Unaffordable: American Healthcare from Johnson to Trump

Jonathan Engel University of Wisconsin Press (FEBRUARY) Hardcover $34.95 (296pp), 978-0-299-31410-1

The massive $2.3 trillion American healthcare system is in need of radical attention—no surprise to legions of consumers who must navigate Medicare, Medicaid, and employer-provided benefit plans. In Unaffordable, Jonathan Engel, author of four previous books on healthcare policy, presents a deeply researched, authoritative, and rigorous account of healthcare’s flaws.

By the 1970s, American healthcare had ballooned into an unorganized, financially outof-control service, especially when compared to those in other developed nations, including France, Canada, Germany, and the United Kingdom. Attempts to rein in costs were unpopular, the author shows. Engel identifies the 1980s rise of Big Pharma—major drug producers with expensive goods––as fueling medical care costs, which have yet to be controlled.

The book is at its best when it considers the politics of healthcare, from President Johnson’s Medicare and Medicaid to President Clinton’s dead-in-the-water Universal Healthcare Act to President Obama’s Affordable Care Act, which is struggling to survive in the age of President Trump.

Out of what the author calls the “irrational” state of healthcare have emerged winners and losers. As expected, the winners include insurers and medical specialists who earn as much as four times more than primary care physicians. Losers include the middle class; it has seen premiums and co-pays skyrocket. Meanwhile, the poor are denied adequate coverage due to low Medicaid payments and a lack of accessible physicians.

Although Engel offers no surefire remedies for the dismal state of healthcare, this book is an important, concise appraisal of the current situation and of the way that America got here. It should be required reading for government officials and healthcare policy scholars.