Money-Driven Medicine: The Real Reason Health Care Costs So Much / Edition 1by Maggie Mahar
Pub. Date: 05/09/2006
Publisher: HarperCollins Publishers
Why is medical care in the United States so expensive? For decades, Americans have taken it as a matter of faith that we spend more because we have the best health care system in the world. But as costs levitate, that argument becomes more difficult to make. Today, we spend twice as much as Japan on health care—yet few would argue that our health care system… See more details below
Why is medical care in the United States so expensive? For decades, Americans have taken it as a matter of faith that we spend more because we have the best health care system in the world. But as costs levitate, that argument becomes more difficult to make. Today, we spend twice as much as Japan on health care—yet few would argue that our health care system is twice as good.
Instead, startling new evidence suggests that one out of every three of our health care dollars is squandered on unnecessary or redundant tests; unproven, sometimes unwanted procedures; and overpriced drugs and devices that, too often, are no better than the less expensive products they have replaced.
How did this happen? In Money-Driven Medicine, Maggie Mahar takes the reader behind the scenes of a $2 trillion industry to witness how billions of dollars are wasted in a Hobbesian marketplace that pits the industry's players against each other. In remarkably candid interviews, doctors, hospital administrators, patients, health care economists, corporate executives, and Wall Street analysts describe a war of "all against all" that can turn physicians, hospitals, insurers, drugmakers, and device makers into blood rivals. Rather than collaborating, doctors and hospitals compete. Rather than sharing knowledge, drugmakers and device makers divide value. Rather than thinking about long-term collective goals, the imperatives of an impatient marketplace force health care providers to focus on short-term fiscal imperatives. And so investments in untested bleeding-edge medical technologies crowd out investments in information technology that might, in the long run, not only reduce errors but contain costs.
In theory, free market competition should tame health care inflation. In fact, Mahar demonstrates, when it comes to medicine, the traditional laws of supply and demand do not apply. Normally, when supply expands, prices fall. But in the health care industry, as the number and variety of drugs, devices, and treatments multiplies, demand rises to absorb the excess, and prices climb. Meanwhile, the perverse incentives of a fee-for-service system reward health care providers for doing more, not less.
In this superbly written book, Mahar shows why doctors must take responsibility for the future of our health care industry. Today, she observes, "physicians have been stripped of their standing as professionals: Insurers address them as vendors ('Dear Health Care Provider'), drugmakers and device makers see them as customers (someone you might take to lunch or a strip club), while . . . consumers (aka patients) are encouraged to see their doctors as overpaid retailers. . . . Before patients can reclaim their rightful place as the center—and indeed as the raison d'être—of our health care system," Mahar suggests, "we must once again empower doctors . . . to practice patient-centered medicine—based not on corporate imperatives, doctors' druthers, or even patients' demands," but on the best scientific research available.
- HarperCollins Publishers
- Publication date:
- Edition description:
- New Edition
- Sales rank:
- Product dimensions:
- 6.00(w) x 9.00(h) x 1.45(d)
Table of Contents
|1||The road to corporate medicine||1|
|2||The cost of competition : an overview||30|
|3||For-profit hospitals : a flaw in the business model?||80|
|4||Not-for-profit hospitals : "no margin, no mission"?||139|
|5||When more care is not better care||155|
|6||"Too little, too late" : the cost of rationing care||198|
|7||Doing less and doing it right : is pay for performance the answer?||225|
|8||Device makers, drugmakers, and the FDA||270|
|Where we are now : everyone out of the pool||325|
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Every chapter except one hits the nail on the head. As I was reading the book I kept saying 'This is what I have been thinking for years'. She did an excellent job researching the book for the most part. The only chapter that I felt she missed the marked on was the chapter dealing with the VA. She should have interviewed some of the veterans waiting in line for their medications or asked them if they had a second doctor in the private sector. This is the dirty little secret. Many veterans retain a private doctor in case of an emergency. They also get most of their testing in the private sector because they trust the results more. I see around 10 patients who are veterans and they only go to the VA to get their 'free' medications. Could this be the reason the VA is so cost efficient? Most of the expense of acute care and testing is done in the private sector at the patient's request.
Written in common English, yet intelligent and comprehensive, everyone can benefit from the tons of information in this book. It should be the bible for anyone interested in the current debate on health care reform, as well as standard reading for all medical students, especially medical ethics classes. This book's value to serious medical professionals cannot be overstated. It is also a must read for anyone with medical problems or those caring for someone with chronic health problems requiring professional care. Professionals involved in all aspects of medicine can benefit immensely from this book. People who earn their living in pharmacy, insurance, medical practice, medical devices, hospital administration, etc. etc. all have something to learn from this book, as does the average intellectually curious individual. For some, it could literally be a life-saver. Mahar's volumes of research is apparent from her many interviews, references, and statisical dredging, on which she bases her profound conclusions. A large book, 9.5" x 6.25" hardcover (text fills the page) of 450 pages with 83 pages of fine print footnotes (The type is large in the text) and a 20 page index, this book is obviously one of the best bargains in the bookstore. It is listed as a textbook, and as such one of the best bargains for the classroom as well. Mahar gives a "just the facts, Ma'am" dissertation - devoid of any liberal or conservative leaning, however, dispelling the myths and false claims on either side of the political spectrum. As a person with severe [multiple] chemical sensitivity, I found the ink and paper non-toxic, and I read it without problems. My only complaint as a reader is that, with the copy I had, some pages had weaker shade of black print ink than I thought it should have had.
The author kept my attention so well it was like reading a thriller. Not a dull moment in it. But be warned. It'll make you think twice about heading for a hospital, especially if you don't have insurance.