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

Rosenthal recounts key events that have occurred since the publication of An American Sickness. Most notably, President Trump, who “squeaked into office with a vague pledge to ‘repeal and replace’ Obamacare with ‘something better,’” has since moved to put this plan into action with support from a Republican controlled Congress (331). However, it seems as though this is more difficult to accomplish than Trump previously imagined. Every proposal sent to the Congressional Budget Office revealed weaknesses in the plan that showed that their implementation would be disastrous for most Americans, who would be stuck with high premiums. Tens of millions more would lose their insurance completely. These weak points are ones that have also been noted and critiqued in the ACA: specifically, they do not curb the continually inflating price of insurance or rein in the business interests controlling the market.

In accordance with Republican philosophy, proposed new plans would leave insurance completely up to the “invisible hand” of the market. The GOP also hoped to speed the process for drug approval to allow more competition and allow insurers to reject people once again with pre-existing conditions. When this plan was publicized, many Americans gained a new appreciation for the ACA. While flawed, it allowed them access to health insurance and offered subsidies that would not be available otherwise. A poll conducted by the Kaiser Family Foundation in August of 2017 showed that 78% of Americans wanted Trump to “do what [he] could to make the current health law work” (333).

Rosenthal also follows up with patients she interviewed in her book. Dr. Jeffrey Kivi, from Chapter 1, experienced severe complications after switching off of Remicade. After expressing concerns that he would have to quit his teaching job and go on disability, his rheumatologist tried to restart his Remicade infusions, only for his insurer to suddenly refuse payment. Kivi believes that if he wants to use Remicade again, he “may have to hire a lawyer” (335).

Mary Chapman, from Chapter 4, has since moved to South Carolina. Balancing the notoriously high costs of living in California with those of her medical care became too much. She now flies to John Hopkins for treatment and stays in cheap hotels when she can. Wanda Wickizer, from Chapter 7, never faced the University of Virginia Medical Center in court. In the years following her neurosurgery procedure, the hospital has rejected her repeated offers to give them all the money in her retirement account (around $100,000). In response, the hospital suggested she put a lien on her house. The suit was eventually settled for an undisclosed amount. Hope Marcus, from Chapter 4, continued buying her mesalamine from India until April 2017, when her insurer no longer covered the generic pill. She now pays thousands of dollars a year for a branded pill.

Each of these patients was able to remain engaged in their healthcare decisions. This reflects a broader trend of patients becoming aware of the failures of the American healthcare industry. Voters from both political parties have been strongly opposing the attempted repeals of the ACA. This caused a reckoning amongst GOP politicians, who noticed just how unpopular their plan was. Ultimately, the promise to repeal and replace Obamacare was abandoned due to concerns over constituent reactions. While America still has a long way to come, patients are beginning to understand just what they are missing and are demanding more. Rosenthal sees this as the beginning of a “long war” to take back the healthcare system but believes this is a war that can be won.