That’s the title to the book written by Marty Makary, M. D. who was the speaker at the Fall, 2019 annual whoop de do put on by the Oklahoma Council of Public Affairs. I heard part of a Rich Fisher interview with Dr. Makary on our Tulsa Public Radio station. He made much sense describing the insanity that is pricing, billing and paying for health care in our country, much like was done several years ago in A Bitter Pill. So when I heard at the end he is coming to Oklahoma at the invitation of the OCPA I knew there had to be a catch.
The danger and joy with Nook books is the ease of acquiring, so later that same day I was quickly reading through to learn the rest of the story—I didn’t. Here’s what I did learn. The Price We Pay is a fascinating and effective anecdotal, not analytical, description of much of what is wrong with our health care system. If you’ve never experienced mishaps like I describe in my post Dennis not the Menace then you are lucky and may not understand what all the fuss is about health care financing in our nation, so read this book. It will make your blood boil with descriptions of the problem, but won’t give you the answer. Unless you already have preconceptions, as I do, then you can find it as I did.
I don’t recall if it is his first outrageous example, but around page 22 I made note where a hospital in the United States quotes $150,000 for bypass surgery, then when the potential patient balks at the cost eventually comes down to $25,000. So the patient goes to France and has it done for $15,000. If I were Dr. Makary I’d spend a little time investigating how health care is provided and financed in France—but he doesn’t show that curiosity, unless I skipped over it. What is obvious to many of us, and so eloquently stated by my friend Carlton James (see my post Looking for Mr. James) is apparently lost on Dr. Makary.
He continues giving example after example of how outrageously silly and harmful our health care system is in so many ways, interspersed with examples of how markets sometimes seem to work, as around page 40 with elective procedures as an example—duh—a medical market virtue I addressed as irrelevant to the broader discussion in my post Spoonful of Sugar. Which is why I read his description of the Surgery Center of Oklahoma with skepticism expecting that it is all about elective procedures. I was wrong and it truly appears to be a fascinating outlier, like other providers appearing here and there in The Price We Pay, in our crazy system. Fair, transparent and market-based pricing still doesn’t obviate the need for insurance coverage—we’re not talking about a $500 car repair bill a modest emergency savings should handle—because few of us can pay out of pocket for child birth $12,000 or a hip replacement $15,000, much less a lumbar fusion, two levels, whatever the heck that is, at $50,000—all prices from the Surgery Center of Oklahoma’s website.
He visits a hospital administrator in Nebraska that is making money while not playing the game of charging multiples of actual cost then giving insurers huge discounts. It will discount 4% and that’s it. Medicare and Medicaid make up a normal part of its business and, unlike the usual whining from hospital administrators and government haters like the OCPA, it doesn’t lose money on those patients.
A favorite chapter of mine is the one on flight ambulances, a notorious source of examples where patients and insurance companies are over charged with the patient (remember they made a rational decision for a flight ambulance to save their life…not) usually holding the bag. Unless the patient’s health insurance is one of those bad, wasteful government run single payers—Medicare or Medicaid. He finds they don’t get gouged, so duh???, why not good enough for everyone. Relying on buyers to check price gouging sellers when the buyers have suffered a traumatic health event and may even be unconscious is just plain silly, if not stupid. It’s a classic example of the kind of market that should be regulated or controlled by a single payer with enough market clout.
The author at one point compares insurance brokers to the mortgage bundlers/sellers who fueled the subprime mortgage failures that led to the Great Recession of 2008 (doesn’t seem so Great today). What he doesn’t say or explore is how through government regulation strengthened or kept in place that catastrophe could have been avoided. So of course he makes no mention of a role for government regulation in cleaning up what bothers him with health insurance brokers.
Toward the end he declares that the diet wars are over, that it has been proven there are no benefits to a low fat diet—say what? He even blames low fat advocacy for the obesity epidemic—wow, here he lost me. Just Google up my diet man, Dr. Dean Ornish, if you want my version of the truth. No, the diet wars are not over and low fat doesn’t cause obesity.
He partially redeems himself by pointing out toward the end that Salk and Sabin refused to make money on the polio vaccine—probably because they recognized the overwhelming public good involved and knew monetizing it would send the wrong market signals. But the author ends with a call to more transparent and efficient markets and thus ends a book supposedly contributing to the public discussion about health care policy and not once mentions universal health care, single payer or Medicare for all—all ideas and policy proposals that exist specifically because of the broken system he documents so well.
So it goes; hope the food was good for the fellows of the OCPA last fall. Remember to vote for Medicaid expansion June 30; or if you vote absentee I’ll happily notarize your ballot. As always, a lunch or pizza on me for the first to ID the photo site.