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BOOK BOOK
REVIEW REVIEW

a small facility like CHWC. “Over years — over two generations — they’d become part of a cul-
The Health Care one day heaved and strained too far, blowing two discs in her lower ture of defeat, what doctors liked to call noncompliant … but noncom-
In Valerie*, we have an incredibly hard worker – three jobs! — who
pliant in a bigger sense. They no longer complied with society’s
House of Cards back. “Workers’ compensation covered her vertebrae-fusion surgery prescriptions. They were either unable or unwilling to obey. Maybe
and physical therapy afterward. But then the recession hit.” Her job
some of them had tried to obey, once, but obeying didn’t lead anywhere
disappeared. better, or obeying was just too difficult because everything cost so
By David Alex Schulz, CHP In the book, we see obesity, over-work, hypertension and cardiac is- much, or was so hard to achieve, and so they said to hell with it.”
sues as plaguing suburbs and cities alike. Alexander then discusses ad- Such attitudes, whipsawing people with contradictory messages and
diction as a public health issue. As Alexander points out, “Sociologists magnified by a media alarming the public, leads to a suspicious, dog-
If American health care were its own patient, "code blue" might be a had tried for years to tell politicians that drug abuse was a symptom, matic polarization that COVID-19 lay bare. “The Hospital,” while ini-
generous call. It has never been closer to flatlining, according to Brian not a cause. The kind of drug was irrelevant … alcohol might be more tiated years before the current crisis, deals with the pandemic as its
Alexander’s “The Hospital: Life, Death, and Dollars in a Small Amer- immediately dangerous than obesity, lousy dental care, poverty and low fitting epilogue, a capstone that provides fitting validation for Alexan-
ican Town.” His exam of natural and artificial forces acting on a typical wages, crummy housing, depression, trauma and anxiety. They were all der’s insights.
health care facility leaves the reader shaken and disturbed – particularly part of the same pathology, though, and arguing about which was
as the content largely precedes COVID-19. worse obscured the underlying causes of the abuse.” All quotes from “The Hospital: Life, Death, and Dollars in a Small
Alexander’s analysis of a system gone awry focuses on the Community Herein we find Alexander’s primary thesis: the isolating of health care American Town” by Brian Alexander, St. Martin's Publishing Group
Hospitals and Wellness Centers (CHWC) of Bryan, Ohio: a microcosm as a separate, biologic-only function fouls our approach from the begin- March 2021, Kindle Edition.
through which to see the whole. The author is a storyteller. “The Hospi- ning. To distinguish addiction, depression, or suicidal tendencies as sep-
tal” is a narrative history, not a chronologic recounting. Through the eyes arate from obesity, coronary-disease or cancer is to look only at the David Alex Schulz, CHP is a community member of the
of patients, physicians, staff and governance, we see generosity, greed and manifestations of a deeper, underlying and more widespread epidemic. BCMS Publications Committee.
the effects of happenstance and planned malfeasance.
In Bryan as elsewhere, public service health care only gained mo-
mentum after the Spanish Flu, but relations between private and public
medicine, both competitive and cooperative, created an immediate,
persistent tension. Alexander says that as early as 1929, “The AMA
and local medical societies acted like cartels to block experiments in
medical payment that sought to make care affordable.” When Los An-
geles doctors formed the country’s first group care plan, the Ross-Loos
Medical Group, the Los Angeles Medical Association expelled them. the other,” reflects Ennen.
Such tension left physicians uncertain and patients confused. Spot- Detailing patients’ struggles displays that the forces acting on Amer-
lighting the decade between the Great Recession and Pandemic allows ican health could correlate closely with social and economic disparities.
Alexander to contrast access to insurance with the availability of serv- Although the 36,000 county clients of CHWC were “preternaturally
ices. Many small-town hospitals “went bankrupt, or were absorbed homogenous, there could be as much as eight year’s difference in life
(and sometimes gutted) by bigger regional health systems, or the towns expectancy from one part of the county to the next, and even from one
themselves had slowly become more memory than living reality until part of tiny Bryan to the next.”
there was no point in having a hospital there at all.” In Keith* (surnames redacted), we see the relationship between mar-
CHWC was falling prey to the same travails: “CHWC lost money ginal income and mordant diabetes. Keith discovers his blood sugar
every month of 2018 … dogged by big hospital chains in Toledo and level was more than twice the 400 mg/dL at which his reader topped.
Fort Wayne … Both had been gobbling up small independents like The Medicaid expansion Ohio’s governor accepted provided insulin
CHWC for over a decade in a crazed rush to consolidate before they support. However, when amputation made mobility an issue and only
could be targeted themselves by even bigger predators.” a Dollar Store (accepting SNAP) is reachable, a healthful diet is harder
Phil Ennen, our protagonist and hospital CEO, faces these trials as to access.
a Bryan native and community leader. The author reminds us the title In Marc*, we see a good-hearted person (kidney donor, community
is from business, whereas hospitals once had ‘administrators.’ “Perform- volunteer, model family) suffer a cardiac arrest. Hypertension, arrhyth-
ing like a business while simultaneously taking on a mission nobody mia, arterial blockage; America was a heartsick nation at this time, and
fully understood meant that one goal would always be in tension with performing cardiac catheterizations were a necessary attribute of even

36 SAN ANTONIO MEDICINE • August 2021 Visit us at www.bcms.org 37