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An American Sickness: How Healthcare Became Big Business and How You Can Take It Back Hardcover – April 11, 2017
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“An eye opening discussion . . . [An] important book. . . . Rosenthal told an interviewer her goal was to “start a very loud conversation” that will be “difficult politically to ignore.” We need such a conversation – not just about how the market fails, but about how we can change the political realities that stand in the way of fixing it.”—The New York Times Book Review
“Patients can save thousands of dollars by purchasing An American Sickness by Elisabeth Rosenthal.”—New York Journal of Books
"An authoritative account of the distorted financial incentives that drive medical care in the United States . . . Every lawmaker and administration official should pick up a copy of An American Sickness. Then, at last, the serious debate could begin.” —The Washington Post
“Bold, insightful, well-researched analysis.” —Nature
“Truly remarkable for the extensive interviews and range of documentation it provides.”—American Psychological Association
“In this in-depth analysis of a malfunctioning system, Rosenthal makes a compelling case against the hospital and pharmaceutical executives behind the “money chase,” and it’s hard to imagine a more educated, credible guide…The patients she interviewed share mind-boggling stories…She builds her case with one damning statistic after another…Rosenthal presents solutions both personal and societal in this commanding and necessary call to arms.” —Booklist (starred)
“Provocatively analyzes...Rosenthal unveils with surgical precision the "dysfunctional medical market"...a startling cascade.”—Publishers Weekly (starred review)
“A blast across the bow of the entire health care industry . . . Throughout, the author blends extensive research with human interest . . .A scathing denouncement.”—Kirkus Reviews
“Elisabeth Rosenthal’s meticulous history of the crisis in American health care should be required reading for our generation. I have not read another volume that diagnoses the “deeply, perhaps fatally, flawed” system of health insurance and delivery with such lucidity, dissects its critical shortcomings, and provides such a clear prescription for its ills. Bold, imaginative, tautly written and filled with fury and compassion, this book will serve as the definitive guide to the past and future of health care in America.”—Siddhartha Mukherjee, Pulitzer Prize-winning author of The Emperor of All Maladies and The Gene
“Dr. Elisabeth Rosenthal, a physician turned tenacious reporter, shows how the ‘highly dysfunctional’ American health care system turned the Gentle Art of Healing into a Greedy Arsenal of Profit, where everybody does well—except the patient. She also teaches us how to fight back against useless treatments, outrageous fees, and bewildering bills.”—T. R. Reid, bestselling author of A Fine Mess, The Healing of America, The United States of Europe, The Chip, and Confucius Lives Next Door
“An American Sickness will give you many new reasons to avoid getting sick, but also the resources to help protect your finances and your life if you do. Elisabeth Rosenthal’s remarkable, outrage-inducing book reveals how each attempt to check the health industry’s excesses has been exploited for monetary gain. Both a fascinating history of dysfunction, and a clear manifesto for change.”—Sheri Fink, M.D., Ph.D., Pulitzer Prize-winning author of Five Days at Memorial and War Hospital
“Through vivid, heart wrenching stories and trenchant analysis, Libby Rosenthal unveils the irrationality, indifference, harmfulness, and downright unfairness of the American health care system that can often seem more driven by profit than caring and compassion. She also offers tremendously helpful advice to patients on how to navigate the system to ensure they get the best outcomes.”—Ezekiel J. Emanuel, M.D., Ph.D., Chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania and author of Reinventing American Health Care
About the Author
Dr. Elisabeth Rosenthal was for twenty-two years a reporter, correspondent, and senior writer at The New York Times before becoming the editor in chief of Kaiser Health News, an independent journalism newsroom focusing on health and health policy. She holds an MD from Harvard Medical School, trained in internal medicine, and has worked as an ER physician. She lives in New York City and Washington, DC.
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Because Rosenthal (an MD herself) was a columnist for the New York Times, she received thousands of contacts over the years. She researched them and they provide the vivid and shameful examples of financial abuse in the industry (with real names). She has distilled them into a perverse list of principles of US healthcare that explains everything and forms the backbone of the 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.
As the American economy freefalls into dysfunction, doctors and nurses have become “independent contractors”, just like everyone else. They must look out for themselves first. Administrators are no longer senior caregivers but numbers people who must limit the poorly insured and maximize the profit on every square foot.
What becomes obvious is that the “market” system has failed utterly and completely. Health cannot be left to capitalists, be they doctors, hospitals or manufacturers. The rest of the western world and history are the proof: “If the March of Dimes was operating according to today’s foundation models, we’d have iron lungs in five different colors controlled by iPhone apps – but we wouldn’t have a cheap polio vaccine,” Rosenthal quotes Dr. Michael Brownlee. The incentives are all wrong.
An American Sickness is a public service. It gathers, for the first time I know of, the various scams used by the professions to jack up bills. It explains the why and the how of all those bills being so high. It is well organized, clear and it puts everything into perspective as part of a greater scheme. It identifies what to look out for, what to ask, and how to skirt the event horizon. Rosenthal provides really useful links and sample letters, because customers are all in this same situation – ignorant and powerless. I particularly like her examination of prices for the same procedures around the world. You can afford to have treatments elsewhere, because the costs are so much less, that you can throw in the travel – for two – and still come out well ahead. This book is worth far more than a month’s health insurance; it can save you a fortune, and give you back your life.
I am not a big fan of the government getting involved in healthcare, however if we are going to let free enterprise control the costs I think it is important to know if the healthcare industries will respond to true competition like other industries such as the telecommunication and automotive industries. This book says it will not because it is functionally different. For example only 18% of hospitals are for profit. The 62% majority are nonprofit hospitals that get billions of dollars in tax breaks if they use their profits to help the poor. The government runs the other 20%. If nonprofits make too much money they just spend more. As court case after court case indicates they do not always spend those big profits to help the poor. You also learn the average of how much the pharmaceutical companies actually spend on research and development of a new drug. It is not always the billion dollar figure you hear so much about.
I am sure once conservatives learn that the author is a Harvard Medical School trained doctor that now writes for the New York Times they will discount it as biased against business and not accurate. However, the question is not the author's political leanings, but is the information correct? I have checked some, but not all, of what the author has stated and so far it checks out.
Healthcare is a fine and noble way to earn a living. I am all for healthcare providers making a good living taking care of people. Could there be any profession more satisfying. The training, hours and risk of becoming a healthcare provider should be taken into account when determining prices and that price should allow for a comfortable lifestyle.
But the greed of corporate organizations, a select few physicians and physician group practice managers who want to 'maximize' income charge prices that far exceed the value of what is given. Drug companies have very little to stop them from charging outrageous markups. The heart of medicine seems to have been replaced even in systems where fine physicians are working; often because there are no other choices.
The lack of transparency in healthcare pricing was eye opening. Charge masters and insurance contracts should not be top secret documents. This should be mandatory reading for anyone in the healthcare industry and well, anyone who might ever need health care.