ABOUT THIS BOOK
Medical care prices in the United States are not only the most expensive in the world, but there are wide variations in what physicians are paid. Doctors at the frontlines of medical care who manage complex conditions argue that they receive disproportionately lower fees than physicians performing services such as minor surgeries and endoscopies. Fixing Medical Prices goes to the heart of the U.S. medical pricing process: to a largely unknown yet influential committee of medical organizations affiliated with the American Medical Association that advises Medicare. Medicare’s ready acceptance of this committee’s recommendations typically sets off a chain reaction across the entire American health care system.
For decades, the U.S. policymaking structure for pricing has reflected the influence of physician organizations. What Miriam Laugesen’s rich analysis shows is how these organizations navigate the arcane and complex work of this advisory committee. Contradicting the story of a profession in political decline, Fixing Medical Prices demonstrates that the power of physician organizations has simply become more subtle.
Laugesen’s investigation into the exorbitant cost of American medical care will be of interest to those who follow the politics of health care policy, the influence of interest groups on rate setting, and the medical profession’s past and future role in our health care system.
In Fixing Medical Prices: How Physicians Are Paid, Miriam Laugesen opens the ‘black box’ of policy choices embedded in the nation’s health financing system. Her thorough analysis of physician pricing exposes how seemingly technical decisions on physician prices are actually highly political—riddled with conflicts of interest and largely immune from public accountability. Policymakers and the public owe Miriam Laugesen a debt of gratitude for shining a light on fundamental policy flaws. We now have no excuse for failing to correct them.
-- Judith Feder, Georgetown University
Our medical prices are too high. Moreover, these prices are grossly misaligned with what Americans really need. Warped prices reflect the arcane political economy of our $3 trillion medical system. In this beautiful book, Miriam Laugesen combines the rigor of political science with the granular knowledge of health services research to illuminate these pathologies. Most importantly, she provides a road map to do better. This is an important book.
-- Harold Pollack, University of Chicago
Combining interviews, thoughtful historical perspective, and statistical analysis, Miriam Laugesen offers the best study yet on the politics of physician payment in the United States. A weak administrative apparatus in Washington makes the power of the House of Medicine all the more formidable. The results of that process—including the power of specialty doctors and the weakness of primary care providers—should interest and trouble us all.
-- Daniel Carpenter, Harvard University
Will people still care about these issues for the next four years? I hope so, because this is the best book I know of on Medicare pricing and its influence on pricing throughout the broader U.S. health care system.
-- Tyler Cowen Marginal Revolution
In Fixing Medical Prices, Miriam Laugesen takes a deep dive into the weeds of U.S. medical pricing policy to uncover problems with how Medicare sets physician payments.
-- Kathleen M. Haddad Health Affairs
Fixing Medical Prices is a superb book on a subject—how Medicare determines what it pays physicians—that is both exceedingly complex and arcane, yet also critically important in terms of impacting the structure of health care finance, organization and delivery…The book should be required reading for health policy scholars, medical students, medical historians, and anyone interested in how money—in the form of Medicare payment policy—shapes U.S. health care.
-- Rick Mayes Bulletin of the History of Medicine
TABLE OF CONTENTS
Chapter 1. Introduction: The House of Medicine and Medical Prices
Chapter 2. The Enduring Influence of the House of Medicine over Prices
Chapter 3. The Science of Work and Payment Reform
Chapter 4. How Doctors Get Paid
Chapter 5. Conflicts of Interest and Problems of Evidence
Chapter 6. Complexity, Agency Capture, and the Game of Codes
Chapter 7. Conclusion