An American Sickness

An American Sickness: How Healthcare Became Big Business and How You Can Take It Back is a 2017 book by Dr. Elisabeth Rosenthal about the US business of healthcare. Dr. Rosenthal identifies the motives of the profit-takers in the US healthcare market and learned behaviors of the marketplace. Many of her real-life stories and examples leave the reader frustrated in the system.

I found most of the book focused on the problems that have developed in the US healthcare market. The book did not have many new answers for fixing the system, but Dr. Rosenthal did offer several great actions one should take as an informed consumer.

Ten economic rules are referenced throughout the book:


Dr. Rosenthal shares many shocking examples for these rules throughout the book. She breaks her writing into sections on each of the profit takers:

  • Insurance,
  • Hospitals,
  • Physicians,
  • Pharmaceuticals,
  • Medical Devices,
  • Testing and Ancillary Services,
  • and Contractors

Many of her economic rules are identified in each of these sections. Anyone who questions if the US healthcare market is broken should be convinced by the time they finish the first part of the book.


Fight Back!

The second section of the book shares ways patients can fight back. Here are a few of her tips:

  1. Don’t sign an admitting document that will accept responsibility for charges not covered by your insurer without adding “as long as the providers are in my insurance network.”
  2. If you receive an outrageous bill, don’t wait – negotiate! Request complete itemization and protest bills in writing to create a record.
  3. Shop around like a consumer!


Our family has recently switched insurance plans and has a few examples of our own to share. We went to fill a prescription at a local pharmacy and had our store card scanned: $8 for the refill. My wife then produced her new insurance card (it is a high-deductible health plan with a lower than typical monthly premium) and the clerk gave us the new price: $34. The clerk quickly offered to void the transaction and we paid the $8 without using our insurance card.

A few weeks later, we had a reason to order an MRI scan. Our primary care physician explained that physical therapy would be required first, before insurance would cover the cost. Using our high deductible insurance plan, the scan would likely cost between $1,400 and $1,800 – plus an additional unknown charge for reading the results. I expect our experience would have been excellent and nearby, but cost over $2,000 total.

Through internet research (healthcare cost comparison sites are finally becoming more common – do a search with procedure and location and click several links), calling around, and learning the right way to ask, we found a much lower cost for the service. The key question was, “how much is this MRI if we pay for it out-of-pocket?” Some places we called refused to provide an MRI without insurance. Finally, one center that specializes in MRI scanning quoted $450 for both the scan and for reading the results. The appointment was made on a Tuesday, the scan happened on Friday afternoon (40 minutes from our home), we walked home with the scans on a DVD, the center sent the files to our doctor and we had a phone call with our practice about the results the following Monday. The bill and payment was simple: $450 on a credit card.

We had a great experience and paid less than 25% what we would have paid using our insurance. If enough people make decisions like this maybe we can change the economics of the US healthcare system!


Learn More

Please share your stories with other readers of this blog. If you live in Maine note that Dr. Rosenthal will be the keynote speaker at the 2017 Maine Health Management Coalition symposium October 11, 2017 at the University of Southern Maine. If you would like to register for this event and meet the author please click here.


Share this post:

One thought on “An American Sickness

Leave a Reply

Your email address will not be published. Required fields are marked *