The People’s Hospital: why public healthcare can be successful in the US

<span>Photograph: Aaron M Sprecher/EPA</span>
Photograph: Aaron M Sprecher/EPA

With his first book, The People’s Hospital, author Ricardo Nuila offers a compelling mixture of healthcare policy and gripping stories from the frontlines of medicine. Exploring the question of how Houston’s safety-net hospital, Ben Taub, can have better outcomes by many measures than America’s best private health centers, he deconstructs basic assumptions about healthcare in the US, pulling these ideas from vivid, journalistic accounts of the patients he serves.

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Nuila took a twisty path to his literary vocation. Born into a family of doctors, he always felt the expectation that one day he’d become a doctor too. “I grew up visiting hospitals with my dad. I loved the feeling of being in a place where there was all this activity, and people were being helped.” Nuila’s father, originally from El Salvador, had worked extremely hard to carve out a profitable private practice in Texas, and his grandfather had also became a doctor, returning to El Salvador to serve his home community.

As much as Nuila wanted to heed the expectation that he become an MD, in high school and college he began to feel pulled strongly toward a completely different direction: writing. Books like Blood Meridian and 1984 made strong impressions, and as he made his way through college he was increasingly torn over which direction to choose. Some key advice from Nuila’s father got him thinking that maybe he could do both.

“About that time I told my dad I wanted to be a writer, and he told me: ‘you’d be crazy to leave medicine.’ He said: ‘You can go to graduate school in writing and learn your technique, but where are you going to get your stories? You can get those stories in medicine.’ That was really essential advice.”

He reluctantly returned to medical school in search of a steady income, but literature remained seductive, and after medical school, Nuila took a year off and “wrote probably the worst novel that anybody’s written”. As a medical resident, he would get up at 4.30am to write for two hours before then enduring grueling shifts as a trainee doctor. More and more Nuila fell in love with the idea of being a doctor, and he began viewing medicine as a way to service his vocation as a writer. “I saw medicine as my stability on this quest to write.”

He landed a day job at Ben Taub while moonlighting for McSweeney’s and taking part in the annual Best American Short Stories anthology. As Nuila deepened his work at the hospital, he started noticing that patients there received extremely good care, despite its reputation for serving clientele who could not afford to go anywhere better. The disconnect between the hospital’s reputation and what he saw as a doctor there lingered in his mind, eventually becoming the seeds of The People’s Hospital. “People don’t know that public healthcare can be successful, and these presumptions bother me.”

Early on in his book, Nuila touts Ben Taub’s ability to treat heart attacks as the best in the nation – according to a 2015 study, it removed the blood clots that cause them far faster than any other hospital. Although claims like “best hospital in America” are undoubtedly complex to validate, it is true that throughout The People’s Hospital Nuila offers a mixture of anecdotal and data-backed claims to back up his big claim: that Ben Taub’s model of lower-cost, patient-centered healthcare can yield better results with far less waste than other medical models in the US. “We don’t need as much healthcare for it to be good,” said Nuila. “The cost has gotten excessive, and that makes it so difficult to dole it out to everybody. There’s so much excess and waste in private medicine and in America in general, and we need to think about how that effects everyone, and how it affects specific individuals.”

Although data is very much present in the book, the heart and soul of The People’s Hospital are the patients themselves, consistent with Nuila’s literary nonfiction aspirations along the lines of the gonzo journalists of the 60s and 70s, and, more contemporarily, New Yorker writers like Adrian Nicole LeBlanc and Rachel Aviv. “I didn’t come into this book wanting to make a grand statement about healthcare – I wanted to write patients’ stories. I had to learn to hear the ideas in the patients’ stories.” Although we are introduced to many Ben Taub patients along the way, Nuila principally follows three individuals: Steven, a middle-aged restaurant manager who is shocked by a cancer diagnosis; Roxana, whose severe gangrene leaves her in need of amputations of all four limbs; and Ebonie, whose pregnancy forces her to make an impossible decision.

A patient waits in the hallway at Ben Taub general hospital.
A patient waits in the hallway at Ben Taub general hospital. Photograph: Jessica Rinaldi/Reuters

“The people I encounter on a daily basis are vulnerable,” said Nuila, “and they come from a segment of society with a lot of presumptions about them. When I see that discrepancy, I want to talk about it.”

Now that he’s in effect publicizing Ben Taub to the world, Nuila does have some fears over “unintended consequences”. Ironically, if The People’s Hospital does too well, it might threaten the very care that Nuila so lovingly chronicles. “Say that the book is successful and it drives lots more people to Ben Taub – we’re already overloaded. I’m worried that we’ll get even more overloaded.”

Nuila also fears the backlash that might set in by challenging the status quo. He believes that, in part, Ben Taub has been so successful because it has flown under the radar of the American healthcare system. Making too big of a name for the hospital may attract the very kind of people that Nuila wants to keep away from the model of medicine that he so treasures.

“I’m worried about the politics of publishing a book like this. Over the years the thought has been: ‘let’s do our work, but not broadcast it so that we can do our work.’ There’s something to that logic. I am worried that there will be people who will come out against it, and it will affect the ways we do things.”

  • The People’s Hospital is out now