Power, Politics, and Universal Health Care: The Inside Story of a Century-Long Battle

by Stuart H. Altman, David Shactman, John Kerry (Foreword)

Essential reading for every American who must navigate the US health care system.Why was the Obama health plan so controversial and difficult to understand? In this readable, entertaining, and substantive book, Stuart Altman-internationally recognized expert in health policy and adviser to five US presidents-and fellow health care specialist David Shactman explain not only the Obama health plan but also many of the intriguing stories in the hundred-year saga leading up to the landmark 2010 legislation. Blending political intrigue, policy substance, and good old-fashioned storytelling, this is the first book to place the Obama health plan within a historical perspective. The authors describe the sometimes haphazard, piece-by-piece construction of the nation's health care system, from the early efforts of Franklin Roosevelt and Harry Truman to the later additions of Ronald Reagan and George W. Bush. In each case, they examine the factors that led to success or failure, often by illuminating little-known political maneuvers that brought about immense shifts in policy or thwarted herculean efforts at reform. The authors look at key moments in health care the Hill-Burton Act in 1946, in which one determined poverty lawyer secured the rights of the uninsured poor to get hospital care; the "three-layer cake" strategy of powerful House Ways and Means Committee Chairman Wilbur Mills to enact Medicare and Medicaid under Lyndon Johnson in 1965; the odd story of how Medicare catastrophic insurance was passed by Ronald Reagan in 1988 and then repealed because of public anger in 1989; and the fact that the largest and most expensive expansion of Medicare was enacted by George W. Bush in 2003. President Barack Obama is the protagonist in the climactic chapter, learning from the successes and failures chronicled throughout the narrative. The authors relate how, in the midst of a worldwide financial meltdown, Obama overcame seemingly impossible obstacles to accomplish what other presidents had tried and failed to achieve for nearly one hundred years.

Genres: Health Care, Nonfiction, Politics, Health, History, School

430 pages, Hardcover

First published January 1, 2011

Reviews

[Jgknobler · Rating 3 out of 5]

A comprehensive review of healthcare legislation since the days of Lyndon Johnson, including the details of the many political battles fought. The author (or, one author, Stuart Altman) made the awkward decision to refer to himself in the third person throughout the book. The congratulatory chapter about the Obama plan seems premature considering the terrible possibility that the "mandate" will be struck down by the supreme court.

[Mitchell Felix]

occasionally fascinating but felt like I was reading a 400 page policy memo for most of it. cool to see how politics functions and constantly breaks down

[Melsene G · Rating 4 out of 5]

Don't let the size of this book intimidate you. I had it sitting in my queue and finally gave it a go. This book contains a good deal of detail about universal healthcare and according to the authors has been on the political agenda since the days of Teddy Roosevelt. The authors go back to that time and explore the battles of prior presidents including TR, FDR, Ike, JFK, LBJ, Nixon, Reagan, Clinton and Bush, among others. Mr. Altman himself was directly involved starting with the Nixon admin.

You will get a good sense of healthcare and insurance from Altman's viewpoint, which is left of center, as he is a registered Democrat. Sadly, Altman is unable to speak without bias, so you're not sure what is really accurate. Small jabs at political opponents detract from the story, but alas, most writers are unable to write without spin. That being said, you will learn a lot about the details, and understand all Parts of Medicare, and the ugly tools used by our politicians to get bills passed. This is sausage making at its worst!

I must confess that I recently met and dined with the author and he is certainly an interesting fellow. Nevertheless I am in the business of writing honest and helpful reviews. I'd love to read a book on healthcare from someone with a different political viewpoint (non liberal) - but that is hard to come by.

[Elizabeth Lucas · Rating 2 out of 5]

Altman produced a novel that is informative, yet ultimately disorganized. Altman constantly jumps between time periods while also attempting to maintain an overall chronological account which results in an unstructured reading experience. Multiple grammatical and spelling errors drew attention away from the issue at hand. Perhaps dedicating a chapter towards the beginning for the basics of insurance and health care particulars would have made this book more organized and easier to follow. Altman also clearly displays (in my opinion, unavoidable) preferences regarding health care policy implementation that are hard to distinguish from fact-based support; he rarely criticizes (or even questions) his own ideas or proposals about health care reforms. While never claiming to be an unbiased reporter on health care policy, some internalized reflection might have done him well.

I can always appreciate, however, a particular inclusion regarding the roles of women in political affairs. The details of the hurdles Pelosi overcame, along with her support and negotiations with powerful women-led organizations, were a welcome addition to a topic that typically excludes women's significant roles behind powerful government decisions in the modern era.

[Mary Burch · Rating 3 out of 5]

I am barely through part 1 and having an extremely difficult time following along and maintaining interest. The author refers to himself in the third person, and repeatedly jumps back and forth between topics. The way the book is put together (so far) isn't great, and I'm not thrilled to have to read the entire book for a school paper.

[Jennifer · Rating 4 out of 5]

Worth the time for anyone who wants to understand how the Affordable Health Care Act came about in its current form. I agree with another reviewer that it's definitely odd for one of the authors, Stuart Altman, to refer to himself in third person (especially as a hero) throughout the book. I especially like the very last chapter where these two academics question how costs can be controlled, and what will happen from here - looking forward to reading the next chapter...

[Reese Faust · Rating 5 out of 5]

Excellent, even-handed account of the political struggle to provide access to care for as many Americans as possible (though obviously, there is much to be done). The account is very clearly written, and it paints a compelling picture of the sausage-making that goes into churning out policy. Highly recommended as an introduction to the complex, comprehensive issue that is healthcare.

[Davis Graham · Rating 5 out of 5]

Insightful look from the foundation of the political effort to create universal health care in America and the strain it is put on not only the country but the individual and the most important person in healthcare the patient.

[Peter · Rating 4 out of 5]

A very smart account of the many efforts to pass health care reform in Congress. Unfortunately it is marred by numerous misspellings and small errors that just cry out for an alert editor.

[TimGrace · Rating 5 out of 5]

Very informative read about the process required to get this policy through.

[Alison · Rating 2 out of 5]

It was interesting but very confusing. The author jumps back and forth a lot

[Julie Payton · Rating 3 out of 5]

Had a hard time reading this book. Topics jumped back and forth and hard for me to follow along. Didn't keep my interest.