Health Insurance does not equal Health Care: An American Sickness by Elisabeth Rosenthal

If you’re at all like me, Shonda Rhimes has permanently imprinted many of her TV characters on your brain. And, if you’re a diehard fan like I am, you’ve probably been watching Grey’s Anatomy from the start and following along through to the present 16th season, despite the death of SPOILER or SPOILER’s exit. No matter how many you have consumed in your Hulu or Netflix queue, just a handful of episodes may make you feel like a semi-pro doctor yourself.

I’ve found that conversations with care providers have gotten easier over the years because of how my level of comfort with the jargon has increased. And despite the call-outs many people make about how shows like Grey’s or House (2004-2012)—which I also watched closely when it was on air, and again a few years back—are out of touch with how diseases actually present or how this or that surgery really would have gone. Yet, if these are the only ways an average person is going to learn anything about medicine, why don’t we let them? The biggest criticism on all sides of the conversation about health insurance is that individuals need to advocate for themselves in order to receive better care. So, if delving into a fictional world showcasing actual fatal accidents and illnesses is going to make the viewer ask more questions at their next doctor’s visit for the love of Shonda just leave them alone.

In general, I consider myself to be pretty tough, as in, I won’t bother going to a walk-in for cold symptoms unless I know I’ve had a fever that won’t go away or I’m coughing up a viscous substance that is any color other than clear.

My husband, though, is a worrier.

We live down the street from a hospital (fun fact, it’s where I was born) and whenever I show any type of pain or discomfort for too many hours, he threatens to take me up the street to be checked out. I am quick to assure him that though I’m not good, I am okay and I haven’t reached the point of needing hospitalization and considering the up-charge on any and all tests and procedures, I will have to be at death’s door to find myself willingly going to the hospital.

The two times I have gone to the ER were in 2014 for a sprained ankle that woke me up at 2 a.m. and which I couldn’t even put a sock onto without screaming and would have gone without if it wasn’t January and my mother insisted; and in 2016 when my chronic leg pain presented so prominently in my hip that it felt like the ligament had been torn away from the bone and I wanted someone to do some damn imaging. For both instances I used my parents’ insurance and I won’t go again while on the insurance I pay for unless I’ve met my deductible and know I’ll be at an in-network hospital—this is the true way to learn the value of a dollar. Even with my obsession with Grey’s and my proximity to medical professionals in my personal life, I in no way claim to have all the answers or be an expert in insurance but I sure as hell know that the system is so far from perfect that it doesn’t make sense why more people don’t take issue with it as it is now.

Boots on the Ground

I had a long conversation with my mother-in-law, a nurse with 25 years experience in a pediatric ICU, ready to hear what it’s like for someone who spent most of her career with her boots in the muck of it all. In regards to the care she provides, she firmly believes that the patient comes first. There was one situation she shared which upholds her desire to take the fall for breaking the rules if it means saving a patient:

“Sometimes the hospital wants to cut nurses on the unit when it’s at low census [the number of patients on the floor] despite the high acuity [how sick patients are] of the patients are already there. I kept getting texts from my supervisor asking about the status and every time I told her we were at grid [status quo; not too many staff in relation to the census] even when we weren’t. I needed the extra nurses even though I should have cut them, but by the end of the night we were actually at grid, but we wouldn’t have been able to adequately care for the really sick kids without the extra hands. As the lead I have to justify to my manager why we need the extra staff but I wasn’t willing to compromise the care we were giving.”

She added that she’s been so successful and so well-respected by the other nurses and doctors at the hospital because of how trust is built in the hard moments. “I’ve earned it because of what I’m willing to do.”

And yet, she had to be realistic lest she put multiple lives at risk, she had to make the hard choices: “I was in transport and I already had one kid and no other nurses so I had to say I could not take another. I burst into tears, and I never cry. If they needed intensive care they wouldn’t get it, I couldn’t do anything else.”

Regarding insurance, she sees the good in how they provide due diligence for expensive tests like MRI and sometimes reject authorization where it isn’t deemed necessary. And because it’s tough to handle mentally, she recommends hiring a healthcare advocate who can contest large bills. “Even when you’re going through a scary diagnosis, take notes. I did and fought a large bill after I was quoted $397 but charged over $4,000.”

She was diagnosed with breast cancer in the spring of 2017 and received the news that she was one year cancer-free a few months back. It was tough on her not because of the harsh reality of the situation but because of how her family would react. She’s one of the strongest women I know. She had a rigid plan on how to get through treatment and not miss work or bend in any way toward giving any less of herself to her sons and she held herself to that high standard, bred from decades of living the hardest days of her life seeing children through the hardest days of theirs. In describing her journey through beating cancer, she reminisces:

“Twenty years ago, when I worked at the hospital, me and all of my family got any service covered, free. When my first son was born I left the hospital with a year’s worth of formula. With the next I got maybe half a year’s worth. With my third I got one case, and with the youngest, nothing. They rolled it all back. And when I was going to radiation before work every day for six weeks, I was a hospital employee and they tried to charge me a facilities fee.”

She was able to get it waived because she knew that the original phone call quoting the $397 was recorded and she wasn’t going to let billing get away with pulling anything over on her. She considers herself a good advocate and I agree. We also both agree that “the playing field needs to be leveled because the insurance companies have too much power.”

We spoke briefly on how the Affordable Care Act (ACA) affected not just her work but the patients. She said that Obama had the right idea, trying to make care more accessible to the average person, but the deductibles are still too high. Next year the An Act Concerning Paid Family & Medical Leave (PFMLA) will take effect in the state of Connecticut and adding a payroll tax that withhold 0.5% of a worker’s gross wages in order to contribute to a Family and Medical Leave Insurance Fund from which the employer can retrieve funds to pay the employee for up to 12 weeks of leave, 14 for pregnancy in a 12 month period.

My mother-in-law suggested opting for a tax that would instead fund group healthcare so that more people could really have more affordable treatment. I contested that we could have a sweeping federal law that would double down on how the ACA forces insurers to cover anyone with a preexisting condition and would add that all care providers (hospital systems especially) must also provide transparency to patients seeking treatment so that there are no surprises and so they’d be held accountable for any current morally questionable practices. She said it was too unrealistic and thought that adding the tax to make a huge HSA of sorts would be more beneficial and could happen quicker.

She went on to lament how, at present, the public health system fails the most vulnerable. In the urban hospital she worked in for so long, she has seen many people who speak little English will wait to seek treatment for themselves or their children because they don’t want to be prejudiced for speaking Spanish. Filling prescriptions especially becomes a big issue. She has gone out of her way to use her connections in private practices to make sure that her patients are going to get what they need even when they’re no longer her patient. She says, “The saddest part is that the underserved are the least medically educated. I’ve gone to court to beg judges not to send an undocumented child away because they’re so much safer here.”

A Personal Anecdote

One December I found myself without health insurance. I was at least a year off of my parents’ plan and by a mix of my own balking at an increase in my monthly premium and a communication error to the medical exchange representative, my insurance was cancelled. A month later I ended up buying temporary insurance to cover me through to the next enrollment period, but then, sick to the point I could barely keep my eyes open and my head felt weighted by lead and my throat constricted, I sat and waited alone at an urgent care, the only one near me which was associated with a hospital and could not turn me away despite my uninsured status.

I waited almost an hour, not bad for what is essentially a non-emergent ER, sniffling quietly in the corner, before I was called in by a nurse. She took down a description of my symptoms and said the doctor would be in shortly. However the next person to come into the room was in fact an employee from billing, not the doctor. She wanted all of my personal details and a credit card for my file. I told her I wouldn’t give her a card without knowing what the cost would be. She had a huge binder with her, surely with all the billing codes, but sat with one hand on the binder, the other extending an electronic tablet for me to sign so I could agree to the terms. I verbally disagreed. I pushed her to give me a range of what I could expect to pay. Keep in mind I hadn’t even been seen yet, nothing had been done. I hadn’t been touched with even a blood pressure cuff. She said maybe between $600-900 and I broke into tears of rage and confusion.

I was ill and wanted nothing more to be at home slurping soup and watching bad tv. I’d had pneumonia when I was 10 and the flu a few years later so I knew what more-than-just-a-cold felt like and I thought maybe I had strep or bronchitis, something in between the two I knew. I wanted someone to either confirm what I thought I was feeling so I could get on the right medication ASAP. Instead I got a stoic woman telling me that she couldn’t share what my being there would definitely cost me and that I couldn’t get care unless I agreed to pay whatever they decided to bill me afterward. I did what anyone else in my situation would do, if they could, and called my mom. She started crying too and said to just acquiesce and see the doctor and assured me she’d help me pay the bill.

I hung up. With a shaking voice I told the billing agent how absurd this was. I said I planned on paying for the service but they should be able to tell me what the total would be, in advance. I was uninsured, they didn’t need to do the dance with the insurance company, they would only be dealing with me and I was begging for a number and she refused to give it, likely to cover her ass for when the hospital inevitably decided to raise their rates to the max of what they knew someone as desperate as my sick self might pay.

She left me and I waited some more, this time sniffling from the tears and the illness. A young male doctor came in. He looked scared. I said I was upset about the exchange I had about billing. He said nothing about that and proceeded to examine me, asking why I was there. I explained the cough and the sore throat and the aching head and how I thought I had a fever earlier at work. He felt the lymph nodes in my neck, looked in my ears and my throat, and took a culture for a strep test. He gave me the spiel about how I would hear back in a few days only if the test was positive and he would give me a prescription for antibiotics which I was not supposed to fill unless I wasn’t getting better. I could pick up some Flonase and drink lots of liquids and rest and he could sign a letter to give to my boss if I needed to. I left.

At home I vented to my roommate at the time, one of my best friends, a critical care nurse who was then studying for a FNP degree (she just passed her boards a few weeks ago!) and always interested in talking through my curiosities or personal physical concerns. I explained what had happened and how I was feeling and she wondered aloud why the doctor hadn’t done a flu test. I was momentarily speechless. I screamed. Why hadn’t they done that test?

I stayed in bed for days, mostly ingesting just Day or NyQuil, one soup a day and some Gatorade or tea, sucking on whole bags of Ricola as I rewatched Mad Men for the 3rd or 4th time. I went back to work half days the following week because just walking downstairs to feed myself left me winded. My boss was blessedly understanding. It took 3-4 weeks for me to fully recover and around the same time I got the bill in the mail for my 5-minute doctor’s visit. It was $990. I blacked out whether or not there was breakdown included alongside the total. I was shocked even though I had been expecting this. I couldn’t comprehend how a strep test could be so much. Even though my mom has said she’d helped me pay, it didn’t feel right. I set the bill down and didn’t think about it for a while.

I believe I paid about $100 or so of it and kept getting paper reminders. I called the hospital asking them to explain it. They couldn’t. They said they could knock it down a little bit and I think I said I’d consider it. Months later it went to collections. I’d never been through that and I was first nervous, my whole body tingling, wondering if what I’d done was illegal, but as the woman on the phone read through everything and said I could close the case by paying, at that very second, $150. I conceded and put the balance on my credit card.

On the flip side of this, several years later I went to a specialist for my leg pain and was recommended I get compression stockings, covering me from my thighs down to my ankles, and wary of agreeing to anything my insurance may not cover, the medical assistant was rather forthcoming. She said the cost often gets rejected by insurance but if they can measure me and they have my size in the office, I can leave with them the same day. Without running through insurance they’d be about $32 each. How could I disagree with that? I paid my copay of $50 and the $68 for the stockings. The ultrasound of my veins was fully covered and of no extra cost to me.

Two months later I received a bill from the specialist and I wondered why they’d be charging me since I was sure that I’d paid everything I was meant to. The itemized list was blank but for one word, stockings, and the total amount owed and 30 days overdue was $68. I was fairly certain that I could find the charge to my debit card if it came to that so I called the doctor’s office. I explained that I’d received what seemed like an erroneous bill because I was sure I’d paid in the office. Without knowing my name or anything else, she asked if the bill was for stockings. I laughed. She said they have a new billing system and their patients keep receiving these bills; I hadn’t been the first to call. She told me to disregard the bill and checked my file, there she could see that I had paid at the time of my visit. It was possibly the most pleasant call I’d ever had with a provider’s staff. I hung up, feeling vindicated but also concerned for anyone else who had purchased the stockings at the end of the year and may have already sent in payment, overpaying by 100%. I wonder why the woman I spoke with hadn’t called ME or anyone else affected first.

An American Sickness

After reading Elisabeth Rosenthal’s (no relation) book on the business of healthcare, so much I already theorized about the industry from my own personal experience was proved correct. She prefaces the rest of the book with a heartfelt introduction where she also includes her “Economic Rules of the Dysfunctional Medical Market”. There are ten which she refers back to often, including:

“There is no free choice. Patients are stuck and they’re stuck buying American.”

“There is no such thing as a fixed price for a procedure or test and the uninsured pay the highest prices of all.”

And, “A lifetime of treatment is preferable to a cure.”

If handed a highlighter I would have marked up every single page of this book. It’s so informative and enraging, and the details Rosenthal dug up protect no one, not the legislators, not regional hospital systems, not national drug manufacturers…. The problems run deep.

Photo by Mel Rosenthal (@melannrosenthal)

One notable national case is in regard to professional ambulance services. Surprisingly, or not surprisingly, it wasn’t always the way it is now. In the mid-20th century ambulances calls were serviced by morticians. And yet, slowly, the people bringing the “customers” to the hospitals understood that they had power they were not using. At the turn of the century ambulance companies began charging fees and just ten years later ambulance transport was a lucrative business. Seeing the potential to make money hand over foot, cities and counties across the country began to bill more to insurance and increased the charges for ambulance rides, such that in LA alone, receipts show that the totals increased from $33 million in 2000 to $79 million in 2015. Rosenthal noted that some of the increase “resulted from improved billing practices.”

Another irksome example found while reading was how an increased incidence of Medicare coverage of MRIs in an Arizona hospital was clearly caused by a group of radiologists specializing in MRIs moving in. They had to conduct research so they manipulated the service being provided in order to do so. In almost any other line of work, this would get you fired. For example, I have worked in administration for my whole career and though if given the choice I’d rather spend all of my time leisurely reading or writing, I am not exactly getting paid to do whatever I’d prefer. It baffles me that there isn’t more oversight especially on tests like MRIs which, no matter where you are in the country, will cost someone (your insurer if not you) thousands and thousands of dollars.

There is a chapter titled “Preying on the Elderly, for Profit.” Do we really need more information than that to pursue aggressive action to change healthcare? Or is it more important to protect the billings of providers no matter the risks to the infirm? Some states provide caps according to what Medicare is willing to pay out for certain procedures, but Medicare as also slowly increased their caps for things like physical therapy, and like the increase in MRIs in that hospital in Arizona, with the increase in potential revenue for PT visits, so follows the increase in prescriptions for regular PT visits. That however, is a good example of how insurance can benefit a patient with more care, but pressuring older Americans into unnecessary procedures like colonoscopies when they are nearing death due to unrelated cancers or strokes, it really does start to look more like torture than care.

When I turned 26 I had a full-time job, but not benefits through that job so I was on my own to select coverage from the ACA. It was “revolutionary” to force the insurers to change their ways and drop the lifetime cap on payouts and stop using one-off abnormal test results or use of medication for mental illness as reasons to deem someone ineligible for coverage. As pointed out in her book, in order to remain profitable—as they were now required to insure people with pre-existing conditions who would thus be guaranteed to seek out care and use their plans—they decided to shift more financial cost onto the insured, in order to keep the premiums “reasonable”. If the deductibles were several thousand dollars, owed to whichever providers were sought out before the insurance plan would kick in, the patient would do more due diligence. Though the problem with that logic is two-fold.

First, for an average citizen it’s nearly impossible to find out the exact price tag of things like heart surgery ahead of time because of the opacity of hospital billing practices. The hospitals will also bill you for whatever they can get away with even if you went in for that heart surgery, you may also be billed by a neurologist if one came to say hello to you during recovery, and then of course any drug pumped into to you is going to be up-charged regardless of fair market rates. Rosenthal found that more than half of all hospital bills have mistakes in them. Sometimes the errors are such that a patient is being billed for care on a body part or system that was never actually addressed in the duration of their stay, but because billing codes make so little sense, the patient wouldn’t notice unless they hired a professional to review the itemization.

Second, even when you can get an estimate (subject to change, of course) for a major procedure or test, or even a doctor’s visit, the cost of using the insurance you have before you’ve met your deductible proves enough of a deterrent to simply avoid visiting any doctor. It is counterintuitive considering how high the premiums are, not to use the insurance unless forced to, and yet it’s perfectly understood by the millions of Americans who chose the higher deductible plans so that their premiums would be a little lower. Since the ACA the number of people choosing these plans has increased, but it is likely due to the fact that the inflation of the cost of medical care has far exceeded any increase in the incomes of the individuals signing up, and just paying each month to keep their insurance is all they can afford.

Why is it that every day Americans have to make the choice for themselves or a loved one between their livelihood and their life? And unless you have family members who are able to support you (for me that was my dad who paid my health insurance premiums last year), astronomical medical debt or years-long payment plans are going to be your only options. So is anyone really surprised when the relatively healthy avoid doctors altogether? In the long run, the way the insurance market plays with us is going to be detrimental, it already is. There are often discussions from financial conservatives about irresponsible use of emergency rooms, but we have shaped our system so that would-be patients with a little bit of money, cannot afford regular checkups until it’s too late and their health issues require immediate attention.

I’ve found that while I was uninsured, my dermatologist for example would be willing to take a flat rate of $150 at the time of my visit (sadly not feasible for many Americans) which I paid the 2-3 times that year I had to go in. And when I have been insured? When I saw my gynecologist for my yearly exam, I was billed a copay upfront, $50 due before seeing the doctor, and then charged hundreds more, which did not include the separate bill I received from a nearby hospital where my pap smear was sent.

For a couple years living in a big-ish city I was allotted a subsidy that lowered my monthly premium (which still became unaffordable as Republicans removed ACA pillars and total enrollment decreased), but that didn’t help me afford the actual care. At the end of 2017, I figured out how to best my insurer. As a lifelong sufferer of eczema, I’ve been through dozens of creams both steroidal and OTC and it was still so bad that year that my doctor recommended cortisone injections. It finally cleared me up. I knew though that I couldn’t exceed a handful of injections in a year and it was not a long term solution. My doctor knew of a biologic that was about to clear the FDA and so we waited for it. I went through the preauthorization process, I filled out all of the paperwork, and got my loading dose of Dupixent in December of 2017. Because it was so new, the drug company incentivized use by offering a copay assistance program for anyone making less than $100,000. That meant that as long as the drug was on my insurance’s formulary (a list of drugs that insurers offer varying levels of coverage on according to specific stipulations), and it was deemed necessary to treat me, that each month the specialty pharmacy would call me, set up the delivery, and bill the full amount $2,500 for a 30-day supply to my insurance, but the amount would be covered in its entirety by the copay assistance program. That meant that, finally, picking the high deductible plan was benefiting someone. The $2,500 each month applied to my deductible but not a penny was due from me. The assistance program was good for $13,000 every calendar year. So while the yearly cost of Dupixent is about $30,000, I only had to use $6,500 from the program before my insurance started kicking in to cover 100% of the cost of the drug. I still owed copays for every doctor I went to afterward, but there too, 100% of the actual cost of the visit or procedure was covered. Technically I still owed copays on Dupixent as well, but since I’d only used half of my yearly allowance, I still owed nothing. (Note: because my communication was predominantly with the pharmacy, I could never pinpoint exactly what the copay is less the cost of the drug itself, but based on mistakes made by the person on the phone arranging the delivery, I know it’s somewhere between $250-500.)

Would I have chosen to take Dupixent if I was not eligible for the copay assistance and had to pay the $6,500 of my deductible out of pocket? Absolutely not. I was desperate for a solution for my skin so I may have considered it, somehow getting a loan or something, but no, it’s unlikely I would have gone into that much debt for such an unaffordable drug. But if it was a new, miracle cancer drug and I had no other options? I’d likely say the opposite. Medical debt then would be acceptable. Or is it? Rosenthal’s advice is to end the “heist of our healthcare” driven by capitalism. In Japan the price for tests is determined by a panel of doctors, economists, and policy-makers. There, the cost of an MRI ranges from $92-$160 (plus $45 for the radiologist’s fee), depending on the resolution and age of the machine that is used. This figure provides a small profit on an old technology. In America though, our free market rules prevent fairness towards the patients because healthcare and drug lobbyists are spending more than defense contractors. (Rule number 2: “A lifetime of treatment is preferable to a cure.”) Currently we, Americans, talk more and more often about how much we spent on treatment because those effects are more lasting than the physical and mental effects of the pain or the weight of the chances of recurrence vs. remission, etc.

Months ago I came upon a video on Facebook which was a man-on-the-street style of interview over in the UK asking them, participants in socialized medicine, to guess what we, Americans, have to pay for various medical costs. To summarize, their guesses were far below the actual averages and their faces show how truly shocked they are. When asked to estimate the cost of an ambulance ride, one man asks if there’s actually a price for that and starts at $100, only to be told it’s really more like $2,500 and his mouth drops open. Another man asked the same question answers with $0. One woman raises her eyebrows at the $250-350 price tag of an inhaler and comments, “Man, so if you’re poor you’re dead.” When asked about childbirth a different woman quietly suggests $100 or $200 and she exclaims when told that it’s really more like $10,000 and could go as high as $30,000. The question that comes from most of the Brits is “why?” as in why are Americans subjected to these “mental” rates or why don’t we do something about it?

On Christmas day in 2013, a 50-year-old widow in Virginia was dismissed by paramedics called to her home at the insistence of her teenage son. She’d been vomiting and complaining of headaches and the paramedics said not to worry, it was just food poisoning. In the middle of the night she was disoriented and her fiancé rushed them both to the hospital where a subarachnoid hemorrhage was confirmed. The hospital was unequipped to deal with the emergency surgery she needed so she was airlifted to another. She made it through and recovered slowly, sent home about a month later. By April 2014, she wrote to President Obama. She said, “I survived. And other than some pain in my back and everyday headaches, I’m doing well. My children, my parents, and my fiancé, are all happy. I am not.” Uninsured, she’d been doing okay until she received five separate bills: $16,000 from the first hospital, not including the scan or ER doctor, $40,000 for the air ambulance, $24,000 from doctors at the second, bigger hospital, an additional $54,000 from that same physician's group, and then the main bill from the big hospital for $356,884.42. “My dad said ‘they’ll never expect you to pay that,’” she told Rosenthal, “But they did.” They offered the “standard” 20% reduction given to uninsured patients which left her at $285,507.54.

“She drove to the hospital to visit financial services. ‘The officer said we can put a lien on your house,’ she recalled. When I asked to confirm that the hospital had threatened to take her property, she replied, ‘No, I wouldn’t say threatened. I’d say she was offering that as a good solution.’ On the three-hour drive home she decided that she’d be willing to drain the retirement account, but would declare bankruptcy before giving up the house. It was an emotional time. ‘My kids got really upset because I said—and I meant it—if I’d just died, you’d have money for college. It would be better.’”

In 2016 John Oliver of Last Week Tonight with John Oliver, created a debt collection agency for $50, named it CARP (Central Assets Recovery Professionals) and purchased $15 million worth of medical debt for the low price of $60,000, and transferred the information and “debt” to RIP Medical Debt, a nonprofit, freeing each of the 9,000 individuals included of everything they had previously owed. His intent was to show the irresponsible practices of exchanging personal information like SS numbers in exchange for money, with which anyone else could have used to torture and further ruin the lives of those 9,000 people. And yet it does double work to show how easily manipulated the average and poor citizens of this country can be because someone somewhere decided they could charge whatever they wanted for life-saving procedures and they will continue to do so above all regardless of the effects on the life that will go on but may also live through a bankruptcy and an otherwise uncertain and unstable future.

No more. Educate yourself not just to be your own or your family’s best advocate, that’s a given, but read books like this one, ask “why” when confronted with high costs and zero reasoning other than “that’s the way it is,” and always always always demand itemized billing. Demand human treatment. Currently it is costing us everything we’ve ever worked for just to hold onto our lives. One might say it’s not worth it and they’d be right.

There are more of us, though. Just because we are struggling financially and don’t have the power right now doesn’t mean we can’t one day call the shots. But we have to know NOW how little the system is serving us so we can begin striving towards establishing one that has to answer to all of us and not just go on filling the pockets of board members and investors.

I must emphasize NOW because of the unprecedented moment we are living through. At the time of this writing the unemployed adults in the United States spiked from about 250,000 to over 3 million in a single week. They are going to be without any income for the foreseeable future. And due to the nature of… everything, health insurance is tied to those jobs too many people no longer have. If corporations may not bounce back without extensive bailouts, how are individuals supposed to fare any better? As the feds adopt temporary socialism to get through this crisis offering up free testing (though not free treatment) for COVID-19, and are working towards a stimulus package that will offer modest checks to workers, it’s important to point out that if we could have already trained the nation in seeking out regular healthcare because it is truly affordable not just pretending to be so. If we had years ago adopted socialism in a more serious way at least as it applies to trashing private insurance for more cost-regulated, state-funded care—America may have had the opportunity to get out in front of a pandemic, testing often and without bias to financial means or status.

We’re in a bind, America. This may truly be the harshest period that any of us ever see, but we can make it to the other side. If we make the right moves, fiercely calling out our representatives and adhering only to the advice backed by science, the America we’re living in when social distancing is over just might be a whole lot kinder and accessible to everyone. Hold onto that and any other hope you can grasp while we wait at home for that time to come.

An American Sickness

By Elisabeth Rosenthal

434 pages. 2017.

Buy it here.