It's almost too obvious to be worth pointing out, but healthcare impacts everyone. And it seems like there's one thing everyone can agree on. Healthcare is expensive, whether we're talking about drug prices or insurance premiums. It wasn't always like this. The story of how healthcare got this way is the subject of Elisabeth Rosenthal's book An American Sickness: How Healthcare Became Big Business and How You Can Take it Back. I'm always interested in current events, and with the battles over healthcare on the national stage, this book seemed particularly timely. It turned out that this was the most important book I've read all year.
I read a lot of non-fiction, but this is the first book in a long time that made me truly, absolutely angry. And there is quite a lot to be angry about. Rosenthal charts how multiple players in the healthcare industry figure out all manner of ways to take in as much money as possible. Listing example after mind-numbing example, Rosenthal lifts the curtain and exposes the swindle. A former doctor turned journalist, she's the ideal person to take us on this journey. Having seen the industry up close, and knowing enough to sweep aside jargon, she writes plainly about what's happened. Organized into chapters covering the different segments of healthcare, Rosenthal refers to a series of unwritten rules that govern how industry operates. For instance, her seventh rule explains why the continued aggregation of hospitals and insurers hasn't led to efficiencies and lower prices. Larger units simply have more power to demand whatever they want.
While the evolution of the industry into a profit-obsessed machine played out over decades, the main thrust of Rosenthal's argument is that greed came to dominate. Patient care and wellness took a backseat, and one-by-one most of the players succumbed to the desire for ever-greater financial return. It isn't just the ones you would expect either - even some doctors gave in, putting their bottom line first. Some of the examples boggle the mind. Reading about a plastic surgeon being called in to stitch up a wound and charging tens of thousands of dollars for a service any nurse could have performed was particularly galling.
It isn't all negativity, however. Rosenthal highlights cases of doctors, and even a few insurance providers, fighting back against this excess. Further, she spends several chapters, and a few appendices, detailing how individual patients can push back and avoid being taken in. It's admittedly not much and not sufficient. In the absence of a strong response from state and national government, however, it will have to be enough for now.
An American Sickness was by no means an easy read. But this is a book that needs to be read widely. We all know that something's wrong with healthcare in this country. Seeing just how bad things are might sicken us enough to demand that something be done about it.
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