AANS Neurosurgeon | Volume 28, Number 4, 2019

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The True Impact of Health-care Reform

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KMBT_C454-20150617110638America’s Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System.” Steven Brill. Random House, New York. 2015. 512 pp.

Steven Brill is a brilliant journalist who has written for The New Yorker and TIME, but he is also a patient with a thoracic aortic aneurysm. He knows that our health-care system is broken, but his book is evidence that there is another system that is even more broken — the government.

As he did in his article for TIME on March 4, 2013, Brill, using real patient stories and actual hospital bills, does a beautiful job illuminating the absurdity of health-care finances. He experienced it personally after his own surgery.

Part One recounts the story of the bitterly partisan battle in Congress to get the Affordable Care Act (ACA) passed. The only way our country’s leaders in Washington, D.C., could reform health care was by making shady backroom deals.

Part Two tackles the post-ACA passage era, when the government wasted two years waiting for Obamacare’s rules and regulations. The president did not want anything to jeopardize his re-election in 2012, and the government health-care leaders had no clue how to handle the nitty-gritty details needed to implement the new law.

Part Three tells the tale of the bungled launch of the ACA in October 2013 and the dramatic rescue by a tech team brought in from industry.

The section of this book that makes it all worthwhile is Part Four, which reports on the early results of the ACA and makes suggestions about the future of health care. Because of the ACA, six million new patients have joined Medicaid, and eight million got insurance through the exchange programs. There are 14 million Americans covered because of the ACA.

According to research provided by this book, physician income from 2011 to 2013 increased by 1.4 percent (to a median of $187,200), but during the same period, non-profit hospital administrators’ income rose by 24.2 percent (to a median of $2.2 million).

Brill predicts that private industry — not the government — will drive health care to be treated as a public good, not a free-market product. He sees all physicians becoming employees, with health-care systems proving insurance, as well as hospital and all other provider care. Even though physicians will lose their independence, he thinks that it will yield a significant increase in the quality of care at a marked cost reductions.

This is a big book with lots of thought-provoking intrigue. Read it if you want to learn inside information on how health-care reform came about, and how our broken political system functions.

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