An incredible book on its own, but its insights into the state of the contemporary American healthcare system means it should be required reading for everyone. Highly recommended

Bryan, Ohio is a small town with small-town problems. Keeping the town afloat. Keeping the hospital open. Alexander takes us into small-town hospitals and the quickly disappearing small-town hospitals and medical care.

Phil Ennen, CEO of the hospital is fighting what looks like a losing battle. They are losing money and the big guys are waiting around the corner to grab up another local hospital.

You find out a lot of things you may have never thought about if you didn’t grow up in a small town. I don’t think I have ever given it a thought since I’ve always lived in the city. On a road trip this past year we took the back roads to explore Oklahoma and it was then that I saw entire towns dying when the hospitals go down. Miles and miles from any form of emergency care or just continued care. It was shocking how the towns were just empty.

We see real people in real life or death situations and the consequences from lack of dependable medical care. We have one such town right now trying not to close its doors or give in to a buyout. With a lot of small towns still recovering from the 2008 recession, money is not exactly flowing in. People can’t afford to drive 2 hours in an emergency and they can’t afford healthcare.

With the Medical and Hospital Industry puts money over care, we all suffer. Look at the situation we are in now. Covid. Rural hospitals aren’t able to care for the people in their small community. Even big cities are ill-equipped to fight this one. Why? This gave me a new insight into the issues we all will face.

NetGalley/ St. Martin’s Press March 09, 2021

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-Hodgkins 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 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.

Thanks for the advanced copy. An interesting take on small town healthcare and the history behind it all.

Thank you NetGalley for providing me with a copy of this book in exchange for my honest review.

I absolutely adore medical stories / books. So I was definitely excited to read The Hospital.
It held up to my standards and expectations. The stories of the clients were interesting and informative.
Brian Alexander has a great writing style that makes it easy to read and follow.

I'll definitely be looking out for other work by this author.

Fascinating book on hospital care in rural America. Although the book is about a rural county in Ohio, it could be in any place. Great and informative!

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.

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.

Thanks Netgalley for allowing me to read this book. This book focuses on a hospital in Bryan, Michigan. The hospital is in a small blue collar county where the people are living paycheck to paycheck and can barely afford the medicine they are prescribed. One man by name of Keith is diagnosed with type 2 diabetes. He lowers the amount of insulin he takes due to the cost. Years later he went blind in one eye and had part of his leg amputated. His is just one of many who have suffered the same fate. The price for medical care keeps skyrocketing at an alarming rate. This book was very emotional and well written.

This is definitely a compelling, yet disturbing book regarding a small hospital and "survival of the fittest" in these days of turmoil.
How do hospitals stay afloat?
It has gotten worse as times and economic troubles have 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!

2 stars
I really wanted to like this more than I did. It is very scattered and blame filled. I agree there is much blame Tobe had in the health care industry but this just came off as whiny.

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.

This book was the perfect escape. It was lovely and fun. It was my first book by this author and I will definitely be on the look out for more!!

Comprehensive look at small town hospital. Ton of information. Felt like you were a fly on the wall.

Thanks to author, publisher and Netgalley for the chance to read this book. While I got the book for free it had no bearing on the rating I gave it.

I received an advance copy of, The Hospital by, Brian Alexander. I really wanted to like this book, but its like the blame game, it was a little to judgemental for me. Its our fault for the health care crisis.

A heart wrenching look at a hospital in a small town.A raw real look at our medical systems struggles Doctors ,nurses aids caring trying to help the patients.The hospital administration struggling to keep it open operating efficiently to help the patients.The people who live in this town are introduced to us as they struggle to make ends meet and we are introduced to them in the moments of medical struggles.People with hardly enough money to pay for daily needs let alone medical costs.A book that really exposes today’s medical system and it’s shortages especially now in the time of COVID,This is a brilliant intimate look at this hospital and those who are involved with it.Will be highly recommending,#netgalley#st.Martins boojs