Peter Zhang

The Price We Pay

Review

The Price We Pay documents Marty Makary’s perspective working with American healthcare. An established physician famous for working with Atul Gawande on WHO’s surgery checklists, Makary recounts his journey discovering and addressing the disfunctions of the healthcare system. His core belief is that healthcare requires transparency in prices, performance, and transactions. He believes that accessible billing, good physician metrics, and awareness of middlemen can reduce costs, improve quality, and cut out scheming businesspeople.

Here’s the paperback and audiobook.

Utility: ★★★★✰ (4/5)

Writing: ★★★★✰ (4/5)

This book paired really nicely with Elisabeth Rosenthal’s An American Sickness. In contrast on Rosenthal’s writing style, Makary uses more personal narration, every analogy, and reference to statistics. I liked his writing more.

The story follows an investigative journey across the country and throughout the healthcare system. As a reader, you get to experience Makary’s outrage firsthand he finds more and more examples of waste and fraud. His commentary is also very insightful.

Notes

  • A broken system can emerge from well-intentioned actors. Community “health fairs” and most “wellness” programs are expensive and useless (or even harmful). Hospital executives may not know how often they garnish patient wages.

  • Niche industries like air ambulances can charge exorbitant amounts by exploiting panicked patients, wooing over doctors, and billing insurance companies as they see fit.
  • Simple public metrics can nudge doctors towards avoiding poor practices. For Moh’s surgery, privately informing doctors of their performance (in terms of tissue blocks removed) produced a significant and lasting improvement that saved patients money.
  • Over prescription is widespread. The opioid epidemic, for example, is due in large part to outdated training and profit incentives. Often, a simple lifestyle change is the ideal prescription. Other causes include overdiagnosis, as in the case of a South Korean thyroid cancer “epidemic.”
  • A novel model of healthcare treats patients in blocks. A team of physicians and health coaches are paid a lump-sum to provide care to an entire community, all-expenses included. The model puts doctors and patients on the same team: everyone wins if they prevent disease before it arises and avoid needless expenses.
  • Middlemen throughout healthcare inflate our costs. These include insurance brokers (who present themselves as independent but receive commissions from insurance companies), pharmacy benefit managers (who mark up the price of pills), and group purchasing organizations (who have a stranglehold on medical equipment, creating a pay-to-play system for manufacturers).
  • Language matters. The official vocabulary is needlessly technical and depersonalized. We should speak from the patient’s perspective and cut the bullshit.
  • Patients should demand price transparency. Physicians and hospitals should develop measures of appropriate care. Hospitals should invest in billing systems. Health professionals of all kinds should lead the way.

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