This book was actually painful to read. My brain hurt from all the information, my heart hurt from the stories of people mercilessly used and abused by the healthcare system, and my soul hurt from considering the greed and heartlessness exhibited in all the moving pieces that have converged to bring us to where we are today in American healthcare.

There doesn’t seem to be a single entity touching the medical world that hasn’t been implicated as having a role in the dismal mess we find ourselves in today. Insurance companies, pharmaceutical companies, and hospitals have long been perceived as money-sucking monsters, and it’s no surprise that legislators, lobbyists, medical device manufacturers and doctors are all complicit or even actively partaking in the erosion of average Americans’ ability to afford medical care. But charities whose missions claim to be the betterment of individuals suffering from chronic or devastating illnesses who reject funding research for potential cures because they’d prefer to have a stake in new and lucrative treatments?

The only reason I made it all the way through was the promise of something that can be done to combat this ridiculousness. And the author certainly delivered. Actionable ideas, a wealth of resources to seek out information, and a call to get involved as consumers and check ourselves for what’s really important when it comes to our medical care. Do we want the highest-tech gadgets and tech and comfiest doctor’s offices? What if that comes at the expense of reasonable costs and rising insurance premiums? The biggest takeaway here for me is that yes, this is a great big, gross mess, but yes, we can do something about it. ( )

Read for information on how

-insurance
-your doctor
-your local hospital
-pharma
-local and federal healthcare laws
-the FDA (oh yes, that FDA)

are messing with your life.

Read for reasons to take care of your own health and do your own research (because I doubt it will be fixed soon).
Read for reasons why you should have health insurance, but why you shouldn't trust it when you do have it.

Read, if you're me, for reasons that are both pro- and anti- government regulated healthcare.

But, most of all, just read. Bug your doctor, exercise, eat right, and save those trips for real emergencies.

And look into something called BCG. ( )

Elisabeth Rosenthal's exploration of healthcare costs is a must read for anyone who is interested in why their premiums keep rising and their hospital bills convoluted.

We're all familiar with blaming insurance companies and drugmakers. But our system is much more complicated and problem ridden. The American healthcare system is a giant money trough, and providers, suppliers, payers, and consultants are lined up with their snouts buried. Providers inflate their costs; insurers pay it and pass it on. As soon as the payers--whether commercial insurers or Medicare--close one loophole, an army of consultants is lined up to find a new one. Your PCP may do an extra exam at a quick visit to justify billing as a Level 4 or 5 to maximize visit reimbursement. He may be pushed to send your labwork to the more expensive hospital lab, instead of Quest. Your local hospital network may be leveraging their brand name to charge more than its competitors. Even salaried doctors may have their salaries tied to billing, and as their practices are increasingly controlled by larger groups and healthcare systems, have their billing micromanaged to ensure revenue is maximized. The bulk of the book is devoted to exploring this and it's eye opening.

The solutions section is shorter, and for good reason: She doesn't have a ton to offer that wouldn't entail a giant overhaul of the health system. There are temptations here on both right and left. Conservatives will hail sections as proof of their "skin in the game" theory. For example, drug prices jumped after the introduction of Medicare Part D, because it's easier to squeeze money from the insurer. But as Dr. Rosenthal points out, when we're talking thousands of dollars, it's a kidney in the game, not skin. It doesn't matter to you if it's $75,000 or $45,000 for back surgery, because you can't pay for either one by yourself.

On the left, it's a demonstration of our need for single payer, but it's also a cautionary note. The payer is not the only problem, as the examples with Medicare show. The pay per procedure model derives from a formula devised by CMS. We need to change far more than who pays the bills. It's easy to talk about politicians who are in the pocket of insurers or pharmaceutical companies, but the scale of the changes we'd need to control costs and the effect they would have on the gigantic health care industry we've grown--with its attendant jobs--could scare a much more liberally minded politician.

She adds some tips that are meant to help you with your own bills, but they are of somewhat limited use (as I think she knows). For example, she suggests waiting rather than rushing for treatment, but you need to know when to do that. Or you should call your doctor rather than heading straight in for a visit, but since these are uncompensated care, your doctor may be unable or unwilling to do that. If you have limited medical choices in your area, her tips for learning more about cost won't help. They're not really terrible, but add only a small amount to the book. ( )

The American healthcare system famously spends more per person than any other system in the world, yet in outcomes, it ranks 37th. In this work, Rosenthal examines why that is the case and what practically can be done about it. Her examination operates both at levels of the patient, healthcare worker, business, insurance agency, and government/public. This book will leave you fuming that too many people are profiteering off of Americans’ health. It will also leave you better equipped to meet the challenges of tomorrow.

With such high costs yet such low results, more than one problem exists in our system. Unfortunately, politics tends to oversimplify the arguments. Rosenthal spends the first eleven chapters reviewing the historical and systemic evidence of how we got to this place. She leaves no leaf unturned in dealing with central topics like insurance, hospitals, physicians, “big pharma,” ObamaCare (the Affordable Care Act or ACA), research, and more. She illustrates how just about every element in the system has become decadent and profit-hungry. She also compares how other countries are doing a better job with much less financial investment.

After this first part of the book, Rosenthal pivots to deal with specifics of what can be done, both as individuals and as a society. This book thus has great impact both for individuals who rely heavily on healthcare and for public policymakers who want to get a leg up on the next reform. The suggestions are eminently practical and possible. Examples include avoiding hospital labs in favor of commercial lab businesses like Quest and LabCorp, negotiating national prices on drugs, offering a standard price for procedures, and pursuing antitrust legal activity against medical conglomerates.

Rosenthal, a Harvard-educated practicing MD with further training as a journalist, spares no detail in confronting this societal ill. Readers will leave with a much better understanding of the problem and future options. She even has several appendices of resources available – for challenging bills, researching prices, or undertaking social advocacy. As someone professionally invested in our healthcare system, I notice that many authors show some kind of bias; Rosenthal, however, shows none as she shines a bright light on almost every player in the system. The pro-profit orientation claims the prime space as it seems that everyone seeks to claim a monopoly on patients’ pocketbooks by holding their healthcare hostage.

This book is as comprehensive as it is erudite. Think of it as preparation for the next battle in America’s healthcare war. The new afterword, written after the failure to repeal the ACA in 2018, updates her narrative amidst new points of social discussion (or perhaps battle). An American Sickness won’t cure our problems, but it sure does shine some light on what’s going wrong and what can be done. In treatment of the problem, she does not posit over-generalized socialized medicine but merely a slew of pragmatic next steps (which can be taken or rejected individually). Overall, however, she makes clear that the spirit of gaining profit by holding patients’ health hostage needs to go. Otherwise, any new system will surely morph into something weird again. I cannot help but think Hippocrates would be proud of her work. ( )

I saw and listened to the author when she was on C-SPAN prior to reading her book. I was so impressed by her knowledge and empathy on C-SPAN that I was anxious to read her thoughts on healthcare. I borrowed this book from the library. However, I would encourage people to buy the book as it is an excellent resource if you are dealing with personal medical and healthcare issues.

Ms Rosenthal looks at the entire healthcare system. She shares many stories on how the system affects patients, doctors, hospitals and health related companies. Many of her stories will anger you, particularly the ones where patients receive poor treatment and huge medical costs that often lead them to personal bankruptcy. What is very distressing is that many other countries are offering health related services similar to ours at a much lower cost and without all the hassles.

The author also has a section which is a great reference if you are a patient and are looking for a doctor. There is a very informative checklist on how to choose the best physician for your needs and income. There is very useful information on just about every page of this book – – that is why I think it belongs in every reader's personal library.

This lady, not Ben Carson, deserves to be in a leadership role regarding healthcare and health insurance related issues.

( )