The Hospital Quotes

“Working-class wages in the United States just about flatlined from 1979 to 2017. Over that thirty-seven years, the bottom 10 percent of earners saw a 4.1 percent rise in wages. Meanwhile, economic productivity rose 70 percent. Most of the reward for that productivity was scooped up by the top 5 percent of earners, who enjoyed a 69.3 percent rise in real wages. The top 0.1 percent increased their haul by over 343 percent.”
― Brian Alexander, The Hospital: Life, Death, and Dollars in a Small American Town

“Covid-19 was a crisis, all right—a bad one—but it was far from the first epidemic to hit the United States, or even the deadliest. The United States had been living with epidemics for decades but had pretended otherwise, soothing itself by saying that the epidemics existed only among the undisciplined, the noncompliant. Covid-19 stripped away the fiction.

There’d been an epidemic of financial manipulation, of dismantling the rights of workers, of eroding the social contract and therefore eroding community. There’d been an epidemic of sending work outside the country or to “right-to-work” states, of using the poor and working class—as well as, increasingly, the middle class—as “human capital” suitable for sacrifice in the service of the market. (The lieutenant governor of Texas, Dan Patrick, made the attitude explicit by saying Texas had to reopen its economy in the face of Covid-19 because “there are more important things than living.”) There’d been an epidemic of consolidation in industry, and an epidemic of deregulation that allowed those industries to acquire more power than ever. There’d been an epidemic of ignorance, disinformation, and rank propaganda in the service of vote-getting and profit-making. All these epidemics killed many more people than Covid-19 would, even as the Hundred Years’ War waged against the manufactured evil of “socialized medicine” left behind casualties of its own.

America had become an unforgiving nation, a fearful place, hiding behind a pyroclastic flow of guns, flag-waving, and ever-emptier jingoistic bragging. Then Covid-19 arrived. It just showed up, like lightning. There was no way to wrap it up in the comforting notion that the victims were to blame. It killed 170,000 by August 2020 and would probably kill many more, experts said.”
― Brian Alexander, The Hospital: Life, Death, and Dollars in a Small American Town

“When it finally came to America, the virus seeped into the fault lines created by America’s pathologies. The country had changed from being an ongoing project to improve democratic society and live humanistic ideals to being a framework for fostering corporate profit.”
― Brian Alexander, The Hospital: Life, Death, and Dollars in a Small American Town

“America had gone too far down a bad road and had no choice but to keep going. There was too much money at stake to blow it up. Doctors would make less. So would the drug companies and their shareholders. So would the big hospital systems and the private equity outfits that were beginning to dominate American medicine. The device makers would make less, too, and so would the consultants, the accountants, the medical records software companies, and the ambulance companies. Lots of people in the insurance industry would lose their jobs. Not in a million years, everybody agreed, because nobody wanted to give up their current piece of the pie.”
― Brian Alexander, The Hospital: Life, Death, and Dollars in a Small American Town

“He already knew the answer: too many people in Williams County were being used the way mining companies used coal in West Virginia. Human beings were the object of an extractive industry. They were mined for their labor and for their money. Too often, they were a “workforce” and not people at all. The goal was to pay them as little as possible and to get as much work out of them as possible while taking the least amount of responsibility possible. The modern American version of capitalism encouraged—even demanded—that employers extract the value from their employees while returning scraps to them and their communities. And then others—like some medical professionals, business owners, politicians—questioned why poor and working-class people didn’t take care of themselves. Why didn’t they comply? This was the same argument employers had used in 1916 to oppose a state health plan, blaming the working class for “absences caused by intemperance, by ball games.” If they were sick, they had only themselves to blame.”
― Brian Alexander, The Hospital: Life, Death, and Dollars in a Small American Town

“One might have thought that a nonprofit hospital system like ProMedica would pass it on to the public. ProMedica, Parkview, OhioHealth, Mercy: most of the consolidated regional systems in the United States, including the state university systems, were all officially nonprofit. They were supposed to serve charitable functions, receiving 501(c)(3) tax-free status from the Internal Revenue Service. That was why their profits were officially called “operating surpluses.” But there was no meaningful difference between the behaviors of for-profit giants like Hospital Corporation of America and those of the big “nonprofit” systems. Michigan’s Spectrum Health, for example, took in $6.9 billion in operating revenue in fiscal year 2019 (for a 14.7 percent total margin), while providing only $6 million in charity care. They were all big corporations. They all acted with the same goal in mind: to increase market share.”
― Brian Alexander, The Hospital: Life, Death, and Dollars in a Small American Town

“What free market?” Henry County’s Kim Bordenkircher wanted to know. Politicians, businesspeople, and ideological conservatives “assumed healthcare is a free-market economy. It’s not!” This was the flaw in Tinkel’s push for a consumerist approach. There was no such thing as a free market for medicine in the United States, and there hadn’t been for some time. Asking patients to become consumers burdened them with the responsibility to shop wisely in an opaque economy, even as hospitals introduced high-cost, hotel-like extras to lure them through the doors. The idea that doctors could or would steer patients to low-cost hospitals or to high-quality ones was laughable. Doctors had no idea what hospitals—even hospitals where they worked—charged for services, and neither did most other people. Hospitals and insurers kept their pricing and their insurance contract negotiations confidential. So a broken leg for one patient could wind up costing much more—or much less—than the exact same break would cost someone else.”
― Brian Alexander, The Hospital: Life, Death, and Dollars in a Small American Town

“When the universe of patients, small hospitals in rural places, urban hospitals in poor neighborhoods intersected with the universe of the healthcare industrial complex, they were squashed.”
― Brian Alexander, The Hospital: Life, Death, and Dollars in a Small American Town

“Even suicide could become part of a culture. “If somebody you know, or in your family, has ever taken their life,” Long said, “it is another huge risk factor. It breaks a taboo. It becomes a solution to look at.”
― Brian Alexander, The Hospital: Life, Death, and Dollars in a Small American Town

“Both were told there was one version of a successful American life, and it was the consumerist ideal. Those who succeeded in aping that version were seen not only as successful and smarter but also as good. Only flawed people failed to achieve it. But even those who seemed to have won the American race could suffer, because “when the storm comes—and it comes to all of us—they find out having that perfect pair of jeans and the right manicure doesn’t help you in this situation. That can be devastating. That’s one reason why suicide cuts across everything. That is really a dark place to be, to make the decision you want to end your life.”
― Brian Alexander, The Hospital: Life, Death, and Dollars in a Small American Town

“He was uncomfortable seeing so many Muslims in one place, “but I have Muslim friends I talk to here and there. Again, it’s one of them things: people get angry about race and things, but it’s just understanding somebody’s culture, where they come from, their background. I mean, knowledge is everything. Ignorance is nothing.”
― Brian Alexander, The Hospital: Life, Death, and Dollars in a Small American Town

“Foster had misread Ennen. Change was part of his agenda, and it had been since he assumed the CEO job. But he believed that, like an experienced comic, he knew his audience. Abrupt change was neither the Bryan way nor the CHWC way. It was certainly not in keeping with the hospital’s family ethos. So, as with the vaccine policy, Ennen preferred to execute change gradually whenever possible, in a person-to-person way, and with a minimum of drama. Foster viewed this as conflict avoidance; Ennen viewed it as tactical prudence.”
― Brian Alexander, The Hospital: Life, Death, and Dollars in a Small American Town

“The very day the WCTU announced the list of committee members, the county fair in Montpelier, the biggest event in the county by far during the 1920s, opened its gates. There, for the first time in its history—and like many other county and state fairs at the time—the fair held a eugenics-inspired healthy children contest. Just as cows, pigs, and sheep were judged, kids in two classes, ages two to six and six to fourteen, were weighed and measured. Judges examined their teeth, hair, skin, posture, hearts, lungs, noses, and throats. The winning children in each age group received $5.”
― Brian Alexander, The Hospital: Life, Death, and Dollars in a Small American Town

“month waiting list. And Parkview doctors weren’t much happier with the center, Sunderhaus believed, “because they’re charging hospital outpatients for everything. And their job in Bryan is to refer those patients to big services in Fort Wayne. Their job is merely as a feeder site for testing. And for their specialists. That is their only purpose for having family practice there, to feed their beast. Feed the beast of the MRI, the CAT scan machine. They keep track of those docs: how much they prescribe, how many tests they ordered. That’s how they decide who gets bonuses and who gets big bucks. Yeah! We piss everybody off!”
― Brian Alexander, The Hospital: Life, Death, and Dollars in a Small American Town

“When pneumonia or typhoid strikes down a breadwinner or when a major surgical operation becomes necessary, poverty may soon knock on the door,” the New York Times opined.”
― Brian Alexander, The Hospital: Life, Death, and Dollars in a Small American Town

“Pieces of plastic and paper and sections of tube floated to the floor: a snow of medical garbage.”
― Brian Alexander, The Hospital: Life, Death, and Dollars in a Small American Town

“The same situation applied to working-class people in big cities. “Health is, for the most part, a commodity which can be purchased,” Matthew Sloan, president of the New York Edison Company—a utility company and one of the nation’s major employers—said in 1929. “The difficulty now is that its cost is beyond the reach of a great majority of people.”
― Brian Alexander, The Hospital: Life, Death, and Dollars in a Small American Town

“Though Menard believed himself a self-made man, he and the company he controlled craved corporate welfare. After”
― Brian Alexander, The Hospital: Life, Death, and Dollars in a Small American Town

“Perhaps even more than he hated environmental laws, Menard hated labor unions. “The Manager’s income shall be automatically reduced by sixty percent (60%) of what it would have been if a union of any type is recognized within your particular operation during the term of this Agreement,” read an employment contract managers were required to sign. “If a union wins an election during this time, your income will automatically be reduced by sixty percent (60%).”
― Brian Alexander, The Hospital: Life, Death, and Dollars in a Small American Town

“And in some towns benefactors donated money for hospitals just as Andrew Carnegie built libraries. (Bryan took Carnegie’s money to build its library in 1903.)”
― Brian Alexander, The Hospital: Life, Death, and Dollars in a Small American Town

“Them old Dutchmen, them old Germans—they’d work all day in a factory in Bryan, then head home to work on the farm. It was like they couldn’t be sure the factory would last, and they wanted to hang on to the farm, just in case—because a farm is forever,”
― Brian Alexander, The Hospital: Life, Death, and Dollars in a Small American Town

“always be in tension with the other. To make matters worse, the board, a huddle of local pooh-bahs,”
― Brian Alexander, The Hospital: Life, Death, and Dollars in a Small American Town

“By 1926, medical costs had become a pressing national issue. “When pneumonia or typhoid strikes down a breadwinner or when a major surgical operation becomes necessary, poverty may soon knock on the door,” the New York Times opined.”
― Brian Alexander, The Hospital: Life, Death, and Dollars in a Small American Town