Book Review – Reinventing American Healthcare

By | January 18, 2018

Reinventing American Healthcare is a pleasurable antidote to the ongoing misinformation about the ACA and the US healthcare system. In Part 1, Dr. Ezekiel Emanuel describes in great detail how the American healthcare system has evolved into its current overly complex state, riddled with misaligned incentives. As has happened in other industries, well-intentioned changes resulted in unfortunate, unintended consequences. For example, the VA greatly expanded their hospital system to accommodate the increased number of eligible veterans, many of them needing ongoing care due to war injuries. As part of other post-war recovery efforts, this was accompanied by the Hill-Burton Act of 1946 that fueled an enormous expansion of hospitals, many of which would not have otherwise been financially viable. In the following decades, major technical advances led to these hospitals being the sites of increased treatment that would have likely otherwise been performed at lower cost and greater safety in clinics and other low-cost facilities.

The second part of the book explains the ACA in rigorous detail. While increasing access to healthcare for more individuals was a very important part of the ACA, less than 25% of the ACA is actually about access. While more of the ACA should have been about controlling costs, the reality is that many compromises were made in order to pass any bill and the Republican-controlled government has actively worked to weaken most of the parts of the ACA that do control costs. The rollout of healthcare.gov was initially a disaster, though the site now works extremely well, due in large part to a lack of oversight of the private firms hired to build the federal exchange.

Emanuel closes the book with a look forward (as of 2013-14) on the future of the ACA and other potential healthcare reform. His optimism is so far not being delivered upon, as the opportunity for improving the ACA has been shut down by desperate attempts to destroy it, no matter how destructive the impact will be on the most vulnerable Americans. But with the growing popularity of the ACA now that more people know what it actually contains, I share his hope that it will be constructively improved.

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