An American Sickness is a meticulously reported book on the troubled US healthcare industry. Rosenthal clearly lays out deeply compelling facts, but the book is much more than that. She weaves in a fantastic collection of her personal stories and those of many others regarding significant impacts on their lives from complex and unjustifiably high healthcare pricing. It took me a long to finish the book and write this review because I read it twice, taking extensive notes the second time through. I highly recommend An American Sickness to anyone looking for a detailed, factual explanation of why healthcare pricing is problematic in the US, the practical steps you can take to mitigate the impact on you, and a few ideas on how we might work together to make a difference.
My employer Castlight Health is mentioned in a brief discussion of companies hired by employers to help their employees understand in advance the likely costs for specific procedures performed by specific providers. In my 6+ years at Castlight and in my current role as CTO, I’ve had a front seat view of the crazy, complicated mess that is healthcare pricing in the US. I can confirm Elisabeth’s claims concerning the lack of correlation of cost to quality, unjustifiably wide variance in amounts charged, and unpredictability of prescription drug pricing. In our experience, the strongest correlation to cost is often the market power of the negotiating medical provider.
As much as I enjoyed the book, I found a few parts frustrating. She writes critically of hospital’s efforts to learn from the travel and hospitality industry to create a better patient experience, while at the same time emphasizing that hospitals are often criticized for providing poor patient experiences. That criticism could still make sense if they’re spending most of the money on the wrong things, but I haven’t seen conclusive evidence of this. While it’s easy to criticize the fancy lobbies, appearances do matter. Otherwise, the better hotels wouldn’t bother, either. And she sometimes writes critically of companies trying to mitigate the screwed up aspects of our healthcare system because they have their own financial motives. But that is how these firms manage to stay in business and pay their employees. We can’t all be non-profits, though in the healthcare business, being a non-profit doesn’t necessarily mean you don’t rake in revenues far exceeding the required expenses.