An American Sickness: How Healthcare Became Big Business and How You Can Take It Back

by Elisabeth Rosenthal

The price of a Prius at a dealership in Princeton, New Jersey, is not five times higher than what you would pay for a Prius in Hackensack and a Prius in New Jersey is not twice as expensive as one in New Mexico. The price of that car at the very same dealer doesn’t depend on your employer, or if you’re self-employed or unemployed. Why does it matter for healthcare?

chief complaint: What major symptoms does the patient notice? history of the present illness and review of systems: How did the problem evolve? How has it affected each organ separately? diagnosis and treatment: What is the underlying cause? What can be done to resolve the patient’s illness or symptoms?

ECONOMIC RULES OF THE DYSFUNCTIONAL MEDICAL MARKET More treatment is always better. Default to the most expensive option. A lifetime of treatment is preferable to a cure. Amenities and marketing matter more than good care. As technologies age, prices can rise rather than fall. There is no free choice. Patients are stuck. And they’re stuck buying American. More competitors vying for business doesn’t mean better prices; it can drive prices up, not down. Economies of scale don’t translate to lower prices. With their market power, big providers can simply demand more. There is no such thing as a fixed price for a procedure or test. And the uninsured pay the highest prices of all. There are no standards for billing. There’s money to be made in billing for anything and everything. Prices will rise to whatever the market will bear.

The earliest health insurance policies were designed primarily to compensate for income lost while workers were ill.

thanks to surrogate endpoints, 74 percent of cancer drugs approved by the FDA during the previous decade ultimately did not extend life by even a single day.

Companies in the device industry spent $32.8 million on lobbying in 2014 to get rid of the tax, with top individual donations going to Senators Franken ($47,249) and Klobuchar ($39,900). It was a success. Congress suspended the tax for two years in December 2015,

The surprising result is that today there is generally far less careful scrutiny of new devices than of new drugs, even though most drugs can be stopped in an instant if problems emerge and many devices are permanently implanted in the body. Many devices are not even tested in animals before they are placed into humans; in fact, there are often no clinical trials at all for devices.

American patients need to take back ownership of what it means to be healthy or sick. Commercialization has recast our health as a series of disease states: the cause of every symptom needs to be urgently diagnosed and treated. “Do something!” “Time is of the essence.” The healthcare industry spends nearly $15 billion on advertising annually to encourage worry. That’s good business, but not smart medicine.

Cost and cost-effectiveness should be integrated into medical school curricula, and national medical boards should test this knowledge.

Price transparency is routine in many other countries and demands for it are growing in the United States.