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.
