An American Sickness summary

The origins of many American hospitals, most of which began as charitable institutions set up by religious groups, can be traced back to the nineteenth century.

But today, hospitals are more like major corporations than philanthropic foundations.

In 1990, the American College of Surgeons required its members to make a pledge that included these words: “I will set my fees commensurate with the services rendered.” Unsurprisingly, this statement was removed from the pledge in 2004.

While it’s fair to expect doctors to be reasonably compensated, given their years of intensive education and training, the definition of “reasonable” has recently been stretched to a patently unreasonable degree. Today, America’s wealthiest one percent includes around 27 percent of the nation’s doctors.

Like hospitals, many of the big US pharmaceutical companies can be traced back to the nineteenth century. Back then, they were small businesses selling tonics and potions that succeeded in mixing a little bit of science with a whole lot of fanciful marketing.

Though this formula for success sounds quaint, the sad truth is that it hasn’t changed all that much. Prices, however, have.

In 2006, Robin Miller’s brother had a heart attack and during his recovery he required an implantable defibrillator, which is similar to a pacemaker. Robin’s brother was uninsured, so Robin agreed to cover the costs. But neither the hospital nor the manufacturer would tell him exactly what these costs would amount to.

This particular case is representative of a general problem. Much of what goes on in the area of medical devices is hidden from customers, and yet these devices are often the single most expensive part of a medical bill.

If you’ve ever worked in the service industry, you may know that restaurants make most of their profit by selling expensive cocktails and drinks.

As it turns out, hospitals have their own version of this. But instead of booze, they make the real money from testing and ancillary services, such as physical therapy sessions.

In a 2014 study of US customer debt, 52 percent of the overdue debt on current credit reports was the result of unpaid medical bills. In fact, one out of every five Americans had medical debt that was affecting their credit score, and therefore their chances of buying a car or getting a loan or a mortgage.

While we’ve looked at many of the reasons for massive medical bills, it all boils down to this: health care today is being run like big business.

You’ve probably heard about the refugee crisis, but have you heard of “health-care refugees”? This is the growing number of middle- to upper-middle-class Americans who are moving to other countries in an effort to avoid unbearable medical costs.

The author once met a graduate student with diabetes who was searching for an academic position abroad because she could no longer afford treatment in the United States.

Before trying a new restaurant these days, people tend to check online reviews. This is something you can – and should – do before picking a hospital as well.

Many hospitals in the United States are reviewed on Yelp, and the customer reviews to be found there can give you a good idea of what to expect. U.S. News & World Report publishes a ranking of the country’s best hospitals that takes into account their reputation within the medical community. This valuable resource also considers the ratio between nurses and patients and the number of medical mishaps. And then you can always check Medicare’s online Hospital Compare program, too.

In a 2015 poll, 72 percent of Americans said they felt the cost of prescription drugs was unreasonably high and approximately 25 percent reported difficulties in paying for their medication. Unfortunately, this problem is even worse for people with poor health.

If you hope to lower your drug expenses, here are a few tips.