THE HOSPITAL

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.