The Price We Pay by Marty Makary

The Price We Pay: What Broke American Health Care – And How To Fix It
by Marty Makary
Bloomsbury USA, 2019

One of the biggest concerns in the United States today is the high cost of healthcare. Medical bills have sent many into bankruptcy while politicians argue and present their best healthcare plan for lower premiums. In The Price We Pay: What Broke American Health Care – And How To Fix It, Marty Makary looks at the reasons why healthcare costs for Americans are out of control and the ways in which people are working to change the fundamentally structure of healthcare and focus more on the patient than profits. Makary has written about healthcare before in his book Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care, and as a doctor is highly qualified and positioned to offer a critique of the healthcare system.

The book is split into three parts. The first part covers the effects of profit-driven healthcare. Throughout this section Makary looks at how innocent-sounding health fairs, the lack of transparency in hospital billing and harsh bill-collecting practices are causing undue angst to patients. He does this by relating the stories of average Americans, stories he's collected in his travels and in talking to healthcare professionals. The reader will be angered to hear how health fairs conduct screenings that are not necessary to fish for patients to send to their clinics, how hospitals' predatory billing services are sending people into debt and garnishing their wages at marked-up prices and how much the prices for ground and air ambulances have been inflated. Patients are left with high bills and opaque pricing and billing procedures that work against them. “Honest, hardworking Americans feel helpless against the oligarchs who use power and access to rewrite rules in their favor,” Makary writes, “creating fine print and laws that give themselves the upper hand.” Seeing one hospital sue almost 20% of the small town they are supposed to serve, many who receive low incomes, one can’t help but ask: Is this really how healthcare is supposed to operate?

Makary then discusses the importance and impact of developing good quality metrics for medical practitioners. He describes how he and his team went about developing metrics for clinical appropriateness to highlight overuse of procedures by doctors compared to their peers. For the 500 measures they developed, Makary’s team “relied on the experts to define a threshold that would clearly identify outliers in that clinical situation. The goal was not to punish outliers but to let them know where they stand and offer help.” Evidence showed that doctors began to improve their performance after receiving the report resulting in fewer unnecessary procedures performed. The pilot study alone was calculated to have saved millions of dollars. Thus, identifying and addressing the overtreatment not just of procedures but also of prescription drugs can results in large savings. This is especially relevant when talking about prescribing opioids, and Makary relates how his own team tackled the problem.

In the last section, Makary delves into the hidden parts of the healthcare system that add additional costs. These include health insurance brokers, who sell insurance to employers, pharmacy benefit managers, middlemen who manage pharmacy benefits for employers and group purchasing organizations (GPOs) that hospitals buy their products from. These industries are driven by profit and Makary shows how they fleece employers and hospitals which lead to money that could be used for employee raises being earmarked to pay for the rising cost of doing business with these industries and in the case of the GPOs in some cases stifling innovation in the medical device field. But the author also shows us examples of companies in these industries that are being disruptive and providing more honest and transparent services while remaining profitable. He points to these examples of the positive changes that the healthcare community should take note of and strive to emulate.

Makary has written an engaging and eye-opening look at the healthcare system. As someone also perplexed by the intricacies of the healthcare system, I could not put the book down as Makary shed light on the games that many different components of healthcare are engaged in with patients. I was inspired by the efforts of people like Makary who are taking the initiative to fix the broken parts of the healthcare system. After reading this book, you’ll probably never look at the healthcare system the same again, but you may also have a glimmer of hope for the future.

—Justin Staley is a young professional who enjoys reading and sharing his love for books through his YouTube channel: