America's health care system is unraveling. Every day, millions of hard-working people struggle to find affordable medical treatment for themselves and their families—unable to pay for prescription drugs and regular checkups, let alone hospital visits. Some of these people end up losing money. Others end up losing something even more valuable: their health or even their lives. In this powerful work of original reportage, Jonathan Cohn travels across the United States—the only country in the developed world that does not guarantee access to medical care as a right of citizenship—to investigate why this crisis is happening and to see firsthand its impact on ordinary Americans.

The stories he brings back are tragic and infuriating. In Boston, a heart attack victim becomes a casualty of emergency room overcrowding when she is turned away from the one hospital that could treat her. In South Central L.A., a security guard loses part of his vision when he can't find affordable treatment for his diabetes. In the middle of the prairie heartland, a retired meatpacker sells his house to pay for the medications that keep him and his aging wife alive. And, in a tiny village tucked into the Catskill mountains, a mother of three young children decides against a costly doctor's visit—and lets a deadly cancer go undetected—because her husband's high-tech job no longer provides health insurance.

Passionate, illuminating, and often devastating, Sick interweaves these stories with clear-eyed reporting from Washington and takes us inside the medical industry to chronicle the decline of America's health care system—and lays bare the consequences any one of us could suffer if we don't replace it.

"In this addition to the growing list of exposs of the toll our patchwork, profit-based health-care system takes on Americans, Cohn makes a plea for a universal coverage with a single-payer system regulated by the government. Drawing on research and riveting anecdotes, Cohn, a senior editor at the New Republic, describes how private insurers decide who and what they will — and will not — cover. He also examines how rising health-care costs lead corporations to seek ways to deny coverage to employees, such as hiring full-time workers as temps or independent contractors without health insurance. In tale after tale, Cohn documents the sometimes catastrophic results. they couldn't. Cohn points out that managed care initially had an altruistic goal of making health-care affordable for all. But by 1997, two-thirds of HMOs were controlled by for-profit companies concerned with making money rather than preventing and easing sickness. The author convincingly argues that Medicare and universal health care in such countries as France, though not perfect, are far superior to the system most Americans face. Much of this is well-trod territory, but Cohn is eloquent, and he's good at using case studies to dramatize and explain complex issues." Publishers Weekly (Copyright Reed Business Information, Inc.)

"Thirteen long years after the failure of the Clinton health care plan — and with Democrats back in control of a Congress that they lost in part due to the plan's collapse — Washington is again talking health care in a serious way. John Edwards has even made universal health care, paid for by tax increases on the wealthy, a centerpiece of his presidential campaign.

But the interregnum..." Washington Post Book Review (read the entire Washington Post review) has exacted a terrible human price, as Jonathan Cohn documents movingly in 'Sick.' Aside from the 46 million uninsured, there are the millions of underinsured, and ever-increasing restrictions on coverage have undoubtedly cost lives among the diabetic, the mentally ill and many others. Cohn's emphatic title may refer to the state of our nation, but he's clearly pretty sick of all this himself.

Among journalists, Cohn, a senior editor at the New Republic, is one of America's leading experts on health care policy. Advocates of a more generous system may reasonably hope that 'Sick' will do for universal coverage what Michael Harrington's 'The Other America' once did for the war on poverty.

For the most part, 'Sick' delivers. Its eight expository chapters deftly interweave discussions of health care policy and history with personal stories of people who have been pricked by the system's sharpest brambles, with each story humanizing a specific shortcoming of our current system.

A man in upstate New York who 'supposedly did all the right things to realize the American dream' could not get coverage for his wife's breast cancer because he was laid off from his aerospace-manufacturing job and then rehired — but as an independent contractor, without insurance. A retiree in Sioux Falls, S.D., was reduced to penury when the meatpacking plant where he'd worked almost all his life took away retirees' coverage. 'We kept saying, "they just can't do this, they can't,"' his wife tells Cohn. 'But they did.'

In a heart-rending story that highlights the limits of mental health coverage, a teacher in Denver with generous insurance can't afford his wife's psychiatric treatments. She had been sexually abused as a child and suffered from severe depression. She was hospitalized, and her husband was hopeful, but once the bill hit $50,000 the hospital tossed her out. Burdened by the financial strain she was placing on her husband and son, she tried suicide three times, finally succeeding on the third attempt.

In each chapter, Cohn breaks from the personal narrative to relay the history of an aspect of health care. For instance, in a moving chapter about a couple reduced to poverty and divorce because their HMO insufficiently covered treatment for their son's cerebral palsy, we learn the details of how a great many health maintenance organizations have strayed from their original purpose by becoming for-profit rather than nonprofit.

These history and policy sections are fascinating but too brief. I sense that Cohn feared readers' eyes glazing over, and so worked very hard not to write a policy book. But he actually should have written more of one.

Hence, the book's lone — but not insignificant — shortcoming: It doesn't really describe the system as a system. Few if any doctors, hospital administrators, HMO executives, insurance officials, Wall Street analysts, nurses, home-care providers or free clinic managers are quoted in 'Sick.' I'm not arguing for a 'fair and balanced' account; like Cohn, I'm not particularly sympathetic to the plights of some of the above. But I think that getting the motivations of some of these players on the record might have strengthened his case even more. In any event, it would have made for a more authoritative work.

But Cohn wrote a different sort of book, one that is intended to pierce the conscience of the nation. He has done his part, in many ways to great effect. Now we have only to see if history hands the Democrats another chance, and if they can exploit it a little more cleverly this time.

Michael Tomasky was recently named editor of Guardian America, the British newspaper's American Web site.

" Reviewed by Amanda SchafferDaniel StashowerMichael Tomasky, Washington Post Book World (Copyright 2006 Washington Post Book World Service/Washington Post Writers Group)
(hide most of this review)

Drawing on his travels across the U.S. through major cities and small towns, Cohn (senior editor, the New Republic; Demos think tank) presents historical context on and examples of how the sorry state of the country's health care system affects real people. Reporting on how lack of affordable health care and the dysfunctional system can result in economic ruin, health complications, and even death, he concludes by arguing for universal health care coverage though realistic about such existing systems' flaws. Annotation ©2007 Book News, Inc., Portland, OR (booknews.com)

A penetrating work of reporting about the failure of America's medical system, as examined through the stories of the people who engineered the current health care revolution and those who have suffered from it.

Jonathan Cohn is a senior editor at The New Republic, where he has written about national politics and its impact on American communities for the past decade. He is also a contributing editor at The American Prospect and a senior fellow at the think tank Demos. Cohn, who has been a media fellow with the Kaiser Family Foundation, has written for The New York Times, The Washington Post, Mother Jones, Rolling Stone, Slate, and The Washington Monthly. A graduate of Harvard, he lives in Ann Arbor, Michigan, with his wife and two children.