POLICY/INDUSTRY: Money-driven Medicine, a sorta review

I must be getting vaguely famous as I was sent (unsolicited) a copy of a new book by Maggie Mahar called Money-Driven Medicine. On Sunday it was reviewed in the Boston Globe, which fairly accurately portrayed it as an indictment of 30 years of corporate medicine. Here’s the Globe’s conclusion:

The core message of "Money-Driven Medicine" is that the quintessential doctor-patient relationship has been transformed by the requirements of corporate medicine into a retailer-consumer relationship, and every sector of the system is trying to sell its products and services to that consumer and reap profits for its stockholders.This market-driven system, Mahar shows, turns the law of supply and demand on its head. The competition generates excess supply, but that does not lead to less costly medical care. It is the cost of replicated facilities, equipment, products, and services, along with millions spent on marketing and advertising, that keep the cost of medical care in this country soaring

So unlike many others, as this was a book looking at my core topic, I read it cover to cover. It’s a good read and broadly accurate as a narrative. If I had to nitpick I’d complain that Mahar spends too much time quoting other people rather than telling the story herself. I got the impression that being a financial journalist who came to health care as a fresh topic, she was a little over-wowed by what she found — although I guess that means that old middle-aged fogeys like me are too cynical about how badly people in the system behave. But at least the people she quotes at length like Jamie Robinson and Sheryl Scholnick are pretty sensible.

There were also one or two minor gems. I didn’t know that the AMA had a televised presentation opposing Medicare in 1962 immediately after JFK had a rally promoting it in Madison Square Garden—although it’s worth remembering that the AMA (and by extension most doctors) opposed Medicare and universal health insurance basically all through the 20th century. I also missed the fact that the SEC dropped an investigation into Bill Frist’s brothers conduct in the Columbia/HCA scandal immediately before the 2002 elections under pressure from the Administration—but that’s not exactly surprising.

Overall it’s a pretty comprehensive review of the corporatization of the health care system, and probably a pretty good introduction for people who don’t understand health care much. Although I remember another other book very like it written in the 1980s (which I can’t remember the title of) which also decried the new world of the for-profit hospital chains and that was before the most recent round of Columbia/HCA and Tenet undertakings.

Where I disagree with Mahan is that the perversion of medicine by money is somehow a recent thing caused by Wall Street & corporate incentives — sure you could argue that it’s worse now, but the manipulation of the health care system for the ends of power and profit is as old as the economy. And the impact that has had on the quality and cost of medical care is just as crucial, as whatever Tenet, HCA or HealthSouth has been up to. Paul Starr and Michael Millenson wrote much better books about that in the 80s and 90s. On the human issues involved Jonathan Cohn has what promises to be an even more interesting book coming up (although I’ve only seen two chapters)

Meanwhile I’ve given the book to John Irvine, who’s a more recent arrival in health care than I am…so I hope that he’ll be able to do an interesting review later unclouded by my biased perspective.

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