Want to know what ails America?
Read the richly researched ‘Hospital’
I think we can all agree that health care in this country is messed up.
When I Google “healthcare crisis” the first three links returned are from medical journals dated 2020, 2006 and 1993. This urgent problem has been urgent for at least 30 years, and whatever progress we’ve made to mitigate the crisis seems rather insufficient.
The thing is, because it’s so complicated, and been messed up for so long, the average person — and I’m talking about me here — has, at best, a partial understanding of why American health is not great (and getting worse), while costing more and more, year after year.
This is why Brian Alexander’s newly released “Hospital: Life, Death, and Dollars in a Small American Town” is so vital. Alexander has dug to the roots to present a richly researched, highly contextualized, deeply compelling narrative, centered on an independent hospital and the citizens who use its services as they try to survive in the small Ohio town of Bryan.
The big picture story of “Hospital” is a portrait of a system that has little to do with being oriented around ensuring the health of as many people as possible as efficiently as possible; it is instead designed to enrich the few, at the expense of the many.
Alexander illustrates this dynamic with stories of individuals such as Keith, a man in his 40s, whom we follow over more than a year as he goes from someone who works six days a week to a near invalid, blind in one eye, parts of his foot amputated due to complications from uncontrolled diabetes. Sporadic insurance coverage and high deductibles led to waiting too long to address burgeoning problems. The price of insulin climbs over 10 times, making it impossible to afford medication that would prevent expensive surgeries and hospital stays.
The community hospital in Bryan, under constant threat of having to sell to a larger hospital group, manages to stay solvent through a combination of guile, luck and scotch tape. Phil Ennen, the hospital CEO and a kind of tragic hero in the book, has to find ways to bring in revenue to make up for necessary services that lose money. Interventional cardiology is a big one, as putting stents in to pry open clogged arteries is a high-dollar procedure.
Of course, it would be better if those dollars went towards preventing heart disease. This is where Alexander’s book is especially valuable. People should be responsible and eat better, we might think, but over time, grocery stores offering fresh, nutritious foods have closed, leaving dollar stores, with their sugary drinks and snack foods as the alternative. Working multiple jobs to make up for low wages means grabbing fast food on the run. No paid time off means ignoring that cough or that chest pain; if you don’t work, the fragile economics of life falls apart.
Health-care problems compound by generation.
Despair takes hold, and addiction and suicide become epidemics.
Alexander shows that we don’t have a problem with health care. We have a problem with society. Consultants who tell hospitals how to become profitable make millions. Private-equity firms squeeze dollars out of doctors’ groups, discarding them like a husk once the wealth is extracted.
Patients, particularly those most in need, suffer.
By the end, Alexander convinces us that you could not craft a system less suited to the its putative purpose than what we have. Because it is a system that generally works for the wealthiest and most powerful, change is hard to come by.
But make no mistake, we’re all paying the price.