Excerpt from An American Sickness by Elisabeth Rosenthal, plus links to reviews, author biography & more

Part 2 of this book, "Diagnosis and Treatment," offers not only advice and recommendations that will make your insurers, doctors, and hospitals more affordable and responsive to you but also a range of potential, and politically viable, fixes that would tamp down the costs and the financial crimes imposed on our bodies in the name of health.

The next steps are up to us. There are self-help strategies you can implement tomorrow to reduce your medical expenses, not to mention political solutions that could revamp American healthcare once and for all if you understand how to effectively press for their deployment. They're not mutually exclusive. We can start now.

Each market has certain rules that are determined by the conditions, incentives, and regulations under which it operates. Currently, we buy and sell medical encounters and accoutrements like commodities, but how do participants in the marketplace make purchasing choices? Prices are often unknowable and unpredictable; there's little robust competition for our business; we have scant information on quality to guide our decisions; and very often we lack the power ourselves to even make the decisions.

The rules governing the delivery of healthcare in the United States have grown out of the market's design. The type of healthcare we get these days is exactly what the market's financial incentives demand. So we have to get wise to them, and be smarter, far more active participants in this ugly, rough–and-tumble world. More important, we have to change the rules of the game, with different incentives and new types of regulation. I've set out the current rules at the end of this introduction. As you read on, you'll see how they play out, and their terrible effects on the health and finance of patients, as illustrated by real-life case studies.

The economist Adam Smith spoke of an "invisible hand" with respect to income distribution. But in American healthcare, there's a different type of invisible hand at work: it's on the till.


Economic Rules of the Dysfunctional Medical Market

1. More treatment is always better. Default to the most expensive option.

2. A lifetime of treatment is preferable to a cure.

3. Amenities and marketing matter more than good care.

4. As technologies age, prices can rise rather than fall.

5. There is no free choice. Patients are stuck. And they're stuck buying American.

6. More competitors vying for business doesn't mean better prices; it can drive prices up, not down.

7. Economies of scale don't translate to lower prices. With their market power, big providers can simply demand more.

8. There is no such thing as a fixed price for a procedure or test. And the uninsured pay the highest prices of all.

9. There are no standards for billing. There's money to be made in billing for anything and everything.

10. Prices will rise to whatever the market will bear.

From An American Sickness by Elisabeth Rosenthal. Reprinted by arrangement with Penguin Press, a member of Penguin Group (USA) LLC, A Penguin Random House Company. Copyright © Elisabeth Rosenthal, 2017.