Elisabeth L. Rosenthal's An American Sickness: How Healthcare Became Big Business and How You Can Take It Back dissects the grim truth:
Rosenthal is a physician with a degree from Harvard Medical School and and journalist with twenty-two years experience working for the New York Times on a variety of beats including Beijing, bird flu, and environmental degradation. Back in New York, she covered adoption of the ACA and moved on to researching the cost of U.S. medicine. (She's now editor-in-chief at Kaiser Health News.)
In this utterly readable volume, Rosenthal lays out through anecdote and expertise what has gone wrong in the delivery of medicine. Separate chapters explain how all facets of the system have organized themselves over the last 25 years to extract maximum cash from largely defenseless patient/consumers. We're being ripped off every which way -- by insurance companies, hospitals, doctors, drug makers, medical device vendors, lab testing and other ancillary service contractors, and increasingly by monopolistic health conglomerates.
The second half of the book is as deep and detailed as Rosenthal's description of the problem. She is full of ideas about how to fix this foul cesspool of exploitation of human helplessness. She explains what individual patients should question and what they should protest; she even provides sample letters. She makes suggestions for how play various parts of the system off against each other, such as insurance companies, doctors, and pharmacists; make 'em work for your business. She has solid suggestions for collective political remedies, particularly in the area of strengthening and making responsive the various state-level insurance commissioners. (This caught my attention because California made this an elected position by initiative in 1988 and some subsequent occupants been quite useful to patients.) There are numerous state and regional regulatory tweaks that could help some.
But ultimately the federal government is going to have to root out the greed that defines the healthcare system. Obviously with the party representing the One Percent in power, that's not currently happening. But we can and will demand better; it is our lives at stake. Rosenthal reminds us, patients do have allies within the system:
Here are Rosenthal's Rules for understanding the U.S. medical system to ponder; click to enlarge:
Rosenthal would recognize this sentiment and this determination.