Reinventing American Health Care: How the Affordable Care Act will Improve our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System

Ezekiel Emanuel has written a very interesting book about the U.S. health care system. In the introduction, he tries to make sense of how three individuals were affected by this system. He then proceeds to get into the nitty-gritty of the American health care system beginning with it roots. The book is divided into three parts. In Part I we review the history of the American health care system, in Part II we explore the efforts to reform the system, and finally, in part III, we gaze into the crystal ball of the future.In the first part, he provides us with a brief history of healthcare in the U.S. It was interesting to learn how the employer-base system came to predominate in society. In the rest of the section we get a very detailed description of how healthcare is financed, who the providers are, how Americans get their healthcare, and interestingly, how this all works together to give us our current healthcare system. We are provided with many tables, charts, and diagrams, which provide some interesting statistics.In part two Emanuel discusses the history of health care reform. He first covers the history of health care from Teddy Roosevelt, to Franklin Roosevelt, to Truman, to Lyndon Johnson, and on to Clinton. Truman was a strong advocate for national health care but was stopped by the first Republican controlled Congress since 1932. Johnson did manage to introduce Medicare and Medicaid laws, and most can remember what happened to Clinton’s proposal. Interestingly in 1971, there were 22 separate health insurance bills before Congress. Not one made it out of committee. We clearly see the difficult road that was followed to achieve some sort of national health care.Emanuel continues on to explain to us the details of the enactment of the Affordable Care Act (ACA) and the immediate challenges to the law. Just minutes after being signed into law, over 20 states filed a lawsuit challenging its constitutionality. This was to be followed by an incessant barrage of lawsuits over the ensuing years, some of which the Supreme Court had to decide.In Chapter eight, we get some very detailed information about exactly what is in the ACA. This is a very valuable chapter; it contains a wealth of information on the inner workings of the ACA. Many tables and charts are presented to explain to us exactly what this law does. It would behoove anyone interested in healthcare in American to read this over and learn the wealth of benefits provided by the law. Most people have no idea of all the things provided for by the law that ensures affordable healthcare, and it manages to (after ten years) be revenue positive, according to the Congressional Budget Office. In addition to access, according to Emanuel, “The ACA also addresses cost, quality, prevention and health promotion, health care workforce issues, and many other matters.”In a following chapter, the author shows us what the ACA means to us, before delving into Part III, where he discusses the future of health care in America. We are introduced to various “dashboards” that cover coverage, cost-control, quality, and overall health status. The author also discusses various reforms that build on the ACA to advance health promotion and prevention, cost control, and quality improvement that he says are “shovel ready.” In the final chapter, we are informed of the long-term impact of the ACA. It is the author’s belief we will eventually see the demise of insurance companies as we know them, and even the end of employer-sponsored health insurance. We will see more accountable care organizations (networks of physicians, hospitals and other providers). He also discusses four other trends.I recommend that anyone desiring an understanding of our American health care system read this book. It is as the author says, “in the longer sweep of history, beginning in 2020 or so, the ACA will increasingly be seen as a world historical achievement, even more important for the United States than Social Security and Medicare has been.” I think you will share this conclusion after reading this book.

This is a well-written and well-organized book with interesting information. The beginning part of the book starts out with the history of medical care and attempts at medical reform in the history of the United States. It points out that as many as 98,0000 people die in hospitals each year as a result of preventable medical errors. The book also points out the following information: Half the American population hardly uses any services. 10% of Americans use nearly 2/3rds of all health care services. The mandate reduces adverse selection. 55% of those earning less than 100% of the Federal Poverty line were not offered Health Insurance from their employers. 51% of the uninsured have been uninsured for three years or more. Of course, these figures are as of the end of last year before the Affordable Care Act went into effect. Before ACA went into effect, at least 15% Americans were uninsured. One out of 7 Americans lacked health insurance in the richest country of the world. Not having health insurance can cost you your life. Being uninsured means your chance of dying in a car accident is 40% higher than that of a privately insured person. The author of the book feels that the mandate is the only way insurance companies can offer to all-including those with pre-existing conditions. The mandate is to balance the sick and the healthy. The drawback of this book is that it does not mention the fact that in California for Medi-Cal as of the present time this review is written, the Government can seek recovery (reimbursement) from the estate of anyone 55 or over who died for all health insurance premiums that were paid into it. Some people feel that this is unjust because it allows people with higher income levels to get subsidized health insurance through the new health insurance exchange and not have to pay back any of it. There is a bill that could be signed or vetoed by California Governor Brown by the end of September 2014 that could still retain this or change it. Some people feel that it is Orwellian to have to choose between having health protection and your estate.

This is a good primer on the Affordable Care Act. It goes into sufficient detail to leave the reader with a basic understanding of the law. The book emphasizes the ACA goes well beyond its headline attracting features like the individual and employer mandate and includes many provisions that will fundamentally change the health care industry. One of the Act's main objectives the author notes is to tame rising health care costs for all Americans, which, since the 1970's, has outpaced the growth of the economy. The author also points out that the Act is structured to provide incentives and penalties, particularly for hospitals, intended not only to lower costs, but to improve the quality of health care as well. As one of those intimately involved in passage of the ACA, the author is sometimes defensive about the events surrounding passage, but overall does a very good job of explaining - in neutral terms - the details of the law and how they are intended to effect health care in the United States. For those wishing to learn about the specifics of the law beyond partisan interpretation, this book will fill the bill.