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!! Download Ebook Power, Politics, and Universal Health Care: The Inside Story of a Century-Long Battle, by Stuart Altman

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

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



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

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

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 history: 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Johnson in 1965; the odd story of how Medicare catastrophic insurance was passed by Ronald Reagan in 1988 and then repealed because of public anger in 1989; and the fact that the largest and most expensive expansion of Medicare was enacted by George W. Bush in 2003.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.


From the Hardcover edition.

  • Sales Rank: #479050 in eBooks
  • Published on: 2011-09-27
  • Released on: 2011-09-27
  • Format: Kindle eBook

Review
"At times, Power, Politics, and Universal Health Care reads more like a novel than a policy book as it tells the fascinating story of how the forces that frustrated past efforts to provide universal insurance coverage were overcome to pass the Obama health reform." --Robert D. Reischauer, president, Urban Institute, former director, Congressional Budget Office

"There is not an American who has been more active and relevant in the health reform debate for the last forty years than Stuart Altman. With his talented partner, David Shactman, he has produced a well-written, insightful personal recollection of the evolution of health reform. It is an invaluable contribution to understanding how all major reforms are built on the triumphs and failures of past attempts and cannot be achieved without the application of lessons learned, leadership, good timing, and luck." --Chris Jennings, former Senior Health Reform Adviser to President William Jefferson Clinton

"A riveting journey through the history of US health care reform. This book is a must read for anyone who wants to understand America's elusive search for universal coverage and affordable care. Altman and Shactman do the impossible&mdash:making sense of our complex health system in an accessible and compelling way." -- Jonathan Oberlander, PhD, professor, University of North Carolina-Chapel Hill; author, Political Life of Medicare

"Stuart Altman and David Shactman's new book does a superb job of capturing the essence of the meandering odyssey of health care policy as it reaches insurance coverage for all America. They describe the pivotal events and characters of the development of universal health care with the intimacy of good storytelling. The authors make you feel you are there." --Charles N. Kahn III, president and CEO, Federation of American Hospitals, former staff director of the House Ways and Means Health Subcommittee, 1995-1998

"It took nearly a century to pass universal health coverage, and I know we won't figure out all the solutions to long-term cost containment overnight. But as we move forward, it's critically important to understand where we've been—and there's no better expert to navigate the history of health policy than Stuart Altman. The Altman/Shactman book is an important chronicle of America's history with health reform. It contains lessons we should all keep in mind as we continue our ongoing journey to build a stronger, fairer, and more efficient health care system for all of our citizens." --Senator John Kerry, from the foreword

"...Engagingly written...Readers can learn much from these syntheses of historical scholarship as well as the helpful sketches of policy details that the book provides at the close of some important chapters." --Health Affairs journal

About the Author
Stuart Altman (Waltham, MA), the Sol C. Chaikin Professor of National Health Policy at the Heller School for Social Policy and Management, Brandeis University, is an internationally recognized expert in health policy. He served as a Deputy Assistant Secretary of Health, Education, and Welfare in the Nixon administration and was one of the architects of Nixon's plan for universal health care. He was chair of the Prospective Payment Assessment Commission (ProPAC) for twelve years under President Ronald Reagan, George H.W. Bush, and Bill Clinton. ProPac was responsible for overseeing the way Medicare paid hospitals and other health institutions. He also served on President Clinton's transition team and was appointed to the president's Bipartisan Commission on the Future of Medicare. Recently, he was a member of the health policy team for Barack Obama during his presidential campaign.

David Shactman (Newton, MA) is a freelance writer who was a Senior Fellow in Health Policy at the Heller School and worked with Stuart Altman for eleven years. During that time, he was coeditor of two books—Policies for an Aging Society (with Stuart Altman) and Regulating Managed Care (with Stuart Altman and Uwe E. Reinhardt). He has also written numerous articles published in peer-reviewed journals and trade magazines.

Most helpful customer reviews

16 of 17 people found the following review helpful.
Master Story-tellers weave a dramatic and true tale of US Health Care
By Garen L. Corbett
The authors manage to make readers feel like they are sitting in on key high level meetings on health care reform- whether with key senators, President Nixon or President Clinton. It is mind boggling that these efforts spanned multiple presidencies, and that Stuart Altman has been working on many of these efforts for all of these years. Altman and Shactman take us on remarkable journey of health reform, leading into the somewhat improbable passage of health reform in 2010. Despite the extraordinary amount of fascinating details, this book is eminently approachable and highly readable-- more like a novel than a dry policy text. Anyone interested in understanding how the many subtle and not so subtle competing forces derailed past attempts at health reform will be interested in this book. Those of you interested in feeling like you've wrangled front row seats to one of the most vexing public policy and political questions of the past forty years will also find tremendous value in this book. Highly recommended.

15 of 19 people found the following review helpful.
Inside Nationalized Health Care
By John Ames
Altman and Shactman have given us an engaging, comprehensive account of the history of federally managed universally available health care in the United States, but Altman is the central figure and narrator.
The idea of universal health care has circulated among Progressives for more than a century, starting with Teddy Roosevelt. The path included some turns that seem surprising to us now, such as Samuel Gompers, the early 20th century labor leader, opposing it on the grounds that it would weaken the need for unions. Franklin Roosevelt studied the idea, but chose not to pursue it because he felt that it would detract support from his proposal for Social Security. These are examples of the political insights that Altman adds to the historical account.

The modern story begins with Richard Nixon who, according to Altman, came closer to establishing a national health program than any president before Obama. Nixon worked with Senator Ted Kennedy and Congressman Wilbur Mills to enact a program crafted in large part by Altman, who at the time was a deputy assistant secretary of Health, Education, and Welfare. It might have passed except for Mills being caught in in a Washington reflecting pool with a lady of uncertain reputation, Nixon becoming embroiled with Watergate, and Kennedy's continuing problems with Chappaquiddick. Nixon did, though, manage to enact the Health Maintenance Act of 1973, a "historic" piece of legislation that greatly expanded the availability of HMOs by requiring all employers to offer them if any health plan was provided.

The story continues with the Hill Burton Act, which requires hospitals to treat indigent patients up to a certain fraction of their business. Then on to Medicare, Medicaid, Reagan's disastrous foray into Catastrophic coverage, HIPAA, SCHIP,and Bush's Prescription Drug Program. In each case, Altman provides not only a fascinating account of the political horse trading and arm twisting that led to the final bills, but sufficient description of the various plan concepts and concerns of the interested pressure groups for the reader to appreciate the process.

A continuing theme is the question of cost, and who pays it. Altman makes the case that previous attempts to pass a national program failed because they tried to control costs at the same time they expanded coverage. Every specific cost reduction is someone's livelihood, so it motivates strong opposition. Obama succeeded in part because he avoided any serious attempt to control costs. Instead he emphasized universal coverage and prevented the admittedly huge costs from appearing in the federal budget by imposing them directly on individuals, the insurance and medical industries, and Medicare recipients.

Obama Care was passed as a complex combination of House and Senate regular and budget reconciliation bills that can be seen as either legislative brilliance or Chicago thugery, depending on one's sense of statecraft. Altman provides the raw material for making either case.

He is clearly a committed Progressive who believes that a nationally controlled and supported health care system is a worthy and achievable objective. He would prefer a single-payer government run medical system, but feels that starting with a system cobbled together using the appearance of some individual choice for consumers and providers was the only way to pass the law. It is also clear that he is comfortable with the basic financing principle of taking as much as necessary from those with the ability to pay in order to give to others according to their need.

He is, however, professional enough to provide a fair exposition of the competing positions in the long history of the issue. In this respect, he describes in some detail the positions of groups such as hospital associations, factions of the Catholic Church, the pharmaceutical industry, and unions; all of whom had serious objections to elements of early versions of the program, but were eventually brought around by a variety of gifts, concessions, or ambiguities. The remaining unconvinced opposition is dismissed as "conservatives", or Republicans who simply could not vote for anything that would give the Democrats a victory. While this clearly exposes Altman's bias, it doesn't detract from the value of his story as long as the reader can apply the appropriate filter.

The only real gap in the book is the complete absence of any consideration of the enumerated powers granted to the federal government by the Constitution. Surprisingly for a book that thoroughly recounts the history of a profound expansion of federal power; the Constitution itself is never mentioned. (I let my Kindle search for me.) The only oblique reference is to an obscure case (Newsom vs. Vanderbilt), later reversed, that tried to imply that the Hill-Burton Act guaranteed unlimited indigent care, which it did not. I can only conclude that Altman considers the Constitution irrelevant in this context. His entire emphasis is on recounting the relative power and machinations of the various factions, which in my opinion he does well and reasonably fairly.

Aside from the fascinating history, Altman gave me a better picture of the awesome complexity of the modern American medical industry. I cannot imagine a better case for the classical liberal (a la F. Hayek) judgment that no single agency, such as a government, can possibly know enough or be wise enough to manage it to the satisfaction of all concerned. The size of the Obama Care law, some 2000 pages, and its reliance on administrative decisions for fundamental issues are supporting evidence. Its passage without any cloak of consensus, except for negotiation of details among its supporters, bodes ill for the future.

0 of 0 people found the following review helpful.
great information
By Jeffrey
Great historical background on the fight for what in a modern 1st world society should be viewed as a right of citizenship instead of a privilege. I wonder when/if we will ever have universal Medicare. If it's good enough for the elderly & disabled, why its it good enough for everyone else. I also wonder when more people will start voting in their own interests more?

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