Flat lines and bottom lines: think money drives medicine? You don't know the half of it.

• Author: Klein, Ezra
• Position: Money-Driven Medicine - Book review

Money-Driven Medicine By Maggie Mahar Collin, $27.95

Filled with arresting statistics and stunning anecdotes, Maggie Mahar's Money-Driven Medicine is the sort of book you can't help but tattoo with a thousand underlines, exclamation points, and scrawled comments. So it's surprising that the most poignant lines come just seven pages into the preface. "In the course of these interviews," Mahar writes, "I was surprised by just how many physicians returned my calls. The great majority did not know me; I expected responses from perhaps 20 percent. Instead, four out of five called back. Most talked for 30 minutes--or longer." Generally, a writer researching her expose of an industry needs to seek out, convince, and cajole her informants. Not here. The state of health-care is so alarming that the participants are desperate to blow their whistles, if only someone would listen.

Mahar did, and closely. Her book offers a guided tour to the medical landscape few patients like to envision--the one where profit, not health, guides the actors. Money-Driven Medicine is really an investigation into the ways the quest for cash infects and distorts every level of the health-care system. It's a big topic, and Mahar's dogged insistence on allowing no facet to go unreported makes it larger than even the cynical among us assume. Insurance companies, we already knew, are watching for the bottom line. Big Pharma, too. But your doctor? Did you know that his reimbursement rates encourage him to give you the most, rather than the least, treatment? And did you know that your hospital is likely a private institution, dedicated to improving its bottom line by lowering labor costs, which means dangerously overstretching your anesthesiologists and surgeons? Or that senior administrators in the FDA consider the pharmaceutical industry, rather than the American people, their clients? Money, Mahar believes, is destroying the quality, integrity, and efficiency of the American health-care system, leaving it prey to all manner of incentives and imperatives decent people would be repulsed by if they understood. And if her point isn't precisely new, the hundreds of unnerving examples, anecdotes, and tales of times when lucre's influence turned filthy give it a force and coherence it's never had before.

If the book has a flaw, in fact, it's that the air is too thick with noise, the crush of complaints and concerns overwhelming in their urgency. The result is nightmarish, both in...