The Cost of Hope by Amanda Bennett

I came away from The Cost of Hope by Amanda Bennett (copy sent me by publisher) full of admiration for two people the book barely mentions: Bennett’s parents. How did they raise her to be such a competent and resourceful person? The book isn’t about her. It is mainly about her husband’s fatal illness and their marriage. She never brags, but glimpses of staggering competence slip through. In 2006,

I am the only editor of a major newspaper in the United States [the Philadelphia Inquirer] to run the Danish cartoon of Mohammed wearing a bomb on his head instead of a turban–the cartoon that causes riots in Europe. By the following Monday, protesters are in front of our building carrying signs with my face and the face of Hitler. Joe Natoli, my publisher, and I plunge into the crowd, shaking hands, talking to families, listening to their stories. The crowd turns friendly. I emerge with several copies of the Koran.

She tells this story because her husband is proud of her, which means a lot to her:

The pride I see on Terence’s face . . . keeps me going, even when I am scared.

However, she was courageous before she met him. In 1983, she took a job in Beijing as a correspondent for the Wall Street Journal, which is where she met her husband. Their first encounters, she says, were a series of fights.

Most of the book is about what happened when her husband came down with a rare form of kidney cancer — especially how much the treatments cost. For $600,000 — paid mostly by insurance — they bought a few more years of life together. It was worth it, says Bennett, adding but did it have to cost so much? Her best insight comes when she notices the wildly different prices paid for exactly the same treatment (CAT scans) — exactly the same treatment, same machine, same operator. The “retail” rate is, let’s say, $20,000. One insurer pays $5,000, another pays $1,000. She wonders why. Her moment of insight comes when she is back in Beijing at a fakes market with her 10-year-old daughter. At such markets, tourists are told prices wildly above what the seller will accept. In one case a fake Chanel purse is offered for 2000 yuan ($300). A woman who pays 200 yuan walks away happy. “I got it for 200!” she tells her friends. Bennett’s (adopted Chinese) daughter pays 20 yuan. (Apparently Bennett has her parents’s parenting skills.) Wildly inflated retail prices for health care — so much more than what sellers will accept that they are almost meaningless — exist to take advantage of poor negotiators, Bennett realizes.

The Cost of Hope was a pleasure to read and, as I’ve said, Bennett is an astonishing person, but it omits an important point. Bennett, like most people who write about the high cost of American health care, fails to point out its central tenet: First, let them get sick. Bennett’s husband died young (early 60s). He was significantly overweight, how much we aren’t told. Apparently he had diabetes — again, few details are given. Obesity and diabetes are preventable. One of the first treatments her husband receives for his cancer is IL-2, meant to boost the immune system. What about boosting his immune system before he got sick? For example, by improving his sleep. This neglected approach might have prevented or delayed her husband’s cancer and extended his life much more cheaply and painlessly than what happened. The biggest flaw of her book is her failure to ask — literally ask, such as ask the head of the National Institutes of Health — why prevention, especially cheap prevention, is ignored.