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

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[ BOOK AN AMERICAN SICKNESS: HOW HEALTHCARE BECAME BIG BUSINESS AND HOW YOU CAN TAKE IT BACK by ELISABETH ROSENTHAL OVERVIEW ]

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A New York Times bestseller/Washington Post Notable Book of 2017/NPR Best Books of 2017/Wall Street Journal Best Books of 2017 

"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 Date: Reviewed in the United States on September 2, 2022
Review: Over the last two years, I have had to navigate through complex, unsatisfactory medical offices / hospitals / physical therapy practices for health conditions that came on unexpectedly. Never in my life did I imagine how hard it would be to get an x-ray or MRI using my convoluted health insurance plan or have to obtain referral after referral to see specialists. This book helped me better understand how the US "health" care system got so off track and why it is increasingly difficult to get good care. I now better understand why our healthcare is so expensive, yet ineffective; why pharmaceuticals cost more in the US than other countries; and many other inefficiencies in the system. I learned that hospitals tend to charge more for imaging (like x-rays and MRIs), so go elsewhere for those kinds of services. There are also some good tips on how to navigate the system, negotiate outrageous bills, etc. This book was enligtening. But I also felt angry and sad after reading stories of patients who could not afford the exorbitant costs of needed medications or procedures. US healthcare needs some serious reform. I see that after experiencing my own health issues. Reading this book made me feel that I was not alone and reinforced what I experienced ...

Name: Emilio Corsetti III
Rating: 5.0 out of 5 stars
Title: Educating yourself is the first step
Date: Reviewed in the United States on January 25, 2019
Review: American Sickness by Elisabeth Rosenthal is an exhaustive, detailed look at the American healthcare system. The author examines every facet of healthcare, going back to the beginning in order to understand how we have gotten to where we are.

If there is one overriding theme that one could point to as the cause of skyrocketing healthcare costs, it is greed. Our healthcare system has morphed from a patient-centric system to one where profits come before patient care.

The first half of the book is a history lesson. What were things like before there was health insurance? When did things change from a need to protect people to one where maximizing profits became the primary goal? Along the way, the author uses real-world examples culled from actual patient bills to illustrate just how out-of-control things have become.

The second half of the book looks at what needs to happen in order to gain control of costs. The author offers a wide array of solutions. The first step is to be more proactive with your own healthcare. Ask questions. Challenge unethical practices. One example the author gives is a patient who is visited by an anesthesiologist. The anesthesiologist stops by the patient's hospital room. "How are you doing?" "Fine, thanks."Okay, let me know if you have any questions?" The anesthesiologist leaves and the patient finds out later that he or she was charged a $500 consultation fee.

The second step in controlling costs is government intervention. There are going to be a lot of people who are going to argue against this. The government shouldn't be in control of my health. Regulations hamper innovation. The truth is that the benefits of sensible government intervention and regulations far outweigh any negatives. For example, a government-controlled fee schedule would prevent wide disparity in charges for the same procedure. A national health database would allow patients to have their health records stored in a single location, accessible to healthcare providers anywhere, eliminating duplicate and unnecessary tests. Many of the problems we have today are the direct result of politicians bending to the demands of political donors over the interests of their constituents.

What about the Affordable Care Act? The author calls it a good first step. Unfortunately, Republican opposition and efforts by industry PACS have weakened its effectiveness.

There are hundreds of examples of outrageous charges and bills from actual patients. One that stood out for me involved a plastic surgeon who charged $50,000 for three stitches in a toddlers face. The parents of the child not only complained to the hospital, the doctor, and to their insurance company, but they also sent a copy of their complaint to a plastic surgeon professional group. The pressure from the complaint eventually led to a final bill of $5,000.

This is one book where I listened rather than read. The deluge of facts and figures were easier to consume. I highly recommend this book. I especially recommend this book to the regulators and healthcare professionals who are in the best position to make the changes needed.

Name: rickzz
Rating: 4.0 out of 5 stars
Title: 3.5 stars (Informative but a tough read)
Date: Reviewed in the United States on May 7, 2017
Review: PRO: A very timely book about one of the most important issues of our time. With lots of detail and data, Rosenthal shows how all of the various sectors of our health-care system are at fault in driving exorbitant cost (in the first section) and she then suggests improvements in the second half. Her ten rules on the dysfunctional medical market are also spot-on and are a devastating indictment of the system.

CON: I have to confess this was a tough read for me and I struggled though some sections. The problem is the framework- the chapters of the first half are all about "the age of" insurance/hospitals/...conglomerates, etc. and explains how each sector developed into the mess we have today. Health-care is a very complex business so perhaps this approach was unavoidable but the book is choppy and doesn't flow. Even within the same chapter, there's too much detail and jumbled information. I wish the first half had been more concise and focused more on the bigger picture. There's also not much analysis about why we got into this mess in the first place although Rosenthal does briefly allude to the nature of health-care insurance itself as perhaps being the root cause.

Finally, here are some important points that I got from this book and from reading a dozen other medical books:

1) It's long past time to take doctors (and scientists) off of their pedestal. They don't deserve the implicit trust/respect that society has given them (just like priests aren't blindly trusted anymore). Doctors are like auto mechanics (some are honest and some will do their best to rip you off- and both will sometimes have no clue what's really wrong). The traditional doctor-patient relationship, which is very paternalistic, has got to go. Patients must educate themselves and guide their treatments.

2) Pharmaceuticals aren't innovative anymore and haven't produced any real break-through drugs in decades (with a few possible exceptions like the new cancer immunity drugs). (Overall, the molecular approach to drug development has been a dismal failure.) Most drugs are effective for only a tiny subset of patients and represent an enormous waste of money for society (e.g. statins). Even worse, most new drugs aren't better than older cheaper drugs but are relentlessly promoted by "Bad Pharma" because they're still patented and are hence more profitable.

3) Perhaps the only real fix is to make health-insurance like auto insurance (something only for true emergencies). If everyone had to pay for most of their health-care then we'd all be much more concerned with cost and that would force the system to finally reform and compete on lower price like the rest of the economy.

4) Or perhaps we simply need to make people healthier so that less health-care would be needed. I recently read Gary Taube's "The case against Sugar" where he convincingly argues that sugar (NOT dietary fat) is a major causal factor in tooth decay, obesity, diabetes, heart disease, cancer and possibly Alzheimer's.