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126 of 134 people found the following review helpful
4.0 out of 5 stars Comprehensive Overview of the Healthcare Bill
I'm a family physician that has followed the healthcare reform debate closely, dating well back into the Democratic primary season when Hillary and Obama were duking it out, dating even as far back as the failed Bill and Hillary Clinton first attempt during Bill Clinton's presidency. I found Landmark: The Inside Story of America's New Health Care Law to give a much...
Published on May 24, 2010 by Daniel Murphy

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34 of 45 people found the following review helpful
3.0 out of 5 stars Interesting, but nothing new
Much of this book is simply a summary of the events surrounding the passage of the health care legislation. There's not much new in the way of "insider" accounts (those books are forthcoming, I'm sure), and what appear to be enlightening passages is simply rehashed conventional wisdom (Rahm Emanuel like to curse, we get it). For people that didn't follow the process as it...
Published on May 12, 2010 by Will Klinger


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126 of 134 people found the following review helpful
4.0 out of 5 stars Comprehensive Overview of the Healthcare Bill, May 24, 2010
I'm a family physician that has followed the healthcare reform debate closely, dating well back into the Democratic primary season when Hillary and Obama were duking it out, dating even as far back as the failed Bill and Hillary Clinton first attempt during Bill Clinton's presidency. I found Landmark: The Inside Story of America's New Health Care Law to give a much richer historical perspective, and to give a much better analysis of the actual impact that the bill is likely to have, than was available from the fragmented and sensational mainstream media coverage.

The book is a collection of essays written by Washington Post reporters, followed by the actual text of the bill. The essays in the book are far more analytical and informative than what was typically available throughout the somewhat histrionic coverage of Republican and Democratic maneuvering to respectively block or pass the eventual bill. One could have been left with the impression, when it was all over but the shouting, that the resulting bill was weakened to the point of being inconsequential from the point of view of reform, and enormous regarding eventual cost. Read Landmark, and you'll have a different opinion on both those points.

What was useful in the book? The many failed historical efforts to provide some form of national healthcare coverage go back over 100 years, a battle that until this last month stymied many presidents (including Teddy Roosevelt). The historical review alone made the book a worthwhile read for me. Secondly, the authors make a convincing case that, much in contrast to the typical media coverage, this bill represents a deep and broad change in the American approach to healthcare for its citizens, far more so than the Medicare and Medicaid legislation. After reading the essays, and even more powerfully after reading the actual legislation, I'm convinced that the authors are correct. Why? Though it is true that the bill is corrupted in places by special interests, and weakened by the deletions forced by political compromise, it also becomes clear that through a combination of fiat and incentive the new healthcare law will, for better or for worse, markedly change the way doctors/providers do business, and how their patients/clients experience their healthcare.

Fiats? No exclusion for pre-existing conditions, no excisions from insurance because you actually USE what you've purchased, no lifetime limits on coverage just because you actually got sick. Incentives? Buried in the legislation itself is a long list of encouragements to do what amounts to serious R & D (research and development) in methods to improve American health, and to treat American illness. In a country where 85% of health related research is done by notoriously biased private industry (the reverse of the ratio in Europe), creating conditions more amenable to less biased scientific research is a welcome and little discussed part of bill. Creating incentives for physicians/providers to focus on quality will change what you experience when you go in for healthcare, and this book details what you will be seeing change over the next few years.

As a socially liberal, financially conservative physician (voted for Reagan, actually went to his inaugural parade) my bottom line about Landmark is this: whether you love or hate the bill, your perspective on it will be different, and better balanced, when you are done reading it. Your ability to discuss the bill accurately will be significantly enhanced, as I've already found out on multiple occasions when confronted with nonsense statements from both the left and the right. If you wish to consider yourself informed on the Healthcare Reform Bill, this book will go a long way to getting you there.
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17 of 20 people found the following review helpful
5.0 out of 5 stars Great Research and Expanation of the New Health Care Law, May 24, 2010
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This book gives the history of the work put into the passing of the new health care bill. Then it goes into explanations of how the new law works and tells the good and bad of each segment. Each writter put their own knowledge and research into their part of the book. It made me look at the new law with a more open and optimistic mind.
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12 of 14 people found the following review helpful
5.0 out of 5 stars Landmark: The Inside Story of America's New Health Care Law and What it Means for Us All, September 3, 2010
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Landmark: The Inside Story of America's New Health Care Law and What It Means for Us All (Publicaffairs Reports)

The book is well written and very easy to understand helping to clarify specific portions of the new Health Care Reform Law through the analysis of several Washington Post reporters. What is exceptional is that it contains the law itself so that anyone can read and see EXACTLY what this law does and does not do. With all the hype from so many sides this book and the actual law is a must read to understanding all elements of this reform. It is truly a "Landmark". I highly recommend it. I purchased this book through Amazon.com.
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34 of 45 people found the following review helpful
3.0 out of 5 stars Interesting, but nothing new, May 12, 2010
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This review is from: Landmark: The Inside Story of America's New Health-Care Law—The Affordable Care Act—and What It Means for Us All (Publicaffairs Reports) (Kindle Edition)
Much of this book is simply a summary of the events surrounding the passage of the health care legislation. There's not much new in the way of "insider" accounts (those books are forthcoming, I'm sure), and what appear to be enlightening passages is simply rehashed conventional wisdom (Rahm Emanuel like to curse, we get it). For people that didn't follow the process as it unfolded over the past year and half, this part of the book should prove interesting. The real utility of the book is its comprehensive summary of what's in the legislation and how it will affect different people.

I do have one major technical issue with formatting of the Kindle edition. The entire book is presented in brief one- or two-sentence paragraphs (much like a newspaper article) with a space between each paragraph. The spaces are very distracting, as if I'm reading a bullet list rather than a cohesive, flowing narrative. It makes for very halting, choppy reading.
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5 of 5 people found the following review helpful
4.0 out of 5 stars Slightly biased, but still the best book available, November 8, 2012
"Landmark" by the staff of the Washington Post is a great book for learning about the Patient Protection and Affordable Care Act. Naturally it is difficult to write such a book and maintain political neutrality, but "Landmark" is as reasonably unbiased a book as you'll find on bookshelves today. Some of my reasons for recommending this book include:

-This book includes two main sections: the first describes the process of the bill becoming law and the second is a description of what the new law will change. Both sections are thorough and miss none of the important portions of the law.
-It makes clear how the law will affect different groups. Young, working age, and old, male and female, poor and rich, are all given treatment in this book.
-Health care before the law is explained so that the reader can see how things have changed. This is especially important for people who (like myself) don't have a full understanding of how programs like Medicaid, Medicare, and CHIP worked before the new law. Because the book explains where we're coming from, it is more clear where we are headed.

A few of the downsides of this book are:

-The authors constantly doubt many estimates, especially those done by the CBO, that suggest a potential problem with the new law. Although the book does give both sides of the debate their space, any official estimate that supports the new law is treated as undeniably true and any estimate that is critical of the benefits of the law is treated with undue skepticism.
-Some sections are confusing because the authors discuss various different plans that were proposed before explaining what ultimately passed. One example of this is how the law affects abortion providers. Politicians changed that section many times before the law was passed, but the book makes it difficult to understand what the final outcome was.

Overall I recommend the book to anyone who doesn't know much about the new healthcare law and would like to learn about all of its provisions. If you're looking for an argumentative piece that judges the new law, this book is not going to match your needs.
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9 of 11 people found the following review helpful
5.0 out of 5 stars Very clear review of a most complex legislation, January 13, 2011
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Obama signed this Act into law in March 2010. Nearly a year later with politicians so polarized, it seems like a miracle that he ever did. Republicans did not want any part of health care reform. Meanwhile, Democrats often viewed a public-option as a must.

The first part of the book does a good job reporting the history of this legislative miracle. It culminated soon after Scott Brown won the Massachusetts Senatorial seat and broke the Democrats filibuster proof majority. Thereafter, the Democrats pulled the nuclear option with the House approving the Senate bill, and then working out details in a separate budget reconciliation bill.

The preface to the next section clearly outlines the U.S. health care problems. Our former system was broken. Our health care costs are nearly twice as much as everyone else. Among OECD countries, we have by far the largest portion of our population uninsured. Every year, 700,000 Americans file for bankruptcy because of medical bills. And, over 22,000 die because of inadequate access to health care. Among our major trading partners those respective figures are zero and zero. Also, health care costs are growing far faster than the economy. Thus, they have risen from 5.4% of GDP in 1960 to 16.2% in 2007. This trend is not sustainable. While spending so much, our health care outcomes are bad relative to other countries as shown by preventable deaths per 100,000 and infant deaths per 1,000 live births (pg. 67).

The authors clarify complex issues with helpful visual aids. The timeline table (pg. 70) readily illustrates the complex phase-in of this legislation over the 2010-2014 period. The four tiers of coverage ranging from 60% of medical cost (bronze) to 90% (platinum) are well outlined (pg. 78). The complex structure of insurance subsidies for lower income is clearly spelled out (pg. 80). The table showing how insurance coverage will be expanded to nearly the entire population is insightful (pg. 86). The visual aids showing how the Medicare Part D doughnut hole will progressively be reduced through 2020 is informative (pg. 116). The table showing what are the main costs and revenue sources of the Act over the next decade is excellent (pg. 173). Both expenses and revenues total around $1 trillion. Half of the expenses consist of subsidies for lower income individuals to buy insurance on the exchanges. The other half consists mainly in the expansion of Medicaid. Half the revenue sources come from cuts to Medicare, Medicaid, and other Government programs. And, the other half comes from taxes on individuals and fees on health industry companies.

Certain key concepts are well fleshed out. 'Why a mandate matters' (pg. 87) is well explained. If insurers can't insure near the entire population, there is no way they can offer reasonable premiums, cover all health risks, and remain solvent. This is because of negative selection whereby only the sick get insurance and the healthy do not. This is like insuring only the houses already on fire. It does not work. The sections referring to the law's effort in improving the quality and efficiency of care are really interesting. It covers concepts unknown to the general public such as the "accountable-care organizations" networks (the current Kaiser Permanente and Mayo Clinic model) that will have salaried doctors and will closely track the efficiency and quality of health care services delivery. Later, a section addresses the conundrum of better preventive care access that results in higher utilization and higher medical costs according to a CBO study. However, this Act also takes numerous measures to attempt "bending the curve" of health care costs. Those include comparative effectiveness studies and the mentioned accountable-care organizations. Beginning in 2014, it indicates that employers will have the right to sensitize the premiums paid by their employees based on wellness standards. A healthy employee's premium could be as much as 50% less as the one of an unhealthy one (smoking, overweight, high cholesterol, etc...). That's going to be interesting.

The section on the new taxes is informative. The rich will bear new taxes such as the higher medicare payroll tax of 2.35% (vs 1.45%) and the special 3.8% investment income tax on income greater than $200,000 (for singles).

The conclusion is also insightfull. It suggests that we won't know for a long time how much will the Act eventually improve our nearly bankrupt and costly health care system; This is because Republicans in Congress are opposed to the Act's implementation. Similarly, many Republican Governors vigorously oppose the Act's implementation. This political opposition could prove crucial to the Act's (lack of) success. The Republicans' obstructions could play out in numerous ways including weakening the Act ensuing legislation and the funding necessary to implement the Act effectively. As a result, if the Act does truly fail it will be difficult to assess how much was it due to a failure of policy vs politics. Another related challenge is the disparity between the proposed bare-bone plans (Bronze) vs the gold-plated ones (Gold & Platinum). The young and healthy will select the Bronze one; meanwhile, the older will take the Gold one and above. The healthy being so minimally insured, their low premiums may be inadequate to subsidize the richer policies of older citizens. Will see...
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1 of 1 people found the following review helpful
4.0 out of 5 stars A coherent summary and objective evaluation of Obamacare, April 14, 2014
First and foremost, while “Landmark” is over 250 pages, not all of it will be of interest to all audiences. If you’re not sure if you want to commit to reading 250 pages about the Affordable Care Act, that might be attractive, as the core of the book is succinct and very accessible. On the other hand, if you’ve been closely following the progress of the law and are looking for an in-depth exploration of its nuances, you may be left wanting more.

Specifically, the book is divided up into three very distinct parts. The first 62 pages provide a history of efforts to pass healthcare reform, concluding with a summary of what it took to get the ACA passed in 2010. The next 132 pages discuss the what the bill does and does not do, how it’s paid for, and how it will impact different people. The last 66 pages are a summary of the law and the reconciliation act prepared by the government. It is the second section that most people will be buying this book for.

As a political moderate, I tend to be very sensitive to partisan rhetoric or bias. And that can be difficult to avoid when covering a politically charged topic. Nonetheless, the Washington Post did a remarkable job providing a reasonably objective and balanced view. Most of the chapters are provided without editorial. Political rhetoric from both sides of the aisle is acknowledged, then addressed based on what the actual law states. Blatant myths are debunked, while valid promises and criticisms are both evaluated.

I suspect most people will walk away from this book concerned about some aspects of the law, excited about others, and surprised on any number of points. If you’re like me, you’ll keep the book on hand as a reference so you can clarify the many misperceptions perpetuated by partisan friends.

That said, there are some disappointments in the book. The biggest, to me, is that while it provides a condensed summary of the law itself, the primary section doesn’t cross-reference it. Ideally, each point in the book would have cross-referenced to that summary as a means of citing claims, indexing content, and making it easy for readers to dive into the details for areas that were of particular interest. Positively, the index does cover the summary of the law.

The second issue is not a fault of the book, but of the fact that it was published shortly after the law passed in 2010. Since then, a lot has changed. There are quite a few areas of the law that are ambiguous, and the book correctly notes that the final implementation will be largely dependent on how federal officials will translate the law into specific regulations. Further, aspects of the summary have been invalidated by the Supreme Court decision to allow states to opt-out of Medicaid expansion. Ideally, I’d love to see The Washington Post publish a second edition of the book with updates based on how the law has actually been implemented.

Despite those two considerations, this remains a coherent and well-structured summary of the law, and a valuable reference for people eager to cut through the partisan shouting match.
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4 of 5 people found the following review helpful
4.0 out of 5 stars Landmark review, October 3, 2010
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Its a well written and informative book about the new health reform policy, however quite political-as expected- since it is difficult to divorce politics from this policy but this makes you yearn for the other side of the story. On the whole, a very good read.
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4 of 5 people found the following review helpful
5.0 out of 5 stars a must read, November 24, 2010
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I found this book to be very informative, quite objective, and an easy read. Every American should read this book to try and understand the overhaul of the health care system.
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1 of 1 people found the following review helpful
4.0 out of 5 stars Great summary, April 23, 2013
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I thought the book was an great summary of the legislation, and I thought it was excellent that it included the full text of the bill. There is clearly some bias in the writing, but nothing substantial or that effects the summary of the law.
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