REINVENTING AMERICAN HEALTH CARE

Emanuel (Medical Ethics and Health Policy/Univ. of Pennsylvania; Brothers Emanuel: A Memoir of an American Family, 2013, etc.) views the Affordable Care Act as a success story.

The author, who serves as a special White House adviser on health care reform, is optimistic that its glitches will be resolved within the year and that it will transform how patients are cared for over the coming decades. He reprises the complex history of American health care policy beginning in 1942, when the National War Labor Board ruled that health insurance could be treated as a nontaxable fringe benefit despite the wage freeze. The later inclusion of Medicare and Medicaid increased the complexity of the system. Emanuel details the many inequities that developed—most notably, the exclusion of people with pre-existing health conditions from the system and the financial vulnerability of the uninsured, who also frequently receive substandard treatment—e.g.,“Being uninsured means your chance of dying in a car accident is 40% higher than that of a privately insured person.” The author asserts that the passage of the Affordable Care Act in 2010 “was a historic event,” especially in the context of the ongoing recession and political restraints, coupled with the need to deal with opposition from “physicians, insurers, and pharmaceutical manufacturers” and others. He offers an insider’s account of some of the infighting that occurred within the Obama administration, including his own altercations with his brother, Rahm, then chief of staff to the president. The author takes a long view of the reforms beginning with incentives and penalties for the adoption of uniform electronic health records in the 2009 Recovery Act. The ACA, he writes, “will increasingly be seen as a world historic achievement,” and “Barack Obama will be viewed more like Harry Truman—judged with increasing respect over time.”

An important challenge to the naysayers on both sides of the political divide.