"[A] clear, comprehensive, and compelling chronicle of the health care debate....Starr is at the top of his game."—Glenn Altschuler, Huffington Post (Glenn C. Altschuler Huffington Post)
"[Starr's] unsentimental perspective serves him well in this outstanding volume."—Harold Pollack, Washington Monthly
(Harold Pollack Washington Monthly
Winner of the 2011 American Publishers Awards and Scholarly Excellence (PROSE) in the Government and Politics category, as given by the Association of American Publishers
(PROSE Award in Government and Politics Association of American Publishers
"Remarkable. . . . There couldn't be a more astute insider to the politics of reform than Starr. . . . Starr's history of America's battle over whether health care should be a right is an exacting look at politics and policies—and a challenge to Americans to overcome their fear and distrust in order to protect the sick and vulnerable."—Publishers Weekly, Starred Review
"First, [Starr] objectively draws together the threads of myriad voices and special interests in the centurylong American health-care debate and weaves them into a wholly comprehensible pattern. ...Second, Starr cogently explains the highlights of the recently passed and highly controversial Affordable Care Act...In sum, this self-admitted universal-health-care advocate and seasoned realist leaves readers questioning, as he does, whether Americans can 'summon the elementary decency toward the sick that characterizes other democracies.'" —Donna Chavez, Booklist (starred review)
(Donna Chavez Booklist
“The best summary and political analysis of health care reform I’ve read....Starr nails every nuance while taking the analysis one level deeper than any other treatment I’ve read.”—Austin Frakt, The Incidental Economist
(Austin Frakt The Incidental Economist
“Paul Starr has written a fascinating chronicle of America’s century-long journey to health reform that is, at once, erudite history, vivid journalism, and authoritative guide to a debate that will continue for decades.”—Henry J. Aaron, co-author of Using Taxes to Reform Health Care
(Henry Aaron 2011-06-02)
"Three decades ago Paul Starr wrote the definitive history of American medicine. Remedy and Reaction now offers the definitive analysis of American health care reform—its history, nature, and continuing vulnerability."—Timothy Jost, co-editor, Transforming American Medicine: A Twenty Year Retrospective
(Timothy Jost 2011-06-06)
"Remedy and Reaction is the story of health care in America, told by the man who knows it best. Whether you're a serious scholar or just a serious citizen, you should read this."—Jonathan Cohn, senior editor, The New Republic
(Jonathan Cohn 2011-06-14)
"Here’s the book we’ve been waiting for—a lucid history of America’s struggle over healthcare reform, blending the political, economic, and social pressures that have brought us to where we are, and suggesting where we’re headed. With great insight and impeccable writing, Paul Starr explains why that struggle has been particularly bitter and partisan in the United States, why the resulting compromises have left so many people unsatisfied, and why the underlying problems continue to evade us. Brilliant and important."—Robert B. Reich, Chancellor's Professor of Public Policy, Goldman School of Public Policy, University of California, Berkeley
(Robert B. Reich 2011-06-17)
"Paul Starr, who gave us a magisterial account of the history of American medicine, now has given us the definitive account of the history of the struggle to enact health reform in America. Starr has done more than just study reform—he was a player in efforts to achieve it. Remedy and Reaction
is in some ways thus an insider's history, which only enriches the experience of the reader. This book is a lively read, but has depth and insight. From its account of the early experiences in the twentieth century with reform, up through the disappointments in our livetimes to achieve any comprehensive change, through the enactment of the Affordable Care Act and the story of its uncertain future, Remedy and Reaction
is the definitive account of the history of health reform in America." —Norman Ornstein, co-author of The Broken Branch: How Congress Is Failing America and How to Get it Back on Track
(Norman Ornstein 2011-06-27)
"Few books as important as this one is are as clearly and compellingly written. Remedy and Reaction is a brilliant analysis of the political conflicts and compromises that led to the passage of the Affordable Care Act, and a fitting sequel to Paul Starr's masterful book, The Social Transformation of American Medicine. The final page came much too soon."—Shannon Brownlee, author of Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer
(Shannon Brownlee 2011-06-28)
"[D]elivers an insightful political analysis."—Kristen Greencher, The Charlotte Observer
(Kristen Greencher The Charlotte Observer
"As a work of policy history Remedy and Reaction excels…. [Starr] chronicles just how difficult a struggle it has been to make the U.S. healthcare system more equitable and efficient and how far we still have to go."—Jonathan Oberlander, Science
“ [A] remarkable chronicle of the hundred-year effort to legislate universal health insurance in the United States…. Nobody with a sense of history—that is, nobody who reads Starr’s book—could doubt how sensible and brave was the president’s effort to drive the Patient Protection and Affordable Care Act of 2010 through Congress.” —Bernard Avishai, The Nation
(Bernard Avishai The Nation
"[An] interesting and engaging account of the many attempts made over the past century to reform care in this country. As daunting, even wonkish, as this may sound, Starr does an excellent job of explaining the different proposals and identifying the reasons why some succeeded where others failed so spectacularly."—Dennis Rosen, Boston Globe
(Dennis Rosen Boston Globe
"[A] useful and lucid history of American health reform . . . Anyone seeking to understand how difficult it will be to implement President Barack Obama's health care reforms will be enlightened by Starr's readable and engrossing narrative. Highly recommended."—Jeff Goldsmith, Health Affairs
(Jeff Goldsmith Health Affairs
"[C]oncise and beautifully written."—Michael Gusmano, Commonweal
(Michael Gusmano Commonweal
"None of the numerous other histories of US health care policy develops these themes in such an illuminating fashion. . . . [an] excellent, cogently argued work."—Samuel Y. Sessions, Journal of the American Medical Association
(Samuel Y. Sessions Journal of the American Medical Association
“Excellent, cogently argued.”—Journal of the American Medical Association
(Journal of the American Medical Association
From the Author
See all Editorial Reviews
What do you most want people to understand from reading this book?
I hope the book illuminates how an issue that is more or less settled in every other democracy became a seemingly intractable political problem in the United States.
It did not have to turn out this way. The legislation adopted in 2010 has its roots in moderate Republican proposals. But America’s polarized politics make it difficult to see the reforms clearly and put them in historical perspective. I hope the book helps to provide that understanding.
What’s the relationship of Remedy and Reaction to your 1984 book, The Social Transformation of American Medicine?
In some ways it’s a sequel, but each of its three parts has a somewhat different foundation. Part One, about how health-care reform and the health-care system took shape during the twentieth century, presents the same kind of social and historical analysis as Social Transformation did.
But Part Two, which deals with the parallel stories of the Clinton health plan and Republican health reforms in the Gingrich and Bush years, also reflects my observations inside the Clinton White House. That’s a kind of experience not usually available to historians.
Finally, Part Three, about the battle over health-care reform under Obama, combines journalism and historical analysis because it draws on interviews with participants, many of whom I know from my prior time in Washington.
Why did Obama succeed where Clinton failed?
Between 1993 and 2009, the biggest change was the emergence of a consensus about the basic elements of legislation among reformers, major interest groups, and leading Democrats in Congress. The reforms adopted in Massachusetts in 2006 as a result of Mitt Romney’s leadership were critical in shaping that consensus. Obama accepted that approach; he didn’t originate it. Romney probably deserves more credit for the basic architecture of the national reforms, and I hope one day he proudly accepts that credit.
Didn’t Obama’s leadership matter?
If Obama hadn’t decided to make health-care reform a priority as president, it would never have passed. Why did he take it on? His earlier history didn’t indicate a deep commitment to health-care reform. I think the 2008 presidential campaign was crucial because of the pressure from the party base to confront the issue, plus an accident of history: he ran into Hillary Clinton on the way to the nomination, and debating her forced him to master health policy. Perhaps most important, the support for reform from key stakeholder groups and members of Congress changed the political calculus on health care. That’s what made it a better bet than climate legislation.