Pub. Date:
The Doubleday Religious Publishing Group
Critical Condition: How Health Care in America Became Big Business--and Bad Medicine / Edition 1

Critical Condition: How Health Care in America Became Big Business--and Bad Medicine / Edition 1

by Donald L. Barlett
Current price is , Original price is $24.95. You
  • $4.99 $24.95 Save 80% Current price is $4.99, Original price is $24.95. You Save 80%.
    Note: Access code and/or supplemental material are not guaranteed to be included with textbook rental or used textbook.

    Temporarily Out of Stock Online

    Please check back later for updated availability.

  • This Item is Not Available

  • Product Details

    ISBN-13: 2900385504545
    Publisher: The Doubleday Religious Publishing Group
    Publication date: 10/05/2004
    Edition description: New Edition
    Pages: 288
    Product dimensions: 6.00(w) x 1.25(h) x 9.00(d)

    About the Author

    DONALD L. BARLETT and JAMES B. STEELE are America’s most widely acclaimed investigative journalism team. They have worked together for three decades, first at the Philadelphia Inquirer, and, since 1997, as editors at large for Time. They are the only journalists in history to have won two Pulitzer Prizes and two National Magazine Awards, as well as dozens of other national awards. They are the coauthors of six books, including America: What Went Wrong?, which spent eight months on the New York Times bestseller list.

    Read an Excerpt


    A Second-Rate System

    It was billed as a “Garage Sale for Mason.” By the time all the donations had come in, no garage could hold them. So the clothes, toys, old appliances, tools, car accessories–everything–were loaded onto a church moving van and carted to an open lot next to the Heartland Furniture store on the south side of town. Volunteers marked every item with white price tags, then spread them out in the lot in row after row for the big event Saturday. Nobody had any idea how many would come, but when the gates opened, people poured in, and for hours neighbors, friends, and passersby flowed through to buy something and to say hello to the six-year-old boy in whose name the event was held.

    Mason McIlnay was just completing kindergarten in Salem, Oregon, when doctors discovered that he had neuroblastoma, an aggressive childhood cancer that already had spread to his bone marrow. He had been troubled by pain at night, and at first his doctor thought he might have just pulled a muscle. A CT scan turned up the cancer. Over the next two months, Mason would be in and out of the hospital for surgery, chemotherapy, and treatment of infections and side effects, as he battled a famously virulent cancer. His medical expenses ran into the tens of thousands of dollars.

    It was a bill that Mason’s parents, Les and Gina McIlnay, could not afford to pay. They had no health insurance. As employees of the family flower shop, with a computer and video business on the side, they felt they just couldn’t afford it. “You never consider that something like this would ever happen to you,” said Les.

    Friends and neighbors of the McIlnays got together to organize a fund-raiser for the family. Everyone pitched in, searching basements, storage bins, and closets to donate something for the “Garage Sale for Mason.” That afternoon they raised $14,000. Another fund-raiser at a car show brought in $9,000. The McIlnays were humbled. Les said he had “never seen an event like it.” A Cub Scout leader and a volunteer along with Gina at their boys’ school, Les was used to helping, not needing help, so the outpouring from the community was all the more remarkable. While the proceeds from the two events certainly eased the couple’s financial burden, the McIlnays still had thousands of dollars in medical expenses outstanding.

    Every weekend in neighborhoods across America, fund-raisers like this help collect money to pay someone’s medical bills. They may be for a teenager who has a serious sports injury, a young mother who isn’t covered by her husband’s insurance policy, a victim of a catastrophic illness whose insurance has run out–anyone who has been blindsided by the overwhelming expenses of an unexpected major medical problem. These fund-raisers take many forms: auctions, walkathons, concerts, pancake breakfasts, bingo games, pie socials, car washes, barbecues, basketball competitions, church suppers, dances, and hot-air balloon rides.

    In Simms, Montana, a colt, assorted livestock, and three tons of hay are auctioned offto assist with the medical expenses of horse trainer Lennard Rains, who was thrown through the windshield of his truck in an accident that paralyzed him from the chest down. In Fond du Lac, Wisconsin, a dance and raffle at the Elks Club raise money for chemotherapy treatments for Kyle Goebel, a seventeen-year-old high school senior who has bone cancer. In Quarryville, Pennsylvania, students and faculty of Solanco High School stage a variety show to benefit Meg Walck, a teacher’s wife who is battling a rare cancer. In Estancia, New Mexico, a local band performs during a dinner at the Short Stop Cafe to raise money for six-year-old Kasey Solomon, who needs a heart transplant. In Belvidere, Illinois, police officers host an all-you-can-eat chili supper at the local VFW club for community-service officer Ray Edwards, who was left with medical bills after the death of his wife. In Asbury Park, New Jersey, musicians volunteer their talent for a concert to benefit Bernie Brausewetter, a blues guitarist who suffers from congestive heart failure.

    In Minetto, New York, friends and colleagues of graphic artist Dan Distler organize a banquet and silent auction to help him pay his medical bills while he fights lung cancer. In Clifton Heights, Pennsylvania, guests pay $25 a person to attend a buffet featuring a DJ and a raffle, to defray the medical expenses of thirty-year-old Ken Fleischman Jr., who is undergoing chemotherapy to treat lymphoblastic lymphoma. In central Texas, 850 people turn out for a barbecue and auction at the Medina County Fair Hall to help with the medical expenses of sixteenyear-old Josh Schueling, a high school football player who broke his neck while making a tackle and became paralyzed below his chest. In Omaha, Nebraska, members of the community line up to pay five dollars a plate for a spaghetti dinner at the American Legion post to contribute to the cost of fifteen-year-old JeffSpellman’s kidney transplant. In Severna Park, Maryland, members of the Antioch Apostolic Church perform at a gospel songfest to help pay medical expenses for Henry Bundy, a twenty-five-year-old bakery worker who was diagnosed with a brain tumor. Near Tampa, Florida, students and staffat the Wesley Chapel Elementary School present “The True Story of the Three Little Pigs” in the school cafeteria to raise money for Stephanie Granier, a fifth-grader who has non-Hodgkin’s lymphoma.

    These outpourings represent the very best of America, the volunteer spirit of which the nation is justly proud, when friends, neighbors, families, and caring strangers come together to help someone in need. But what does it say about the richest country on earth that its citizens must depend upon raffles and spaghetti dinners to pay the medical bills–a situation that exists in no other civilized country? What does it say about members of Congress and presidents, Democrats and Republicans all, who are content with a health care system that ignores the needs of tens of millions of Americans while it makes multimillionaires out of those who profit from disease and death? What does it say about lawmakers and presidents who, along with their spouses and families, enjoy the very best that American health care has to offer, while they consign their constituents to a system that drives millions of sick people and their families into bankruptcy and poverty? And finally, what does it say about those lawmakers and presidents who refuse to overhaul a system that spends $1.7 trillion–that’s trillion– on a health care system that overall is little better than mediocre.

    American health care mediocre? Not if you believe the people in Washington. In June 2003, President George W. Bush told seniors in Miami: “We live in a great country that has got the best health care system in the world, and we need to keep it that way.” That sounded much like former president Clinton, who, although he wanted to recast portions of the system, said in February 2000: “We do have the best health care system in the world . . . ”

    This is one of America’s most enduring myths, that the United States has “world-class health care.” It doesn’t. To be sure, it does offer the very best of care to some folks. It does offer world-class high-tech surgery and some space-age medical procedures. But these benefit 2 or 3 percent of the population at most, along with the richest citizens of other countries who come here for the highly specialized treatment. Overall, isolated pockets of excellence aside, the system is second-rate when it comes to meeting basic day-in, day-out medical needs of the population at large.

    Many countries around the world take far better care of their people, achieve better results from their health care systems, and do it all with far fewer dollars. In 2001, per capita health care spending in the United States amounted to $4,887. That was 75 percent more than the $2,792 that Canada spent. Yet Canadians can expect to live two and a half years longer than Americans. The Canadian life span at birth: 79.8 years. The American: 77.1 years. U.S. spending was 205 percent greater than Spain’s, yet the Spanish can expect to live 2.1 years longer. As for the Japanese, with a life span of 80.9 years, the world’s longest, they can expect to live nearly four years longer than Americans. This even though Japan’s per capita spending on health care is only 41 percent of U.S. outlays. In sum, Americans pay for a Hummer but get a Ford Escort.

    On this scale, the United States does not even rank in the top ten. But the statistics are even grimmer when life span is counted in years of healthy living. A comparatively new yardstick devised by the World Health Organization (WHO), this formula subtracts from traditional life expectancy the number of years spent in poor health, the years when individuals are unable to engage in all the activities their peers do, when they are confined to beds in nursing homes and must be fed by someone else. By this measure, the United States in 2002 ranked a distant 29th among the countries of the world, between Slovenia and Portugal.

    At birth, American males can anticipate 67.2 healthy years of life. But the men in Sweden fare better. They get another 4.7 years, even though the country spends less than half per capita what the United States does on health care. Italian women enjoy 74.7 years of healthy living at birth, while for American women it’s 3.4 fewer years. The women in San Marino, an enclave in central Italy that bills itself as the world’s oldest republic, do even better. They can plan on 75.9 years of healthy living–or 4.6 years longer than American women. Men in Iceland may expect a healthy life for 72.1 years, or 4.9 years longer than American men. This even though Iceland’s per capita spending on health care is little more than half that of the United States.

    The United States also compares poorly with other industrialized countries in infant mortality, with 6.9 deaths per 1,000 live births in 2000. In Japan, it was 3.2; in Sweden, 3.4; in France, 4.6; in Denmark, 5.3.

    And in a more revealing WHO global ranking of health care, the United States placed even farther down the list at No. 37–between Costa Rica and Slovenia, nowhere near the top five countries, France, Italy, San Marino, Andorra, and Malta.

    How is this possible, especially since the United States devotes 15.3 percent of its gross domestic product to health care–double that of many countries, triple of some? The WHO survey considered two factors the U.S. government and health care community ignore: Does everyone have access? Is the cost distributed equitably across all of society? WHO reasoned that “a fairly financed health system ensures financial protection for everyone. Health systems can be unfair by either exposing people to large, unexpected costs they must pay on their own or by requiring those least able to pay for care to contribute more, proportionately, than wealthier citizens.” On that score, Americans have little competition. “The United States and South Africa are seen as the only prominent examples of industrialized countries that do not have comprehensive social health insurance.”

    Thereby rests the second most enduring American myth: that all citizens have access to the highest-quality care if they really need it. Again, in isolated instances this is true. Some of Baltimore’s inner-city poor get the very best medical care America has to offer at Johns Hopkins, albeit as winners of a kind of sickness lottery. The same is true in select other cities. But the overwhelming majority of people, especially the working poor and middle-income families–including those with insurance–can get that care only if they make draconian sacrifices. They must be willing to lose everything.


    Almost everybody knows that a hospital stay can be hazardous to your financial health if you don’t have insurance. What isn’t so well known is that hospitals charge the highest prices to those who don’t have insurance. In other words, those least able to pay are charged the most. In a system riddled with inequities, this may be the most egregious.

    Hospitals have a so-called official price list for their services. It’s the equivalent of a sticker price on a car. Big health insurers, health maintenance organizations (HMOs), and Medicare negotiate to obtain volume discounts off those rates, so they pay only a fraction of a hospital’s official price. Studies show an uninsured person who is not backed by the muscle of a pool is billed three, four, five, sometimes as much as ten times more than an insurance company whose patient has the exact same treatment.

    OU Medical Center in Oklahoma City, Oklahoma, charged an uninsured patient $85,400 for a craniotomy. A typical insurer would have paid $15,600 for the same procedure. Medicare would have paid $13,900. For the unfortunate Oklahoma patient, the bill represented a 447 percent premium over the price an insured patient would have been charged and 514 percent over Medicare. The OU Medical Center is part of the country’s largest for-profit hospital chain, HCA Inc.

    Florida Hospital in Orlando, Florida, charged an uninsured patient $35,200 for an appendectomy. A typical insurer would have paid the hospital $7,000 for the same procedure. Medicare would have paid $6,200. For the uninsured Florida patient, the bill represented a 403 percent premium over the price an insured patient would have been charged, and 468 percent over Medicare. The hospital is part of the Adventist Health System, which is owned and operated by the Seventh-Day Adventist Church.

    The Medical Center of Aurora in Aurora, Colorado, charged an uninsured patient $24,100 for cranial and peripheral nerve disorder treatment. The average insurer would have paid $4,600 for the same care. Medicare would have paid $4,100. For the hapless Colorado patient, the bill was a 424 percent premium over the price an insured patient would have been charged and 488 percent over Medicare. The Medical Center of Aurora is an acute-care hospital in the eastern metropolitan Denver area that is part of a joint operation by HCA and HealthONE, the largest health care delivery system in the metropolitan Denver area.

    Every type of hospital–for-profit, nonprofit, community, and university–takes advantage of our most vulnerable citizens in this way. The victims are Americans who work at low-paying jobs and fall between the economic cracks, folks who earn a little too much money to qualify for Medicaid or charity, but not enough to afford the stiff premiums for health insurance. Even middle-income families who are insured can find themselves confronting huge bills from an unsympathetic hospital if they have a catastrophic medical expense not covered by their plans. Unlike the very poor, who have few if any assets, many middle-class families have salaries, savings accounts, and homes– assets that hospitals aggressively pursue.

    This practice of gouging the uninsured and those with limited coverage would probably have remained a secret to all but hospital insiders had it not been for the work of a crusading activist, Kevin Brendan Forbes.

    From the Hardcover edition.

    Table of Contents

    Prologue: The Crisis1
    1A Second-Rate System9
    Rampant Overcharging15
    Without A Safety Net24
    A Teacher Learns A Lesson27
    Spending More for Less32
    Watchdog for the Drug Companies35
    Emergency in the Er45
    America's Unknown Killer51
    Favors and Fraud63
    Politics and Profits69
    2Wall Street Medicine75
    How Profit Became Policy88
    Selling the Hospitals94
    Corporate Culture99
    Buying the Doctors109
    Nurses Who Battle the Bottom Line113
    3Anatomy of a Systems Failure123
    A Bad Business Model128
    Doctor C's Empire132
    Vanishing Histories145
    4The Labyrinth of Care155
    The New Bureaucrats158
    Overruling the Physicians161
    The Wrong Jobs170
    The Insurers' Secret Codes172
    Long-Distance Diagnosis182
    Online and Offshore189
    5Madison Avenue Medicine195
    Blame it on Bad Breath199
    The TV Ad Blitz203
    "Ask Your Doctor"210
    Risky Business215
    The Celebrity Pitch223
    Your Next Drugs227
    6The Remedy235
    Curing the Ills240
    Crisis and Opportunity247
    Epilogue: Medicine in the Media251

    Customer Reviews

    Most Helpful Customer Reviews

    See All Customer Reviews

    Critical Condition: How Health Care in America Became Big Business--and Bad Medicine 4.4 out of 5 based on 0 ratings. 5 reviews.
    Guest More than 1 year ago
    after 35 years of dealing with the issues in CRITICAL CONDITION as a family doc,this is the best synopsis of the flaws in our health delivery system that I have seen. Most remarkable was the brilliant suggestion on how to administer a new national agency outside of the political maze modeled after the federal reserve agency that controls our money supply. Ever since the Rockefeller Foundation studied US healthcare '72-'76 and published HEALTH CARE IN THE UNITED STATES sub-titled 'DOING BETTER - FEELING WORSE' I have been studying the de-evolution of healthcare in America. Cudos to Bartlette & Steele for taking this Goliath on. There are thousands of inteligent, well meaning people out there who recognize the need for universal health care coverage but a rational system of health care will not evolve in a for-profit, greed driven economy. The political aspect of universal coverage remains pivitol for its future existance. It calls for effective political leadership. I agree we have the most expensive healthcare in the world...this does not make it the best health care system if it is not available to all. The fundamental question regarding healthcare is: does it promote or produce Health? Should acces to health care be a universal right protected by the government or should healthcare remain a comodity to be exploited for profit. I seriously thought this book would spark much more heated discussion about national health coverage: but so far the politicos and insurance companies, and medical organizations do not want to admit they would be the loosers if govt. administered (expansion of medicare) health care became a reality. So far greed trumps need who deals next?
    Guest More than 1 year ago
    As a family physician in favor of a universal single payor system, this book had nothing new. It provides good examples underlying the inherent conflict of interest between providing health care and providing for the stockholders. Unfortunately the book's tone is too sensationalized, like a tabloid, and minimizes the honest efforts of the vast majority of people who work in health care because we feel it is our calling.
    Guest More than 1 year ago
    An informative and well-written expose of how greed and politics have hijacked our health care system in America. Highly recommended.
    Guest More than 1 year ago
    'Surviving a Successful Heart Attack' left the author and me with many unanswered questions - 'Critical Condition' gives some valid answers and valuable insight on the real reason that we are prescribed many of the medicines that we take today.
    Guest More than 1 year ago
    This book contains a bounty of research and facts from several sources that show the systematic failure of our 'for profit' healthcare system and how big companies have spent 100's of millions to hide the facts from us. If most people realized we 'truly' enjoy sub-standard health care compared to most wealthy western nations, they would be shocked. A book everyone who cares about the future of American Society should read.