An American Sickness: How Healthcare Became Big Business and How You Can Take It Back is physician and journalist Elisabeth Rosenthal’s overview and critique of the American healthcare system. It was initially published in April 2017, arriving during a time in which healthcare reform became a prominent cornerstone of both Democratic and Republican political campaigns. The book offers a mixture of testimonials from a myriad of people impacted by the health industry, including medical professionals, scholars, and patients. Despite what Rosenthal sees as a dire prognosis, she also offers solutions for America’s patients so that they might have an easier time navigating the healthcare system. This guide corresponds with the 2018 edition published by Penguin Books.

Summary

The book is divided into two parts. Part 1, “History of the Present Illness and Review of Symptoms,” identifies the healthcare system’s various ailments through a review of its history. Part 2, “Diagnosis and Treatment: Prescriptions for Taking Back Our Healthcare,” strives to give readers insight into how they can change the industry’s status quo. The solutions she offers are broad and range from acts of political protest to simply being empowered with information about options for medical treatment. This approach garnered Rosenthal significant praise, as the book went on to become a New York Times bestseller and a Washington Post Notable Book of 2017.

Part 1 takes the reader through the healthcare industry piece by piece. Each chapter discusses different ways that the medical industry exploits patients. This reflects a tension between healthcare’s charitable roots and need for profits. Some doctors and hospitals try to remain true to their past, but experience pressure from superiors and financial woes. The book begins with the history of insurance and explains how it grew from a few scattered teachers’ unions in Texas to a multi-billion-dollar sector within the healthcare industry. It also explores its relationship to doctors and hospitals, who often exploit patients for profit due to cleverly crafted loopholes within healthcare. She demonstrates this with testimonies from everyday American patients who come from radically different backgrounds but are bonded by their catastrophic, life-altering experiences with the healthcare industry.

While readers will be familiar with the issues patients face at the hands of insurance, hospitals, and doctors, Rosenthal also seeks to combat ignorance by exposing the practices of certain sectors that are less visible to the public eye. The next three chapters cover pharmaceuticals, medical devices, and ancillary services. Many of these sectors exploit a lack of both governmental regulations and oversight from patients and professionals to corner specific areas of the market with overpriced drugs. The pharmaceutical industry is frequently going toe to toe with Congress about legal matters pertaining to patents and price gouging.

The next three chapters discuss the political and bureaucratic forces that control the industry. Third party billing contractors rarely have any notion of charitable obligation and can potentially wreak havoc on a family. Bills are also written with intentionally confusing code to prevent patients from digging too deeply into their itemized bill and to take opportunities to monetize higher-coded services. Medical nonprofits tout treatments for diseases while seldom funding potential cures. They also lead PACs (Political Action Committees) with undue influence on medical policy, contributing to a political system where interest groups are writing the legislation that governs their own practices. Lastly, America limits healthy competition amongst hospitals by failing to regulate the market and allows conglomerates to overtake entire cities.

Some of these problems were addressed by the 2010 passage of the Affordable Care Act. However, the medical industry is armed with consultants that can find the perfect provision or loophole that excuses their actions. Despite this, the fact that the ACA provided millions of Americans with insurance for the first time cannot be overlooked. When President Trump sought to repeal it in 2017, his administration found that the public viewed the ACA favorably.

Part 2 operates like a guidebook. Rosenthal explains how Americans can change the health industry, ranging from taking individual action to pressuring Congress. She offers a wealth of information, and patients are able to choose any course of action that particularly calls to them. More seasoned political participants may choose to organize a lobbying visit to Congress or endure an argument with a debt collection agency, while those just getting started can have a simple conversation with their doctor to ensure they are informed about their care plan. Each method is given equal credence, and readers are shown the potential positive outcomes of each path they might pursue.