Book Review: An American Sickness
Rosenthal, Elisabeth. An American sickness : how healthcare became big business and how you can take it back. Penguin Press, 2017.
An American Sickness: How Healthcare Became Big Business and How You Can Take It Back by Elisabeth Rosenthal is a sobering look at the history and current state of the American healthcare system. Rosenthal, a journalist and former physician, paints a bleak picture, but her accessible style and systematic organization make the book an engaging read.
Rosenthal pulls no punches, beginning with “Ten Economic Rules of the Dysfunctional Medical Market” which include “A lifetime of treatment is preferable to a cure,” and “As technologies age, prices can rise rather than fall.” She periodically refers back to these rules when logic and common sense fail.
Each chapter begins with a brief history of a part of the system such as insurance, hospitals, or pharmaceuticals, and then proceeds with an explanation of how each has changed in response to shifting values, to legislation, and to transformation in other parts – for example, how physician practices have affiliated themselves with hospital systems. Rosenthal pairs this overview with stories of patients, families, and doctors to help connect this complex system with personal healthcare decisions. While she presents a system that has moved from advancing patient well-being to delivering maximum profit, she generally absolves individuals; patients and caregivers are cast as victims of a predatory system. This portrayal may be an accurate reflection of the current system, but it is also the result of past decisions by many individuals who abdicated control of their healthcare decisions and dollars.
Rosenthal concludes with her solutions, which seem small and ineffectual against a vast and complicated system that hides true costs and deflects outside scrutiny. Her solutions are two-pronged: things to do immediately – such as asking for the cash cost of prescriptions or for an itemized hospital bill – and changes to advocate for on a systemic level over the long haul. In the appendices, she provides a number of useful tools to put these solutions into action. Rosenthal acknowledges that these solutions seem inconsequential, but encourages them nonetheless, emphasizing the power of numbers. If enough individuals take control of their healthcare and its costs, the system can be transformed into one that is both patient-centered and affordable. The book is a solid, if sometimes simplistic, introduction to a complicated topic.
Also available as an eBook and audiobook on OverDrive.
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