Sick: The Untold Story of America's Health Care Crisis---and the People Who Pay the Price [Paperback]

Jonathan Cohn (Author)

Book Description

Publication Date: May 6, 2008

America's health care system is unraveling, with millions of hard-working people unable to pay for prescription drugs and regular checkups, let alone hospital visits. Jonathan Cohn traveled across the United States—the only country in the developed world that does not guarantee its citizens access to medical care—to investigate why this crisis is happening and to see firsthand its impact on ordinary Americans. Passionate, powerful, illuminating, and often devastating, Sick chronicles the decline of America's health care system, and lays bare the consequences any one of us could suffer if we don't replace it.

Editorial Reviews

From Publishers Weekly

In this addition to the growing list of exposés of the toll our patchwork, profit-based health-care system takes on Americans, Cohn makes a plea for a universal coverage with a single-payer system regulated by the government. Drawing on research and riveting anecdotes, Cohn, a senior editor at the New Republic, describes how private insurers decide who and what they will—and will not—cover. He also examines how rising health-care costs lead corporations to seek ways to deny coverage to employees, such as hiring full-time workers as temps or independent contractors without health insurance. In tale after tale, Cohn documents the sometimes catastrophic results. they couldn't. Cohn points out that managed care initially had an altruistic goal of making health-care affordable for all. But by 1997, two-thirds of HMOs were controlled by for-profit companies concerned with making money rather than preventing and easing sickness. The author convincingly argues that Medicare and universal health care in such countries as France, though not perfect, are far superior to the system most Americans face. Much of this is well-trod territory, but Cohn is eloquent, and he's good at using case studies to dramatize and explain complex issues. (Apr. 10)
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved. --This text refers to an out of print or unavailable edition of this title.

From Booklist

Overcrowded emergency rooms force ambulances to drive patients to more distant hospitals; the uninsured crowd emergency rooms for nonemergency health care, adding to the problem as hospitals and patients struggle to balance supply and demand, and profitability. New Republic reporter Cohn offers personal stories of families--and the nation--suffering health-care crises. A man who has lost his health insurance watches his wife die of cancer that might have been detected earlier if he'd had better coverage, a Texas woman fights with her insurer to get her disabled baby therapy that could help him learn to walk. Cohn presents case after case of Americans bereft of adequate health care coverage after losing their jobs, or seeing their employers cut back on coverage, or insurers fight to provide the minimum of coverage. Cohn uses each case study to provide a historical and modern perspective on insurance and health care delivery, and the factors that have led to the current crisis. Vanessa Bush
Copyright © American Library Association. All rights reserved --This text refers to an out of print or unavailable edition of this title.

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Product Details

• Paperback: 316 pages
• Publisher: Harper Perennial (May 6, 2008)
• Language: English
• ISBN-10: 0060580461
• ISBN-13: 978-0060580469
• Product Dimensions: 8 x 5.4 x 0.8 inches
• Shipping Weight: 8.8 ounces (View shipping rates and policies)
• Average Customer Review: 3.8 out of 5 stars  See all reviews (27 customer reviews)
• Amazon Best Sellers Rank: #69,753 in Books (See Top 100 in Books)

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41 of 41 people found the following review helpful:

5.0 out of 5 stars Cohn has the passion of a muckraker and the erudition of a scholar, June 30, 2007

By 

Stephen R. Laniel (Cambridge, MA USA) - See all my reviews
(REAL NAME)   

This review is from: Sick: The Untold Story of America's Health Care Crisis---and the People Who Pay the Price (Hardcover)

I can't recommend this book highly enough. At first glance, one might expect its structure to be gimmicky:

1. Interview someone who suffered because of our country's health-insurance system.
2. Zoom out from that person to explain the political and economic background to his or her suffering.
3. Zoom back in.
4. Repeat 2) and 3) a few times.
5. Move on to the next person and repeat from step 1).

Far from being a gimmick, I couldn't imagine a better narrative device. Jonathan Cohn combines the passion of a muckraking journalist with the erudition of a historian. His delivery is simple, unpretentious, and never cloying.

His conclusion is simple: health insurance as delivered by private companies doesn't work, because their incentive is always to cut services to the bone; the ideal hospital for an insurer is one that has no patients. The history of health insurance, as Cohn tells it, is the history of nonprofit corporations and idealistic doctors slowly getting replaced by for-profit corporations that destroyed the industry they were ostensibly meant to save.

Of course there's a way out; it's the way that every other industrialized nation uses, namely guaranteeing citizens the right to health care as a basic condition of citizenship. They spend far less than 16% of their GDP on health care, which is where the U.S. is today. The main obstacle to universal health care in this country is political. We overcame that obstacle in the Sixties and got Medicare and Medicaid; in Cohn's telling, they are models of efficient health-care delivery. (He says that surveys of the elderly, who are covered by these programs, find that they're more satisfied with their coverage than are young people in private insurance programs.) It will take a political change to bring us universal health care, but we've come close before. There's no reason we couldn't do it again.

25 of 26 people found the following review helpful:

4.0 out of 5 stars Our Dysfunctional Health Care System, May 22, 2007

By 

Izaak VanGaalen (San Francisco, CA USA) - See all my reviews
(REAL NAME)   

This review is from: Sick: The Untold Story of America's Health Care Crisis---and the People Who Pay the Price (Hardcover)

Why this book is subtitled "The Untold Story of America's Health Care Crisis - And the People Who Pay the Price" is beyond me. Everyone has a story about the failure of our health care system or "non-system" and everyone is paying the price. Not only is it becoming more obvious by the day, almost every presidential contender is promising some kind of reform.

Jonathan Cohn of The New Republic has given us a number of revealing and disturbing case studies, each indicating system failure; and with each study he gives us some historical background as to how certain institutions - Medicare, Medicaid, managed care, employer-based health insurance, etc. - came to be. The historical background is good because is shows that there was no single policy or grand design behind our current mess; it is more a product of haphazard decisions made over a long period of time.

Let's look at some facts. America spends about $7,000 per capita on health care annually, about twice as much as the country in second place. Yet we are ranked 37th in health system performance, according to WHO. There is indisputably something very wrong.

Our system can best be described as a private, employer-based health insurance system. It started during World War II with the wartime freeze on wages. Companies started offering health insurance to attract and keep employees. And the rest, as they say, is history. Today we have Daimler basically giving away Chrysler because they have about $18 billion worth of health care liabilities. Every single worker is paying for about three retirees - and their families. Now, the only way Chrysler can keep employees is if they drastically reduce their health benefits.

So what's the author's solution? The first step in any serious reform would be to separate people's health insurance from their employment. Health insurance must be portable. The second step to any solution would be universal coverage. Everyone must be insured, those who cannot afford it must be subsidized.

There are two ways to get everyone insured: one is to make everyone buy private insurance, and the other is a single-payer system. The author leans toward a single-payer system as they have in France. One must remember a single-payer system is not "government-run" health care; hospitals and doctor's practices are still private, government is only the financing mechanism. Think of it as "Medicare for all." This is not an ideal solution, but it is better than our current fragmented system.

Private insurance is not working for two reasons: for one thing, it wants to shut out the sick and the poor - which is understandable since insurance companies are in the business of making money. The second reason is that administrative costs are about 30% - again, because they are in the business of making money. The administrative costs of a single-payer system are less than 2% - that would be Canada's. The problem with a single-payer system is that providers will tend to overprovide, since they know the government will pay for it anyway. To remedy this some controls would have to be put in place, such as strategically placed co-payments and deductibles.

The author is vague on how his modal of health care would work other than it being single-payer, and that there would be universal coverage. Critics may call it socialized medicine, which it is not, but with employee health care no longer burdening American business, capitalism would work more efficiently and more jobs would be created, or at least remain in this country. Under a single-payer system employers would be able to pay higher wages to cover what would be a higher payroll tax - yes, that would mean a higher FICA. Everyone would benefit from this system, except the insurance industry which would be missing their 30% of the $7,000 per capita in fees; but not to worry, they'll find other ways of making money. Single-payer insurance can save American health care, and it can save the country. This book does well in presenting the problem, but hesitates with the solution. Very good read, nevertheless.

36 of 42 people found the following review helpful:

5.0 out of 5 stars Thoughtful analysis, April 16, 2007

By 

Anthony M. Zipple (Louisville, KY) - See all my reviews
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This review is from: Sick: The Untold Story of America's Health Care Crisis---and the People Who Pay the Price (Hardcover)

The US health care system is not in good shape and this book suggests some of the reasons. 40% of US citizens with problems do not get care due to cost issues. Patient satisfaction is lower in the US than in Canada, the UK and many other countries with some form a national plan. The US spends more than any other country with worse overall results and lower rates of coverage in the population than any other industrial country. We spend less on preventive care as a percentage of expenditures than any industrial nation. In 2004, 35% of Americans believe that the US health care system needed fundamental rebuilding.

I could go on, but the clear FACT is that US health care is in bad shape and getting worse quickly for many, many Americans. What is the solution? A single payer system is a good start. Only those ideologically paranoid about government (anyone who still thinks that the current Administration in DC is doing a good job, that global warming is a hoax, and that abstinence only education works is probably in that camp) big pharmacy, big insurance, and affluent folks with good jobs and good insurance disagree. Creating competition on the basis of value (like reduced illness) rather than cost and risk shifting would be a second place to go.

Lots of countries have great single payer, national plans that do well. I have lived in some of these places (like Germany) and they are great. Most allow for supplemental and/or private plans at an extra cost (like Japan) but they provide a good base of care for all. Speaking of Germany, they pay about 35% of what we pay for drugs. Like I said, the current system works well... for big pharma!

Cohn's book give an excellent historical context for the problem. Greed, ignorance, narrow self-interest, and paranoid account for most of the causes. It is a bit short on solutions (look at Redefining Health Care by Porter and Teisberg) for a good start on that) but it is a good read, a tragic story, and an enlightening book.