A deeply insightful and disheartening portrait of America’s diseased health care system.

THE HOSPITAL

LIFE, DEATH, AND DOLLARS IN A SMALL AMERICAN TOWN

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. 24, 2020

Kirkus Reviews Issue: Dec. 15, 2020

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Not an easy read but an essential one.

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HOW TO BE AN ANTIRACIST

Title notwithstanding, this latest from the National Book Award–winning author is no guidebook to getting woke.

In fact, the word “woke” appears nowhere within its pages. Rather, it is a combination memoir and extension of Atlantic columnist Kendi’s towering Stamped From the Beginning (2016) that leads readers through a taxonomy of racist thought to anti-racist action. Never wavering from the thesis introduced in his previous book, that “racism is a powerful collection of racist policies that lead to racial inequity and are substantiated by racist ideas,” the author posits a seemingly simple binary: “Antiracism is a powerful collection of antiracist policies that lead to racial equity and are substantiated by antiracist ideas.” The author, founding director of American University’s Antiracist Research and Policy Center, chronicles how he grew from a childhood steeped in black liberation Christianity to his doctoral studies, identifying and dispelling the layers of racist thought under which he had operated. “Internalized racism,” he writes, “is the real Black on Black Crime.” Kendi methodically examines racism through numerous lenses: power, biology, ethnicity, body, culture, and so forth, all the way to the intersectional constructs of gender racism and queer racism (the only section of the book that feels rushed). Each chapter examines one facet of racism, the authorial camera alternately zooming in on an episode from Kendi’s life that exemplifies it—e.g., as a teen, he wore light-colored contact lenses, wanting “to be Black but…not…to look Black”—and then panning to the history that informs it (the antebellum hierarchy that valued light skin over dark). The author then reframes those received ideas with inexorable logic: “Either racist policy or Black inferiority explains why White people are wealthier, healthier, and more powerful than Black people today.” If Kendi is justifiably hard on America, he’s just as hard on himself. When he began college, “anti-Black racist ideas covered my freshman eyes like my orange contacts.” This unsparing honesty helps readers, both white and people of color, navigate this difficult intellectual territory.

Not an easy read but an essential one.

Pub Date: Aug. 13, 2019

ISBN: 978-0-525-50928-8

Page Count: 320

Publisher: One World/Random House

Review Posted Online: April 28, 2019

Kirkus Reviews Issue: May 15, 2019

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A top-notch political memoir and serious exercise in practical politics for every reader.

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A PROMISED LAND

In the first volume of his presidential memoir, Obama recounts the hard path to the White House.

In this long, often surprisingly candid narrative, Obama depicts a callow youth spent playing basketball and “getting loaded,” his early reading of difficult authors serving as a way to impress coed classmates. (“As a strategy for picking up girls, my pseudo-intellectualism proved mostly worthless,” he admits.) Yet seriousness did come to him in time and, with it, the conviction that America could live up to its stated aspirations. His early political role as an Illinois state senator, itself an unlikely victory, was not big enough to contain Obama’s early ambition, nor was his term as U.S. Senator. Only the presidency would do, a path he painstakingly carved out, vote by vote and speech by careful speech. As he writes, “By nature I’m a deliberate speaker, which, by the standards of presidential candidates, helped keep my gaffe quotient relatively low.” The author speaks freely about the many obstacles of the race—not just the question of race and racism itself, but also the rise, with “potent disruptor” Sarah Palin, of a know-nothingism that would manifest itself in an obdurate, ideologically driven Republican legislature. Not to mention the meddlings of Donald Trump, who turns up in this volume for his idiotic “birther” campaign while simultaneously fishing for a contract to build “a beautiful ballroom” on the White House lawn. A born moderate, Obama allows that he might not have been ideological enough in the face of Mitch McConnell, whose primary concern was then “clawing [his] way back to power.” Indeed, one of the most compelling aspects of the book, as smoothly written as his previous books, is Obama’s cleareyed scene-setting for how the political landscape would become so fractured—surely a topic he’ll expand on in the next volume.

A top-notch political memoir and serious exercise in practical politics for every reader.

Pub Date: Nov. 17, 2020

ISBN: 978-1-5247-6316-9

Page Count: 768

Publisher: Crown

Review Posted Online: Nov. 16, 2020

Kirkus Reviews Issue: Dec. 15, 2020

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