The Washington PostDemocracy Dies in Darkness

Author paints grim portrait of U.S. health care and our soaring medical debt. He also suggests potential solutions.

Surgeon and health policy commentator Marty Makary is author of “The Price We Pay,” a book that explores health care and medical debt in America. (Michael B. Lloyd)

For many Americans, questions about the cost of health care in the United States start when they open their mail to see an unexpected bill or pick up their phone to answer a call from a medical debt collector.

Medical debt is all too common: According to the Kaiser Family Foundation, 1 in 5 working-age Americans with health insurance has had problems paying medical bills within the past year, and the Consumer Finance Protection Bureau finds that nearly 1 in 5 credit reports include medical collections.

Behind those debts, suggests Marty Makary, a Johns Hopkins surgeon and health policy commentator, is a broken system that can be fixed.

The Price We Pay,” his new book, is stuffed with examples of predatory billing, confusing costs and statistics that could make you despondent. But there’s plenty of honesty, problem-solving and hope to leaven all that despair.

Makary paints a grim portrait of American health care, from companies that won’t reveal how much their services cost to unnecessary medical procedures, unneeded diagnoses and medications that shouldn’t be prescribed. He asks how the industry lost sight of its “sacred mission”: caring for people who need help.

Then he lays out a potential solution: honesty. Organizations that insist on transparency and measure performance can lead the way to a revitalized, more common-sense system, he suggests.

“People blame doctors, hospitals, payers, pharma, device companies, and even patients for not taking better care,” Makary writes. “But every one of us in health care, every stakeholder, needs to look inward and address the waste in our own backyard.”

Though Makary’s calls for more market “disruption” feel familiar, his argument for a return to medicine’s mission is fresh indeed. Individuals must demand transparent pricing; physicians and hospitals must promise to avoid unnecessary procedures. But if everyone recommits and pitches in, he suggests, there might just be a way to stop the medical madness.

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