Reinventing American Health Care

Starred review from April 15, 2014
"New York Times" columnist Emanuel (medical ethics, health policy, Univ. of Pennsylvania), a White House special adviser on health care reform, ably assesses the impact of the Affordable Care Act (ACA; commonly called Obamacare) on the American health care system in this timely volume. Emanuel carefully explains and illustrates serious problems with the current set up, the history of failed attempts at improvement, and the details of the ACA itself. In his estimation, controlling health care costs is good economics and will accelerate the economy rather than slow it down. Although the author acknowledges that the ACA is politically divisive, he makes a convincing case for its potential. Emanuel concedes that he is an optimist, but nevertheless admits that no piece of legislation is perfect and devotes a chapter of the book to possible implementation problems. He also points out that the health care system is dynamic and will require ongoing amendments and maintenance. VERDICT Readers with an interest in current political and social issues will appreciate Emanuel's frank policy discussions. Because all Americans are affected by the ACA the chapters detailing the content and personal implications of the act will be of value and interest to everyone.--Linda F. Petty, Wimberley, TX

Copyright 2014 Library Journal, LLC Used with permission.

March 1, 2014
Emanuel (Medical Ethics and Health Policy/Univ. of Pennsylvania; Brothers Emanuel: A Memoir of an American Family, 2013, etc.) views the Affordable Care Act as a success story. The author, who serves as a special White House adviser on health care reform, is optimistic that its glitches will be resolved within the year and that it will transform how patients are cared for over the coming decades. He reprises the complex history of American health care policy beginning in 1942, when the National War Labor Board ruled that health insurance could be treated as a nontaxable fringe benefit despite the wage freeze. The later inclusion of Medicare and Medicaid increased the complexity of the system. Emanuel details the many inequities that developed--most notably, the exclusion of people with pre-existing health conditions from the system and the financial vulnerability of the uninsured, who also frequently receive substandard treatment--e.g.,"Being uninsured means your chance of dying in a car accident is 40% higher than that of a privately insured person." The author asserts that the passage of the Affordable Care Act in 2010 "was a historic event," especially in the context of the ongoing recession and political restraints, coupled with the need to deal with opposition from "physicians, insurers, and pharmaceutical manufacturers" and others. He offers an insider's account of some of the infighting that occurred within the Obama administration, including his own altercations with his brother, Rahm, then chief of staff to the president. The author takes a long view of the reforms beginning with incentives and penalties for the adoption of uniform electronic health records in the 2009 Recovery Act. The ACA, he writes, "will increasingly be seen as a world historic achievement," and "Barack Obama will be viewed more like Harry Truman--judged with increasing respect over time." An important challenge to the naysayers on both sides of the political divide.

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March 1, 2014
In this unabashedly pro-Obama-care book, prominent bioethicist Emanuel makes a convincing, albeit one-sided, case for overhauling what he sees as an unfair health system in the U.S. Deftly using numbers to make his arguments, Emanuel organizes his book into three parts: the current system (largely its financing), health-care reform (the nearly 1,000-page Affordable Care Act ACA and legal challenges to it), and the future (lots of hospital closings). Today more money goes to the 4,985 acute-care hospitals ($970 billion in 2012) than all of Social Security ($730 billion) or national defense ($650 billion). And before ACA, nearly 50 million Americans, including 12 million undocumented aliens, lacked insurance. He also touches on important history (the creation of Medicare in 1965) and clearly explains complicated issues. For example, he uses a menu-pricing analogy to explain bundled payments: If fee-for-service is ordering la carte, bundled payment is prix fixe. A plain-English explanation of a tricky topic.(Reprinted with permission of Booklist, copyright 2014, American Library Association.)