Well, a spoonful of sugar makes the medicine go down, and by the time you get to the answers, which are woven in throughout the chapter, you’re actually interested in reading about them. And by presenting the explanatory policy and history segments in small chunks (usually not much more than four or five pages at a time), Cohn makes them easily digestible. At about the time a reader might be tempted to start skimming ahead, the wonkishness stops and the storytelling picks up again.
It helps that Cohn is a terrific storyteller, as well as one who doesn’t insist on twisting his tales into polemics. The story of the Sampsons is typical. Their lives were never threatened. By hook or by crook they always managed to get the treatment they needed. They had to sell their retirement home, but they were never reduced to poverty by medical bills. What’s more, Cohn even makes clear that Morrell’s decision, as brutal as it was, was driven by competitive forces in the meat-processing industry that were mostly beyond the company’s control. Morrell was caught in the middle of the same screwy, jury-rigged health care system that all the rest of us are caught in, too.
This makes Sick an honest read. It’s hard not to come away appalled by the American health care system, but it’s also hard not to come away thinking that, one way or another, it does mostly work. Sort of. For the most part, it’s not that people die or literally fail to get lifesaving treatment—though that happens more often than it should—but that chronic conditions (like diabetes or hypertension) are frequently undertreated, while people treated for serious conditions too often end up alive but in penury. And all this despite the fact that American health care is far more expensive than any other health care on the planet. There must be a better way.
It’s at this point that we’re brought face-to-face with the drawbacks of narrative journalism. As good as Sick is—and it’s very good—one can’t help but notice that after more than two hundred pages of diagnosing the ills of the U.S. health care system, Cohn devotes little space at the end of his book to suggesting solutions. And while authors may have a legitimate beef with reviewers who spend time essentially complaining that the author didn’t write the book they wanted written, in this case the criticism is hard to escape. It’s glaringly anticlimactic to get to the end of Sick and discover little more than a few paragraphs suggesting that, yes, universal health care would be a good idea, and perhaps it could take the form of Medicare for everyone. Or maybe we should emulate the French system. Or something.
What to do? This dilemma is displayed in high relief by comparing Sick to The Health Care Mess: How We Got Into It and What It Will Take To Get Out, by Julius Richmond and Rashi Fein, originally published in 2005 but recently released in paperback. Both books cover much of the same ground (though Richmond and Fein spend a lot of time on issues of medical education, a subject not likely to interest many laymen), but if Sick is like a high school class in the history of American health care, The Health Care Mess is more like a college course. (The graduate seminar version would be one of those indigestible Brookings tomes.) Richmond and Fein spend a fair amount of time explaining how the incentives of the American health care system work mostly in the direction of making care more expensive, and the result is that by the time they start talking about solutions in their final chapter we’re better prepared to understand both the substantive tradeoffs between different plans as well as the political lay of the land for getting any of them implemented.
Unfortunately, not many people will get to that final chapter. In taking the usual policymaker’s approach to book writing, Richmond and Fein have produced a treatise that few ordinary citizens—even smart, engaged citizens—will ever pick up. Where Sick reads like a novel, The Health Care Mess reads like a white paper.