An American Sickness by Elisabeth Rosenthal
Every single one of us has probably had an interaction with the medical system in this country that has been frustrating, incomprehensible, unsatisfactory and, of course, expensive.
You know the statistics, the current U.S. healthcare bill is some $3 trillion and we still have millions of people uninsured. We spend more money than any other developed country on healthcare without discernibly better results. Along with extraordinary advances in treatment have come extraordinary prices. Americans can die because of lack of insurance or become bankrupt because of healthcare costs. In fact, the majority of bankruptcies in this country are because of medical bills.
This is all so familiar but how did it get this way? Elisabeth Rosenthal’s new book is a must read for every American who wants to understand how we got to this place and it’s also a guide to consumers out there to figure what to do individually to change the system.
In “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back” Rosenthal clinically and methodically shows all the forces that have come into play to create our current system. She lays out the disease, the cause and at least some of the treatment as befits her first profession, medicine. She was an Emergency Room doctor before she became a full-time journalist for the New York Times. She now runs the non-profit Kaiser Health News.
Rosenthal provides a guide at the front of the book to the Economic Rules of the Dysfunctional Medical Market, rules she refers to regularly throughout the book. They are rules that would make no sense in any other consumer market and puts a lie to the notion that we have a free market healthcare system. We, the consumers are not free, as rule #5 reminds us “There is no free choice. Patients are stuck. And they’re stuck buying American.”
As someone who grew up in Britain with the services of the National Health Service I always wondered why health insurance was tied to employment in the States. The American house of healthcare was built around the time of World War II, when the National War Labor Board froze salaries and at a time of labor shortages companies found they could entice workers by offering health insurance. Not the routine, preventative care insurance that existed before the war, but major medical coverage. In addition, the government made that coverage tax free. Since then, we have built room and room upon this house as opposed gutting and renovating the house.
With a combination of affecting personal stories of interaction with the medical system and deep reporting Rosenthal systematically examines every part of the system – insurance; hospitals, physicians, pharmaceuticals, medical devices, testing, billing, research, conglomerates, business – bringing us right up to the Affordable Care act. Each step quietly sprung upon us, the unsuspecting patients, and we couldn’t even see it coming.
The work is enlightening for the consumer and damning of the “medical industrial complex.” My copy of the book is well worn and the outrages are underlined: the tax code, which allows non-profit hospitals to get away with that categorization by doing the bare minimum; the FDA; the lobbying efforts of the medical establishment and every subspecialty you can imagine; legislation that allows drug makers to advertise on TV (making the U.S. one of only two countries that allows this); payment codes that are proprietary, the list goes on and on and on.
FDA approvals don’t measure a new drug against others currently on the market, but against taking nothing, hence the plethora of “me too” drugs, compounds that are just a little different from what is already out there but become the hot new drug, very heavily marketed. Excessive testing, often demanded by patients, has spawned a slew of extras. Rosenthal notes “Over the course of the past decade, testing, medical equipment, and ancillary services became to hospitals and clinics what booze is to restaurants: high-profit-margin items that can be billed for nearly any amount.”
As discussion of healthcare continues to dominate our political discourse this book should be required reading for our legislators on Capitol Hill, who may have forgotten how we got here or who need to be shamed into thinking about their voting constituents as opposed to their funders.
This book is also recommended reading for every patient in America. If you thought you were mad about big banks, wait until you read about the lobbying efforts of the medical profession (that’s just the doctors, not the hospitals or insurance!). But if all it did was make you mad it wouldn’t be very satisfying.
What works so well in this book is that Rosenthal spends the last third of the book providing you, the patient/consumer, with tools to do your part to slow down this runaway train, this heist of our healthcare. She even has some templates for letters of complaint that you can adapt and use.
You will come away from this book mad as hell, but enlightened and empowered to do your part to challenge whichever part of the system that you interact with. Mine involved a conversation about coding with my insurance provider.
Rosenthal makes no bones about the “high prices of patient complacency” and provides a call to arms “the American healthcare system is rigged against you. It’s a crapshoot and from day to day, no one knows if it will work well to address a particular ailment. Unless you’re part of the 1 percent, you’re only ever one unlucky step away from medical financial disaster…When the medical industry presents us with the false choice of your money or your life, it’s time for us all to take a stand for the latter.”
BEFORE YOU READ:
LENGTH: 392 pages (including Appendices and Notes)
GENRE: non-fiction
THEMES: history, policy, personal stories, healthcare
COMMITMENT: Immensely readable, motivating and important
Buy the book here and support this site & indie bookstores
