Health Care in America

From Obamacare to Medicaid, tracing a polarizing topic in U.S. politics.

hot topic covers august 2017

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Béland, Daniel. Obamacare wars: federalism, state politics, and the Affordable Care Act, by Daniel Béland, Philip Rocco, and Alex Waddan. University Press of Kansas, 2016. 215p index afp ISBN 9780700621910, $29.95; ISBN 9780700621965 ebook, contact publisher for price.
Reviewed in CHOICE August 2016

Beland et al. examine the Affordable Care Act (ACA) through action at the state level. The authors examine the three key elements of the legislation: the insurance exchanges, Medicaid expansion, and insurance reform. They find that partisanship has had varying impacts on the statute, and that opponents of the law have had different levels of success. Partisanship had the greatest impact on insurance exchanges, where the federal government unexpectedly found itself having to create exchanges, as many states with Republican governors and/or legislatures refused to establish their own. Similarly, many “red” states refused to expand Medicaid following the Supreme Court’s decision holding that the states could not be forced to expand. There were some exceptions, notably Ohio and Arizona, where Republican governors broke ranks to accept Medicaid funding that increased access and pumped money into their respective health care sectors. The greatest collaboration was in insurance reform, since federal regulations did not conflict sharply with existing regulatory regimes in most states. The authors’ most significant contribution is shedding light on ACA’s implementation, demonstrating how state actions have, and may continue, to frustrate advocates of “Obamacare.” Summing Up: Highly recommended. Lower-division undergraduates through faculty. —J. F. Kraus, Wagner College

Forbes, Steve. Reviving America: how repealing Obamacare, replacing the tax code, and reforming the Fed will restore hope and prosperity, by Steve Forbes and Elizabeth Ames. McGraw-Hill Education, 2015. 211p bibl index ISBN 9781259641121, $26.00; ISBN 9781259641138 ebook, contact publisher for price.
Reviewed in CHOICE May 2016

Reviving America is a valuable resource for undergraduate and even graduate students. It is valuable both for the topics it covers (e.g., Obamacare, the tax code, the Federal Reserve, the gold standard) and for its easy-to-read style of analysis. Forbes (publisher, Forbes magazine) and Ames include a particularly valuable chapter that presents and analyzes criticisms of the gold standard, thus offering pro and con positions. This volume provides a non-intimidating introduction to key issues facing the US economy, to which students can be referred as a starting point for deeper investigations. This reviewer emphasizes that Reviving America is just a starting point for research because the authors unfortunately state arguments in favor of their positions that are sometimes intellectually sloppy. For example, they state (p. 74) that Estonia’s “flat Tax on business and personal incomes proved so successful that, less than a decade later, [Estonia] had become the second-fastest growing in Europe….” While this argument has some merit, the fact that one followed the other is not proof that one caused the other. Nevertheless, overall Reviving America is definitely worthwhile reading. Summing Up: Highly recommended. All readership levels. —J. A. Stevano, Coker College

Galarneau, Charlene. Communities of health care justice. Rutgers, 2016. 142p bibl index ISBN 9780813577678, $85.00; ISBN 9780813577661 pbk, $27.95; ISBN 9780813577685 ebook, $27.95.
Reviewed in CHOICE June 2017

This book should be required reading for every nurse and health care professional as well as anyone interested in improving health care in the US. What Galarneau speaks to is just health care, and she says it “must involve communities as well as the nation and individuals.” She describes communities as “diverse groups typically smaller than society and larger than most families—groups internally connected by culture, religion, locale, or illness.” These communities must be engaged with more seriously to help individuals who live with chronic illnesses, provide caretaker functions and child care at a fair cost, and assist families and individuals with life challenges. The author has firsthand experience in knowing how integrated sickness, health care, and communities are. She explains her work with community/migrant health centers and how it has greatly impacted her ability to share the significance that communities offer to individuals regarding life, particularly in terms of health and health care. Her extensive notes and bibliography are excellent resources. Summing Up: Highly recommended. Upper-division undergraduates through faculty. —S. C. Grossman, Fairfield University

Maunder, Robert. Love, fear, and health: how our attachments to others shape health and health care, by Robert Maunder and Jonathan Hunter. Toronto, 2015. 332p bibl index afp ISBN 9781442647510, $75.00; ISBN 9781442615601 pbk, $30.95; ISBN 9781442668409 ebook, $30.95.
Reviewed in CHOICE June 2016

This book is an excellent contribution to the literature on human attachment as it relates to health issues. Psychiatrists Maunder and Hunter (both, Univ. of Toronto) synthesize a vast amount of theoretical information on biology, evolutionary psychology, development, interpersonal relationships, and attachment, and present it in a very readable fashion. Case studies of people grappling with attachment issues help to make the work come alive. Using this method, the authors clearly elucidate how for some individuals, the stress of illness, loss, and other life events can cause an imbalance in an already challenged attachment style. Importantly, the authors focus on the need for a humanistic health care system, on micro and macro levels. They provide needed guidance on how health care professionals can and should respond in a humanistic manner to help patients with compromised attachment styles; they also address the importance of comfortable treatment settings. The well-organized book includes 30 pages of notes and a 36-page bibliography, which will be a useful resource for students and professionals. Summing Up: Highly recommended. Lower-division undergraduates through professionals/practitioners in the health sciences. —M. C. Matteis, Regis College

Medicare and Medicaid at 50: America’s entitlement programs in the age of affordable care, ed. by Alan B. Cohen et al. Oxford, 2016. 370p index afp ISBN 9780190231545, $24.95.
Reviewed in CHOICE August 2016

This book provides a collection of 16 essays about the core public financing programs for health care in the US. Its broad overviews and deep dives into specific topics eschew statistics and detailed tables (which are voluminous and readily available elsewhere) in favor of contextual analysis and political insight. Of particular interest are chapters on under-appreciated aspects, such as the drive to end overt discrimination and establish civil rights, the impact of judicial decisions, individualism and inequality, the somewhat astounding resilience and growth of Medicaid, the changing role of Medicare from passive tail to the big dog whose every step reverberates through the whole health care system, and how creating a financial program gave rise to the “the elderly” as a coherent political force. Some brief attention is also paid to how the legacy of Medicare and Medicaid will carry forward into the Affordable Care Act (“Obamacare”). Both serious and casual students of health care policy and medical organization will find this book worthwhile and eminently readable. Summing Up: Highly recommended. Lower-division undergraduates through professionals. —T. E. Getzen, iHEA and Temple University

Reforming America’s health care system: the flawed vision of Obamacare, ed. by Scott W. Atlas with Richard A. Epstein et al. Hoover Institution, 2010. 182p ISBN 0817912746, $19.95; ISBN 9780817912741, $19.95.
Reviewed in CHOICE May 2011

This is a welcome, timely addition to the literature on health care reform, particularly in reference to the 2010 Patient Protection and Affordable Care Act (aka ObamaCare). Editor Atlas (senior fellow, Hoover Institution; professor, Stanford Univ. Medical Center) draws contributions from medical doctors, policy experts, economists, and others. Using a list of “ignored facts,” Atlas demonstrates the superiority of American medical care to that of other countries. He also recognizes a number of problems in the US system that could be solved by an increase in competition in the health insurance market, transparency in pricing, information about quality issues, and reduction in state mandates that require consumers to purchase insurance covering some services (e.g., wigs, acupuncture) that increase insurance rates and are demanded by only a small minority of the purchasers. The other contributors provide analyses on a range of topics including medical malpractice reform, restrictions on consumer-directed programs such as Health Savings Accounts (HSAs), and the problems inherent in the state health reforms as well as those in Canada and western Europe. Summing Up: Highly recommended. General readers; upper-division undergraduate students through professionals. —F. W. Musgrave, Ithaca College

Saldin, Robert P. When bad policy makes good politics: running the numbers on health reform. Oxford, 2017. 168p index ISBN 9780190255435, $99.99; ISBN 9780190255442 pbk, $29.95; ISBN 9780190255459 ebook, contact publisher for price.
Reviewed in CHOICE July 2017

Saldin (Univ. of Montana) describes how adding the Community Living Assistance Services and Supports Act (CLASS) to the Affordable Care Act of 2010 (ACA) contributed to the passage of the Obama Administration’s signature health reform legislation. He argues that the bill’s proponents used the Congressional Budget Office’s accounting rules to produce misleading projections of the cost of the CLASS legislation. CLASS was indeed “bad policy” as that section of the ACA, designed to improve the system of long-term care, could not be implemented. CLASS was arguably “good politics” as it contributed to passage of the ACA. Saldin wisely puts this case study into the context of both earlier legislation (e.g., passage of Medicare) and other efforts to manipulate cost projections (e.g., enactment of the Bush tax cuts). Saldin suggests that the requirement for cost projections in the 1974 Budget Act has significantly changed legislative outcomes well beyond this case study. The degree to which he is right is unclear, but he has made a strong case for the value of studying how the 1974 Budget Act may have had perverse consequences. Solid scholarship and clear, jargon-free writing. Summing Up: Highly recommended. Upper-division undergraduates through faculty. —R. E. O’Connor, National Science Foundation