An expert bottoms-up examination of our diseased health care system.
A fierce denunciation of American medicine in which physicians are the heroes—mostly.
Doctors Dean and Talbot, founders of a nonprofit called The Moral Injury of Healthcare, explain that “moral injury” occurs when we experience something that transgresses our beliefs. For doctors, that means the oath to put patients’ needs first. It’s no secret that doctors must now comply with powerful stakeholders in the system, including insurers, hospital administrators, and oppressive regulators, as well as lugubrious electronic medical records. Stories of health care workers suffering “burnout” fill the media, but most blame overwork aggravated by the pandemic. Not so, maintain the authors. The culprit is moral injury, the result of applying aggressive, modern business methods to medical practice. In the introduction, the authors describe a dynamic entrepreneur whose massive hospital earned huge profits by minimizing staff and maximizing testing and services whether necessary or not, and perhaps breaking the law. Finally sent away with a golden parachute, he was replaced by another entrepreneur who promised “significant value for our shareholders.” As the authors demonstrate consistently, hospital executives see themselves as responsible to stockholders, not to physicians or patients. This includes many nonprofits, whose administrators give profits priority and benefit from them. Dean and Talbot profile the work of physicians forced to endure moral injury who then try, sometimes successfully, to find a practice more to their liking. In the final chapter, they deliver a passionate plea for more sensible and better enforced government regulation and more generous reimbursement from public and private insurance. Neither seems on the horizon. Sadly, heartless, assembly-line health care is more profitable than the good kind and, despite lurid stories, only slightly less effective. Doctors and patients hate it, but in a nation that worships the free market, profit is evidence of a well-run institution. Pair this powerful book with an equally painful yet important view from the top: Brian Alexander’s The Hospital.
An expert bottoms-up examination of our diseased health care system.Pub Date: April 4, 2023
ISBN: 9781586423544
Page Count: 306
Publisher: Steerforth
Review Posted Online: Jan. 11, 2023
Kirkus Reviews Issue: Feb. 1, 2023
A clearly delineated guide to finally eradicate poverty in America.
A thoughtful program for eradicating poverty from the Pulitzer Prize–winning author of Evicted.
“America’s poverty is not for lack of resources,” writes Desmond. “We lack something else.” That something else is compassion, in part, but it’s also the lack of a social system that insists that everyone pull their weight—and that includes the corporations and wealthy individuals who, the IRS estimates, get away without paying upward of $1 trillion per year. Desmond, who grew up in modest circumstances and suffered poverty in young adulthood, points to the deleterious effects of being poor—among countless others, the precarity of health care and housing (with no meaningful controls on rent), lack of transportation, the constant threat of losing one’s job due to illness, and the need to care for dependent children. It does not help, Desmond adds, that so few working people are represented by unions or that Black Americans, even those who have followed the “three rules” (graduate from high school, get a full-time job, wait until marriage to have children), are far likelier to be poor than their White compatriots. Furthermore, so many full-time jobs are being recast as contracted, fire-at-will gigs, “not a break from the norm as much as an extension of it, a continuation of corporations finding new ways to limit their obligations to workers.” By Desmond’s reckoning, besides amending these conditions, it would not take a miracle to eliminate poverty: about $177 billion, which would help end hunger and homelessness and “make immense headway in driving down the many agonizing correlates of poverty, like violence, sickness, and despair.” These are matters requiring systemic reform, which will in turn require Americans to elect officials who will enact that reform. And all of us, the author urges, must become “poverty abolitionists…refusing to live as unwitting enemies of the poor.” Fortune 500 CEOs won’t like Desmond’s message for rewriting the social contract—which is precisely the point.
A clearly delineated guide to finally eradicate poverty in America.Pub Date: March 21, 2023
ISBN: 9780593239919
Page Count: 288
Publisher: Crown
Review Posted Online: Nov. 30, 2022
Kirkus Reviews Issue: Jan. 1, 2023
BOOK REVIEW
PERSPECTIVES
PERSPECTIVES
SEEN & HEARD
Alternately admiring and critical, unvarnished, and a closely detailed account of a troubled innovator.
A warts-and-all portrait of the famed techno-entrepreneur—and the warts are nearly beyond counting.
To call Elon Musk (b. 1971) “mercurial” is to undervalue the term; to call him a genius is incorrect. Instead, Musk has a gift for leveraging the genius of others in order to make things work. When they don’t, writes eminent biographer Isaacson, it’s because the notoriously headstrong Musk is so sure of himself that he charges ahead against the advice of others: “He does not like to share power.” In this sharp-edged biography, the author likens Musk to an earlier biographical subject, Steve Jobs. Given Musk’s recent political turn, born of the me-first libertarianism of the very rich, however, Henry Ford also comes to mind. What emerges clearly is that Musk, who may or may not have Asperger’s syndrome (“Empathy did not come naturally”), has nurtured several obsessions for years, apart from a passion for the letter X as both a brand and personal name. He firmly believes that “all requirements should be treated as recommendations”; that it is his destiny to make humankind a multi-planetary civilization through innovations in space travel; that government is generally an impediment and that “the thought police are gaining power”; and that “a maniacal sense of urgency” should guide his businesses. That need for speed has led to undeniable successes in beating schedules and competitors, but it has also wrought disaster: One of the most telling anecdotes in the book concerns Musk’s “demon mode” order to relocate thousands of Twitter servers from Sacramento to Portland at breakneck speed, which trashed big parts of the system for months. To judge by Isaacson’s account, that may have been by design, for Musk’s idea of creative destruction seems to mean mostly chaos.
Alternately admiring and critical, unvarnished, and a closely detailed account of a troubled innovator.Pub Date: Sept. 12, 2023
ISBN: 9781982181284
Page Count: 688
Publisher: Simon & Schuster
Review Posted Online: Sept. 12, 2023
Kirkus Reviews Issue: Oct. 15, 2023
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