A compact, perceptive diagnosis of the nation’s terminally ill health care system.

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Fall from Grace

A PHYSICIAN'S RETROSPECTIVE ON THE PAST FIFTY YEARS OF MEDICINE AND THE IMPACT OF SOCIAL CHANGE

A physician laments the rise of corporations and the decline of the doctor-patient relationship in American medicine.

Marr (Biochemistry and Molecular Biology of Parasites, 1995) asserts that American medicine has been radically changed by technological innovations, the growth of private and public health insurance, and the profit motive. Over the past half-century, these factors have “altered medical care almost beyond recognition.” Although technology brought many advances, the advent of “Star Trek medicine” helped distance doctors from patients by inserting “physician extenders” —medical assistants, nurses, and techs—into patient care. Outside clinics mainly staffed by these workers grew as insurance companies attempted to control costs. Private and government insurers tried to tamp down rising health care costs by saddling physicians with complex and time-consuming cost-control programs. But doctors aren’t really the problem, Marr argues. Physicians account for only about 10 percent of America’s medical bill. Technology, profits, and other factors have driven the explosion in costs, along with added layers of bureaucrats, managers, and executives. “Medicine lost its soul when big business entered,” Marr writes. As doctors became more like team managers than personal physicians, they distanced themselves from patients, who were “relegated to the status of a product.” Ultimately, this will increase misdiagnoses, he avers. Compared to other advanced nations, the U.S. has extraordinarily high per capita medical costs, while citizens enjoy only mediocre health. Marr has produced a tightly written, forcefully argued indictment of the U.S. health care system that’s well-documented and benefits from his insider knowledge of how hospitals and health care professionals work. His explanation of what led to this mess is succinct and clear. Although it’s hard to feel sorry for handsomely paid physicians, Marr’s argument that they’re more victims than beneficiaries of the corporatized, bureaucratized system rings true, though he could bolster his case with more details about just how much of the massive U.S. medical bill bureaucracy, for-profit hospitals, and insurance companies account for. He’s probably right, however, that this sick system will ultimately crash—a prediction that calls into question his perhaps too-pessimistic conclusion that the system’s structure can’t be changed.

A compact, perceptive diagnosis of the nation’s terminally ill health care system.

Pub Date: Feb. 6, 2015

ISBN: 978-1-4917-5484-9

Page Count: 134

Publisher: True Directions

Review Posted Online: Feb. 24, 2016

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SLEEPERS

An extraordinary true tale of torment, retribution, and loyalty that's irresistibly readable in spite of its intrusively melodramatic prose. Starting out with calculated, movie-ready anecdotes about his boyhood gang, Carcaterra's memoir takes a hairpin turn into horror and then changes tack once more to relate grippingly what must be one of the most outrageous confidence schemes ever perpetrated. Growing up in New York's Hell's Kitchen in the 1960s, former New York Daily News reporter Carcaterra (A Safe Place, 1993) had three close friends with whom he played stickball, bedeviled nuns, and ran errands for the neighborhood Mob boss. All this is recalled through a dripping mist of nostalgia; the streetcorner banter is as stilted and coy as a late Bowery Boys film. But a third of the way in, the story suddenly takes off: In 1967 the four friends seriously injured a man when they more or less unintentionally rolled a hot-dog cart down the steps of a subway entrance. The boys, aged 11 to 14, were packed off to an upstate New York reformatory so brutal it makes Sing Sing sound like Sunnybrook Farm. The guards continually raped and beat them, at one point tossing all of them into solitary confinement, where rats gnawed at their wounds and the menu consisted of oatmeal soaked in urine. Two of Carcaterra's friends were dehumanized by their year upstate, eventually becoming prominent gangsters. In 1980, they happened upon the former guard who had been their principal torturer and shot him dead. The book's stunning denouement concerns the successful plot devised by the author and his third friend, now a Manhattan assistant DA, to free the two killers and to exact revenge against the remaining ex-guards who had scarred their lives so irrevocably. Carcaterra has run a moral and emotional gauntlet, and the resulting book, despite its flaws, is disturbing and hard to forget. (Film rights to Propaganda; author tour)

Pub Date: July 10, 1995

ISBN: 0-345-39606-5

Page Count: 432

Publisher: Ballantine

Review Posted Online: May 20, 2010

Kirkus Reviews Issue: May 1, 1995

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Erudite writing from an author struggling to find meaning through music.

THEY CAN'T KILL US UNTIL THEY KILL US

An Ohio-based poet, columnist, and music critic takes the pulse of the nation while absorbing some of today’s most eclectic beats.

At first glance, discovering deep meaning in the performance of top-40 songstress Carly Rae Jepsen might seem like a tough assignment. However, Abdurraqib (The Crown Ain’t Worth Much, 2016) does more than just manage it; he dives in fully, uncovering aspects of love and adoration that are as illuminating and earnest as they are powerful and profound. If he can do that with Jepsen's pop, imagine what the likes of Bruce Springsteen, Prince, or Nina Simone might stir in him. But as iconic as those artists may be, the subjects found in these essays often serve to invoke deeper forays into the worlds surrounding the artists as much as the artists themselves. Although the author is interested in the success and appeal of The Weeknd or Chance the Rapper, he is also equally—if not more—intrigued with the sociopolitical and existential issues that they each managed to evoke in present-day America. In witnessing Zoe Saldana’s 2016 portrayal of Simone, for instance, Abdurraqib thinks back to his own childhood playing on the floor of his family home absorbing the powerful emotions caused by his mother’s 1964 recording of “Nina Simone in Concert”—and remembering the relentlessly stigmatized soul who, unlike Saldana, could not wash off her blackness at the end of the day. In listening to Springsteen, the author is reminded of the death of Michael Brown and how “the idea of hard, beautiful, romantic work is a dream sold a lot easier by someone who currently knows where their next meal is coming from.” In all of Abdurraqib’s poetic essays, there is the artist, the work, the nation, and himself. The author effortlessly navigates among these many points before ultimately arriving at conclusions that are sometimes hopeful, often sorrowful, and always visceral.

Erudite writing from an author struggling to find meaning through music.

Pub Date: Nov. 14, 2017

ISBN: 978-1-937512-65-1

Page Count: 288

Publisher: Two Dollar Radio

Review Posted Online: Oct. 2, 2017

Kirkus Reviews Issue: Oct. 15, 2017

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