The book of the year?

The price we pay book cover
Lots of books are published each year, and I can only read a few of them. But, when a really important general interest book comes along, I often put it on the top of my “to be read” pile. In September, Dr. Marty Makary, a surgeon associated with Johns Hopkins, released a book entitled The Price We Pay: What Book American Healthcare—And How to Fix ItSince most people in America eventually get sick or have an accident, and only a few of us are fifty rich, this is the ultimate general interest book.

In Part I, entitled “Gold Rush” Makary doesn’t have to travel far—he visits “health fairs” at local churches, where salespeople disguised as medical professionals do screening tests and scare participants, mostly those on Medicare, into unnecessary and rather expensive procedures, such as placing stents into leg veins. In the second chapter, he discusses the lack of transparency in hospital pricing, as well as the astronomical rise in common procedures. For instance, a medical center in New Jersey offers joint replacement surgery for $135,400.00, which rose a mere 76.8% in a single year. BTW, Medicare only pays 13K for that procedure. For his third chapter, Makary travels to Carlsbad, NM, where the medical center seems to have overcharged and then sued almost everyone in town. Back in Virginia, Makary visits the courthouse to learn more about similar shenanigans at Mary Washington Hospital in Fredericksburg. Sadly, this hospital is supposed to be a “not for profit” hospital, and thus receives favored tax status, too. Also in this section, Makary provides an analysis of the proliferation of for profit helicopter ambulance services, which charge somewhere between $40K and $60K for a ride that I could make in an hour in my Toyota.

In the second portion of the book, Makary delves into some medical practices that can be improved by focusing on individual physicians. One OB doctor in Florida had a reasonable rate of C-sections, until figuring in Fridays, when the rate rose 80%. Why? The good doctor didn’t want to be bothered on the weekend, so moms who were in labor on Friday got the surgery. This section of the book also discusses the opioid crisis, and Makary admits that he had to learn to write fewer prescriptions for pain pills, after learning about the misuse of all those pills.

Part III of the book is about “Redesigning Healthcare” and it does offer several solutions to problems, but one chapter in this section explains how drug prices are affected by middle men (pharmacy benefits managers) who don’t supply anything other than a big bill for their services. Here’s an example: A pharmacy is paid $34.94 for 90 40mg doses of Zocor, but the employer is charged $442.85–and the PBM gets over $400 on that one transaction. Another chapter discusses problems in health insurance, which less and less helpful except in catastrophic circumstances, and there is even a chapter on “wellness” and how those well meaning programs are far too costly, especially as they often mean an invasion of privacy, or worse, over-treatment for minor issues.

Makary doesn’t make the mistake of only discussing problems without discussing solutions. Several positive programs are mentioned throughout the text, including websites such as ImprovingWisely.com, and the last chapter is a bit of a call to arms. In short, legislators and employers need to be educated on these matters, and healthcare consumers should do everything possible to demand transparent pricing for upcoming procedures.

The Price We Pay is a very important book. This should be the topic of your next book club, a gift for your friends and/or family, or even a holiday gift for your doctor or your legislator. Please buy this book, read it, and pass it on. Knowledge is power, and as this text has lots of information for Americans, this may well be the most important book you will read this year.

America by Charles Kuralt

Okay, this book is seriously vintage as it was published in 1995, but my hubby is recently retired, so he wants to do some traveling. But, when and where should we travel? A friend mentioned that a CBS news feature reporter who spent much of his career “on the road” discussed his favorite places to be in Charles Kuralt’s America, and the narrative relates his first year of retirement, where he spent time visiting them, at the best time of year to be in those spots. Despite the passage of time, the weather and scenery is no doubt much as it was in Kuralt’s retirement year, so the book is still relevant.

What’s special about this book is the magical prose that Kuralt employs to describe his series of destinations. In January, he spent time in New Orleans. As he is riding from the airport to his hotel in the French Quarter, he says, “I could have closed my eyes in the backseat of the taxi and known where I was purely by the pungent accent washing over me from up front.” I once worked with a lady from Louisiana, and the accent is unique, for sure. Kuralt further states that there are ” three main themes of the city: family, music, and food.” All three are the subject of his discourse, and apart from not actually tasting the jambalaya and crawfish étouffée, the reader feels as if he, too, had visited New Orleans. In February, Kuralt visited Key West, and again, he makes the reader feel like a participant in the trip. March’s destination was Charleston, a city that I’ve visited, but Kuralt stayed longer, met more natives, and has some interesting stories to share. In April, Kuralt ended up enjoying the emerging sign of spring, daffodils, which sounds incredibly boring, but it is not when Kuralt describes them.

In May, he is traveling again, and his destination is again in the south—Grandfather Mountain. His discussion of this scenic area of North Carolina includes everything from what makes the best barbecue to why one should make the drum of a banjo from squirrel skin. Kuralt packs more information into each chapter than I’ve read in several guide books for the area. June he spends in Ketchikan, Alaska; July in Ely, Minnesota; and August in Boothbay Harbor, Maine. Kuralt’s love of boating and fishing is apparent in all of these destinations, as it is in his September destination of Twin Bridges, Montana. For local color in October, Kuralt visits Woodstock, Vermont. As the weather in the north chills, he goes to Rio Grande Valley, New Mexico, soaking up history along with the sunshine. For December, he returns to the place where he made his home for many years, New York City. However, as Kuralt explains, people don’t live in New York; rather, they live in a neighborhood within the city. Again, he gives the reader several examples of people and places in the city, which is decorated for the holidays in his prose.

Charles Kuralt’s “On the Road” feature stories for CBS news on television were a part of my youth. His voice rings true in this rambling, but never unfocused, narrative. For those who remember him, this is a nostalgic read. For those who don’t know his work, the book could serve as an introduction to a time when people didn’t spend time on their smart phones and computers, but spent leisure time in scenic places, learning from the people who inhabit those places. I’m glad that my friend recommended this book so highly, because I certainly enjoyed savoring it.