Title: Sick: The Untold Story of America?s Health Care Crisis?and the People Who Pay the Price

Author: Jonathan Cohn

Amazon Link: Click Here

My Rating: 9 out of 10

Summary: This book summarizes the crisis in American Healthcare. It offers vignettes giving examples for the different areas where the current system is causing financial and/or physical harm to Americans. The vignettes are accompanied by the historical facts as to what has brought on the specific area of crisis.

Examples of areas covered in the book:

  • Working Uninsured
  • Managed Care
  • Medicare
  • Medicaid
  • Psychiatric Care
  • Charity Care
  • Public/County hospitals

At the end of the book, Mr. Cohn gives his suggestion as to how the situation can be improved.

What is good about the book:

I think that overall this is a tremendously helpful book for anyone who wants to understand the state of healthcare in the United States. In truth, anyone who works in the US healthcare system should also consider reading this book. Cohn takes a methodical approach through the different aspects of our system and not only shows what is wrong with it, but shows how it got that way. It is easy to tell stories of woe for people who have been hurt by the system, but it is much harder to back that up with concrete facts. Mr. Cohn consistently backs up the vignettes with the history, politics, and overall impact of the problem on our society. He does not come off like he is grinding an axe, or espousing a political position, but instead he states the facts in a way that I could easily identify with.

Even in the section at the end where he gives his opinion that a single-payer system of sorts should be adopted, he does so in a way that I did not find at all unrealistic (despite the fact that I have serious hesitations with his solution).

Negatives:

The reason this book did not get a 10/10 from me was because the one part of medicine he did leave out was the part in which I live. The primary care office suffers greatly at the hands of all of these areas of crisis. His approach was to discuss things from the standpoint of the patient, not the doctor. This means that his solution is far more oriented to the patient than to the doctor. At one point in his argument for a single-payer system, he uses the success of Medicare as an example:

Medicare, in fact, is remarkably efficient. It doesn't have to invest in marketing or clever actuarial schemes to avoid financially risky beneficiaries. It has no executives on which to lavish seven- or eight-figure salaries and it has no shareholders to whom it is expected to deliver dividends. Medicare has its problems for sure. If anything, the program could probably stand to spend a little more money on administration, to encourage better quality care. But precisely because its overhead is so ridiculously low compared with that of private insurance, it could afford to do so and still provide more insurance bang for the buck. (Pg. 225)

What he fails to consider (or at least mention) is that there is a large crisis among physicians regarding Medicare. Reimbursement rates are dropping, and many physicians (especially those in primary care) are finding it increasingly difficult to continue practicing with these low reimbursement rates.

It would have been nice for him to consider a day in the life of a physician when shedding light on the current crisis. Making a system that is wonderful for patients at the expense of doctors is one that is doomed to fail. The transaction of medicine is between doctor and patient, so both must be satisfied with the outcome.

The other thing neglected in his summary of the crisis of care is the fact that medical quality is, in general, very poor. Studies show consistently that the average patient is getting only about 50% of the care they should be getting. I do not suggest that this is a deficiency on the part of the physician; instead, it is the fact that our system relies either on data from an archaic records system or from insurance companies' claims data - which is not only unreliable, it is tainted with the for-profit motivation of those companies.

Summary:

The positives greatly outweigh the negatives. My objections are really confined to the last chapter of the book, and even then he puts up very compelling arguments for a single-payer system. Mr. Cohn gives his reader a much better understanding at what is happening in the system and what is at stake if the system does not change.