May 13, 2014

Positive, by Michael Saag, M.D.

"Positive" is Dr. Michael Saag's memoir-manifesto about HIV/AIDS and the United States' healthcare system. It has a bit too much memoir for my taste; while I find his anecdotes about patients and what they and he went through to fight back against the plague that is AIDS important and edifying, I could have done without his own family history. I guess it's a little mean to say it, but I'm not at all interested in Dr. Saag, while I am very interested in his work and his insider's view of the healthcare industry. His "magical thinking" is cute, and I don't mean to imply that it's untrue that he does think that way, but it's a little silly in such a serious piece of work.

As you might imagine, this isn't an easy book to read. I reached for tissues multiple times as Dr. Saag writes about the terrified, incredibly ill men and women he's treated over the years. Due to a bill called Ryan White, the federal government allocates money to cover any gaps in treatment of HIV-infected patients. As Dr. Saag notes, the program has completely eliminated any difference in care due to economic status, meaning that a poor person will get as good treatment and have as good a chance at life and health as a rich person. America outspends every single other developed country - by A LOT - in healthcare, yet ranks very low in actual health when compared to those same countries. So why don't we have Ryan White-like funding for ALL healthcare, instead of just one single disease?

Dr. Saag puts together a comprehensive list of what a good American healthcare system should look like, while acknowledging that it's a drastic change and will incur plenty of growing pains. What he doesn't do is suggest ways we can start making this actually happen, beyond informing ourselves of how the system really works and, um, complaining about it, I guess? What about letter writing campaigns? Surely he knows which recipients would be most effective. Or what if he starts a group of healthcare professionals that give "The System" an ultimatum: fix it, or we'll stop working? He makes no such recommendation, however, and as such, this is a manifesto without teeth, an exercise in mental masturbation as he tries to make himself feel better about the situation by unburdening his thoughts into a book. It's nice and all, but in the end, the only people reading it will be the choir to which he is already preaching.

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