Cracking Health Costs: Good read for fact seekers

Guest blogger Linda K. Riddell reviews the new book Cracking Health Costs (Wiley, 2013). Are you likely to read it? Share your thoughts in the comments. —Andrea Davis, Managing Editor

Tom Emerick and Al Lewis’s book, Cracking Health Costs, takes on a big challenge: To arm employers against the “epidemic of prevention, diagnosis and treatment.” With a quirky mix of irreverence and science, it busts myths about wellness plans and outlines practical, effective steps that employers can take. 

My only fear is that the people who need this book — the ones devoting every waking minute to fantasy-based ineffective wellness plans — will be put off by its bluntness. Here is a quote: “a lot of what you think you know about controlling health expenses is mistaken.”  

Mistaken beliefs are described and then dismantled. For example, one well-loved myth: Biometric screening to find illness early saves money and saves lives. It doesn’t, and it can actually cause more harm than good – follow-up tests, treatment for illnesses that would never have progressed, and so forth. 

Granted, they support this statement with science. Continuing the screening example, a “$40 biometric screen will find at best one avoidable heart attack in every 4,000 people . . . at a cost of $160,000. Add in, for instance, $200 in incentives and $20 in time off from work to persuade people to participate, and you’ve now created the million-dollar heart attack screen.”

Science often doesn’t win the argument. The anecdote with its emotional appeal is more compelling:  The story of the one guy who gets his silent heart attack discovered at a benefits fair versus the hundreds of women who have unnecessary breast biopsies and overexposure to radiation because of widespread breast cancer screening mammograms. 

Each mistaken belief is neatly connected to the actions that employers should or shouldn’t take. This supports the book’s mission of providing practical, small steps that an employer can take to reduce direct medical costs. 

Employers would be far ahead simply by shedding the mythology-based programs. Yet the book goes on to offer one entirely different approach to reducing costs: Company-sponsored centers of excellence for specialty care. I am not sure many readers will survive the onslaught of the first several chapters, and then be ready to take on new approaches. 

The final chapter on health insurance exchanges feels out of place. It is useful information but it doesn’t feel like it flows logically with the rest of the content. 

For many readers, this book will seem heretical. For people who want a realistic, science-based, dispassionate approach, you couldn’t ask for a clearer summary of the issues and the implications. 

You can order Cracking Health Costs at Amazon.

Guest blogger Linda K. Riddell is a principal at Health Economy, LLC. She can be reached at

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