What Ails Us

Reviewed by Michael Tomasky
Sunday, May 20, 2007


The Untold Story of America's

Health Care Crisis-- And the People Who Pay the Price

By Jonathan Cohn

HarperCollins. 302 pp. $25.95

Thirteen long years after the failure of the Clinton health care plan -- and with Democrats back in control of a Congress that they lost in part due to the plan's collapse -- Washington is again talking health care in a serious way. John Edwards has even made universal health care, paid for by tax increases on the wealthy, a centerpiece of his presidential campaign.

But the interregnum has exacted a terrible human price, as Jonathan Cohn documents movingly in Sick. Aside from the 46 million uninsured, there are the millions of under-insured, and ever-increasing restrictions on coverage have undoubtedly cost lives among the diabetic, the mentally ill and many others. Cohn's emphatic title may refer to the state of our nation, but he's clearly pretty sick of all this himself.

Among journalists, Cohn, a senior editor at the New Republic, is one of America's leading experts on health care policy. Advocates of a more generous system may reasonably hope that Sick will do for universal coverage what Michael Harrington's The Other America once did for the war on poverty.

For the most part, Sick delivers. Its eight expository chapters deftly interweave discussions of health care policy and history with personal stories of people who have been pricked by the system's sharpest brambles, with each story humanizing a specific shortcoming of our current system.

A man in upstate New York who "supposedly did all the right things to realize the American dream" could not get coverage for his wife's breast cancer because he was laid off from his aerospace-manufacturing job and then rehired -- but as an independent contractor, without insurance. A retiree in Sioux Falls, S.D., was reduced to penury when the meat-packing plant where he'd worked almost all his life took away retirees' coverage. "We kept saying, 'they just can't do this, they can't,' " his wife tells Cohn. "But they did."

In a heart-rending story that highlights the limits of mental health coverage, a teacher in Denver with generous insurance can't afford his wife's psychiatric treatments. She had been sexually abused as a child and suffered from severe depression. She was hospitalized, and her husband was hopeful, but once the bill hit $50,000 the hospital tossed her out. Burdened by the financial strain she was placing on her husband and son, she tried suicide three times, finally succeeding on the third attempt.

In each chapter, Cohn breaks from the personal narrative to relay the history of an aspect of health care. For instance, in a moving chapter about a couple reduced to poverty and divorce because their HMO insufficiently covered treatment for their son's cerebral palsy, we learn the details of how a great many health maintenance organizations have strayed from their original purpose by becoming for-profit rather than non-profit.

These history and policy sections are fascinating but too brief. I sense that Cohn feared readers' eyes glazing over, and so worked very hard not to write a policy book. But he actually should have written more of one.

Hence, the book's lone -- but not insignificant -- shortcoming: It doesn't really describe the system as a system. Few if any doctors, hospital administrators, HMO executives, insurance officials, Wall Street analysts, nurses, home-care providers or free clinic managers are quoted in Sick. I'm not arguing for a "fair and balanced" account; like Cohn, I'm not particularly sympathetic to the plights of some of the above. But I think that getting the motivations of some of these players on the record might have strengthened his case even more. In any event, it would have made for a more authoritative work.

But Cohn wrote a different sort of book, one that is intended to pierce the conscience of the nation. He has done his part, in many ways to great effect. Now we have only to see if history hands the Democrats another chance, and if they can exploit it a little more cleverly this time. *

Michael Tomasky was recently named editor of Guardian America, the British newspaper's American Web site.

© 2007 The Washington Post Company