You can't fix healthcare with ideology. We need practical solutions.
People need to take agency and get proactive to dig our nation out of the horror of the healthcare system today. Dr. Henry Buchwald (@Dr. Buchwald) is a surgeon of 60 years and the emeritus professor of surgery and biomedical engineering at the University of Minnesota. His new book, Healthcare Upside Down, is packed full of his observations, research, and in-depth perceptions of why the United States is one of the world’s lowest-ranked healthcare countries.
“Healthcare needs to be treated with respect.”
– Henry Buchwald
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Mark Divine 0:00
This is Mark Divine, and this is the Mark Divine Show. Thank you so much for joining me today. Super stoked to talk to people from all walks of life who are at the top of their game, doing extremely interesting and important work in the world. I talk to folks such as NASA astronauts, Navy SEALs, elite athletes, top CEOs, and today I’m going to be talking to a lifetime surgeon, emeritus professor of surgery and biomedical engineering, Henry Buchwald, MD, PhD, and a bunch of other letters. He’s uh, that, Owen Wangensteen instant chair and experimental surgery at the University of Minnesota. And He’s a graduate of Columbia College and Columbia Medical School. He’s written over 350 publications, 10 books, and his latest book is called Healthcare Upside Down, which we’ll be discussing today. Dr. Buchwald, thanks so much for joining me on the Mark Divine Show.
Mark Divine 0:54
Henry thanks for joining me today on the Mark Divine Show, I want to start just like, what were some of the forces that forged and shaped who you were, you know, your identity, your, you know, the challenges, and what led you kind of into the military? And then, you know, like, I like to get a sense for your life trajectory and, and your character, what were the forces that shaped your character, family events, challenges, those types of things.
Henry Buchwald 1:18
I grew up in New York City. I never liked New York City. Some people just liked a big city, I always wanted to get to a smaller place, and went through Columbia when I was in the Bronx High School of Science, which is sort of a magnet school. And basically, in my early years, I did a lot of sports. I was on the soccer team, swimming team, etc. And then Columbia College, and then Columbia Medical School. And at that point, I served two years in the Air Force, in the Strategic Air Command, and then came to Minnesota because Minnesota really was what I was looking for all the time. It was making a surgical training for an intelligent surgeon who wanted to do research and academia, and not just be a technician.
Unfortunately, at that time, on the East Coast, surgeons were looked upon mostly as technicians. The intern says, cut here, cut there, do this, and then we’ll take over. And I didn’t like that. And I did research when I was in medical school. So I came to this extraordinary program here at the University of Minnesota under Owen Wangensteen, and instead of a five year program, it was six or however long you wanted, and I never left. So I went through the program, and actually, I had the honor and distinction of being the first Owen Wangensteen professor, went on to be Owen Wangensteen chair after he had passed on. When the chair was endowed I was the first Owen Wangensteen chair. And just this past July, I took emeritus status. And it’s given me time to write actually before I wasn’t in the operating room for the last few years. But I wrote this book, Healthcare Upside Down. Because of my unhappiness with the current medical situation in the United States.
I saw it in an era where it was much better. I saw it where we were world leaders. And all of a sudden we’re not. And we’re faced with a lot of rhetoric. Yes, we’re the greatest. We’re the greatest. We’re not at all. We’re a little bit above a third-world country and all the statistics. There are about 10 world statistics globally used by everybody. Mortality rate, well, we’re about at the same level as Lebanon, who lives they could have been saved by profit therapy, we’re way down, in all the individual diseases. Except for Cancer, we have a small edge, but everything else, heart attacks, strokes, accidents, everything else, we’re lower than all the European nations, Australia, New Zealand, and our neighbor Canada. Mortality rates for children, infant mortality, were lowest all these statistical parameters, except one where we are the world leaders. And that’s the cost.
Mark Divine 4:29
Henry Buchwald 4:29
We spend over 17% of our national product on health care.
Mark Divine 4:35
Henry Buchwald 4:36
And the closest is Switzerland at 11%, and they have much better health care.
Mark Divine 4:41
How do we get so far off track?
Henry Buchwald 4:43
We relied on a business model for health care. And though I’m a confirmed capitalist, I don’t know if a strict business model could be running health care. And there was a tremendous fear, probably still is in the United States about socialized medicine. Oh, terrible, terrible socialized medicine. I don’t think most Americans realize that 65% of our medicine is socialized medicine right now, VA benefits, armed forces, Medicare, medical assistance, Indian services, etc. It amounts to 5% federally funded. But that’s not federally funded as a magic thing out there in space. That’s us. We pay taxes. And that’s what funds that. The rest is private insurance companies, the CEOs of these companies are taking home $30-40 million a year, and deeply in their office, the vice presidency, vice vice presidents, the little vice president, they’re all taking home a lot of money.
So where is that money coming from? It has to be coming from the people who are subscribers to the insurance policy.
Mark Divine 6:02
Henry Buchwald 6:02
And could that money instead go to doing away with co-payments, doing away with restricted services, doing away with all the other things that are imposed upon the payer, the patient. Because the money is going to stockholders and to the CEOs and people in that category.
Mark Divine 6:28
Isn’t it true also, sir, that the hospital or the system itself has been perversely incentivized to constantly ratchet up prices, because of the relationship is with the insurance company and or the government and not the patient? You know, because you see many, many accounts of like, if you get intercede or have someone negotiate on your behalf, because you don’t have the insurance, the insurance won’t cover it, then the hospitals or the doctors always, always lower their price in general, it’s often times to like 10, or 20%, of what they were going to charge the insurance company. How do you factor that in, that’s not a business model that anyone thought would have made sense.
Henry Buchwald 7:05
Doctors cannot do pro bono work. There are five federal laws, they could put a doctor in jail for doing pro bono work. Can you imagine that? There are federal guidelines for what you can charge. Now the lawyers who make up most of Congress, they can charge whatever they want. And they can do pro bono work. As a matter of fact, most law firms require 50 hours of pro bono work for each one of their partners a year or they’re aspiring partners. But doctors cannot do pro bono work. In my day, first of all, we never charged the fellow doctor, or somebody or nurse or something. And second of all, when patients came to us and had no money, we wrote off the bill.
Or put them on a payment plan. My local doctor, you know, we had that mean, in the 60s, I grew up in the 60s, in upstate New York, there was no insurance company for us, we had a relationship with a doctor, and he would do a payment plan. And literally send us a bill at the end of the month. Same thing with our grocer, by the way because this is pre credit cards, right? You remember those days where the grocer would…
Henry Buchwald 8:11
Mark Divine 8:12
You know, put it on your, your tab basically, and you’d go in you pay at the end of the month. I mean, those days were awesome in the sense that it took a lot of the friction out of the system, all these things that are supposed to bring efficiency, these intermediaries actually really have complicated and added so much extra cost and stress to our lives. And the medical system is a good example.
Henry Buchwald 8:33
The other thing is in running as a business model. First of all, when you call today, you’re rarely ever going to get the physician that you once thought was your doctor, that doctor-patient relationship has been destroyed. First of all, you talk to a robot who tells you to go away and call the emergency or do this or do that and then you get another robot. And then you get an interrogator, why are you calling etc, and so on. And in this book, I have a little stories, there made up stories for the most part that somebody calls and says, I just had surgery by Dr. so and so and I’m bleeding. And the interrogators says, Well, how long have you been bleeding? But before we can do that, what is your insurance? And so finally, when they get around to the patient, usually the person says, well, you can see doctor so and so in three months, and the patient would say, well, I’m bleeding now. Well, then we can have you come in in a few days to see Dr. so and so… why? Because maybe the doctor who operated on the patient is very popular. And you’ve got to keep him in the operating room making money. Whereas some other doctor is young or is not popular or isn’t so good. And he has a slot to fill. And so you fill this slot. I mean, that’s the way businesses run, but it’s not the way medicine should be run.
And the other thing is, actually, before I stopped seeing patients, the clinic said, we have you scheduled 15 minutes per patient. And I said, that makes no sense at all. A post op patient will take me five minutes, how are you doing, etc, and so on, see you in three months. But a new patient with problems, I have to spend more than 15 minutes. But it’s a business model where doctors are interchangeable, where you may have a surgeon operate on you. But if there’s a problem that night, there’s another doctor at hospitals who will take care of nobody ever fields anymore, that they have a doctor-patient relationship. And it’s accepted.
And I was hoping that maybe calling attention to this, people will realize they wouldn’t accept this in any other venue. I mean, would you if you wanted to take your kids to the ballgame, and you call them say, I want a couple of tickets the guy says yes, we’ll give you the ticket for the date, we want you to come for the team we want you to see, and for the seats we’ll assign you; wouldn’t buy the tickets. I still think that on the everyday level, the people who are administering health care are good people.
Mark Divine 11:22
Henry Buchwald 11:22
It just the system they’re in, that may make them maybe insensitive. I mean, it works the same both ways. You know, if the patient doesn’t feel they have a doctor, the patient used to say my doctor, my doctor, what does that mean? They have trust in that individual. But you can’t trust individuals is always changing. And the doctor used to say my patient, that doesn’t mean a sign of possession, it means taking responsibility. So trust, responsibility, doctor-patient relationship today it’s gone.
Mark Divine 11:58
And we have a huge shortage of nurses. And we have apparently doctors who are saying, You know what, I can’t make money doing this, or I don’t like this environment, or this whole system is not my thing anymore. So what are we gonna do about that, right, so not only we have a broken system, but if all of a sudden the professionals flood out of the system, right, we won’t have a medical system left.
Henry Buchwald 12:16
Maybe they’re realizing that this doctor-patient relationship or doctor or patient-nurse relationship has been broken. And they no longer have that satisfaction or feeling that this is a calling, this is what I do, and I make a difference. We used to work all sorts of hours when I was a surgeon. Many a time, when one of my children had an athletic event, I would get there just in time, my wife would hand me a sandwich. That was dinner. But it was it was my life, it was my calling. And if you don’t have that relationship, and also now administration will dictate to doctors, you can’t use this drug because it’s too expensive. You shouldn’t do the surgery because he keeps the patient in hospital too long.
Today, administrators of hospitals would love to get patients in, because that first day is a moneymaker. You get all sorts of labs, X-rays, this, maybe do this procedure, but then they want to get them out. Because the next few days, they’re just lying there in pain. That’s no sense, doing anything for the patient, tell them their pain is minimal and go home, so that you take another patient in and do X-rays, etc, and so on. So that’s really the business reason behind a lot of today’s come into the hospital, and we’ll do all the tests, or do it as an outpatient. And then we want to have you out of the hospital as soon as possible. Things have to change or should change. I don’t know if they have to or will.
Mark Divine 13:59
What’s your vision, like both at a business model level and also at a societal level? Like how do we move forward and and begin to improve this disaster?
Henry Buchwald 14:09
I have 10 ideas in the back of my book. Before we go into that for a minute, in Norway, I’m advocating socialized medicine. I mean, it works in some countries, especially with a uniform population and small size, it works very well. But I don’t think it will work in our country, and in so many countries isn’t working at all. I now have a good friend, a fellow physician in England, who needs a knee replacement, and he’s going to pay for it out of pocket. Because on the health plan, it would take two years to get the quarter system, Socialized medicine is not an answer. And as I say that today’s system of business model insurance medicine is not an answer, what is an anwer? Well, I think it’s insurance through fraternal organizations, you I’m sure, as I belong to the USAA insurance, right?
Mark Divine 15:09
Henry Buchwald 15:10
I mean, it’s our group, we’re a fraternity. And it’s a great organization. And it gives great insurance coverage. And the head people and the board of directors don’t take home 70-60-40-50 million a year, and the country is full of these organizations. There’s the United postal workers, they have millions, the Longshoreman, have millions, and instead of buying into what’s available today, it would be a wonderful thing for a entrepreneur, a real capitalist to say, I can give you more for less, and I can make a deal with the postal workers with, so I think that’s one way of maybe solving the problem is fraternal organizations getting together, because then they’re serving themselves. It’s a sort of self insurance.
Mark Divine 16:07
I think you are starting to see some of these pop up. You know, it’s like the resurrection of the old guild concept, right, where the guild takes care of their members and multidimensionally. So not just health care, but also maybe help them with education can help them with childcare. You can even have corporations, you know, so you’re starting to see corporations be more involved. Instead of just sloughing off healthcare and saying, well, we don’t have to provide insurance because there’s the Obamacare plan or, or the Affordable Care Act. Actually leaning in the other direction, right in providing health services. Also, faith based organizations are starting to provide member based supported health services. There’s other also Newton, those that are popping up that are crowdfunded. If I don’t have the money for my, my surgery, then I put my issue out to the crowd, the crowd comes together, and those who are sensitive to my cause, help fund me, and then you know, in the future, I’m there to fund them, if they have an issue. Those are actually pretty effective, too. So it’s interesting to see these things starting to pop up. To your point, I think these are really interesting solutions. It’d be nice to be nice if the government didn’t go like, oh, those are a threat to our single payer system.
Henry Buchwald 17:20
And the other thing is, right now, in the current system of insurance, outside of the government supported insurance, people, let’s say work for a big corporation, and the corporation gives them health insurance. And so there’s two levels of bargaining going on, they go to a health insurance company. And they say, well, we can give it to you that much cheaper if you don’t do obesity surgery. And the owner of the corporation says, well, all right, and goes to the Union, and says, your union contribution could be less if we don’t do obesity surgery.
At that point, that union, that fraternity has to say, no, some of our patients, some of our members may need obesity surgery, and we’ll pay a little more or whatever. So again, it gets down to not accepting a bargain price, by the fraternity themselves, who is going to be impacted. I’m certain that if the leadership of that corporation needs obesity surgery, they’ll go get it. So right within the current system of people in a corporation, getting health care, and bargaining with insurance company, if the people themselves get together, individuals cannot do it. The individual will be trampled. I’ve seen people stand up for this kind of stuff get trampled. But if let’s say a whole union says, hey, listen, we want this, we want this, you say to go to cost more. Alright, of course more, but that’s what we want.
Mark Divine 19:04
So what are some of the other ideas you have? Because this is such a multi dimensional problem?
Henry Buchwald 19:11
Trusting your fraternal organizations, and there’s so many of them, bargain with knowledge. And again, stay within the group. Because you go out by yourself, you’re not going to accomplish anything. And obtain knowledge, realize that the large percentage, forgot the exact number, the fortune 500 companies are in healthcare. So that means they’re making the most money and the money should be going to the health care. Why are people putting up with this? Well, ignorance, they don’t know any better. And fear. They’re afraid that oh my god, if I make waves, I’m gonna lose it when I really need it. People just don’t like to move forward.
Mark Divine 19:55
Again, like you said, individuals don’t feel like they have a voice. You know, but if they could find, you know, looking in their environment, and who is the power structure and work within that power circle as your corporation or your labor union or your church or networks. And, you know, it’s like, we don’t have to be a labor union to be a collective bargaining unit, the whole communities could come together and be a collective bargaining unit. I think that’s your point. It doesn’t sound like you have a lot of hope that government is going to solve this issue.
Henry Buchwald 20:25
Yes, they can solve the issue with law. But again, most politicians, when they get into office start running for the next term. And they get the next term by getting the majority votes. So if a community comes forth and says to the local congressman, senator, governor, ect., we want this! They’ll do it, because if their opponent says, we want this, and I’ll give it to you. They’ll vote for the opponent.
I can tell you on what little things sometimes elections are based on. I was in Sweden many, many years ago, when they were thinking of joining the European Union. And I was there as a visiting professor. And I asked one of my colleagues, how is it gonna go? And they said, well, there’s about 48%, for and 48% against, and that leaves 4% in the middle. And that’s up to the whales. And I said, what do you mean it’s up to the whales? This is when it’s the Green Party, the party that gives them the most Whales, they’ll vote for. And so that was the basis of their election. It’s a model. In the sense, your representatives will vote for what the people tell them to vote. And if there’s a party that represents better health care, they can do a lot. Especially let’s say, in parliamentary countries. We’re not a parliamentary country, but a small group is needed for a coalition. But in our country, today, nobody works across the aisle. Republicans work against Democrats, Democrats work against Republicans.
Mark Divine 22:08
I agree. And you can’t fix healthcare with ideology, right, you have to have practical solutions. And you have to look at it from an integral or holistic perspective, because there’s many moving parts and some things that need to be changed or anathema to one side. And other things that need to be changed are anethma on the other side. So what! Let’s you know, come together and solve it. Because it’s, it’s not only killing people, and frustrating people, but it’s bleeding the nation, like you said, 70% of our GDP., so that’s insane. And you add the debt on top of that the debt service that’s growing and growing, and then there’s all these others entitlements, this country is in a tough place financially, in the next five to 10 years, it’s gonna get worse before it gets better. So any other big takeaways from the book that you we haven’t talked about or you like to share with the listeners?
Henry Buchwald 22:56
You know, I tried to inject some humor, based on each chapter with a little story, and a quote, I think my first chapter is the statistics. This isn’t just my opinion. I backed it up with numbers. And people don’t know these numbers. They say, oh, we’re number one. Your not number one, you way down on the list. That’s the first thing. And then there’s a chapter which is interesting, I think, because it shows that before things change, the language changes. Orwell, in his book 1984, knew how important language was. I mean, today, I am no longer a doctor. I’m a provider. You’re no longer a patient, you know what you are, or everybody else who goes to a doctor, you’re a client. That’s the language that’s used. And when I was still seeing patients, my service, or my station, or where I had my surgery patient was now called the firm. Your patient is now on firm A, and you are the provider and this is the name of your client. And when you accept these terms, you are on the road to accepting the depersonalized medical system, where the doctor patient relationship is asunder, it’s gone. Can I read you the last two paragraphs in my book?
Mark Divine 24:30
Sure. Yeah, please do that’d be great.
Henry Buchwald 24:32
The opening moment of life, birth, involves health care for mother and child. Growing up in achieving adulthood involves health care. Being able to live a mature life to work, to love, to have children is dependent on health care. And the final chapter aging can be realized and even made pleasurable by healthcare. Healthcare is therefore integral to life from beginning to end, healthcare is not a commodity, but a necessity. Healthcare needs to be treated with respect. The establishment practice and financing of health care affect everyone, should not be neglected by anyone, and most people concern of all of us.
I have been a doctor for 60 years. And during those years at times, I’ve also been a patient. I’ve held the hands of my patients, I have been the one whose hand has been held. I have received trust and given trust. The therapeutic decisions my patients and I reach, were not subject to the intrerdiction of a third party. I do not want to have my life’s role as a physician surgeon, my joy in the process, usurped by an admin-aristocracy. As a patient, I do not want to hold hands with a robot and confide my health problems through a faceless entity. As a doctor, patient, a person, I reject the currently shattered doctor-patient relationship. Healthcare is upside down, let us set it right side up.
Mark Divine 26:09
Wow, thank you so much for your contribution to this important discussion, that said, got to have the conversation. And people have to take charge. Yeah, don’t just outsource such an important aspects of your life to these mega corporations and insurance companies and the government. Right. So let’s help direct the recovery of this system. And you know, part of that, for me is also bringing more and more attention to wellness.
Henry Buchwald 26:37
Mark Divine 26:38
Right, so that you avoid the the hospital more often than not. Part of the narrative in this country is you get sick and to go to is to go to the doctor the hospital and I for me in my community, my go to is to not get sick. To develop a strong immune system to healthy habits, you know, a lot of good sleep, exercising every day, eating, you know, a lean diet, Paleo centric kind of diet, getting tons of time in nature, using practices like breathing and, you know, effective communication for stress release. Being more present with your wife and kids, you know, just like really normal natural stuff, which we didn’t have to worry about when we were growing up, because things were like moving a lot slower. We didn’t have the distractions of, of social media and the constant barrage of negative 24/7 News. And, you know, we spent time around the dinner table with our families. Anyways, our culture has has separated and fragmented people and driven them into a sick care culture, as opposed to a wellness culture. So so this is a two part problem, right, as people are getting sicker and more obese, because the narrative has been pushing him toward unwell practices and habits, while simultaneously the medical system is become utterly bloated, like you said, and isn’t serving people very, very well. So it’s a big problem.
Henry Buchwald 28:00
You said it beautifully.
Mark Divine 28:02
Thank you. Well, I learned a lot. I learned a lot from you today. So there we go.
Henry Buchwald 28:06
Can I put you down as a co author of the book.
Mark Divine 28:08
Haha, no, I don’t want to take any of that glory. Healthcare Upside Down, Do you have a place that you’d like people to come to learn more about you? Or do you send them to Amazon? Or what’s your preference?
Henry Buchwald 28:20
Well, I have a website and just look up my name. There’s several other podcasts on that too.
Mark Divine 28:27
Henry Buchwald 28:28
And find stuff about me on Google.
Mark Divine 28:30
So is the website, exactly your name, Henry Buchwald.
Henry Buchwald 28:34
Mark Divine 28:34
Henry Buchwald 28:35
I think I’d like people to read the book. I didn’t write it to make money. I wrote it, to educate. I’m an academic, it’s my role. I’m an educator, and I spend my life in the joy of medicine. It’s been my calling. And so I felt, at my older years, my calling is not complete. If I just don’t say anything. And then seeing that I’ve seen so much and, and documented as academic as a researcher. I believe you just don’t say things, you show the data for it.
Mark Divine 29:15
What’s been the reaction from your peers in the medical profession?
Henry Buchwald 29:19
You know, they all say you did a wonderful job and right, but so what, if I did a wonderful job, things will change.
Mark Divine 29:27
Let’s hope so. Dr. Buchwald. Well, thank you so much for your time today. Thanks for your contribution with your book, Healthcare Upside Down in your many years of service as a medical professional and surgeon.
Henry Buchwald 29:36
Thank you ever so much for having me. And thank you for your years of service as a SEAL.
Mark Divine 29:42
Henry Buchwald 29:43
I believe in saying thank you for service for people who have served.
Mark Divine 29:47
Me too and we will pay it forward to those who are still serving because they’re the ones in danger, right?
Henry Buchwald 29:52
Mark Divine 29:53
All right. Take care of thanks again.
Henry Buchwald 29:55
Thank you. Bye bye now. All right.
Mark Divine 29:57
Thank you. Bye bye.
Unknown Speaker 30:01
Well, that was important information. I mean, our healthcare industry is extremely broken. It’s a kind of a sad state of affairs that our healthcare is worse than Lebanon’s and some many third world countries. And doesn’t seem like there’s any momentum to fix it. So we’ve got to start having this dialogue. Dr. Buchwald’s book, Healthcare Upside Down can provide you some firepower to have sound conversations. So get the book, do your research. And let’s start agitating for some change. Show notes will be up on Mark Divine.com. The video will be up on my YouTube channel. You can reach me on Twitter at Mark Divine and on Instagram and Facebook at Real Mark Divine, send me ideas on guests and anything else you want to shout out to me.
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Transcribed by Catherine and https://otter.ai