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

Review by Dave Gamrath

One-liner: In An American Sickness, author Elisabeth Rosenthal provides an in-depth review of America’s healthcare system, then follows with practical information to help readers navigate its dysfunctionality.

Book Review:

Author Elisabeth Rosenthal, a Harvard-trained doctor, decided to forgo practicing medicine and write about it instead, spending over two decades at the New York Times before becoming editor at Kaiser Health News. Her book An American Sickness is a bold attempt to dissect America’s healthcare system and provide readers a thorough yet readable history on the system’s evolution, dysfunctionality and strategic development to be as profitable as possible for providers, at the expense of American patients. The United States spends roughly one trillion dollars per year, or nearly one-fifth of GDP, on healthcare, which is about double the percent of GDP other western countries spend. Yet on average, health-outcomes in the US are far worse. How does this happen? Rosenthal answers this question in vivid detail in An American Sickness.

Rosenthal first lists what she calls ten “economic rules of the dysfunctional medical market.” These are striking and include things like “more treatment is always better…default to the most expensive option” and “a lifetime of treatment is preferable to a cure”. Other rules include backward concepts such as “aging technologies result in higher prices”, “more competition drives up prices”, “economies of scale don’t lead to lower prices”, “no standards exist for pricing or for billing”, and “prices will rise to whatever the market will bear”. These rules show how the economic rules in our American healthcare system are backwards from normal economic principles. Throughout her book, Rosenthal gives example after example, including many personal stories, of outrageous healthcare rip-offs, and often links each example back to these ten dysfunctional rules. This corruption is rampant throughout the system.

Rosenthal explains the historic development as well as the current operating practices of most all aspects of healthcare, including insurance, hospitals, physicians, pharmaceuticals, medical devices, tests, billing, coding, collections, new medical businesses, and research. She describes how healthcare has evolved into an system of being purely a profit-maximizing business. As I read each chapter, thoughts kept arising along the lines of “those bastards!” and “how can they get away with this?”. As much as one understands how in a society likes ours based on capitalism, profit motives drive behavior, it is still outrageous how this is also true in healthcare, when people’s lives are literally on the line. Rosenthal explains how this evolved within each of the segments of the system, and continues to play out today.

Outside of the wealthy, or those lucky enough to still have good healthcare through their employer, most Americans are likely not happy with our healthcare system. Yet Americans still seem to believe capitalism is the best system to guide our lives. Many Americans decry national healthcare systems in other countries as evil socialism. Even Americans that have been bankrupt by America’s healthcare system fear change towards greater government involvement. Rosenthal covers the evolution of the Affordable Care Act (Obamacare), and how key players, including politicians, insurers, hospitals and doctors worked to undermine it, often playing on entrenched American fears. The result has been that Obamacare remains a fairly inefficient national healthcare system, for which Democrats largely, and unfairly, get the blame.

The second half of Rosenthal’s book, Diagnosis and Treatment, is a solid attempt to inspire us as patients and consumers of healthcare to fight back. Rosenthal provides useful guidelines and specific tools to help resist and navigate our healthcare system, including letter templates for filing complaints, websites with helpful information, and advice on shopping around to lower costs. It provides useful, specific guidance to fight back on doctor bills, hospital bills, insurance costs, drugs, medical devices, tests and more. Rosenthal also provides an overview into needed system changes, with specific details on what needs to change for each key market segment.

Lastly, Rosenthal closes the book with a call to action: “High-priced healthcare is America’s sickness and we are all paying, being robbed. When the medical industry presents us with the false choice of your money or your life, it’s time for us all to take a stand for the latter.” Although An American Sickness is not a political manifesto, Rosenthal certainly does provide the reader with information to motivate us to get out there and fight for change. There are many opinions on the best way to reform our healthcare system, including having a public option, moving to a single payer system, some version of Medicare for All, and others. There’s the German approach, the English approach, the Canadian approach, and many others to pick and choose from. But all approaches will face tremendous resistance. So arm yourself for this fight by reading An American Sickness. Outside of some mental anguish, it’s a fairly painless way to help you obtain the information you need to engage in the fight for needed change to our dysfunctional American healthcare system.

Reviewer Opinion:

Important book to read.

Reviewer Rating of Book:

Thumb up.