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America's Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System Paperback – August 18, 2015
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“A tour de force . . . a comprehensive and suitably furious guide to the political landscape of American healthcare . . . persuasive, shocking.”—The New York Times
“An energetic, picaresque, narrative explanation of much of what has happened in the last seven years of health policy . . . [Steven Brill] has pulled off something extraordinary—a thriller about market structure, government organization and billing practices.”—The New York Times Book Review
“A thunderous indictment of what Brill refers to as the ‘toxicity of our profiteer-dominated healthcare system’ . . . For its insights into our nation’s fiscal, psychological and corporeal health—and for our own long-term social well-being—it is a book that deserves to be read and discussed widely by anyone interested in the politics and policy of healthcare.”—Los Angeles Times
“A sweeping and spirited new book [that] chronicles the surprisingly juicy tale of reform . . . [Brill’s] book brims with unconventional insight delivered in prose completely uninfected by the worn out tropes and tired lingo of the Sunday shows.”—The Daily Beast
“This is one of the most important books of our time. Through revealing personal stories, dogged political reporting, and clear analysis, it makes the battle over Obama’s healthcare plan come alive and shows why it matters. It should be required reading for anyone who cares about our healthcare system.”—Walter Isaacson
“Superb . . . Brill has achieved the seemingly impossible—written an exciting book about the American health system.”—The New York Review of Books
“[An] ambitious new history of the Affordable Care Act.”—Malcolm Gladwell, The New Yorker
“Steven Brill’s new book about the process of passing the Affordable Care Act is so meticulously reported, I found myself surprised by many details of a process I myself was deeply involved in. . . . Brill has written an outstanding book about the administration’s efforts to pass Obamacare. Now it is up to the administration to prove him wrong about what the legislation does to the trajectory of health-care costs.”—Peter R. Orszag, Bloomberg View
“Brill’s book performs an admirable job of getting behind the scenes. . . . [A] state-of-the-nation account of the broken U.S. healthcare system and Obama’s partially successful attempt to heal it.”—The National
“A landmark study, filled with brilliant reporting and insights, that shows how government really works—or fails to work.”—Bob Woodward
“America’s Bitter Pill is deeply impressive, an important diagnosis of what America needs to know if we’re ever to develop a healthcare system that is fair, efficient, and effective.”—Tom Brokaw
“In America’s Bitter Pill, Steven Brill brilliantly ties together not only the saga of Obamacare, but also the larger story of our dysfunctional healthcare system and its disastrous impact on both businesses and ordinary Americans. In a gripping narrative, his thorough reporting is made all the more powerful by his own scary experience looking up from a gurney.”—Arianna Huffington
From the Hardcover edition.
About the Author
Steven Brill has written for The New Yorker, Time, and The New York Times Magazine. A graduate of Yale College and Yale Law School, he also founded and ran Court TV, The American Lawyer magazine, ten regional legal newspapers, and Brill’s Content magazine. Brill was the author of Time’s March 4, 2013, Special Report “Bitter Pill: Why Medical Bills Are Killing Us,” for which he won the 2014 National Magazine Award for Public Service. Brill also teaches journalism at Yale, where he founded the Yale Journalism Initiative to encourage and enable talented young people to become journalists. He is married, with three adult children, and lives in New York.
From the Hardcover edition.
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Top Customer Reviews
Another reviewer refers to Bismark's dictum that one should not watch either laws or sausages being made, and the first half of Brill's book demonstrates that -- exhaustively and and times exhaustingly. He shows how it was that, even with a Democratic majority in both houses, lobbyists for special interests (the drug companies, the insurers, the hospitals, the device makers, the patient's groups, and on and on and on) were able to force those in favor of reform to water down proposals, compromise, buy off, and on and on an on. In so doing, I learned a lot about the economics and the power structure of the U.S. health care system, but I also learned more than I probably wanted to know about a few too many individuals. I also learned (or was confirmed in my belief) that within the Obama administration there were major divisions of opinion and major shortages of communication.
The second part of the book, on what happened after the legislation was passed, was more interesting -- or perhaps more accurately less exhausting. First, in this part, Brill intersperses the political narrative with stories of individuals who ran into financial catastrophe through illness, and looks at what varioius institutions (mostly hospitals) did to bring these individuals close to financial ruin. Second, his narrative of the failed launch of the Obamacare website is eyeopening -- the launch failed because the project was badly run from its inception, and that reflected bad management by the administration, all the way up to the top. That, however, is followed by the livliest part of the book, in which a "Geek Squad" of mostly private sector techies saves the day. There is a lot in this section to gratify anti-Obama types and anti-govenment types, but only if you read it in isolation from the context. That context is one of "non profit" hospitals with CEO's who earn millions a year, drug companies whose devotion to research is far exceeded by their devotion to their profit margins, and an overall situation in which the consumer of healthcare comes in last.
At the end of the book, Brill argues that there is no way that the U.S. healthcare system can be rebuilt from the ground up in a way that would minimize costs and maximize outcomes. That would mean single payer, it would mean Medicare drug price negotiation if not drug price regulation, it would mean serious research on comparative outcomes and costs, and it would mean a whole lot of other violent change to one-sixth of the U.S. economy. That sixth has a very powerful interest in resisting change, while the five-sixths of the economy that would benefit has a more diffuse interest. Granted that, he proposes that perhaps we should consider making the institutions that directly provide more and more U.S, medical care --the hospitals -- into insurers as well as providers. It's an interesting idea that sounds a little like handing the whole henhouse over to the fox, but it bears discussion. As to Obamacare, Brill concludes that it was a major accomplishment, in that it brought healthcare into the reach of many more Americans. Still, Brill argues that it was essentially tinkering with the jalopy, not putting in a new engine.
This book is the best overall summary of the U.S. healthcare situation that I have read in years, which is why five stars. It could have been a better book, better organized and more readable. Still, I think it is one of those books you should read even if it takes effort.
If nothing else, it proved to me what an awful mess we've made of our system of health insurance coverage and payments systems, and how it is that the private sector neither has offered a reasonable degree of reliable and cost-effective health insurance to policy holders, nor have pharmaceutical firms or hospitals been able to cope with the morass. If the industry started with basic coverage for essential services, profits would be $0.
Bottom line: universal health insurance is a "public good" like a fire department, public school system, but on a much larger scale. It needs to be guided in scope by medical professionals, financed with taxes, managed in a businesslike way, and financially available to everyone.
Really, no one should escape high school without have read this book!
The Affordable Health Act, just like the Medicare Part D Prescription Drug law, transfers billions of dollars of taxpayer money to insurance companies, drug companies, and hospitals, yet for most people, the co-pays for medical treatment and drugs for a serious illness, such as HIV or cancer, remain bankrupting.
England, Canada, and Australia found an easy way to provide health care to 100% of their citizens: get rid of insurance companies. Drug companies and hospitals are paid quickly and fairly for services rendered. The result is every single person gets health care, and at HALF the cost per person as in America's broken system.