Healthcare: America's Bitter Pill  JAN 06 2015

Steven Brill has written a book about the making of the Affordable Care Act called America's Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System.

America's Bitter Pill is Steven Brill's much-anticipated, sweeping narrative of how the Affordable Care Act, or Obamacare, was written, how it is being implemented, and, most important, how it is changing -- and failing to change -- the rampant abuses in the healthcare industry. Brill probed the depths of our nation's healthcare crisis in his trailblazing Time magazine Special Report, which won the 2014 National Magazine Award for Public Interest. Now he broadens his lens and delves deeper, pulling no punches and taking no prisoners.

Malcolm Gladwell has a review in the New Yorker this week.

Brill's intention is to point out how and why Obamacare fell short of true reform. It did heroic work in broadening coverage and redistributing wealth from the haves to the have-nots. But, Brill says, it didn't really restrain costs. It left incentives fundamentally misaligned. We needed major surgery. What we got was a Band-Aid.

I haven't read his book yet, but I agree with Brill on one thing: the ACA1 did not go nearly far enough. Healthcare and health insurance are still a huge pain in the ass and still too expensive. My issues with healthcare particular to my situation are:

- As someone who is self-employed, insurance for me and my family is absurdly expensive. After the ACA was enacted, my insurance cost went up and the level of coverage went down. I've thought seriously about quitting my site and getting an actual job just to get good and affordable healthcare coverage.

- Doctors aren't required to take any particular health insurance. So when I switched plans, as I had to when the ACA was enacted, finding insurance that fit our family's particular set of doctors (regular docs, pediatrician, pediatric specialist that one of the kids has been seeing for a couple of years, OB/GYN, etc.) was almost impossible. We basically had one plan choice (not even through the ACA marketplace...see next item) or we had to start from scratch with new doctors.

- Many doctors don't take the ACA plans. My doctor doesn't take any of them and my kids' doc only took a couple. And they're explicit in accepting, say, United Healthcare's regular plan but not their ACA plan, which underneath the hood is the exact same plan that costs the same and has the same benefits. It's madness.

- The entire process is designed to be confusing so that insurance companies (and hospitals probably too) can make more money. I am an educated adult whose job is to read things so they make enough sense to tell others about them. That's what I spend 8+ hours a day doing. And it took me weeks to get up to speed on all the options and pitfalls and gotchas of health insurance...and I still don't know a whole lot about it. It is the most un-user-friendly thing I have ever encountered.

The ACA did do some great things, like making everyone eligible for health insurance and getting rid of the preexisting conditions bullshit, and that is fantastic...the "heroic work" mentioned by Gladwell. But the American healthcare system is still an absolute shambling embarrassment when you compare it to other countries around the world, even those in so-called "developing" or "third world" countries. And our political system is just not up to developing a proper plan, so I guess we'll all just limp along as we have been. Guh.

  1. I hate the word "Obamacare" and will not use it. It's a derisive term that has been embraced for some reason by ACA/Obama supporters. It needlessly politicizes an already over-politicized issue.

Read more posts on kottke.org about:
America's Bitter Pill   Barack Obama   books   economics   healthcare   Malcolm Gladwell   medicine   politics   Steven Brill

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