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Power, Politics, and Universal Health Care: The Inside Story of a Century-Long Battle Hardcover – September 20, 2011

4.4 out of 5 stars 12 customer reviews

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Editorial Reviews

Review

"Power, Politics, and Universal Health Care is a first-rate analysis, skillfully tracing the political, social, and economic forces that, for nearly a century, thwarted efforts to enact universal health insurance legislation. At times, it reads more like a novel than a policy book as it tells the fascinating story of how the forces that frustrated past efforts to provide universal insurance coverage were overcome to pass the Affordable Care Act."
-Robert D. Reischauer, president of the Urban Institute and former director of the Congressional Budget Office, 1989–1995

"A riveting journey through the history of US health care reform. This book is a must-read for anyone who wants to understand America’s elusive search for universal coverage and affordable care. Altman and Shactman do the impossible—make sense of our complex health system in an accessible and compelling way."
-Jonathan Oberlander, PhD, professor at the University of North Carolina at Chapel Hill and author of The Political Life of Medicare

"Stuart Altman and David Shactman’s new book does a superb job of capturing the essence of the meandering odyssey of health care policy.... They describe the pivotal events and characters of the development of universal health care with the intimacy of good storytelling. The authors make you feel like you are there."
-Charles N. Kahn III, president and CEO of the Federation of American Hospitals and former staff director of the House Ways and Means Health Subcommittee, 1995–1998

"There is not an American who has been more active and relevant in the health reform debate for the last forty years than Stuart Altman. With his talented partner, David Shactman, he has produced a well-written, insightful personal recollection of the evolution of health reform. It is an invaluable contribution to understanding how all major reforms are built on the triumphs and failures of past attempts and cannot be achieved without the application of lessons learned, leadership, good timing, and luck."
-Chris Jennings, former senior health reform adviser to President Bill Clinton, 1994–2001

"Rendered more in the riveting prose of a spy novel than in the turgid text that usually emits from academia, the authors present an insider’s narrative of the major defeats and small victories in the century-old quest to provide all Americans, rich and poor, financial and physical access to timely health care without bankrupting their families."
-Uwe E. Reinhardt, PHD, James Madison Professor of Political Economy at the Woodrow Wilson School at Princeton University

About the Author

Stuart Altman, the Sol C. Chaikin Professor of National Health Policy at the Heller School for Social Policy and Management, Brandeis University, is an internationally recognized expert in health policy. He served as a deputy assistant secretary of Health, Education, and Welfare in the Nixon administration and was one of the architects of Nixon’s plan for universal health care. He was chair of the Prospective Payment Assessment Commission (ProPAC) for twelve years under presidents Ronald Reagan, George H. W. Bush, and Bill Clinton. ProPAC was responsible for overseeing the way Medicare paid hospitals and other health institutions. He also served on President Clinton’s transition team and was appointed to the president’s Bipartisan Commission on the Future of Medicare. Recently, he was a member of the health policy team for Barack Obama during his presidential campaign.

David Shactman is a freelance writer who was a senior fellow at the Schneider Institute for Health Policy at the Heller School for Social Policy and Management, Brandeis University, and worked with Stuart Altman for eleven years. During that time, he was coeditor of two books: Policies for an Aging Society (with Stuart Altman) and Regulating Managed Care (with Stuart Altman and Uwe E. Reinhardt). He has also written numerous articles published in peer-reviewed journals and trade magazines, including Health Affairs and the New England Journal of Medicine.
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Product Details

  • Hardcover: 429 pages
  • Publisher: Prometheus Books; 1 edition (September 20, 2011)
  • Language: English
  • ISBN-10: 1616144564
  • ISBN-13: 978-1616144562
  • Product Dimensions: 6.3 x 1.2 x 9.4 inches
  • Shipping Weight: 1.6 pounds (View shipping rates and policies)
  • Average Customer Review: 4.4 out of 5 stars  See all reviews (12 customer reviews)
  • Amazon Best Sellers Rank: #51,681 in Books (See Top 100 in Books)

Customer Reviews

Top Customer Reviews

By Garen L. Corbett on October 18, 2011
Format: Hardcover Verified Purchase
The authors manage to make readers feel like they are sitting in on key high level meetings on health care reform- whether with key senators, President Nixon or President Clinton. It is mind boggling that these efforts spanned multiple presidencies, and that Stuart Altman has been working on many of these efforts for all of these years. Altman and Shactman take us on remarkable journey of health reform, leading into the somewhat improbable passage of health reform in 2010. Despite the extraordinary amount of fascinating details, this book is eminently approachable and highly readable-- more like a novel than a dry policy text. Anyone interested in understanding how the many subtle and not so subtle competing forces derailed past attempts at health reform will be interested in this book. Those of you interested in feeling like you've wrangled front row seats to one of the most vexing public policy and political questions of the past forty years will also find tremendous value in this book. Highly recommended.
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Format: Kindle Edition Verified Purchase
Altman and Shactman have given us an engaging, comprehensive account of the history of federally managed universally available health care in the United States, but Altman is the central figure and narrator.
The idea of universal health care has circulated among Progressives for more than a century, starting with Teddy Roosevelt. The path included some turns that seem surprising to us now, such as Samuel Gompers, the early 20th century labor leader, opposing it on the grounds that it would weaken the need for unions. Franklin Roosevelt studied the idea, but chose not to pursue it because he felt that it would detract support from his proposal for Social Security. These are examples of the political insights that Altman adds to the historical account.

The modern story begins with Richard Nixon who, according to Altman, came closer to establishing a national health program than any president before Obama. Nixon worked with Senator Ted Kennedy and Congressman Wilbur Mills to enact a program crafted in large part by Altman, who at the time was a deputy assistant secretary of Health, Education, and Welfare. It might have passed except for Mills being caught in in a Washington reflecting pool with a lady of uncertain reputation, Nixon becoming embroiled with Watergate, and Kennedy's continuing problems with Chappaquiddick. Nixon did, though, manage to enact the Health Maintenance Act of 1973, a "historic" piece of legislation that greatly expanded the availability of HMOs by requiring all employers to offer them if any health plan was provided.

The story continues with the Hill Burton Act, which requires hospitals to treat indigent patients up to a certain fraction of their business.
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Format: Hardcover
I recommend reading the 4 star review of John Ames. This is a good book by seasoned experts who definitely did their homework. It isn't perfect, they don't make it clear enough that the health insurance companies had great power in determining the outcome of Obamacare and they are not critical enough of the faults of our health care system. They never mention the work of David Eddy, the father of evidence based medicine, who has shown that a large % of what providers do is not supported by evidence. The book is worth reading for anyone who wants to understand the history of the US health care system and the fight for universal health care which is still a ways off.

I create and maintain educational websites, Midwest Independent Research. I have one on improving health, mwir-improvinghealth.blogspot com.
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Format: Kindle Edition Verified Purchase
Great historical background on the fight for what in a modern 1st world society should be viewed as a right of citizenship instead of a privilege. I wonder when/if we will ever have universal Medicare. If it's good enough for the elderly & disabled, why its it good enough for everyone else. I also wonder when more people will start voting in their own interests more?
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By Joanne B. on January 23, 2012
Format: Hardcover Verified Purchase
I had to order this book for a class in my Master program and dreaded reading the entire book on top of everything else. It turned out I had nothing to worry about because the book, while a comprehensive and informative text, is also written well enough to be entertaining.
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This is a really good book with a cohesive narrative about the 40 year fiasco that was national health care policy in the United States. It documents lost opportunities that ultimately cost thousands of lives (Richard Nixon would've lept at the chance to sign Obamacare, but Ted Kennedy wouldn't make that compromise). It also describe well the interplay between different stakeholders, the iron triangle effect, etc.

Finally, it's documentation of the Clinton health care failure and the Bush Medicare Part D success are instructive as to how health care in America is too political and not about outcomes and inefficiencies. I enjoyed the book and highly recommend it.
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