Marty Makary, M.D. provides dozens of examples of how average Americans overpay for health care. Markary supplies ample evidence that we are being over-tested, over-medicated, and over-operated on. The Price We Pay opens with a story about a traveling clinic that would provide “free” diagnostic testing for common aliments like high blood pressure, diabetes, and heartburn at churches around the country. One of the questions the staff would ask of participants was “Do you have leg pain?” Just about 100% of the answers were “Yes.” The clinic staff would then refer them to surgeons who “sold” the idea of stents in leg arteries to “cure” the pain. The result was a $25,000 operation that provided minimal relief from pain.

Makay claims the opioid crisis resulted from over-medicating patients. Studies show that 15 opioid pills were sufficient for most post-operative patients to manage pain. But doctors prescribed 60 opioid pills. Makay suggests we can fix our health care system by providing transparency on pricing for starters. Why should a hip replacement operation cost $30,000 in Pennsylvania and $80,000 in New York City? The variance in prices is one of the biggest medical scams today. I learned a lot about current medical practices. But I always knew medicine was not just a profession but a business. The Price We Pay proves that convincingly. GRADE: A
Preface ix
Part I Gold Rush
1 Health Fair 1
2 Welcome to the Game 15
3 Carlsbad 36
4 Two Americas 52
5 The Ride 70
Part II Improving Wisely
6 Woman in Labor 89
7 Dear Doctor 99
8 Scaling Improvement 111
9 Opioids like Candy 127
10 Overtreated Patients like Me 139
Part III Redesigning Health Care
11 Starting from Scratch 153
12 Disruption 167
13 Buying Health Insurance 177
14 Pharmacy Hieroglyphics 191
15 4K Screens 205
16 Diagnosis: Overwellnessed 215
17 The Words We Use 227
18 What We Can Do 237
Acknowledgments 247
Notes 249
Index 261


  1. Deb

    I think my biggest problem with a book like this is that it already accepts the status quo—which is that we pay for-profit insurers for health care. In almost every other first-world country, universal health care is one of the standard services provided by the government. Don’t jump on me about socialism, etc. As the late, great Molly Ivans used to say, when you make a person’s health part of a for-profit paradigm, that person’s wellness will come second to profit. The fact is, even with “gold standard” health insurance, very few people could afford all of the co-pays and deductibles that go with treating a long illness and hospital stay. I personally know two people—with health insurance—who had to file for bankruptcy after major medical emergencies. To me, while I agree about over-testing and over-medication (and get rid of tv ads for prescription meds, ffs), the biggest crisis we have in health care right now is that some corporation is making a huge profit based in part in denying you benefits…and, unless you’re a billionaire, that is not a sustainable system.

    /Dismounting soapbox now.

    1. george Post author

      Deb, you’re right on all counts. Our healthcare is alway second to the profit-motive. And THE PRICE WE PAY clearly demonstrations dozens of ways the healthcare system is rigged to take our money. The Democrats need to focus on this issue in their campaigning.

  2. wolf

    This is one problem of the rich USA which I’ve never understood.
    It’s being discussed everywhere with horror stories like the legal opioids being proscribed like …
    I remember only one case where the doc gave me Fentanyl – after a hernia, done in the afternoon, at home by 8 p m, at 10 p m the doc called and asked whether I was ok. And he told me to take it only in case of really strong pain – so I didn’t!
    And of course I didn’t pay a single Cent …
    If that is Socialism I’m all for it and very happy with it.
    I remember reading that US citizens pay about twice as much for medical services and prescription as EU citizens …
    For us tourists the first step in planning to travel to the USA:
    Get health insurance!
    Most of us Europeans have travel insurance – but it often says:
    Not valid for the USA (and some other extreme countries)! Get extra insurance!
    PS – an example:
    Every EU citizen who is a member in the “Socialist Insurance system” (some people in Germany e g have private insurance) gets a so called EHIC card which is valid in the whole EU. I had to go to the hospital in Hungary, showed my card and my insurance was billed – didn’t have to pay anything.
    Now everybody is wondering how the Brits will handle this with Brexit – there’s more than a million Brits living in the other EU countries.

    1. george Post author

      Wolf, our goofy healthcare system is easy to understand: it’s all about the money. Unnecessary tests, unnecessary procedures, expensive medications, etc. are all part of a money grab. THE PRICE WE PAY show how many Americans are traveling to other countries–France is a popular choice–for operations that cost a fraction of what American doctors and hospitals charge.

  3. Jeff Meyerson

    All true. The opioids: I’ve mentioned before how the idiot doctor on call at the rehab place where Jackie went after her knee replacement (their only interaction went like this. Doctor: “So how’s the hip?” Jackie [showing scar]: “It was my knee [moron].”) just handed me about eight SHEETS of pills when she checked out, including Oxycontin. We dumped most of them.

    We have Medicare and secondary insurance (plus dental, something else that kills people with the cost), but when you see how much they are charging for even the simplest service, it is eye-opening even when we don’t have to shell out most of it. My trip (so to speak) to the ER last December when I fell and broke my shoulder would have put the average working person in a major financial hole. Ambulance, tests, more tests, you name it. Whereas, had I fallen and done the same damage to myself on a trip to London, the cost would not even be a consideration.

    1. george Post author

      Jeff, medical problems while on vacation are a huge problem. One of our friends suffered a heart attack in Panama (he was down there to see the Canal). He needed to be helicoptered to a hospital. His health insurance wouldn’t cover it so he had to put the chopper flight on his credit card: $20,000! Good thing he had a high credit card limit.

      1. Jeff Meyerson

        Ouch! My cousin was in the Dominican Republic when he had a bad gall bladder attack. The problem wasn’t the money but the inadequate medical care. Eventually, he was stabilized and flew back to the States for surgery. Scary.

      2. george Post author

        Jeff, the whole drama with David Ortiz getting shot in the Dominican Republic and his medical issues afterward presents a cautionary tale for those who want to visit Third World countries.

  4. Steve Oerkfitz

    I pay over $2,000 a year for my meds. Most of this is for insulin. I have copay but they only cover about 50% of my insulin.

    1. Rick Robinson

      About the Opioid “crisis”: yes, they have been over-prescribed by SOME doctors, but misuse has been the biggest problem. If you are given 10 and 5 does the trick, then dump the other 5. Simple, or should be.

      Medical insurance is a joke, but the Republicans have been fighting national health coverage for 80 years. They just don’t want to do the right thing for the American public. I have both Medic-Care and secondary insurance, and still have to pay a lot, especially for my Insulin.

      1. Jeff Meyerson

        About the last two comments, we have great coverage through Jackie’s union (even though she retired 15 years ago). We get back $770 a year from the union’s Welfare Fund for our prescription costs each year, and if we had higher bills would get a percentage
        of our costs.

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