An American Sickness

An American Sickness argues that the United States now operates a healthcare system in which every participant — insurers, hospitals, physicians, drug companies, device manufacturers, testing services, billing contractors, professional societies, and even disease-focused nonprofits — rationally optimizes inside a set of rules that no longer rewards the production of health, and that the cumulative consequence is a three-trillion-dollar industry whose pricing is opaque, whose competition is illusory, and whose outcomes lag substantially behind peer nations spending far less per capita; the book's deeper claim is that this outcome was not the product of any single villain but of decades of legal and regulatory choices — the wartime tax treatment of employer-provided insurance, the AMA's stewardship of billing codes, the FDA's deference on device equivalence, the prohibition on Medicare drug-price negotiation, the unchecked consolidation of regional providers — and that the response must therefore operate on two fronts simultaneously: patients defending themselves through informed, persistent, and unembarrassed engagement with the actors billing them, and citizens demanding structural reforms that would restore the basic disciplines of transparency, accountability, and value to a system that has long since lost them.

Dr. Elisabeth Rosenthal is an American physician and journalist whose work has placed her among the most influential voices in contemporary American health policy reporting. She earned her undergraduate degree at Stanford, her medical degree at Harvard Medical School, and went on to practice as an emergency room physician at New York Hospital (now NewYork-Presbyterian) before transitioning into full-time journalism. She joined the New York Times in 1988 and spent more than two decades as a Times reporter and editor, with assignments that included a long stint as the paper's Beijing bureau chief during the SARS epidemic and extensive international environmental reporting on climate change. She returned to American healthcare reporting in 2013 with a celebrated investigative series titled "Paying Till It Hurts," which exposed the extraordinary and inconsistent pricing of routine procedures across the United States and which served as the journalistic foundation for An American Sickness. The book, published in 2017, became a New York Times bestseller and was widely reviewed as one of the definitive accounts of how the American healthcare system reached its current condition. Following the book's success she was named editor-in-chief of Kaiser Health News (now KFF Health News), the independent newsroom focused on health policy reporting that operates as part of the Kaiser Family Foundation. In that role she has continued to lead investigative journalism on prescription drug pricing, surprise billing, hospital consolidation, and the persistent affordability crisis. She lives in the Washington, D.C., area and remains one of the most-cited authorities on the economic and policy dimensions of American medicine.