Book Review:
An American Sickness – How Healthcare
Became Big Business and How You Can Take
It Back by Elizabeth Rosenberg MD
Dennis Slater, MD
The American healthcare system is in disarray and
failing. 20% of the gross national product is spent on
medical care and our health statistics are at the bottom
of the wealthy industrialized countries. This rant is now
cliché, tossed at healthcare professionals from every
angle – industry, politicians, patient advocacy groups.
Out of this cacophony comes a treatise by Elizabeth
Rosenberg, an internist. Her voice is clear and familiar.
She thinks and writes like a doctor who has been in the
trenches, carefully documenting through a series of
personal encounters shared by all of us, the dysfunction
and decay of our medical system.
So what is new? Nothing really, except that Dr.
Rosenberg dramatically shows that competitive
market forces, designed to lower costs in a free market,
paradoxically and shockingly heightened costs at
every level – hospital bills, doctor bills, insurance
premiums, drug costs, laboratory and radiology costs.
And we doctors, willingly or not, are drawn into the
vortex of spiraling costs. The distortion of the market
inescapably argues for external (governmental) controls.
The chapter on “The Age of Conglomerates” is
particularly relevant to physicians at Backus Hospital.
Dr. Rosenberg targets Sutter Health, a corporate giant
in Cali rnia, ic u s financiall tr u le spitals,
monopolizing healthcare access geographically, thereby
increasing charges. No surprise. This scheme works for
a while until Sutter Health is shunned by insurances.
But it is the story of Coastal Hospital, a small
community owned hospital which joins Sutter Health,
which is personally poignant.
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“…in 2009 Sutter Health ended its role of supporting
locally owned hospitals and embarked on a state wide
merger strategy called regionalization.”
“In 2011, a Sutter Health representative rewrote the
hospital bylaws with more than a thousand changes…
Sutter drew up a plan to replace Coastal Hospital’s
board, then made up partially of locals, with a
committee that had no decision making authority
under regionalization.”
“Regionalization is okay if it brings operational
e ciencies, ut an e ecutive even t l us t ere are n
e ciencies in t is mer er t s a ut c ntr l, pricin ,
c ntracts, pr fits
“In December 2013 Sutter announced that Coastal
spital as n t financiall via le an ul e
converted into a critical care hospital – downsizing
from 49 to 25 beds.”
Needless to say, a familiar ring and chillingly prophetic.
Dr. Rosenberg’s prescription for curing the sick
healthcare system is fuzzy, but her sense of direction is
spot on – patients (inevitably all of us) must know the
cost of care and be educated and empowered to select
quality care at lower cost. But who among us knows
our own cost? g
TH E O P E N JO URNAL • FALL 017