these behaviors in a little more thoughtful way. Would you guess then that loners have less oxytocin than people who have lots of friends? So we have found that people who release the most oxytocin are more empathic, personality-wise, and actually have more close friends. Having said that, we haven't found a difference between, for example, extroverts and introverts. So, you know, again, it's a gradated response, and it's also a tunable system. So, you know, the brain is constantly remodeling itself, and it does suggest, for example, I'm an introvert, and I've worked very hard the last couple of years to connect better to people around me,

and I found that it gets easier and easier. But besides touch, does anything else release it? Oh, lots of things. So again, praying, meditating, exercising, soldiers marching release oxytocin, warm bath like a jacuzzi, even sharing a meal will do it. So again, there's lots of ways that, it's like why we have business meetings over meals. Why do you have to eat? Oh yeah, maybe you're multitasking, but it's a calming factor.

Oxytocin is this calming agent that says, everything's safe. You can let your guard down. It's okay. And from that sense of safety comes a sense of connection, empathy, and then moral behavior. So this is actually a really interesting system.

Again, it's not a sledgehammer system. It's a very subtle system, but it's a system that we really didn't know much about. Well, this is really so interesting because all of this is going on in the brain, and we're completely unaware of it, and yet it really provides like a roadmap as to, you know, who to deal with, who not to deal with, who to trust, who not to trust. It's fascinating. Paul Zak has been my guest. He is author of the book, The Moral Molecule, How Trust Works. And you'll find a

link to that book in the show notes for this episode. Hi, this is Rob Benedict. And I am Richard Spate. We were both on a little show you might know called Supernatural. It had a pretty good run, 15 seasons, 327 episodes. And though we have seen, of course, every episode many times, we figured, hey, now that we're wrapped, let's watch it all again. And we can't do that alone. So we're inviting the cast and crew that made the show along for the ride. We've got writers, producers, composers, directors, and we'll of course have

some actors on as well, including some certain guys that played some certain pretty iconic brothers. It was kind of a little bit of a left field choice in the best way possible. The note from Kripke was, he's great, we love him, but we're looking for like a really intelligent Duchovny type. With 15 seasons to explore, it's going to be the road trip of several lifetimes. So please join us and subscribe to Supernatural then and now. People who listen to Something You Should Know are curious about the world, looking to hear new ideas and perspectives.

So I want to tell you about a podcast that is full of new ideas and perspectives, and one I've started listening to called Intelligence Squared. It's the podcast where great minds meet. Listen in for some great talks on science, tech, politics, creativity, wellness, and a lot more. A couple of recent examples, Mustafa Suleiman, the CEO of Microsoft AI, discussing the future of technology. That's pretty cool. And writer, podcaster, and filmmaker John Ronson, discussing the rise of conspiracies and culture wars. Intelligence Squared is the kind of podcast that gets you thinking a little more openly about the important conversations going on today.

Being curious, you're probably just the type of person Intelligence Squared is meant for. Check out Intelligence Squared wherever you get your podcasts. In the world of healthcare, it's weird because it seems that everybody hates the way it is. Patients complain, doctors complain. So is anybody making out on the current state of health care in America, or is it just a complete mess all the way around? And what, if anything, can we as individuals do to make it better and, more importantly, less expensive. For that conversation, we have Elizabeth Rosenthal, who was for many years a senior writer at the New York Times.

She is now the editor-in-chief of Kaiser Health News, and she is also author of a brand-new book on the subject called An American Sickness, How Healthcare Became Big Business and How You Can Take It Back. Welcome to the program, Elizabeth. And so where are you in this conversation about healthcare? Well, I trained as a doctor, so I know what that's about. And my dad was a doctor.

But I really come to this now from the patient's perspective because I think in all the healthcare debates we've had, we have insurers at the table, we have hospitals, device makers, pharma, but no one really represents the patient's perspective. And what I've heard from patients over and over again as a journalist for the last four or five years covering this topic is whatever the debates in Washington, this system is not working for them. It's not affordable. The care is not working for them. It's not affordable. The care is not accessible. It's just an incredibly difficult system for patients to navigate. And after all, you know, what is health care about? It's about people. It's about patients. It's not about the business of health care. So what happened? I remember growing up, you know, we went to the

doctor. My mom or dad would write you know, we went to the doctor. My mom or dad would write a check because we went to the doctor and would pay for the visit. And if there was some insurance, they would probably only cover something catastrophic. And no one talked about health care back then. Everybody just kind of went about their business. So what happened? What changed? Well, that's what I wanted to trace in my research is, you know, how did we get to this place that nobody likes from a place that, you know, people were pretty happy with? And the answer is it's evolved pretty slowly, kind of step by step in a way that we almost didn't notice.

So you could say that the original issue was the broadening of health insurance so that it covered more things, more people had it. And that's a good thing. I always feel compelled to point out it's good to have health insurance. But what happened is there was a sense that nobody was paying because if you remember in the 80s and the 90s, health insurance tended to just cover everything, you know, from soup to nuts. So it was as if you didn't really pay much attention. And when I was training as a physician in the late 80s and early 90s, because of that, there was this, why don't we just get this test? Why don't we just, you know, let's schedule these extra visits. Now what's happened is, once again,

patients are paying more out of pocket. The co-pays are rising, the deductibles are rising, our premiums are rising, and so we're feeling those costs again. But at that time, during that time when there was a sense that nobody was paying, there was, of course, this crazy inflationary spiral where if nobody's paying and you're in this for the business, which, you know, pharma, the device makers, the hospitals are not officially for profit, but they are big money makers. So everyone's trying to kind of up the charges because it seemed like a victimless crime, but now we're all paying. Yeah. So what's wrong, as simplistic as this

sounds, is let's go back to the way it was when everybody seemed relatively okay with it. Well, the problem is now that technology has improved, so things are in fact more expensive, sometimes for really good reasons. So you can't expect, you know, when a hospital day costs $5, well, it was fine if you had to pay out of your pocket at the beginning of the last century. But now a hospital bill is unsupportable. If you're paying $150,000 or $100,000 for a hip replacement, I mean, $10,000 is a lot of money to ask someone to pony up.

So in other countries, there is this sense that patients should pay a part of the ultimate cost so that they, what we call, have skin in the game. So they sense how much it costs. So in Japan, for example, patients all have a co-pay. But if you have a co-pay on an MRI that costs $110, okay, so you pay $10, right? If you have a copay on an MRI, that same MRI, which in our country will be billed at $1,000, $2,000, even $5,000, then you're talking serious money. So I like to say we're not asking patients to have skin in the game. It's more like we're asking them to put a kidney in the game. You know, this is big money.

Donating an organ. Right. So I think this is a big frustration with people, is who is or what is creating this economic whatever it is that premiums go up 300%, a Band-Aid costs $40 to have a nurse put it on. Who's doing this, and how does this happen? Well, that was the question I wanted to answer, and what I came away with, because everyone wants a bad guy, right? Everyone wants to say, oh, pharma's bad, oh, my hospital's bad. Oh, this evil doctor. But there are really no individual, there are individual

bad guys, but no one part of the system is to blame. It's every part is feeding off each other. So once you see historically, as you trace this, and as I do in the book, you know, first there's insurance, and then the insurers become for-profit. Then they want to take money. Then the hospitals go, well, if they're making money, we should be making money. And once the hospitals have all these business guys there to maximize their revenue, the doctors feel like schnooks because they're not making so much money, so they want in. And it's just this incredible inflationary cycle where there's no one person to blame. It's the system. And that's why I feel like as we move forward to health reform,

everyone's going to have to change the way they do their job. And everyone's probably going to have to accept less money. And you know what? That's okay, because the rest of the world delivers health care at a fraction of the cost that we do, and they get pretty similar outcomes. And I would add to that, patients also have to kind of change their attitude. I hold us all somewhat accountable, too, for allowing it to get so out of hand in the sense of, yes, we haven't had a place to speak up, and now you see at the town halls people rising up and saying, wait, this is too expensive. Why are my premiums going up?

And part of the answer is our employers have not stood up for us in terms of what's a reasonable price, how much should we be expected to pay, so that's allowed the norms of premiums to go up. But also, you know, we've been kind of suckers when hospitals say, wow, we need this money, we're going broke. And some hospitals or rural hospitals are in serious trouble. But you know, you walk into others in big cities, you see the marble lobbies and the fountains and the, you know, the art on the walls. And these don't look like struggling institutions. I mean, one thing that always bothers me is I've been, I'll go to a hospital for a procedure. And what I get

simultaneously almost when I get home is a big bill that because I have good insurance, I often don't have to pay and be a solicitation asking for a donation. And I'm good insurance, I often don't have to pay, and B, a solicitation asking for a donation. And I'm thinking like, wow, this doesn't feel like charity to me. So I think, you know, when patients say to me, oh, I love that hospital, there's like free coffee in the lobby and it's so beautiful, I say, yeah, but we're all paying for that. You know, we're paying through the nose for that. And so partly we have to look at what counts in health care.

I know everyone likes private rooms, but, you know, if you had to pay $5,000 instead of $2,000 for a private room, you wouldn't do it. And I think we need to understand that even if we're not paying directly, we are paying because that's driving our premiums up and bringing us these higher deductibles. So even if the costs feel invisible today, they'll come back to haunt us later. I'm speaking with Elizabeth Rosenthal. She is author of the book An American Sickness, How Healthcare Became Big Business and How You Can Take It Back. Do you love Disney? Then you are going to love our hit podcast, Disney Countdown.

I'm Megan, the Magical Millennial. And I'm the Dapper Danielle. On every episode of our fun and family-friendly show, we count down our top 10 lists of all things Disney. There is nothing we don't cover. We are famous for rabbit holes, Disney themed games, and fun facts you didn't know you needed, but you definitely need in your life. So if you're looking for a healthy dose of Disney magic, check out Disney Countdown wherever you get your podcasts. Hey everyone, join me, Megan Rinks.

And me, Melissa Demonts, for Don't Blame Me, But Am I Wrong? Each week, we deliver four fun-filled shows. In Don't Blame Me, we tackle our listeners' dilemmas with hilariously honest advice. Then we have But Am I Wrong? which is for the listeners that didn't take our advice. Plus, we share our hot takes on

current events. Then tune in to see you next Tuesday for our listener poll results from But Am I Wrong? And finally, wrap up your week with Fisting Friday, where we catch up and talk all things pop culture. Listen to Don't Blame Me, But Am I Wrong on Apple Podcasts, Spotify, or wherever you get your podcasts. New episodes every Monday, Tuesday, Thursday, and Friday. So Elizabeth, in healthcare, why don't market forces that work on other industries work on healthcare? Why doesn't somebody say, you guys are paying too much?

Come on over to Joe's Healthcare because we're slashing prices. Right. Well, I'm waiting for some hospital to do that. You know, there are a bunch of hospital systems here in New York, and I'm waiting for one to put up a billboard that says no surprise charges. But, in fact, we like to say we have market-based health care, but it's not like any other market on earth. Look, if I want to get, in my favorite example, an X-ray of my knee, and my doctor says, you need this.

Okay, first of all, I'm not really a consumer because I've been told I need this, right? It's not like an optional thing where I can say, oh, blueberries are expensive this month. I'm not going to get it. But more than that, I think there are 100 different x-ray centers where I could go. And I have no way of knowing which ones are expensive and which ones are cheap. And you know what? Within a few block radius, you can find one that might do that x-ray for $40 and another one that would charge $2,000. So, you know, we can't, this is the fiction of, you know, well, you, you, you, patients have to

be better consumers. Well, great. Give us the tools we need and the information we need to be better consumers, and then maybe we can act on it. But, you know, I like to think about it like my local supermarket. Imagine if you went into a supermarket and you bought a bunch of stuff and you didn't have to pay when you left the supermarket, and then a month later you got a bill saying that those 10 things you bought cost $1,200. Well, no one would ever go shopping again. No one would eat that way.

So, you know, yes, I think it's a big burden to put on consumers. I mean, it's a big burden to ask patients to be better consumers. But if you want us to try that out, we need the tools. We need much more price transparency than we get now. Yeah, well, and I've often thought that it must be a part of the problem, and you were talking about it before, that you have good insurance, so you'll get a hospital bill after your hospital stay, but you don't have to pay it. So you're never even going to look at it, or if you do look at it, you're going to go, geez, thank God I don't have to pay that, but you certainly aren't

going to fight it. Right. Well, I'm a wonk, so I do. I care a lot about this. And I think what I encourage others to do, even if you have good insurance, is to look at those explanation of benefits and look at those bills, because half of them will have mistakes. And you know what, you know if you didn't get physical therapy. So you should call the hospital and say, I didn't get that, because you will pay through your insurance premiums next year. Wait, wait, wait, wait. Is that a real statistic? Half of hospital bills have errors on them?

Yeah, in studies sometimes it's as high as 90%. And some of the errors will be small. You know, it will say you got physical therapy on this day. It will say you got oxygen after surgery because most people do, but maybe you didn't. You know, the thing is, too, that we have to realize we do pay. When we don't pay attention, we don't pay that month or that day. But in the long run, when people say, why are my premiums going up? Why do I have a $2,000 deductible this year? It's because the costs are going up, the prices are going up,

and insurers are for-profit companies. If they see prices and costs going up that they're paying, they're going to pass it on to you. They're not going to take the hit. Well, isn't it also true, I haven't been to the hospital lately, but the bills themselves are almost impossible for a layman to decipher? The initial bills often are, and the initial bills are often, I mean, they're just like, I've seen bills from patients, you know, everyone sends me their bills now, and I welcome them. I have a nice collection. You know, $45,000 miscellaneous. Okay, as a consumer, again, you know, you want to act

like a consumer, break it down. I tell people, call the hospital and say, I'm not paying until I get an itemization of charges. Also, I think one goal we can have as a country and as a medical system is a standard clear-cut medical bill that ordinary people can understand. How are you expected to be a consumer when your bill is delivered in a foreign language? And this is not impossible. That's the great thing about this. In other countries, you look at medical bills, they're in English or in the appropriate language, so others can understand them.

In France, in Australia, there are price lists, there are upfront price estimates. This is not an impossible science. It's something we can and should be asking for. Well, one has to wonder, being the skeptic that I am, that all the codes and the gobbledygook on those bills are there by design, so people won't know what they mean and won't question it. Yeah, I think they were designed, they weren't designed to obfuscate and to confuse people, but they were designed not so patients could understand them. They were designed for billing purposes largely, to make sure providers and insurers could understand what was being billed

and to optimize revenue. It's a very efficient system for doing, not efficient, but it's a very efficient system for doing, not efficient, but it's a very effective system for doing that. It is not an effective system for informing patients of what was done to them or for allowing patients to understand what they're being billed for. So, you know, one of the amusing things is someone sent me a bill for a hip replacement that was done in Belgium. It was a total of $13,000. This was done privately. And I look at this bill, it's a page, it's one page. And I can understand it better than I can understand a US bill, even though

it's in Flemish. You know, it says implantin for the parts of the hip that were put in. It says two-person comer for a double-bedded room. It's all there. And I can say, oh, yeah, I get why it costs $13,000. A hip replacement bill in the U.S., it would be tens of thousands, if not over $100,000. And it would be pages and pages long and pretty much incomprehensible to the average patient. Which is ridiculous. If you're sending someone a bill and they can't read it, well, why even send them the bill? Right, right. Well, you know, it's the best way to confuse people is to send them a bill in a foreign language. Yeah, and then they can say,

well, we sent you the bill. Yeah, but I can't read it. I don't know what it means. So what's the point? So what's going to happen? Where are we in five or ten years from now, do you think? really, really enraged, frustrated by their health care issues. And they see the debates going on in Washington, you know, the Affordable Care Act versus the Republicans plan now. And I think they're just kind of boiling over at a place like, this doesn't work for me. So I think the time is ripe for a kind of real patient-centered movement where patients demand, and we demand of our legislatures and politicians, a patient bill of rights.

And part of that patient bill of rights is not the current patient bill of rights, which says things like, you know, right to a non-smoking room. Well, that's great. It's been illegal to smoke in hospitals for years now. But that says an upfront explanation of charges. Why shouldn't that be our right? Why shouldn't cost be part of the informed consent forms we sign when we go into hospitals? There are doctors now, and this is the heartening thing for me, many physicians agree with me. They're on board with this. There have been articles in medical journals about how informed consent needs to include financial understanding. So I think we can ask for that.

We can ask our employers to push back more against high costs. They could, but it just hasn't been in their interest. It's kind of easier to go out to a benefits consultant and say, what are my options this year? And the benefits consultant will say, here are three insurance plans you could choose, and they'll choose the cheaper one. And your premiums go up 10%, 5%, and we all kind of pat ourselves on the back now when premiums only go up 10%, which is pretty shocking and unsustainable. If your premium goes up 10% every year, you pretty quickly end up at a ridiculously high number. And yet, that's the kind of price increases that a lot of people are seeing. Well, it's really interesting, and it's certainly a subject that affects every single person on the planet.

I mean, it's just... It's a basic pocketbook issue for Americans at this point. I have many patients who call me who are now spending 20-30% of their income, their household income, on health insurance and health care. And that's not even with a serious disease. That's more than their mortgage, more than they pay for food. That's just messed up. That's not how it should be.

Elizabeth Rosenthal has been my guest. Elizabeth was a senior writer at the New York Times for a long time. She is also trained as a physician, and she is now editor-in-chief of Kaiser Health News, and her book is An American Sickness, and there is a link to that book at Amazon in the show notes. You really shouldn't argue. I mean, that seems like good common sense advice, but it turns out a little arguing now and then is good for you. The results of research show that when you experience tension with someone, whether it's your boss or your spouse or your child, sidestepping the confrontation can be bad for your health. In fact, avoiding conflict was

associated with more symptoms of physical problems the next day than actually having that argument. Specifically, it had to do with abnormal levels of the stress hormone cortisol. Other studies have shown that married couples who avoid arguments are more likely to die earlier than those who do argue. Another study found that expressing anger contributes to a sense of control and optimism that just doesn't exist in people who respond in a fearful manner. And that is something you should know. Happy New Year. I'm Mike Carruthers, and we'll see you next year with more Something You Should Know. Welcome to the

small town of Chinook, where faith runs deep and secrets run deeper. In this new thriller, religion and crime collide when a gruesome murder rocks the isolated Montana community. Everyone is quick to point their fingers at a drug-addicted teenager, but local deputy Ruth Vogel isn't convinced. She suspects connections to a powerful religious group. Enter federal agent V.B. Loro, who has been investigating a local church for possible criminal activity. The pair form an unlikely partnership to catch the killer, unearthing secrets that leave Ruth torn between her duty to the law, her religious convictions, and her very own family. But something more sinister than murder is afoot, and someone is watching Ruth. Chinook, starring Kelly Marie Tran and Sanaa Lathan.

Listen to Chinook wherever you get your podcasts. Hi, I'm Jennifer, a co-founder of the Go Kid Go Network. At Go Kid Go, putting kids first is at the heart of every show that we produce. That's why we're so excited to introduce a brand new show to our network called The Search for the Silver Lightning, a fantasy adventure series about a spirited young girl named Isla who time travels to the mythical land of Camelot.

During her journey, Isla meets new friends, including King Arthur and his Knights of the Round Table, and learns valuable life lessons with every quest, sword fight, and dragon ride. Positive and uplifting stories remind us all about the importance of kindness, friendship, honesty, and positivity. Join me and an all-star cast of actors, including Liam Neeson, Emily Blunt, Kristen Bell, Chris Hemsworth, among many others, in welcoming the Search for the Silver Lining podcast to the Go Kid Go network by listening today. Look for the Search for the Silver Lining on Spotify, Apple, or wherever you get your podcasts.