An American Sickness: How Healthcare Became Big Business and How You Can Take It Back

Nonfiction | Book | Adult | Published in 2017

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Summary

Chapter Summaries & Analyses

Introduction and Part 1, Chapters 1-3

Part 1, Chapters 4-6

Part 1, Chapters 7-9

Part 1, Chapters 10-11

Part 2, Chapters 12-15

Part 2, Chapters 16-18

Epilogue and Afterword

Key Figures

Themes

Index of Terms

Important Quotes

Essay Topics

Tools

Beta

Discussion Questions

Themes

Prioritization of Profit in Healthcare

Rosenthal discusses the tension many medical professionals feel between prioritizing profit and prioritizing patient care. In a field increasingly ruled by unfettered market interests, every sector of the healthcare industry is forced to consider financial gain on a similar, if not equal, level to patient care. This theme is in play at the very beginning of Chapter 1, when the reader learns that Jeffrey Kivi’s clinic collects royalties from his use of a trial drug. The passages following the story detail the humble beginnings of insurance plans, and how they were meant to support teachers and other workers in doing their jobs. That past and the modern reality conveyed in this book are at complete odds with each other.

Not all physicians are exploitative and money hungry. Some seem to genuinely struggle with their inability to properly balance the expectations of working in the field. Dr. Lakowsky, who struggled after selling his independent practice to medical conglomerate Sutter Health, is an example of a figure who has difficulty balancing the two facets of the healthcare industry. He partially sold to Sutter Health for financial reasons, acknowledging that he would receive 25 to 30% more than he had been making previously. However, he also thought the extra medical infrastructure would allow him to provide better services to his patients. When this ended up backfiring, he was most upset about his inability to “be [his] patients’ advocate” anymore (210). The system of profit prioritization in healthcare defeated the doctor’s good intentions.

Conversely, other doctors make this choice very easily. Dr. Yasser Awaad, a neurologist from Chapter 6, over-prescribed electroencephalography (brain wave) scans to young children, who he would follow up with every few months. Electroencephalography is a treatment that can be prescribed frequently without too much concern for a patient’s safety. Dr. Awaad ended up making over $600,000 a year, not including a $250,000 productivity bonus. As it turns out, many children he “diagnosed” did not actually have seizures, and he ended up moving back to Saudi Arabia (152). To be fair, Dr. Awaad was not interviewed in the same capacity that Dr. Lakowsky was, but each of these doctors show how money can drive a practice and treatment plan.

The Power of the Individual

Rosenthal presents her belief in the power of the individual differently in each part of the book, but it is a common thread that goes to highlight the strength patients must have and the power behind speech and expression. Personal testimonies are the driving force behind the first part of the book. The interviewed patients all reflect different life experiences, but each has emotional responses to the healthcare industry that readers can connect to.

In the first part of An American Sickness, the power of the individual contributes to the emotional reaction that the testimonies are meant to elicit out of the readers. Any reader, whether they have experienced medical debt or not, can sympathize with Wanda Wickizer considering death by suicide so that her kids do not have to bear the burden of their debt (170), or Hope Marcus’s candid description of the fear she felt upon realizing she would have to illegally order her medication abroad (87). Even if the interviewees did not necessarily know how to respond to their struggles with the medical industry, the inclusion of their candid stories serves as the first part of Rosenthal’s call to action.

Having now been motivated by Rosenthal’s curated testimonies, Part 2 builds on the reader’s budding desire to act. If Part 1 was guided by the power behind an individual’s story, Part 2 is driven by Rosenthal’s strong faith in the power of an individual’s actions. By entrusting the reader with explicit steps that they must take in order to contribute to changing the industry, Rosenthal is demonstrating that she believes in their potential. A patient asking a simple question of their doctor has the potential to set off a “chain reaction of price transparency” and can affect change within other doctors they may never meet or hospitals they may never visit (255). Patients can also become powerful by seeking out information. Rosenthal offers frequent comparisons to medical systems in other countries and charts the history of medical legislation so that the reader knows what worked and what didn’t. They can use this information to lobby their government officials, but they can also use if and when people are able to come together and rebuild the healthcare system.

Certain testimonies from Part 1 demonstrate the outcome of following Rosenthal’s advice. Dr. Greg Duncan advocated for the preservation of the obstetrician ward at Coast Hospital after its critical access designation, and despite initial backlash, Sutter Health eventually responded to his demand. This shows that any reader can use the information in Part 2 of An American Sickness to build the future they desire.

Corruption by Business Interests

Rosenthal repeatedly proves that the medical industry cannot be trusted to regulate itself. Both she and her interviewees partially blame this on the proliferation of money and business interests into the industry. As hospitals were forced to adopt bureaucratic tendencies to survive, they left more and more of their management to trained administrators, contractors, and consultants, all of whom encouraged them to focus solely on money.

The government also fails to regulate the industry. The healthcare industry’s consultants allow them to be one step ahead of legislation at all times. This is best exemplified by drugmakers’ consistent manipulation of the Hatch-Waxman Act in order to slow down the approval process for competitive drugs (95). The American government also frequently receives lobby visits and many politicians court big donors. Sometimes, the prospect of profits brings the worlds of healthcare and politics together, as medical PACs and legislative bodies exchange donations and support for favorable legislation (199-200). Business interests have dictated the interests of the healthcare industry and the government. This has always come at the expense of the patient.

This is thematically significant because Rosenthal sees her readers as the keys to reforming the industry. By repeatedly showing how failing to rein in business interests renders certain regulations unenforceable, Rosenthal is telling the readers what mistakes cannot be repeated as they seek reforms. They should also be discerning as to who (or what) they select to regulate this industry. In the epilogue to An American Sickness, Rosenthal theorizes that the corruption of the healthcare industry is a sign of an “age of decadence” that heralds the end of a great society (328). If we have truly reached this point and are tasked with rebuilding the healthcare industry from the ground up, it will be essential that we relegate a new role for business in society, preferably far away from healthcare.