What do you think?
Rate this book
The Hospital: Life, Death, and Dollars in a Small American Town
USA Today 's 5 BOOKS NOT TO MISS
"Alexander nimbly and grippingly translates the byzantine world of American health care into a real-life narrative with people you come to care about." ― New York Times
"Takes readers into the world of the American medical industry in a way no book has done before." ― Fortune
"With his signature gut-punching prose, Alexander breaks our hearts as he opens our eyes to America’s deep-rooted sickness and despair by immersing us in the lives of a small town hospital and the people it serves." ― Beth Macy, bestselling author of Dopesick
By following the struggle for survival of one small-town hospital, and the patients who walk, or are carried, through its doors, The Hospital takes readers into the world of the American medical industry in a way no book has done before. Americans are dying sooner, and living in poorer health. Alexander argues that no plan will solve America’s health crisis until the deeper causes of that crisis are addressed.
Bryan, Ohio's hospital, is losing money, making it vulnerable to big health systems seeking domination and Phil Ennen, CEO, has been fighting to preserve its independence. Meanwhile, Bryan, a town of 8,500 people in Ohio’s northwest corner, is still trying to recover from the Great Recession. As local leaders struggle to address the town’s problems, and the hospital fights for its life amid a rapidly consolidating medical and hospital industry, a 39-year-old diabetic literally fights for his limbs, and a 55-year-old contractor lies dying in the emergency room. With these and other stories, Alexander strips away the wonkiness of policy to reveal Americans’ struggle for health against a powerful system that’s stacked against them, but yet so fragile it blows apart when the pandemic hits. Culminating with COVID-19, this book offers a blueprint for how we created the crisis we're in.
"Alexander nimbly and grippingly translates the byzantine world of American health care into a real-life narrative with people you come to care about." ― New York Times
"Takes readers into the world of the American medical industry in a way no book has done before." ― Fortune
"With his signature gut-punching prose, Alexander breaks our hearts as he opens our eyes to America’s deep-rooted sickness and despair by immersing us in the lives of a small town hospital and the people it serves." ― Beth Macy, bestselling author of Dopesick
By following the struggle for survival of one small-town hospital, and the patients who walk, or are carried, through its doors, The Hospital takes readers into the world of the American medical industry in a way no book has done before. Americans are dying sooner, and living in poorer health. Alexander argues that no plan will solve America’s health crisis until the deeper causes of that crisis are addressed.
Bryan, Ohio's hospital, is losing money, making it vulnerable to big health systems seeking domination and Phil Ennen, CEO, has been fighting to preserve its independence. Meanwhile, Bryan, a town of 8,500 people in Ohio’s northwest corner, is still trying to recover from the Great Recession. As local leaders struggle to address the town’s problems, and the hospital fights for its life amid a rapidly consolidating medical and hospital industry, a 39-year-old diabetic literally fights for his limbs, and a 55-year-old contractor lies dying in the emergency room. With these and other stories, Alexander strips away the wonkiness of policy to reveal Americans’ struggle for health against a powerful system that’s stacked against them, but yet so fragile it blows apart when the pandemic hits. Culminating with COVID-19, this book offers a blueprint for how we created the crisis we're in.
320 pages, Hardcover
First published March 9, 2021
410 people are currently reading
5397 people want to read
About the author
Brian Alexander
8 books72 followersBrian Alexander is an award-winning journalist and the author of several books, including Rapture: How Biotech Became the New Religion andAmerica Unzipped: The Search for Sex and Satisfaction. He lives in San Diego.
Ratings & Reviews
Friends & Following
Create a free account to discover what your friends think of this book!
Community Reviews
Displaying 1 - 30 of 335 reviews
January 22, 2021
This is a book that you will need to take a break from every now and then. This book is so intense, you will need time to think about the concepts and the lives chronicled.
I loved this book. This book was so much more then ONE hospital in Ohio. It was the larger picture. I loved that the author combined history, social, economic, local, and national policies all within the one book.
I loved the personal stories of Keith and the other local community members.
I think every single American should read this book and weep at what our health care system, hospitals, doctors, insurance people have become.
The ONLY drawback was I felt that the author spent WAY TOO MUCH time with the CEO of the hospital Eannon. I felt that about 20% of the book could have been pared down if the author had not focused so much on the Eannon scandal, history, meetings, etc.
Overall, LOVED this book and I really feel an appreciation for the authors hardwork that made this book. And this book made me mad as heck because I think all Americans understand that our health care system is broken.
Thank you to Netgalley and the publisher for allowing me this ARC for this honest review.
I loved this book. This book was so much more then ONE hospital in Ohio. It was the larger picture. I loved that the author combined history, social, economic, local, and national policies all within the one book.
I loved the personal stories of Keith and the other local community members.
I think every single American should read this book and weep at what our health care system, hospitals, doctors, insurance people have become.
The ONLY drawback was I felt that the author spent WAY TOO MUCH time with the CEO of the hospital Eannon. I felt that about 20% of the book could have been pared down if the author had not focused so much on the Eannon scandal, history, meetings, etc.
Overall, LOVED this book and I really feel an appreciation for the authors hardwork that made this book. And this book made me mad as heck because I think all Americans understand that our health care system is broken.
Thank you to Netgalley and the publisher for allowing me this ARC for this honest review.
February 13, 2021
I wish every American would read this book but it's a tough subject to sit with for more than a small bit at a time. It's that good and that intense. During this pandemic time it was even harder to face the realities laid out in this excellent book. Our system is so very, very broken I weep for our future. This is not just the story of a small town hospital and its struggle for survival, the story of so many hard working and dedicated people - it's a picture of our healthcare system that can't be allowed to continue.
The issue is a tangled mess of insurance companies run wild, medical costs out of this world costly, medicine unaffordable at a time when the minimum wage stuck at $7.25, not having moved in over a decade and Social Security stalled for the seniors who made their retirement plans based on hoped for amounts. We were in grave danger as a country when Brian Alexander started his research. Now we are starting our second pandemic year and the fallout for our health care system will destroy what little we have working for us. Every single American needs to read this book and get as furious as I did. If we don't wake up and demand changes - my mind can't imagine a post pandemic America working with this broken system. We must act STAT. There is no time to waste.
My thanks to the publisher St. Martin's and to NetGalley for giving me an advance copy in exchange for my honest review.
The issue is a tangled mess of insurance companies run wild, medical costs out of this world costly, medicine unaffordable at a time when the minimum wage stuck at $7.25, not having moved in over a decade and Social Security stalled for the seniors who made their retirement plans based on hoped for amounts. We were in grave danger as a country when Brian Alexander started his research. Now we are starting our second pandemic year and the fallout for our health care system will destroy what little we have working for us. Every single American needs to read this book and get as furious as I did. If we don't wake up and demand changes - my mind can't imagine a post pandemic America working with this broken system. We must act STAT. There is no time to waste.
My thanks to the publisher St. Martin's and to NetGalley for giving me an advance copy in exchange for my honest review.
August 12, 2021
This is one of the most impacting, painful books on the subject of the broken, ineffective money making machine that is the American healthcare system, and if there is a good case to be made for universal healthcare and there is in my opinion, this author does an excellent job of presenting it. I am going to be thinking of Keith and the residents of Bryan Ohio for a long time to come, but deep down every American knows that the problem is much larger than a small town in Ohio and that this so called healthcare "system" is unsustainable. No American should die because they are too poor to afford health insurance, the question is are enough of us willing to inform ourselves before we go to the polls to vote for the very same politicians that continue to feed the monster.
"American health care was an absurdist game of Jenga" Brian Alexander
"American health care was an absurdist game of Jenga" Brian Alexander
February 17, 2021
American healthcare was an absurdist game of Jenga.
~From The Hospital by Brian Alexander
The Hospital: Life, Death and Dollars in a Small American Town by Brian Alexander is the portrait of a Byran, Ohio hospital between 2018 and 2020. Alexander followed management, staff, and patients, investigating the complexities of healthcare in America in one small town. The news headlines we have all seen is presented in a personalized narrative that is deeply affecting; you want to rant, or cry. Likely both.
What America did have was a jumble of ill-fitting building blocks: the doctoring industry, the hospital industry, the insurance industry, the drug industry, the device industry. ~from The Hospital by Brian Alexander
Alexander follows the Bryan hospital's struggles to keep in the black when other small hospitals were being consolidated or put out of business by larger hospitals. And he shows how medical care has become a profit-making business.
I was surprised to learn that deductibles were not always a part of health insurance. The rationale was that people would not abuse insurance if they had to pay a portion out of pocket. Affordable insurance comes with a high deductible, and people think twice before using it. Consequently, people go without preventative care and medications and treatment for illnesses.
It could have been my family when we had to forward paid bills to the health care provider for reimbursement--after we met the deductible. Our baby suffered from continual ear and sinus infections and we often met the deductible by the end of January, which meant a huge decrease in available income for other bills and necessities at the start of every year.
The patients in the book exemplify the danger of skipping care. Those who can't afford medications pay a higher personal and economic cost when disease or illness progresses. Some pay with their lives, some become disabled and permanently lose jobs and income, and many are hopelessly mired in debt.
Alexander writes that America has struggled with the crisis in medical care costs for a hundred years. Citizens resisted health insurance a hundred years ago the way they resisted the Affordable Care Act later. Health insurance was, an is, considered unAmerican and socialist by some--even those who benefit from Medicare and other governmental programs.
"Health...is a commodity which can be purchased," Alexander quotes the president of a utility company, and major employer, in 1929. "The difficulty now is its cost is beyond the reach of a great majority of people."
Almost a hundred years later, it remains true.
In 1963, my dad sold the business his father had built in Tonawanda, NY, and came to Detroit to look for work in the auto industry. Mom had an autoimmune disease. They needed health insurance. My folks were very lucky. They went from struggling to a nice home, two cars, health insurance to treat mom's crippling rheumatoid arthritis and, later, dad's non-Hodgkin's lymphoma, plus my folks paid for my first two years of college.
Today, my son has to purchase his own health insurance. He has to invest his own money in a retirement account. Of course, he has school loans, too.
We have gone backwards.
Alexander touched on Michigan hospitals, like William Beaumont Hospital, the Royal Oak, Michigan based hospital where my parents and grandparents were treated. A few years back they tore down an the aging shopping center of my youth and built a new one. It did seem strange to me that a hospital was in real estate. When Covid-19 hit and Michigan went into lockdown, hospitals lost elective surgery patients. Like my husband, who was considering shoulder replacement surgery a year ago. Beaumont laid off thousands and eliminated 450 jobs. During a pandemic.
The book brought back a lot of memories of our seven years living along the Michigan-Ohio border. I had been to the towns Brian Alexander writes about.
After fifteen years living in Philadelphia, we moved back to Michigan so our son could grow up knowing his extended family. Neither of us had lived in a small town before. There were under 9,000 people in Hillsdale, and about 40,000 in the entire county. There was a turnover of doctors; our first family doctor, one of the few who delivered babies, left family practice, demoralized after lawsuits. We did have a small hospital at the end of our street. When our son was three, he came down with pneumonia and we were glad the hospital was so close.
Small town life was an adjustment. We left a racially eclectic city neighborhood for a county with five African Americans; one was my ob/gyn, one his nurse wife, and one his daughter who was in my son's class in grade school. I was surprised by rural poverty. Our son told us that half his kindergarten class did not have a phone and most had no books in their homes. We took took day trips antiquing in small Ohio towns like Pioneer and I took my Bernina sewing machine for cleaning in Bryan, OH.
I am pleased that the publisher offered me a free egalley in exchange for a fair review. I found this to be an immersive, thought-provoking book.
~From The Hospital by Brian Alexander
The Hospital: Life, Death and Dollars in a Small American Town by Brian Alexander is the portrait of a Byran, Ohio hospital between 2018 and 2020. Alexander followed management, staff, and patients, investigating the complexities of healthcare in America in one small town. The news headlines we have all seen is presented in a personalized narrative that is deeply affecting; you want to rant, or cry. Likely both.
What America did have was a jumble of ill-fitting building blocks: the doctoring industry, the hospital industry, the insurance industry, the drug industry, the device industry. ~from The Hospital by Brian Alexander
Alexander follows the Bryan hospital's struggles to keep in the black when other small hospitals were being consolidated or put out of business by larger hospitals. And he shows how medical care has become a profit-making business.
I was surprised to learn that deductibles were not always a part of health insurance. The rationale was that people would not abuse insurance if they had to pay a portion out of pocket. Affordable insurance comes with a high deductible, and people think twice before using it. Consequently, people go without preventative care and medications and treatment for illnesses.
It could have been my family when we had to forward paid bills to the health care provider for reimbursement--after we met the deductible. Our baby suffered from continual ear and sinus infections and we often met the deductible by the end of January, which meant a huge decrease in available income for other bills and necessities at the start of every year.
The patients in the book exemplify the danger of skipping care. Those who can't afford medications pay a higher personal and economic cost when disease or illness progresses. Some pay with their lives, some become disabled and permanently lose jobs and income, and many are hopelessly mired in debt.
Alexander writes that America has struggled with the crisis in medical care costs for a hundred years. Citizens resisted health insurance a hundred years ago the way they resisted the Affordable Care Act later. Health insurance was, an is, considered unAmerican and socialist by some--even those who benefit from Medicare and other governmental programs.
"Health...is a commodity which can be purchased," Alexander quotes the president of a utility company, and major employer, in 1929. "The difficulty now is its cost is beyond the reach of a great majority of people."
Almost a hundred years later, it remains true.
In 1963, my dad sold the business his father had built in Tonawanda, NY, and came to Detroit to look for work in the auto industry. Mom had an autoimmune disease. They needed health insurance. My folks were very lucky. They went from struggling to a nice home, two cars, health insurance to treat mom's crippling rheumatoid arthritis and, later, dad's non-Hodgkin's lymphoma, plus my folks paid for my first two years of college.
Today, my son has to purchase his own health insurance. He has to invest his own money in a retirement account. Of course, he has school loans, too.
We have gone backwards.
Alexander touched on Michigan hospitals, like William Beaumont Hospital, the Royal Oak, Michigan based hospital where my parents and grandparents were treated. A few years back they tore down an the aging shopping center of my youth and built a new one. It did seem strange to me that a hospital was in real estate. When Covid-19 hit and Michigan went into lockdown, hospitals lost elective surgery patients. Like my husband, who was considering shoulder replacement surgery a year ago. Beaumont laid off thousands and eliminated 450 jobs. During a pandemic.
The book brought back a lot of memories of our seven years living along the Michigan-Ohio border. I had been to the towns Brian Alexander writes about.
After fifteen years living in Philadelphia, we moved back to Michigan so our son could grow up knowing his extended family. Neither of us had lived in a small town before. There were under 9,000 people in Hillsdale, and about 40,000 in the entire county. There was a turnover of doctors; our first family doctor, one of the few who delivered babies, left family practice, demoralized after lawsuits. We did have a small hospital at the end of our street. When our son was three, he came down with pneumonia and we were glad the hospital was so close.
Small town life was an adjustment. We left a racially eclectic city neighborhood for a county with five African Americans; one was my ob/gyn, one his nurse wife, and one his daughter who was in my son's class in grade school. I was surprised by rural poverty. Our son told us that half his kindergarten class did not have a phone and most had no books in their homes. We took took day trips antiquing in small Ohio towns like Pioneer and I took my Bernina sewing machine for cleaning in Bryan, OH.
I am pleased that the publisher offered me a free egalley in exchange for a fair review. I found this to be an immersive, thought-provoking book.
April 24, 2021
In the last decade I have had a great deal of contact with the US medical "system;" because of aging parents, and my own health issues, I have seen just about every part of the medical "system" up close and personal. I'm in what I think will be the last generation to have excellent full medical coverage, and even so, (EVEN SO!) there are huge problems. This book mostly focuses on the working poor (they can check out anytime they want, but they can never leave). The author tries to challenge the middle class beliefs that the poor are lazy and just want handouts, and that their lot in life is a result of poor decisions and lack of personal responsibility. Anyone who has ever worked in the criminal justice system, the medical system, or the foster care system and who has had personal contact with the working poor on a regular basis knows that simply isn't true. Are there welfare cheats? definitely, but probably fewer proportionally than corporate tax cheats - and which do you think costs the economy more?
Alexander goes back to around 1900, when medicine and medical care really began becoming widespread. Hospitals were being built across the country (and the world) because they could actually provide assistance to the sick. But how were we going to pay for it? It quickly became clear that individual sick people couldn't foot the bills for this new larger medical world, so what to do? All kinds of proposals were made, lots of folks wanted to copy the centralised system some European countries were trying - but guess what, ultimately it was rejected here because, well, socialism. When you read the arguments from the teens and 20's, you have to keep double checking the dates because the language has hardly changed from what is used to argue against the single payer system today.
The book examines the medical world of rural northern Ohio, outside of Toledo and Fort Wayne -- not far at all from where I live in Detroit. I recognized many of the corporate names, which also made this resonate for me. I very much liked the way the author tied up a whole number of social history strands, which gave a much fuller picture than just focusing on health insurance, or corporations moving off shore. This book was written before covid - but there is a brief epilogue that considers covid and its early impacts on the medical "system." After reading this, its clear why covid so disproportionately devastates the poor and working poor communities around the world.
My favorite quote: "The country had changed from being an ongoing project to improve democratic society and live humanistic ideals to being a framework for fostering corporate profit." My only disagreement is whether our country every truly wanted to live humanistic ideals?
Alexander goes back to around 1900, when medicine and medical care really began becoming widespread. Hospitals were being built across the country (and the world) because they could actually provide assistance to the sick. But how were we going to pay for it? It quickly became clear that individual sick people couldn't foot the bills for this new larger medical world, so what to do? All kinds of proposals were made, lots of folks wanted to copy the centralised system some European countries were trying - but guess what, ultimately it was rejected here because, well, socialism. When you read the arguments from the teens and 20's, you have to keep double checking the dates because the language has hardly changed from what is used to argue against the single payer system today.
The book examines the medical world of rural northern Ohio, outside of Toledo and Fort Wayne -- not far at all from where I live in Detroit. I recognized many of the corporate names, which also made this resonate for me. I very much liked the way the author tied up a whole number of social history strands, which gave a much fuller picture than just focusing on health insurance, or corporations moving off shore. This book was written before covid - but there is a brief epilogue that considers covid and its early impacts on the medical "system." After reading this, its clear why covid so disproportionately devastates the poor and working poor communities around the world.
My favorite quote: "The country had changed from being an ongoing project to improve democratic society and live humanistic ideals to being a framework for fostering corporate profit." My only disagreement is whether our country every truly wanted to live humanistic ideals?
May 19, 2021
As someone who grew up dependent on a rural, small town Iowa hospital, I was excited for the opportunity to read this book. The hospital was less than 15 minutes from where we lived. It was the hospital I was born in, went to for doctor appointments, and my parents were cared for several times for various ailments. Somehow this hospital has survived over the years, mostly due to joining a much bigger health system, but I can absolutely attest that it still has that small town feel. Two years ago, I spent nearly a month there while my dad was very ill and the staff from the PAs to the nurses to the aides to the respiratory therapists to the housekeeping and food service staff, every single one was kind and generous and personable. They seemed to love their jobs and care deeply for their patients and each other. I couldn’t have asked for a better experience for my dad. But, I know this isn’t always the case and many communities have lost their hospitals and have had to travel an hour or more to the closet hospital to receive care.
In THE HOSPITAL, Alexander begins with the history of the community he is writing about, the small town of Bryan, Ohio, in the NW corner of the state. It is just a bit over an hour to Toledo when traveling east or to Fort Wayne, Indiana, to the southwest. When you google Bryan, Ohio, you see images similar to many small towns across America; brick buildings on the main street, many empty, residential areas of older homes as well as newer, churches, parks, and businesses, some still thriving and others closed. Bryan’s history of having a hospital goes back to the early 1900s and I found the details of the creation of the hospital quite interesting. Over the years, the economics of the small town, businesses and factories closing, farms in crisis, and little too few jobs all had an effect on the success of the hospital. When families were struggling, the ER became their doctor’s office and the bulk of the fees fell to the hospital knowing that the patients weren’t going to be able to afford the care. Because the patients got whoever was on call, there wasn’t a lot of “shopping for care” or “personal care for the patient” because you got who you got in the ER and the ER doctor was just there to do their job and not build relationships. It was a horrible cycle that created numerous unpaid medical bills that eventually taxed the hospital’s bottom line.
At only nine chapters plus an epilogue, the chapters are quite long. I’m a chapter reader, which made this hard for me to need to spend several days reading just one chapter. It was my Kindle bedtime read and typically I only read in 10-20 minute chunks which made the chapters seem even longer. The research was very detail-heavy in spots and often more than I needed or wanted to know regarding specific dollar amounts or conversations held in the board room.
I really empathized with the personal stories of various residents of the Bryan, Ohio area and their struggles with receiving adequate health care and then paying for that care once it was received, often too late for true healing. I have no doubt that our health care system is extremely flawed. For those who can afford health care, it’s a constant worry to have the right deductible vs monthly premium and pray that nothing drastic happens to have to use it. For those who can’t afford health care, but make too much for Medicaid, there is the constant battle of how long can I avoid going to the doctor for this particular ailment because I can’t afford to pay for it.
The end of the book concludes with the beginnings of the Pandemic hitting our country and the impact on hospitals. I was disappointed in the abrupt shift to a very liberal tone once the author began this section. I would have preferred more facts on how COVID-19 affected hospitals rather than an opinionated rant about how COVID-19 was handled in the beginning stages. I also was frustrated because frankly, I was hoping for some solutions that could be taken from this in-depth look at small-town hospitals. But, there really were no solutions except for overhauling the insurance system, which isn’t something most of us, as readers, can do. Can we talk to our Senators and Representatives? Yes. Can we support our local hospitals by going to them and receiving care? Yes. But, keeping qualified doctors, specialized care, and systems that support those that struggle to pay for the care is a much bigger issue and one that needs to be tackled at the governmental level. Overall, I found parts of this research interesting and inspiration for conversations, but the systemic problems are much bigger than you or I can tackle.
In THE HOSPITAL, Alexander begins with the history of the community he is writing about, the small town of Bryan, Ohio, in the NW corner of the state. It is just a bit over an hour to Toledo when traveling east or to Fort Wayne, Indiana, to the southwest. When you google Bryan, Ohio, you see images similar to many small towns across America; brick buildings on the main street, many empty, residential areas of older homes as well as newer, churches, parks, and businesses, some still thriving and others closed. Bryan’s history of having a hospital goes back to the early 1900s and I found the details of the creation of the hospital quite interesting. Over the years, the economics of the small town, businesses and factories closing, farms in crisis, and little too few jobs all had an effect on the success of the hospital. When families were struggling, the ER became their doctor’s office and the bulk of the fees fell to the hospital knowing that the patients weren’t going to be able to afford the care. Because the patients got whoever was on call, there wasn’t a lot of “shopping for care” or “personal care for the patient” because you got who you got in the ER and the ER doctor was just there to do their job and not build relationships. It was a horrible cycle that created numerous unpaid medical bills that eventually taxed the hospital’s bottom line.
At only nine chapters plus an epilogue, the chapters are quite long. I’m a chapter reader, which made this hard for me to need to spend several days reading just one chapter. It was my Kindle bedtime read and typically I only read in 10-20 minute chunks which made the chapters seem even longer. The research was very detail-heavy in spots and often more than I needed or wanted to know regarding specific dollar amounts or conversations held in the board room.
I really empathized with the personal stories of various residents of the Bryan, Ohio area and their struggles with receiving adequate health care and then paying for that care once it was received, often too late for true healing. I have no doubt that our health care system is extremely flawed. For those who can afford health care, it’s a constant worry to have the right deductible vs monthly premium and pray that nothing drastic happens to have to use it. For those who can’t afford health care, but make too much for Medicaid, there is the constant battle of how long can I avoid going to the doctor for this particular ailment because I can’t afford to pay for it.
The end of the book concludes with the beginnings of the Pandemic hitting our country and the impact on hospitals. I was disappointed in the abrupt shift to a very liberal tone once the author began this section. I would have preferred more facts on how COVID-19 affected hospitals rather than an opinionated rant about how COVID-19 was handled in the beginning stages. I also was frustrated because frankly, I was hoping for some solutions that could be taken from this in-depth look at small-town hospitals. But, there really were no solutions except for overhauling the insurance system, which isn’t something most of us, as readers, can do. Can we talk to our Senators and Representatives? Yes. Can we support our local hospitals by going to them and receiving care? Yes. But, keeping qualified doctors, specialized care, and systems that support those that struggle to pay for the care is a much bigger issue and one that needs to be tackled at the governmental level. Overall, I found parts of this research interesting and inspiration for conversations, but the systemic problems are much bigger than you or I can tackle.
March 6, 2021
An excellent account of what it takes to keep a smaller hospital in business. He intersperses stories of people & community & other businesses that all affect/are affected by the hospital's success or failure. The author did a great job of making this so compelling & readable, & I found myself staying up late at night to read on.....maybe kind of surprising , considering that it's non fiction about a smaller community hospital trying to remain independent & operational as long as possible. He sheds light on a number of factors that play big parts here...personal stories/history, giant insurance companies & pharmacies, medical device makers, corporations & politicians/lobbyists......it's actually very scary.....what is going on around all of us. After reading this, you'll probably have a new outlook on healthcare...... Definitely worth 5 stars. I highly recommend it to everyone!
I received an e-ARC from St. Martin's Press via NetGalley, in return for reading it & offering my own fair & honest review.
I received an e-ARC from St. Martin's Press via NetGalley, in return for reading it & offering my own fair & honest review.
March 23, 2021
The Hospital is a sobering look at the business and politics behind healthcare in America, specifically in rural America. This book literally hit close to home for me...I grew up in West Unity, one of the small towns in NW Ohio featured throughout the book. The EMS director interviewed is a family friend, and I'm pretty sure I went to high school with at least a couple of the other "characters" mentioned. The Hospital examines what it's like to run a small independent hospital; trying to maintain that independence while staying solvent against the big hospital chains that seem to keep increasing their chokehold on American healthcare. It also takes a close look at the people that the hospital serves and the paradox of the community I grew up in; people are very much against taxes and "socialization" of anything government related, while at the same time being all in favor of government subsidies for farms and corporations. There's a belief that poor people don't want to work and that's why they're poor, when in reality, the majority are working (sometimes 3 or more jobs) but not bringing in enough income to raise themselves out of poverty. The author does an excellent job of blending a thorough (and thoroughly depressing) examination of the business side of healthcare with the real-life stories of the people who live and work in Williams County, keeping the reader engaged. It was enlightening, to say the least, to truly begin to understand the levels of poverty that many people in rural areas are dealing with, and how that poverty affects their health.
June 10, 2025
Such a thorough explanation of our healthcare system. This was extra interesting for me because I live in the area and am familiar with the institutions mentioned.
January 30, 2021
The Hospital by Brian Alexander is such an important book. Alexander has given us an unflinching, uncomfortable look at our health care system and challenges us to face the obvious: so many people in our country suffer from poor health and the role that we allow poverty to play in that neglect is costly.
Alexander's story focuses on a rural hospital in Bryan, Ohio; the hospital is trying to stay independent and offer the most affordable, best care that it can to the people. CEO Phil Ennen runs the hospital with compassion and good sense, but even he can't overcome all of the problems in the American medical industry. This book takes you deep into this industry, how we got here, where we are now, and what to do next.
The narratives of the Bryan residents and patients that are woven throughout the text are heartfelt and often tragic. Some die, some suffer needlessly, some recover. But it always seems to come down to systemic poverty, here. If only Keith had been able to afford insulin earlier in his life, he might not have lost his foot. It goes on and on. Suicide seems like the only option to more than a couple of people. So tragic.
Alexander brings all of these characters to life, and you truly feel for them. I highly recommend this book and suggest reading with an open mind and a desire to learn. Thank you to NetGalley and the publisher for the opportunity to read The Hospital.
Alexander's story focuses on a rural hospital in Bryan, Ohio; the hospital is trying to stay independent and offer the most affordable, best care that it can to the people. CEO Phil Ennen runs the hospital with compassion and good sense, but even he can't overcome all of the problems in the American medical industry. This book takes you deep into this industry, how we got here, where we are now, and what to do next.
The narratives of the Bryan residents and patients that are woven throughout the text are heartfelt and often tragic. Some die, some suffer needlessly, some recover. But it always seems to come down to systemic poverty, here. If only Keith had been able to afford insulin earlier in his life, he might not have lost his foot. It goes on and on. Suicide seems like the only option to more than a couple of people. So tragic.
Alexander brings all of these characters to life, and you truly feel for them. I highly recommend this book and suggest reading with an open mind and a desire to learn. Thank you to NetGalley and the publisher for the opportunity to read The Hospital.
December 29, 2021
Probably 1/3 of this is about the hospital, and it is intersecting and illuminating. Too much of the rest is boilerplate anti-conservative idealism, swirling around generalities regarding capitalism is bad, government is good. I’m politically liberal and I found it tiring and thin. For good measure the author throws in a chapter at the end about the first months of COVID, but with very little perspective from this small hospital. Meh. So disappointing, because I’m genuinely interested in the topic.
In fairness, the author writes well on a sentence-by-sentence level, and I found the book easy to read.
In fairness, the author writes well on a sentence-by-sentence level, and I found the book easy to read.
September 24, 2021
I thought Alexander's earlier book "Glass House" was good to very good but lacking in cohesion. I preferred this book but some of the issues persisted.
Here he takes us back to Ohio where we meet the people connected to a hospital in the rural northwestern part of the state. The business focal points are different but the general overlap is significant.
Alexander displays the same strengths when discussing the business aspects of his story. Private equity comes back into the picture along with the many business decisions to improve hospital revenues and reduce expenses. I never gave a second thought about why hospitals offer certain services but I now more fully appreciate that it's mainly driven by economics and competition. (Duh.) Along with choices about imaging and other ancillary services Alexander highlights the many flaws in America's healthcare system ("It's not a system!" is quoted several times throughout the book.). Hospitals, health insurance companies, pharmaceutical companies, medical equipment manufacturers, all becoming monolithic, all with powerful lobbies, all working in their own self-interests. The whole thing is a multibillion dollar shambles and too many Americans are left without sufficient health coverage. It's an inarguable disgrace.
Where Alexander is good but not more is in his depictions of the people. As in "Glass House" we learn about the people making the business decisions (here the hospital administrators) and those that are struggling financially (and medically). These parts are fine but lack depth. I kept thinking back to books more singularly focused on topics raised by the author and wished that he'd either enlarged or shortened the book to make it more thorough or less distracting. The particular books I had in mind were "The Working Poor" by David Shipler and "Strangers in Their Own Land" by Arlie Russell Hochschild.
The early part about the decisions and challenges of starting a hospital in the early 1900s aptly demonstrated the permanence of human nature. It was useful background material but more than necessary. The book quickly got better as it moved into current times.
It's worth mentioning that the timeframe covers 2018 through summer 2020 but the bulk of the book relates to 2018-2019. There's an epilogue that briefly touches on COVID-19 and wraps up some of the personal stories. If ever there was a book that would greatly benefit from an updated version this is it. I'd be very interested to learn what became of the hospital during and after the pandemic. I recommend the book but advise waiting a few years for a possible update.
Here he takes us back to Ohio where we meet the people connected to a hospital in the rural northwestern part of the state. The business focal points are different but the general overlap is significant.
Alexander displays the same strengths when discussing the business aspects of his story. Private equity comes back into the picture along with the many business decisions to improve hospital revenues and reduce expenses. I never gave a second thought about why hospitals offer certain services but I now more fully appreciate that it's mainly driven by economics and competition. (Duh.) Along with choices about imaging and other ancillary services Alexander highlights the many flaws in America's healthcare system ("It's not a system!" is quoted several times throughout the book.). Hospitals, health insurance companies, pharmaceutical companies, medical equipment manufacturers, all becoming monolithic, all with powerful lobbies, all working in their own self-interests. The whole thing is a multibillion dollar shambles and too many Americans are left without sufficient health coverage. It's an inarguable disgrace.
Where Alexander is good but not more is in his depictions of the people. As in "Glass House" we learn about the people making the business decisions (here the hospital administrators) and those that are struggling financially (and medically). These parts are fine but lack depth. I kept thinking back to books more singularly focused on topics raised by the author and wished that he'd either enlarged or shortened the book to make it more thorough or less distracting. The particular books I had in mind were "The Working Poor" by David Shipler and "Strangers in Their Own Land" by Arlie Russell Hochschild.
The early part about the decisions and challenges of starting a hospital in the early 1900s aptly demonstrated the permanence of human nature. It was useful background material but more than necessary. The book quickly got better as it moved into current times.
It's worth mentioning that the timeframe covers 2018 through summer 2020 but the bulk of the book relates to 2018-2019. There's an epilogue that briefly touches on COVID-19 and wraps up some of the personal stories. If ever there was a book that would greatly benefit from an updated version this is it. I'd be very interested to learn what became of the hospital during and after the pandemic. I recommend the book but advise waiting a few years for a possible update.
November 15, 2021
The Hospital is an in-depth look at a community hospital in Bryan, Ohio called CHWC - a cornerstone of this poor, rural community, but constantly under threat. In diving into this small rural town as a case study, Alexander shows us a richer picture of what's going on in the U.S.'s medical system and how it affects poor, often isolated towns. Alexander pulls out themes that show up all around the country, risking the independence of these vital community hospitals, putting the physical and financial health of the residents and patients it serves in danger, and letting the increasingly consolidated healthcare conglomerates squeeze the most vulnerable populations.
CHWC plays a vital role in Bryan, a town of about 8,500 in northwest Ohio. The second-nearest hospital is about an hour away by car, and in serious emergencies and/or inclement weather, that's not a viable option. But CHWC is a small nonprofit hospital that struggles to make ends meet for a variety of reasons: most of its patients are on Medicare/Medicaid, and the reimbursement rates for supplies and treatment (the primary way hospitals make their money) are much lower compared to private insurance plans. CHWC is not part of a purchasing conglomerate either, so they are charged much higher rates for equipment, supplies, and medications than hospitals that are part of a large network. CHWC prides itself on its independence, but the finances don't agree - CHWC's CEO, Phil Ennon, fields negotiations all day long from Parkview Medical, a huge healthcare giant that wants to buy out this small town hospital and fundamentally change it.
There's a lot more to be said about the hospital itself, but the residents/patients of Bryan are a large part of the story as well. Bryan is one of thousands and thousands of small rural towns that isn't close to recovering from the Great Recession of 2007/2008. There are simply very few jobs left in Bryan, and those that are there don't pay a living wage, offer healthcare, or provide any sort of stable employment. Basically all the residents of Bryan are living in a precarious state - barely employed, in deep debt, wondering how they're going to make their next rent or mortgage payment, struggling to put food on the table. Mental health is at an all-time low and suicides are more and more common.
Not to mention that many Bryan residents have health issues that are common in poor towns, ranging from diabetes to heart problems to chronic injuries, and are often forced to be "noncompliant" with their medical instructions to manage these issues because of the cost of care, cost of basic medical supplies like diabetes test strips, need to work and put further strain on their bodies, or general instability that puts them in fight-or-flight mode.
One of the most interesting parts of this book is the discussion of intergenerational trauma and the real physical/mental health effects that generations of instability can have on individuals. For those of us who are in relatively stable points in life and have all of our basic necessities secured for the near future, it's extremely difficult to imagine the utter stress that food, shelter, and financial instability places on you. But for anyone who has endured that, it's the only thing you can think about, and studies have shown that this constant state of uncertainty leaves a mark on not only you, but your children. This is the reality for pretty much everyone in Bryan.
Alexander's whole thesis in this book is that American healthcare cannot be solved until these underlying issues - like rural employment, the disparity in treatment between private and public insurance, and the free-for-all nature of medical conglomerates that squash independent community hospitals - are addressed. Although it's a huge bummer to hear this, the medical system is a complex beast, with so many interlocking and interdependent issues causing the decline of health outcomes and quality healthcare availability for vulnerable Americans. This book taught me so much about a system that I know so little about, and although it's not particularly uplifting, it's an important read for understanding yet another problem that rural Americans face. My one criticism of the book is that it focuses on primarily white perspectives in a predominantly white town. Alexander discusses some things like Muslim doctors coming in and the subsequent anti-Muslim sentiment in town, but it's not detailed. But you can imagine that if things are this bad for white folk in Ohio, opportunities, risks, and challenges are probably even worse for Black Americans, immigrants, and other doubly or triply-marginalized groups.
Thank you to St. Martin's Press for the ARC via Netgalley.
CHWC plays a vital role in Bryan, a town of about 8,500 in northwest Ohio. The second-nearest hospital is about an hour away by car, and in serious emergencies and/or inclement weather, that's not a viable option. But CHWC is a small nonprofit hospital that struggles to make ends meet for a variety of reasons: most of its patients are on Medicare/Medicaid, and the reimbursement rates for supplies and treatment (the primary way hospitals make their money) are much lower compared to private insurance plans. CHWC is not part of a purchasing conglomerate either, so they are charged much higher rates for equipment, supplies, and medications than hospitals that are part of a large network. CHWC prides itself on its independence, but the finances don't agree - CHWC's CEO, Phil Ennon, fields negotiations all day long from Parkview Medical, a huge healthcare giant that wants to buy out this small town hospital and fundamentally change it.
There's a lot more to be said about the hospital itself, but the residents/patients of Bryan are a large part of the story as well. Bryan is one of thousands and thousands of small rural towns that isn't close to recovering from the Great Recession of 2007/2008. There are simply very few jobs left in Bryan, and those that are there don't pay a living wage, offer healthcare, or provide any sort of stable employment. Basically all the residents of Bryan are living in a precarious state - barely employed, in deep debt, wondering how they're going to make their next rent or mortgage payment, struggling to put food on the table. Mental health is at an all-time low and suicides are more and more common.
Not to mention that many Bryan residents have health issues that are common in poor towns, ranging from diabetes to heart problems to chronic injuries, and are often forced to be "noncompliant" with their medical instructions to manage these issues because of the cost of care, cost of basic medical supplies like diabetes test strips, need to work and put further strain on their bodies, or general instability that puts them in fight-or-flight mode.
One of the most interesting parts of this book is the discussion of intergenerational trauma and the real physical/mental health effects that generations of instability can have on individuals. For those of us who are in relatively stable points in life and have all of our basic necessities secured for the near future, it's extremely difficult to imagine the utter stress that food, shelter, and financial instability places on you. But for anyone who has endured that, it's the only thing you can think about, and studies have shown that this constant state of uncertainty leaves a mark on not only you, but your children. This is the reality for pretty much everyone in Bryan.
Alexander's whole thesis in this book is that American healthcare cannot be solved until these underlying issues - like rural employment, the disparity in treatment between private and public insurance, and the free-for-all nature of medical conglomerates that squash independent community hospitals - are addressed. Although it's a huge bummer to hear this, the medical system is a complex beast, with so many interlocking and interdependent issues causing the decline of health outcomes and quality healthcare availability for vulnerable Americans. This book taught me so much about a system that I know so little about, and although it's not particularly uplifting, it's an important read for understanding yet another problem that rural Americans face. My one criticism of the book is that it focuses on primarily white perspectives in a predominantly white town. Alexander discusses some things like Muslim doctors coming in and the subsequent anti-Muslim sentiment in town, but it's not detailed. But you can imagine that if things are this bad for white folk in Ohio, opportunities, risks, and challenges are probably even worse for Black Americans, immigrants, and other doubly or triply-marginalized groups.
Thank you to St. Martin's Press for the ARC via Netgalley.
April 4, 2021
Who knew? Little old Bryan, Ohio, featured in this book ...
(Review written by Tammy Schoch. This amazon account, and an old Travelocity account, are the only remaining vestiges of shared marital internet accounts with my husband Jim, from a time long ago when households shared one email address, as they also shared one landline phone.)
I grew up one mile east of Williams County, in Northwest Ohio, where the Bryan Hospital is located. My family never called it by its proper name. It was known as the Bryan Hospital, and still is to this day. I was taken down memory lane, and also slapped with today’s reality, in reading this book.
I’ve lived about half of my adult years in that area, at various times. This book was simultaneously delightful, frustrating, heart-wrenching, and humorous. It was true to life, as judged by my history of having lived and worked in the Four County area as a psychiatric RN in a local hospital, in the regional jail, and in the four county community mental health center. I recognized so many names, places, and businesses mentioned in this book.
If anyone needs to better understand what is meant by the social determinants of health, here is the book for you. If anyone is interested in the interplay between politics, religion, healthcare, and culture, this is your book. If anyone believes that the people in charge have it easy, or that the poor bring it on themselves, or that government is a dirty word, or that there are obvious and easy solutions, this book will challenge your misconceptions.
I had no choice but to give it 5 stars. This guy needs an honorary doctorate for this book.
(Review written by Tammy Schoch. This amazon account, and an old Travelocity account, are the only remaining vestiges of shared marital internet accounts with my husband Jim, from a time long ago when households shared one email address, as they also shared one landline phone.)
I grew up one mile east of Williams County, in Northwest Ohio, where the Bryan Hospital is located. My family never called it by its proper name. It was known as the Bryan Hospital, and still is to this day. I was taken down memory lane, and also slapped with today’s reality, in reading this book.
I’ve lived about half of my adult years in that area, at various times. This book was simultaneously delightful, frustrating, heart-wrenching, and humorous. It was true to life, as judged by my history of having lived and worked in the Four County area as a psychiatric RN in a local hospital, in the regional jail, and in the four county community mental health center. I recognized so many names, places, and businesses mentioned in this book.
If anyone needs to better understand what is meant by the social determinants of health, here is the book for you. If anyone is interested in the interplay between politics, religion, healthcare, and culture, this is your book. If anyone believes that the people in charge have it easy, or that the poor bring it on themselves, or that government is a dirty word, or that there are obvious and easy solutions, this book will challenge your misconceptions.
I had no choice but to give it 5 stars. This guy needs an honorary doctorate for this book.
December 26, 2020
By following the struggle for survival of one small-town hospital, and the patients who walk, or are carried, through its doors, The Hospital (St. Martin’s Press) takes readers into the world of the American medical industry in a way no book has done before. Americans are dying sooner and living in poorer health. Brian Alexander argues that no plan will solve America’s health crisis until the deeper causes of that crisis are addressed. Culminating in COVID-19, this book details how we’ve created the dilemma we’re in.
May 13, 2021
This author was such a snob.
January 19, 2022
I particularly wanted to review this book I read in December about a hospital in small town Ohio because it was one of my favorite reads last year for many reasons. First of all, it was pretty cool that it was in a town that's only about an hour and a half from where I went to high school. Second, it was an incredible insider account of a how a small town, independent hospital works. I enjoyed learning about the challenges they face financially; the difficulty they have recruiting doctors; and the pressures they face from larger hospital systems that receive bulk discounts on medical supplies and insurers. It's truly impressive how broken the system is. Last but not least, the author's description of the town itself was a compassionate, but not uncritical look at the beliefs and lives of the people in this conservative Ohio town. So, in many ways this was a look at parts of the world I am close to, but knew nothing about. I really appreciated the use of interviews and personal stories to teach me something new.This review was originally posted on Doing Dewey
April 10, 2021
What a great book that was!!! I do mean it, because it shows how the American medical mentality monopolizes money. It takes a hell of work to run an entire hospital, CEOs have to be smart to pick out the most essential departments that the building can run under various insurance companies with lasting doctors. Bryan, Ohio is such a small town to have handled such a small hospital with this load of specialists; regardless if it was the only hospital for miles. The amount of work on doctors, nurses, and staff would be far more stressful than other somewhat bigger, more capable hospitals.
The book presents with the stresses and illnesses of society in such a small town trying to thrive its medical system. Excellent book with honest real-life relatable scenarios.
The book presents with the stresses and illnesses of society in such a small town trying to thrive its medical system. Excellent book with honest real-life relatable scenarios.
This entire review has been hidden because of spoilers.
April 28, 2021
A very good look into America's broken healthcare system from a new perspective: rural hospitals and the lives of rural patients. A great addition for a must-read booklist for med students & healthcare professionals
October 7, 2021
An interesting topic but not done super well. The skipping around to different stories throughout the entirety of the book was annoying and unnecessary.
November 4, 2021
A hard-hitting, devastating, disturbing account of the critical illness of the U.S. health care system. The author makes his case concrete by focusing especially on a small, independent, non-profit, community-based hospital in Bryan, Ohio, a small county-seat town in the extreme northwest corner of the state, though he also employs examples from across the region and the country. He also followed a number of particular individuals, both patients and people who worked in the hospital and the county health department, to make his account even more concrete and personal. The particular focus on the Bryan hospital and community added to my interest in the book because that's the hospital where I was born and where my family's doctor practiced. I didn't know before reading the book that our family's elderly doctor was the person who single-handedly founded the Bryan hospital in the 1930s. It was a little jarring to see the community treated as coastal urbanites usually treat such communities--as home to an impoverished, overweight, undereducated, drug-addled populace because, from the perspective of the tiny village where I grew up (7 miles to the southeast), Bryan seemed to be a relatively affluent community in the region, even compared to our county seat, Defiance, 12 more miles to the southeast, which had more than twice the population and a liberal arts college in town. I realize that times have changed since I grew up there in the 1950s & '60s, as some manufacturing plants have closed and others have been taken over by larger firms based elsewhere. In any case, the conservative politics of the area was certainly familiar, and the focus on how the failures of the health care system, while a problem for everyone, are especially devastating for the working poor was especially illuminating if not surprising.
August 12, 2021
Another book that lays bare the despair of the former middle class in rural and small town America. The Hospital continues in the spirit of Strangers in Their Own Land: Anger and Mourning on the American Right, Janesville: An American Story, and Hillbilly Elegy: A Memoir of a Family and Culture in Crisis.
Alexander embeds himself in a small town hospital in Bryan Ohio. The hsopital is in the upper northwest corner of the state and serves the population of Williams County. Prior to the Great Recession, the county was home of many manufacturing jobs that paid decent wages. But that economic shock plus the general tide of globalization left the residents with low paying warehouse and service sector jobs. Needless to say, ground zero for general despair.
The story is told from multiple vantage points - hospital administration and board who are desperate to maintain the hospital's independent status and resist the wave of healthcare mergers; healthcare practitioners at the hospital and within emergency services, and various county residents whose health and finances have both collapsed.
There are dollops of discourse on healthcare industry economics - many things I did not know such as that small hospitals pay more per unit for their medical devices (because they don't qualify for volume discounts), they have to pay more for doctors than larger hospitals just to attract talent, and that rival hospitals engage in anti-competitive practices in order to force their competitors into financial distress or bankruptcy so they can expand into new markets.
Underlying all of this, one realizes that such an appealing small town hospital as portrayed in the book is torn between wanting more of the local residents to need its services (like stents) that are profit centers and wanting fewer demands on its services from low-income, Medicaid and Medicare patients because reimbursements are so low and the patient responsibility so often became uncollected medical debt. But the county is not rich, suffers from the opiod and obesity crises, has food deserts, and there are many broken families.
The Williams County residents featured in the book who eventually end up needing to go to the hospital have deferred preventative care for decades until eventually they have no choice but to be picked up by EMS. They don't always survive or if they do, may become permanently disabled. The folks grew up believing that their future would be to work in manufacturing at a decent wage and when that became impossible, their health and life options declined.
There are no policy prescriptions in this book but you certainly won't come away thinking that the "free market" in healthcare will solve it. If anything, the pace of consolidation and market power in the healthcare industry will only lead to a greater percentage of the nation's GDP going into healthcare rather than any progress towards improving health outcomes.
The book covers 2018-2019 and touches on the COVID pandemic in 2020. Super readable and 5 stars because the chapters on the lives of the real people were so compelling, I stayed up past my bedtime. There are no photos. You'll want to take a quick look at a map to place Bryan Ohio in context of larger cities like Toledo and Ft Wayne which play a role as specialist centers.
Alexander embeds himself in a small town hospital in Bryan Ohio. The hsopital is in the upper northwest corner of the state and serves the population of Williams County. Prior to the Great Recession, the county was home of many manufacturing jobs that paid decent wages. But that economic shock plus the general tide of globalization left the residents with low paying warehouse and service sector jobs. Needless to say, ground zero for general despair.
The story is told from multiple vantage points - hospital administration and board who are desperate to maintain the hospital's independent status and resist the wave of healthcare mergers; healthcare practitioners at the hospital and within emergency services, and various county residents whose health and finances have both collapsed.
There are dollops of discourse on healthcare industry economics - many things I did not know such as that small hospitals pay more per unit for their medical devices (because they don't qualify for volume discounts), they have to pay more for doctors than larger hospitals just to attract talent, and that rival hospitals engage in anti-competitive practices in order to force their competitors into financial distress or bankruptcy so they can expand into new markets.
Underlying all of this, one realizes that such an appealing small town hospital as portrayed in the book is torn between wanting more of the local residents to need its services (like stents) that are profit centers and wanting fewer demands on its services from low-income, Medicaid and Medicare patients because reimbursements are so low and the patient responsibility so often became uncollected medical debt. But the county is not rich, suffers from the opiod and obesity crises, has food deserts, and there are many broken families.
The Williams County residents featured in the book who eventually end up needing to go to the hospital have deferred preventative care for decades until eventually they have no choice but to be picked up by EMS. They don't always survive or if they do, may become permanently disabled. The folks grew up believing that their future would be to work in manufacturing at a decent wage and when that became impossible, their health and life options declined.
There are no policy prescriptions in this book but you certainly won't come away thinking that the "free market" in healthcare will solve it. If anything, the pace of consolidation and market power in the healthcare industry will only lead to a greater percentage of the nation's GDP going into healthcare rather than any progress towards improving health outcomes.
The book covers 2018-2019 and touches on the COVID pandemic in 2020. Super readable and 5 stars because the chapters on the lives of the real people were so compelling, I stayed up past my bedtime. There are no photos. You'll want to take a quick look at a map to place Bryan Ohio in context of larger cities like Toledo and Ft Wayne which play a role as specialist centers.
August 28, 2021
Not enough of the stories of the people affected by the hospital in the small town of Bryan, Ohio especially when there was too much banal fact regurgitation of the dollars, cents, politics, and red tape associated with running such a "band-aid station". If the two were woven together with a little more pizzazz, a focus on true storytelling, I could have loved the book (which I was quite excited to start) but once I read a few pages I found myself picking it up and putting it down too much to know it was going to be something I'd dive in to.
Certainly there were elements that I learned a thing or two and I was fascinated by how the administration of a hospital ties with those who needs its services, but it didn't tug at the heartstrings or make me super frustrated and angry because I didn't know enough about the money and laws that governed it as they were shared without a way to help me understand why I needed to know these things. It's not the kind of information I can retain while reading if I can't make the connection.
Certainly there were elements that I learned a thing or two and I was fascinated by how the administration of a hospital ties with those who needs its services, but it didn't tug at the heartstrings or make me super frustrated and angry because I didn't know enough about the money and laws that governed it as they were shared without a way to help me understand why I needed to know these things. It's not the kind of information I can retain while reading if I can't make the connection.
November 22, 2022
It’s not that I disagree with Alexander, but boy was this a slog. It’s overly detailed and lacks a bit of cohesion. All maladies that fall on people or the hospital or the town are simply the fault of…society. It’s too much for a book that’s ostensibly just about the struggles of one rural hospital.
Which all wouldn’t be so bad if the book weren’t so grim!! Its thesis is basically “we’re fucked and there’s nothing we can do to make it better.” I suppose it’s good at showing how this one town encapsulates everything wrong with our health care system. But it sure is depressing.
Which all wouldn’t be so bad if the book weren’t so grim!! Its thesis is basically “we’re fucked and there’s nothing we can do to make it better.” I suppose it’s good at showing how this one town encapsulates everything wrong with our health care system. But it sure is depressing.
July 13, 2021
Incredibly well reported, this book lucidly encapsulates the economic trials of small-town America and the pervasive brokenness of our health care system through the lives of one Ohio community. If you want to better understand the state of American health care—or ever were tempted to read “Hillbilly Elegy” to ‘understand real America’—read this book, which is narratively rich and acidic in its indictment.
May 22, 2022
If rated purely for the journalism this would be a five star review. The stories within this book were exceptional as was the author’s ability to weave together a coherent plot line. However, I couldn’t get fully behind his criticism of the medical system. I know there are flaws in the system and there is certainly corruption, but I’m not sure that the author is always correct in his diagnosis or his prognosis of the problems.
June 6, 2021
I debated whether to categorize this as non-fiction dystopia. The way Americans have organized the health care system only makes sense historically--a step-by-step creation of a monster--not practically or in the quest to provide everyone high-quality healthcare. This is an immersive, necessary read charting the effects on a single, small hospital. Very worth your time.
June 24, 2021
fantastic book about a hospital in a small rural northwestern Ohio town. This town is about 40 miles west of Toledo where we lived for 20 years. The book chronicles the struggles of both the hospital and the town's residents. It's an up close and personal account of fragilities of a rural Midwest town and the health care system that is trying to provide care. It's a sobering read.
August 12, 2021
Oof this one's a doozy. Brutally examines so many aspects of the cruelty and inhumanity of US healthcare by telling the story of a small rural independent community hospital. Single payer now.
dnf
December 7, 2021Listened to the audiobook.
DNF @ 26%
I just got bored.
DNF @ 26%
I just got bored.
Displaying 1 - 30 of 335 reviews