Un­af­ford­able: Amer­i­can Health­care from John­son to Trump

Foreword Reviews - - Reviews - KARL HELICHER

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.

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