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The People's Hospital: Hope and Peril in American Medicine
“Nuila’s storytelling gifts place him alongside colleagues like Atul Gawande.” — Los Angeles Times
This “compelling mixture of health care policy and gripping stories from the frontlines of medicine” ( The Guardian ) explores the where does an uninsured person go when turned away by hospitals, clinics, and doctors?
Here, we follow the lives of five uninsured Houstonians as their struggle for survival leads them to a hospital that prioritizes people over profit. First, we meet Stephen, the restaurant franchise manager who signed up for his company’s lowest priced plan, only to find himself facing insurmountable costs after a cancer diagnosis. Then Christian—a young college student and retail worker who can’t seem to get an accurate diagnosis, let alone treatment, for his debilitating knee pain. Geronimo, thirty-six years old, has liver failure, but his meager disability check disqualifies him for Medicaid—and puts a life-saving transplant just out of reach. Roxana, who’s lived in the community without a visa for more than two decades, suffers from complications related to her cancer treatment. And finally, there’s Ebonie, a young mother whose high-risk pregnancy endangers her life. Whether due to immigration status, income, or the vagaries of state Medicaid law, all five are denied access to care. For all five, this exclusion could prove life-threatening.
Each patient eventually lands at Ben Taub, the county hospital where Dr. Nuila has worked for over a decade. Nuila delves with empathy into the experiences of his patients, braiding their dramas into a singular narrative that contradicts the established idea that the only way to receive good health care is with good insurance. As readers follow the moving twists and turns in each patient’s story, it’s impossible to deny that our system is broken—and that Ben Taub’s innovative model, where patient care is more important than insurance payments, could help light the path forward.
This “compelling mixture of health care policy and gripping stories from the frontlines of medicine” ( The Guardian ) explores the where does an uninsured person go when turned away by hospitals, clinics, and doctors?
Here, we follow the lives of five uninsured Houstonians as their struggle for survival leads them to a hospital that prioritizes people over profit. First, we meet Stephen, the restaurant franchise manager who signed up for his company’s lowest priced plan, only to find himself facing insurmountable costs after a cancer diagnosis. Then Christian—a young college student and retail worker who can’t seem to get an accurate diagnosis, let alone treatment, for his debilitating knee pain. Geronimo, thirty-six years old, has liver failure, but his meager disability check disqualifies him for Medicaid—and puts a life-saving transplant just out of reach. Roxana, who’s lived in the community without a visa for more than two decades, suffers from complications related to her cancer treatment. And finally, there’s Ebonie, a young mother whose high-risk pregnancy endangers her life. Whether due to immigration status, income, or the vagaries of state Medicaid law, all five are denied access to care. For all five, this exclusion could prove life-threatening.
Each patient eventually lands at Ben Taub, the county hospital where Dr. Nuila has worked for over a decade. Nuila delves with empathy into the experiences of his patients, braiding their dramas into a singular narrative that contradicts the established idea that the only way to receive good health care is with good insurance. As readers follow the moving twists and turns in each patient’s story, it’s impossible to deny that our system is broken—and that Ben Taub’s innovative model, where patient care is more important than insurance payments, could help light the path forward.
384 pages, Paperback
First published May 7, 2020
704 people are currently reading
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Displaying 1 - 30 of 556 reviews
October 26, 2023
Cried so many times reading this!
This book was such an emotional journey because the United States is at a tipping point: Who are we? Are we going to treat others how we would like to be treated? Where is the humanity?
Think about healthcare – Does everyone deserve it? Is it a right? Or do you have to be worthy enough?
This book isn’t bogged down in statistics or high-level medical jargon. This book focuses on the patients at Ben Taub, the hospital in Houston which accepts patients without insurance. And….wow! This book pulls on your heartstrings.
Read this book because healthcare can’t be reduced to numbers on a spreadsheet.
Should we as a country say that every life is valuable and deserves medical care or are we going to tiptoe around the person?
“A 2019 article in the American Journal of Public Health showed that 66 percent of all bankruptcies in America – affecting more than 530,000 families – were due to medical bills, by far the most of any cause.”
One of the patients in The People’s Hospital, a pregnant woman, who lost 2.5 liters of blood could not qualify for an abortion because of Texas’s restrictive abortion laws. Although there is an exemption for the life of the mother, she was not dying “enough” to qualify.
Diabetics on average pay $4,800 yearly. Who can pay this? Federal minimum wage is $7.25 an hour.
*Thanks, Scribner, for a free copy of this book in exchange for my fair and unbiased opinion.
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This book was such an emotional journey because the United States is at a tipping point: Who are we? Are we going to treat others how we would like to be treated? Where is the humanity?
Think about healthcare – Does everyone deserve it? Is it a right? Or do you have to be worthy enough?
This book isn’t bogged down in statistics or high-level medical jargon. This book focuses on the patients at Ben Taub, the hospital in Houston which accepts patients without insurance. And….wow! This book pulls on your heartstrings.
Read this book because healthcare can’t be reduced to numbers on a spreadsheet.
Should we as a country say that every life is valuable and deserves medical care or are we going to tiptoe around the person?
“A 2019 article in the American Journal of Public Health showed that 66 percent of all bankruptcies in America – affecting more than 530,000 families – were due to medical bills, by far the most of any cause.”
One of the patients in The People’s Hospital, a pregnant woman, who lost 2.5 liters of blood could not qualify for an abortion because of Texas’s restrictive abortion laws. Although there is an exemption for the life of the mother, she was not dying “enough” to qualify.
Diabetics on average pay $4,800 yearly. Who can pay this? Federal minimum wage is $7.25 an hour.
*Thanks, Scribner, for a free copy of this book in exchange for my fair and unbiased opinion.
Connect With Me!
Blog Twitter BookTube Facebook Insta
October 21, 2022
I work in healthcare in Houston, so reading this was a very personal experience for me. The way Dr. Nuila describes the system that patients in Ben Taub hospital must navigate while all being significantly and chronically ill is what I see on a daily basis in a similar hospital in the Houston suburbs. My hospital also being a safety-net hospital for the area, really allowed me to make appropriate parallels to the stories of these patients. This book should be required reading for residents who will be working in hospitals such as Ben Taub, not only does it do a delicate job of explaining how the system works, but it gives careful, and thoughtful consideration to the needs of the patients, the government and how things got to where they are. The writing is appropriate for people who have no medical background, or who have only stepped foot in a hospital for births, or broken bones. The ability to explain in such detail while also keeping in mind that most people don't understand medical terminology, diagnosis, or lab results is a gift not many physicians have. I will be recommending this book to the physicians I work with. This is the most personable story of a physician in a broken system that I have ever read. Thank you to Dr. Nuila for the opportunity to learn.
June 8, 2024
When someone writes a book about your favorite hospital 🥹 I learned tons from this book and recommend to anyone wanting to learn about our current US healthcare system from a human perspective. Feeling so honored to have trained at Ben taub 🖤
February 22, 2023
Firstly, thank you NetGalley for gifting me this for an advanced reading!
As a dentist who works in a rural community health center and who is also living in a Republican state, this book spoke to so many experiences I've had. The stories included are both inspiring and realistic; each patient description is gut wrenching, complex, and true to life. My favorite parts of the book are the author's descriptions of how the failures in America's insurance system leads to burn out and shortage of healthcare personnel.
My biggest criticism is that I think this book suffers from a lack of editing. There are parts in the first half of the book that feel disorganized and, at times, disconnected. It jumps from story to story often, and I found myself trying to understand how each story fit into the subject of the chapter I was on. While I do think that the last third of the book makes it a worthwhile read, I also kept going because I was given this as an ARC. I might have put it down and not returned to it otherwise.
Unlike the author, I grew up with government insurance and used "safety net" options in healthcare. While I think some of the book's strongest points are when the author describes his passion in caring for his patients, another criticism I have is that I wish he had stated more outright how privileged he was to be standing on the other side of the system as the son of a doctor and the one giving the care rather than needing the care.
There were times when I was unsure who the audience for this book was meant to be and whether the general public would have anything to gain from reading this. From the author's tone, it seemed to me that he was often describing his shock in how many people experience such difficult situations in healthcare. But for the majority of Americans, this is just a fact of life. This book seems more like a call to action for hospital administration and government officials who are disconnected from the day-to-day realities of healthcare than for the average person and consumer.
Overall, I'm glad that I read it. I would say that this is more of a 3,5 star read than a 4 star, but I'm rounding up because I think it would be a worthwhile read for the right person.
As a dentist who works in a rural community health center and who is also living in a Republican state, this book spoke to so many experiences I've had. The stories included are both inspiring and realistic; each patient description is gut wrenching, complex, and true to life. My favorite parts of the book are the author's descriptions of how the failures in America's insurance system leads to burn out and shortage of healthcare personnel.
My biggest criticism is that I think this book suffers from a lack of editing. There are parts in the first half of the book that feel disorganized and, at times, disconnected. It jumps from story to story often, and I found myself trying to understand how each story fit into the subject of the chapter I was on. While I do think that the last third of the book makes it a worthwhile read, I also kept going because I was given this as an ARC. I might have put it down and not returned to it otherwise.
Unlike the author, I grew up with government insurance and used "safety net" options in healthcare. While I think some of the book's strongest points are when the author describes his passion in caring for his patients, another criticism I have is that I wish he had stated more outright how privileged he was to be standing on the other side of the system as the son of a doctor and the one giving the care rather than needing the care.
There were times when I was unsure who the audience for this book was meant to be and whether the general public would have anything to gain from reading this. From the author's tone, it seemed to me that he was often describing his shock in how many people experience such difficult situations in healthcare. But for the majority of Americans, this is just a fact of life. This book seems more like a call to action for hospital administration and government officials who are disconnected from the day-to-day realities of healthcare than for the average person and consumer.
Overall, I'm glad that I read it. I would say that this is more of a 3,5 star read than a 4 star, but I'm rounding up because I think it would be a worthwhile read for the right person.
June 9, 2023
I'm definitely in the camp of saying, the hospital where you take people who get shot. I never thought I would ever say that I would prefer to go to Ben Taub for an emergency, but here I am thinking it, saying it, and maybe doing it. Reading this book made me rethink a lot of things. I loved the stories he presents in all different ways, but all have the same issue, they don't have insurance to start. The stories will make you happy and sad and anxious. Some of the stories will make you angry like when the guy was kicked off of Medicaid for being $175 over the very max of receiving $730 (total for living and everything). It's not surprising to me that Texas is one of the lowest in the country for the max Medicaid/Medicare money; West Virginia even has double what we provide. I loved that he presented data for all the different hospitals, and his book isn’t attacking the other hospitals on the quality of care, but he shows that it’s not always bad if you get sent to Ben Taub. Its astounding to me knowing that one cancer surgery at Ben Taub would be $230,000, but at the non-profit hospital, it's $770,000. There were also some instances when I said, that happened to me like the many options of MRI (that aren't paid for by Insurance); the doctors do not have time to really look at the results and it ends up being a less than par service for the patient. I loved the history of medicine and this hospital. The author also presents an ideal that would work for Americans when it comes to healthcare using the model of Ben Taub. I probably won't ever see it in my lifetime, because we have the politicians that we do now, but it would be nice to dream.
This book was mind blowing, especially for a Houston native. And does make me look at Ben Taub in a different way and it makes me look at healthcare solutions in a different way. I recommend this book even if you in the camp of only private insurance or if you are in the camp of something akin to NHS in the UK. Either way, it will make you think things and that's the point of these nonfiction books.
This book was mind blowing, especially for a Houston native. And does make me look at Ben Taub in a different way and it makes me look at healthcare solutions in a different way. I recommend this book even if you in the camp of only private insurance or if you are in the camp of something akin to NHS in the UK. Either way, it will make you think things and that's the point of these nonfiction books.
August 13, 2023
Although I thoroughly enjoyed this, it is impossible for me to write an unbiased review. I have never met Dr. Nuila but I too work at Ben Taub. I’m a physician in the same training program he once graduated from.
Because of that, I entered this book already possessing a fierce love for Ben Taub - serving patients there is a source of deep pride and joy and I’m so grateful to be there. I also have a thorough knowledge of not only Ben Taub but the healthcare system in general and the social/economic/financial/political complexities that abound. And I also happened to already agree strongly with a variety of the viewpoints and positions advocated for here. So I encourage you to look to other reviews for whether this complex system is explained well for laypeople or whether the arguments made are compelling. But while I’m hardly objective what I can say is that Dr. Nuila’s writing affirms and reflects the experiences both myself and my patients have every day.
If nothing else, that alone was enough for me to appreciate this beyond words. I hope that more and more physicians continue to enter the field who prioritize people over profits and have a vision for a just system. I hope that we as a society are able to push our governments into action. And most of all I hope that someday these stories will be seen as a relic of incomprehensible past, that people will no longer suffer and die over a few hundred dollars.
Because of that, I entered this book already possessing a fierce love for Ben Taub - serving patients there is a source of deep pride and joy and I’m so grateful to be there. I also have a thorough knowledge of not only Ben Taub but the healthcare system in general and the social/economic/financial/political complexities that abound. And I also happened to already agree strongly with a variety of the viewpoints and positions advocated for here. So I encourage you to look to other reviews for whether this complex system is explained well for laypeople or whether the arguments made are compelling. But while I’m hardly objective what I can say is that Dr. Nuila’s writing affirms and reflects the experiences both myself and my patients have every day.
If nothing else, that alone was enough for me to appreciate this beyond words. I hope that more and more physicians continue to enter the field who prioritize people over profits and have a vision for a just system. I hope that we as a society are able to push our governments into action. And most of all I hope that someday these stories will be seen as a relic of incomprehensible past, that people will no longer suffer and die over a few hundred dollars.
July 5, 2023
This is the story of healthcare as it stands today in America, but it is also the inspirational story of Ben Taub Hospital in Houston.
October 9, 2023
1) Do you work in healthcare?
Yes-don’t read this book
No-continue with question 2
2) Do you live with, or are you good friends with someone who works in healthcare?
Yes-don’t read this book
No-continue with question 3
3)Do you consider yourself at least somewhat knowledgeable about how healthcare works and some of the issues surrounding it?
Yes-don’t read this book
No-continue with question 4
4)Do you have no idea about the current issues surrounding healthcare in the US but you want to learn about it?
Yes-then read this book.
So, perhaps I’m biased, having worked with the underserved as a physician for the past 13 years of my life, but this book shared ABSOLUTELY nothing new about healthcare. No cogent arguments about how healthcare should change, glossing over some of the challenges of making change in the complex not-a-system that we have in the US, and placing his hospital on a pedestal (it’s the 2nd most efficient hospital? Well what’s the first then???).
BUT, if you’re just jumping into the issues of how messed up US healthcare is, and want to learn more, without a clear argument as to how to make things better (universal healthcare? NHS-like two tier system?
A Ben Taub in every city?) then this book is a great place to start. But for the rest of you, no need to waste your time.
Yes-don’t read this book
No-continue with question 2
2) Do you live with, or are you good friends with someone who works in healthcare?
Yes-don’t read this book
No-continue with question 3
3)Do you consider yourself at least somewhat knowledgeable about how healthcare works and some of the issues surrounding it?
Yes-don’t read this book
No-continue with question 4
4)Do you have no idea about the current issues surrounding healthcare in the US but you want to learn about it?
Yes-then read this book.
So, perhaps I’m biased, having worked with the underserved as a physician for the past 13 years of my life, but this book shared ABSOLUTELY nothing new about healthcare. No cogent arguments about how healthcare should change, glossing over some of the challenges of making change in the complex not-a-system that we have in the US, and placing his hospital on a pedestal (it’s the 2nd most efficient hospital? Well what’s the first then???).
BUT, if you’re just jumping into the issues of how messed up US healthcare is, and want to learn more, without a clear argument as to how to make things better (universal healthcare? NHS-like two tier system?
A Ben Taub in every city?) then this book is a great place to start. But for the rest of you, no need to waste your time.
April 10, 2023
Learned so much, wow.
October 29, 2022
Received free copy from publisher, in advance of publication. Wow! I really enjoyed this. I don’t say this lightly as I’ve worked as a medical social worker for 20 years and like to think I’m familiar with most things social justice. But the Ben Taub system is new. Author did a great job developing patient stories which highlight the benefits of paradigm. And yes he also explains limitations but in context of cost savings, ethical considerations and overall good to society. Highly recommend.
August 26, 2024
Finishing this book on the day I start grad school feels very fitting. Patients do better when money is taken out of healthcare and their treatment plans, which isn’t a surprise, but we rarely get to see that happen due to private insurance and America’s need to profit off of everyone. I want to work at social safety net hospital badly
November 11, 2024
A phenomenal record of the complex healthcare system that patients must navigate within the US. This book details the histories of how the US healthcare system came to be, while telling the stories of resilient individuals within these systems. As a healthcare worker, this book inspired me to always understand a patient’s story - who are they, where do they come from, and what social and cultural ideas do they bring with them.
December 31, 2023
Mixed feelings on this medical memoir. Dr. Nuila has spent almost his entire attending physician career to date as an internist and hospitalist at Harris Health Ben Taub Hospital located within the Texas Medical Center in Houston, where he also did part of his residency and medical school training through the Baylor College of Medicine program. I'm a physician myself, and I've found that one of the benefits of switching institutions multiple times as I've done is to see how differently medicine is practiced between small regional hospitals, university-affiliated academic hospitals, and large enterprise systems. Not to diminish Dr. Nuila's very commendable experiences serving the underserved, uninsured, and undocumented at Houston's largest safety net hospital, but his high praise of Ben Taub's model of healthcare lacks the nuance that experience in more diverse healthcare delivery settings would likely lend.
Further reading: social and financial issues in medicine
Lifelines: A Doctor's Journey in the Fight for Public Health by Leana Wen, MD
What the Eyes Don't See: A Story of Crisis, Resistance, and Hope in an American City by Mona Hanna-Attisha, MD
The Beauty in Breaking by Michele Harper, MD
Love Thy Neighbor: A Muslim Doctor's Struggle for Home in Rural America by Ayaz Virji, MD
The Long Fix: Solving America's Health Care Crisis with Strategies that Work for Everyone by Vivian Lee, MD, PhD
Black Man in a White Coat: A Doctor's Reflections on Race and Medicine by Damon Tweedy, MD
Further reading: social and financial issues in medicine
Lifelines: A Doctor's Journey in the Fight for Public Health by Leana Wen, MD
What the Eyes Don't See: A Story of Crisis, Resistance, and Hope in an American City by Mona Hanna-Attisha, MD
The Beauty in Breaking by Michele Harper, MD
Love Thy Neighbor: A Muslim Doctor's Struggle for Home in Rural America by Ayaz Virji, MD
The Long Fix: Solving America's Health Care Crisis with Strategies that Work for Everyone by Vivian Lee, MD, PhD
Black Man in a White Coat: A Doctor's Reflections on Race and Medicine by Damon Tweedy, MD
July 3, 2025
This was depressing at times, but I definitely appreciated the solutions provided to all of the problems with "Medicine, Inc." If I do end up making it to medical school, I certainly would have been one to barrel headfirst into a healthcare system I did not understand, thinking that there was nothing I would be able to do within a flawed system. I think this book did a great job of laying out the history for why private insurance developed into the behemoth that it is in the U.S. all while humanizing the real people who suffer the consequences. I found hope in the solutions and for my own potential career, that there are still hospitals and public health systems that would encourage me to put the patient and their quality of life first before resulting to "algorithmania."
April 16, 2023
A look at the Houston community through the lens of its safety net hospital Ben Taub. Nuila doesn’t import answers or solutions as much as he navigates how we got here to the current state of care for Houston’s most vulnerable populations in public hospitals. Profit over patients is the overall theme as he breaks down the non for profit hospitals vs. what is offered through the safety net. There are the miracle stories and the ones that slip through the cracks.
April 19, 2023
I have brought this book up in so many conversations since reading it and that’s not going to stop any time soon. Ricardo Nuila is a physician at Ben Taub, a locally funded safety-net hospital in Houston that focuses on the uninsured and underinsured. He takes us through a few different patients whose experiences illustrate how the American healthcare system has become insurance-focused healthcare, instead of patient-centered, and how that can lead to devastating consequences. In the US, our healthcare is only as good as our health insurance and it should not be that way.
While Nuila mentions the long waits for the emergency room, he paints a mostly rosy picture of Ben Taub. And in many ways, it does sound ideal: patients being treated based on what they need, not whether or not they can pay. There are limitations; Ben Taub doesn’t do transplants, for instance. But for the most part, this is patient-centered care and for people who need it the most, who have often gotten lost in the cracks in the system long before they learn about Ben Taub.
This is largely focused on the safety-net hospital experience but Nuila also weaves in his family history and personal losses. The chapter on COVID-19 and the burnout and emotional toll experienced by staff was much appreciated. It was refreshing to hear a doctor discuss his mental health and what he did to take care of himself.
The author is son of Salvadoran immigrants; he takes pains to discuss the impact of racism on those who are uninsured. While it could have been more broadly intersectional, medical racism was front and center, as it needs to be. However, this account is fully focused on a doctor’s perspective. It’s not interdisciplinary at all, which is quite the failing. A hospital is not built on doctors alone. What do the other staff think? As a former medical social worker, I was really disappointed by the examples where social work involvement should have been prioritized or doctors belatedly realizing things social workers could have informed them about, like why a patient might be late to an appointment. No one book can cover everything but it would have been interesting to know more about the average patient’s experience at Ben Taub and what the long wait times mean for them.
It’s difficult for me to say how this hospital experience could be replicated more widely. While I’m all in favor of universal healthcare, we have a long way to go before we’re there and I don’t know how we’d be able to mobilize for more safety-net hospitals in the meantime. It’s well worth considering, however. This is the value of a book like this. I hope it will be read widely by hospital administrators and healthcare providers alike.
Content notes: intimate partner violence, child physical abuse, suicidal ideation (author), depression (author), death of author’s best friend/mentor by suicide, death of author’s grandmother (diagnosed with esophageal cancer, ICU), death of patients, hospice, various illnesses (including cancer), racism, vasovagal reaction (author’s wife), traumatic premature delivery (baby in NICU but okay), obstetric bleeding, past miscarriages, maternal mortality rate, substance abuse, gambling addiction, conversion disorder, weight loss due to illness, amputation, blood, vomit, STI, pregnancy, childbirth, HIV/AIDS, COVID-19, medical mistreatment/malpractice due to lack of insurance, Haiti earthquake, Hurricane Harvey, concussion (author), undocumented immigrants, past parental divorce (author), gendered pejoratives, ableist language (including “special needs kids”)
While Nuila mentions the long waits for the emergency room, he paints a mostly rosy picture of Ben Taub. And in many ways, it does sound ideal: patients being treated based on what they need, not whether or not they can pay. There are limitations; Ben Taub doesn’t do transplants, for instance. But for the most part, this is patient-centered care and for people who need it the most, who have often gotten lost in the cracks in the system long before they learn about Ben Taub.
This is largely focused on the safety-net hospital experience but Nuila also weaves in his family history and personal losses. The chapter on COVID-19 and the burnout and emotional toll experienced by staff was much appreciated. It was refreshing to hear a doctor discuss his mental health and what he did to take care of himself.
The author is son of Salvadoran immigrants; he takes pains to discuss the impact of racism on those who are uninsured. While it could have been more broadly intersectional, medical racism was front and center, as it needs to be. However, this account is fully focused on a doctor’s perspective. It’s not interdisciplinary at all, which is quite the failing. A hospital is not built on doctors alone. What do the other staff think? As a former medical social worker, I was really disappointed by the examples where social work involvement should have been prioritized or doctors belatedly realizing things social workers could have informed them about, like why a patient might be late to an appointment. No one book can cover everything but it would have been interesting to know more about the average patient’s experience at Ben Taub and what the long wait times mean for them.
It’s difficult for me to say how this hospital experience could be replicated more widely. While I’m all in favor of universal healthcare, we have a long way to go before we’re there and I don’t know how we’d be able to mobilize for more safety-net hospitals in the meantime. It’s well worth considering, however. This is the value of a book like this. I hope it will be read widely by hospital administrators and healthcare providers alike.
Content notes: intimate partner violence, child physical abuse, suicidal ideation (author), depression (author), death of author’s best friend/mentor by suicide, death of author’s grandmother (diagnosed with esophageal cancer, ICU), death of patients, hospice, various illnesses (including cancer), racism, vasovagal reaction (author’s wife), traumatic premature delivery (baby in NICU but okay), obstetric bleeding, past miscarriages, maternal mortality rate, substance abuse, gambling addiction, conversion disorder, weight loss due to illness, amputation, blood, vomit, STI, pregnancy, childbirth, HIV/AIDS, COVID-19, medical mistreatment/malpractice due to lack of insurance, Haiti earthquake, Hurricane Harvey, concussion (author), undocumented immigrants, past parental divorce (author), gendered pejoratives, ableist language (including “special needs kids”)
March 20, 2024
Book of the year so far. This book captures so well our health care system (aka Medicine Inc.) and why it is everyone’s problem that we refuse to take care of our vulnerable and tie health care with an ability to pay. It feels accessible to those not in the weeds and personalizes the macro issues with how America does health care. I cannot recommend it enough.
“This is the great paradox of our time: we can decide the genome, but we can’t seem to treat the sick”
“Forty years later, business and medicine no longer act as partners in supplying healthcare: business has subsumed and digested medicine. Medicine is business.”
“Does the hospital serve a purpose beyond the medical?”
“Healthcare remains linked to the question of worthiness. The question of who deserves healthcare and who doesn’t remains fundamental to how Americans access doctors and hospitals.”
“A national safety net would help us place people at the center of medicine”
“I’m really sorry you’re from the United States”
“Just as all people are responsible for their larger community, so too are communities responsible for people. If someone is suffering, and there is capacity within the community to help, in a way that doesn’t harm anyone else, then we owe it to that person; we also owe it to ourselves to help”
“This is the great paradox of our time: we can decide the genome, but we can’t seem to treat the sick”
“Forty years later, business and medicine no longer act as partners in supplying healthcare: business has subsumed and digested medicine. Medicine is business.”
“Does the hospital serve a purpose beyond the medical?”
“Healthcare remains linked to the question of worthiness. The question of who deserves healthcare and who doesn’t remains fundamental to how Americans access doctors and hospitals.”
“A national safety net would help us place people at the center of medicine”
“I’m really sorry you’re from the United States”
“Just as all people are responsible for their larger community, so too are communities responsible for people. If someone is suffering, and there is capacity within the community to help, in a way that doesn’t harm anyone else, then we owe it to that person; we also owe it to ourselves to help”
March 29, 2024
One of my best friends works as a doctor in the hospital system highlighted in this book. Feel like I learned a lot about the medical system and how it’s so broken. I’m also a proud friend.
Medicine Inc., as it’s referred to in this book, is a profit driven problem. The incentives for doctors are completely messed up and I’ve lost a bit of faith in the current system. Are Doctors driven by $$? Why are so many other countries able to provide affordable healthcare and we can’t??
This Houston based hospital is driven not by profit but by helping its patients. It also is able to give high quality healthcare to the uninsured.
Very interesting read that also delves into specific stories of Houston residents and the problems they face trying to get treatment.
Really liked this book, but not a page turner…
4.3/5.0
Medicine Inc., as it’s referred to in this book, is a profit driven problem. The incentives for doctors are completely messed up and I’ve lost a bit of faith in the current system. Are Doctors driven by $$? Why are so many other countries able to provide affordable healthcare and we can’t??
This Houston based hospital is driven not by profit but by helping its patients. It also is able to give high quality healthcare to the uninsured.
Very interesting read that also delves into specific stories of Houston residents and the problems they face trying to get treatment.
Really liked this book, but not a page turner…
4.3/5.0
January 12, 2025
no words for how important this story is, got emotional multiple times and had to put it down to digest.
it is known that the US healthcare system is broken, but this book provides a crucial perspective on the building of its foundation and the negative impacts of hidden factors like implicit bias, assumptions, and algorithms in medicine. my heart breaks knowing that these stories only showcase a small sliver of patient suffering. the largest medical center in the world with an abundance of resources, yet so many patients denied treatment. health insurance companies are literal evil.
recommending this book to everyone working in medicine, and tbh everyone in general!
it is known that the US healthcare system is broken, but this book provides a crucial perspective on the building of its foundation and the negative impacts of hidden factors like implicit bias, assumptions, and algorithms in medicine. my heart breaks knowing that these stories only showcase a small sliver of patient suffering. the largest medical center in the world with an abundance of resources, yet so many patients denied treatment. health insurance companies are literal evil.
recommending this book to everyone working in medicine, and tbh everyone in general!
March 18, 2025
Incredibly nostalgic of clerkships. I felt like I was back at Ben Taub and the Harris Health clinics again. Will miss this side of adult medicine and can’t recommend it enough especially to those growing up or training in Houston
March 18, 2025
So many good things to take away from this book. This reminded me of our purpose in healthcare and the corrupt healthcare system we can have at times. Definitely recommend this book. Dr Nuila was a great physician in a broken system.
February 8, 2025
Great analysis of the American healthcare system. Who deserves healthcare? How should it be paid for? Is private insurance really it? The book made me reflect on the patients I see at work, and in the endless cost-cutting measures of my for-profit-healthcare-system employer. A heavy read, but an important one!
December 9, 2023
A must-read if the crisis of affordable, quality medical care in the USA is of interest to you or potentially impacts you or your loved ones and your fellow humans, which is everyone.
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December 4, 2025Humane 👏 healthcare 👏 is a human 👏 right 👏
(AND access to it)
and I will always say that louder for the people in the back
our healthcare system and government is so broken and books like this will hopefully inspire change to these systems
(AND access to it)
and I will always say that louder for the people in the back
our healthcare system and government is so broken and books like this will hopefully inspire change to these systems
June 11, 2023
Even though I'm someone who blanches at the slightest mention of a medical procedure and gets lightheaded at the sight of blood, I can't stay away from narrative nonfiction about the medical field. I was particularly interested in this iteration of medical writing for the way it lent itself to comparisons to education.
I believe the school where I work is equivalent to a safety-net hospital--educates everyone regardless of socioeconomic status, prison record, expulsion record, etc--but we do not perform like Ben Taub. Does the time commitment of med school weed out the apathetic? Does the salary attract quality candidates? Are there fewer doctors than teachers in any given city? Or is Ben Taub a safety-net anomaly?
Nuila writes, "Money didn't stop us from trying what we could to help. He was at a public hospital, yes, but he got the same care he would've received at a private hospital. Before I started seeing patients as a medical student at Ben Taub, I assumed these statements to be inherently true of medicine in America. I continue to work where I work because I can stand before a small gathering of bereaved and saddened people, say this to them, and know I'm not lying" (328). I'm constantly wondering why teachers in MPS (and across the country, quite frankly) who are lauded as the "best" teach at the best resourced schools attended by the most proficient students. Why don't they also feel the pull to ensure that students in the most dire public schools receive education equivalent to the best resourced public schools? How do we incentivize working at the lowest performing schools? CAN you incentivize this? Or does it have to come from within, like in Dr. Nuila, who cried when he didn't get hired at Ben Taub?
I also can't stop thinking about Jan de Hartog's definition of disaster syndrome, quoted by Nuila: "The disaster syndrome can be diagnosed when normal reactions of protest or outrage in the face of intolerable conditions are absent and the overriding reaction is not to correct those conditions but to accept them as permanent and to circumvent them" (271). It resonates a little too much.
I believe the school where I work is equivalent to a safety-net hospital--educates everyone regardless of socioeconomic status, prison record, expulsion record, etc--but we do not perform like Ben Taub. Does the time commitment of med school weed out the apathetic? Does the salary attract quality candidates? Are there fewer doctors than teachers in any given city? Or is Ben Taub a safety-net anomaly?
Nuila writes, "Money didn't stop us from trying what we could to help. He was at a public hospital, yes, but he got the same care he would've received at a private hospital. Before I started seeing patients as a medical student at Ben Taub, I assumed these statements to be inherently true of medicine in America. I continue to work where I work because I can stand before a small gathering of bereaved and saddened people, say this to them, and know I'm not lying" (328). I'm constantly wondering why teachers in MPS (and across the country, quite frankly) who are lauded as the "best" teach at the best resourced schools attended by the most proficient students. Why don't they also feel the pull to ensure that students in the most dire public schools receive education equivalent to the best resourced public schools? How do we incentivize working at the lowest performing schools? CAN you incentivize this? Or does it have to come from within, like in Dr. Nuila, who cried when he didn't get hired at Ben Taub?
I also can't stop thinking about Jan de Hartog's definition of disaster syndrome, quoted by Nuila: "The disaster syndrome can be diagnosed when normal reactions of protest or outrage in the face of intolerable conditions are absent and the overriding reaction is not to correct those conditions but to accept them as permanent and to circumvent them" (271). It resonates a little too much.
February 3, 2024
I wasn’t expecting this book to romanticize Ben Taub so much. I think it gives a really good overview of the idea of safety net hospitals and the American medical system’s many flaws. Working in Harris Health, a lot of this didn’t seem new to me but I could see where someone outside of medicine may find this book more beneficial. I did, however, really like how the author described honoring humanity in medicine and found his stories moving.
March 17, 2024
A hopeful portrayal at health care in America from the pov of a doctor and through the stories of his patients. Learned as much from this book as I took away from an intro healthcare policy college course.
Probably 5 stars if I wasn’t salty about my medical debt
Probably 5 stars if I wasn’t salty about my medical debt
July 4, 2023
I'll probably be thinking about this book for a while after having finished it, as it tackles so many important aspects of a failing healthcare system that deserve to be discussed and considered. From the increasingly expensive cost of healthcare to the struggles of insurance to medical racism, so many facets of healthcare are assessed in this work, and they often impact each other to the detriment of patients.
I was initially intrigued by the description for the book leading up to its release, as my own struggles with my health have made me far more conscious of the failings of the broader system and the ways those failings likely impact people who do not share the privileges I have. It took me years of actively seeking doctors who would just listen to me and not write me or my symptoms off (because I'm young, because of weight, because I'm female) to finally find a primary care doctor who listened to me and explained everything to me, while also practicing trauma-informed care that I so desperately needed. After years of unexplained and worsening pains, unusual symptoms, and traumatizing medical experiences from other doctors, I finally got answers to some of my questions and a level of care I had not experienced before. While I do still have to wait months to see certain specialists, and still can't get certain specialists to listen, I have had the privilege of seeing those specialists and taking medication to manage my chronic issues because I have good insurance. Every time I pay a medical bill or am informed of what the cost will be if insurance won't cover something, I think about what would happen to those without insurance at all.
A central question throughout Dr. Nuila's book is "Who is worthy of care, and who decides that?" He delves into how and why these decisions are made, the roles that insurance companies and hospitals and doctors play in making that decision, and the impacts it can have on safety-net systems and patients. There is so much important information discussed, and I feel that Dr. Nuila does a good job of using both facts and statistics along with patient stories to convey that information in a way that makes sense and has a solid impact on the reader.
The only big issue is that he focuses on the doctor's role in Ben Taub and the work done at safety-net hospitals. I understand that is where his expertise and experience are, so it makes sense that it would be the focus. However, there are many people who play a role in the care of those patients beyond the doctor that he mentions, such as social workers and surgeons and administration. One book can only cover so much in a coherent way that is also focused enough to convey a particular point or story, but I would be interested in another book being written with similar goals but from the perspectives of those other players.
I was initially intrigued by the description for the book leading up to its release, as my own struggles with my health have made me far more conscious of the failings of the broader system and the ways those failings likely impact people who do not share the privileges I have. It took me years of actively seeking doctors who would just listen to me and not write me or my symptoms off (because I'm young, because of weight, because I'm female) to finally find a primary care doctor who listened to me and explained everything to me, while also practicing trauma-informed care that I so desperately needed. After years of unexplained and worsening pains, unusual symptoms, and traumatizing medical experiences from other doctors, I finally got answers to some of my questions and a level of care I had not experienced before. While I do still have to wait months to see certain specialists, and still can't get certain specialists to listen, I have had the privilege of seeing those specialists and taking medication to manage my chronic issues because I have good insurance. Every time I pay a medical bill or am informed of what the cost will be if insurance won't cover something, I think about what would happen to those without insurance at all.
A central question throughout Dr. Nuila's book is "Who is worthy of care, and who decides that?" He delves into how and why these decisions are made, the roles that insurance companies and hospitals and doctors play in making that decision, and the impacts it can have on safety-net systems and patients. There is so much important information discussed, and I feel that Dr. Nuila does a good job of using both facts and statistics along with patient stories to convey that information in a way that makes sense and has a solid impact on the reader.
The only big issue is that he focuses on the doctor's role in Ben Taub and the work done at safety-net hospitals. I understand that is where his expertise and experience are, so it makes sense that it would be the focus. However, there are many people who play a role in the care of those patients beyond the doctor that he mentions, such as social workers and surgeons and administration. One book can only cover so much in a coherent way that is also focused enough to convey a particular point or story, but I would be interested in another book being written with similar goals but from the perspectives of those other players.
January 13, 2024
I picked this book up in the middle of my second year of medical school when I’ve felt closest to regretting the path I’ve chosen. If I read this book 2 years ago, it would stoke the flames of social change that inspired me to be a doctor to begin with. But reading it now at first just made me sad. I’m sad that I haven’t found mentorship in doctors who view medicine as a vocation, as a practice, as an art. I’m disappointed that I see myself becoming hardened by the rough tread of this path. And I’m beyond devastated by the amount of life that continues to be lost to maintain the bottom line.
That said, I was pleasantly surprised by the amount of hope this book brought me. I had borderline nihilistic thoughts about healthcare in the country when I picked this up, and I’m so glad that Nuila’s writing on his patients’ lives had such a profound impact on me. This book is a beautiful personal-as-political project. Not only did I see this with Nuila’s patients’ stories, but also through his relationship with his father. These flares of vulnerability provided a lens in which disputes between father and son — doctor and doctor — mirror much larger political arguments about this country’s healthcare infrastructure.
———————————————————————————
“Healthcare remains linked to the question of worthiness. The question of who deserves healthcare and who doesn’t remains fundamental to how Americans access doctors and hospitals.”
“Often in healthcare, the challenge isn’t in finding answers but in implementing them.”
“By reducing medicine to a set of ones and zeroes, algorithmania puts medicine’s focus on the doctor, not the patient; the doctor becomes the protagonist. If a doctor satisfies the road map, then in their own mind, they have satisfied the patient. Diagnosis and treatment come down to how a doctor follows a road map rather than the report the patient gives. Ultimately, algorithmania pushes people out in the name of science and costs. It makes medicine more of a technical job rather than a vocation.”
“If we look at Medicine Inc.’s history and how it operates today, five basic assumptions stand out that make it distinctly American: The government should not produce or provide healthcare. It’s okay to use public funds to purchase private healthcare for certain people, but only companies or private practitioners should provide healthcare. Those who receive healthcare have earned it, whether through work or through wealth. Fairness means ensuring that the deserving people receive better healthcare. There is no significant conflict between the income a doctor generates and their duty to the public. Doctors can practice simultaneously as businesspeople and as professionals sworn to a code of ethics without major repercussions. Science is impersonal and best aligns with commercial needs, not public ones. Science’s primary beneficiaries should be people who can afford to pay for it. The primary goal of healthcare is to generate income for providers. Other goals, like preventing sickness and empowering people, can happen, but only if the first goal is met. These tenets are so much a part of American healthcare that we don’t even realize our political debates reinforce them.”
“‘Medical-industrial complex’ paints the picture of a firing squad, except the squad is disorganized, each of the gunmen—the insurance companies, doctors, hospitals, and Big Pharma—aiming not only for us but also for the other gunmen.”
That said, I was pleasantly surprised by the amount of hope this book brought me. I had borderline nihilistic thoughts about healthcare in the country when I picked this up, and I’m so glad that Nuila’s writing on his patients’ lives had such a profound impact on me. This book is a beautiful personal-as-political project. Not only did I see this with Nuila’s patients’ stories, but also through his relationship with his father. These flares of vulnerability provided a lens in which disputes between father and son — doctor and doctor — mirror much larger political arguments about this country’s healthcare infrastructure.
———————————————————————————
“Healthcare remains linked to the question of worthiness. The question of who deserves healthcare and who doesn’t remains fundamental to how Americans access doctors and hospitals.”
“Often in healthcare, the challenge isn’t in finding answers but in implementing them.”
“By reducing medicine to a set of ones and zeroes, algorithmania puts medicine’s focus on the doctor, not the patient; the doctor becomes the protagonist. If a doctor satisfies the road map, then in their own mind, they have satisfied the patient. Diagnosis and treatment come down to how a doctor follows a road map rather than the report the patient gives. Ultimately, algorithmania pushes people out in the name of science and costs. It makes medicine more of a technical job rather than a vocation.”
“If we look at Medicine Inc.’s history and how it operates today, five basic assumptions stand out that make it distinctly American: The government should not produce or provide healthcare. It’s okay to use public funds to purchase private healthcare for certain people, but only companies or private practitioners should provide healthcare. Those who receive healthcare have earned it, whether through work or through wealth. Fairness means ensuring that the deserving people receive better healthcare. There is no significant conflict between the income a doctor generates and their duty to the public. Doctors can practice simultaneously as businesspeople and as professionals sworn to a code of ethics without major repercussions. Science is impersonal and best aligns with commercial needs, not public ones. Science’s primary beneficiaries should be people who can afford to pay for it. The primary goal of healthcare is to generate income for providers. Other goals, like preventing sickness and empowering people, can happen, but only if the first goal is met. These tenets are so much a part of American healthcare that we don’t even realize our political debates reinforce them.”
“‘Medical-industrial complex’ paints the picture of a firing squad, except the squad is disorganized, each of the gunmen—the insurance companies, doctors, hospitals, and Big Pharma—aiming not only for us but also for the other gunmen.”
Read
August 10, 2024i was speaking with a friend in the aftermath of hurricane beryl and they expressed how so many houstonians feel angry and cynical about the level of state failure and how the political and corporate elite keep pushing the phrase "houston strong" to deflect and distract. residents are expected to get used to the power outages and flooding and shitty infrastructure. those in power avoid responsibility and the work of protecting residents from future storms. during the chapter called "disaster syndrome" i kept thinking back to this conversation. so many people recognize the problems with our medical system in the us. but we allow these problems to fester; we speak loudly about compassionate healthcare workers and resilient patients and generous donors and are silent about those who can't afford insurance or care, about the hospitals and insurance companies and providers who shut their doors to these patients.
throughout this book dr. nuila breaks down "medicine inc" and the horrors enabled within our medical system when we prioritize profit over people. at the same time, he humanizes his patients and colleagues in the safety-net hospital where he works and helps us imagine a different, better system. he brings us into the wards of ben taub as he shares humbling moments and the triumphs. i enjoyed his audiobook narration of his writing -- there was a lot of new terminology but i could get the gist of what he was saying and understand the devastating decisions people have to make everyday in relation to their health and well-being (and how the devastation is compounded when insurance isn't available). in the final part of the book ("faith"), when he ties everything together and lays out his vision for what our healthcare system could be, a system built upon the idea that every person is equally deserving of healthcare, i got goosebumps. it was so beautifully written.
i grew up minutes from johnson space center and lived in the shadow of the texas medical center for the last few years. i feel fortunate that i've gotten to hear stories of brilliance and creativity all my life -- who needs sci fi and fantasy when you hear about space exploration and medical miracles! people are capable of amazing things when they put their heads together. but while listening to this book, i asked myself again and again how this city (and this whole country), home to such wealth and innovation, fails so many people and makes quality, affordable healthcare damn near impossible to reach. i feel so many things after reading this book. i'm grateful that ben taub exists and that dr. nuila and these patients shared their stories -- they gave me a much better idea of the things going on nearby me. but i'm also angry and sad. i recommend this book to everyone, but esp those who work in/adjacent to healthcare.
throughout this book dr. nuila breaks down "medicine inc" and the horrors enabled within our medical system when we prioritize profit over people. at the same time, he humanizes his patients and colleagues in the safety-net hospital where he works and helps us imagine a different, better system. he brings us into the wards of ben taub as he shares humbling moments and the triumphs. i enjoyed his audiobook narration of his writing -- there was a lot of new terminology but i could get the gist of what he was saying and understand the devastating decisions people have to make everyday in relation to their health and well-being (and how the devastation is compounded when insurance isn't available). in the final part of the book ("faith"), when he ties everything together and lays out his vision for what our healthcare system could be, a system built upon the idea that every person is equally deserving of healthcare, i got goosebumps. it was so beautifully written.
i grew up minutes from johnson space center and lived in the shadow of the texas medical center for the last few years. i feel fortunate that i've gotten to hear stories of brilliance and creativity all my life -- who needs sci fi and fantasy when you hear about space exploration and medical miracles! people are capable of amazing things when they put their heads together. but while listening to this book, i asked myself again and again how this city (and this whole country), home to such wealth and innovation, fails so many people and makes quality, affordable healthcare damn near impossible to reach. i feel so many things after reading this book. i'm grateful that ben taub exists and that dr. nuila and these patients shared their stories -- they gave me a much better idea of the things going on nearby me. but i'm also angry and sad. i recommend this book to everyone, but esp those who work in/adjacent to healthcare.
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