The Hospital: Life, Death, and Dollars in a Small American Town
by Brian Alexander. This book is a powerful story involving the small city of Bryan in Northwest Ohio. The local hospital and the collapse of the American healthcare following the 2008 recession is tragic.
Growing up in Northwest Ohio, this book feels personal. As if it was written about a town just west of home. It was, an hour west of Lucas County heading to Chicago on the Ohio turnpike. In addition, I have not read a book that clearly conveys the struggles and failure of our country’s healthcare system. As many health professionals, doctors, government, and community business leaders admit throughout the book, there is no healthcare ‘system’ in America today for those working multiple jobs who still cannot afford healthcare offered by their employer.
There is no healthcare ‘system’ in America today. Many health professionals, doctors, government, and community business leaders admit throughout the book.
Many working multiple jobs still cannot afford healthcare offered by their employer. The abuse heroin along with stunning numbers of citizens with diabetes is frankly depressing in itself. Yet, it is depression that is leading to a rise in suicides across Williams County. Guns, drugs, or rope are the tool around Williams County. Men and women, mothers and fathers from their early 20s to their late 60s. It proves that suicide, like COVID is spreading without restriction across Northwest Ohio.
Brian writes difficult stories of many failing to survive the 2008 recession. Keith Swihart, is just one of many who struggles with holding a down job while in declining health. He is one of many who do not have basic income to acquire medical prescriptions including insulin.
The launch of Bryan’s hospital was driven, in fact by the the Woman’s Christian Temperance Union. The implications of this are not so subtle today as in the early 1920s. This was maybe not surprising for rural Ohio.
Bryan Ohio turned over the exploration of the enterprise’s feasibility—and leading of a fund drive—to the local chapter of the Woman’s Christian Temperance Union….If any group could ram a hospital through, it was the WCTU.
pp. 33-34.
Yet with this group, came practices and customs treating black and minorities different compared to white patients across Williams County.
How Menards cheats your local hospital
The layers of society around Bryan Ohio changed due to the 2008 recession. However corporate welfare is well documented within Chapter 5: Pray The Iniquity of Inequity. Keith finds a full time job at a local Menards, but healthcare remains out of reach for him:
In 2012, the average Menards wage was $11.30 an hour. When Keith started in 2018, he made $14. With wages so low, many employees felt they couldn’t afford the Menards health plan, which was administered by Anthem Blue Cross and Blue Shield. Some people working full-time at Menards made so little money that they qualified for Medicaid, making it the unofficial backup health plan for Menards. Others played roulette with insurance in an effort to save money.
p. 200
Many Menards workers across the Midwest relied upon Medicad (our tax dollars) to pay hospitals at a cut rate. It was even less impressive to see multi-millionaire John Menard paying dark money to Wisconsin Governor-elect Scott Walker. Once in office, Walker stopped his State’s legal actions against Menards. A free corporate pass for dumping poisons into the Menomonee River, among other violations.
A Single Ohio Hospital Reveals All That’s Wrong With American Health Care
There is an honest tragedy before your eyes engulfing Williams County. Many find themselves one mistake, one dead car battery, one illness from bankruptcy. Moreover, it appears they will never escape poverty.
Fighting an uphill battle almost every day
When a truck lost control during a winter storm hitting Keith’s car in a Menards parking lot. He had to buy a car from a anyone willing to take the risk of his low credit score:
The buy-here-pay-here industry was jubilant at the election of Donald Trump in 2016. For years the trade group had fought regulation by the new Consumer Financial Protection Bureau (CFPB), which in 2013 banned forced arbitration of disputes and allowed borrowers to seek redress in courts. The CFPB had also asserted it could regulate the dealers’ financing schemes….Congressional Republicans, to whom the NIADA made generous campaign contributions (NIADA also donated to Democrat Nancy Pelosi), passed a joint resolution calling on Trump to nullify the CFPB’s assertion of jurisdiction. Trump signed it into law on May 21.
So Keith found himself negotiating with a newly unleashed buy-here-pay-here dealer who sold him a 2007 Saturn Outlook SUV with 140,000 miles on it for $15,000. Keith handed over the $2,500 insurance money and drove out owing $12,500 he had no hope of repaying (though he insisted he could): $110 every week, at 21 percent interest.
pp. 443-444.
Keith already had child support, food, and housing bills that took priority. His insulin, related surgeries, and medications fell by the wayside. Yet he passed on insulin simply because he had nothing left in his bank account. The coming short term results were tragic.
As The Hospital reveals the layers of a healthcare onion, you can see how our society is collapsing upon itself:
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.
p. 231
The American Dream is dead
At the heart of this book is the tragic story of the American worker:
We say we believe in people working hard, and people being true and honest, but we don’t really believe that. We have set up a society in which people are not paid enough wages to buy the products they are producing. Companies want more and more profit and less and less well-being for their workers” while simultaneously projecting “impossible standards of what a successful life in this country looks like. But [people] are not paid enough to achieve it.
We were built on the idea of the American Dream. You pull yourself up by bootstraps. You work hard—and that’s all true—but people must have opportunities to work hard, and I mean work hard so you get ahead and things get better for you. But then they don’t.
If you are a person who does not have any means—you’re poor, living in Williams County, and that is your whole experience—what are your options? We say in America anything is possible. Well, how? If you’ve got babies? Have you seen the price of childcare? And you wanna work where? And for how much?” Many say “‘choices have to be made and sacrifices made,’ but why should only poor people have to make sacrifices and choices?”
She used words that evoked those of hospital board member Chris Kannel, who said Williams County had to lift its eyes to Jesus to cure its heart problem, but she had a different target in mind. “They keep us looking down. If we looked up, where the real crime and greed is going on, and people are raking in enormous amounts of money and power and rigging the system so people cannot get ahead…?” She raised her eyebrows at the prospect of what might happen if people looked up.
pp.226-227
How Pizza became a vegetable
Perhaps the story of food stamps, known as Supplemental Nutrition Assistance Program (SNAP) is just as powerful. SNAP has been manipulated by corporate lobbyists and is robbing those living across Williams County:
Two other chains, Family Dollar and Dollar Tree (Dollar Tree acquired Family Dollar in 2013), sprinted to catch up. By 2019, all three chains combined had opened around twenty thousand stores, often wiping out small-town grocers and preventing any new independent stores from ever opening. By the time Shilo and Jimmy arrived in West Unity, the IGA was out of business.
They, and everybody else who couldn’t easily reach the Chief in Bryan, were left with meager pickings. She could use her food stamps at the West Unity Dollar General (“SNAP and EBT accepted here,” the sign on the store read), but if she were to walk in on the day I did, she’d find a tiny section of shelving—about four feet of it—dotted with a few bananas, some garlic, a couple of heads of lettuce, half a dozen tomatoes, four cucumbers, and a couple of green peppers. Some canned vegetables—green peas and green beans, mainly—sat on another shelf.
On the other hand, she could choose from almost any popular soft drink made in America. Their red, blue, orange, and green hues lit up an entire aisle, from the front of the store all the way to the back: Red Bull, Monster, Mountain Dew, sugared teas, flavored waters, Pepsis, Cokes. She could also buy any number of salty snacks and chips.
Stores in the SNAP program were supposed to abide by certain minimum stocking requirements established by the Department of Agriculture. Those requirements were enhanced in 2014 as a way to provide more nutritional options and variety to shoppers, and in late 2016, the Obama administration issued a rule implementing the change.
But in 2017, the new Republican-controlled Congress passed legislation: “None of the funds made available by this Act may be used to implement, administer, or enforce the ‘variety’ requirements of the final rule entitled ‘Enhancing Retailer Standards in the Supplemental Nutrition Assistance Program (SNAP)’ published by the Department of Agriculture in the Federal Register on December 15, 2016.
Lobbyists for the convenience-store industry convinced legislators that requiring more fresh fruits and vegetables—and more varieties of other foods—was too burdensome. The Trump administration agriculture department agreed. So a can of ravioli in tomato sauce counted as a vegetable.
The Dollar General offered the bare minimum of the even more relaxed food menu, and yet a long aisle of sugary drinks, because the drinks produced high profit margins and were also eligible for purchase with food stamps. “The SNAP program paid billions of dollars a year—about $4 billion, by one estimate—to the soft drink industry, to the stores, and, by extension, to the sugar and corn syrup industries, via SNAP recipients. In other words, taxpayers were subsidizing the promotion of diabetes and obesity.
p. 371
I am reminded of the workers who struggle to maintain our grocery store shelves in The Secret Life of Groceries: The Dark Miracle of the American Supermarket by Benjamin Lorr.
At the same time, What did predictive analytics tell KKR? It would appear it provided insights to game small market food supply chains:
When the private equity giant Kohlberg Kravis Roberts bought Dollar General for about $7 billion just as the Great Recession snuck up on America, some experts wondered why: it was a chain of roughly sixty-five hundred stores that sold cheap stuff to poor people. But soon the recession created lots of poor people. Under KKR’s ownership, Dollar General exploded, spawning more than a thousand additional little concrete-block shotgun-shack stores in one small town after another and in the poor neighborhoods of cities. By 2009, when KKR relisted the stock on the public markets, more than eight thousand Dollar Generals had metastasized across the United States. When KKR sold all of its stake in 2013, the company was worth three times what KKR had paid for it, and the financial press hailed the play’s success.
pp. 369-370
Northwest Ohio remains struggling from the 2008 recession. Workers cannot afford healthy food, nor health insurance to keep them living a safe, productive life. Then COVID came to Ohio….
In conclusion, Brian has authored a very powerful look at the failure of the Ohio health system in Williams County. His excellent writing brings struggles of many living across Northwest Ohio to confront a failing healthcare system. He proves repeatedly, that for those on the brink, there is actually no ‘system’ at all exactly when they need it the most.
His honest view of hospital systems that continue leveraging legacy approaches to the business of healthcare is dramatic. You will be reading in slow motion the collapse of small cities across Northwest Ohio. The impact is chilling to the rest of our country.
The Book Loft | A Conversation with Brian Alexander
HEC Books | Author Brian Alexander
Boston Public Library | Brian Alexander