kcourts's review against another edition
3.75
A solid companion for clearing brush. Not sure I would have kept with it other. Mostly because it's all the things I know and am frustrated about.
laurenkd89's review against another edition
3.0
The Hospital is an in-depth look at a community hospital in Bryan, Ohio called CHWC - a cornerstone of this poor, rural community, but constantly under threat. In diving into this small rural town as a case study, Alexander shows us a richer picture of what's going on in the U.S.'s medical system and how it affects poor, often isolated towns. Alexander pulls out themes that show up all around the country, risking the independence of these vital community hospitals, putting the physical and financial health of the residents and patients it serves in danger, and letting the increasingly consolidated healthcare conglomerates squeeze the most vulnerable populations.
CHWC plays a vital role in Bryan, a town of about 8,500 in northwest Ohio. The second-nearest hospital is about an hour away by car, and in serious emergencies and/or inclement weather, that's not a viable option. But CHWC is a small nonprofit hospital that struggles to make ends meet for a variety of reasons: most of its patients are on Medicare/Medicaid, and the reimbursement rates for supplies and treatment (the primary way hospitals make their money) are much lower compared to private insurance plans. CHWC is not part of a purchasing conglomerate either, so they are charged much higher rates for equipment, supplies, and medications than hospitals that are part of a large network. CHWC prides itself on its independence, but the finances don't agree - CHWC's CEO, Phil Ennon, fields negotiations all day long from Parkview Medical, a huge healthcare giant that wants to buy out this small town hospital and fundamentally change it.
There's a lot more to be said about the hospital itself, but the residents/patients of Bryan are a large part of the story as well. Bryan is one of thousands and thousands of small rural towns that isn't close to recovering from the Great Recession of 2007/2008. There are simply very few jobs left in Bryan, and those that are there don't pay a living wage, offer healthcare, or provide any sort of stable employment. Basically all the residents of Bryan are living in a precarious state - barely employed, in deep debt, wondering how they're going to make their next rent or mortgage payment, struggling to put food on the table. Mental health is at an all-time low and suicides are more and more common.
Not to mention that many Bryan residents have health issues that are common in poor towns, ranging from diabetes to heart problems to chronic injuries, and are often forced to be "noncompliant" with their medical instructions to manage these issues because of the cost of care, cost of basic medical supplies like diabetes test strips, need to work and put further strain on their bodies, or general instability that puts them in fight-or-flight mode.
One of the most interesting parts of this book is the discussion of intergenerational trauma and the real physical/mental health effects that generations of instability can have on individuals. For those of us who are in relatively stable points in life and have all of our basic necessities secured for the near future, it's extremely difficult to imagine the utter stress that food, shelter, and financial instability places on you. But for anyone who has endured that, it's the only thing you can think about, and studies have shown that this constant state of uncertainty leaves a mark on not only you, but your children. This is the reality for pretty much everyone in Bryan.
Alexander's whole thesis in this book is that American healthcare cannot be solved until these underlying issues - like rural employment, the disparity in treatment between private and public insurance, and the free-for-all nature of medical conglomerates that squash independent community hospitals - are addressed. Although it's a huge bummer to hear this, the medical system is a complex beast, with so many interlocking and interdependent issues causing the decline of health outcomes and quality healthcare availability for vulnerable Americans. This book taught me so much about a system that I know so little about, and although it's not particularly uplifting, it's an important read for understanding yet another problem that rural Americans face. My one criticism of the book is that it focuses on primarily white perspectives in a predominantly white town. Alexander discusses some things like Muslim doctors coming in and the subsequent anti-Muslim sentiment in town, but it's not detailed. But you can imagine that if things are this bad for white folk in Ohio, opportunities, risks, and challenges are probably even worse for Black Americans, immigrants, and other doubly or triply-marginalized groups.
Thank you to St. Martin's Press for the ARC via Netgalley.
CHWC plays a vital role in Bryan, a town of about 8,500 in northwest Ohio. The second-nearest hospital is about an hour away by car, and in serious emergencies and/or inclement weather, that's not a viable option. But CHWC is a small nonprofit hospital that struggles to make ends meet for a variety of reasons: most of its patients are on Medicare/Medicaid, and the reimbursement rates for supplies and treatment (the primary way hospitals make their money) are much lower compared to private insurance plans. CHWC is not part of a purchasing conglomerate either, so they are charged much higher rates for equipment, supplies, and medications than hospitals that are part of a large network. CHWC prides itself on its independence, but the finances don't agree - CHWC's CEO, Phil Ennon, fields negotiations all day long from Parkview Medical, a huge healthcare giant that wants to buy out this small town hospital and fundamentally change it.
There's a lot more to be said about the hospital itself, but the residents/patients of Bryan are a large part of the story as well. Bryan is one of thousands and thousands of small rural towns that isn't close to recovering from the Great Recession of 2007/2008. There are simply very few jobs left in Bryan, and those that are there don't pay a living wage, offer healthcare, or provide any sort of stable employment. Basically all the residents of Bryan are living in a precarious state - barely employed, in deep debt, wondering how they're going to make their next rent or mortgage payment, struggling to put food on the table. Mental health is at an all-time low and suicides are more and more common.
Not to mention that many Bryan residents have health issues that are common in poor towns, ranging from diabetes to heart problems to chronic injuries, and are often forced to be "noncompliant" with their medical instructions to manage these issues because of the cost of care, cost of basic medical supplies like diabetes test strips, need to work and put further strain on their bodies, or general instability that puts them in fight-or-flight mode.
One of the most interesting parts of this book is the discussion of intergenerational trauma and the real physical/mental health effects that generations of instability can have on individuals. For those of us who are in relatively stable points in life and have all of our basic necessities secured for the near future, it's extremely difficult to imagine the utter stress that food, shelter, and financial instability places on you. But for anyone who has endured that, it's the only thing you can think about, and studies have shown that this constant state of uncertainty leaves a mark on not only you, but your children. This is the reality for pretty much everyone in Bryan.
Alexander's whole thesis in this book is that American healthcare cannot be solved until these underlying issues - like rural employment, the disparity in treatment between private and public insurance, and the free-for-all nature of medical conglomerates that squash independent community hospitals - are addressed. Although it's a huge bummer to hear this, the medical system is a complex beast, with so many interlocking and interdependent issues causing the decline of health outcomes and quality healthcare availability for vulnerable Americans. This book taught me so much about a system that I know so little about, and although it's not particularly uplifting, it's an important read for understanding yet another problem that rural Americans face. My one criticism of the book is that it focuses on primarily white perspectives in a predominantly white town. Alexander discusses some things like Muslim doctors coming in and the subsequent anti-Muslim sentiment in town, but it's not detailed. But you can imagine that if things are this bad for white folk in Ohio, opportunities, risks, and challenges are probably even worse for Black Americans, immigrants, and other doubly or triply-marginalized groups.
Thank you to St. Martin's Press for the ARC via Netgalley.
orangesloth1's review against another edition
5.0
Sad. I’m glad this book didn’t end on a hopeful note. The state of our healthcare system doesn’t deserve it. It forces us to sit in and process the mess we are in.
jameshendrickson's review against another edition
5.0
This was such a powerful and eye opening book. I've probably though more about this book in 2021 than any other. It is often incredibly hard to read but also amazingly powerful. People think I'm joking when I tell them that UPMC has a branch in Italy.