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Money-Driven Medicine: The Real Reason Health Care Costs So Much
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 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.
480 pages, Hardcover
First published May 1, 2006
30 people are currently reading
788 people want to read
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Displaying 1 - 30 of 34 reviews
November 23, 2009
This really is a well thought out and well put together book... unfortunately, it is depressing as hell. Doctors who overtreat, doctors who are run out of practices they love, pharmaceutical reps gone mad, insurance companies running amok... PROFIT PROFIT PROFIT.
Other good books to check out include Overtreated and Our Daily Meds
This whole book makes me realize that a system made to profit on your personal health, or lack thereof, sucks. Now, don't get me wrong, doctors need to be paid for the services they provide. We have to pay for medications we need. But when is it enough? How much is enough?
The system is sick.
Insurance companies use your health as a commodity. (you getting sick and needing tests COSTS THEM MONEY! How rude!
The pharmaceutical companies profit from you getting ill. (They will invent illnesses to sell you a pill!)
The system is flatlining.
Do people really think Obama is gonna bring on the crash cart and revive it?
I'm not seeing it.
I especially like the new finding that mammograms should be done at age 50.
http://www.usatoday.com/news/health/2...
(after YEARS of nagging about early detection...) But what? Screening costs money? Costs who money? Insurance companies? Oh. Hold off on that screening for a bit. Maybe we can skip those pricey, er, pesky chemo treatments as well.
Anyway, the author did an amazing job on this book. My only complaint is that someone so intelligent and common sensical can't fix it. Damn it woman, wave a wand and fix it for the millions of uninsured.
Please?
Other good books to check out include Overtreated and Our Daily Meds
This whole book makes me realize that a system made to profit on your personal health, or lack thereof, sucks. Now, don't get me wrong, doctors need to be paid for the services they provide. We have to pay for medications we need. But when is it enough? How much is enough?
The system is sick.
Insurance companies use your health as a commodity. (you getting sick and needing tests COSTS THEM MONEY! How rude!
The pharmaceutical companies profit from you getting ill. (They will invent illnesses to sell you a pill!)
The system is flatlining.
Do people really think Obama is gonna bring on the crash cart and revive it?
I'm not seeing it.
I especially like the new finding that mammograms should be done at age 50.
http://www.usatoday.com/news/health/2...
(after YEARS of nagging about early detection...) But what? Screening costs money? Costs who money? Insurance companies? Oh. Hold off on that screening for a bit. Maybe we can skip those pricey, er, pesky chemo treatments as well.
Anyway, the author did an amazing job on this book. My only complaint is that someone so intelligent and common sensical can't fix it. Damn it woman, wave a wand and fix it for the millions of uninsured.
Please?
September 20, 2009
A very well-written book about the health care industry in the United States. The book details how the American health system started and its evolution into the mess it is today. This is clearly an issues book, no solutions are really considered, though, they are implied while reading. In short, doctors are paid per procedure, if there is an excess of supply, people will use it, possibly in an unconscious way. This means that there are real economic reasons to offer all sorts of agressive procedures. There are good doctors out there who care about their patients and try to do only what is necessary. Health insurance generally pays for every procedure, no matter how unnecessary it might be, to avoid a public backlash. When they do try to restrict coverage, they get media attention, often deservedly so. As such, they pass the rising costs onto policy holders. There are also several sections about specialty hospitals, more on insurers, how other countries handle health care, and pharma. By the end of the book, it became even more clear that the health system in the U.S. is broken and in desperate need of being fixed, or scrapped entirely and replaced with something different. Many argue that in doing so, health care will be rationed. However, it already is rationed. Unlike other countries, who have supply-side rationing, the U.S. health care industry rations based on what you can pay, so it is demand rationing. The affluent can usually afford to pay for all the procedures they want, but everyone else is stuck paying a fortune. Even middle class policy holders often find themselves in sticky financial situations during an illness, thanks to bad insurance policies. This ultimately means that many medical procedures are focused on fixing problems once things have broken rather than keeping them from breaking in the first place. Once again, this is a very good book and a must read for anyone interested in the health care debate in the United States.
June 15, 2011
Why does health care cost so much more in the US than in other developed nations while achieving inferior results overall? Maggie Mahar attempts to answer this question in Money-Driven Medicine and the answer is not a simple one. Some of the contributing factors include:
• The fact that doctors bill piecemeal by procedure or test rather than for the overall health outcome of the patient
• No one has an incentive to provide preventative care because profits are low
• Too much money is spent in the last year of a patient’s life on heroic measures when palliative care would be better suited
• Patients with insurance and the doctors who treat them are not motivated to seek out the most cost effective treatments
• Drug companies and medical device manufacturers reap huge profits often on products that are no better than existing ones
• Insurance companies act as intermediaries between a doctor and his patient skimming profits better spent on treatment
Because the US is now pouring 2 trillion dollars a year into healthcare, the sharks are circling. With deep vested interests in the status quo it is no wonder changes to the system have been nearly impossible.
Mahar does an excellent job explaining the current state of medicine in the US using both anecdotes and hard data to back her conclusions.
• The fact that doctors bill piecemeal by procedure or test rather than for the overall health outcome of the patient
• No one has an incentive to provide preventative care because profits are low
• Too much money is spent in the last year of a patient’s life on heroic measures when palliative care would be better suited
• Patients with insurance and the doctors who treat them are not motivated to seek out the most cost effective treatments
• Drug companies and medical device manufacturers reap huge profits often on products that are no better than existing ones
• Insurance companies act as intermediaries between a doctor and his patient skimming profits better spent on treatment
Because the US is now pouring 2 trillion dollars a year into healthcare, the sharks are circling. With deep vested interests in the status quo it is no wonder changes to the system have been nearly impossible.
Mahar does an excellent job explaining the current state of medicine in the US using both anecdotes and hard data to back her conclusions.
July 16, 2008
Free markets tend to balance out over the long run. The problem, as John Kenneth Galbraith noted, is that in the long run, we are all are dead. The problem of letting the market rule is even more problematic in a market that is as dysfunctional as medicine.
Mahar illustrates throughout Money-Driven Medicine why market forces don't work as one might expect in healthcare, and why it comprehensive reform is urgently needed.
By far the best of the healthcare policy books I've read over the past year. Where Jonathan Cohn's Sick consisted of anecdotes illustrating our healthcare system's brokenness, and Overtreated looked at how our healthcare system often delivers unnecessary treatments, Money-Driven Medicine gets to the root of the problems with the system, and offers some alternative solutions, including a look at the VA's incredible turnaround from being a poorly managed bureau to delivering some of the best and most technologically-savvy care in the United States.
Definitely worth reading if you're interested in the Gordian Knot that is the American healthcare system.
Mahar illustrates throughout Money-Driven Medicine why market forces don't work as one might expect in healthcare, and why it comprehensive reform is urgently needed.
By far the best of the healthcare policy books I've read over the past year. Where Jonathan Cohn's Sick consisted of anecdotes illustrating our healthcare system's brokenness, and Overtreated looked at how our healthcare system often delivers unnecessary treatments, Money-Driven Medicine gets to the root of the problems with the system, and offers some alternative solutions, including a look at the VA's incredible turnaround from being a poorly managed bureau to delivering some of the best and most technologically-savvy care in the United States.
Definitely worth reading if you're interested in the Gordian Knot that is the American healthcare system.
December 14, 2009
I have heard many people, including some prominent politicians, state that the U.S. health care system works well for most Americans, therefore it should not be meddled with or overhauled.
My response to this claim would be that, first of all, just because the majority of Americans have health coverage, that doesn't imply that it is "working" for them. What about the extremely high costs involved? What about the hassles and worries that we all have to deal with that citizens in other countries don't have to deal with? What about our friends and loved ones who don't have coverage? If it's not working for my loved ones, is it really working for me?
Secondly, I would point out that Nazism was working very well for the vast majority of Germans also. But, unfortunately for the Jews, Gypsies, homosexuals, disabled, dissenters, and other "undesirables" of Germany, Nazism didn't really do much good for them. So, was there a valid reason to modify or overhaul Nazism in Germany when it was working quite well for most Germans? Obviously, the "working well for most" argument is completely bogus.
The facts are that health care in the U.S. costs nearly double per capita what modern European countries pay and we get significantly worse results from our system than they do (by most methods of measurement, including life expectancy). Furthermore, all citizens of European countries have access to basic health care, while at least 20% of Americans, including millions of children, have no access. And for the millions of Americans who "fall through the cracks" of our health care system, life often becomes mired in financial and medical disaster that is not only unnecessary, but excessively costly to our whole society as well.
So, why does health care in the U.S. cost so much and deliver so little? The reasons are numerous, and they are so ingrained into our culture and economic structure that significant improvement in the near term is very unlikely. This book spells out the problems in fine detail with many clear examples to illustrate the points. The book offers few, if any, solutions; it merely spells out the problems. But it becomes obvious that formulating solutions or simple improvements to the quagmire we are in will be a monumental task.
This is a very good book for learning about this very important issue. However, it is not an easy or enjoyable read -- but, then again, why should it be? How could it be? The three-star rating is simply a reflection of my enjoyment and life-impact levels, because this really is a good, accurate, well-researched book.
My response to this claim would be that, first of all, just because the majority of Americans have health coverage, that doesn't imply that it is "working" for them. What about the extremely high costs involved? What about the hassles and worries that we all have to deal with that citizens in other countries don't have to deal with? What about our friends and loved ones who don't have coverage? If it's not working for my loved ones, is it really working for me?
Secondly, I would point out that Nazism was working very well for the vast majority of Germans also. But, unfortunately for the Jews, Gypsies, homosexuals, disabled, dissenters, and other "undesirables" of Germany, Nazism didn't really do much good for them. So, was there a valid reason to modify or overhaul Nazism in Germany when it was working quite well for most Germans? Obviously, the "working well for most" argument is completely bogus.
The facts are that health care in the U.S. costs nearly double per capita what modern European countries pay and we get significantly worse results from our system than they do (by most methods of measurement, including life expectancy). Furthermore, all citizens of European countries have access to basic health care, while at least 20% of Americans, including millions of children, have no access. And for the millions of Americans who "fall through the cracks" of our health care system, life often becomes mired in financial and medical disaster that is not only unnecessary, but excessively costly to our whole society as well.
So, why does health care in the U.S. cost so much and deliver so little? The reasons are numerous, and they are so ingrained into our culture and economic structure that significant improvement in the near term is very unlikely. This book spells out the problems in fine detail with many clear examples to illustrate the points. The book offers few, if any, solutions; it merely spells out the problems. But it becomes obvious that formulating solutions or simple improvements to the quagmire we are in will be a monumental task.
This is a very good book for learning about this very important issue. However, it is not an easy or enjoyable read -- but, then again, why should it be? How could it be? The three-star rating is simply a reflection of my enjoyment and life-impact levels, because this really is a good, accurate, well-researched book.
October 23, 2007
Mahar thoroughly investigates the current US health care crisis in Money-Driven Medicine. She has compiled a diverse and expansive sampling of interviews with physicians, hospital administrators, insurance providers, pharmaceutical companies, government agencies, and Wall Street analysts. She uses her proven economic savvy (see Bull!) to illuminate the source of many crucial problems we are experiencing with our free-market health care system.
She quotes expert opinion extensively and delivers her message in a concise, efficient way. The book is fairly long, but is literally packed with statistics, case studies and the like. I cannot validate the credibility of all of the experts she quotes, but from a small amount of investigation I've done they seem to be fairly notable.
Totally recommended for anyone who is curious about why injustice doesn't merely strike the poor, but the middle class as well in our country. You won't want to go to the doctor afterwards though, so study up on your Physician's Handbook.
She quotes expert opinion extensively and delivers her message in a concise, efficient way. The book is fairly long, but is literally packed with statistics, case studies and the like. I cannot validate the credibility of all of the experts she quotes, but from a small amount of investigation I've done they seem to be fairly notable.
Totally recommended for anyone who is curious about why injustice doesn't merely strike the poor, but the middle class as well in our country. You won't want to go to the doctor afterwards though, so study up on your Physician's Handbook.
October 18, 2015
One factor that does not drive high healthcare costs is malpractice lawsuits and insurance, which together make up 0.5% of healthcare spending in the US as in other industrialized nations. The data are clear. Healthcare spending in the US is high vs. other countries because we pay higher prices for the same services, have higher administrative costs, and perform more specialized procedures. The reasons we pay higher prices and receive more services are many but one stands out and that is that in US healthcare supply determines demand. Elements of Obamacare (e.g. ACOs) offer hope but large provider groups, insurers, pharmaceutical firms, and device makers have shared interests that will be difficult to overcome.
December 19, 2009
Maggie Mahar's fascinating and compelling book, Money-Driven Medicine: The Real Reason Health Care Costs So Much, contributes much to our understanding of the current health care crisis. Mahar takes the reader behind the hysterical ranting about "pulling the plug on grandma" and "socialized medicine." In doing so, she provides the reader with a clear and accessible analysis of the underlying dynamics that result in our paying more, for less effective care.
The disciples of the free market would have us believe that competition between insurance companies serves to dampen soaring prices. Unfortunately, as Mahar shows, the fiercely competitive health care arena pits doctors against doctors and hospitals against hospitals. In the current system, everyone gets paid on a piece rate basis. The more procedures, prescriptions, surgeries provided the higher the profit. The problem with this kind of arrangement is that often times more is not necessarily better. That is, more treatment does not result in better health outcomes for patients.
Mahar is at her best when she present strong evidence of the failure of more treatment to foster greater health. She details examples of how the flurry of unproven treatments, unnecessary tests, and defective medical devices actually threatens patients' well-being.
Money-Driven Medicine should be required reading for every member of Congress as well as all Americans. We need to move beyond distracting and obfuscating hyperbole toward a thorough accounting of exactly how our health care system works. Only then will we be able to develop more rational and effective policy options to ensure the health and well-being for all.
The disciples of the free market would have us believe that competition between insurance companies serves to dampen soaring prices. Unfortunately, as Mahar shows, the fiercely competitive health care arena pits doctors against doctors and hospitals against hospitals. In the current system, everyone gets paid on a piece rate basis. The more procedures, prescriptions, surgeries provided the higher the profit. The problem with this kind of arrangement is that often times more is not necessarily better. That is, more treatment does not result in better health outcomes for patients.
Mahar is at her best when she present strong evidence of the failure of more treatment to foster greater health. She details examples of how the flurry of unproven treatments, unnecessary tests, and defective medical devices actually threatens patients' well-being.
Money-Driven Medicine should be required reading for every member of Congress as well as all Americans. We need to move beyond distracting and obfuscating hyperbole toward a thorough accounting of exactly how our health care system works. Only then will we be able to develop more rational and effective policy options to ensure the health and well-being for all.
August 17, 2012
A very engrossing book on the economics of health care in the United States. There's plenty of blame for everyone to go around in this one when it comes to why Americans pay so much for health care yet don't get the quality of other countries. It appears that the single largest problem is that unlike in typical economics, the supply drives the demand in health care. This is borne out in the fact that health care costs are greater in parts of the country where there are more hospital beds and more specialist physicians. In other words, if you build it, they (the patients) will come and they (the physicians and hospitals) will find procedures and treatments to do in order to fill their calendars and pocket books. The only disappointing thing about this book was that it didn't seem to provide too many solutions. For example, it discusses the negative impact of pay for service, but then goes on to almost equally disparage pay for performance outcomes without offering another idea. Regardless, this is an extremely interesting read full of amazing statistics regarding health care provision in the U.S. - highly recommended.
November 26, 2009
Well-documented expose on the many factors driving up the cost of health care in America. There is $$ to be made from the sick and no $$ from teaching prevention. Hospitals and specialty medical centers vie for well-insured patients. Investors demand higher returns on their health care portfolios. Family doctors are a vanishing breed because specialized medicine is where the big bucks are earned. And no one wants to treat the uninsured...at all. Even emergency rooms are turning away those who can't pay the bill. No politics--just cold, unrelenting facts that bare the evils and greed driving all Americans to bankruptcy.
August 29, 2007
A front to back dissection of the influence of money on our health care system, this book covers virtually everything. Mahar has done her homework and seems to have a real understanding of the perverse incentives that drive health care. Unfortunately, she follows the unparalleled blow-by-blow with some tacked on suggestion about empowering doctors. Just pretend that the last chapter doesn't exist, because the rest of it is the most accessible in-depth primer on health care that I've ever read. Essential.
August 30, 2009
Superbly written. Financial jouranlist and now health care blogger Maggie Mahar distills the economics behind medicine in a balanced way while offerring solutions.
Her health care blog provides balanced, critical insight into the economic, practical and political issues of the current bills and process.
Book was made into a TV documentary that PBS has been airing.
Her health care blog provides balanced, critical insight into the economic, practical and political issues of the current bills and process.
Book was made into a TV documentary that PBS has been airing.
February 15, 2013
This is essential reading if you ever expect to see a doctor or visit a hospital. The business of medicine pushes the hippocratic oath into a dark corner more frequently than you might imagine.
You should also read the excellent Overdiagnosed: Making People Sick in the Pursuit of Health by H. Gilbert Welch.
Think of these two books as a self preservation kit.
You should also read the excellent Overdiagnosed: Making People Sick in the Pursuit of Health by H. Gilbert Welch.
Think of these two books as a self preservation kit.
July 29, 2009
An amazingly easy read on the many troubles of our current health care system.
The greatest takeaway I have from the book is that the health industry is not and should not be ruled by the common economic theory of supply and demand.
The greatest takeaway I have from the book is that the health industry is not and should not be ruled by the common economic theory of supply and demand.
October 14, 2012
Maggie Mahar provides one of the best opportunities I have yet found that helps explain just what the hell is going on with the health care system and why it's so freakin' expensive. I highly suggest reading this book.
September 9, 2011
A most timely (even though written in 2006) title on why our health care system is an expensive octopus. I was especially intrigued by the chapter on providing too much treatment when perhaps less care would provide the same (if not better) results. Interesting read.
June 27, 2007
a lively jaunt through the perils of US healthcare. eye-opening, depressing, informative, will stick with me. it is structured really well and the writing is outstanding.
October 26, 2012
Grim look at how poorly the US health care system works. I appreciated that while the author has an obvious perspective, she expresses this not by getting on a soapbox, but by adding more facts.
July 20, 2019
I would love for an updated version of this to be written with a chapter on the ACA. Still, this is a thorough explanation of just how we got to this point in U.S. healthcare (and how much worse it is than I already thought).
April 10, 2022
Unflinching muckracking of today’s corporate-driven healthcare industry. The author offers honest analysis while avoiding alarmist tones. If you want a high-level overview of how our healthcare system got here, this is a must-read.
January 8, 2017
Good read despite being 2006 so no Obamacare coverage but given the new reality, how things used to be may be the future. The author makes the point that it is FUNDAMENTALLY NOT APPROPRIATE to apply the "laws" of supply and demand to healthcare.
She states that"Put simply, over the past 25 years, power in our health care system has shifted from the physician to the corporation."
That was a startlingly accurate insight that I had not identified as contributing to the systemic failure of American health care such as it is.
Our system with copays and deductibles and insurance control of coverage (or not) is in fact deliberately established to make "consumers" self-ration their use of available medical treatments. Basically, you get the healthcare you can pay for (even under ACA) or die.
She states that"Put simply, over the past 25 years, power in our health care system has shifted from the physician to the corporation."
That was a startlingly accurate insight that I had not identified as contributing to the systemic failure of American health care such as it is.
Our system with copays and deductibles and insurance control of coverage (or not) is in fact deliberately established to make "consumers" self-ration their use of available medical treatments. Basically, you get the healthcare you can pay for (even under ACA) or die.
August 14, 2012
I got bored and quit about halfway through. It was depressing and interesting to learn about the history of the healthcare industry in America, the book was just really out of date now that the ACA has come into effect.
Which is obviously not to say that I think the ACA has fixed everything she says are the problems, of course it hasn't. But it has addressed some of the broader issues in her book. And now that we have the ACA, I got tired of reading her constant pleas for something to be done and really wanted a discussion of how the ACA has helped. So I gave up because that discussion was not going to happen, given that this book was written before Obama entered office.
Which is obviously not to say that I think the ACA has fixed everything she says are the problems, of course it hasn't. But it has addressed some of the broader issues in her book. And now that we have the ACA, I got tired of reading her constant pleas for something to be done and really wanted a discussion of how the ACA has helped. So I gave up because that discussion was not going to happen, given that this book was written before Obama entered office.
April 7, 2008
This is a very detailed review of a lot of serious problems with the US health care industry, and worth spending time to read & understand. It covers advanced topics without too much jargon, so it doesn't require specific knowledge of health policy or economics to read. However, sections of it are structured too much like a laundry list of problems and issues. It would be better served with a little more organization and analysis, at the expense of a few of the details.
December 26, 2013
Healthcare in the U.S. is expensive and it does not deliver results. This, like similar works, does a good job of describing the symptoms. The prescriptions are less clear. Is there too much capitalism? Does supply drive costs higher? Will more technology and evidence based care improve outcomes? Is more palliative care the secret to better results and lower costs?
These are important questions, but the answers are not obvious.
These are important questions, but the answers are not obvious.
July 17, 2010
Maggie Mahar is an excellent writer and after reading this book about our health care system it is clearly evident that she did much research but I have trouble agreeing with her conclusions. She concludes that the best example of where health care needs to go can be found in the Federal Governments VA system and in Kaiser Permanente. I have a problem with this.
Read
November 1, 2009People with insurance get too much care and those without get too little. If electronic medical records were widely used, the outcomes and costs of various treatments could be accurately measured. That would help doctors to decide what course of treatment to follow.
Read
February 15, 2016I really wanted to read this- great information- but it was almost too much. It was like a giant data-dump of information and my brain didn't have the processing speed to take it all in. It was due back at the library and I just couldn't get though it. I'll try again sometime.
October 31, 2007
Whenever I hear about the healthcare crisis, I always wonder, "Just where is all the money going?" This book gives a good explanation.
December 24, 2009
Alas, I can't remember a whole lot, since I read it back before the hell-cold, but I do know that it was a good compliment to The Healing of America, with lots of detail about our current system.
February 19, 2010
depressing!
Displaying 1 - 30 of 34 reviews