By Tyler Jefford
Brian Alexander’s The Hospital: Life, Death, and Dollars in a Small American Town is a sobering, deeply human look into the quiet collapse of rural healthcare in America. Set in Bryan, Ohio, the book follows Community Hospitals and Wellness Centers (CHWC) from 2018 to 2020, offering a ground-level view of a system straining under financial pressures and policy contradictions.
The reporting is immersive and unflinching. He embeds with CHWC’s leadership, staff, and patients, capturing both the administrative tightrope walked by CEO Phil Ennen and the lived experiences of those seeking care. The result is a narrative that’s as much about spreadsheets and boardroom politics as it is about ambulance rides and ER visits.
What struck me most was how Alexander connects the dots between local struggles and national dysfunction. He shows how CHWC’s fight to remain independent mirrors a broader trend: rural hospitals being squeezed by consolidation, insurance gamesmanship, and the relentless logic of profit. The book doesn’t just diagnose the problem—it makes you feel it.
This isn’t a policy book, but it’s impossible to read without thinking about policy. Alexander doesn’t offer neat solutions, but he makes clear that any fix must reckon with the structural rot in how we fund and prioritize care. His prose is clear-eyed and empathetic, never veering into sentimentality or despair.
If you’ve ever wondered why healthcare feels so broken—especially outside big cities—this book is essential reading. It’s a reminder that behind every headline about hospital closures or rising costs are real people trying to do good work in a system that often works against them.
The Hospital is a powerful, necessary read. It left me angry, informed, and more committed to understanding the forces shaping our healthcare landscape.
