This episode starts out with a typical monologue intro rant about some of the Inherent Problems in U.S. Healthcare. Then, we transition into learning more about our guest, Dr. Taylor Beckman, DO, who will finish his residency training in June and start on a cardiology fellowship in July. We talk about the issues with the horrifically high (and only getting higher) costs of healthcare in the United States, especially in comparison to other first-world countries and health systems, as well as in comparison to our past selves. We discuss several individual cases of healthcare expenditures for patients and how there is no set standard for what hospitals in America are allowed to charge for their services, and how the complicated intricacies of hidden hospital fees and insurance coverage are bankrupting Americans. Spending so much on healthcare as a country restricts spending in other areas (I certainly AM NOT recommending we spend any more money on defense) and ultimately, makes it difficult for so many individuals and families to save money and accumulate assets and generational wealth. This is leading to a progressively widening wealth gap in America, where the richer get richer, and the middle-class is just getting by. Some of the statistics will astound you.
Next, we discuss the corporatization of our healthcare system, how changes in the last 20-40 years have led to fewer and fewer providers operating their own private practices as the system continues to funnel them into working for large corporate conglomerates trending towards a monopolization of healthcare. HIPAA was a huge factor in this trend towards corporatization and nearly co-emerged with the advent of the Electronic Health/Medical Record (EHR/EMR), which today is essentially mandated by the system. This forces providers to document NOT based on effectively transmitting the most important information for other clinicians (as it was in the past), but rather to document so that patient's visits get covered and providers claims are accepted, with so much erroneous data that it waters down the medical record. Not to mention, it is damn near impossible to get medical records in a timely fashion, despite these supposedly 'integrated' systems. Lastly, on this topic we discuss how a conscientious and persistent Bronx Urologist, Alex Shteynshlyuger, unveiled the corruption of former CMS employee Matthew Albright and the Electronic Transfer Fees, or ETFs, payment system that allows ANOTHER group of middlemen to siphon profits from prescribers, making it even more difficult to co-exist with these large conglomerates in your own private practice.
Lastly, we give several examples of over-treatment in the American system, specifically discussing the overabundance of heart catheterizations, the MAJOR problems in manipulating the research around what's called the beta-amyloid deposition theory of Alzheimer's Dementia and how the new Alzheimers' drugs targeting beta-amyloid removal, Aducanumab and Lecanamab, don't really work AND likely cause more harm than good. Finally, we talk a little bit about the trend of GLP-1 Agonists, including Ozempic, and again try to bring the discussion back towards the center; while they're helpful for weight loss, they are not devoid of side effects and co-utilizing them with preventive measures and limiting prescription lengths may be more beneficial in treatment. In our final section, we discuss potential system-wide solutions, as well as give listeners specific advice on how to fight their high healthcare costs.
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Disclaimer, this podcast is for informational purposes only. The information provided in this podcast and related materials are meant only to educate. This information is not intended as a substitute for professional medical advice. While I am a medical doctor and many of my guests have extensive medical training and experience, nothing stated in this podcast nor materials related to this podcast, including recommended websites, texts, graphics, images, or any other materials should be treated as a substitute for professional medical or psychological advice, diagnosis or treatment. All listeners should consult with a medical professional, licensed mental health provider or other healthcare provider if seeking medical advice, diagnosis, or treatment.
[00:00:00] Welcome to Renegade Psych, a nuanced podcast dedicated to
[00:00:03] informing the American public about the flagrant shortcomings
[00:00:06] of our healthcare system. I'm a board certified psychiatrist and
[00:00:10] along with my guests, break down interesting and important topics
[00:00:13] into several segments to appeal to both the general public, as
[00:00:16] well as medical and psychiatric students, residents and
[00:00:19] practitioners. My primary motivations are to appreciate
[00:00:22] nuance in major medical and psychiatric discussions, educate
[00:00:26] listeners on the undue and widespread influence of big Nothing stated in this podcast nor materials related to this podcast including recommended websites, texts, graphics, images, or any other materials should be treated as a substitute for professional, medical, or psychological advice, diagnosis, or treatment. All listeners should consult with a medical professional, licensed mental health provider, or other health care provider if seeking demise by causing dependence and rebound symptoms that oscillate between manageable and unbearable, correlating with blood levels of our medications. Throughout my training and clinical experience, I've witnessed how
[00:03:04] the consumerist American medical system pushes 15-minute fast food drive-through than 20% of household disposable income in the United States goes towards healthcare expenditures. Yet despite spending so much more on healthcare every year, we have some of the highest rates of maternal childbirth mortality, some of the highest rates of suicide and obesity, arguably the highest rates of
[00:04:21] preventable deaths, inarguably to the highest number of patients in the shortest possible time frame, leading to not just suboptimal care but to poor and
[00:05:41] uninformed care. And then they are rewarded via end-of-network coverage, long wait times to speak with agents, etc, etc. Cheap medications with proven efficacy but lack of profitability are deferred for newer medications and treatments that promise large ROIs. We like to jingoistically exclaim that the US has the greatest healthcare system,
[00:07:03] medications, treatments, and health insurance in the fields of medicine, research, or working at big pharmaceutical companies are actively or knowingly working against progress. But there is enough manipulation of the system for individual and company benefit that have
[00:08:21] stymied progress for decades and will continue to stymie progress for decades to come if start out learning more about Taylor. Then we talk a little bit about the history of insurance and the corporatization of US healthcare. Discuss over treatment in cardiology, in weight loss and in Alzheimer's. Review some of the data on life expectancy, polypharmacy and the opioid epidemic. Dr. Beckman, tell to as many places they can because they're saying the more interviews I get, the better the changes I have a matching. And this is such a big commitment that it's worth, even if I have to take out a loan in order to do this. I know when I started medical school, that the fourth year's average number of applications they put in for residency was like 12 to 15.
[00:11:03] It's not realistic to have to fly to all these different cities.
[00:11:06] No, no.
[00:12:02] more difficult if you're not as great of an applicant because in the past you've had to travel
[00:12:05] to each residency program all around the country
[00:12:09] and that shit gets expensive really quick.
[00:12:11] Now you've got really good candidates
[00:12:14] that are casting a really wide net
[00:12:17] and then those programs are gonna rank
[00:12:19] those really good candidates.
[00:12:21] And a lot of programs, if they're not keeping up
[00:12:24] with the numbers and keeping up with the times,
[00:12:27] then they're gonna have a limited number of applicants make the decision or what was your path to going to medical school in the first place? I feel like a lot of people applying to medical school have some like aha moment. One of their family members got sick, they saw someone in the streets, have an accident. I never really had anything like that. If you talk to my parents as far back as they can remember, I was going to be a doctor.
[00:13:44] I even got pretty specific with it in like fourth grade. before I got into medical school. And it wasn't for lack of test scores or GPA. It's just become very competitive. And sometimes it's kind of the role of the dice too. I had interviews at a couple places. Some of those interviews didn't go as well, which is a whole nother topic that people during these medical school interviews
[00:15:01] are trying to play psychological games with you.
[00:15:03] I know, it's kind of wild.
[00:15:06] Did I tell you on the psychological mind fuck, sometimes a resident, upper level resident. My first interview was with the program director. And the program director is like, you know, I read your personal statement. Essentially this story that I called the pirate story. It was told to me in a high school 45 minute religion class actually. The first 22 and a half minutes or half of the class,
[00:16:21] the teacher detailed this whole tale about this pirate
[00:16:25] and how evil he was and all these horrible things So I'm already nervous. I didn't bring a tie. I get to borrow it from the bellhop. I go into that interview Was it like a normal looking tie or was it like I mean, it wasn't the nicest tie, you know, it was a little thin It was it was all I had right like I literally am in the lobby of the hotel looking around at people Who am I about to ask for a tie?
[00:17:41] That one obviously didn't go very well and it's with the program director and I'm like between the 10% of the best ones I've ever read and the 10% of the red flags that I'm not going to interview, there's a very fine line in between those. And sometimes it's hard to tell the difference. Just be boring. That is all. Just be boring. Don't be unique. Don't try to stand out. So if you could go into the
[00:19:02] completely ideal job situation when you're done friends getting into. So after college I actually had to take a couple gap years. I took a research job doing clinical research working with a nephrologist which is a kidney doctor and a family practitioner.
[00:20:23] They were doing phase two, three, and four drug trials working with pharmaceutical and I worked in a research lab. I didn't see so much the drug approval process side of things, but what I did see was a couple of kind of head researchers bolster their resumes with research, people that were just trying to publish anything that they could. Coming to conclusions that the research did not actually support 2013,
[00:21:43] I had guaranteed colleagues in medical school.
[00:23:00] Cause when you go in straight through from college,
[00:23:04] I definitely saw a different attitude that...
[00:23:06] Some of them were still in the frat.
[00:23:08] Yeah. doing something meaningful in my occupation is the important thing to me. It's not even necessarily medicine. That is one of the biggest things that I value is having meaning in my professional career. Oh shit, hold on. I could not get into medical school and still find meaning in my professional life.
[00:24:20] Yeah, that realization definitely hit home after getting a few rejection letters became a regional manager. He eventually had to relocate to Atlanta and manage the branches they were opening up in Georgia. So I actually grew up in a restaurant. He was working all the time. Eventually they went public as a company. He thought it was a good time to get out and start his own restaurant as anyone that works in the restaurant business wants to do. Unfortunately he opened his
[00:25:43] restaurant the same time the recession hit. She was a real estate agent at the time, started working some extra jobs and carried us financially through high school. But there were some tight financial times growing up, which definitely affected my older brother and I, I think was another driver of me going into medicine.
[00:27:03] Hopefully people don't go into medicine just wanting to make money,
[00:27:05] but there is a lot of financial security involved in this career.
[00:28:05] But when we got into a physical education, even though we were like 13 and 15, it was a big deal
[00:28:09] Had some of those growing up. I know you come from a family of a lot of brothers
[00:28:13] but back then I think the way it manifested to me is I really
[00:28:21] started to develop a pretty serious work ethic instead of dealing with those emotions and the stress I channeled it all into
[00:28:24] work, which was always working through high school, college, always had a job, always had a hard work ethic. If I really think hard about it, that financial insecurity had that effect on me. And I don't want to say positive versus negative. It's just a thing that happened
[00:29:40] that affected me in this way.
[00:29:43] But the consequences of that,
[00:29:45] I do view in a positive light.
[00:29:46] Me always feeling like I later and have a different, probably more full perspective on it. I had more superficial financial hardship because my parents, especially my dad, came from a very poor family. Single mother family, four kids.
[00:31:01] His dad died when he was six years old.
[00:31:03] And so he drove that point home
[00:31:07] to what I thought was a flaw. It's not bad. It is what it is, but it's a much fuller perspective and more complete understanding of how those influences Shaped who I was But it's funny how we look back and we view things that happen in our lives drastically different than we did in the moment and that Drive that we're both talking about amongst the most