An American Sickness: How Healthcare Became Big Business

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What is An American Sickness: How Healthcare Became Big Business and How You Can Take It Back?

An American Sickness: How Healthcare Became Big Business and How You Can Take It Back by Dr. Elisabeth Rosenthal is a detailed critique of the U.S. healthcare system, revealing how profit-driven practices have undermined patient care. Rosenthal, a former physician and seasoned journalist, explains how hospitals, insurance companies, pharmaceutical manufacturers, and other players prioritize financial gain over public health. She breaks down the evolution of the system, showing how decisions like opaque billing practices and the commodification of medical services have contributed to skyrocketing costs and inequities in care.

The book is structured around a set of “Economic Rules of the Dysfunctional Medical Market,” which illustrate how different sectors within healthcare profit at the expense of patients. For example, Rosenthal highlights cases of exorbitant hospital charges for routine procedures and the pricing strategies of pharmaceutical companies that keep life-saving medications out of reach for many. These examples expose how a lack of transparency and regulation allows the system to thrive on inefficiency and exploitation.

What We Learned About American Healthcare

Medical staff in scrubs and white coats rush a patient on a stretcher through a bright hospital corridor. The scene conveys urgency. — "Healthcare has become a business, and patients are the product."

Exorbitant Hospital Charges

“A hospital bill is often less about the care you received and more about the profits they aim to achieve.”

In the U.S., hospital prices are nearly three times higher than those in comparable countries, according to the International Federation of Health Plans. The book highlights the case of a patient charged $17,000 for a routine appendectomy, a procedure that typically costs far less in other developed countries. Rosenthal explains how hospitals exploit opaque billing systems to inflate costs with items like “facility fees” or unnecessary tests. Patients need to demand itemized bills and question charges. Advocacy for price transparency and regulation is essential to curb hospital exploitation.

Pharmaceutical Price Inflation

“Drugs in America aren’t priced according to what they cost to make; they’re priced according to what the market will bear.”

A 2020 report found that Americans pay more than twice as much for prescription drugs as residents of other high-income countries. Rosenthal discusses the drastic increase in the cost of insulin, which has tripled in price over the last decade despite no significant advancements in the product. She attributes this to a lack of pricing regulation and collusion among pharmaceutical companies. Advocacy for price caps on essential medications and greater government oversight can ensure life-saving drugs remain affordable.

Insurance Industry Inefficiencies

“The insurance model has become less about protecting patients and more about preserving their bottom line.”

Administrative costs account for 34% of U.S. healthcare expenditures, compared to 17% in Canada, according to the Journal of the American Medical Association. Rosenthal recounts a patient’s experience of being denied coverage for a medically necessary MRI, only to have the decision reversed after months of appeals. She highlights how insurance companies profit by delaying or denying care. Patients must be vigilant in challenging insurance denials, and systemic reforms are needed to simplify and streamline healthcare administration.

What Others Are Saying

“This book opened my eyes to how deeply broken the system is and gave me practical advice to better navigate it.” -Amazon Reviewer

“The stories are engaging, but I was hoping for more in-depth analysis of healthcare reform proposals.” -Amazon Reviewer

Amazon reviews of An American Sickness by Elisabeth Rosenthal reflect a mix of praise and criticism, highlighting its strengths and perceived limitations. Rosenthal’s blend of personal anecdotes, case studies, and hard-hitting statistics resonates with reviewers who appreciate her clear explanation of the complex U.S. healthcare system. Critics argue that while Rosenthal effectively diagnoses the problems, the book falls short on offering systemic solutions. Overall, An American Sickness is widely appreciated for its insights into the healthcare system, though some readers desire a stronger emphasis on actionable reforms.

Project Democracy's Review

Two doctors examine brain scan images on a lightbox. One points with a pen. The setting is clinical, focused, and professional. — "In a system shrouded in secrecy, transparency is the first step toward reform."

An American Sickness is a compelling and eye-opening exploration of the systemic failures within the U.S. healthcare system. From rising costs to inequitable access, Rosenthal lays bare how a profit-driven model undermines the health and well-being of citizens, a core responsibility of any government committed to a thriving democracy. The book underscores the importance of equity in healthcare, illustrating how exorbitant costs disproportionately harm marginalized communities and deepen societal divides. A well-functioning healthcare system, as Rosenthal suggests, is not just about treating illness—it’s about fostering stability, productivity, and trust in public institutions, all of which are essential to a strong democracy.

At Project Democracy, we believe that accessible and affordable healthcare is foundational to ensuring equal opportunity and civic engagement. Rosenthal’s work not only educates readers on the challenges but also empowers them to advocate for transparency and reform. An American Sickness is an essential read for anyone seeking to understand how healthcare impacts the broader democratic landscape and how we can work toward a system that prioritizes people over profits.