Reading it is a sobering experience, one that shows what’s really at stake when it comes to our sprawling, costly and illogical health-care system ... Rosenthal — who practiced medicine before entering journalism and now serves as editor in chief of Kaiser Health News — combines her reportorial and medical skills to provide an authoritative account of the distorted financial incentives that drive medical care in the United States. As a result, she has produced a fairly grim tale of how patients — and at times, insurers — are getting ripped off, sometimes with devastating consequences ... While Rosenthal does her best to squeeze in a few jokes (mostly lighthearted references at pathologists’ expense), the subject matter makes for dense reading at times. This is a thorough book, but it’s hard to envision a casual reader picking it up and whiling away the weekend with it ... Maybe every lawmaker and administration official should pick up a copy of An American Sickness. Then, at last, the serious debate could begin.
As Rosenthal describes American health care, it’s not really a market; it’s more like a protection racket — tolerated only because so many different institutions are chipping in to cover the extortionary bill and because, ultimately, it’s our lives that are on the line ... Rosenthal’s book doesn’t conclude with conglomerates. She also provides an eye-opening discussion of skyrocketing drug prices, as well as the less-familiar pathologies of excessive medical testing and overpriced medical devices ... She also weaves in moving tales of those who are paying dearly for that enhanced bottom line — which, in the end, includes all of us. Where Rosenthal’s account falls short is in explaining why this deeply broken system persists ... Without a clear view of the political economy of health care, it’s easy to see the problem as Justice Scalia did. If we could just start treating health care like broccoli, the market would solve the problem. But as Rosenthal’s important book makes clear, the health care market really is different.
While she highlights a handful of players who have fought to bring down costs or resisted what she sees as usurious practices, her theme is not the good but the bad and the ugly, and she never strays far from condemnation. The points she makes are valuable, but her broader case might have been more persuasive with more balance and a greater willingness to acknowledge the many trade-offs that any health-care arrangement will require, even the single-payer alternative she seems to favor ... much of the time it seems as if Dr. Rosenthal sees no justification for anyone to get paid or turn a profit, which of course would sink any business ... It isn’t necessary to accept all of Dr. Rosenthal’s criticisms—or to agree with her assessment that profit is the main driver behind everything in American health care—to concede that reform is needed. Nor is it necessary to unequivocally condemn a system that has done so much for so many, whatever its flaws.
In this in-depth analysis of a malfunctioning system, Rosenthal makes a compelling case against the hospital and pharmaceutical executives behind the 'money chase,' and it’s hard to imagine a more educated, credible guide ... After laying out the problem, Rosenthal presents solutions both personal and societal in this commanding and necessary call to arms.
The first part amounts to a comprehensive dissection of profiteering in sector after sector of the health economy, buttressed by extensive reporting on the human impact of these developments ... Rosenthal doesn’t claim to propose one major systemic reform—though she briefly reviews a few such proposals over a few pages—but instead to offer a slew of steps that we as individual patients can take to protect our wallet, or our health, together with relatively smaller scale reforms that mostly would not require Congressional action. Many of Rosenthal’s proposed solutions make sense...But many of Rosenthal’s solutions accept the basic merit of health care consumerism ... There is simply no way to square this circle: Price shopping requires cost-sharing, and cost sharing hurts us, both financially and medically. And in any event, the notion that people need 'skin in the game' so as to prudently 'consume healthcare' misses an essential fact of human behavior.
Rosenthal unveils with surgical precision the 'dysfunctional medical market' that plays by rules that have little to do with patient-centered, evidence-based medical care ... Her advice for now is starkly simple: we need to question everything, including your choice of doctor, hospital, billing statement, insurance, and the drugs and devices we’re prescribed. Given the 'false choice of your money or your life,' Rosenthal argues, 'it’s time for us all to take a stand for the latter.'
Throughout, the author blends extensive research with human interest. A personal horror story, with names and dates, opens each chapter ... A scathing denouncement, stronger in portraying the system’s problems than in offering pragmatic solutions.
