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“America’s Bitter Pill: Money, Politics, Backroom Deals and the Fight To Fix Our Broken Healthcare System”

by Andrew Feld

Steven Brill’s America’s Bitter Pill: Money, Politics, Backroom Deals and the Fight To Fix Our Broken Healthcare System provides a detailed account of the Affordable Care Act’s tumultuous passage through Congress and shaky implementation. 

Quotes from former Senator Max Baucus (D-Montana) and still-serving Senator Charles Grassley, (D-Iowa), who were President Barack Obama’s top economics and health policy advisors — as well as commentary from Obama himself — make reading the book feel like you’re getting information that could not be found elsewhere. Brill includes the stories of countless individuals who were either denied coverage for preexisting conditions or had an insurance plan that did not adequately cover their healthcare bills. These personal experiences enhance the overall narrative by showing that the policies Congress sets forth carry real-world consequences, despite all the partisanship.

Brill also does a great job covering all policies debated throughout the process. A government-paid health insurance option, setting price limits on prescription drugs, allowing importation of drugs from companies where they are cheaper, and making malpractice suits harder to prove were just a few of the ideas talked about. Imagining a world where just one of these was in force was eye-opening. 

The law Congress passed was not strictly a result of policy debate but also power from lobbyists. The pharmaceutical companies, hospitals, health insurers, and workers unions are some of the main lobbies that impacted the law, and Brill covers them in depth.  

The main objective of Obamacare was to expand access to health care and reduce costs. Inarguably, more people now have health coverage as a result; however many of the policies aimed at reducing costs were either watered down or completely left out. Thus, healthcare expenditures have paradoxically increased. 

Brill proposes an interesting solution to this problem in part four of the book. He suggests we incentivize a system where hospital systems are the insurers. That would mean, for example, that Emory would provide care to patients and pay for that care as the insurer. Systems like this already exist (such as Geisinger Health, based in Pennsylvania) and Brill believes the alignment of incentives makes quality care available at cost-effective prices. 

To hear more of what Brill has to say, you can buy the book here.