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New York Times best seller. A New York Times notable book.
America's Bitter Pill is Steven Brill's acclaimed book on how the Affordable Care Act, or Obamacare, was written, how it is being implemented, and, most important, how it is changing - and failing to change - the rampant abuses in the healthcare industry. It's a fly-on-the-wall account of the titanic fight to pass a 961-page law aimed at fixing America's largest, most dysfunctional industry.Â
It's a penetrating chronicle of how the profiteering that Brill first identified in his trailblazing Time Magazine cover story continues, despite Obamacare.Â
And it is the first complete, inside account of how President Obama persevered to push through the law, but then failed to deal with the staff incompetence and turf wars that crippled its implementation.Â
But by chance America's Bitter Pill ends up being much more - because as Brill was completing this book, he had to undergo urgent open-heart surgery. Thus, this also becomes the story of how one patient who thinks he knows everything about health-care "policy" rethinks it from a hospital gurney - and combines that insight with his brilliant reporting. The result: a surprising new vision of how we can fix American health care so that it stops draining the bank accounts of our families and our businesses and the federal treasury.  Â
Praise for America's Bitter Pill:Â Â Â
"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.... [Brill] has pulled off something extraordinary." (The New York Times Book Review)
"A thunderous indictment of what Brill refers to as the 'toxicity of our profiteer-dominated healthcare system.'" (Los Angeles Times)Â Â Â
"A sweeping and spirited new book [that] chronicles the surprisingly juicy tale of reform." (The Daily Beast)
"One of the most important books of our time." (Walter Isaacson)Â Â
"Superb...Brill has achieved the seemingly impossible - written an exciting book about the American health system." (The New York Review of Books)
Product details
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Audible Audiobook
Listening Length: 17 hours and 10 minutes
Program Type: Audiobook
Version: Unabridged
Publisher: Random House Audio
Audible.com Release Date: January 5, 2015
Whispersync for Voice: Ready
Language: English, English
ASIN: B00RC2NYRA
Amazon Best Sellers Rank:
I often wondered why the conservative right wing attacks the Affordable Healthcare Act (Obamacare) with such ferocity. After all, it protects those with vested interests and expensive lobbyists - keeps the insurance companies in the mix by steering away from the "single payer" idea that much of the world uses so efficiently, bars the government from bargaining with the pharmaceutical companies (so we end up with drug price 50% higher than the rest of world - so much for "free markets" so admired by these folks). The hated requirement the individual mandate that requires the purchase of the insurance or payment of a fine was invented by the conservative think tank The Heritage Group and was a solid component of "Romneycare" in Massachusetts, the predecessor of this program. Well, let Steven Brill lead you down the path of how the program came about and was enacted. Interesting story for us "policy wonks" and great to get the details from someone without a political axe to grind. Well done!
For any one who is seriously interested in healthcare, it is critical reading, if sometimes heavy going reading. Brill focusses on the history of Obamacare, and in doing so makes it clear that the root of the U.S. health care problem is political. Healthcare now accounts for one sixth of the US economy, and that means that the money and influence t that can be rallied against any change are formidable. This made the enactment of Obamacare so torturous a process, and explains why the result is a U.S. system that still has profound problems.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.
Mr. Brill does an incredible job in two areas. First he is able to explain some very complicated concepts in very simple layman terms. Secondly he tells the story of Obamacare with a pace and intrigue you would expect from a great mystery writer. Even though we all know how it turned out eventually Mr. Brill is able to make the story very suspenseful. In terms of politics he seems to play the ball straight down the middle to use a golf analogy. For that reason I think even if you feel strongly one,way of the other about Obamacare you will come away with new insights that may just soften your position slightly.
Brill has always been a writer who asks the hard questions. The basic question he asks in "Bitter Pill" is: how does extending private health insurance to millions of Americans solve the most basic problems of our broken health care system: price gouging where a hospital can charge $50 for a box of Kleenix, $30 for one band-aide, or $20 for one aspirin? How does MORE insured people solve the problem of insurance companies refusing to pay for treatment or drugs that doctors say are essential? How does having more insured people solve the problem of Medicare Part D paying 400% more than the price Costco charges for prescription drugs, and the price of drugs in Detroit (in the USA) being ten times higher than the same drugs one mile south in Windsor Canada?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.
As a doctor in the US, I see the problems inherent in our medical system from the inside every day. This book is not just about Obamacare, but about the sorry state of our health care in general. The author clearly, and often infuriatingly, explains why Obamacare ended up being so ineffectual, limited, and riddled with unintended consequences as a result of all the compromises in favor of special interest groups who made sure a real reform would not be passed.
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