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

“The financial structure of a hospital, due to legal and philosophical constraints, has not developed in the same manners as that of a commercial corporation [...] The [philanthropic] benefactor alone cannot subsidize hospital operations.”

This is a quote from a book entitled The Financial Management of Hospitals by Howard J. Berman and Lewis E. Weeks. Though published in 1982, the book proved to be extremely prescient in predicting the next few decades of changes to the healthcare industry.

“If Republicans were disingenuous in evoking death panels to discredit the Affordable Care Act, Democrats have been equally so in heeding their local hospitals’ calls for more residents.”

While this quote is describing a specific problem within the healthcare industry, it demonstrates the depth of the influence the medical industrial complex has in politics. The Democrats have staked much of their political reputation on passing the ACA and championing healthcare programs that serve all the people. However, they supported a move that ultimately benefited healthcare conglomerates. This shows the true scope of the power the healthcare industry wields in society.

“Thousands of physicians made more than $1 million each from Medicare in 2012, and dozens more than $10 million.”

This quote demonstrates both the gaps in what doctors say about their wages and the extent of the tension between Medicare and physicians. A prominent theme in Chapter 3 is that doctors and Medicare constantly grapple over regulations, with doctors frequently seeking out loopholes on the grounds that they are underpaid. This quote, which is describing the content of a donor dataset released by Medicare, shows that many doctors make more than any American will ever hope to in their lifetime, and highlights just how dire the need is for stronger regulations.

“Medicine is a business. It won’t police itself.”

This quote is from William Sage, who is a professor of health law at the University of Texas. Sage highlights a key tension within the medical industry. It is constantly attempting to balance its current bureaucratic, profit-driven structure and its charitable origins that are a point of pride for many doctors. By explicitly describing medicine as a business, Sage presents an industry professional’s opinion of which side is winning.

“You don’t put down the hose if the water becomes more expensive.”

This quote is in response to Rosenthal’s depiction of the consistent, expensive treatment required for multiple sclerosis. However, it is broadly applicable to the current plight of patients trying to navigate the healthcare industry and illustrates why change is so sorely needed. At some point, patients cannot let certain illnesses or injuries remain untreated and are forced to drain their finances for the sake of health.

“[C]ost-saving new treatments have had a maddeningly hard time finding their way into the American medical bazaar, because lower prices for patients often translate into loss of income for someone with greater clout.”

This quote serves as a rebuttal to the idea that Americans get new treatments first, a common defense meant to excuse certain flaws in the industry. American manufacturers often move to block any new treatment that threatens their profit, which ends up keeping many medications off the market.

“[I]ndustry knowingly targets less experienced surgeons, knowing these mesh kits have not, and never will be accepted by more experienced surgeons who are fully aware of their inherent risk without benefit.”

Rosenthal urges readers of An American Sickness to note that ignorance can lead to patient exploitation. While readers may expect to see this predominantly mentioned in reference to consumers, this quote demonstrates that it is a problem that is just as prevalent amongst health professionals. Planting this seed in readers’ minds is likely to inspire them to demand more from their healthcare professionals, something Rosenthal sees as crucial in the pursuit of changing the industry.

“[T]he base rate for a basic ambulance ride in 2014 was $1,033 ($1,445 if an advanced life support team is on board), plus $19 per mile and $51.50 for every fifteen minutes of waiting. And that didn’t include extras, such as $84.75 if it’s after 7 p.m., $67.75 for the use of an oxygen tank, and $27.25 for each ice pack and bandage, and the oxygen mask.”

This quote describes the fees associated with an ambulance ride in Los Angeles, CA. By clearly displaying an instance of excessive billing, Rosenthal shows the dire reality of an unregulated medical market. 

“Just imagine if your monthly credit card bill arrived as a haphazard list of some random meals and clothing purchases, accompanied by a demand that you pay for everything, including the items you couldn’t see.”

This quote is an example of a strategy Rosenthal employs often, which is asking the reader to question whether they would accept standard medical practices in other parts of their life. This strategy encourages the reader to contextualize these issues within more familiar frames of references.

“My kids got really upset because I said—and I meant it—if I’d just died, you’d have money for college. It would be better.”

Wanda Wickizer recalls telling her kids that they would be better off if she were dead, so that they would not continue to be burdened by her extreme medical debt. When Wickizer offered the hospital the entirety of her retirement funds to offset some of the costs, they refused.

“If the March of Dimes was operating according to today’s foundation models, we’d have iron lungs in five different colors controlled by iPhone apps, but we wouldn’t have a cheap polio vaccine.”

This quote is describing the nonprofit sector, which is rarely associated with corruption. However, the profit-oriented mindset that infiltrated the medical industry is also corrupting charity. This ties into Rosenthal’s broader claim that the decline of the medical industry is connected to a broader social decline that America must overcome.

 “[...] Dr. Norton said of the exercise: ‘The questions and the methodology were designed to capture the largest range and the biggest market.’”

This quote refers to the steps medical societies take to evaluate the prevalence of certain procedures, noting that they are executed in such a way that calls the validity of their results into questions. It lends support to the book’s broader theme of the importance of being informed about the context behind certain medical procedures that may be recommended to you.

“[I]ndependent doctors have struggled for financial survival in a region where Sutter owns so much of the healthcare infrastructure and has so dominated insurance negotiations that independent doctors found themselves excluded from many patients’ insurance networks—especially plans that paid well.” 

This quote reflects the effects of artificially stifling competition. Sutter Health is not inherently better than its counterparts—in fact, most testimonials in this chapter suggest it offers a lower standard of care for a higher price. However, it used its financial power to completely corner the Bay Area healthcare industry.

“Doctors and medical centers, who two decades ago might have worked hard to figure out an affordable payment, now rapidly turned over patient accounts to billing services and collection and credit rating agencies. By 2014, 52 percent of overdue debt on credit reports was due to medical bills and one in five Americans had medical debt on their credit record […].”

This dire picture of American medical debt shows a clear example of the healthcare industry abandoning its original purpose. Receiving high quality medical treatments can actually cause patients to experience a decrease in their quality of life.

“But a 2015 study found that when patients were switched into a high-deductible health plan, they didn’t become smarter, more cost-conscious shoppers for medical care. The exorbitant prices demanded by the U.S. healthcare system meant that they mostly just avoided any interactions with medicine at all.”

This quote describes how the Affordable Care Act was no match for the existing profit-driven insurance market, who began wheeling out high-deductible plans in response to its passage. These plans almost appear to be punishing patients for seeking necessary healthcare. Even a well-intentioned, highly researched insurance program with federal backing was dwarfed by the cutthroat industry standards.

“There is no Supreme Court of the ACA to parse its original intent.”

This quote describes how certain medical sectors have exploited the Affordable Care Act to profit off of patients. While it is referring to doctors’ behavior, it brings up an interesting point about the affect a lack of strong oversight has on patients’ experiences within the healthcare industry.

“Unless you’re part of the 1 percent, you’re only ever one unlucky step away from medical financial disaster.”

Rosenthal repeatedly identifies patient ignorance and complacency as a factor that allows the medical sector to continue certain corrupt behaviors. She forces her reader to contend with the precarity of their situation, and she encourages them to engage with the problem.

“I had always felt good that I’d saved a patient’s life by a simple act like taking out an appendix [...] I realized right then that I was bankrupting them too.”

This is a quote from Dr. Hans Rechsteiner, a surgeon from Wisconsin. He is describing the moment he realized the extent of the financial plight many of his patients face. Seeking lifesaving medical care can paradoxically condemn a patient to a life of debt and financial insecurity. This moment led him to publicly endorse a number of healthcare reforms, including the expansion of Medicare.

“Dr. Jha, who had practiced in Great Britain and Australia, said he was shocked at the batteries of tests Americans routinely received, many of them useless.”

This quote gives the reader insight into how other developed countries view America’s healthcare system. This is one of many testimonies Rosenthal collected from doctors who have practiced in other countries; almost all of them had the same critiques. They do not understand how Americans pay so much but receive so little.

“Surveys show that millions of Americans don’t fill a prescription because of cost.”

This interpretation of survey data demonstrates that patients are forced to put their financial security above their healthcare needs. It shows the direct ramifications of living in a country whose medical field is treated as an industry.

“The lure of easy patents and big profits has induced drugmakers and device manufacturers to invest heavily in research and development to tease out new cures. For better or worse, this is how we reward innovation.”

The potential to make huge profits from research endeavors is often too big for drugmakers to ignore, leading them to completely invest their resources. The profit that comes from peddling treatments has taken focus away from finding cures.

“A business-friendly peculiarity of U.S. law means that the government bodies charged with the responsibility to ensure patient-centered healthcare cannot directly consider the pricing of treatments, medicines, or devices in their recommendations and deliberations.”

This quote shows the extent to which business interests have proliferated the government, affecting the healthcare industry. This passage goes on to describe how certain provisions of the ACA are difficult to enforce due to existing laws protecting businesses. This gives the government very little room to advocate for patients.

“The fathers of modern medicine [...] like Frederick Banting, who pioneered insulin treatment; Jonas Salk, who discovered the polio vaccine; Albert Starr, who invented a lifesaving artificial heart valve; and Thomas Starzl, who fathered modern organ transplant—helped usher in a new era of scientific healing [...] But the respect they earned through their noble efforts has been squandered in the past quarter century. The treatments we get and the prices we pay are governed as much by commerce as by humanism or science.”

This quote contrasts the “golden age” of medicine with today’s reality. Charity-driven medicine is something older readers will have distant memories of, and younger readers have not experienced. Many of these treatments only earned their place in history because of their accessibility: Salk’s vaccine has rendered polio effectively extinct. It is difficult to conceive of a scientist making similar choices today, especially when there is a profit to be made.