THE PRICE WE PAY

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 (Health Policy/Johns Hopkins Univ.; Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care, 2012, etc.) 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.