The Price We Pay

It’s not very often that I read a book that makes me alternate between tears of outrage and a deep sense of gratitude and wonder.

Dr. Marty Makary’s book, The Price We Pay, is one of those rare books.

In it, Dr. Makary (a Johns Hopkins cancer surgeon), shares his quest to understand what’s gone wrong with healthcare in America - and what we can do to fix it.

I found myself overwhelmed with outrage to read about patients who’s lives had been shattered by the unjust and predatory practices of a system that claims to be committed to healing.

Just a few pages later, I found myself marveling at the good fortune I have to live in a time and place where there are people struggling mightily to right the wrongs of a bad system.

To be clear, while there are unscrupulous individuals involved in American healthcare, much of the suffering patients encounter stems from emergent properties of the system - they’re basically collateral damage caused by poorly-designed incentive and feedback loops.

That is to say, it’s not that American healthcare is evil. It’s just that many people with the authority to make systemic decisions about healthcare (and how it’s financed) benefit monetarily from the status quo, while the people who suffer most - the average American patients - are far-removed from the rooms where decisions are made.

One of the concrete results of Dr. Makary’s work is President Trump’s November 2019 Executive Order that stipulates that federally-funded hospitals must disclose prices for hospital procedures to patients upfront.

Though many corporate interests sued President Trump in an attempt to maintain the highly-profitable status quo, their lawsuits failed, and beginning in 2021, patients will be able to see what they’re being charged for, and so “shop around” to avoid price-gouging.

I’m grateful to Dr. Makary, his team, and his collaborators around the country, who are striving mightily to protect people of all backgrounds.

Truly, if you have any interest whatsoever in medicine, healthcare, or even understanding maladaptive incentive systems, this book is worth reading and owning.