An American Sickness: How Healthcare Became Big Business and How You Can Take It Back Hardcover – April 11, 2017

American Sickness by Elisabeth Rosenthal is an exhaustive, detailed look at the American healthcare system. The author examines every facet of healthcare, going back to the beginning in order to understand how we have gotten to where we are.If there is one overriding theme that one could point to as the cause of skyrocketing healthcare costs, it is greed. Our healthcare system has morphed from a patient-centric system to one where profits come before patient care.The first half of the book is a history lesson. What were things like before there was health insurance? When did things change from a need to protect people to one where maximizing profits became the primary goal? Along the way, the author uses real-world examples culled from actual patient bills to illustrate just how out-of-control things have become.The second half of the book looks at what needs to happen in order to gain control of costs. The author offers a wide array of solutions. The first step is to be more proactive with your own healthcare. Ask questions. Challenge unethical practices. One example the author gives is a patient who is visited by an anesthesiologist. The anesthesiologist stops by the patient's hospital room. "How are you doing?" "Fine, thanks."Okay, let me know if you have any questions?" The anesthesiologist leaves and the patient finds out later that he or she was charged a $500 consultation fee.The second step in controlling costs is government intervention. There are going to be a lot of people who are going to argue against this. The government shouldn't be in control of my health. Regulations hamper innovation. The truth is that the benefits of sensible government intervention and regulations far outweigh any negatives. For example, a government-controlled fee schedule would prevent wide disparity in charges for the same procedure. A national health database would allow patients to have their health records stored in a single location, accessible to healthcare providers anywhere, eliminating duplicate and unnecessary tests. Many of the problems we have today are the direct result of politicians bending to the demands of political donors over the interests of their constituents.What about the Affordable Care Act? The author calls it a good first step. Unfortunately, Republican opposition and efforts by industry PACS have weakened its effectiveness.There are hundreds of examples of outrageous charges and bills from actual patients. One that stood out for me involved a plastic surgeon who charged $50,000 for three stitches in a toddlers face. The parents of the child not only complained to the hospital, the doctor, and to their insurance company, but they also sent a copy of their complaint to a plastic surgeon professional group. The pressure from the complaint eventually led to a final bill of $5,000.This is one book where I listened rather than read. The deluge of facts and figures were easier to consume. I highly recommend this book. I especially recommend this book to the regulators and healthcare professionals who are in the best position to make the changes needed.

Dr. Elizabeth Rosenthal is well poised to appraise our current healthcare system and offer advice for individuals and policy makers. The author is a Harvard trained physician who practiced emergency medicine, was a New York Times reporter, and in September 2016, became the Editor in Chief for Kaiser Health News."An American Sickness - How Healthcare Became Big Business and How You Can Take It Back" tells how we got where we are. Dr. Rosenthal exposes physicians, hospitals, health insurers, pharmaceutical companies and even the government, for roles in getting us where we are now. The United States spends more for healthcare than any other country in the world, yet medical bills threaten financial ruin for many Americans.Dr. Rosenthal uses stories to carry her narrative. Patient stories will help the reader understand the implication of current health policy. It will help you understand your medical bills and arm you with tactics to advocate for yourself.This book is not superficial. Dr. Rosenthal crafts her approach citing laws and regulations that shaped our current healthcare system. Her explanation of “Observation” status rather than being “Admitted” to the hospital is concise, yet revealing. “Observation” allows you to receive hospital care while not actually being admitted to the hospital. This has far reaching implications as Medicare does not count an observation stay in the hospital as a qualifier for paid care at a nursing home or rehabilitation center. Observation status also circumvents financial penalties to a hospital should a patient be re-admitted within 30 days. After all, the patient was never “admitted,” he or she was only in the hospital for observation.My favorite advice regards “your willingness to accept financial responsibility for charges not covered by your insurance” (p. 264). Dr. Rosenthal recommends you add a sentence before you sign, “As long as the providers are in my insurance network.” Throughout the book, the author provides vignettes where patients receive surprise bills. Even if you seek care at a hospital in your health plan’s network, some of the medical providers may not be in your plan’s network, leaving you with thousands of dollars of medical bills. Dr. Rosenthal’s advice seeks to stop this injustice.I highly recommend “An American Sickness.” As our government seeks to repeal and replace the Patient Protection and Affordable Care Act of 2010, it is worthwhile for all of us to better understand how we got where we are. For the individual, this book provides advice that could save you financial ruin due to healthcare bills. Successfully navigating our healthcare system, as this book teaches, could save your life.Michael J. Warner, DO, CPC, CPMA2017 AACOM Health Policy FellowPresident, Patient Advocacy InitiativesCo-author Rise of the Patient Advocate – Healthcare in the Digital Age