Sick: The Untold Story of America's Health Care Crisis---and the People Who Pay the Price
Product Type: Book
Product Price: $14.99
Manufacturer: Harper Perennial
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Description
America's health care system is unraveling, with millions of hard-working people unable to pay for prescription drugs and regular checkups, let alone hospital visits. Jonathan Cohn traveled across the United States—the only country in the developed world that does not guarantee its citizens access to medical care—to investigate why this crisis is happening and to see firsthand its impact on ordinary Americans. Passionate, powerful, illuminating, and often devastating, Sick chronicles the decline of America's health care system, and lays bare the consequences any one of us could suffer if we don't replace it.
Reviews
Rating: 4 / 5
Date: 2010-03-09
Summary: "Tugs @ the heartstrings, but a good overview of the problem"
I bought this last summer & found it a helpful overview of many aspects of the healthcare crisis. The author provides examples that illustrate different dimensions of the problem and how individuals are impacted by our flawed system. Some may feel the stories border on the maudlin, but I heard an interview of Cohn by Terry Gross and I believe he is sincere and honest. The book is entertaining, informative and worth reading.
Rating: 4 / 5
Date: 2009-09-27
Summary: "Excellent entry into the narrative of American health care."
Jonathan Cohn, a Harvard grad, is a senior editor at The New Republic, contributing editor at The American Prospect and a senior fellow at the think tank Demos. He has also written for The New York Times, The Washington Post, Mother Jones, Rolling Stone, Slate and The Washington Monthly.
I found Sick to be an excellent primer on the U.S. health care system. The subtitle: the untold story of America's health care crisis - and those who pay the price, turns out to be the focus of this book (shocking, I know). I say this with a bit of sarcasm because of some of the reader reviews I've seen that either criticize Cohn for advocating for universal coverage (a topic he spends about 18 pages at the end of the book discussing) or for not throwing enough data, analysis and policy at the reader. This book is about average Americans trying to navigate a perverse and often baffling health care system.
Each chapter highlights a different city (from Boston to Deltona to Sioux Falls and Los Angeles) and a few of its inhabitants as they interface with doctors, hospitals, insurance companies and employers. Several reviews site the use of anecdotes as a weakness but I found them to be the just the opposite. Cohn's use of personal stories aims to engender empathy in the reader and it does so in spades. Each chapter also highlights a different aspect of the system from the history of employer-based health insurance to Medicare and Medicaid to the rise of managed care. The narrative switches back and forth between personal story to policy discussion, but does so in a way that flows naturally. Reviewer Abigail Zuger wrote of Cohn's style: "I suspect that committed policy wonks might find his analysis fairly basic, but for those of us without formal background in the area, it is a pleasure to have the whole drama laid out, act by act."
This book is neither a rant nor propaganda. Cohn is as objective as one can hope to be on the topic. Of the negative reviews I've read, I have yet to come across one that assails the author's investigations, analysis and ultimate portrayal of the health care system. Perhaps this is because Cohn devotes 53 pages to his sources and notes.
I highly recommend this book to anyone looking for a point of entry into the discussion of health care reform. This book has sparked my interest and has spurred me on to read more books on the subject.
Rating: 4 / 5
Date: 2009-08-10
Summary: "Well written, but you'll love this or hate it based solely on your political ideology"
Reform of the medical care system has been an ongoing debate in American society for many decades now, but renewed interest during the Presidential Primaries and Michael Moore's 2007 documentary film "Sicko" pushed the issue to the forefront of American politics. The resultant deluge of books on the topic have widely varied in terms of quality and what the author advocates as the solution to the problems inherent in the health care system. "Sick" was one of the first books out of the gate and is an unabashed polemic advocating for single-payer universal coverage offered by the federal government that takes a hard critical look at the existing system and particularly it's flaws, faults and drawbacks. Cohn paints a portrait of a system that is not only faltering, but is at times failing miserably. All of this has been documented almost ad nauseum elsewhere, but there is a clarity and cogency to Cohn's writing that helps to dramatize his arguments. And Cohn points out the flaws that exist in single-payer universal health care systems elsewhere, but makes a compelling argument that anything would be an improvement over our existing system. Cohn uses individual cases to illustrate the failures of the system and in doing so personalizes the argument in ways that many books fail to do. At the same time Cohn pulls back for the broader macro picture that helps to illustrate the broader benefits to the change he advocates.
But as with many of these polemics about the health care system "Sick" is either likely to re-enforce what you already believe or will fail to convince you to change your mind and rethink your position. Most Americans have already formed an opinion regarding health care reform or are downright fearful of change. Cohn seeks more to allay the fears of those resistant to change, but fear is a powerful emotion that the reasoned arguments of "Sick" may not be able to placate. While Cohn does make a compelling case for the single-payer universal health care approach it seems unlikely that enough Americans would be willing to embrace such a bold change as opposed to the more tepid and timid incrementalist changes. Furthermore, the complexity of the health care system in its present form is such that any drastic changes may have dire unintended consequences that may cause potential supporters to flinch. In the end Cohn makes a compelling case for his radical surgery as opposed to the tentative half-steps of reform. This is telling as there are few books out there touting reform of the existing system; clearly that tells you of the dysfunction that exists and only makes Cohn's argument that more persuasive. There also is no shortage of titles out there warning of what may come to pass if America goes the single-payer universal health care route, but most are not as well researched, as well written, or as persuasively reasoned as "Sick." Rather than appealing to fear and emotions Cohn appeals to the intellect and reason in a way that should persuade readers to reconsider their beliefs about single-payer universal health care coverage.
Rating: 4 / 5
Date: 2009-06-27
Summary: "good overview of the problems with for profit heath care"
Coming from a Scandinavian country, living in the US, and being a physician; this has been an interesting issue to me.
I think this book does a very decent job of clarifying some of the problems with having a for-profit-health care system. It does this through real-world examples of what happens to individuals caught up in the for-profit game. The examples are carefully chosen, and I think the author wisely avoids being overly sentimental or person-story oriented, but instead uses the examples for illumination of general points.
The hospitals, health insurers, and employers all need to make money, and ultimately, the only way to achieve that is for the customers (the potential patients) to pay, either directly or through taxation. In a for-profit system, there is a natural tendency for cost to go up, unless the users (patients) by free market principles can drive cost down by competition. Health care has not shown itself to be easily self-regulated by competition (save perhaps some simple, non-emergency surgical procedures), instead all the different players who want to make a profit will help cost spiral. The situation is exacerbated when cost spiraling is reflected in higher insurance premiums, which leads to fewer who can afford to partake, and the cost being shared by fewer.
One core question asked in this book is this: Why does the American health care cost 16% of GDP, more than twice that of the other Western countries. Many Americans think they have the best health care in the world. I wonder about that. At best, this is true for the 80% who are covered. Personally, I am also curious from a quality perspective. When all players, including the hospital owners and doctors are working for profit, the costs will have a natural tendency to go up. This means more tests, more procedures etc, which provides income for the providers (and expenses for the insurers who will try to defer that cost somehow). Costly malpractice suits probably also have something to do with the tendency to take tests 'to be safe'.
These tests and procedures may be way more costly than beneficial in a community perspective, and downright dangerous for some individuals. This is something a free-market healthcare may have difficulty regulating, since individual interest may sometimes do not coincide with the community perspective, but most importantly it can be very difficult for a layman to obtain the necessary information to make informed decisions with very complicated health care decisions; especially in case of emergencies.
Again, I think this book shows some of these dilemmas very well, with a balanced political perspective.
The only caveat I have with this book, is the lack of discussion about the one central problem facing all health care systems, regardless of whether run entirely privately, entirely by government or in some combination:
The inability of the health care system to measure its production.
Essentially all health care systems have one important similarity - all health care have to be paid for, either through direct taxes or indirect (health insurance premiums or a lower salary than could be the case if the employers did not have to provide coverage).
But, what are we producing in a health care system? This could vary vastly. Ideally we produce health. To do so, we make the highest quality decision about an individuals health issue at any given time. How do we measure the quality of all those decisions?
Quality in health care is difficult to define, and hinges on a large number of 'small' decisions, where what is right for one individual with a disease may not be right for another. The exact right dosage of a medicine, the combination, the length of a course of antibiotics, the length of observation time before an intervention, handling of complications, information to patient and relatives about the disease, cause, and prognosis, are all important aspects of quality (to name a few), yet we can barely measure them. Or, in some cases, the bureaucracy involved in actually measuring all the little nuances become prohibitively expensive.
Thus, although we are increasingly being able to measure cost, we are still (in any health care system I can think of) amateurs in actually measuring our production.
This is crucial, both since we should all care about getting the highest level of quality care possible and since what we should be willing to pay should match what we actually receive.
Anyway, I found this to be a timely book, helping me to better understand how the American health system works, how it got there (lots of good historical perspective), and some of the problems facing it now.
Rating: 5 / 5
Date: 2009-02-26
Summary: "great service"
the book arrived even before the estimated delivery time and it was in great shape, better than the posted description. So overall, i have received a great service.