Sick: The Untold Story of America’s Health Care Crisis — and the People Who Pay the Price
By Jonathan Cohn
HarperCollins, 302 pages, $25.95
Jonathan Cohn, a senior editor at The New Republic, is one serious health-care-policy wonk. Cohn can relate — blessedly, in accessible language — the financial intricacies of every important health-care reform of the 20th Century.
But incisive prose pertaining to policy is not the primary reason Cohn’s “Sick” is such an important book. That distinction goes to the people Cohn portrays, who are the centerpieces and catalysts for heartbreaking tales of medical woe.
The people who pay the price for America’s health-care ills are the millions of uninsured and underinsured who suffer so unfairly, and so unnecessarily, from our country’s stubborn resistance to national health care. They leave young children behind when they die of undiagnosed cancer — when they could have been treated. They are forced to sell their homes when the companies for which they worked for decades unilaterally revoke their health benefits. And, most tragically, they commit suicide because our nation has not yet even tried to achieve genuine parity in coverage for mental health, in comparison with the insurance available for physical ailments.
Take the case of Gary and Betsy Rotzler of Gilbertsville, N.Y. In 1993, Gary lost his engineering job when his company downsized. Unemployed for more than a year, he finally got a new position with a former employer, which hired him as a “temporary” worker.
But there was nothing temporary about his position. As has become routine throughout corporate America, this was simply a designation that allowed the company to get away with providing no health insurance. Gary worked up to 70 hours a week while Betsy, the mother of their three children, worked providing home-based child care.
Then Betsy got sick. For a long time she would not admit it to anyone, fearful that her family could not even afford the price of a basic office visit. Eventually the pain in her back became so excruciating she agreed to an examination. A discovery of metastatic breast cancer quickly followed — and within a few weeks Betsy was dead. A month later, Gary finally got the position he’d been pleading for, one that provided his family with health insurance. By that point he had accumulated $40,000 in medical bills. Despite the heroic fundraising of neighbors, he was forced to declare bankruptcy.
As the example of the Rotzlers indicates, those who suffer because of America’s health-insurance crisis are not always the most deprived and the most wretched. To be sure, poor people have suffered inordinately under the current system, and Cohn does not ignore them. One of his most chilling chapters tells the story of Marijon Binder, a stone-broke former nun taken to court for failing to pay charges for emergency room treatment at Chicago’s Resurrection Medical Center.
That said, Cohn’s tract largely targets the middle-class mainstream, emphasizing the ways bankers, high-tech workers, real-estate agents and teachers have played by all the rules and still have suffered immensely when they or their family members got seriously sick.
Russ Doren, for example, was a chemistry teacher in a prestigious Denver suburb. Yet neither his master’s degree nor his comfortable job helped him cover the huge bills generated by his wife, Gina’s, repeated hospitalization for severe depression. Soon after her treatment was cut off because of insurance limitations, she fatally overdosed on her own psychiatric medication. Even after she died, and despite Doren’s desperate pleas, his school district refused to beef up mental-health benefits.
Cohn’s character sketches are consistently harrowing. Each one also opens up discussion of a particular kind of health-care problem. Interwoven with the tales of human suffering and resilience are effective and engaging riffs on the history of American medical insurance, from the increasing exclusiveness of Blue Cross programs to the decline of corporation-based coverage. If it is a quick history and explanation of Medicare, Medicaid, or managed care that you seek, this is your book.
And while Cohn is self-consciously partisan in these matters, he analyzes the crisis of the health-care system dispassionately, with few if any villains. (George W. Bush, it should be said, does receive several zingers for his archaic belief in the virtues of private, profit-driven medical insurance.)
While Cohn spends the bulk of the book diagnosing ailments, he also proposes a cure: national health care. Cohn sympathizes with the ambivalence that Americans have toward what they perceive as the waste and regimentation of socialized medicine. Yet he effectively demonstrates that countries like France and Japan have implemented successful national-health systems that avoid bureaucracy and needless expense while maintaining quick, universal access to primary care and high-tech medicine. These countries also spend a lot less on health care than we do.
Cohn is persuasive when he argues that the insurance crisis has grown immensely just since the Clinton health-care-reform fiasco of the 1990s. It is therefore once again time to push for implementation of a universal, and much more egalitarian, system of medical care in this country. One forecast puts the number of uninsured Americans as high as 56 million by 2013. It’s clear that whatever “safety net” might have once existed has been completely shredded.
So, note to Americans: Read Jonathan Cohn’s book for a vivid, and frequently terrifying, account of what fate could await you, your family and your friends. Note to 2008 presidential hopefuls: Read Cohn’s book and latch onto what could actually become one of the most powerful issues of the campaign. And one of the most ethically charged. As Rev. Martin Luther King Jr. declared long ago, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”
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Robert D. Johnston teaches history at the University of Illinois at Chicago. He is writing a book on vaccination controversies in American history.
Author at book fair
Jonathan Cohn will be at the Chicago Tribune Printers Row Book Fair, June 9 and 10. For more information visit www.printersrowbookfair.org .
