An American Sickness by Elisabeth Rosenthal – book review/critique

 An American Sickness: how healthcare became big business and how you can take it back by Elisabeth Rosenthal (Penguin Press, 2017) is both important and disappointing.

Part I: History of the Present Illness and Review of Systems

The first 238 pages are a comprehensive review of the machinery of our healthcare system. This exploration is built around her “Economic Rules of the Dysfunctional Medical Market” – see image left.

Each of these is illustrated in detail.

Rosenthal concludes Part I with the following paragraph:

Part II – Diagnosis and Treatment: Prescriptions for Taking Back Our Healthcare

Despite all of the information about the failings of our market-based healthcare system Rosenthal abandons her analysis when it comes to treatment. After 238 pages detailing why healthcare is not suited to a marketplace, a fact well understood by every other developed country on earth, Rosenthal turns back to the tropes of the free-market ideologues in both the Republican nf Democratic Parties – if only we could get individuals to take responsibility and if we could only bring a bit of transparency to the medical market place everything would get better. The title of the first chapter in Part II, “The High Price of Patient Complacency” tells it all. It is the laziness and incompetence of the American people that is the source of this disaster.

As I and many others have noted numerous times, the US healthcare system is not about healthcare at all. It is a market system in which the providers set prices and then use the market incentives to drive the sale of as many medical devices, prescriptions and procedures as possible. No one is responsible or incentivized to worry about health. The system serves to produce sales and profits. The size of the ripoff of Americans is breathtaking. We spend over $9,800 per capita while our competitors spend approximately half at $4,500 – $5000 per capita. But all of our spending delivers disastrous results. We rank 48th in longevity and 52nd in infant mortality.

As Jacob Hacker, Yale professor and public intellectual wrote in his NYTimes review, “Why an Open Market Won’t Repair American Health Care” 1

The difference between the United States and other countries isn’t the role of insurance; it’s the role of government. More specifically, it’s the way in which those who benefit from America’s dysfunctional market have mobilized to use government to protect their earnings and profits. In every country where people have access to sophisticated medical care, they must rely heavily on the clinical expertise of providers and the financial protections of insurance, which, in turn, creates the opportunity for runaway costs. But in every other rich country, the government not only provides coverage to all citizens; it also provides strong counterpressure to those who seek to use their inherent market power to raise prices or deliver lucrative but unnecessary services — typically in the form of hard limits on how much health care providers can charge.

You can find more information here among my other posts about healthcare.


  1. accessed 8/2/2017