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beckimoody29's review against another edition
5.0
If I wasn't already upset about medical care in America, I would be after reading this book. The author has unprecedented access to the behind the scenes working of a small town hospital, attending board meetings and interviewing everyone from local politicians, to executives, to doctors and nurses and EMT technicians. Interviews with patients reveal how decisions made affect actual patients. Despite the current political landscape, there are no villains here (except maybe the big conglomerates) --just a poorly cobbled together system focused on profits over health. Everyone involved wants to save lives and do good, but are forced to "play the game" in order to survive. These aren't the guys retiring with billion dollar stock options. This is the CFO paying three times as much for saline (literally bags of salt water!!!) because he doesn't order enough volume. Alexander backs up his interviews with solid reporting and research into the history of health care and the current landscape.
lajacquerie's review against another edition
4.0
This was a fascinating look at the US healthcare system through the lens of one small independent hospital. It's a slice, of course—our system is too large and idiosyncratic to be fully captured in any document totaling less than 1,000 pages, probably—but it's an instructive one.
Alexander gives us a brief overview of How This Came to Be, harkening back to the days before doctors were trusted white-coats, and how the work of men like Morris Fishbein laid the groundwork for our current system (read: trust doctors, not the government! / to be fair, Fishbein did important work exposing quacks, but he also helped found a system wherein doctors are incentivized to care more about profit than care).
Then he dives in to the Now, in a small town smack dab in the middle of the Rust Belt. Through conversations with staff, observations of leadership meetings at the hospital, and wrenching vignettes of how life unfolds (and ultimately ends, in some cases) of local townspeople, we see all of the intersecting challenges that align to create a system that barely works and is slowly collapsing under its own weight, hurting everyone involved in the process. And despite the very great efforts of individuals little change is made.
I walked away from this one feeling pretty dispirited. Things need to change, and fundamentally so—this system is predicated on profit and structured in such a way that it's a zero-sum game, to where any potential increase for one group (loosely, Alexander tends to look at these groups as Patients, Doctors, Insurance Companies, Hospitals, and Suppliers) leads to loss for the others and an eventual attempt to gain back what was lost. A sort of medical arms race with no winner, only losers.
Alexander gives us a brief overview of How This Came to Be, harkening back to the days before doctors were trusted white-coats, and how the work of men like Morris Fishbein laid the groundwork for our current system (read: trust doctors, not the government! / to be fair, Fishbein did important work exposing quacks, but he also helped found a system wherein doctors are incentivized to care more about profit than care).
Then he dives in to the Now, in a small town smack dab in the middle of the Rust Belt. Through conversations with staff, observations of leadership meetings at the hospital, and wrenching vignettes of how life unfolds (and ultimately ends, in some cases) of local townspeople, we see all of the intersecting challenges that align to create a system that barely works and is slowly collapsing under its own weight, hurting everyone involved in the process. And despite the very great efforts of individuals little change is made.
I walked away from this one feeling pretty dispirited. Things need to change, and fundamentally so—this system is predicated on profit and structured in such a way that it's a zero-sum game, to where any potential increase for one group (loosely, Alexander tends to look at these groups as Patients, Doctors, Insurance Companies, Hospitals, and Suppliers) leads to loss for the others and an eventual attempt to gain back what was lost. A sort of medical arms race with no winner, only losers.
stephand2449's review against another edition
challenging
informative
reflective
medium-paced
4.5
Content Warnings
Moderate: Medical content and Medical trauma
arp9081's review against another edition
4.0
If there was a 4.5-star option, this book would definitely be it. Brian Alexander takes us to a small town in Ohio and explores its relationship with healthcare and the medical industry. The anecdotes of impoverished residents paired with academic research paints an image that we are all too well accustomed to. The United States' healthcare system is failing, because it is not a system. It's an amalgamation of for-profit enterprises trying to extract as much money from the population as possible. The epilogue had to address the elephant in the room that was the covid-19 pandemic. I wish there would be more follow up on the impact of the pandemic on small, independent hospitals. But the book was published in 2021 so not much can be blamed on the author.
An excellent resource for anybody that wants to dive into the failings of healthcare in the U.S. for academics and casual readers.
An excellent resource for anybody that wants to dive into the failings of healthcare in the U.S. for academics and casual readers.
lyonsmw's review against another edition
5.0
Sobering. In a well reported narrative, Alexander deftly describes the stark reality of the healthcare crisis in America. Using the lens of a small hospital, he takes the reader through unimaginable choices made by managers, healthcare workers, and most importantly, patients. Troubling does not begin to cover the state our healthcare system is in. Appreciate very much what Alexander does here.
candaceross321's review against another edition
5.0
This book leaves me simultaneously grateful for my family’s excellent insurance and fantastic medical professionals who truly are essential public servants, and outraged by the entire medical and insurance industries. Is it any wonder that so many people are reluctant to comply with public health interventions when there is legitimately so much greed and corruption in “Big Pharma” and medical insurance and billing. It can be very difficult to separate the good work and advice of caring dedicated doctors, nurses, and scientists from the political spin of the people keeping all the profits.
This book was especially meaningful as a Northwest-Ohioan. Knowing all the locations and the communities makes it just that much more heartbreaking.
This book was especially meaningful as a Northwest-Ohioan. Knowing all the locations and the communities makes it just that much more heartbreaking.