The Hospital: Life, Death and Dollars in a Small American Town, by Brian Alexander (St. Martins Press)
For the reader, its hard to avoid an abiding sense of sadness and shame that creeps in about halfway through The Hospital: Life, Death and Dollars in a Small American Town, when it becomes clear that a health care companys insatiable drive for more money has overcome the high ideals of patient care, of ministering to people in their hours of greatest need.
As author Brian Alexander shows, the history of the hospital in Bryan, Ohio, parallels Americas struggle to come to some consensus on how to provide health care.
Again and again, Alexander finds people avoiding seeing doctors because they cant pay for the service, skipping medications because they cant afford them, struggling to overcome poor dietary habits and imprisoned in an economy of government aid and low-pay service jobs.
Meantime, consultants are talking to hospital administrators about data analytics and profit centers.
For Bryan, a town of about 8,500, the dragons gathered as long-time CEO Phil Ennen, a native son, tries to keep the town hospital independent.
But the arithmetic is relentless.
Hospital services charges rose 200% from 1998 through mid-2019, nearly four times the rate of inflation. The bigger hospital chains offer higher pay because they have maximized their ability to get the greatest return on every procedure and supply used.
Moreover, when they need medical care, the people of Bryan and elsewhere in America enter an industry of almost numbing complexity.
As Alexander notes, the CT scan that might cost $1,400 at the Bryan hospital could cost $4,000 in nearby Fort Wayne but even the lower price is higher than that charged in Americas peer countries.
A months supply of a cholesterol drug that costs $217 at Walmart can be obtained for $17 at another pharmacy.
Alexander spent almost two years researching and reporting this book. He was given complete access to meetings at the hospital, where financial topics dominated. He reviewed 3,100 documents and interviewed so many people that a spreadsheet would be helpful to keep track of all the characters.
Alexander hopes his book will show the cruel gulfs in American health care how the financially secure can get the best health care while the tens of millions of lower-income people lack health care, get little-to-no preventative care, self-ration their medicines and die young.
For the millions of low-income Americans lucky enough to have a health care plan, the deductible often is a mountain too high to climb. They stop going to the doctor, until it is too late.