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A review by lajacquerie
The Hospital: Life, Death, and Dollars in a Small American Town by Brian Alexander
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.