Elisabeth Rosenthal, a Harvard-trained physician, decided to forgo practicing medicine and write about it instead. She spent more than 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 health care system and provide readers a thorough yet readable history on the system’s evolution, dysfunction and strategic development to be as profitable as possible for providers, at the expense of patients.
The United States spends roughly $1 trillion per year — or nearly one-fifth of our gross domestic product — on health care, which is about double the percent of GDP other western countries spend. Yet on average, health outcomes in the U.S. are far worse. How does this happen? Rosenthal answers in vivid detail.
Rosenthal first lists what she calls 10 “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 health care system are backward from normal economic principles. Throughout her book, Rosenthal gives example after example, including many personal stories, of outrageous health care rip-offs, and often links each example back to these 10 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 health care, including insurance, hospitals, physicians, pharmaceuticals, medical devices, tests, billing, coding, collections, new medical businesses and research. She describes how health care has evolved into a 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 that in a capitalist society like ours, profit motive drives behavior, it still is outrageous that this is true in health care because people’s lives literally are on the line. Rosenthal explains how this situation developed within each segment of the system and continues to play out today.
Outside of the wealthy, or those lucky enough to still have good health care through their employer, most Americans are likely not happy with our system. Yet Americans still seem to believe capitalism is the best system to guide our lives. Many Americans decry national health care systems in other countries as evil socialism. Even Americans that have been bankrupted by America’s system fear change toward greater government involvement. Rosenthal covers the evolution of the Affordable Care Act (Obamacare), and how key players — 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 health care 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 health care to fight back. Rosenthal provides useful guidelines and specific tools to help resist and navigate our system, including letter templates for filing complaints, websites with helpful information, and advice on shopping around for lower costs. It provides specific guidance to fight back on doctor bills, hospital bills, insurance costs, drugs, medical devices, tests and more. Rosenthal also provides details on what needs to change for each key market segment in order to change the system.
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 health care 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 health care system.
Read the full Feb. 26 - Mar. 3 issue.
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