Great reporting

Alexander feels handicapped at times by some ideological biases, but the on the ground reporting and access is top notch. ( )

4.5 stars. Powerful, devastating, and depressing ( )

There is nothing surprising about any of what the author writes or concludes--I think that's the main reason I give this study of American healthcare a four star. Otherwise, this work does an excellent job of highlighting the system's failings by illustrating the lives of those on the frontline. A good one for anyone that cares about the healthcare problems in the US. ( )

Like too many books lately, I hesitated on how best to review this book. This is not a big book, but it powerfully captures the complexity of a subject that far too many Americans have no clue how complex it is, namely, America's healthcare system. Need proof? The U.S. elected a president who famously asked, who knew how complicated it was? Who indeed? Pretty much anybody paying close attention. Something I've been doing for decades, arguably starting 50 years ago when I was working in the Orthopedic clinic for a major regional research hospital with world-class physicians. There are other healthcare related books I would recommend, but this book gives, I believe, the average reader of whatever political persuasion, the best grasp of where they stand in our system's maelstrom. What the author did to get the intimate access to a host of "characters" is really stunning journalism. I have only one gripe, and that really is perhaps not fully the author's fault. After such good investigative journalism, two things happen in the community he is covering. One is an action taken by the hospital and the other is a pandemic. Frankly, it seems to me, the author sort of loses it, as everything falls apart, and his narrative shifts gear rather dramatically. One might call it a rant. Maybe, but it is still a very accurate rant. It just isn't in keeping with the rest of the reporting. Perhaps I'm asking too much, for a slightly smaller book, and a follow-up magazine piece, to keep the two parts separate. It's not as if the author is wrong. He's painfully, depressingly accurate. I feel a little badly at knocking off a point on my rating. It really is very well worth reading. ( )

Everything Wrong with American Healthcare

As the Covid pandemic has clearly demonstrated, a large segment of the American population lives in a delusional world completely divorced from reality. Here, in The Hospital, Brian Alexander lays bare one of the great delusions. It’s not that America has a good healthcare system that with a few tweaks and enhancements could serve the majority of the population. No, the delusion is that America has anything that can be called a real healthcare system.

At the root, as his time spent in a small American town shows, are two deadly ideas: that all Americans not only are personally responsible for their own healthcare, but that the sickest among us bear full responsibility for their bad health and early death due to some defect in their character. And that America’s obsession with raw, unfettered capitalism must encompass all aspects of American life, including healthcare. These ideas, shared by the well-off, the poorest, and everybody in-between, deliver to Americans a hodgepodge collection of medical services that only those with the deepest pockets can afford, a system that not even the commercial medical insurance available to those employed can afford, as evidenced by some of the sorry stories in this book.

This is not to say that those involved in the healthcare industry, and make no mistake it is an industry that happens to have as its end product the delivery of healing services; it’s not to say these people don’t care and want to do their best. It’s that they operate in a system that prevents them from delivering the best care and treatment to all but the well-off. Alexander gained access to the boardroom discussions in Bryan, Ohio’s small, independent hospital. As readers will see firsthand, CEO Phil Ennen and his team spent a good deal of their time devising strategies for fending off the large hospital systems from Fort Wayne, Toledo, and as distant as Pittsburgh, who wished to take them over as part of their consolidation efforts. The struggle never seems to cease: how to attract medical talent and hold onto it; how to add the most profitable speciality services; how to generate the surplus income that constitutes profits and fuels independence, salaries, and the like. Make no mistake as the annual reports of nonprofit hospitals show, nonprofits can be very profitable, as a perusal of your large regional nonprofit hospitals will clearly show.

Probably the most enlightening chapter is Chapter 6: What Free Market? The Myth of Free-Market Medicine. Here you’ll learn about profit and loss, about regional consolidation and the building of medical oligarchies, about pricing; generally about the economics of hospitals and medical practice in a system fiercely devoted to capitalism in every aspect of American life. If you read nothing else in this book, spend some time with this chapter.

Some reviewers have accused Alexander of sounding angry on the page. Some say this is an exercise in support of socialized medicine. Well, if he’s angry about a so-called system that eats up nearly twenty percent of American GDP, more than twice as much as any developed country, and delivers abysmal results for the majority of Americans, and especially for those most in need, well, he, and more importantly you, should be angry. And as for socialism, nonsense. How about an orderly system that delivers the best possible care to the most people at reasonable cost? Can’t do it? We already do it, but only for a segment of the population. We call it Medicare and Medicaid.

Please read The Hospital with an open mind and then demand something better for your sake and that of your family, and for your fellow Americans who may not be as well off as you. ( )