Kirkus Review
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 describese.g., health fairs that serve as prospecting events to hospitals that grossly overchargethe 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. Copyright Kirkus Reviews, used with permission.
Booklist Review
In this thoroughly reported primer, Makary, a Johns Hopkins surgeon and professor of health policy, authoritatively and conversationally explains the money games of medicine. How did costs get so high? Blame overtesting, overdiagnosing, and overtreating. A University of Iowa study asked hospitals what they would charge for the same type of bypass operation; the replies ranged from $44,000 to $448,000. Makary, who visited 22 cities over two years, uses anecdotes liberally and effectively. One patient received an $11,000 bill for altitude sickness treatment. Some hospitals are depressingly litigious. In 2017, the nonprofit Mary Washington Hospital in Fredericksburg, Virginia, sued more than 4,300 patients and garnished the wages of 1,756, according to court records. Makary suggests that people ask their local hospitals if they sue patients. He found that working Americans feel that the system is stacked against them; it seems that they're right. He also critiques the workplace wellness industry, with experts unnecessarily screening healthy people, leading to false positives and harmful medical procedures. Consider this book a powerful call to action for more information about health costs and for restoring the noble mission of treating everyone with fairness and dignity.--Karen Springen Copyright 2010 Booklist
Choice Review
In this excellent and clearly argued book, best-selling author Makary (Johns Hopkins Univ.) exposes the drivers of rising health care expenses, which the current US fee-for-service system seems unable to rein in. The problem of continuous cost increases is a well-examined topic, but Makary does more than repeat this litany of woe. He discusses a variety of cost drivers, most important among them being the near impossibility for a patient to find the price of care before receiving it. This opacity stems from the manner in which insurance is brokered to employers and other factors, including transportation costs, the hidden marketing that occurs in health fairs or wellness programs, and overdiagnosis in screening programs. The groups responsible for these activities are well organized, powerful, and hard to dislodge. Because the United States has no budget cap, there is no incentive to cut costs. A possible counterexample is the chain of Iora primary care clinics catering to Medicare patients. They work under financial constraints yet provide holistic, patient-centered care, offering a clear example of what the so-called Triple Aim can achieve. Medicine, Makary claims, can lose its soul (to heal the sick!) if the price of medicine is not controlled. Summing Up: Highly recommended. Lower-division undergraduates through faculty and professionals. General readers. --Thomas P. Gariepy, Stonehill College
