An American Sickness audiobook cover - How Health Became Big Business and How You Can Take It Back

An American Sickness

How Health Became Big Business and How You Can Take It Back

Elisabeth Rosenthal

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Society & CultureHealth & Nutrition

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An American Sickness
Industry Evolution+
Profit-Driven Players+
Systemic Impact & Reforms+
Actionable Patient Defense+

Quiz — Test Your Understanding

Question 1 of 10
How did the Affordable Care Act's requirement that insurers spend 80 to 85 percent of their earnings on patient care inadvertently affect insurance companies' attitudes toward high medical bills?
  • A. It forced them to aggressively negotiate lower prices with hospitals to maintain their profit margins.
  • B. It made them more willing to accept absurdly high bills because their allowable profit grows as total spending increases.
  • C. It caused them to drop coverage for expensive preexisting conditions to balance their budgets.
  • D. It led them to transition back to the nonprofit business models of the early 1900s.
Question 2 of 10
What major shift occurred in the 1970s that transformed how American hospitals operate?
  • A. They were nationalized by the federal government to ensure universal coverage.
  • B. They successfully lobbied to ban private insurance companies from operating in their states.
  • C. They began hiring business consultants who introduced profit-optimizing concepts like 'strategic pricing.'
  • D. They transitioned completely to outpatient care to avoid the overhead costs of overnight stays.
Question 3 of 10
Who are 'No Patient Contact' (NPC) specialists, and how have they maximized their revenue in recent years?
  • A. They are specialists like anesthesiologists and radiologists who open private practices and sign highly expensive contracts with hospitals.
  • B. They are medical researchers who patent new drug formulas and sell them directly to pharmaceutical companies.
  • C. They are hospital administrators who take a percentage of every surgery performed in their facility.
  • D. They are foreign doctors who provide telehealth diagnostics to American patients at premium out-of-network rates.
Question 4 of 10
How do pharmaceutical companies frequently manipulate patent laws to keep their profits high?
  • A. By bribing government regulatory boards to extend their original patents indefinitely.
  • B. By moving their manufacturing plants to countries with no patent expiration laws.
  • C. By suing generic drug manufacturers for copyright infringement on their marketing materials.
  • D. By combining existing, non-patented ingredients to secure a new patent for a 'new' drug.
Question 5 of 10
Why are medical devices, such as knee implants and defibrillators, often the most expensive part of a medical bill?
  • A. They undergo decades of rigorous clinical testing by the FDA, which drives up research and development costs.
  • B. The market is controlled by a tight-knit oligopoly with little competition, allowing intermediaries to endlessly mark up prices.
  • C. They are exclusively manufactured in Europe and are subject to massive import tariffs.
  • D. Hospitals are legally required to purchase them at wholesale prices set by the federal government.
Question 6 of 10
What is the typical financial impact on a town or city when a local hospital joins a large medical conglomerate?
  • A. Health-care costs tend to decrease due to the conglomerate's massive purchasing power.
  • B. Health-care costs stabilize because conglomerates are heavily regulated by state governments.
  • C. Health-care costs generally increase by 40 to 50 percent because the conglomerate acts as a local monopoly.
  • D. Health-care costs remain the same, but the quality of care significantly improves.
Question 7 of 10
Why did Dr. Denise Faustman struggle to find funding from major foundations for her type 1 diabetes research?
  • A. Her research relied on highly controversial and unapproved stem cell treatments.
  • B. She refused to share her preliminary findings with the broader medical community.
  • C. The Affordable Care Act banned private funding for independent medical researchers.
  • D. Her proposed cure had no potential for ongoing commercial profit compared to lifetime treatments.
Question 8 of 10
According to the text, what is a recommended strategy for patients to protect themselves from unexpected hospital costs upon admission?
  • A. Add a 'limited consent' clause stating you agree to costs only if providers are in your insurance network.
  • B. Refuse to sign any paperwork until a doctor has physically examined you.
  • C. Pay the entire estimated bill in cash upfront to secure a wholesale discount.
  • D. Demand that the hospital legally transfer your care to a nonprofit insurance plan.
Question 9 of 10
To reduce expenses on medical tests, what specific action does the book recommend regarding blood and fluid specimens?
  • A. Always have them tested in the hospital's in-house lab for the most accurate and cost-effective results.
  • B. Ask your doctor to send them to an in-network commercial lab rather than using the pricier hospital lab.
  • C. Request that the tests be categorized as 'miscellaneous' so insurance covers them automatically.
  • D. Only allow physician assistants to order these tests, as they charge lower fees than doctors.
Question 10 of 10
How do countries like Germany, Japan, and Belgium maintain reasonable healthcare costs compared to the United States?
  • A. They completely ban private healthcare practices and pharmaceutical companies.
  • B. They set a national fee schedule negotiated by doctors, academics, and government personnel that cannot be suddenly raised.
  • C. They utilize a single-payer system where the government covers all medical expenses without exception.
  • D. They require patients to pay for all routine care out-of-pocket, using insurance only for catastrophic events.

An American Sickness — Full Chapter Overview

An American Sickness Summary & Overview

An American Sickness (2017) takes an honest look at the state of the American health-care system and frankly diagnoses its many ailments. When big business started taking over what were once charitable organizations, things began to go truly wrong. Rosenthal presents valuable information on how to reduce health-care bills and not get taken for a ride by greedy hospitals and over-prescribing doctors.

Who Should Listen to An American Sickness?

  • Americans, both healthy and sick
  • Workers in the health-care and insurance industry
  • Readers who want to save money

About the Author: Elisabeth Rosenthal

Dr. Elisabeth Rosenthal, after spending many years as a correspondent and reporter for the New York Times, became editor-in-chief of Kaiser Health News, a position she still holds. A graduate of Harvard Medical School, she has invaluable experience as an ER physician and extensive training in internal medicine.

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