My interest in "County: Life, Death and Politics at Chicago's Public Health Hospital", by David Ansell was primarily parochial, because it's about the Cook County Hospital in Chicago, near where I was born and raised. I used to pass it all the time, and it's where my cousin did his Residency. I remember some of my cousin's stories, and was curious about this other doctor's take on the hospital for Chicago's downtrodden, primarily the uninsured poor urban blacks of the inner City. I initially thought the book would be of little interest unless you knew something of the area.

But I've changed my mind, and believe this book has broader appeal. While it's specific to Dr. Ansell's experiences at Cook County Hospital, but it also give you broader insights into public health clinics, and a peek at the disparity in health care between the "haves" and the "have nots" in this Country. I found it meaningful in the bigger picture thinking about our National Health Care. While Dr. Ansell clearly has liberal leanings and would most likely consider himself more sympathetic to Democratic vs. Republican viewpoints, the book wasn't overtly political or preachy in nature.

We've had a big debate in this Country over the past few years on Health Care as a National issue. During the debate, some have pointed to the statistics which show our National Health Care does not compare favorably to many other developed countries in many categories, and others point out that people world-wide come to the U.S. to be treated for their illnesses. Those are confusing and counter-intuitive points. But reading Dr. Ansell's book showed me how and why those two differing views on our National Health Care can and do coexist. I think many of us, myself included, had trouble appreciating the need for national health care, for universal health insurance, or the potential benefit of a single payer option. In my case, if I need health care, I call for an appointment, get a reasonably quick response, and receive top notch treatment, which my insurance covers. And if I have an emergency need (not often thankfully), I know I can go to any hospital and be treated without being transferred and dumped to some other inferior facility. So it's hard to really appreciate the needs and deficiencies that the uninsured and very poor have to face when it comes to health care. This book fills in some of those blanks for me, and I think gave me a better appreciation, and makes me a more informed person during conversations on Health Care in our Country.

Harold Cain made a comment during the Republican Party debates a month or two ago, which basically said if someone is poor, it's their own fault. You get a more sympathetic viewpoint from this book. And Mitt Romney stepped on his tongue a few weeks ago when he said "... he wasn't worried about the poor - they have a safety net in place". He later tried to explain that his original quote continued by saying that if the safety net needed improving, he'd address that as president. I hope, if he gets the nomination and becomes president, that he would do this. Dr. Ansel's book does point out that the safety net for the poor needs mending, and I believe Obama has tried to address this, and hope that if Romney gets elected, he will find an economic way to follow up on his words. One thing this book does make clearer is the gap in quality in our approach to health care, and there are many, through no fault of their own, who are left out. ( )

Dr. David Ansell came to Chicago's Cook County Hospital right out of medical school. County had once been an institution that boasted some of the finest doctors and most competitive internships in the country. But Chicago's black population quadrupled between 1930 and 1960, and thanks to racial segration, County Hospital became the de-facto hospital for black Chicagoans. ("Racial segregation was actively enforced and many Chicago hospitals refused to serve black patients until laws like the Hill-Burton Act and Medicare-mandated desegregation.") Additionally, County became the default dumping ground for private hospitals who didn't want to accept only $500 for Medicare patients. Political corruption (particularly bad in Chicago at this time) and a lack of public will to provide free care to the uninsured meant that funding was scarce.

By the time Ansell arrived at County in 1978, it was a run-down, deeply dysfunctional institution that nevertheless treated hundreds of thousands of patients a year. Patients waited for an average of 8 hours in the emergency room, or weeks to get medications filled. Months passed between a breast cancer diagnosis and treatment. To get a CAT scan, doctors had to personally wheel their patient to the nearby private hospital, and wait with them for hours to get the scan. The private hospital doctors wouldn't treat the public patients, so County doctors had to bring all medications and equipment they might need (including everything they needed if their patient coded, because even then the Presbyterian doctors couldn't/wouldn't help). Attending physicians were rarely actually on the floor; nurses slept during the night instead of tending to patients; there were never enough chairs, beds, space, medication, or x-ray equipment. Everything had to be double-checked, because tests would be ordered but never done, medications were never delivered. And meanwhile, funding for County was perpetually in doubt, even though it was clear that even the existing system wasn't enough to satisfy Chicagoans' health care needs. Ansell and his collegues continually fought to get funding for their programs and get better care for their patients.

The anecdotes that Ansell shares are haunting and arresting. His tales of blatent corruption and cronyism, racism, classism, homophobia and sexism are clearly just the tip of the iceburg--there are many more lurking beneath the surface. His calls for a single-payer health care system are passionate and well-informed. The history of Chicago and County are equally well-researched, and he tells their stories in a clear, easy-to-follow manner. The only arena he falters in is when he talks about himself; his writing comes across as a little braggy, even though he's clearly fought for and accomplished a lot. It's not that he hasn't earned respect, it's just that his writing is a little too blunt for my taste.

The story of County is so fascinating and infuriating that no matter who told it, it would be a ripping book. Ansell's passion for social justice, and the long, hard struggle (that continues to be necessary) to achieve it, come through perfectly, needing no authorial flourishes or polish. ( )

Part memoir and part powerful indictment of the American health care system, Ansell gives a heartbreaking and maddening account of his time at Chicago’s old Cook County Hospital (a new facility opened in 2002). Situated west of the Chicago Loop, this public hospital served the city’s poor and uninsured populations (almost entirely African American and Spanish-speaking immigrants) for over 100 years.

Taking the reader from his time as a resident, to his tenure as an attending physician, Ansell describes his activist work and the inhumane conditions experienced by the patients. The ancient building still had open wards; the restrooms were filthy; there were too few nurses and doctors to serve the patients that needed care; the corrupt, patronage politics practiced by the Chicago political machine installed incompetent leadership; and funding was always lacking and the threat of closure loomed continuously. Additionally, the customer service was atrocious, with patients often treated like animals by over-worked and jaded hospital clerks. Most importantly, the unbelievably long wait times for care, caused by lack of funding and resources, literally caused death.

Ansell’s honest account of his time at County leaves no one off-the-hook, including himself. He describes his time as a nearly unsupervised resident attempting to make decisions on his own that sometimes led to patient harm and even death. He describes the disturbing practice of patient dumping, where other hospitals turn away patients needing immediate care (based on insurance status) and send them to the Cook County Hospital Emergency Room, delaying their treatment.

In 2002, the new building opened, and while it remedies some of the hospital’s problems (really only those related to facilities), it remains part of the two-tier system of healthcare that exists in America (those with employer-based insurance and those without). Ansell’s main conclusion is that quality healthcare is a human right and the system in place today is both inhumane and racist. He argues that the United States needs some kind of single-payer health care system where equal access to quality healthcare is available to all people, regardless of economic status. A wonderful, brave, and powerful book. Highly recommended. ( )

County is a memoir of David Ansell’s medical training and career at Chicago’s Cook County [public] Hospital from 1978-95.

It’s also a glimpse into patronage politics; healthcare economics; 1910s-era hospital design and operation; and County’s patients and staff. I had been interested to read, in Isabel Wilkerson's The Warmth of Other Suns, that the most migrated-to cities during the African-American Great Migration became America’s most severely and enduring segregated cities; that is reinforced here in Ansell’s characterization of Chicago as “hypersegregated” -- even Blacks with health insurance went to County. I was aware of what a good place the hospital was to be a physician-in-training; until this book, I was less aware of what a sketchy place it was to be a patient. “Can healthcare be separate but equal?” seems an impossible question to be asking still, and Ansell makes the answer obvious. ( )