Book Review: The People's Hospital

Ricardo Nuila, The People's Hospital: Hope and Peril in American Medicine. New York: Scribner, 2023. ISBN: 9781501198045. 

Genre: nonfiction, memoir, history

Subgenre: medical, health care, United States, policy, Bad Economy 

Format: hardcover

Source: Hutchins Library, Berea College. I ordered this one for our collection. 

This is a book that can be moving, angering, upsetting, even a bit horrifying at times. Yet it also offers some moments of hope in the midst of the Hard Times.

Dr. Nuila, the author, works at Ben Taub Hospital in Houston, Texas. I picked up this book in part because it was about Ben Taub. I had a sojourn in Houston early in my librarian career, and one of the things about the city I was told early on is that if I ever got shot I would be taken to Ben Taub, that in Houston that was the hospital you wanted to go to if you got shot. However, in addition to being a local trauma center, Ben Taub is a hospital of last resort, a safety net hospital. It is basically the indigents' hospital. If you are poor and/or uninsured, and you have no place to go, or more likely other hospitals won't take you, especially if you don't have health insurance or vast wealth, Ben Taub will take you in and provide you with quality care. This is not easy, and there are costs given that health care always has costs, but Ben Taub and its doctors and staff make it work with compassion and finding funding wherever they can. Doctors at Ben Taub are what doctors everywhere should be: more concerned with patient care than money and fancy medical facilities. The difference at Ben Taub is that doctors treat you based on your need. At most other hospitals they treat you, if at all, based on what you can pay. Now some not so bright readers may chime in about emergency rooms and how they take everyone, it's the law. Well, not quite. An ER will take you and stabilize you at most, especially if you can't pay, and they will still bill you in obscene ways. Anyhow, the book goes over that, so go read it. 

The book is divided into four parts with 15 chapters. The author blends stories of specific patients with a look at his hospital and how it operates. Along the way we also get a history of hospitals and health care in the United States. Things could be a lot better in American health care, but let's be honest, Americans often make some seriously bad and selfish choices, and those choices have led to the medical industrialized disaster of for-profit American health care. It does not have to be that way, but unlike other civilized nations where health care is a right, Americans would rather let others die based on income than caring for others and sharing resources. I digress. 

The patient stories can be moving, and they can be gruesome at times. Some may have a good ending; others will not. A small detail in the reading is how some of the stories play out. When Dr. Nuila writes that so and so, who was relatively healthy and often young, chose to get the cheapest possible health insurance (assuming of course they have an employer that offers health insurance), you can hear the ominous shark movie music. You and I know what happens next: someone is getting medically royally fucked. 

If you have a heart, some empathy, and a sense of humanity, reading this may not be easy. Some details of patients' suffering are not easy to read. Learning how the U.S. health care system works, or rather does not work, can be frustrating and infuriating. To humane readers with compassion, they may find themselves asking "what the fuck?" and "how is this allowed to happen?" a lot. 

On the other hand, if you are a materialist right winger who worships capitalism and believes you only deserve health care if you earn it and are worthy, then this book will go right over your head. Although to be honest, I don't expect many of those selfish libertarian wannabe capitalists to read this book. That is often an issue with books like this: the people who actually need to read it and learn its lessons are not going to read it. 

A strength in the book is also in the historical overviews. Concepts such as medical wards, insurance coverage, and even patient privacy are well presented and explained. The author provides a lot of good information and demystifies a lot of the American health care industry, and it is an industry, often very inhumane. Another strength is that the writing is very accessible for common readers and/or people without medical backgrounds.

I recommend this book for public and academic libraries. Medical libraries need this in their collections as well. Here on my campus this book may be of interest to courses in general studies (GSTR 210, 410), sociology, nursing, and a couple other academic areas. Any students writing papers on health care in the United States and/or poverty in the United States needs to be reading this book. 

Overall I found this powerful book hard to read. It invokes a lot of emotions, and if you have any sense of humanity it will move you. If may also, if you are healthy, make you pray you never need health care services in the United States. I am not one of the healthy. I have my own health issues and, so far, I am lucky only because my employer offers semi-decent health insurance that does what I need (for now at least). If I was unemployed and/or indigent, I would likely have died in a ditch by now. There but for the amusement of the Cosmic Joker go you and me, a concept I wish more folks would take to heart (just insert your deity of choice). Again, I digress for a moment. Bottom like is this is a strong book but worth reading if you are willing to seriously consider its lessons and warnings and integrate them. 

4 out of 5 stars. 

Additional reading notes: 

What inspires this book: 

"The stories in this book are inspired by [Anton] Chekhov's portrayal of people hidden from us. But this book also shows what Chekhov didn't live to see: more people working to alleviate this suffering, and government, not charity, helping in this work. It is a love letter to the hospital, my hospital, where people find healthcare and revere it like treasure. It is also a letter to those sitting in positions of authority, to alert them to the consequences of failing to act with immediacy" (17). 

 

The three options for sick and uninsured in the United States. I am just listing them but do read the book for details on why these are not really options (see pages 31 and 32): 

• Find a clinic or doctor and pay cash (good luck on that). 
• Go to an ER (assuming you get it the bill you get after may well kill you). 
• Suffer through your sickness (what too many people end up doing).
   

The racket of for-profit care (and nonprofit care; they are not any better): 

"The promise of profit means each of these players is clawing and charging the others: insurance denies claims, hospitals inflate bills for insurance, Big Pharma ups drug prices to scrounge from insurance's profits. Let's call it 'Medicine Inc.,' then, this amalgam of healthcare suppliers in America, for its level of sheer conscience-less competition. It's not a perfect term, and it's not meant to disparage business or capitalism" (37). 

The above passage is also one of the various moments in the book where the author is not willing and/or able to go far enough. Business and capitalism do need to be disparaged and fully called out. The capitalistic American way is a key obstacle to having a good compassionate health care system in the United States, which most of the rest of the world already has. I wonder if his timid moment here reflects the fact he does work in Texas. 

A bit of what Europe did, which the United States could've done except asshole American doctors lobbied against it (they were not the only culprits, but again, read the book for details), another example of "I've got mine Jack, so fuck you!" 

"Europe played differently. In the nineteenth and twentieth centuries, many European countries restricted doctors' fees to keep healthcare affordable to the public. Healthcare access became a public good, with the government providing access to doctors and clinics for those who could not afford it. But American doctors lobbied against such a plan" (46). 

The doctors' excuse was fear of losing control of what and how they could, often arbitrarily, charge. The irony is that insurance companies just allowed them to bill even more because they can get away with it. It also means doctors who take insurance end up going along with what the insurance dictates. All very American and very capitalistic. 

So thus, what many American doctors do now: 

"But as healthcare grew more expensive and inaccessible, doctors tailored their diagnostics and treatments to what a patient could afford rather than the best course of treatment" (55).