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An American Sickness Pdf

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Download An American Sickness Free Ebooks in PDF format. Download free ebook of An American Sickness soft copy pdf or read online by'Elisabeth Rosenthal'Published on 2018-03-13 by Penguin

A New York Times bestseller A Washington Post Notable Book of the Year At a moment of drastic political upheaval, An American Sickness is a shocking investigation into our dysfunctional healthcare system - and offers practical solutions to its myriad problems. In these troubled times, perhaps no institution has unraveled more quickly and more completely than American medicine. In only a few decades, the medical system has been overrun by organizations seeking to exploit for profit the trust that vulnerable and sick Americans place in their healthcare. Our politicians have proven themselves either unwilling or incapable of reining in the increasingly outrageous costs faced by patients, and market-based solutions only seem to funnel larger and larger sums of our money into the hands of corporations. Impossibly high insurance premiums and inexplicably large bills have become facts of life; fatalism has set in. Very quickly Americans have been made to accept paying more for less. How did things get so bad so fast? Breaking down this monolithic business into the individual industries--the hospitals, doctors, insurance companies, and drug manufacturers--that together constitute our healthcare system, Rosenthal exposes the recent evolution of American medicine as never before. How did healthcare, the caring endeavor, become healthcare, the highly profitable industry? Hospital systems, which are managed by business executives, behave like predatory lenders, hounding patients and seizing their homes. Research charities are in bed with big pharmaceutical companies, which surreptitiously profit from the donations made by working people. Patients receive bills in code, from entrepreneurial doctors they never even saw. The system is in tatters, but we can fight back. Dr. Elisabeth Rosenthal doesn't just explain the symptoms, she diagnoses and treats the disease itself. In clear and practical terms, she spells out exactly how to decode medical doublespeak, avoid the pitfalls of the pharmaceuticals racket, and get the care you and your family deserve. She takes you inside the doctor-patient relationship and to hospital C-suites, explaining step-by-step the workings of a system badly lacking transparency. This is about what we can do, as individual patients, both to navigate the maze that is American healthcare and also to demand far-reaching reform. An American Sickness is the frontline defense against a healthcare system that no longer has our well-being at heart.

This Book was ranked at 31 by Google Books for keyword Economics Free Enterprise bestseller books.

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American healthcare is commonly known to be in a deplorable state, costing 18% of GDP while underperforming in quality among developed nations. Changing the situation systemically also seems intractable—passing new regulation is a political landmine, and costs continue to rise without a clear winning strategy.

American Sickness unpacks how US healthcare got to this state. It examines the competing interests of the major blocs in healthcare - hospitals and doctors, pharmaceuticals and devices, and insurers. Written by a Harvard-trained doctor and New York Times reporter, this book clarifies how deeply entrenched the interests are and why it’s so difficult to change anything.

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Even the FDA benefits from fees for each application for a drug, incentivizing more me-too drug applications.

A Dysfunctional Market

The maximization of incentives is true of any market, but several factors make healthcare an especially dysfunctional market.

Consolidation of healthcare providers has led to functional monopolies in certain geographies.
- Massive health systems consolidate and become the only game in town. If you have the only maternity ward in the local region, all the local patients want access to you.
- Patients want insurance that covers this big player, and they reject narrow-network insurance. Thus employers are pressured to get insurance with good coverage.
- Therefore, large health systems with a local monopoly have massive leverage over insurers in setting prices and favorable policies.
Given the complexity of medicine, most patients cannot be fully informed about the tradeoffs of medical treatment. Thus they are swayed by pharma marketing and providers, who have their own competing incentives.
The recipients of healthcare (patients) are not paying directly for the service—insurers are. This leads to moral hazard problems, where patients tend to opt for the highest-priced care if they’re not paying for it.
Doctors are often ignorant of prices and thus can’t serve as effective advisors for the patient on cost-effectiveness.
Prices are opaque and often discovered only after treatment. Often this is because of confidentiality agreements between insurers and providers.
High regulatory barrier to entry for getting drugs/devices approved (FDA trials) limits open competition for generics.

By now, all the major blocs are so deeply entrenched that any zero-sum change is strongly opposed. For example, lowering compensation to doctors might mean cheaper costs for the system, but doctors will staunchly oppose this.

Fragmentation makes it difficult to change anything systemically.

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Much of healthcare is regulated on a state-by-state basis instead of nationally.
Employers are fundamentally competing with each other for talent, impeding collaboration between employers.
Even within each bloc, there is further fragmentation.
- Providers are divided into specialties, and they battle for a fixed pie of Medicare RVU reimbursements.
- Different blocs of patients want different things (eg AARP vs millennials)
Other countries have a single payer (the government) that can negotiate prices and reject treatments not proven to be cost-effective. However, much of the US is philosophically opposed to the expansion of federal government and allergic to structures resembling “socialism.”

What You Can Do

Even if you can’t change the healthcare system yourself, what can you do to reduce your own price of care? The book recommends these actionables:

Question your doctor and hospital about fees before you get treatment.

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