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

An American Sickness is a gripping, fast paced and revolting dive from 50,000 feet above into the morass of what passes for healthcare in the USA. Patients are barely tolerated in a system optimized to pass money from bank accounts to providers. The industry is mean, nasty and greedy, with worse results than comparable nations – for far more cost. Everything you feared is true, and there is much more in these 400 pages.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.

Not a subject matter I would normally be interested in, but in the current political climate I felt I should get a better understanding of what is going on in the healthcare industries. The four chapters on the history of the American heath insurance industry, hospitals, doctors and pharmaceutical industry alone make the book worthwhile to read.

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.

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