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

Usually I share key takeaways in my book reviews. However, this book is special to me (for reasons you’ll read about below) and so, instead of sharing just my takeaways, I’m sharing the way this one book changed the trajectory of my life: An American Sickness: How Healthcare Became Big Business and How You Can Take It Back by Dr. Elisabeth Rosenthal. The power of a book!!

Back in 2019, I went in for what was supposed to be a safe, “routine” surgery. But instead, I got to find out the hard way that “medicine is more of an art than a science”, as my mom likes to say. My doctor was an experienced surgeon who had practiced for 10+ years on countless patients. He had a great record and was beloved by the community. He told me I was the only patient he had ever had whose body had such an inflammatory response to the surgery. 

The doctor had no answers. In fact, I remember him summing it up: “Just like 1 in every so many tires has a manufacturing problem for no apparent reason, 1 in every so many of these routine surgeries also has a problem. That’s just how it goes.” I remember raising an eyebrow at the fact that life-affecting medical errors were being compared to tire manufacturing issues.

Well, during my months-long recovery period (by the way, I’m completely fine now), I had plenty of time to think, reflect, and read. I wanted to know everything about the American Healthcare system: How common were surgical errors? Bad surgical outcomes for routine surgeries? Misdiagnoses?

That’s when I stumbled upon An American Sickness, in which Dr. Rosenthal breaks down the monolithic medical industry into its components - from insurers and hospitals to device makers and pharmaceutical companies.

Key Takeaway #1: If there is only one key takeaway from this book, it’s that healthcare has a lot of opportunity for improvement. This is no secret. However, this book does an excellent job of comprehensively laying out all the problems within our American healthcare ecosystem. 

And, if there’s one thing consultants are known for, it’s turning problems and challenges into opportunities. In healthcare, I saw an overwhelming amount of opportunities for improvement, plus, having recently gone through my own healthcare debacle, the work felt close to home.

Adding fuel to my new healthcare fire, Dr. Rosenthal specifically called out the consulting company I had joined in early 2019 - Deloitte - as perpetuating the medical community's (and specifically hospital’s) transition from “a caring endeavor into a business that puts profits before patients”.

Was this true? I had to see for myself. It was after reading this book that healthcare became the primary focus of my consulting career. Fast forward 3+ years later and I have had the opportunity to consult for provider, payer, pharmacy benefit manager (PBMs), and pharmaceutical clients on everything from rebate audits, technology/system transformations, enterprise architecture design, AI/ML implementations, future of health strategy, interoperability, pricing transparency, precision care, population health, and more. 

What’s shone through for me is this: the healthcare industry - whether it’s doctors, healthcare insurers, pharmacists, C-suite executive, or consultants - is full of people who genuinely want to make a positive impact on their patients/members/clients despite the constant battle against systemic challenges and the need to meet business objectives.

I’m personally very excited by some of the ways our healthcare system is evolving and the ways the consulting industry is helping our clients adapt:

• Interoperability - the ability for patients to easily access and share their health data across providers and medical systems
• Pricing Transparency - the ability for patients, providers, and insurers to quickly understand the cost of the medical care they seek, prior to receiving that care
• Precision Insights - the ability for patients and providers to use AI/ML to detect disease on-set and progression
• Telehealth - the ability for patients to access care/medical advice quickly and conveniently, while helping to reduce the health inequities that arise from in-person only options

Key Takeaway #2: If you are looking for a solid understanding of America’s healthcare system and its evolution, this is the perfect book. But remember to take what you read with a grain of salt. Some of the actors painted as villains in this book may have the best intentions and be caught in a web of systemic challenges, misunderstood, or working towards solutions that aren’t publicly visible yet. 

As always, please reach out with any comments, questions, or ideas!