The reporting for this book was conducted between March 2018 and August 2020 and included reference to over 3,100 documents and my own observations and interviews. The following books provided important background, insights, and facts: In Sickness and in Wealth: American Hospitals in the Twentieth Century, by Rosemary Stevens (Baltimore: Johns Hopkins University Press, 1999); Health Care for Some: Rights and Rationing in the United States Since 1930, by Beatrix Hoffman (Chicago: University of Chicago Press, 2012); Remaking the American Patient: How Madison Avenue and Modern Medicine Turned Patients into Consumers, by Nancy Tomes (Chapel Hill: University of North Carolina Press, 2016); Selling Our Souls: The Commodification of Hospital Care in the United States, by Adam D. Reich (Princeton, NJ: Princeton University Press, 2014); An American Sickness: How Healthcare Became Big Business and How You Can Take It Back, by Elisabeth Rosenthal (New York: Penguin Books, 2017).
I attempted to interview Michael Packnett, CEO of Parkview, and Randy Oostra, CEO of ProMedica. Both declined through their press officers.
The following selected notes are not a complete list of sources or attributions.
Hundreds more such hospitals, over six hundred by some estimates: Sharita R. Thomas et al., “Geographic Variation in the 2019 Risk of Financial Distress Among Rural Hospitals,” North Carolina Rural Health Research Program, April 2019; “NRHA Endorses Reintroduction of Save Rural Hospitals Act to New Congress,” press release, June 20, 2017.
18 percent of the entire economy, health was the nation’s largest industry by far: “US Health Spending Recovers After Two Slow Years: CMS,” Reuters, December 5, 2019.
four hundred nursing-care facilities in thirty states and $1.16 billion in revenue: Genesis earnings release, Q1, 2019.
while Hillsdale County, Michigan, where Hi-Lex was located, hit 20 percent: Unemployment rate in Hillsdale County, Michigan, St. Louis Federal Reserve.
He used this sole white outpost as a base from which to annihilate Native American villages: https://ohiohistorycentral.org/w/Fort_Defiance?rec=703.
Twenty years later, just 265 people lived in the new city of Bryan, the county seat: Presentation by Kevin Maynard, Wiliams County Public Library, March 25, 2019.
“People are negligent as to health conditions”: Logs and notebooks of the Williams County Health Department, 1922.
The chief’s enthusiasm failed to sway tightfisted taxpayers: “Chief Bowersox Suggests Use of Cherry School for Hospital,” Bryan Democrat, April 12, 1918.
By 1926, there were 6,946: Vital Statistics, Health, and Nutrition (Series C 1-155), 1789–1945, National Office of Vital Statistics.
All he asked was that the city come up with a matching $25,000: “Committee of 29 Given Charge of Hospital Project,” Bryan Press, September 16, 1926.
The winning children in each age group received $5: “Healthiest Kids at Fair to Get Prizes,” Bryan Press, September 9, 1926.
“Logically, the next step would seem to be to institute sickness insurance”: “Sickness Insurance and Its Possibilities in Mining and Railroading,” The National: A Journal Devoted to the Interests of the National Window Glass Workers of America, August 1915.
“We are not yet ready therefore to assent to the advantage of a system so startling to our American theories and ideals”: Proceedings of the Conference on Social Insurance, December 5–9, 1916, Workmen’s Insurance and Compensation Series, Department of Labor, Bulletin of the United States, number 212.
by the work of a statistician named Frederick Ludwig Hoffman (and subsequent information and quotes from Hoffman): Beatrix Hoffman, “Scientific Racism, Insurance, and Opposition to the Welfare State: Frederick L. Hoffman’s Transatlantic Journey,” Journal of the Gilded Age and Progressive Era 2 (April 2003): 150–190.
by branding such legislation as “Bolshevistic”: “Women Assail Welfare Foes,” New York Times, March 23, 1920.
The measure passed both houses of Congress by wide margins in 1921: Sheppard-Towner Maternity and Infancy Protection Act (1921), Embryo Project Encyclopedia, https://embryo.asu.edu.
“The legislation is economically unsound. It did not accomplish what its proponents claimed for it”: “Deplores Passing of Personal Doctor,” New York Times, September 22, 1927.
from 76 per 1,000 live births when the law was passed to 65 in 1927: “CB and the Sheppard-Towner Act of 1921,” Department of Health and Human Services.
The median net income of a Shelbyville County doctor in 1930 was $3,066: Committee on the Costs of Medical Care, Publication Number 6, A Survey of the Medical Facilities of Shelby County, Indiana, 1929.
“The difficulty now is that its cost is beyond the reach of a great majority of people”: “$6,000,000 Sought for New Hospital,” New York Times, October 3, 1929.
A simple hospital tonsillectomy would cost a week’s pay: History of Wages in the United States from Colonial Times to 1928, Bulletin of the United States Bureau of Labor Statistics, number 604, United States Bureau of Labor Statistics, October 1929.
in Chester County, Tennessee, the average net annual income of a physician was $991: “Reports Ten States Lack Medical Care,” New York Times, November 18, 1932.
But those rich households accounted for 9.8 percent of hospital cases: Data derived from Rosemary Stevens, In Sickness and in Wealth: American Hospitals in the Twentieth Century (Baltimore: Johns Hopkins University Press, 1999), 136; National Bureau of Economic Research, bulletin number 46, May 1, 1933.
The Los Angeles Medical Association expelled them: “Dr. Donald Ross, Pioneer in Prepaid Health,” Washington Post, June 18, 1981.
Other physicians who deviated from AMA orthodoxy regarding payments were denied hospital privileges or were harassed: “Moderate Medical Costs,” New York Times, July 11, 1929.
He called the proposed group practice idea “medical soviets” and warned of the “destruction of private practice”: Morris Fishbein, “The Committee on the Costs of Medical Care,” Journal of the American Medical Association, December 3, 1932.
Fishbein argued that the public should trust doctors and the AMA: “Abstract of Dr. Morris Fishbein’s Lecture at Battle Creek, December 6, 1932,” Journal of the Michigan State Medical Society, January 1933.
“It is absurd for the editor of a leading American medical journal”: Isidore Falk, “The Present and Future Organization of Medicine,” Milbank Memorial Fund Quarterly 12, no. 2 (1934).
By the end of 1933, there were 930 fewer cars and trucks in the county than there’d been in 1929: “Fewer Autos; More Taxes in 5 Years,” Bryan Press, May 3, 1934.
two people committed suicide in 1929: Records of the Williams County Health Department, various years.
federal money had flooded into the pockets of more than 1,100 of the county’s farmers: “AAA Knocked Out, Many Farmers in County Affected,” Bryan Democrat, January 6, 1936.
an inventor and entrepreneur named John C. Markey sold more than two thousand shares of ARO Equipment Corporation: “Wesley Life Learns About Aro, Ancestry,” Bryan Times, March 30, 2012.
ARO was listed on the New York Curb Exchange: “Listings Increased by Curb Exchange,” New York Times, June 13, 1940.
Cameron, who practiced in Fort Wayne, married the daughter of the U.S. congressman who represented Angola: “Memoirs of Two Hospitals: As Recalled by Don F. Cameron M.D.,” Cameron Memorial Hospitals, Inc.
for a −2 percent operating margin: CHWC IRS Form 990, Year Ending September 30, 2018; Phil Ennen memo to CHWC Employees, November 15, 2018.
His chief financial officer, Chad Tinkel, figured it could happen within three years: Interview with Dave Swanson, January 23, 2019.
loan covenants with Fifth Third Bank that required it to maintain a cash-to-debt ratio of 1.25: Reimbursement Agreement by and between Community Hospitals and Wellness Centers, an Ohio nonprofit corporation, and Fifth Third Bank, dated July 1, 2008.
The board, he thought, gave him the autonomy to “find a glide path that gets the job done”: Interview with Phil Ennen, June 21, 2018.
the hospital received a pitch from a firm called Quest Health Enterprises: 1994 letter from James R. Swope, CEO, Quest Health Enterprises, to Rusty Brunicardi.
By 2007, Quest was charging hospitals $1 million a year to license the software: June 20, 2007, letter from James R. Swope, CEO, Quest Health Enterprises, to Rusty Brunicardi.
“Are you hiring Isis?” it read: Interview with Phil Ennen, November 11, 2018.
“They wanna shut me out?”: Interview with Hanan Bazzi, February 18, 2019.
his family had to force him to go on vacation: Interview with Demoder Kesireddy, April 24, 2019.
Kim Owen, the radiation oncology center director, was beginning to rethink her own career with CHWC: Interview with Kim Owen, April 23, 2019.
“An apple a day won’t keep this doctor away”: Interview with Angelia Foster, February 9, 2019.
“That uncorks a variety of bad things, like a more public airing, perhaps questioning”: Interview with Phil Ennen, February 23, 2019.
In 1985, Todd Shipyards, in deep financial trouble, raided ARO to add its solvent pension fund to Todd’s assets: “Todd Shipyards to Acquire Aro,” New York Times, October 22, 1985; interview with Dean Spangler, March 7, 2018.
Mohawk, caught up in a wave of consolidation of auto suppliers: “Acquisition of Montpelier Mohawk Tools Is Completed,” Crescent-News, November 4, 1986.
shut down about the same time as ARO: Federal Register, February 4, 1992, “Notices,” Department of Labor.
When the recession hit, unemployment in the United States rose to 10 percent, but in Williams County it was 17.2 percent: Federal Reserve of St. Louis, using U.S. Bureau of Labor statistics.
so only a few hundred people still farmed full-time: 1978 Census of Agriculture, Williams County, Ohio; 1997 Census of Agriculture, Williams County, Ohio; Ohio County Profiles, Williams, State of Ohio.
because she’d just started, she had no health insurance and no paycheck yet: Interview with Valerie Moreno, December 3, 2018.
They offered sketchy loans to buyers with poor credit scores, who then snapped up the homes: Mike Baker and Daniel Wagner, “The Mobile-Home Trap: How a Warren Buffett Empire Preys on the Poor,” Seattle Times/Center for Public Integrity, April 2, 2015.
their homes were repossessed, and manufacturing slowed until, finally, as the recession hit, it stopped altogether: Interview with Marc Tingle, March 9, 2019.
one of the 920 people in Ohio who would kill themselves with guns that year: “Years of Lost Life: Firearm Fatalities 2009–2018,” Ohio Alliance for Innovation in Population Health.
Besides, the last time she’d had the test, the results were okay: Stephanie Swihart’s medical information derived from medical records and billings viewed by the author, with permission from Keith Swihart.
Hassouneh knew the diagnosis had come far too late: Interview with Samar Hassouneh, April 22, 2019.
Cameron united his Angola and Bryan operations into a single tax-exempt charitable corporation: Letter from Dallas A. Riddle, Ohio Hospital Association, to Donald F. Cameron, March 15, 1961.
in the mold of beneficent medical pioneers like the Mayo brothers: Draft letter from law firm Baker Hostetler & Patterson to the Internal Revenue Service, May 1962.
“among indigents, a medical triumph often adds to the taxpayer’s burden”: Donald Cameron speech to the Quest Club of Fort Wayne, Indiana, April 8, 1960.
By 1962, Cameron was receiving $500 a month: Letter with attached history and finances of Cameron Hospitals, Inc., from Baker Hostetler & Patterson to the Internal Revenue Service, May 1960; Financial Report, Cameron Memorial Hospitals, Inc., February 29, 1964; affidavit of Lloyd Leo McCormack to Internal Revenue Service agent Robert Cantwell, July 29, 1960; affidavit of Ramesh Carpentar to Internal Revenue Service agent Robert Cantwell, August 5, 1960; draft letter from law firm Baker Hostetler & Patterson to the Internal Revenue Service, May 1962.
By 1973, the hospital found itself in deep trouble: Letter from Ralph Hause to Miss Ada Mitchell and Robert Dilworth, M.D., September 11, 1972.
Brown called Brunicardi: Interview with Rusty Brunicardi, February 19, 2019.
“Effective immediately, I am placing the hospital on a fiscal watch”: Phil Ennen memo to CHWC employees, October 8, 2008.
“The economic recovery that Washington keeps talking about has not arrived in Northwest Ohio”: Phil Ennen memo to CHWC employees, December 10, 2009.
The two teenagers earned a little extra spending money by helping Brunicardi compile a database of rural hospitals: Interview with Kim Jerger, April 16, 2019.
charging between $10,000 and $20,000 a talk: www.allamericanspeakers.com/speakers/3157/Chris-Spielman.
Main Street turned out to be a stark dividing line: PowerPoint presentation by Jim Watkins and Meagan Riley, Williams County Health Department.
“the stage at the time of diagnosis was advanced in the east side of Bryan”: Bryan Cancer Cases Study 2017 Data, February 15, 2019.
In Franklinton, a neighborhood in Columbus, the average life expectancy was sixty: Joann Viviano, “Report: Two Columbus Neighborhoods Among Lowest in Ohio for Life Expectancy Rates,” Columbus Dispatch, October 17, 2018.
a seven-year chasm had opened between states: Andy Miller, “Life Expectancy Rates Vary Across Census Tracts,” Georgia Health News, September 17, 2018; Laura Dwyer-Lindgren et al., “Inequalities in Life Expectancy Among US Counties,” Health Care Policy and Law, July 2017; Vital and Health Statistics, Series 2, Number 181, September 2018, National Center for Health Statistics; Steven H. Woolf and Heidi Schoomaker, “Life Expectancy and Mortality Rates in the United States, 1959–2017,” Journal of the American Medical Association, November 26, 2019.
When the Robert Wood Johnson Foundation issued rankings for counties: Lynn Thompson, “Latest County Health Rankings Released,” Bryan Times, March 18, 2019.
Ohio ranked forty-sixth out of the fifty states: 2019 Health Value Dashboard, Health Policy Institute of Ohio.
“negative trends in premature death, life expectancy and overall health status”: State Health Assessment Ohio 2019 (Preliminary Draft), Health Policy Institute of Ohio and Ohio Department of Health.
815.7 people out of 100,000 (age-adjusted) died of all causes: Deaths: Final Data for 2010, National Vital Statistics Reports, volume 61, number 4.
By 2017, 849.7 died: Deaths: Final Data for 2017, National Vital Statistics Reports, volume 68, number 9.
Sixteen percent of young people said they seriously considered suicide: 2019 Williams County Health Needs Assessment, Williams County Health Department, Community Hospitals and Wellness Centers.
“We saw four thousand more patients in 2017 than we did in 2016”: Interview with Les McCaslin, December 3, 2018.
It was called to twenty-eight attempted suicides in 2018: Montpelier Police Department 2017 Annual Report; Montpelier Police Department 2018 Annual Report.
Six days after Keith’s buddy Chad killed himself: Williams County Year-to-Date Filed Deaths 2017, Williams County Health Department; Holly Hedegaard et al., “Suicide Mortality in the United States, 1999–2017,” NCHS Data Brief, no. 330, November 2018.
Nearly half of all people ages thirty to sixty-four were obese: 2019 Williams County Health Needs Assessment, Williams County Health Department, Community Hospitals and Wellness Centers.
Williams had a higher rate of infections of the sexually transmitted disease: Ohio 2018 Chlamydia Rates, Ohio Department of Health, STD Surveillance.
The Joint Commission was a private body with roots stretching back to 1913: www.facs.org/about-acs/archives/acshistory.
By 1952, several organizations agreed to carve out a stand-alone hospital standards group: Rosemary Stevens, In Sickness and in Wealth: American Hospitals in the Twentieth Century (Baltimore: Johns Hopkins University Press, 1999).
The 2018 edition of Hospital Accreditation Standards: 2018 Hospital Accredidation Standards, The Joint Commission, January 2018.
he emptied his 401(k) account of the little that was left: Interview with Keith Swihart, February 15, 2019.
“Final request for payment,” the invoice for $852.84 from Mercy Health announced: Invoices from consulting pathologists, Mercy Health.
Twelve percent of adults—including 16 percent of all men and 27 percent of all people over age sixty-five—in Williams County had been diagnosed with diabetes: 2019 Williams County Community Health Needs Assessment, Williams County Health Department, Community Hospitals and Wellness Centers.
The ER bill alone, just for the doctor’s time, was $1,250: Invoice from Schumacher Clinical Partners dated November 21, 2018.
Barb Purvis, the nurse practitioner at the community health center, saw Keith: Medical records for Keith Swihart, Bryan Community Health Center.
“There’s no point in kicking the can down the road”: Phil Ennen memo to CHWC departments, November 15, 2018.
“Or they can’t pass a drug test”: Interview with Brian Davis, March 8, 2018.
“We have good, hardworking people, and they are the reason for our continued growth”: 2017 WEDCO Annual Report (presented at the 2018 annual meeting).
“The sense I get is that people look at Bryan as ‘our best days are behind us’”: Interview with Kevin Maynard, December 5, 2018.
Only three permits to build new houses would be issued in the city of Bryan in 2018: Max Reinhart, “Planning and Zoning Director Issues Annual Report,” Bryan Times, February 12, 2019.
while there’d be 567 permits issued to carry a concealed gun in Williams County: Ron Osborn, “Williams County Issues 567 Concealed Carry Licenses in 2018,” Bryan Times, March 3, 2019.
Snyder was sentenced to two years in prison and ordered to pay back $781,000: “Former Ruralogic Chairman Sentenced to Two Years in Prison,” Bryan Times, November 30, 2018.
“The only thing that can save our community is Jesus”: Interview with Chris Kannel, April 16, 2019.
Valerie tried to stay as involved as she could in the life of her younger one: Interview with Valerie Moreno, December 3, 2018.
Fayette Tubular was sold to a French conglomerate that shut the plant and moved the jobs to Tennessee: “Fayette Tubular,” New York Times, December 6, 1995; “Hutchinson Seeks a Place in U.S. Hose Market,” Automotive News, July 7, 1997.
In 2010, Global Automotive Systems closed the Bryan factory as part of its “global optimization strategy”: “Auto Parts Supplier in Bryan to Close,” Bryan Times, December 2, 2010.
Contrary to the gospel, five families in the entire county received government cash assistance: Interview with Fred Lord, March 22, 2019.
The median household income … in Williams County was $47,593: Ohio County Profiles, Williams County, Ohio Office of Research.
About 13.5 percent of Williams County residents lived in poverty: The Ohio Poverty Report, February 2019, Ohio Development Services Agency.
Williams County, with a population of about 37,000 people, had about 4,600 ALICE households: Williams County Health Department via U.S. Census Bureau.
“People talk about that all the time”: Interview with Chastity Yoder, March 26, 2019.
Some flouted the law for decades: Beatrix Hoffman, Health Care for Some: Rights and Rationing in the United States Since 1930 (Chicago: University of Chicago Press, 2012).
there was an incentive for hospitals to plead poverty to the government and report lots of uncompensated care: “Hospital Uncompensated Care,” United States Government Accountability Office, June 2016.
CHWC reported nearly $3 million in bad debt: Community Hospitals and Wellness Centers, IRS Form 990, FY Ending September 30, 2018.
Henry County Hospital, over in Napoleon, was losing money every month, too: Interview with Kim Bordenkircher, March 14, 2019.
“Transformational changes dictate that leaders within the physician enterprise focus on enterprise sustainability”: www.dhg.com/services/advisory/healthcare-consulting/achieve; DHG Healthcare Executive Brief.
a few board members hankered for a more formal process: Interview with Chris Kannel, April 16, 2019.
Ennen, without consulting the board, paid for his mistake with a million-dollar buyout of the physician’s contract: Interview with Phil Ennen, April 24, 2019.
“But they’d leave Bryan alone, because of its isolation, and we weren’t competitive”: Interview with Phil Ennen, February 8, 2019.
Younger doctors, he thought, were preoccupied with money: Interview with Nick Walz, January 19, 2019.
Coleman had run his own little contracting company up in Michigan: Interview with Greg Coleman, December 4, 2018.
DHL got another $122 million in state-paid road construction and tax breaks: “Wilmington Closes Deal to Finance DHL Expansion,” Dayton Daily News, March 7, 2007; Jack Lyne, “Blockbuster Deal,” Site Selection Magazine, week of July 5, 2004.
The mayor of Wilmington called the closure “catastrophic”: Bob Driehaus, “DHL Cuts 9,500 Jobs in U.S., and an Ohio Town Takes the Brunt,” New York Times, November 10, 2008.
He founded what became Menards in 1958 in Wisconsin: www.menards.com/main/footer/company-information/about-us/our-history/c-3588.htm.
State regulators did, however, and levied a $1.7 million fine: Michael Isikoff, “Secret $1.5 Million Donation from Wisconsin Billionaire Uncovered in Scott Walker Dark-Money Probe,” Yahoo Politics, March 23, 2015; Mary Van de Kamp Nohl, “Big Money,” Milwaukee Magazine, April 30, 2007.
The company paid $2 million: “Menards Inc. Fined $2 Million in Pollution Case,” Milwaukee Business Journal, August 9, 2005; Bruce Murphy, “Murphy’s Law: The Strange Life of John Menard,” Urban Milwaukee, June 20, 2013.
The billionaire had given $1.5 million in “dark” money to a group supporting Walker’s campaign: Isikoff, “Secret $1.5 Million Donation”; “Influence Peddler of the Month—John Menard, Jr.,” Wisconsin Democracy Campaign, June 1, 2016.
“your income will automatically be reduced by sixty percent (60%)”: Bill Lueders, “Managers at Menards Stand to Lose Big Money if Unions Form,” The Progressive, December 8, 2015.
In 2015, the company paid a $1 million settlement in a race discrimination case: “Menards Ends Discrimination Claim for $1 Million,” Pioneer Press, February 7, 2012.
they had to pay for their own lawyers as well as half the cost of the arbitration process, even if Menards was found to be at fault: Faber v. Menard, No. C 03-3034-MWB, United States District Court, N.D. Iowa, Central Division, June 17, 2003.
In 2015, it wrote to the commissioners of Kansas’s Douglas County: December 7, 2015, letter to Douglas County Commission from Scott R. Nuttelman.
Menards lapped up $23,321,779 in subsidies: Subsidy Tracker, GoodJobsFirst.org.
Hundreds of thousands of dollars’ worth of infrastructure—including a road, water and sewer systems, and power systems—were used to build what Menards wanted built: Williams County Engineer Todd Roth, May 12, 2020.
Menards was by far the biggest beneficiary: Williams County Single Audit for the Year Ended December 31, 2016, Dave Yost, Auditor, State of Ohio.
Roughly nine hundred people worked at Menards: Housing Opportunities Assessment, Williams County, Ohio, July 17, 2018.
If they tried to lower those premiums by enrolling in a “B” plan, their deductibles could rise into the thousands: Menards Benefits at a Glance, last updated January 1, 2019.
The 2019–2020 “B” plan deductible for a single Menards employee was $5,750: “Health and Dental Information 2020,” Menards. (Author’s note: Repeated calls, over a period of months, to Menards human resources in Holiday City and to the Menards general number in Holiday City went unanswered.)
CHWC cut their bill in half and wrote off $8,500 as charity: CHWC Charitable Care Program intake form.
A private equity firm, Taglich Private Equity LLC, had created Unique Fabricating: U.S. Securities and Exchange Commission, form 10-Q, Unique Fabricating, Inc., for the quarterly period ended September 29, 2019.
Unique Fabricating decided to close the Bryan plant: Josh Ewers, “Unique-Chardan Plant to Close,” Bryan Times, January 3, 2020.
Hassouneh continued to see the woman—who, now pain free, was able to get a job and begin pulling herself out of debt: Interview with Samar Hassouneh, April 22, 2019.
ER nurse Heather Gaylord found herself fighting the urge to judge: Interview with Heather Gaylord, April 13, 2019.
“they’re not keepin’ it controlled because they can’t afford the meds and the services”: Interview with Jim Hicks, December, 6, 2018.
A lot of people in such places had bad credit and low incomes: Heather Long, “A Record 7 Million Americans Are 3 Months Behind on Their Car Payments, a Red Flag for the Economy,” Washington Post, February 12, 2019.
they were “selling money, not cars”: Rex Collins, “Buy Here/Pay Here Dealerships Can Generate Substantial Profit,” July 1, 2016, https://www.hbkcpa.com/buy-herepay-here-dealerships-can-generate-substantial-profit.
“In BHPH one fact of life is vehicle breakdowns”: “BHPH News & Articles,” NABD, bhphinfo.com/bhph-library#2.
NIADA made generous campaign contributions: Schedule B, Itemized Disbursements, National Independent Automobile Dealers Association PAC Fund, 2016 and 2019.
Trump signed it into law on May 21: “Statement of Administration Policy,” SJ Res. 57, April 17, 2018; Neil Haggerty, “Trump Makes Repeal of CFPB Auto Lending Rule Official,” American Banker, May 21, 2018.
Zach shot himself almost two years to the day: Williams County Health Department, 2018–2019 Deaths.
When he wasn’t working, Zach liked to go fishing for catfish at night, hang out with his bros, drive his car with the stereo blasting, and go target shooting: “Lance Corporal Zachary Allan Rhinard (1998–2019),” Bryan Times, January 17, 2019.
The call would be one of four hundred runs Jim Hicks’s EMS crews would make in January: Interview with Jim Hicks, January 21, 2019.
If you were a police and fire dispatcher in Bryan, you started at $11.76 an hour, about what Taco Bell offered: Max Reinhart, “Council Approves Pay Increase for Police Dispatchers,” Bryan Times, May 21, 2019.
Working-class wages in the United States just about flatlined from 1979 to 2017: Cumulative Percent Change in Real Annual Wages, by Wage Group, 1979–2017, “State of Working America: Wages 2018,” Economic Policy Institute; Cumulative Percent Change in Real Annual Wages, by Wage Group, 1979–2017, “State of Working America: Wages 2019,” Economic Policy Institute.
Only 14.6 percent had a bachelor’s degree: “Ohio County Profiles: Williams County,” Ohio Office of Research.
“We put this stuff on the outside, but inside—who we are? Who are we?”: Interview with Tonie Long, January 23, 2019.
And so you learned from disappointment and defeat: A rich academic literature has explored these effects of inequality. Among the many consulted for this book: Michael J. Solomon Weiss et al., “What Explains the Negative Consequences of Adverse Childhood Experiences on Adult Health?,” American Journal of Preventive Medicine 14, no. 4 (1998); J. T. Maguire et al., “Decision Makers Calibrate Behavioral Persistence on the Basis of Time-Interval Experience,” Cognition, August 2012; Shannon Monnat, “Place-Based Economic Conditions and the Geography of the Opioid Overdose Crisis” and “The Contributions of Socioeconomic and Opioid Supply Factors to Geographic Variation in U.S. Drug Mortality Rates,” Institute for New Economic Thinking, January 2019; Shannon Monnat, “Our Problem Is Bigger Than Opioids,” U.S. News and World Report, February 26, 2019; Hawre Jalal et al., “Changing Dynamics of the Drug Overdose Epidemic in the United States from 1979 Through 2016,” Science, September 21, 2018; Aaron Antonovsky, “Social Class, Life Expectancy and Overall Mortality,” Milbank Memorial Fund Quarterly, April 1967; Anne Case and Angus Deaton, “Mortality and Morbidity in the 21st Century,” Brookings Papers on Economic Activity, BPEA Conference Drafts, March 23–24, 2017; Nancy E. Adler and Katherine Newman, “Socioeconomic Disparities in Health: Pathways and Policies,” Health Affairs 21, no. 2, 2002; Atheendar S. Venkataramani et al., “Association Between Automotive Assembly Plant Closures and Opioid Overdose Mortality in the United States: A Difference-in-Differences Analysis,” JAMA Internal Medicine, December 30, 2019; Priya Fielding-Singh, “A Taste of Inequality: Food’s Symbolic Value Across the Socioeconomic Spectrum,” Sociological Science, August 2017; Norman J. Waitzman and Ken R. Smith, “Separate but Lethal: The Effects of Economic Segregation on Mortality in Metropolitan America,” Milbank Quarterly 76, no. 3 (1998); Ichiro Kawachi and Bruce P. Kennedy, “Income Inequality and Health: Pathways and Mechanisms,” Health Services Research, April 1999.
Montpelier police chief Dan Magee arrested generations of the same families: Interview with Dan Magee, March 20, 2019.
“And some other people make less, and they have kids. That’s stressful”: Interview with Sarah Vashaw, March 8, 2018.
“Because there’s so many factors in their life that they can’t control if that paycheck doesn’t come through”: Interview with Carrie Schlade, February 14, 2019.
38.6 percent of the children qualified for free or reduced-price school lunch: Data for Free and Reduced Meals, Ohio Department of Education.
equipped that school with forty-eight security cameras: Presentation of school resource officers, November 13, 2018, Bryan, Ohio.
Meadow Creek, built by an out-of-town development company: United States of America v. Miller-Valentine Operations Inc. et al., United States District Court for the Southern District of Ohio Western Division, filed May 9, 2019.
In 2015, Wisconsin governor Scott Walker tried to change the state university’s mission statement: Valerie Strauss, “A University of Wisconsin Campus Pushes Plan to Drop 13 Majors—Including English, History and Philosophy,” Washington Post, March 21, 2018.
DeMaria set the standard in consultation with industry as a way to tailor the “workforce” to its needs: Patrick O’Donnell, “Ohio Graduates Won’t Have to Be ‘Proficient’ in Math or English, Under State Superintendent’s Plan,” Cleveland Plain Dealer, February 22, 2020.
The highest price listed for a CT scan at Parkview’s flagship hospital in Fort Wayne was over $4,000: Parkview Chargemaster.
but even the lower prices were higher than the prices in almost any other peer country in the world: Irene Papanicolas et al., “Health Care Spending in the United States and Other High-Income Countries,” Journal of the American Medical Association, March 13, 2018.
Even within the same market region, the price in one hospital could be double the price in another: Zack Cooper et al., “The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured,” NBER Working Paper no. 21815, December 2015.
“And maybe that’s how it feels for them”: Interview with Angelia Foster, February 15, 2019.
It had already closed its wound care clinic, home healthcare service, pain clinic, and an urgent care center: “Sturgis Hospital Restructuring Plan: Frequently Asked Questions.”
Emilia Pearl Miller became the last baby born in Sturgis Hospital: Michelle Patrick, “Emilia Miller Is Final Birth at Sturgis Hospital,” Sturgis Journal, January 3, 2019.
The CEO would be fired, but Sturgis’s financial crisis would continue: Anuja Vaidya and Kelly Gooch, “Michigan Hospital CEO Ousted,” Becker’s Hospital Review, January 29, 2019.
A few paid $1,600: Interview with John Rymer, March 6, 2018.
“We pay anywhere from three times as much as they might”: Interview with Chad Tinkel, March 6, 2018.
“But I don’t have the volume”: Interview with Kim Bordenkircher, March 14, 2019.
including a $14 billion deal between Zimmer and Biomet in 2015: “Zimmer Completes Combination with Biomet,” press release, June 24, 2015.
35 percent of the knee market and 31 percent of the hip market: Zimmer Biomet Holdings, Inc., 2018 Annual Report.
In 2018, Zimmer Biomet CEO Bryan C. Hanson made about $9.7 million: www.execpay.org/news/zimmer-biomet-holdings-inc-2018-compensation-1112; Zimmer Biomet Holdings, Inc., proxy statement, 2018 annual meeting.
the firm spent nearly $1 billion buying back its own shares: Fortuna Advisors, 2019 Fortuna Buyback ROI Report, April 19, 2019.
for repeatedly violating the Foreign Corrupt Practices Act: “Biomet Charged with Repeating FCPA Violations,” U.S. Securities and Exchange Commission, January 12, 2017.
Zimmer had to pay $169.5 million for violating anti-kickback laws: “Five Companies in Hip and Knee Replacement Industry Avoid Prosecution by Agreeing to Compliance Rules and Monitoring,” United States Department of Justice, U.S. Attorney, District of New Jersey, September 27, 2007.
subpoena from the Office of Inspector General for the U.S Department of Health and Human Services demanding the company produce additional records: Zimmer Biomet Holdings, Inc., 2018 Annual Report.
B. Braun Medical … would raise its price for them by 100 percent: Jared S. Hopkins, “Drugmakers Push Their Prices Higher,” Wall Street Journal, July 1, 2019.
Insulin medications like the ones Keith needed ballooned in cost by 700 percent: Drew Pendergrass, “How Insulin Became Unaffordable,” Harvard Political Review, January 22, 2018; Max Filby, “Insulin Prices Double, Forcing Diabetics to Carefully Budget,” Columbus Dispatch, December 9, 2019; Megan Henry, “Insulin Prices Double, Pinching Diabetics’ Budgets,” Columbus Dispatch, December 9, 2019.
was forced to pay $7 million to buy its way out of price-fixing accusations: Ed Silverman, “Heritage Pharma Admits to Price Fixing as Part of Far-Reaching Generic Drug Probe,” Pharmalot, May 31, 2019.
the drug would now cost them nearly $200,000 per year: Rebecca Spalding, “Celgene Boosted the Price of Its Top Cancer Drug on the Same Day of Mega-Deal,” Bloomberg News, January 4, 2019.
New York City hospitals pioneered the strategy in 1910: Rosemary Stevens, In Sickness and in Wealth: American Hospitals in the Twentieth Century (Baltimore: Johns Hopkins University Press, 2012).
Established in 1906: www.stlukeshospital.com/about.
good care at lower prices than some of the other regional hospitals: United States District Court, Northern District of Ohio Western Division Federal Trade Commission, Plaintiffs v. Promedica Health System, Inc., Defendants, Docket No. 3:11CV47 (various documents).
so Anthem capitulated: In the Matter of ProMedica Health System, Inc., Docket No. 9346, Opinion of the Commission.
St. Luke’s was so troubled by ProMedica’s tactics, it considered mounting an antitrust lawsuit: Transcript of TRO Hearing Before the Honorable David A. Katz, United States District Judge, January 13, 2011.
pay us a little more now, or you’ll have to pay us a lot more later when we become a ProMedica hospital: In the Matter of Promedica Health System, Inc., Respondent, Initial Decision.
“stick it to employers, that is, to continue forcing high rates on employers and insurance companies”: United States of America Before the Federal Trade Commission Office of Administrative Law Judges, in the matter of Promedica Health System, Inc., a corporation; Docket number 9346.
In 2008, he’d accused ProMedica of taking “the greatest resources from the community” and performing “poorly in terms of costs of outcomes”: Complaint Counsel’s post-trial reply brief.
“sure would make life much easier right now, though”: United States of America Before the Federal Trade Commission Office of Administrative Law Judges, in the matter of Promedica Health System, Inc., a corporation; Docket number 9346.
In 2018, Atrium Health, a North Carolina “nonprofit” system, was forced by the FTC: Ames Alexander and Cassie Cope, “Atrium Health to Settle Federal Antitrust Suit over Health Care Costs,” Charlotte Observer, November 15, 2018.
Stung, the FTC retreated: Email from Martin Gaynor, January 14, 2020.
“One, pass it on to the public; two, increase the bottom line?”: Transcript of Preliminary Injunction Proceedings Before the Honorable David A. Katz, Senior United States District Judge, February 11, 2011.
Michigan’s Spectrum Health, for example: “Spectrum Health System and Affiliates Consolidated Financial Statements,” June 30, 2019.
Parkview Health System reported gross receipts of $2,130,554,741: Parkview Health System, IRS Form 990, year ending December 31, 2017; 2018 Parkview Health System, Inc., and Subsidiaries Consolidated Financial Report.
ProMedica reported net assets of $2,467,501,418: ProMedica 2017 IRS Form 990.
paid to R. Milton Johnson, CEO of for-profit hospital operator Hospital Corporation of America: $109,050,692: Axios Healthcare Executive Compensation, 2018.
Employers Forum of Indiana asked the Rand Corporation to study Indiana hospitals: “Hospital Prices in Indiana: Findings from an Employer-Led Transparency Initiative,” Chapin White, 2017.
a Ball State University study: Michael J. Hicks, “Indiana Has a Monopoly Problem in Healthcare: Preliminary Evidence and Recommendations,” Center for Business and Economic Research, Ball State University.
Hospital services rose over 200 percent: Mark J. Perry, “Chart of the Day … or Century?,” Carpe Diem (blog), American Enterprise Institute, July 12, 2019, www.aei.org/carpe-diem/chart-of-the-day-or-century-2.
In Colorado, hospital profits increased 280 percent from 2009 through 2018, from $538 per patient to $1,518: Colorado Hospital Cost Shift Analysis, Colorado Department of Health Care Policy and Financing, January 2020.
ProMedica parked money in “Central America and the Caribbean”: ProMedica IRS Form 990, 2016.
Indiana University’s center closed in 2014: Jay Hancock, “As Proton Centers Struggle, a Sign of a Health Care Bubble?,” Kaiser Health News, May 2, 2018.
in 2020 it would announce that its UPMC Enterprises arm, a venture capital outfit, would invest $1 billion in a drugs, devices, and diagnostics business: Tina Reed, “JPM20: UPMC Venture Arm Announces $1B Life Sciences Commitment,” Fierce Healthcare, January 14, 2020.
then asking for a city schools tax abatement of nearly $20 million on the for-profit drug company: Alissa Widman Neese, “Nationwide Children’s Asks Columbus School Board for Tax Abatement on For-Profit Company,” Columbus Dispatch, January 21, 2020.
While it was possible that a takeover could improve the health of Williams County residents, such acquisitions often raised prices and reduced the quality of care: Many studies over years have shown such effects. Among those consulted for this book: Patrick S. Romano and David J. Balan, “A Retrospective Analysis of the Clinical Quality Effects of the Acquisition of Highland Park Hospital by Evanston Northwestern Healthcare,” Federal Trade Commission Working Paper 307, November 2010; “Diagnosing the Problem: Exploring the Effects of Consolidation and Anticompetitive Conduct in Health Care Markets,” Martin Gaynor, statement before the Committee on the Judiciary Subcomittee on Antitrust, Commercial, and Administrative Law, U.S. House of Representatives, March 7, 2019; Martin Gaynor, “What to Do About Health-Care Markets? Policies to Make Health-Care Markets Work,” Brookings Institution, Policy Proposal 2020-10; Nancy D. Beaulieu et al., “Changes in Quality of Care After Hospital Mergers and Acquisitions,” New England Journal of Medicine, January 2, 2020; Martin Gaynor, “2013 MacEachern Symposium: On a Collision Course? Health Care Integration and Antitrust,” June 5, 2013.
they’d charged the Medicaid program $224 million more for dispensed drugs than they had actually paid out to pharmacies: Marty Schladen et al., “Local Pharmacies and Their Personal Care in Danger of Disappearing,” Columbus Dispatch, July 15, 2018.
The AMA issued regular reports on competition in metropolitan statistical areas: “Competition in Health Insurance: A Comprehensive Study of U.S. Markets,” American Medical Association, 2018 update.
becoming part of National Pain and Spine Centers with offices in seven states: Jonathan LaMantia, “Physician Practices Increasingly Turn to Private Equity for Capital,” Modern Healthcare, April 26, 2019.
Advanced Dermatology and Cosmetic Surgery became the country’s largest provider in its specialty: Katie Hafner, “Why Private Equity Is Furious Over a Paper in a Dermatology Journal,” New York Times, October 26, 2018.
Kohlberg Kravis Roberts (KKR) bought a controlling stake in Heartland Dental: “Global Healthcare Private Equity and Corporate M&A Report 2019,” Bain and Company.
at an average of 637 percent of what Medicare would charge: Zack Cooper et al., “Surprise! Out-of-Network Billing for Emergency Care in the United States,” Institution for Social and Policy Studies Working Paper, July 2017.
TeamHealth agreed to settle Justice Department charges that the company used fake billings to defraud the government. It paid $60 million: “Healthcare Service Provider to Pay $60 Million to Settle Medicare and Medicaid False Claims Act Allegations,” United States Department of Justice, February 6, 2017.
Brown Brothers Harriman gained control of American Physician Partners, doubling its size in a year: “BBH Capital Partners Completes Recapitalization of American Physician Partners,” BBH press release, January 11, 2017.
In 2018 alone, private equity made 855 deals into which it invested $100 billion: Eileen Appelbaum, “Private Equity’s Engagement with Health Care: Cause for Concern?,” Report to the Institute for New Economic Thinking, December 27, 2019.
paid $1,000 per night for hotel rooms that normally cost $200: Rebecca Spalding, “Ex-Banker Walks into a Conference, Walks out with $480 Million,” Bloomberg News, January 10, 2019.
The journal removed it from its website: Hafner, “Why Private Equity Is Furious.”
Seven children died over three states: Sabrina Willmer, “When Wall Street Took Over This Nursing Company, Profits Grew and Patients Suffered,” Bloomberg News, October 22, 2019.
Under Carlyle’s ownership: Peter Whoriskey and Dan Keating, “Overdoses, Bedsores, Broken Bones: What Happened When a Private-Equity Firm Sought to Care for Society’s Most Vulnerable,” Washington Post, November 25, 2018.
In 2016, Schumacher rolled up another ER staffing company, ECI, for $140 million: “Management’s Discussion and Analysis and Financial Statements,” Onex, December 31, 2016.
ER company revenues rose 21.9 percent over just five years: Cooper et al., “Surprise! Out-of-Network Billing.”
The bill stalled: Elizabeth Dexheimer, “Blackstone-KKR Hidden Hand in Ad Blitz Unleashes Washington Fury,” Bloomberg News, January 8, 2020.
Brooks swerved, but there wasn’t much he could do about it. George hit him head-on: “A Two Vehicle Accident Wednesday Afternoon Claimed the Life of a Frontier Man,” Hillsdale Daily News, January 24, 2019.
Brian George would be arrested: “Trial Scheduled in Fatal Drunk Driving Case,” Hillsdale Daily News, December 13, 2019.
Brooks’s wife and some of the children were there. It was an emotional scene for everybody: Interview with Wade Patrick, February 13, 2019.
“I told Chad, ‘Show me you’ve got some heart’”: Interview with Dave Swanson, January 23, 2019.
Around the country, fourteen rural hospitals closed in 2018, and there were already reports of more closings in 2019: Rural Health Research Program, University of North Carolina.
Ellwood stiffed its employees by missing payroll: Patrick O’Shea, “Another Payroll Delay Reported at Ellwood City Medical Center,” Ellwood City Ledger, November 15, 2018.
That deal blew up in 1998, and the hospital limped into the twenty-first century: Patrick O’Shea, “Ellwood City Hospital Workers Might Benefit from Revamped Grove City Medical Center,” Ellwood City Ledger, January 11, 2020.
“We desperately need this hospital to prosper”: “‘We Desperately Need This Hospital’: Ellwood City Medical Center Closes to Inpatient, ER Services,” KDKA, November 29, 2019.
“If we try to live our values, then we’ll make the best of a difficult situation”: Phil Ennen memo to CHWC Leadership Council, January 28, 2019.
She would think about Marc’s case for weeks afterward, rehashing it in her mind: Interview with Heather Gaylord, April 24, 2019.
all were either in short supply or not available at any price: CHWC Drug Shortage List.
the U.S. Food and Drug Administration suggested the harms from the shortages were “drastically underestimated”: “Drug Shortages: Root Causes and Potential Solutions, 2019,” U.S. Food and Drug Administration.
“because of the costs they tell you, ‘I am going to choose to die’”: Interview with Mike Liu, February 14, 2019.
It also had the lowest rate of meeting colorectal screening guidelines in the state: Ohio Cancer Atlas, 2019.
Studies linked hundreds of thousands of cancer deaths around the world to the effects of the Great Recession: Mahiben Maruthappu et al., “Economic Downturns, Universal Health Coverage, and Cancer Mortality in High-Income and Middle-Income Countries, 1990–2010: A Longitudinal Analysis,” The Lancet, May 25, 2016.
An estimated ten thousand American and European suicides were attributed to it: Karen Weintraub, “Great Recession Tied to More Than 10,000 Suicides,” USA Today, June 11, 2014.
Blood pressure and blood sugar measures worsened in American adults: Teresa Seeman et al., “The Great Recession Worsened Blood Pressure and Blood Glucose Levels in American Adults,” Proceedings of the National Academy of Sciences, March 27, 2018.
she couldn’t help but be outraged and then try to do something about it: Interview with Janis Sunderhaus, March 15, 2019.
“Dispensaries” were as old as the United States … and they could be affiliated with a nearby hospital or with a charity or social service organization: Beatrix Hoffman, Health Care for Some: Rights and Rationing in the United States Since 1930 (Chicago: University of Chicago Press, 2012).
George W. Bush reinvigorated federally qualified health centers by pouring money into an effort to open twelve hundred of them during his first five years in office: Kevin Sack, “Community Health Clinics Increased During Bush Years,” New York Times, December 26, 2008.
Barb Purvis, the nurse practitioner who cared for Keith, made $120,000 a year, plus a bonus that was dependent upon her patient volume: Interview with Barb Purvis, April 18, 2019.
During the rise of the Great Society clinics, AMA president Milton Rouse called them “unnecessary” and “wasteful”: Hoffman, Health Care for Some.
not a single private-practice dentist in Williams County accepted Medicaid patients: Interview with Carl Cheney, August 13, 2019.
The Ohio Turnpike Commission paid ADW $342,000 a year to keep that plaza clean: Ohio Turnpike Commission, Resolution Awarding Agreements for Janitorial Services at the Commission’s Middle Ridge and Vermilion Valley Service Plazas (Agreement TRM-10D), the Blue Heron and Wyandot Service Plazas (Agreement TRM-10E), and the Indian Meadow and Tiffin River Service Plazas (Agreement TRM-10F).
“That is almost $1 million more than our budgeted margin for this year”: Phil Ennen memo, November 22, 2011.
“I wish I could always give everyone more clarity”: Email from Phil Ennen to CHWC leadership, February 13, 2019.
He loaned a personal car to Vasi’s wife: Interview with Zoher Vasi, January 21, 2019.
Ennen wrote to the area’s federal legislators in the wake of Donald Trump’s 2017 anti-Muslim travel ban: “Ennen: Ban Has Negative Effect on CHWC,” reprinted in Bryan Times, February 8, 2017.
CHWC sometimes had no choice but to offer top salaries: CHWC IRS Form 990; “2018 Review of Physician and Advanced Practitioner Recruiting Incentives,” Merrit Hawkins.
physician compensation rose over 16 percent in the four years between 2013 and 2017: Stephen Zuckerman et al., “Analysis of Disparities in Physician Compensation,” Report by the Urban Institute and SullivanCotter for the Medicare Payment Advisory Commission, January 2019.
“I have no desire to lose my job”: Email from Phil Ennen to CHWC vice presidents, February 14, 2019.
When KKR sold all of its stake in 2013, the company was worth three times what KKR paid for it, and the financial press hailed the play’s success: Phil Wahba, “Making Billions at the Dollar Store,” Fortune, May 22, 2019; Matt Jarzemsky, “KKR, Goldman Exit from Dollar General Stake with $252 Million Stock Sale,” Wall Street Journal, December 12, 2013; Daniel Gross, “How KKR Scored with Dollar General,” Newsweek, June 10, 2009.
often wiping out small-town grocers and preventing any new independent stores from ever opening: Marie Donahue and Stacy Mitchell, “Dollar Stores Are Targeting Struggling Urban Neighborhoods and Small Towns. One Community Is Showing How to Fight Back,” Institute for Local Self-Reliance, December 6, 2018.
“published by the Department of Agriculture in the Federal Register on December 15, 2016”: www.congress.gov/bill/115th-congress/house-bill/244/text?overview=closed.
Lobbyists for the convenience-store industry convinced legislators that requiring more fresh fruits and vegetables … was too burdensome: Memorandum to NACS from Doug Kantor, Eva V. Rigamonti, RE: SNAP “Variety” Proposed Rule, Providing Regulatory Flexibility for Retailers in the Supplemental Nutrition Assistance Program (RIN 0584-AE61), Steptoe and Johnson LLP, April 11, 2019.
So a can of ravioli in tomato sauce counted as a vegetable: “What Are Staple Foods?,” U.S. Department of Agriculture, updated March 5, 2018.
The SNAP program paid billions of dollars a year—about $4 billion, by one estimate: Nicole E. Negowetti, “The SNAP Sugar-Sweetened Beverage Debate: Restricting Purchases to Improve Health Outcomes of Low-Income Americans,” Journal of Food Law and Policy 14, no. 1 (2018).
“one doctor bill or one car repair bill away from not being in such good shape”: Nathaniel Meyersohn, “Dollar General Is Opening 1,000 New Stores Next Year,” CNN Business, December 5, 2019.
Cullis now found himself in the most uncomfortable spot of his life: Interview with Chris Cullis, April 22, 2019.
Cullis finally sent a confidential memo on CHWC letterhead to the entire staff: Memo from Chris Cullis to CHWC staff, March 5, 2019.
“If it gets too difficult, we will just leave”: Interview with Hanan Bazzi, March 7, 2019.
Williams County residents received medical payments of $150,323,000 from government in 2018: Williams County Profile, Ohio Office of Research, 2018.
Total government transfer payments to individuals came to $339,480,000: Williams County Profile, Ohio Office of Research, 2018.
Even if they didn’t plant a crop, they could receive $15 an acre: Lucas Bechtol, “Third Round of MFP Payments Released to Farmers,” Bryan Times, February 9, 2020.
the county commissioners, approved of government welfare for corporations—most recently granted to Love’s Travel Stops: Williams County Resolution 19-0123, April 8, 2019; Lisa Lockwood, “Kylie Jenner Makes Forbes List of America’s Richest Self-Made Women,” Women’s Wear Daily, July 11, 2018.
half of whom would make $9 an hour: Don Koralewski, “Schools and Government Agree on Tax Financing District for Love’s,” Bryan Times, April 8, 2019.
And they were more likely to be sick with conditions like heart disease, cancer, emphysema, bone fractures, hepatitis, and general poor health: Vincent J. Felitti et al., “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study,” American Journal of Preventive Medicine 14, no. 4 (1998).
Between 1959 and 1979, life expectancy in the United States increased from about seventy years to about seventy-five: Steven H. Woolf and Heidi Schoomaker, “Life Expectancy and Mortality Rates in the United States, 1959–2017,” Journal of the American Medical Association, November 26, 2019; U.S. Census, “Life Expectancy at Birth, at 65 Years of Age, and at 75 Years of Age, by Race and Sex: United States, Selected Years 1900–2007,” Health, United States, 2010, Trend Tables.
By 2019, the United States was one of the most unequal countries on Earth: Drew DeSilver, www.pewresearch.org/fact-tank/2013/12/19/global-inequality-how-the-u-s-compares/; https://www.stlouisfed.org/on-the-economy/2017/october/how-us-income-inequality-compare-worldwide; www.cia.gov/library/publications/the-world-factbook/rankorder/2172rank.html; Catherine Rampell, “Why Income Inequality Is So Much Worse in the U.S. Than in Other Rich Countries,” Washington Post, April 11, 2017.
The lines crossed for other age groups, too: Anne Case and Angus Deaton, “Mortality and Morbidity in the 21st Century,” Brookings Papers on Economic Activity, March 17, 2017.
Those who were born in 1960 and at the bottom 20 percent of earnings could, at age fifty, expect to live to seventy-six, a difference of about thirteen years: Katelin P. Isaacs and Sharmila Choudhury, “The Growing Gap in Life Expectancy by Income: Recent Evidence and Implications for the Social Security Retirement Age,” Congressional Research Service, May 12, 2017.
People in rich, better-educated counties lived longer, healthier lives than people living in poorer, less-educated counties: Laura Dwyer-Lindgren et al., “Inequalities in Life Expectancy Among US Counties: 1980 to 2014,” JAMA Internal Medicine, July 2017.
Family distress was one symptom of the disease, and it generated more adverse childhood experiences: Among the research supporting this statement: Melissa T. Merrick et al., “Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention—25 States, 2015–2017,” Morbidity and Mortality Weekly Report, November 8, 2019; Ichiro Kawachi and Bruce P. Kennedy, “Income Inequality and Health: Pathways and Mechanisms,” Health Services Research, April 1999; Woolf and Schoomaker, “Life Expectancy and Mortality Rates in the United States, 1959–2017”; Jacob Bor et al., “Population Health in an Era of Rising Income Inequality: USA, 1980–2015,” The Lancet, April 8, 2017; Raj Chetty et al., “The Association Between Income and Life Expectancy in the United States, 2001–2014,” Journal of the American Medical Association, April 26, 2016; Peter A. Muennig et al., “America’s Declining Well-Being, Health, and Life Expectancy: Not Just a White Problem,” American Journal of Public Health, December 2018; Nancy E. Adler and Katherine Newman, “Socioeconomic Disparities in Health: Pathways and Policies,” Health Affairs, March/April 2002.
Overall, West Unity and Montpelier received D grades, while Bryan city schools earned a C: Ohio Schools Report Cards, Ohio Department of Education, https://reportcard.education.ohio.gov/district/overview/043679.
though DARE had been shown to be worse than ineffective back in the early 1990s: Steven L. West and Keri K. O’Neal, “Project D.A.R.E. Outcome Effectiveness Revisited,” American Journal of Public Health, June 2004.
Towns would resign his position in February 2020 under threat of being charged with felony crimes involving misuse of public money: State of Ohio v. Steven M. Towns, June 20, 2019.
more than medical care itself, which accounted for only about 15 percent of the inequity in mortality: Steven H. Woolf, “Necessary but Not Sufficient: Why Health Care Alone Cannot Improve Population Health and Reduce Health Inequities,” Annals of Family Medicine, May/June 2019.
The nurse practitioner there said, “You’re sick”: Interview with Valerie Moreno and Betty Franks, March 9, 2019.
Beth Pool understood the dilemmas: Interview with Beth Pool, February 15, 2019.
Joseph Padway argued that health was “not an article of commerce”: Beatrix Hoffman, Health Care for Some: Rights and Rationing in the United States Since 1930 (Chicago: University of Chicago Press, 2012).
They imagined chic loft apartments, new cafés, rising property values: “ProMedica Breathes New Life into Toledo’s Downtown Riverfront,” press release, JobsOhio.
In May, Mick Frisbie: Williams County Health Department death records; Shannon Keil.
he explored either creating a dedicated CHWC long-distance ambulance service or contracting for one: Interview with Chad Tinkel, April 16, 2020.
In 2009, the U.S. Department of Health and Human Services advised: William Lazonick and Matt Hopkins, “How ‘Maximizing Shareholder Value’ Minimized the Strategic National Stockpile,” The Academic-Industry Research Network, July 2020.
About fifty thousand people who worked for health departments like the one Watkins ran for Williams County lost their jobs: Jeneen Interlandi, “The U.S. Approach to Public Health: Neglect, Panic, Repeat,” New York Times, April 9, 2020.
The federal government slashed the money it allocated to prepare for an emergency like Covid-19: “New Report: Funding for Public Health Has Declined Significantly Since the Great Recession,” Trust for America’s Health, March 1, 2018.
Only three states spent less: State Health Compare, State Health Access Data Assistance Center, University of Minnesota.
After Jonas Salk and his team produced a vaccine: Dwight Eisenhower, “Statement by the President,” May 31, 1955.
The decline in American health was abetted by deliberate policy: Jennifer Karas Montez et al., “US State Policies, Politics, and Life Expectancy,” The Millbank Quarterly, August 2020.
She, Watkins, and the rest of the department coordinated with rehab facilities: Interview with Jim Watkins, April 16, 2020.
Tinkel figured CHWC had lost $10 million: Interview with Chad Tinkel August 5, 2020.
July set a record for outpatient business: Memo from Chad Tinkel to CHWC employees, August 6, 2020.
Thirteen small hospitals around the country closed between January 2020 and August 1: Closures Database, North Carolina Rural Health Research Program, University of North Carolina.
By one estimate, a quarter of all rural hospitals in the United States were in danger: Alex Kacik, “A Quarter of Rural Hospitals Are at Risk of Closing,” Modern Healthcare, April 8, 2020.
Representative Nino Vitale … called her “an unelected Globalist Health Director: Brett Zelman, “Ohio State Rep. Nino Vitale Calls Dr. Amy Acton, Who Is Jewish, a Globalist,” Cleveland Scene, May 1, 2020.
State senator Andrew Brenner likened Acton’s health mandates to actions taken by Nazi Germany: Darrel Rowland, “Wife of Ohio State Senator Compares Dr. Amy Acton Statement with Nazi Mandates,” Columbus Dispatch, April 22, 2020.
By the end of July, forty-nine health officials in twenty-three states had either resigned or been fired: Michelle R. Smith and Lauren Weber, “Health Officials Are Quitting or Getting Fired amid Outbreak,” AP and Kaiser Health News, August 10, 2020.
“regardless of the casualties”: Lucas Bechtol, “Local Reaction to State Plan Mixed,” Bryan Times, May 3, 2020.
A winery in Napoleon held a “Name That Tune” contest: Emily Tian, “Henry County Winery Event Linked to 83 Coronavirus Cases,” Toledo Blade, July 28, 2020.
the rate of Covid-19 infections in African Americans was 14,703 per million: Governor Gretchen Whitmer, EXECUTIVE DIRECTIVE No. 2020-9, August 5, 2020.
African Americans, who comprised roughly 13 percent of the population, accounted for nearly 25 percent of the Covid deaths: Samrachana Adhikari, et al., “Assessment of Community-Level Disparities in Coronavirus Disease 2019 (COVID-19) Infections and Deaths in Large US Metropolitan Areas,” JAMA Network, July 28, 2020; “Minorities Are Disproportionately Affected by COVID-19. This Is How It Varies by State,” USA Today, July 21, 2020; CDC, https://www.cdc.gov/nchs/nvss/vsrr/covid19/health_disparities.htm.
Ohio state senator Stephen Huffman: Adriana Velez Kalsekar, “It’s Not Unhealthy Behavior. It’s Systemic Racism,” EndocrineWeb, July 10, 2020.
an estimated 5.4 million lost health insurance because their insurance was tied to their employment: Sheryl Gay Stolberg, “Millions Have Lost Health Insurance in Pandemic-Driven Recession,” New York Times, July 13, 2020.
The richest figured out how to take government money anyway: Natasha Lindstrom, “UPMC to Get $1 Billion in Federal Aid After Hard Hit from Coronavirus Pandemic,” Tribune Review, May 29, 2020; Jessica Silver-Greenberg, Jesse Drucker, and David Enrich, “Hospitals Got Bailouts and Furloughed Thousands While Paying C.E.O.s Millions,” New York Times, June 8, 2020; David Kocieniewski and Caleb Melby, “Private Equity Lands Billion-Dollar Backdoor Hospital Bailout,” Bloomberg News, June 2, 2020.
ProMedica had taken $240 million: Jon Chavez,“Federal Aid Protects ProMedica During Pandemic,” Toledo Blade, August 17, 2020.
Private equity-owned businesses like EmCare borrowed about $1.5 billion from the taxpayers: Rosemary Batt and Eileen Appelbaum, “Hospital Bailouts Begin—for Those Owned by Private Equity Firms,” American Prospect, April 2, 2020; Kocieniewski and Melby, “Private Equity Lands Billion-Dollar Backdoor Hospital Bailout.”
they still forced employees to take pay cuts: Katherine Doherty, “KKR-Backed Envision Withholds Doctor Pay as Routine Care Slows,” Bloomberg News, April 3, 2020.
They then used this group to continue their advertising and lobbying efforts: Isaac Arnsdorf, “Medical Staffing Companies Cut Doctors’ Pay While Spending Millions on Political Ads,” ProPublica, April 20, 2020.
the two businesses signed a deal, though both sides claimed the details of the contract: Rosa Salter Rodriguez, “Parkview, Anthem Sign Contract,” Journal-Gazette, July 31, 2020.
Covidien backed out of the government deal after it bought Newport, and the ventilators were never made: Ben Remaly, “Ventilator Merger Scrutinised as Potential ‘Killer Acquisition,’” Global Competition Review, March 31, 2020; Nicholas Kulish, Sarah Kliff, and Jessica Silver-Greenberg, “The U.S. Tried to Build a New Fleet of Ventilators. The Mission Failed,” New York Times, March 29, 2020; William Lazonick and Matt Hopkins, “How ‘Maximizing Shareholder Value’ Minimized the Strategic National Stockpile,” The Academic-Industry Research Network, July 2020.
The bill’s language was weakened: Sarah Karlin-Smith, “How the Drug Industry Got Its Way on the Coronavirus,” Politico, March 5, 2020.
Attorneys general for several states urged the feds to “march in” on Gilead’s patent rights: Ron Leuty, “Feds Should ‘March In’ on Covid Drug Remdesivir, State AGs Say. Gilead Says They’re Wrong,” San Francisco Business Times, August 5, 2020.
Thirty days into the program, not a single test had been run through the system: Catherine Candisky, “Efforts to Expand Ohio COVID Testing to Community Pharmacies Stalls,” Columbus Dispatch, July 30, 2020.
By July 29, American renters owed $21.5 billion in back rent: Michelle Conlin, “U.S. Renters Owe $21.5 Billion in Back Rent; Republicans Offer No Eviction Relief,” Reuters, July 29, 2020.