Brandon Eleuterio

What Broke American Health Care — and How to Fix It

Author: Marty Makary, MD

ISBN: 1635574110

Length: 269 pages

Date Read: 10/17/2019

My rating: 5/5

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Health care is expensive in the US and costs are increasing fast. Some might say more tax dollars should be allocated to health care, some might say price caps are needed, and still others might say the government is too restrictive and needs to step out of the way. But what if the solution is none of the above?

Dr. Marty Makary, a Johns Hopkins surgeon and advocate for fixing health care, makes the case that the health care cost crisis stems from a lack of information. Medical professionals, insurance companies, and patients collectively don’t know what constitutes appropriate medical treatment or what it should cost. This information failure results in medical care that is often unnecessary, incorrect, and overpriced.

The solution? Disruptive groups and individuals finding ways to correct these imbalances.

Readability – 5/5

The author offers many first-hand accounts of unnecessary medical care, administrative waste, and predatory billing practices. He uses simple concepts like selling ice cream and buying oranges to effectively illustrate economic inefficiencies.

I was skeptical early on that this book would saddle me with a slew of problems and leave me thirsty for solutions. My thirst was quickly extinguished as I read about one person or group after another disrupting the status quo and actually making a difference.

You might enjoy this book if…

You want to understand more about the US health care system and what you can do to fix it.

Key Takeaways

1. “…the two root issues driving health care’s cost crisis—the appropriateness of care and pricing failures.”
2. Some hospitals have a disconnect between their words and actions. Many say their mission is to help the poor and the sick, while their billing departments inflate prices, sue patients and garnish the wages of those unable to pay.
3. Hospitals that are transparent with their prices can be more profitable.
4. Consent forms in the ER are invalid because patients are asked to sign their financial life away while under duress.
5. RestoringMedicine.org gives patients and doctors resources to help fight things like predatory billing, lawsuits, and medical over-screenings.
6. Uber and Lyft cars are becoming the preferred mode of transport to ERs for many people.
7. ChoosingWisely.org gives doctors and patients guidelines to help fight unnecessary or excessive treatment.
8. SolveTheCrisis.org provides appropriate guidelines for doctors prescribing pain medication to help fight the opioid crisis, which is unique to America.
9. Over 50% of Americans are on four or more medications. Many of these are lifestyle medications, meaning instead of changing their diet or exercising to fix heartburn for example, doctors are nudging patients toward taking a pill.
10. Use resources such as HealthcareBluebook.com to find out typical costs for common operations.
11. Independent insurance brokers usually get kickbacks from insurance companies to sell higher premium products.
12. PBMs (Pharmacy Benefit Managers) use “a fog of fees, rebates, and discounts” to markup the price that patients and employers pay for prescription drug programs.
13. GPOs (Group Purchasing Organizations) use pay-to-play games and sole supplier contracting to mark up the prices of medical supplies hospitals buy.
14. Beware of corporate wellness programs that sell your personal information and dispense inaccurate or out of date medical advice. Quizzify is one company that does wellness the right way, educating employees about overtreatment and dispelling myths about healthy living, all without asking for personal information.

My favorite part of the book

The author and his team interviewed Amish people, half of whom said they take Amtrak to Mexico when they need serious medical treatment. Why? “Because the medical quality is good and the prices are fair and disclosed up front.”

Why did I read this book?

I heard Dr. Marty Makary interviewed on Dr. Peter Attia’s podcast.

What other books did this inspire me to read?

Unaccountable by Marty Makary, MD.

Best Quote

“The law allows us to charge whatever we want. If we want to charge a million dollars, she has to pay it.”

– A billing rep at a non-profit hospital