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



Perhaps not magic but appealing nonetheless.

Want to get ahead in business? Consult a dictionary.

By Wharton School professor Berger’s account, much of the art of persuasion lies in the art of choosing the right word. Want to jump ahead of others waiting in line to use a photocopy machine, even if they’re grizzled New Yorkers? Throw a because into the equation (“Excuse me, I have five pages. May I use the Xerox machine, because I’m in a rush?”), and you’re likely to get your way. Want someone to do your copying for you? Then change your verbs to nouns: not “Can you help me?” but “Can you be a helper?” As Berger notes, there’s a subtle psychological shift at play when a person becomes not a mere instrument in helping but instead acquires an identity as a helper. It’s the little things, one supposes, and the author offers some interesting strategies that eager readers will want to try out. Instead of alienating a listener with the omniscient should, as in “You should do this,” try could instead: “Well, you could…” induces all concerned “to recognize that there might be other possibilities.” Berger’s counsel that one should use abstractions contradicts his admonition to use concrete language, and it doesn’t help matters to say that each is appropriate to a particular situation, while grammarians will wince at his suggestion that a nerve-calming exercise to “try talking to yourself in the third person (‘You can do it!’)” in fact invokes the second person. Still, there are plenty of useful insights, particularly for students of advertising and public speaking. It’s intriguing to note that appeals to God are less effective in securing a loan than a simple affirmative such as “I pay all bills…on time”), and it’s helpful to keep in mind that “the right words used at the right time can have immense power.”

Perhaps not magic but appealing nonetheless.

Pub Date: March 7, 2023

ISBN: 9780063204935

Page Count: 256

Publisher: Harper Business

Review Posted Online: March 23, 2023

Kirkus Reviews Issue: April 15, 2023


Striking research showing the immense complexity of ordinary thought and revealing the identities of the gatekeepers in our...

A psychologist and Nobel Prize winner summarizes and synthesizes the recent decades of research on intuition and systematic thinking.

The author of several scholarly texts, Kahneman (Emeritus Psychology and Public Affairs/Princeton Univ.) now offers general readers not just the findings of psychological research but also a better understanding of how research questions arise and how scholars systematically frame and answer them. He begins with the distinction between System 1 and System 2 mental operations, the former referring to quick, automatic thought, the latter to more effortful, overt thinking. We rely heavily, writes, on System 1, resorting to the higher-energy System 2 only when we need or want to. Kahneman continually refers to System 2 as “lazy”: We don’t want to think rigorously about something. The author then explores the nuances of our two-system minds, showing how they perform in various situations. Psychological experiments have repeatedly revealed that our intuitions are generally wrong, that our assessments are based on biases and that our System 1 hates doubt and despises ambiguity. Kahneman largely avoids jargon; when he does use some (“heuristics,” for example), he argues that such terms really ought to join our everyday vocabulary. He reviews many fundamental concepts in psychology and statistics (regression to the mean, the narrative fallacy, the optimistic bias), showing how they relate to his overall concerns about how we think and why we make the decisions that we do. Some of the later chapters (dealing with risk-taking and statistics and probabilities) are denser than others (some readers may resent such demands on System 2!), but the passages that deal with the economic and political implications of the research are gripping.

Striking research showing the immense complexity of ordinary thought and revealing the identities of the gatekeepers in our minds.

Pub Date: Nov. 1, 2011

ISBN: 978-0-374-27563-1

Page Count: 512

Publisher: Farrar, Straus and Giroux

Review Posted Online: Sept. 3, 2011

Kirkus Reviews Issue: Sept. 15, 2011

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