Guest Editorial > ‘Health Care: The New American Sadism’ by Charles Simic



‘Health Care: The New American Sadism’ by Charles Simic | Roger Steer

Where do you stand on competition, privatisation, light touch regulation, risk stratification and “sophisticated“ billing. Roger Steer reviews a book and an article that will make every thinking person think hard and take a position.

‘Health Care: The New American Sadism’ by Charles Simic


Review of “Health Care: The New American Sadism “- Charles Simic: NYRB April 2nd 2013 and

“Why Medical Bills Are Killing Us” Steven Brill: Time Magazine Feb 21st 2013


As the UK indulges in wistful nostalgia for the Thatcher years, with propaganda ringing in our ears on the bracing merits of rugged individualism, the pursuit of profit, and a scarcely concealed contempt for the undeserving poor these articles provide a timely reminder from the US on where it all may be leading.


In the land of “free enterprise” healthcare is not seen as a public good to be managed collectively and most efficiently but as a commercial product where “caveat emptor” is the watchword.


Charles Simic perhaps exaggerates a tad in describing the American healthcare system as sadistic in the way it exploits those with emergency needs and without adequate insurance coverage but Steven Brill gives the evidence. He asks the questions why a cancer case can generate $500,000 in bills, why 14 administrators at a New York cancer hospital are each paid more than $500,000 per annum ,why “non-profit” hospitals are often the biggest , most lavish businesses in town and why the healthcare industry absorbs getting on for 20% of the US economy.


The answers are that the healthcare industry is ripping people off, that vested interests are corrupting the political process by financing politicians re-election campaigns in return for favours (or for looking away) and that the media share in the windfall from advertising and so they fail to arm people with knowledge, understanding and a full range of alternatives.


Perhaps this is not just a US problem because I note that the second wealthiest French Cabinet Minister is a cancer specialist with wealth of Euros5.4m. But only in America does the problem scale the same heights and coincide with such a weak public response. Wilful blindness does not describe the half of it. Public gullibility and political, corporate and professional corruption are closer to the mark.


Just as the example of PFI hospitals reminds us every day that the alternative of publicly financed and managed healthcare may remain a viable option so the existence of US healthcare and articles such as these should be the subject of compulsory study by would be health service managers and politicians purporting to represent our best interests. The wonder is that ministers, NHS leaders and the Kings Fund still promote competition, privatisation, light touch regulation, and seek to ape the US system. HMO’s (CCG’s), risk stratification, restricted professional access to healthcare and “sophisticated“ billing systems are all US inventions reappearing in the UK in the name of increased efficiency and more effective healthcare.


I recommend reading these articles and asking yourself where you stand in response.


The good man understands what is right,

the bad man understands profit.



Roger Steer


NHS Managers