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An American Sickness

When my colleague Rachel Lewis generously gifted me a copy of An American Sickness, I thought: ‘Oh no, another turgid book about a turgid healthcare system.’

After all, life is complex enough writing about health care across Europe and Emerging markets without seeking to understand the world’s most dysfunctional health care system. But the trouble is non-Americans can not ignore the US healthcare system, particularly if they are in for-profit health care. It dominates any discussion as to the merits or demerits of for-profit health care in any other country. The left always says: “We don’t want to end up like America!”

So you can’t ignore it. And this is an exceptionally good book, which is why I’m writing about it four years after its publication. It is also unputdownable.

Journalist and former doctor Elisabeth Rosenthal writes from the standpoint of patients with each chapter starting with another shocking anecdote of callous greed and overbilling.

So what are the main lessons?

The American medical profession certainly gets it in the neck for its enormous avarice. There is a lesson here which the Left in Europe won’t want to hear about people it regards as saints. Doctors left to their own devices and allowed to set their own prices will gouge away. She is particularly angry about doctors who deploy so-called “extendible” nursing staff to do the job for them and then bill both their own time and that of the nurse. By building a team of such people, a doctor can become a shape-shifter able to charge at four or five beds simultaneously!

Insurers are chocolate fireguards who only care about their take and have no incentive to reduce overall prices. And the not-for-profit hospital sector, which dominates America, is exposed as a money making machine which pays its CEOs multi-million dollar salaries. She charts the subversion of Obamacare which mandated that preventive tests should be free to encourage patients to come forwards. But these tests have been redefined as “diagnostic” to enable them to charge $8,000 for a colonoscopy.

OK, so she doesn’t like for-profit hospitals much either – particularly the type who achieve local dominance and then massively up prices. But for anyone seeking to defend people who dare to make a profit from health care services, this book is useful. It lays the main blame elsewhere. And at around 15%, for-profit hospitals remain a surprisingly small slice of the US system. Much smaller than the near 50pc of all procedures in socialist France.

Solutions in the book come in two forms – those for individual Americans unlucky enough to fall ill and system solutions. She is stronger on the former. For instance, she advises Americans in hospital thus: “If you are feeling well enough, ask to know the identity of every unfamiliar person who appears at your bedside, what he or she is doing and who sent him or her. Beware the nice doctor who stands at the foot of your bed and asks if everything is going OK. That pleasantry may constitute a $700 consultation.”

Systemwide panaceas include setting up a single payor system, expanding HMOs and (inevitably) digital health. She should write more on these. But buy the book. You will love it, and, if you work in health care, it should also challenge your thinking and ethics.

We would welcome your thoughts on this story. Email your views to Max Hotopf or call 0207 183 3779.