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.

***

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

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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.

 

***

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 — Steve Richardson

We Need a Game-Changer

boston 0614If there is any issue that should unite our divided nation, it’s health care.  Mortality limits every one of us; even those blessed with good genes and good habits are one accident away from dependency.  And we all have relationships that change quickly – or cease to exist – if either party is seriously ill.  Most of us spend an enormous amount of money on health insurance – or earn what our employer pays for it.  Instead of appealing to our interest, the industry and our own Congress have taken advantage of us.

Dr. Rosenthal pulls no punches in applying her medical knowledge and journalism experience to exposing the collusion among health care providers, insurers, and politicians that has us in such an unenviable financial and moral predicament.  As an economist, I was impressed with her “Economic Rules of the Dysfunctional Medical Market,” which are carefully linked to examples that I could easily relate to as a consumer.  And I especially appreciated her documentation in Part I of how we got here (“The Age of”  Insurance, Hospitals, Physicians, Pharmaceuticals, etc.).  What comes across quite clearly is that it is indeed a systemic problem.  As she notes in the Introduction, the rules that govern delivery of health care in the US are no accident, and it’s up to us to change those rules.

Of course, we’re a few Davids taking on many Goliaths.  So in Part II, Dr. Rosenthal provides thoughtful measures for personal and political action to incrementally address the dysfunctional relationships we have with insurance companies and providers.  Each is worth considering and sure to benefit some of us, and taken together, they are a good start toward reform.  However, I don’t think we’ll see real change unless we amputate the “invisible hand” on the till that she refers to in the Introduction.  The Affordable Care Act was stillborn because the health care industry made sure it posed no real threat to their market power.  In my view, we will never win control of our own health care by working within a system designed and controlled by special interests.  We need something radical like single-payer, but I would prefer something that restores a free market – like eliminating tax deduction of health insurance premiums by employers and making all health care expenses (premiums and out-of-pocket) deductible for individuals.  That’s not a new idea and it’s not the only solution, but it would be a game-changer.

Steve Richardson is a founding member of the Virginia Independent Voters Association and serves on IndependentVoting.org’s national Election Reform Committee.

***

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#

 

 

Reader’s Forum —Cynthia Carpathios

An American Sickness: The Commodification of Americans

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

Although most of us are aware that the healthcare system in America is not well, we may not have realized the extent of the illness.  If you are fortunate enough to have a job with decent insurance, you may not realize how vulnerable you really are.

Elisabeth Rosenthal’s book, An American Sickness: How Healthcare Become Big Business and How You Can Take It Back, is a History and Physical of American Healthcare.  It is compelling, sometimes funny, and absolutely appalling.

The Chief Complaint is “hugely expensive medical care that doesn’t deliver quality results.”  Rosenthal then lays out the History of the Present Illness and Review of Systems, a look at how American medicine has transformed from one based on caring to one based on profit. And in the Diagnosis and Treatment, she gives us resources for ourselves and for the broader good, what we can do to be less vulnerable to outrageous doctor bills, hospital bills, insurance costs and what kinds of systemic changes we need to demand from our lawmakers, insurance companies, providers and healthcare institutions, hospital and insurance regulators.

What is so shocking is how vulnerable we all are, even those of us with the best insurance.  All we need is a hospitalization or emergency situation in which, without choice or informed consent, we receive service from out-of-network providers or end up in an out-of-network facility and we can be on the line for astronomical charges.  The provider may just say hello to you at your bedside in the hospital. You may be taken to the nearest facility when you are in a situation where every minute counts, and you may not even be conscious. And the rest of your life you may be in financial ruin.

Increasingly certain groups of providers and certain facilities don’t sign up in networks at all and charge whatever they want.

And this is only one outrageous way to go deeply into debt to our broken medical system.

The breakdown in relationship between the medical industry and the people they serve is one that touches all of us, and I feel particularly close to it. My father was a thoracic surgeon in the “golden age” of medicine.  He accepted what people could pay. We had several beautiful oil paintings from one of his patients. One of my brothers is a physician employed by a large medical conglomerate, who has considered repeatedly whether he can bear to stay in medicine. The differences between my father’s and my brother’s experience of the medical field are enormous.

I work in a hospital, a community hospital that has recently been acquired by a larger medical entity. I do payroll and accounting for the physician practices that are under the hospital’s wing.  I see the bankruptcy paperwork coming in for patients who have gone underwater. I see what we pay for consultants, for drugs, the closing of departments that don’t bring in enough money (we no longer deliver babies at this hospital) and the struggle our little hospital has had to stay open. I see the doctors who experience that despite their big paychecks, they are stressed and unhappy, many of them feeling like drivers being pushed to go ever faster and do more in a system whose focus is on the mighty dollar.

It is riveting and distressing to read Rosenthal’s history of the moves that have been made that have been part of creating the current state of affairs where patients are no longer related to on a human level – where they have become a commodity, a dollar figure.

The medical industry is not alone in this regard.  We have seen similar breakdowns in higher education, in banking and investor relations, in the relationship of employers to their workers, in government and its representatives to the people they are mandated to represent.  Things have never been perfect, there have always been ways in which certain groups have been more privileged; this is embedded in our country’s history. But what we are now seeing is a wholesale breakdown of the relationship between the service industries and the people they are purporting to serve.

What we are seeing is something that can’t just be changed by laws or more regulation.  The creativity of those at the top of the money-making pile to work around issues is enormous.  Yes, those changes are needed, and we need to support them. And we need cultural/social/human development at the same time, without which anything else will never be fully successful.  

Despite the infuriating advantage being taken by those who have the power and money to do so, they are also victims of this system.  Their humanity has been eroded and their growth as human beings stunted. We need to support functional changes where we can do so and we need to bring growth and development into our lives and those around us, transforming the systems that underlie our medical system, our society, our economy, our political system, our country from the inside out. 

Cynthia Carpathios is a long-time political independent and a novice Buddhist monk.  She lives in Alliance, Ohio.

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Rick Robol and Cynthia Carpathios of Independent Ohio

*Reminder*

Conference Call with Elisabeth Rosenthal

Author of American Sickness

Sunday, December 2nd at 7 pm EST

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

Elisabeth Rosenthal at Politics and Prose (video)

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Elisabeth Rosenthal discusses her debut book about the American health care system


In her first book, Rosenthal, editor in chief of Kaiser Health News as well as an M.D., takes a comprehensive look at the country’s ailing health care system. By breaking down the whole into its parts, she guides readers through a complicated tangle of hospitals, doctors, insurance companies, and drug manufacturers, focusing especially on the problems that have arisen in recent years as more hospitals are run by business executives and more research charities enter into profitable relationships with drug companies. Rosenthal shows how these arrangements harm patients and suggests ways we can heal the system.

Founded by Carla Cohen and Barbara Meade in 1984, Politics and Prose Bookstore is Washington, D.C.’s premier independent bookstore and cultural hub, a gathering place for people interested in reading and discussing books. Politics and Prose offers superior service, unusual book choices, and a haven for book lovers in the store and online.

Visit them on the web at http://www.politics-prose.com/

Produced by Tom Warren

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*Reminder*

Conference Call with Elisabeth Rosenthal

Author of American Sickness

Sunday, December 2nd at 7 pm EST

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

Reader’s Forum – Frank Fear, Sr. and Frank Fear, Jr.

Rosenthal Demystifies America’s Health Care System and How to Fix It

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Frank Fear, Jr. and Frank Fear, Sr.

When beating cancer costs $17,000 a month, what do you do?read the newspaper headline. “1,495 Americans describe the financial reality of being really sick” reads another.  It’s no wonder that health care weighs heavily on the minds of America’s voters as they head to the mid-term polls.

That’s no surprise to Frank Fear, Jr., former vice president of a community hospital and current chief information officer at a regional health system. It’s no surprise to his father, Frank Fear, Sr., a cancer survivor.

Cancer had an indelible impact on Fear Sr.—and not just because of the disease. It was also because of the cost, which totaled tens of thousands of dollars. Fear’s cost-share was manageable. He had employer-sponsored health/medical insurance.

Fear, Sr. was fortunate. Many are not. That’s a problem. It’s America’s problem.

And it’s why Elisabeth Rosenthal’s An American Sickness is such an important book. A physician and journalist, Rosenthal shares her grounded perspective understandably and persuasively. “In the past quarter century,” she begins, “the American medical system has stopped focusing on health or even science. Instead, it attends more or less single-mindedly to its own profits.” (p. 1)

Profit-making isn’t a new story and it’s not even a bad story, either—at least on its face. It becomes a problem when for-the-public-good operations get out of balance, focusing too much on money and not enough on public obligations.

To make that point, Rosenthal analyzes the system’s components—insurance, hospitals, physicians, pharmaceuticals, testing services, medical devices, billing, and general management. The centerpiece of her critique is what she labels, “Economic Rules for the Dysfunctional Medical Market” (p. 8).

If you read nothing else from this book, read that material! The reason? Rosenthal pinpoints what needs to change, things like: More treatment is always better. Treatment is preferable to a cure. There’s no such thing as a ‘fixed price.’

Rosenthal doesn’t believe our current plight is caused by bad people doing bad things. Indeed, she recounts story after story of people and organizations doing good things. They share a common characteristic, though: swimming against the tide trying (as hokey as it may sound) to do the right thing.

What’s the answer? Rosenthal’s answer is clear: “return the system to affordable, evidence-based, patient-centered care” (p. 328). For that to happen, she says, “we need to…become bolder, more active and thoughtful about what we demand in health care and the people who deliver it. We must be more engaged in finding and pressing the political levers to promote the evolution of the medical care we deserve” (p. 329).

The “we” to which Rosenthal refers is us— everyday citizens. She’s right, but there’s a hitch, and a big one, too. Rosenthal’s advice applies to other areas in need of public reform (the cost of public higher education, for example), which require citizens to roll up their sleeves, be bold and knowledgeable, and get the political system to work as it should.

In all of those situations, resolution also requires ‘smarts,’ including the ability to figure out solutions that don’t generate a new set of problems. That’s especially important when change-seekers want BIG change (as they do in health care) by replacing existing systems with entirely new ones. (For Rosenthal’s critique of the single-payer model, go here).

That’s why the option we prefer involves fixing the system that exists in America today—the market-based system. That system isn’t the problem. The problem is that it’s not patient-centered.

What would it take to make that happen? First, the system needs to operate the way that other (and perfectly sensible) customer-driven systems work. And, second, the system needs to be wellness- not illness-focused.

Fixing the first problem means making costs more transparent and for health vendors/providers to be more accountable. Rosenthal gives plenty of examples of how to do both, including providing patients with upfront figures regarding the full costs of medicines, tests, and medical interventions—even enabling patients to price-compare. Doing that just makes common sense.

The second matter involves changing the mindset that drives the system, including the way that many of us think about health, doctors, and hospitals. Rosenthal gives examples of how organizations, states, and the Federal government have incentivized the health system to keep people healthy vs. paying them to treat patients when they’re sick. Examples include the Boeing Company (p. 289) and the State of Maryland (p. 298). Another example is Medicare Advantage.

What’s it all mean? The clock is ticking, just as it is with other critical issues facing America (e.g. climate change). In the meantime, too many people are being hurt as we stumble around trying to figure out how to improve the system.

At issue is figuring out what change is workable (politically and economically) and how to make change a reality. It’s with those objectives in mind that Elisabeth Rosenthal gives America a get well card—how to figure out both.

Frank Fear, Jr. is Chief Information Officer at Covenant Healthcare (Saginaw, MI), a non-profit health care system that serves twenty counties in central and northeast Michigan. Frank served previously as vice president at Memorial Healthcare (Owosso, MI), a non-profit hospital offering inpatient and outpatient services to those living in its 100,000-person service area. He received a B.A. in psychology from Albion College and graduated from Michigan State University with an M.A. in counseling psychology.

Frank A. Fear, Sr. is professor emeritus, Michigan State University, where he served as a faculty member and worked in a variety of administrative positions. He is primarily interested in how public and nonprofit institutions serve the public good. Frank currently works as Managing Editor/columnist at The Sports Column (Baltimore, MD) and writes regularly about social issues for the Los Angeles-based, LA Progressive

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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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