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Health Care Reform: What It Is, Why It's Necessary, How It Works

You won't have to worry about going broke if you get sick.

We will start to bring the costs of health care under control.

And we will do all this while reducing the federal deficit.

That is the promise of the Affordable Care Act. But from the moment President Obama signed the bill into law in 2010, a steady and mounting avalanche of misinformation about the ACA has left a growing majority of Americans confused about what it is, why it's necessary, and how it works. If you're one of them, buy this book. From how to tame the twin threats of rising costs and the increasing number of uninsured to why an insurance mandate is good for your health, Health Care Reform dispels false fears by arming you with facts.

A Look Inside Health Care Reform: What It Is, Why It's Necessary, How It Works
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3 thoughts on “Looking for Health Care Reform: What It Is, Why It’s Necessary, How It Works

  1. Reply L. Wilson Nov 19,2012 9:25 pm
    42 of 53 people found the following review helpful
    4.0 out of 5 stars
    Needs more substance, January 7, 2012
    L. Wilson (Chicagoland) –

    This review is from: Health Care Reform: What It Is, Why It’s Necessary, How It Works (Paperback)
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    The book is well worth getting and loaning or finding and borrowing. “Health Care Reform” provides a pretty complete overview of the Affordable Care Act–a subject of much distortion and complaint from the left, the right, and the extreme right.

    Jonathan Gruber presents his information in the form of a black and white graphic book. It is easy and quick to read, while gives important information about this new law that is slowly going into effect. He covers all aspects of the law, addresses many of the extreme-right myths, and includes reasons that many of the decisions were made. Throughout the book, he appears to focus on the economics rather than the health aspects, although he frequently includes the fact that people will be healthier.

    Gruber was actively involved with the development of both the Massachusetts health care program and the ACA. He is able to write from the position of knowledge of both the economics and the politics involved. His conclusions are overall optimistic: The ACA will improve the health of Americans and keep down the cost.

    Gruber is pretty optimistic about the further development of the law. He “has confidence” that state planning will work. In states like Wisconsin, though, the governor is refusing to do any planning in hopes that it won’t work and he and his cronies can blame someone else for it. Gruber mentions this kind of situation, but there is little he can do to address it in a book with this focus and size.

    Unfortunately, I have a few complaints. First, his description of the crisis is pretty extreme. The health care crisis is very serious, but it is not as extreme as some people have painted it. On the other hand, the opposition smiles and says, “Everything is perfect,” so maybe the overstating is necessary.

    Second, lumping Medicare and Medicaid together overlooks a lot of important differences in the programs. E.g., Medicaid is means based and Medicare is age based. Medicaid payments are revenue based. Medicare is self-funded by a separate payroll tax.

    Third, he hit a real sore point with me. One of the big complaints about the cost of health care is people staying in the hospital too long and getting too many tests. In my case, I had a successful operation. I was sent home the next day early and was not given a $250 test. The result was another visit to the operating room ten days later for $10,000 and the successful operation turned into a personal disaster. This doesn’t apply to everyone, but the important thing is to treat each patient with what they need–and many of us don’t actually need that extra test. (Some of the tests are definitely overpriced. My doctor gives me a $25.00 test each time I go in, but the insurance company only pays a contracted $2.00 for it.)

    This kind of generality about hospitals, doctors, etc., is pretty common and annoying, but, after all, the book is only about 150 pages.

    Gruber’s “Health Care Reform” packs more accurate and complete information than I have seen anywhere else into a very readable and re-readable form. Definitely worth getting hold of and worth sharing.

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  2. Reply Gaetan Lion Nov 19,2012 10:12 pm
    56 of 74 people found the following review helpful
    5.0 out of 5 stars
    The advent of the excellent short visual book!, December 21, 2011
    Gaetan Lion
    (TOP 1000 REVIEWER)

    This review is from: Health Care Reform: What It Is, Why It’s Necessary, How It Works (Paperback)
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    This is a daring experiment consisting in treating a complex subject and distilling it to its essential information through a short cartoon medium. After reading this book slowly in just an hour and a half I am convinced this experiment is onto something.

    The experiment worked for several reasons. First, Jonathan Gruber, the author is the real deal. As an MIT economics professor specializing in health care policy no one understands this topic any better. Additionally, Gruber expresses himself in clear and simple everyday language that is appropriate for the cartoon medium. He also uses an apolitical tone acknowledging fully the reservations of both the left and the right. Second, the illustrator, Nathan Schreiber, is very good. The cartoon is not too cute. It is just right.

    In just a little bit over an hour, you will absorb most of what you need to know about the Patient Protection and Affordable Care Act (ACA). This short book makes you understand why the existing system is costly, unsustainable, broken, and dangerous. Every year the majority of individual bankruptcies are caused by medical related expenses (running probably at one million individual bankruptcies a year). And, over 20,000 die a year because of inadequate access to health care. Defending the current system can only be explained as an act of ignorance. Similarly, screaming against the ACA as many have is also an act of ignorance. Gruber addresses all the screaming on either side of the aisle and simply states, Ok let’s cool down here is what ACA really is and is not.

    Gruber explains at length the basic trade off. Its foundation is the reviled mandate. If you want a system that attempts to cover all individuals and that is effective and reliable (no denial for preexisting condition, no annual and lifetime limits, no policy cancellation, no coverage denial) you need a mandate. It is simple if the insurance industry can’t reduce their claim risk, they need to insure the whole population. With no mandate, the insurance industry would become insolvent due to the negative self-selected bias (only the sick and the old seek insurance). If people understood this straight forward concept, support for the ACA would not be an issue. Hopefully, Gruber’s book will be successful and contribute to the masses understanding why the mandate is necessary.

    Gruber acknowledges the mandate will be subject to a Supreme Court decision (by June 2012). He states that even if the mandate is deemed unconstitutional, the remainder of the ACA would proceed. But, he states that based on CBO’s estimates it will be far less successful than otherwise. Only half as many uninsured would get covered. Premium for individual health plans will be 20% higher. Employer provided insurance will fall twice as fast. Health care costs will run much higher. In other words, the ACA without a mandate (even though still better than the existing system) will be far less effective than ACA with a mandate.

    This short book is surprisingly detailed oriented. Gruber covers the parameters of the mandate (MAX ($95 or 1% of income) in 2014 rising to MAX ($695 or 2.5% or income in 2016). Similarly, businesses with more than 50 employees will incur a penalty of $2000 per employees if they do not provide health care. Gruber states that the penalty is only 1/3 of the cost of covering an employee. Gruber covers many other technical details that by the end of the book, you have an encompassing knowledge of the ACA.

    This book is also really interesting because of what the author has done. Gruber was the main architect of Massachusetts health care (dubbed Romneycare). He also was an important advisor to Obama in the design of the ACA. Within the book, Gruber shows that the ACA was designed after Romneycare. Gruber states explicitly that Romneycare also has a mandate (penalty of $240 to $1,100 per annum). This fact contradicts Romney’s Powerpoint where he states the Massachusetts plan does not have a mandate. Romney states that the ACA is a government over reach while his Massachusetts plan is not. Meanwhile, per Gruber there are no clear distinctions in structure between the two plans. So, when Romney campaigns on the pledge that one of the first things he would do is dismantle the ACA; it is inconsistent given he has implemented a preceding plan almost identical to the ACA.

    In summary, this is an excellent book if you want to understand the ACA and spend not much more than an entertaining hour on the subject.

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  3. Reply anon Nov 19,2012 10:46 pm
    16 of 20 people found the following review helpful
    3.0 out of 5 stars
    simple but a little misleading, March 11, 2012

    This review is from: Health Care Reform: What It Is, Why It’s Necessary, How It Works (Paperback)

    The book is fun, the illustrations are good, and the cartoon-Gruber is a like-able guy. Though I really respect Gruber and some of his scholarly work, I think he’s a bit misleading. For instance, he highlights the Massachusetts Health Reform Plan as a resounding success (solved universal coverage, no cost control). What he failed to mention was that for patients, finding primary care takes much longer in MA compared to other states. And costs didn’t stay flat post-reform; they increased significantly.
    It’s also impossible to separate his book from the fallacies of the new law. He talks about cost control—doctors make too much, taxes on pharma and device companies, etc.—but fails to mention that defensive medicine drives healthcare cost (and the healthcare bill doesn’t address this either).

    I will give him credit for explaining the necessity of the individual mandate. He does a great job explaining the benefits of expanded coverage and insurance exchanges, and for that alone I think the book is worth reading.

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