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lizmart88's review against another edition
4.0
Excellent overview of the passage of health care reform from the promise in the campaign of 2008 to the online exchanges. Easy to read, interesting anecdotes.
tortue_abroad's review against another edition
3.0
Honestly more like 2.5 by the end. This book ended up being a slog to finish but I finally did it. I wanted to learn more about Obamacare and health care in the US in general to better understand the continued debate about it now and I did do that from parts of the book, but I think it could have been done much better. There are so many details in this book but when I felt like he had been talking too specifically about Washington and I wanted more of an outsider perspective, I found myself thinking ‘ok but not that one’ when he switched to a new perspective. He spent a lot (A LOT) of time talking about all the ways in the background that the website didn’t work, for instance, and this one new insurance company made by Jared Kushner. To be fair, he also explained a lot of what was broken about old health care plans and how their caps left people monetarily ruined, and a lot of time was spent on how prices are inflated. But it felt like the book was organized poorly so it was jumping around and when he got back to prices being inflated he had to give another example that was very much like the first just to show how pervasive the issue was. I got it; I agreed after the first few. So yeah, read selectively you can learn things that are useful, but it’s hard to avoid an avalanche of a lot of other stuff. Oh, also, he clearly had his own idea that he wanted health care to work and I get that anyone writing a book will have an opinion but I felt like he was beating me over the head with it. Especially at the end.
barrysweezey's review against another edition
A well-sourced, well reported and well written story of the passage of the ACA. His prescription for fixing health care? Kaiser Permanente.
xmastaflex's review against another edition
2.0
This was really well done until the author put his uninformed opinion, but more importantly, unsubstantiated claims and conclusions into the book right at the end. He provides no evidence on where he came up with his "solution." What a waste of my time.
barry_sweezey's review against another edition
A well-sourced, well reported and well written story of the passage of the ACA. His prescription for fixing health care? Kaiser Permanente.
colleenh's review against another edition
4.0
Most of this book is tediously written but I learned a ton about Obamacare and the health care system in the US.
blckngld18's review against another edition
4.0
Every American should read this book. Don't get your info from sound bites and clever memes. Warning though. ...it will make you angry and sick
lmuskal's review against another edition
3.0
Informative book about the affordable care act and health policy. Even though I'm interested in the subject, this book was dry... I could never get through more than 20 pages at a time.
minnejenny's review against another edition
4.0
This should be covered in our history or government classes in high school from now on. There are no winners overall in the story of ACA. Brill pens the tale in a well thought out, journalistic way. I learned so much about the backwards way of politics and how we ended up with this "jalopy" of a health care system in the first place. I would recommend not listening to it as I did. If I was reading the book, I could've gone back to reference people and places. And you definitely don't want to zone out on the book from driving, etc.
mancolepig's review against another edition
4.0
We’ve swallowed a bitter pill indeed, considering how divisive, controversial, and in many ways, utterly ineffective the Affordable Care Act is. Steven Brill leaves no stone unturned in his balanced investigation of the bill’s history, passage, and implementation over 6 or 7 years in Washington D.C. This makes the book a bit of a slog with its meticulous recordings of email correspondances and meetings, and its cast of thousands of congressmen, senators, aids, department heads, lobbyists, doctors, and insurance salesmen. But it is worth wading into the swamp to see what Washington “deal-making” really entails, and how that deal-making has affected our country’s healthcare crisis. Or hasn’t. I’ll leave the nitty gritty details to Brill, but I’ll give you a few of my conclusions:
First of all, everyone’s a hypocrite. President Obama and the Democratic legislators made and broke many of the promises that Republicans have been slamming them for ever since. They did indeed make backroom deals with lobbyists to protect corporate interests for pharmaceuticals and insurance companies among others, and they rammed a poor patch job of a bill all the way through to the top without bipartisan support as talks with Republicans gradually broke down. Of course the Republicans were no saints either, refusing to admit that Obamacare was based on a Republican idea (Massachusetts’s Romneycare) and using the benefits of the bill while publicly calling for its demise. Brill particularly nails Mitch McConnell, who has been one of Obamacare’s harshest critics while simultaneously promising to keep Kentucky’s successful healthcare marketplace: Kynect. As Brill astutely points out, Kynect would never have existed if not for Obamacare.
Second of all, this bill is a mess. There is no single payer, no public option for insurance (In other words, we are forced to buy a product from a private company or face having to pay a mandate to the government), and pharmaceuticals can still set pill prices however they damn well please, even though every other developed nation on Earth has strict regulations and negotiating powers. I get incensed over this because pharmaceuticals have made it ILLEGAL for Americans to buy cheaper drugs from Canada (Who has much more effective regulations on prices), and they have also made it ILLEGAL for the government to negotiate for discounted prices. Combine that with pharmaceutical patents that don’t expire for years, and these scumbags can charge $1000 PER PILL (In the case of Sovaldi) while their CEOs make upwards of $13 million per year plus stock options. But that’s what happens when you let lobbyists write laws. Obamacare really bombed there.
Third and finally, this bill (I guess I should say law) is a mess but it gives me hope. As we saw with the attempts to repeal this law in the past year, the genie is out of the bottle, and even a Republican controlled government could not erase its impact. It turns out that people like having healthcare, and if Obamacare did nothing else it gave millions of Americans a chance to afford that healthcare. On a personal note, I have a close friend who was able to get Medicaid while she was looking for full-time employment thanks to Obamacare and Governor Kasich’s choice to expand Medicaid in Ohio. I don’t think this law “fixed” our broken healthcare system, and taxpayers will be footing a lot of the bill, but you can’t deny that it has truly helped a lot of people get the coverage they need.
Brill offers some ideas on how to make the fixes we need. Honestly, I’m not sure his ideas will work, and I don’t know that making fixes to the law will even be possible in Washington’s current state. Republicans want a repeal or bust, and Democrats are ready to defend the law to the death. Meanwhile the insurance companies, device makers, and Pharmaceuticals keep raking in the publicly-funded profits, but on the plus side I feel that I understand the law so much better now than I did before, and I’d recommend this book to anyone who feels confused about it. It’s a long book but so much more understandable than the 1,000 pages of the Affordable Care Act’s actual text.
First of all, everyone’s a hypocrite. President Obama and the Democratic legislators made and broke many of the promises that Republicans have been slamming them for ever since. They did indeed make backroom deals with lobbyists to protect corporate interests for pharmaceuticals and insurance companies among others, and they rammed a poor patch job of a bill all the way through to the top without bipartisan support as talks with Republicans gradually broke down. Of course the Republicans were no saints either, refusing to admit that Obamacare was based on a Republican idea (Massachusetts’s Romneycare) and using the benefits of the bill while publicly calling for its demise. Brill particularly nails Mitch McConnell, who has been one of Obamacare’s harshest critics while simultaneously promising to keep Kentucky’s successful healthcare marketplace: Kynect. As Brill astutely points out, Kynect would never have existed if not for Obamacare.
Second of all, this bill is a mess. There is no single payer, no public option for insurance (In other words, we are forced to buy a product from a private company or face having to pay a mandate to the government), and pharmaceuticals can still set pill prices however they damn well please, even though every other developed nation on Earth has strict regulations and negotiating powers. I get incensed over this because pharmaceuticals have made it ILLEGAL for Americans to buy cheaper drugs from Canada (Who has much more effective regulations on prices), and they have also made it ILLEGAL for the government to negotiate for discounted prices. Combine that with pharmaceutical patents that don’t expire for years, and these scumbags can charge $1000 PER PILL (In the case of Sovaldi) while their CEOs make upwards of $13 million per year plus stock options. But that’s what happens when you let lobbyists write laws. Obamacare really bombed there.
Third and finally, this bill (I guess I should say law) is a mess but it gives me hope. As we saw with the attempts to repeal this law in the past year, the genie is out of the bottle, and even a Republican controlled government could not erase its impact. It turns out that people like having healthcare, and if Obamacare did nothing else it gave millions of Americans a chance to afford that healthcare. On a personal note, I have a close friend who was able to get Medicaid while she was looking for full-time employment thanks to Obamacare and Governor Kasich’s choice to expand Medicaid in Ohio. I don’t think this law “fixed” our broken healthcare system, and taxpayers will be footing a lot of the bill, but you can’t deny that it has truly helped a lot of people get the coverage they need.
Brill offers some ideas on how to make the fixes we need. Honestly, I’m not sure his ideas will work, and I don’t know that making fixes to the law will even be possible in Washington’s current state. Republicans want a repeal or bust, and Democrats are ready to defend the law to the death. Meanwhile the insurance companies, device makers, and Pharmaceuticals keep raking in the publicly-funded profits, but on the plus side I feel that I understand the law so much better now than I did before, and I’d recommend this book to anyone who feels confused about it. It’s a long book but so much more understandable than the 1,000 pages of the Affordable Care Act’s actual text.