Health at Risk: America's Ailing Health System—and How to Heal It

Columbia University Press
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In this volume, the nation's leading advisors on health policy and financing appraise America's ailing healthcare system and suggest reasonable approaches to its rehabilitation. Each chapter confronts a major challenge to the country's health security, from runaway costs and uneven quality of care to declining levels of insurance coverage, medical bankruptcy, and the growing enthusiasm for health plans that put patients in charge of risk and cost. Bringing the latest research to bear on these issues, contributors diagnose the problems of our present system and offer treatments grounded in extensive experience. Free of bias and rhetoric, Health at Risk is an invaluable tool for those who are concerned with the current state of healthcare and are eager to effect change.
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About the author

Jacob Hacker is professor of political science at the University of California at Berkeley, where he heads the Center on Health and Economic Security at the Boalt Law School. A frequent media commentator and author of numerous scholarly and popular articles, he is the author of four books, most recently The Great Risk Shift: The New Economic Insecurity and the Decline of the American Dream. Contributors: Jacob Hacker: "Health Insecurity and the Middle Class"; Elizabeth McGlynn and David Meltzer: "Health Quality"; Brandon McKelvey and Jill Quadagno: "The Transformation of American Health Insurance"; Katherine Swartz: "The Uninsured and Underinsured"; Elizabeth Warren: "Medical Bankruptcy"
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Additional Information

Publisher
Columbia University Press
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Published on
Nov 6, 2008
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Pages
152
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ISBN
9780231518611
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Language
English
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Genres
History / United States / 20th Century
Medical / General
Medical / Health Care Delivery
Medical / Health Policy
Political Science / American Government / National
Political Science / General
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Content Protection
This content is DRM protected.
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Eligible for Family Library

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NEW YORK TIMES BESTSELLER • 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. It’s a penetrating chronicle of how the profiteering that Brill first identified in his trailblazing Time magazine cover story continues, despite Obamacare. 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.
 
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 healthcare “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 healthcare so that it stops draining the bank accounts of our families and our businesses, and the federal treasury.
 
Praise for America’s Bitter Pill
 
“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
 
“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
 
“Superb . . . Brill has achieved the seemingly impossible—written an exciting book about the American health system.”—The New York Review of Books
American Federalism in Practice is an original and important contribution to our understanding of contemporary health policy. It also illustrates how contentious public policy is debated, formulated, and implemented in today's overheated political environment.

Health care reform is perhaps the most divisive public policy issue facing the United States today. Michael Doonan provides a unique perspective on health policy in explaining how intergovernmental relations shape public policy. He tracks federal-state relations through the creation, formulation, and implementation of three of the most important health policy initiatives since the Great Society: the State Children's Health Insurance Program (CHIP) and the Health Insurance Portability and Accountability Act (HIPAA), both passed by the U.S. Congress, and the Massachusetts health care reform program as it was developed and implemented under federal government waiver authority. He applies lessons learned from these cases to implementation of the Affordable Care Act.

"Health policymaking is entangled in a complex web of shared, overlapping, and/or competing power relationships among different levels of government," the author notes. Understanding federal-state interactions, the ways in which they vary, and the reasons for such variation is essential to grasping the ultimate impact of federalism on programs and policy. Doonan reveals how federalism can shift as the sausage of public policy is made while providing a new framework for comprehending one of the most polarizing debates of our time.

Although the United States spends 16 percent of its gross domestic product on health care, more than 46 million people have no insurance coverage, while one in four Americans report difficulty paying for medical care. Indeed, the U.S. health care system, despite being the most expensive health care system in the world, ranked thirty-seventh in a comprehensive World Health Organization report. With health care spending only expected to increase, Americans are again debating new ideas for expanding coverage and cutting costs. According to the historian Paul V. Dutton, Americans should look to France, whose health care system captured the World Health Organization's number-one spot.

In Differential Diagnoses, Dutton debunks a common misconception among Americans that European health care systems are essentially similar to each other and vastly different from U.S. health care. In fact, the Americans and the French both distrust "socialized medicine." Both peoples cherish patient choice, independent physicians, medical practice freedoms, and private insurers in a qualitatively different way than the Canadians, the British, and many others. The United States and France have struggled with the same ideals of liberty and equality, but one country followed a path that led to universal health insurance; the other embraced private insurers and has only guaranteed coverage for the elderly and the very poor.

How has France reconciled the competing ideals of individual liberty and social equality to assure universal coverage while protecting patient and practitioner freedoms? What can Americans learn from the French experience, and what can the French learn from the U.S. example? Differential Diagnoses answers these questions by comparing how employers, labor unions, insurers, political groups, the state, and medical professionals have shaped their nations' health care systems from the early years of the twentieth century to the present day.

The collapse of the financial markets in 2008 and the resulting 'Great Recession' merely accelerated an already worrisome trend: the shift away from an employer-based social welfare system in the United States. Since the end of World War II, a substantial percentage of the costs of social provision--most notably, unemployment insurance and health insurance--has been borne by employers rather than the state. The US has long been unique among advanced economies in this regard, but in recent years, its social contract has become so frayed that is fast becoming unrecognizable. Despite Obama's election, the burdens of social provision are falling increasingly upon individual families, and the situation is worsening because of the unemployment crisis. How can we repair the American social welfare system so that workers and families receive adequate protection and, if necessary, provision from the ravages of the market? In Shared Responsibility, Shared Risk, Jacob Hacker and Ann O'Leary have gathered a distinguished group of scholars on American social policy to address this most fundamental of problems. Collectively, they analyze how the 'privatization of risk' has increased hardships for American families and increased inequality. They also propose a series of solutions that would distribute the burdens of risks more broadly and expand the social safety net. The range of issues covered is broad: health care, homeownership, social security and aging, unemployment, wealth (as opposed to income) creation, education, and family-friendly policies. The book is also comparative, measuring US social policy against the policies of other advanced nations. Given the current crisis in America social policy and the concomitant paralysis within government, the book has the potential to make an important intervention in the current debate.
From six-time #1 New York Times bestselling author, FOX News star, and radio host Mark R. Levin comes a groundbreaking and enlightening book that shows how the great tradition of the American free press has degenerated into a standardless profession that has squandered the faith and trust of the American public, not through actions of government officials, but through its own abandonment of reportorial integrity and objective journalism.

Unfreedom of the Press is not just another book about the press. Levin shows how those entrusted with news reporting today are destroying freedom of the press from within: “not government oppression or suppression,” he writes, but self-censorship, group-think, bias by omission, and passing off opinion, propaganda, pseudo-events, and outright lies as news.

With the depth of historical background for which his books are renowned, Levin takes the reader on a journey through the early American patriot press, which proudly promoted the principles set forth in the Declaration of Independence and the Constitution, followed by the early decades of the Republic during which newspapers around the young country were open and transparent about their fierce allegiance to one political party or the other.

It was only at the start of the Progressive Era and the twentieth century that the supposed “objectivity of the press” first surfaced, leaving us where we are today: with a partisan party-press overwhelmingly aligned with a political ideology but hypocritically engaged in a massive untruth as to its real nature.
Justice Anthony Kennedy slipped out of the Supreme Court building on June 27, 2018, and traveled incognito to the White House to inform President Donald Trump that he was retiring, setting in motion a political process that his successor, Brett Kavanaugh, would denounce three months later as a “national disgrace” and a “circus.”

Justice on Trial, the definitive insider’s account of Kavanaugh’s appointment to the Supreme Court, is based on extraordinary access to more than one hundred key figures—including the president, justices, and senators—in that ferocious political drama.

The Trump presidency opened with the appointment of Neil Gorsuch to succeed the late Antonin Scalia on the Supreme Court. But the following year, when Trump drew from the same list of candidates for his nomination of Brett Kavanaugh, the justice being replaced was the swing vote on abortion, and all hell broke loose.

The judicial confirmation process, on the point of breakdown for thirty years, now proved utterly dysfunctional. Unverified accusations of sexual assault became weapons in a ruthless campaign of personal destruction, culminating in the melodramatic hearings in which Kavanaugh’s impassioned defense resuscitated a nomination that seemed beyond saving.

The Supreme Court has become the arbiter of our nation’s most vexing and divisive disputes. With the stakes of each vacancy incalculably high, the incentive to destroy a nominee is nearly irresistible. The next time a nomination promises to change the balance of the Court, Hemingway and Severino warn, the confirmation fight will be even uglier than Kavanaugh’s.

A good person might accept that nomination in the naïve belief that what happened to Kavanaugh won’t happen to him because he is a good person. But it can happen, it does happen, and it just happened. The question is whether America will let it happen again.
A New York Times bestseller/Washington Post Notable Book of 2017/NPR Best Books of 2017/Wall Street Journal Best Books of 2017 

"This book will serve as the definitive guide to the past and future of health care in America.”—Siddhartha Mukherjee, Pulitzer Prize-winning author of The Emperor of All Maladies and The Gene  

At a moment of drastic political upheaval, An American Sickness is a shocking investigation into our dysfunctional healthcare system - and offers practical solutions to its myriad problems.

In these troubled times, perhaps no institution has unraveled more quickly and more completely than American medicine. In only a few decades, the medical system has been overrun by organizations seeking to exploit for profit the trust that vulnerable and sick Americans place in their healthcare. Our politicians have proven themselves either unwilling or incapable of reining in the increasingly outrageous costs faced by patients, and market-based solutions only seem to funnel larger and larger sums of our money into the hands of corporations. Impossibly high insurance premiums and inexplicably large bills have become facts of life; fatalism has set in. Very quickly Americans have been made to accept paying more for less. How did things get so bad so fast?

Breaking down this monolithic business into the individual industries—the hospitals, doctors, insurance companies, and drug manufacturers—that together constitute our healthcare system, Rosenthal exposes the recent evolution of American medicine as never before. How did healthcare, the caring endeavor, become healthcare, the highly profitable industry? Hospital systems, which are managed by business executives, behave like predatory lenders, hounding patients and seizing their homes. Research charities are in bed with big pharmaceutical companies, which surreptitiously profit from the donations made by working people. Patients receive bills in code, from entrepreneurial doctors they never even saw. 

The system is in tatters, but we can fight back. Dr. Elisabeth Rosenthal doesn't just explain the symptoms, she diagnoses and treats the disease itself. In clear and practical terms, she spells out exactly how to decode medical doublespeak, avoid the pitfalls of the pharmaceuticals racket, and get the care you and your family deserve. She takes you inside the doctor-patient relationship and to hospital C-suites, explaining step-by-step the workings of a system badly lacking transparency. This is about what we can do, as individual patients, both to navigate the maze that is American healthcare and also to demand far-reaching reform. An American Sickness is the frontline defense against a healthcare system that no longer has our well-being at heart.
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