An American Sickness: How Healthcare Became Big Business and How You Can Take It Back by Elisabeth Rosenthal


From Mom

Part I

(what is wrong)


  1. Insurance
  2. Hospitals
  3. Pysicians
  4. Parmaceuticals
  5. Medical Devices
  6. Testing/Ancillary Services
  7. Contractors, billing, coding, etc.
  8. Research and good works for profit
  9. Conglomerates
  10. Healthcare as business
  11. ACA

Economic Rules of the Dysfunctional Medical Market

  1. More treatment is always better. Default to the most expensive option.
  2. A lifetime of treatment is preferable to a cure.
  3. Amenities and marketing matter more than good care.
  4. As technologies age, prices can rise rather than fall.
  5. There is no free choice. Patients are stuck. And they're stuck buying American.
  6. More competitors vying for business doesn't mean better prices; it can drive prices up, not down.
  7. Economies of scale don't translate to lower prices. With their market power, big providers can simply demand more.
  8. There is no such thing as a fixed price for a procedure or test. And the uninsured pay the highest prices of all.
  9. There are no standards for billing. There's money to be made in billing for anything and everything.
  10. Prices will rise to whatever the market will bear.

Part II

(what you can do)

Chapter 13: Doctor Bills

Questions to ask your doctor:

  • Is the practice owned by a hospital or licensed as a surgery center? (Answer should be No)
  • Will you refer me only to other physicians in my insurance netwrok, or explain in advance if you can't?
  • If I need blood work or radiology testing, can you send me to an in-network lab?
  • Will there be charges for phone advice or filling out forms? Is there an annual practice fee?
  • If I'm hospitalized, will you be seeing me in the hospital? What is your coverage on weekends?

Questions to ask any healthcare provider:

  • How much will this test/surgery/exam cost?
  • How will this test/surgery/exam change my treatment?
  • Which blood test are you ordering? Why?
  • Are there cheaper alternatives that are equally good, or nearly so?
  • Where will this test/surgery/exam be performed and how does this impact the price?
  • Who else will be involved in my treatment? Will I be getting a separate bill from another provider? Can you recommend someone in my insurance network?

Chapter 14: Hospital Bills

What you can do:

  • Vet your hospital beforehand
  • Make it clear you did not request a private room
  • Before signing financial documents, write in "as long as the providers are in my insurance network"
  • Ask if you are being admitted under "observation status"
  • Ask to know the identity of every person who appears at your bedside, what he or she is doing, and who send him or her. Write it down.
  • If the hospital tries to send you home with equipment you don't need, refuse it

Dealing with bills:

  • If you receive an outrageous bill, negotiate
  • Request itemization
  • Check the bill against your notes from the hospital
  • Protest bills in writing to create a record
  • Argue against surprise out-of-network bills

Chapter 16: Drug and Medical Device Costs

  • Shop around
  • Consider imports
  • Be skeptical of advertising

Chapter 17: Ancillary Services

  • Only use in-network providers
  • Avoid having tests sent to a hospital lab
  • Ask for a printout of your results