An excellent and informative look at today's healthcare challenges, the argument for a single payor health care system. An engaging mix of personal stories, research, and behind the scenes looks of administration life paint a complete picture of a problem that needs solving. Does this book solve those problems, or provide solutions, no. But it is a fascinating and enraging read nonetheless. Living in NW Ohio where this book is set, specifically in the Toledo Metro area, I am fully aware of ProMedica and it's infiltration everywhere. Suggested this for my book discussion group and we read for this month!

The Hospital is an in-depth look at a community hospital in Bryan, Ohio called CHWC - a cornerstone of this poor, rural community, but constantly under threat. In diving into this small rural town as a case study, Alexander shows us a richer picture of what's going on in the U.S.'s medical system and how it affects poor, often isolated towns. Alexander pulls out themes that show up all around the country, risking the independence of these vital community hospitals, putting the physical and financial health of the residents and patients it serves in danger, and letting the increasingly consolidated healthcare conglomerates squeeze the most vulnerable populations.

CHWC plays a vital role in Bryan, a town of about 8,500 in northwest Ohio. The second-nearest hospital is about an hour away by car, and in serious emergencies and/or inclement weather, that's not a viable option. But CHWC is a small nonprofit hospital that struggles to make ends meet for a variety of reasons: most of its patients are on Medicare/Medicaid, and the reimbursement rates for supplies and treatment (the primary way hospitals make their money) are much lower compared to private insurance plans. CHWC is not part of a purchasing conglomerate either, so they are charged much higher rates for equipment, supplies, and medications than hospitals that are part of a large network. CHWC prides itself on its independence, but the finances don't agree - CHWC's CEO, Phil Ennon, fields negotiations all day long from Parkview Medical, a huge healthcare giant that wants to buy out this small town hospital and fundamentally change it.

There's a lot more to be said about the hospital itself, but the residents/patients of Bryan are a large part of the story as well. Bryan is one of thousands and thousands of small rural towns that isn't close to recovering from the Great Recession of 2007/2008. There are simply very few jobs left in Bryan, and those that are there don't pay a living wage, offer healthcare, or provide any sort of stable employment. Basically all the residents of Bryan are living in a precarious state - barely employed, in deep debt, wondering how they're going to make their next rent or mortgage payment, struggling to put food on the table. Mental health is at an all-time low and suicides are more and more common.

Not to mention that many Bryan residents have health issues that are common in poor towns, ranging from diabetes to heart problems to chronic injuries, and are often forced to be "noncompliant" with their medical instructions to manage these issues because of the cost of care, cost of basic medical supplies like diabetes test strips, need to work and put further strain on their bodies, or general instability that puts them in fight-or-flight mode.

One of the most interesting parts of this book is the discussion of intergenerational trauma and the real physical/mental health effects that generations of instability can have on individuals. For those of us who are in relatively stable points in life and have all of our basic necessities secured for the near future, it's extremely difficult to imagine the utter stress that food, shelter, and financial instability places on you. But for anyone who has endured that, it's the only thing you can think about, and studies have shown that this constant state of uncertainty leaves a mark on not only you, but your children. This is the reality for pretty much everyone in Bryan.

Alexander's whole thesis in this book is that American healthcare cannot be solved until these underlying issues - like rural employment, the disparity in treatment between private and public insurance, and the free-for-all nature of medical conglomerates that squash independent community hospitals - are addressed. Although it's a huge bummer to hear this, the medical system is a complex beast, with so many interlocking and interdependent issues causing the decline of health outcomes and quality healthcare availability for vulnerable Americans. This book taught me so much about a system that I know so little about, and although it's not particularly uplifting, it's an important read for understanding yet another problem that rural Americans face. My one criticism of the book is that it focuses on primarily white perspectives in a predominantly white town. Alexander discusses some things like Muslim doctors coming in and the subsequent anti-Muslim sentiment in town, but it's not detailed. But you can imagine that if things are this bad for white folk in Ohio, opportunities, risks, and challenges are probably even worse for Black Americans, immigrants, and other doubly or triply-marginalized groups.

Thank you to St. Martin's Press for the ARC via Netgalley.

This was a fabulous medical nonfiction book, on par with Stiff by Mary Roach or Five Days at Memorial by Sheri Fink. The story of what is wrong with the American medical system through the lens of a dying small-town hospital and it's patients, The Hospital read like a page-turning medical drama, made all the more haunting by the fact of its veracity. Anyone who has anything to do with healthcare in America should read this book.

This was such a well researched book into the inner workings of a small town hospital. The residents that live in the area as well as their home life and jobs. It also seem to point out some of what's wrong with our health system. The book was educational and insightful

As someone who grew up dependent on a rural, small town Iowa hospital, I was excited for the opportunity to read this book. The hospital was less than 15 minutes from where we lived. It was the hospital I was born in, went to for doctor appointments, and my parents were cared for several times for various ailments. Somehow this hospital has survived over the years, mostly due to joining a much bigger health system, but I can absolutely attest that it still has that small town feel. Two years ago, I spent nearly a month there while my dad was very ill and the staff from the PAs to the nurses to the aides to the respiratory therapists to the housekeeping and food service staff, every single one was kind and generous and personable. They seemed to love their jobs and care deeply for their patients and each other. I couldn’t have asked for a better experience for my dad. But, I know this isn’t always the case and many communities have lost their hospitals and have had to travel an hour or more to the closet hospital to receive care.

In THE HOSPITAL, Alexander begins with the history of the community he is writing about, the small town of Bryan, Ohio, in the NW corner of the state. It is just a bit over an hour to Toledo when traveling east or to Fort Wayne, Indiana, to the southwest. When you google Bryan, Ohio, you see images similar to many small towns across America; brick buildings on the main street, many empty, residential areas of older homes as well as newer, churches, parks, and businesses, some still thriving and others closed. Bryan’s history of having a hospital goes back to the early 1900s and I found the details of the creation of the hospital quite interesting. Over the years, the economics of the small town, businesses and factories closing, farms in crisis, and little too few jobs all had an effect on the success of the hospital. When families were struggling, the ER became their doctor’s office and the bulk of the fees fell to the hospital knowing that the patients weren’t going to be able to afford the care. Because the patients got whoever was on call, there wasn’t a lot of “shopping for care” or “personal care for the patient” because you got who you got in the ER and the ER doctor was just there to do their job and not build relationships. It was a horrible cycle that created numerous unpaid medical bills that eventually taxed the hospital’s bottom line.

At only nine chapters plus an epilogue, the chapters are quite long. I’m a chapter reader, which made this hard for me to need to spend several days reading just one chapter. It was my Kindle bedtime read and typically I only read in 10-20 minute chunks which made the chapters seem even longer. The research was very detail-heavy in spots and often more than I needed or wanted to know regarding specific dollar amounts or conversations held in the board room.

I really empathized with the personal stories of various residents of the Bryan, Ohio area and their struggles with receiving adequate health care and then paying for that care once it was received, often too late for true healing. I have no doubt that our health care system is extremely flawed. For those who can afford health care, it’s a constant worry to have the right deductible vs monthly premium and pray that nothing drastic happens to have to use it. For those who can’t afford health care, but make too much for Medicaid, there is the constant battle of how long can I avoid going to the doctor for this particular ailment because I can’t afford to pay for it.

The end of the book concludes with the beginnings of the Pandemic hitting our country and the impact on hospitals. I was disappointed in the abrupt shift to a very liberal tone once the author began this section. I would have preferred more facts on how COVID-19 affected hospitals rather than an opinionated rant about how COVID-19 was handled in the beginning stages. I also was frustrated because frankly, I was hoping for some solutions that could be taken from this in-depth look at small-town hospitals. But, there really were no solutions except for overhauling the insurance system, which isn’t something most of us, as readers, can do. Can we talk to our Senators and Representatives? Yes. Can we support our local hospitals by going to them and receiving care? Yes. But, keeping qualified doctors, specialized care, and systems that support those that struggle to pay for the care is a much bigger issue and one that needs to be tackled at the governmental level. Overall, I found parts of this research interesting and inspiration for conversations, but the systemic problems are much bigger than you or I can tackle.

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.

Thank you so much for my copy of The Hospital by Bryan Alexander.
I’ve always wanted to go into the medical field and this book gave a great look into a rural hospital and the inner workings.
I definitely recommend it!

Brian Alexander illustrates what's wrong with health care (and the country) on all levels. Deeply personal stories, well told and well-researched. This is a must read for everyone.

This is a masterful piece of reporting on the state of American health care and the American economy, told through several years at one rural Ohio hospital. Brian Alexander shifts effortlessly between the micro - scenes in the ER and hospital boardroom, and the macro - the financial and policy landscape that's led community hospitals to be both a last line of defense and an increasingly unviable business. It's hard to write about dense policy and large forces in American society in a way that's clear and gripping, but Alexander does both, without ever losing sight of the humans at the center of the story.

THE HOSPITAL by Brian Alexander (The Glass House) is an in-depth look at an independent community hospital called CHWC in Bryan, Ohio (population about 8,000). The day it arrived, our copy was checked out by a student researching healthcare in rural America. Alexander, already recognized by Medill School of Journalism for his public interest journalism, writes eloquently here about "Life, Death, and Dollars in a Small American Town." He has divided this text into three sections, beginning in Autumn 2018, followed by Winter/Spring, 2018-2019, and then the start of Covid in late 2019- early 2020. Throughout, Alexander highlights the many services the local hospital provides while struggling to stay competitive with larger regional providers. Providing context ("at almost 18 percent of the entire economy, health was the nation’s largest industry by far") and profiling individual stories of cancer patients, meth addicts and heart attack victims, Alexander points out that "America was sick, and getting sicker and dying earlier with every passing year." He moves beyond the local community and its hospital's many issues to discuss the minimum wage in Ohio (actually lower than 40 years ago when adjusted for inflation), the loss of pensions and unions, and the role of government, contrasting the business metrics and the mission of the hospital, "a battlefield clinic in an amorphous and mutating social and economic war that was killing people." Extensive notes and a helpful index are included. THE HOSPITAL was universally acclaimed, receiving starred reviews from Booklist, Kirkus, Library Journal and Publishers Weekly.

Strong, journalistic writing about the struggle of a small town hospital throughout its history but with a focus on the recent conglomerate takeovers. Enlightening.

The Hospital deserves 5 stars and more. This is not an easy or fast read, but Alexander’s seamless storytelling between all the players in the American health care system makes this a compelling must read. He shines a spotlight on one small town and one rural hospital to uncover this complicated behemoth of a system that is making so many of us sicker and causing many around us to die sooner. The author carefully explains how we got to where we are with his research and interviews of individuals, providers, businesses, governments, insurance giants, policies, and even first responders. We cannot make improvements and necessary changes without taking a hard, honest look at where we are right now. This is that hard look that we all need to take. I wholeheartedly highly recommend this book. Thanks to NetGalley and the publisher, St. Martin’s Press, for the advanced readers copy. All opinions are my own.

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

This book is perfect for teaching students what is wrong with our systems here in the states. Well researched and written.

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.

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.

As a Canadian, this book was a real eye opener for me, and left me saddened. Why is it so difficult for Americans to make healthcare available and affordable for every citizen? Anytime free healthcare for all is mentioned, what you hear is cries of socialism. How about looking at it from the standpoint of loving your neighbour? My husband and I have had multiple interactions with the Canadian healthcare system, including major surgeries and cancer treatments. We never had to wonder how we were going to pay for all of it. Our system is not perfect, but neither is the system described in Brian Alexander’s book. We need more people to call out the injustice of this system.

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.

This is a book that basically documents the sorry state of healthcare in the United States. The author accomplishes this with a blend of facts, statistics, history, discussions with hospital staff, and heart-wrenching stories from patients who use a hospital located in the tiny town of Bryan, Ohio. The final chapters of the book document the impact of the Covid-19 pandemic, which results in severe stress on an already overburdened system. It was a lot of information, and it took me awhile to get through the entire book, but it was definitely worth it! Thank you to NetGalley for providing with this ARC in exchange for my honest review.

Really enjoyable and informative read about the American healthcare system. Really enjoyed the writers style.