An American Sickness

by Elisabeth Rosenthal
Penguin Press, 2017
Review by Christian Perring on Nov 7th 2017

In An American Sickness, Elisabeth Rosenthal outlines the unscrupulous business practices of hospitals, doctors and insurance companies in the USA that result in massive medical bills for patients and often second-rate health care too. She is a doctor and now works as a medical journalist, and in An American Sickness she piles up the evidence for her case. There is shameless profiteering, exploiting of patients, deception, collusion, between the different health providers and the bureaucrats who run them. She powerfully presents medicine in the USA as a profession that has betrayed its roots as a caring profession, becoming one that maximizes profit at the expense of patient welfare.

After reading this book, it will be hard for anyone in the USA to trust any health professional. People will avoid hospitals if at all possible. When medical bills arrive, they will want to just burn them. The information Rosenthal reveals paints the medical profession as an enemy of the people. Other information that Rosenthal does not focus on, about how careless doctors have been in prescribing opioid drugs in recent decades, fueling the resulting crisis of addiction that is riddling the USA, has been another source of major distrust in doctors. Rosenthal does discuss some cases of medications that were released but not sufficiently tested for their safety, resulting in many deaths.

The second part of the book gives guidelines about how to protect oneself against all this medical and financial malpractice. Her basic message is that you need to educate yourself and be ready to go into any medical office or institution with a lot of attitude, ready to demand your rights, and not take any lies or obfuscation from medical staff, insurance companies, or anyone representing them. Keep all the paperwork you get from them and demand more. Shop for the best prices and question the bills that you are given. Arm yourself with information from the Internet. If necessary, go for medical service outside of the USA. It's enough to make one want to just leave and move to a civilized country.

Of course, this won't be an option for most. Indeed, most of us don't have time to even fight medical bills, because it is time-consuming and is clearly designed to be an exhausting process. Rosenthal's solutions might be right -- they are based on experience and so they are certainly worth trying when faced by a corrupt billing practices and second rate medical practices designed to maximize profit rather than promote patient health.

But Rosenthal doesn't fully address the implications for the doctor-patient relationship. When trust is largely undermined, and one has to be ready to be a difficult patient in order to get good treatment at a fair price. Even reading the book is liable to make one angry and upset that we have come to such a pass in the USA that medicine has been so utterly corrupted.

I watch the UK TV show24 Hours in A&E whenever I can. A reality show filmed in a London hospital emergency department, the doctors and nurses show care, compassion, great skill and patience, along with a good deal of humor and wisdom in the quieter moments. While their depiction might not be completely balanced, we see that no patient is ever billed for services, and they can focus on the health issues. We know that any visit to a US hospital entails one has on the guard against maltreatment, negligence, and especially unnecessary treatment. After a visit to a US hospital, many patients will have to spend months or years dealing with confusing billing for ridiculous amounts of money. The moral implications are that going into US medicine is no longer an admirable or honorable choice for most people. It is a morally compromised profession.

That's not to say that every doctor and other medical profession is out to take advantage of patients. I know quite a few psychiatrists, and they are all good people who care for their patients. But undeniably in the US, the state of medicine is so much run for money and profit (even in so called "non profit" organizations) that the work is a real challenge to the integrity of the workers. (Parenthetically, I write this with the awareness that much the same can be said of the education industry in the US these days, with the problem of college debt and many people with college degrees unable to find jobs.)

Christian Perring teaches in NYC.

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