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

by Ezekiel J. Emanuel

Overview

The definitive story of American health care today—its causes, consequences, and confusions

In March 2010, the Affordable Care Act was signed into law. It was the most extensive reform of America’s health care system since at least the creation of Medicare in 1965, and maybe ever. The ACA was controversial and highly political, and the law faced legal challenges reaching all the way to the Supreme Court; it even precipitated a government shutdown. It was a signature piece of legislation for President Obama’s first term, and also a ball and chain for his second.

Ezekiel J. Emanuel, a professor of medical ethics and health policy at the University of Pennsylvania who also served as a special adviser to the White House on health care reform, has written a brilliant diagnostic explanation of why health care in America has become such a divisive social issue, how money and medicine have their own—quite distinct—American story, and why reform has bedeviled presidents of the left and right for more than one hundred years.
Emanuel also explains exactly how the ACA reforms are reshaping the health care system now. He forecasts the future, identifying six mega trends in health that will determine the market for health care to 2020 and beyond. His predictions are bold, provocative, and uniquely well-informed. Health care—one of America’s largest employment sectors, with an economy the size of the GDP of France—has never had a more comprehensive or authoritative interpreter.

Product Details

ISBN-13:	9781610395427
Publisher:	PublicAffairs
Publication date:	03/03/2015
Edition description:	First Trade Paper Edition
Pages:	400
Sales rank:	187,582
Product dimensions:	5.50(w) x 8.10(h) x 1.20(d)

About the Author

Ezekiel J. Emanuel is vice provost for global initiatives and chair of the department of medical ethics and health policy at the University of Pennsylvania. From January 2009 to January 2011, he was a special adviser on health care reform to the White House. He is the author or editor of ten books and over 250 scientific articles. He is currently a senior fellow at the Center for American Progress, a columnist for the New York Times, a regular contributor to the Wall Street Journal, contributing editor at The New Republic, and appears regularly on television, including Morning Joe, Real Time with Bill Maher, Hardball with Chris Matthews, and The Rachel Maddow Show.

Table of Contents

Contents

Acknowledgments xiii
Introduction: Erin’s Disease 1

PART I: THE AMERICAN HEALTH CARE SYSTEM
1 How Did We Get Here? 17
2 Financing Health Care 34
3 How Americans Get Their Health Care 68
4 Five Problems with the American Health Care System 95

PART II: HEALTH CARE REFORM

5 The Surprising History of Health Care Reform in the
United States 127
6 Enacting the Affordable Care Act 159
7 What the Supreme Court Said 188
8 What Is in the Affordable Care Act? 201
9 What Does the ACA Mean for Me? 259

PART III: THE FUTURE OF AMERICAN HEALTH CARE
10 ACA Implementation Problems 279
11 The ACA Dashboards 295
12 Health Care Reform 2.0 306
13 Six Megatrends in Health Care 317

Coda: A Final Thought 345
Further Readings 351
Index 357
About the Author 381

Editorial Reviews

Americans spend more money per capita on health care than people in any other country, but in the world, we rank 50th in longevity. In this clarifying, timely book, physician and New York Times health columnist Ezekiel Emanuel addresses the intricate problems related to our troubled health care system as an insider, having been involved in White House discussions on details of the Affordable Health Care Act. (His brother is Ron Emanuel, Obama's first chief of staff and current mayor of Chicago.) Now that the dust on the controversies over "Obamacare" has someone settled, The Reinvention of American Health Care enables readers to tackle practical questions about how this new law will really affect their family's medical issues. A core text that arrives just when we need it.

“For Americans poisoned by nefarious medical insurance companies and a G.O.P. dying to gut Obamacare, I prescribe Ezekiel Emanuel’s Reinventing American Health Care (PublicAffairs) to clarify how the Affordable Care Act can rehabilitate our nauseatingly unjust, grossly expensive, and senselessly complicated health-care system. My personal recommendation? Lay off the toxic propaganda.”—Vanity Fair

“Whether you agree with his conclusions or not, they’re well argued, and he has marshaled an impressive amount of information.”—Washington Post

“Infused with diagrams, charts, and tables, this book is informative, thought-provoking, and immensely important. Given his role in the program, and as is reflected in the subtitle of the book, Emanuel clearly wants to persuade, but he also wants to explain. And because he was an insider — and proves himself a gifted writer — he makes an able guide to the complexities of the landmark legislation… Clearly, if Obamacare is to fulfill its promise there will need to be significant changes and that will require collaboration among citizens, health care professionals, scholars, and lawmakers from across the political spectrum. And the only way this can happen is if people understand what exactly is at stake. ‘Reinventing American Health Care’ spells this out clearly, and by doing so, lays the foundation for this kind of collaboration to occur.”—Dennis Rosen, Boston Globe

“The facts and history that Emanuel lays out would be useful to anyone involved in the debate over health care, no matter what their point of view is.”—250Words.com

“With this book, Zeke Emanuel has done the country an immense service. He does the impossible—explain the dysfunctional American health care system—and then takes it one better. For here he also makes the hard-eyed case for understanding that the passage of health reform—of Obamacare—has set us on a path for a health system that works. Our system has left millions without needed care, bankrupt, or both, and tied the fate of their health to where they work. This book explains how we got in this fix, how we will get out of it—and even more boldly, when. If you wanted to read one book to understand health care, this is the one you want.” —Atul Gawande, surgeon, staff writer for The New Yorker, and author of The Checklist Manifesto

“There are thoughtful doctors, savvy policy makers and profound scholars of morality. Zeke Emanuel is the only person in America who is all three. That makes him the right person to write the definitive primer on health care in America. It should be read by anyone who wants to understand what may be the most important set of domestic issues facing America.” —Lawrence H. Summers, former Secretary of the Treasury of the United States, & President Emeritus and Charles W. Eliot University Professor of Harvard University

“Zeke Emanuel has written a book that tells people interested health care policy what they need to know but all too often do not. He brings together a staggering variety of information, never before available in one place, on economics, medicine, legislative history, governmental operations, politics, and the gory, boring, and surpassingly important issue of implementation. No single book can tell one all one needs to know about the most complex health care system in the world, but this one comes very close indeed.” —Henry J. Aaron, the Bruce and Virginia MacLaury Senior Fellow in the Economic Studies program at the Brookings Institution

“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 offers an insider’s account of some of the infighting that occurred within the Obama administration…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…An important challenge to the naysayers on both sides of the political divide.”–Kirkus Reviews

“Prominent bioethicist Emanuel makes a convincing, albeit onesided, 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) …He also touches on important history (the creation of Medicare in 1965) and clearly explains complicated issues…A plain-English explanation of a tricky topic.”–Booklist

“Few people have had a more favorable influence on the shaping of the current processes of health care reform than Zeke Emanuel has. And no one is a better, clearer, or wiser interpreter of the insanely complex non-system that we are trying to fix. This book is an instant classic—mandatory reading for anyone who wants to know how we got where we are in American health care and where we need to go.” —Donald M. Berwick, MD, MPP, president emeritus and senior fellow
at the Institute for Healthcare Improvement, and former administrator
of the Centers for Medicare and Medicaid Services

“Reinventing American Health Care is an informed and informative book and likely to be just as controversial as Zeke Emanuel was during his tenure in the Obama administration.”—Gail Wilensky, senior fellow at Project HOPE and former deputy assistant to President George H. W. Bush for policy development

“Emanuel provides an entertaining and informative mix of history, fact, argument, and speculation. His book’s subtitle to the contrary, it is not simply a defense of the ACA. Emanuel does a superb job of describing the history of health care in the United States, the complexities involved with it, and the various attempts that have been made to reform it. And while he is a defender of the ACA, he is also honest about the difficulties the law has faced during implementation…This is essential reading for anyone interested in understanding one of the most pressing issues of American politics today and in the future." — Health Affairs

From the Publisher

★ 04/15/2014
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

Library Journal

2014-02-12
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.

Kirkus Reviews