In “The Price We Pay,” Dr. Marty Makary, a professor at The John Hopkins University School of Medicine, explores the strained relationship between Americans and the health care system.

Makary walks the reader through relevant issues pertaining to Americans across the country — such as medical debt, the opioid crisis, price gouging and high insurance premiums — giving anecdotes and statistics along the way

As he travels through the country, Makary speaks to everyday Americans and medical professionals to better understand their environment and interactions with the health care system. He exposes the lack of transparency by hospitals about prices and how innocent people are preyed on during times of distress.

The Kaiser Family Foundation found that almost one in every 10 Americans over 18 years old owe medical debt. The study also found that three million adults owe more than $10,000 in debt.

Reading the book helps explain why so many Americans had a hard time trusting the advice of health officials about COVID-19 and might also explain the hesitancy toward the vaccine.

The New York Times reported how despite repeated announcements by government officials that the COVID-19 vaccine would be free of charge, many Americans were still hesitant because they or someone they knew was charged a surprise bill for a coronavirus test.

Surprise bills, which occur when out-of-network providers are involved in a patient’s treatment, were banned by Congress in January.

The American Journal of Public Health found in a 2019 study that 66.5% of all bankruptcies in the United States were medical related, despite 90% of Americans having some degree of medical insurance.

Makary urges politicians to pass legislation that requires hospitals to be transparent about service costs and advises doctors to be more aware of their hospitals’ billing practices.

The opioid epidemic is also covered in the book, with Markey confessing that he used to over-prescribe opioids due to lack of knowledge on their addictiveness and poor efforts to educate health care professionals on the severity of the crisis.

Opioid manufacturers including Purdue Pharma LP, Johnson & Johnson, McKesson Corp., Cardinal Health Inc. and AmerisourceBergen Corp. have numerous cases filed against them in recent years for downplaying the addictiveness of opioids and for not halting sales.

The Sackler family, which owns Purdue, received roughly $13 billion in opioid sales, according to a bankruptcy case against the company.

From 2006 to 2012, Purdue held 10% of the markets, raking in billions of dollars yearly just on OxyContin painkillers. A lawsuit revealed that high pill dosages were a focal point in Purdue’s marketing plan, which accounted for 25% of its profits.

The book takes a dark turn, revealing opioids caused over 100,000 deaths in 2021.

“For decades cancer patients were undertreated for pain. But then things swung to the other extreme when pharmaceutical companies sold us on a lie that opioids were not addictive,” Makary wrote.

Markey reveals that the rising cost of insurance is also an issue for small business owners who feel the pressure of providing costly health care to their employees.

In 1960, health care made up 5% of the United States’ GDP, but in 2020, it was four times that. Markey believes that this is because of the lack of flexibility in health insurance plans, and he offers suggestions in the book on how to deal with increasing prices.

Employers are expecting these numbers to rise on average by 4.7% according to a survey, especially with the pandemic.

Over the past two decades, the consumer price index for medical care has grown on average 3.5% per year, compared to the CPI for other products and services at a rate of 2.1% per year.

This is attributed to company-sponsored private health insurance, which the country relies on and allows health care service companies to raise prices. The government’s attempt to lower costs by providing for those without insurance plans further increased prices.

Pharmaceutical companies also market these drugs directly to consumers through advertisements, while the Food and Drug Administration continued to approve drugs by the same companies that fund them.

Makary’s exploration of this problem shows how disproportionately certain parts of the country and certain communities are subjected to medical malpractice and unfair costs. In the chapter titled “Carlsbad,” he writes about a small community that has a single nearby hospital known for charging patients expensive amounts for treatment, hurting their paychecks.

In the past few years, Americans watched stocks of pharmaceutical companies increase exponentially but have failed to acknowledge their exploitation of everyday Americans, how powerful their lobbying in Washington, D.C. are and how they add fuel to the growing distrust Americans feel toward the health care system. Markey’s book is for those who do not want to turn a blind eye to their business practices and effect on the public.