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.

A Door in the Earth by Amy Waldman

A DOOR IN THE EARTH by Amy Waldman (The Submission) is a complex text. In this novel, a recent Berkeley college grad and Afghan-American named Parveen is inspired by the earlier efforts of Dr. Gideon Crane to bring medical care to women in Afghanistan.  She decides to take a risk and retrace his steps, to live in a remote village for a few months in order to better document changes in attitudes and experiences for these women. Of course, the changes and observations which Parveen makes about the contrasts between her earlier life and current circumstances are fascinating, too, such as when she reflects on the items in her suitcase or on returning to a pre-digital life. Thinking about the absence of the written word, Parveen muses, “reading was perhaps the only learned behavior that became as involuntary as breathing. It couldn’t be unlearned, couldn’t be switched off, … Only now did she feel … how much work, how much filtering, her brain had been doing to withstand it.” And flashbacks allow for incorporating provocative comments by her professor: “Might opens the door for mission, which in turn justifies might.  Controlling land and bodies paves the way for saving souls, and saving souls solidifies control over land.” 

If there is any criticism of this novel it is that Parveen seems unwilling or unable to trust the evidence of her own eyes and, as a result, parts of the novel move slowly. However, Waldman is masterful at helping readers to appreciate the Afghan culture, particularly the role of women. While reading, many will recall the popularity and subsequent controversy associated with Greg Mortenson’s Three Cups of Tea – I was surprised to learn that Jon Krakauer had written Three Cups of Deceit, one of the many texts that Waldman consulted when writing this. Her references to media portrayal by “usual prominent white men (Charlie Rose, Tom Friedman, Tom Brokaw, David Brooks)”, the military, and America’s use of “kind power” are certainly thought-provoking and Waldman’s latest novel is a title worth considering as an addition to our Global Voices class’ syllabus.  A DOOR IN THE EARTH received starred reviews from both Booklist and Kirkus.