An American Sickness: The Commodification of Americans
“Unless you’re part of the 1 percent, you’re only ever one unlucky step away from medical financial disaster.”
Although most of us are aware that the healthcare system in America is not well, we may not have realized the extent of the illness. If you are fortunate enough to have a job with decent insurance, you may not realize how vulnerable you really are.
Elisabeth Rosenthal’s book, An American Sickness: How Healthcare Become Big Business and How You Can Take It Back, is a History and Physical of American Healthcare. It is compelling, sometimes funny, and absolutely appalling.
The Chief Complaint is “hugely expensive medical care that doesn’t deliver quality results.” Rosenthal then lays out the History of the Present Illness and Review of Systems, a look at how American medicine has transformed from one based on caring to one based on profit. And in the Diagnosis and Treatment, she gives us resources for ourselves and for the broader good, what we can do to be less vulnerable to outrageous doctor bills, hospital bills, insurance costs and what kinds of systemic changes we need to demand from our lawmakers, insurance companies, providers and healthcare institutions, hospital and insurance regulators.
What is so shocking is how vulnerable we all are, even those of us with the best insurance. All we need is a hospitalization or emergency situation in which, without choice or informed consent, we receive service from out-of-network providers or end up in an out-of-network facility and we can be on the line for astronomical charges. The provider may just say hello to you at your bedside in the hospital. You may be taken to the nearest facility when you are in a situation where every minute counts, and you may not even be conscious. And the rest of your life you may be in financial ruin.
Increasingly certain groups of providers and certain facilities don’t sign up in networks at all and charge whatever they want.
And this is only one outrageous way to go deeply into debt to our broken medical system.
The breakdown in relationship between the medical industry and the people they serve is one that touches all of us, and I feel particularly close to it. My father was a thoracic surgeon in the “golden age” of medicine. He accepted what people could pay. We had several beautiful oil paintings from one of his patients. One of my brothers is a physician employed by a large medical conglomerate, who has considered repeatedly whether he can bear to stay in medicine. The differences between my father’s and my brother’s experience of the medical field are enormous.
I work in a hospital, a community hospital that has recently been acquired by a larger medical entity. I do payroll and accounting for the physician practices that are under the hospital’s wing. I see the bankruptcy paperwork coming in for patients who have gone underwater. I see what we pay for consultants, for drugs, the closing of departments that don’t bring in enough money (we no longer deliver babies at this hospital) and the struggle our little hospital has had to stay open. I see the doctors who experience that despite their big paychecks, they are stressed and unhappy, many of them feeling like drivers being pushed to go ever faster and do more in a system whose focus is on the mighty dollar.
It is riveting and distressing to read Rosenthal’s history of the moves that have been made that have been part of creating the current state of affairs where patients are no longer related to on a human level – where they have become a commodity, a dollar figure.
The medical industry is not alone in this regard. We have seen similar breakdowns in higher education, in banking and investor relations, in the relationship of employers to their workers, in government and its representatives to the people they are mandated to represent. Things have never been perfect, there have always been ways in which certain groups have been more privileged; this is embedded in our country’s history. But what we are now seeing is a wholesale breakdown of the relationship between the service industries and the people they are purporting to serve.
What we are seeing is something that can’t just be changed by laws or more regulation. The creativity of those at the top of the money-making pile to work around issues is enormous. Yes, those changes are needed, and we need to support them. And we need cultural/social/human development at the same time, without which anything else will never be fully successful.
Despite the infuriating advantage being taken by those who have the power and money to do so, they are also victims of this system. Their humanity has been eroded and their growth as human beings stunted. We need to support functional changes where we can do so and we need to bring growth and development into our lives and those around us, transforming the systems that underlie our medical system, our society, our economy, our political system, our country from the inside out.
Cynthia Carpathios is a long-time political independent and a novice Buddhist monk. She lives in Alliance, Ohio.