Tom Mueller's "How To Make a Killing"
26 September 2023
I only picked up Tom Mueller’s new book How To Make a Killing: Blood, Death, and Dollars in American Medicine because Tom Mueller also wrote one of the best books I’ve ever read on whistleblowers (Crisis of Conscience).
I am no fan of American “healthcare” and think it is rapidly becoming one of the most expensive and least effective systems in the world. Actually, I don’t have to think this, I now know it (thanks to this book):
“In 1980, the year Reagan was first elected president, America spent around 9 percent of its GDP on healthcare, roughly the same as other member nations of the Organization for Economic Co-Operation and Development (OECD), and enjoyed strong medical outcomes compared to its OECD peers…In 2019, after decades of neoliberalism, the United States spent 17.6 percent of its GDP on healthcare…And America’s medical outcomes have dropped to the bottom of the OECD lit by nearly all measures: the United States currently ranks twenty-ninth in life expectancy, and thirty-third in infant mortality.” (p. 133.)
Mueller’s book is about the process and costs of dialysis (specifically) and the larger breakdown of for-profit healthcare as it is currently practiced in America (generally).
It’s also a perfect example of how nonfiction books can be a tricky beast to classify and offer to other readers. This book will primarily be given the subjects of “kidney disease” and “dialysis” and even “medicine,” but none of those quite hit the mark. It is in fact a very good investigative work on both the current practice of medicine that puts profits above patient health, as well as a readable history on the development and somewhat miraculous process of dialysis, which is the process whereby patients with advanced kidney disease have their blood cleaned (which is one of the things kidneys do) so, you know, they can keep on living.
On a regular day I would never go out looking for a book for dialysis. But it has been a great book to read, because Mueller is one of those authors who can use one very specific subject to illuminate entire other truths for you.
Consider this paragraph, which is one of my favorites in the entire book, and is about the corrupt current system of dialysis provided by for-profit corporations, but is also about one big human weakness:
“Since World War II, researchers in a range of disciplines have revealed the psychological tools that certain organizations — the Nazi Party, the Nixon White House, Enron and Purdue Pharma — use to compel basically good people within their sphere to do bad things. Many such strategies draw on deep human susceptibilities to authority and peer pressure, and operate at the subconscious level. Social and evolutionary psychologists have established that most people take their cues on what to consider morally acceptable from members of their in-group, rather than from their own conscience. When an organization creates an intense us versus them culture, often expressed in metaphors of sports and war, many of its members experience a fading of conscience, together with a heightened self-identification with that organization, and a sense that it can do no wrong.” (pp. 120–121.)
Read that paragraph a couple of times. It is a very succinct explanation of what is going wrong in health care, if not the entire world.
This book helped me learn about dialysis, and the business that is American medicine. But it also helped me learn what happens when a lot of basically good people go along with a lot of very bad ideas that are solely driven by the profit motive.