Sick: The Untold Story of America's Health Care Crisis -- and the People Who Pay the Price

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Overview

America's health care system is unraveling. Every day, millions of hard-working people struggle to find affordable medical treatment for themselves and their families—unable to pay for prescription drugs and regular checkups, let alone hospital visits. Some of these people end up losing money. Others end up losing something even more valuable: their health or even their lives. In this powerful work of original reportage, Jonathan Cohn travels across the United States—the only country in the developed world that does not guarantee access to medical care as a right of citizenship—to investigate why this crisis is happening and to see firsthand its impact on ordinary Americans.

The stories he brings back are tragic and infuriating. In Boston, a heart attack victim becomes a casualty of emergency room overcrowding when she is turned away from the one hospital that could treat her. In South Central L.A., a security guard loses part of his vision when he can't find affordable treatment for his diabetes. In the middle of the prairie heartland, a retired meatpacker sells his house to pay for the medications that keep him and his aging wife alive. And, in a tiny village tucked into the Catskill mountains, a mother of three young children decides against a costly doctor's visit—and lets a deadly cancer go undetected—because her husband's high-tech job no longer provides health insurance.

Passionate, illuminating, and often devastating, Sick interweaves these stories with clear-eyed reporting from Washington and takes us inside the medical industry to chronicle the decline of America's health care system—and lays bare the consequences any one of us could suffer if we don't replace it.

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Editorial Reviews

E.J. Dionne
“No one has thought harder about our heath care system than Jonathan Cohn.”
Jerome Groopman
“Jonathan Cohn’s Sick is an eye-opening work on healthcare in America told through the stories of those in need.”
Atul Gawande
“This is a stunningly important book. Jonathan Cohn lays bare the tragedy of our health care system.”
David K. Shipler
“Cohn’s book will infuriate you enough to make you want to scream at every member of Congress, ‘Read this!’”
Alex Kotlowitz
“In Sick, Jonathan Cohn . . . has written a call-to-arms for a complete transformation of American medicine.”
Buzz Bissinger
Sick is one of those rare books that combines the personal with the sharply analytical.
Slate
“An 80-year chronology of repeated market failure. . . . Read it and weep.”
Paul Krugman
“A terrific new book on our dysfunctional health care system.”
Sally Satel
By the end of Cohn’s narrative we’ve run the gamut of woes: the hopeless fragmentation of the mental heath system; staggering medical debt; the dependence on job-based insurance; frayed social safety nets; lousy (or no) guarantees of preventive care; selective access to medications. Lack of insurance is a meaningful problem, too, especially for the mentally ill. But since 80 percent of all emergency room visits in 2004 were made by people who had at least some form of coverage, the problem can’t be pinned solely on insurance.
— The New York Times
Michael Tomasky
For the most part, Sick delivers. Its eight expository chapters deftly interweave discussions of health care policy and history with personal stories of people who have been pricked by the system's sharpest brambles, with each story humanizing a specific shortcoming of our current system.
— The Washington Post
Publishers Weekly

In this addition to the growing list of exposés of the toll our patchwork, profit-based health-care system takes on Americans, Cohn makes a plea for a universal coverage with a single-payer system regulated by the government. Drawing on research and riveting anecdotes, Cohn, a senior editor at the New Republic, describes how private insurers decide who and what they will—and will not—cover. He also examines how rising health-care costs lead corporations to seek ways to deny coverage to employees, such as hiring full-time workers as temps or independent contractors without health insurance. In tale after tale, Cohn documents the sometimes catastrophic results. they couldn't. Cohn points out that managed care initially had an altruistic goal of making health-care affordable for all. But by 1997, two-thirds of HMOs were controlled by for-profit companies concerned with making money rather than preventing and easing sickness. The author convincingly argues that Medicare and universal health care in such countries as France, though not perfect, are far superior to the system most Americans face. Much of this is well-trod territory, but Cohn is eloquent, and he's good at using case studies to dramatize and explain complex issues. (Apr. 10)

Copyright 2006 Reed Business Information.
Library Journal

As a serious discussion of universal healthcare takes place once again in the United States, Cohn (senior editor, New Republic) offers a convincing collection of stories about people dealing with the inequities and problems in the present system. Each story is linked to a specific issue—including shrinking employer-based insurance, disappearing retiree insurance, private insurance, managed care, Medicaid, the uninsured, and coverage for mental health—and connected to the politics and economics that control the system. Cohn comes to what he considers the inevitable conclusion—universal care deserves a fresh look—before comparing the U.S. system to those of other industrialized countries. The stories are based largely on first-person interviews; primary and secondary sources are well documented. Cohn's coverage is far from "untold," however, as his book joins a number of others on the same topic, including Susan Sered and Rushika Fernandopulle's similar Uninsured in America: Life and Death in the Land of Opportunity. Recommended for libraries with large healthcare policy collections.
—Dick Maxwell

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Product Details

  • ISBN-13: 9780060580452
  • Publisher: HarperCollins Publishers
  • Publication date: 4/10/2007
  • Pages: 320
  • Product dimensions: 6.00 (w) x 9.00 (h) x 1.13 (d)

Meet the Author

Jonathan Cohn is a senior editor at The New Republic, where he has written about national politics and its impact on American communities for the past decade. He is also a contributing editor at The American Prospect and a senior fellow at the think tank Demos. Cohn, who has been a media fellow with the Kaiser Family Foundation, has written for The New York Times, The Washington Post, Mother Jones, Rolling Stone, Slate, and The Washington Monthly. A graduate of Harvard, he lives in Ann Arbor, Michigan, with his wife and two children.

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Read an Excerpt

Sick
The Untold Story of America's Health Care Crisis---and the People Who Pay the Price

Chapter One

Gilbertsville

New York's Leatherstocking Country sits at the northern foothills of the Catskill Mountains, a few hours' drive from Manhattan. The name is a reference to the leggings that colonial settlers wore during the 1700s, but it was James Fenimore Cooper who immortalized the region in the early 1800s, when he used it as the setting for his five books about the frontier hero Natty Bumppo, a collection that later became known as the Leatherstocking Tales. To see the area today is to glimpse a landscape remarkably like the one that first captured Cooper's imagination: a "succession of hills and dales" rolling through the countryside; "beautiful and thriving villages" nestled in the "narrow, rich, and cultivated" valleys, with only the occasional gas station and roadside pizza shack to pierce the "romantic and picturesque character." For the people who live in Leatherstocking Country now, this largely unmolested geography provides precious insulation from the rest of New York—even, it would seem, from modernity itself.

Perhaps nowhere is this more evident than in the village of Gilbertsville. Gilbertsville is a two-hour drive from Syracuse, the closest city with a major airport, and the last part of the journey takes place along a winding road, more than 1,000 feet up in the hills. Gilbertsville becomes visible only after the final turn, when the road descends into a valley, depositing drivers near the entrance to Major's Inn—a Tudor-style building that hosts such events as the annual Gilbertsville Quilting Fair. HereGilbertsville's commercial district begins and nearly ends, with a small grocery store, a quilt shop, and a few offices operating out of more Tudor-style storefronts that line one side of the street. The buildings look almost precisely as they did when they were built in the 1890s, after a fire destroyed the old business district. The effort to replicate a small English town was apparently the inspiration of Joseph T. Gilbert III, whose great-grandfather, Abijah Gilbert, helped settle the township in the 1780s after migrating from Great Britain.

Some of Abijah's direct descendants still live in Gilbertsville. In fact, say the locals, many of the 377 people that the 2000 U.S. Census placed in Gilbertsville have roots in the area that go back at least 100 years. More than surnames were handed down over the generations. The people in this part of New York have a long-standing reputation for hard work, conservative values, and attachment to the land—a reputation that still seems fitting today. The inhabitants attend church regularly and strongly prefer conservative politicians, electing mostly Republicans to the five-member village governing body. As for their awareness of their heritage, perhaps the most celebrated episode in Gilbertsville's modern past came in 1982, when its residents won a seventy-year fight to block construction of a proposed dam that would have flooded most of the village. They prevailed by methodically cataloging the architectural heritage of every local building, commercial and residential, then successfully lobbying to have the entire village placed on the National Register of Historic Places, forever protecting it from disturbance.

It was four years after that victory that Gary and Betsy Rotzler moved to Gilbertsville, fitting into the community fabric almost seamlessly. They'd grown up together in neighboring Delaware County. Although Betsy was born in the Bronx, Gary's Leatherstocking lineage went back a dozen generations, to its very earliest days as a settlement in the New World. (Family legend had it that one of Gary's ancestors came from Britain to the United States on the ship immediately following the Mayflower.) The long hair Gary wore during his adolescence was typical for boys in the 1960s and early 1970s, but in most other respects he and Betsy were remarkably traditional. They had become high school sweethearts after going on a date to the county fair in 1975, while Gary was a junior and Betsy still a freshman, then continued dating after Gary went to college upstate. On June 25, 1978, just one day after Betsy's graduation from high school, the two were married in a small ceremony held at the home of Betsy's parents. A year later they would have their first child, a daughter named Sarah. Two more would follow: another daughter, Amanda; and then a son, Luke.

The Rotzlers came from relatively modest roots: Gary's father was a diesel mechanic who worked for the local highway department; Betsy's parents ran a residential treatment center for alcoholics. But by the time the couple came to Gilbertsville, the Rotzlers had every reason to expect they were on their way to realizing the American dream. Gary was noted for being industrious, having missed not a single day of classes in college. Shortly after graduating, he began working at Bendix, a large aerospace manufacturing company—first as a design technician at a plant in the nearby town of Sidney, later as a field engineer managing the company's midwestern clients from Dallas, Texas. Another engineering job at the Bendix Sidney plant had lured the Rotzlers back to central New York—where they hoped to remain, for good. Betsy, for her part, had chosen to stay at home and raise the three children, getting involved primarily in activities that revolved around them, like the La Leche League for mothers who were breast-feeding and, later, the Girl Scouts. Around town, she would become known for her artistic flair, particularly the individualized Raggedy Ann–style dolls that were her trademark.

But the American dream would prove fleeting for the Rotzlers, just as it did for much of central New York in the early 1990s. The regional economy depended on defense manufacturing jobs, like Gary's, that vanished as Washington cut the Pentagon budget and a recession fell over most of the country. One by one, Gary's colleagues lost their jobs. In 1993, he lost his, too. And while Gary would find ways to replace some of his lost wages over the ensuing two years, he would have a much tougher time coming up with something else: health insurance. Like most working Americans, Gary had always depended on his employer to provide medical coverage; when the job was gone, so was his coverage. And even after Gary finally found full-time work, he still couldn't get insurance for his family, because his employer—a company for which he'd worked previously—was no longer providing benefits to many of its employees.

Sick
The Untold Story of America's Health Care Crisis---and the People Who Pay the Price
. Copyright © by Jonathan Cohn. Reprinted by permission of HarperCollins Publishers, Inc. All rights reserved. Available now wherever books are sold.
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Table of Contents


Introduction: Boston     ix
Gilbertsville     1
Deltona     27
Austin     55
Sioux Falls     87
Lawrence County     115
Chicago     141
Los Angeles     167
Denver     189
Conclusion: Washington     215
Sources and Notes     233
Acknowledgments     289
Index     293
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Sort by: Showing 1 – 5 of 2 Customer Reviews
  • Posted March 17, 2009

    I Also Recommend:

    Review of SICK by Jonathan Cohn

    The book explains what can happen when a person loses illness/injury insurance coverage. A reader will understand the benefit an individual policy brings instead of relying on employer based coverage, during employment, between jobs, and during retirement. Some of the examples raise the question of whether the medical services received were medically necessary, such as a hospitalization for a patient who was clearly dying of cancer when hospice care would have been a better solution. Absent from the discussion is the value that a primary care physician can bring to help patients navigate health care services without insurance. Mr. Cohn links the changes in law and employer fortunes to the lives of affected individuals, which approach is very helpful for policy makers and legislators. On the other hand, the examples raise the question of the need for personal responsibility and liability for unhealthy life style choices (e.g. smoking) that impair health and cannot be mitigated due to limited financial resources and/or medical intervention limitations. Sick makes a good case for universal health care (not to be confused with single payer). It also provides examples in which health care can be provided at a lower cost to acheive the same outcomes, which, if repeated enough, will lower the resources needed overall, lower costs, improve value, and make insurance more affordable. Sick also shows the need for individual catastrophic coverage, COBRA coverage, and personal savings.

    2 out of 2 people found this review helpful.

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