Money-Driven Medicine

March 27, 2006
Mahar, a financial journalist whose previous book (Bull!
) tracked the history of the stock market from 1982 to 1999, here applies her keen analytic talents and economic savvy to America's complicated and increasingly dysfunctional health-care system. Mahar's diagnosis: our privately managed yet mainly publicly funded system produces the worst of both worlds—high costs, rampant inefficiencies and intense competition among providers that doesn't benefit patients. She traces how today's market-driven medical system emerged over the past century thanks to trends that gradually stripped power from doctors and gave it to corporations, turning patients into profit centers. No one is spared in Mahar's thoroughly researched and carefully reasoned study: she criticizes frustrated (and increasingly money-minded) physicians, self-serving insurance companies, for-profit hospital chains and pharmaceutical companies driven by inflated Wall Street expectations. Mahar uncovers isolated pockets of good news, including the VA hospital system, which provides excellent care at modest cost thanks largely to its exemption from the pressures of competition. But her goal is not to offer any programmatic solution. Instead, she wants to show why the most common economic assumptions about health care—especially those that extol the magic power of free markets—are false and stand in the way of real reform.

Starred review from May 1, 2006
Mahar ("Bull!: A History of the Boom and Bust, 1982 -2004") challenges the idea that American healthcare is simply a commodity whose problems free markets will solve. What we have instead, she writes, is capitalism turned on its head. As new devices, drugs, and treatments emerge, their supply creates and drives demand. Beginning by tracing how -what was once a profession evolved into a $2 trillion industry, - she points out the conflicts created when doctors, hospitals, drug and device makers, insurers, and stockholders all have to balance caring and quality against profit. By contrast, she says, the Veterans Health Administration has become a model for how a system can work when efficiency and quality -and not revenue production -are the driving forces. Mahar's research and interviews are extensive, up-to-date, and well documented, and her writing style is lively and engaging. While she reaches some of the same conclusions as David M. Cutler in "Your Money or Your Life: Strong Medicine for America's Health Care System", her book is more wide-ranging and accessible. Recommended for public, academic, and hospital libraries." - Dick Maxwell, Porter Adventist Hosp. Lib., Denver"

Copyright 2006 Library Journal, LLC Used with permission.

May 15, 2006
As Americans, we pride ourselves on having the best of everything, but when it comes to health care, compared to other industrialized nations, we pay more for the same services; receive more complex, unnecessary procedures; and leave the most neediest of our population uncared for. That's because a profit-driven health-care system tends to do what's best for shareholders rather than what is in the best interest of the patient. Mahar does an excellent job of explaining how we went from the individual family doctor who made house calls to the bureaucratic, faceless, broken system we have today. As far back as 1970, it was recognized that health care in this country was wasteful and inefficient, so much so that President Nixon actually sided with the Left and proposed a national health-care system in 1974 (it was derailed by Watergate). Whether the fault of drugmakers, insurers, doctors, hospitals, HMOs, big government, or trial lawyers, American health care is careening off a cliff, and Mahar is to be praised for bringing clarity to one of the most complex issues of our times.(Reprinted with permission of Booklist, copyright 2006, American Library Association.)