The health care debate we're not having: two new books show how access to health care is only part of the problem.

• Author: Brownlee, Shannon
• Position: "An American Sickness: How Healthcare Became Big Business and How You Can Take It Back" and "Mistreated: Why We Think We're Getting Good Health Care - And Why We're Usually Wrong" - Book review

An American Sickness: How Healthcare Became Big Business and How You Can Take It

Back

by Elisabeth Rosenthal

Penguin Press, 416 pp.

Mistreated: Why We Think We're Getting Good Health Care--And Why We're Usually

Wrong

by Robert Pearl

Public Affairs, 336 pp.

As I write this, a dear friend is lying in an intensive care unit in Washington, D.C What started as a bad summer cold quickly turned into pneumonia, and after a few harrowing days she had to be put on a ventilator, while her doctors filled her IV line with a cocktail of antibiotics until lab tests could tell them what kind of infection she had. Sixty years ago, patients with such severe pneumonia either got better on their own, or died. There was no such thing as an ICU. Mechanical ventilators only became standard equipment in hospitals in the 1970s. Faster and more accurate diagnostic tests and more drugs for treating pneumonia came on line after the AIDS epidemic led to a crash research effort.

Ventilators, novel drugs and tests, and all the other accoutrements of modern medicine serve as a reminder of the astonishing power of medical science. I've also witnessed the art of medicine in action. I've seen an anesthesiologist lay a palm on the cheek to comfort a frightened patient about to go into surgery, and a physician assistant review a patient's confusing constellation of symptoms, ask a few probing questions, and diagnose her rare disease. But health care has a dark side, too, where greed and self-delusion allow health care providers and drug and device manufacturers to treat patients less like vulnerable fellow human beings and more like ATM machines.

That dark side is on vivid display in An American Sickness, Elisabeth Rosenthal's groundbreaking book that makes it impossible not to be shocked, if not enraged, by the gulf between the good care that is possible and the profiteering our health care industrial complex so often engages in. Trained as an emergency physician, Rosenthal joined the New York Times as a health reporter, and is now the editor in chief of Kaiser Health News. In addition to having an insider's view of medicine, she has a reporter's eye for stories, and this book is full of them--tales of patients being mistreated by a system that has become not merely dysfunctional, but at times actively predatory.

Here are just a few examples. A hospital charges wildly inflated prices and then duns a patient who has few assets and no insurance. A physician with no specialized expertise performs brain surgery on a young woman because he has an exclusive contract with the hospital and happens to be on call. Pharmaceutical companies raise the price of life-saving drugs whose production costs are low or negligible, simply because they can. As a sop, they offer "co-pay assistance" to patients, a practice that Rosenthal calls "a kind of bribe," by establishing nonprofit organizations to which patients can apply for financial aid. Meanwhile, the company charges insurers its full, inflated price for the drug--driving up the cost of premiums for the rest of us.

One routine practice, aptly called "simultaneous surgery," involves a single surgeon performing a procedure on...