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WORK TITLE: An American Sickness
WORK NOTES:
PSEUDONYM(S):
BIRTHDATE: 1956
WEBSITE:
CITY: New York
STATE: NY
COUNTRY:
NATIONALITY:
Lives in NYC and Washington, DC * http://www.penguinrandomhouse.com/authors/305931/elisabeth-rosenthal * http://www.kff.org/person/elisabeth-rosenthal/ * http://www.npr.org/sections/health-shots/2017/04/10/523005353/how-u-s-health-care-became-big-business
RESEARCHER NOTES:
PERSONAL
Born 1956.
EDUCATION:Stanford University, B.A.; Cambridge, M.A.; Harvard Medical School, M.D.
ADDRESS
CAREER
Writer. Kaiser Health News, Editor-in-Chief, 2016-present. Worked formerly as an emergency room doctor, as a correspondent at the New York Times, 1994-2016, and as the creator of New York Times series “Paying Till it Hurts,” 2013-2014.
WRITINGS
SIDELIGHTS
Elisabeth Rosenthal is a writer and the editor-in-chief of Kaiser Health News. Rosenthal was a correspondent for the New York Times between 1994 through 2016. During this time she was responsible for the series, “Paying Till it Hurts,” which examined the costs of health care in America.
Rosenthal received her bachelor’s degree from Stanford University, a master’s in English from Cambridge, and her medical degree from Harvard Medical School. Following graduation from Harvard, she briefly practiced emergency medicine in New York City before becoming a full-time journalist. She lives in New York City and Washington, DC.
Rosenthal’s first book, An American Sickness: How Healthcare Became Big Business and How You Can Take it Back, dissects the issues in America’s current healthcare system and presents ideas of how it can be fixed moving forward. The book opens with an introduction titled “Economic Rules of the Dysfunctional Medical Market.” In the introduction, Rosenthal presents a list of illogical rules that run the current medical system, including ideas such as “more treatment is better,” and the notion that costs of procedures should rise as high as the market will allow.
Each chapter begins with an unsavory anecdote, resulting in a patient’s fatality, near fatality, over-treatment, or extremely high bill for a simple procedure. Rosenthal then explains the reason that the described misstep occurred, and how this is a reflection of a deeply flawed medical system. She examines the roles of hospitals, physicians, pharmaceuticals, medical devices, testing, and assorted medical business and details the various ways that they play into an unhealthy system or are hurt by it. Rosenthal includes a combination of extensive medical research with a description of human experience to present her arguments.
While sections of the book focus on the flaws of the medical market in America, Rosenthal also provides suggestions for what can be done to change and improve the system. She offers advice both to healthcare consumers as well as to the medical market itself. To healthcare consumers, she explains what they can do on an individual level to put pressure on the medical system and insurance providers to make healthcare more affordable, responsive, and transparent. For society as a whole, she provides suggestions for changes that should be demanded regarding regulations and laws. Despite these suggestions, a contributor to Kirkus Reviews described the book as “a scathing denouncement, stronger in portraying the system’s problems than in offering pragmatic solutions.”
BIOCRIT
PERIODICALS
Booklist, February 15, 2017, Karen Springen, review of An American Sickness: How Healthcare Became Big Business and How You Can Take It Back, p. 4.
Kirkus Reviews, March 1, 2017, review of An American Sickness.
New York Times, May 25, 2017, “Here to Help; Three Books to Help You Understand the Health Care System,” p. A3(L).
Publishers Weekly, February 6, 2017, review of An American Sickness, p. 56.
Washington Post, May 19, 2017, Juliet Eilperin, “Book World: Illogical Forces Driving a Dysfunctional Health-care System.”*
How U.S. Health Care Became Big Business
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April 10, 201712:01 PM ET
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TERRY GROSS
Fresh Air
The current health care system focuses too often on financial incentives over health or science, says Elisabeth Rosenthal in her new book, An American Sickness.
Bill Diodato/Getty Images
Health care is a trillion-dollar industry in America, but are we getting what we pay for? Dr. Elisabeth Rosenthal, a medical journalist who formerly worked as a medical doctor, warns that the existing system too often focuses on financial incentives over health or science.
"We've trusted a lot of our health care to for-profit businesses and it's their job, frankly, to make profit," Rosenthal says. "You can't expect them to act like Mother Teresas."
Big California Firms Take On Health Care Giant Over Cost of Care
SHOTS - HEALTH NEWS
Big California Firms Take On Health Care Giant Over Cost of Care
Rosenthal's new book, An American Sickness, examines the deeply rooted problems of the existing health-care system and also offers suggestions for a way forward. She notes that under the current system, it's far more lucrative to provide a lifetime of treatments than a cure.
"One expert in the book joked to me ... that if we relied on the current medical market to deal with polio, we would never have a polio vaccine," Rosenthal says. "Instead we would have iron lungs in seven colors with iPhone apps."
Interview Highlights
On what consolidation of hospitals is doing to the price of care
In the beginning, this was a good idea: Hospitals came together to share efficiencies. You didn't need every hospital ordering bed sheets. You didn't need every hospital doing every procedure. You could share records of patients so the patient could go to the medical center that was most appropriate.
Now that consolidation trend has kind of snowballed and skyrocketed to a point ... that in many parts of the country, major cities only have one, maybe two, hospital systems. And what you see with that level of consolidation is it's kind of a mini-monopoly.
'Paying Till It Hurts': Why American Health Care Is So Pricey
HEALTH CARE
'Paying Till It Hurts': Why American Health Care Is So Pricey
What happens, of course, when you have a mini-monopoly is you have an enormous sway over price. And so, what we see in research over and over again is that the cities that have the most hospital consolidation tend to have the highest prices for health care without any benefit for patient results. So consolidation, which started as a good idea in many places, has evolved to a point where it's not benefiting patients anymore, it is benefiting profits.
An American Sickness
An American Sickness
How Healthcare Became Big Business and How You Can Take It Back
by Elisabeth Rosenthal
Hardcover, 406 pages purchase
On the ways the health-care industry stands to profit more from lifetime treatment than it does from curing disease
If you're a pharmaceutical manufacturer and you have a problem like diabetes, for example, if I invented a pill tomorrow that would cure diabetes — that would kill a multi-billion dollar business market. It's far better to have treatments, sometimes really great treatments ... [that] go on for life. That's much better than something that will make the disease go away overnight.
On how prices will rise to whatever the market will bear
Another concept that I think is unique to medicine is what economists call "sticky pricing," which is a wonderful term. It basically means ... once one drugmaker, one hospital, one doctor says "Hey we could charge $10,000 for that procedure or that medicine." Maybe it was $5,000 two months ago, but once everyone sees that someone's getting away with charging $10,000, the prices all go up to that sticky ceiling. ...
What you see often now is when generic drugs come out ... the price doesn't go down to 20 percent of the branded price, it maybe goes down to 90 percent of the branded price. So we're not getting what we should get from a really competitive market where we, the consumers, are making those choices.
On initiating conversations early on with doctors about fees and medical bills
You should start every conversation with a doctor's office by asking "Is there a concierge fee? Are they affiliated with a hospital? Which hospital are they affiliated with? Is the office considered part of a hospital?" In which case you're going to be facing hospital fees in addition to your doctor's office fees. You ask your doctor always ... "If I need a lab test, if I need an X-ray, will you send me to an in-network provider so I don't get hit by out-of-network fees?" ...
Medical Bills Still Take A Big Toll, Even With Insurance
SHOTS - HEALTH NEWS
Medical Bills Still Take A Big Toll, Even With Insurance
Often that will be a little hard for your doctor, because they may have to fill out a different requisition, but it's worth asking. And any doctor who won't help you in that way, I think, isn't attuned to the financial cost that we're bearing today.
On getting charged for "drive-by doctors" brought in by the hospital or primary doctor
You do have to say "Who are you? Who called you?" and "Am I going to be billed for this?" And it's tragic that in recovery people have to think in this kind of keep-on-your-guard, somewhat adversarial way, but I think if we don't push back against the system in the way it bills, we're complicit in allowing it to continue.
On how to decipher coded medical bills
Don't be alarmed by the "prompt payment discount." Go back to the hospital and say, "I want a fully itemized bill. I want to know what I'm paying for." Some of it will be in codes, some of it will be in medical abbreviations. I've discovered you can Google those codes and find out what you're being charged for, often, and most importantly, you might find you're being charged for stuff that obviously you know you didn't have.
Elizabeth Rosenthal is editor-in-chief of Kaiser Health News, an editorially independent news program of the Henry J. Kaiser Family Foundation and a partner of NPR's. Neither KFF nor KHN is affiliated with Kaiser Permanente. Radio producers Sam Briger and Thea Chaloner and web producers Bridget Bentz and Molly Seavy-Nesper contributed to this story.
ELISABETH ROSENTHAL
Editor-in-Chief, Kaiser Health News
Washington, D.C.
202-347-5270
Elisabeth Rosenthal, Editor-in-Chief, joined KHN in September 2016 after 22 years as a correspondent at the New York Times, where she covered a variety of beats from healthcare to environment to reporter in the Beijing bureau. While in China she covered SARs, bird flu and the emergence of HIV/AIDS in rural areas. Libby’s two-year-long New York Times series “Paying Till it Hurts” (2013-14) won many prizes for both health reporting and its creative use of digital tools. She is the author of An American Sickness: How Healthcare became Big Business and How You Can Take it Back, published by Penguin Random House in April 2017. She is a graduate of Stanford University and Harvard Medical School and briefly practiced medicine in a New York City emergency room before converting to journalism.
Elisabeth Rosenthal
Photo of Elisabeth Rosenthal
Photo: © Nina Subin
ABOUT THE AUTHOR
Dr. Elisabeth Rosenthal was for twenty-two years a reporter, correspondent, and senior writer at The New York Times before becoming the editor in chief of Kaiser Health News, an independent journalism newsroom focusing on health and health policy. She holds an MD from Harvard Medical School, trained in internal medicine, and has worked as an ER physician. She lives in New York City and Washington, DC.
Rosenthal, Elisabeth: AN AMERICAN
SICKNESS
Kirkus Reviews.
(Mar. 1, 2017):
COPYRIGHT 2017 Kirkus Media LLC
http://www.kirkusreviews.com/
Full Text:
Rosenthal, Elisabeth AN AMERICAN SICKNESS Penguin Press (Adult Nonfiction) $28.00 4, 11 ISBN: 978-1-
59420-675-7
A blast across the bow of the entire health care industry, which "attends more or less single-mindedly to its own
profits."Rosenthal, a senior writer for the New York Times who has a Harvard Medical School degree and served as a
physician at New York-Presbyterian Hospital, asserts that the American medical system is sick, having lost its focus on
health. In the introduction, her list of "Economic Rules of the Dysfunctional Medical Market" includes such gems as
"1. More treatment is always better. Default to the most expensive option," and "10. Prices will rise to whatever the
market will bear." She begins by demonstrating how for-profit insurance changed the way hospitals operate and doctors
practice medicine and how it has revolutionized the pharmaceutical and medical device industries. Throughout, the
author blends extensive research with human interest. A personal horror story, with names and dates, opens each
chapter: an individual dies or nearly dies, someone is overtreated, or someone receives a staggering bill for a simple
test or procedure. In forthright language--Rosenthal uses blunt terms like "crapshoot" and "mess"--individual chapters
focus in turn on hospitals, physicians, pharmaceuticals, medical devices, testing, and assorted medical business such as
billing, coding, and collection agencies. One or more of the 10 "Economic Rules" sums up each presentation, driving
home the author's message of a deeply flawed medical-industrial system. Rosenthal then offers advice to patients on
how to make the system more responsive and affordable. Beyond that, she details what changes society could and
should demand through updates of regulations and laws. Five appendices provide further guidance, including a
glossary of terms used in medical billing, sources of information on the internet about doctors, hospitals, procedures,
and drugs, and templates for concise and effective protest letters. A scathing denouncement, stronger in portraying the
system's problems than in offering pragmatic solutions.
Source Citation (MLA 8th
Edition)
"Rosenthal, Elisabeth: AN AMERICAN SICKNESS." Kirkus Reviews, 1 Mar. 2017. General OneFile,
go.galegroup.com/ps/i.do?
p=ITOF&sw=w&u=schlager&v=2.1&id=GALE%7CA482911518&it=r&asid=a253444ea078206dda74ae88036fb662.
Accessed 15 Oct. 2017.
Gale Document Number: GALE|A482911518
10/15/2017 General OneFile - Saved Articles
http://go.galegroup.com/ps/marklist.do?actionCmd=GET_MARK_LIST&userGroupName=schlager&inPS=true&prodId=ITOF&ts=1508094619686 2/3
An American Sickness: How Healthcare Became
Big Business and How You Can Take It Back
Karen Springen
Booklist.
113.12 (Feb. 15, 2017): p4.
COPYRIGHT 2017 American Library Association
http://www.ala.org/ala/aboutala/offices/publishing/booklist_publications/booklist/booklist.cfm
Full Text:
* An American Sickness: How Healthcare Became Big Business and How You Can Take It Back. By Elisabeth
Rosenthal. Apr. 2017.416p. Penguin, $28 (9781594206757). 362.10973.
Physicians take the Hippocratic oath to do no harm. But the businessmen running the country's medical industry worry
about reaping profits, not about reliably delivering quality results. As a result, the U.S. spends nearly 20 percent of its
national budget, $3 trillion, on healthcare. In this in-depth analysis of a malfunctioning system, Rosenthal makes a
compelling case against the hospital and pharmaceutical executives behind the "money chase," and it's hard to imagine
a more educated, credible guide. The daughter of a doctor, Rosenthal holds a degree in biology from Stanford, a
master's degree in English from Cambridge, and a medical degree from Harvard, and she writes about health for the
New York Times. The patients she interviewed share mind-boggling stories. One tells of a hospital bill for $132,000 for
an infusion of an arthritis drug with a wholesale price of $1,200. She builds her case with one damning statistic after
another. For example, each year the American Medical Association spends more than $20 million on lobbying--and the
healthcare industry spends $15 billion on advertising. After laying out the problem, Rosenthal presents solutions both
personal and societal in this commanding and necessary call to arms. --Karen Springen
Source Citation (MLA 8th
Edition)
Springen, Karen. "An American Sickness: How Healthcare Became Big Business and How You Can Take It Back."
Booklist, 15 Feb. 2017, p. 4+. General OneFile, go.galegroup.com/ps/i.do?
p=ITOF&sw=w&u=schlager&v=2.1&id=GALE%7CA485442431&it=r&asid=a010768b2a5d430973a9ae5f93ee4be0.
Accessed 15 Oct. 2017.
Gale Document Number: GALE|A485442431
10/15/2017 General OneFile - Saved Articles
http://go.galegroup.com/ps/marklist.do?actionCmd=GET_MARK_LIST&userGroupName=schlager&inPS=true&prodId=ITOF&ts=1508094619686 3/3
An American Sickness: How Healthcare Became
Big Business and How You Can Take It Back
Publishers Weekly.
264.6 (Feb. 6, 2017): p56.
COPYRIGHT 2017 PWxyz, LLC
http://www.publishersweekly.com/
Full Text:
* An American Sickness: How Healthcare Became Big Business and How You Can Take It Back
Elisabeth Rosenthal. Penguin Press, $28
(416p) ISBN 978-1-59420-675-7
Rosenthal, a New York Times senior writer and former physician, provocatively analyzes the U.S. healthcare system
and finds that it's "rigged against you," delving into what's gone wrong as well as how Americans can make it right. In
the first part of this astounding takedown, Rosenthal unveils with surgical precision the "dysfunctional medical market"
that plays by rules that have little to do with patient-centered, evidence-based medical care. In part two she prescribes
the rigorous but necessary steps to fix the broken system. Rosenthal chronicles a startling cascade of escalating
pressures that steadily drove up medical costs, including the skyrocketing spread of health insurance coverage in the
1940s and '50s, hospitals' adoption of big-business models, and doctors' convoluted payment schemes. "Our healthcare
system today treats illness and wellness as just another object of commerce: revenue generation," Rosenthal writes. She
also notes that politicians, insurers, hospitals, and doctors have all maneuvered to "undermine" the Affordable Care
Act. Her advice for now is starkly simple: we need to question everything, including your choice of doctor, hospital,
billing statement, insurance, and the drugs and devices we're prescribed. Given the "false choice of your money or your
life," Rosenthal argues, "it's time for us all to take a stand for the latter." (Apr.)
Source Citation (MLA 8th
Edition)
"An American Sickness: How Healthcare Became Big Business and How You Can Take It Back." Publishers Weekly, 6
Feb. 2017, p. 56. General OneFile, go.galegroup.com/ps/i.do?
p=ITOF&sw=w&u=schlager&v=2.1&id=GALE%7CA480593870&it=r&asid=45cb91d4f25396d021bc97ca04f8d5ad.
Accessed 15 Oct. 2017.
Gale Document Number: GALE|A480593870
Book World: Illogical forces driving a dysfunctional health-care system
Juliet Eilperin
The Washington Post. (May 19, 2017): News:
Copyright: COPYRIGHT 2017 The Washington Post
http://www.washingtonpost.com/
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Full Text:
Byline: Juliet Eilperin
An American Sickness: How Healthcare Became Big Business and How You Can Take It Back
By Elisabeth Rosenthal
Penguin Press. 416 pp. $28
---
Covering the current health-care debate in Washington, I hear politicians every day (and read them on Twitter) describing our current system as a disaster. Health and Human Services Secretary Tom Price informed a key House Appropriations panel recently that the Affordable Care Act is making health "unaffordable for so many Americans." President Trump has predicted that the federal insurance exchanges the ACA has created will both "explode" and "implode" (in which order, I'm still unclear). Having just passed the American Health Care Act through the House, congressional leaders and administration officials have promised that the legislation will return the country to "patient-centered care" and lower the costs of premiums for Americans in some states who have seen them spike, once it's eventually signed into law.
But with just one exception - Trump's call for lower prescription drug prices - almost no one inside the Beltway is coming up with plausible ideas to cut the cost of health care. Luckily, Elisabeth Rosenthal, a longtime health-care journalist and former emergency room physician, has tackled this question in her new book, "An American Sickness: How Healthcare Became Big Business and How You Can Take It Back." Reading it is a sobering experience, one that shows what's really at stake when it comes to our sprawling, costly and illogical health-care system.
Other authors have taken on this territory before: David Goldhill's 2013 book, "Catastrophic Care: How American Health Care Killed My Father - and How We Can Fix It," provided a persuasive case for applying free-market principles and greater transparency to the health-care industry. But Rosenthal - who practiced medicine before entering journalism and now serves as editor in chief of Kaiser Health News - combines her reportorial and medical skills to provide an authoritative account of the distorted financial incentives that drive medical care in the United States. As a result, she has produced a fairly grim tale of how patients - and at times, insurers - are getting ripped off, sometimes with devastating consequences. In short, this is the antithesis of a feel-good book.
Yet it is illuminating, because Rosenthal does plenty of digging to explain the puzzling outcomes that patients and those who care for them often encounter. How does the American Medical Association determine the value of specific services that are entered as codes in a given bill? The AMA convenes the Relative Value Scale Update Committee three times a year, where representatives from different specialties argue over how much they're worth. One former committee member, a dermatologist, tells her it's like having "26 sharks in a tank with nothing to eat but each other." Why did the reimbursement rate for immunological tests done by pathologists drop? Rosenthal offers one theory: "Pathologists tend to be quiet, antisocial types and have never been very good at forming alliances or lobbying." Why doesn't the Food and Drug Administration have more tools to ensure that drug development is cost effective? Because Congress was in a rush to respond to the thalidomide tragedy in the early 1960s, when the babies of some women who took the morning-sickness drug were left with permanent birth defects.
Plenty of Americans are familiar with the idea that pharmaceutical drugs are vastly more expensive in the United States than in other nations and that drugmakers spend enormous sums on advertising their wares while keeping generic versions of these same medicines off the market. But few probably know that many medical devices get scant scrutiny from the FDA because they fit into the "Class 2" category of devices, which are "substantially similar" to ones on the market and used for a similar purpose. While this might sound reasonable in theory, it means different versions of a vaginal mesh taken off the market in 2002 continued to sell, even though the original one had caused a significant number of internal injuries.
Throughout the book, Rosenthal intersperses human stories that demonstrate what happens when the medical profession fails us. Wanda Wickizer was a healthy 50-year-old until she had "a random explosion deep within her skull" on Christmas in 2013; since she was uninsured, her physical injuries were accompanied by hundreds of thousands of dollars in bills. At one point, a hospital official suggested seizing her home as a way to help erase the debt. A 36-year-old diabetic in Memphis, Catherine Hayley, noted that the insulin pump she wears on the waistband of her jeans is "made of plastic and runs on triple-A batteries, but it's the most expensive thing I own, aside from my house."
While Rosenthal does her best to squeeze in a few jokes (mostly lighthearted references at pathologists' expense), the subject matter makes for dense reading at times. This is a thorough book, but it's hard to envision a casual reader picking it up and whiling away the weekend with it. And on occasion her obvious immersion in the medical field slows the writing down a bit, as when she decries the disappearance of two anti-nausea generic drugs. "Not having prochlorperazine available in an emergency room is like not having acetaminophen (Tylenol) in a drugstore." I couldn't help wondering why the book's editor hadn't just struck "acetaminophen" and left "Tylenol" in its place.
Still, Rosenthal does include a set of very practical tips at the end of the book for ensuring that individual patients lower their bills and obtain the treatment they need. This sort of "news you can use" served as a pick-me-up after the parade of horribles that preceded it. She provides smart questions consumers can ask not just their doctors, but also hospitals and insurers. She even strikes a rebellious tone by suggesting that readers consider importing "long-term medicines whose efficacy can be clearly measured" since that's an easy way to cut costs. "Importing drugs for personal use is technically illegal," she notes blithely, "but intercepting small packages of medicine is impossible from a practical standpoint - and the U.S. government has for a long time intentionally turned a blind eye to the practice."
There are several policy prescriptions at the end, too, but even Rosenthal acknowledges that most of them aren't going to be adopted anytime soon. And that's the irony of this book: At a time when the national health debate is largely centered on how to manage insurance rules for about 15 percent of Americans, Rosenthal has made a powerful case for everything else that's wrong in the way that we treat illness in this country. Maybe every lawmaker and administration official should pick up a copy of "An American Sickness." Then, at last, the serious debate could begin.
Here to Help; Three Books to Help You Understand the Health Care System
The New York Times. (May 25, 2017): News: pA3(L).
Copyright: COPYRIGHT 2017 The New York Times Company
http://www.nytimes.com
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Full Text:
Health care policy in the United States has for years been a contentious issue, provoking deep political rifts among voters and frustrated ire from patients. Earlier this month, the House passed a measure to repeal and replace the Affordable Care Act. As the full repercussions of the overhaul come to light (the Congressional Budget Office released its assessment on Wednesday), here are a few books to help you understand the unwieldy system and its major players, recommended by Newsbook columnist Concepcion de Leon:
[...]
AN AMERICAN SICKNESS: HOW HEALTHCARE BECAME BIG BUSINESS AND HOW YOU CAN TAKE IT BACK (2017)
Elisabeth Rosenthal argues that rising drug prices and the bureaucratization of nonprofit hospitals are largely to blame for making the American health care system prohibitively expensive. In this deep dive into the economics of health care, Ms. Rosenthal cites examples like the Providence Portland Medical Center, a hospital started by nuns that became, she writes, ''a weird mix of Mother Teresa and Goldman Sachs.''