A searing and sobering indictment of the public health care system that highlights the inequality of treatment.

A Spirit of Charity


In the spirit of investigative journalism, this assessment of public hospitals paints a grim picture of health care for the poor in America.

Debut author King, a former newspaper reporter, focuses primarily on Atlanta’s Grady Memorial Hospital, showing that the public hospital in general has become “the symbol of how the poor are cared for in the United States.” This book traces Grady’s history and compares it to the evolution of four other public hospitals, demonstrating the challenges such centers face in serving their communities. Grady’s story is deftly interwoven with the advents of Medicare and Medicaid and, more recently, the Affordable Care Act. Perhaps most disturbing is King’s insightful exploration of the intersection of race, poverty, and health care, particularly in the South. Grady, for example, which started as “White Grady” and “Black Grady,” was desegregated after the 1964 Civil Rights Act; still, “remnants of Grady’s segregated past lingered for years.” The larger issue, however, was Grady’s compensation for taking impoverished patients. Grady’s Emergency Room, like those of other public hospitals, couldn’t turn away patients with life-threatening ailments. King notes, however, that nonprofit and private hospitals routinely “send patients without life-threatening conditions who come to their ERs to a public hospital for what they deem to be nonemergency care.” Public hospitals typically receive payment for these poor patients via Medicaid—but in the South, “state Medicaid programs have been unusually restrictive.” In fact, the author reports, “by refusing to expand Medicaid, Georgia was leaving about $9 million a day on the table, unclaimed for use by the neediest people in the state and the hospitals that treat them.” Grady survived, writes King, because of the efforts of local business leaders rather than county or state governments. In this important book, the author more briefly recounts similar stories of the other four public hospitals: Parkland Memorial Hospital in Dallas, Jackson Memorial Hospital in Miami, the John H. Stroger Hospital of Cook County in Chicago, and Charity Hospital in New Orleans. Carefully documented, journalistically crafted, and artfully told, this account illuminates the myriad struggles of public hospitals to effectively treat the indigent. King bluntly asks: “Have we reached the point where public officials, particularly those in the South, are frozen in the ice of their own indifference when it comes to the government’s responsibility in caring for the poor?”

A searing and sobering indictment of the public health care system that highlights the inequality of treatment.

Pub Date: May 31, 2016

ISBN: 978-1-944962-06-7

Page Count: 352

Publisher: Secant Publishing

Review Posted Online: May 4, 2016

Kirkus Reviews Issue: June 15, 2016

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A moving meditation on mortality by a gifted writer whose dual perspectives of physician and patient provide a singular...

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A neurosurgeon with a passion for literature tragically finds his perfect subject after his diagnosis of terminal lung cancer.

Writing isn’t brain surgery, but it’s rare when someone adept at the latter is also so accomplished at the former. Searching for meaning and purpose in his life, Kalanithi pursued a doctorate in literature and had felt certain that he wouldn’t enter the field of medicine, in which his father and other members of his family excelled. “But I couldn’t let go of the question,” he writes, after realizing that his goals “didn’t quite fit in an English department.” “Where did biology, morality, literature and philosophy intersect?” So he decided to set aside his doctoral dissertation and belatedly prepare for medical school, which “would allow me a chance to find answers that are not in books, to find a different sort of sublime, to forge relationships with the suffering, and to keep following the question of what makes human life meaningful, even in the face of death and decay.” The author’s empathy undoubtedly made him an exceptional doctor, and the precision of his prose—as well as the moral purpose underscoring it—suggests that he could have written a good book on any subject he chose. Part of what makes this book so essential is the fact that it was written under a death sentence following the diagnosis that upended his life, just as he was preparing to end his residency and attract offers at the top of his profession. Kalanithi learned he might have 10 years to live or perhaps five. Should he return to neurosurgery (he could and did), or should he write (he also did)? Should he and his wife have a baby? They did, eight months before he died, which was less than two years after the original diagnosis. “The fact of death is unsettling,” he understates. “Yet there is no other way to live.”

A moving meditation on mortality by a gifted writer whose dual perspectives of physician and patient provide a singular clarity.

Pub Date: Jan. 19, 2016

ISBN: 978-0-8129-8840-6

Page Count: 248

Publisher: Random House

Review Posted Online: Sept. 29, 2015

Kirkus Reviews Issue: Oct. 15, 2015

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Occasionally wonky but overall a good case for how the dismal science can make the world less—well, dismal.


“Quality of life means more than just consumption”: Two MIT economists urge that a smarter, more politically aware economics be brought to bear on social issues.

It’s no secret, write Banerjee and Duflo (co-authors: Poor Economics: A Radical Rethinking of the Way To Fight Global Poverty, 2011), that “we seem to have fallen on hard times.” Immigration, trade, inequality, and taxation problems present themselves daily, and they seem to be intractable. Economics can be put to use in figuring out these big-issue questions. Data can be adduced, for example, to answer the question of whether immigration tends to suppress wages. The answer: “There is no evidence low-skilled migration to rich countries drives wage and employment down for the natives.” In fact, it opens up opportunities for those natives by freeing them to look for better work. The problem becomes thornier when it comes to the matter of free trade; as the authors observe, “left-behind people live in left-behind places,” which explains why regional poverty descended on Appalachia when so many manufacturing jobs left for China in the age of globalism, leaving behind not just left-behind people but also people ripe for exploitation by nationalist politicians. The authors add, interestingly, that the same thing occurred in parts of Germany, Spain, and Norway that fell victim to the “China shock.” In what they call a “slightly technical aside,” they build a case for addressing trade issues not with trade wars but with consumption taxes: “It makes no sense to ask agricultural workers to lose their jobs just so steelworkers can keep theirs, which is what tariffs accomplish.” Policymakers might want to consider such counsel, especially when it is coupled with the observation that free trade benefits workers in poor countries but punishes workers in rich ones.

Occasionally wonky but overall a good case for how the dismal science can make the world less—well, dismal.

Pub Date: Nov. 12, 2019

ISBN: 978-1-61039-950-0

Page Count: 432

Publisher: PublicAffairs

Review Posted Online: Aug. 28, 2019

Kirkus Reviews Issue: Sept. 15, 2019

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