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The Hospital: Life, Death, and Dollars in a…
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The Hospital: Life, Death, and Dollars in a Small American Town (edição 2021)

por Brian Alexander (Autor)

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Título:The Hospital: Life, Death, and Dollars in a Small American Town
Autores:Brian Alexander (Autor)
Informação:St. Martin's Press (2021), 320 pages
Colecções:A sua biblioteca

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The Hospital: Life, Death, and Dollars in a Small American Town por Brian Alexander

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Alexander gives a rare perspective on America's health-care crisis, that of a local hospital's CEO. Of courses this introduces some bias and one has to read between the lines, but the story is well worth reading. Alexander supplements the narrative with stories from EMTs and patients, and with historical explanations of how the system developed in this way. Particularly at the end, he also dives into the politics. This was all reasonable, if not especially novel. The job and economics of running a hospital was for me the main attraction. ( )
  breic | Apr 15, 2021 |
American healthcare was an absurdist game of Jenga.
~From The Hospital by Brian Alexander

The Hospital: Life, Death and Dollars in a Small American Town by Brian Alexander is the portrait of a Byran, Ohio hospital between 2018 and 2020. Alexander followed management, staff, and patients, investigating the complexities of healthcare in America in one small town. The news headlines we have all seen is presented in a personalized narrative that is deeply affecting; you want to rant, or cry. Likely both.

What America did have was a jumble of ill-fitting building blocks: the doctoring industry, the hospital industry, the insurance industry, the drug industry, the device industry. ~from The Hospital by Brian Alexander
Alexander follows the Bryan hospital's struggles to keep in the black when other small hospitals were being consolidated or put out of business by larger hospitals. And he shows how medical care has become a profit-making business.

I was surprised to learn that deductibles were not always a part of health insurance. The rationale was that people would not abuse insurance if they had to pay a portion out of pocket. Affordable insurance comes with a high deductible, and people think twice before using it. Consequently, people go without preventative care and medications and treatment for illnesses.

It could have been my family when we had to forward paid bills to the health care provider for reimbursement--after we met the deductible. Our baby suffered from continual ear and sinus infections and we often met the deductible by the end of January, which meant a huge decrease in available income for other bills and necessities at the start of every year.

The patients in the book exemplify the danger of skipping care. Those who can't afford medications pay a higher personal and economic cost when disease or illness progresses. Some pay with their lives, some become disabled and permanently lose jobs and income, and many are hopelessly mired in debt.

Alexander writes that America has struggled with the crisis in medical care costs for a hundred years. Citizens resisted health insurance a hundred years ago the way they resisted the Affordable Care Act later. Health insurance was, an is, considered unAmerican and socialist by some--even those who benefit from Medicare and other governmental programs.

"Health...is a commodity which can be purchased," Alexander quotes the president of a utility company, and major employer, in 1929. "The difficulty now is its cost is beyond the reach of a great majority of people."

Almost a hundred years later, it remains true.

In 1963, my dad sold the business his father had built in Tonawanda, NY, and came to Detroit to look for work in the auto industry. Mom had an autoimmune disease. They needed health insurance. My folks were very lucky. They went from struggling to a nice home, two cars, health insurance to treat mom's crippling rheumatoid arthritis and, later, dad's non-Hodgkins lymphoma, plus my folks paid for my first two years of college.

Today, my son has to purchase his own health insurance. He has to invest his own money in a retirement account. Of course, he has school loans, too.

We have gone backwards.

Alexander touched on Michigan hospitals, like William Beaumont Hospital, the Royal Oak, Michigan based hospital where my parents and grandparents were treated. A few years back they tore down an the aging shopping center of my youth and built a new one. It did seem strange to me that a hospital was in real estate. When Covid-19 hit and Michigan went into lockdown, hospitals lost elective surgery patients. Like my husband, who was considering shoulder replacement surgery a year ago. Beaumont laid off thousands and eliminated 450 jobs. During a pandemic.

The book brought back a lot of memories of our seven years living along the Michigan-Ohio border. I had been to the towns Brian Alexander writes about.

After fifteen years living in Philadelphia, we moved back to Michigan our son could grow up knowing his extended family. Neither of us had lived in a small town before. There were under 9,000 people in Hillsdale, and about 40,000 in the entire county. There was a turnover of doctors; our first family doctor, one of the few who delivered babies, left family practice, demoralized after lawsuits. We did have a small hospital at the end of our street. When our son was three, he came down with pneumonia and we were glad the hospital was so close.

Small town life was an adjustment. We left a racially eclectic city neighborhood for a county with five African Americans; one was my ob/gyn, one his nurse wife, and one his daughter who was in my son's class in grade school. I was surprised by rural poverty. Our son told us that half his kindergarten class did not have a phone and most had no books in their homes. We took took day trips antiquing in small Ohio towns like Pioneer and I took my Bernina sewing machine for cleaning in Bryan, OH.

I am pleased that the publisher offered me a free egalley in exchange for a fair review. I found this to be an immersive, thought-provoking book. ( )
  nancyadair | Feb 2, 2021 |
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