Why Is American Healthcare So Expensive? New Book Gives Readers An Inside Look

There’s nothing funny about healthcare costs in the United States. Half the country lives with medical debt and nearly one-third of Americans report skipping medical care because of cost, sometimes with detrimental results for their health. 

But in Cost of Living, an essay collection released today from Holt, author Emily Maloney might make you laugh. At a minimum, she’ll open your eyes to some of the more dysfunctional aspects of the U.S. healthcare system.

Maloney’s wry and unflinching take on American healthcare is informed in part by her own experiences as a patient. At age 19, Maloney attempted to take her own life and wound up with a five-figure debt from the ambulance and hospitalization bills. The debt followed her for years.

“Suicide should be cheaper,” Maloney writes in the book.

Cost of Living also delves into the details of Maloney’s ongoing psychiatric care, describing the litany of psychiatric drugs she was prescribed—26 in total over five years. She details the cost of each in a chapter called “A Brief Inventory of My Drugs and Their Retail Price.” 

As many questions as Maloney’s own healthcare journey raises about the cost and quality of healthcare in the United States, she knows her experience is not unique. 

“There are so many other people who have the same story or a similar story,” Maloney said. 

What separates Maloney’s story from others is that she also has an insider’s view of the healthcare system, having worked as both an emergency room (ER) technician and later as a medical writer and project manager for a pharmaceutical company. 

Those experiences allow Maloney to pull back the curtain on the inner workings of the system, such as how much hospitals can bill insurance for patients who die in the ER and how awkward medical students can be when they’re learning to discuss a patient’s care in front of the patient. 

Maloney also writes about recognizing herself in women who would arrive in the ER and not be taken seriously. One of those women presented with excruciating headaches; the doctor assumed she’d gone off her psychiatric medication until a CT scan turned up a brain tumor the size of an orange.

“We still obviously have a really long way to go when it comes to the treatment of women and people of color,” Maloney said.

If you can, avoid the ER

According to Maloney, the ER is a terrible place for most people. 

“If you get hit by a bus, the ER is an excellent place to go,” she said. “You’re unconscious, the EMTs scrape you off the sidewalk, they bring you in, they patch you up…you have a heart attack…this is a good place to go.”

But for people who need care that can be delivered by a primary care provider, the ER will be unnecessarily expensive and make you wait a long time—if you’re lucky. 

“If you don’t have to [wait] a long time, it means that there is something terribly wrong with you and you are in danger of imminently dying,” Maloney said.

Maloney’s advice: Unless you’re having a true emergency, stay home or visit urgent care. 

“Unfortunately what you define as an emergency might not actually be what your doctor is going to define as an emergency,” Maloney said. 

Maloney herself worked in the urgent care side of the ER, called “fast track” at her hospital, which she said is ideal for people with less severe medical needs, such as if “you cut off your thumb with a meat slicer—the edge of your thumb, not the whole thing.”

Writing for change 

Maloney’s own healthcare experiences, along with her observations of countless patients, lead her to call for dramatic changes in the United States’ approach to healthcare.

“We allegedly have all of these resources at our disposal and yet people are dying due to lack of care,” Maloney said.

She hopes her book will shine a light on the harsh realities and injustices in the U.S. system. She also hopes it will inspire change. 

“Whether people want to admit it or not, the cost of care in the United States far exceeds costs anywhere else in the world,” she said. “We don’t even realize what we’re missing.”

If Maloney could redesign U.S. healthcare to fix the ills she identifies, she says she’d make it a single payer system. To people who say single payer healthcare would cost more, Maloney says, “It’s not possible!”

Maloney also says she’d make health insurance and pharmacy benefits managers (companies that manage prescription drug benefits for health insurers) illegal. 

“They’re middlemen,” she said. “All they do is increase the cost of healthcare, so they take their chunk and then they pass it along. Everybody’s in the business of making money.”

Make no mistake, though. Cost of Living is not a book about policy. Her critique of American healthcare is not grounded in complex analysis or theory.

Rather, Maloney’s writing is vivid, at times poetic. Her keen observations stem from her eclectic professional healthcare experiences—from working in the ER and in the pharmaceutical industry to EMT training and graduate school in bioethics—and her quirky take on the world around her, as she recalls it. 

The best part of this essay collection may be that it’s just the beginning, according to  Maloney. 

“There are more books forthcoming.”

If you or someone you know needs help, call the National Suicide Prevention Lifeline at 800-273-TALK (8255). You can also text a crisis counselor by messaging the Crisis Text Line at 741741.