An American Sickness by Elisabeth Rosenthal Summary

An American Sickness examines how the U.S. healthcare system became profit-driven, exposing exploitative practices by insurers, hospitals, pharmaceutical companies, and medical device firms. Rosenthal, a physician-journalist, structures the book like a medical SOAP note—diagnosing systemic issues (e.g., inflated drug prices, unnecessary tests) and offering actionable steps for patients to reduce costs. The book blends patient stories, historical analysis, and critiques of market-driven healthcare.

This book is essential for patients, policymakers, and healthcare professionals seeking to understand systemic flaws in U.S. healthcare. It’s particularly valuable for those navigating insurance complexities, medical billing disputes, or prescription drug costs. Rosenthal’s insights also appeal to readers interested in healthcare reform or corporate ethics.

Yes—it’s a New York Times bestseller and Washington Post Notable Book praised for its depth and clarity. Rosenthal’s dual perspective as a doctor and journalist provides credible analysis, while patient stories make abstract issues relatable. Critics note it focuses more on problems than solutions but still call it a “sobering” must-read for healthcare consumers.

Rosenthal argues that profit motives have corrupted U.S. healthcare, leading to exploitative practices like price gouging (e.g., $600 EpiPens), surprise billing, and overtesting. She identifies “Economic Rules of the Dysfunctional Medical Market,” such as “A lifetime of treatment is preferable to a cure” and “Prices rise rather than fall with aging technologies.”

Unlike memoirs or policy deep dives, this book adopts a systemic lens, dissecting each sector (insurance, hospitals, pharma) to show how profits supersede patient care. It’s often compared to The Price We Pay by Marty Makary but stands out for its SOAP note structure and patient empowerment strategies.

Rosenthal recommends immediate actions:

• Negotiate hospital bills and demand itemized statements.
• Opt for nonprofit insurance plans (e.g., Kaiser Permanente).
• Research cash prices for medications.
  Long-term, she advocates for price transparency laws, patent reform, and antitrust enforcement against healthcare monopolies.

Some reviewers argue it oversimplifies systemic fixes and underplays the role of individual accountability in healthcare decisions. Others note its 2017 data feels dated amid post-COVID healthcare shifts. However, most praise its thorough diagnosis of “dysfunctional” industry practices.

Rosenthal traces costly medications to patent abuses (e.g., “evergreening” minor drug tweaks), lack of price regulation, and middleman markups. For example, pharmaceutical companies hike prices on generics like insulin, exploiting patent loopholes and opaque supply chains.

Hospitals are depicted as profit centers prioritizing revenue over care—charging $50 for a Tylenol pill, upcoding treatments, and partnering with private equity firms. Rosenthal highlights “facility fees” and unnecessary testing as key drivers of inflated bills.

Key tips include:

• Request itemized bills to dispute errors.
• Ask for cash discounts (often 30-50% lower).
• Negotiate payment plans directly with hospitals, bypassing debt collectors.
• Use advocacy groups like Patient Advocate Foundation for billing disputes.

Rosenthal critiques insurers for prioritizing shareholder profits via denied claims, narrow networks, and high deductibles. She urges readers to scrutinize plan details (e.g., out-of-pocket caps) and consider nonprofit insurers focused on patient outcomes.

Despite healthcare reforms since 2017, issues like hospital consolidation, drug price hikes, and surprise billing persist. Rosenthal’s framework for understanding profit-driven care remains critical as AI-driven diagnostics and telehealth introduce new cost challenges.