An American Sickness: How Healthcare Became Big Business and How You Can Take It Back

An American Sickness is an excellent synopsis of how we got to where we are with healthcare in the United States. Healthcare has gradually become a $3 trillion business that has shifted from affordable care for Americans to healthcare dictated by profit models that were previously only seen in America’s largest corporations. Elisabeth Rosenthal, an M.D. herself, takes a bipartisan approach in placing the blame squarely on members of both parties as they have been the benefactors of the largest lobbying group in the United States: healthcare. Members of both parties have been allowing the travesty of out of control healthcare costs to rise in the United States while other developed nations, with similar and often better care, have healthcare costs significantly lower in comparison. This book will make you appreciate the good intentions of the Affordable Care Act (ACA), with many of these intentions defeated by powerful lobbying groups from not only the medical insurance lobby but the hospital, pharmaceutical, and medical device lobbies as well. If you believe that repealing the ACA or Obamacare is the answer then you may possibly gain another perspective upon reading this book. The growing costs of healthcare in America is a problem that Americans are increasingly becoming burdened with and the answer is government intervention against those who espouse “free markets” in the healthcare industry, which has directly led to the rising costs of healthcare. Rosenthal lists the principles of the current “dysfunctional medical market” which is what drives the narrative of her excellent book: 1. More treatment is always better. Default to the most expensive treatment. 2. A lifetime of treatment is preferable to a cure. 3. Amenities and marketing matter more than good care. 4. As technologies age, prices go up rather than fall. 5. There is no free choice. Patients are stuck. And they’re stuck buying American. 6. More competition vying for business doesn’t mean better prices. It can drive prices up, not down. 7. Economies of scale don’t translate to lower prices. With their market power, big providers can simply demand more. 8. There is no such thing as a fixed price for a procedure or test. And the uninsured pay the highest prices of all. 9. There are no standards for billing. There’s money to be made in billing for anything and everything. 10. Prices will rise to whatever the market will bear.

American Sickness by Elisabeth Rosenthal is an exhaustive, detailed look at the American healthcare system. The author examines every facet of healthcare, going back to the beginning in order to understand how we have gotten to where we are. If there is one overriding theme that one could point to as the cause of skyrocketing healthcare costs, it is greed. Our healthcare system has morphed from a patient-centric system to one where profits come before patient care. The first half of the book is a history lesson. What were things like before there was health insurance? When did things change from a need to protect people to one where maximizing profits became the primary goal? Along the way, the author uses real-world examples culled from actual patient bills to illustrate just how out-of-control things have become. The second half of the book looks at what needs to happen in order to gain control of costs. The author offers a wide array of solutions. The first step is to be more proactive with your own healthcare. Ask questions. Challenge unethical practices. One example the author gives is a patient who is visited by an anesthesiologist. The anesthesiologist stops by the patient's hospital room. "How are you doing?" "Fine, thanks."Okay, let me know if you have any questions?" The anesthesiologist leaves and the patient finds out later that he or she was charged a $500 consultation fee. The second step in controlling costs is government intervention. There are going to be a lot of people who are going to argue against this. The government shouldn't be in control of my health. Regulations hamper innovation. The truth is that the benefits of sensible government intervention and regulations far outweigh any negatives. For example, a government-controlled fee schedule would prevent wide disparity in charges for the same procedure. A national health database would allow patients to have their health records stored in a single location, accessible to healthcare providers anywhere, eliminating duplicate and unnecessary tests. Many of the problems we have today are the direct result of politicians bending to the demands of political donors over the interests of their constituents. What about the Affordable Care Act? The author calls it a good first step. Unfortunately, Republican opposition and efforts by industry PACS have weakened its effectiveness. There are hundreds of examples of outrageous charges and bills from actual patients. One that stood out for me involved a plastic surgeon who charged $50,000 for three stitches in a toddlers face. The parents of the child not only complained to the hospital, the doctor, and to their insurance company, but they also sent a copy of their complaint to a plastic surgeon professional group. The pressure from the complaint eventually led to a final bill of $5,000. This is one book where I listened rather than read. The deluge of facts and figures were easier to consume. I highly recommend this book. I especially recommend this book to the regulators and healthcare professionals who are in the best position to make the changes needed.

... but it will make you a better patient and advocate. Very informative and thought provoking discussion about the US healthcare industry facilitated by a physician and journalist. Individual anecdotes help explore the tangible consequences of boughten policy, uninformed regulation and stagnation in our current healthcare system. The individual stories also help the reader to grasp the more formal and abstract data references. The author provides great counter points to much of her commentary and recommendations, giving a nicely balanced consideration of the topics. The language and pace of the book makes it an approachable and enjoyable read. I would have enjoyed a deeper dive into some of the topics, such as tort reform and private practice reimbursement. That being said the book hits the mark for its larger audience. Acceptionally useful reference material in the appendices for patients and healthcare professionals alike.

This is a must-read book for anyone involved with or interested in the American health care system, which means most of us. Ms. Rosenthal is a medical doctor as well as a New York Times reporter. In this book, she examines American health care in all its gory detail, achieving a clear and compelling explanation of why we pay twice as much for healthcare as other rich countries, and get far worse results. The answer is simple and straightforward: money, as the author shows in detail, via overall statistics, and via personal anecdotes. The book also provides an extraordinary amount of information that will be of use to patients -- or more accurately in the current context, consumers of medical care. Finally, Ms. Rosenthal proposes a number of steps that we as individuals, as groups, and as a society could do to change things. The book can be depressing, upsetting, or angry-making in places, when it makes it clear how much the conversion of healthcare into a business has shaped and distorted our system, and how much damage that has done to individuals. Overall, however, it is a very valuable effort. I expect to consult it before future encounters with the medical system. The overall conclusion is right there in the subtitle -- "How Healthcare Became Big Business". So is the assertion that we can do something to change it. The book grew out of a series of articles in the New York Times by Ms. Rosenthal, is an MD as well as a brilliant researcher.

An American Sickness is a timely and authoritative work which describes the dysfunctional United States Health Care (USHC) System. Rosenthal lays out how USHC has evolved into an intricate, layered system which benefits the numerous special interests that make up this bureaucracy, at the expense of the patient. This book should be read by those involved in health care policy, in hospital administration and in medical study including doctors. Most of all, it MUST be read by patients! The overarching theme is that the USHC system is designed to profit all the stakeholders except the patient. As such, this system is now 17-18% of GDP compared with 10-11% of GDP in the developed countries of the world. Despite this bloated investments, US health care metrics are far inferior to other nations including life span over 60 years old and the % of population covered. This is what happens when financial profits Trumps health care. Rosenthal provides numerous real-life vignettes demonstrating how pricing vagaries and inequities, lack of billing transparency and consistency have victimized patients and cost them in terms of their living standards. What other industry can charge hundreds of thousands of dollars without bill itemization; can charge patients hugely different prices for the same procedures within a single hospital; can raise prices a hundred-fold on common drugs? The answer- The USHC system which is unique in the world and the US people are paying the price. The second half of the book provides defensive strategies for the victims; the patients. Rosenthal methodically outlines the important questions to ask doctors, hospitals and insurers. She provides the steps to take when those ridiculous bills are inevitably sent. Most importantly, this book is a “call to action” for the American people to contact their Representatives and to insist that science and humanistic health care once again become the bedrock of the medical system. All rational people can agree that price transparency for hospital billing, for drugs and implants and for doctors charges should be a Right. In addition, the cost details should be coupled with transparency on the medical outcomes such as readmission rates, infection rates, and patient satisfaction scores. If these demands are made and changes implemented, prices will invariable decrease in line with other industrialize countries. Bravo Dr. Elisabeth Rosenthal for providing this provocative work- An American Sickness: How Healthcare Became Big Business and How You Can Take It Back.

I picked up this book due to recent events, as it was referenced in the recently released manifesto. I highly recommend this book to anyone interested in the issue of Health Insurance in America. This book explains just how broken the system is in great detail, using both individual cases and the statistical data. However, more prudently, it discusses the non-violent solutions to dealing with health insurance in America. Not only does it discuss the potential policy that might help, but also the personal steps a person can take. The anger that people feel is justified, but if you want to learn the real logical and humane solutions to this problem, read this book.

If I could afford it, I would buy about a thousand copies of this book and scattered them around on park benches, cafes, trains, busses, taxis, church pews, movie theaters, post offices, bars, airports, planes and anywhere that people might pick one up and READ THIS BOOK. The books goes through all the games that the health care industry has developed to gouge obscene amounts of cash and influence from every citizen in this country. I found the writing style very lucid but the parade of case histories of legal robbery made it hard to keep going. I would be so furious at what I read that I had to put the book down and relax. Please don't let that put you off reading this book. It is a short, expertly researched course in the fine arts of health care piracy. Having read this book I can look at the debates going on about health care and know that both sides of the aisle are blowing a lot of smoke to cover the real problems that they cannot or do not want to change. It's not all gloom, though. There is a large amout of good advice about what you can do to protect yourself when choosing insurance. In addition, Dr. Rosenthal gives some practical suggestions on how all of us can help to demand answers and action from federal, state and local government to end this astonishing abuse. Since reading this I've become so much more aware of what the magicians are doing behind their backs that it's left me hungry for more information. This subject that I had little interest in and almost no knowledge about seems to me to be a cause worth fighting

The provision of health care in the United States is currently in the spotlight. Unfortunately, the entire industry has been in decline for decades, neither political party seems to have the ability to make the required structural changes, and thus too many residents of this country are one medical procedure away from financial peril. The first part of the book is mesmerizing, as Rosenthal picks apart each component of the medical-industrial complex, illuminating the roles of the FDA and other government agencies as well as the greed of medical center conglomerates and everyone's favorite target, big pharma. Why are many of us, care providers and patients alike, ignorant of prices? (Hint: it's not our fault.) Why do medications, including those that have been in service for decades, cost so much less outside the United States? (Innovation is not the reason.) While Martin Shkreli was grabbing headlines, likeminded souls were similarly scheming to extract every possible cent from hapless consumers and their insurers. In the race to riches, most of us wind up as collateral damage, some of us bankrupt despite having "decent insurance that was supposed to cover everything." In the second part of the book, Rosenthal enumerates the steps that individuals and care providers can take to address the problems while we wait for deliverance from healthcare purgatory. Her lists of questions are thoughtful, but simply not practical for most people in this country who live outside a metropolitan area and don't have the luxury of interviewing multiple care providers and hospitals until they find a match. Nor do most individuals have the flexibility to move to another country where the care is affordable. Rosenthal does not spend much time on big picture solutions, though she points to a few countries who have figured it out, alludes to single payer systems, and notes that we'd be better off if we focused more on maintaining health -- right now, that's not profitable -- rather than treating sickness. HMOs like Kaiser may seem ideal to Rosenthal, but she overlooks the fact that an organization which serves as both insurer and provider will tend to focus on the former and do its best to ignore the latter, famously refusing to order diagnostic tests. The book is impressively researched, with footnotes and the bibliography consuming more than 1/3 of the space (on my Kindle, the body of text ended at the 61% mark). For that, and for the anecdotes that may give you new insights into this particular and most American sickness, it is worth your time.