You’re Being Overcharged

Why Americans pay too much for health care

July/​August 2018 • Policy Report

Why do we pay $600 for EpiPens, a long‐​existing piece of technology that contains just a dollar’s worth of medicine? Why do hospitalized patients so frequently receive bills laden with inflated charges that come out of the blue from out‐​of‐​network providers or that demand payment for services that weren’t delivered?

Why is more than $1 trillion — one of every three dollars that passes through the health care system — lost to fraud, wasted on services that don’t help patients, or otherwise misspent? Meanwhile, why have the costs of so many elective procedures and retail clinics, like Lasik eye surgery or MinuteClinic, gone down as rapidly as conventional care costs have gone up?

Media Name: cpr-v40n4-2.jpg
In Overcharged, a new book from the Cato Institute, adjunct scholars Charles Silver and David Hyman answer these questions with a fascinating deep dive into the strange world of American health care. While plenty of books and articles are available that focus on specific problems with the health care system — how patents enable monopolies in the drug industry, for example, or the pervasive problem of doctors gaming the payment system to upcharge insurance companies — this book gathers all these problems together to give a comprehensive view of our troubled system. The authors then trace these problems to several root causes. One cause is political control of the health care system. Another is the third-party payment system, which enables skyrocketing costs, massive fraud, and waste. The first half of the book takes a detailed look at the problems with health care, and the second offers ways to solve them.

Ultimately, the authors are optimistic about the future. They acknowledge that change will be an uphill battle, since the beneficiaries of the current system are so firmly entrenched and will fight to convince the American people that health care can’t operate like a normal business. But the numbers of self-paying consumers are already growing, and Silver and Hyman predict that this trend will begin an unstoppable, bottom-up revolution where consumers will reject traditional providers for the retail sector, which will become better and better at giving Americans higher-quality medical treatment at lower costs. “Markets do a good job of supplying food, clothing, housing, transportation, and other essentials,” they write. “They can help us meet our needs for medical treatments.”

Purchase your copy at

Download the Policy Report Article