Books to Get You Thinking

The United States spends almost fifty percent more on healthcare than other developed nations.* According to statistics published by the WHO, the ratio of total healthcare expenditure to overall GDP in 2013 was the highest at 17.1 percent for the US as compared to 9.1 percent for the UK, 10.3 percent for Japan and 9.4 percent for Australia. Despite higher levels of spending, the current healthcare system has poorer health outcomes, as well as uncontrolled costs and inadequate access to health resources. Factors such as fragmentation of care delivery, insurance benefits design, fees for service reimbursement, administrative overheads, higher costs of research and development, and an aging population have all contributed to rising healthcare costs. The recent introduction of the Affordable Care Act, while making significant progress towards meeting the goal of universal health insurance coverage, still leaves some key problems to be addressed. There is a critical need to formulate and implement measures that would increase the effectiveness of health care and maximize the return on investment of national health care expenditures by addressing the spiraling cost structures inherent in the system.

At the Mercer County Library, readers can delve into a rich collection of books authored by health policy experts who provide fascinating insights into the current American healthcare system while providing a framework of reforms and changes to address its inefficiencies.

America's Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System by Steven Brill
The book provides an in-depth multi-faceted analysis of the American system of healthcare and delivery while also providing a riveting history of the developments and changes that have taken place over the last seven years. Over a course of more than two years, interviewing two hundred forty-seven individuals including policymakers and senior administration officials in the White House, Steven Brill, a veteran journalist, provides a fascinating reconstruction of events that led to the formulation and implementation of the Affordable Care Act (ACA). Stories of individuals and families, as well as his personal experiences when he was hospitalized for heart surgery, are woven into the analysis to illustrate different facets of the health care crisis. Brill pinpoints the high prices and the enormous profits being raked up by pharmaceuticals, medical device manufacturers, hospitals and insurance companies that have contributed to the skyrocketing costs of health care, making it unaffordable and inaccessible to so many. Readers learn about the powerful lobbies representing the different groups and the political play and compromises that had to be made to ensure the final passage of the ACA. While applauding the passage of the APA that extended insurance coverage and brought the country closer to the goal of universal coverage, Brill is critical of its failure to address the inherently high cost structure of the health care industry, the misaligned system of incentives, and runaway drug prices. Brill advocates a system of integrated managed care where the big regional health care systems would also provide health insurance to patients. This would provide hospitals with both powerful incentives as well as the means to curtail costs, and in the end make health care more affordable in America.

Reinventing American Health Care: How the Affordable Care Act Will Improve Our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System by Ezekiel Emanuel
Ezekiel Emanuel, professor of health policy at the University of Pennsylvania, authors this lucid and detailed analysis of the different complex components that make up the American health care system. Using extensive data, Emanuel provides readers with the historical development and evolution of the American healthcare system over the past century. Despite the hundreds of health insurance companies, as well as specialists and big hospitals, the American healthcare system has failed to provide access to millions of uninsured Americans. Emanuel investigates the many attempts made over the past decades to reform the system and the reasons why they failed. Switching to the present, Emanuel studies in detail the Affordable Care Act of 2010 (ACA) that has sought to bring about wider access to healthcare by providing health insurance to millions of previously uninsured Americans. Despite its flaws and the initial rollout problems with the website offerings, Ezekiel perceives the ACA as a big step in the right direction with further modifications and amendments required in the coming years. He is particularly critical of its failure to address payment reform directed at the current fee for service system that encourages using more services, particularly those that are highly paid. Future success of effective health care reform in the following years would require sharpening the focus on alternative payment models that result in rewarding health systems and physicians for providing better quality of care, as well as training health care providers to operate in digitally-based team-based care. A shift away from hospital-based care to care in an outpatient or home based setting could also help to reign in the current high costs of health care in the US.

The American Health Care Paradox: Why Spending More is Getting Us Less by Elizabeth Bradley and Lauren Taylor
This thought provoking book addresses the disturbing paradox that, despite the United States having a significantly higher level of per capita health spending when compared to other developed nations, it nevertheless has consistently lower life expectancy rates, higher maternal and infant mortality rates and an overall higher incidence of disease. In analyzing the reasons for the poor health outcomes in the US, the focus so far has been on the inherent inefficiencies in the system, the high prices of drugs, the malpractice system in place and the indiscriminate use of expensive therapies. While these different elements are all important contributing factors, authors Bradley and Taylor from Yale have conducted a novel analysis that provides a compelling explanation of the underlying cause of the poor performance of health in the US. They look at health care spending in the US and then add to this figure the amounts spent on education, housing, and other social service programs that are indirect but critical determinants of individual health and wellness. Looking at this aggregated sum of expenditures on health and welfare, they find the US slipping down to the thirteenth place when compared to other developed countries. This provides a plausible explanation of the mediocre health outcomes in the US. The authors stress the importance of a shift towards a more holistic view of health, and towards more policies that address the social, environmental and behavioral determinants of health when designing the national health investment strategy. Investments in services such as nutritional counselling, physical exercise training and help in navigating treatment options could lead to dramatic improvements in life expectancy, incidence of disease and other key indicators of health that are on par with other industrialized countries.

-Nita Mathur

* Source: World Health Organization