Politics for the People Book Club Recordings — A Conversation with Dr. Elisabeth Rosenthal

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On Sunday, December 2nd the book club had the pleasure of spending an hour in conversation with Dr. Elisabeth Rosenthal, the author of An American Sickness: How Healthcare Became Big Business and How You Can Take It Back. You can listen to our full conversation at the end of this post.

Dr. Rosenthal is a graduate of Stanford University and Harvard Medical School.  Dr. Rosenthal practiced emergency medicine before joining the New York Times where she was a senior writer. She is currently editor-in-chief of Kaiser Health News, an independent non-profit DC-based newsroom focusing on health and health policy.

In the introduction of the call, you can hear Dr. Rosenthal and P4P founder and host, Cathy Stewart, discuss Dr. Rosenthal’s journey from the emergency room to writing about healthcare reform, thinking she would one day be able to return to her calling as a doctor. Twenty years later, Dr. Rosenthal decided to write An American Sickness and told us that in working on the book she “…dug into each area of healthcare to see for myself really how it came to be that we put profit on the front burner and health on the back burner.”

Give a listen here or below:

 

Steve Hough of Florida Fair and Open Primaries kicked us off by asking what Dr. Rosenthal’s views were on the demand for the U.S. to move to a single-payer healthcare system. You can hear Dr. Rosenthal’s response and how she feels that the solution to our healthcare crisis is a political decision here or below.  On the role of the insurance industry, Dr. Rosenthal thinks “…much of what we get from the insurance world, or from a lot of the layers in our healthcare system, has nothing to do with health care, it adds layers of complexity and cost…”

 

Our next question came from Cynthia Carpathios of Independent Ohio. Cynthia asked about part two of Dr. Rosenthal’s book—Diagnosis and Treatment: Prescriptions for Taking Back Our Healthcare—specifically how she sees us changing the culture of healthcare and how can we transform our healthcare system into one where patient care is the primary concern. Listen here.

 

Harriet Hoffman of New York, a consultant who helps people understand the Medicare system and make the best, most cost-effective and access-friendly decisions, raised the push by some for ‘Medicare for All.’ She asked if Dr. Rosenthal thinks a ‘Medicare for All’ system would be viable or even desirable as it is now. Hear her answer or check it out below.

 

Dr. Jessie Fields pointed out that though the healthcare industry spends $3 trillion a year, our life expectancy is going down in the United States. Dr. Fields went on to talk about how the medical industry is the country’s biggest lobbying force, which requires political reform and the removal of profit incentives from healthcare. Despite all of this, Dr. Fields asked Dr. Rosenthal what glimmers of change she can see. An enlightening discussion followed where Dr. Rosenthal shared her view that “…there’s great hope for a kind of physician-patient alliance to bring change.”

 

Reverend Carl McCluster, an independent organizer in Connecticut, spoke of how many of his parishioners are suffering from high medical and drug costs. Reverend McCluster asked Dr. Rosenthal for three suggested steps that advocates could take to push back against the medical industry. Listen to how to fight back here.

 

Susan Massad, a retired physician and a clinician educator of over fifty years, worked with young physicians on their listening skills and their abilities to respond to patients. Susan asked if there are things that Dr. Rosenthal thinks patients should be doing that will amplify their voices and could be helpful to challenge the system. Hear the response.

 

Cathy and Dr. Rosenthal wrapped up the conversation on a note of hope for change and reform. “I tell everyone when I go talk to hospitals,” Dr. Rosenthal said, “just do something. Do something in whatever space you exist to start changing things because I think that’s how empowerment starts.”

 

You can listen to our entire conversation below:

 


For easy reference, from An American Sickness:

Dr. Rosenthal’s

Economic Rules of the Dysfunctional Medical Market

  1. More treatment is always better. Default to the most expensive option.
  2. A lifetime of treatment is preferable to a cure.
  3. Amenities and marketing matter more than good care.
  4. As technologies age, prices can rise rather than fall.
  5. There is no free choice. Patients are stuck. And they’re stuck buying American.
  6. More competitors vying for business doesn’t mean better prices; it can drive prices up, not down.
  7. Economies of scale don’t translate to lower prices. With their market power, big providers can simply demand more.
  8. There is no such thing as a fixed price for a procedure or test. And the uninsured pay the highest prices of all.
  9. There are no standards for billing. There’s money to be made in billing for anything and everything.
  10. Prices will rise to whatever the market will bear.

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STAY TUNED
We will announce our next selection soon.

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Reader’s Forum — Lou Hinman and Jeff Aron

Lou Hinman 

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The runaway inflation in the cost of living in America is worst in precisely those sectors of the economy that the 99% can’t live without — higher education, housing, and healthcare. In An American Sickness, Dr. Elisabeth Rosenthal describes in excruciating detail how American healthcare has been hijacked.

How did this happen?  How did we Americans get so divided that a plastic surgeon dares to bill $50,000 for 3 stitches – just one of the many examples that Dr. Rosenthal sites.  (I also read a story not long ago in the New York Times about an “out-of-network” surgeon who ambushed an unsuspecting patient, sewing him up after his operation, and then billing him for a quarter of a million dollars!)

Medicare has become a vast, publicly owned resource  – a huge accumulation of money, automatically withheld from the paychecks of working people for their entire working lives – that is ripe for systematic looting by private interests.  In exactly the same way, private insurance companies don’t complain about extortion by the drug companies, and the newly privatized “not-for-profit” hospitals and their incorporated medical practices, because they can pass the extortionate billing on to their tens of millions of subscribers – you and me.

The corruption of the American system of healthcare has become institutionalized.  Indeed, our healthcare system now fits Irving Goffman’s description of a “total institution” – an institution that, whatever its original or nominal purpose, has as it’s real priority perpetuating itself and benefiting its hangers-on.  Such total institutions are, as Dr. Rosenthal suggests, a sign of a culture in decline.

When President Eisenhower left office in 1961, he warned us about what he called the “military-industrial complex.” In the decades that followed, military production did, in fact, become a juggernaut of profit-making for private interests and, simultaneously, an institutionalized parasite on the productive resources of the American economy and the needs of the American people.  Healthcare in America has now become just such a parasite – the “medical-industrial complex!”

As Dr. Rosenthal astutely observes: “In healthcare, entrepreneurship outsmarts regulation every time.” In the independent political movement, we know this pattern very well.  We’ve learned, for example, that trying to stop the flow of money to Democrat and Republican politicians by campaign finance reform can’t succeed, because new regulations, written by those politicians, come with new loopholes.  The development of new corrupt practices is impossible to keep up with, in both politics and in healthcare, without addressing the question of political power.  We can’t reclaim either our government or our healthcare without creating a new political culture.

Lou Hinman lives in New York City and is an activist with IndependentVoting.org and the New York City Independence Clubs.

Jeff Aron

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I won’t say that I “enjoyed” reading An American Sickness by Dr. Elizabeth Rosenthal. It corresponded too closely to experiences of my family and friends – not merely the illnesses and deaths but the difficult engagements with all aspects of a system that creates economic and existential insecurity which have nothing to do with “health.”

Whether based on personal interviews or other research, the stories Dr. Rosenthal shares help us to understand and are devastating critiques of the (mis)organization of healthcare in the United States. So many people are failed by this “system”. I kept wondering what those who supported it might say in its defense. More to the point, I wondered what we as a country would need to do to produce a system(s) other than what we have. What can we do about the overweening power of hospitals, insurance companies, and pharmaceuticals — all of which have enormous political leverage as well as economic incentive to keep things as they are? Would it be possible to build partnerships between those who currently profit from this state of affairs and those who are not served well by it? How might that be organized?

I really appreciated Dr. Rosenthal’s suggestions about what individuals can do. However, I feel similarly to Susan Massad and others who have written that something bolder — more grassroots and more challenging of the larger system of which healthcare is a part — needs to be undertaken.

As I read An American Sickness, from my location as an activist in the mental health arena who also has been a community organizer, I thought of areas of concern and contention in healthcare which might have been more fully explored, e.g., severe mental disorders, aging, and lack of access and education for marginalized groups. While addressing these may not have strengthened the very strong case Rosenthal makes, including these populations as resources would be powerful elements of a movement for change.

I also thought about my brother, my mother, my life partner — all of whom died of serious illnesses — the challenges we faced, the diversity of people we met, the pharmaceuticals that were prescribed, the offices, clinics and hospitals we entered — and how all of us were shaped (deformed) by the economic and political forces that organize the practice of medicine — and everything else in our society. We can and must do better.

Jeff Aron has been active in independent political efforts in New York City and nationally since the late ’70s. He is a passionate supporter of IndependentVoting.org


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Politics for the People

Conference Call

An American Sickness

With Author Elisabeth Rosenthal

Sunday, Dec. 2nd at 7 pm EST.

Call in number:  641-715-3605 

Passcode 767775#

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Reader’s Forum — Maureen Albanese and Helen Abel

Maureen Albanese

Maureen Albanese

Elizabeth Rosenthal lays out in clear language why our healthcare system got in this sorry state and what we can do to help ourselves get better and cheaper care — but that is not enough.  We must also start electing politicians who will get us to a better healthcare system.  Healthcare should be a right — not a privilege as it is now.  We need to organize our fellow Americans around this issue as we are all but one illness away from homelessness.  This book will be a great conversation starter, but more people need to read it and work together to get the system we deserve.

We can look to France, which has the best healthcare in the world, to help us formulate a better healthcare system.  This healthcare system is not sustainable and until a major overhaul is done America itself will be bankrupt.

Maureen Albanese is an administrative assistant and activist. She lives in Manhattan.

Helen Abel

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I found An American Sickness a provocative look at the health care industry and how big profits have been substituted for humane patient care.  Elisabeth goes into great detail about how this has happened and definitely makes a case for the Canadian or Great Britain models of health care.  She also gives tips on how to find out how your hospital rates nationally, where to get drugs more cheaply, and a host of other information.  A good go-to also if you are dealing with a difficult medical situation.

Helen Abel is a Life performance coach and political activist.

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Politics for the People

Conference Call

An American Sickness

With Author Elisabeth Rosenthal

Sunday, Dec. 2nd at 7 pm EST.

Call in number:  641-715-3605 

Passcode 767775#

 ***

Reader’s Forum — Dr. Jessie Fields

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Dr. Jessie Fields (center) with Carrie Sackett, Alvaader Frazier, David Belmont and Nardo Reyes –  New York City Independence Club Activists in Harlem doing street outreach.

Health Care Should Be About Health 

I am a community primary care physician. I grew up seeing the effects of social isolation and poverty in the black community and I became a doctor because I wanted to help improve the life conditions of the black poor. Practicing in the poor community, initially on the West Side of Chicago, I soon realized that I had to go outside the walls of the clinic and outside the institution of medicine to be able to work on improving the community’s health.

This lesson is also relevant to the book, An American Sickness: How Healthcare Became Big Business and How You Can Take It Back by Elisabeth Rosenthal. The book is a revealing analysis of the high costs of for-profit medicine as well as an activist guidebook for the American people and patients to confront and change a system that impacts all people.

Those outside the system in partnership with caring health providers I believe can and are making changes. I look forward to our discussing efforts to change the system when we speak with Elisabeth Rosenthal on the conference call on December 2nd. As Rosenthal states in the last few sentences of the book’s Afterward, “…the crusade to take back our health care system…. it’s going to be a long war.”

She documents how American medicine became the highly expensive, wasteful, inefficient complex business designed to generate profit that it is today. Rosenthal tells the story of the beginning of health insurance with Blue Cross and its partner, Blue Shield, which were nonprofit and accepted everyone who sought to sign up. “The original purpose of health insurance was to mitigate financial disasters brought about by serious illness…” Over the subsequent decades, especially through the 1970s and 1980s, “For-profit insurance companies moved in, unencumbered by the Blues’ charitable mission. They accepted only younger, healthier patients on whom they could make a profit. They charged different rates, depending on factors like age, as they had long done with life insurance. And they produced different levels of protection.”

She outlines all the components of the high cost of medicine: insurance, hospitals, pharmaceuticals, doctors, conglomerates, etc. while also focusing on how high costs impact patients.

“Nearly a third of Americans said they had problems paying medical bills, many among those forced to cut back on food, clothing, or basic household items…But will Congress head their distress call? Or will the powerful business of medicine hold sway, as it has for the past thirty years? Time will tell, but there’s a glimmer of hope on the horizon. But that glimmer comes from you, not from Washington.”

Dr. Rosenthal also discusses the benefits and limitations of the Affordable Care Act. Namely that it has increased access to coverage and care but that in the face of the insurance lobbies and partisan political dysfunction, the ACA did not address the high costs of medicine.

Of course, the high costs of medical care are not limited to the money and financial losses by patients and the larger society. The human costs are even more deeply incalculable. The health and well being of patients and families is undermined.

New approaches to healing that involve human compassion and support are needed but not pursued because the focus is how to make a profit from the latest technology. Expensive technology has replaced the hands-on art of a thorough physical examination.

Departments that do not make money such as Obstetrics, especially in medical clinics that serve poor communities, are closed. Pregnant women have limited access to quality prenatal care, resulting in the United States high infant mortality rate — especially relative to other developed countries. The United States spends more than $3 trillion a year on a health care system that is unequal and unjust. We the people have to change it and I look forward to our conversation with Dr. Rosenthal.

Dr. Jessie Fields is a physician practicing in Harlem, a leader in the New York City Independence Clubs, and a board member of the All Stars Project and Open Primaries.

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Politics for the People

Conference Call

An American Sickness

With Author Elisabeth Rosenthal

Sunday, Dec. 2nd at 7 pm EST.

Call in number:  641-715-3605 

Passcode 767775#

 ***

Dr. Rosenthal on CBS This Morning (Video)

Elisabeth Rosenthal provides tips to drive down medical bills on CBS

From CBS This Morning
November 28th, 2018

In our collaboration with Kaiser Health News and NPR, we’re taking a look at surprise medical bills that catch many Americans off guard. The latest “Bill of the Month” reveals how costly life-saving drugs can be. Shereese Hickson was bedridden with MS symptoms at one point and was prescribed an infusion called Ocrevus. It costs $65,000 a year. Medicare and Medicaid paid for nearly all of her previous treatments, so Hickson was surprised when she was billed more than $3,600 for the first two doses of this new medicine. Kaiser Health News editor-in-chief Dr. Elisabeth Rosenthal joins “CBS This Morning” to discuss the bill.

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THIS SUNDAY

Politics for the People

Conference Call

An American Sickness

With Author Elisabeth Rosenthal

Sunday, Dec. 2nd at 7 pm EST.

Call in number:  641-715-3605 

Passcode 767775#

 ***

Reader’s Forum — PJ Steiner, Steve Guarin, and Jessica Marta

PJ Steiner

An American Sickness: How Healthcare Became Big Business and How You Can Take It Back was recommended to Politics for the People by PJ Steiner. Read on to see PJ’s response to Elisabeth Rosenthal’s book.  

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I initially heard about An American Sickness by Elisabeth Rosenthal while listening to an NPR interview with Terry Gross. Dr. Rosenthal was incredibly well versed on what the challenges in our healthcare “system” really are and how those challenges came to be. She absolutely wowed me with her excellent communication skills and journalistic chops.

But unfortunately, I became immediately worried about my own, and my children’s, healthcare future. As a Dad of two awesome autistic children, I worry about how they will be cared for throughout their life. I worry even more because our healthcare system (like public education) doesn’t really want to help them as much as it wants to profit from them.

Now that I’ve had a chance to read Dr. Rosenthal’s book, I feel the true immensity of the amoral “healthcare industrial complex” we have in this country. But I also feel some hope. There are a lot of tools and advice to be had to help the regular American fight their way to better care at a more reasonable cost.

Pick this book up. You’ll be glad you did.

PJ Steiner is the Vice President of The Utah League of Independent Voters.

Steve Guarin

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Steve Guarin (r) being presented with a 2016 Anti-Corruption Award by Juliana Francisco

If you want to learn why your wallet is getting lighter and your purse is becoming empty, read An American Sickness by Elisabeth Rosenthal. She lists and explains all the many ways medical care robs your billfold. They will even charge you for things you didn’t use. People have called the billing predatory, which is an outrageous situation to be put in by the people and organizations that are supposed to be helping you.

The subtitle of the story is, “How Health Care Became Big Business and How You Can Take It Back.” In a small part of the book I felt as if she was talking directly at me, the Compliant Patient. Up until I read this book I strived to be a compliant patient. I thought these were the people trying to make me better, but I have learned that is not true. Your family doctor is under a lot of pressure to make use of the expensive facilities of the hospital or medical group that employs him. One type of lab-test which we all get is the simple blood test. It behooves you to ask your doctor to use one of the commercial laboratories, i.e. Quest or LabCorp. It will be exactly the same test but the results from a hospital can be priced one hundred times higher.

Read this book and you will learn how medical care became a rapacious big business. More importantly, the author will teach you to be a Non-Compliant patient, and save some money.

Steve Guarin lives in the Bronx.  He is retired and an activist with the New York City Independence Clubs.

Jessica Marta

Marta

As a health-care provider, I’m familiar with many of the issues that Ms. Rosenthal is talking about in An American Sickness. All the unscrupulous things Ms. Rosenthal mentions, particularly price-fixing by pharmaceutical companies, are happening every day.

Is single payer health-care the solution? I don’t know. The single-payer idea has been around since the ’50s. Back then the American Medical Association shot it down by hiring Ronald Reagan to do TV ads telling the American public that single-payer health-care would take away our Freedom of Choice.

If not single-payer, then why couldn’t the government set limits or standards on the price of drugs or medical procedures? Because our government still caters to powerful special interests.

As long as we live under the current paradigm, that making money is the supreme good, poor people won’t have access to good care and middle-class people who can’t afford to pay for their own health insurance will go bankrupt after paying for long-term treatment. But we just see these as consequences for “others” and hope we are never in those situations.

I feel that patients are not the only casualties of our dysfunctional system. There are many providers who go out of their way for patients, jump through bureaucratic hoops to get care, but these folks can get very weary. I don’t know what the answer is, except a shift in political power on behalf of the interests of ordinary people.

Jessica Marta is an independent activist with Independent Voting and the New York City Independence Clubs. She lives in Manhattan and is an Adult Psychiatric Nurse Practitioner.

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THIS SUNDAY

Politics for the People

Conference Call

An American Sickness

With Author Elisabeth Rosenthal

Sunday, Dec. 2nd at 7 pm EST.

Call in number:  641-715-3605 

Passcode 767775#

 ***

Reader’s Forum — Al Bell

A Commentary on An American Sickness: How Healthcare Became Big Business and How You Can Take it Back by Elisabeth Rosenthal

DSC_7664My first question to any elected official I contact about health care legislation (and I will) will be: “Have you read Elisabeth Rosenthal’s book, An American Sickness?”

If the answer is yes, my second question will be: “How have her ideas been incorporated in health care legislation you will sponsor or support?” You can probably imagine the course of the ensuing conversation.

If the answer is no, my second question will be: “Why not?” If the answer is, “I haven’t heard of that book,” or any pathetic derivatives of that answer, I will proceed as follows.

“Here is why you should buy it and read it. Elisabeth presents a comprehensive picture of why and how the medical industrial complex in America mistreats patients, the people we used to believe were the beneficiaries of what we used to think of as our health care system. Patients: that is us. She reveals why and how the complex focuses on profit and not health; why it is a cartel and not a system. She goes on to offer advice on how to work around the obstacles to effective health care despite the non-system by providing information on important sources of aid. She closes by explaining what needs to happen to reclaim a responsive health care system from the piranhas that now call the shots. She reminds us that we have a cadre of superb medical professionals, some of whom have become complicit in this disaster, but most of whom ache to carry out their role as healers and menders to those in need.”

“If you are not willing to read it yourself, then assign it to one of your brightest staff members and insist that she/he communicate with Elisabeth before getting back to you with recommendations on how to proceed. Then contact me and let me know what you intend to do, when you intend to do it, and who else you have joined forces with to make it happen. I especially want to know the names of any in the latter category who are not members of your political party.”

While it may be generally agreed that health care has become a major, if not the major, current concern of Americans, it is also self-evident that the medical industrial complex has shanghaied our political world and inoculated it against any conceivable common sense fix. The same force that is necessary to rescue our dysfunctional federal governance miasma from itself is the one that will turn health care around as well: we the people.

We the people need a tool for opening doors, slamming inattention to the floor, and prying open windows to an approach that will actually work. Elisabeth Rosenthal has given us the pry-bar; it is now up to us to wield it.

Elisabeth is not asking the doctors, specialists, technicians, hospitals, pharmacists, pharmaceutical companies, and others to sacrifice reasonable income and profit. She is making the case that extortion in those areas is not legitimate, especially when we pay with not only our money, but our health outcomes as well.

A message to my 60-some active contacts and my elected (some newly) officials in Arizona urging them to read and act on An American Sickness will go out this week.

Oh, one more thing. Thank you, Elisabeth, for the immense public service you have performed in crafting this report to the American people. Bravo, indeed!

Al Bell lives in Peoria, AZ and is an activist with Independent Voters for Arizona.

 

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Politics for the People

Conference Call

An American Sickness

With Author Elisabeth Rosenthal

Sunday, Dec. 2nd at 7 pm EST.

Call in number:  641-715-3605 

Passcode 767775#

 ***

Reader’s Forum — Susan Massad

susan head shot

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

I am a consumer of health care, a practitioner and educator in general internal medicine for over fifty years, and a lifelong advocate for health care reform–single payer, a national health care service, and health care for all.  In college, my sophomore term paper was a history of the AMA’s role in defeating Truman’s proposal for a national health service for America.

Critiques of the American medical system have been with us for decades but more recently, as our system becomes more and more dysfunctional, the level and volume of critique has accelerated. The system is too big, too bureaucratic, user-unfriendly, exploitative, bad for our health, inaccessible, and too costly.  These are some of the recurring themes that one encounters in the explosion of commentary in books, articles, political polls and in my favorites, television shows, such as New Amsterdam, and the Resident, that are chronicling the faults in our system that make it so impenetrable to both consumers and practitioners.

I was an avid reader of this literature until there were just too many articles and books to keep up with. I am grateful that I was introduced to Elisabeth Rosenthal’s An American Sickness through Politics for the People as I might have dismissed it as just another critique that I already knew what it was going to say. Even for the jaded and cynical, Rosenthal grabs your attention. I was totally engaged with the first part of the book, How Health Care Became Big Business. She brings her talents and experience as a doctor, social critic, and journalist to her writing, producing a devastating analysis of how the patient, aka the consumer, is caught in a web of confounding business operations designed to maximally exploit them and their illnesses. The book is filled with clinical vignettes that are case studies in patient exploitation, such as the shell game of adding expensive testing, medical equipment and ancillary services to the hospital bill, the charging for the extra anesthesiologist, the moving of procedures to ancillary sites where extra facility fees can be collected as providers form LLCs to increase profit. It is the patient who is left alone with the financial impact of an unregulated drug market, lack of transparency in anticipating hospital and procedure costs, and an insurance market that simply passes on the costs of this exploitative care to the consumer in the form of higher and higher premiums.

Coming away from the book one is left with a strong sense of outrage, and a much better grasp of the complexities and deceptions of the system. I have been in treatment for breast cancer for over six years and continue to be confounded by my monthly bills that quote the charge for the service as one amount, the amount the plan pays as another and the copay as another inexplicable amount and none of it adds up. Rosenthal gives us some way of understanding how these unfathomable charges have landed on our health care bills.

I was somewhat disappointed in the second half of the book “How you can take it back.”  Rosenthal provides some invaluable tools in the form of apps and sources of information and organizations that support us to become more astute consumers of health care as we shop around for the best hospitals, compare drug prices, and question the charges on our hospital bills. She exhorts us to speak up and push back; something that is not so easy to do as individual operators in a system so big and opaque as ours.

What I found most lacking was some recognition of how politicized our health care system is. The three-trillion-dollar American medical machine did not just happen to become the profit center for insurers, hospitals, doctors, manufacturers, politicians, regulators, charities, banks, real estate, and tech—or any of the many other entities that have no connection to health or health care. Much of this giveaway was accomplished through the compliance of our representatives, who vote on the legislation that has facilitated the turnover of medical care to private industry. Medicare and Medicaid were established in 1965 under Lyndon Johnson, a master of the deal. Steven Brills’s book, America’s Bitter Pill, is the sad story of the making of the Affordable Care Act, a political-mash up of deal-making and trade-offs that is the best that our partisan and divided Congress could offer the American people. I am not critical of Rosenthal for not including an analysis of the politics of health care in America in the book, and I would have liked to have some recognition of what we are being asked to push back against in challenging big business health care. I have learned in my many years as a health care activist that I could not impact the flawed nature of our health care system without engaging in changing the way politics is conducted in our country. Health care reform, like educational reform and other major reforms, is not a single-issue item. It is embedded in everything we do.

Where does one look for hope, a way out of this mass of corruption and deception that health care in the US has become? For me, one has to get out of the system and look elsewhere to a number of grassroots, community-based, and patient-initiated efforts to take control of their own health care.  A few examples of this are: Patient run self help organizations such as SHARE that provide support, education and empowerment to women affected by breast or ovarian cancer; Gilda’s Club, a community organization for people with cancer, their families and friends; Project Open Notes, an international movement advocating change in the way visit notes are managed by providing access to patient and families of their medical records; The Maven Project that is leveraging medical school alumni to connect experienced volunteer physicians with safety net clinics across the US to augment and meet unmet health care needs in underserved and uninsured patient populations; The Beryl Institute, a global community of practice dedicated to improving the patient experience through collaboration and shared knowledge, as well as my own efforts to help patients to self-organize health teams that perform as collective, social units for health and healing that is amplifying the patient’s voice in taking control of their own health care.

In An American Sickness Rosenthal eloquently chronicles how dreadfully sick our health care system is. It made me think about the advice that All Stars Project and East Side Institute founder Fred Newman gave at the Performing the World conference in 2007.  In speaking about the despair and chaos of our world, Newman says, “We have to perform the world again—and we are all involved in this—because this one stinks.”

I take this to mean that if we are going to create our way out of the three-trillion-dollar morass that health care in the US has become, it is we the people who will have to do it.

Susan Massad is a retired primary care physician educator who is on the faculty of the East Side Institute where she leads workshops/conversations exploring what it means for people to grow and develop in the face of serious illness, aging or memory loss. Susan is a long time independent activist with Independent Voting.  

 

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Politics for the People

Conference Call

An American Sickness

With Author Elisabeth Rosenthal

Sunday, Dec. 2nd at 7 pm EST.

Call in number:  641-715-3605 

Passcode 767775#

 ***

Reader’s Forum — Jennifer Bullock

Healthcare as a Social Activity

Thank you, Elizabeth Rosenthal for An American Sickness: How Healthcare Became Big Business and How You Can Take it Back.

It is a sobering and useful breakdown of what has happened with our healthcare industry in the last several decades.  I so appreciate your helpful and insightful outline for how we can ‘take back’ this for-profit machine and put human healthcare and cost-savings into action.

As a progressive psychotherapist practicing a group therapy approach called Social Therapy, we work outside of the medical/insurance/ healthcare industry as independent collaborators with clients and communities.  I work to help clients exercise our collective power to live a more humane, less alienated life together.  From that perspective, I wonder what you think about an added recommendation to how to take back our healthcare:  Do our healthcare socially, collectively, in teams, in partnership with our support networks.  I often invite clients to take a friend to a medical appointment, have a friend on hand when doing the fun activity of calling an insurance company to clarify a bill or ask for coverage, and have a support ‘health team’ when admitted to a hospital to help navigate medical care, billing, treatment direction.  It seems to me our collective power needs to be exercised against the monstrosity of big business industries, and especially so when it comes to a vulnerable area of life called our health care.

Jennifer Bullock is the Director of Independent Pennsylvanians and a social therapist in Philadelphia.

 

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Jennifer Bullock gathering signatures in Philadelphia. 

 

*Reminder*

Conference Call with Elisabeth Rosenthal

Author of American Sickness

Sunday, December 2nd at 7 pm EST

Call: 641-715-3605
Pass code: 767775#

 

 

An American Sickness New York Times Review

 

Why an Open Market Won’t Repair American Health Care

CreditPing Zhu

 

AN AMERICAN SICKNESS 
How Healthcare Became Big Business and How You Can Take It Back 
By Elisabeth Rosenthal 
406 pp. Penguin Press. $28.

A few years back, the future of American health policy appeared to hinge on how similar medical care was to broccoli. It was March 2012, and the Affordable Care Act (a.k.a. Obamacare) was before the Supreme Court. Justice Antonin Scalia zeroed in on its controversial requirement that all Americans purchase health insurance. Yes, everybody needs health care, Scalia conceded, but everybody needs food too. If the government could make people buy insurance, why couldn’t it “make people buy broccoli”?

The Affordable Care Act survived, of course — though not before a fractured court made the expansion of Medicaid optional, leaving millions of poorer Americans without its promised benefits. But the question Justice Scalia asked remains at the heart of a debate that has only intensified since: Why is health care different? Why does it create so much more anxiety and expense, heartache and hardship, than does buying broccoli — or cars or computers or the countless other things Americans routinely purchase each day?

For those leading the charge to roll back the 2010 law, the question has a one-word answer: government. President Trump’s point man on health policy, the former congressman (and ultrawealthy orthopedic surgeon) Tom Price, has said that “nothing has had a greater negative effect on the delivery of health care than the federal government’s intrusion into medicine through Medicare.” Senator Rand Paul (another surgeon) and House Speaker Paul Ryan have claimed that the affordability of Lasik eye surgery — generally not covered by health insurance — shows that a much freer health care market would be much less expensive. Their idea of “reform” is to cut back public and private insurance so consumers have “more skin in the game” and thus shop more wisely.

Elisabeth Rosenthal
Credit Nina Subin

The physician-turned-journalist Elisabeth Rosenthal offers a very different answer in her eye-opening “An American Sickness.” Rosenthal — formerly a reporter for The New York Times, now the editor in chief of the nonprofit Kaiser Health News — is best known for a prizewinning series of articles, “Paying Till It Hurts.” In them, Rosenthal chronicled the seemingly endless pathologies of America’s medical-industrial complex, from prescription drugs that grew more costly as they became more dated to hip-replacement surgery so expensive it was cheaper for a patient to fly to a hospital in Belgium.

Rosenthal thinks the health care market is different, and she sums up these differences as the “economic rules of the dysfunctional medical market.” There are 10 — some obvious (No. 9: “There’s money to be made in billing for anything and everything”); some humorous (No. 2: “A lifetime of treatment is preferable to a cure”) — but No. 10 is the big one: “Prices will rise to whatever the market will bear.” To Rosenthal, that’s the answer to Scalia’s question. The health care market doesn’t work like other markets because “what the market will bear” is vastly greater than what a well-functioning market should bear. As Rosenthal describes American health care, it’s not really a market; it’s more like a protection racket — tolerated only because so many different institutions are chipping in to cover the extortionary bill and because, ultimately, it’s our lives that are on the line.

Consider the epicenter of America’s cost crisis: the once humble hospital. Thanks in part to hit TV shows, we think of hospitals as public-spirited pillars of local communities. Yet while most are legally classified as nonprofits, they are also very big businesses, maximizing surpluses that can be plowed into rising salaries and relentless expansion even when they are not earning profits or remunerating shareholders. And they have grown much bigger and more businesslike over time.

Rosenthal tells the story of Providence Portland Medical Center, a Northwest hospital system founded by nuns. Four decades ago, its operational hub in Portland, Ore., consisted of two modest hospitals: Providence and St. Vincent. As it happens, my mother was a nurse at St. Vincent for more than half those years, and thus had a front-row seat as Providence transformed from a Catholic charity into one of the nation’s largest nonprofit hospital systems, with annual revenues of $14 billion in 2015.

Along the way, Providence jettisoned most of its original mission, replacing nuns with number crunchers. Once run mainly by doctors, it filled its growing bureaucracy with professional coders capable of gaming insurance-reimbursement rules to extract maximum revenue. Meanwhile, Providence stopped paying doctors as staff and reclassified them as independent contractors (though not so independent they could skip a “charm school” designed by its marketers). Yet even as its C.E.O. earned more than $4 million, Providence touted itself as a “not-for-profit Catholic health care ministry” upholding the “tradition of caring” started by the nuns (now listed as “sponsors” in promotional materials). Rosenthal sums up the result as “a weird mix of Mother Teresa and Goldman Sachs.”

Actually, not much of Mother Teresa: Providence-like consolidation in every part of American health care has created a structure at least as concentrated as the European systems conservatives decry, yet without the economy or coordination of care such concentration might offer if it were focused on people rather than profits. The Yale economist Zack Cooper has shown that prices paid by private insurers are not just massively higher than those paid by Medicare. (They’re in a different orbit from those paid abroad.) They are also hugely variable from place to place and even institution to institution, without any evidence that higher prices produce better care. Providers charge high prices not when and where they need to; but when and where — courtesy of consolidation — they can.

Rosenthal’s book doesn’t conclude with conglomerates. She also provides an eye-opening discussion of skyrocketing drug prices, as well as the less-familiar pathologies of excessive medical testing and overpriced medical devices, such as artificial hips and knees — a market dominated by a few manufacturers that, like big drug companies, shun direct competition in favor of building cozy relationships with the people who prescribe their products. In each case, Rosenthal diagnoses the incentives of the system by recalling the professional advice of Willie Sutton, who said he robbed banks because “that’s where the money is.” What outsiders might see as inefficiency or a conflict of interest, she shows, insiders have carefully constructed to maximize their bottom line. She also weaves in moving tales of those who are paying dearly for that enhanced bottom line — which, in the end, includes all of us.

Where Rosenthal’s account falls short is in explaining why this deeply broken system persists. Early on, Rosenthal seems to side with Speaker Ryan and Senator Paul, describing “the very idea of health insurance” as “in some ways the original sin that catalyzed the evolution of today’s medical-industrial complex.” But, as Rosenthal (too briefly) discusses, countries where people are much better insured don’t have anything like our self-dealing, upside-down incentives and outrageous costs. Somehow, despite largely keeping citizens’ skin out of the game, other rich democracies manage to have much lower costs per person — as well as greater utilization of physician and hospital services and better basic health measures.

The fact is that people need insurance for the highest costs they face. They may be able to pay for Lasik, a nonessential, nonemergency procedure for which consumers have plenty of time to shop around. But the biggest-ticket items — cancer care, cardiac surgery, organ transplants — are beyond the reach of all but the richest, and not so easy to shop around for when they’re needed. Just as we shouldn’t blame the idea of mortgages for the financial crisis, we shouldn’t blame the idea of health insurance for the health care crisis.

The difference between the United States and other countries isn’t the role of insurance; it’s the role of government. More specifically, it’s the way in which those who benefit from America’s dysfunctional market have mobilized to use government to protect their earnings and profits. In every country where people have access to sophisticated medical care, they must rely heavily on the clinical expertise of providers and the financial protections of insurance, which, in turn, creates the opportunity for runaway costs. But in every other rich country, the government not only provides coverage to all citizens; it also provides strong counterpressure to those who seek to use their inherent market power to raise prices or deliver lucrative but unnecessary services — typically in the form of hard limits on how much health care providers can charge.

 

In the United States, such counterpressure has been headed off again and again. The industry and its elected allies have happily supported giveaways to the medical sector. But anything more, they insist, will kill the market. Although this claim is in conflict with the evidence, it is consistent with the goal of maximum rewards to (and donations from) the industry. As a result, Medicare beneficiaries have prescription drug coverage (passed by Republicans in 2003), but Medicare administrators have no ability to do what every other rich country does: negotiate lower drug prices. In January, President Trump said drug companies were “getting away with murder” because they had “a lot of lobbyists and a lot of power,” insisting he would get Medicare to bargain. Should we really be surprised that the dealmaker in chief dropped the subject after meeting with pharma executives earlier this year?

Without a clear view of the political economy of health care, it’s easy to see the problem as Justice Scalia did. If we could just start treating health care like broccoli, the market would solve the problem. But as Rosenthal’s important book makes clear, the health care market really is different. Speaking of her Times series in 2014, Rosenthal told an interviewer her goal was to “start a very loud conversation” that will be “difficult politically to ignore.” We need such a conversation — not just about how the market fails, but about how we can change the political realities that stand in the way of fixing it.

Jacob S. Hacker, a co-author of “American Amnesia: How the War on Government Led Us to Forget What Made America Prosper,” is the Stanley B. Resor professor of political science at Yale.
Original content at New York Times American Sickness Book Review
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