Sick: The Untold Story of America's Health Care Crisis -- and the People Who Pay the Price. Brief summary of the book, including strengths and weaknesses

Jonathan Cohn's "The Untold Story of America's Health-Care Crisis and the People Who Pay the Price" provides a detailed account of challenges that exist within the current healthcare system. The book highlights true stories from five years of travel conducted by the author. During his travels, he interviewed everyday citizens facing difficult circumstances in terms of insurance policies, claims, reimbursements, coverage exclusions and high costs. Examples includes a story of New Yorkers who followed all protocol and still found themselves without insurance when they needed it most, and a Florida woman with diabetes, viewed as a pre-existing condition by most insurers, who faced similar hardship due to self-employment and coverage refusals.

Most of the chapters detail a unique situation of a family, couple or individual and how insurance companies have responded -- or failed to respond -- in a way that helps those most in need. Red tape is often one of the major issues. This includes complications dealing with health-maintenance organizations (HMO's). For example, in one chapter a Texas family discovered that seeking care for their son's cerebral palsy was hampered by policies, lengthy waits, and ambiguity. Even more unsettling, are accounts of how those with mental illness are treated, the inadequacies of employer-based coverage, reductions in charity care, and also overburdened hospital systems (Cohen, 2007). There is also a great deal of information about the challenges faced by Medicare and Medicaid patients.

A major positive about the book is how it seeks to put many of the stories in the proper perspective by providing historical analysis to help illustrate how the current healthcare situation in America has evolved. This is valuable education for the reader. Early on private health insurance began as a way to keep hospitals out of bankruptcy. This eventually evolved into hospital group plans, including Blue Cross, Blue Shield which is the flagship group plan in operation today. Cohn also describes the nation's employer-based system of paying for coverage, which arose from the wage controls of World War II. He talks about how Medicare and Medicaid came about after universal health care petitions failed to be implemented without political strife, and explains that HMO's are popular today because they initially served as a response to rising healthcare costs. However, he also points out that HMO's have fallen short of their intended aim because they can result in less control over medical decisions causing frustrations patients.

The final chapter, aptly entitled "Washington," summarizes all the points raised through the stories and histories in the book. It appears that Cohn would like the reader to draw a conclusion similar to his -- that publicly funded, universal health care should exist in America. He posits that the basic underpinnings of private insurance could work better if they fell under government regulations and subsidies that work. He admits this would not be a perfect solution, but feels that it would be more equitable for Americans. He pays particular attention to the disparities faced by marginalized communities such as the poor, elderly, and those with pre-existing/chronic conditions.

Overall, the book sheds light on current issues, presenting very compelling cases that warrant our attention, regardless of which political party we identify with. Some areas that could fall under criticism include the broad social conclusions he makes in some areas (about HMO's for example) and his lack of a definitive stance on proposed reforms presented today. More solid solutions would be beneficial and help to convince the reader. A more solid response to the complex problems raised in the book would help sum up the anecdotes and historical analysis. He does offer that a healthcare system similar to that of the French could work in America, but does not tell explain his reasons in full. It is unclear how the French system correlates directly to the sad stories presented in the book. The real strength of this read lies in the humanization of the impact of healthcare and pharmaceutical policies and the real life examples presented.

Relationship of the book's primary subject to current healthcare events and class lectures

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I was particularly taken with the pre-existing condition dilemma presented in the book and how this affects so many families -- particularly those who are elderly or families of small children with debilitating illnesses. Conditions from cancer to heart disease to chronic asthma to HIV / AIDS can create massive healthcare costs and yet, under the current system of things, those who fall into these categories are most likely to be unable to receive the care they so desperately need because insurance companies can be biased (Deinard, & Russell, 2011). Reform measures should help in this regard. Insurers will no longer be able to discriminate for such cases or cancel coverage once chronic conditions are revealed. Also, this reform places shared responsibility on all -- those who are healthy and those who are not.
That being said, there is one area that seemed markedly lacking in the book personal responsibility. If financial responsibility for a healthy society moves to a broader shared model, what implications exist for the individual? What measures should be taken to ensure one's own positive health outcomes? I believe that there are steps citizens can take to safeguard their own health in many cases. Smoking and obesity are two areas where behavioral changes would help. We cannot overlook our own role when it comes to preventable disease. Working with healthcare agencies, public health educators and prevention programs can be helpful in this regard and with proper education, awareness and support people can change their fate. The major plus is that personal responsibility can help curtail costs and eliminate a great deal of frustration that many may feel trying to navigate through complex policies and insurance challenges.

The Medicare discussion presented in the book is also timely and important. Medicare, supplemented by Medicaid, provides access to health insurance coverage for more than 45 million people who qualify due to disability or age (Aaron, 2011). It is widely believed that the aging of the U.S. population is a major driver of the annual growth in the demand for health care and in national health spending. That coupled with unemployment, less private insurance coverage due to the current recession, and increases in hospital and prescription drug costs has affected the entire health care sector (Deinard & Russell, 2011). Program costs will most likely continue to grow in proportion to the poor economy, the needs of an aging population and emerging public health crises and emergencies.

Newer forms of healthcare legislation under the Affordable Care Act include a number of policies to help physicians, hospitals, and other caregivers improve the safety and quality of patient care and make health care more affordable (Aaron, 2011). By focusing on the needs of patients and linking payments to outcomes, these delivery system reforms are hoping to improve the health of individuals and communities and lessen costs. In 2011, the Department of Health and Human Services also released new rules to help doctors, hospitals, and other providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs). ACOs create incentives for health care providers to work together to treat an individual patient across myriad care settings -- including doctor's offices, nursing homes, hospitals, and other long-term care facilities. A Medicare Shared Savings Program will reward ACOs that lower growth in health care costs while meeting performance standards for quality care. This saves money by improving the coordination of care and also supports increased choice for consumers; updates in medical technology; investments in research, development and education; and, finally, an…