Healthcare from the Trenches: An Insider Account of the Complex Barriers of U.S. Healthcare from the Providers and Patients' Perspective

by Alejandro Badia

As Americans, we’re facing serious problems – not only with skyrocketing healthcare costs but also lack of patient access and inefficient delivery. Now with the frightening Coronavirus pandemic that is further taxing our healthcare system – and consequently, our economy – we are seeing these issues amplified. Despite all the political debates and media coverage on healthcare policy and reform, there is always one glaring feedback from the people in the trenches – the doctors and other healthcare professionals who actually provide care to the patients.  This book is written from a doctor’s perspective, by Alejandro Badia, M.D., F.A.C.S. He didn’t want to write this book but felt he had to because of the incredible problems he sees every day in getting the patient the care they need; and, as an expert, his treatment plans are constantly second-guessed and obstructed by the system which has a near-zero understanding of the problem that the patient faces. It became unbearable for Dr. Badia to continue to practice without calling out what is happening, every day, as the norm, and not the exception anymore. Dr. Badia has been a practicing orthopedic surgeon for three decades and is the founder of OrthoNOW® clinics in South Florida. He has been in the trenches with our broken healthcare system since 1989. Medicine, once a noble calling, as evidenced by The Hippocratic Oath (Do No Harm), has transformed into an oppressive burdensome system for both doctors and patients. Non-Medical Experts hired by the Insurance Companies with zero medical training, and without any degrees or knowledge (in most cases) are calling the shots and continue to interfere with the doctor-patient relationship, delay and prevent the delivery of care, and present an obstacle to innovations that would improve patient outcomes and reduce overall healthcare costs. Since the implementation of Obamacare, healthcare in America has devolved into a bureaucratic nightmare. What began as incremental interference in the relationship between doctor and patient with the passage of The Medicare Act of 1965 is now an impenetrable barrier made up of governmental and healthcare insurance industry red tape. The result? Higher costs and unnecessary inefficiencies. What can we do about it? First, we must understand and recognize the underlying problems. Healthcare from the Trenches will give you an in-depth behind the scenes look at our system from a practicing doctors’ perspective along with contributors ranging from fellow colleagues to beleaguered patients, who offer their insights and share their personal stories to illustrate the inherent shortcomings in the U.S. healthcare industry as well as proposed solutions and suggestions for actions every one of us can take to enact positive, long-lasting change.
 
It’s time for every American to understand and be educated about the root causes of our healthcare crisis and demand meaningful reform to improve healthcare efficiencies in America.  

Genres: Medicine, Nonfiction, Health, Medical, Health Care

465 pages, Paperback

Published June 24, 2020

Reviews

[Grady · Rating 5 out of 5]

An accurate diagnosis: US Healthcare illness

Florida author Alejandro Badia, MD earned his undergraduate degree from Cornell University, his MD degree from NYU, his specialty training in orthopedics from NYU, and additional training in AO trauma in Germany. He founded Badia Hand to Shoulder Center and co-founded the Miami Anatomical Research Center in Florida, and created the OrthoNOW – an orthopedic urgent care center engaging healthcare entrepreneurs and surgeons. An honored surgeon, teacher and international lecturer, his mission is focused on improving healthcare delivery in orthopedics and sports medicine. An expert at dealing with broken bones, Dr. Badia is equally concerned with attending to and healing our broken healthcare system.

Written with an obvious informed stance, one of the reasons this important book surfaces as a vital clarion call for change is the genuinely caring beside manner in which Dr. Badia communicates his concerns and need for change. ‘In terms of US healthcare, we face some serious problems – not only with skyrocketing costs but also patient access and efficient delivery. Yes, our healthcare system is fraught with challenges…and as a foolhardy, obstinate physician with an entrepreneurial soul, I believed I could somehow make an impact in my own specialty of orthopedics and musculoskeletal medicine. Despite the barriers and frustrations, I still enjoy caring for my patients. Wait, let me rephrase that: I LOVE being a surgeon, relying upon my core knowledge in physiology and anatomy, and healing my fellow man.’

In that accessible tone of writing, Dr. Badia goes beyond the current controversy of the failing of our healthcare exacerbated by the focus on the pandemic management, and instead sharpens his diagnostic acumen by exploring the actual factors involved in the differential diagnosis – Big Pharma, health insurance costs, hospital organizations, expensive new medical devices (robotics, MRI, etc), and even information technology modes. The costs of medical care delivery have exploded to the point that many patients cannot afford healthcare.

Instead of simply squatting under the dark cloud of our current healthcare system, Dr. Badia stands tall and offers the opinions and perspectives of healthcare providers and patients, discussing the path all physicians take to become providers, now only to be frustrated with the loss of the sacred doctor/patient relationship that cannot be replaced by the interference of the government’s uninformed impediments, the crippling costs of health insurance, the ‘big business’ mindset of hospitals, the costs and threats of medical malpractice insurance, the manner in which doctors are ‘rated’ in the internet, telemedicine, etc.

How do we restore, aka ‘heal’, the broken system? When was the last time you made eye contact with the doctor more focused on the EMR that is there to assure every possible charge to the insurance provider than on gentle face-to-face compassionate concern for you and your problem? Our current status: physician burnout due to lack of full control of the art of providing medical care. Dr. Badia generously reports the views of other physicians that enhance our knowledge of the problems, examines the need for transparency, and ‘from the trenches’ offers his wise thoughts on how the current money-driven system can and must be excised and replaced by such concepts as converting health insurance companies to non-profit status through meaningful legislation. ‘Efficient quality care requires accountability and a collaborative effort’ (Dr. Scott Sigman), “We need more education and prevention’ (Kristin Forno, OT) – examples of comments from those in the trenches.

Dr. Badia concludes, ‘The goal is to provide the patient with the care they need, at the time they need it, and minimizing any interference to that process…further complexities only serve to drive up cost and increase delays…we can roll up our sleeves and provide better care for less cost.’ Hats off to Dr Alejandro Badia: this book should be read by everyone – patients and healthcare providers – and change can happen! Grady Harp MD

[Susan Keefe · Rating 5 out of 5]

A comprehensive look at the healthcare system by a trusted professional.

Alejandro Badia, M.D., F.A.C.S. was born in Cuba and came to the United States with his parents in 1962. His passion for medicine is in his genes, and at a very early age, he realized it was the career for him. He studied physiology at Cornell and attained his medical degree at New York University, where he also trained in orthopedics. He is co-founder of the world-renowned Miami Anatomical Research Center (M.A.R.C) the world’s largest surgical cadaveric training lab. He then went on to completed the Badia Hand to Shoulder Center, a fully integrated clinical facility for the upper limb also encompassing the Surgery Center at Doral, rehabilitation, and an MRI imaging facility, and then he inaugurated OrthoNOW®, the first walk-in orthopedic care center in South Florida, which later became an officially licensed system. As well as incredible achievements in medical care he has studied, lectured, and taught in many countries, and has also written multiple scientific articles and book chapters in the field of small joint arthroscopy.

The author wrote this book because he passionately believes that the key participants in every healthcare transaction deserve a voice, and this is just what this book does. With such a vast experience, not only in his chosen field but also of others linked to it, the author provides his reader with in-depth information on every aspect of the healthcare system. In giving voice to so many medical professionals, and patients who share their stories on its pages, he hopes to educate others and hopefully encourage discussions to take place so that solutions can be found to restore the health system and go forward positively in the future.

As a layperson, I found the whole book fascinating. Like most people I look up to doctors and specialists with respect and admiration for the wonderful things, they achieve on a day to day basis. However, the author has done a wonderful job of allowing his reader to glimpse fly-on-the-wall like behind the scenes into the Doctor’s Lounge, the offices, committees, and careers of health professionals and the challenges they face. Through it, I learned so much and realized that the general public, on the whole, has no concept of how long hours medical professionals work, and how much paperwork and collaboration with other professionals goes on behind the scenes.

He is not shy in saying what he feels is necessary whatever the topic. The influences politics have in healthcare, hidden agendas, the workings of the health insurance companies, all are examined frankly and he offers solutions backed with solid reasoning.

Nearing the completion of this book the COVID pandemic hit the world, and its effects on the United States healthcare system and its impact on the patients and workers are discussed, and of course, this is an ongoing problem. He also examines the roles of regenerative medicine, and the anti-aging industry and with these, as other branches of the industry, he stresses the importance of comprehensive research when looking for a healthcare professional, and indicates factors which should be a priority.

This book makes fascinating and extremely interesting reading. It contains volumes of information and solid reasoning backed up by facts and examples. Highly recommended!

[Sarah English · Rating 3 out of 5]

Read this for school. It was a LOT. Lots of personal information. Dr. Badia makes some really good points that are relatable as a healthcare provider. Just a really long read out of my normal!

[John J. · Rating 5 out of 5]

With the COVID-19 pandemic still raging and America’s healthcare system creating more problems than in solves, Dr. Alejandro Badia’s insightful and fascinating book, “Healthcare From The Trenches” comes at an urgent and essential time and encourages dramatic reforms to the current crisis. This book is a call to arms and an open discussion of the failure of the U.S. healthcare system written from the perspective of the providers and patients – a perspective that Dr. Badia says is sorely lacking from the ongoing debate. Written by a doctor with more than a quarter century of experience dealing with healthcare issues, this book offers remedies for what is clearly a broken and dysfunctional system.
Dr. Badia is a highly-respected hand surgeon with a medical degree from NYU. He is the founder and chief medical officer of the Florida-based OrthoNOW. And he knows firsthand about the myriad problems that afflict the U.S. healthcare system. He says he wrote this book to begin to identify the problems and create a broader discussion of the issues from the point of view of those who battle daily with the red tape and abuses of a healthcare system that clearly needs resuscitation.

“Since the implementation of the Affordable Care Act,” explains Dr. Badia, “healthcare in America has become an even greater bureaucratic nightmare than before. What started as incremental interference in the relationship between doctor and patient … is now an impenetrable barrier,” says the author. He calls it a “life and death matter” with people dying because it is a flawed system.
In “Healthcare From The Trenches,” Dr. Badia argues succinctly and effectively that the key participants in every healthcare matter deserve a stronger voice. He offers countless situations where this does not occur and the decision making is left to insurance company staffers with no medical training. He says this results, time after time, in a “breakdown in the doctor-patient relationship” which leads to a breakdown or complete failure of delivery of care. Most importantly, Dr. Badia says there is no time to waste in starting a national dialogue about how to fix this broken system.

If you have found yourself or a loved one caught up in the frustrating and debilitating maze that is today’s healthcare system in America, this book will show you that you are far from alone. A 2019 Gallup poll showed that 70 percent of Americans believe the current U.S. healthcare system has “major problems” or is “in crisis.” This book is a critically important expose that uncovers the correct prescription to fix these problems. It’s a brave and honest critique of the entrenched bureaucracy that is growing more out of control with each new day.

Every member of Congress needs to read this illuminating book.

[Nan · Rating 5 out of 5]

How do you feel about the current U.S. healthcare system?

Compare your thoughts to those of a doctor working in the healthcare system by reading the book entitled “Healthcare from the Trenches: An insider account of the Complex Barriers of U.S. Healthcare from the Providers and Patients’ Perspective” by Dr. Alejandro Badia, M.D., F.A.C.S.

Dr. Badia believes, “I still think we have one of the best systems in the world,” but we have a “dysfunctional, healthcare bureaucracy.” “What began as an incremental interference in the relationship between doctor and patient is now an almost impenetrable wall comprised of governmental and insurance busybodies. These nonmedical forces contribute to increased costs, inefficiencies and delays that, at best, needlessly exacerbate a patient’s pain and suffering, and at worst, aggravate the initial injury and/or illness until they may no longer be reparable.”

This book contains stories of “surgeons, nurses, occupational therapists and clinicians” who are working “in the trenches” and patients who have volunteered to share their stories.

The author believes that “Healthcare is part of corporate America: The pharmaceutical companies and the insurance companies have taken over.”

He also believes, “It is one of the many privileges that has been taken away from physicians: the ability to make their own judgment when a patient should be admitted.”

The author believes, “Doctors work hard and take on a tremendous amount of responsibility and our compensation should reflect that. We should be paid at least as much as other professions.”

The author says, “The healthcare system is not properly run. We do not have one system, but three: a socialized system, a fee-for-service system and an insurance system.”

The author said, “Efficient, quality care requires accountability and a collaborative effort.”

The author believes that the “health insurance industry adds zero value to the delivery of care” and that health insurance should “collect premiums and reimburse care.”

How can we “restore and preserve the world’s best healthcare system for ourselves and future generations?”

[Mikki · Rating 4 out of 5]

About 80% into this book, at end September 2020, I'm starting a review. A very interesting read, generally speaking, with lots of anecdotal illustration of the points Dr Badia wished to make about the health care system in this country (USA) - and much of it mirrors my own experience, limited though that is as a patient in the system. What I can concur with is the amount of waste I've observed and the bureaucracy underpinning the system. Also foreign to me, as a Brit, has been the insurance industry which surrounds getting healthcare coverage of adequate and appropriate proportions and its cost, even on low income. As an aside, I'm grateful for the layer of guidance available through my third party broker that has enabled me to choose wisely from the many packages available. Anyway, back to the book...

I found myself skimming a lot of chapters and skipping material I found to be repetitive, although I'm sure other readers will find the minutiae fascinating. I'm left thinking that Dr Badia makes some very valid points and I can see where change is desirable and/or necessary, but am wondering if the will to effect change is actually there. It's a behemoth of an industry (a sad description) and the current system keeps many people in jobs which would likely disappear if simplification were enacted or if surrounding areas of connected employment were disconnected or if litigation were not so lucrative for 'ambulance chasing' lawyers.

On the related issue of physician burnout, Dr Badia quotes his colleague and friend Dr Andrew Gurman, who stated that '60 percent of physicians are burned out, meaning, they are so frustrated with the profession that they are abandoning their vocation and retiring early. He attributes this to “being unsupported by administrators, dogged by unnecessary regulations, stressed by the pace of their jobs, and mired in mountains of paperwork.” Many criteria define physician burnout, but certainly one of them is a sense of helplessness. That helplessness translates into an attitude of, “Well, fine. Why try to advance care when blocked and encumbered and nobody seems to care?” Apathy and frustration abound because you realize there is nothing you can do to change or even impact a certain situation.' Dr Badia prefers to refer to the issue as something which results from 'moral injury.' He describes this very well, so I won't go into it here but will recommend reading his book for further elucidation.

On reading this book it conjured up an image of a health system seemingly like an overloaded juggernaut which has gained so much momentum in its current heavy form that the brakes are not powerful enough to slow it down, let alone bring it to a halt so that it can be somewhat unloaded - disencombered of the unnecessarily heavy weight of bureaucracy and 'meddling' from the outside. As things stand, only the truly dedicated or the bullheaded will survive, meaning that the bulk of those struggling to keep from going under will eventually give up - or succumb to early burnout.

Doctors like Dr Badia are essential (and I have met another of his 'type' locally), but they survive only because they have elected to set up in practice outside the hospitals and health systems which keep these institutions running as part of the juggernaut, while (thankfully) choosing to help people whose insurance covers their services. Other patients are at the mercy of the main system, although occasionally the two may overlap, especially as there may be insufficient specialists in the hospitals to do the work a patient needs. Then it's a question of 'eating up' the inconveniences and lack of proper financial compensation for services rendered. But that's a price the dedicated physician is generally willing to pay - the usually positive outcomes are their own reward.

Now I've finished reading I find myself feeling rather overwhelmed by the immense task to be undertaken in order to make changes to the system. How to get things better? Dr Badia has some ideas, as do other contributors to his book but he is honest enough to say, "As I stated unabashedly, I do not have the solution. It will take a combination of bold initiatives to move the needle. This will require not only great ideas but across-the-board collaboration. I believe the genesis will be from the grassroots, from a public who will be roused to demand change. Perhaps this will stem from a 2-nanometer virus but, it is far more likely that recognizing the issues and openly speaking about them will encourage intelligent and motivated entrepreneurs to propose and enact the solutions that are already present. However, we must remove the barriers to adoption. As stated, the current stakeholders have little incentive to change. The public must demand it, debate it on social media, and prioritize it as a goal."

[Brad Butler · Rating 5 out of 5]

Healthcare from the Trenches by Dr. Alejandro Badia, an incredible piece of work, is a multi-faceted look into how healthcare in the United States is delivered, or not delivered, and the elements of the system which have sent costs skyrocketing. Dr. Alejandro Badia, an Orthopedic surgeon based in Miami, is one of those rare birds who is part of, and yet set apart, from the system of practicing medicine. Specializing in hand and shoulder reconstructions, he runs an independent clinic that caters to an international clientele and, amazingly enough, is part of few if any U.S. private insurance networks. Operating on his own for decades, he has the perspective of an entrepreneurial businessman/owner and a highly dedicated and competent surgeon, something only a small minority of physicians can claim.

The book starts with his journey as a youngster, dreaming of becoming a doctor like his ancestors, and then grinding his way through med school and years of treacherous residencies in the U.S. and Europe. This alone gives the reader an education in the sacrifice doctors make to acquire the skills and credentials to practice in their chosen disciplines. Big lesson here: Don’t take your doctor for granted and know the good ones deserve to be well compensated!

Badia then takes the reader into the woefully tangled mess of a horror show which “can be” the U.S. medical system. For simplicity, it can be broken down into two sides: Large hospitals, big pharma, huge insurance and government versus healthcare providers (doctors, nurses, etc.) and patients. In the middle, dipping into both sides of the equation, lies the medical malpractice world and the plaintiff’s lawyers and insurance companies lurking within that corrupted construct.

After completing his own story, Healthcare from the Trenches becomes a compilation work as experts from many different sides contribute well-written pieces showcasing problems like insurance company denial and underpayment, medication shortages because of patent expirations or medical inflation due to few payers and one big one, government.

One startling section covers “Defensive Medicine.” This is when doctors order a multitude of tests to avoid malpractice lawsuits, and it mostly happens in large hospital ER facilities because they know insurance will always pay for tests ordered in the first 24 hours. While massive amounts of time, money and energy are wasted, on useless tests, the hospital loves the solid revenue source! Here is how malpractice lawsuit abuse, which drives up costs by itself, also blasts away money which could be employed more usefully. Doctors like Badia need to get permission for procedures and waiting often delays much needed care or surgery.

Each contributor is put in perspective with running commentary from Dr. Badia that creates a seamless transition from point to point. Healthcare from the Trenches should serve as a wake-up call and must be read by consumers, medical pros and politicians.

Flatly stating that the U.S. healthcare system is indeed the world’s finest, partly due to creative innovation, the final section of Badia’s “get well” book is replete with solid ideas for helping to heal a sickened system.

Brad Butler, Author of A World Flight Over Russia

[Kaitlin Martinez · Rating 5 out of 5]

Who needs to read this book? Everyone who wants to put “care” back into health care!

Dr. Badia’s “Insider account” on US healthcare “From The Trenches” details not only his journey to becoming an orthopedic specialist in the healthcare industry, but how his time working in hospitals, then running his own private practice has given him insight into some of the bigger picture issues in US healthcare like: reliance on hospitals for non-emergency situations, overcrowding in hospitals that lead to long wait times for patients and doctors, insurance hurdles that keep doctors from being reimbursed, and patients from seeking more affordable preventative care and the list goes on…I know it’s a lot, but if you really want an in-depth look at our healthcare system, I encourage you to pick it up.

What I appreciate most about Dr. Badia’s account is that he focused on common sense solutions as well as problems in the US healthcare system, like centralizing diagnosis, surgery and therapy at a non-hospital setting to make getting non-emergency care easier and more affordable for us, patients. As someone who has PPO insurance, I appreciate that I don’t need a referral to see a specialist, and I can go out-of-network if needed. Basically, I like that my insurance plan eliminates redundancy and gives me options. With this personal healthcare experience in mind, Dr. Badia’s centralizing solution (which he coined as OrthoNOW for his one-stop-shop for orthopedic care) makes a lot of sense to me. I also appreciate that while his logic was heavily anecdotal, he also referenced numerous studies to give greater context and weight to the stories he shared, and focused on patient impact, as well as his own experience on the clinical side of the fence. I think anyone can glean something from his in-depth assessment of our healthcare system with us, patients, in mind.

“We need to shock folks into a discussion ‘across the aisle’ and finally work towards positive change. Our politician counterparts have become more polarized as of late, and recent challenges this country is facing, including COVID-19, demonstrate how this impacts all of us. It is no different in healthcare. How Ironic that a medical crisis may now shock both sectors of society – government and healthcare – to compromise and pursue real progress.”

And while I personally do not agree with his stance against government regulation of healthcare, I can appreciate his attempt with this book and other healthcare efforts to “reach across the aisle.” In fact, I put that aside when reading the book. His examples of frustrating government bureaucracy helped me understand his resistance to government intervention in healthcare, and the importance of having patients and clinicians be the key influencers in healthcare. Because of this experience, I think the book is still helpful for people wanting to learn more about the complexities in the healthcare industry (which I learned, there are MANY), regardless if they are for government involvement or oppose it.

[Andrew Adams · Rating 5 out of 5]

Fantastic book to bring physicians’ perspective to light

Dr. Badia’s and his medical colleagues bring the physicians’ perspective to light in a clear and compelling way. From the years of training to become leaders in their field (a decade plus in many cases) to the complex patients who can only be effectively treated by these expert physicians. Dr. Badia’s stories of saving limbs and functionality (the ability of his patients to continue to use their hands or arms after a trauma) are amazing. It gave me a new appreciation for the incredible doctors who dedicate their careers and lives (that’s what it takes) to helping patients.

Yet, as Dr. Badia and his colleagues outline in Healthcare from the Trenches, physicians are working in an increasingly difficult environment, where large insurance companies often influence how physicians treat their patients and then withhold payment or fight tooth and nail to not pay the physicians fairly or timely for the life and health saving work they perform. And how various parties take advantage of the altruism of physicians for their own gain. Or the aggressive malpractice lawsuit environment that have forced many physicians away from treating patients in certain hospital settings.

Why have we allowed the most talented, dedicated group of people (IMO), the physicians at the center of patient care who have trained for decades to be able to work the miracles they perform to save lives and health, to be treated so poorly, while management at insurance companies and large health systems take home the lions share of profits?

Fortunately, there are some very specific things you can do to demand change: 1) vote with you feet - go to Dr. Badia’s orthopedic walk-in clinic and others like it. There are many brilliant physician entrepreneurs around the country that have developed new patient care models. The result - you get faster care, you get the right care, and you get to avoid the hours of waiting in a hospital ER only to be stuck with massive bills. 2) talk to your employers who set up your health benefits. There are options for health insurance that don’t start with BUCAH. Demand that we start paying physicians more and paying less in the form of profits to the big insurance companies who add little value, extract massive profits, and interfere with patient care often in directly conflict with your physicians care plan. 3) Appreciate the years of training and dedication your doctor has endured to be able to treat you. Honor their massive contributions to you and society. Don’t fight the doctor’s office and pay your copays on time; don’t get too upset when you have a longer wait to see the doctor (who may have been pulled into an emergency surgery to save a patient, for example); and don’t partake in frivolous lawsuits against doctors.

[Mrs. Varela · Rating 4 out of 5]

Dr. Alejandro Badia shares his viewpoints on a topic that is affects us all. Healthcare in the Trenches: An Insider Account of the Complex Barriers of U.S. Healthcare from the Providers and Patient's Perspective is an informative book about the healthcare industry from the physician to the patient plus the middlemen - the insurance industry and the government. Throughout the book readers will also learn about Dr. Badia as a person, as a medical student and as hand and upper extremity orthopedic surgeon.

As medical doctors across the country tirelessly struggle to treat Covid-19 patients, high healthcare costs are a major issue for those of us who have lost health insurance or have high co-payments and deductibles. For this point the title is quite fitting, both doctors and patients are literally in the trenches. Although Dr. Badia is an orthopedic surgeon, he understands the urgency of the current situation. His intention in this book is to help readers realize the challenges doctors are facing to provide us with quality medical care.

The author uses many examples of how he and his patients have had to jump through hurdles to give his patients the best care. He discusses the differences between healthcare in other countries from the U.S. and adds several eye-opening stories from his colleagues who share his frustrations with our healthcare system. As readers learn how his facility operates, they will understand where his concept of quality healthcare could possibly make a difference. He tells readers of countless times he has approached local government in the state of Florida to share cost-effective ways to lower healthcare costs only to be given the runaround. With hopes dashed of reaching the ears of Washington politicians, Dr. Badia encourages patients to use their voices to help improve our healthcare system.

This book is very enlightening for patients and medical professionals across the world. It should be essential reading for medical students.

[Ronald J. · Rating 4 out of 5]

Dr. Badia is an orthopedic surgeon and a “reluctant healthcare entrepreneur.” He started OrthoNow, a full service clinic to deal with hand and upper extremity injuries, surgeries, etc. He’s an immigrant from Cuba, now practicing in Florida. The book is part biography, dealing with his years as a medical student, residency, etc. He then diagnosis the troubles in the USA’s healthcare system: hospitals are too expensive (1/3 of healthcare spending happens here); government regulation; health insurance; medical malpractice and tort reform; trial lawyers; popular media. He also deals with doctor burnout, more about what he calls moral injury—not being appreciated or valued for the work you do. He makes a lot of sane proposals to reform healthcare to get more value for what we spend. Ambulatory Surgery Centers, health saving accounts, etc. I didn’t there was enough emphasis on heath savings accounts and getting insurance for only those things you cannot afford, but Dr. Badia is not an economist. Many of the stories he tells, along with contributions from patients, doctors, etc., will resonate with anyone who has had contact with the medical bureaucracy. My only complaint about this book is it is far too long. Though I found Dr. Badia an amazing person, highly skilled and dedicated to his profession, and many of his stories were fascinating, the book dragged on in parts. That said, it proves that medical entrepreneurs will show the way out of our current medical morass, proving that the free market can work. I don’t think Dr. Badia is right that the patients will be a big part of the reform. Innovation happens on the supply-side, not the demand side, and Dr. Badia’s own clinic proves this fact. Give people more choices and they will gravitate to the highest value.

[Rachel · Rating 5 out of 5]

What a timely read. With the world so focused on COVID-19, healthcare in America has become more of a hot button issue than ever. No matter where you stand on the healthcare debate, it is clear that something needs to change. In Healthcare from the Trenches, Dr Alejandro Badia offers an inside perspective on how the American healthcare system works, and how, especially in recent years, it continuously fails the American people.

Told with lyricism, wit, intelligence, and heart, Dr. Badia recounts his own journey through medical school and his training as a hand surgeon. He shares stories of pain and triumph, humor and sadness, as he points to the maddening bureaucracy that embroils the American healthcare system. He dares to ask why entrenched politicians, sensationalist media, and fiery popular opinion are able to make such lasting changes to the medical system without consulting the people who know the most about it—its doctors and patients.

A stimulating and fascinating read, I cannot recommend Healthcare from the Trenches more highly. Dr. Badia has a wealth of information to share about what it’s truly like to be a doctor in the United States, if only we would listen.

[Timothy Swartout · Rating 3 out of 5]

This book brings to light to the average American many of the frustrations felt by healthcare providers due to the constraints of the US health system. Dr. Badia discusses many situations using various and true-life anecdotes in which many healthcare workers will recognize to some degree an analogy in their own careers.
The bottom line is that healthcare in the US is costly and inefficient when compared to other industrialized countries. Dr. Badia points fingers at the usual suspects; for-profit insurance companies and healthcare administrators making millions of dollars more than those who sacrifice daily to heal people and I tend to agree with him.
The book is easy to read for all, including laymen with no medical background. It definitely needed a much better editor, as countless typos abound throughout the book.
The US healthcare system certainly needs, and we Americans certainly deserve, an overhaul of the system.
Good luck with that....

[Jennifer Paige · Rating 5 out of 5]

overall a good perspective on the state of medical care in 2023

As a veterinarian, and a patient of Dr. Badia’s, I saw much of my own health care experience in this book both from my professional experience and the handling of a work related injury that could have ended my career. I have chosen NOT to have health insurance for many years and instead saved for my own care along with a catastrophic policy. When injured at work, workman’s comp delayed my treatment and declined care. If I had been allowed to cash pay in my state my injury would have been treated a year earlier. The procedure Dr. Badia used resolved my pain and had me back to partial work at least 6 weeks earlier than other options, but is not covered by traditional insurance. We all have to push for reform in this industry and this book gives a unique look at the problems and possible solutions. Worth a critical read and consideration. Appreciated the many hyper links to additional explanation and resources. Some readers will find the medical jargon a bit cumbersome.

[Judy Eaton · Rating 3 out of 5]

I was hoping for more patients stories…

[HR-ML · Rating 3 out of 5]

Non-fiction. I thought Dr. Badia at times spun
his wheels complaining about medical insurance,
government regs, big hospitals and medical
liabilities. I got to almost halfway and skimmed
the rest. Gave this 3 stars.

Dr. Badia, a Cuban-American, attended Cornell U.
and the NYU medical school. He had fellowships
and did some research. He learned medical
approaches/ practices from fellow MDs in Germany,
France, Italy. Badia was very smart. He got some
push-back from fellow doctors when he wanted
to try innovative approaches.

Dr. Badia specialized in orthopedic study/ practice
of upper limb problems, especially the hand. He
joined a medical practice in Miami, he was the 2nd
MD, which eventually grew to 5 doctors.

Good aspects.
1) His family background and medical training.
2) Patient stories (w/ permission).

So so aspects.
1) He was not fond of a primary care doc as
gatekeeper. He thought most patients needed
free-standing Urgent Care & best to reserve
the ER for heart attacks, strokes, heavy bleeders.
2) He wanted the ortho doc to be part of an
ambulatory surgery center where he/she could
see the patient from start to finish.
3) He thought surgeons should charge based
on how many hours spent in surgery on one
patient. One patient accidently cut off 4 fingers
with a circular saw. Badia & an ortho doc in his
practice took 5 hours for both to successfully
re-attach the 4 digits.
4) He thought government regs impeded MDs
from doing the job he/she was trained to do.
5) He thought the AMA out of line to support
the creation of "Obamacare." Ironically the
AMA fought the creation of Medicare. (I have
a book about this).

I'm a retired social worker who had 2 jobs in
health care. In my experience MDs order tests
but really don't care-can the patient afford this
test or procedure? Patients have co-pays and
deductibles & medication costs and hidden costs.
One specialist told me I'd have to pay 1/2 'up-front'
on a $2K procedure, in case medical insurance
did not pay. Is this legal? Badia was not keen on
HIPPA. Patients need medical info privacy,
sometimes from their birth family or offspring.
Some only want Mom, Dad, Uncle or Grandpa's
Social Security # to clear out her/ his bank account.

Dr Badi needs to understand finding an MD &
transport to/from is not easy. Try waiting 2-6
months to see a specialist. Some of my homeless
clients said to Walgreens- give me $10 bucks
of blood pressure medicine. (I subsequently linked
the patient to medical insurance.)

The ideal medical insurance planning team would
have MDs, nurses, allied health workers, dentists,
pharmacists, government CMS administrators,
insurance companies, & a cross section of patients.
And medical transport providers. And government
regs protect the medical consumer from scammers.
This doc had more to learn.