The Price We Pay by Marty Makary

THE PRICE WE PAY by Marty Makary is subtitled “What Broke American Health Care—and How to Fix It.” Makary has long been concerned with health care costs and helping consumers to be more knowledgeable. He is a best-selling author (Unaccountable, 2012), surgeon, and a professor of Health Policy at the Johns Hopkins School of Public Health. In THE PRICE WE PAY, Makary divides his chapters into three broad sections titled Gold Rush, Improving Wisely, and Redesigning Health Care. In the first, he looks at issues like “Two Americas” where he describes situations for individual patients such as the horrific one for Jennifer and her husband, young parents from Carlsbad, New Mexico where the hospital repeatedly sued them for non-payment and then garnished wages even though many of the costs were associated with an infection caused by the hospital itself. He also profiles Mary Washington Hospital, serving a community of about 25,000 in Fredericksburg, Virginia; over the last five years, that hospital has filed 24,200 lawsuits! He and his team documented the pattern wherein American workers (especially those in retail like Walmart, Lowe’s, Kroger, etc.) with health insurance “made too little money to afford inflated hospital bills but made too much to qualify for Medicaid.”

In the second section of THE PRICE WE PAY, Makary focuses on specific issues like unnecessary C-sections for women in labor or overtreatment with drug prescriptions and devotes one chapter to the opioid epidemic. Finally, he uses the last section of his book to explore disruption in the industry, to look more specifically at health insurance, and to offer a concluding call to action and more transparency in the face of price gouging and “ugly” billing procedures. Although Makary does an excellent job of outlining issues and abuses, his proposed solution seems to rely mostly on medical doctors policing a system that will be hard to change. THE PRICE WE PAY contains several pages of notes and an index; this new title received a starred review from Booklist.