“Sick” – Jonathan Cohn’s Book on the Healthcare Crisis

Health_Healthcare.jpgNearly 43 million Americans are without health insurance and the number is rising, as the average cost of a family’s healthcare insurance is about $12,000. America pays 16% of its national income for healthcare, more than any other country, yet its position on the health chart among developed countries is astonishingly low. The WHO lists USA below even Costa Rica, Morocco, and Chile! Jonathan Cohn, Senior Editor of the Republic, traveled across the USA to interview families denied access to healthcare because of the looming cost-spiraled-out-of-proportion crisis faced by America’s healthcare system. The problems are largely due to a convoluted system that Americans use to pay for their healthcare costs.

ERs across the country are often the worst hit by this funding crisis. The book provides recent instances of how crowded hospital facilities have caused deaths due to diverting ambulances with critically ill patients to other hospitals, resulting in long delays. In a chilling example, a 21 year old at Houston hit by a car could not be treated at the local hospital due to a lack of space — he had to be airlifted 150 miles away to Austin, where he died shortly after arrival.

Many believe that the Clinton administration’s proposal for a Universal Healthcare System in 1993-4 was a missed opportunity. Americans simply refused to believe that the system of healthcare funding is fundamentally flawed. The book selects eight stories, selected from hundreds of interviews that the author performed, which demonstrate how vulnerable ordinary Americans are to a medical and financial crisis with the current system of insurance. The system of employment-linked insurance worked well from the 1920’s to the 70’s, when people had jobs for life, and with that health benefits for a lifetime. Even Medicare and Medicaid were adequate to pay for the poor and the elderly. By the 80’s, 90% of Americans had health insurance, and everybody was optimistic that the system was sustainable.

But then the economy changed. Jobs were outsourced, fewer came with benefits, and unemployment rose at the same time as healthcare became a lot more expensive. Managed healthcare worked to some extent, but the safety net is covering fewer and fewer Americans. It’s time we had a fresh look at Universal Healthcare, which works well in countries like France and Switzerland, but at much lower costs.

Until then, the average American, as Jonathan Cohn explains, lives life with “a big dice” determining our fate — if we are unlucky to have a major illness, it might spell the end of our economic lives. The debate about a major change to our health insurance system, is fortunately still open, and it remains to be seen what the future years hold for us.


WHO Ranking of the World’s Health Systems.

Fora TV Video (full-length).

Sick. The Untold Story of America’s Health Care Crisis — and the People Who Pay the Price. By Jonathan Cohn. 302 pp. HarperCollins Publishers. ISBN 0060-58045-3.

  • The general comments about our health care system are correct, but in fact the truths are more problematic. US citizens who earn enough to pay taxes actually pay $11,000 per person or $44,000 for a family of four to cover health care for themselves and for others in the country. This includes the cost of health insurance, taxes to cover Medicare, Medicaid, local health clinics for the indigent, and state sponsored payments to cover uncompensated care given by hospitals. The costs of health insurance and the out of pocket expenses to cover deductibles and copayments are a relatively, but painfully, small part of the overall costs that we all pay for health care in this country. As insurance premiums continue to increase, employee contributions, deductibles and copayments will also increase. this will dramatically raise the number of uninsured and underinsured. The only way to bring this problem under control is to create a system of universal health care supported by a single payer system paid for by a unviersal payroll tax and additional payments for people who do not work. This will cost dramatically less than we are paying now. Savings could amount to, in excess of, $400B annually. Consider “Medicare for all” with an overhead of 1.6% {the current Medicare overhead} versus the private health insurance system with a current overhead of >20%. The hidden costs of our multipayer system amounts to more than $600B per year which could be eliminated by a single payer system.
    The proposal of “Medicare for all” is not socialized medicine, as has been characterized by propaganda from the insurance industry Further, senior citizens love the system in that it provides freedom of choice of doctors, hospitals, testing, treatments, medications. No Medicare recipient that I have known in the past 30 years of practicing cardiology has had any negative comments towards Medicare. Contrast this with the existing system of private health insurance where freedom of choice of the above issues is limited and you must often get permission from the insurer to be treated. That is more socialized than the Medicare system.
    A more detailed, annotated discussion of this issue can be found in US Healthcare on Life Support: Resuscitating the Dying System. Additional information is at http://www.health-financing.com


Sudip Ghosh, MD

Sudip Ghosh, MD, is a surgeon at the University of Manchester, UK and a medical writer.

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