A deeply insightful and disheartening portrait of America’s diseased health care system.
A superb account of a small-town hospital whose first priority is delivering high-quality medical care. Sadly, in today’s brutally competitive free market, that means it’s barely surviving.
In this eye-opening investigative study, journalist Alexander takes us to Bryan, Ohio, which has mostly recovered from the 2008 recession and possesses a surprisingly good hospital for its size (pop. 8,000). The author offers vivid portraits of a dozen individuals, including the hospital’s CEO, Phil Ennen, and readers will receive an expert education in his duties. Delivering care is one, but the business side is difficult. If rival medical centers steal business, customers don’t pay, or income doesn’t match expenses, his hospital will fail. Small hospitals have two strikes against them: Suppliers charge them more, and insurance companies pay them less (big medical systems negotiate for higher reimbursement; small ones have no clout). The free market extols efficiency above all. Once part of a larger system, Bryan’s hospital would see its staff trimmed, unprofitable services eliminated, and specialists moved to bigger cities. With less to offer, the hospital would become a drag on larger facilities; if it continued down that path, it would eventually close, a process that is playing out across the U.S. As of 2020, the hospital is hanging on and may even survive the pandemic, which is proving equally disastrous to rival hospitals. However, the future looks grim. Like all hospitals, Bryan’s depends heavily on government money, especially Medicare and Medicaid, but it’s not adequate, and this is unlikely to change in the near future. Like many states, Ohio has been cutting taxes and social services since the Reagan years, producing stagnant wages and declining health but only scattered calls for reform—certainly not in Bryan, where “a local politician could blame problems associated with a…business on the fact the owner was ‘not of American extraction’ and know he wouldn’t hear any disapproval.”
A deeply insightful and disheartening portrait of America’s diseased health care system.Pub Date: March 9, 2021
ISBN: 978-1-250-23735-4
Page Count: 320
Publisher: St. Martin's
Review Posted Online: Nov. 23, 2020
Kirkus Reviews Issue: Dec. 15, 2020
A hopeful civic sermon favoring inspiration over concrete prescriptions.
A New Jersey senator’s moral manifesto.
Booker situates his narrative in the wake of his 2025 record-breaking 25-hour stand on the Senate floor, an act of physical endurance and moral insistence that serves as its animating example. Though not framed as memoir, the episode implicitly positions Booker himself as a model of the virtues he argues are essential to democratic life. Organized around 10 qualities, including agency, vulnerability, truth, perseverance, and grace, the book advances a clear thesis. “In this book, I argue that many Americans who came before us, and many among us today, have consistently proven that virtues are practical: They expand our power, deepen our sense of belonging, and equip us to endure and ultimately prevail.” Booker illustrates this claim through figures such as the late U.S. Rep. John Lewis, whose willingness to endure sacrifice for principle anchors the book’s moral lineage, and Supreme Court Justice Ketanji Brown Jackson, whose composure under public scrutiny is presented as an example of dignity as civic strength. These portraits reinforce Booker’s belief that character, sustained over time, can shape public life, even when political outcomes remain uncertain or incomplete. He supplements these examples with personal stories drawn from family, faith, and community, delivered with emotional conviction and a tone that remains affirming and carefully calibrated. Much of the narrative reads like an expansive commencement address, earnest and reassuring, offering moral affirmation at moments when readers might reasonably expect sharper confrontation. That rhetorical choice ultimately defines the book’s limits. Booker acknowledges political conflict and compromise, but rarely examines them in depth, and while urging leaders to take moral risks, he avoids sustained reflection on how some of his own political decisions have tested the virtues he promotes. The result is a principled but self-conscious work that affirms shared values while offering little guidance for navigating power and accountability.
A hopeful civic sermon favoring inspiration over concrete prescriptions.Pub Date: March 24, 2026
ISBN: 9781250436733
Page Count: 272
Publisher: St. Martin's
Review Posted Online: March 24, 2026
Kirkus Reviews Issue: March 15, 2026
A moving meditation on mortality by a gifted writer whose dual perspectives of physician and patient provide a singular...
A neurosurgeon with a passion for literature tragically finds his perfect subject after his diagnosis of terminal lung cancer.
Writing isn’t brain surgery, but it’s rare when someone adept at the latter is also so accomplished at the former. Searching for meaning and purpose in his life, Kalanithi pursued a doctorate in literature and had felt certain that he wouldn’t enter the field of medicine, in which his father and other members of his family excelled. “But I couldn’t let go of the question,” he writes, after realizing that his goals “didn’t quite fit in an English department.” “Where did biology, morality, literature and philosophy intersect?” So he decided to set aside his doctoral dissertation and belatedly prepare for medical school, which “would allow me a chance to find answers that are not in books, to find a different sort of sublime, to forge relationships with the suffering, and to keep following the question of what makes human life meaningful, even in the face of death and decay.” The author’s empathy undoubtedly made him an exceptional doctor, and the precision of his prose—as well as the moral purpose underscoring it—suggests that he could have written a good book on any subject he chose. Part of what makes this book so essential is the fact that it was written under a death sentence following the diagnosis that upended his life, just as he was preparing to end his residency and attract offers at the top of his profession. Kalanithi learned he might have 10 years to live or perhaps five. Should he return to neurosurgery (he could and did), or should he write (he also did)? Should he and his wife have a baby? They did, eight months before he died, which was less than two years after the original diagnosis. “The fact of death is unsettling,” he understates. “Yet there is no other way to live.”
A moving meditation on mortality by a gifted writer whose dual perspectives of physician and patient provide a singular clarity.Pub Date: Jan. 19, 2016
ISBN: 978-0-8129-8840-6
Page Count: 248
Publisher: Random House
Review Posted Online: Sept. 29, 2015
Kirkus Reviews Issue: Oct. 15, 2015
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