Name: An American sickness
ISBN: 9781594206757

An American sickness

"An award-winning New York Times reporter Dr. Elisabeth Rosenthal reveals the dangerous, expensive, and dysfunctional American healthcare system, and tells us exactly what we can do to solve its myriad of problems. It is well documented that our healthcare system has grave problems, but how, in only a matter of decades, did things get this bad? Dr. Elisabeth Rosenthal doesn't just explain the symptoms; she diagnoses and treats the disease itself. Rosenthal spells out in clear and practical terms 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, explaining step by step the workings of a profession sorely lacking transparency. This is about what we can do, as individual patients, both to navigate a byzantine system and also to demand far-reaching reform. Breaking down the monolithic business into its individual industries--the hospitals, doctors, insurance companies, drug manufacturers--that together constitute our healthcare system, Rosenthal tells the story of the history of American medicine as never before. The situation is far worse than we think, and it has become like that much more recently than we realize. Hospitals, which are managed by business executives, behave like predatory lenders, hounding patients and seizing their homes.

What Hacker News says

bcookeMar 2026

This project reminds me of a book I highly recommend called An American Sickness. It sheds a lot of light on the same sorts of issues.

One underlying, perverse incentive behind many of the problems is that insurers are regulated based on percentages of spending rather than total costs.

The US passed laws meant to limit marketing and overhead that tied insurers economics to the size of the overall medical bill... which means as healthcare spending rises, the dollars they’re allowed to retain can rise too, which basically means they're incentivized to drive costs up rather than down.

Here's a link to the book: https://www.helmpublishing.com/products/an-american-sickness...

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triceratopsOct 2025

> [you] are essentially making a hand-waving argument

I'm not the only one.

"In Elisabeth Rosenthal’s excellent book, An American Sickness, she notes:

'The median cost to a hospital for each full-time resident in 2013 was $134,803. That includes a salary of between $50,000 and $80,000. Federal support translates into about $100,000 per resident per year. Researchers have calculated that the value of the work each resident performs annually is $232,726. Even without any subsidy, having residents is a better than break-even deal.' "

And

"In the old days, hospitals paid for resident training by building those costs into the bills they sent patients. But in 1965, Congress acknowledged resident medical training as a public good deserving of public investment, and firmly established federal funding for graduate medical education costs with the Medicare Act.

(What’s interesting is that Congress intended for the public funding to be temporary, with language in both the House and Senate reports noting that the funds were intended to last only “until the community undertakes to bear such educational costs in some other way.” Unsurprisingly, once governmental funds became available, hospitals have had little interest in undertaking how to bear these costs any other way.)"

https://thesheriffofsodium.com/2022/02/04/how-much-are-resid...

> they generally have to be directly supervised by an attending physician, which is expensive

The blog post argues that they also free up attending physicians to focus on the highest-compensated doctoring activities.

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stevebmarkOct 2023

Read the book “An American Sickness”. It is indeed everyone.

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stevebmarkSep 2023

HMOs are so much better than PPOs, but they're rare these days. They are significantly cheaper than PPOs. Most HMOs don't have deductibles, and all of them have lower premiums than PPOs. The "out of network" coverage of PPOs is an irrelevant scam. Your insurer covering 10% of a $200,000 out of network surgery is still going to bankrupt 99% of people in America.

HMOs require you to get a referral from your primary care doctor to see a specialist, which has the added benefit of making sure people actually have a PCP. Primary care is one of the few types of care where the more you apply it, the better a patient's health outcome.

No one gets an HMO because they're scared of having less choice of which doctors they can see. They pay more to have a choice that's ultimately irrelevant to their health. Most people choose doctors based on friend/family referrals and Yelp reviews, meaning they don't know how to choose a doctor. Reviews/referrals have no relation to health outcomes.

The end of the article refers to the "medical loss ratio" enforced by the ACA, which did indeed incentivize insurance carriers to tolerate higher healthcare bills. This affects PPOs much worse than HMOs. It should all be burnt down.

Further reading, one of the best books on the subject: "An American Sickness"

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SamuelAdamsAug 2021

Good points in here. If you want to read a good book that discusses all the different players in healthcare, i recommend “An American Sickness” by Elisabeth Rosenthal.

It does a great job pointing out the various players and the conflicting interests between them. Highly recommend for anyone looking to learn more.

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whitej125Jan 2021

For those interested... I thought this was a pretty good book going over the creation and evolution of the US Healthcare system. It's equal parts fascinating and infuriating.

An American Sickness: How Healthcare Became Big Business and How You Can Take It Back

by Elisabeth Rosenthal

ASIN : 1594206759 Publisher : Penguin Press; 1st edition (April 11, 2017) Language : English Hardcover : 416 pages ISBN-10 : 9781594206757 ISBN-13 : 978-1594206757

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