Genres
Collection
Publication
Penguin Books (2017), Edition: Reprint, 407 pages
Description
Business. Medical. Politics. Nonfiction. HTML: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 The Emperor of All Maladies and The Gene At a moment of drastic political upheaval, An American Sickness is a shocking investigation into our dysfunctional healthcare system - and offers practical solutions to its myriad problems. In these troubled times, perhaps no institution has unraveled more quickly and more completely than American medicine. In only a few decades, the medical system has been overrun by organizations seeking to exploit for profit the trust that vulnerable and sick Americans place in their healthcare. Our politicians have proven themselves either unwilling or incapable of reining in the increasingly outrageous costs faced by patients, and market-based solutions only seem to funnel larger and larger sums of our money into the hands of corporations. Impossibly high insurance premiums and inexplicably large bills have become facts of life; fatalism has set in. Very quickly Americans have been made to accept paying more for less. How did things get so bad so fast? Breaking down this monolithic business into the individual industries�??the hospitals, doctors, insurance companies, and drug manufacturers�??that together constitute our healthcare system, Rosenthal exposes the recent evolution of American medicine as never before. How did healthcare, the caring endeavor, become healthcare, the highly profitable industry? Hospital systems, which are managed by business executives, behave like predatory lenders, hounding patients and seizing their homes. Research charities are in bed with big pharmaceutical companies, which surreptitiously profit from the donations made by working people. Patients receive bills in code, from entrepreneurial doctors they never even saw. The system is in tatters, but we can fight back. Dr. Elisabeth Rosenthal doesn't just explain the symptoms, she diagnoses and treats the disease itself. In clear and practical terms, she spells out exactly how to decode medical doublespeak, avoid the pitfalls of the pharmaceuticals racket, and get the care you and your family deserve. She takes you inside the doctor-patient relationship and to hospital C-suites, explaining step-by-step the workings of a system badly lacking transparency. This is about what we can do, as individual patients, both to navigate the maze that is American healthcare and also to demand far-reaching reform. An American Sickness is the frontline defense against a healthcare system that no longer has our well-bei… (more)
User reviews
LibraryThing member DavidWineberg
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
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.
David Wineberg
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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.
David Wineberg
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LibraryThing member annbury
This is a must-read book for anyone involved with or interested in the American health care system, which means most of us. Ms. Rosenthal is a medical doctor as well as a New York Times reporter. In this book, she examines American health care in all its gory detail, achieving a clear and
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compelling explanation of why we pay twice as much for healthcare as other rich countries, and get far worse results. The answer is simple and straightforward: money, as the author shows in detail, via overall statistics, and via personal anecdotes. The book also provides an extraordinary amount of information that will be of use to patients -- or more accurately in the current context, consumers of medical care. Finally, Ms. Rosenthal proposes a number of steps that we as individuals, as groups, and as a society could do to change things. The book can be depressing, upsetting, or angry-making in places, when it makes it clear how much the conversion of healthcare into a business has shaped and distorted our system, and how much damage that has done to individuals. Overall, however, it is a very valuable effort. I expect to consult it before future encounters with the medical system. Show Less
LibraryThing member cissa
A thorough and devastating look at what's gone badly wrong in the USA's healthcare industry and why, with some suggestions about improvements possible.
Mostly, what's gone wrong is greed and profiteering from everyone who collects payment for dealing with the ill or wounded. At this point, it is
Basically, the "health care industry" has a captive audience that often cannot afford to spend the time to shop around for the best prices... and when we can, they make sure that such information is not available, making a mockery of an "informed consumer" for their products.
Remember their "products" consist of life and health, literally.
One of the most valuable aspects of Rosenthal's analysis shows how- unlike in most industries- health care can make competition a race to the MOST expensive rather than the least expensive prices possible. It's not just PharmaBro, though he's a perfect example of the phenomenon; it's everyone involved in the industry, at least in a decision-making capacity.
Mostly, what's gone wrong is greed and profiteering from everyone who collects payment for dealing with the ill or wounded. At this point, it is
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mostly structural- which means that no individual can do much to fight it.Basically, the "health care industry" has a captive audience that often cannot afford to spend the time to shop around for the best prices... and when we can, they make sure that such information is not available, making a mockery of an "informed consumer" for their products.
Remember their "products" consist of life and health, literally.
One of the most valuable aspects of Rosenthal's analysis shows how- unlike in most industries- health care can make competition a race to the MOST expensive rather than the least expensive prices possible. It's not just PharmaBro, though he's a perfect example of the phenomenon; it's everyone involved in the industry, at least in a decision-making capacity.
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LibraryThing member deldevries
This is an education into the economics of a big pot of insurance money that all Americans put money into for healthcare. The outflow from that big pot is what this book is all about. Hospitals, doctors, specialists, labs, clinics, pharma, etc. A historical look at changes in the industry and the
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strategies for maximizing payment for services. Not balanced by players passionate about helping others for reasonable compensation. Wraps up with some practical strategies for individuals to use in managing their personal healthcare expenses. An important book for understanding some things that you personally have to do to manage health care expenses. High deductible health care plans and health savings account put individuals squarely in the payor category vs relying on insurance only. Show Less
LibraryThing member themulhern
An analysis, and practical advice about dealing with, our American health care system. Not a bad effort, as far as I could tell, but I had accidentally checked it out in a large print edition, and found it difficult going.
LibraryThing member strandbooks
This was a tough read because it's easier to keep my head in the sand, but it was well-reviewed and well-researched. Our current model is unsustainable and as the book showed you can't point the finger at one part of the industry. The last 100 pages are about what each of us can do to right the
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ship because as many of us have experienced our healthcare system still does have a lot of good in it. Show Less
LibraryThing member larryerick
If you have had any thought about the high cost of healthcare in America, then you owe yourself the benefit of reading this book. Imagine yourself needing (only wanting?) $20 desperately. Not having anyone you know willing to just give it to you, you could take a gun or knife and try to rob someone
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for it. You could sit on the sidewalk and beg for it from passers-by. You could simply walk around all day looking for money lost on the ground hoping to find enough. Or, you could follow the fundamental model of many modern American healthcare businesses and prearrange for a local clothing store to sell only pants with holes in the pockets and then follow along behind people waiting for their money to fall out and for you to pick it up, and, if someone catches you doing that and complains, you can have your other prearrangement with the police result in your victim being arrested for flagrant littering. Okay, maybe American healthcare isn't quite that bad. Most probably aren't. Probably. But some are occasionally worst. Read the book. The author leaves no stone left unturned in pointing out the many ways all aspects of the American healthcare system find ways to make some revenue even more revenue. Doctors, hospitals, ancillary providers, drug companies, insurance companies, medical societies, foundations, device manufacturers...am I leaving anybody out? This portion of the book is outstanding. Fortunately, she goes on to show the reader how to avoid many of these financial pitfalls, or, at least, to not fall so far down the financial holes. Unfortunately, she is only moderately successful in this task, because many "prearrangements" have been made to make this task very difficult for us. This is essential reading, if only to get you realize what all of us are up against, including those of us actually working in healthcare. Show Less
LibraryThing member hopeevey
I really, really wanted to like this book. I agree with her on a lot of points, but either through ignorance or guile she's written a book that's easy to understand and fundamentally inaccurate. I'm sure she will sell a lot of copies. I'm also sure that such a simplistic approach to addressing the
Without understanding the economic forces at work and failing to work in the medical field in the US, fixing the pervasive issues are doomed to failure. At best, they'll be a band-aid. More likely, the futile attempt at solution will only make things worse. Dr. Rosenthal's focus on facile rabble-rousing will, I fear, do more harm than good.
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medical/industrial complex won't make any difference. Without understanding the economic forces at work and failing to work in the medical field in the US, fixing the pervasive issues are doomed to failure. At best, they'll be a band-aid. More likely, the futile attempt at solution will only make things worse. Dr. Rosenthal's focus on facile rabble-rousing will, I fear, do more harm than good.
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LibraryThing member writemoves
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
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.
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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.
Show Less
LibraryThing member scottjpearson
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
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.
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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.
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LibraryThing member arosoff
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 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.
We're all familiar with blaming insurance companies and drugmakers. But our system is much more complicated and problem ridden.
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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.
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Awards
American Bar Association Silver Gavel Award (Finalist — 2018)
Booklist Editor's Choice: Adult Books (Social Sciences — 2017)
NPR: Books We Love (2017)