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The Price We Pay

What Broke American Health Care—and How to Fix It

(amazon)

Marty Makary, M.D. (View Bio)
Hardcover: Bloomsbury, 2019.

The Price We Pay
(amazon)

One in five Americans now has medical debt in collections and rising health care costs today threaten every small business in America. Dr. Makary, one of the nation's leading health care experts, travels across America and details why health care has become a bubble. Drawing from on-the-ground stories, his research, and his own experience, The Price We Pay paints a vivid picture of price-gouging, middlemen, and a series of elusive money games in need of a serious shake-up. Dr. Makary shows how so much of health care spending goes to things that have nothing to do with health and what you can do about it. Dr. Makary challenges the medical establishment to remember medicine's noble heritage of caring for people when they are vulnerable.

The Price We Pay offers a roadmap for everyday Americans and business leaders to get a better deal on their health care, and profiles the disruptors who are innovating medical care. The movement to restore medicine to its mission, Makary argues, is alive and well--a mission that can rebuild the public trust and save our country from the crushing cost of health care.

"In this thoroughly reported primer, Makary, a Johns Hopkins surgeon and professor of health policy, authoritatively and conversationally explains the money games of medicine. How did costs get so high? Blame overtesting, overdiagnosing, and overtreating. A University of Iowa study asked hospitals what they would charge for the same type of bypass operation; the replies ranged from $44,000 to $448,000. Makary, who visited 22 cities over two years, uses anecdotes liberally and effectively. One patient received an $11,000 bill for altitude sickness treatment. Some hospitals are depressingly litigious. In 2017, the nonprofit Mary Washington Hospital in Fredericksburg, Virginia, sued more than 4,300 patients and garnished the wages of 1,756, according to court records. Makary suggests that people ask their local hospitals if they sue patients. He found that working Americans feel that the system is stacked against them; it seems that they’re right. He also critiques the workplace ‘wellness’ industry, with experts unnecessarily screening healthy people, leading to ‘false positives and harmful medical procedures.’ Consider this book a powerful call to action for more information about health costs and for restoring the ‘noble mission’ of treating everyone with fairness and dignity." — Karen Springen, Booklist (starred review)

"Plain talk from a surgeon and professor who has long studied health care issues and finds the American system badly in need of repair. Makary has plenty of harsh words for the health care industry. He clearly demonstrates how medical care is secretive and predatory and why skyrocketing costs can be accounted for by the money games of medicine, loaded with middlemen, kickbacks, hidden costs, and the bait-and-switch techniques of the so-called wellness industry. Traveling across the country and talking to patients, doctors, business leaders, and insurance brokers, the author concludes that overtesting, overdiagnosing, and overtreatment are all too common. Throughout the book, Makary refuses to hold back and does not hesitate to name names. However, despite all the wrongs that he describes—e.g., health fairs that serve as prospecting events to hospitals that grossly overcharge—the author is optimistic about the future of health care. He cites as positive examples an organization that negotiates with pharmacy benefit managers for better rates for employers; the national Choosing Wisely project, which promotes meaningful conversations between patients and clinicians; and the Johns Hopkins-based Improving Wisely, which enables physicians to see how their practice patterns and outcomes compare to those of others in their field. Makary, who has witnessed a groundswell of physicians working toward a fair and functional health care system, writes that hospitals and doctors can and should return to their historic altruistic mission of serving their communities and that medical schools must focus on compassion and humility. Some states have already passed price transparency legislation, and consumers, he writes, should ask for a price every time they consider a health service. Makary rightly takes the health care business to task, but he also offers a ray of hope that change can and will happen." — Kirkus Reviews

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