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
Deliberately provocative, with much for left-inclined activists to ponder.
A wide-ranging critique of leftist politics as not being left enough.
Continuing his examination of progressive reform movements begun with The Cult of Smart, Marxist analyst deBoer takes on a left wing that, like all political movements, is subject to “the inertia of established systems.” The great moment for the left, he suggests, ought to have been the summer of 2020, when the murder of George Floyd and the accumulated crimes of Donald Trump should have led to more than a minor upheaval. In Minneapolis, he writes, first came the call from the city council to abolish the police, then make reforms, then cut the budget; the grace note was “an increase in funding to the very department it had recently set about to dissolve.” What happened? The author answers with the observation that it is largely those who can afford it who populate the ranks of the progressive movement, and they find other things to do after a while, even as those who stand to benefit most from progressive reform “lack the cultural capital and economic stability to have a presence in our national media and politics.” The resulting “elite capture” explains why the Democratic Party is so ineffectual in truly representing minority and working-class constituents. Dispirited, deBoer writes, “no great American revolution is coming in the early twenty-first century.” Accommodation to gradualism was once counted heresy among doctrinaire Marxists, but deBoer holds that it’s likely the only truly available path toward even small-scale gains. Meanwhile, he scourges nonprofits for diluting the tax base. It would be better, he argues, to tax those who can afford it rather than allowing deductible donations and “reducing the availability of public funds for public uses.” Usefully, the author also argues that identity politics centering on difference will never build a left movement, which instead must find common cause against conservatism and fascism.
Deliberately provocative, with much for left-inclined activists to ponder.Pub Date: Sept. 5, 2023
ISBN: 9781668016015
Page Count: 256
Publisher: Simon & Schuster
Review Posted Online: June 28, 2023
Kirkus Reviews Issue: Aug. 1, 2023
A cogent “horror story” about the plot to reanimate mid-20th-century White male supremacy at the expense of abortion access.
Incisive look at the destructive path of anti-abortion ideology in the U.S.
Even though most Americans believe in a woman’s right to choose—“consistent research has shown that more than 7 in 10 Americans support legal access to abortion”—the radical right has succeeded in steadily eroding reproductive freedoms since Roe v. Wade. According to NARAL Pro-Choice America leaders Hogue and Langford, the campaign against abortion is but a means to an end for the architects of the pro-life movement. Their true aim is the uncontested dominion of White Christian men. The battle began in 1954, when Brown v. Board of Education struck down “state laws used by segregationists to maintain structural inequality in the nation’s schools.” In 1976, the IRS rescinded the tax-exempt status of the Rev. Jerry Falwell’s segregationist Bob Jones University. What has followed, argue the authors convincingly, is more than a half-century of machinations designed “to halt progressive cultural change and maintain power for a privileged minority.” Anti-abortion rhetoric is just a weapon, driven by design, propaganda, disinformation, and cowed Republican politicians—hallmarks of the Trump era. Hogue and Langdon make a strong case that the rises of Trump, fake news, and science skepticism are not flukes but rather the culmination of a dogged campaign by forces still smarting from desegregation and second- and third-wave feminism. The reproductive freedom of American women is the victim of an “anti-democratic power grab on a historic scale.” The authors build a chilling case that the startling 2019 wave of abortion bans across the nation should serve as a canary in the coal mine for citizens concerned with democracy and a catalyst for bolder messaging, better strategic planning, and sustained action to combat disinformation.
A cogent “horror story” about the plot to reanimate mid-20th-century White male supremacy at the expense of abortion access.Pub Date: July 22, 2020
ISBN: 978-1-947492-50-9
Page Count: 280
Publisher: Strong Arm Press
Review Posted Online: Aug. 6, 2020
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