BookBrowse Reviews The Price We Pay by Marty Makary

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In this daring exposé of American healthcare, Dr. Marty Makary hits the road in search of answers to why medical costs are skyrocketing and leaving thousands of Americans in debt.

The Hippocratic Oath is one of the oldest affidavits in history, originating in ancient Greece. Written by Hippocrates between the fifth and third centuries BC, it is still used in medical schools by students upon graduation as a sacred oath of ethics; one of the key promises new physicians swear to follow is to "do no harm." According to Dr. Marty Makary, however, this promise is becoming increasingly forgotten in the United States. In his exposé of the nation's for-profit healthcare system, The Price We Pay, Makary clearly demonstrates that a disturbing regimen of overtreating and overcharging has overtaken American hospitals, fueled by the increased privatization of medical services in recent decades (for a brief comparison of American healthcare to other countries, see Beyond the Book).

Ahead of writing the book, the author traveled the country, from Pennsylvania to New Mexico, in order to hear from average Americans about their experiences with the healthcare system. He also interviewed medical professionals about their beliefs about the industry, which tended to differ dramatically from those held by patients. Again and again he found individuals who were victims of medical establishments' unethical billing practices and subpar care, and professionals who were out of touch with the needs of those they served. The work successfully links patients' frustrations, despite their geographic distance from each other.

Makary's research shows that medical professionals often are unaware of their employers' exploitative policies, much less the impact such policies can have on people's lives. For example, many American healthcare providers demand hospitals file lawsuits against patients who cannot afford to pay steep bills, then garnish those patients' wages. When Makary shared information about this with other medical professionals, he found a shocking lack of awareness across the industry. Many had little idea about how widespread the practice is:

Again and again, I observed this irony of hospital leaders appalled by the idea of lawsuits filed against patients without realizing their own hospitals engaged in just such predatory practices. Clearly, there is a disconnect.

Later, he convincingly argues that such "predatory practices" have gotten so out of control that many people avoid getting care because they are terrified of receiving a bill they cannot pay.

As the book unfolds, it becomes apparent that more and more Americans are losing trust in a medical system that is more concerned with making money than helping people. Makary finds an extreme example of this in a large Amish community in Pennsylvania. Through his interviews with community members, he discovered an astonishing fact: many in the town take an Amtrak to Mexico when someone in their family gets seriously ill. They find the six-day train ride to a foreign country worth the arduous journey, insisting that hospitals in Mexico are more affordable and transparent. Makary stresses that such cases should be a call to action for doctors, nurses, and hospital leaders to hold their profession accountable and protest for more equitable healthcare nationwide.

As a surgeon at Johns Hopkins University, Makary brings a sharp authority to his writing that is both illuminating and entertaining. His remarkable acuity shines throughout the text, and riveting descriptions of medical procedures are common. There are also surprising moments of sarcasm that poke fun at today's tech-obsessed culture: "(For young readers, ground mail was a way people sent written documents, like letters, from the 1600s through the late twentieth century.)"

There is a satisfying message of hope present despite Makary's sobering findings. He often highlights his profession's movers and shakers, doctors and students who are fed up with 'the game.' These bright minds are coming up with their own solutions to America's exploitative healthcare system, and it's nothing short of exhilarating to learn about their efforts. As a reader, I was especially moved by the author's own determination to help change the industry. He and his team have set up projects aimed at making healthcare more affordable, transparent, and accountable. One such example is Improving Wisely, which is a database aiming to identify areas of overuse, underuse, or misuse in treatment using a physician-led, consensus process.

With so much bitterness surrounding our country's medical system, The Price We Pay offers a much-needed diagnosis of what exactly is wrong with it, and imagines bold solutions to what we can do about it.

This review was originally published in The BookBrowse Review in November 2019, and has been updated for the June 2021 edition. Click here to go to this issue.

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