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The Hospital: Life, Death, and Dollars in a Small American Town

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USA Today's 5 BOOKS NOT TO MISS The Washington Post's 10 BOOKS TO READ IN MARCH Fortune's 11 BOOKS TO READ IN MARCH From the C-suite's tension-filled strategic planning meetings to life-or-death moments at the bedside, Alexander nimbly and grippingly translates the byzantine world of American health care into a real-life narrative with people you come to care about. -- N USA Today's 5 BOOKS NOT TO MISS The Washington Post's 10 BOOKS TO READ IN MARCH Fortune's 11 BOOKS TO READ IN MARCH From the C-suite's tension-filled strategic planning meetings to life-or-death moments at the bedside, 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....details how we've created the dilemma we're in. -- 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.


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USA Today's 5 BOOKS NOT TO MISS The Washington Post's 10 BOOKS TO READ IN MARCH Fortune's 11 BOOKS TO READ IN MARCH From the C-suite's tension-filled strategic planning meetings to life-or-death moments at the bedside, Alexander nimbly and grippingly translates the byzantine world of American health care into a real-life narrative with people you come to care about. -- N USA Today's 5 BOOKS NOT TO MISS The Washington Post's 10 BOOKS TO READ IN MARCH Fortune's 11 BOOKS TO READ IN MARCH From the C-suite's tension-filled strategic planning meetings to life-or-death moments at the bedside, 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....details how we've created the dilemma we're in. -- 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.

30 review for The Hospital: Life, Death, and Dollars in a Small American Town

  1. 4 out of 5

    Jen Juenke

    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 r 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.

  2. 5 out of 5

    Nancy

    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 b 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.

  3. 5 out of 5

    Susan

    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 b 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.

  4. 5 out of 5

    Laurie

    This is definitely a compelling, yet disturbing book regarding a small hospital and "survival of the fittest" in these days and times. How do hospitals stay afloat? It has gotten worse as economic turmoil has flourished. However, hospitals are needed and top notch care will be forever in demand. It is difficult and challenging to "make it" when huge corporations are your competition and you always operate in the "red". This is a novel of despair, opposition and hope that it CAN be done! This is definitely a compelling, yet disturbing book regarding a small hospital and "survival of the fittest" in these days and times. How do hospitals stay afloat? It has gotten worse as economic turmoil has flourished. However, hospitals are needed and top notch care will be forever in demand. It is difficult and challenging to "make it" when huge corporations are your competition and you always operate in the "red". This is a novel of despair, opposition and hope that it CAN be done!

  5. 5 out of 5

    Patricia Becker

    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 th 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.

  6. 5 out of 5

    Tammy Schoch

    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 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.

  7. 5 out of 5

    Donna Boyd

    The Hospital Life, Death and Dollars in a Small American Town, by Brian Alexander is an eye opening account of America's health care system as it plays out in a community hospital in Bryan, Ohio. It brings to life the fact that America's health care system is in trouble and until we begin to address the root causes of this health care crisis, things will never change. Alexander gave a face to this issue by introducing us to people who are struggling right now. People who are living off of Social The Hospital Life, Death and Dollars in a Small American Town, by Brian Alexander is an eye opening account of America's health care system as it plays out in a community hospital in Bryan, Ohio. It brings to life the fact that America's health care system is in trouble and until we begin to address the root causes of this health care crisis, things will never change. Alexander gave a face to this issue by introducing us to people who are struggling right now. People who are living off of Social Security where getting a prescription for $20 less makes a huge difference. People who support their family off of the wages from a fast food job and cannot afford the medical care they need. A diabetic who cannot afford to eat the healthy food that his disease requires but instead exists on canned and frozen food. But in this case, it is not just the people that are struggling, it is also the hospital. The hospital is losing money and is fighting for its own survival. This is an inside look at how medicine really does work in the United States and it is not encouraging. I recommend that everyone read this book. Thank you to NetGalley for providing me with a free digital copy of this book prior to publication in exchange for my honest review.

  8. 4 out of 5

    TEELOCK Mithilesh

    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 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.

  9. 4 out of 5

    Jennifer Schultz

    Read if you: Want an unflinching and eye-opening investigation into our health care crisis, through the struggles of a rural hospital in Ohio. The early days of COVID-19 in the area are briefly chronicled near the end, so it's extremely timely. Librarians/booksellers: This is an important and very personal read, epecially in our current health climate. Many thanks to St. Martin's Press and NetGalley for a digital review copy in exchange for an honest review. Read if you: Want an unflinching and eye-opening investigation into our health care crisis, through the struggles of a rural hospital in Ohio. The early days of COVID-19 in the area are briefly chronicled near the end, so it's extremely timely. Librarians/booksellers: This is an important and very personal read, epecially in our current health climate. Many thanks to St. Martin's Press and NetGalley for a digital review copy in exchange for an honest review.

  10. 4 out of 5

    Scott Whitmore

    I was born in a town in the American Midwest just a bit smaller than the one featured in The Hospital: Life, Death, and Dollars in a Small American Town. I drew my first breath in that town’s community hospital, as did my wife – one year later to the day, in the same delivery room and with the same doctor attending. To say this book resonated with me would be an understatement. In Bryan, Ohio, I recognized my birth town, and in the people described I recognized those I lived beside for my first I was born in a town in the American Midwest just a bit smaller than the one featured in The Hospital: Life, Death, and Dollars in a Small American Town. I drew my first breath in that town’s community hospital, as did my wife – one year later to the day, in the same delivery room and with the same doctor attending. To say this book resonated with me would be an understatement. In Bryan, Ohio, I recognized my birth town, and in the people described I recognized those I lived beside for my first two decades. I am intimately familiar with their financial and personal struggles, and also with their prejudices and the willful ignorance exploited so effectively by politicians and corporations. So effectively that many in that area reliably support political policies that are harmful to themselves. I’d be a liar if I didn’t admit to fearing what my life would be – who I’d be – if I hadn’t enlisted in the Navy. In the nearly forty years since leaving, I’ve only returned for a handful of short visits, none in the past twenty-plus years. The glimpses obtained through social media and family are enough. Much of The Hospital focuses on the struggle to maintain the independence of Bryan’s Community Hospitals and Wellness Centers (CHWC). Independence, as opposed to becoming one more facility in a regional health chain, generally means highly quality of care for patients but also greater cost. So much so that independent hospitals have steadily disappeared from the landscape. Indeed: the community hospital I was born in no longer exists, having first been absorbed by a regional health system and then the actual building was demolished after the services moved into a newly constructed, smaller, facility outside of town. The author does an exceptional job explaining how that happened, weaving lessons about the history of health care and community hospitals in America seamlessly into a narrative that is laser-focused on the human impact of our dysfunctional health care system. The struggles of working-class people, some holding multiple jobs yet living paycheck to paycheck, are vividly described. As are the efforts of those trying to help them despite a tattered, barely-existent safety net. The book closes with the arrival of the COVID virus, and I can’t but wonder what happened next for the hospital, its employees and those it serves. Perhaps there will be a follow-up. Perhaps this once-a-generation event will spur much needed reforms and the acknowledgment that high-quality, affordable health care for every human is a right, not a privilege. But then I come back to these words from a social worker: “There’s nothing you can really believe in. We say we hold these American ideals, but then we don’t live by them.” The ideals, she said, are fake. “They are like clothes,” she said. “We put this stuff on the outside, but inside—who we are? Who are we? “We say we believe in people working hard, and people being true and honest, but we don’t really believe that. We have set up a society in which people are not paid enough wages to buy the products they are producing. Companies want more and more profit and less and less well-being for their workers” while simultaneously projecting “impossible standards of what a successful life in this country looks like. But [people] are not paid enough to achieve it.… “We were built on the idea of the American Dream. You pull yourself up by bootstraps. You work hard—and that’s all true—but people must have opportunities to work hard, and I mean work hard so you get ahead and things get better for you. But then they don’t. ..." – Alexander, Brian. The Hospital (p. 133). St. Martin's Publishing Group. Kindle Edition.

  11. 4 out of 5

    Miriam

    Have you ever wondered how hospitals and health insurance work? Read this! Within the pages of this engaging book, you’ll travel to Bryan, Ohio in Williams County, the most northwestern county in the state. The county borders Michigan and Indiana and is entirely rural. The biggest employer is Community Hospitals and Wellness Centers (CHWC), an independent non-profit hospital and associated clinics. It’s the only hospital in the county. Reading this book, you’ll learn about the history of Bryan’s Have you ever wondered how hospitals and health insurance work? Read this! Within the pages of this engaging book, you’ll travel to Bryan, Ohio in Williams County, the most northwestern county in the state. The county borders Michigan and Indiana and is entirely rural. The biggest employer is Community Hospitals and Wellness Centers (CHWC), an independent non-profit hospital and associated clinics. It’s the only hospital in the county. Reading this book, you’ll learn about the history of Bryan’s independent hospital, the development and shifts in health insurance, changes in the economic fortunes of the residents of the county and the hospital itself. Brian Alexander peels back the mysteries behind medical care, how hospitals operate, are funded, and how they survive financially. You’ll learn how Medicare and Medicaid (and Obamacare) cover and don’t cover its subscribers and hospitals, where the profits and loses are, and how much health insurance, medicine, and supplies have increased over the past several decades. There’s more to the story within “The Hospital.” Alexander follows the lives of several residents of the county, how their financial status changes with the closure of businesses, how they make ends meet, or don’t, and how their health is affected by these changes. Alexander writes about the effect of diabetes and obesity on the poor, the cost of insulin and healthy food, and the shifting middle class that’s slid into the lower/ poorer classes and what that’s done to the physical and mental health of everyone. There are chapters that talk about economics and insurance, about the drug industry and pharmaceuticals, and government programs. There’s not much on the opioid epidemic although there’s lots of the treatment and costs of diabetes and the problems of putting off well-care until it becomes acute. Much like “Glass House: The 1% Economy and the Shattering of the All-American Town,” Alexander’s book about Anchor-Hocking and the economic changes in Lancaster, Ohio, “The Hospital” examines the decline of life in (rural) America and what that means for the health and welfare of our nation. “The Hospital” by Brian Alexander ends in August 2020 as the nation deals with the ravages of COVID-19 on hospitals, health care, and jobs. When you finish “The Hospital” you know there’s more to the story, for COVID-19 and the efforts to out-run the disease has damaged the life, livelihood, and welfare of many if not all of the residents of every town and city in the nation. “The Hospital” is a snapshot of “Life, Death, and Dollars in a Small American Town.” Thanks to the BookLoft of German Village (Columbus, OH) http://www.bookloft.com for a copy to read a review

  12. 5 out of 5

    Janet

    Date reviewed: October 18, 2020 When life for the entire universe and planet turns on its end and like everyone else you "have nothing to do" while your place of work is once again closed and you are continuing to be in #COVID19 #socialisolation as the #secondwave is upon us, superspeed readers like me can read 300+ pages/hour, so yes, I have read the book … and many more today. I requested and received a temporary digital Advance Reader Copy of this book from #NetGalley, the publisher and the aut Date reviewed: October 18, 2020 When life for the entire universe and planet turns on its end and like everyone else you "have nothing to do" while your place of work is once again closed and you are continuing to be in #COVID19 #socialisolation as the #secondwave is upon us, superspeed readers like me can read 300+ pages/hour, so yes, I have read the book … and many more today. I requested and received a temporary digital Advance Reader Copy of this book from #NetGalley, the publisher and the author in exchange for an honest review. From the publisher, as I do not repeat the contents or story of books in reviews, I let them do it as they do it better than I do 😸. 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. Being seriously connected to two small-town/city hospitals (Welland and Sarnia) and one very large (LHSC) I was drawn to this book and so happy that I was approved. (So happy that it will be our book club pick for April 2021!) I could see and understand every bit of this book and anyone with an interest in health care, health insurance and small towns can identify with this book. The medical industry is very different in the USA vs. Canada where I live but it was very easy to identify with both the hospital and the patients. It is a searing book that begs to be read by people and book clubs everywhere. I cannot recommend it more than saying. READ THIS BOOK....READ THIS BOOK...READ THIS BOOK...!!! As always, I try to find a reason to not rate with stars as I simply adore emojis (outside of their incessant use by "🙏-ed Social Influencer Millennials/#BachelorNation survivors/Tik-Tok and YouTube Millionaires/snowflakes etc. " on Instagram and Twitter... Get a real job, people!) so let's give it 🏥  🏥  🏥  🏥  🏥 

  13. 5 out of 5

    Sarah

    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 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?

  14. 4 out of 5

    Jesse Cole

    This book was frustrating to read because, so many times, the author comes *so close* to getting it. He paints a vivid picture of how sick America is today, and correctly attributes that sickness not just to lack of access to health care, but more broadly to the social & structural determinants of health. Occasionally, he even uses the word "capitalism." I just wish he took these arguments one step further. The author seems to believe that America was once a constantly-improving society striving This book was frustrating to read because, so many times, the author comes *so close* to getting it. He paints a vivid picture of how sick America is today, and correctly attributes that sickness not just to lack of access to health care, but more broadly to the social & structural determinants of health. Occasionally, he even uses the word "capitalism." I just wish he took these arguments one step further. The author seems to believe that America was once a constantly-improving society striving towards Democracy (lol), but around the time of the Reagan Revolution fell victim to 'crony capitalism' and transformed into a country of the 1%. Given how well-researched other parts of this book were, I was frustrated by this white-washed, revisionist understanding of American history. This book is filled with detailed, heartbreaking vignettes of people in Bryan, Ohio who are very clearly being slowly killed by capitalism, followed by arguments that this is the fault of capitalism gone awry, or perhaps the fault of the modern-day GOP. I wish the author could realize that all the suffering he bore witness to was American politics and capitalism working exactly as designed, and proof that these structures must be abolished to achieve a healthy country. Finally, the author makes only intermittent references to the vast racial disparities present in virtually every metric of health in America. This, combined with the overwhelmingly white population of Bryan, and more alarmingly the author's willingness to excuse their bigotry, adds to this book's missing the bigger picture of the true war being waged in America by Capital and structural racism. Instead of reading this book, I recommend reading "Health Justice Now: Single Payer and What Comes Next" by Tim Faust. Like "The Hospital," Faust's book details the history and present standing of the American 'health care system' with intermixed vignettes of patient stories. This book, unlike "The Hospital," correctly attributes this suffering to capitalism working exactly as designed. Importantly, Faust goes further and makes a compelling argument for how single-payer health care can not only provide universal access to health care, but also leverage structural determinants of health to truly begin to heal this country.

  15. 5 out of 5

    Arun Murali

    The title of this book could have just as easily been "Life, Death and Dollars in a Small American Town" leaving out "The Hospital." The reason is that the stories that are captured in this book are as important as they regard the stories of individuals in the community who are dependent on The Hospital. As someone who works in the HealthCare industry, the trials and tribulations of the executives, providers, health care workers and administrators are compelling and very easy to empathize with. The title of this book could have just as easily been "Life, Death and Dollars in a Small American Town" leaving out "The Hospital." The reason is that the stories that are captured in this book are as important as they regard the stories of individuals in the community who are dependent on The Hospital. As someone who works in the HealthCare industry, the trials and tribulations of the executives, providers, health care workers and administrators are compelling and very easy to empathize with. After all, maintaining any semblance of independence in Health Care these days seems to be too steep a climb. This hospital and the story behind the book are a microcosm of the challenge all small businesses and community driven organizations face as larger, more well funded entities take over and consolidate the care of our communities in the modern age. There are compelling and heart wrenching stories of the patients who require care, and the administrators who strive to provide it - stories of providers who dedicate their entire lives to caring for patients who cannot afford to pay them for their services. This is a book capturing the hypocrisy of non-profit hospitals dominating the market place with their "profits." When you read this book, you feel like you know the people of Bryan, Ohio. You feel like you know the patients who need care. You feel like you know the administrators. This is an important book connecting the reader to middle America and the struggle to exist as we did in the latter half of the 20th century and what it means to these communities as we move towards the middle of this one.

  16. 4 out of 5

    alyssa miller

    Essential Reading I have worked in health care in the Midwest as an RN for over 20 years. This book is an elegant and masterful exploration of our past, present and potentially insurmountable disastrous approach to healthcare. I have borne witness to hundreds of patients who mirror the experiences of Keith and others described. We do not have a "health" care system in this country but a "sick" care system. I don't know who to attribute this quote to but it is profoundly and absurdly true: "our sy Essential Reading I have worked in health care in the Midwest as an RN for over 20 years. This book is an elegant and masterful exploration of our past, present and potentially insurmountable disastrous approach to healthcare. I have borne witness to hundreds of patients who mirror the experiences of Keith and others described. We do not have a "health" care system in this country but a "sick" care system. I don't know who to attribute this quote to but it is profoundly and absurdly true: "our system is set up in such a way that we don't want you to die, but we certainly don't want you to get better." Because we have allowed our sick care system to be a consumer driven model we equate more interventions ( in the form of costly prescriptions, diagnostics and procedures) with good care. The opposite is true. The social determinants of health are by FAR the most prognostic factors in wellness, longevity and positive outcomes. I am so exhausted by the politicization and monetization of access to healthcare and a living wage. The vast majority of Americans are suffering as a result of the profound income disparity in this country. It is so in-your-face OBVIOUS and has a historical roadmap detailing the results and ramifications of not correcting it. Yet many cling to the ridiculous and absurd rhetoric spouted by Trump and the 1980s joke of "trickle down economics". The emperor has no clothes people!!!!! I truly hope that people who NEED to understand why single pay healthcare is an essential step in rectifying the nightmare that has replaced the American dream will read this book.

  17. 4 out of 5

    Gaye Beckman

    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 maintai 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.

  18. 5 out of 5

    Susan

    Well-written, extremely disturbing look at the modern healthcare industry primarily seen through the lens of a rural Ohio hospital that is struggling to keep from being gobbled up by one of the huge healthcare systems, and the mostly low-income patients who show up at its ER in crisis because they can't afford regular ongoing care. The thread through all of it is 21st century capitalism that thinks everything should run like a business, deplores anything that smacks of "socialized medicine," and Well-written, extremely disturbing look at the modern healthcare industry primarily seen through the lens of a rural Ohio hospital that is struggling to keep from being gobbled up by one of the huge healthcare systems, and the mostly low-income patients who show up at its ER in crisis because they can't afford regular ongoing care. The thread through all of it is 21st century capitalism that thinks everything should run like a business, deplores anything that smacks of "socialized medicine," and doesn't care that "full employment" means people working 3 part-time jobs with no health insurance, or at best insurance with very high deductibles. And the bottom line is that until we address persistent poverty and income inequality, we will never be able to address healthcare issues. Not a very rosy outlook, and then COVID came along and made everything worse. As a social worker involved with mental health systems change, none of this is new information to me, but Alexander's ability to present historical background, healthcare policy, and stories of people doing their best but losing their health and their lives makes this book a compelling read for anyone who cares about our country's future. I had to look up Bryan's community hospital online to see if it remains independent in March 2021(view spoiler)[(it is) (hide spoiler)] , but even if it is, the deck is stacked against it.

  19. 5 out of 5

    Shannon Monnat

    Brian Alexander details the struggles of a small town hospital and tells heartbreaking stories about its residents to illustrate the larger tale about everything that's wrong with America's health care system. American health care is a ponzi scheme. A scam. We all lose, and some lose much more than others. Some especially compelling nuggets: "The modern American version of capitalism encouraged - even demanded - that employers extract value from their employees while returning scraps to them and Brian Alexander details the struggles of a small town hospital and tells heartbreaking stories about its residents to illustrate the larger tale about everything that's wrong with America's health care system. American health care is a ponzi scheme. A scam. We all lose, and some lose much more than others. Some especially compelling nuggets: "The modern American version of capitalism encouraged - even demanded - that employers extract value from their employees while returning scraps to them and their communities.The goal was to pay them as little as possible and to get as much work out of them as possible while taking the least amount of responsibility as possible. Too many people [are] being used the way mining companies used coal. Human beings were the object of an extractive industry. They are mined for their labor and their money. Too often they are a workforce and not people at all." "Few considered that something inherent in the way America had come to function was to blame." "There was nothing you could count on, and the insecurity bred by that knowledge had now been indelibly etched into the minds - and often the bodies - of every working person for the past 40 years." (On the effects of first econ restructuring and then the Great Recession)

  20. 4 out of 5

    Cooljoe815

    My three takeaway from the book are 1. hospitals like the food industrial complex have been taken over by big conglomerate greedy company. Independent hospital in Bryan, Ohio the story is about is surviving takeovers and mergers. 2. Small Hospitals are dependent on government as in this hospital 2/3 of the income from Medicare and Medicaid. 3. the health system hypocrisy is that is all about patient care but is in fact patients are customers and you need to squeeze every penny from them. Many are My three takeaway from the book are 1. hospitals like the food industrial complex have been taken over by big conglomerate greedy company. Independent hospital in Bryan, Ohio the story is about is surviving takeovers and mergers. 2. Small Hospitals are dependent on government as in this hospital 2/3 of the income from Medicare and Medicaid. 3. the health system hypocrisy is that is all about patient care but is in fact patients are customers and you need to squeeze every penny from them. Many are against the government running health care because they already inept and incompetent. but in fact with Obamacare, Medicaid and Medicare they are running part the health system. The prices of medicine keep rising, deductible are increasing and the quality of medical care has decreased. The author says the only solution which is not elegant but functional is Medicare for all. My recommendation for the author is to tie it all up. What are your thoughts about the system , some conclusion would have been nice. The final chapter touches upon Covid-19 I wished he would have spend more time on Covid because that is a game changer.

  21. 4 out of 5

    Lissa

    Investigating a small community hospital in northwest Ohio, this book follow the administrators trying to keep the hospital independent from the bigger conglomerates and the citizens struggling to make ends meet while struggling with terrible health concerns...and most of this takes place pre Covid-19. This is not an easy read, and I would not suggest reading it right now if you are not in a good place. It is a timely read, though, maybe one of the most timely I have read recently. The problems Investigating a small community hospital in northwest Ohio, this book follow the administrators trying to keep the hospital independent from the bigger conglomerates and the citizens struggling to make ends meet while struggling with terrible health concerns...and most of this takes place pre Covid-19. This is not an easy read, and I would not suggest reading it right now if you are not in a good place. It is a timely read, though, maybe one of the most timely I have read recently. The problems with healthcare in the United States are so deep-seated, that I am not sure there is an answer besides to tear it all down and start over. That's why this is such a depressing book to read...but one that needs to be in the hand of every elected official in the country. The only part that does provide an iota of hope are the hard working health care providers that continue to do their best and the people that keep getting up and trying again even after getting continuously knocked down. I received this book through NetGalley in exchange for an honest review.

  22. 5 out of 5

    Cynthia

    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 sh 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.

  23. 4 out of 5

    Randy Rasa

    A deep dive into America's deeply dysfunctional health care system, a monstrous tangle of interconnected and interdependent interests that all too often fails in it's main mission of protecting people's health. No sane person would design this crazy-quilt of a system, where each element is so invested in its own survival that it loses sight of its purpose, but we seem to be stuck with it. The focus here is on a small independent hospital in a small rural community, but the insights are very much A deep dive into America's deeply dysfunctional health care system, a monstrous tangle of interconnected and interdependent interests that all too often fails in it's main mission of protecting people's health. No sane person would design this crazy-quilt of a system, where each element is so invested in its own survival that it loses sight of its purpose, but we seem to be stuck with it. The focus here is on a small independent hospital in a small rural community, but the insights are very much applicable across the entire nation, and reflect problems far beyond healthcare. I live in a small town very much like the community profiled here, but I could have sworn many times that they were examining and explaining my town; the situations, though different in details, are exactly the same in the larger sense. I have never felt so seen. This is not a "fun" read. It is profoundly depressing, disturbing, and maddening. But this is an important book, if you want to understand where we are and how we got here.

  24. 4 out of 5

    Shivesh

    I wish the author was more discerning or critical of the decisions and behavior of the various parasitic careerists and corporate goons - including the CEO and all his gross underlings - in this masterstroke of journalistic investigation and broad cultural commentary on the very sick body politic that is the American medical system. Upton Sinclair is the closest comparison to this book, and it deserves all that praise. But I am especially sickened by the general incompetence and clownish mentali I wish the author was more discerning or critical of the decisions and behavior of the various parasitic careerists and corporate goons - including the CEO and all his gross underlings - in this masterstroke of journalistic investigation and broad cultural commentary on the very sick body politic that is the American medical system. Upton Sinclair is the closest comparison to this book, and it deserves all that praise. But I am especially sickened by the general incompetence and clownish mentality of the administrators that are supposed to know better by running everything, including a fundamental human right such as health care, as a frickin "business". If this was a free market and a true business, all these people would have been fired long ago and the government would have investigated all these hospitals at every level for price gouging, market manipulation and robbing the community of proper medical care.

  25. 5 out of 5

    Helen

    Well-researched, exceptional writing, thought-provoking. As a Canadian, I read this book purely for interest-sake and had to shake my head. For a country as powerful as the United States, the health care system is frightening. Canada has problems but there is a lot the US could learn from Canada's publicly funded health care system (universal coverage for medically necessary health care services provided on the basis of need, rather than the ability to pay). Perhaps not perfect with our long wait Well-researched, exceptional writing, thought-provoking. As a Canadian, I read this book purely for interest-sake and had to shake my head. For a country as powerful as the United States, the health care system is frightening. Canada has problems but there is a lot the US could learn from Canada's publicly funded health care system (universal coverage for medically necessary health care services provided on the basis of need, rather than the ability to pay). Perhaps not perfect with our long waits to see specialists, get tests or surgeries, slow vaccine roll-out, understaffed paramedics, etc. but we are constantly trying to improve. My pet peeve: people who avoid paying taxes. They'll call police, fire, ambulance, use roads and bridges and hospitals and schools but they can't bear to pay for it! Thanks so much to Goodreads for this wonderful giveaway win.

  26. 5 out of 5

    Marion

    This book was compelling, eye-opening, and devastating. Brian Alexander explores all aspects of the healthcare industry and really shows how reach sub-industry (pharmaceuticals, device makers, insurance, hospitals) have become capitalist, money-seeking oligopolies. In spite of having excellent providers, amazing medical treatments, and in spite of our country spending a ton of money on healthcare, U.S. residents have low life expectancy and absurd barriers to getting care. Alexander also shows a This book was compelling, eye-opening, and devastating. Brian Alexander explores all aspects of the healthcare industry and really shows how reach sub-industry (pharmaceuticals, device makers, insurance, hospitals) have become capitalist, money-seeking oligopolies. In spite of having excellent providers, amazing medical treatments, and in spite of our country spending a ton of money on healthcare, U.S. residents have low life expectancy and absurd barriers to getting care. Alexander also shows all the other factors that impact one’s ability to get care - including all the “social determinants of health.” He looks at low-income jobs that offer only high-priced insurance and the foster care system and a variety of other factors that impact how people spend make & spend money, and when and how much health care & medication they can access. This was a very well-researched book that makes a strong argument about how broken our system is, even when it is populated by people who want to provide quality care.

  27. 5 out of 5

    Kathleen Gray

    This is both illuminating and discouraging but it's also an important contribution if it makes anyone more informed on what's happening to health care in the US. Alexander has profiled the hospital in Bryan, Ohio = a hospital which could be a stand-in for one almost anywhere else except perhaps urban areas where the issues are tilted a bit differently but the same underneath. The crisis in insurance coverage and the politics of health care come into clear focus with the stories of individual pat This is both illuminating and discouraging but it's also an important contribution if it makes anyone more informed on what's happening to health care in the US. Alexander has profiled the hospital in Bryan, Ohio = a hospital which could be a stand-in for one almost anywhere else except perhaps urban areas where the issues are tilted a bit differently but the same underneath. The crisis in insurance coverage and the politics of health care come into clear focus with the stories of individual patients. Alexander spends a great deal of time with the CEO, Phil Ennen, who does as much as he can to keep the place afloat. It's well written and thoughtful without polemics (so easy when discussion the health care industry. Thanks to the publisher for the ARC. A good read.

  28. 5 out of 5

    Vnunez-Ms_luv2read

    This book took me back to a time when if you were sick, the doctor made house calls. Yes, I just gave my age away, lol, but it is too make an observation. I remember going to the doctor or hospital and the doctor/nurse took their time with you. This book highlights how much that has changed. Gone is the compassion that once was. Medical care is a business now with no compassion. No insurance? You may get medical care but it may also be subpar. The way the author presents the book is engaging. I This book took me back to a time when if you were sick, the doctor made house calls. Yes, I just gave my age away, lol, but it is too make an observation. I remember going to the doctor or hospital and the doctor/nurse took their time with you. This book highlights how much that has changed. Gone is the compassion that once was. Medical care is a business now with no compassion. No insurance? You may get medical care but it may also be subpar. The way the author presents the book is engaging. I appreciated the medical stories. They only add to the book. Wonderful read. Thanks to Netgalley, the author and the publisher for the arc of this book in return for my honest review. Receiving the book in this manner had no bearing on this review. Oh and by the way, I am a child of the 70’s, lol

  29. 5 out of 5

    Katie Bananas

    This review has been hidden because it contains spoilers. To view it, click here. 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, nurs 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.

  30. 5 out of 5

    Marika

    In the book "The Hospital," author Brian Alexander pulls back the curtain of how the medical healthcare system REALLY works in the United States. Alexander embedded himself in Bryan, Ohio, a typical small town with a small healthcare system. He follows the lives of local residents who are ill and in desperate need of prescriptions & healthcare but are caught in a system that they can't navigate. Readers will be shocked at how the system is seemingly against those who can't afford insurance; those In the book "The Hospital," author Brian Alexander pulls back the curtain of how the medical healthcare system REALLY works in the United States. Alexander embedded himself in Bryan, Ohio, a typical small town with a small healthcare system. He follows the lives of local residents who are ill and in desperate need of prescriptions & healthcare but are caught in a system that they can't navigate. Readers will be shocked at how the system is seemingly against those who can't afford insurance; those working and those who are unemployed. A must read for those interested in how medicine works in the U.S. * I read an advance copy and was not compensated

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