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

by Brian Alexander

Overview

USA Today's 5 BOOKS NOT TO MISS

"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." —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.

Product Details

ISBN-13:	9781250237361
Publisher:	St. Martin's Publishing Group
Publication date:	03/09/2021
Sold by:	Macmillan
Format:	eBook
Pages:	320
Sales rank:	560,344
File size:	2 MB

About the Author

Brian Alexander, the author of Glass House and winner of the Ohioana Book Awards, is a contributing writer to The Atlantic. He’s written for the New York Times, Los Angeles Times, Esquire, among others. He’s spoken at The Obama Foundation Summit, and in Washington to members of the Senate and House of Representatives. He lives in San Diego.
Brian Alexander has written about American culture for decades. A former contributing editor to Wired magazine, he has been recognized by Medill School of Journalism's John Bartlow Martin awards for public interest journalism, and by other organizations. He grew up in Lancaster, with a family history in the glass business. He lives in California. Brian is the author of Glass House.

Table of Contents

Prologue 1

Part I Autumn, 2018

1 A Ready Haven of Refuge: The Battle to Control Health 15

2 Everybody Is Coming After This Hospital: Surviving the Business 34

3 Chasing the Symptoms: Searching for the Roots of American Sickness 62

4 Powers Beyond Us: The Contagion of the New Capitalism 87

5 Pray: The Iniquity of Inequity 113

Part II Winter/Spring, 2018-2019

6 What Free Market? The Myth of Free-Market Medicine 145

7 The Crap End of the Stick: The Hospital as Hope 175

8 Puppies Are Drowning: The Thin Safety Net 200

9 They Don't Have to See: The Limits of the Band-Aid Station 228

Part III Winter/Spring/Summer, 2019-2020

Epilogue: Then Everything Changed: Covid-19 261

Acknowledgments 281

Notes 283

Index 301

Editorial Reviews

★ 01/11/2021

Journalist Alexander (Glass House) delivers an anguished and incisive look at the struggles of an independent community hospital in northwestern Ohio between March 2018 and August 2020. Alternating boardroom politics and financial details with heartrending stories of uninsured and disadvantaged patients, Alexander documents CEO Phil Ennen’s desperate efforts to keep Community Hospitals and Wellness Centers of Bryan, Ohio, solvent without lowering standards of care. To offer more services and draw patients from neighboring counties, hospital administrators set out to recruit medical professionals from abroad who would be willing to deal with rural Ohio’s cold winters and lack of amenities; meanwhile, CHWC doctors gave patients money for lifesaving prescriptions so they didn't have to wait until payday. Alexander delves into the complicated history of U.S. healthcare and lucidly describes how the Trump administration’s anti-immigration and pro-corporation policies impacted both the hospital’s ability to attract staff and the economic difficulties faced by locals. The story of diabetic Keith Swihart, who undergoes “two amputations, three eye surgeries, and one colonoscopy,” brings home the steep cost of not providing universal health care. Alexander’s in-depth research also makes clear why CHWC and hospitals like it have struggled to deal with the Covid-19 pandemic. This wrenching account brilliantly diagnoses the flaws in America’s healthcare system. (Mar.)

Publishers Weekly

Named one of “Ten Books to Read in March” — Washington Post


Named top ten books of 2021 – Chicago Tribune


Best Books of 2021 – New York Post


Best Books of 2021 – Dayton Daily News


Notable Books of 2021 – American Library Association

"A richly researched, highly contextualized, deeply compelling narrative."
—Chicago Tribune

"Brian Alexander spares no punches... an awesome book, hopefully in the running for a well-deserved award."
—San Francisco Book Review

“A superb account of a small-town hospital whose first priority is delivering high-quality medical care...In this eye-opening investigative study, [Alexander] offers vivid portraits of a dozen individuals ... Deeply insightful.”
—Kirkus (Starred)

"Gripping...A blueprint of how the American health crisis came to be."
—The New York Post

"Compelling."
—Salon

"Emotionally and politically astute... Alexander’s analysis is insightful and compelling; above all, it is empathetic."
—SAGE

"Alexander also brings to his writing a deep understanding of the larger economic, political, and social trends that are slowly crushing the lives of the people he met in Bryan, and of people like them all over this country. In his telling, Bryan becomes a microcosm of American sickness in all its dimensions."
—Washington Monthly

"An absorbing story of one small hospital in a state of rapid transition."
—The Columbus Dispatch

"Even in a year when the failures of the American healthcare system are painfully, catastrophically clear, Brian Alexander’s portrayal of a small-town hospital fighting for survival stands out."
—LitHub

"The Hospital shows how fragile our country’s health care was even before the pandemic, and how that fragility affects staff and administration as well as patients."
—The Washington Post

"America is broken, but sometimes it takes looking at the smallest shattered pieces to realize how broken. That is the sad lesson at the core of Alexander’s The Hospital."
—Rolling Stone

"Show[s] the cruel gulfs in American health care."
—Associated Press

"Hillbilly Elegy with a bad cough... Political, scary, and empathetic."
—Sidney Herald

"Puts a human face on broader issues of social inequality. This expertly reported account will resonate and find a wide audience.”
—Library Journal (Starred)

"This wrenching account brilliantly diagnoses the flaws in America’s healthcare system."
—Publishers Weekly (Starred)

“Alexander’s scorching reportage provides a distressing, infuriating picture of health care delivery and highlights the heroic fight of a little hospital and humble hamlet to stay vital.”
—Booklist (starred review)

"The irony of it all, captured... Alexander won deep access."
—Ohio Capital Journal

"'Potent."
—Dayton Daily News

"This book is an essential read for anyone involved in healthcare. If we are to bring about sweeping changes in this system, we must understand the forces involved. Alexander does a masterful job of using several perspectives to lay bare the greed at the center of it all."
—Intima

"A heart-rending and unforgettable real-time journalistic deep dive... I can't think of a more timely book. The doctors, nurses and medical technicians in these pages are front-line heroes. Highly recommended!"
—Douglas Brinkley, Katherine Tsanoff Brown Chair in Humanities and Professor of History, Rice University, author of The Great Deluge

"A brilliantly imaginative and creative way of telling the story of today's America... In The Hospital, Brian Alexander does again so well what he did in Glass Housefitelling the big story from the small place."
—Sam Quinones, author of Dreamland: The True Tale of America's Opiate Epidemic

"A stunning achievement—closely observed, deeply compassionate and beautifully written. What 'The Wire' did for the Baltimore drug trade, The Hospital does for the business of healthcare in a struggling Rust Belt community... It's not just good—it's important."
—Carl Elliott, MD, PhD, Professor, University of Minnesota Center for Bioethics

“Brian Alexander, a master storyteller, delivers an extraordinary tale... He shows us why rural hospitals matter.”
—Eric Eyre, Pulitzer Prize winner and author of Death In Mud Lick

“In this clear-eyed biography of a community hospital, Brian Alexander offers a powerful indictment of the American healthcare system. The Hospital will break your heart.”
—Andrea Pitzer, author of Icebound

"Devastating, gripping, and beautiful."
—Beatrix Hoffman, Professor of History, Northern Illinois University and author of Health Care for Some

From the Publisher

★ 03/01/2021

Small nonprofit hospitals in the United States faced increasing difficulties even before the COVID-19 pandemic upended economic realities for businesses of all kinds. With intimate access to a small nonprofit hospital in the community of Bryan, OH, Alexander (Glass House) spent fall 2018 through summer 2020 using it as a template for a study of health care in the U.S., the forces transforming it, and the real impact it has on people. The hospital CEO's story becomes the linchpin for the broader view, as he deals with financial and structural issues, personnel, government at all levels, local needs and wants, and the corporatization of hospitals. Alexander also spends time with health care workers, leaders of other hospitals, and many people in the surrounding community, relating their struggles to the larger picture. His clear conclusion is that the increasing disparity in health care is inextricably linked to the income and social disparities that the pandemic has made all too clear. VERDICT The time Alexander spent embedded in the community gives continuity and depth to the stories of the individuals he connected with and puts a human face on broader issues of social inequality. This expertly reported account will resonate and find a wide audience.—Richard Maxwell, Porter Adventist Hosp. Lib., Denver

Library Journal

★ 2020-11-24
A superb account of a small-town hospital whose first priority is delivering high-quality medical care. Sadly, in today’s brutally competitive free market, that means it’s barely surviving.

In this eye-opening investigative study, journalist Alexander takes us to Bryan, Ohio, which has mostly recovered from the 2008 recession and possesses a surprisingly good hospital for its size (pop. 8,000). The author offers vivid portraits of a dozen individuals, including the hospital’s CEO, Phil Ennen, and readers will receive an expert education in his duties. Delivering care is one, but the business side is difficult. If rival medical centers steal business, customers don’t pay, or income doesn’t match expenses, his hospital will fail. Small hospitals have two strikes against them: Suppliers charge them more, and insurance companies pay them less (big medical systems negotiate for higher reimbursement; small ones have no clout). The free market extols efficiency above all. Once part of a larger system, Bryan’s hospital would see its staff trimmed, unprofitable services eliminated, and specialists moved to bigger cities. With less to offer, the hospital would become a drag on larger facilities; if it continued down that path, it would eventually close, a process that is playing out across the U.S. As of 2020, the hospital is hanging on and may even survive the pandemic, which is proving equally disastrous to rival hospitals. However, the future looks grim. Like all hospitals, Bryan’s depends heavily on government money, especially Medicare and Medicaid, but it’s not adequate, and this is unlikely to change in the near future. Like many states, Ohio has been cutting taxes and social services since the Reagan years, producing stagnant wages and declining health but only scattered calls for reform—certainly not in Bryan, where “a local politician could blame problems associated with a…business on the fact the owner was ‘not of American extraction’ and know he wouldn’t hear any disapproval.”

A deeply insightful and disheartening portrait of America’s diseased health care system.

Kirkus Reviews