Stuart Altman & David Shactman
Prometheus Books, 2011
It is not every day that a new book comes out from a health economist that has advised five Presidents over 30 years about health care reform efforts in the U.S. Thus, there is perhaps few in America who have more experience and insights to share about what has occurred over the last century to provide affordable, equitable and high quality care to all Americans. Dr. Stuart Altman, and his colleague David Shactman, have written what is clearly one of the definitive books on the quest for universal health care for the American public, and as such, the book is a must read for experienced clinicians, patients, consumers, politicians, and students of all persuasions.
Dr. Altman has clearly “been there” to analyze pivotal moments of health care reform in the U.S. Starting with adoption of Medicare in 1965, to Social Security Disability Insurance in 1972, to coverage of End Stage Renal Disease, he has examined, advised and led many efforts to expand health care coverage to at-risk populations. In the last decade, we have witnessed prescription drug coverage, coverage of children, and finally the Affordable Care Act under President Obama. Dr. Altman has been there through the good, the bad and the ugly of health care reform.
In this book, Dr. Altman and Mr. Shactman take us into the narrative of not just what has worked and what has failed, but why they have worked and why they have failed. They tell us about how reform wins or loses based on the national economy, interest group agreement and opposition, and of course political opposition. The best part of this book is that it reads much like a detective novel, with chapter titles like “Nixon comes close- plan looks like a slam dunk, but end with just a dunk” and “Clinton chooses wrong- the colossal defeat of managed competition.
Through sexual trysts by leading politicians to purposeful gaffs by the American Medical Association, the authors hold little back. In so doing, the let us know why health care reform happens and what it will take to take on the next chapter, regardless of whether or not the Supreme Court rules the Obama plan Constitutional or not. All the people that the authors describe appear eminently human, and that is what gives the book its special appeal. The blueprint they offer for future health reform is something to take note: strike early, get Congressional buy-in, don’t deal with expanded costs and access at the same time, use every tool, including public relations, and maintain commitment and determination. In the end, we are left with a better health care system, but one that still spends close to 20% of its GDP on health care. Such costs are not sustainable, and ultimately, we will all have to figure out how to pay the price of what everyone desires, health care as a right for all.