Remedy and Reaction: The Peculiar American Struggle over Health Care Reform

The United States has the most complicated and expensive healthcare system of any modern western industrialized nation. We also have the highest percentage of the population that goes uninsured. Why is this? In his book, Starr explained how we go to this point and why it has been so difficult to fix. The efforts to reform healthcare in this country is nothing new. There have been various efforts and reforms since the New Deal era and other than a few notable exceptions, such as Medicare, Medicaid and prescription drug benefits that target certain segments of the population we have failed to cover everyone. Starr argues that it is these very reforms that doomed the efforts to broaden medical coverage to even larger segments of the population. By covering certain constituencies such as the elderly, children and the very poor while leaving others uncovered the American people were divided into different groups with very different personal interests when it coms to health care. Those that are already covered want to maintain the status quo for fear that their benefits will be impacted while those that are not covered are to few and political powerless to influence policy while at the same time driving up care for the covered through emergency care. Add to this the various interests from doctors, hospitals, and drug manufacturers and the nature of our legislative process and you get a history of thwarted reform. In addition to giving the history of healthcare in the U.S., Starr does a very good job of explaining The Affordable Care Act (Obamacare) and putting it in the context of the previous 70+ years of attempts and failures to reform. Starr does a good job of putting a dense and confusing topic in the proper historical, political, and social context and then explaining it in a way that a layman can understand. While he definitely comes to the issue with a particular perspective (he played a part in President Clinton's healthcare reform efforts) he takes pains to give the perspective of both sides.

This is a succinct and subtle exploration of the long-time debate over nationalized healthcare in the U.S. and about why "Hilarycare" lost and "Obamacare" was enacted. The fundamental problem, which Starr calls the "policy trap", is that important segments of society get enough out of a woefully inefficient system to resist, and to be suspicious of, any reform. The deductibility of health insurance premiums by employers and nationalized healthcare for the elderly via Medicare means that the most important voting blocs in society do well under the system without really appreciating the ridiculously high cost of what they are provided. Middle class people with jobs and senior citizens vote -- and they are invested in the status quo.Starr also probes into the darker side of American society -- the tolerance of suffering by others rationalized by the notion that I earned what I'm getting. Unlike any other advanced Western society, Americans question the right of citizens to get some minimum level of healthcare. And the polarization on this issue has gotten worse -- e.g., Starr cites polls showing that the percentage of Republicans who agreed with some such right has fallen from 37% to the low double digits.While Starr does not espouse an explicitly Marxian message, the implication of his argument is that the healthcare debate is simply class warfare by other means. The political branches protect, respond to, and even subsidize the economically powerful in society, while the dispossessed are frozen out, and then are blamed for their own predicament (in American mythology all can be obtained by effort and hard work, so if you can't provide healthcare to your family it's only because you're not applying yourself). The healthcare debate brings together all the contradictions of the American character and sets the stage for a raw battle between the haves and the dispossessed in an increasingly polarized economy and society.Whether or not you agree with Starr's progressive-left point of view, his recounting of the history of reform and the still uncertain future of that reform is excellent.

Paul Starr wrote "The Social Transformation of American Medicine" in the early 1980s. It was a captivating and complete history of the forces that changed medicine and the medical providers up to 1980. In "Remedy," Starr - who was selected to be a participant in the Clinton medical study (now called Hillary Care) - related the events and challenges that were responsible for the failed attempt to develop a Governmental medical assistance bill in the Clinton administration. It is a fascinating read, and describes the situation well. Although it is clearly biased toward the agenda and political leanings of Hillary and that of her participants, (and thus against the Republicans who he thought were argumentative and unpatriotic), the history is valuable even for us who were not disposed toward the effort at that time. Although it appears that President Obama was more partial to the Nixon attempt (if you can believe it) in Obamacare,the Hillary effort was very instrumental in generating support from those who killed the Hillary bill (namely the insurance industry.) Remedy is a fascinating and necessary read for those who want to understand the genesis of Obamacare.

I bought this book for a class on the history of health system in the US and enjoyed it very much. If your interested in this book check out Starr's book Remedy and Reaction about the health policy of the Affordable Care Act and the context in which it was passed and strategies used to pass the legislation. This book describes the policy climate and strategies used to pass the legislation, it's very unique and influences what the bill sought to do regarding the provision of health care for Americans. If your interested in this book check out another of Starr's book, The Social Transformation of American Medicine. Also, check out his Ted Talk, American Struggle over Health Care Reform on youtube .