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Reinventing American Health Care: How the Affordable Care Act will Improve our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System Hardcover – March 4, 2014

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Editorial Reviews

From Booklist

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 à la carte, bundled payment is prix fixe.” A plain-English explanation of a tricky topic. --Karen Springen

Review


“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
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Product Details

  • Hardcover: 400 pages
  • Publisher: PublicAffairs; 1 edition (March 4, 2014)
  • Language: English
  • ISBN-10: 1610393457
  • ISBN-13: 978-1610393454
  • Product Dimensions: 1 x 6.1 x 9.2 inches
  • Shipping Weight: 1.4 pounds (View shipping rates and policies)
  • Average Customer Review: 4.2 out of 5 stars  See all reviews (78 customer reviews)
  • Amazon Best Sellers Rank: #59,547 in Books (See Top 100 in Books)

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Most Helpful Customer Reviews

38 of 40 people found the following review helpful By Philip Lederer on March 23, 2014
Format: Kindle Edition Verified Purchase
Ezekiel Emanuel just published an important book with a great title, "Reinventing American Health Care: How the Affordable Care Act Will Improve Our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System." In it, he describes the history of health care reform in the US, gives an overview of the Affordable Care Act (ACA), and speculates about future trends in American health care.

The concluding chapter of Emanuel's book is entitled, "Six Megatrends in Health Care: The Long-Term Impact of the ACA." I will devote this review to discussing his six "megatrends."

Megatrend 1) The End of Insurance Companies as We Know Them

Emanuel argues that health insurance companies will "shift their business to focus on offering services they have expertise in, particularly analytics, actuarial modeling, risk management, and other management services...." or "transform themselves into integrated delivery systems," or they will go out of business. This seems quite plausible. However, I think it will depend on how the ACA implementation goes over the next several years. If insurance companies raise their rates, there could be major political fallout.

Megatrend 2) VIP Care for the Chronically and Mentally Ill

Emanuel argues that "tertiary prevention" for chronically ill people with diabetes, heart disease, cancer, etc, and mental health care for people with depression/anxiety, will become an increasing focus of our health care system. I agree. I've taken care of many patients with chronic diseases and mental illness who cycle in and out of the hospital. The question is if our fragmented health system can provide coordinated, community-based care for these vulnerable people.
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29 of 40 people found the following review helpful By Loyd E. Eskildson HALL OF FAME on March 7, 2014
Format: Hardcover
American health care leads the world in costs - 18% of GDP (while excluding about 15% from insurance coverage), vs. 4% for Singapore (excluding no-one) at the low-end. It also infects 5% of hospitalized patients - of which nearly 100,000 die, and kills another estimated 44,000 - 98,000 from other hospital errors. Surely this complicated mess deserves rethinking. Unfortunately, getting from the mess we have now to something akin to the high-quality, much-lower cost care in Singapore, South Korea, Japan, and Taiwan has proven beyond the capability of America's legislative leaders. Decades of failed prior attempts, followed by compromise after compromise was required to even get the limited improvements afforded by the ACA when it was enacted in 2010.

Dr. Emanuel clearly likes the ACA - understandable given his role in its development. However, he minimizes trying to sell the ACA, doesn't mince words excoriating the initial ACA rollout efforts, and focuses on explaining our current complicated, dysfunctional system. I'm very hopeful that one of ACA's mandates (electronic medical records) will prove far more valuable than imagined, helping to identify important interactions, improve treatment protocols, and save lives. Improving access to care will also save lives. Similarly, encouraging the growth of accountable care organizations with bundled payments should also save lives and reduce costs by incentivizing quality improvement and removing incentives to over-treat. Finally, taxing 'Cadillac' plans will also hopefully make a dent in cost control.

An excellent and objective overview of complicated subjects
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11 of 15 people found the following review helpful By Deborah Sue St Clair on May 17, 2014
Format: Kindle Edition Verified Purchase
This book, like the affordable care act, was born from a combination of idealistic beliefs that the dysfunctional health care system was somehow separate from the dysfunctional class divided society that it supports and that the health care systems fails because of inefficiency within itself. In reality the system re-aligns itself periodically according to the payments system, and in this sense delivers what society asks of it to do. The book supports the myth that better technology and electronic health records will allow advanced data mining to discover new medical truths and improve efficiency, in spite of the fact that every advance in technology beyond immunization has raised costs.. It celebrates the highly efficient veteran's administration hospital system as the best we have.
All this has some validity, but it was written before the Snowden revelations and before we discovered that the veterans hospitals cook the scheduling books before reporting their outcomes, bringing into disbelief all that these hospital system claims.
But I was happy to read this book, and it is a smooth fast read giving insights into what the health care planners of the federal government read before they wrote the bill that congress voted after a year of heated debate, but never actually read themselves.
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2 of 2 people found the following review helpful By Neil Benson on July 16, 2014
Format: Kindle Edition Verified Purchase
I'm a Brit living in the US. I'm used to the UK National Heath Service which offers great healthcare outcomes and reasonable value for taxpayers' money. Arriving in the US I find myself completely confused by a complex, bureaucratic, expensive private healthcare insurance system. Emanuel's book offered a comprehensive and insightful history of the US healthcare system and explained all the complexities of co-insurance and co-pays. The main topic, of course, was the Affordable Care Act and how it came to pass, what it set out of delivered and the compromises along the way. Emanuel was an architect of the ACA and is principles and pride shine through his writing, but that doesn't stop him pulling his punches when criticizing the Act's failings. An enlightening read.
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