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Landmark: The Inside Story of America's New Health Care Law and What It Means for Us All (Publicaffairs Reports)

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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.

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.

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.

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.

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...

I am a professor, looking for a case-study book on major legislative change, similar to Showdown at Gucci Gulch, or The Bill. Unfortunately, this book is not in that category. It has a couple short chapters describing the major milestones in the legislative battle, many chapters describing the tenets of health care reform (policy analysis style), and then a summary of the legislation itself. This is fine, in of itself, but it is certainly not "an inside story." the way that Showdown or The Bill was. Its also more policy analysis oriented than Policy Process oriented. It would make a good primer for an analysis of the health care reform bill.

This book is just a rehash of content that was in the paper and provides no depth. Also, the articles were not coordinated and in places material is repeated multiple times.

Getting the legislative history and getting a feel for the many parts of this historic legislation is a must for those of us who (i.e. the entire adult population of the USA) will make this law into a force in the economy. This book can be an intoduction to how the legislative process can actually work to propose a solution to a complex set of problems. Without a doubt, readers will see that this is the first step in what will become a series of attempts to solve a problem facing the country. When financial interests confront voters with opposite views of a situation, we become confused about who to believe when what we should understand is that the financial interests are presenting a position that favors "them" not "us", and "we" must educate ourselves to fully understand the issues. It should be the responsibility of politicians to act for "us" and in many instances, they fail, not because they don't believe the "us" advocates are right but because they only get one side of the issue. This book helps "us" understand all of those views to come closer to what should be done.

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.

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.