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
As elegant and moving as a grief memoir can be.
A deeply felt, searching examination of the feelings and memories provoked by the death of a best friend.
“Would I have been this person without you? Would I have been bold and fearless without you by my side, provoking me and laughing with joy when I succeeded at anything? I will never know, you were with me throughout my most formative years, you are so intrinsically linked to my molding that I cannot think about my fundamental traits…without also thinking of you." Carson and her best friend, Larissa, were a magical pair—not just tall and gorgeous, but also smart, funny, and very well-read Black models who shared a flat in London and went out to clubs, where people got in line to pay for their drinks. Their connection was intense, their love for each other radiant in the anecdotes and text exchanges included here. The decision to include the texts was inspired, since the friends' silly nicknames for each other ("shmoo" and "shmoomies,” "poo head," "poopoo," and more) and their many declarations of love ("You're my soulmate, do you know that?" "Of course I know that") brilliantly evoke the particular flavor of the friendship. Carson was married and living on the West Coast with a husband and baby at the time of Larissa's death at 32; at first, she was only told that she died in the bath. The author didn't know her friend was involved with heroin, so when that was revealed, a whole new set of painful, unanswerable questions emerged. "You know the obsessiveness—weeks spent poring over the minutiae of the days and hours prior to death, as if somewhere, hidden in plain sight, is the answer. Something you missed that could have prevented it all," she writes. So many of us fully understand this obsessiveness, and in sharing the specifics of hers, Carson strikes a deeply resonant chord.
As elegant and moving as a grief memoir can be.Pub Date: April 11, 2023
ISBN: 9781685890452
Page Count: 240
Publisher: Melville House
Review Posted Online: Dec. 9, 2022
Kirkus Reviews Issue: Jan. 1, 2023
Gates offers a persuasive, 30,000-foot view of a global problem that, he insists, can be prevented given will and money.
The tech mogul recounts the health care–related dimensions of his foundation in what amounts to a long policy paper.
“Outbreaks are inevitable, but pandemics are optional.” Thus states the epidemiologist Larry Brilliant, a Gates adviser, who hits on a critically important point: Disease is a fact of nature, but a pandemic is a political creation of a kind. Therefore, there are political as well as medical solutions that can enlist governments as well as scientists to contain outbreaks and make sure they don’t explode into global disasters. One critical element, Gates writes, is to alleviate the gap between high- and low-income countries, the latter of which suffer disproportionately from outbreaks. Another is to convince governments to ramp up production of vaccines that are “universal”—i.e., applicable to an existing range of disease agents, especially respiratory pathogens such as coronaviruses and flus—to prepare the world’s populations for the inevitable. “Doing the right thing early pays huge dividends later,” writes Gates. Even though doing the right thing is often expensive, the author urges that it’s a wise investment and one that has never been attempted—e.g., developing a “global corps” of scientists and aid workers “whose job is to wake up every day thinking about diseases that could kill huge numbers of people.” To those who object that such things are easier said than done, Gates counters that the development of the current range of Covid vaccines was improbably fast, taking a third of the time that would normally have been required. At the same time, the author examines some of the social changes that came about through the pandemic, including the “new normal” of distance working and learning—both of which, he urges, stand to be improved but need not be abandoned.
Gates offers a persuasive, 30,000-foot view of a global problem that, he insists, can be prevented given will and money.Pub Date: May 3, 2022
ISBN: 978-0-593-53448-9
Page Count: 304
Publisher: Knopf
Review Posted Online: April 12, 2022
Kirkus Reviews Issue: May 1, 2022
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