The Price We Pay: What Broke American Health Care--and How to Fix It

Dr. Marty Makary’s "The Price We Pay" is a powerful and eye-opening investigation into the systemic dysfunctions plaguing the American health care system. A practicing surgeon and public health expert, Makary combines investigative journalism with medical insight to reveal the hidden forces driving up costs, diminishing trust, and ultimately harming patients. The book is not only an indictment of the status quo but also a hopeful blueprint for reform, offering a rare mix of critique and constructive solutions. At the heart of Makary’s argument is the notion that the U.S. health care system has evolved into a profit-driven industry where patients are treated as revenue sources rather than human beings. He explores how non-transparent pricing, medical billing abuse, unnecessary procedures, and predatory collection practices have created an environment where even insured patients often find themselves saddled with staggering debt. Through real-life stories—such as patients sued by hospitals over surprise bills or undergoing needless surgeries—Makary illustrates the devastating impact of these practices. Makary criticizes what he calls the "money games" in health care, pointing to how hospitals, insurance companies, and pharmaceutical firms engage in opaque negotiations and markups that inflate costs without improving outcomes. One particularly eye-opening example is his discussion of "middlemen" like pharmacy benefit managers, who profit from hidden rebates and incentives while patients pay the price. He also calls out the role of nonprofit hospitals that behave like aggressive corporations—reaping massive profits, lobbying against transparency reforms, and even suing low-income patients. What sets "The Price We Pay" apart is that it does not merely dwell on problems—it seeks out solutions. Makary highlights "health care rebels" across the country who are pioneering more ethical, transparent, and patient-centered approaches. These include employers who contract directly with providers to lower costs, doctors who abandon fee-for-service models in favor of flat-rate or subscription-based care, and institutions that eliminate surprise billing practices entirely. Equally powerful is Makary’s advocacy for a new cultural mindset in medicine. He argues that healing should return to its roots—focused on relationships, trust, and prevention. He champions transparency in pricing, reform in medical education, and greater investment in social determinants of health. Most importantly, he calls on physicians to reclaim leadership in driving reforms rather than ceding control to administrators and third-party payers. Stylistically, the book is accessible and engaging, combining policy analysis with gripping storytelling. Makary avoids jargon, making complex issues understandable for a general audience. The stories are emotional and often infuriating, but they serve a critical purpose: they humanize the consequences of a broken system. In sum, "The Price We Pay" is a wake-up call and a roadmap. It confronts the deep moral and financial failures in American health care with honesty and clarity while offering hope through examples of those who are changing the system from within. It is essential reading for anyone concerned with health, fairness, and the future of medicine in the United States.

Absolutely mind-blowing book. If you want an expert, data-driven, and shocking view of a few of the many factors that are driving up the costs of healthcare in America, and what can be done to stop the madness, you need to read this book. The book is now at the top of my list of influential books for the decade. Working in the healthcare industry myself and already having an inside view of how things operate, and knowing the ins and outs of fee for service vs. value based healthcare, etc, I thought I understood most of the key root causes behind increasing healthcare costs and decreased healthcare outcomes, but this book took things to a new level. After the first few chapters, I found myself utterly infuriated and outraged from specific examples of price gouging by some healthcare systems across the nation; downright criminal and greedy middlemen (insurance brokers and pharmaceutical PBMs or Pharmacy Benefit Managers with their hidden and obscene markups marketed as discounts); preditorial health screening of the elderly in churches; over-treatment by a small percentage of physician outliers who are gaming the system for personal gain and profit; for profit healthcare systems marking up their services to the point that patients are unable to pay and then either suing them or offering a 10% discount on their already 500% markup prices; and the overall perverse impacts of the lack of price transparency from those who have everything to lose by creating a fair and competitive marketplace. But by the middle of the book, Makary provides a glimmer of hope and some optimism based on the amazing work he and his colleagues are doing nation wide to combat perverse financial and medical practices, and force the healthcare industry to be incentivized on quality vs. quantity, price transparency vs. price gouging, data transparency, etc. Some significant steps forward have already occurred, outlined by Makary.

{topnotch review of what's wrong with American Medicine

Brilliant! A MUST read!

This book is an absolute must read for anyone involved in health care provision, world wide. The American approach to health care has universally been viewed as obscene, as how can health care provision be a for-profit business? The red necked right wing in the USA carp on endlessly about the horrors of "socialist medicine" - which is actually the provision of health care to those who need it, rather those who can afford it. I think there are a few fundamentals that should define a country as "First World" - education for all, health for all, real freedom to go about your daily life without fear, and provision for our societies elders who have given the country so much for so long. America provides none of these - education is expensive, health care is for profit, complete lack of gun control now has schoolkids doing "active shooter" sims in class rooms, and the elderly who are not wealthy just die out. The USA is third world in everything except except armed power. God help us all!

Well articulated and real problems with healthcare prices. It’s specific to the US but is very helpful to understand as the trend is happening globally .

You need to read this . For you sake . For the sake of anyone who you care about.